title: Meeting increased demand for total knee replacement and follow-up: determining optimal follow-up.
abstract: The strain on clinic and surgeon resources resulting from a rise in demand for total knee replacement (TKR) requires reconsideration of when and how often patients need to be seen for follow-up. Surgeons will otherwise require increased paramedical staff or need to limit the number of TKRs they undertake. We reviewed the outcome data of 16 414 primary TKRs undertaken at our centre to determine the time to re-operation for any reason and for specific failure mechanisms. Peak risk years for failure were determined by comparing the conditional probability of failure, the number of failures divided by the total number of TKRs cases, for each year. The median times to failure for the most common failure mechanisms were 4.9 years (interquartile range (IQR) 1.7 to 10.7) for femoral and tibial loosening, 1.9 years (IQR 0.8 to 3.9) for infection, 3.1 years (IQR 1.6 to 5.5) for tibial collapse and 5.6 years (IQR 3.4 to 9.3) for instability. The median time to failure for all revisions was 3.3 years (IQR 1.2 to 8.5), with an overall revision rate of 1.7% (n = 282). Results from our patient population suggest that patients be seen for follow-up at six months, one year, three years, eight years, 12 years, and every five years thereafter. Patients with higher pain in the early post-operative period or high body mass index (≥ 41 kg/m(2)) should be monitored more closely.
authors.affiliation: The Center for Hip and Knee Surgery Research Foundation, 1199 Hadley Road, Mooresville, Indiana 46158, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Meding
authors.forename: M A
authors.initials: MA
authors.lastname: Ritter
authors.forename: K E
authors.initials: KE
authors.lastname: Davis
authors.forename: A
authors.initials: A
authors.lastname: Farris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Actuarial method; Clinic; Follow-up; Total knee arthroplasty; Total knee replacement