Knee replacement: epidemiology, outcomes, and trends in Southern California 17,080 replacements from 1995 through 2004
Knee replacement: epidemiology, outcomes, and trends in Southern California 17,080 replacements from 1995 through 2004
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DOI：
10.1080/17453670810016902
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发表时间：
2008-01-01
影响因子：
3.7
通讯作者：
Fithian, Donald C.
中科院分区：
文献类型：
--
作者：
Khatod, Monti;Inacio, Maria;Fithian, Donald C.
背景和目的关于全膝关节置换术（TKA）的应用、结局和趋势的人群数据有限。本研究的目的是在一家预付费健康维护组织（HMO）中检查TKA的利用率和短期结局，并确定比率和翻修负担是否随时间变化。我们还研究了这一人群是否代表一般人群在加州和在美国。方法使用1995年至2004年的医院利用率和会员数据库，我们计算的发病率（IR）为每10,000名健康计划成员的初次和翻修TKA。HMO人口的人口统计数据进行了比较，从加州和美国的人口普查数据。结果研究人群的年龄和性别分布相似的一般人群在加州和美国。在10年期间进行了15，943例初次TKA和1，137例翻修TKA。65岁以下的患者占所有初次置换的三分之一，占所有翻修置换的三分之一。初次TKA的IR从1995年的6.3/10，000增加到2004年的11.0/10，000，每年增加5%（p < 0.001）。TKA翻修的IR从1995年的0.41/10，000增加到2004年的0.74/10，000（p = 0.4）。翻修负担在10年观察期内保持稳定。翻修TKA的手术并发症高于初次TKA（10% vs. 7.7%; p = 0.007）。90-初次和翻修TKA的日并发症发生率（包括死亡）分别为0.3%和0.6%（p = 0.1），肺栓塞分别为0.5%和0.4%（p = 0.6）。90-初次和翻修TKA包括感染的日再入院率分别为0.5%和4.2%（p < 0.001），心肌梗死分别为0.1%，肺炎分别为0.2%和0.4%（p = 0.08）。术后并发症发生率低。研究人群与关注的潜在一般人群的比较表明，该人群可用于预测加州和整个美国一般人群中TKA的发生率和结局。
Background and purpose There are limited population-based data on utilization, outcomes, and trends in total knee arthroplasty (TKA). The purpose of this study was to examine TKA utilization and short-term outcomes in a pre-paid health maintenance organization (HMO), and to determine whether rates and revision burden changed over time. We also studied whether this population is representative of the general population in California and in the United States.Methods Using hospital utilization and membership databases from 1995 through 2004, we calculated incidence rates (IRs) of primary and revision TKA for every 10,000 health plan members. The demographics of the HMO population were compared to published census data from California and the United States.Results The age and sex distributions of the study population were similar to those of the general population in California and the United States. 15,943 primary TKAs and 1,137 revision TKAs were performed during the 10-year period. Patients below the age of 65 accounted for one-third of all primary replacements and one-third of all revision replacements. IRs of primary TKAs increased from 6.3 per 10,000 in 1995 to 11.0 per 10,000 in 2004, at a rate of 5% per year (p < 0.001). IRs of revision TKAs increased from 0.41 per 10,000 in 1995 to 0.74 per 10,000 in 2004 (p = 0.4). Revision burden remained stable over the 10-year observation period. Surgical complications were higher in revision TKA than in primary TKA (10% vs. 7.7%; p = 0.007). 90-day complication rates for primary and revision TKA including death were 0.3% and 0.6% (p = 0.1) and for pulmonary embolism 0.5% and 0.4% (p = 0.6). 90-day re-admission rates for primary and revision TKA including infection were 0.5% and 4.2% (p < 0.001), for myocardial infarction 0.1% each, and for pneumonia 0.2% and 0.4% (p = 0.08).Interpretation The incidence of primary and revision TKA increased between 1995 and 2005. The rates of postoperative complications were low. Comparisons of the study population and the underlying general populations of interest indicate that this population can be used to predict the incidences and outcomes of TKA in the general population of California and of the United States as a whole.