Risk Factors for Total Knee Arthroplasty Aseptic Revision

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Abstract

Using a Total Joint Replacement Registry, patient, operative, implant, surgeon, and hospital risk factors associated with aseptic revision after primary total knee arthroplasty (TKA) were evaluated. From 04/2001 to 12/31/2010 64,017 primary TKA cases, followed for a median time of 2.9 years, were registered and included in the analysis. Patients were predominantly female, white, with osteoarthritis, and obese. The crude aseptic revision rate is 1.3% (N = 826). The cumulative survival for aseptic revision at 8 years is 97.6% (95% CI 97.3%–97.8%). Adjusted models revealed that age, race, body mass index, diabetic status, bilateral procedures, high-flex implants, and the LCS mobile bearing knee are associated with risk of revision. Gender, general health status, diagnosis, surgeon fellowship training, surgeon volume, hospital volume, fixation, and bearing surface material were not associated with risk of aseptic revision. Recognition of surgical factors associated with TKA failures can help the surgeons with their choices of surgical techniques and implants.

Section snippets

Background

Total knee arthroplasty (TKA) outcomes are dependent on a variety of factors, which include the patient [1], the surgeon [2], type of implant [3], and the hospital 2., 4., challenging the ability of researchers to comprehensively study variables affecting TKA. Tertiary medical centers may provide detailed information on patient and surgical factors, but the patient populations, and surgeon experience, may not be representative of the situation in the United States. In addition, sample sizes may

Study Design, Inclusion Criteria, and Data Collection

A retrospective analysis of a prospectively followed cohort of primary TKAs was conducted using data from a community based Total Joint Replacement Registry (TJRR). All primary TKAs, with any diagnosis, registered from 4/1/2001 to 12/30/2010 were included. Unicompartmental procedures, bi-compartment procedures, patella-femoral procedures, and procedures performed with constrained and hinged implants were excluded. Data collection, participation, and coverage for the TJRR, used to identify the

Results

A total of 64,017 primary TKA cases, followed for a median time of 2.9 years (interquartile range 1.2–4.9 years), were included in the analysis. Patients were predominantly female (62.6%), white (71.0%), with diagnosis of osteoarthritis (97.2%), and obese (56.5% had BMI ≥ 30 kg/m2). The mean age was 67.3 years old (SD = 9.5) and prevalence of diabetes was 26.3%. The implants were cemented in 91.4% of the cases, 12.2% of the cases had high-flex designs, and 86.4% of the cases had CoCr on conventional

Discussion

TKA is a successful and widely performed procedure for the treatment of end-stage knee arthritis. The cumulative incidence of aseptic revision of our study sample of 64,017 patients was 1.3% and the revision rate/100 years of observation time was 0.4. Multivariable regression models identified specific patient, implant, and surgical factors associated with risk of aseptic revision.

The outcomes of TKA are affected by a variety of patient, implant and surgical factors. The current investigation

References (38)

  • Swedish Knee Arthroplasty Register

    The annual report 2010

  • National Joint Registry for England and Wales

    7th annual report 2010

  • E.W. Paxton et al.

    The Kaiser Permanente National Total Joint Replacement Registry

    Perm J

    (2008)
  • E. Paxton et al.

    A prospective study of 80,000 total joint and 5,000 anterior cruciate ligament reconstruction procedures in a community-based registry in the United States

    J Bone Joint Surg

    (2010)
  • E.W. Paxton et al.

    Kaiser Permanente National Total Joint Replacement Registry: aligning operations with information technology

    Clin Orthop Relat Res

    (2010)
  • E.W. Paxton et al.

    The Kaiser Permanente Implant Registries: effect on patient safety, quality improvement, cost effectiveness, and research opportunities

    Perm J

    (2012)
  • D.Y. Lin et al.

    The robust inference for the Cox proportional hazards model

    J Am Stat Assoc

    (1989)
  • D.Y. Lin et al.

    Checking the Cox model with cumulative sums of martingale-based residuals

    Biometrika

    (1993)
  • I.R. White et al.

    Imputing missing covariate values for the Cox model

    Stat Med

    (2009)
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      Spanning from 1994 to 2021, articles included in this review were comprised of 457-27,656,346 White, Black, Hispanic, Asian, American Indian/Alaska Native (AIAN), and Pacific Islander (PI) patients who had mean ages ranging from 57 to 77 years. Studies evaluated rates of utilizations [3,4,15–30], complications [3,4,31–42], mortalities [3–5,22,23,31–39,41–47], LOS [3–5,32,33,35,37,39,41,42,48–59], discharge dispositions [4,5,33,34,39,48,49,54,56–64], readmissions [5,33–35,37,39,42,43,46,47,49,50,56,57,59,64–71], and reoperations [32,33,35,37,39,42,43,46,56,57,59,72–74] for THA and TKA to determine any racial and ethnic disparities. A summary of study characteristics is provided in Table 1.

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    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.04.050.

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