Clinical Orthopaedics and Related Research®

, Volume 472, Issue 4, pp 1198–1207 | Cite as

Risk Factors for Revision Within 10 Years of Total Knee Arthroplasty

  • Christopher J. Dy
  • Robert G. Marx
  • Kevin J. Bozic
  • Ting Jung Pan
  • Douglas E. Padgett
  • Stephen Lyman
Clinical Research

Abstract

Background

An in-depth understanding of risk factors for revision TKA is needed to minimize the burden of revision surgery. Previous studies indicate that hospital and community characteristics may influence outcomes after TKA, but a detailed investigation in a diverse population is warranted to identify opportunities for quality improvement.

Questions/purposes

We asked: (1) What is the frequency of revision TKA within 10 years of primary arthroplasty? (2) Which patient demographic factors are associated with revision within 10 years of TKA? (3) Which community and institutional characteristics are associated with revision within 10 years of TKA?

Methods

We identified 301,955 patients who underwent primary TKAs in New York or California from 1997 to 2005 from statewide databases. Identifier codes were used to determine whether they underwent revision TKA. Patient, community, and hospital characteristics were analyzed using multivariable regression modeling to determine predictors for revision.

Results

The frequency of revision was 4.0% at 5 years after the index arthroplasty and 8.9% at 9-years. Patients between 50 and 75 years old had a lower risk of revision than patients younger than 50 years (hazard ratio [HR], 0.47; 95% CI, 0.44, 0.50). Black patients were at increased risk for needing revision surgery (HR, 1.39; 95% CI, 1.29, 1.49) after adjustment for insurance type, poverty level, and education. Women (HR, 0.82; 95% CI, 0.79, 0.86) and Medicare recipients (HR, 0.82; 95% CI, 0.79, 0.86) were less likely to undergo revision surgery, whereas those from the most educated (HR, 1.09; 95% CI, 1.02, 1.16) and the poorest communities (HR, 1.08; 95% CI, 1.01, 1.15) had modest increases in risk of revision. Mid-volume hospitals (200–400 annual cases) had a reduction of early revision (HR, 0.91; 95% CI, 0.83, 0.99) compared with those performing less than 200 cases annually, whereas higher-volume hospitals (greater than 400 cases) showed little effect compared with low-volume hospitals.

Conclusions

Patient, community, and institutional characteristics affect the risk for revision within 10 years of index TKA. These data can be used to develop process improvement and implant surveillance strategies among high-risk patients.

Level of Evidence

Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Notes

Acknowledgments

We thank Timothy Wright PhD, Hospital for Special Surgery, New York, NY, for guidance in the development of the research questions and scientific approach, and Huong Do MA, Hospital for Special Surgery, New York, NY, for assistance with preparation of the data for further analysis.

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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Christopher J. Dy
    • 1
    • 2
  • Robert G. Marx
    • 1
  • Kevin J. Bozic
    • 3
  • Ting Jung Pan
    • 2
  • Douglas E. Padgett
    • 1
  • Stephen Lyman
    • 2
  1. 1.Department of Orthopaedic SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.Epidemiology and Biostatistics CoreHospital for Special SurgeryNew YorkUSA
  3. 3.Department of Orthopaedic Surgery and Philip R. Lee Institute for Health Policy StudiesUniversity of California San FranciscoSan FranciscoUSA

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