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Background and purpose -- Total knee replacement (TKR) studies usually analyze all-cause revision when considering relationships with patient and prosthesis factors. We studied how these factors impact different revision diagnoses. Patients and methods -- We used data from 2003 to 2019 of TKR for osteoarthritis from the arthroplasty registries of Sweden, Australia, and Kaiser Permanente, USA to study patient and prosthesis characteristics for specific revision diagnoses. There were 1,072,924 primary TKR included and 36,626 were revised. Factors studied included age, sex, prosthesis constraint, fixation method, bearing mobility, polyethylene type, and patellar component use. Revision diagnoses were arthrofibrosis, fracture, infection, instability, loosening, pain, patellar reasons, and wear. Odds ratios (ORs) for revision were estimated and summary effects were calculated using a meta-analytic approach. Results -- We found between-registry consistency in 15 factor/reason analyses. Risk factors for revision for arthro- fibrosis were age < 65 years (OR 2.0; 95% CI 1.4--2.7) and mobile bearing designs (MB) (OR 1.7; CI 1.1--2.5), for fracture were female sex (OR 3.2; CI 2.2--4.8), age ≥ 65 years (OR 2.8; CI 1.9--4) and posterior stabilized prostheses (PS) (OR 2.1; CI 1.3--3.5), for infection were male sex (OR 1.9; CI 1.7--2.0) and PS (OR 1.5; CI 1.2--1.8), for instability were age < 65 years (OR 1.5; CI 1.3--1.8) and MB (OR 1.5; CI 1.1--2.2), for loosening were PS (OR 1.5; CI 1.4--1.6), MB (OR 2.2; CI 1.6--3.0) and use of ultra-high molecular weight polyethylene (OR 2.3; CI 1.8--2.9), for patellar reasons were not resurfacing the patella (OR 13.6; CI 2.1--87.2) and MB (OR 2.0; CI 1.2--3.3) and for wear was cementless fixation (OR 4.9; CI 4.3--5.5). Interpretation -- Patients could be counselled regarding specific age and sex risks. Use of minimally stabilized, fixed bearing, cemented prostheses, and patellar components is encouraged to minimize revision risk. [ABSTRACT FROM AUTHOR]

Background and purpose — Rates of knee replacement (KR) are increasing worldwide. Based on population and practice changes, there are forecasts of a further exponential increase in primary knee replacement through to 2030, and a corresponding increase in revision knee replacement. We used registry data to document changes in KR over the past 15 years, comparing practice changes across Sweden, Australia, and the United States. This may improve accuracy of future predictions. Patients and methods — Aggregated data from the Swedish Knee Arthroplasty Register (SKAR), the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and the Kaiser Permanente Joint Replacement Registry (KPJRR) were used to compare surgical volume of primary and revision KR from 2003 to 2017. Incidence was calculated using population census statistics from Statistics Sweden and the Australian Bureau of Statistics, as well as the yearly active membership numbers from Kaiser Permanente. Further analysis of KR by age < 65 and ≥ 65 years was carried out. Results — All registries recorded an increase in primary and revision KR, with a greater increase seen in the KPJRR. The rate of increase slowed during the study period. In Sweden and Australia, there was a smaller increase in revision surgery compared with primary procedures. There was consistency in the mean age at surgery, with a steady small decrease in the proportion of women having primary KR. The incidence of KR in the younger age group remained low in all 3 registries, but the proportional increases were greater than those seen in the ≥ 65 years of age group. Interpretation — There has been a generalized deceleration in the rate of increase of primary and revision KR. While there are regional differences in KR incidence, and rates of change, the rate of increase does not seem to be as great as previously predicted. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in the perioperative management of patients who have indications for hip and knee arthroplasty in the setting of modifiable risk factors such as morbid obesity, poorly controlled diabetes, and smoking. A recent survey of the American Association of Hip and Knee Surgeons (AAHKS) found that 95% of respondents address modifiable risk factors prior to surgery. The aim of this study was to poll Australian arthroplasty surgeons regarding their approach to patients who have modifiable risk factors., Methods: The survey tool used in the AAHKS study was adapted for use in the Australian context and distributed to the membership of the Arthroplasty Society of Australia via SurveyMonkey. There were 77 responses received, representing a response rate of 64%., Results: The majority of respondents were experienced, high volume arthroplasty surgeons. Overall, 91% of respondents restricted access to arthroplasty for patients who have modifiable risk factors. There were 72% restricting access for excessive body mass index, 85% for poor diabetic control, and 46% for smoking. Most respondents made decisions based on personal experience or literature review rather than hospital or departmental pressures. While 49% of surgeons believed that current payment systems did not impair their ability to achieve good outcomes, 58% believed that certain arthroplasty patients would benefit from additional intervention, based on their socioeconomic status., Conclusion: Over 90% of surgeons who responded address modifiable risk factors prior to surgery. This finding aligns with the practice patterns of AAHKS members, despite differences in healthcare systems., (Copyright © 2023 Elsevier Inc. All rights reserved.)