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BACKGROUND: Remaining pain and functional limitations may cause dissatisfaction in patients after total knee arthroplasty (TKA). Furthermore, anxiety and depression are associated with remaining postoperative symptoms and dissatisfaction. We investigated if patient-reported anxiety or depression increased the risk of dissatisfaction 1 year after TKA in patients who improved in pain or function. METHODS: Data on primary TKAs due to osteoarthritis between 2017 and 2019 were obtained from the Swedish Knee Arthroplasty Register. Out of 14,120 patients, 9,911 completed the Knee injury and Osteoarthritis Outcome Score and satisfaction rate with the result of the surgery. According to the Outcome Measures in Rheumatology-Osteoarthritis Research Society International criteria patients were classified as responders (improved in pain or function) or nonresponders. Anxiety and depression were assessed through EuroQol-5 Dimension 3 levels. Log-linear regression models estimated the risk ratios (RRs) for dissatisfaction in all patients and stratified by age groups (< 65, 65 to 74, and > 74 years). There were 8,745 patients who were classified as responders whereas 11% were defined as dissatisfied. The proportion of patients who reported anxiety or depression was 35% preoperatively and 17% postoperatively. RESULTS: Anxiety or depression increased the risk of dissatisfaction preoperatively (RR 1.23, 95% confidence interval = 1.09 to 1.40) and postoperatively (RR 2.65, confidence interval 2.33 to 3.00). Patients younger than 65 years reported preoperative anxiety or depression to a greater extent but did not have an increased risk of dissatisfaction. CONCLUSIONS: Patient-reported anxiety or depression preoperatively and postoperatively are important and potentially treatable factors to consider, as they were found to increase the risk of dissatisfaction after TKA despite improvements in pain or function.
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BACKGROUND: Patients with obesity have a higher risk of complications after total knee arthroplasty (TKA). We investigated the change in weight 1 and 2 years post-Bariatric Surgery (BS) in patients that had undergone both TKA and BS as well as the risk of revision after TKA based on if BS was performed before or after the TKA. METHODS: Patients who had undergone BS within 2 years before or after TKA were identified from the Scandinavian Obesity Surgery Register (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) between 2007 and 2019 and 2009 and 2020, respectively. The cohort was divided into two groups; patients who underwent TKA before BS (TKA-BS) and patients who underwent BS before TKA (BS-TKA). Multilinear regression analysis and a Cox proportional hazards model were used to analyze weight change after BS and the risk of revision after TKA. RESULTS: Of the 584 patients included in the study, 119 patients underwent TKA before BS and 465 underwent BS before TKA. No association was detected between the sequence of surgery and total weight loss 1 and 2 years post-BS, - 0.1 (95% confidence interval (CI), - 1.7 to 1.5) and - 1.2 (95% CI, - 5.2 to 2.9), or the risk of revision after TKA [hazard ratio 1.54 (95% CI 0.5-4.5)]. CONCLUSION: The sequence of surgery in patients undergoing both BS and TKA does not appear to be associated with weight loss after BS or the risk of revision after TKA.
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Artroplastia de Reemplazo de Rodilla , Cirugía Bariátrica , Humanos , Índice de Masa Corporal , Reoperación , Obesidad/cirugía , Cirugía Bariátrica/efectos adversos , Pérdida de Peso , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: Antibiotic-loaded bone cement (ALBC) and systemic antibiotic prophylaxis (SAP) have been used to reduce periprosthetic joint infection (PJI) rates. We investigated the use of ALBC and SAP in primary total knee arthroplasty (TKA). PATIENTS AND METHODS: This observational study is based on 2,971,357 primary TKAs reported in 2010-2020 to national/regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, the Netherlands, New Zealand, Norway, Romania, South Africa, Sweden, Switzerland, the UK, and the USA. Aggregate-level data on trends and types of bone cement, antibiotic agents, and doses and duration of SAP used was extracted from participating registries. RESULTS: ALBC was used in 77% of the TKAs with variation ranging from 100% in Norway to 31% in the USA. Palacos R+G was the most common (62%) ALBC type used. The primary antibiotic used in ALBC was gentamicin (94%). Use of ALBC in combination with SAP was common practice (77%). Cefazolin was the most common (32%) SAP agent. The doses and duration of SAP used varied from one single preoperative dosage as standard practice in Bolzano, Italy (98%) to 1-day 4 doses in Norway (83% of the 40,709 TKAs reported to the Norwegian arthroplasty register). CONCLUSION: The proportion of ALBC usage in primary TKA varies internationally, with gentamicin being the most common antibiotic. ALBC in combination with SAP was common practice, with cefazolin the most common SAP agent. The type of ALBC and type, dose, and duration of SAP varied among participating countries.
