A REVISION ARTHROPLASTY NETWORK HAS SIGNIFICANTLY REDUCED EARLY RE-REVISION RATES FOLLOWING REVISION TOTAL KNEE ARTHROPLASTY COMPARED WITH THE REST OF ENGLAND: AN ANALYSIS OF THE EAST MIDLANDS SPECIALIST ORTHOPAEDIC NETWORK USING A NATIONAL ADMINISTRATIVE DATA SET

Abstract

AbstractIntroductionRevision total knee arthroplasty (RTKA) is a complex procedure with higher rates of re-revision, complications and mortality compared to primary TKA. We report the effects of the establishment of a Revision Arthroplasty Network (The East Midlands Specialist Orthopaedic Network; EMSON).MethodologyThe Revision Arthroplasty Network was established in January 2015 and covered the Nottinghamshire and Lincolnshire areas of England. This comprises a collaborative weekly multidisciplinary meeting where upcoming RTKA procedures are discussed, and a plan agreed.Using the Hospital Episode Statistics database, RTKA procedures carried out between 2011 and 2018 from the five EMSON hospitals were compared to all other hospitals in England. Age, sex, and Hospital Frailty Risk scores were used as covariates.The primary outcome was re-revision surgery within 1 year of the index revision. Secondary outcomes were re-revision surgery within two years, any complication within one and two years and median length of stay.Results33,828 RTKA procedures were performed across England; 1,028 (3.0%) were conducted within EMSON. Re-revision rates within 1 year were 11.6% and 7.4% pre- and post-intervention respectively within the network. This compares to a pre-post change from 11.7% to 9.7% for the rest of England. In comparative interrupted time-series analysis, there was a significant immediate improvement in re-revision rates for EMSON hospitals compared to the rest of England at 1 year (p = 0.024) and 2 years (p=0.032).ConclusionRe-revision rates for RTKA improved significantly at one and two years with the introduction of EMSON, when compared to the rest of England.