Changes in Mortality Patterns Following Total Hip or Knee Arthroplasty Over the Past Two Decades: A Nationwide Cohort Study

Lalmohamed, Arief; Vestergaard, Peter; Boer, Anthonius de; Leufkens, H.G.M.; Staa, Tjeerd van; Vries, Frank de

doi:10.1002/art.38232

Cited by 52 publications

(42 citation statements)

References 38 publications

(39 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We found decreasing mortality in the early post‐operative period (30 and 90 days) similar to other publications,29, 30 this despite an increase in comorbidity. The reason for this is likely to be multi‐factorial and will certainly include advances in in the pre‐ and peri‐operative investigation and care of patients.…”

Section: Discussionsupporting

confidence: 91%

Trends in hip replacements between 1999 and 2012 in Sweden

Cnudde

Nemes

Bülow

et al. 2017

Journal Orthopaedic Research

View full text Add to dashboard Cite

National Registers document changes in the circumstance, practice, and outcome of surgery with the passage of time. In the context of total hip replacement (THR), registers can help elucidate the relevant factors that affect the clinical outcome. We evaluated the evolution of factors related to patient, surgical procedure, socio‐economy, and various outcome parameters after merging databases of the Swedish Hip Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare. Data on 193,253 THRs (164,113 patients) operated between 1999 and 2012 were merged. We studied the evolution of surgical volume, patient demographics, socio‐economic factors, surgical factors, length‐of‐stay, mortality rate, adverse events, re‐operation and revision rates, and Patient Reported Outcome Measures (PROMs). Throughout this time period the majority of patients were operated on with a diagnosis of primary osteoarthritis. Comorbidity indices increased each year observed. The share of all‐cemented implants has dropped from 92% to 68%. More than 88% of the bearings were metal‐on‐polyethylene. Length‐of‐stay decreased by 50%. There was a reduction in 30‐ and 90‐day mortality. Re‐operation and revision rates at 2 years are decreasing. The post‐operative PROMs improved despite the observation of worse pre‐operative pain scores getting over time. The demographics of patients receiving a THR, their comorbidities, and their primary diagnosis are changing. Notwithstanding these changes, outcomes like mortality, re‐operations, revisions, and PROMs have improved. The practice of hip arthroplasty has evolved, even in a country such as Sweden that is considered to be conservative with regard taking on new surgical practices. © 2017 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:432–442, 2018.

show abstract

Section: Discussionsupporting

confidence: 91%

Trends in hip replacements between 1999 and 2012 in Sweden

Cnudde

Nemes

Bülow

et al. 2017

Journal Orthopaedic Research

View full text Add to dashboard Cite

show abstract

“…With a mean follow-up of 11 years, we were able to show that the temporal improvements in in mortality is not just confined to the first year of surgery, and, at least in the case of total knee replacement, may have occurred even faster than the general population. Combined with the results of the short-term mortality studies[13, 14, 21], we can conclude that total hip and knee replacement patients have much lower mortality today than their counterparts about a decade ago.…”

Section: Discussionmentioning

confidence: 79%

“…Although this was previously demonstrated for short-term mortality[13, 14, 21, 22], only one prior study from Norway reported declines in long-term mortality[8]. In a nationwide total hip replacement cohort, investigators observed a statistically significant difference in the SMR between 1987–90 and 1995–98 but a significance test for trend was not significant.…”

Section: Discussionmentioning

confidence: 88%

“…Second, although our follow-up extended to August 2014, the cohort of joint replacement patients was limited to those who underwent surgery prior to 2008. Therefore, we cannot extrapolate our findings to patients who underwent surgery after 2008, who may have a different underlying mortality risk[21]. Third, due to the small cohort size, we had limited power for some of the analyses, such as mortality patterns among younger arthroplasty patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Long-Term Mortality Trends After Total Hip and Knee Arthroplasties: A Population-Based Study

