The authors declare no competing interests. None of the authors has financial and/or personal relationships with other people or organizations that could potentially and inappropriately influence our work and conclusions.
BUN was involved in study design, data analysis and interpretation, writing the manuscript and critical revision of the manuscript. EBG was involved in critical revision of the manuscript, statistical expertise and performing most of the analyses presented in the paper. VL was involved in study conception and design, data collection, development of data collection instruments and critical revision of the manuscript. JEC was involved in data collection, preliminary data analysis and interpretation, critical revision of the manuscript and statistical expertise. TST was involved in the conception and design of the study, analysis and interpretation of data, critical revision of the manuscript and supervision and administrative support. EL was involved in study conception and design, data analysis and interpretation, critical revision of the manuscript. JNK was involved in study conception and design, data analysis and interpretation, writing the manuscript, critical revision of the manuscript, supervision and administrative support. All authors approved the final manuscript.
Increasing utilization of primary total knee arthroplasty (TKA) is projected to expand demand for revision TKA. Revision TKAs are procedurally complex and incur high costs on our financially constrained healthcare system. The purpose of this study was to use a case-control design to identify factors predisposing to revision TKA, particularly demographic, clinical and perioperative technical factors.
We conducted a case control study to investigate patient, surgical and perioperative factors associated with greater risk of revision TKA. We included patients who received TKA at a tertiary center between 1996 and 2009. Cases (patients that had primary and revision TKA) were matched to controls (patients with primary TKA that was not revised) in a 1:2 ratio and risk of revision examined using conditional logistic regression.
We identified 146 cases and 290 controls. Patient factors independently associated with revision included male sex (OR 1.73; 95 % CI 1.06-2.81) and smoking (OR 2.87; 1.33-6.19). Older age was associated with decreased risk (OR 0.83 per 5-year increment; 95 % CI 0.75-0.92). Lateral release was the only technical factor associated with revision (OR 1.92; 1.07-3.43).
In this case control study younger patient age, male gender, soft tissue release and active smoking status were associated with increased revision risk. Although we do not know whether the risk of smoking arises from short- or long-term exposure, smoking cessation prior to TKA should be considered as an intervention for decreasing revision risk.
Healthcare Cost and Utilization Project (HCUP). Nationwide Inpatient Sample (NIS). Agency for Healthcare Research and Quality. http://hcupnet.ahrq.gov/HCUPnet.jsp. Accessed May 18 2013.
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Kumar PJ, Dorr LD. Severe malalignment and soft-tissue imbalance in total knee arthroplasty. Am J Knee Surg. 1997;10(1):36–41. PubMed
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- Effect of smoking and soft tissue release on risk of revision after total knee arthroplasty: a case- control study
Benedict U. Nwachukwu
Ellen B. Gurary
Jamie E. Collins
Thomas S. Thornhill
Jeffrey N. Katz
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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