Risk of Subsequent Revision after Primary and Revision Total Joint Arthroplasty

Abstract

Background Revision is technically more demanding than primary total joint arthroplasty (TJA) and requires more extensive use of resources. Understanding the relative risk of rerevision and risk factors can help identify patients at high risk who may require closer postsurgical care. Objectives/purposes We therefore evaluated the risk of subsequent revision after primary and revision TJA in the elderly (65 years or older) patient population and identified corresponding patient risk factors. Patients and Methods Using the 5% Medicare claims data set (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006), we identified a total of 35,746 patients undergoing primary THA and 72,913 undergoing primary TKA; of these, 1205 who had THAs and 1599 who had TKAs underwent initial revision surgery. The rerevision rate after primary and revision TJAs was analyzed by the Kaplan-Meier method. The relative risk of revision surgery for primary and revision TJAs was compared using hazard ratio analysis. ResultsThe 5-year survival probabilities were 95.9%, 97.2%, 81.0%, and 87.4% for primary THA and TKA and revision THA and TKA, respectively. Patients with revision arthroplasty were five to six times more likely to undergo rerevision (adjusted relative risk, 4.89 for THA; 5.71 for TKA) compared with patients with primary arthroplasty. Age and comorbidities were associated with initial revision after primary THA and TKA. Conclusions Patients should undergo stringent preoperative screening for preexisting health conditions and careful patient management and followup postoperatively so as to minimize the risk of an initial revision, which otherwise could lead to a significantly greater likelihood of subsequent rerevisions.

Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

“…The proportion of patients with older age (C 65 years) undergoing revision THA affects the underlying frequencies of population comorbidities. Revision THAs tend to be performed in sicker patients, and comorbidities particularly influence the rate of revision after primary THA [38], including the rate of early revision in the elderly [9]. Risk-assessment tools may offer physicians the opportunity to counsel elderly patients regarding the specific risks of infection after THA [10].…”

“…However, despite the clinical success of THAs and TKAs, the number of revision THAs [4,38] and TKAs [4,21,34,35] performed in the United States has increased with time. The revision THA and TKA caseload per orthopaedic surgeon also has increased [28].…”

Risk Factors for Early Revision After Primary Total Hip Arthroplasty in Medicare Patients

“…THA outcomes have previously been characterized at the population level for the Medicare population [3,16,17]. Most studies have shown that THA is associated with high rates of success as defined by decreased pain and improved function in patients who suffer from disabling arthritis of the hip [12].…”

Do We Need Gender-specific Total Joint Arthroplasty?

“…Recent studies have attempted to summarize the causes and epidemiology of revision procedures [5,6,39] and what can be done to minimize clinical and radiographic failures [34,35]. One aspect where surgeons and patients may differ, however, lies in the difference between a patient's and surgeon's definition of a successful procedure.…”