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J Knee Surg 2023; 36(02): 121-131
DOI: 10.1055/s-0041-1731324
Original Article

Analyzing the Burden of Revision Total Knee Arthroplasty in the United States between 2009 and 2016

Isaac Livshetz
1   Department of Orthopedic Surgery, White Plains Hospital, White Plains, New York
,
Benjamin H. Sussman
2   Department of Orthopedic Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
,
Vivian Papas
3   Department of Orthopedic Surgery, Lenox Hill Hospital Northwell Health, New York, New York
,
Nequesha S. Mohamed
4   Department of Orthopedic Surgery, Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Hytham S. Salem
3   Department of Orthopedic Surgery, Lenox Hill Hospital Northwell Health, New York, New York
,
Ronald E. Delanois 
4   Department of Orthopedic Surgery, Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Michael A. Mont
3   Department of Orthopedic Surgery, Lenox Hill Hospital Northwell Health, New York, New York
,
Giles R. Scuderi
3   Department of Orthopedic Surgery, Lenox Hill Hospital Northwell Health, New York, New York
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Abstract

As the number of total knee arthroplasties (TKAs) increases, it is reasonable to expect the number of revision TKAs (rTKAs) to rise in parallel. The patient-related and societal burdens of rTKA are poorly understood. Therefore, the purpose of this study was to determine temporal changes in: (1) the incidence of rTKA; (2) patient and hospital characteristics; (3) complications, hospital lengths of stay (LOSs), and discharge dispositions; and (4) costs, charges, and payer types. All patients who underwent rTKA between 2009 and 2016 were identified from the National Inpatient Sample database using International Classification of Diseases, Ninth Revision and Tenth Revision codes and were studied. Univariate analyses were performed to compare the incidence of rTKA, patient and hospital characteristics, LOS and discharge dispositions, as well as costs, charges, and payer types. A multivariate logistic regression model was built to compare the odds of complications in 2009 and 2016. Over our study period, there was a 4.3% decrease in the incidence of rTKA. The mean age of patients who underwent rTKA was 65 years and a majority were female (58%). Mean hospital LOS decreased from 4.1 days in 2009 to 3.3 days in 2016 (p < 0.001). The rate of several complications decreased significantly over our study period including myocardial infarction, cardiac arrest, transfusion, pneumonia, urinary tract infection, and mortality. A significantly lower percentage of rTKA patients were discharged to a skilled nursing facility in 2016 (26.5%) compared with 2009 (31.6%; p < 0.001). There was an 18.7% increase in the mean costs, and a 43.3% increase in the mean charges (p < 0.001). Over the study period, there was a decrease in the incidence of rTKAs. Despite potential improvements in primary TKA, the burden associated with rTKA remains large. This report can be used to help educate medical providers about outcomes that may result from a primary and/or revised TKA.

Keywords

knee - total knee arthroplasty - revision - economics


Publication History

Received: 13 July 2020

Accepted: 01 May 2021

Article published online:
08 July 2021

© 2021. Thieme. All rights reserved.

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