Most shoulder replacements last longer than a decade

Most shoulder replacements last longer than a decade
NIHR Alert 30 April 2021

• Analysis of global data has found that nine out of ten shoulder replacements last for at least a decade. The patient-reported outcomes showed a large, long-lasting, and positive effect up to 10 years after surgery.

How long do revised and multiply revised knee replacements last?

How long do revised and multiply revised knee replacements last? A retrospective observational study of the National Joint Registry
The Lancet, Rheumatology 29 April 2021 https://doi.org/10.1016/S2665-9913(21)00079-5

• A retrospective observational registry-based study of the National Joint Registry in England and Wales, UK was carried out to understand longevity of knee replacement revision surgery. It found that males and younger patients are at higher risk of multiple revisions. Patients who undergo a revision have a steadily increasing risk of further revision the more procedures they undergo, and each subsequent revision lasts for approximately half the time of the previous one.

Revision knee arthroplasty: Can good outcomes be achieved at lower volumes?

Revision knee arthroplasty: Can good outcomes be achieved at lower volumes?
Knee. 2021 Apr 16;30:63-69. doi: 10.1016/j.knee.2021.03.012.

• It has been suggested that revision knee arthroplasty (RKA) cases be centralised in specialist centres with a multidisciplinary team (MDT) approach. 
• Analysis of RKA surgery performed in a four surgeon, lower volume revision knee unit over 10 years to December 2016 (RKAs = 192) concluded that RKA can be reliably performed at lower volume centres with appropriate MDT systems in place.

Revision knee replacement surgery in the NHS: A BASK surgical practice guideline.

BASK Revision Knee Working Group. Revision knee replacement surgery in the NHS: A BASK surgical practice guideline.
Knee. 2021 Mar 6;29:353-364. doi: 10.1016/j.knee.2021.01.032

• This document outlines practice guidelines for units providing a revision knee replacement (KR) service and sets out: the current landscape of revision KR in England, Wales and Northern Ireland; service organisation within a network model; the necessary infrastructure required to provide a sustainable revision service; outcome metrics and auditable standards and financial mechanisms to support this service model.

The effect of surgical approach in total hip replacement on outcomes:

The effect of surgical approach in total hip replacement on outcomes: an analysis of 723,904 elective operations from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man
BMC Med 18, 242 (2020). https://doi.org/10.1186/s12916-020-01672-0

• Analysis of 723,904 hip replacement operations performed between 2003 and 2016 found that lateral procedures were associated with more deaths and a greater risk of further hip surgery. Compared to the posterior approach, the lateral approach was predicted to have an increased risk (between 5% and 12%) of revision surgery at 12 years and a 15% increased risk of death within three months of surgery.
• See NIHR summary here.

National Joint Registry Annual Reports

National Joint Registry Annual Reports

HQIP

• The National Joint Registry (NJR) collects information about hip, knee, ankle, elbow and shoulder joint replacement operations (arthroplasty) from all participating hospitals.
• NJR Annual Reports are available on the HQIP website with more details on the National Joint Registry website https://reports.njrcentre.org.uk/ 

Artificial intelligence and surgical innovation: lower limb arthroplasty

Artificial intelligence and surgical innovation: lower limb arthroplasty.
Br J Hosp Med (Lond). 2020 Oct 2;81(10):1-7. doi: 10.12968/hmed.2020.0309. Epub 2020 Oct 6.

• A review of the use of artificial intelligence and surgical innovation in lower limb arthroplasty, with a particular focus on robotic-assisted surgery in total knee arthroplasty.

Provision of revision knee surgery and calculation of the effect of a network service reconfiguration:

Provision of revision knee surgery and calculation of the effect of a network service reconfiguration: An analysis from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man.
Knee. 2020 Oct;27(5):1593-1600. doi: 10.1016/j.knee.2020.07.094. 

• The aim of this study was to 1) describe the current provision of revision KR in England, Wales and Northern Ireland at the individual surgeon and unit level and 2) investigate the effect on workload of case distribution in a network model.

Costs of joint replacement in osteoarthritis

Costs of joint replacement in osteoarthritis: a study using the National Joint Registry and Clinical Practice Research Datalink datasets
Arthritis Care Re. 2020 Oct 1. doi: 10.1002/acr.24470.

• Analysis of National Joint Registry linked with Hospital Episode Statistics data to estimate of the costs of primary hip and knee replacement in individuals with osteoarthritis. The mean censor-adjusted 1-year hospitalisation costs for hip and knee replacement were £7,827 (95% CI £7,813 to £7,842) and £7,805 (95% CI £7,790 to £7,818), respectively. Complications and revisions were associated with up to a three-fold increase in 1-year hospitalisation costs. Adding primary and outpatient care, the mean total hip and knee replacement 2-year costs were £11,987 and £12,578, respectively.

Association between surgical volume and failure of primary total hip replacement

Association between surgical volume and failure of primary total hip replacement in England and Wales: findings from a prospective national joint replacement register
BMJ Open 2020;10:e033045. doi: 10.1136/bmjopen-2019-033045

• Following analysis of the association between consultant surgical volume and the risk of revision in patients undergoing elective THA the authors support the practice of specialisation of hip arthroplasty but do not support the practice of low-volume consultants increasing their personal volume.