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Artroplastia de Reemplazo de Rodilla , Infecciones Relacionadas con Prótesis , Humanos , Antibacterianos/uso terapéutico , Artroplastia de Reemplazo de Rodilla/efectos adversos , Cementos para Huesos/uso terapéutico , Cefazolina , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/prevención & control , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Gentamicinas , América del Norte , Europa (Continente) , Oceanía , ÁfricaRESUMEN
BACKGROUND: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a severe complication in terms of disability, morbidity, and cost. We performed a study to investigate whether early PJI (within 90 days of primary TKA) is associated with increased mortality. Secondary aims were to compare mortality rates over time and between surgical treatment methods. METHODS: Patients with suspected PJI were identified by linkage of the Swedish Knee Arthroplasty Register (SKAR) and the Swedish Prescribed Drug Register (SPDR) in 2007-2008 and 2012-2013. Medical records of patients receiving more than 4 weeks of continuous antibiotic therapy were subsequently reviewed to verify the PJI diagnosis. Information on mortality was obtained through the SKAR which is updated daily from the tax agency and patients with PJI were compared to patients without PJI. RESULTS: Four hundred sixty-six patients were diagnosed with PJI within 90 days and compared to 40,362 patients without PJI. Mortality rates were significantly higher for PJI patients in both short- and long term: 2.6% vs. 0.8% at 1 year, 4.9% vs. 1.9% at 2 years, 15.7% vs. 7.1% at 5 years, and 38% vs. 21.4% at 10 years. The difference in mortality rate remained after adjusting for sex, age, diagnosis, and time period for surgery with Hazard Ratio 1.8 (95% CI:1.6-2.1). Mortality rates did not differ between time periods, and we found no correlation to surgical treatment. CONCLUSION: Patients with early PJI after primary TKA have an increased mortality rate compared to TKA patients without PJI. Improvements in surgical treatment strategy has not resulted in better survival. Long term difference in mortality rates indicates that PJI is not the sole reason for mortality suggesting a general frailty in PJI patients.
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Articulación de la Rodilla , HumanosRESUMEN
BACKGROUND: Instability after total knee arthroplasty is a common but poorly understood complication. METHODS: Data from a large national registry was used to study patient and prosthesis characteristics of 2605 total knee arthroplasty revisions for instability. The cumulative percent revision was calculated using Kaplan-Meier estimates, and Cox proportional models used to compare revision rates. The rate of further revision was analyzed with regard to prostheses used in the first revision. RESULTS: Instability increased from 6% of all first revision procedures in 2003 to 13% in 2019. The revision risk was lower for minimally stabilized prostheses, males, and patients aged ≥65 years. Polyethylene insert exchange was used for 55% of revision procedures, using a thicker insert in 93% and a change in insert conformity in 24% of cruciate-retaining knees. The increase in either thickness or conformity had no effect on the rate of further revision. After a revision for instability, 24% had a second revision by 14 years. Recurrent instability accounted for 32% of further revisions. A lower second revision rate was seen after revision of both femoral and tibial components, and where constrained components were used. CONCLUSION: Revision for instability is increasing. Revising both femoral and tibial components led to a lower rate of second revision compared to a change in insert alone. Recurrent instability was common.
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Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Artroplastia de Reemplazo de Rodilla/efectos adversos , Humanos , Prótesis de la Rodilla/efectos adversos , Masculino , Diseño de Prótesis , Falla de Prótesis , Sistema de Registros , ReoperaciónRESUMEN
Background and purpose - Knowing how to interpret values obtained with patient reported outcome measures (PROMs) is essential. We estimated the substantial clinical benefit (SCB) and patient acceptable symptom state (PASS) for Forgotten Joint Score 12 (FJS) and explored differences depending on methods used for the estimates. Patients and methods - The study was based on 195 knee arthroplasties (KA) performed at a university hospital. We used 1 item from the Knee injury and Osteoarthritis Outcome Score domain quality of life and satisfaction with surgery, obtained 1-year postoperatively, to assess SCB and PASS thresholds of the FJS with anchor-based methods. We used different combinations of anchor questions for SCB and PASS (satisfied, satisfied with no or mild knee difficulties, and satisfied with no knee difficulties). A novel predictive approach and receiver-operating characteristics curve were applied for the estimates. Results - 70 and 113 KAs were available for the SCB and PASS estimates, respectively. Depending on method, SCB of the FJS (range 0-100) was 28 (95% CI 21-35) and 22 (12-45) respectively. PASS was 31 (2-39) and 20 (10-29) for satisfied patients, 40 (31-47) and 38 (32-43) for satisfied patients with no/mild difficulties, and 76 (39-80) and 64 (55-74) for satisfied patients with no difficulties. The areas under the curve ranged from 0.82 to 0.88. Interpretation - Both the SCB and PASS thresholds varied depending on methodology. This may indicate a problem using meaningful values from other studies defining outcomes after KA. This study supports the premise of the FJS as a PROM with good discriminatory ability in patients undergoing KA.
