scholarly journals Assessing the non-inferiority of prosthesis constructs used in total and unicondylar knee replacements using data from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man: a benchmarking study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026736 ◽  
Author(s):  
Kevin C Deere ◽  
Michael R Whitehouse ◽  
Martyn Porter ◽  
Ashley W Blom ◽  
Adrian Sayers
Keyword(s):  
Relative Risk ◽  
Knee Replacement ◽  
National Joint Registry ◽  
Joint Registry ◽  
Replacement Surgery ◽  
Kaplan Meier ◽  
Knee Replacements ◽  
Total Knee ◽  
The Difference ◽  
Using Data

ObjectivesTo investigate the relative performance of knee replacement constructs compared with the best performing construct and illustrate the substantial variability in performance.DesignA non-inferiority study.SettingEngland and Wales.ParticipantsAll primary total and unicondylar knee replacements performed and registered in the National Joint Registry between 1 April 2003 and 31 December 2016.Main outcome measuresKaplan-Meier failure function for knee replacement constructs. Failure difference between best performing construct (the benchmark) and other constructs.MethodsUsing a non-inferiority analysis, the performance of knee replacement constructs by brand were compared with the best performing construct. Construct failure was estimated using the 1-Kaplan Meier method, that is, an estimate of net failure. The difference in failure between the contemporary benchmark construct and all other constructs were tested.ResultsOf the 449 different knee replacement constructs used, only 27 had ≥500 procedures at risk at 10 years postprimary, 18 of which were classified as inferior to the benchmark by at least 20% relative risk of failure. Two of these 18 were unicondylar constructs that were inferior by at least 100% relative risk. In men, aged 55–75 years, 12 of 27 (44%) constructs were inferior by at least 20% to the benchmark at 7 years postprimary. In women, aged 55–75 years, 8 of 32 (25%) constructs were inferior at 7 years postprimary. Very few constructs were classified as non-inferior to the contemporary benchmark.ConclusionsThere are few knee replacement constructs that can be shown to be non-inferior to a contemporary benchmark. Unicondylar knee constructs have, almost universally, at least 100% worse revision outcomes compared with the best performing total knee replacement. These results will help to inform patients, clinicians and commissioners when considering knee replacement surgery.

scholarly journals Benchmarking total knee replacement constructs using noninferiority analysis: the New Zealand joint registry study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
MC Wyatt ◽  
CF Frampton ◽  
MR Whitehouse ◽  
KC Deere ◽  
A Sayers ◽  
...  
Keyword(s):  
At Risk ◽  
New Zealand ◽  
Relative Risk ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Survival Function ◽  
Joint Registry ◽  
Kaplan Meier ◽  
Total Knee ◽  
The Difference

Abstract Background The aim of this study was to compare the relative performance of total knee replacement constructs and discern if there is variability in performance in currently commonly used prostheses in the New Zealand Joint Registry (NZJR) using a noninferiority analysis. Methods All patients who underwent a primary total knee replacement (TKR) registered in the NZJR between 1st January 1999 to June 2020 were identified. Using a noninferiority analysis, the performance of total knee replacement prostheses were compared with the best performing contemporary construct. Construct all-cause revision rate was estimated using the 1-Kaplan Meier survival function method to estimate net failure. The difference in all-cause revision rates between the contemporary benchmark and all other constructs was tested. Results In total 110 183 TKR were recorded and 25 constructs (102 717 procedures) had > 500 procedures at risk at 3 years post-primary of which 5 were inferior by at least 20 % relative risk of which, one was inferior by at least 100 % relative risk. 14 constructs were identified with > 500 procedures at risk at 10 years with 5 inferior by at least 20 %, of which 2 were inferior by > 100 % relative risk. Conclusions We discerned that there is great variability in construct performance and at all time points, greater than 25 % of constructs are inferior to the best performing construct by at least 20 %. These results can help inform patients, clinicians and health care funders when considering TKR surgery.

Hip and knee arthroplasty

2017 ◽  
Vol 11 (1) ◽  
pp. 20-27
Author(s):  
Dominic Marley ◽  
Nomaan Sheikh ◽  
John Taylor ◽  
Amit Kumar
Keyword(s):  
Primary Care ◽  
Knee Pain ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
National Joint Registry ◽  
Knee Replacement Surgery ◽  
Joint Registry ◽  
Replacement Surgery ◽  
Knee Replacements ◽  
Hip And Knee Arthroplasty

The incidence of hip and knee replacement surgery has risen dramatically in recent years. The latest National Joint Registry figures indicate that almost 190 000 total hip and knee replacements were performed in 2015. The aim of this article is to discuss the management of hip and knee pain in primary care, the indications for hip and knee arthroplasty and surgical considerations.

