Khatod Monti, Inacio Maria, Paxton Elizabeth W, Bini Stefano A, Namba Robert S, Burchette Raoul J, Fithian Donald C
Southern California Permanente Medical Group, San Diego,CA, USA.
Acta Orthop. 2008 Dec;79(6):812-9. doi: 10.1080/17453670810016902.
There are limited population-based data on utilization, outcomes, and trends in total knee arthroplasty (TKA). The purpose of this study was to examine TKA utilization and short-term outcomes in a pre-paid health maintenance organization (HMO), and to determine whether rates and revision burden changed over time. We also studied whether this population is representative of the general population in California and in the United States.
Using hospital utilization and membership databases from 1995 through 2004, we calculated incidence rates (IRs) of primary and revision TKA for every 10,000 health plan members. The demographics of the HMO population were compared to published census data from California and the United States.
The age and sex distributions of the study population were similar to those of the general population in California and the United States. 15,943 primary TKAs and 1,137 revision TKAs were performed during the 10-year period. Patients below the age of 65 accounted for one-third of all primary replacements and one-third of all revision replacements. IRs of primary TKAs increased from 6.3 per 10,000 in 1995 to 11.0 per 10,000 in 2004, at a rate of 5% per year (p<0.001). IRs of revision TKAs increased from 0.41 per 10,000 in 1995 to 0.74 per 10,000 in 2004 (p=0.4). Revision burden remained stable over the 10-year observation period. Surgical complications were higher in revision TKA than in primary TKA (10% vs. 7.7%; p=0.007). 90 day complication rates for primary and revision TKA including death were 0.3% and 0.6% (p=0.1) and for pulmonary embolism 0.5% and 0.4% (p=0.6). 90 day re-admission rates for primary and revision TKA including infection were 0.5% and 4.2% (p<0.001), for myocardial infarction 0.1% each, and for pneumonia 0.2% and 0.4% (p=0.08).
The incidence of primary and revision TKA increased between 1995 and 2005. The rates of postoperative complications were low. Comparisons of the study population and the underlying general populations of interest indicate that this population can be used to predict the incidences and outcomes of TKA in the general population of California and of the United States as a whole.
关于全膝关节置换术（TKA）的使用情况、治疗结果及发展趋势，基于人群的数据有限。本研究的目的是调查一家预付制健康维护组织（HMO）中TKA的使用情况和短期治疗结果，并确定其发生率及翻修负担是否随时间变化。我们还研究了该人群是否能代表加利福尼亚州及美国的普通人群。
利用1995年至2004年的医院使用情况和会员数据库，我们计算了每10000名健康计划会员中初次和翻修TKA的发生率（IRs）。将HMO人群的人口统计学特征与加利福尼亚州和美国已公布的人口普查数据进行比较。
研究人群的年龄和性别分布与加利福尼亚州和美国的普通人群相似。在这10年期间共进行了15943例初次TKA和1137例翻修TKA。65岁以下的患者占所有初次置换手术的三分之一和所有翻修置换手术的三分之一。初次TKA的发生率从1995年的每10000人6.3例增加到2004年的每10000人11.0例，年增长率为5%（p<0.001）。翻修TKA的发生率从1995年的每10000人0.41例增加到2004年的每10000人0.74例（p=0.4）。在10年的观察期内，翻修负担保持稳定。翻修TKA的手术并发症高于初次TKA（10%对7.7%；p=0.007）。初次和翻修TKA包括死亡在内的90天并发症发生率分别为0.3%和0.6%（p=0.1），肺栓塞发生率分别为0.5%和0.4%（p=0.6）。初次和翻修TKA包括感染在内的90天再入院率分别为0.5%和4.2%（p<0.001），心肌梗死发生率均为0.1%，肺炎发生率分别为0.2%和0.4%（p=0.08）。
1995年至2005年间，初次和翻修TKA的发生率有所增加。术后并发症发生率较低。研究人群与相关普通人群的比较表明，该人群可用于预测加利福尼亚州及美国普通人群中TKA的发生率和治疗结果。