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Artroplastia de Reemplazo de Rodilla , Traumatismos de la Rodilla , Artroplastia de Reemplazo de Rodilla/efectos adversos , Humanos , Traumatismos de la Rodilla/cirugía , Articulación de la Rodilla/cirugía , Medición de Resultados Informados por el Paciente , Calidad de Vida , Resultado del TratamientoRESUMEN
Background and purpose - Strenuous efforts to minimize postoperative infection rates have been made, including the Swedish nationwide initiative Prosthesis Related Infections Shall be Stopped (PRISS). This study calculated the incidence rate of periprosthetic joint infection (PJI) following primary total knee arthroplasty (TKA) before and after PRISS. Patients and methods - All 45,438 primary TKAs registered in the Swedish Knee Arthroplasty Register (SKAR) during 2007-2008 and 2012-2013 were included. Matched data on antibiotic prescriptions were obtained from the Swedish Prescribed Drug Register (SPDR). All patients with ≥ 28 days of continuous antibiotic treatment within 2 years of primary surgery had their medical charts reviewed to identify cases of PJI. The incidence rate was calculated by dividing the number of PJIs by the total time at risk during each time period and presented as percentages with 95% confidence interval (CI). Results - 644 PJIs were identified, equaling a 2-year incidence rate of 1.45% (CI 1.34-1.57). The incidence rate was 1.44% (CI 1.27-1.61) before PRISS and 1.46% (CI 1.31-1.61) after. Diagnosis was made within 30 days of primary TKA in 52%, and within 90 days in 73% of cases. 603 cases were reoperated on or revised. Median time from operation to diagnosis was 29 days (1-716), for both time periods. Debridement with exchange of the insert was performed in 32% and 63% of cases before and after PRISS, respectively. Interpretation - We found similar incidence rates before and after the PRISS initiative without any statistically significant difference. Time to diagnosis was similar during both time periods. The project may have contributed to increased compliance with treatment protocols.
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Artroplastia de Reemplazo de Rodilla/métodos , Control de Infecciones/métodos , Infecciones Relacionadas con Prótesis/epidemiología , Anciano , Antibacterianos/uso terapéutico , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Suecia/epidemiologíaRESUMEN
BACKGROUND AND PURPOSE: Total knee replacement (TKR) studies usually analyze all-cause revision when considering relationships with patient and prosthesis factors. We studied how these factors impact different revision diagnoses. PATIENTS AND METHODS: We used data from 2003 to 2019 of TKR for osteoarthritis from the arthroplasty registries of Sweden, Australia, and Kaiser Permanente, USA to study patient and prosthesis characteristics for specific revision diagnoses. There were 1,072,924 primary TKR included and 36,626 were revised. Factors studied included age, sex, prosthesis constraint, fixation method, bearing mobility, polyethylene type, and patellar component use. Revision diagnoses were arthrofibrosis, fracture, infection, instability, loosening, pain, patellar reasons, and wear. Odds ratios (ORs) for revision were estimated and summary effects were calculated using a meta-analytic approach. RESULTS: We found between-registry consistency in 15 factor/reason analyses. Risk factors for revision for arthrofibrosis were age < 65 years (OR 2.0; 95% CI 1.4-2.7) and mobile bearing designs (MB) (OR 1.7; CI 1.1-2.5), for fracture were female sex (OR 3.2; CI 2.2-4.8), age ≥ 65 years (OR 2.8; CI 1.9-4) and posterior stabilized prostheses (PS) (OR 2.1; CI 1.3-3.5), for infection were male sex (OR 1.9; CI 1.7-2.0) and PS (OR 1.5; CI 1.2-1.8), for instability were age < 65 years (OR 1.5; CI 1.3-1.8) and MB (OR 1.5; CI 1.1-2.2), for loosening were PS (OR 1.5; CI 1.4-1.6), MB (OR 2.2; CI 1.6-3.0) and use of ultra-high molecular weight polyethylene (OR 2.3; CI 1.8-2.9), for patellar reasons were not resurfacing the patella (OR 13.6; CI 2.1-87.2) and MB (OR 2.0; CI 1.2-3.3) and for wear was cementless fixation (OR 4.9; CI 4.3-5.5). INTERPRETATION: Patients could be counselled regarding specific age and sex risks. Use of minimally stabilized, fixed bearing, cemented prostheses, and patellar components is encouraged to minimize revision risk.
