The Epidemiology of Revision Total Knee Arthroplasty in the United States

Abstract

Understanding the cause of failure and type of revision total knee arthroplasty (TKA) procedures performed in the United States is essential in guiding research, implant design, and clinical decision making in TKA. We assessed the causes of failure and specific types of revision TKA procedures performed in the United States using newly implemented ICD-9-CM diagnosis and procedure codes related to revision TKA data from the Nationwide Inpatient Sample (NIS) database. Clinical, demographic, and economic data were reviewed and analyzed from 60,355 revision TKA procedures performed in the United States between October 1, 2005 and December 31, 2006. The most common causes of revision TKA were infection (25.2%) and implant loosening (16.1%), and the most common type of revision TKA procedure reported was all component revision (35.2%). Revision TKA procedures were most commonly performed in large, urban, nonteaching hospitals in Medicare patients ages 65 to 74. The average length of hospital stay (LOS) for all revision TKA procedures was 5.1 days, and the average total charges were $49,360. However, average LOS, average charges, and procedure frequencies varied considerably by census region, hospital type, and procedure performed.Level of Evidence: Level II, economic and decision analysis. See Guidelines for Authors for a complete description of levels of evidence.

Prosthetic Joint Infection Risk after TKA in the Medicare Population

“…Infection is currently the most frequently reported reason for revision in TKA [3]. However, the current risk of infection as well as the relative importance of various risk factors remains under debate as a result of the rarity of the complication, changes in the treatment and prevention of infection over time as well as the practical difficulties associated with conducting well-controlled clinical studies on this topic with long-term followup.…”

“…In light of our longitudinal analysis of the incidence of PJI in the Medicare patient population, along with other followup studies [17] and cross-sectional analysis of national hospitalization records [3], emphasis should be placed on minimizing the risk of PJI after primary TKA. Because PJI is a challenging complication for patients, hospitals, surgeons, and payers [4], effective strategies such as stringent patient screening for risk factors or adequate antibiotic prophylaxis [17] should be developed and implemented to combat this complication.…”

“…Infection is currently the most frequently reported reason for revision in TKA [3]. Recent epidemiologic studies using the Nationwide Inpatient Sample suggest both the incidence and prevalence of PJI may be increasing over time in the United States [10,11].…”

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

“…Infection is a leading cause for revision total knee arthroplasty (RTKA) [11,12]. Studies have shown that 6.6% to 38% of RTKAs are attributable to prosthetic knee infections [5,11,23,24,31,41,43,55,58,76,95,96].…”

“…Studies have shown that 6.6% to 38% of RTKAs are attributable to prosthetic knee infections [5,11,23,24,31,41,43,55,58,76,95,96]. Although some [56,63] prefer it, a two-stage procedure for chronic prosthetic knee infection requires temporary cement spacers to preserve limb length and reduce soft tissue retraction.…”