How long do revised and multiply revised knee replacements last?: A retrospective observational study of the National Joint Registry

Kevin C Deere; Michael R Whitehouse; Setor K Kunutsor; Adrian E Sayers; Andrew J Price; James Mason; Ashley W Blom

doi:10.1016/S2665-9913(21)00079-5

How long do revised and multiply revised knee replacements last? A retrospective observational study of the National Joint Registry

Kevin C Deere, Michael R Whitehouse, Setor K Kunutsor, Adrian E Sayers, Andrew J Price, James Mason, Ashley W Blom^*

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

12 Citations (Scopus)

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Abstract

Background
Knee replacements are common and effective operations but patients that undergo this intervention are at risk of needing subsequent costly and often complex revision surgery with poorer outcomes than primary surgery. The treatment pathway over the life of the patient in terms of risk of revision and re-revision(s) is poorly described. We aim to provide detailed information on the longevity of revision surgery.

Methods
This was a retrospective observational registry-based study of the National Joint Registry. Kaplan-Meier estimates were used to determine the cumulative probability of revision and subsequent re-revision(s) following primary knee replacement. Analyses were stratified by age and gender and the influence of time from first to second revision on the risk of further revision was explored.

Findings
There were 33,292 revision knee replacements with a linked primary episode. Revision rates of revision knee replacements were higher in males and younger patients. 19·9% of revisions were revised again within 13 years, 20·7% of second revisions were revised again within 5 years and 20·7% of third revisions were revised again within 3 years. A shorter time between revision episodes was associated with earlier subsequent revision.

Interpretation
Males and younger patients are at higher risk of multiple revisions. Patients who undergo a revision have steadily increasing risk of further revision the more procedures they undergo, and each subsequent revision lasts for approximately half the time of the previous one.

Funding
This study was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston National Health Service Foundation Trust and the University of Bristol. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also supported by funding from Healthcare Quality Improvement Partnership and the National Joint Registry. Posts of authors of this work are part funded by a grant from the National Joint Registry to conduct statistical analysis for the National Joint Registry. AS was funded by a Medical Research Council Strategic Skills Fellowship MR/L01226X/1.

Original language	English
Pages (from-to)	e438-e446
Journal	Lancet Rheumatology
Volume	3
Issue number	6
Early online date	29 Apr 2021
DOIs	https://doi.org/10.1016/S2665-9913(21)00079-5
Publication status	Published - Jun 2021

Bibliographical note

Funding Information:
KD, MRW, AS, and AJP are members of the National Joint registry lot 2 contract team. AJP reports personal fees from Zimmer Biomet, outside the submitted work. AWB reports being the principal investigator on a grant funded by Stryker investigating the outcome of a total knee replacement manufactured by Stryker; and being an editor of Apley & Solomon's System of Orthopaedics and Trauma 10th Edition textbook for which he receives royalty payments. MRW reports being a principal investigator on two NIHR funded grants investigating the treatment of knee cartilage defects and injections in the treatment of osteoarthritis; and is a co-applicant on a grant funded by Stryker investigating the outcome of a total knee replacement manufactured by Stryker. MRW's institution receives market rate payments for teaching on basic science and hip replacement that he delivers on courses organised by Heraeus and DePuy. MRW is also an editor of Apley & Solomon's System of Orthopaedics and Trauma 10th Edition textbook for which he receives royalty payments. KD, AS, AWB, MRW, and AJP are part funded by a grant from the National Joint Registry to conduct statistical analysis for the National Joint Registry. AS was funded by a Medical Research Council Strategic Skills Fellowship MR/L01226X/1. SKK and JM declare no competing interests.

Funding Information:
This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also supported by funding from Healthcare Quality Improvement Partnership (HQIP) and the National Joint Registry. We thank the patients and staff of all the hospitals in England, Wales and Northern Ireland who have contributed data to the National Joint Registry. We are grateful to the HQIP, the National Joint Registry Research Committee and staff at the National Joint Registry Centre for facilitating this work. The authors have conformed to the National Joint Registry's standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or the HQIP who do not vouch for how the information is presented.