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Artroplastia de Reemplazo de Rodilla , Fracturas Óseas , Prótesis de la Rodilla , Anciano , Artroplastia de Reemplazo de Rodilla/efectos adversos , Femenino , Humanos , Masculino , Polietileno , Sistema de Registros , Suecia/epidemiologíaRESUMEN
BACKGROUND AND PURPOSE: Characteristics of patients receiving total knee arthroplasty (TKA) and prostheses used vary between regions and change with time. How these practice variations influence revision remains unclear. We combined registry data for better understanding of the impact of variation, which could potentially improve revision rates. PATIENTS AND METHODS: We used data from 2003 to 2019 for primary TKA from arthroplasty registries of Sweden (SKAR), Australia (AOANJRR), and Kaiser Permanente (KPJRR). We included 1,072,924 TKA procedures for osteoarthritis. Factors studied included age, sex, ASA class, BMI category, prosthesis constraint, fixation, bearing mobility, patellar resurfacing, and polyethylene type. Cumulative percentage revision (CPR) was calculated using Kaplan-Meier estimates, and unadjusted Cox hazard ratios were used for comparisons. Random-effects generic inverse-variance meta-analytic methods were used to determine summary effects. RESULTS: We found similarities in age and sex, but between-registry differences occurred in the other 7 factors studied. Patients from Sweden had lower BMI and ASA scores compared with other registries. Use of cement fixation was similar in the SKAR and KPJRR, but there were marked differences in patellar resurfacing and posterior stabilized component use. Meta-analysis results regarding survivorship favored patients aged ≥ 65 years and minimally stabilized components. There were inconsistent results with time for sex, fixation, and bearing mobility, and no differences for the patellar resurfacing or polyethylene type comparisons. INTERPRETATION: Marked practice variation was found. Use of minimally stabilized and possibly also cemented and fixed bearing prostheses is supported.
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Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Artroplastia de Reemplazo de Rodilla/métodos , Humanos , Polietileno , Diseño de Prótesis , Falla de Prótesis , Sistema de Registros , ReoperaciónRESUMEN
BACKGROUND AND PURPOSE: We have previously observed differences in treatment and outcome of knee arthroplasties in the Nordic countries. To evaluate the impact of Nordic collaboration in the last 15 years we aimed to compare patient demographics, methods, and revision rates in primary knee arthroplasties among the 4 Nordic countries. PATIENTS AND METHODS: We included 535,051 primary knee arthroplasties reported 2000-2017 from the Nordic Arthroplasty Register Association (NARA) database. Kaplan-Meier analysis (KM) and restricted mean survival time (RMST) analysis were used to evaluate the cumulative revision rate (CRR) and RMST estimates with 95% confidence intervals (CI) and to compare countries in relation to risk of revision for any reason. RESULTS: After 2010, the increase in incidence of knee arthroplasty plateaued in Sweden and Denmark but continued to increase in Finland and Norway. In 2017 the incidence was highest in Finland with 226 per 105 person-years, while it was less than 150 per 105 in the 3 other Nordic countries. In total knee arthroplasties performed for osteoarthritis (OA), overall CRR at 15 years for revision due to any reason was higher in Denmark (CRR 9.6%, 95% CI 9.2-10), Norway (CRR 9.1%, CI 8.7-9.5), and Finland (CRR 7.0%, CI 6.8-7.3) compared with Sweden (CRR 6.6%, CI 6.4-6.8). There were differences among the countries in use of implant brand and type, fixation, patellar component, and use of unicompartmental knee arthroplasty. INTERPRETATION: We evinced a slowing growth of incidence of knee arthroplasties in the Nordic countries after 2010 with Finland having the highest incidence. We also noted substantial differences among the 4 Nordic countries, with Sweden having a lower risk of revision than the other countries. No impact of NARA could be demonstrated and CRR did not improve over time.
