Factors associated with the incidence of revision total knee arthroplasty in Korea between 2007 and 2012: an analysis of the National Claim Registry.
BACKGROUND
The number of revision total knee arthroplasties (TKAs) in Asian countries is projected to increase with the rapid growth of primary TKA. We investigated the factors associated with the incidence of revision TKA using a nationally representative database.


METHODS
Data collected by the Health Insurance Review Agency of Korea, from 260,068 TKA patients between 2007 and 2012, were used to estimate the incidence rate and cumulative incidence of revision TKA according to age, gender, and hospital TKA and prosthesis manufacturer volume. Age, hospital, and manufacturer volume were categorized into three groups. The incidence rates and cumulative incidences of revision TKA were computed by combining age and gender, and by combining hospital and prosthesis manufacturer volume.


RESULTS
Incidence rates per 100,000 person-years were as follows: 1) by age: < 65 years, 447.2; 65-74 years, 363.7; ≥ 75 years, 270.9, 2) by gender: male, 537.8; female, 346.1; 3) by hospital volume (procedures/year): < 20, 536.9; 20-199, 432.3; ≥ 200, 300.1; and 4) by manufacturer volume (prostheses/year): < 1500, 772.3; 1500-3999, 453.9; ≥ 4000, 345.6. The revision TKA incidence rate in young males was significantly higher compared to that in elderly females. The difference in cumulative incidence, between hospitals with an annual volume of < 20 procedures and those with a volume of 20-199 procedures, was reduced for manufacturers with an annual volume of ≥ 4000. Similarly, the difference in cumulative incidence between manufacturers with an annual volume of <1500 prostheses and those with a volume of 1500-3999 prostheses was reduced in hospitals with an annual volume of ≥ 200.


CONCLUSIONS
Revision TKA incidence varied according to age, gender, and hospital and manufacturer volume. This data could inform clinical decisions and healthcare strategies.
Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Seoul, Dongjak-gu, 156-707, Republic of Korea. drshinch@gmail.com.
Chang Ho
CH
Shin
Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Seoul, Dongjak-gu, 156-707, Republic of Korea. ccbknee@gmail.com.
Chong Bum
CB
Chang
Review and Assessment Committee, Health Insurance Review and Assessment Service, Seoul, Republic of Korea. drpoet@hiramail.net.
Suk-Hyun
SH
Cho
Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Seoul, Dongjak-gu, 156-707, Republic of Korea. jj59275@naver.com.
Jin Hwa
JH
Jeong
Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Seoul, Dongjak-gu, 156-707, Republic of Korea. ossbkang@gmail.com.
Seung-Baik
SB
Kang
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007720:Knee Prosthesis / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D056910:Republic of Korea