Funding Information:
This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also supported by funding from Healthcare Quality Improvement Partnership (HQIP) and the National Joint Registry. We thank the patients and staff of all the hospitals in England, Wales and Northern Ireland who have contributed data to the National Joint Registry. We are grateful to the HQIP, the National Joint Registry Research Committee and staff at the National Joint Registry Centre for facilitating this work. The authors have conformed to the National Joint Registry's standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or the HQIP who do not vouch for how the information is presented.

Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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Full-text PDF (author’s accepted manuscript)
This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Elsevier at https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(21)00079-5/fulltext#:~:text=A%20pooled%20analysis%20of%20registry,rates%20following%20a%20first%20revision. . Please refer to any applicable terms of use of the publisher.
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A Sayers Pre-Doc Fellowship: 'FEMORAL: Factors affEcting MortALity, morbidity and patient outcomes after joint replacement surgery'
Sayers, A. E.
1/07/14 → 30/09/19
Project: Research

Cite this

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title = "How long do revised and multiply revised knee replacements last?: A retrospective observational study of the National Joint Registry",

abstract = "BackgroundKnee replacements are common and effective operations but patients that undergo this intervention are at risk of needing subsequent costly and often complex revision surgery with poorer outcomes than primary surgery. The treatment pathway over the life of the patient in terms of risk of revision and re-revision(s) is poorly described. We aim to provide detailed information on the longevity of revision surgery.MethodsThis was a retrospective observational registry-based study of the National Joint Registry. Kaplan-Meier estimates were used to determine the cumulative probability of revision and subsequent re-revision(s) following primary knee replacement. Analyses were stratified by age and gender and the influence of time from first to second revision on the risk of further revision was explored.FindingsThere were 33,292 revision knee replacements with a linked primary episode. Revision rates of revision knee replacements were higher in males and younger patients. 19·9% of revisions were revised again within 13 years, 20·7% of second revisions were revised again within 5 years and 20·7% of third revisions were revised again within 3 years. A shorter time between revision episodes was associated with earlier subsequent revision. InterpretationMales and younger patients are at higher risk of multiple revisions. Patients who undergo a revision have steadily increasing risk of further revision the more procedures they undergo, and each subsequent revision lasts for approximately half the time of the previous one.FundingThis study was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston National Health Service Foundation Trust and the University of Bristol. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also supported by funding from Healthcare Quality Improvement Partnership and the National Joint Registry. Posts of authors of this work are part funded by a grant from the National Joint Registry to conduct statistical analysis for the National Joint Registry. AS was funded by a Medical Research Council Strategic Skills Fellowship MR/L01226X/1. ",

author = "Deere, {Kevin C} and Whitehouse, {Michael R} and Kunutsor, {Setor K} and Sayers, {Adrian E} and Price, {Andrew J} and James Mason and Blom, {Ashley W}",