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Artroplastia de Reemplazo de Rodilla , Humanos , Rótula , Países Escandinavos y Nórdicos/epidemiología , Finlandia , DemografíaRESUMEN
BACKGROUND: Patient-reported outcome measures (PROMs) are validated questionnaires that are completed by patients. Arthroplasty registries vary in PROM collection and use. Current information about registry collection and use of PROMs is important to help improve methods of PROM data analysis, reporting, comparison, and use toward improving clinical practice. QUESTIONS/PURPOSES: To characterize PROM collection and use by registries, we asked: (1) What is the current practice of PROM collection by arthroplasty registries that are current or former members of the International Society of Arthroplasty Registries, and are there sufficient similarities in PROM collection between registries to enable useful international comparisons that could inform the improvement of arthroplasty care? (2) How do registries differ in PROM administration and demographic, clinical, and comorbidity index variables collected for case-mix adjustment in data analysis and reporting? (3) What quality assurance methods are used for PROMs, and how are PROM results reported and used by registries? (4) What recommendations to arthroplasty registries may improve PROM reporting and facilitate international comparisons? METHODS: An electronic survey was developed with questions about registry structure and collection, analysis, reporting, and use of PROM data and distributed to directors or senior administrators of 39 arthroplasty registries that were current or former members of the International Society of Arthroplasty Registries. In all, 64% (25 of 39) of registries responded and completed the survey. Missing responses from incomplete surveys were captured by contacting the registries, and up to three reminder emails were sent to nonresponding registries. Recommendations about PROM collection were drafted, revised, and approved by the International Society of Arthroplasty Registries PROMs Working Group members. RESULTS: Of the 25 registries that completed the survey, 15 collected generic PROMs, most frequently the EuroQol-5 Dimension survey; 16 collected joint-specific PROMs, most frequently the Knee Injury and Osteoarthritis Outcome Score and Hip Disability and Osteoarthritis Outcome Score; and 11 registries collected a satisfaction item. Most registries administered PROM questionnaires within 3 months before and 1 year after surgery. All 16 registries that collected PROM data collected patient age, sex or gender, BMI, indication for the primary arthroplasty, reason for revision arthroplasty, and a comorbidity index, most often the American Society of Anesthesiologists classification. All 16 registries performed regular auditing and reporting of data quality, and most registries reported PROM results to hospitals and linked PROM data to other data sets such as hospital, medication, billing, and emergency care databases. Recommendations for transparent reporting of PROMs were grouped into four categories: demographic and clinical, survey administration, data analysis, and results. CONCLUSION: Although registries differed in PROM collection and use, there were sufficient similarities that may enable useful data comparisons. The International Society of Arthroplasty Registries PROMs Working Group recommendations identify issues that may be important to most registries such as the need to make decisions about survey times and collection methods, as well as how to select generic and joint-specific surveys, handle missing data and attrition, report data, and ensure representativeness of the sample. CLINICAL RELEVANCE: By collecting PROMs, registries can provide patient-centered data to surgeons, hospitals, and national entities to improve arthroplasty care.
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Artroplastia , Medición de Resultados Informados por el Paciente , Mejoramiento de la Calidad , Humanos , Encuestas y CuestionariosRESUMEN
BACKGROUND: The microbiology and the susceptibility patterns of infected total knee arthroplasties (TKAs) vary depending on demographic, local antimicrobial stewardship, and surgical factors. We wanted to compare the recent microbial profile and antimicrobial resistance pattern in revisions due to infections after primary TKAs in Sweden and Lithuania. Our hypothesis was that there is a difference in bacteriology and resistance pattern based on patient related, societal and local hospital factors as almost similar praxis have been applied for TKA surgery, short term systemic prophylaxis and routine use of local gentamicin containing bone cement. METHODS: Primary TKAs revised for the first time due to verified or suspected infection were collected nationwide in Sweden during 2018, and in Lithuania between 2011 and 2020 from a single major TKA revision centre in Kaunas. We identified 202 TKAs in Sweden from the Swedish Knee Arthroplasty Register and 84 from Kaunas revised due to infection. We collected available culture reports and evaluated the type of microorganisms with antimicrobial resistance pattern at revision. RESULTS: The majority of the infected cases in Sweden were early-type prosthetic joint infection (PJI) (44%), whereas late-type PJI (52%) were more common in the Kaunas cases. Gram-positive bacteria prevailed in both Sweden (55%) and Lithuania (80%). Staphylococcus aureus was the most frequent organism identified in both countries (33% in Sweden and 34% in Lithuania). More polymicrobial infections were observed in Sweden than in Lithuania (16 and 6% respectively). Methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci were higher in Lithuania (4/28 and 19/29) than in Sweden (1/42 and 9/41). CONCLUSIONS: The type of infections, microbial profile, and drug resistance pattern differed between Sweden and Lithuania. Societal and local hospitals factors with emerging resistance in Lithuania are the most plausible explanation for the difference. Lack of complete data on a national level in Lithuania underlines the importance of adding microbiology of PJIs in implant registers for national aggregation and allow cross country comparisons.
