nach oben

Clinical Orthopaedics and Related Research®

Erschienen in:

01.04.2014 | Clinical Research

Risk Factors for Revision Within 10 Years of Total Knee Arthroplasty

verfasst von: Christopher J. Dy, MD, MSPH, Robert G. Marx, MD, MSc, Kevin J. Bozic, MD, MBA, Ting Jung Pan, MPH, Douglas E. Padgett, MD, Stephen Lyman, PhD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 4/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

An in-depth understanding of risk factors for revision TKA is needed to minimize the burden of revision surgery. Previous studies indicate that hospital and community characteristics may influence outcomes after TKA, but a detailed investigation in a diverse population is warranted to identify opportunities for quality improvement.

Questions/purposes

We asked: (1) What is the frequency of revision TKA within 10 years of primary arthroplasty? (2) Which patient demographic factors are associated with revision within 10 years of TKA? (3) Which community and institutional characteristics are associated with revision within 10 years of TKA?

Methods

We identified 301,955 patients who underwent primary TKAs in New York or California from 1997 to 2005 from statewide databases. Identifier codes were used to determine whether they underwent revision TKA. Patient, community, and hospital characteristics were analyzed using multivariable regression modeling to determine predictors for revision.

Results

The frequency of revision was 4.0% at 5 years after the index arthroplasty and 8.9% at 9-years. Patients between 50 and 75 years old had a lower risk of revision than patients younger than 50 years (hazard ratio [HR], 0.47; 95% CI, 0.44, 0.50). Black patients were at increased risk for needing revision surgery (HR, 1.39; 95% CI, 1.29, 1.49) after adjustment for insurance type, poverty level, and education. Women (HR, 0.82; 95% CI, 0.79, 0.86) and Medicare recipients (HR, 0.82; 95% CI, 0.79, 0.86) were less likely to undergo revision surgery, whereas those from the most educated (HR, 1.09; 95% CI, 1.02, 1.16) and the poorest communities (HR, 1.08; 95% CI, 1.01, 1.15) had modest increases in risk of revision. Mid-volume hospitals (200–400 annual cases) had a reduction of early revision (HR, 0.91; 95% CI, 0.83, 0.99) compared with those performing less than 200 cases annually, whereas higher-volume hospitals (greater than 400 cases) showed little effect compared with low-volume hospitals.

Conclusions

Patient, community, and institutional characteristics affect the risk for revision within 10 years of index TKA. These data can be used to develop process improvement and implant surveillance strategies among high-risk patients.

Level of Evidence

Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Bang H, Chiu YL, Memtsoudis SG, Mandl LA, Della Valle AG, Mushlin AI, Marx RG, Mazumdar M. Total hip and total knee arthroplasties: trends and disparities revisited. Am J Orthop (Belle Mead NJ). 2010;39:E95–102.PubMed

Berend ME, Davis PJ, Ritter MA, Keating EM, Faris PM, Meding JB, Malinzak RA. “Thicker” polyethylene bearings are associated with higher failure rates in primary total knee arthroplasty. J Arthroplasty. 2010;25(6 suppl):17–20.PubMedCrossRef

Borkhoff CM, Hawker GA, Kreder HJ, Glazier RH, Mahomed NN, Wright JG. The effect of patients’ sex on physicians’ recommendations for total knee arthroplasty. CMAJ. 2008;178:681–687.PubMedCentralPubMedCrossRef

Bozic KJ, Kinder J, Meneghini RM, Zurakowski D, Rosenberg AG, Galante JO. Implant survivorship and complication rates after total knee arthroplasty with a third-generation cemented system: 5 to 8 years followup. Clin Orthop Relat Res. 2005;430:117–124.PubMedCrossRef

Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468:45–51.PubMedCentralPubMedCrossRef

Collins TC, Daley J, Henderson WH, Khuri SF. Risk factors for prolonged length of stay after major elective surgery. Ann Surg. 1999;230:251–259.PubMedCentralPubMedCrossRef

