Liddle, Lancet 2014 - Adverse Outcomes after Total and Unicompartmental Knee Replacement in 101,330 Matched Patients: A Study of Data from the National Joint Registry for England and Wales
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Adverse Outcomes after Total and Unicompartmental Knee Replacement in 101,330 Matched Patients: A Study of Data from the National Joint Registry for England and Wales
Liddle, Murray, et al.·Lancet·2014·664 citations·Retrospective cohort
Liddle and colleagues compared revision, reoperation, medical complications, readmission, death and hospital stay after unicompartmental vs total knee replacement in propensity‑matched registry patients.
Propensity‑matched registry cohort of 101,330 knee replacements from England and Wales, operations April 2003 to August 2012, followed up to 8 years.
Methods
Design
Propensity‑matched cohort
Regression models for each outcome
Data source
National Joint Registry, England and Wales
Linked Hospital Episode Statistics for confounders
Patients
101,330 matched knee replacements
UKRs matched to TKRs by propensity score
Exposure
UKR vs TKR
Follow-up
Up to 8 years
Operations April 2003 to August 2012
Outcomes
Revision
Revision or reoperation
Complications
Readmission
Mortality
Length of stay
Key Findings
At 8 years, UKR had about twice the revision risk of TKR (SHR 2.12, 95% CI 1.99 to 2.26) and a smaller excess for revision or reoperation (SHR 1.38, 95% CI 1.31 to 1.44).
30‑day mortality was 0.24% after TKR vs 0.06% after UKR, HR 0.23 (95% CI 0.11 to 0.50).
TKR patients were about twice as likely as UKR patients to have venous thromboembolism, MI or deep infection, 3 times as likely to have a stroke and 4 times as likely to need transfusion.
Mean hospital stay was 1.38 days shorter after UKR (4.14 vs 5.52 days, p < 0.0001).
Most UKR revisions (67%) were conversions to a primary TKR, whereas most TKR revisions (64%) needed larger, more constrained components.
Revision for arthritis progression or bearing dislocation occurred almost exclusively after UKR.
Board pearl
By the authors' estimate, giving UKR instead of TKR to 100 patients would mean about 1 fewer death and 3 more reoperations within 4 years.
Authors' conclusion
In decisions about which procedure to offer, the higher revision/reoperation rate of UKR than of TKR should be balanced against a lower occurrence of complications, readmission, and mortality, together with known benefits for UKR in terms of postoperative function. If 100 patients receiving TKR received UKR instead, the result would be around one fewer death and three more reoperations in the first 4 years after surgery.
Adverse Outcomes after Total and Unicompartmental Knee Replacement in 101,330 Matched Patients: A Study of Data from the National Joint Registry for England and Wales
Liddle, Murray, et al.·Lancet·2014·664 citations·Retrospective cohort
Liddle and colleagues compared revision, reoperation, medical complications, readmission, death and hospital stay after unicompartmental vs total knee replacement in propensity‑matched registry patients.
Propensity‑matched registry cohort of 101,330 knee replacements from England and Wales, operations April 2003 to August 2012, followed up to 8 years.
Methods
Design
Propensity‑matched cohort
Regression models for each outcome
Data source
National Joint Registry, England and Wales
Linked Hospital Episode Statistics for confounders
Patients
101,330 matched knee replacements
UKRs matched to TKRs by propensity score
Exposure
UKR vs TKR
Follow-up
Up to 8 years
Operations April 2003 to August 2012
Outcomes
Revision
Revision or reoperation
Complications
Readmission
Mortality
Length of stay
Key Findings
At 8 years, UKR had about twice the revision risk of TKR (SHR 2.12, 95% CI 1.99 to 2.26) and a smaller excess for revision or reoperation (SHR 1.38, 95% CI 1.31 to 1.44).
30‑day mortality was 0.24% after TKR vs 0.06% after UKR, HR 0.23 (95% CI 0.11 to 0.50).
TKR patients were about twice as likely as UKR patients to have venous thromboembolism, MI or deep infection, 3 times as likely to have a stroke and 4 times as likely to need transfusion.
Mean hospital stay was 1.38 days shorter after UKR (4.14 vs 5.52 days, p < 0.0001).
Most UKR revisions (67%) were conversions to a primary TKR, whereas most TKR revisions (64%) needed larger, more constrained components.
Revision for arthritis progression or bearing dislocation occurred almost exclusively after UKR.
Board pearl
By the authors' estimate, giving UKR instead of TKR to 100 patients would mean about 1 fewer death and 3 more reoperations within 4 years.
Authors' conclusion
In decisions about which procedure to offer, the higher revision/reoperation rate of UKR than of TKR should be balanced against a lower occurrence of complications, readmission, and mortality, together with known benefits for UKR in terms of postoperative function. If 100 patients receiving TKR received UKR instead, the result would be around one fewer death and three more reoperations in the first 4 years after surgery.