Trends in revision hip and knee arthroplasty observations after implementation of a regional joint replacement registry

Singh, Jas; Politis, Angelos; Loucks, Lynda; Hedden, David R.; Bohm, Éric

doi:10.1503/cjs.002916

Cited by 24 publications

(26 citation statements)

References 5 publications

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“…27 Alternatively, Singh et al assessed Canadian data and found that the prevalence of PJI-related revision TKA remained stable over the study period. 26 In our study, PJI prevalence particularly increased in medium-and large-sized hospitals, while decreasing in small-sized hospitals. This is in line with a previous study where Bozic et al reported a consistent finding that revision TKAs were most commonly performed in large hospitals (61.3%), while only 13.7% of revision TKAs were reported in small hospitals.…”

Section: Discussionmentioning

confidence: 42%

“…25 Singh et al reported the findings from the Canadian Joint Registry and found the prevalence of PJI-related revision TKA to be 39%. 26 The wide range in these prevalences indicates the difficulty in comparing these data among different health systems. Moreover, these differences also emphasize the need for more granular data analysis on the plethora of total knee replacements performed in the United States.…”

Section: Discussionmentioning

confidence: 99%

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Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data

et al. 2020

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Given increasing demand for primary knee arthroplasties, revision surgery is also expected to increase, with periprosthetic joint infection (PJI) a main driver of costs. Recent data on national trends is lacking. We aimed to assess trends in PJI in total knee arthroplasty revisions and hospitalization costs. From the National Inpatient Sample (2003–2016), we extracted data on total knee arthroplasty revisions (n = 782,449). We assessed trends in PJI prevalence and (inflation-adjusted) hospitalization costs (total as well as per-day costs) for all revisions and stratified by hospital teaching status (rural/urban by teaching status), hospital bed size (≤299, 300–499, and ≥500 beds), and hospital region (Northeast, Midwest, South, and West). The Cochran–Armitage trend test (PJI prevalence) and linear regression determined significance of trends. PJI prevalence overall was 25.5% (n = 199,818) with a minor increasing trend: 25.3% (n = 7,828) in 2003 to 28.9% (n = 19,275) in 2016; p < 0.0001. Median total hospitalization costs for PJI decreased slightly ($23,247 in 2003–$20,273 in 2016; p < 0.0001) while median per-day costs slightly increased ($3,452 in 2003–$3,727 in 2016; p < 0.0001), likely as a function of decreasing length of stay. With small differences between hospitals, the lowest and highest PJI prevalences were seen in small (≤299 beds; 22.9%) and urban teaching hospitals (27.3%), respectively. In stratification analyses, an increasing trend in PJI prevalence was particularly seen in larger (≥500 beds) hospitals (24.4% in 2003–30.7% in 2016; p < 0.0001), while a decreasing trend was seen in small-sized hospitals. Overall, PJI in knee arthroplasty revisions appears to be slightly increasing. Moreover, increasing trends in large hospitals and decreasing trends in small-sized hospitals suggest a shift in patients from small to large volume hospitals. Decreasing trends in total costs, alongside increasing trends in per-day costs, suggest a strong impact of length of stay trends and a more efficient approach to PJI over the years (in terms of shorter length of stay).

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Section: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data

et al. 2020

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“…Balancing of a TKA is essential to the proper function and overall longevity of the implant. 8,17 Defining instability of the patellofemoral joint is difficult to quantify. A study by Sasaki et al assessed the influence of patella height on soft tissue balance in PS TKA and found that at 90°and 135°of flexion the joint component gap correlated with high-positioned patellae as compared with low-positioned patellae.…”

Section: Discussionmentioning

confidence: 99%

“…8,[10][11][12][13] Diminished outcomes have been associated with poorly balanced or placed patella implants and continue to be a common cause of revision TKA as evidenced in a recent study using a Canadian joint registry in which 7% of revisions were due to patella maltracking or instability. [14][15][16][17] The effect of different techniques to achieve flexionextension balance and the use of PS versus CR implant designs on patellofemoral balancing has not been previously studied. The purpose of this study is to utilize a previously validated computational analysis software (LifeMOD/Knee-SIM; LifeModeler, Inc., San Clemente, CA) to simulate the effects of patellofemoral pressure based on component position and size of femoral component in PS and CR TKA designs.…”

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confidence: 99%

Patellofemoral Imbalance in a Balanced Total Knee Arthroplasty: How Does it Occur?

