Science Current Events | Science News | Brightsurf.com
 
Email a Friend Send to a friend
Printer Friendly Print How often do hip and knee replacements need revision?

How often do hip and knee replacements need revision?

September 02, 2008

A comprehensive study using nationwide data on hip and knee replacements in England has found that one in seventy-five patients require a revision of their joint replacement after three years. Although this compares favourably with the rest of the world, the study published in this week's PLoS Medicine reinforces concerns about the new surgical techniques of hip resurfacing and unicondylar knee replacement.

Hip and knee replacements are amongst the most frequent surgical operations performed, with around 160,000 carried out in England and Wales in 2006. However, there is little evidence to compare the patient outcomes of hip and knee replacement with the many types of surgical techniques and prostheses used to replace the joint. Jan van der Meulen and colleagues from the Royal College of Surgeons used records from the National Joint Registry (NJR) for England and Wales to address this lack of evidence; the NJR being the largest national joint registry of any in the world. Since it was established in April 2003 the NJR has collected data available immediately following surgery, including patient characteristics, the type of prostheses and the surgical technique used to replace the joint, with the aim of providing patients, healthcare professionals and regulators with evidence to assess these prostheses and techniques.




In order to identify the revision rates - how often the hip or knee replacement had to be re-done - the researchers linked the NJR records with another database: the Hospital Episodes Statistics (HES), which contains information on all admissions to National Health Service (NHS) hospitals in England. They considered revisions for any reason in the three years following a hip or knee replacement. They also paid particular attention to hip resurfacing and unicondylar knee replacement, two techniques that are increasingly used but about which there is little evidence of their performance. Hip resurfacing was introduced in the 1990s for younger patients or those with less severe disease. Rather than replacing the head of the femur, as happens in total hip replacement, the diseased surface of the joint is replaced with a metal component. In unicondylar knee replacement only the damaged part of the knee is replaced and it also results in shorter recovery time.

Of the 167,076 procedures that could be linked between the two databases between April 2003 and September 2006 - about half of all such operations carried out in England in this period - one in seventy-five patients required a revision of their joint replacement, which is considered to be low. As expected the patients who had cemented prostheses - cement being used to position the metal implant in place in the original replacement surgery - had the lowest revision rates. For hip replacements the highest revision rates were experienced by women who had undergone hip resurfacing rather than total joint replacement. Of patients who had undergone knee replacement operations, those who had unicondylar prostheses had the highest revision rates. According to the study there appears to be no connection between a patient's age and revision rates for hip replacements, whereas revision rates after knee replacement decreased strongly with age.

The study demonstrates what can be achieved by linking together the two databases and it shows convincing success rates of knee and hip replacement surgery, with few patients requiring a revision. However, on the basis of the data, the researchers suggest that "consideration should be given to using hip resurfacing only in male patients and unicondylar knee replacement only in elderly patients." They point out that different patterns may emerge over a longer follow-up period, so it is not possible to directly draw conclusions on the long-term efficacy of the different procedures. However, this first national study on joint replacement does provide benchmark data for the further research that is needed to evaluate the performance of different procedures and types of implant.

Public Library of Science



Related Knee Replacement Current Events and Knee Replacement News Articles Knee Replacement Current Events and Knee Replacement News RSS Knee Replacement Current Events and Knee Replacement News RSS
Nearly half of U.S. adults will develop painful knee osteoarthritis by age 85: study
Almost half of all U.S. adults and nearly two-thirds of obese adults will develop painful osteoarthritis of the knee by age 85, a study based at the University of North Carolina at Chapel Hill suggests.

New test to diagnose osteoarthritis early
A newly developed medical imaging technology may provide doctors with a long-awaited test for early diagnosis of osteoarthritis (OA), scientists from New York reported today at the 236th National Meeting of the American Chemical Society.

No justification for denying obese patients knee replacements
There is no justification for denying obese patients knee replacement surgery: They benefit almost as much as anyone else from the procedure, concludes a small study published ahead of print in the Annals of the Rheumatic Diseases.

Research Examines Factors in Delaying or Declining Total Knee Replacement Surgery
A study led by Dr. Ann F. Jacobson, associate professor in Kent State's College of Nursing, unveils the reasons why people may initially choose to postpone but ultimately undergo total knee replacement surgery and emphasizes the need for better patient education before and after the procedure.

Are blood thinners post-op killers?
New study shows that the use of powerful anticoagulants to prevent pulmonary embolism may actually lead to more deaths after surgery

Young patients with knee disorder get active after new Stanford surgical procedure
At 14 years old, Adam Vasser of Los Altos, Calif., was an active kid who loved baseball. Then a mysterious virus attacked his heart, making a heart transplant necessary to save his life.

