The most common reasons for failure within 2 years after TKA were infection and stiffness. The multivariable regression identified the following preoperative risk factors for TKA failure: history of drug abuse (hazard ratio [HR] 4.68; P = 0.03), deformity/mechanical preoperative diagnosis (HR 3.52; P < .01), having a constrained condylar knee implant over posterior-stabilized implant (HR 1.99; P < .01), post-traumatic/trauma preoperative diagnosis (HR 1.78; P = .03), and younger age (HR 0.61; P < .01) CONCLUSION: These findings add to the growing data that primary TKAs are no longer failing from polyethylene wear-related issues. This study identified preoperative risk factors for failure of primary TKAs, which may be useful information for developing strategies to improve outcomes following TKA.

Background Race is an important predictor of TKA outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA. Questions/purposes We asked: (1) Are race and socioeconomic factors at the individual level associated with patient-reported pain and function 2 years after TKA? (2) What is the interaction between race and community poverty and patient-reported pain and function 2 years after TKA? Methods We identified all patients undergoing TKA enrolled in a hospital-based registry between 2007 and 2011 who provided 2-year outcomes and lived in New York, Connecticut, or New Jersey. Of patients approached to participate in the registry, more than 82% consented and provided baseline data, and of these patients, 72% provided This work was funded by the Clinical and Translational Science Center at Weill Cornell (UL1TR000457-06) (SMG), the Agency for Healthcare Research and Quality Grant U18 HS016075 (SMG), and the Block Family Foundation (SMG). One of the authors certifies that he (MPF), or a member of his immediate family, has or may receive payments or benefits, during the study period, in an amount of USD 100,001-USD 1,000,000, from Zimmer Biomet (Warsaw, IN, USA), and an amount of USD 10,000-USD 100,000 from Lima (Arlington, TX, USA). One of the authors certifies that he (MLP), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from Zimmer Biomet (Warsaw, IN, USA) related to this work. One or more of the authors certify that he (JTN), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from the National Center for Advancing Translational Sciences (Bethesda, MD, USA) related to this work. One or more of the authors certify that she (Y-YL), or a member of her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from the National Center for Advancing Translational Sciences ((Bethesda, MD, USA) related to this work. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. 123Clin Orthop Relat Res (2016) 474:1986-1995 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® 2-year data. Proportions of patients with complete followup at 2 years were lower among blacks (57%) than whites (74%), among patients with Medicaid insurance (51%) compared with patients without Medicaid insurance (72%), and among pa...

Background:The quality-adjusted life year (QALY) is the preferred outcome measurement for cost-effectiveness analysis in health care. QALYs measure patient health-related quality of life with use of a value between 0 and 1. Few studies have provided original data delineating QALYs after hip and knee arthroplasty. In the present study, we evaluated patient utility preoperatively and 2 years after total hip arthroplasty, hip resurfacing, revision hip arthroplasty, total knee arthroplasty, unicompartmental knee arthroplasty, and revision knee arthroplasty.Methods:A single-hospital joint registry, which enrolled patients from 2007 to 2011, was retrospectively examined for all patients who underwent primary or revision hip or knee arthroplasty and who had preoperative and 2-year postoperative Short Form-36 (SF-36), Short Form-12 (SF-12), or EuroQol 5-Dimension (EQ-5D) scores available. Patient age, body mass index (BMI), sex, American Society of Anesthesiologists (ASA) score, and Charlson Comorbidity Index were recorded. QALYs were determined from the EQ-5D index and the Short Form-6 Dimension (SF-6D) index.Results:Five thousand, four hundred and sixty-three patients underwent total hip arthroplasty, with a mean annual increase (and standard deviation) of 0.25 ± 0.2 QALY; 843 patients underwent hip resurfacing, with a mean annual increase of 0.24 ± 0.17 QALY; 5,398 patients underwent primary total knee arthroplasty, with a mean annual increase of 0.17 ± 0.19 QALY; and 240 patients underwent medial unicompartmental knee arthroplasty, with a mean annual increase of 0.16 ± 0.17 QALY. Aseptic revision arthroplasty (440 hips, 323 knees) was associated with a smaller QALY gain than primary arthroplasty. Patient age, BMI, female sex, ASA category, and higher preoperative health-related quality of life were negative predictors for QALY gain after primary arthroplasty. Forty additional hip procedures and 35 additional knee procedures were also analyzed.Conclusions:Primary hip and knee arthroplasty, on average, result in substantially increased patient quality of life. Revision hip and knee replacement result in a lower, but still positive, gain in quality of life. However, there is a considerable variation in patient outcomes across all procedures. Our results may be used to improve the certainty of future cost-effectiveness analyses of hip and knee arthroplasty.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Update This article was updated on September 19, 2018, because of a previous error. On page 1546, in the section titled “Discussion,” the sentence that had read “Although a significant improvement was found in the vast majority of the inactive group, surprisingly, a majority of the active group (72.7%) reported a decrease in their activity levels below their baseline at 5 to 10 years postoperatively.” now reads “Although a significant improvement was found in the vast majority of the inactive group, surprisingly, a majority of the active group (72.7%) reported no change or a decrease in their activity levels below their baseline at 5 to 10 years postoperatively.” An erratum has been published: J Bone Joint Surg Am. 2018 Oct 17;100(20):e137. Background: Patients undergoing total knee arthroplasty expect pain relief, functional improvement, and a return to physical activity. The objective of this study was to determine the impact of patients’ baseline physical activity level on preoperative expectations, postoperative satisfaction, and clinical outcomes in patients undergoing total knee arthroplasty. Methods: Using an institutional registry from 2007 to 2012, we retrospectively identified patients who underwent a unilateral primary total knee arthroplasty for osteoarthritis and completed a preoperative Lower Extremity Activity Scale (LEAS), a Hospital for Special Surgery Knee Replacement Expectations Survey (HSS-KRES), and a Knee injury and Osteoarthritis Outcome Score (KOOS) evaluation in addition to 2-year KOOS and satisfaction evaluations. Active patients were defined by an LEAS level of 13 to 18. Active patients (n = 1,008) were matched to inactive patients (n = 1,008) by age, sex, body mass index, and comorbidities. The cohorts were compared with regard to the association of expectations with KOOS and satisfaction, the change in LEAS level from baseline to 2 years, complications, and revision surgical procedures. Multivariable analyses identified predictors of satisfaction, KOOS, and revision surgical procedures. Results: Significantly more active patients (68.2%) expected to be back to normal with regard to the ability to exercise and participate in sports compared with inactive patients (55.5%; p < 0.0001). Although overall satisfaction was equivalent, active patients were more commonly very satisfied with regard to the ability to do recreational activities (67.2% compared with 57.7%; p = 0.001). There were no associations between expectations and satisfaction or outcomes. Only the inactive patient group improved in activity level at 2 years. At 2 years, 69.5% of the inactive patients and 27.3% of the active patients improved upon their baseline activity levels (p < 0.0001). Complications rates were similar. The revision rate was higher for active patients (3.2%) compared with inactive patients (1.6%) at 5 to 10 years postoperatively (p = 0.019). Conclusions: At 2 years following total knee arthroplasty, inactive patients improved from baseline activity levels and active patients did not. Active patients had an elevated revision risk. Therefore, active patients should be carefully counseled regarding total knee arthroplasty to give them an understanding of its limitations and the potential risk of future revision. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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