Delanois Ronald E, Mistry Jaydev B, Gwam Chukwuweike U, Mohamed Nequesha S, Choksi Ujval S, Mont Michael A
Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
J Arthroplasty. 2017 Sep;32(9):2663-2668. doi: 10.1016/j.arth.2017.03.066. Epub 2017 Apr 6.
Revision surgery for failed total knee arthroplasty (TKA) continues to pose a substantial burden for the United States healthcare system. The predominant etiology of TKA failure has changed over time and may vary between studies. This report aims to update the current literature on this topic by using a large national database. Specifically, we analyzed: (1) etiologies for revision TKA; (2) frequencies of revision TKA procedures; (3) various demographics including payer type and region; and (4) the length of stay (LOS) and total charges based on type of revision TKA procedure.
The Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database was used to identify all revision TKA procedures performed between 2009 and 2013. Clinical, economic, and demographic data were collected and analyzed for 337,597 procedures. Patients were stratified according to etiology of failure, age, sex, race, US census region, and primary payor class. The mean LOS and total charges were also calculated.
Infection was the most common etiology for revision TKA (20.4%), closely followed by mechanical loosening (20.3%). The most common revision TKA procedure performed was all component revision (31.3%). Medicare was the primary payor for the greatest proportion of revisions (57.7%). The South census region performed the most revision TKAs (33.2%). The overall mean LOS was 4.5 days, with arthrotomy for removal of prosthesis without replacement procedures accounting for the longest stays (7.8 days). The mean total charge for revision TKAs was $75,028.07.
Without appropriate measures in place, the burden of revision TKAs may become overwhelming and pose a strain on providers and institutions. Continued insight into the etiology and epidemiology of revision TKAs may be the principle step towards improving outcomes and mitigating the need for future revisions.
全膝关节置换术（TKA）失败后的翻修手术持续给美国医疗系统带来沉重负担。TKA失败的主要病因随时间发生了变化，且不同研究之间可能存在差异。本报告旨在通过使用一个大型国家数据库来更新该主题的当前文献。具体而言，我们分析了：（1）TKA翻修的病因；（2）TKA翻修手术的频率；（3）包括付款人类型和地区在内的各种人口统计学特征；以及（4）基于TKA翻修手术类型的住院时间（LOS）和总费用。
利用医疗成本与利用项目（HCUP）的全国住院患者样本（NIS）数据库，识别2009年至2013年间进行的所有TKA翻修手术。收集并分析了337,597例手术的临床、经济和人口统计学数据。患者根据失败病因、年龄、性别、种族、美国人口普查地区和主要付款人类别进行分层。还计算了平均住院时间和总费用。
感染是TKA翻修最常见的病因（20.4%），紧随其后的是机械松动（20.3%）。最常见的TKA翻修手术是全组件翻修（31.3%）。医疗保险是大部分翻修手术的主要付款人（57.7%）。南部人口普查地区进行的TKA翻修手术最多（33.2%）。总体平均住院时间为4.5天，其中不进行假体置换的关节切开术取出假体的住院时间最长（7.8天）。TKA翻修的平均总费用为75,028.07美元。
若未采取适当措施，TKA翻修的负担可能变得难以承受，并给医疗服务提供者和机构带来压力。持续深入了解TKA翻修的病因和流行病学可能是改善治疗效果并减少未来翻修需求的主要步骤。
