Major Aseptic Revision Following Total Knee Replacement: A Study of 478,081 Total Knee Replacements from the Australian Orthopaedic Association National Joint Replacement Registry

Nicholas B. Jorgensen, Michael McAuliffe, Thomas Orschulok, Michelle Lorimer, Richard De Steiger

Research output: Contribution to journalArticle

Abstract

Background:Major revision is associated with less satisfactory outcomes, substantial complications, and added cost. Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were analyzed to identify factors associated with major aseptic revision (MAR) of primary total knee replacement (TKR).Methods:The cumulative percent major aseptic revision rate following all primary TKRs performed in Australia from September 1, 1999, to December 31, 2015, was assessed. Kaplan-Meier estimates of survivorship were utilized to describe the time to first revision. Hazard ratios (HRs) from Cox proportional hazard models, adjusted for age and sex, were utilized to compare revision rates.Results:There were 5,973 MARs recorded from the total cohort of 478,081 primary TKRs. The cumulative percent MAR at 15 years was 3.0% (95% confidence interval [CI], 2.8% to 3.2%). Fixed bearings had a significantly lower rate of MAR at 15 years: 2.7% (95% CI, 2.4% to 2.9%) compared with 4.1% (95% CI, 3.8% to 4.5%) for mobile bearings (HR, 1.77 [95% CI, 1.68 to 1.86]; p < 0.001). Age had a significant effect on MAR rates, with a cumulative percent revision at 15 years for patients <55 years old of 7.8% (95% CI, 6.5% to 9.2%) compared with 1.0% for those ≥75 years old (95% CI, 0.8% to 1.1%; p < 0.001). Minimally stabilized TKR had a lower rate of MAR compared with posterior-stabilized TKR after 2 years (HR, 0.83 [95% CI, 0.77 to 0.90]; p < 0.001). Cementless fixation had a higher rate of revision than cemented or hybrid fixation. There was a higher rate of MAR with non-navigated compared with computer navigated TKR (HR, 1.32 [95% CI, 1.21 to 1.44], p < 0.001). The tibial component was revised more commonly than the femoral component.Conclusions:Younger age, posterior stabilization, cementless fixation, a mobile bearing, and non-navigation were risk factors for higher rates of MAR following TKR.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

LanguageEnglish
Pages302-310
Number of pages9
JournalJournal of Bone and Joint Surgery - American Volume
Volume101
Issue number4
DOIs
Publication statusPublished - 20 Feb 2019

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

@article{1f2ab91445fb4f11bf42dd7e6a089089,
title = "Major Aseptic Revision Following Total Knee Replacement: A Study of 478,081 Total Knee Replacements from the Australian Orthopaedic Association National Joint Replacement Registry",
abstract = "Background:Major revision is associated with less satisfactory outcomes, substantial complications, and added cost. Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were analyzed to identify factors associated with major aseptic revision (MAR) of primary total knee replacement (TKR).Methods:The cumulative percent major aseptic revision rate following all primary TKRs performed in Australia from September 1, 1999, to December 31, 2015, was assessed. Kaplan-Meier estimates of survivorship were utilized to describe the time to first revision. Hazard ratios (HRs) from Cox proportional hazard models, adjusted for age and sex, were utilized to compare revision rates.Results:There were 5,973 MARs recorded from the total cohort of 478,081 primary TKRs. The cumulative percent MAR at 15 years was 3.0{\%} (95{\%} confidence interval [CI], 2.8{\%} to 3.2{\%}). Fixed bearings had a significantly lower rate of MAR at 15 years: 2.7{\%} (95{\%} CI, 2.4{\%} to 2.9{\%}) compared with 4.1{\%} (95{\%} CI, 3.8{\%} to 4.5{\%}) for mobile bearings (HR, 1.77 [95{\%} CI, 1.68 to 1.86]; p < 0.001). Age had a significant effect on MAR rates, with a cumulative percent revision at 15 years for patients <55 years old of 7.8{\%} (95{\%} CI, 6.5{\%} to 9.2{\%}) compared with 1.0{\%} for those ≥75 years old (95{\%} CI, 0.8{\%} to 1.1{\%}; p < 0.001). Minimally stabilized TKR had a lower rate of MAR compared with posterior-stabilized TKR after 2 years (HR, 0.83 [95{\%} CI, 0.77 to 0.90]; p < 0.001). Cementless fixation had a higher rate of revision than cemented or hybrid fixation. There was a higher rate of MAR with non-navigated compared with computer navigated TKR (HR, 1.32 [95{\%} CI, 1.21 to 1.44], p < 0.001). The tibial component was revised more commonly than the femoral component.Conclusions:Younger age, posterior stabilization, cementless fixation, a mobile bearing, and non-navigation were risk factors for higher rates of MAR following TKR.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.",
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Major Aseptic Revision Following Total Knee Replacement : A Study of 478,081 Total Knee Replacements from the Australian Orthopaedic Association National Joint Replacement Registry. / Jorgensen, Nicholas B.; McAuliffe, Michael; Orschulok, Thomas; Lorimer, Michelle; De Steiger, Richard.