note = "Funding Information: KD, MRW, AS, and AJP are members of the National Joint registry lot 2 contract team. AJP reports personal fees from Zimmer Biomet, outside the submitted work. AWB reports being the principal investigator on a grant funded by Stryker investigating the outcome of a total knee replacement manufactured by Stryker; and being an editor of Apley & Solomon's System of Orthopaedics and Trauma 10th Edition textbook for which he receives royalty payments. MRW reports being a principal investigator on two NIHR funded grants investigating the treatment of knee cartilage defects and injections in the treatment of osteoarthritis; and is a co-applicant on a grant funded by Stryker investigating the outcome of a total knee replacement manufactured by Stryker. MRW's institution receives market rate payments for teaching on basic science and hip replacement that he delivers on courses organised by Heraeus and DePuy. MRW is also an editor of Apley & Solomon's System of Orthopaedics and Trauma 10th Edition textbook for which he receives royalty payments. KD, AS, AWB, MRW, and AJP are part funded by a grant from the National Joint Registry to conduct statistical analysis for the National Joint Registry. AS was funded by a Medical Research Council Strategic Skills Fellowship MR/L01226X/1. SKK and JM declare no competing interests. Funding Information: This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also supported by funding from Healthcare Quality Improvement Partnership (HQIP) and the National Joint Registry. We thank the patients and staff of all the hospitals in England, Wales and Northern Ireland who have contributed data to the National Joint Registry. We are grateful to the HQIP, the National Joint Registry Research Committee and staff at the National Joint Registry Centre for facilitating this work. The authors have conformed to the National Joint Registry's standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or the HQIP who do not vouch for how the information is presented. Funding Information: This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also supported by funding from Healthcare Quality Improvement Partnership (HQIP) and the National Joint Registry. We thank the patients and staff of all the hospitals in England, Wales and Northern Ireland who have contributed data to the National Joint Registry. We are grateful to the HQIP, the National Joint Registry Research Committee and staff at the National Joint Registry Centre for facilitating this work. The authors have conformed to the National Joint Registry's standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or the HQIP who do not vouch for how the information is presented. Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license",

year = "2021",

month = jun,

doi = "10.1016/S2665-9913(21)00079-5",

language = "English",

volume = "3",

pages = "e438--e446",

journal = "Lancet Rheumatology",

issn = "2665-9913",

publisher = "Elsevier",

number = "6",

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TY - JOUR

T1 - How long do revised and multiply revised knee replacements last?

T2 - A retrospective observational study of the National Joint Registry

AU - Deere, Kevin C

AU - Whitehouse, Michael R

AU - Kunutsor, Setor K

AU - Sayers, Adrian E

AU - Price, Andrew J

AU - Mason, James

AU - Blom, Ashley W

N1 - Funding Information: KD, MRW, AS, and AJP are members of the National Joint registry lot 2 contract team. AJP reports personal fees from Zimmer Biomet, outside the submitted work. AWB reports being the principal investigator on a grant funded by Stryker investigating the outcome of a total knee replacement manufactured by Stryker; and being an editor of Apley & Solomon's System of Orthopaedics and Trauma 10th Edition textbook for which he receives royalty payments. MRW reports being a principal investigator on two NIHR funded grants investigating the treatment of knee cartilage defects and injections in the treatment of osteoarthritis; and is a co-applicant on a grant funded by Stryker investigating the outcome of a total knee replacement manufactured by Stryker. MRW's institution receives market rate payments for teaching on basic science and hip replacement that he delivers on courses organised by Heraeus and DePuy. MRW is also an editor of Apley & Solomon's System of Orthopaedics and Trauma 10th Edition textbook for which he receives royalty payments. KD, AS, AWB, MRW, and AJP are part funded by a grant from the National Joint Registry to conduct statistical analysis for the National Joint Registry. AS was funded by a Medical Research Council Strategic Skills Fellowship MR/L01226X/1. SKK and JM declare no competing interests. Funding Information: This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also supported by funding from Healthcare Quality Improvement Partnership (HQIP) and the National Joint Registry. We thank the patients and staff of all the hospitals in England, Wales and Northern Ireland who have contributed data to the National Joint Registry. We are grateful to the HQIP, the National Joint Registry Research Committee and staff at the National Joint Registry Centre for facilitating this work. The authors have conformed to the National Joint Registry's standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or the HQIP who do not vouch for how the information is presented. Funding Information: This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also supported by funding from Healthcare Quality Improvement Partnership (HQIP) and the National Joint Registry. We thank the patients and staff of all the hospitals in England, Wales and Northern Ireland who have contributed data to the National Joint Registry. We are grateful to the HQIP, the National Joint Registry Research Committee and staff at the National Joint Registry Centre for facilitating this work. The authors have conformed to the National Joint Registry's standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or the HQIP who do not vouch for how the information is presented. Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

