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

被引：16
作者：
Hunt, Linda P. [1 ]
Blom, Ashley W. [1 ,2 ,3 ]
Matharu, Gulraj S. [1 ]
Kunutsor, Setor K. [1 ,2 ,3 ]
Beswick, Andrew D. [1 ]
Wilkinson, J. Mark [4 ,5 ]
Whitehouse, Michael R. [1 ,2 ,3 ]
机构：
[1] Univ Bristol, Southmead Hosp, Bristol Med Sch, Musculoskeletal Res Unit, 1st Floor Learning & Res Bldg, Bristol BS10 5NB, Avon, England
[2] Univ Hosp Bristol & Weston NHS Fdn Trust, Bristol Biomed Res Ctr, Natl Inst Hlth Res, Bristol, Avon, England
[3] Univ Bristol, Bristol, Avon, England
[4] Univ Sheffield, Northern Gen Hosp, Dept Oncol & Metab, Sheffield, S Yorkshire, England
[5] Univ Sheffield, Ctr Integrated Res Musculoskeletal Ageing, Sheffield, S Yorkshire, England
来源：
JOURNAL OF ARTHROPLASTY | 2021年 / 36卷 / 02期
关键词：
outcomes; mortality; revision rates; total knee replacement; unicompartmental knee; MATCHED PATIENTS; ARTHROPLASTY; OUTCOMES; OSTEOARTHRITIS; MODELS; HIP;
D O I：
10.1016/j.arth.2020.08.063
中图分类号：
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];
学科分类号：
摘要：
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, and assess 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 modeling (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: Ten-year UKR revision rates were 2.5 times higher than expected from TKR, equivalent to 70 excess revisions/1000 cases within 10 years (5861 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% confidence interval [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). Ninety-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 1000 cases. Conclusion: 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. (C) 2020 Elsevier Inc. All rights reserved.
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页码：471 / +
页数：13
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