scholarly journals Obesity and revision surgery, mortality, and patient-reported outcomes after primary knee replacement surgery in the National Joint Registry: A UK cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (7) ◽  
pp. e1003704
Author(s):  
Jonathan Thomas Evans ◽  
Sofia Mouchti ◽  
Ashley William Blom ◽  
Jeremy Mark Wilkinson ◽  
Michael Richard Whitehouse ◽  
...  
Keyword(s):  
Knee Replacement ◽  
Revision Surgery ◽  
Early Years ◽  
Minimal Detectable Change ◽  
National Joint Registry ◽  
Joint Registry ◽  
Obese Class ◽  
Patient Reported ◽  
Surgery Mortality ◽  
High Bmi

Background One in 10 people in the United Kingdom will need a total knee replacement (TKR) during their lifetime. Access to this life-changing operation has recently been restricted based on body mass index (BMI) due to belief that high BMI may lead to poorer outcomes. We investigated the associations between BMI and revision surgery, mortality, and pain/function using what we believe to be the world’s largest joint replacement registry. Methods and findings We analysed 493,710 TKRs in the National Joint Registry (NJR) for England, Wales, Northern Ireland, and the Isle of Man from 2005 to 2016 to investigate 90-day mortality and 10-year cumulative revision. Hospital Episodes Statistics (HES) and Patient Reported Outcome Measures (PROMs) databases were linked to the NJR to investigate change in Oxford Knee Score (OKS) 6 months postoperatively. After adjustment for age, sex, American Society of Anaesthesiologists (ASA) grade, indication for operation, year of primary TKR, and fixation type, patients with high BMI were more likely to undergo revision surgery within 10 years compared to those with “normal” BMI (obese class II hazard ratio (HR) 1.21, 95% CI: 1.10, 1.32 (p < 0.001) and obese class III HR 1.13, 95% CI: 1.02, 1.26 (p = 0.026)). All BMI classes had revision estimates within the recognised 10-year benchmark of 5%. Overweight and obese class I patients had lower mortality than patients with “normal” BMI (HR 0.76, 95% CI: 0.65, 0.90 (p = 0.001) and HR 0.69, 95% CI: 0.58, 0.82 (p < 0.001)). All BMI categories saw absolute increases in OKS after 6 months (range 18–20 points). The relative improvement in OKS was lower in overweight and obese patients than those with “normal” BMI, but the difference was below the minimal detectable change (MDC; 4 points). The main limitations were missing BMI particularly in the early years of data collection and a potential selection bias effect of surgeons selecting the fitter patients with raised BMI for surgery. Conclusions Given revision estimates in all BMI groups below the recognised threshold, no evidence of increased mortality, and difference in change in OKS below the MDC, this large national registry shows no evidence of poorer outcomes in patients with high BMI. This study does not support rationing of TKR based on increased BMI.

Trust compliance with best practice tariff criteria for total hip and knee replacement

2019 ◽  
Vol 80 (9) ◽  
pp. 537-540
Author(s):  
Ivor Vanhegan ◽  
Andrew Sankey ◽  
Warwick Radford ◽  
Simon Ball ◽  
Charles Gibbons
Keyword(s):  
Knee Replacement ◽  
Best Practice ◽  
Outcome Measure ◽  
Participation Rate ◽  
Patient Reported Outcome ◽  
Measure Data ◽  
National Joint Registry ◽  
Joint Registry ◽  
Patient Reported Outcome Measure ◽  
Patient Reported

Background: Satisfaction of the best practice tariff criteria for primary hip and knee replacement enables on average an additional £560 of reimbursement per case. The Getting it Right First Time report highlighted poor awareness of these criteria among orthopaedic departments. Methods: The authors investigated the reasons for non-compliance with the best practice tariff criteria at their trust and implemented a quality improvement approach to ensure successful adherence to the standards (a minimum National Joint Registry compliance rate of 85%, a National Joint Registry unknown consent rate below 15%, a patient-reported outcome measure participation rate of ≥50%, and an average health gain not significantly below the national average). This was investigated using quarterly online reports from the National Joint Registry and NHS Digital. Results: Initially, the trust had a 31% patient-reported outcome measures participation rate arising from a systematic error in the submission of preoperative patient-reported outcome measure scores. Re-audit following the resubmission of patient-reported outcome measure data under the trust's correct organization data service code confirmed an improvement in patient-reported outcome measure compliance to 90% and satisfaction of all criteria resulting in over £450 000 of additional reimbursement to the trust. Conclusions: The authors would urge others to review their compliance with these four best practice tariff criteria to ensure that they too are not missing out on this significant reimbursement sum.

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 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.

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