Revision rates after primary hip and knee replacement in England between 2003 and 2006.

Nokuthaba Sibanda,Martyn Porter,Keith Tucker,Mick Borroff,Martin Pickford,Jim D Lewsey,Jan H Van Der Meulen,Alex J Macgregor,Lynn P Copley,Paul Gregg

doi:10.1371/journal.pmed.0050179

Abstract

BackgroundHip and knee replacement are some of the most frequently performed surgical procedures in the world. Resurfacing of the hip and unicondylar knee replacement are increasingly being used. There is relatively little evidence on their performance. To study performance of joint replacement in England, we investigated revision rates in the first 3 y after hip or knee replacement according to prosthesis type.Methods and FindingsWe linked records of the National Joint Registry for England and Wales and the Hospital Episode Statistics for patients with a primary hip or knee replacement in the National Health Service in England between April 2003 and September 2006. Hospital Episode Statistics records of succeeding admissions were used to identify revisions for any reason. 76,576 patients with a primary hip replacement and 80,697 with a primary knee replacement were included (51% of all primary hip and knee replacements done in the English National Health Service). In hip patients, 3-y revision rates were 0.9% (95% confidence interval [CI] 0.8%–1.1%) with cemented, 2.0% (1.7%–2.3%) with cementless, 1.5% (1.1%–2.0% CI) with “hybrid” prostheses, and 2.6% (2.1%–3.1%) with hip resurfacing (p < 0.0001). Revision rates after hip resurfacing were increased especially in women. In knee patients, 3-y revision rates were 1.4% (1.2%–1.5% CI) with cemented, 1.5% (1.1%–2.1% CI) with cementless, and 2.8% (1.8%–4.5% CI) with unicondylar prostheses (p < 0.0001). Revision rates after knee replacement strongly decreased with age.InterpretationOverall, about one in 75 patients needed a revision of their prosthesis within 3 y. On the basis of our data, consideration should be given to using hip resurfacing only in male patients and unicondylar knee replacement only in elderly patients.

Highlights

Total hip replacement was first successfully performed in 1962 in the United Kingdom and approved for use in the United States in 1969 [1,2]
We investigated how these rates differed according to prosthesis type and we gave special attention to revision rates after hip resurfacing and unicondylar knee replacement
94% of patients who underwent a hip replacement because of osteoarthritis and this percentage was similar across the prosthesis groups

Summary

Introduction

Total hip replacement was first successfully performed in 1962 in the United Kingdom and approved for use in the United States in 1969 [1,2]. Total knee replacement was introduced in its modern form in the early 1970s [3] Since these procedures have developed at an astonishing pace and they are among the most frequently performed major surgical procedures in the world. It can be expected that these numbers will continue to increase both as a result of new suppliers entering the market and new brands being introduced by existing suppliers These prosthesis brands are most often grouped according to the method of fixation of the components into cemented and cementless prostheses. To study performance of joint replacement in England, we investigated revision rates in the first 3 y after hip or knee replacement according to prosthesis type. The techniques for hip and knee replacement can be divided into those where a cement is used to position the metal implant into the bone (cemented) versus those where cement is not used (cementless)

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