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Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Infecciones Relacionadas con Prótesis , Antibacterianos/uso terapéutico , Artroplastia de Reemplazo de Rodilla/efectos adversos , Humanos , Lituania/epidemiología , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/epidemiología , Reoperación , Estudios Retrospectivos , Staphylococcus aureus , Suecia/epidemiologíaRESUMEN
Background and purpose - Obesity is a considerable medical challenge in society. We investigated the risk of revision for any reasons and for infection in patients having total knee arthroplasty (TKA) for osteoarthritis (OA) within 2 years after bariatric surgery (BS) and compared them with TKAs without BS.Patients and methods - We used the Scandinavian Obesity Surgery Registry (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) to identify patients operated on in 2009-2019 with BS who had had primary TKA for OA within 2 years after the BS (BS group) and compared them with TKAs without prior BS (noBS group). We determined adjusted hazard ratio (HR) for the BS group and noBS group using Cox proportional hazard regression for revision due to any reasons and for infection. Adjustments were made for sex, age groups, and BMI categories preoperatively.Results - 441 patients were included in the BS group. The risk of revision for infection was higher for the BS group with HR 2.2 (95% CI 1.1-4.7) adjusting for BMI before the TKA, while the risk of revision for any reasons was not statistically significant different for the BS group with HR 1.3 (CI 0.9-2.1). Corresponding figures when adjusting for BMI before the BS were HR 0.9 (CI 0.4-2) and HR 1.2 (CI 0.7-2).Interpretation - Our findings did not indicate that BS prior to TKA was associated with lower risk of revision.
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Artroplastia de Reemplazo de Rodilla , Cirugía Bariátrica , Falla de Prótesis/etiología , Infecciones Relacionadas con Prótesis/etiología , Reoperación/estadística & datos numéricos , Adulto , Anciano , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Sistema de Registros , SueciaRESUMEN
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.
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Artroplastia de Reemplazo de Rodilla , Complicaciones Posoperatorias/cirugía , Reoperación/tendencias , Anciano , Femenino , Humanos , Masculino , Sistema de RegistrosRESUMEN
Background and purpose - The population of the Nordic countries is aging and the number of elderly patients undergoing total knee arthroplasty (TKA) is also expected to increase. Reliable fixation methods are essential to avoid revisions. We compared the survival of different TKA fixation concepts with cemented fixation as the gold standard.Patients and methods - We used data from the Nordic Arthroplasty Register Association (NARA) database of 265,877 unconstrained TKAs performed for patients aged ≥ 65 years with primary knee osteoarthritis between 2000 and 2016. Kaplan-Meier (KM) survival analysis with 95% confidence intervals (CI) and the Cox multiple-regression model were used to compare the revision risk of the fixation methods.Results - Cemented fixation was used in 243,166 cases, uncemented in 8,000, hybrid (uncemented femur with cemented tibia) in 14,248, and inverse hybrid (cemented femur with uncemented tibia) fixation in 463 cases. The 10-year KM survivorship (95% CI) of cemented TKAs was 96% (96 - 97), uncemented 94% (94 - 95), hybrid 96% (96 - 96), and inverse hybrid 96% (94 - 99), respectively. Uncemented TKA was associated with increased risk of revision compared with the cemented TKA; the adjusted hazard ratio was 1.3 (95% CI 1.1 - 1.4).Interpretation - Cemented, hybrid, and inverse hybrid TKAs showed 10-year survival rates exceeding 95%. Uncemented fixation was associated with an increased risk of revision in comparison with cemented fixation. As both hybrid and inverse hybrid fixation were used in only a limited number of TKAs, indicating possibility of selection bias in their favor, cemented TKA still remains the gold standard, as it works reliably in the hands of many.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Cementación , Prótesis de la Rodilla , Diseño de Prótesis , Falla de Prótesis/etiología , Reoperación/estadística & datos numéricos , Anciano , Artroplastia de Reemplazo de Rodilla/instrumentación , Estudios de Cohortes , Femenino , Humanos , Masculino , Sistema de Registros , Países Escandinavos y NórdicosRESUMEN
