Dataset Information

Comparing contemporary revision burden among hip and knee joint replacement registries.

ABSTRACT:

Background

Hip and knee arthroplasties are common and successful procedures, however, success and durability are not guaranteed. The revision burden, defined as the ratio of implant revisions to the total number of arthroplasties in a specific period, is a measure of the steady state of arthroplasty success in a given registry. This study examines the hypothesis that revision burden would be similar among contemporary joint replacement registries and improving over time compared with historic controls.

Methods

We evaluated the national joint registries of 5 health systems (Australian Orthopaedic Association National Joint Replacement Registry [AOANJRR]; National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man; New Zealand Joint Registry [NZJR]; Swedish Hip Arthroplasty Register [SHAR] and Swedish Knee Arthroplasty Register [SKAR]; and the American Joint Replacement Registry [AJRR]) for hip and knee revision burden over the past 4 years or since registry inception. Historic controls were obtained from previously published reports.

Results

The 2014 hip revision burden varied from 9.7 percent (NJR) to 11.9 percent (NZJR), and the unweighted average was 10.4 percent. The 2011, 2012, and 2013 mean hip revision burden was 11.9, 11.9, and 11.4 percent. The 2014 knee revision burden varied from to 6.0 percent (NJR) to 8.1 percent (AJRR), and the unweighted average for the 5 registries studied was 7.0 percent. The 2011, 2012, and 2013 mean knee revision burden was 6.9, 7.0, and 7.0 percent. Historically, the observed hip revision burden was 15.8 percent and the knee revision burden 8.0 percent.

Conclusions

Revision burden has gradually decreased for hip replacements and has remained relatively constant for knee replacements both for the last 4 years and compared to historic controls. Knee revision burden was lower than hip revision burden for each period examined. Revision burden is one measure that may be helpful in following the effect of changes in surgical technique and implant design over time in registry populations and may be a helpful way to compare overall results between registries.

SUBMITTER: McGrory BJ

PROVIDER: S-EPMC4957265 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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Publications

Comparing contemporary revision burden among hip and knee joint replacement registries.

McGrory Brian J BJ Etkin Caryn D CD Lewallen David G DG

Arthroplasty today 20160527 2

<h4>Background</h4>Hip and knee arthroplasties are common and successful procedures, however, success and durability are not guaranteed. The revision burden, defined as the ratio of implant revisions to the total number of arthroplasties in a specific period, is a measure of the steady state of arthroplasty success in a given registry. This study examines the hypothesis that revision burden would be similar among contemporary joint replacement registries and improving over time compared with his ...[more]

PMID: 28326404

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Project description:ObjectivesThe association of joint replacement registries with outcomes such as revision burden is uncertain. This study aimed to evaluate whether joint replacement registries are associated with the burden of revision changes while controlling for confounders that could affect the association.DesignA longitudinal study involving a combination of cross-sectional and time series data from 1980 to 2018. The study was a panel regression analysis using the difference-in-difference method.SettingData from countries with joint replacement registries and countries without joint replacement registries were used. Registry data were obtained from joint replacement registries' annual reports, while non-registry data were obtained from each included country's pooled hospitals' annual revision burden reported in the literature.Outcome measuresChanges in revision burden from 1980 to 2018 was the outcome measure. The revision burden in the registry periods of registry countries was compared with the non-registry periods of registry and non-registry countries.ResultsData were obtained from 12 registry periods and 8 non-registry periods. The average difference in revision burden in the registry periods of registry countries relative to the non-registry periods of registry and non-registry countries was statistically significant for hip, -3.80 (95% CI (-2.50 to -5.10); p<0.001) percentage points and knee, -1.63 (95% CI (-1.00 to -2.30); p<0.001) percentage points. This translates to a 19.30%, and 21.85% reduction in revision burden for hip and knee registries, for the whole sampling period.ConclusionJoint replacement registries are associated with a significant reduction in the burden of revision. Although revision burden reduces over time even without the registries, the establishment of joint replacement registries is associated with an increased reduction. The establishment of joint replacement registries in non-registry countries would be a worthwhile decision as it will further improve the outcomes of arthroplasty surgeries.

