The epidemiology of revision total knee and hip arthroplasty in England and Wales

Patel, Amit; Pavlou, George; Mújica-Mota, Rubén; Toms, Andrew

doi:10.1302/0301-620x.97b8.35170

Cited by 456 publications

(146 citation statements)

References 17 publications

Supporting

Mentioning

139

Contrasting

Unclassified

Order By: Relevance

“…While the number of primary total knee arthroplasties (TKA) has already reached a high level in some western industrialized countries, global data suggest that other countries are quickly catching up [1–6]. Due to this trend and an ageing society it is expected that especially the rate of revision TKA surgery will increase disproportionately in the next decade [7–9].…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

et al. 2017

View full text Add to dashboard Cite

BackgroundThe most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available.Questions/PurposesA retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations.MethodsA total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes.ResultsAseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p <.001).On the level of the separate hospitalizations the mean direct costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p <.001). Major cost drivers were the cost of the implant and general staff. The septic implantation part was on average $3,142.87 more expensive than septic explantations (p <.001).ConclusionsOur study for the first time provides a detailed analysis of the major direct case costs of aseptic and septic revision TKA from the hospital-department’s perspective which is the basis for long-term orientated decision making. In the future, our cost analysis has to be interpreted in relation to reimbursement estimates. This is important to check whether revision TKA lead to a financial loss for the operating department.

show abstract

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Epi demiological studies suggest that there is a constantly increas ing demand for this type of treatment [8]. It is estimated that in the United States of America in 2030 there will be a 673% increase in the number of hip replacement procedures and a 174% increase in knee replacements [8].…”

Section: Hip Surgery In the Modern Worldmentioning

confidence: 99%

Cardioorthopedics — is it necessary in clinical practice? A study of patients with hip replacement surgery

et al. 2017

View full text Add to dashboard Cite

“…A substantial increase in the prevalence of TKA over time and a shift to younger ages was noted [3], such that the number of revision TKAs has increased annually [4]. The common causes of revision TKA include infection, mechanical loosening, and pain and knee instability [5].…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of tranexamic acid in revision total knee arthroplasty: a meta-analysis

Tian

Liu

et al. 2017

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundThere is no consistent conclusion regarding the efficacy and safety of the intravenous administration of tranexamic acid (TXA) for reducing blood loss in revision total knee arthroplasty (TKA). We performed a meta-analysis of comparative trials to evaluate the efficacy and safety of TXA in revision TKA.MethodsWe conducted a search of PubMed, EMBASE, The Cochrane Library and Web of Science for randomized controlled trials (RCTs) and non-RCTs. Two authors selected the studies, extracted the data, and assessed the risk of bias independently. A pooled meta-analysis was performed using RevMan 5.3 software.ResultsFour non-RCTs met the inclusion criteria. The meta-analysis indicated that the use of TXA was related to significantly less transfusion requirements (RD = −0.25; 95% CI: -0.43 to −0.08; P = 0.005), drainage volume (MD = −321.07; 95% CI: -445.13 to −197.01, P = 0.005), hemoglobin reduction (MD = −0.52; 95% CI: -0.79 to −0.25, P = 0.0001), and length of hospital stay (MD = −2.36; 95% CI: -4.00 to −0.71, P = 0.005). No significant differences in the incidence of deep venous thrombosis (DVT) or pulmonary embolism (PE) were noted.ConclusionsThe use of TXA for patients undergoing revision TKA may reduce blood loss and transfusion requirements without increasing the risk of postoperative venous thromboembolism. Due to the limited quality of the currently available evidence, more high-quality RCTs are required.

show abstract

The epidemiology of revision total knee and hip arthroplasty in England and Wales

Cited by 456 publications

References 17 publications

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

Cardioorthopedics — is it necessary in clinical practice? A study of patients with hip replacement surgery

The efficacy and safety of tranexamic acid in revision total knee arthroplasty: a meta-analysis

Contact Info

Product

Resources

About