Patients Receiving A Primary Unicompartmental Knee Replacement Have A Higher Risk Of Revision But A Lower Risk Of Mortality Than Predicted Had They Received A Total Knee Replacement: Data From The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

Linda P Hunt; Ashley W Blom; Gulraj Matharu; Setor K Kunutsor; Andrew D Beswick; J Mark Wilkinson; Michael R Whitehouse

doi:10.1016/j.arth.2020.08.063

Patients Receiving A Primary Unicompartmental Knee Replacement Have A Higher Risk Of Revision But A Lower Risk Of Mortality Than Predicted Had They Received A Total Knee Replacement: Data From The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

Linda P Hunt, Ashley W Blom, Gulraj Matharu^*, Setor K Kunutsor, Andrew D Beswick, J Mark Wilkinson, Michael R Whitehouse

^*Corresponding author for this work

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

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Abstract

Background
To determine unicompartmental (UKR) and total knee replacement (TKR) revision rates, compare UKR revision rates with what they would have been had they received TKR instead, subsequent re-revision and 90-day mortality rates.

Methods
Using National Joint Registry data, we estimated UKR and TKR revision and mortality rates. Flexible Parametric Survival modelling (FPM) was used to model failure in TKR and make estimates for UKR. Kaplan-Meier estimates were used to compare cumulative re-revision for revised UKRs and TKRs.

Results
10-year UKR revision rates were 2.5-times higher than expected from TKR, equivalent to 70 excess revisions/1,000 cases within 10-years (5,861 excess revisions in this cohort). Revision rates were 2.5 times higher for the highest quartile volume UKR surgeons compared to the same quartile for TKR, and 3.9 times higher for the lowest quartiles respectively. Re-revision rates of revised TKRs (10-years=17.5%; 95%CI=16.4,18.7) were similar to revised UKRs (15.2%; 95%CI=13.4,17.1) and higher than revision rates following primary TKR (3.3%, 95%CI=3.1,3.5). 90-day mortality rates were lower after UKR compared with TKR (0.08% vs. 0.33%) and lower than predicted had UKR patients received a TKR (0.18%), equivalent to 1 fewer death per 1,000 cases.

Conclusions
UKR revision rates were substantially higher than TKR even when demographics and caseload differences were accounted for, however fewer deaths occur after UKR. This should be considered when forming treatment guidelines and commissioning services. Re-revision rates were similar between revised UKRs and TKRs, but considerably higher than for primary TKR, therefore UKR cannot be considered an intermediate procedure.

Original language	English
Pages (from-to)	471-477.e6
Number of pages	7
Journal	Journal of Arthroplasty
Volume	36
Issue number	2
Early online date	7 Sept 2020
DOIs	https://doi.org/10.1016/j.arth.2020.08.063
Publication status	Published - 1 Feb 2021

Bibliographical note

Funding Information:
Funding: This article presents independent research funded by the Healthcare Quality Improvement Partnership , National Joint Registry , and by grant 20894 from Arthritis Research UK. This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health and Social Care. The funder had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript beyond the contribution of the listed co-authors.

Funding Information:
Funding: This article presents independent research funded by the Healthcare Quality Improvement Partnership, National Joint Registry, and by grant 20894 from Arthritis Research UK. This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health and Social Care. The funder had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript beyond the contribution of the listed co-authors.

Publisher Copyright:
© 2020 Elsevier Inc.

Keywords

outcomes
mortality
revision rates
total knee replacement
unicompartmental knee

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Hunt, L. P., Blom, A. W., Matharu, G., Kunutsor, S. K., Beswick, A. D., Wilkinson, J. M., & Whitehouse, M. R. (2021). Patients Receiving A Primary Unicompartmental Knee Replacement Have A Higher Risk Of Revision But A Lower Risk Of Mortality Than Predicted Had They Received A Total Knee Replacement: Data From The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Journal of Arthroplasty, 36(2), 471-477.e6. https://doi.org/10.1016/j.arth.2020.08.063

Hunt, Linda P ; Blom, Ashley W ; Matharu, Gulraj et al. / Patients Receiving A Primary Unicompartmental Knee Replacement Have A Higher Risk Of Revision But A Lower Risk Of Mortality Than Predicted Had They Received A Total Knee Replacement : Data From The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. In: Journal of Arthroplasty. 2021 ; Vol. 36, No. 2. pp. 471-477.e6.

