Risk factors for early revision after total hip and knee arthroplasty: National observational study from a surgeon and population perspective

AIMS: To identify predictors of early revision (within 3 years of the index operation) for hip and knee replacement (HR, KR) from both surgeon and population perspectives. PATIENTS AND METHODS: Hierarchical logistic regression on national administrative data for England for index procedures between April 2009 and March 2014. RESULTS: There were 315,273 index HR procedures and 374,530 index KR procedures for analysis. Three-year revision rates were 2.1% for HR and 2.2% for KR. The highest odds ratios for HR were for 3+ previous emergency admissions, drug abuse, Parkinson’s disease, resurfacing and ages under 60; for KR these were patellofemoral or partial joint replacement, 3+ previous emergency admissions, paralysis and ages under 60. Smaller effects were found for other comorbidities such as obesity (HR) and diabetes (KR). From a population perspective, the only population attributable fractions over 5% were for male gender, uncemented total hip replacements and partial knee or patellofemoral replacements. CONCLUSIONS: Meeting the rising demand for revision surgery is a challenge for healthcare leaders and policymakers. Our findings suggest optimising patients pre-operatively and improving patient selection for primary arthroplasty may reduce the burden of early revision of arthroplasty. Our study gives useful information on the additional risks of various comorbidities and procedures, which enables a more informed consent process. CLINICAL RELEVANCE: Surgeons should make patients with certain risk factors such as age and procedure type aware of their higher revision risk as part of shared decision-making.