PY - 2021/6

Y1 - 2021/6

N2 - BackgroundKnee replacements are common and effective operations but patients that undergo this intervention are at risk of needing subsequent costly and often complex revision surgery with poorer outcomes than primary surgery. The treatment pathway over the life of the patient in terms of risk of revision and re-revision(s) is poorly described. We aim to provide detailed information on the longevity of revision surgery.MethodsThis was a retrospective observational registry-based study of the National Joint Registry. Kaplan-Meier estimates were used to determine the cumulative probability of revision and subsequent re-revision(s) following primary knee replacement. Analyses were stratified by age and gender and the influence of time from first to second revision on the risk of further revision was explored.FindingsThere were 33,292 revision knee replacements with a linked primary episode. Revision rates of revision knee replacements were higher in males and younger patients. 19·9% of revisions were revised again within 13 years, 20·7% of second revisions were revised again within 5 years and 20·7% of third revisions were revised again within 3 years. A shorter time between revision episodes was associated with earlier subsequent revision. InterpretationMales and younger patients are at higher risk of multiple revisions. Patients who undergo a revision have steadily increasing risk of further revision the more procedures they undergo, and each subsequent revision lasts for approximately half the time of the previous one.FundingThis study was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston National Health Service Foundation Trust and the University of Bristol. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also supported by funding from Healthcare Quality Improvement Partnership and the National Joint Registry. Posts of authors of this work are part funded by a grant from the National Joint Registry to conduct statistical analysis for the National Joint Registry. AS was funded by a Medical Research Council Strategic Skills Fellowship MR/L01226X/1.

AB - BackgroundKnee replacements are common and effective operations but patients that undergo this intervention are at risk of needing subsequent costly and often complex revision surgery with poorer outcomes than primary surgery. The treatment pathway over the life of the patient in terms of risk of revision and re-revision(s) is poorly described. We aim to provide detailed information on the longevity of revision surgery.MethodsThis was a retrospective observational registry-based study of the National Joint Registry. Kaplan-Meier estimates were used to determine the cumulative probability of revision and subsequent re-revision(s) following primary knee replacement. Analyses were stratified by age and gender and the influence of time from first to second revision on the risk of further revision was explored.FindingsThere were 33,292 revision knee replacements with a linked primary episode. Revision rates of revision knee replacements were higher in males and younger patients. 19·9% of revisions were revised again within 13 years, 20·7% of second revisions were revised again within 5 years and 20·7% of third revisions were revised again within 3 years. A shorter time between revision episodes was associated with earlier subsequent revision. InterpretationMales and younger patients are at higher risk of multiple revisions. Patients who undergo a revision have steadily increasing risk of further revision the more procedures they undergo, and each subsequent revision lasts for approximately half the time of the previous one.FundingThis study was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston National Health Service Foundation Trust and the University of Bristol. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also supported by funding from Healthcare Quality Improvement Partnership and the National Joint Registry. Posts of authors of this work are part funded by a grant from the National Joint Registry to conduct statistical analysis for the National Joint Registry. AS was funded by a Medical Research Council Strategic Skills Fellowship MR/L01226X/1.

U2 - 10.1016/S2665-9913(21)00079-5

DO - 10.1016/S2665-9913(21)00079-5

M3 - Article (Academic Journal)

C2 - 35043097

SN - 2665-9913

VL - 3

SP - e438-e446

JO - Lancet Rheumatology

JF - Lancet Rheumatology

IS - 6

ER -

How long do revised and multiply revised knee replacements last? A retrospective observational study of the National Joint Registry

Abstract

Bibliographical note

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Projects

A Sayers Pre-Doc Fellowship: 'FEMORAL: Factors affEcting MortALity, morbidity and patient outcomes after joint replacement surgery'

Cite this