Variation and trends in reasons for knee replacement revision: a multi-registry study of revision burden

Abstract

Background and purpose — Studies describing time-related change in reasons for knee replacement revision have been limited to single regions or institutions, commonly analyze only 1st revisions, and may not reflect true caseloads or findings from other areas. We used revision procedure data from 3 arthroplasty registries to determine trends and differences in knee replacement revision diagnoses. Patients and methods — We obtained aggregated data for 78,151 revision knee replacement procedures recorded by the Swedish Knee Arthroplasty Register (SKAR), the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and the Kaiser Permanente Joint Replacement Registry (KPJRR) for the period 2003–2017. Equivalent diagnosis groups were created. We calculated the annual proportions of the most common reasons for revision. Results — Infection, loosening, and instability were among the 5 most common reasons for revision but magnitude and ranking varied between registries. Over time there were increases in proportions of revisions for infection and decreases in revisions for wear. There were inconsistent proportions and trends for the other reasons for revision. The incidence of revision for infection showed a uniform increase. Interpretation — Despite some differences in terminology, comparison of registry-recorded revision diagnoses is possible, but defining a single reason for revision is not always clear-cut. There were common increases in revision for infection and decreases in revision for wear, but variable changes in other categories. This may reflect regional practice differences and therefore generalizability of studies regarding reasons for revision is unwise.

Impact of patient and prosthesis characteristics on common reasons for total knee replacement revision: a registry study of 36,626 revision cases from Australia, Sweden, and USA

“…We found infection, loosening, instability, and patellar reasons were the most common diagnoses for revision of TKR for OA in all 3 registries, with the only difference seen in the KPJRR where 98% of TKR had a primary patellar resurfacing and patellar causes for revision were rare. These findings, along with the timing of these revisions, are consistent with previous studies ( 25 , 28 , 29 ). When patient and prosthesis factors for revision reasons were studied, 15 of 56 possible factor/reason combinations showed between-registry consistency, varying from 3 concordant factors for each of revision for fracture and loosening, and no factor consistency for revision for pain.…”

“…While there seems no direct link of the implant–bone interface to the bearing, cementless fixation may have been selected for more active patients ( 44 ). Surgeons may also have difficulty deciding between wear and loosening as the primary mechanism leading to revision ( 25 ). The lack of further associations with wear may be due to the relative rarity of revisions for this diagnosis, particularly in Sweden.…”

“…In this study only 1 reason for revision was permitted for each revision procedure. Revision diagnoses were classified by a previously created harmonized table of equivalent diagnosis groups ( 25 ).…”

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

“…Following on from this, it is evident that comparatively little is understood about the epidemiology of re-revision KR (that is second or subsequent revision procedures), despite their considerable impact on individual patients and their potential to consume large amounts of health resource [18] . A recent multi-registry study from Australia, Sweden and the United States found that the proportion of rKR performed for infection had increased in recent years [19] , with one hypothesis that an increase in the rate of re-revision KR may be responsible.…”

The effect of patient and prosthesis factors on revision rates after total knee replacement using a multi-registry meta-analytic approach

“…In a previous study we found inter-registry differences regarding reasons for knee replacement revision and theorized this was related to patient selection and prosthesis choice ( 30 ). This study (i) documents regional and temporal variation in primary TKA practice across 3 registries between 2003 and 2019 and (ii) uses a meta-analytic technique to determine the influence of each factor on the risk of revision.…”