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.

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 Hip Replacement Constructs Using Noninferiority Analysis: The New Zealand Joint Registry Study

2020 ◽  
Author(s):  
Michael Wyatt ◽  
Chris Frampton ◽  
Michael Whitehouse ◽  
Kevin Deere ◽  
Adrian Sayers ◽  
...  
Keyword(s):  
At Risk ◽  
New Zealand ◽  
Relative Risk ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Best Practice ◽  
Survival Function ◽  
Total Hip ◽  
Joint Registry ◽  
The Difference

Abstract Background: The aim of this study was to compare the relative performance of total hip replacement constructs and discern if there is substantial 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 hip replacement (THR) registered in the NZJR between 1st January 1999 to June 2020 were identified. Using a noninferiority analysis, the performance of hip prostheses were compared with the best performing contemporary construct. Construct failure was estimated using the 1-Kaplan Meier survival function method to estimate net failure. The difference in failure between the contemporary benchmark and other constructs was examined.Results: In total 135 432 THR were recorded comprising 1 035 different THR constructs. Notably 328 constructs were used just once. 48 constructs (62 251 THR) had >500 procedures at risk at 3 years post-primary of which 28 were inferior by at least 20% relative risk of which, 10 were inferior by at least 100% relative risk. 16 constructs were identified with >500 procedures at risk at 10 years with 9 inferior by at least 20%, of which one was inferior by >100% relative risk. There were fewer constructs noninferior to the best practice benchmark when we performed analysis by gender. In females at 10 years, from 5 constructs with >500 constructs at risk, 2 were inferior at the 20% margin. In males at 10 years, there were only 2 eligible constructs of which one was inferior at the 20% margin.Conclusions: We discerned that there is substantial variability in construct performance and at most time points, just over half of constructs are inferior to the best performing construct by at least 20%. These results can facilitate informed decision-making when considering THR surgery.

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

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Michael Wyatt ◽  
Chris Frampton ◽  
Michael Whitehouse ◽  
Kevin Deere ◽  
Adrian Sayers ◽  
...  
Keyword(s):  
At Risk ◽  
New Zealand ◽  
Relative Risk ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Best Practice ◽  
Survival Function ◽  
Total Hip ◽  
Joint Registry ◽  
The Difference

Abstract Background The aim of this study was to compare the relative performance of total hip replacement constructs and discern if there is substantial 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 hip replacement (THR) registered in the NZJR between 1st January 1999 to June 2020 were identified. Using a noninferiority analysis, the performance of hip prostheses were compared with the best performing contemporary construct. Construct failure was estimated using the 1-Kaplan Meier survival function method to estimate net failure. The difference in failure between the contemporary benchmark and other constructs was examined. Results In total 135,432 THR were recorded comprising 1035 different THR constructs. Notably 328 constructs were used just once. Forty-eight constructs (62,251 THR) had > 500 procedures at risk at 3 years post-primary of which 28 were inferior by at least 20% relative risk of which, 10 were inferior by at least 100% relative risk. Sixteen constructs were identified with > 500 procedures at risk at 10 years with 9 inferior by at least 20%, of which one was inferior by > 100% relative risk. There were fewer constructs noninferior to the best practice benchmark when we performed analysis by gender. In females at 10 years, from 5 constructs with > 500 constructs at risk, 2 were inferior at the 20% margin. In males at 10 years, there were only 2 eligible constructs of which one was inferior at the 20% margin. Conclusions We discerned that there is substantial variability in construct performance and at most time points, just over half of constructs are inferior to the best performing construct by at least 20%. These results can facilitate informed decision-making when considering THR surgery.

scholarly journals Assessing the non-inferiority of prosthesis constructs used in hip replacement 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. e026685 ◽  
Author(s):  
Kevin C Deere ◽  
Michael R Whitehouse ◽  
Martyn Porter ◽  
Ashley W Blom ◽  
Adrian Sayers
Keyword(s):  
At Risk ◽  
Relative Risk ◽  
Northern Ireland ◽  
Hip Replacement ◽  
Hip Prosthesis ◽  
Survival Function ◽  
National Joint Registry ◽  
Joint Registry ◽  
Isle Of Man ◽  
Kaplan Meier

