School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia.
Acta Orthop. 2012 Jun;83(3):220-6. doi: 10.3109/17453674.2012.684140. Epub 2012 May 4.
An increasing number of patients have several joint replacement procedures during their lifetime. We investigated the use and suitability of multi-state model techniques in providing a more comprehensive analysis and description of complex arthroplasty histories held in arthroplasty registries than are allowed for with traditional survival methods.
We obtained data from the Australian Orthopaedic Association National Joint Replacement Registry on patients (n = 84,759) who had undergone a total hip arthroplasty for osteoarthritis in the period 2002-2008. We set up a multi-state model where patients were followed from their first recorded arthroplasty to several possible states: revision of first arthroplasty, either a hip or knee as second arthroplasty, revision of the second arthroplasty, and death. The Summary Notation for Arthroplasty Histories (SNAH) was developed in order to help to manage and analyze this type of data.
At the end of the study period, 12% of the 84,759 patients had received a second hip, 3 times as many as had received a knee. The estimated probabilities of having received a second arthroplasty decreased with age. Males had a lower transition rate for receiving a second arthroplasty, but a higher mortality rate.
Multi-state models in combination with SNAH codes are well suited to the management and analysis of arthroplasty registry data on patients who experience multiple joint procedures over time. We found differences in the progression of joint replacement procedures after the initial total hip arthroplasty regarding type of joint, age, and sex.
越来越多的患者在其一生中需要进行多次关节置换手术。我们研究了多状态模型技术在分析和描述关节置换登记处中复杂的关节置换史方面的应用和适用性，这种方法比传统的生存方法更为全面。
我们从澳大利亚矫形协会国家关节置换登记处获取了 2002 年至 2008 年间因骨关节炎接受初次全髋关节置换术的 84759 例患者的数据。我们建立了一个多状态模型，其中患者从首次记录的关节置换开始，可能会经历多个状态：初次关节置换的翻修、作为第二次关节置换的髋关节或膝关节、第二次关节置换的翻修以及死亡。为了帮助管理和分析这类数据，我们开发了关节置换史的简写注释（SNAH）。
在研究期末，84759 例患者中有 12%接受了第二次髋关节置换，是接受膝关节置换的 3 倍。接受第二次关节置换的估计概率随着年龄的增长而降低。男性接受第二次关节置换的转移率较低，但死亡率较高。
多状态模型与 SNAH 编码相结合，非常适合管理和分析关节置换登记处中随时间推移经历多次关节手术的患者的数据。我们发现，初次全髋关节置换后关节置换程序的进展在关节类型、年龄和性别方面存在差异。