@article{41ced850da514c35a8c1d85b4a3ff49b,

title = "Patients Receiving A Primary Unicompartmental Knee Replacement Have A Higher Risk Of Revision But A Lower Risk Of Mortality Than Predicted Had They Received A Total Knee Replacement: Data From The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man",

abstract = "BackgroundTo determine unicompartmental (UKR) and total knee replacement (TKR) revision rates, compare UKR revision rates with what they would have been had they received TKR instead, subsequent re-revision and 90-day mortality rates.MethodsUsing National Joint Registry data, we estimated UKR and TKR revision and mortality rates. Flexible Parametric Survival modelling (FPM) was used to model failure in TKR and make estimates for UKR. Kaplan-Meier estimates were used to compare cumulative re-revision for revised UKRs and TKRs.Results10-year UKR revision rates were 2.5-times higher than expected from TKR, equivalent to 70 excess revisions/1,000 cases within 10-years (5,861 excess revisions in this cohort). Revision rates were 2.5 times higher for the highest quartile volume UKR surgeons compared to the same quartile for TKR, and 3.9 times higher for the lowest quartiles respectively. Re-revision rates of revised TKRs (10-years=17.5%; 95%CI=16.4,18.7) were similar to revised UKRs (15.2%; 95%CI=13.4,17.1) and higher than revision rates following primary TKR (3.3%, 95%CI=3.1,3.5). 90-day mortality rates were lower after UKR compared with TKR (0.08% vs. 0.33%) and lower than predicted had UKR patients received a TKR (0.18%), equivalent to 1 fewer death per 1,000 cases.ConclusionsUKR revision rates were substantially higher than TKR even when demographics and caseload differences were accounted for, however fewer deaths occur after UKR. This should be considered when forming treatment guidelines and commissioning services. Re-revision rates were similar between revised UKRs and TKRs, but considerably higher than for primary TKR, therefore UKR cannot be considered an intermediate procedure.",

keywords = "outcomes, mortality, revision rates, total knee replacement, unicompartmental knee",

author = "Hunt, {Linda P} and Blom, {Ashley W} and Gulraj Matharu and Kunutsor, {Setor K} and Beswick, {Andrew D} and Wilkinson, {J Mark} and Whitehouse, {Michael R}",

note = "Funding Information: Funding: This article presents independent research funded by the Healthcare Quality Improvement Partnership , National Joint Registry , and by grant 20894 from Arthritis Research UK. This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health and Social Care. The funder had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript beyond the contribution of the listed co-authors. Funding Information: Funding: This article presents independent research funded by the Healthcare Quality Improvement Partnership, National Joint Registry, and by grant 20894 from Arthritis Research UK. This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health and Social Care. The funder had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript beyond the contribution of the listed co-authors. Publisher Copyright: {\textcopyright} 2020 Elsevier Inc.",

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language = "English",

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Hunt, LP, Blom, AW, Matharu, G, Kunutsor, SK, Beswick, AD, Wilkinson, JM & Whitehouse, MR 2021, 'Patients Receiving A Primary Unicompartmental Knee Replacement Have A Higher Risk Of Revision But A Lower Risk Of Mortality Than Predicted Had They Received A Total Knee Replacement: Data From The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man', Journal of Arthroplasty, vol. 36, no. 2, pp. 471-477.e6. https://doi.org/10.1016/j.arth.2020.08.063

Patients Receiving A Primary Unicompartmental Knee Replacement Have A Higher Risk Of Revision But A Lower Risk Of Mortality Than Predicted Had They Received A Total Knee Replacement: Data From The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. / Hunt, Linda P; Blom, Ashley W; Matharu, Gulraj et al.
In: Journal of Arthroplasty, Vol. 36, No. 2, 01.02.2021, p. 471-477.e6.

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

TY - JOUR

T1 - Patients Receiving A Primary Unicompartmental Knee Replacement Have A Higher Risk Of Revision But A Lower Risk Of Mortality Than Predicted Had They Received A Total Knee Replacement

T2 - Data From The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

AU - Hunt, Linda P

AU - Blom, Ashley W

AU - Matharu, Gulraj

AU - Kunutsor, Setor K

AU - Beswick, Andrew D

AU - Wilkinson, J Mark

AU - Whitehouse, Michael R

N1 - Funding Information: Funding: This article presents independent research funded by the Healthcare Quality Improvement Partnership , National Joint Registry , and by grant 20894 from Arthritis Research UK. This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health and Social Care. The funder had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript beyond the contribution of the listed co-authors. Funding Information: Funding: This article presents independent research funded by the Healthcare Quality Improvement Partnership, National Joint Registry, and by grant 20894 from Arthritis Research UK. This study was supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health and Social Care. The funder had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript beyond the contribution of the listed co-authors. Publisher Copyright: © 2020 Elsevier Inc.

