Melbourne EpiCentre, Royal Melbourne Hospital, and The University of Melbourne, Parkville, Victoria, Australia.
Arthritis Care Res (Hoboken). 2014 Mar;66(3):424-31. doi: 10.1002/acr.22122.
To estimate the lifetime risk of total knee replacement (TKR) and examine temporal trends in TKR incidence in the state of Victoria, Australia.
We performed a retrospective analysis of a population-based longitudinal cohort of patients (ages ≥40 years) who received a primary TKR in Victoria from 1999-2008. Hospital separations and life tables were used to estimate lifetime risk. Temporal changes in TKR incidence were examined according to health care setting (public versus private), socioeconomic status (SES), and geographic location (regional versus metropolitan).
There were 43,570 incidents of primary TKRs identified over the study period. In 2008, the lifetime risk of surgery was 10.4% (95% confidence interval [95% CI] 10.13-10.64%) for men and 11.9% (95% CI 11.63-12.13%) for women. TKRs increased steadily over the study period in private hospitals (overall increase of 90%) with a smaller growth in procedure numbers for public hospitals (overall increase of 40%). From 2002-2003 onward, the low SES tertile showed a lower incidence of TKR compared to the middle and high SES groups, with incidence rates of 1.09 (95% CI 1.04-1.15), 1.22 (95% CI 1.17-1.28), and 1.20 (95% CI 1.16-1.25) per 1,000 population, respectively (based on 2007-2008 figures). Increased numbers of TKRs were also found to be occurring among people residing in regional areas of Victoria (from 1.12 [95% CI 1.04-1.31] to 1.84 [95% CI 1.72-2.02] per 1,000 population).
Increases in lifetime risk of TKR were evident. Although improved access to TKR for those living in regional areas was observed, sustained disparities relating to health care setting and SES warrant further investigation.
估计全膝关节置换术（TKR）的终生风险，并检查澳大利亚维多利亚州 TKR 发病率的时间趋势。
我们对 1999-2008 年维多利亚州接受初次 TKR 的基于人群的纵向队列患者（年龄≥40 岁）进行了回顾性分析。使用住院分离和生命表来估计终生风险。根据医疗保健环境（公共与私人）、社会经济地位（SES）和地理位置（区域与大都市）检查 TKR 发病率的时间变化。
在研究期间，共确定了 43570 例初次 TKR 事件。2008 年，男性手术终生风险为 10.4%（95%置信区间[95%CI]为 10.13-10.64%），女性为 11.9%（95%CI 为 11.63-12.13%）。在研究期间，私立医院的 TKR 数量稳步增加（总体增加 90%），而公立医院的手术数量增长较小（总体增加 40%）。自 2002-2003 年以来，低 SES 三分位组的 TKR 发病率低于中高 SES 组，发病率分别为 1.09（95%CI 为 1.04-1.15）、1.22（95%CI 为 1.17-1.28）和 1.20（95%CI 为 1.16-1.25）每 1000 人（基于 2007-2008 年的数据）。还发现维多利亚州地区的 TKR 数量也在增加（从每 1000 人 1.12（95%CI 为 1.04-1.31）增加到 1.84（95%CI 为 1.72-2.02））。
TKR 的终生风险增加是明显的。尽管观察到居住在地区的人获得 TKR 的机会有所改善，但与医疗保健环境和 SES 相关的持续差距仍需要进一步调查。
