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Risk Factors for Early Revision After Primary TKA in Medicare Patients

Clinical Orthopaedics and Related Research®

An Erratum to this article was published on 18 June 2013

Abstract

Background

Patient, surgeon, health system, and device factors are all known to influence outcomes in total knee arthroplasty (TKA). However, patient-related factors associated with an increased risk of early failure are not well understood, particularly in elderly patients.

Questions/purposes

The purpose of this study was to identify specific comorbid conditions associated with increased risk of early revision in Medicare patients undergoing TKA.

Methods

A total of 117,903 Medicare patients who underwent primary TKA between 1998 and 2010 were identified from the Medicare 5% national sample administrative database and used to determine the relative risk of revision within 12 months after primary TKA as a function of baseline medical comorbidities. Cox regression was used to evaluate the impact of 29 comorbid conditions on risk of early failure controlling for age, sex, race, census region, socioeconomic status, and all other baseline comorbidities.

Results

The most significant independent risk factors for revision TKA within 12 months were chronic pulmonary disease, depression, alcohol abuse, drug abuse, renal disease, hemiplegia or paraplegia, and obesity.

Conclusions

This information could be valuable to patients and their surgeons when making shared medical decisions regarding elective TKA and for risk-stratifying publicly reported outcomes in Medicare patients undergoing TKA.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Kevin J. Bozic MD, MBA.

Additional information

The institution of one or more of the authors (KJB) has received, during the study period, funding from the Orthopaedic Research and Education Foundation (Rosemont, IL, USA). One of the authors (SMK) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,000, from Exponent, Inc (Philadelphia, PA, USA). One of the authors (KO) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,000, from Exponent, Inc. One of the authors (EL) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,000, from Exponent, Inc. One of the authors (DJB) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,000, from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (TPV) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of USD 10,000, from DePuy Orthopaedics, Inc. One of the authors (HER) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,000, from Zimmer, Inc (Warsaw, IN, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This work was performed at University of California, San Francisco, CA, USA; and Exponent, Inc, Menlo Park, CA, USA; and Exponent, Inc, Philadelphia, PA, USA.

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Bozic, K.J., Lau, E., Ong, K. et al. Risk Factors for Early Revision After Primary TKA in Medicare Patients. Clin Orthop Relat Res 472, 232–237 (2014). https://doi.org/10.1007/s11999-013-3045-0

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  • DOI: https://doi.org/10.1007/s11999-013-3045-0

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