PY - 2021/2/1

Y1 - 2021/2/1

N2 - BackgroundTo determine unicompartmental (UKR) and total knee replacement (TKR) revision rates, compare UKR revision rates with what they would have been had they received TKR instead, subsequent re-revision and 90-day mortality rates.MethodsUsing National Joint Registry data, we estimated UKR and TKR revision and mortality rates. Flexible Parametric Survival modelling (FPM) was used to model failure in TKR and make estimates for UKR. Kaplan-Meier estimates were used to compare cumulative re-revision for revised UKRs and TKRs.Results10-year UKR revision rates were 2.5-times higher than expected from TKR, equivalent to 70 excess revisions/1,000 cases within 10-years (5,861 excess revisions in this cohort). Revision rates were 2.5 times higher for the highest quartile volume UKR surgeons compared to the same quartile for TKR, and 3.9 times higher for the lowest quartiles respectively. Re-revision rates of revised TKRs (10-years=17.5%; 95%CI=16.4,18.7) were similar to revised UKRs (15.2%; 95%CI=13.4,17.1) and higher than revision rates following primary TKR (3.3%, 95%CI=3.1,3.5). 90-day mortality rates were lower after UKR compared with TKR (0.08% vs. 0.33%) and lower than predicted had UKR patients received a TKR (0.18%), equivalent to 1 fewer death per 1,000 cases.ConclusionsUKR revision rates were substantially higher than TKR even when demographics and caseload differences were accounted for, however fewer deaths occur after UKR. This should be considered when forming treatment guidelines and commissioning services. Re-revision rates were similar between revised UKRs and TKRs, but considerably higher than for primary TKR, therefore UKR cannot be considered an intermediate procedure.

AB - BackgroundTo determine unicompartmental (UKR) and total knee replacement (TKR) revision rates, compare UKR revision rates with what they would have been had they received TKR instead, subsequent re-revision and 90-day mortality rates.MethodsUsing National Joint Registry data, we estimated UKR and TKR revision and mortality rates. Flexible Parametric Survival modelling (FPM) was used to model failure in TKR and make estimates for UKR. Kaplan-Meier estimates were used to compare cumulative re-revision for revised UKRs and TKRs.Results10-year UKR revision rates were 2.5-times higher than expected from TKR, equivalent to 70 excess revisions/1,000 cases within 10-years (5,861 excess revisions in this cohort). Revision rates were 2.5 times higher for the highest quartile volume UKR surgeons compared to the same quartile for TKR, and 3.9 times higher for the lowest quartiles respectively. Re-revision rates of revised TKRs (10-years=17.5%; 95%CI=16.4,18.7) were similar to revised UKRs (15.2%; 95%CI=13.4,17.1) and higher than revision rates following primary TKR (3.3%, 95%CI=3.1,3.5). 90-day mortality rates were lower after UKR compared with TKR (0.08% vs. 0.33%) and lower than predicted had UKR patients received a TKR (0.18%), equivalent to 1 fewer death per 1,000 cases.ConclusionsUKR revision rates were substantially higher than TKR even when demographics and caseload differences were accounted for, however fewer deaths occur after UKR. This should be considered when forming treatment guidelines and commissioning services. Re-revision rates were similar between revised UKRs and TKRs, but considerably higher than for primary TKR, therefore UKR cannot be considered an intermediate procedure.

KW - outcomes

KW - mortality

KW - revision rates

KW - total knee replacement

KW - unicompartmental knee

U2 - 10.1016/j.arth.2020.08.063

DO - 10.1016/j.arth.2020.08.063

M3 - Article (Academic Journal)

C2 - 33011013

SN - 0883-5403

VL - 36

SP - 471-477.e6

JO - Journal of Arthroplasty

JF - Journal of Arthroplasty

IS - 2

ER -

Hunt LP, Blom AW, Matharu G, Kunutsor SK, Beswick AD, Wilkinson JM et al. Patients Receiving A Primary Unicompartmental Knee Replacement Have A Higher Risk Of Revision But A Lower Risk Of Mortality Than Predicted Had They Received A Total Knee Replacement: Data From The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Journal of Arthroplasty. 2021 Feb 1;36(2):471-477.e6. Epub 2020 Sept 7. doi: 10.1016/j.arth.2020.08.063