BACKGROUND: Modern modular implants allow surgeons to mix different combinations of components within the same brand. From 1999 to 2012, the NexGen®-CR Option femoral component, together with a NexGen® Option Stemmed tibial plate (stemmed baseplate), which uses a short central stem, was the most-frequently used NexGen® combination in the Swedish Knee Arthroplasty Register. However, from 1999 to 2012, the same femoral component was also used along with the NexGen® Precoat four-pegged tibial baseplate (pegged baseplate). Considering the difference in the fixation concepts for these two tibial baseplates, we wanted to study whether their revision rates differed. QUESTIONS/PURPOSES: To investigate the difference in (1) all-cause revision and (2) the risk of revision for aseptic loosening between the NexGen® pegged and stemmed baseplates when used with the NG-CR Option femoral component and the same two types of inserts. METHODS: The Swedish Knee Arthroplasty Register provided data. The register, which was started in 1975, has since 1999 registered part numbers for individual implant components, allowing it to assess the combinations of components used in each patient. It has been shown to have high completeness (97%) and validity [12, 15]. The inclusion period was 1999 to 2012; during that time, 137,143 primary knee arthroplasties were registered, of which 125,094 were TKAs. Only TKAs performed for osteoarthritis and without patellar resurfacing were included, since not resurfacing the patella is the standard procedure in Sweden. This left 15,287 knees with the stemmed baseplate and 2479 with the pegged baseplate, or 12% and 2% of the total number of TKAs, respectively. Two general hospitals used the pegged baseplate exclusively during that period. Thus, specific patients were not selected for having the pegged plate. The mean age, mortality, and length of followup were similar for the two groups.We used the Kaplan-Meier statistics to calculate the cumulative revision rate (CRR) and Cox regression to compare risk ratios after adjusting for age and sex. The end point was a knee revision for respective all causes or aseptic loosening. The study ended on December 31, 2016. Due to the free healthcare system in Sweden it is highly unusual for patients to seek elective revision abroad, and by use of the extensive Swedish census register, we estimate the level of followup approximately 97%. RESULTS: Knees with the pegged baseplate had a higher risk for all-cause revision than did those with the stemmed baseplate (5.8% [95% confidence interval {CI}, 4-8.3] and 3% [95% CI, 2.6-3.5] at 15 years; p = 0.003). After controlling for age and sex, the aseptic loosening risk in the pegged baseplate group was still higher than that in the stemmed group (relative risk, 5.40; 95% CI, 3.64-8.02; p < 0.001). CONCLUSIONS: In this Swedish registry study, we observed a higher loosening risk with the pegged baseplate than the stemmed one, even after controlling for age and sex. Because this was only a comparison of implants from one vendor, and because there may have been other between-group differences for which we could not fully control, this concerning finding should be explored using data from other registries. LEVEL OF EVIDENCE: Level III, therapeutic study.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Placas Óseas , Prótesis de la Rodilla , Falla de Prótesis , Tibia/cirugía , Anciano , Femenino , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Factores de RiesgoRESUMEN
Background and purpose - Obesity defined as increased BMI is commonly associated with higher revision rates following total knee arthroplasty (TKA). We examined the effect of BMI on the rate of revision after TKA, for both infection and other reasons, and analyzed weight and height separately to provide better understanding of the risk profile.Patients and methods - The Swedish national knee arthroplasty register was used to identify 107,228 patients operated with primary TKA for osteoarthritis between 2009 and 2017. Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for BMI (categories: < 18.5, 18.5-24.9, 25-29.9, 30-34.9, 35-39.9, ≥ 40), weight (categories: < 65, 65-89, 90-114, ≥ 115 kg) and height (categories: < 160, 160-179, ≥ 180 cmResults - There were 2,503 revisions in the follow-up period; 1,036 for infection and 1,467 for other reasons. Higher BMI and weight categories were associated with a similar and statistically significantly increased risk of revision for all causes and for infection. The risk of revision for infection was almost twice in the highest BMI and highest weight group: HR = 3.4 (CI 2.3-4.7) and HR = 3.1 (CI 2.5-3.9) respectively. For BMI and weight categories there was no statistically significant association between revision for other reasons than infection, contrary to the tallest height category where it was statistically significant (HR = 1.3 [CI 1.1-1.5]).Interpretation - BMI, weight, and height may be associated with different types of risks for revision following TKA.
