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. 2022 Dec;104-B(12):1313-1322.
doi: 10.1302/0301-620X.104B12.BJJ-2021-1631.R3.

The estimated lifetime risk of revision after primary knee arthroplasty is influenced by age, sex, and indication

Liam Z Yapp  1   2   3 , Nick D Clement  1   3 , Matthew Moran  1   2   3 , Jon V Clarke  2   4 , A Hamish R W Simpson  1   3 , Chloe E H Scott  1   3
Affiliations

The estimated lifetime risk of revision after primary knee arthroplasty is influenced by age, sex, and indication

Liam Z Yapp et al. Bone Joint J. 2022 Dec.

Abstract

Aims: The aim of this study was to assess factors associated with the estimated lifetime risk of revision surgery after primary knee arthroplasty (KA).

Methods: All patients from the Scottish Arthroplasty Project dataset undergoing primary KA during the period 1 January 1998 to 31 December 2019 were included. The cumulative incidence function for revision and death was calculated up to 20 years. Adjusted analyses used cause-specific Cox regression modelling to determine the influence of patient factors. The lifetime risk was calculated as a percentage for patients aged between 45 and 99 years using multiple-decrement life table methodology.

Results: The estimated lifetime risk of revision ranged between 32.7% (95% confidence interval (CI) 22.6 to 47.3) for patients aged 45 to 49 years and 0.6% (95% CI 0.1 to 4.5) for patients aged over 90 years. At 20 years, the overall cumulative incidence of revision (6.8% (95% CI 6.6 to 7.0)) was significantly less than that of death (66.3% (95% CI 65.4 to 67.1)). Adjusted analyses demonstrated converse effect of increasing age on risk of revision (hazard ratio (HR) 0.5 (95% CI 0.5 to 0.6)) and death (HR 3.6 (95% CI 3.4 to 3.7)). Male sex was associated with increased risks of revision (HR 1.1 (95% CI 1.1 to 1.2); p < 0.001) and death (HR 1.4 (95% CI 1.3 to 1.4); p < 0.001). Compared to patients undergoing primary KA for osteoarthritis, patients with inflammatory arthropathy had a higher risk of death (HR 1.7 (95% CI 1.7 to 1.8); p < 0.001), but were less likely to be revised (HR 0.9 (95% CI 0.7 to 1.0); p < 0.001). Patients with a greater number of comorbidities (HR 1.4 (95% CI 1.3 to 1.4)) and greater levels of socioeconomic deprivation (HR 1.4 (95% CI 1.4 to 1.5)) were at increased risk of death, but neither increased the risk of revision.

Conclusion: The estimated lifetime risk of revision KA varied depending on patient sex, age, and underlying diagnosis. Patients aged between 45 and 49 years had a one in three risk of undergoing revision surgery within their lifetime, which decreased with age to one in 159 in those aged 90 years or more.Cite this article: Bone Joint J 2022;104-B(12):1313-1322.

Keywords: Arthroplasty; Cox regression modelling; Knee; Mortality; Primary knee arthroplasty; Revision; Risk; TKA; arthroplasty; clinicians; comorbidities; inflammatory arthropathy; knee; osteoarthritis (OA); revision surgery.

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