Cram P, Vaughan-Sarrazin MS, Rosenthal GE. Hospital characteristics and patient populations served by physician owned and non physician owned orthopedic specialty hospitals. BMC Health Serv Res. 2007;7:155.PubMedCentralPubMedCrossRef

Curtin B, Malkani A, Lau E, Kurtz S, Ong K. Revision after total knee arthroplasty and unicompartmental knee arthroplasty in the Medicare population. J Arthroplasty. 2012;27:1480–1486.PubMedCrossRef

Duffy GP, Trousdale RT, Stuart MJ. Total knee arthroplasty in patients 55 years old or younger: 10- to 17-year results. Clin Orthop Relat Res. 1998;356:22–27.PubMedCrossRef

10.

Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.PubMedCrossRef

11.

FitzGerald JD, Soohoo NF, Losina E, Katz JN. Potential impact on patient residence to hospital travel distance and access to care under a policy of preferential referral to high-volume knee replacement hospitals. Arthritis Care Res (Hoboken). 2012;64:890–897.PubMedCrossRef

12.

Francis ML, Scaife SL, Zahnd WE, Cook EF, Schneeweiss S. Joint replacement surgeries among medicare beneficiaries in rural compared with urban areas. Arthritis Rheum. 2009;60:3554–3562.PubMedCrossRef

13.

Heck DA, Melfi CA, Mamlin LA, Katz BP, Arthur DS, Dittus RS, Freund DA. Revision rates after knee replacement in the United States. Med Care. 1998;36:661–669.PubMedCrossRef

14.

Ibrahim SA, Siminoff LA, Burant CJ, Kwoh CK. Variation in perceptions of treatment and self-care practices in elderly with osteoarthritis: a comparison between African American and white patients. Arthritis Rheum. 2001;45:340–345.PubMedCrossRef

15.

Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am. 2004;86:1909–1916.PubMedCrossRef

16.

Katz JN, Mahomed NN, Baron JA, Barrett JA, Fossel AH, Creel AH, Wright J, Wright EA, Losina E. Association of hospital and surgeon procedure volume with patient-centered outcomes of total knee replacement in a population-based cohort of patients age 65 years and older. Arthritis Rheum. 2007;56:568–574.PubMedCrossRef

17.

Katz JN, Wright EA, Baron JA, Corbett KL, Nti AA, Malchau H, Wright J, Losina E. Predictive value of Medicare claims data for identifying revision of index hip replacement was modest. J Clin Epidemiol. 2011;64:543–546.PubMedCrossRef

18.

Khatod M, Inacio M, Paxton EW, Bini SA, Namba RS, Burchette RJ, Fithian DC. Knee replacement: epidemiology, outcomes, and trends in Southern California: 17,080 replacements from 1995 through 2004. Acta Orthop. 2008;79:812–819.PubMedCrossRef

19.

Krieger N. Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health. 1992;82:703–710.PubMedCentralPubMedCrossRef

20.

Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87:1487–1497.PubMedCrossRef

21.

Labek G, Thaler M, Janda W, Agreiter M, Stockl B. Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. J Bone Joint Surg Br. 2011;93:293–297.PubMedCrossRef

22.

Mahomed NN, Barrett J, Katz JN, Baron JA, Wright J, Losina E. Epidemiology of total knee replacement in the United States Medicare population. J Bone Joint Surg Am. 2005;87:1222–1228.PubMedCrossRef

23.

Manley M, Ong K, Lau E, Kurtz SM. Total knee arthroplasty survivorship in the United States Medicare population: effect of hospital and surgeon procedure volume. J Arthroplasty. 2009;24:1061–1067.PubMedCrossRef

24.

Mulhall KJ, Ghomrawi HM, Scully S, Callaghan JJ, Saleh KJ. Current etiologies and modes of failure in total knee arthroplasty revision. Clin Orthop Relat Res. 2006;446:45–50.PubMedCrossRef

25.

