UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): What does analysis of linked, routinely collected national data sets tell us about mid-late term revision risk after hip replacement? Retrospective cohort study

Lindsay K Smith; Cesar Garriga; Sarah R. Kingsbury; Rafael Pinedo-Villanueva; Antonella Delmestri; Nigel K Arden; Martin H. Stone; Philip G Conaghan; Andrew Judge

doi:10.1136/bmjopen-2021-050877

UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): What does analysis of linked, routinely collected national data sets tell us about mid-late term revision risk after hip replacement? Retrospective cohort study

Lindsay K Smith^*, Cesar Garriga, Sarah R. Kingsbury, Rafael Pinedo-Villanueva, Antonella Delmestri, Nigel K Arden, Martin H. Stone, Philip G Conaghan, Andrew Judge

^*Corresponding author for this work

Bristol Medical School (THS)

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

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Abstract

Objective To identify patients at risk of mid-late term revision of hip replacement to inform targeted follow-up.

Design Analysis of linked national data sets from primary and secondary care (Clinical Practice Research Datalink (CPRD-GOLD); National Joint Registry (NJR); English Hospital Episode Statistics (HES); Patient-Reported Outcome Measures (PROMs)).

Participants Primary elective total hip replacement (THR) aged≥18.

Event of interest Revision surgery≥5 years (mid-late term) after primary THR.

Statistical methods Cox regression modelling to ascertain risk factors of mid-late term revision. HR and 95% CI assessed association of sociodemographic factors, comorbidities, medication, surgical variables and PROMs with mid-late term revision.

Results NJR-HES-PROMs data were available from 2008 to 2011 on 142 275 THR; mean age 70.0 years and 61.9% female. CPRD GOLD-HES data covered 1995–2011 on 17 047 THR; mean age 68.4 years, 61.8% female. Patients had minimum 5 years postprimary surgery to end 2016. In NJR-HES-PROMS data, there were 3582 (2.5%) revisions, median time-to-revision after primary surgery 1.9 years (range 0.01–8.7), with 598 (0.4%) mid-late term revisions; in CPRD GOLD, 982 (5.8%) revisions, median time-to-revision 5.3 years (range 0–20), with 520 (3.1%) mid-late term revisions.

Reduced risk of mid-late term revision was associated with older age at primary surgery (HR: 0.96; 95% CI: 0.95 to 0.96); better 6-month postoperative pain/function scores (HR: 0.35; 95% CI: 0.27 to 0.46); use of ceramic-on-ceramic (HR: 0.73; 95% CI: 0.56 to 0.95) or ceramic-on-polyethylene (HR: 0.76; 95% CI: 0.58 to 1.00) bearing surfaces.

Increased risk of mid-late term revision was associated with the use of antidepressants (HR: 1.32; 95% CI: 1.09 to 1.59), glucocorticoid injections (HR: 1.33; 95% CI: 1.06 to 1.67) and femoral head size≥44 mm (HR: 2.56; 95% CI: 1.09 to 6.02)

No association of gender, obesity or Index of Multiple Deprivation was observed.

Conclusion The risk of mid-late term THR is associated with age at primary surgery, 6-month postoperative pain and function and implant factors. Further work is needed to explore the associations with prescription medications observed in our data.

Original language	English
Article number	e050877
Pages (from-to)	e050877
Number of pages	29
Journal	BMJ Open
Volume	12
Issue number	3
Early online date	9 Mar 2022
DOIs	https://doi.org/10.1136/bmjopen-2021-050877 https://doi.org/10.1136/bmjopen-2021-050877
Publication status	E-pub ahead of print - 9 Mar 2022

Bibliographical note

Funding Information:
This article presents independent research funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (14/70/146) and by the NIHR Leeds Biomedical Research Centre (BRC). SRK, MS and PGC were supported in part by the NIHR Leeds Biomedical Research Centre. AJ was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol.

