Skip to main content
SpringerLink
Log in

Does interaction occur between risk factors for revision total knee arthroplasty?

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Several risk factors for revision TKA have previously been identified, but interactions between risk factors may occur and affect risk of revision. To our knowledge, such interactions have not been previously studied. As patients often exhibit multiple risk factors for revision, knowledge of these interactions can help improve risk stratification and patient education prior to TKA.

Materials and methods

The State Inpatient Databases (SID), part of the Healthcare Cost and Utilization Project (HCUP), were queried to identify patients who underwent TKA between January 1, 2006 and December 31, 2015. Risk factors for revision TKA were identified, and interactions between indication for TKA and other risk factors were analyzed.

Results

Of 958,944 patients who underwent TKA, 33,550 (3.5%) underwent revision. Age, sex, race, length of stay, Elixhauser readmission score, urban/rural designation, and indication for TKA were significantly associated with revision (p < 0.05). Age was the strongest predictor (p  < 0.0001), with younger patients exhibiting higher revision risk. Risks associated with age were modified by an interaction with indication for TKA (p < 0.0001). There was no significant interaction between sex and indication for TKA (p = 0.535) or race and indication for TKA (p = 0.187).

Conclusions

Age, sex, race, length of stay, Elixhauser readmission score, urban/rural designation, and indication for TKA are significantly associated with revision TKA. Interaction occurs between age and indication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Daigle ME, Weinstein AM, Katz JN, Losina E (2012) The cost-effectiveness of total joint arthroplasty: a systematic review of published literature. Best Pract Res Clin Rheumatol 26:649–658

    Article  PubMed  Google Scholar 

  2. Kamaruzaman H, Kinghorn P, Oppong R (2017) Cost-effectiveness of surgical interventions for the management of osteoarthritis: a systematic review of the literature. BMC Musculoskelet Disord 18:183

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fingar KR, Stocks C, Weiss AJ, Steiner CA (2006) Most frequent operating room procedures performed in U.S. Hospitals, 2003–2012: Statistical Brief #186. Healthcare cost and utilization project (HCUP) statistical briefs. Rockville: Agency for Healthcare Research and Quality (US)

  4. Bozic KJ, Bashyal RK, Anthony SG, Chiu V, Shulman B, Rubash HE (2013) Is administratively coded comorbidity and complication data in total joint arthroplasty valid? Clin Orthop Relat Res 471:201–205

    Article  PubMed  Google Scholar 

  5. Schwartz AJ, Della Valle CJ, Rosenberg AG, Jacobs JJ, Berger RA, Galante JO (2010) Cruciate-retaining TKA using a third-generation system with a four-pegged tibial component: a minimum 10-year followup note. Clin Orthop Relat Res 468:2160–2167

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bohl DD, Samuel AM, Basques BA, Della Valle CJ, Levine BR, Grauer JN (2016) How much do adverse event rates differ between primary and revision total joint arthroplasty? J Arthroplasty 31:596–602

    Article  PubMed  Google Scholar 

  7. Nichols CI, Vose JG (2016) Clinical outcomes and costs within 90 days of primary or revision total joint arthroplasty. J Arthroplasty 31:1400-1406.e1403

    Article  PubMed  Google Scholar 

  8. Bhandari M, Smith J, Miller LE, Block JE (2012) Clinical and economic burden of revision knee arthroplasty. Clin Med Insights Arthritis Musculoskelet Disord 5:89–94

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bass AR, McHugh K, Fields K, Goto R, Parks ML, Goodman SM (2016) Higher total knee arthroplasty revision rates among united states blacks than whites: a systematic literature review and meta-analysis. J Bone Joint Surg Am 98:2103–2108

    Article  PubMed  Google Scholar 

  10. Cancienne JM, Werner BC, Browne JA (2016) Complications of primary total knee arthroplasty among patients with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and osteoarthritis. J Am Acad Orthop Surg 24:567–574

