Abstract
Introduction
Satisfaction and survival rates after total knee arthroplasty were high according to literatures. However, around 8% of revision surgeries were still noted and almost half of them were early failures, which were most seen in 2 years after primary surgery. This study aimed to find out the factors lead to early failures after total knee arthroplasty.
Materials and Methods
Data were collected based on the National Health Insurance Research Data Base of Taiwan from 1996 to 2010. Primary total knee arthroplasty surgeries were included. Revisional total knee arthroplasty, removal of total knee implant and arthrotomy surgeries registered after primary total knee surgeries are seen as failures.
Results
1. Overall prevalence
Total failure rate is 3.67% (4820 in 131441) and 44.46% of them are early failures in two years after primary surgery (2143 in 4820).
2. Characters of patient
Higher early failure rates were found in patients who accepted primary surgery under 56 years old, compared to 56∼64 years old and <65 years old groups (>65years/old compared to <56years/old, HR:0.51 [95% CI 0.44–0.58]; 56–64 years/old compared to <56years old, HR:0.61 [95% CI 0.52–0.72]). Male patients were found to have higher early failure rates compared to female group (compared to female, HR:1.55, [95% CI 1.41–1.69]).
3. Character of disease
Diagnosis of Osteoarthritis or rheumatoid arthritis would have no difference in failure rates, but gouty arthritis and other reasons would lead to higher early failure rates (compared to osteoarthritis, HR:1.94, [95% CI 1.55- 2.42]).
4. Influences of comorbidity
Diabetes Mellitus would lead to higher early failure rate (compared to non-DM, HR:1.28, [95% CI 1.13–1.46]). No significant differences were found in Renal disease and higher Charlson Comorbidity Index.
5. Character of Health Care Provider
41.50% surgeries were performed in Medical Centers(>500 beds), 27.20% in Metropolitan Hospitals(>250 beds) and 31.20% in Local Community Hospitals(>20 beds). Surgeries performed in Metropolitan and Local Community Hospitals would have higher early failure rates (Local compared to center H, HR:1.42 [95% CI 1.28 −1.57]; Metropolitan compared to center H, HR:1.23 [95% CI 1.11 −1.37]).
83.40% surgeries were performed by high volume surgeons. High volume surgeons would have lower early failure rates (compared to low volume, HR:0.62, [95% CI 0.52–0.75]).
87.20% surgeries were performed in high volume hospitals. High volume hospitals would have lower early failure rates (compared to low volume, HR:0.51, [95% CI 0.41- 0.63]).
Conclusion and Discussion
Early failure rate (<2 years after primary surgery) in Taiwan is compatible to global data. Younger patients accepted total knee arthroplasty would have more failures, which might be a result of higher activity demand. Reasons other than osteoarthritis and rheumatoid arthritis such as gouty arthritis, hemophilia, post-traumatic arthritis and osteonecrosis can complicate the surgery and lead to higher failure rates. Patients with diabetes mellitus would have more infection risks and therefore lead to higher failures. High volume surgeons, high volume hospitals and even non-local hospitals could provide better trainings and facilities to patients, which can therefore lead to lower failures.