Kremers

Larson

Noureldin

et al. 2016

The Journal of Arthroplasty

View full text Add to dashboard Cite

BACKGROUND Mortality following total hip and knee replacement is lower than the general population, but it is unknown whether there are differences by surgery type, demographics and calendar year. Our objective was to evaluate trends and determinants of long-term mortality among patients with total hip and knee replacement. METHODS Using a historical cohort study design, we passively followed up population-based cohorts of total hip and total knee replacement patients with degenerative arthritis who underwent surgery between 1/1/1969 and 12/31/2008. Patients were followed up until death or 8/31/2014. Observed and expected survival was compared using standardized mortality ratios (SMR). Poisson regression models were used to examine relative mortality patterns by surgery type, age, sex, calendar year and time since surgery. RESULTS The overall age- and sex-adjusted mortality was significantly lower than the general population following both total hip (SMR: 0.82, 95% CI: 0.76, 0.88) and total knee (SMR = 0.80, 95% CI: 0.75, 0.86) replacement. Despite the low relative mortality within the first 8 years of surgery, we observed a worsening of relative mortality beyond 15 years after total knee replacement surgery. Both short and long term mortality improved over calendar time, and the improvement occurred about a decade earlier in total knee replacement than in total knee replacement. CONCLUSION Survival following total hip and total knee replacement is better than the general population for about 8 years following surgery. Secular trends are encouraging and suggest that survival following both procedures has been improving even further in recent years.

show abstract

“…Previous studies have shown 30‐day mortality after hip and knee arthroplasty to be a little less than 0.5% and approximately doubling at 90 days. There is evidence that these rates have been decreasing over time . Early post‐operative mortality rates are higher than the expected mortality without surgery, based on population norms .…”

Section: Introductionmentioning

confidence: 99%

Declining early mortality after hip and knee arthroplasty

Harris

Hatton

Steiger

et al. 2019

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background We aimed to measure the period effect (change over time) in 30‐day mortality after total hip arthroplasty (THA) and total knee arthroplasty (TKA) using data from the Australian Orthopaedic Association National Joint Replacement Registry. Methods We performed an observational study using national registry data from all hospitals performing THA and TKA in Australia including people undergoing primary elective conventional THA and TKA for osteoarthritis from 2003 to 2017, inclusive. Data from the Australian Orthopaedic Association National Joint Replacement Registry, the National Death Index and the Australian Bureau of Statistics were used to generate unadjusted 30‐day mortality, the incident rate ratio for mortality adjusted for age and gender, and the standardized mortality ratio at 30 days for each year separately. Results For the years 2003 and 2017, respectively, for THA, the unadjusted 30‐day mortality was 0.23% and 0.06%, and the standardized mortality ratio was 1.11 (95% CI: 0.73, 1.49) and 0.38 (95% CI: 0.16, 0.59). The incident rate ratio was significantly higher than the reference year (2017) from 2003 to 2010, and for 2012, 2013 and 2016, decreasing over time. For the years 2003 and 2017, respectively, for TKA, the unadjusted 30‐day mortality was 0.17% and 0.08%, and the standardized mortality ratio was 0.84 (95% CI: 0.55, 1.13) and 0.61 (95% CI: 0.38, 0.83). The incident rate ratio was significantly higher than the reference year (2017) from 2003 to 2009 inclusive, decreasing over time. Conclusions Thirty‐day mortality after THA and TKA declined from 2003 to 2017. This may be due to improvements in intra‐operative and post‐operative patient management.

show abstract

Changes in Mortality Patterns Following Total Hip or Knee Arthroplasty Over the Past Two Decades: A Nationwide Cohort Study

Cited by 52 publications

References 38 publications

Trends in hip replacements between 1999 and 2012 in Sweden

Trends in hip replacements between 1999 and 2012 in Sweden

Long-Term Mortality Trends After Total Hip and Knee Arthroplasties: A Population-Based Study

Declining early mortality after hip and knee arthroplasty

Contact Info

Product

Resources

About