Risk of Subsequent Revision after Primary and Revision Total Joint Arthroplasty
- 1 November 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Orthopaedics & Related Research
- Vol. 468 (11), 3070-3076
- https://doi.org/10.1007/s11999-010-1399-0
Abstract
Background Revision is technically more demanding than primary total joint arthroplasty (TJA) and requires more extensive use of resources. Understanding the relative risk of rerevision and risk factors can help identify patients at high risk who may require closer postsurgical care. Objectives/purposes We therefore evaluated the risk of subsequent revision after primary and revision TJA in the elderly (65 years or older) patient population and identified corresponding patient risk factors. Patients and Methods Using the 5% Medicare claims data set (1997-2006), we identified a total of 35,746 patients undergoing primary THA and 72,913 undergoing primary TKA; of these, 1205 who had THAs and 1599 who had TKAs underwent initial revision surgery. The rerevision rate after primary and revision TJAs was analyzed by the Kaplan-Meier method. The relative risk of revision surgery for primary and revision TJAs was compared using hazard ratio analysis. Results The 5-year survival probabilities were 95.9%, 97.2%, 81.0%, and 87.4% for primary THA and TKA and revision THA and TKA, respectively. Patients with revision arthroplasty were five to six times more likely to undergo rerevision (adjusted relative risk, 4.89 for THA; 5.71 for TKA) compared with patients with primary arthroplasty. Age and comorbidities were associated with initial revision after primary THA and TKA. Conclusions Patients should undergo stringent preoperative screening for preexisting health conditions and careful patient management and followup postoperatively so as to minimize the risk of an initial revision, which otherwise could lead to a significantly greater likelihood of subsequent rerevisions. Level of Evidence Level II, prognostic study. See Guideline for Authors for a complete description of levels of evidence.Keywords
This publication has 34 references indexed in Scilit:
- Why Revision Total Hip Arthroplasty FailsClinical Orthopaedics & Related Research, 2008
- Periprosthetic Joint Infection: The Incidence, Timing, and Predisposing FactorsClinical Orthopaedics & Related Research, 2008
- High body mass index is associated with increased risk of implant dislocation following primary total hip replacement: 2,106 patients followed for up to 8 yearsActa Orthopaedica, 2008
- An Analysis of the Risk of Hip Dislocation with a Contemporary Total Joint RegistryClinical Orthopaedics and Related Research, 2006
- Economic Burden of Revision Hip and Knee Arthroplasty in Medicare EnrolleesClinical Orthopaedics and Related Research, 2006
- Cost Effectiveness of Revision Total Knee ArthroplastyClinical Orthopaedics and Related Research, 2006
- Charlson Index Is Associated with One-year Mortality in Emergency Department Patients with Suspected InfectionAcademic Emergency Medicine, 2006
- Charlson Index Is Associated with One‐year Mortality in Emergency Department Patients with Suspected InfectionAcademic Emergency Medicine, 2006
- Reoperations after 3200 Revision TKAsPublished by Ovid Technologies (Wolters Kluwer Health) ,2004
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databasesJournal of Clinical Epidemiology, 1992