Jain Nitin B, Higgins Laurence D, Ozumba Donald, Guller Ulrich, Cronin McNeil, Pietrobon Ricardo, Katz Jeffrey N
Duke University Medical Center, Durham, North Carolina, USA.
Arthritis Rheum. 2005 Dec;52(12):3928-33. doi: 10.1002/art.21420.
There is little information on longitudinal trends in the epidemiology of total knee arthroplasty (TKA). This study was undertaken to determine whether, during the past decade, TKA rates increased in younger adults and older adults, whether utilization of TKA increased among minorities, and whether more patients underwent surgery at high-volume hospitals.
TKA cases (n = 443,008) were extracted from the 1990-2000 Nationwide Inpatient Sample database. TKA trends for 3 time periods were obtained (1990-1993 [period I], 1994-1997 [period II], and 1998-2000 [period III]).
Between period I and period III, the proportion of TKAs performed increased by 95.2% in the 40-49-year age group and by 53.7% in the 50-59-year age group. Black patients and Hispanic patients were more likely to undergo TKA in period III than in period I (odds ratio [OR] = 1.6, 95% confidence interval [95% CI] 1.5-1.6 and OR 2.7, 95% CI 2.5-2.9, respectively). However, white patients accounted for 93.0%, 89.9%, and 87.5% of TKAs in the 3 time periods, respectively. In period III, the proportion of patients undergoing surgery in high-volume hospitals increased compared with periods I and II. Both mortality and length of hospital stay diminished significantly in period III, but the rate of discharge to an inpatient facility increased by 89.7% (period I to period III).
Over the past decade, TKA was increasingly performed in younger patients, which suggests a broadening of indications for this procedure. Although utilization of TKA increased among minorities, the vast majority of TKAs were performed in white patients. Further efforts to narrow this disparity are required. The shift toward TKAs being increasingly performed at high-volume centers may improve surgical outcomes. Finally, the effect of increased discharge to inpatient facilities on TKA outcomes needs to be ascertained.
关于全膝关节置换术（TKA）流行病学的纵向趋势，相关信息较少。本研究旨在确定在过去十年中，TKA在年轻成年人和老年成年人中的发生率是否上升，少数民族中TKA的使用率是否增加，以及是否有更多患者在高容量医院接受手术。
从1990 - 2000年全国住院患者样本数据库中提取TKA病例（n = 443,008）。获取了三个时间段的TKA趋势（1990 - 1993年[第一阶段]、1994 - 1997年[第二阶段]和1998 - 2000年[第三阶段]）。
在第一阶段和第三阶段之间，40 - 49岁年龄组中进行TKA的比例增加了95.2%，50 - 59岁年龄组中增加了53.7%。与第一阶段相比，第三阶段黑人患者和西班牙裔患者更有可能接受TKA（优势比[OR]分别为1.6，95%置信区间[95%CI]为1.5 - 1.6；OR为2.7，95%CI为2.5 - 2.9）。然而，在这三个时间段中，白人患者分别占TKA患者的93.0%、89.9%和87.5%。在第三阶段，与第一阶段和第二阶段相比，在高容量医院接受手术的患者比例有所增加。第三阶段的死亡率和住院时间均显著降低，但转至住院机构的出院率增加了89.7%（从第一阶段到第三阶段）。
在过去十年中，TKA在年轻患者中的实施越来越多，这表明该手术的适应症在扩大。尽管少数民族中TKA的使用率有所增加，但绝大多数TKA手术是在白人患者中进行的。需要进一步努力缩小这种差距。TKA手术越来越多地在高容量中心进行的转变可能会改善手术结果。最后，转至住院机构的出院率增加对TKA结果的影响需要确定。
