Upfill-Brown Alexander, Hsiue Peter P, Sekimura Troy, Shi Brendan, Ahlquist Seth A, Patel Jay N, Adamson Micah, Stavrakis Alexandra I
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Arthroplast Today. 2022 May 21;15:188-195.e6. doi: 10.1016/j.artd.2022.03.004. eCollection 2022 Jun.
As primary total knee arthroplasty volume continues to increase, so will the number of revision total knee arthroplasty (rTKA) procedures. The purpose of this study is to provide an updated perspective on the incidence, indications, and financial burden of rTKA in the United States.
This was a retrospective epidemiologic analysis using the National Inpatient Sample. International Classification of Diseases ninth and tenth revision codes were used to identify patients who underwent rTKA and create cohorts based on rTKA indications from 2012 to 2019. National and regional trends for length of stay, cost, and discharge location were evaluated.
A total of 505,160 rTKA procedures were identified. The annual number of rTKA procedures increased by 29.6% over the study period (56,490 to 73,205). The top 3 indications for rTKA were aseptic loosening (23.1%), periprosthetic joint infection (PJI) (20.4%), and instability (11.0%). Over the study period, the proportion of patients discharged to skilled nursing facility decreased from 31.7% to 24.1% ( < .001). Hospital length of stay decreased from 4.0 days in 2012 to 3.8 days in 2019 ( < .001). Hospital costs increased by $1300 from $25,730 to $27,077 ( < .001). The proportion of rTKA cases performed at urban academic centers increased (52.1% to 74.3%, < .001) while that at urban nonacademic centers decreased (39.0% to 19.2%, < .001).
The top 3 indications for rTKA were aseptic loosening, PJI, and instability, with PJI becoming the most common indication in 2019. These cases are increasingly being performed at urban academic centers and away from urban nonacademic centers.
3 (Retrospective cohort study).
随着初次全膝关节置换手术量持续增加，翻修全膝关节置换术（rTKA）的数量也会随之增加。本研究的目的是提供关于美国rTKA的发病率、适应证及经济负担的最新观点。
这是一项使用国家住院患者样本的回顾性流行病学分析。采用国际疾病分类第九版和第十版编码来识别接受rTKA的患者，并根据2012年至2019年的rTKA适应证创建队列。评估住院时间、费用及出院地点的全国和地区趋势。
共识别出505,160例rTKA手术。在研究期间，rTKA手术的年数量增加了29.6%（从56,490例增至73,205例）。rTKA的前三大适应证为无菌性松动（23.1%）、假体周围关节感染（PJI）（20.4%）和不稳定（11.0%）。在研究期间，出院至专业护理机构的患者比例从31.7%降至24.1%（P<0.001）。住院时间从2012年的4.0天降至2019年的3.8天（P<0.001）。医院费用从25,730美元增加了1300美元至27,077美元（P<0.001）。在城市学术中心进行的rTKA病例比例增加（从52.1%增至74.3%，P<0.001），而在城市非学术中心进行的比例下降（从39.0%降至19.2%，P<0.001）。
rTKA的前三大适应证为无菌性松动、PJI和不稳定，其中PJI在2019年成为最常见的适应证。这些病例越来越多地在城市学术中心进行，而不在城市非学术中心进行。
3级（回顾性队列研究）。
