Clinical Orthopaedics and Related Research®

, Volume 472, Issue 1, pp 232–237 | Cite as

Risk Factors for Early Revision After Primary TKA in Medicare Patients

  • Kevin J. Bozic
  • Edmund Lau
  • Kevin Ong
  • Vanessa Chan
  • Steven Kurtz
  • Thomas P. Vail
  • Harry E. Rubash
  • Daniel J. Berry
Symposium: 2013 Knee Society Proceedings

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.

References

  1. 1.
    Baker PN, Deehan DJ, Lees D, Jameson S, Avery PJ, Gregg PJ, Reed MR. The effect of surgical factors on early patient-reported outcome measures (PROMS) following total knee replacement. J Bone Joint Surg Br. 2012;94:1058–1066.PubMedCrossRefGoogle Scholar
  2. 2.
    Bozic KJ, Bashyal RK, Anthony SG, Chiu V, Shulman B, Rubash HE. Is administratively coded comorbidity and complication data in total joint arthroplasty valid? Clin Orthop Relat Res. 2013;471:201–205.PubMedCrossRefGoogle Scholar
  3. 3.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468:45–51.PubMedCrossRefGoogle Scholar
  4. 4.
    Bozic KJ, Lau E, Kurtz S, Ong K, Berry DJ. Patient-related risk factors for postoperative mortality and periprosthetic joint infection in Medicare patients undergoing TKA. Clin Orthop Relat Res. 2012;470:130–137.PubMedCrossRefGoogle Scholar
  5. 5.
    Centers for Medicare & Medicaid Services (CMS) Medicare and Medicaid programs: hospital outpatient prospective payment; ambulatory surgical center payment; hospital value-based purchasing program; physician self-referral; and patient notification requirements in provider agreements. Final rule with comment period. Fed Regist. 2011;76:74122–74584.Google Scholar
  6. 6.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.PubMedCrossRefGoogle Scholar
  7. 7.
    Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.PubMedCrossRefGoogle Scholar
  8. 8.
    Gioe TJ, Novak C, Sinner P, Ma W, Mehle S. Knee arthroplasty in the young patient: survival in a community registry. Clin Orthop Relat Res. 2007;464:83–87.PubMedGoogle Scholar
  9. 9.
    Goroll AH, Schoenbaum SC. Payment reform for primary care within the accountable care organization: a critical issue for health system reform. JAMA. 2012;308:577–578.PubMedCrossRefGoogle Scholar
  10. 10.
    Harris WH, Sledge CB. Total hip and total knee replacement. N Engl J Med. 1990;323:725–731.PubMedCrossRefGoogle Scholar
  11. 11.
    Heck DA, Melfi CA, Mamlin LA, Katz BP, Arthur DS, Dittus RS, Freund DA. Revision rates after knee replacement in the United States. Med Care. 1998;36:661–669.PubMedCrossRefGoogle Scholar
  12. 12.
    Hernandez-Vaquero D, Fernandez-Carreira JM, Perez-Hernandez D, Fernandez-Lombardia J, Garcia-Sandoval MA. Total knee arthroplasty in the elderly. Is there an age limit? J Arthroplasty. 2006;21:358–361.PubMedCrossRefGoogle Scholar
  13. 13.
    Kapadia BH, Johnson AJ, Naziri Q, Mont MA, Delanois RE, Bonutti PM. Increased revision rates after total knee arthroplasty in patients who smoke. J Arthroplasty. 2012;27:1690–1695.e1691.Google Scholar
  14. 14.
    Kurtz SM, Ong KL, Schmier J, Mowat F, Saleh K, Dybvik E, Karrholm J, Garellick G, Havelin LI, Furnes O, Malchau H, Lau E. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am. 2007;89(Suppl 3):144–151.PubMedCrossRefGoogle Scholar
  15. 15.
    Maloney WJ. National Joint Replacement Registries: has the time come? J Bone Joint Surg Am. 2001;83:1582–1585.PubMedGoogle Scholar
  16. 16.
    Mortazavi SM, Schwartzenberger J, Austin MS, Purtill JJ, Parvizi J. Revision total knee arthroplasty infection: incidence and predictors. Clin Orthop Relat Res. 2010;468:2052–2059.PubMedCrossRefGoogle Scholar
  17. 17.
    Ong KL, Lau E, Suggs J, Kurtz SM, Manley MT. Risk of subsequent revision after primary and revision total joint arthroplasty. Clin Orthop Relat Res. 2010;468:3070–3076.PubMedCrossRefGoogle Scholar
  18. 18.
    Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008;466:1710–1715.PubMedCrossRefGoogle Scholar
  19. 19.
    Saleh KJ, Santos ER, Ghomrawi HM, Parvizi J, Mulhall KJ. Socioeconomic issues and demographics of total knee arthroplasty revision. Clin Orthop Relat Res. 2006;446:15–21.PubMedCrossRefGoogle Scholar
  20. 20.
    Sheng PY, Konttinen L, Lehto M, Ogino D, Jamsen E, Nevalainen J, Pajamaki J, Halonen P, Konttinen YT. Revision total knee arthroplasty: 1990 through 2002. A review of the Finnish arthroplasty registry. J Bone Joint Surg Am. 2006;88:1425–1430.Google Scholar
  21. 21.
    VanLare JM, Conway PH. Value-based purchasing—national programs to move from volume to value. N Engl J Med. 2012;367:292–295.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Kevin J. Bozic
    • 1
    • 2
  • Edmund Lau
    • 3
  • Kevin Ong
    • 4
  • Vanessa Chan
    • 1
    • 2
  • Steven Kurtz
    • 4
  • Thomas P. Vail
    • 1
  • Harry E. Rubash
    • 5
  • Daniel J. Berry
    • 6
  1. 1.Department of Orthopaedic SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Philip R. Lee Institute for Health Policy StudiesUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Exponent, IncMenlo ParkUSA
  4. 4.Exponent, IncPhiladelphiaUSA
  5. 5.Department of Orthopaedic SurgeryMassachusetts General HospitalBostonUSA
  6. 6.Department of Orthopaedic SurgeryMayo ClinicRochesterUSA

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