Trends and Economic Impact of Hip and Knee Arthroplasty in Central Europe: Findings from the Austrian National Database

Leitner, Lukas; Türk, Silvia; Heidinger, Martin; Stöckl, B.; Posch, Florian; Maurer-Ertl, Werner; Leithner, Andreas; Sadoghi, Patrick

doi:10.1038/s41598-018-23266-w

Cited by 61 publications

(40 citation statements)

References 17 publications

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“…Our study results demonstrate an increasing demand and rising annual numbers of performed KJR in the aging western populations, in line with what described in other high-income states 2 , 6 , 8 – 11 . These temporal trends regarding total numbers of KJR and perioperative complications are important for adequate management of public health as well as health care service planning.…”

Section: Discussionsupporting

confidence: 91%

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Venous thromboembolism in patients hospitalized for knee joint replacement surgery

Keller

Hobohm

Schmidtmann

et al. 2020

Sci Rep

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Patients undergoing knee joint replacement (KJR) are at high risk of postoperative venous thromboembolism (VTE), but data on the time trends of VTE rate in this population are sparse. In this analysis of the German nationwide inpatient sample, we included all hospitalizations for elective primary KJR in Germany 2005–2016. Overall, 1,804,496 hospitalized patients with elective primary KJR (65.1% women, 70.0 years [IQR 63.0–76.0]) were included in the analysis. During hospitalization, VTE was documented in 23,297 (1.3%) patients. Total numbers of primary KJR increased from 129,832 in 2005 to 167,881 in 2016 (β-(slope)-estimate 1,978 [95% CI 1,951 to 2,004], P < 0.001). In-hospital VTE decreased from 2,429 (1.9% of all hospitalizations for KJR) to 1,548 (0.9%) cases (β-estimate − 0.77 [95% CI − 0.81 to − 0.72], P < 0.001), and in-hospital death rate from 0.14% (184 deaths) to 0.09% (146 deaths) (β-estimate − 0.44 deaths per year [95% CI − 0.59 to − 0.30], P < 0.001). Infections during hospitalization were associated with a higher VTE risk. VTE events were independently associated with in-hospital death (OR 20.86 [95% CI 18.78–23.15], P < 0.001). Annual number of KJR performed in Germany increased by almost 30% between 2005 and 2016. In parallel, in-hospital VTE rates decreased from 1.9 to 0.9%. Perioperative infections were associated with higher risk for VTE. Patients who developed VTE had a 21-fold increased risk of in-hospital death.

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Section: Discussionsupporting

confidence: 91%

“…With increasing numbers of KJR procedures in western countries 2 , 6 , 9 – 11 , the number of VTE events is expected to rise 2 , 6 . Actual data about temporal trends regarding total numbers of performed KJR and particularly the impact of VTE on in-hospital mortality of KJR patients is sparse.…”

Section: Introductionmentioning

confidence: 99%

Venous thromboembolism in patients hospitalized for knee joint replacement surgery

Keller

Hobohm

Schmidtmann

et al. 2020

Sci Rep

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“…We can make a rough estimation on the number of PJIs that may be preventable when appropriate prophylaxis for S. epidermidis is given by using the PJI prevalence of 1% (low estimate), and that one third of new prosthetic joints infections will be of delayed type due to coagulase-negative staphylococci [8], and that appropriate surgical prophylaxis for joint arthroplasty reduces the risk for PJI for >80% [2]. In The Netherlands and Austria, 50 000 [9] and 35 000 [10] new prosthetic joints are implanted, respectively. Using these numbers, around 133 and 93 delayed PJIs could be prevented annually.…”

Section: Introductionmentioning

confidence: 99%

Vancomycin prophylaxis in prosthetic joint surgery?

Yusuf

Croughs

2020

Clinical Microbiology and Infection

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“…However, in many cases, a delay is not possible. Taking global aging into consideration, these early interventions result in a continuously increasing number of primary total joint arthroplasty and cases of loosening at an earlier age that requires revision surgery worldwide [33][34][35][36]. The number of revision surgeries of the hip is projected to increase with >300% until 2030 [37,38], which in turn will put an enormous burden on the clinical and economic situation of the national health care systems [39][40][41].…”

Section: Primary Total Joint Arthroplasty -The Surgery Of the Last Cementioning

confidence: 99%

Mechanisms of mechanically induced Osteoclastogenesis : in a novel in vitro model for bone implant loosening

Bratengeier

2019

Linköping University Medical Dissertations

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Total joint arthroplasty is the primary intervention in the treatment of end-stage osteoarthritis.The majority of joint arthroplasties will last the whole lifetime. However, in some patients, the replacement will fail during their lifetime requiring a revision of the implant. These revisions are strenuous for the patient and costly for health care. To avoid a revision, therefore, is the uttermost goal of modern orthopedics. Joint replacement at a younger age, in combination with a more active lifestyle, increases the need for an early revision of the joint prosthesis. The main reason for revision surgeries is aseptic loosening, a condition where the prosthesis is loosening due to bone degradation at the peri-prosthetic interface in the absence of infections. The most well-established pathological mechanism for aseptic loosening is related to wear particles, generated from different parts of the prosthesis that will trigger bone degradation and bone loss.In addition, early micromotions of the prosthesis and resulting local pressurized fluid flow in the peri-prosthetic interface (supraphysiological loading) have also been identified as a cause for aseptic loosening. However, it remains unknown what cells are the primary responders to supraphysiological loading, and what underlying physical, cellular and molecular mechanism that triggers osteoclast differentiation and osteolysis.The main goal of this thesis is to shed light on three currently unknown aspects of mechanical loading-induced peri-prosthetic osteolysis, leading to aseptic loosening of orthopedic prostheses: (1)Which cells are the primary responder to supraphysiological loading? (2)What characteristics of the mechanical stimulus induce an osteo-protective or osteo-destructive response? (3)Which cellular mechano-sensing mechanisms are involved in an osteo-destructive response?The first study focused on the creation and validation of a novel in vitro model for mechanical loading-induced bone degradation. This model simulates the mechanical (over)loading conditions around a loosening prosthesis, as observed in the clinics, and in animal models for mechanical induced osteolysis. Using the MLO-Y4 osteocyte-like cell line, we verified that osteocytes exposed to supraphysiological mechanical loading in our model induce differentiation of progenitor cells into osteoclasts by direct cell-to-cell communication and through the release of soluble factors. This was accompanied by the release of an increased concentration of nitric oxide and higher expression of membrane-bound RANKL, while the concentration of soluble RANKL was not altered. These findings confirm the successful translation of mechanical-induced bone loss to an in vitro model for bone implant loosening. Many people have supported me during my time as a Ph.D. student and I am deeply grateful. I want to highlight a few people specifically, as they contributed significantly to my success: Anna Fahlgren Thank you for giving me the opportunity to become part of your research team and guiding me to become a c...

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Trends and Economic Impact of Hip and Knee Arthroplasty in Central Europe: Findings from the Austrian National Database

Cited by 61 publications

References 17 publications

Venous thromboembolism in patients hospitalized for knee joint replacement surgery

Venous thromboembolism in patients hospitalized for knee joint replacement surgery

Vancomycin prophylaxis in prosthetic joint surgery?

Mechanisms of mechanically induced Osteoclastogenesis : in a novel in vitro model for bone implant loosening

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