Patient-Relevant Outcomes Following First Revision Total Knee Arthroplasty, by Diagnosis: An Analysis of Implant Survivorship, Mortality, Serious Medical Complications, and Patient-Reported Outcome Measures Utilizing the National Joint Registry Data Set.



Sabah, Shiraz A ORCID: 0000-0003-2401-1372, Knight, Ruth ORCID: 0000-0001-6810-2845, Alvand, Abtin, Palmer, Antony JR ORCID: 0000-0003-4616-7482, Middleton, Robert ORCID: 0000-0002-0427-1727, Abram, Simon GF ORCID: 0000-0002-4452-6499, Hopewell, Sally ORCID: 0000-0002-6881-6984, Petrou, Stavros ORCID: 0000-0003-3121-6050, Beard, David J ORCID: 0000-0001-7884-6389 and Price, Andrew J ORCID: 0000-0002-4258-5866
(2023) Patient-Relevant Outcomes Following First Revision Total Knee Arthroplasty, by Diagnosis: An Analysis of Implant Survivorship, Mortality, Serious Medical Complications, and Patient-Reported Outcome Measures Utilizing the National Joint Registry Data Set. The Journal of bone and joint surgery. American volume, 105 (20). pp. 1611-1621.

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Abstract

<h4>Background</h4>The purpose of this study was to investigate patient-relevant outcomes following first revision total knee arthroplasties (rTKAs) performed for different indications.<h4>Methods</h4>This population-based cohort study utilized data from the United Kingdom National Joint Registry, Hospital Episode Statistics Admitted Patient Care, National Health Service Patient-Reported Outcome Measures, and the Civil Registrations of Death. Patients undergoing a first rTKA between January 1, 2009, and June 30, 2019, were included in our data set. Patient-relevant outcomes included implant survivorship (up to 11 years postoperatively), mortality and serious medical complications (up to 90 days postoperatively), and patient-reported outcome measures (at 6 months postoperatively).<h4>Results</h4>A total of 24,540 first rTKAs were analyzed. The patient population was 54% female and 62% White, with a mean age at the first rTKA of 69 years. At 2 years postoperatively, the cumulative incidence of re-revision surgery ranged from 2.7% (95% confidence interval [CI], 1.9% to 3.4%) following rTKA for progressive arthritis to 16.3% (95% CI, 15.2% to 17.4%) following rTKA for infection. The mortality rate at 90 days was highest following rTKA for fracture (3.6% [95% CI, 2.5% to 5.1%]) and for infection (1.8% [95% CI, 1.5% to 2.2%]) but was <0.5% for other indications. The rate of serious medical complications requiring hospital admission within 90 days was highest for patients treated for fracture (21.8% [95% CI, 17.9% to 26.3%]) or infection (12.5% [95% CI, 11.2% to 13.9%]) and was lowest for those treated for progressive arthritis (4.3% [95% CI, 3.3% to 5.5%]). Patients who underwent rTKA for stiffness or unexplained pain had some of the poorest postoperative joint function (mean Oxford Knee Score, 24 and 25 points, respectively) and had the lowest proportion of responders (48% and 55%, respectively).<h4>Conclusions</h4>This study found large differences in patient-relevant outcomes among different indications for first rTKA. The rate of complications was highest following rTKA for fracture or infection. Although rTKA resulted in large improvements in joint function for most patients, those who underwent surgery for stiffness and unexplained pain had worse outcomes.<h4>Level of evidence</h4>Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Item Type: Article
Uncontrolled Keywords: Humans, Arthritis, Pain, Treatment Outcome, Arthroplasty, Replacement, Knee, Reoperation, Retrospective Studies, Cohort Studies, Knee Prosthesis, Aged, State Medicine, Female, Male, Patient Reported Outcome Measures, Survivorship, Routinely Collected Health Data
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Clinical Directorate
Depositing User: Symplectic Admin
Date Deposited: 25 Aug 2023 07:42
Last Modified: 28 Oct 2023 02:20
DOI: 10.2106/jbjs.23.00251
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3172338