Migration Patterns for Revision Total Knee Arthroplasty in the United States as Reported in the American Joint Replacement Registry.
PJI
academic
infection
migration
revision knee arthroplasty
total knee arthroplasty
Journal
The Journal of arthroplasty
ISSN: 1532-8406
Titre abrégé: J Arthroplasty
Pays: United States
ID NLM: 8703515
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
26
03
2021
revised:
19
05
2021
accepted:
05
06
2021
pubmed:
10
7
2021
medline:
27
10
2021
entrez:
9
7
2021
Statut:
ppublish
Résumé
Revision total knee arthroplasty (TKA) is associated with a higher complication rate and a greater cost when compared to primary TKA. Based on patient choice, referral, or patient transfers, revision TKAs are often performed in different institutions by different surgeons than the primary TKA. The aim of this study is to evaluate the effect of hospital size, teaching status, and revision indication on the migration patterns of failed primary TKA in patients 65 years of age and older. All primary and revision TKAs reported to the American Joint Replacement Registry from January 2012 through March 2020 were included and merged with the Centers for Medicare and Medicaid Services database. Migration was defined as a patient having a primary TKA and revision TKA performed at separate institutions by different surgeons. In total, 9167 linked primary and revision TKAs were included in the analysis. Overall migration rates were significantly higher from small (<100 beds; P = .019), non-teaching institutions (P = .002) driven primarily by patients diagnosed with infection. Infection patients had significantly higher migration rates from small (46.8%, P < .001), non-teaching (43.5%, P < .001) institutions, while migration rates for other causes of revision were statistically similar. Most patients migrated to medium or large institutions (84.7%) for revision TKA rather than small institutions (15.3%, P < .001) and to teaching (78.3%) rather than non-teaching institutions (21.7%, P < .001). There is a diagnosis-dependent referral bias that affects the migration rates of infected primary TKA from small non-teaching institutions leading to a flow of more medically complex patients to medium and large teaching institutions for infected revision TKA.
Sections du résumé
BACKGROUND
Revision total knee arthroplasty (TKA) is associated with a higher complication rate and a greater cost when compared to primary TKA. Based on patient choice, referral, or patient transfers, revision TKAs are often performed in different institutions by different surgeons than the primary TKA. The aim of this study is to evaluate the effect of hospital size, teaching status, and revision indication on the migration patterns of failed primary TKA in patients 65 years of age and older.
METHODS
All primary and revision TKAs reported to the American Joint Replacement Registry from January 2012 through March 2020 were included and merged with the Centers for Medicare and Medicaid Services database. Migration was defined as a patient having a primary TKA and revision TKA performed at separate institutions by different surgeons.
RESULTS
In total, 9167 linked primary and revision TKAs were included in the analysis. Overall migration rates were significantly higher from small (<100 beds; P = .019), non-teaching institutions (P = .002) driven primarily by patients diagnosed with infection. Infection patients had significantly higher migration rates from small (46.8%, P < .001), non-teaching (43.5%, P < .001) institutions, while migration rates for other causes of revision were statistically similar. Most patients migrated to medium or large institutions (84.7%) for revision TKA rather than small institutions (15.3%, P < .001) and to teaching (78.3%) rather than non-teaching institutions (21.7%, P < .001).
CONCLUSION
There is a diagnosis-dependent referral bias that affects the migration rates of infected primary TKA from small non-teaching institutions leading to a flow of more medically complex patients to medium and large teaching institutions for infected revision TKA.
Identifiants
pubmed: 34238622
pii: S0883-5403(21)00545-3
doi: 10.1016/j.arth.2021.06.005
pmc: PMC8687704
mid: NIHMS1763190
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
3538-3542Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR003143
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
Références
Infect Dis (Lond). 2019 May;51(5):348-355
pubmed: 30938200
JBJS Rev. 2018 Apr;6(4):e9
pubmed: 29664872
J Bone Joint Surg Am. 1982 Oct;64(8):1121-7
pubmed: 7130225
Osteoarthritis Cartilage. 2013 Feb;21(2):263-8
pubmed: 23220555
J Arthroplasty. 2020 Jun;35(6S):S79-S85
pubmed: 32151524
Clin Orthop Relat Res. 2010 Aug;468(8):2039-45
pubmed: 20401555
Clin Orthop Relat Res. 2018 Oct;476(10):1995-2002
pubmed: 30179927
J Bone Joint Surg Am. 2020 Feb 19;102(4):325-331
pubmed: 31851028
Clin Orthop Relat Res. 2019 Jun;477(6):1424-1431
pubmed: 31136446
J Arthroplasty. 2017 Feb;32(2):390-394
pubmed: 27659395
JAMA. 2012 Sep 26;308(12):1227-36
pubmed: 23011713
Arthroplast Today. 2017 Mar 14;3(2):67-69
pubmed: 28695176
J Arthroplasty. 2014 Sep;29(9):1774-8
pubmed: 25007726
J Arthroplasty. 2017 Sep;32(9):2663-2668
pubmed: 28456561
J Arthroplasty. 2019 Mar;34(3):542-548
pubmed: 30559011
J Arthroplasty. 2018 Feb;33(2):521-526
pubmed: 29033158
J Arthroplasty. 2013 Oct;28(9):1687-92
pubmed: 23932757
J Arthroplasty. 2010 Sep;25(6 Suppl):103-7
pubmed: 20570103
Surg Oncol. 2013 Jun;22(2):e17-22
pubmed: 23506709
ScientificWorldJournal. 2012;2012:196515
pubmed: 22619626
J Arthroplasty. 2013 Mar;28(3):423-8
pubmed: 23433254
J Arthroplasty. 2016 Mar;31(3):622-5
pubmed: 26541220
J Bone Joint Surg Am. 2007 Apr;89(4):780-5
pubmed: 17403800
Clin Microbiol Rev. 2014 Apr;27(2):302-45
pubmed: 24696437
J Clin Ethics. 2018 Spring;28(1):62-68
pubmed: 29565798
J Arthroplasty. 2016 May;31(5):952-6
pubmed: 26703194
J Bone Joint Surg Am. 2005 Aug;87(8):1746-51
pubmed: 16085614
Orthopedics. 2010 Mar;33(3):
pubmed: 20349859