et al. 2018

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Despite the overall successful outcomes following primary total knee arthroplasty (TKA) and the concept that a well-balanced TKA yields a more successful result, concerns still remain in the reported literature regarding the patellofemoral joint. Diminished outcomes have been associated with poorly balanced or placed patella implants. The effect of different techniques to achieve flexion-extension balance and the use of posterior stabilized (PS) versus cruciate retaining (CR) implant designs on patellofemoral balancing has not been previously studied. The purpose of this study is to utilize a validated computational analysis software to simulate the effects of varying implant positions and sizes of femoral components. The patellofemoral retinaculum (PFR) load was significantly affected by some conditions, while others did not reach significance. The proximal-distal implant position with knee flexion angle ( < 0.001), the implant size ( < 0.001), and the implant bearing type (CR/PS) ( < 0.05) were significant. For the proximal-distal implant position and knee flexion angle, a more proximal implant position (elevating the joint line) increased the PFR load from 15 to 30°, and a more proximal implant position reduced retinaculum load from 60 to 135°. However, at 45°, implant position does not affect retinaculum load. Achieving the appropriate balance between the dynamic nature of both the tibiofemoral and the patellofemoral interaction in TKA has proven to be complex and challenging to manage. Balancing of a TKA is essential to the proper functioning and overall longevity of the implant. These results demonstrate that patellofemoral balance is affected by implant size and position during flexion-extension gap balancing.

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“…21 The United States hopes to replicate the reduction in revision arthroplasty rates through registries seen in several other countries. 22,23 Along with AJRR, NIS relies on ICD coding to identify procedures, capture diagnoses, and report comorbidities. Errors and discrepancies in administrative databases are well documented.…”

Section: Discussionmentioning

confidence: 99%

Increased Total Hip Arthroplasty Utilization, Osteoarthritis Diagnoses, and Comorbidity Burden in Patients Younger Than the Age of 65 Years: National Inpatient Trends 1998 to 2013

et al. 2018

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Primary total hip arthroplasty (THA) in patients younger than the age of 65 years demands long-term success to minimize lifetime revision surgery risks. Age at implantation, etiology of arthrosis, and comorbidity burden all have associations with revision risk. This study uses Nationwide Inpatient Sample (NIS) data between 1998 and 2013 to (1) report the annual utilization of THA in patients age 18 to 99 years divided into age groups, (2) determine trends in primary diagnoses, and (3) explore Elixhauser comorbidity burden trends. The authors reviewed 5,174,020 THA cases from the NIS. Cases were divided into age groups: 18 to 24, 25 to 34, 35 to 44, 45 to 54, 55 to 64, and 65 to 99 years. The annual utilization rate, primary diagnoses, and average count of Elixhauser comorbidities were plotted. Mann–Kendall's nonparametric tests determined significance with p < 0.05. The mean utilization of primary THA in patients aged 18 to 64 years was 57 cases per 105 persons (cpp). The incidence of utilization increased rapidly in patients age 55 to 64 years (123–240 cpp, p < 0.001) and age 45 to 54 years (46–100 cpp, p < 0.001). The predominant diagnoses were osteoarthritis increasing from 65 to 83% (p < 0.001), avascular necrosis decreasing from 17 to 7% (p < 0.001), and trauma decreasing from 11 to 6% (p < 0.001). The average count of Elixhauser comorbidities increased in all age groups from a minimum of 58% (1.2–1.9, p < 0.001) in patients age 55 to 64 years to a maximum of 200% (0.4–1.2, p = 0.003) in patients age 18 to 24 years. Increases in primary THA utilization are occurring disproportionately among patients age 45 to 64 years. The trends in etiologies and comorbidities show mixed anticipated effects on the risks for revision. Increased osteoarthritis diagnoses may be favorable as the etiology with the longest relative implant survival. However, increasing comorbidities may unfavorably heighten the risks of revision. Primary THA utilization is increasing for patients younger than the age of 65 years with osteoarthritis and rising comorbidity burdens. Current national administrative databases add valuable insights to large THA trends, but lack the granularity to fully characterize the causes behind revisions of primary THA.

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Trends in revision hip and knee arthroplasty observations after implementation of a regional joint replacement registry

Cited by 24 publications

References 5 publications

Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data

Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data

Patellofemoral Imbalance in a Balanced Total Knee Arthroplasty: How Does it Occur?

Increased Total Hip Arthroplasty Utilization, Osteoarthritis Diagnoses, and Comorbidity Burden in Patients Younger Than the Age of 65 Years: National Inpatient Trends 1998 to 2013

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