Revision total knee replacement case-mix at a major revision centre

Sabah, Shiraz A.; Fritsch, Lennart von; Khan, Tanvir; Shearman, Alexander D.; Rajasekaran, Raja Bhaskara; Beard, David; Price, Andrew; Alvand, Abtin

doi:10.1186/s40634-022-00462-2

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…LoS distribution (Fig 3 ) showed a similar pattern to those of at Nuffield Orthopaedic Centre, Oxford 'most complex/salvage' knee with a median LoS = 11 days (IQR 7-19) [5]. Furthermore, we observed longer LoS for hip than knee PJI in agreement with previous [63].…”

Section: Pji Health Resource Consumption and Outcomessupporting

confidence: 84%

“…However, TJA failure are observed as consequence of periprosthetic joint infections (PJIs) [ 3 , 4 ]. The reported rate of PJI is one to two percent after primary TJA despite prevention and management policies [ 5 , 6 ]. PJI prevention mainly relys on antimicrobial prophylactic therapy either systemically or in situ from antibiotic laden bone cement; Management can involve debridement, removal of the implant and his replacement or, in extreme cases, amputation; furthermore, PJI can also lead to death [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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A retrospective study of risk factors, causative micro-organisms and healthcare resources consumption associated with prosthetic joint infections (PJI) using the Clinical Practice Research Datalink (CPRD) Aurum database

2023

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Background Prosthetic joint infection (PJI) is a serious complication after joint replacement surgery and it is associated with risk of mortality and morbidity along with high direct costs. Methods The Clinical Practice Research Datalink (CPRD) data were utilized to quantify PJI incidence after hip or knee replacement up to 5 years after implant and a variety of risk factors related to patient characteristics, medical and treatment history along with characteristics of the original surgery were analyzed through Cox proportional hazard. Results 221,826 patients (individual joints 283,789) met all the inclusion and exclusion criteria of the study; during the study follow-up period (5 years), 707 and 695 PJIs were diagnosed in hip and knee, respectively. Patients undergoing joint replacement surgery during an unscheduled hospitalization had greater risk of PJI than patients whose surgery was elective; similarly, the risk of developing PJI after a secondary hip or knee replacement was about 4 times greater than after primary arthroplasty when adjusted for all other variables considered. A previous diagnosis of PJI, even in a different joint, increased the risk of a further PJI. Distribution of average LoS per each hospitalization caused by PJI exhibited a right skewed profile with median duration [IQR] duration of 16 days [8–32] and 13 days [7.25–32] for hip and knee, respectively. PJIs causative micro-organisms were dependent on the time between initial surgery and infection offset; early PJI were more likely to be multispecies than later (years after surgery); the identification of Gram- pathogens decreased with increasing post-surgery follow-up. Conclusions This study offers a contemporary assessment of the budgetary and capacity (number and duration of hospitalizations along with the number of Accident and Emergency (A&E) visits) posed by PJIs in UK for the national healthcare system (NHS). The results to provide risk management and planning tools to health providers and policy makers in order to fully assess technologies aimed at controlling and preventing PJI. The findings add to the existing evidence-based knowledge surrounding the epidemiology and burden of PJI by quantifying patterns of PJI in patients with a relatively broad set of prevalent comorbidities.

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Section: Pji Health Resource Consumption and Outcomessupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

A retrospective study of risk factors, causative micro-organisms and healthcare resources consumption associated with prosthetic joint infections (PJI) using the Clinical Practice Research Datalink (CPRD) Aurum database

2023

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“…Another possible explanation for the smaller than expected increase in the rate of rKR is a lag in time between increases in pKR and the need for revision surgery (though it is evident that increases in the incidence of pKR have also slowed). The trends we have observed may indicate difficulties increasing capacity for joint replacement procedures in the NHS, particularly for rKR which may be resource-intensive [33] , and this requires further investigation. One important methodological consideration for future studies on the incidence rate of joint replacement is how to handle data generated around the time of the Covid-19 pandemic.…”

