Analyzing the Burden of Revision Total Knee Arthroplasty in the United States between 2009 and 2016

Isaac Livshetz; Benjamin H. Sussman; Vivian Papas; Nequesha S. Mohamed; Hytham S. Salem; Ronald E. Delanois; Michael A. Mont; Giles R. Scuderi

doi:10.1055/s-0041-1731324

The Journal of Knee Surgery, Inhaltsverzeichnis

J Knee Surg 2023; 36(02): 121-131
DOI: 10.1055/s-0041-1731324

Original Article

Analyzing the Burden of Revision Total Knee Arthroplasty in the United States between 2009 and 2016

Isaac Livshetz

¹Department of Orthopedic Surgery, White Plains Hospital, White Plains, New York

,

Benjamin H. Sussman

²Department of Orthopedic Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania

,

Vivian Papas

³Department of Orthopedic Surgery, Lenox Hill Hospital Northwell Health, New York, New York

,

Nequesha S. Mohamed

⁴Department of Orthopedic Surgery, Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland

,

Hytham S. Salem

³Department of Orthopedic Surgery, Lenox Hill Hospital Northwell Health, New York, New York

,

Ronald E. Delanois

⁴Department of Orthopedic Surgery, Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland

,

Michael A. Mont

³Department of Orthopedic Surgery, Lenox Hill Hospital Northwell Health, New York, New York

,

Giles R. Scuderi

³Department of Orthopedic Surgery, Lenox Hill Hospital Northwell Health, New York, New York

› Institutsangaben

Abstract

As the number of total knee arthroplasties (TKAs) increases, it is reasonable to expect the number of revision TKAs (rTKAs) to rise in parallel. The patient-related and societal burdens of rTKA are poorly understood. Therefore, the purpose of this study was to determine temporal changes in: (1) the incidence of rTKA; (2) patient and hospital characteristics; (3) complications, hospital lengths of stay (LOSs), and discharge dispositions; and (4) costs, charges, and payer types. All patients who underwent rTKA between 2009 and 2016 were identified from the National Inpatient Sample database using International Classification of Diseases, Ninth Revision and Tenth Revision codes and were studied. Univariate analyses were performed to compare the incidence of rTKA, patient and hospital characteristics, LOS and discharge dispositions, as well as costs, charges, and payer types. A multivariate logistic regression model was built to compare the odds of complications in 2009 and 2016. Over our study period, there was a 4.3% decrease in the incidence of rTKA. The mean age of patients who underwent rTKA was 65 years and a majority were female (58%). Mean hospital LOS decreased from 4.1 days in 2009 to 3.3 days in 2016 (p < 0.001). The rate of several complications decreased significantly over our study period including myocardial infarction, cardiac arrest, transfusion, pneumonia, urinary tract infection, and mortality. A significantly lower percentage of rTKA patients were discharged to a skilled nursing facility in 2016 (26.5%) compared with 2009 (31.6%; p < 0.001). There was an 18.7% increase in the mean costs, and a 43.3% increase in the mean charges (p < 0.001). Over the study period, there was a decrease in the incidence of rTKAs. Despite potential improvements in primary TKA, the burden associated with rTKA remains large. This report can be used to help educate medical providers about outcomes that may result from a primary and/or revised TKA.

Keywords

knee - total knee arthroplasty - revision - economics

Volltext

Referenzen

References
1 Delanois RE, Mistry JB, Gwam CU, Mohamed NS, Choksi US, Mont MA. Current epidemiology of revision total knee arthroplasty in the United States. J Arthroplasty 2017; 32 (09) 2663-2668
2 Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S. Projected increase in total knee arthroplasty in the United States – an alternative projection model. Osteoarthritis Cartilage 2017; 25 (11) 1797-1803
3 Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018; 100 (17) 1455-1460
4 Bozic KJ, Kamath AF, Ong K. et al. Comparative epidemiology of revision arthroplasty: failed THA poses greater clinical and economic burdens than failed TKA. Clin Orthop Relat Res 2015; 473 (06) 2131-2138
5 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
6 Calliess T, Ettinger M, Hülsmann N, Ostermeier S, Windhagen H. Update on the etiology of revision TKA -- evident trends in a retrospective survey of 1449 cases. Knee 2015; 22 (03) 174-179
7 Dalury DF, Pomeroy DL, Gorab RS, Adams MJ. Why are total knee arthroplasties being revised?. J Arthroplasty 2013; 28 (8, Suppl): 120-121
8 Schroer WC, Berend KR, Lombardi AV. et al. Why are total knees failing today? Etiology of total knee revision in 2010 and 2011. J Arthroplasty 2013; 28 (8, Suppl): 116-119
9 Gonzalez MH, Mekhail AO. The failed total knee arthroplasty: evaluation and etiology. J Am Acad Orthop Surg 2004; 12 (06) 436-446
10 Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today--has anything changed after 10 years?. J Arthroplasty 2014; 29 (09) 1774-1778
11 Culler SD, Jevsevar DS, Shea KG, Wright KK, Simon AW. The incremental hospital cost and length-of-stay associated with treating adverse events among Medicare beneficiaries undergoing TKA. J Arthroplasty 2015; 30 (01) 19-25
12 Lovald ST, Ong KL, Malkani AL. et al. Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. J Arthroplasty 2014; 29 (03) 510-515
13 Kurtz SM, Ong KL, Schmier J. et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am 2007; 89 (Suppl. 03) 144-151
14 Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. JAMA 2012; 308 (12) 1227-1236
15 Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 2008; 79 (02) 168-173
16 Kim L, Kim J-A, Kim S. A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples. Epidemiol Health 2014; 36 (Jul): e2014008
17 HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2012. Agency for Healthcare Research and Quality, Rockville, MD. Available at: www.hcup-us.ahrq.gov/nisoverview.jsp
18 Horn SD, Horn RA, Sharkey PD. The Severity of Illness Index as a severity adjustment to diagnosis-related groups. Health Care Financ Rev 1984; Suppl(Suppl): 36: 33-45
19 HCUP Cost-to-Charge Ratio (CCR) for the National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2017 . Agency for Healthcare Research and Quality, Rockville, MD. Available at: www.hcup-us.ahrq.gov/db/ccr/ip-ccr/ip-ccr.jsp
20 Ong KL, Mowat FS, Chan N, Lau E, Halpern MT, Kurtz SM. Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res 2006; 446: 22-28
21 Bozic KJ, Kurtz SM, Lau E. et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010; 468 (01) 45-51
22 Bedard NA, Pugely AJ, Lux NR, Liu SS, Gao Y, Callaghan JJ. Recent trends in blood utilization after primary hip and knee arthroplasty. J Arthroplasty 2017; 32 (03) 724-727
23 Ramkumar PN, Gwam C, Navarro SM. et al. Discharge to the skilled nursing facility: patient risk factors and perioperative outcomes after total knee arthroplasty. Ann Transl Med 2019; 7 (04) 65
24 Bayliss LE, Culliford D, Monk AP. et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet 2017; 389 (10077): 1424-1430