Does changes in unicompartmental knee arthroplasty practice pattern influence reasons for revision?: a study of 9,639 cases
Aims: The aim of this study was to describe the pattern of revision indications for unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) and any change to this pattern for UKA patients over the last 20 years, and to investigate potential associations to changes in surgical prac...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2023-12-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.412.BJO-2023-0096.R1 |
| _version_ | 1797383241381969920 |
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| author | Mette Mikkelsen Lasse E. Rasmussen Andrew Price Alma B. Pedersen Kirill Gromov Anders Troelsen |
| author_facet | Mette Mikkelsen Lasse E. Rasmussen Andrew Price Alma B. Pedersen Kirill Gromov Anders Troelsen |
| author_sort | Mette Mikkelsen |
| collection | DOAJ |
| description | Aims: The aim of this study was to describe the pattern of revision indications for unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) and any change to this pattern for UKA patients over the last 20 years, and to investigate potential associations to changes in surgical practice over time. Methods: All primary knee arthroplasty surgeries performed due to primary osteoarthritis and their revisions reported to the Danish Knee Arthroplasty Register from 1997 to 2017 were included. Complex surgeries were excluded. The data was linked to the National Patient Register and the Civil Registration System for comorbidity, mortality, and emigration status. TKAs were propensity score matched 4:1 to UKAs. Revision risks were compared using competing risk Cox proportional hazard regression with a shared γ frailty component. Results: Aseptic loosening (loosening) was the most common revision indication for both UKA (26.7%) and TKA (29.5%). Pain and disease progression accounted for 54.6% of the remaining UKA revisions. Infections and instability accounted for 56.1% of the remaining TKA revision. The incidence of revision due to loosening or pain decreased over the last decade, being the second and third least common indications in 2017. There was a decrease associated with fixation method for pain (hazard ratio (HR) 0.40; 95% confidence interval (CI) 0.17 to 0.94) and loosening (HR 0.29; 95% CI 0.10 to 0.81) for cementless compared to cemented, and units UKA usage for pain (HR 0.67, 95% CI 0.50 to 0.91), and loosening (HR 0.51; 95% CI 0.37 to 0.70) for high usage. Conclusion: The overall revision patterns for UKA and TKA for the last 20 years are comparable to previous published patterns. We found large changes to UKA revision patterns in the last decade, and with the current surgical practice, revision due to pain or loosening are significantly less likely. Cite this article: Bone Jt Open 2023;4(12):923–931. |
| first_indexed | 2024-03-08T21:18:05Z |
| format | Article |
| id | doaj.art-208c9b1f5f694fc49d89eef8bf561048 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-03-08T21:18:05Z |
| publishDate | 2023-12-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-208c9b1f5f694fc49d89eef8bf5610482023-12-21T12:27:35ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622023-12-0141292393110.1302/2633-1462.412.BJO-2023-0096.R1Does changes in unicompartmental knee arthroplasty practice pattern influence reasons for revision?: a study of 9,639 casesMette Mikkelsen0https://orcid.org/0000-0002-1189-1633Lasse E. Rasmussen1Andrew Price2Alma B. Pedersen3https://orcid.org/0000-0002-3288-9401Kirill Gromov4https://orcid.org/0000-0002-8114-5193Anders Troelsen5https://orcid.org/0000-0003-0132-8182Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre, DenmarkDepartment of Orthopedic Surgery, Vejle Hospital, Vejle, DenmarkNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UKDepartment of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, DenmarkDepartment of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre, DenmarkDepartment of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre, DenmarkAims: The aim of this study was to describe the pattern of revision indications for unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) and any change to this pattern for UKA patients over the last 20 years, and to investigate potential associations to changes in surgical practice over time. Methods: All primary knee arthroplasty surgeries performed due to primary osteoarthritis and their revisions reported to the Danish Knee Arthroplasty Register from 1997 to 2017 were included. Complex surgeries were excluded. The data was linked to the National Patient Register and the Civil Registration System for comorbidity, mortality, and emigration status. TKAs were propensity score matched 4:1 to UKAs. Revision risks were compared using competing risk Cox proportional hazard regression with a shared γ frailty component. Results: Aseptic loosening (loosening) was the most common revision indication for both UKA (26.7%) and TKA (29.5%). Pain and disease progression accounted for 54.6% of the remaining UKA revisions. Infections and instability accounted for 56.1% of the remaining TKA revision. The incidence of revision due to loosening or pain decreased over the last decade, being the second and third least common indications in 2017. There was a decrease associated with fixation method for pain (hazard ratio (HR) 0.40; 95% confidence interval (CI) 0.17 to 0.94) and loosening (HR 0.29; 95% CI 0.10 to 0.81) for cementless compared to cemented, and units UKA usage for pain (HR 0.67, 95% CI 0.50 to 0.91), and loosening (HR 0.51; 95% CI 0.37 to 0.70) for high usage. Conclusion: The overall revision patterns for UKA and TKA for the last 20 years are comparable to previous published patterns. We found large changes to UKA revision patterns in the last decade, and with the current surgical practice, revision due to pain or loosening are significantly less likely. Cite this article: Bone Jt Open 2023;4(12):923–931.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.412.BJO-2023-0096.R1unicompartmental knee arthroplastyosteoartheritisknee replacementrevisionimplant survivalrevision indicationanteromedial osteoartheritisunicompartmental knee arthroplasty (uka)total knee arthroplasty (tka)propensity score matchingcomorbiditiesinfectionsprimary knee arthroplasty surgeriesfrailtycox proportional hazard regressionarthroplasty registerrevision tkas |
| spellingShingle | Mette Mikkelsen Lasse E. Rasmussen Andrew Price Alma B. Pedersen Kirill Gromov Anders Troelsen Does changes in unicompartmental knee arthroplasty practice pattern influence reasons for revision?: a study of 9,639 cases Bone & Joint Open unicompartmental knee arthroplasty osteoartheritis knee replacement revision implant survival revision indication anteromedial osteoartheritis unicompartmental knee arthroplasty (uka) total knee arthroplasty (tka) propensity score matching comorbidities infections primary knee arthroplasty surgeries frailty cox proportional hazard regression arthroplasty register revision tkas |
| title | Does changes in unicompartmental knee arthroplasty practice pattern influence reasons for revision?: a study of 9,639 cases |
| title_full | Does changes in unicompartmental knee arthroplasty practice pattern influence reasons for revision?: a study of 9,639 cases |
| title_fullStr | Does changes in unicompartmental knee arthroplasty practice pattern influence reasons for revision?: a study of 9,639 cases |
| title_full_unstemmed | Does changes in unicompartmental knee arthroplasty practice pattern influence reasons for revision?: a study of 9,639 cases |
| title_short | Does changes in unicompartmental knee arthroplasty practice pattern influence reasons for revision?: a study of 9,639 cases |
| title_sort | does changes in unicompartmental knee arthroplasty practice pattern influence reasons for revision a study of 9 639 cases |
| topic | unicompartmental knee arthroplasty osteoartheritis knee replacement revision implant survival revision indication anteromedial osteoartheritis unicompartmental knee arthroplasty (uka) total knee arthroplasty (tka) propensity score matching comorbidities infections primary knee arthroplasty surgeries frailty cox proportional hazard regression arthroplasty register revision tkas |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.412.BJO-2023-0096.R1 |
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