Revision knee arthroplasty: Can good outcomes be achieved at lower volumes?
Autor: | Andrew Wheelton, G.J. McLauchlan, D.N. Haughton |
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Rok vydání: | 2021 |
Předmět: |
Male
Reoperation medicine.medical_specialty Prosthesis-Related Infections Revision procedure medicine.medical_treatment 03 medical and health sciences 0302 clinical medicine Primary outcome Survivorship curve medicine Spoke-hub distribution paradigm Humans Orthopedics and Sports Medicine Registries 030212 general & internal medicine Arthroplasty Replacement Knee Aged Surgeons 030222 orthopedics business.industry General surgery Mean age Middle Aged Arthroplasty Low volume Treatment Outcome Female Complication business |
Zdroj: | The Knee. 30:63-69 |
ISSN: | 0968-0160 |
Popis: | Background The National Joint Registry (NJR) demonstrates a re-revision rate for primary knee arthroplasty of 14.2% at 7 years. The 2015 Getting it Right First Time (GIRFT) report highlighted that 58% of surgeons undertaking revision knee arthroplasty (RKA) performed fewer than five cases per year. It has been suggested that revision cases be centralised in specialist centres with a multidisciplinary team (MDT) approach. Such a hub and spoke or cluster models may still require revision surgery to be performed at relatively low volume units. Methods An analysis of RKA surgery performed in a four surgeon, lower volume revision knee unit over 10 years to December 2016 was undertaken. The effect of the introduction of a MDT was reviewed. The minimum follow up was two years. The primary outcome measure was re-revision. Hospital data as well as individual surgeon NJR reports were used to ensure all re-revisions were accounted for. Outcome scores were available for 68% of cases. Results There were 192 RKAs performed in 187 patients at a mean (stdev) of 6.3 (5.4) years from the index procedure. The mean age at surgery was 68.2 (10.9) years. Twenty nine (15.5%) patients had died at the time of final review. Twelve (6.3%) cases required a further revision procedure. The commonest complication was stiffness requiring MUA. The overall 7 year survivorship was 94.9% (95% CI 90.2–97.3). The mean Oxford score at 5.4 years was 30.4 (10.4). Conclusions RKA can be reliably performed at lower volume centres with appropriate MDT systems in place. |
Databáze: | OpenAIRE |
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