Predictors of mid-late term revision of knee replacement: A nation-wide retrospective cohort study (UK SAFE)

Judge, Andrew; Garriga-Fuentes, Cesar; Smith, Lindsay; Porter, Martin; Pinedo-Villanueva, Rafael; Arden, Nigel; Conaghan, Philip

Abstract

Objective: Identify patients likely to require mid-late revision of knee replacement (KR) to inform targeted follow-up.

Methods: Setting: Primary care using Clinical Practice Research Datalink (CPRD) data and secondary care using National Joint Registry (NJR) data linked to English Hospital Episode Statistics (HES) and Patient Reported Outcome Measures (PROMs). Patients: Primary elective KRs aged ≥18. Event of interest: Revision surgery ≥5 years after primary. Statistical methods: Cox regression modelling to ascertain influential factors of mid-late term revision. Hazard ratios (HR) and 95% confidence intervals (CI) assessed association of sociodemographic factors, comorbidities, medication, surgical variables and PROMs with mid-late term revision.

Results: NJR-HES-PROMs data was available from 2008-2011 on 188,509 KR. CPRD-HES data covered 1995-2011 on 17,378 KR. Patients had minimum 5-years post primary surgery to end 2016. Age and gender distribution were similar across datasets; mean age 70 years, 57% female. In NJR there were 8607 (4.6%) revisions, median time-to-revision 1.8 years (range 0-8.8), with 1,055 (0.6%) mid-late term revisions. In CPRD 877 (5.1%) revisions, median time-to-revision 4.2 years (range 0.02-18.3), with 352 (2.0%) mid-late term revisions. Older age was related to significantly lower revision after 5 years (HR: 0.95; 95% CI: 0.95-0.96); male gender increased risk of revision (1.32; 1.04-1.67). Obesity (0.78; 0.64- 0.96), living in deprived areas (0.76; 0.62-0.93), and non-white ethnicity (0.63; 0.47-0.84) were associated with reduced mid-late revision. No implant factors were identified. Patients with less pain and functional limitation at primary surgery (0.29; 0.23-0.36), or moderate anxiety/depression (0.80; 0.70-0.92) had reduced risk for mid-late term revision. Risk was increased when anticonvulsants (gabapentin, pregabalin) (1.58; 1.01-2.47) and opioids (1.36; 1.08-1.71) were required prior to primary surgery.

Conclusion: There appears to be evidence of sociodemographic inequality in mid-late revision KR. Patient case-mix factors for increased risk of revision surgery indicate those requiring closer monitoring for extended follow-up.

• Presentation Conference Type: Conference Paper (published)
• Conference Name: British Orthopaedic Association Annual Congress 2020
• Start Date: Sep 14, 2020
• End Date: Sep 25, 2020
• Acceptance Date: Aug 24, 2020
• Online Publication Date: Sep 25, 2020
• Publication Date: Sep 25, 2020
• Deposit Date: Jun 21, 2021
• Public URL: https://uwe-repository.worktribe.com/output/6814457
• Publisher URL: https://www.boa.ac.uk/abstracts2020.html
• Additional Information: BOA Virtual Congress 2020/Abstracts/Knee/Accepted Abstracts: 697