In: Journal of Bone and Joint Surgery - American Volume, Vol. 101, No. 4, 20.02.2019, p. 302-310.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Major Aseptic Revision Following Total Knee Replacement

T2 - Journal of Bone and Joint Surgery - American Volume

AU - Jorgensen, Nicholas B.

AU - McAuliffe, Michael

AU - Orschulok, Thomas

AU - Lorimer, Michelle

AU - De Steiger, Richard

PY - 2019/2/20

Y1 - 2019/2/20

N2 - Background:Major revision is associated with less satisfactory outcomes, substantial complications, and added cost. Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were analyzed to identify factors associated with major aseptic revision (MAR) of primary total knee replacement (TKR).Methods:The cumulative percent major aseptic revision rate following all primary TKRs performed in Australia from September 1, 1999, to December 31, 2015, was assessed. Kaplan-Meier estimates of survivorship were utilized to describe the time to first revision. Hazard ratios (HRs) from Cox proportional hazard models, adjusted for age and sex, were utilized to compare revision rates.Results:There were 5,973 MARs recorded from the total cohort of 478,081 primary TKRs. The cumulative percent MAR at 15 years was 3.0% (95% confidence interval [CI], 2.8% to 3.2%). Fixed bearings had a significantly lower rate of MAR at 15 years: 2.7% (95% CI, 2.4% to 2.9%) compared with 4.1% (95% CI, 3.8% to 4.5%) for mobile bearings (HR, 1.77 [95% CI, 1.68 to 1.86]; p < 0.001). Age had a significant effect on MAR rates, with a cumulative percent revision at 15 years for patients <55 years old of 7.8% (95% CI, 6.5% to 9.2%) compared with 1.0% for those ≥75 years old (95% CI, 0.8% to 1.1%; p < 0.001). Minimally stabilized TKR had a lower rate of MAR compared with posterior-stabilized TKR after 2 years (HR, 0.83 [95% CI, 0.77 to 0.90]; p < 0.001). Cementless fixation had a higher rate of revision than cemented or hybrid fixation. There was a higher rate of MAR with non-navigated compared with computer navigated TKR (HR, 1.32 [95% CI, 1.21 to 1.44], p < 0.001). The tibial component was revised more commonly than the femoral component.Conclusions:Younger age, posterior stabilization, cementless fixation, a mobile bearing, and non-navigation were risk factors for higher rates of MAR following TKR.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

AB - Background:Major revision is associated with less satisfactory outcomes, substantial complications, and added cost. Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were analyzed to identify factors associated with major aseptic revision (MAR) of primary total knee replacement (TKR).Methods:The cumulative percent major aseptic revision rate following all primary TKRs performed in Australia from September 1, 1999, to December 31, 2015, was assessed. Kaplan-Meier estimates of survivorship were utilized to describe the time to first revision. Hazard ratios (HRs) from Cox proportional hazard models, adjusted for age and sex, were utilized to compare revision rates.Results:There were 5,973 MARs recorded from the total cohort of 478,081 primary TKRs. The cumulative percent MAR at 15 years was 3.0% (95% confidence interval [CI], 2.8% to 3.2%). Fixed bearings had a significantly lower rate of MAR at 15 years: 2.7% (95% CI, 2.4% to 2.9%) compared with 4.1% (95% CI, 3.8% to 4.5%) for mobile bearings (HR, 1.77 [95% CI, 1.68 to 1.86]; p < 0.001). Age had a significant effect on MAR rates, with a cumulative percent revision at 15 years for patients <55 years old of 7.8% (95% CI, 6.5% to 9.2%) compared with 1.0% for those ≥75 years old (95% CI, 0.8% to 1.1%; p < 0.001). Minimally stabilized TKR had a lower rate of MAR compared with posterior-stabilized TKR after 2 years (HR, 0.83 [95% CI, 0.77 to 0.90]; p < 0.001). Cementless fixation had a higher rate of revision than cemented or hybrid fixation. There was a higher rate of MAR with non-navigated compared with computer navigated TKR (HR, 1.32 [95% CI, 1.21 to 1.44], p < 0.001). The tibial component was revised more commonly than the femoral component.Conclusions:Younger age, posterior stabilization, cementless fixation, a mobile bearing, and non-navigation were risk factors for higher rates of MAR following TKR.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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DO - 10.2106/JBJS.17.01528

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JO - Journal of Bone and Joint Surgery - American Volume

JF - Journal of Bone and Joint Surgery - American Volume

SN - 0021-9355

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