Asunto(s)
Obesidad/epidemiología , Infecciones Relacionadas con Prótesis/epidemiología , Reoperación/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla , Estatura , Índice de Masa Corporal , Peso Corporal , Humanos , Sobrepeso/epidemiología , Modelos de Riesgos Proporcionales , Infecciones Relacionadas con Prótesis/cirugía , Sistema de Registros , Suecia/epidemiologíaRESUMEN
Background and purpose - Total knee arthroplasty (TKA) has increased substantially in Sweden. We quantified the relative risk for TKA in the Swedish population for different BMI categories and age groups to investigate whether the continued increase in TKA is attributable to increased prevalence of obesity and elderly people in the population, and to put forward model predictions for coming needs for TKA. Patients and methods - We used the Swedish Nationwide Health Survey (SNHS) and the Swedish Knee Arthroplasty Register (SKAR) 2009-2015 to calculate the relative risk (RR) of TKA by age (middle-aged 45-64 years and elderly 65-84 years) and BMI (BMI 18.5-24.9 normal weight; BMI 25.0-29.9 overweight; BMI > 30 obese). The RR for TKA was applied to the demographic forecasts for the Swedish population as a forecasting model. Results - Population size increased 5.2% from 2009 to 2015 to 40,000 middle-aged and 250,000 elderly, and the prevalence of obesity increased from 16% to 18% in these 2 age categories. Compared with those of normal weight, the RR for TKA was 2.7 (95% CI 2.5-3.0) higher for the overweight and 7.3 (6.7-8.0) higher for the obese, aged 45-64. The corresponding figures for individuals aged 65-84 were 2.1 (2.0-2.2) and 4.0 (3.8-4.3) higher, respectively. The changes in the prevalence of obesity and an increase in the elderly population accounted for an estimated increase of 1,700 TKAs over the 7 years. Interpretation - The increase in obesity frequency and the rise in the population of middle-aged and elderly may, to some extent, explain the rise in TKA utilization in Sweden.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Obesidad , Osteoartritis de la Rodilla , Utilización de Procedimientos y Técnicas , Factores de Edad , Anciano , Artroplastia de Reemplazo de Rodilla/métodos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Índice de Masa Corporal , Causalidad , Femenino , Predicción , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Obesidad/epidemiología , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/epidemiología , Osteoartritis de la Rodilla/cirugía , Prevalencia , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Utilización de Procedimientos y Técnicas/tendencias , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Suecia/epidemiologíaRESUMEN
Background and purpose - Having patients self-evaluate the outcome is an important part of the follow-up after knee arthroplasty. The Forgotten Joint Score-12 (FJS-12) introduced joint awareness as a new approach, suggested to be sensitive enough to differentiate well-functioning patients. This study evaluated the Swedish translation of the FJS-12 and investigated the validity, reliability, and interpretability in patients undergoing knee arthroplastyPatients and methods - We included 109 consecutive patients 1 year after primary knee arthroplasty to assess construct validity (Pearson's correlation coefficient, r), internal consistency (Cronbach's alpha [CA]), floor and ceiling effects, and score distribution. The Knee injury and Osteoarthritis Outcome Score (KOOS) was the comparator instrument for the analyses. Further, 31 patients preoperatively and 22 patients postoperatively were included to assess test-retest reliability (intraclass correlation coefficient [ICC]).Results - Construct validity was moderate to excellent (r = 0.62-0.84). The FJS-12 showed a high degree of internal consistency (CA = 0.96). The ICC was good preoperatively (0.76) and postoperatively (0.87). Ceiling effects were 2.8% in the FJS-12 and ranging between 0.9% and 10% in the KOOS.Interpretation - The Swedish translation of the FJS-12 showed good validity and reliability and can be used to assess outcome after knee arthroplasty. Moreover, the FJS-12 shows promising results in its ability to differentiate well-functioning patients. Future studies on unidimensionality, scale validity, interpretability, and responsiveness are needed for a more explicit analysis of the psychometric properties.
Asunto(s)
Actividades Cotidianas , Artroplastia de Reemplazo de Rodilla , Calidad de Vida , Anciano , Concienciación , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Reproducibilidad de los Resultados , Deportes , SueciaRESUMEN
Background and purpose - Fast-track care programs have been broadly introduced at Swedish hospitals in elective total hip and knee replacement (THR/TKR). We studied the influence of fast-track programs on patient-reported outcomes (PROs) 1 year after surgery, by exploring outcome measures registered in the Swedish arthroplasty registers.Patients and methods - Data were obtained from the Swedish Knee and Hip Arthroplasty Registers and included TKR and THR operations 2011-2015 on patients with osteoarthritis. Based on questionnaires concerning the clinical pathway and care programs at Swedish hospitals, the patients were divided in 2 groups depending on whether they had been operated in a fast-track program or not. PROs of the fast-track group were compared with not fast-track using regression analysis. EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS were analyzed for both THR and TKR operations. The PROMs for TKR also included KOOS.Results - The differences of EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS 1 year after surgery were small but all in favor of fast-track for both THR and TKR, also in subscales of KOOS for TKR except KOOS QoL. However, the effect sizes as measured by Cohens' d formula were < 0.2 for all PROs, in both THR and TKR.Interpretation - Our results indicate that the fast-track programs may be at least as good as conventional care from the perspective of PROs 1-year postoperatively.