Oduwole KO, Molony DC, Walls RJ, Bashir SP, Mulhall KJ. Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2010;18:945–948.PubMedCrossRef

26.

Pabinger C, Berghold A, Boehler N, Labek G. Revision rates after knee replacement: cumulative results from worldwide clinical studies versus joint registers. Osteoarthritis Cartilage. 2013;21:263–268.PubMedCrossRef

27.

Psaty BM, Cheadle A, Koepsell TD, Diehr P, Wickizer T, Curry S, VonKorff M, Perrin EB, Pearson DC, Wagner EH. Race- and ethnicity-specific characteristics of participants lost to follow-up in a telephone cohort. Am J Epidemiol. 1994;140:161–171.PubMed

28.

Rand JA, Ilstrup DM. Survivorship analysis of total knee arthroplasty: cumulative rates of survival of 9200 total knee arthroplasties. J Bone Joint Surg Am. 1991;73:397–409.PubMed

29.

Ritter MA, Worland R, Saliski J, Helphenstine JV, Edmondson KL, Keating EM, Faris PM, Meding JB. Flat-on-flat, nonconstrained, compression molded polyethylene total knee replacement. Clin Orthop Relat Res. 1995;321:79–85.PubMed

30.

Robertsson O, Knutson K, Lewold S, Lidgren L. The Swedish Knee Arthroplasty Register 1975-1997: an update with special emphasis on 41,223 knees operated on in 1988-1997. Acta Orthop Scand. 2001;72:503–513.PubMedCrossRef

31.

Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, Coyte PC, Wright JG. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008;51:428–436.PubMedCentralPubMed

32.

Skinner J, Weinstein JN, Sporer SM, Wennberg JE. Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients. N Engl J Med. 2003;349:1350–1359.PubMedCrossRef

33.

Skinner J, Zhou W, Weinstein J. The influence of income and race on total knee arthroplasty in the United States. J Bone Joint Surg Am. 2006;88:2159–2166.PubMedCentralPubMedCrossRef

34.

SooHoo NF, Lieberman JR, Ko CY, Zingmond DS. Factors predicting complication rates following total knee replacement. J Bone Joint Surg Am. 2006;88:480–485.PubMedCrossRef

35.

Tejwani NC, Takemoto RC, Nayak G, Pahk B, Egol KA. Who is lost to followup?: a study of patients with distal radius fractures. Clin Orthop Relat Res. 2010;468:599–604.PubMedCentralPubMedCrossRef

36.

Worland RL, Johnson GV, Alemparte J, Jessup DE, Keenan J, Norambuena N. Ten to fourteen year survival and functional analysis of the AGC total knee replacement system. Knee. 2002;9:133–137.PubMedCrossRef

37.

Young NL, Cheah D, Waddell JP, Wright JG. Patient characteristics that affect the outcome of total hip arthroplasty: a review. Can J Surg. 1998;41:188–195.PubMedPubMedCentral

Titel: Risk Factors for Revision Within 10 Years of Total Knee Arthroplasty
verfasst von: Christopher J. Dy, MD, MSPH
Robert G. Marx, MD, MSc
Kevin J. Bozic, MD, MBA
Ting Jung Pan, MPH
Douglas E. Padgett, MD
Stephen Lyman, PhD
Publikationsdatum: 01.04.2014
Verlag: Springer US
Erschienen in: Clinical Orthopaedics and Related Research® / Ausgabe 4/2014
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-3416-6

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2014

In Vivo Kinematics of the Thumb Carpometacarpal Joint During Three Isometric Functional Tasks

The Classic: Radiography of the Trapeziometacarpal Joint. Degenerative Changes of This Joint

Intra- and Interobserver Reliability of the Eaton Classification for Trapeziometacarpal Arthritis: A Systematic Review

Are Younger Patients Undergoing TKAs Appropriately Characterized As Active?

How Does Accounting for Worker Productivity Affect the Measured Cost-Effectiveness of Lumbar Discectomy?