Kaplan-Meier Survival Analysis Overestimates the Risk of Revision Arthroplasty: A Meta-analysis

Lacny, Sarah; Wilson, Todd; Clement, Fiona; Roberts, Derek J.; Faris, Peter; Ghali, William A.; Marshall, Deborah A.

doi:10.1007/s11999-015-4235-8

Cited by 98 publications

(74 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The discrepancy is more heavily influenced by diminishing strength of our Kaplan-Meier estimates at those time points given the effects of loss to follow-up and mortality in our cohort, with median follow-up of 9.8 years and only 49% of patients completing longer than 10 years of follow-up. Furthermore, some authors suggest the Kaplan-Meier method overestimates the risk of revision after TKA especially in studies with long follow-up durations [23]. By design, this form of analysis estimates the time to a distinct event that will ultimately occur for all subjects.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty

Yong

Young

Molloy

et al. 2020

The Journal of Arthroplasty

View full text Add to dashboard Cite

a b s t r a c tBackground: There is limited evidence describing long-term implant survivorship and modes of failure in simultaneous concurrent bilateral total knee arthroplasty (TKA). Methods: We performed a retrospective review of 266 consecutive patients (532 knees) who underwent simultaneous concurrent bilateral TKA. We reviewed medical records for preoperative characteristics, perioperative complications, and revision surgeries. The primary outcome was TKA survivorship. Secondary outcomes included indication and type of revision surgery. We used the Kaplan-Meier method to estimate survivorship and characterize risk of revision up to 20 years post-TKA. Results: Our cohort had median follow-up of 9.8 years (interquartile range, 3.9-15.9). Forty-four patients (17%) underwent revision. Revision was more common among younger and male patients. The cumulative incidence of first-time revision per knee (n ¼ 532) was 1.27 per 100 component-years. Implant survival was 99% (confidence interval, 97%-99%) at 5 years, 92% (89%-95%) at 10 years, 83% (77%-87%) at 15 years, and 62% (50%-73%) at 20 years. Five and 10-year survivorship compared favorably to estimates of TKA survivorship in the literature. The cumulative incidence of revision surgery per patient was 1.91 per 100 component-years. Implant survival at 5-, 10-, 15-, and 20-year time points was 96% (CI, 92%-98%), 84% (77%-89%), 71% (62%-79%), and 59% (46%-70%), respectively. Aseptic loosening (40%), polyethylene wear (34%), and infection (11%) were the most common indications for revision. Conclusion: Simultaneous concurrent bilateral TKA is associated with a higher risk of reoperation for the patient when both knees are evaluated but similar implant survivorship to the literature when each knee was evaluated in isolation.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty

Yong

Young

Molloy

et al. 2020

The Journal of Arthroplasty

View full text Add to dashboard Cite

show abstract

“…(24,25) Competing risk analysis was chosen instead of Kaplan-Meier in order to avoid a potential overestimation of infection risk. (26) The overall cumulative incidences were calculated within 15, 30, 90, and 365 days of surgery date. For the hip fracture cohort, we calculated overall 30-day incidence rates (IRs) as the number of hip fracture patients with hospital-treated infection during each calendar year (or biennial) divided by the total of risk-time during the same time period following the hip fracture admission, expressed per 1000 person-years..…”

Section: Discussionmentioning

confidence: 99%

Increasing Risk of Hospital-Treated Infections and Community-Based Antibiotic Use After Hip Fracture Surgery: A Nationwide Study 2005–2016