    Article  PubMed  Google Scholar 

  11. Dy CJ, Marx RG, Bozic KJ, Pan TJ, Padgett DE, Lyman S (2014) Risk factors for revision within 10 years of total knee arthroplasty. Clin Orthop Relat Res 472:1198–1207

    Article  PubMed  Google Scholar 

  12. Hinman AD, Chan PH, Prentice HA, Paxton EW, Okike KM, Navarro RA (2020) The association of race/ethnicity and total knee arthroplasty outcomes in a universally insured population. J Arthroplasty 35:1474–1479

    Article  PubMed  Google Scholar 

  13. Jasper LL, Jones CA, Mollins J, Pohar SL, Beaupre LA (2016) Risk factors for revision of total knee arthroplasty: a scoping review. BMC Musculoskelet Disord 17:182

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Jorgensen NB, McAuliffe M, Orschulok T, Lorimer MF, de Steiger R (2019) Major aseptic revision following total knee replacement: a study of 478,081 total knee replacements from the Australian orthopaedic association national joint replacement registry. J Bone Joint Surg Am 101:302–310

    Article  PubMed  Google Scholar 

  15. Julin J, Jämsen E, Puolakka T, Konttinen YT, Moilanen T (2010) Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis A follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta Orthop 81:413–419

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lee DK, Kim HJ, Cho IY, Lee DH (2017) Infection and revision rates following primary total knee arthroplasty in patients with rheumatoid arthritis versus osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 25:3800–3807

    Article  PubMed  Google Scholar 

  17. MacDonald SJ, Charron KD, Bourne RB, Naudie DD, McCalden RW, Rorabeck CH (2008) The John Insall Award: gender-specific total knee replacement: prospectively collected clinical outcomes. Clin Orthop Relat Res 466:2612–2616

    Article  PubMed  PubMed Central  Google Scholar 

  18. Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS (2003) Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am 85:259–265

    Article  PubMed  Google Scholar 

  19. Roberts VI, Esler CN, Harper WM (2007) A 15-year follow-up study of 4606 primary total knee replacements. J Bone Joint Surg Br 89:1452–1456

    Article  CAS  PubMed  Google Scholar 

  20. Moore BJ, White S, Washington R, Coenen N, Elixhauser A (2017) Identifying increased risk of readmission and in-hospital mortality using hospital administrative data: The AHRQ elixhauser comorbidity index. Med Care 55:698–705

    Article  PubMed  Google Scholar 

  21. Boyer B, Bordini B, Caputo D, Neri T, Stea S, Toni A (2019) What are the influencing factors on hip and knee arthroplasty survival? Prospective cohort study on 63619 arthroplasties. Orthop Traumatol Surg Res 105:1251–1256

    Article  PubMed  Google Scholar 

  22. Harrel FE (2021) Regression modeling strategies. Available at: https://cran.r-project.org/web/packages/rms/rms.pdf

  23. Rubin DB (2004) Multiple imputation for nonresponse in surveys. Wiley, New York

    Google Scholar 

  24. Bottle A, Parikh S, Aylin P, Loeffler M (2019) Risk factors for early revision after total hip and knee arthroplasty: National observational study from a surgeon and population perspective. PLoS ONE 14:e0214855

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Meehan JP, Danielsen B, Kim SH, Jamali AA, White RH (2014) Younger age is associated with a higher risk of early periprosthetic joint infection and aseptic mechanical failure after total knee arthroplasty. J Bone Joint Surg Am 96:529–535

    Article  PubMed  Google Scholar 

  26. Namba RS, Cafri G, Khatod M, Inacio MC, Brox TW, Paxton EW (2013) Risk factors for total knee arthroplasty aseptic revision. J Arthroplasty 28:122–127

    Article  PubMed  Google Scholar 

  27. Pitta M, Esposito CI, Li Z, Lee YY, Wright TM, Padgett DE (2018) Failure after modern total knee arthroplasty: a prospective study of 18,065 knees. J Arthroplasty 33:407–414