Patients Receiving a Primary Unicompartmental Knee Replacement Have a Higher Risk of Revision but a Lower Risk of Mortality Than Predicted Had They Received a Total Knee Replacement

Patients Receiving a Primary Unicompartmental Knee Replacement Have a Higher Risk of Revision but a Lower Risk of Mortality Than Predicted Had They Received a Total Knee Replacement: Data From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man
J Arthroplasty. 2020 Sep 7;S0883-5403(20)30972-4. doi: 10.1016/j.arth.2020.08.063.

• Analysis of National Joint Registry data indicates that Unicompartmental Knee Replacement (UKR) revision rates were substantially higher than Total Knee Replacement (TKR) even when demographics and caseload differences were accounted for. However, fewer deaths occur after UKR. Re-revision rates were similar between revised UKRs and TKRs, but considerably higher than for primary TKR, therefore UKR cannot be considered an intermediate procedure.

How long does a shoulder replacement last?

How long does a shoulder replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 10 years of follow-up
The Lancet Rheumatology (1 September 2020) v2(9) E539-E548 DOI: https://doi.org/10.1016/S2665-9913(20)30226-5

• “Our data show that approximately 90% of shoulder replacements last for longer than 10 years and patient-reported benefits are sustained. Our findings will be of use to surgeons and patients in the informed consent process and to health-care providers for resource planning.”

Dynamic early identification of hip replacement implants with high revision rates.

Dynamic early identification of hip replacement implants with high revision rates. Study based on the NJR data from UK during 2004-2012.
PLoS One. 2020;15(8):e0236701. Published 2020 Aug 4. doi:10.1371/journal.pone.0236701

• The authors have developed an algorithm for early detection of poorly performing components in hip replacement surgery.

Abstract

Can Machine-learning Algorithms Predict Early Revision TKA in the Danish Knee Arthroplasty Registry?

Can Machine-learning Algorithms Predict Early Revision TKA in the Danish Knee Arthroplasty Registry?
Clin Orthop Relat Res. 2020;10.1097/CORR.0000000000001343. doi:10.1097/CORR.0000000000001343

• Although several well-known presurgical risk factors for revision were coupled with four different machine learning methods, the authors could not develop a clinically useful model capable of predicting early TKA revisions in the Danish Knee Arthroplasty Registry based on preoperative data.

Threshold for Computer- and Robot-Assisted Knee and Hip Replacements in the English NHS

Threshold for Computer- and Robot-Assisted Knee and Hip Replacements in the English National Health Service.
Value Health. 2020;23(6):719-726. doi:10.1016/j.jval.2019.11.011

• This study provides estimates of threshold prices for a range of potential improvements in the effectiveness of knee and hip replacement that could be realised from the adoption of computer- and robot-assisted knee and hip replacement.
• At a cost-effectiveness threshold of £20 000 per additional quality-adjusted life-year (QALY), the threshold price for a 5% improvement in post-primary unrevised quality of life (approximately equivalent to an additional two points in postoperative Oxford Knee Score [OKS]/Oxford Hip Score [OHS]) would be £10 000. The threshold price for a 50% reduction in the risk of revision would be £1000 per procedure.

Abstract

Tele-orthopaedics: A systematic mapping study

Tele-orthopaedics: A systematic mapping study
J Telemed Telecare. 2020;1357633X20919308. doi:10.1177/1357633X20919308

• Tele-orthopaedics is widely acknowledged for decreasing travel, time and cost, increasing accessibility and quality of care. 
• A systematic mapping to identify and classify the tele-orthopaedic applications and services concludes that telemonitoring (teleconsultation and telemetry) and telesurgery (telerobotics and telementoring) were found to be the two major forms of tele-orthopaedics. Mobile phones were used asynchronously in most of the teleconsultations. The development of different applications may result in the use of multiple smartphones applications in real-time teleconsultation.

Abstract

Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy.

Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy.
Cochrane Database of Systematic Reviews 21 April 2020, Issue 4. Art. No.: CD012879. DOI: 10.1002/14651858.CD012879.pub2.

• Conclusion: Although it is an established procedure, no high‐quality randomised trials have been conducted to determine whether shoulder replacement might be more effective than other treatments for osteoarthritis or rotator cuff tear arthropathy of the shoulder. We remain uncertain about which type or technique of shoulder replacement surgery is most effective in different situations.

The management of emergency spinal surgery duringthe COVID-19 pandemic in Italy. A preliminary report

The management of emergency spinal surgery during the COVID-19 pandemic in Italy. A preliminary report
Bone Joint J 2020;102-B(6):1–6. 23 Apr 2020 https://doi.org/10.1302/0301-620X.102B6.BJJ-2020-0537

• “The structural organization and the management protocol we describe allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available. We hope that our early experience can be of value to the medical communities that will soon be in the same emergency situation.”

Hip replacements: do public or private providers do better?

Hip replacements: do public or private providers do better?
BMJ 2020;368:m362, 19 February 2020 doi: https://doi.org/10.1136/bmj.m362

• Analysis of health outcomes using EQ-5D after hip replacement or revision in  NHS and non-NHS hospitals.

Patient Reported Outcome Measures (PROMs) Finalised Hip & Knee Replacements, April 2018 – March 2019

Finalised Patient Reported Outcome Measures (PROMs) in England for Hip & Knee Replacements, April 2018 – March 2019
NHS Digital 13 February 2020

• The data includes improvement for revision surgery.
• Data by provider or CCG Click here to access the report.