Kjørholt

Johnsen

Kristensen

et al. 2018

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

We aimed to examine trends in the incidence of treated infections following hip fracture surgery in Denmark from 2005 to 2016. We conducted a nationwide cohort study using individual‐level linked data from Danish population‐based registries. We calculated cumulative incidence considering death as competing risk and, based on the pseudo‐observation method, risk ratios (RRs) with 95% confidence interval (CI) using the period 2005–2006 as a reference. RRs were adjusted for age, sex, and comorbidity. A total of 74,771 patients aged 65 years or older with first‐time hip fracture surgery were included. The risk of postoperative (at 15, 30, 90, and 365 days) infections increased during 2005–2016. The 30‐day cumulative incidence of all hospital‐treated infections increased from 10.8% (95% CI, 10.2% to 11.3%) in 2005–2006 to 14.3% (95% CI, 13.7% to 15.0%) in 2015–2016 (adjusted RR 1.32; 95% CI, 1.23 to 1.42). Adjusted RR for 30‐day hospital‐treated pneumonia was 1.70 (95% CI, 1.49 to 1.92). The 30‐day cumulative incidence of redeeming community‐based antibiotic prescriptions increased from 17.5% (95% CI, 16.8% to 18.2%) in 2005–2006 to 27.1% (95% CI, 26.3% to 27.9%) in 2015–2016 (adjusted RR 1.54; 95% CI, 1.47 to 1.62). The largest increase was observed for broad‐spectrum antibiotic use (adjusted RR 1.79; 95% CI, 1.68 to 1.90). During 2005–2016, risk of infections was substantially higher in hip fracture patients than in the general population. The risk of hospital‐treated pneumonia and antibiotic prescriptions increased more over time among hip fracture patients. We found increased risks of postoperative treated infections following hip fracture surgery during the 12‐year study period, which could not entirely be explained by similar infection trends in the general population. Given the high mortality following infections in the elderly, further research is needed to identify patients at increased risk to target preventive treatment and potentially reduce complications and mortality in hip fracture patients. © 2018 American Society for Bone and Mineral Research.

show abstract

“…The optimal cutoff to determine acceptable early migration in this cohort was calculated by the Youden index [2]. A competing risk model [15,21] was used to estimate longterm survival of stems with large early distal migration compared with stems with little early distal migration at 2 years with the endpoint ''aseptic stem loosening'', stems were assigned to groups of high and low early migration according to the calculated cutoff. We considered p values less than 0.05 to be significant.…”

Section: Discussionmentioning

confidence: 99%

Early Migration Predicts Aseptic Loosening of Cementless Femoral Stems: A Long-term Study

Streit

Haeussler

Brückner

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Excessive early migration of cemented stems and cups after THA has been associated with poor long-term survival and allows predictable evaluation of implant performance. However, there are few data regarding the relationship between early migration and aseptic loosening of cementless femoral components, and whether early migration might predict late failure has not been evaluated, to our knowledge. Einzel-Bild-Röntgen-Analyse-femoral component analysis (EBRA-FCA) is a validated technique to accurately measure axial femoral stem migration without the need for tantalum markers, can be performed retrospectively, and may be a suitable tool to identify poor performing implants before their widespread use. Questions/purposes We asked: (1) Is axial migration within the first 24 months as assessed by EBRA-FCA greater among cementless stems that develop aseptic loosening than those that remain well fixed through the second decade; (2) what is the diagnostic performance of implant migration at 24 months postoperatively to predict later aseptic loosening of these components; and (3) how does long-term stem survivorship compare between groups with high and low early migration? Methods We evaluated early axial stem migration in 158 cementless THAs using EBRA-FCA. The EBRA-FCA measurements were performed during the first week postoperatively (baseline measurement) and at regular followups of 3, 6, and 12 months postoperatively and annually thereafter. The mean duration of followup was 21 years (range, 18-24 years). The stems studied represented 45% (158 of 354) of the cementless THAs performed during that time, and cementless THAs represented 34% (354 of 1038) of the THA practice during that period. No patient enrolled in this study was lost to followup. Multivariate survivorship analysis using Cox's regression model The institution of one or more of the authors (MRS) has received, during the study period, funding from the noncommercial research fund of Deutsche Arthrose-Hilfe e.V (Frankfurt, Germany). The institution of one or more of the authors (TG) has received, during the study period, funding from Biomet Europe (Berlin, Germany) and from Depuy Orthopädie GmbH (Kirkel, Germany). One of the authors certifies that he (TG), 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 Pfizer Pharma GmbH (Karlsruhe, Germany), and an amount of less than USD 10,000 from MSD Sharp&Dohme (Haar, Germany was performed with an endpoint of aseptic loosening of the femoral component. Loosening was defined according to the criteria described by Engh et al. and assessed by two independent observers. Patients with a diagnosis of prosthetic joint infection were excluded. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance of axial stem migration 1, 2, 3, and 4 years postoperatively as a predictor of aseptic loosening. Survivorship of hips with high (C 2.7 mm) and low (\ 2.7 mm) migration was co...

show abstract

Kaplan-Meier Survival Analysis Overestimates the Risk of Revision Arthroplasty: A Meta-analysis

Cited by 98 publications

References 43 publications

Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty

Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty

Increasing Risk of Hospital-Treated Infections and Community-Based Antibiotic Use After Hip Fracture Surgery: A Nationwide Study 2005–2016

Early Migration Predicts Aseptic Loosening of Cementless Femoral Stems: A Long-term Study

Contact Info

Product

Resources

About