ObjectivesTo investigate the relative performance of hip prosthesis constructs as compared with the best performing prosthesis constructs and illustrate the substantial variability in performance of currently used prostheses.DesignA non-inferiority study.SettingThe National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR).ParticipantsAll patients with a primary total hip replacement registered in the NJR between 1 April 2003 and 31 December 2016.Main outcome measuresKaplan-Meier failure function for hip prosthesis constructs. Failure difference between best performing construct and remaining constructs.MethodsUsing a non-inferiority analysis, the performance of hip prosthesis constructs by brand were compared with the best performing contemporary construct. Construct failure was estimated using the 1-Kaplan-Meier survival function method, that is, an estimate of net failure. The difference in failure between the contemporary benchmark and all other constructs was tested.ResultsOf the 4442 constructs used, only 134 had ≥500 procedures at risk at 3 years postprimary, 89 of which were not demonstrated to be inferior to the benchmark by at least 100% relative risk. By 10 years postprimary, there were 26 constructs with ≥500 at risk, 13 of which were not demonstrated to be inferior by at least 20% relative risk.Even fewer constructs were not inferior to the benchmark when analysed by age and gender. At 5 years postprimary, there were 15 constructs in males and 11 in females, aged 55–75 years, not shown to be inferior.ConclusionsThere is great variability in construct performance and the majority of constructs have not been demonstrated to be non-inferior to contemporary benchmarks. These results can help to inform patients, clinicians and commissioners when considering hip replacement surgery.

scholarly journals Primary total knee replacement using dished polyethylene with resected posterior cruciate ligament

2021 ◽  
Vol 7 (4) ◽  
pp. 781
Author(s):  
Mohan M. Kumar ◽  
Satvik N. Pai ◽  
Pravin K. Vanchi ◽  
Raghav Ravi ◽  
Syam Nath
Keyword(s):  
Total Knee Replacement ◽  
Posterior Cruciate Ligament ◽  
Knee Replacement ◽  
Tibial Component ◽  
Cruciate Ligament ◽  
Womac Score ◽  
Senior Author ◽  
Kaplan Meier ◽  
Total Knee

<p><strong>Background: </strong>The choice between preserving, sacrificing or substituting the posterior cruciate ligament (PCL) is always a controversial topic in total knee replacement (TKR). Dished polyethylene insert with PCL resection enables correction of the commonly present fixed flexion and varus deformities. Additionally, the risk of premature wear of polyethylene is less because of the confirming articular geometry between the femoral and tibial component.<strong></strong></p><p><strong>Methods: </strong>This is a retrospective study in which we studied 120 knees in 95 consecutive patients undergoing primary TKR by the senior author at our institute. We used TKR system with dished metal backed polyethylene tibial component. PCL resection was performed in all cases. Pre-operative and post-operative functional assessment were done using knee society clinical scores and Western Ontario and McMaster universities osteoarthritis index (WOMAC). All radiographs were assessed using the knee society Roentgenographic scoring system (KSRES). Statistical analysis was performed using paired student t tests. Survivorship was determined using Kaplan-Meier survivorship curves. <strong></strong></p><p><strong>Results: </strong>Mean follow-up was 8 years. Range of motion increased from 75 degrees to 110 degrees.  The knee society pain score increased from 30 to 94. The knee society function score increased from 35 to 75. WOMAC score increased in terms of pain, stiffness and physical function.<strong></strong></p><p><strong>Conclusions: </strong>We conclude that deep dish bearing is a viable option in presence of deficient PCL and provides adequate stability and functional outcome. We need a larger sample size, multicentre trial and longer follow-up to see for complication rate, revision rate and survival.</p>

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