Date Published: September 2, 2008
Publisher: Public Library of Science
Author(s): Nokuthaba Sibanda, Lynn P Copley, Jim D Lewsey, Mick Borroff, Paul Gregg, Alex J MacGregor, Martin Pickford, Martyn Porter, Keith Tucker, Jan H van der Meulen, Harri Sievanen
Abstract: BackgroundHip and knee replacement are some of the most frequently performed surgical procedures in the world. Resurfacing of the hip and unicondylar knee replacement are increasingly being used. There is relatively little evidence on their performance. To study performance of joint replacement in England, we investigated revision rates in the first 3 y after hip or knee replacement according to prosthesis type.Methods and FindingsWe linked records of the National Joint Registry for England and Wales and the Hospital Episode Statistics for patients with a primary hip or knee replacement in the National Health Service in England between April 2003 and September 2006. Hospital Episode Statistics records of succeeding admissions were used to identify revisions for any reason. 76,576 patients with a primary hip replacement and 80,697 with a primary knee replacement were included (51% of all primary hip and knee replacements done in the English National Health Service). In hip patients, 3-y revision rates were 0.9% (95% confidence interval [CI] 0.8%–1.1%) with cemented, 2.0% (1.7%–2.3%) with cementless, 1.5% (1.1%–2.0% CI) with “hybrid” prostheses, and 2.6% (2.1%–3.1%) with hip resurfacing (p < 0.0001). Revision rates after hip resurfacing were increased especially in women. In knee patients, 3-y revision rates were 1.4% (1.2%–1.5% CI) with cemented, 1.5% (1.1%–2.1% CI) with cementless, and 2.8% (1.8%–4.5% CI) with unicondylar prostheses (p < 0.0001). Revision rates after knee replacement strongly decreased with age.InterpretationOverall, about one in 75 patients needed a revision of their prosthesis within 3 y. On the basis of our data, consideration should be given to using hip resurfacing only in male patients and unicondylar knee replacement only in elderly patients.
Partial Text: Total hip replacement was first successfully performed in 1962 in the United Kingdom and approved for use in the United States in 1969 [1,2]. Total knee replacement was introduced in its modern form in the early 1970s . Since then, these procedures have developed at an astonishing pace and they are now among the most frequently performed major surgical procedures in the world. In 2006, about 160,000 total hip and knee replacement procedures were carried out in England and Wales and about 500,000 in the United States [4,5].
The NJR aims to collect data on all hip and knee replacements in England and Wales. Candidates for inclusion are patients who undergo a cemented, cementless, or “hybrid” total hip replacement or hip resurfacing, those who undergo a total knee replacement, unicondylar replacement, or patello-femoral replacement, and those who had a revision of any of these procedures. Hybrid hip prostheses have one cemented and one cementless component. Further information can be found in the NJR 4th Annual Report . We considered all 170,410 NJR records on primary hip procedures and 167,498 on primary knee procedures carried out between April 1, 2003 and September 30, 2006 (Figure 1).
Of the 327,557 primary hip or knee replacement procedures carried out between April 1, 2003 and September 30, 2006 in the NHS in England according to the HES database, 167,076 (51%) could be linked to an NJR record (Figure 1). The remaining records could not be linked because the NJR records did not contain the necessary patient identifiers. After removal of 9,803 records of the second joint replacement in patients who had undergone bilateral primary hip or knee replacements on different dates, 157,273 patients were available for analysis (Tables 1 and 2).
Revision rates in the first 3 y after hip and knee replacements carried out in the NHS in England since April 2003 were low. Overall, we found that about one in 75 patients needed a revision of their joint replacement. Patients who had a cemented hip or cemented knee prosthesis had the lowest revision rates. The highest rates after hip replacement were seen in patients who had undergone hip resurfacing and the highest rates after knee replacement in patients who had a unicondylar prosthesis. Revision rates after hip resurfacing were especially high in women. It is essential to continue following up these patients to assess whether these differences remain beyond the first 3 y, because it has been shown that risk factors for revision as well as reasons for revision change with time after the joint replacement .