Department of Health & Applied Sciences, University of the West of England, Bristol, UK
Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
BMJ Open. 2022 Mar 9;12(3):e046900. doi: 10.1136/bmjopen-2020-046900.
To identify patients at risk of mid-late term revision of knee replacement (KR) to inform targeted follow-up.
Analysis of linked national datasets from primary and secondary care (Clinical Practice Research Datalink (CPRD GOLD), National Joint Registry (NJR), English Hospital Episode Statistics (HES) and Patient Reported Outcome Measures (PROMs)).
Primary elective KRs aged ≥18 years.
Revision surgery ≥5 years (mid-late term) postprimary KR.
Cox regression modelling to ascertain risk factors of mid-late term revision. HRs and 95% CIs assessed association of sociodemographic factors, comorbidities, medication, surgical variables and PROMs with mid-late term revision.
NJR-HES-PROMs data were available from 2008 to 2011 on 188 509 KR. CPRD GOLD-HES data covered 1995-2011 on 17 378 KR. Patients had minimum 5 years postprimary surgery to end 2016. Age and gender distribution were similar across datasets; mean age 70 years, 57% female. In NJR, there were 8607 (4.6%) revisions, median time-to-revision postprimary surgery 1.8 years (range 0-8.8), with 1055 (0.6%) mid-late term revisions; in CPRD GOLD, 877 (5.1%) revisions, median time-to-revision 4.2 years (range 0.02-18.3), with 352 (2.0%) mid-late term revisions.Reduced risk of revision after 5 years was associated with older age (HR: 0.95; 95% CI 0.95 to 0.96), obesity (0.70; 0.56 to 0.88), living in deprived areas (0.71; 0.58 to 0.87), non-white ethnicity (0.58; 0.43 to 0.78), better preoperative pain and functional limitation (0.42; 0.33 to 0.53), better 6-month postoperative pain and function (0.33; 0.26 to 0.41) or moderate anxiety/depression (0.73; 0.63 to 0.83) at primary surgery.Increased risk was associated with male gender (1.32; 1.04 to 1.67); when anticonvulsants (gabapentin and pregabalin) (1.58; 1.01 to 2.47) or opioids (1.36; 1.08 to 1.71) were required prior to primary surgery.No implant factors were identified.
The risk of mid-late term KR revision is very low. Increased risk of revision is associated with patient case-mix factors, and there is evidence of sociodemographic inequality.
确定需要进行膝关节置换术（KR）中期至晚期翻修的患者，以便进行有针对性的随访。
对初级和二级护理的全国性数据集（临床实践研究数据链接（CPRD GOLD）、国家联合登记处（NJR）、英国医院入院统计（HES）和患者报告的结果测量（PROMs））进行分析。
年龄≥18 岁的初次择期 KR。
初次 KR 后≥5 年（中期至晚期）的翻修手术。
Cox 回归模型确定中期至晚期翻修的危险因素。HR 和 95%CI 评估社会人口统计学因素、合并症、药物、手术变量和 PROMs 与中期至晚期翻修的关联。
NJR-HES-PROMs 数据可获得 2008 年至 2011 年 188509 例 KR 的信息。CPRD GOLD-HES 数据可获得 1995 年至 2011 年 17378 例 KR 的信息。患者在初次手术后至少有 5 年的时间，随访截止到 2016 年。各数据集的年龄和性别分布相似；平均年龄为 70 岁，57%为女性。在 NJR 中，有 8607 例（4.6%）翻修，初次手术后中位时间至翻修为 1.8 年（范围 0-8.8），其中 1055 例（0.6%）为中期至晚期翻修；在 CPRD GOLD 中，有 877 例（5.1%）翻修，初次手术后中位时间至翻修为 4.2 年（范围 0.02-18.3），其中 352 例（2.0%）为中期至晚期翻修。在初次手术后 5 年，与翻修风险降低相关的因素包括年龄较大（HR：0.95；95%CI：0.95-0.96）、肥胖（0.70；0.56-0.88）、居住在贫困地区（0.71；0.58-0.87）、非白人种族（0.58；0.43-0.78）、术前疼痛和功能障碍较轻（0.42；0.33-0.53）、术后 6 个月疼痛和功能较好（0.33；0.26-0.41）或中度焦虑/抑郁（0.73；0.63-0.83）。与女性（1.32；1.04-1.67）、术前需要使用抗惊厥药（加巴喷丁和普瑞巴林）（1.58；1.01-2.47）或阿片类药物（1.36；1.08-1.71）有关的风险增加。未发现与植入物相关的因素。
膝关节置换术中期至晚期翻修的风险非常低。翻修风险增加与患者的病例组合因素有关，并且存在社会人口统计学不平等的证据。
