Influence of age on knee replacement selection and outcomes
<p>Knee replacement is a very successful procedure and implantation rates continue to increase. Due to the success of the intervention the indications have been stretched to include patients historically considered too young and too old. Accusations of designer centre bias are used by some to...
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| Format: | Thesis |
| Language: | English |
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2019
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| _version_ | 1811141157333237760 |
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| author | Kennedy, J |
| author2 | Murray, D |
| author_facet | Murray, D Kennedy, J |
| author_sort | Kennedy, J |
| collection | OXFORD |
| description | <p>Knee replacement is a very successful procedure and implantation rates continue to increase. Due to the success of the intervention the indications have been stretched to include patients historically considered too young and too old. Accusations of designer centre bias are used by some to explain discrepancies between national register outcome data and cohort data. This thesis examines the influence of age on selection and outcome for different types of knee replacement and attempts to untangle designer centre bias. </p>
<p>The first section of this thesis examines the influence of age on selection of patients for partial and total knee replacement using a combination of designer and non-designer centres. In patients sufficiently symptomatic to be offered replacement, about half of patients are eligible for partial replacement, with younger patients more likely to be eligible for medial replacement whilst older patients are more eligible for total replacement. The eligibility for partial replacement is far higher than current national usage in all age groups. </p>
<p>Outcomes following partial replacement were examined in designer and non-designer centres and found to be excellent in all age groups and did not vary significantly with age, or between centres. In particular revision rates for those under 55 years of age were found to be lower than that seen for total replacement. A finding strongly contrasting with national registers.</p>
<p>Finally, comparisons were undertaken for outcomes between partial and total replacement of the knee. In a matched comparison, partial replacement had better function and similar implant survival to total. Lifetime revision risk was determined using novel methodology, and was found to be similar in older age groups, but lower in younger age groups (<60 years) with partial replacement.</p>
<p>This thesis has not examined the use of partial replacement in early arthritis, and comparisons with total replacement may be confounded by indication. Possible explanations for the discrepant findings to registers include the use of partial replacement as a ‘pre-total replacement’ in young patients. Further work should examine morbidity and mortality benefits against revision risk in older patients alone (as opposed to all age groups combined). </p>
<p>In conclusion, this thesis rejects ‘designer’ bias, and supports the use of partial replacement in the severely arthritic knee in all age groups, provided appropriate indications are followed, and surgeons have appropriate expertise. </p>
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| first_indexed | 2024-03-06T23:07:08Z |
| format | Thesis |
| id | oxford-uuid:643c2cea-fbe4-44f8-8d7d-de714bb8c617 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-09-25T04:33:25Z |
| publishDate | 2019 |
| record_format | dspace |
| spelling | oxford-uuid:643c2cea-fbe4-44f8-8d7d-de714bb8c6172024-09-10T08:06:54ZInfluence of age on knee replacement selection and outcomesThesishttp://purl.org/coar/resource_type/c_db06uuid:643c2cea-fbe4-44f8-8d7d-de714bb8c617OsteoarthritisKnee replacementEnglishHyrax Deposit2019Kennedy, JMurray, DMellon, S<p>Knee replacement is a very successful procedure and implantation rates continue to increase. Due to the success of the intervention the indications have been stretched to include patients historically considered too young and too old. Accusations of designer centre bias are used by some to explain discrepancies between national register outcome data and cohort data. This thesis examines the influence of age on selection and outcome for different types of knee replacement and attempts to untangle designer centre bias. </p> <p>The first section of this thesis examines the influence of age on selection of patients for partial and total knee replacement using a combination of designer and non-designer centres. In patients sufficiently symptomatic to be offered replacement, about half of patients are eligible for partial replacement, with younger patients more likely to be eligible for medial replacement whilst older patients are more eligible for total replacement. The eligibility for partial replacement is far higher than current national usage in all age groups. </p> <p>Outcomes following partial replacement were examined in designer and non-designer centres and found to be excellent in all age groups and did not vary significantly with age, or between centres. In particular revision rates for those under 55 years of age were found to be lower than that seen for total replacement. A finding strongly contrasting with national registers.</p> <p>Finally, comparisons were undertaken for outcomes between partial and total replacement of the knee. In a matched comparison, partial replacement had better function and similar implant survival to total. Lifetime revision risk was determined using novel methodology, and was found to be similar in older age groups, but lower in younger age groups (<60 years) with partial replacement.</p> <p>This thesis has not examined the use of partial replacement in early arthritis, and comparisons with total replacement may be confounded by indication. Possible explanations for the discrepant findings to registers include the use of partial replacement as a ‘pre-total replacement’ in young patients. Further work should examine morbidity and mortality benefits against revision risk in older patients alone (as opposed to all age groups combined). </p> <p>In conclusion, this thesis rejects ‘designer’ bias, and supports the use of partial replacement in the severely arthritic knee in all age groups, provided appropriate indications are followed, and surgeons have appropriate expertise. </p> |
| spellingShingle | Osteoarthritis Knee replacement Kennedy, J Influence of age on knee replacement selection and outcomes |
| title | Influence of age on knee replacement selection and outcomes |
| title_full | Influence of age on knee replacement selection and outcomes |
| title_fullStr | Influence of age on knee replacement selection and outcomes |
| title_full_unstemmed | Influence of age on knee replacement selection and outcomes |
| title_short | Influence of age on knee replacement selection and outcomes |
| title_sort | influence of age on knee replacement selection and outcomes |
| topic | Osteoarthritis Knee replacement |
| work_keys_str_mv | AT kennedyj influenceofageonkneereplacementselectionandoutcomes |