TRENDS IN KNEE ARTHROPLASTY 1990–2003: RESULTS FROM A UK JOINT REGISTER

Abstract

Introduction and Aims: To audit the practice and evaluate the outcomes of knee arthroplasty surgery in a general setting in the UK.

Method: The Trent & Wales Arthroplasty Audit group collects prospective data on all knee replacements performed within these UK health regions (population eight million). All patients are sent a validated, self-administered questionnaire to assess outcomes. Data has been collected on 27,500 primary and 1400 revision knee procedures.

Results: In the period from 1990 to 2002 there has been a marked decrease in the proportion of knees being replaced for rheumatoid arthritis (21% to 5%). More arthroplasties are being performed in men (35% to 46%). There has been an increase in knee arthroplasty in patients aged 85+ yrs (2.1% to 3.7%), but a decrease in patients aged 55yrs and under (8.6% to 5.3%). Uncemented implants are used less frequently (7.7% to 4.4%). Unicompartmental knee are implanted more frequently (2.8% to 4.1%). In 2002, 10% of the joints implanted had mobile bearings, 8% were PCL sacrificing, 28% had the patella resurfaced, 0.4% were patellofemoral replacements.

The percentage of patients satisfied with their arthroplasty one-year post-surgery has not improved over the 13 years. (O.A 81%, R.A 87.5% , trauma 63%). The incidence of reoperation (for all causes) in the first year is 1.2% (0.5% infection). The incidence of revision for implant failure appears to be increasing. Outcome data for revision surgery is being collected at present.

Conclusion: Over the past 13 years there has been a marked increase in knee arthroplasty surgery and significant demographic trends. However, validated outcome measures have not shown an improvement of outcome over this period.