Temporal Trends in Revision Total Hip and Knee Arthroplasty from 2008 to 2018

Abstract

Background: An overall assessment of how patient demographic characteristics and comorbidities are improving or worsening can allow better understanding of the value of revision total joint arthroplasty (TJA). Therefore, the purpose of this study was to identify patient demographic characteristics and comorbidities trends and episode-of-care outcome trends from 2008 to 2018 in patients undergoing revision TJA. Methods:The National Surgical Quality Improvement Program database was queried to identify patient demographic characteristics, comorbidities, and episode-of-care outcomes in patients undergoing revision TJA from 2008 to 2018 (n = 45,706). Pairwise t tests and pairwise chi-square tests were performed on consecutive years with Bonferroni correction. Trends were assessed using the 2-tailed Mann-Kendall test of the temporal trend.Results: Among patients undergoing revision TJA, there was no clinically important difference, from 2008 to 2018, in age, body mass index (BMI), percentages with >40 kg/m 2 BMI, diabetes (18.8% to 19%), chronic obstructive pulmonary disease (4.1% to 5.4%), congestive heart failure within 30 days (0% to 1%), or acute renal failure (0% to 0.2%). However, modifiable comorbidities including smoking status (14.7% to 12.0%; p = 0.01), hypertension (66% to 26.0%; p = 0.02), anemia (34.5% to 26.3%; p < 0.001), malnutrition (10.4% to 9.3%; p = 0.004), and overall morbidity or mortality probability have improved, with a decrease in the hospital length of stay and 30-day readmission and a significant increase in home discharge (p < 0.001 for all).Conclusions: Time-difference analysis demonstrated that the overall health status of patients undergoing revision TJA improved from 2008 to 2018. However, formal time-trend analysis demonstrated improvements to a lesser degree. The multidisciplinary effort to improve value-based metrics including patient comorbidity optimization and episode-of-care outcomes for primary TJA has been shown to potentially have an impact on revision TJA.

Are All Patients Going Home after Total Knee Arthroplasty? A Temporal Analysis of Discharge Trends and Predictors of Nonhome Discharge (2011–2020)

“…Total knee arthroplasty (TKA) is the mainstay treatment of end-stage knee osteoarthritis and has demonstrated consistent growth annually, increasing by 148% from 2000 to 2014 in the United States (US) 1 . Various surgical advancements have potentially enabled the growing utilization of TKA, including the improvements in anesthetic techniques, development of enhanced recovery programs, increased optimization of modifiable comorbidities, and improvements in venous thromboembolism (VTE) prophylaxis [2][3][4][5][6][7][8][9][10] . Recent changes in legislation have incentivized high-value care in total joint replacement.…”

Intraoperative Fractures Sustained During Total Knee Arthroplasty

“…T otal knee arthroplasty (TKA) is one of the most successful procedures in reducing knee pain, improving function, and restoring patient's quality of life [1][2][3] . The demand for primary TKA is projected to exponentially grow in the upcoming decade [1][2][3] .…”

The Impact of Surgeon Variability on Patient-Reported Outcome Measures, Length of Stay, Discharge Disposition, and 90-Day Readmission in TKA

“…Each year, >100,000 total knee arthroplasties (TKAs) are performed in the United Kingdom, and >700,000 TKAs are performed in the United States 1 . Although the demand for this surgical intervention continues to rise 2-4 , the literature has reported dissatisfaction with TKA in up to 20% to 30% of patients 5-7 . Innovative devices and technology have been developed to attenuate the risk of adverse outcomes and improve patient satisfaction following arthroplasty, yet challenges remain 7-9 .…”