The epidemiology of revision total knee arthroplasty in the United States.
Understanding the cause of failure and type of revision total knee arthroplasty (TKA) procedures performed in the United States is essential in guiding research, implant design, and clinical decision making in TKA. We assessed the causes of failure and specific types of revision TKA procedures performed in the United States using newly implemented ICD-9-CM diagnosis and procedure codes related to revision TKA data from the Nationwide Inpatient Sample (NIS) database. Clinical, demographic, and economic data were reviewed and analyzed from 60,355 revision TKA procedures performed in the United States between October 1, 2005 and December 31, 2006. The most common causes of revision TKA were infection (25.2%) and implant loosening (16.1%), and the most common type of revision TKA procedure reported was all component revision (35.2%). Revision TKA procedures were most commonly performed in large, urban, nonteaching hospitals in Medicare patients ages 65 to 74. The average length of hospital stay (LOS) for all revision TKA procedures was 5.1 days, and the average total charges were $49,360. However, average LOS, average charges, and procedure frequencies varied considerably by census region, hospital type, and procedure performed.


METHODS
Level II, economic and decision analysis. See Guidelines for Authors for a complete description of levels of evidence.
Bozic
Kevin J
KJ
Department of Orthopaedic Surgery and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 500 Parnassus Ave., MU320W, San Francisco, CA 94143-0728, USA. bozick@orthosurg.ucsf.edu
Kurtz
Steven M
SM
Lau
Edmund
E
Ong
Kevin
K
Chiu
Vanessa
V
Vail
Thomas P
TP
Rubash
Harry E
HE
Berry
Daniel J
DJ
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006786:Hospitals, Urban; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare; D011183:Postoperative Complications; D011475:Prosthesis Failure; D012086:Reoperation; D013530:Surgical Wound Infection / Q000453:epidemiology; D014481:United States / Q000453:epidemiology