    Article  PubMed  Google Scholar 

  28. Abdel MP, von Roth P, Cross WW, Berry DJ, Trousdale RT, Lewallen DG (2015) Total knee arthroplasty in patients with a prior tibial plateau fracture: a long-term report at 15 years. J Arthroplasty 30:2170–2172

    Article  PubMed  Google Scholar 

  29. Liu Y, Zhao XD, Zou C (2020) Lingering risk: a meta-analysis of outcomes following primary total knee arthroplasty for patients with post-traumatic arthritis. Int J Surg 77:163–172

    Article  PubMed  Google Scholar 

  30. Shah SH, Schwartz BE, Schwartz AR, Goldberg BA, Chmell SJ (2017) Total knee arthroplasty in the younger patient. J Knee Surg 30:555–559

    Article  PubMed  Google Scholar 

  31. Cordtz RL, Zobbe K, Højgaard P, Kristensen LE, Overgaard S, Odgaard A, Lindegaard H, Dreyer L (2018) Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers. Ann Rheum Dis 77:281–288

    Article  CAS  PubMed  Google Scholar 

  32. Mooney L, Lewis PL, Campbell DG, Peng Y, Hatton A (2019) Rates and outcomes of total knee replacement for rheumatoid arthritis compared to osteoarthritis. ANZ J Surg 89:184–190

    Article  PubMed  Google Scholar 

  33. Boontanapibul K, Amanatullah DF, Huddleston JI 3rd, Maloney WJ, Goodman SB (2021) Outcomes of cemented total knee arthroplasty for secondary osteonecrosis of the knee. J Arthroplasty 36:550–559

    Article  PubMed  Google Scholar 

  34. Chalmers BP, Mehrotra KG, Sierra RJ, Pagnano MW, Taunton MJ, Abdel MP (2019) Reliable outcomes and survivorship of primary total knee arthroplasty for osteonecrosis of the knee. Bone Joint J. 101:1356–1361

    Article  PubMed  Google Scholar 

  35. Attar FG, Khaw FM, Kirk LM, Gregg PJ (2008) Survivorship analysis at 15 years of cemented press-fit condylar total knee arthroplasty. J Arthroplasty 23:344–349

    Article  PubMed  Google Scholar 

  36. Dalury DF, Mason JB, Murphy JA, Adams MJ (2009) Analysis of the outcome in male and female patients using a unisex total knee replacement system. J Bone Joint Surg Br 91:357–360

    Article  CAS  PubMed  Google Scholar 

  37. Ritter MA, Wing JT, Berend ME, Davis KE, Meding JB (2008) The clinical effect of gender on outcome of total knee arthroplasty. J Arthroplasty 23:331–336

    Article  PubMed  Google Scholar 

  38. Fehring TK, Murphy JA, Hayes TD, Roberts DW, Pomeroy DL, Griffin WL (2004) Factors influencing wear and osteolysis in press-fit condylar modular total knee replacements. Clin Orthop Relat Res 428:40–50

    Article  Google Scholar 

  39. Himanen AK, Belt EA, Lehto MU, Hämäläinen MM (2007) A comparison of survival of moulded monoblock and modular tibial components of 751 AGC total knee replacements in the treatment of rheumatoid arthritis. J Bone Joint Surg Br 89:609–614

    Article  PubMed  Google Scholar 

  40. Spanakis EK, Golden SH (2013) Race/ethnic difference in diabetes and diabetic complications. Curr Diab Rep 13:814–823

    Article  PubMed  Google Scholar 

  41. Pfefferle KJ, Shemory ST, Dilisio MF, Fening SD, Gradisar IM (2014) Risk factors for manipulation after total knee arthroplasty: a pooled electronic health record database study. J Arthroplasty 29:2036–2038

    Article  PubMed  Google Scholar 

  42. Springer BD, Odum SM, Nagpal VS, Lombardi AV Jr, Berend KR, Kim RH, Dennis DA (2012) Is socioeconomic status a risk factor for stiffness after total knee arthroplasty? a multicenter case-control study. Orthop Clin North Am 43:e1-7