scholarly journals Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data Set

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e045353
Author(s):  
Muhamed M Farhan-Alanie ◽  
Yujin Lee ◽  
Martin Underwood ◽  
Andrew Metcalfe ◽  
Mark J Wilkinson ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Cox Regression ◽  
National Joint Registry ◽  
Data Set ◽  
Cement Interface ◽  
Joint Registry ◽  
Replacement Surgery ◽  
Primary Surgery ◽  
Total Knee

ObjectiveTourniquet use in total knee replacement (TKR) is believed to improve the bone-cement interface by reducing bleeding, potentially prolonging implant survival. This study aimed to compare the risk of revision for primary cemented TKR performed with or without a tourniquet.DesignWe analysed data from the National Joint Registry (NJR) for all primary cemented TKRs performed in England and Wales between April 2003 and December 2003. Kaplan-Meier plots and Cox regression were used to assess the influence of tourniquet use, age at time of surgery, sex and American Society of Anaesthesiologists (ASA) classification on risk of revision for all-causes.ResultsData were available for 16 974 cases of primary cemented TKR, of which 16 132 had surgery with a tourniquet and 842 had surgery without a tourniquet. At 10 years, 3.8% had undergone revision (95% CI 2.6% to 5.5%) in the no-tourniquet group and 3.1% in the tourniquet group (95% CI 2.8% to 3.4%). After adjusting for age at primary surgery, gender and primary ASA score, the HR for all-cause revision for cemented TKR without a tourniquet was 0.82 (95% CI 0.57 to 1.18).ConclusionsWe did not find evidence that using a tourniquet for primary cemented TKR offers a clinically important or statistically significant reduction in the risk of all-cause revision up to 13 years after surgery. Surgeons should consider this evidence when deciding whether to use a tourniquet for cemented TKR.

Participation in Sports After Total Knee Replacement

1998 ◽  
Vol 26 (4) ◽  
pp. 530-535 ◽  
Author(s):  
Neil Bradbury ◽  
David Borton ◽  
Geoff Spoo ◽  
Mervyn J. Cross
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Retrospective Review ◽  
High Impact ◽  
Regular Exercise ◽  
Sports Activity ◽  
Replacement Surgery ◽  
Knee Replacements ◽  
Total Knee

Return to regular sports activity was evaluated in a retrospective review of 160 patients who had undergone total knee replacement surgery by a single surgeon (208 knee replacements). Mean age of the patients was 68 years (range, 27 to 87) at surgery and 73 years (range, 33 to 91) at review at a mean follow-up of 5 years (range, 3 to 7). Seventy-nine patients regularly participated in sports, at least once per week, before surgery, and 51 patients regularly participated in sports after surgery. Only eight patients took up sports after surgery who were not regularly involved in sports in the year before surgery. Patients were more likely to return to low-impact activities such as bowls (29 of 32, or 91%) than to high-impact activities such as tennis (6 of 30, or 20% returned). Forty-three of 56 patients (77%) who had participated in regular exercise in the year before surgery returned to sports. Eighty patients did not participate in sports before surgery and 54 of these had coexisting disease that prevented sports. None of these patients returned to sports.

All-Polyethylene Tibial Components in Total Knee Replacement: Early Failures

2018 ◽  
Vol 32 (09) ◽  
pp. 919-923
Author(s):  
Zaki Suliman Alhifzi ◽  
Yousef Tawfik Khoja ◽  
Gavin C. Wood
Keyword(s):  
Knee Replacement ◽  
Unit Cost ◽  
Primary Total Knee Arthroplasty ◽  
Functional Results ◽  
Replacement Surgery ◽  
Physical Status Classification ◽  
Knee Replacements ◽  
Early Failures ◽  
Total Knee ◽  
American Society

AbstractIn total primary knee replacement surgery, the use of all-polyethylene tibial (APT) components has many advantages, including no backside wear and no linear dissociation. In addition, the greater polyethylene thickness permits more conservative bone resection compared with that for metal-backed components, with a lower unit cost and similar functional results. Thus, the use of an APT in primary total knee arthroplasty remains an attractive option. This is a review of 158 patients who underwent primary knee replacement using APT components from a single manufacturer. Data collection included age, American Society of Anesthesiology physical status classification, body mass index (BMI), type of deformity, the presence of diabetes mellitus, rate of revision, and characteristics associated with early failure of the components. Average follow-up time was 40 months. The revision rate for any reason was 5.6%, and the average BMI in revision cases was 37.6. Patients with a higher BMI (≥ 37.6) were significantly more likely to require revision surgery than patients with a lower BMI (p = 0.04). In our sample, high BMI was a contributing factor for early failures in total knee replacements using an APT component. Generally, polyethylene tibial components used for primary knee replacements are safe and effective, with good outcomes and subsequent lower costs to the health care system.

