Department of Orthopaedics and Trauma Surgery, The Repatriation General Hospital Adelaide (RGH), Daw Park, South Australia, Australia.
Department of Orthopaedics, Flinders University Adelaide, Bedford Park, South Australia, Australia.
J Knee Surg. 2021 Oct;34(12):1284-1295. doi: 10.1055/s-0040-1708040. Epub 2020 Apr 15.
National registries for primary and revision knee arthroplasty in Australia, New Zealand, and Europe have been successful in ensuring quality control and providing information to drive crucial research. However, they face challenges in delivering the granularity of data useful at a local hospital level. Our aim was to address these challenges by designing and initiating a local revision knee arthroplasty registry and combining the data with national figures to better evaluate the types of revisions undertaken, and improve patient outcomes and care. All revision knee arthroplasty cases in our center were analyzed from April 2014 to December 2015 using our standardized diagnostic algorithm. Information such as reason and type of revision was collected. Results were compared with Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data. Primary outcome was comparison against our center's historical data between January 1999 and December 2013 and secondary outcome was comparison against national data prior to and after our intervention. Between April 2014 and December 2015, our center performed 35 revision knee arthroplasties. When compared with our center's historical data, we observed lower rates of revision knee arthroplasties due to "pain" (14.2 vs. 36.7%) with corresponding lower rates of patella button only revision (8.6 vs. 39.2%). Compared with national data before our intervention, we had lower revision rates from infection (14.2 vs. 22.3%) and loosening/lysis (11.4 vs. 29.2%). We undertook more minor revisions (45.7 vs. 30.5%) and similar total revisions (25.7 vs. 25.3%). Similar trends were seen in comparison to national data after our intervention. Our study shows that a local registry can be designed and successfully implemented for revision knee arthroplasty surgery. Data can be easily compared with historic and current hospital and national registry data trends to assess quality and robustness of revision arthroplasty programs. Our early results suggest our center has succeeded in reducing incidences of major revisions, complications, and the risk of re-revision surgery. This will improve the quality of our service with a significant cost reduction for our local health care budget.
澳大利亚、新西兰和欧洲的原发性和翻修膝关节置换国家登记处成功地确保了质量控制，并提供了推动关键研究的信息。然而，它们在提供对当地医院层面有用的详细数据方面面临挑战。我们的目标是通过设计和启动当地翻修膝关节置换登记处并将数据与国家数据结合起来，更好地评估所进行的翻修类型，从而解决这些挑战，改善患者的结果和护理。我们中心的所有翻修膝关节置换病例均使用我们的标准化诊断算法从 2014 年 4 月至 2015 年 12 月进行分析。收集了有关修订原因和类型的信息。结果与澳大利亚矫形协会国家关节置换登记处（AOANJRR）的数据进行了比较。主要结果是将我们中心 1999 年 1 月至 2013 年 12 月的历史数据与我们的干预前后的国家数据进行比较。2014 年 4 月至 2015 年 12 月，我们中心进行了 35 例翻修膝关节置换术。与我们中心的历史数据相比，我们观察到因“疼痛”而进行翻修膝关节置换的比率较低（14.2%对 36.7%），相应的髌骨按钮单独翻修的比率也较低（8.6%对 39.2%）。与我们干预前的国家数据相比，我们的感染（14.2%对 22.3%）和松动/溶解（11.4%对 29.2%）的翻修率较低。我们进行了更多的小翻修（45.7%对 30.5%），总翻修率相似（25.7%对 25.3%）。与我们干预后的国家数据相比，也出现了类似的趋势。我们的研究表明，可以设计并成功实施用于翻修膝关节置换手术的本地登记处。可以轻松地将数据与历史和当前医院以及国家登记处数据趋势进行比较，以评估翻修关节置换计划的质量和稳健性。我们的早期结果表明，我们中心成功地降低了主要翻修，并发症和再次翻修手术的风险。这将提高我们的服务质量，并为我们当地的医疗保健预算带来显著的成本节约。