Project description:National projections of future joint replacement use can help us understand the changing burden of severe osteoarthritis. This study aimed to compare actual utilisation rates for primary total hip replacement (THR) and total knee replacement (TKR) to previously forecast estimates for Australia. Data from the Australian Orthopaedic Association National Joint Replacement Registry and Australian Bureau of Statistics were used to calculate 'actual' THR and TKR utilisation rates for the years 2014-2019, by sex and age group. 'Forecast' utilisation rates for 2014-2019 were derived from an earlier study that modelled two alternate scenarios for THR and TKR in Australia: Scenario 1 assumed a constant rate of surgery; Scenario 2 assumed continued growth in surgery rates. Actual utilisation rates were compared descriptively to forecast rates for females and males (overall and by age group). Rate ratios were calculated to indicate the association between actual and forecast THR and TKR rates, with a rate ratio of 1.00 reflecting perfect alignment. Over the study period, 191,996 THRs (53% in females) and 312,203 TKRs (55% in females) were performed. For both sexes, actual rates lay clearly between the Scenario 1 and 2 forecast estimates. In 2019, actual THR utilisation rates were 179 per 100,000 females (Scenario 1: 156; Scenario 2: 200) and 158 per 100,000 males (Scenario 1: 139; Scenario 2: 191). Actual TKR utilisation rates in 2019 were 289 per 100,000 females (Scenario 1: 275; Scenario 2: 387) and 249 per 100,000 males (Scenario 1: 216; Scenario 2: 312). Age-specific rate ratios were close to 1.00 for all age groups, indicating good alignment between forecast and actual joint replacement rates. These validation analyses showed that linear plus exponential growth forecasting scenarios provided an efficient approximation of actual joint replacement utilisation. This indicates our modelling techniques can be used to judiciously predict future surgery demand, including for age groups with high surgery rates.

Project description:ImportanceThere are marked racial/ethnic differences in hip and knee joint replacement care as well as concerns that value-based payments may exacerbate existing racial/ethnic disparities in care.ObjectiveTo examine changes in joint replacement care associated with Medicare's Comprehensive Care for Joint Replacement (CJR) model among White, Black, and Hispanic patients.Design, setting, and participantsRetrospective cohort study of Medicare claims from 2013 through 2017 among White, Black, and Hispanic patients undergoing joint replacement in 67 treatment (selected for CJR participation) and 103 control metropolitan statistical areas.ExposuresThe CJR model holds hospitals accountable for spending and quality of joint replacement care during care episodes (index hospitalization through 90 days after discharge).Main outcomes and measuresThe primary outcomes were spending, discharge to institutional postacute care, and readmission during care episodes.ResultsAmong 688 346 patients, 442 163 (64.2%) were women, and 87 286 (12.7%) were 85 years or older. Under CJR, spending decreased by $439 for White patients (95% CI, -$718 to -$161; from pre-CJR spending in treatment metropolitan statistical areas of $25 264) but did not change for Black patients and Hispanic patients. Discharges to institutional postacute care decreased for all groups (-2.5 percentage points; 95% CI, -4.7 to -0.4, from pre-CJR risk of 46.2% for White patients; -6.0 percentage points; 95% CI, -9.8 to -2.2, from pre-CJR risk of 59.5% for Black patients; and -4.3 percentage points; 95% CI, -7.6 to -1.0, from pre-CJR risk of 54.3% for Hispanic patients). Readmission risk decreased for Black patients by 3.1 percentage points (95% CI, -5.9 to -0.4, from pre-CJR risk of 21.8%) and did not change for White patients and Hispanic patients. Under CJR, Black-White differences in discharges to institutional postacute care decreased by 3.4 percentage points (95% CI, -6.4 to -0.5, from the pre-CJR Black-White difference of 13.3 percentage points). No evidence was found demonstrating that Black-White differences changed for other outcomes or that Hispanic-White differences changed for any outcomes under CJR.Conclusions and relevanceIn this cohort study of patients receiving joint replacements, CJR was associated with decreased readmissions for Black patients. Furthermore, Black patients experienced a greater decrease in discharges to institutional postacute care relative to White patients, representing relative improvements despite concerns that value-based payment models may exacerbate existing disparities. Nonetheless, differences between White and Black patients in joint replacement care still persisted even after these changes.