scholarly journals 1064 Extra-Articular Tibial Deformity Management in Total Knee Replacement

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S M Choi ◽  
R Kumar ◽  
R Morgan-Jones ◽  
S Agarwal
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Mechanical Axis ◽  
Corrective Osteotomy ◽  
Oxford Knee Score ◽  
Coronal Plane ◽  
Replacement Surgery ◽  
Tibial Resection ◽  
Knee Replacements ◽  
Total Knee

Abstract Aim In knee replacements, restoration of mechanical alignment is essential. Patients with extra-articular deformities (EAD) pose challenges in planning knee replacements. We present a method, based on our experience and review of literature on planning knee replacement surgery, in the presence of extra-articular coronal plane deformity of the tibia. Method Retrospective analysis was made of six patients with EAD of the tibia who underwent knee replacement at our centre. Mechanical axis of the tibia is considered and positioning of the tibia component is planned perpendicular to the mechanical axis of the tibia. The integrity of the collaterals determines the need for correction. Tibial resection >15mm from medial or lateral aspect of the tibia is an indication for corrective osteotomy prior to replacement surgery. The hip knee ankle angle (HKA) was noted. Pre-operative, post-operative clinical score, degree of constraints and post-operative complications were recorded. A post-operative long leg alignment radiograph was obtained. Result All patients had total knee replacement without correction of deformity. Adequate alignment of the limb and restoration of mechanical axis was achieved in all six patients without the need for correction of tibial deformity. All patients had improvement in their HKA angle and Oxford knee score. No re-operations were required, and no complications recorded. Conclusions Our study will help provide guidance on operative planning and decisions making for patients with extra-articular coronal plane tibial deformities.

scholarly journals A comparison of comorbidity measures for predicting mortality after elective hip and knee replacement: A cohort study of data from the National Joint Registry in England and Wales

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255602
Author(s):  
Chris M. Penfold ◽  
Michael R. Whitehouse ◽  
Ashley W. Blom ◽  
Andrew Judge ◽  
J. Mark Wilkinson ◽  
...  
Keyword(s):  
Knee Replacement ◽  
Additional Patient ◽  
National Joint Registry ◽  
Comorbidity Score ◽  
Primary Operation ◽  
Joint Registry ◽  
Risk Of Mortality ◽  
Knee Replacements ◽  
All Cause Mortality ◽  
Comorbidity Scores

Background The risk of mortality following elective total hip (THR) and knee replacements (KR) may be influenced by patients’ pre-existing comorbidities. There are a variety of scores derived from individual comorbidities that can be used in an attempt to quantify this. The aims of this study were to a) identify which comorbidity score best predicts risk of mortality within 90 days or b) determine which comorbidity score best predicts risk of mortality at other relevant timepoints (30, 45, 120 and 365 days). Patients and methods We linked data from the National Joint Registry (NJR) on primary elective hip and knee replacements performed between 2011–2015 with pre-existing conditions recorded in the Hospital Episodes Statistics. We derived comorbidity scores (Charlson Comorbidity Index—CCI, Elixhauser, Hospital Frailty Risk Score—HFRS). We used binary logistic regression models of all-cause mortality within 90-days and within 30, 45, 120 and 365-days of the primary operation using, adjusted for age and gender. We compared the performance of these models in predicting all-cause mortality using the area under the Receiver-operator characteristics curve (AUROC) and the Index of Prediction Accuracy (IPA). Results We included 276,594 elective primary THRs and 338,287 elective primary KRs for any indication. Mortality within 90-days was 0.34% (N = 939) after THR and 0.26% (N = 865) after KR. The AUROC for the CCI and Elixhauser scores in models of mortality ranged from 0.78–0.81 after THR and KR, which slightly outperformed models with ASA grade (AUROC = 0.77–0.78). HFRS performed similarly to ASA grade (AUROC = 0.76–0.78). The inclusion of comorbidities prior to the primary operation offers no improvement beyond models with comorbidities at the time of the primary. The discriminative ability of all prediction models was best for mortality within 30 days and worst for mortality within 365 days. Conclusions Comorbidity scores add little improvement beyond simpler models with age, gender and ASA grade for predicting mortality within one year after elective hip or knee replacement. The additional patient-specific information required to construct comorbidity scores must be balanced against their prediction gain when considering their utility.

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