Funding Information:
Competing interests LS reports grants from National Institute for Health Research during the conduct of the study. AJ reports grants from National Institute for Health Research and has received consultancy fees from Freshfields Bruckhaus Derringer and Anthera Pharmaceuticals LTD unrelated to this work. AJ was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. NKA reports grants from Merck, personal fees from Pfizer/Lilly, unrelated to the submitted work. SRK, MS and PGC were supported in part by the NIHR Leeds Biomedical Research Centre.

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© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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Smith, L. K., Garriga, C., Kingsbury, S. R., Pinedo-Villanueva, R., Delmestri, A., Arden, N. K., Stone, M. H., Conaghan, P. G., & Judge, A. (2022). UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): What does analysis of linked, routinely collected national data sets tell us about mid-late term revision risk after hip replacement? Retrospective cohort study. BMJ Open, 12(3), e050877. Article e050877. Advance online publication. https://doi.org/10.1136/bmjopen-2021-050877, https://doi.org/10.1136/bmjopen-2021-050877

@article{40b62c6c371845a7a1e8731d866f1915,

title = "UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): What does analysis of linked, routinely collected national data sets tell us about mid-late term revision risk after hip replacement? Retrospective cohort study",

abstract = "Objective To identify patients at risk of mid-late term revision of hip replacement to inform targeted follow-up. Design Analysis of linked national data sets from primary and secondary care (Clinical Practice Research Datalink (CPRD-GOLD); National Joint Registry (NJR); English Hospital Episode Statistics (HES); Patient-Reported Outcome Measures (PROMs)). Participants Primary elective total hip replacement (THR) aged≥18. Event of interest Revision surgery≥5 years (mid-late term) after primary THR. Statistical methods Cox regression modelling to ascertain risk factors of mid-late term revision. HR and 95\% CI assessed association of sociodemographic factors, comorbidities, medication, surgical variables and PROMs with mid-late term revision. Results NJR-HES-PROMs data were available from 2008 to 2011 on 142 275 THR; mean age 70.0 years and 61.9\% female. CPRD GOLD-HES data covered 1995–2011 on 17 047 THR; mean age 68.4 years, 61.8\% female. Patients had minimum 5 years postprimary surgery to end 2016. In NJR-HES-PROMS data, there were 3582 (2.5\%) revisions, median time-to-revision after primary surgery 1.9 years (range 0.01–8.7), with 598 (0.4\%) mid-late term revisions; in CPRD GOLD, 982 (5.8\%) revisions, median time-to-revision 5.3 years (range 0–20), with 520 (3.1\%) mid-late term revisions. Reduced risk of mid-late term revision was associated with older age at primary surgery (HR: 0.96; 95\% CI: 0.95 to 0.96); better 6-month postoperative pain/function scores (HR: 0.35; 95\% CI: 0.27 to 0.46); use of ceramic-on-ceramic (HR: 0.73; 95\% CI: 0.56 to 0.95) or ceramic-on-polyethylene (HR: 0.76; 95\% CI: 0.58 to 1.00) bearing surfaces. Increased risk of mid-late term revision was associated with the use of antidepressants (HR: 1.32; 95\% CI: 1.09 to 1.59), glucocorticoid injections (HR: 1.33; 95\% CI: 1.06 to 1.67) and femoral head size≥44 mm (HR: 2.56; 95\% CI: 1.09 to 6.02) No association of gender, obesity or Index of Multiple Deprivation was observed. Conclusion The risk of mid-late term THR is associated with age at primary surgery, 6-month postoperative pain and function and implant factors. Further work is needed to explore the associations with prescription medications observed in our data.",

author = "Smith, \{Lindsay K\} and Cesar Garriga and Kingsbury, \{Sarah R.\} and Rafael Pinedo-Villanueva and Antonella Delmestri and Arden, \{Nigel K\} and Stone, \{Martin H.\} and Conaghan, \{Philip G\} and Andrew Judge",

