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Comparative Study
. 2008 Sep 30;5(9):e179.
doi: 10.1371/journal.pmed.0050179. Epub 2008 Sep 2.

Revision rates after primary hip and knee replacement in England between 2003 and 2006

Nokuthaba Sibanda  1 , Lynn P Copley, Jim D Lewsey, Mick Borroff, Paul Gregg, Alex J MacGregor, Martin Pickford, Martyn Porter, Keith Tucker, Jan H van der Meulen; Steering Committee of the National Joint Registry (NJR) for England and Wales
Collaborators, Affiliations
Comparative Study

Revision rates after primary hip and knee replacement in England between 2003 and 2006

Nokuthaba Sibanda et al. PLoS Med. .

Abstract

Background: Hip and knee replacement are some of the most frequently performed surgical procedures in the world. Resurfacing of the hip and unicondylar knee replacement are increasingly being used. There is relatively little evidence on their performance. To study performance of joint replacement in England, we investigated revision rates in the first 3 y after hip or knee replacement according to prosthesis type.

Methods and findings: We linked records of the National Joint Registry for England and Wales and the Hospital Episode Statistics for patients with a primary hip or knee replacement in the National Health Service in England between April 2003 and September 2006. Hospital Episode Statistics records of succeeding admissions were used to identify revisions for any reason. 76,576 patients with a primary hip replacement and 80,697 with a primary knee replacement were included (51% of all primary hip and knee replacements done in the English National Health Service). In hip patients, 3-y revision rates were 0.9% (95% confidence interval [CI] 0.8%-1.1%) with cemented, 2.0% (1.7%-2.3%) with cementless, 1.5% (1.1%-2.0% CI) with "hybrid" prostheses, and 2.6% (2.1%-3.1%) with hip resurfacing (p < 0.0001). Revision rates after hip resurfacing were increased especially in women. In knee patients, 3-y revision rates were 1.4% (1.2%-1.5% CI) with cemented, 1.5% (1.1%-2.1% CI) with cementless, and 2.8% (1.8%-4.5% CI) with unicondylar prostheses (p < 0.0001). Revision rates after knee replacement strongly decreased with age.

Interpretation: Overall, about one in 75 patients needed a revision of their prosthesis within 3 y. On the basis of our data, consideration should be given to using hip resurfacing only in male patients and unicondylar knee replacement only in elderly patients.

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Conflict of interest statement

Competing Interests: MB: Chair of ABHI Orthopaedics Special Interest Section; currently employed by DePuy International Ltd, manufacturer of orthopaedic prostheses. PG: Consultant orthopaedic surgeon, South Tees Hospitals NHS Trust. Unit receives research/audit funding from DePuy International Ltd, Stryker UK, and Smith & Nephew plc. Orthopaedic advisor for Capio Healthcare. AJM: Professor of chronic disease epidemiology, University of East Anglia. Consultant rheumatologist, Norfolk and Norwich University Hospital NHS Trust. M Pickford: Managing director of Accentus Medical and consultant to Northgate Informations Systems, the current contractor for the NJR. Does not receive any direct payment from any orthopaedic manufacturer or other third party. M Porter: Consultant orthopaedic surgeon, Wrightington, Wigan and Leigh NHS Trust. Works at a unit that has received financial support from DePuy International for clinical and RSA studies for Elite Plus femoral stem and C-stem. Has acted as consultant to DePuy International for development of a hip femoral stem (C-stem AMT). KT: Consultant orthopaedic surgeon, Norfolk and Norwich University Hospital NHS Trust. Various sources of financial support for research undertaken by orthopaedic department. Paid royalties by Johnson and Johnson Orthopaedic more than 5 y ago for contribution to design of hip prostheses. All royalties paid to orthopaedic charity. NS, LPC, JDL, and JHvdM declare that they have no competing interests.

Figures

Figure 1
Figure 1. Linkage of NJR with the HES Database
Figure 2
Figure 2. Survival Rate Estimates for Primary Hip Replacements
Figure 3
Figure 3. Survival Rate Estimates for Primary Knee Replacements
See this image and copyright information in PMC

References

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