The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.
The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.
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DOI：
10.1016/s0140-6736(17)30059-4
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发表时间：
2017-04-08
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影响因子：
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通讯作者：
Price AJ
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作者：
Bayliss LE;Culliford D;Monk AP;Glyn-Jones S;Prieto-Alhambra D;Judge A;Cooper C;Carr AJ;Arden NK;Beard DJ;Price AJ
髋关节和膝关节终末期骨关节炎的全关节置换术具有成本效益，并显示出显着的临床改善。然而，基于人群的植入物翻修的生命周期风险数据无法帮助患者做出决策，这在年轻患者群体决定手术的最佳时机时是一个特别的问题。我们对临床实践研究数据链中接受全髋关节置换术或全膝关节置换术的所有患者进行了植入物生存分析。这些数据根据国家统计局的数据对全因死亡率进行了调整，并用于根据初次手术时年龄的增加生成翻修手术的终身风险。我们确定了1991年1月1日至2011年8月10日期间接受全髋关节置换术的63158例患者和接受全膝关节置换术的54276例患者，并对这些患者进行了最长20年的随访。 对于全髋关节置换术，10年植入物存活率为95.6%（95% CI 95.3 - 95.9），20年存活率为85.0%（83.2 - 86.6）。对于全膝关节置换术，10年植入物存活率为96.1%（95.8 - 96.4），20年植入物存活率为89.7%（87.5 - 91.5）。在70岁以上接受全髋关节置换术或全膝关节置换术的患者中，需要翻修手术的终生风险约为5%，性别之间无差异。然而，对于年龄小于70岁的手术患者，年轻患者的翻修风险增加，50岁出头的男性高达35%（95% CI 30·9-39·1），男性和女性患者之间存在较大差异（相同年龄组的女性低15%）。年龄小于60岁的患者的翻修中位时间为4.4年。我们的研究使用了新的方法来调查和提供新的见解，年轻的重要性和全髋关节或膝关节置换术后翻修的风险。我们的证据挑战了越来越多的全髋关节置换术和全膝关节置换术在年轻患者群体中进行的趋势，这些数据应该作为共享决策过程的一部分提供给患者。牛津肌肉骨骼生物医学研究单位，国家卫生研究所。
Total joint replacements for end-stage osteoarthritis of the hip and knee are cost-effective and demonstrate significant clinical improvement. However, robust population based lifetime-risk data for implant revision are not available to aid patient decision making, which is a particular problem in young patient groups deciding on best-timing for surgery. We did implant survival analysis on all patients within the Clinical Practice Research Datalink who had undergone total hip replacement or total knee replacement. These data were adjusted for all-cause mortality with data from the Office for National Statistics and used to generate lifetime risks of revision surgery based on increasing age at the time of primary surgery. We identified 63 158 patients who had undergone total hip replacement and 54 276 who had total knee replacement between Jan 1, 1991, and Aug 10, 2011, and followed up these patients to a maximum of 20 years. For total hip replacement, 10-year implant survival rate was 95·6% (95% CI 95·3–95·9) and 20-year rate was 85·0% (83·2–86·6). For total knee replacement, 10-year implant survival rate was 96·1% (95·8–96·4), and 20-year implant survival rate was 89·7% (87·5–91·5). The lifetime risk of requiring revision surgery in patients who had total hip replacement or total knee replacement over the age of 70 years was about 5% with no difference between sexes. For those who had surgery younger than 70 years, however, the lifetime risk of revision increased for younger patients, up to 35% (95% CI 30·9–39·1) for men in their early 50s, with large differences seen between male and female patients (15% lower for women in same age group). The median time to revision for patients who had surgery younger than age 60 was 4·4 years. Our study used novel methodology to investigate and offer new insight into the importance of young age and risk of revision after total hip or knee replacement. Our evidence challenges the increasing trend for more total hip replacements and total knee replacements to be done in the younger patient group, and these data should be offered to patients as part of the shared decision making process. Oxford Musculoskeletal Biomedical Research Unit, National Institute for Health Research.