note = "Funding Information: This article presents independent research funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (14/70/146) and by the NIHR Leeds Biomedical Research Centre (BRC). SRK, MS and PGC were supported in part by the NIHR Leeds Biomedical Research Centre. AJ was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. Funding Information: Competing interests LS reports grants from National Institute for Health Research during the conduct of the study. AJ reports grants from National Institute for Health Research and has received consultancy fees from Freshfields Bruckhaus Derringer and Anthera Pharmaceuticals LTD unrelated to this work. AJ was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. NKA reports grants from Merck, personal fees from Pfizer/Lilly, unrelated to the submitted work. SRK, MS and PGC were supported in part by the NIHR Leeds Biomedical Research Centre. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2022",

month = mar,

day = "9",

doi = "10.1136/bmjopen-2021-050877",

language = "English",

volume = "12",

pages = "e050877",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "3",

}

Smith, LK, Garriga, C, Kingsbury, SR, Pinedo-Villanueva, R, Delmestri, A, Arden, NK, Stone, MH, Conaghan, PG & Judge, A 2022, 'UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): What does analysis of linked, routinely collected national data sets tell us about mid-late term revision risk after hip replacement? Retrospective cohort study', BMJ Open, vol. 12, no. 3, e050877, pp. e050877. https://doi.org/10.1136/bmjopen-2021-050877, https://doi.org/10.1136/bmjopen-2021-050877

UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): What does analysis of linked, routinely collected national data sets tell us about mid-late term revision risk after hip replacement? Retrospective cohort study. / Smith, Lindsay K; Garriga, Cesar; Kingsbury, Sarah R. et al.
In: BMJ Open, Vol. 12, No. 3, e050877, 09.03.2022, p. e050877.

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

TY - JOUR

T1 - UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE)

T2 - What does analysis of linked, routinely collected national data sets tell us about mid-late term revision risk after hip replacement? Retrospective cohort study

AU - Smith, Lindsay K

AU - Garriga, Cesar

AU - Kingsbury, Sarah R.

AU - Pinedo-Villanueva, Rafael

AU - Delmestri, Antonella

AU - Arden, Nigel K

AU - Stone, Martin H.

AU - Conaghan, Philip G

AU - Judge, Andrew

N1 - Funding Information: This article presents independent research funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (14/70/146) and by the NIHR Leeds Biomedical Research Centre (BRC). SRK, MS and PGC were supported in part by the NIHR Leeds Biomedical Research Centre. AJ was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. Funding Information: Competing interests LS reports grants from National Institute for Health Research during the conduct of the study. AJ reports grants from National Institute for Health Research and has received consultancy fees from Freshfields Bruckhaus Derringer and Anthera Pharmaceuticals LTD unrelated to this work. AJ was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. NKA reports grants from Merck, personal fees from Pfizer/Lilly, unrelated to the submitted work. SRK, MS and PGC were supported in part by the NIHR Leeds Biomedical Research Centre. Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2022/3/9

Y1 - 2022/3/9

N2 - Objective To identify patients at risk of mid-late term revision of hip replacement to inform targeted follow-up. Design Analysis of linked national data sets from primary and secondary care (Clinical Practice Research Datalink (CPRD-GOLD); National Joint Registry (NJR); English Hospital Episode Statistics (HES); Patient-Reported Outcome Measures (PROMs)). Participants Primary elective total hip replacement (THR) aged≥18. Event of interest Revision surgery≥5 years (mid-late term) after primary THR. Statistical methods Cox regression modelling to ascertain risk factors of mid-late term revision. HR and 95% CI assessed association of sociodemographic factors, comorbidities, medication, surgical variables and PROMs with mid-late term revision. Results NJR-HES-PROMs data were available from 2008 to 2011 on 142 275 THR; mean age 70.0 years and 61.9% female. CPRD GOLD-HES data covered 1995–2011 on 17 047 THR; mean age 68.4 years, 61.8% female. Patients had minimum 5 years postprimary surgery to end 2016. In NJR-HES-PROMS data, there were 3582 (2.5%) revisions, median time-to-revision after primary surgery 1.9 years (range 0.01–8.7), with 598 (0.4%) mid-late term revisions; in CPRD GOLD, 982 (5.8%) revisions, median time-to-revision 5.3 years (range 0–20), with 520 (3.1%) mid-late term revisions. Reduced risk of mid-late term revision was associated with older age at primary surgery (HR: 0.96; 95% CI: 0.95 to 0.96); better 6-month postoperative pain/function scores (HR: 0.35; 95% CI: 0.27 to 0.46); use of ceramic-on-ceramic (HR: 0.73; 95% CI: 0.56 to 0.95) or ceramic-on-polyethylene (HR: 0.76; 95% CI: 0.58 to 1.00) bearing surfaces. Increased risk of mid-late term revision was associated with the use of antidepressants (HR: 1.32; 95% CI: 1.09 to 1.59), glucocorticoid injections (HR: 1.33; 95% CI: 1.06 to 1.67) and femoral head size≥44 mm (HR: 2.56; 95% CI: 1.09 to 6.02) No association of gender, obesity or Index of Multiple Deprivation was observed. Conclusion The risk of mid-late term THR is associated with age at primary surgery, 6-month postoperative pain and function and implant factors. Further work is needed to explore the associations with prescription medications observed in our data.

