Abstract
We aimed to answer the following questions: (1) How did numbers of revision knee arthroplasty procedures develop in Germany over the last decade compared to primary TKA? (2) How high was the percentage of septic interventions in knee prosthesis revisions? (3) Which treatment strategy was chosen for surgical treatment of knee PJI? Revision arthroplasty rates as a function of age, gender, infection and type of prosthesis were quantified based on Operation and Procedure Classification System codes using revision knee arthroplasty data from 2008 to 2018, provided by the Federal Statistical Office of Germany (Destatis). In 2018, a total number 23,812 revision knee arthroplasties were performed in Germany, yielding an overall increase of 20.76% between 2008 and 2018. In comparison, primary TKA procedures increased by 23.8% from 152,551 performed procedures in 2008 to 188,866 procedures in 2018. Hence, 12.6% of knee arthroplasties required a revision in 2018. Septic interventions increased by 51.7% for all revisions. A trend towards higher numbers in younger patients was observed. Compared to 2008, 17.41% less DAIR procedures were performed, whereby single-stage and two- or multi-stage change increased by 38.76% and 42.76% in 2018, respectively. The increasing number of revision knee arthroplasty in Germany, especially in younger patients and due to infection, underlines the need for future efforts to improve treatment strategies to delay primary arthroplasty and avoid periprosthetic joint infection.
Highlights
We aimed to answer the following questions: (1) How did numbers of revision knee arthroplasty procedures develop in Germany over the last decade compared to primary total knee arthroplasties (TKA)? (2) How high was the percentage of septic interventions in knee prosthesis revisions? (3) Which treatment strategy was chosen for surgical treatment of knee periprosthetic joint infection (PJI)? Revision arthroplasty rates as a function of age, gender, infection and type of prosthesis were quantified based on Operation and Procedure Classification System codes using revision knee arthroplasty data from 2008 to 2018, provided by the Federal Statistical Office of Germany (Destatis)
We have aimed to answer the following questions for the Germany population: (1) How did numbers of revision knee arthroplasty procedures developed over the last decade compared to primary TKA? (2) How high was the percentage of septic interventions in knee prosthesis revisions? (3) Which therapy strategy (debridement antibiotics implant retention (DAIR), single-stage change or two- or multi-stage change) was chosen for surgical treatment of knee PJI?
In 2018, a total number 23,812 revision knee arthroplasties were performed in Germany, yielding an overall increase of 20.76% between 2008 and 2018 (Table 2)
Summary
We aimed to answer the following questions: (1) How did numbers of revision knee arthroplasty procedures develop in Germany over the last decade compared to primary TKA? (2) How high was the percentage of septic interventions in knee prosthesis revisions? (3) Which treatment strategy was chosen for surgical treatment of knee PJI? Revision arthroplasty rates as a function of age, gender, infection and type of prosthesis were quantified based on Operation and Procedure Classification System codes using revision knee arthroplasty data from 2008 to 2018, provided by the Federal Statistical Office of Germany (Destatis). The increasing number of revision knee arthroplasty in Germany, especially in younger patients and due to infection, underlines the need for future efforts to improve treatment strategies to delay primary arthroplasty and avoid periprosthetic joint infection. Since the 1960s, it has led to a significant reduction in pain and movement restrictions, significantly improving patients’ quality of life[1,2] This success and the demographic development in the industrialized nations have led to a significant increase in the number of total hip and total knee arthroplasties (TKA) which is predicted to continue in the d ecades[3,4,5,6]. We have aimed to answer the following questions for the Germany population: (1) How did numbers of revision knee arthroplasty procedures developed over the last decade compared to primary TKA? Description Revision without exchange Exchange of unicondylar prosthesis Exchange of unicondylar prosthesis to unicondylar prothesis Inlay exchange Exchange of unicondylar prosthesis to bicondylar surface replacement prosthesis Exchange of unicondylar prothesis to femoral and tibial shaft-anchored prosthesis Exchange of unicondylar prosthesis to other Exchange of bicondylar surface replacement prosthesis Exchange patella replacement Explantation of bicondylar surface replacement prosthesis Explantation patella replacement Exchange endoprosthesis with extended flexion capability Explantation endoprosthesis with extended flexion capability Exchange of bicompartmental partial joint replacement prosthesis Explantation of bicompartmental partial joint replacement prosthesis Exchange of endoprosthetic joint replacement without movement function Explantation of endoprosthetic joint replacement without movement function Exchange of femoral and tibial shaft-anchored prosthesis Explantation of femoral and tibial shaft-anchored prosthesis
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