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The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study

The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study
The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study
Background

Total joint replacements for end-stage osteoarthritis of the hip and knee are cost-effective and demonstrate significant clinical improvement. However, robust population based lifetime-risk data for implant revision are not available to aid patient decision making, which is a particular problem in young patient groups deciding on best-timing for surgery.

Methods

We did implant survival analysis on all patients within the Clinical Practice Research Datalink who had undergone total hip replacement or total knee replacement. These data were adjusted for all-cause mortality with data from the Office for National Statistics and used to generate lifetime risks of revision surgery based on increasing age at the time of primary surgery.

Findings

We identified 63 158 patients who had undergone total hip replacement and 54 276 who had total knee replacement between Jan 1, 1991, and Aug 10, 2011, and followed up these patients to a maximum of 20 years. For total hip replacement, 10-year implant survival rate was 95·6% (95% CI 95·3–95·9) and 20-year rate was 85·0% (83·2–86·6). For total knee replacement, 10-year implant survival rate was 96·1% (95·8–96·4), and 20-year implant survival rate was 89·7% (87·5–91·5). The lifetime risk of requiring revision surgery in patients who had total hip replacement or total knee replacement over the age of 70 years was about 5% with no difference between sexes. For those who had surgery younger than 70 years, however, the lifetime risk of revision increased for younger patients, up to 35% (95% CI 30·9–39·1) for men in their early 50s, with large differences seen between male and female patients (15% lower for women in same age group). The median time to revision for patients who had surgery younger than age 60 was 4·4 years.

Interpretation

Our study used novel methodology to investigate and offer new insight into the importance of young age and risk of revision after total hip or knee replacement. Our evidence challenges the increasing trend for more total hip replacements and total knee replacements to be done in the younger patient group, and these data should be offered to patients as part of the shared decision making process.

Funding

Oxford Musculoskeletal Biomedical Research Unit, National Institute for Health Research.
1424-1430
Bayliss, L.E.
b9fe1831-7efc-4cd5-b68f-e9626c6ac6ad
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Monk, A.P.
392619a8-0295-4c9f-85e4-251759b22d5d
Glyn-Jones, S.
cd9b71ce-7f5d-43e8-994c-61e24c6cd08c
Prieto-Alhambra, D
051113cd-2da1-4e0d-aa4b-d7b1fe63cd12
Judge, A.
c6a83964-1d7c-4aa8-b2bf-9c264d1e487d
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Carr, A. J.
8aa8de95-0dbc-49b1-976f-d81e25d131ec
Arden, N.K.
43797db2-1a13-4ac5-9ac6-1dd3565cc4f2
Beard, D.J.
c3165e64-3146-49bf-9ce6-8166f3b7f1c1
Price, A.J.
d38e827f-588c-47f8-9590-ce8790423e2c
Bayliss, L.E.
b9fe1831-7efc-4cd5-b68f-e9626c6ac6ad
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Monk, A.P.
392619a8-0295-4c9f-85e4-251759b22d5d
Glyn-Jones, S.
cd9b71ce-7f5d-43e8-994c-61e24c6cd08c
Prieto-Alhambra, D
051113cd-2da1-4e0d-aa4b-d7b1fe63cd12
Judge, A.
c6a83964-1d7c-4aa8-b2bf-9c264d1e487d
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Carr, A. J.
8aa8de95-0dbc-49b1-976f-d81e25d131ec
Arden, N.K.
43797db2-1a13-4ac5-9ac6-1dd3565cc4f2
Beard, D.J.
c3165e64-3146-49bf-9ce6-8166f3b7f1c1
Price, A.J.
d38e827f-588c-47f8-9590-ce8790423e2c

Bayliss, L.E., Culliford, David, Monk, A.P., Glyn-Jones, S., Prieto-Alhambra, D, Judge, A., Cooper, Cyrus, Carr, A. J., Arden, N.K., Beard, D.J. and Price, A.J. (2017) The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. The Lancet, 389 (10077), 1424-1430. (doi:10.1016/S0140-6736(17)30059-4).

Record type: Article

Abstract

Background

Total joint replacements for end-stage osteoarthritis of the hip and knee are cost-effective and demonstrate significant clinical improvement. However, robust population based lifetime-risk data for implant revision are not available to aid patient decision making, which is a particular problem in young patient groups deciding on best-timing for surgery.

Methods

We did implant survival analysis on all patients within the Clinical Practice Research Datalink who had undergone total hip replacement or total knee replacement. These data were adjusted for all-cause mortality with data from the Office for National Statistics and used to generate lifetime risks of revision surgery based on increasing age at the time of primary surgery.

Findings

We identified 63 158 patients who had undergone total hip replacement and 54 276 who had total knee replacement between Jan 1, 1991, and Aug 10, 2011, and followed up these patients to a maximum of 20 years. For total hip replacement, 10-year implant survival rate was 95·6% (95% CI 95·3–95·9) and 20-year rate was 85·0% (83·2–86·6). For total knee replacement, 10-year implant survival rate was 96·1% (95·8–96·4), and 20-year implant survival rate was 89·7% (87·5–91·5). The lifetime risk of requiring revision surgery in patients who had total hip replacement or total knee replacement over the age of 70 years was about 5% with no difference between sexes. For those who had surgery younger than 70 years, however, the lifetime risk of revision increased for younger patients, up to 35% (95% CI 30·9–39·1) for men in their early 50s, with large differences seen between male and female patients (15% lower for women in same age group). The median time to revision for patients who had surgery younger than age 60 was 4·4 years.

Interpretation

Our study used novel methodology to investigate and offer new insight into the importance of young age and risk of revision after total hip or knee replacement. Our evidence challenges the increasing trend for more total hip replacements and total knee replacements to be done in the younger patient group, and these data should be offered to patients as part of the shared decision making process.

Funding

Oxford Musculoskeletal Biomedical Research Unit, National Institute for Health Research.

Full text not available from this repository.

More information

Accepted/In Press date: 1 February 2017
e-pub ahead of print date: 14 February 2017
Published date: 8 April 2017
Organisations: Researcher Development, Medical Research Council

Identifiers

Local EPrints ID: 411653
URI: https://eprints.soton.ac.uk/id/eprint/411653
PURE UUID: bbd787da-956c-4b77-9886-7b54c03496e4
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 21 Jun 2017 16:33
Last modified: 14 Mar 2019 01:50

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Contributors

Author: L.E. Bayliss
Author: David Culliford
Author: A.P. Monk
Author: S. Glyn-Jones
Author: D Prieto-Alhambra
Author: A. Judge
Author: Cyrus Cooper ORCID iD
Author: A. J. Carr
Author: N.K. Arden
Author: D.J. Beard
Author: A.J. Price

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