AB - Objective To identify patients at risk of mid-late term revision of hip replacement to inform targeted follow-up. Design Analysis of linked national data sets from primary and secondary care (Clinical Practice Research Datalink (CPRD-GOLD); National Joint Registry (NJR); English Hospital Episode Statistics (HES); Patient-Reported Outcome Measures (PROMs)). Participants Primary elective total hip replacement (THR) aged≥18. Event of interest Revision surgery≥5 years (mid-late term) after primary THR. Statistical methods Cox regression modelling to ascertain risk factors of mid-late term revision. HR and 95% CI assessed association of sociodemographic factors, comorbidities, medication, surgical variables and PROMs with mid-late term revision. Results NJR-HES-PROMs data were available from 2008 to 2011 on 142 275 THR; mean age 70.0 years and 61.9% female. CPRD GOLD-HES data covered 1995–2011 on 17 047 THR; mean age 68.4 years, 61.8% female. Patients had minimum 5 years postprimary surgery to end 2016. In NJR-HES-PROMS data, there were 3582 (2.5%) revisions, median time-to-revision after primary surgery 1.9 years (range 0.01–8.7), with 598 (0.4%) mid-late term revisions; in CPRD GOLD, 982 (5.8%) revisions, median time-to-revision 5.3 years (range 0–20), with 520 (3.1%) mid-late term revisions. Reduced risk of mid-late term revision was associated with older age at primary surgery (HR: 0.96; 95% CI: 0.95 to 0.96); better 6-month postoperative pain/function scores (HR: 0.35; 95% CI: 0.27 to 0.46); use of ceramic-on-ceramic (HR: 0.73; 95% CI: 0.56 to 0.95) or ceramic-on-polyethylene (HR: 0.76; 95% CI: 0.58 to 1.00) bearing surfaces. Increased risk of mid-late term revision was associated with the use of antidepressants (HR: 1.32; 95% CI: 1.09 to 1.59), glucocorticoid injections (HR: 1.33; 95% CI: 1.06 to 1.67) and femoral head size≥44 mm (HR: 2.56; 95% CI: 1.09 to 6.02) No association of gender, obesity or Index of Multiple Deprivation was observed. Conclusion The risk of mid-late term THR is associated with age at primary surgery, 6-month postoperative pain and function and implant factors. Further work is needed to explore the associations with prescription medications observed in our data.

U2 - 10.1136/bmjopen-2021-050877

DO - 10.1136/bmjopen-2021-050877

M3 - Article (Academic Journal)

C2 - 35264338

SN - 2044-6055

VL - 12

SP - e050877

JO - BMJ Open

JF - BMJ Open

IS - 3

M1 - e050877

ER -

Smith LK, Garriga C, Kingsbury SR, Pinedo-Villanueva R, Delmestri A, Arden NK et al. UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): What does analysis of linked, routinely collected national data sets tell us about mid-late term revision risk after hip replacement? Retrospective cohort study. BMJ Open. 2022 Mar 9;12(3):e050877. e050877. Epub 2022 Mar 9. doi: 10.1136/bmjopen-2021-050877, 10.1136/bmjopen-2021-050877