Project description:BackgroundLittle is known about how often patients have revision total hip replacement in the same hospital in which they had the primary procedure.MethodsWe examined Medicare claims data to identify patients who had primary total hip replacement from July 1995 to June 1996 and subsequently had revision through December 31, 2006. We examined whether the revision was performed in the same or different hospital from the primary procedure, with different hospitals being categorized as being in a lower, a higher, or the same hospital volume stratum. Hospital strata included twenty-five or fewer cases of total hip replacement annually in the Medicare population, twenty-six to fifty cases, fifty-one to 100 cases, and >100 cases. We calculated the number of revisions generated (primary procedures eventuating in revision) by hospitals in each volume stratum and the number of revisions performed in these hospitals.ResultsOf 4448 revision procedures, 3306 (74%) were performed in hospitals in the same volume stratum as the hospital where the primary procedure was performed. Four hundred twenty-nine revisions (9.6%) were performed in a lower-volume hospital, and 713 (16%) were performed in a higher-volume hospital. Thirty-one (3%) of 960 patients who had revision within one year after the primary total hip replacement had the revision in a lower-volume center, compared with 204 (15%) of 1393 who had revision more than six years after the primary procedure (odds ratio = 4.6 ; 95% confidence interval, 3.0 to 6.8). The ratio of revisions performed to revisions generated was 1.21 for the highest-volume centers and 0.86 for the lowest-volume centers.ConclusionsOf 4448 revisions examined in this study, 429 (<10%) were performed in centers with a lower volume of total hip replacement than the center at which the initial hip replacement was performed, whereas 713 (16%) were performed in higher-volume centers. Higher-volume centers performed 21% more revisions than they generated (531 revisions performed, compared with 438 generated). These data will help to inform health-care policy with regard to the utilization of resources for revision total hip replacement.

Project description:BackgroundPrecision medicine has been adopted in a range of clinical settings where omics data have led to greater characterisation of disease and stratification of patients into subcategories of phenotypes and pathologies. However, in orthopaedics, precision medicine lags behind other disciplines such as cancer. Joint registries have now amassed a huge body of data pertaining to implant performance which can be broken down into performance statistics for different material types in different cohorts of patients. The National Joint Registry of England, Wales and Northern Ireland (NJR) is now one of the largest datasets available. Other registries such as those from Sweden and Australia however contain longer follow-up. Together, these registries can provide a wealth of informative for the orthopaedics community when considering which implant to give to any particular patient.Questions/purposesWe aim to explore the benefits of combining multiple large data streams including joint registries, published data on osteoarthritis (OA) pathogenesis and pathology and data concerning performance of each implant material combination in terms of biocompatibility. We believe that this analysis will provide a comprehensive overview of implant performance hopefully aiding surgeons in making more informed choices about which implant should be used in which patient.MethodsData from three joint registries were combined with established literature to highlight the heterogeneity of OA disease and the different clinical outcomes following arthroplasty with a range of material types.ResultsThis review confirms that joint registries are unable to consider differences in arthritis presentation or underlying drivers of pathology. OA is now recognised to present with varying pathology with differing morbidity in different patient populations. Equally, just as OA is a heterogeneous disease, there are disparate responses to wear debris from different material combinations used in joint replacement surgery. This has been highlighted by recent high-profile scrutiny of early failure of metal-on-metal total hip replacement (THR) implants.ConclusionsBringing together data from joint registries, biomarker analysis, phenotyping of OA patients and knowledge of how different patients respond to implant debris will lead to a truly personalised approach to treating OA patients, ensuring that the correct implant is given to the correct patient at the correct time.

Dataset Information

Comparing contemporary revision burden among hip and knee joint replacement registries.

Background

Methods

Results

Conclusions

Publications

Comparing contemporary revision burden among hip and knee joint replacement registries.

Similar Datasets

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