The number of revision total knee replacement surgeries continues to increase with periprosthetic joint infection and mechanical loosening found to be the most common reasons for revision, according to data presented at the American Academy of Orthopaedic Surgeons Annual Meeting.
“Despite the success of primary total knee arthroplasty (TKA) in reducing pain and improving function in patients who suffer from knee osteoarthritis, the number of revision TKA procedures performed annually in the United States continues to rise,” Kevin J. Bozic, MD, MBA, William R. Murry, MD, Endowed Chair in Orthopaedic Surgery, professor and vice chair at the University of California, San Francisco, told Orthopedics Today. “Understanding the cause of TKA failure, the types of revision TKA procedures being performed, and the resource utilization associated with these procedures is essential to improving TKA outcomes.”
Kevin J. Bozic
Researchers used a Nationwide Inpatient Sample to evaluate the cause of failure for 301,718 revision TKA procedures performed between 2005 and 2010 and compared patient characteristics, procedure information and resource utilization across revision TKA procedures.
They found that the number of revision TKA procedures increased from 48,260 in 2006 to 67,534 in 2010. Revision TKA procedures were more common in women and most commonly performed in patients between the ages of 65 years to 74 year.
The researchers recorded a moderate severity of illness score in more than 60% of patients studied. Periprosthetic joint infection and mechanical loosening were the most common reasons for revision, accounting for revision in 25% and 18% of patients, respectively. Among the revisions in 2010, 37% were due to all-component revisions, 13% to arthrotomy/removal of prosthesis, 12% to isolated tibial insert revision, 10% to tibial component revision, 5% to patellar component revisions and 4% to femoral component revisions. Osteolysis and periprosthetic fracture were least common reasons for revision.
Revision TKA procedures were more common in large, urban non-teaching hospitals and in the South and Midwest regions. Longest length of stay was associated with periprosthetic joint infection and periprosthetic fracture and periprosthetic fracture was associated with the highest average hospitalization costs, according to study results. — by Casey Tingle
Bozic KJ. Paper #330. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 11-15, 2014; New Orleans.
Disclosure: Bozic has no relevant financial disclosures.