Estimating an Individual's Probability of Revision Surgery After Knee Replacement: A Comparison of Modeling Approaches Using a National Dataset

Parham Aram, Lea Trela-Larsen, Adrian Sayers, Andrew Hills, Ashley Blom, Eugene McCloskey, Visakan Kadirkamanathan, Jeremy M. Wilkinson

Research output: Contribution to journalArticle (Academic Journal)peer-review

5 Citations (Scopus)
323 Downloads (Pure)

Abstract

Tools that provide personalized risk prediction of the outcomes after surgical procedures help patients to make preference-based decisions amongst the available treatment options. However, it is unclear which modeling approach provides the most accurate risk estimation. We constructed and compared several parametric and non-parametric models for predicting prosthesis survivorship after knee replacement surgery for osteoarthritis. We used 430,455 patient-procedure episodes between April 2003 and September 2015 from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. The flexible parametric survival and random survival forest models most accurately captured the observed probability of remaining event-free. The concordance index for the flexible parametric model was the highest (0.705; 95% confidence interval: 0.702, 0.707) for total knee replacement, 0.639 (95% confidence interval: 0.634, 0.643) for unicondylar knee replacement and 0.589 (95% confidence interval: 0.586, 0.592) for patellofemoral replacement. The observed-to-predicted ratios for both the flexible parametric and the random survival forest approaches indicated that models tended to underestimate the risks for most risk groups. Our results show that the flexible parametric model has a better overall performance compared to other tested parametric methods, and better discrimination compared to the random survival forest approach.
Original languageEnglish
Article numberkwy121
Number of pages11
JournalAmerican Journal of Epidemiology
Early online date11 Jun 2018
DOIs
Publication statusE-pub ahead of print - 11 Jun 2018

Structured keywords

  • Centre for Surgical Research

Keywords

  • knee replacement
  • revision surgery
  • time-to-event analysis
  • random survival forest
  • flexible parametric survival model
  • parametric survival model
  • calibration
  • discrimination

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