    Article  PubMed  Google Scholar 

  43. Lavernia CJ, Villa JM (2015) Does race affect outcomes in total joint arthroplasty? Clin Orthop Relat Res 473:3535–3541

    Article  PubMed  PubMed Central  Google Scholar 

  44. Burn E, Edwards CJ, Murray DW, Silman A, Cooper C, Arden NK, Pinedo-Villanueva R, Prieto-Alhambra D (2018) Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014. BMJ Open 8:e019146

    Article  PubMed  PubMed Central  Google Scholar 

  45. Amanatullah DF, McQuillan T, Kamal RN (2019) Quality measures in total hip and total knee arthroplasty. J Am Acad Orthop Surg 27:219–226

    Article  PubMed  Google Scholar 

  46. Fassihi SC, Malahias MA, Gu A, Richardson SS, Buller LT, Stake S, De Martino I, Pathak N, Chen AZ, Ast MP, Sculco PK (2021) Hospital discharge within a day after total knee arthroplasty does not affect 1-year complications compared with rapid discharge. J Am Acad Orthop Surg 29:397–405

    Article  PubMed  Google Scholar 

  47. Pamilo KJ, Torkki P, Peltola M, Pesola M, Remes V, Paloneva J (2018) Fast-tracking for total knee replacement reduces use of institutional care without compromising quality. Acta Orthop 89:184–189

    Article  PubMed  Google Scholar 

  48. Blum MA, Singh JA, Lee GC, Richardson D, Chen W, Ibrahim SA (2013) Patient race and surgical outcomes after total knee arthroplasty: an analysis of a large regional database. Arthritis Care Res (Hoboken) 65:414–420

    Article  PubMed  Google Scholar 

  49. Frassanito L, Vergari A, Nestorini R, Cerulli G, Placella G, Pace V, Rossi M (2020) Enhanced recovery after surgery (ERAS) in hip and knee replacement surgery: description of a multidisciplinary program to improve management of the patients undergoing major orthopedic surgery. Musculoskelet Surg 104:87–92

    Article  CAS  PubMed  Google Scholar 

  50. Hoffmann JD, Kusnezov NA, Dunn JC, Zarkadis NJ, Goodman GP, Berger RA (2018) The shift to same-day outpatient joint arthroplasty: a systematic review. J Arthroplasty 33:1265–1274

    Article  PubMed  Google Scholar 

  51. Rutherford RW, Jennings JM, Dennis DA (2017) Enhancing recovery after total knee arthroplasty. Orthop Clin North Am 48:391–400

    Article  PubMed  Google Scholar 

  52. Halawi MJ, Vovos TJ, Green CL, Wellman SS, Attarian DE, Bolognesi MP (2015) Current evidence does not support medicare’s 3-day rule in primary total joint arthroplasty. Am J Orthop (Belle Mead NJ) 44:E370-372

    PubMed  Google Scholar 

  53. Banerjee D, Illingworth KD, Novicoff WM, Scaife SL, Jones BK, Saleh KJ (2013) Rural vs urban utilization of total joint arthroplasty. J Arthroplasty 28:888–891

    Article  PubMed  Google Scholar 

  54. Francis ML, Scaife SL, Zahnd WE (2011) Rural-urban differences in surgical procedures for Medicare beneficiaries. Arch Surg 146:579–583

    Article  PubMed  Google Scholar 

  55. Francis ML, Scaife SL, Zahnd WE, Cook EF, Schneeweiss S (2009) Joint replacement surgeries among medicare beneficiaries in rural compared with urban areas. Arthritis Rheum 60:3554–3562

    Article  PubMed  Google Scholar 

  56. Heck DA, Melfi CA, Mamlin LA, Katz BP, Arthur DS, Dittus RS, Freund DA (1998) Revision rates after knee replacement in the United States. Med Care 36:661–669

    Article  CAS  PubMed  Google Scholar 

  57. Peltola M, Järvelin J (2014) Association between household income and the outcome of arthroplasty: a register-based study of total hip and knee replacements. Arch Orthop Trauma Surg 134:1767–1774

