The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study

Abstract

SummaryBackgroundTotal joint replacements for end-stage osteoarthritis of the hip and knee are cost-effective and demonstrate significant clinical improvement. However, robust population based lifetime-risk data for implant revision are not available to aid patient decision making, which is a particular problem in young patient groups deciding on best-timing for surgery.MethodsWe did implant survival analysis on all patients within the Clinical Practice Research Datalink who had undergone total hip replacement or total knee replacement. These data were adjusted for all-cause mortality with data from the Office for National Statistics and used to generate lifetime risks of revision surgery based on increasing age at the time of primary surgery.FindingsWe identified 63 158 patients who had undergone total hip replacement and 54 276 who had total knee replacement between Jan 1, 1991, and Aug 10, 2011, and followed up these patients to a maximum of 20 years. For total hip replacement, 10-year implant survival rate was 95·6% (95% CI 95·3–95·9) and 20-year rate was 85·0% (83·2–86·6). For total knee replacement, 10-year implant survival rate was 96·1% (95·8–96·4), and 20-year implant survival rate was 89·7% (87·5–91·5). The lifetime risk of requiring revision surgery in patients who had total hip replacement or total knee replacement over the age of 70 years was about 5% with no difference between sexes. For those who had surgery younger than 70 years, however, the lifetime risk of revision increased for younger patients, up to 35% (95% CI 30·9–39·1) for men in their early 50s, with large differences seen between male and female patients (15% lower for women in same age group). The median time to revision for patients who had surgery younger than age 60 was 4·4 years.InterpretationOur study used novel methodology to investigate and offer new insight into the importance of young age and risk of revision after total hip or knee replacement. Our evidence challenges the increasing trend for more total hip replacements and total knee replacements to be done in the younger patient group, and these data should be offered to patients as part of the shared decision making process.FundingOxford Musculoskeletal Biomedical Research Unit, National Institute for Health Research.

Selecting and optimising patients for total knee arthroplasty

“…Both young (< 50 years) and old (> 90 years) age are thought to be relative contraindications to undergoing TKA. While younger people have a higher likelihood of requiring revision surgery (both earlier and during their lifetime), and although there is some evidence that clinical results may also be inferior in younger people, youth itself is not a contraindication. Young people can still experience benefits if they satisfy the criteria above.…”

“…Young people can still experience benefits if they satisfy the criteria above. For the very old, important gains are also seen and the risk of revision is lower than for young patients . The concerns in older people reflect the risks of surgery in the presence of comorbidities rather than age per se.…”

Platelet-Rich Plasma for Sport-Active Patients with Knee Osteoarthritis: Limited Return to Sport

“…Recently, a database study on 54.000 knee arthroplasties showed that joint replacement in patients under 55 years old increased the lifetime risk for revision up to 35%. is is questioning the impact of the increasing trend of more knee replacements in the younger patient's population [9]. Unfortunately, although alternative surgical procedures relying on scaffolds, tissue engineering, and cell transplantation have shown promising results in young patients with traumatic lesions, they provide less satisfying results and a low rate of return to sport in sport-active patients affected by cartilage degenerative lesions and OA [10,11].…”

A diet high in fat and fructose adversely affects osseointegration of titanium implants in rats

“…Titanium implants are an established treatment option for both dental and orthopaedic rehabilitation, particularly in an ageing population where demand is rapidly increasing (Srinivasan, Meyer, Mombelli, & Muller, 2017). Although 10-year survival rates of 94.6% for dental implants (Moraschini, Poubel, Ferreira, & Barboza Edos, 2015), 95.6% for total hip replacements and 96.1% for total knee replacements have been reported (Bayliss et al, 2017), failures do occur. Metabolic dysfunction such as type 2 diabetes mellitus (T2DM) has been shown to be associated with reduced dental implant survival rates (Naujokat, Kunzendorf, & Wiltfang, 2016) and an increased risk for revision of total hip replacements (Pedersen, Mehnert, Johnsen, & Sorensen, 2010).…”