UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): what does analysis of linked, routinely collected national datasets tell us about mid-late term revision risk after knee replacement?
UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): what does analysis of linked, routinely collected national datasets tell us about mid-late term revision risk after knee replacement?
Objective: to identify patients at risk of mid-late term revision of knee replacement (KR) to inform targeted follow-up.
Design: analysis of linked national datasets from primary and secondary care (Clinical Practice Research Datalink (CPRD GOLD), National Joint Registry (NJR), English Hospital Episode Statistics (HES) and Patient Reported Outcome Measures (PROMs)).
Participants: primary elective KRs aged ≥18 years.
Event of interest: revision surgery ≥5 years (mid-late term) postprimary KR.
Statistical methods: cox regression modelling to ascertain risk factors of mid-late term revision. HRs and 95% CIs 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 188 509 KR. CPRD GOLD-HES data covered 1995-2011 on 17 378 KR. Patients had minimum 5 years postprimary surgery to end 2016. Age and gender distribution were similar across datasets; mean age 70 years, 57% female. In NJR, there were 8607 (4.6%) revisions, median time-to-revision postprimary surgery 1.8 years (range 0-8.8), with 1055 (0.6%) mid-late term revisions; in CPRD GOLD, 877 (5.1%) revisions, median time-to-revision 4.2 years (range 0.02-18.3), with 352 (2.0%) mid-late term revisions.Reduced risk of revision after 5 years was associated with older age (HR: 0.95; 95% CI 0.95 to 0.96), obesity (0.70; 0.56 to 0.88), living in deprived areas (0.71; 0.58 to 0.87), non-white ethnicity (0.58; 0.43 to 0.78), better preoperative pain and functional limitation (0.42; 0.33 to 0.53), better 6-month postoperative pain and function (0.33; 0.26 to 0.41) or moderate anxiety/depression (0.73; 0.63 to 0.83) at primary surgery.Increased risk was associated with male gender (1.32; 1.04 to 1.67); when anticonvulsants (gabapentin and pregabalin) (1.58; 1.01 to 2.47) or opioids (1.36; 1.08 to 1.71) were required prior to primary surgery.No implant factors were identified.
Conclusions: the risk of mid-late term KR revision is very low. Increased risk of revision is associated with patient case-mix factors, and there is evidence of sociodemographic inequality.
adult orthopaedics, knee, musculoskeletal disorders, surgery
e046900
Smith, Lindsay K.
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Garriga, Cesar
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Kingsbury, Sarah R.
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Pinedo-Villanueva, Rafael
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Delmestri, Antonella
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Arden, Nigel K
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Stone, Martin
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Conaghan, Philip G.
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Judge, Andrew
8fed3977-493a-4290-b6c7-ce1a558698b5
9 March 2022
Smith, Lindsay K.
6a30b0e7-2315-4845-86ab-6e455349b592
Garriga, Cesar
fa2cba58-6872-45dc-97b8-e4005bca1601
Kingsbury, Sarah R.
57a815a8-94af-4a34-ae1b-b0147b0723fe
Pinedo-Villanueva, Rafael
6f5c74a5-7a7c-44fb-b2bd-7c329188cc35
Delmestri, Antonella
d6087fde-5a65-41de-9b5e-bcefc4379ceb
Arden, Nigel K
23af958d-835c-4d79-be54-4bbe4c68077f
Stone, Martin
5840a08a-ecd7-4834-9c2d-bab532f1bbd3
Conaghan, Philip G.
b9e8364a-3056-42a5-b217-9facb9610d79
Judge, Andrew
8fed3977-493a-4290-b6c7-ce1a558698b5
Smith, Lindsay K., Garriga, Cesar, Kingsbury, Sarah R., Pinedo-Villanueva, Rafael, Delmestri, Antonella, Arden, Nigel K, Stone, Martin, Conaghan, Philip G. and Judge, Andrew
(2022)
UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): what does analysis of linked, routinely collected national datasets tell us about mid-late term revision risk after knee replacement?
BMJ Open, 12 (3), , [e046900].
(doi:10.1136/bmjopen-2020-046900).
Abstract
Objective: to identify patients at risk of mid-late term revision of knee replacement (KR) to inform targeted follow-up.
Design: analysis of linked national datasets from primary and secondary care (Clinical Practice Research Datalink (CPRD GOLD), National Joint Registry (NJR), English Hospital Episode Statistics (HES) and Patient Reported Outcome Measures (PROMs)).
Participants: primary elective KRs aged ≥18 years.
Event of interest: revision surgery ≥5 years (mid-late term) postprimary KR.
Statistical methods: cox regression modelling to ascertain risk factors of mid-late term revision. HRs and 95% CIs 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 188 509 KR. CPRD GOLD-HES data covered 1995-2011 on 17 378 KR. Patients had minimum 5 years postprimary surgery to end 2016. Age and gender distribution were similar across datasets; mean age 70 years, 57% female. In NJR, there were 8607 (4.6%) revisions, median time-to-revision postprimary surgery 1.8 years (range 0-8.8), with 1055 (0.6%) mid-late term revisions; in CPRD GOLD, 877 (5.1%) revisions, median time-to-revision 4.2 years (range 0.02-18.3), with 352 (2.0%) mid-late term revisions.Reduced risk of revision after 5 years was associated with older age (HR: 0.95; 95% CI 0.95 to 0.96), obesity (0.70; 0.56 to 0.88), living in deprived areas (0.71; 0.58 to 0.87), non-white ethnicity (0.58; 0.43 to 0.78), better preoperative pain and functional limitation (0.42; 0.33 to 0.53), better 6-month postoperative pain and function (0.33; 0.26 to 0.41) or moderate anxiety/depression (0.73; 0.63 to 0.83) at primary surgery.Increased risk was associated with male gender (1.32; 1.04 to 1.67); when anticonvulsants (gabapentin and pregabalin) (1.58; 1.01 to 2.47) or opioids (1.36; 1.08 to 1.71) were required prior to primary surgery.No implant factors were identified.
Conclusions: the risk of mid-late term KR revision is very low. Increased risk of revision is associated with patient case-mix factors, and there is evidence of sociodemographic inequality.
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Accepted/In Press date: 3 February 2022
Published date: 9 March 2022
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Funding Information:
Competing interests LS reports grants from NIHR during the conduct of the study. AJ reports grants from NIHR 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. NA 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.
Funding Information:
Funding 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.
Keywords:
adult orthopaedics, knee, musculoskeletal disorders, surgery
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Local EPrints ID: 456592
URI: http://eprints.soton.ac.uk/id/eprint/456592
ISSN: 2044-6055
PURE UUID: a7077e4d-0d31-4449-82ad-6057d01c1444
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Date deposited: 05 May 2022 16:44
Last modified: 05 Jun 2024 19:26
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Author:
Lindsay K. Smith
Author:
Cesar Garriga
Author:
Sarah R. Kingsbury
Author:
Rafael Pinedo-Villanueva
Author:
Antonella Delmestri
Author:
Martin Stone
Author:
Philip G. Conaghan
Author:
Andrew Judge
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