    Article  PubMed  Google Scholar 

  58. Bass AR, Mehta B, Szymonifka J, Finik J, Lyman S, Lai EY, Parks M, Figgie M, Mandl LA, Goodman SM (2019) Racial disparities in total knee replacement failure as related to poverty. Arthritis Care Res (Hoboken) 71:1488–1494

    Article  PubMed  Google Scholar 

  59. Chisari E, Yayac M, Sherman M, Kozaily E, Courtney PM (2021) Which socioeconomic factors affect outcomes following total hip and knee arthroplasty? J Arthroplasty 36:1873–1878

    Article  PubMed  Google Scholar 

  60. Courtney PM, Huddleston JI, Iorio R, Markel DC (2017) Socioeconomic risk adjustment models for reimbursement are necessary in primary total joint arthroplasty. J Arthroplasty 32:1–5

    Article  PubMed  Google Scholar 

  61. Inneh IA (2015) The combined influence of sociodemographic, preoperative comorbid and intraoperative factors on longer length of stay after elective primary total knee arthroplasty. J Arthroplasty 30:1883–1886

    Article  PubMed  Google Scholar 

  62. Keeney BJ, Koenig KM, Paddock NG, Moschetti WE, Sparks MB, Jevsevar DS (2017) Do aggregate socioeconomic status factors predict outcomes for total knee arthroplasty in a rural population? J Arthroplasty 32:3583–3590

    Article  PubMed  PubMed Central  Google Scholar 

  63. Arias-de-la Torre J, Smith K, Dregan A, Valderas JM, Evans JP, Prieto-Alhambra D, Lozano L, Molina AJ, Martín V, Domingo L, Muñoz L, Espallargues M (2020) Impact of comorbidity on the short- and medium-term risk of revision in total hip and knee arthroplasty. BMC Musculoskelet Disord 21:447

    Article  PubMed  PubMed Central  Google Scholar 

  64. Goltz DE, Ryan SP, Howell CB, Attarian D, Bolognesi MP, Seyler TM (2019) A Weighted index of elixhauser comorbidities for predicting 90-day readmission after total joint arthroplasty. J Arthroplasty 34:857–864

    Article  PubMed  Google Scholar 

  65. Hinton ZW, Fletcher AN, Ryan SP, Wu CJ, Bolognesi MP, Seyler TM (2021) Body mass index, American society of anesthesiologists score, and elixhauser comorbidity index predict cost and delay of care during total knee arthroplasty. J Arthroplasty 36:1621–1625

    Article  PubMed  Google Scholar 

  66. Inacio MCS, Pratt NL, Roughead EE, Graves SE (2016) Evaluation of three co-morbidity measures to predict mortality in patients undergoing total joint arthroplasty. Osteoarthritis Cartilage 24:1718–1726

    Article  CAS  PubMed  Google Scholar 

  67. Ondeck NT, Fu MC, Skrip LA, McLynn RP, Su EP, Grauer JN (2018) Treatments of missing values in large national data affect conclusions: the impact of multiple imputation on arthroplasty research. J Arthroplasty 33:661–667

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    Georges J. Bounajem & Garen Collett

  2. Department of Biostatistics, Vanderbilt University, Nashville, TN, USA

    Josh DeClercq & Gregory D. Ayers

  3. Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA

    Nitin Jain

  4. UT Southwestern Medical Center at Frisco, 12500 Dallas Parkway, 3rd Floor, Orthopaedic Surgery, Frisco, TX, 75033-9071, USA

    Georges J. Bounajem

Authors
  1. Georges J. Bounajem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Josh DeClercq
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Garen Collett
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gregory D. Ayers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nitin Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georges J. Bounajem.

Ethics declarations

Conflict of interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bounajem, G.J., DeClercq, J., Collett, G. et al. Does interaction occur between risk factors for revision total knee arthroplasty?. Arch Orthop Trauma Surg (2023). https://doi.org/10.1007/s00402-023-05107-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00402-023-05107-2

Keywords

Search

Navigation