Physiotherapy has short-term benefits for patients after knee surgery
Physiotherapy can improve the daily lives of patients who have had knee replacement surgery due to osteoarthritis in the short term, according to a study published on bmj.com today.

Genetics determine optimal drug dose of common anticoagulant
Genetic testing can be used to help personalize the therapeutic dosage of warfarin, a commonly-used anticoagulant, according to research published in the September 1, 2007, issue of Blood, the journal of the American Society of Hematology. This result represents one of the first applications of using an individual's genetic information to guide personal medical care.

Mayo Clinic researchers discover new diagnostic test for detecting infection in prosthetic joints
A team of Mayo Clinic researchers has discovered a new, more accurate diagnostic test to detect infection of prosthetic joints, potentially leading to better treatment options and patient outcomes.

Study compares specialty orthopedic and general hospitals
Specialty orthopedic hospitals serve a healthier population of Medicare patients compared to general hospitals, according to a new study by investigators at the University of Iowa and Department of Veterans Affairs (VA) Iowa City Health Care System.
More Knee Replacement Current Events and Knee Replacement News Articles


Total Knee Replacement and Rehabilitation: The Knee Owner's Manual
by Daniel J. Brugioni, Jeff Falkel

Complete with 145 exercises and nearly 200 illustrations and photos, this comprehensive guide helps readers navigate through the entire process of having one or both knees replaced. It explains what to consider when deciding on knee replacement, details the procedure, and provides extensive suggestions for the crucial postoperative rehabilitation. Patients will learn how to prepare their homes...



A Patient's Guide to Knee and Hip Replacement: Everything You Need to Know
by Irwin Silber

Written by a patient for other patients and in consultation with an Orthopedic Surgeon and a Physical Therapist, A Patient's Guide to Knee and Hip Replacement takes readers through the complete joint-replacement process, from the decision whether to have Surgery and the Preop Preparations, through the operation itself, the hospital stay, and the recovery period.Irwin Silber has had both knees and...



What Your Doctor May Not Tell You About(TM) Hip and Knee Replacement Surgery: Everything You Need to Know to Make the Right Decisions (What Your Doctor May Not Tell You About...)
by Ronald P. Grelsamer

Dr. Ronald P. Grelsamer gives readers all the information they need to decide whether hip or knee replacement is the right choice. From the history and evolution of joint implants to the significant differences between types of implants and surgeries, he arms readers with the need-to-know facts for lasting recovery from surgery in the shortest time possible. Dr. Grelsamer also examines the ...



Your Guide to Total Knee Replacement (Your Guide to)
by Fairview Health Services

Helps patients understand what to expect from knee replacement...



Hip And Knee Surgery: A Patient's Guide To Hip Replacement, Hip Resurfacing, Knee Replacement, And Knee Arthroscopy
by Robert E. Kennon

This friendly and informative book is written by an orthopaedic surgeon specializing in joint replacement and related surgeries, including hip resurfacing and knee arthroscopy. It contains useful information for patients who are considering treatment for hip or knee arthritis and related conditions. Clear and informative chapters explain in plain English what to expect before, during, and after...



Dr. Scott's Knee Book: Symptoms, Diagnosis, and Treatment of Knee Problems Including Torn Cartilage, Ligament Damage, Arthritis, Tendinitis, Arthroscopic Surgery, and Total Knee Replacement
by W. Norman Scott

The team physician for the New York Knicks tells readers everything they need to know about the body's most vulnerable joint--the knee--and provides invaluable advice on how to prevent, recognize, and treat knee injuries. 15 line...



Operative Techniques: Total Knee Replacement: Book, Website and DVD (Operative Techniques)
by Arlen D. Hanssen, W. Norman Scott

This multimedia resource offers you all the how-to guidance you need to perform all of the latest and best techniques in total knee replacement. The complete, lavishly illustrated volume is made even better with a state-of-the-art companion web site! With chapters on such hot topics as cementless fixation, quadriceps sparing MIS TKR, unicompartmental TKR, soft tissue balancing, and extensor...



Surgical Techniques in Total Knee Arthroplasty

Currently, younger and more active patients with arthritis, trauma and other joint diseases are getting predictable and durable results from total knee arthroplasty. Studies show that this procedure maintains a high level of performance, longevity and patient satisfaction for all age groups. Two well-known knee experts have assembled a group of "giants" in the field to present a book encompassing...



Knee Replacement, Total



Controversies in Total Knee Replacement (Controversies in Orthopaedic Surgery Series)

In the 35 years since the first knee replacement surgery was attempted, there have been numerous changes in the way the prostheses are designed and the manner in which they are implanted. We are now in the fortunate position of being able to report that 95% of patients undergoing knee replacement report extraordinary relief of pain and the ability to return to an active and productive life....

© 2008 BrightSurf.com