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

Abstract

Aims To 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 methods Hierarchical logistic regression on national administrative data for England for index procedures between April 2009 and March 2014. Results There 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. Conclusions Meeting 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 relevance Surgeons 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.

Feasibility of Using Common Data Model for Orthopedic Research: Analysis of Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty

“…This study found that a male sex was a signi cant risk factor of PJI after TKA, which coincides with some studies [3,6,15,27,29]. A study suggested that men can get a greater degree of surgical trauma and tissue necrosis than in women [27].…”

“…We searched for all possible risk factors for PJI in the literatures [2,3,13,29,34] and collected the following clinical data: preoperative demographic/social factors (age and sex), previous medical history (comorbidities and drug history), intraoperative factors (operative time, oxygenation, preparation, skin closure, and blood transfusion), laboratory results (albumin, cholesterol, blood cell counts, in ammatory markers, etc.) and others (admission days, observation duration, and venous thromboembolism prophylaxis).…”

Outcomes of outpatient total hip arthroplasty: a systematic review

“…32 In addition, studies have shown that obesity is a risk factor for revision THA. [33][34][35] Ponnusamy et al 35 found that THA patients with a body mass index (BMI) > 35 kg/m 2 were at greater risk for a revision, particularly septic revisions. The findings in this systematic review coincide with the New Zealand registry, revealing favorable outcomes for patients with ASA ⩽ 2.…”

Analysis of early failure rate and its risk factor with 2157 total ankle replacements

“…Patient risk factors for early revision were already studied in total hip arthroplasty (THA) and total knee arthroplasty (TKA) 15 and can be extrapolated. Diagnoses of diabetes, chronic pulmonary disease, dementia, Parkinson’s disease, lung circulation disorders, neurological diseases, alcohol abuse, drug abuse, depression, obesity, and fluid/electrolyte disorders significantly increased the risk for early revision of THA 16 , 17 . In another study, the revision rates were higher among patients with hypertension and those with paraparesis/hemiparesis for THA and among patients with metastatic disease for TKA 18 .…”