Section: Discussionmentioning

confidence: 88%

No exponential rise in revision knee replacement surgery over the past 15 years: an analysis from the National Joint Registry

Sabah

Knight²,

Alvand³

et al. 2022

Osteoarthritis and Cartilage

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“…While this must be considered in planning networks, it is also recognized that the process may have cost benefits in terms of economies of scale. 44 Within emson, we noted a transfer rate from the four revision units to the major revision centre of 4%, mostly due to either a specific need for ancillary services such as intensive care, plastic or vascular surgery, or a requirement for particular surgical expertise such as the management of severe bone loss or the use of a tumour prosthesis. 45 a functional multidisciplinary team meeting has certain requirements in terms of it equipment, a network coordinator, and dedicated time to discuss these cases, all of which must be in place if the network is to be established successfully.…”

Section: Discussionmentioning

confidence: 98%

“…While this must be considered in planning networks, it is also recognized that the process may have cost benefits in terms of economies of scale. 44…”

Section: Discussionmentioning

confidence: 99%

The impact of a revision arthroplasty network on patient outcomes

et al. 2023

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AimsRevision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA) are complex procedures with higher rates of re-revision, complications, and mortality compared to primary TKA and THA. We report the effects of the establishment of a revision arthroplasty network (the East Midlands Specialist Orthopaedic Network; EMSON) on outcomes of rTKA and rTHA.MethodsThe revision arthroplasty network was established in January 2015 and covered five hospitals in the Nottinghamshire and Lincolnshire areas of the East Midlands of England. This comprises a collaborative weekly multidisciplinary meeting where upcoming rTKA and rTHA procedures are discussed, and a plan agreed. Using the Hospital Episode Statistics database, revision procedures carried out between April 2011 and March 2018 (allowing two-year follow-up) from the five network hospitals were compared to all other hospitals in England. Age, sex, and mean Hospital Frailty Risk scores were used as covariates. The primary outcome was re-revision surgery within one year of the index revision. Secondary outcomes were re-revision surgery within two years, any complication within one and two years, and median length of hospital stay.ResultsA total of 57,621 rTHA and 33,828 rTKA procedures were performed across England, of which 1,485 (2.6%) and 1,028 (3.0%), respectively, were conducted within the network. Re-revision rates within one year for rTHA were 7.3% and 6.0%, and for rTKA were 11.6% and 7.4% pre- and postintervention, respectively, within the network. This compares to a pre-to-post change from 7.4% to 6.8% for rTHA and from 11.7% to 9.7% for rTKA for the rest of England. In comparative interrupted time-series analysis for rTKA there was a significant immediate improvement in one-year re-revision rates for the revision network compared to the rest of England (p = 0.024), but no significant change for rTHA (p = 0.504). For the secondary outcomes studied, there was a significant improvement in trend for one- and two-year complication rates for rTHA for the revision network compared to the rest of England.ConclusionRe-revision rates for rTKA and complication rates for rTHA improved significantly at one and two years with the introduction of a revision arthroplasty network, when compared to the rest of England. Most of the outcomes studied improved to a greater extent in the network hospitals compared to the rest of England when comparing the pre- and postintervention periods.Cite this article: Bone Joint J 2023;105-B(6):641–648.

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Revision total knee replacement case-mix at a major revision centre

Cited by 5 publications

References 14 publications

A retrospective study of risk factors, causative micro-organisms and healthcare resources consumption associated with prosthetic joint infections (PJI) using the Clinical Practice Research Datalink (CPRD) Aurum database

A retrospective study of risk factors, causative micro-organisms and healthcare resources consumption associated with prosthetic joint infections (PJI) using the Clinical Practice Research Datalink (CPRD) Aurum database

No exponential rise in revision knee replacement surgery over the past 15 years: an analysis from the National Joint Registry

The impact of a revision arthroplasty network on patient outcomes

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