Benchmarking total knee replacement constructs using noninferiority analysis: the New Zealand joint registry study

Abstract

Background The aim of this study was to compare the relative performance of total knee replacement constructs and discern if there is variability in performance in currently commonly used prostheses in the New Zealand Joint Registry (NZJR) using a noninferiority analysis. Methods All patients who underwent a primary total knee replacement (TKR) registered in the NZJR between 1st January 1999 to June 2020 were identified. Using a noninferiority analysis, the performance of total knee replacement prostheses were compared with the best performing contemporary construct. Construct all-cause revision rate was estimated using the 1-Kaplan Meier survival function method to estimate net failure. The difference in all-cause revision rates between the contemporary benchmark and all other constructs was tested. Results In total 110 183 TKR were recorded and 25 constructs (102 717 procedures) had > 500 procedures at risk at 3 years post-primary of which 5 were inferior by at least 20 % relative risk of which, one was inferior by at least 100 % relative risk. 14 constructs were identified with > 500 procedures at risk at 10 years with 5 inferior by at least 20 %, of which 2 were inferior by > 100 % relative risk. Conclusions We discerned that there is great variability in construct performance and at all time points, greater than 25 % of constructs are inferior to the best performing construct by at least 20 %. These results can help inform patients, clinicians and health care funders when considering TKR surgery.

Clinical Application of Perioperative Anaesthesia Management Based on Enhanced Recovery after Surgery Concept to Elderly Patients Undergoing Total Knee Replacement

“…However, the sympathetic nerves are always chronically activated in older patients, whose neural tone is elevated, so they are highly susceptible to excessive stress reactions, which trigger a series of negative effects that lead to a systemic inflammatory response syndrome [ 18 ]. Elderly patients undergoing TKR have low surgical tolerance, tracheal intubation, postural changes, and expansion of medullary cavity all trigger hemodynamic fluctuations, so they often experience coughing and agitation during extubation, and their oxygen consumption is higher than that of other age groups, and in particular, those with comorbid cardio cerebrovascular diseases are more likely to experience severe cardio cerebrovascular and airway complications postoperatively [ 19 ]. Therefore, the regulated anesthesia management of elderly patients undergoing TKR based on ERAS concept can reduce their stress levels and improve their perioperative indicators.…”