Risk factors for early revision after total hip and knee arthroplasty: National observational study from a surgeon and population perspective.

Alex Bottle,Paul Aylin,Mark Loeffler,Sunny Parikh,Yuanyuan Wang

doi:10.1371/journal.pone.0214855

Alex Bottle, Paul Aylin + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0214855

Copy DOI

Journal: PloS one	Publication Date: Apr 9, 2019
Citations: 35	License type: CC BY 4.0

Affiliation: Imperial College London, Colchester Hospital

Abstract

AimsTo identify predictors of early revision (within 3 years of the index operation) for hip and knee replacement (HR, KR) from both surgeon and population perspectives.Patients and methodsHierarchical logistic regression on national administrative data for England for index procedures between April 2009 and March 2014.ResultsThere were 315,273 index HR procedures and 374,530 index KR procedures for analysis. Three-year revision rates were 2.1% for HR and 2.2% for KR. The highest odds ratios for HR were for 3+ previous emergency admissions, drug abuse, Parkinson’s disease, resurfacing and ages under 60; for KR these were patellofemoral or partial joint replacement, 3+ previous emergency admissions, paralysis and ages under 60. Smaller effects were found for other comorbidities such as obesity (HR) and diabetes (KR). From a population perspective, the only population attributable fractions over 5% were for male gender, uncemented total hip replacements and partial knee or patellofemoral replacements.ConclusionsMeeting the rising demand for revision surgery is a challenge for healthcare leaders and policymakers. Our findings suggest optimising patients pre-operatively and improving patient selection for primary arthroplasty may reduce the burden of early revision of arthroplasty. Our study gives useful information on the additional risks of various comorbidities and procedures, which enables a more informed consent process.Clinical relevanceSurgeons should make patients with certain risk factors such as age and procedure type aware of their higher revision risk as part of shared decision-making.

Highlights

Around 7 million Americans were living with a hip or knee replacement in 2010, with growing prevalence and a shift to younger ages [1]
Our findings suggest optimising patients pre-operatively and improving patient selection for primary arthroplasty may reduce the burden of early revision of arthroplasty
The Dr Foster Unit at Imperial is affiliated with the National Institute of Health Research (NIHR) Imperial Patient Safety Translational Research Centre

Summary

Introduction

Around 7 million Americans were living with a hip or knee replacement in 2010, with growing prevalence and a shift to younger ages [1]. Osteoarthritis has shown the largest growth among the non-communicable diseases in the Global Burden of Disease project, with total disabilityadjusted life years (DALYs) rising by 35% and age-standardised DALY rates by 4% between 1990 and 2015 [3]. It is expected that there will be a corresponding increase in the number of primary and revision surgeries [4,5,6]. Arthroplasty revision is most commonly performed for lysis, infection, fracture and, in hips, dislocation [7]. The clinical burdens of a revision surgery are enormous as it is technically difficult with lower success rates than primary arthroplasty. Aseptic revision for total hip arthroplasty costs £11,897 on average, and £21,937 for a septic case [9]. To minimise the expected increasing burden of revision, in cases of early failure, a comprehensive understanding of the relevant risk factors is crucial.

Methods

Results

Discussion

Conclusion