What are the influencing factors on hip&knee arthroplasty survival? Prospective cohort study on 63619 arthroplasties

Bertrand Boyer; Barbara Bordini; Dalila Caputo; Thomas Neri; Susanna Stea; Aldo Toni

doi:10.1016/j.otsr.2019.07.020

What are the influencing factors on hip&knee arthroplasty survival? Prospective cohort study on 63619 arthroplasties

Bertrand Boyer, Barbara Bordini, Dalila Caputo, Thomas Neri, Susanna Stea, Aldo Toni

Istituti Ortopedici Rizzoli

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Body mass index is used by the World Health Organization to classify obesity. While obesity influences the onset of arthritis and type-2 diabetes, its effect on implant survival is still open to debate, with conflicting results from clinical and registry studies, as well as meta-analyses. Other known factors such as gender or diabetes status could ponderate or mask the effect of BMI on implant survival.

HYPOTHESIS: Our hypothesis was BMI influenced hip and knee arthroplasty survival, when results were made independent of gender and diabetes status.

PATIENT AND METHODS: A registry study was designed on 30733 Total Hip Arthroplasties (THA), 28483 Total Knee Arthroplasties (TKA), 3754 Uni compartmental Knee Arthroplasties (UKA) and 649 Hinged Knee arthroplasties (HK), from 01/01/2003 to 31/12/2015. Mean follow-up was 5.5 years. Diabetes status was added to the model. Each arthroplasty survival was tested for age at implantation, gender, diabetes status, implant characteristics and specifically BMI, taking into account gender and diabetes status.

RESULTS: Gender had a strong influence on arthroplasty results. Age also influenced arthroplasty survival, especially aseptic loosening; a young age would lower implant survival. Diabetes had an influence in hip survival, but its influence on septic loosenings in TKA wasn't proven (p=0.065). A mobile liner and/or a cruciate retaining knee were factors increasing the risk of revision. Weight influenced THA survival, especially aseptic loosening, but didn't have a measurable effect in any other arthroplasty. BMI was not found to influence any arthroplasty survival, whatever the endpoint, when diabetes and gender were taken into account.

DISCUSSION: Gender, age and diabetes influenced survival of the lower limb arthroplasties, whereas BMI did not. Only weight did influence THA results and should be used instead of BMI.

CONCLUSION: Studies on arthroplasty survival should systematically mention gender and diabetes status and beware of potential group incomparability.

LEVEL OF EVIDENCE: III, cohort study.

Original language	English
Pages (from-to)	1251-1256
Number of pages	6
Journal	Orthopaedics and Traumatology: Surgery and Research
Volume	105
Issue number	7
Early online date	Oct 12 2019
DOIs	https://doi.org/10.1016/j.otsr.2019.07.020
Publication status	Published - Nov 2019

Keywords

Arthroplasty survival
BMI
Diabetes
Gender
Hip
Knee
Registry

Access to Document

10.1016/j.otsr.2019.07.020

Cite this

@article{10fe38e49eb84b6f96023b00460a2f6c,

title = "What are the influencing factors on hip&knee arthroplasty survival? Prospective cohort study on 63619 arthroplasties",

abstract = "BACKGROUND: Body mass index is used by the World Health Organization to classify obesity. While obesity influences the onset of arthritis and type-2 diabetes, its effect on implant survival is still open to debate, with conflicting results from clinical and registry studies, as well as meta-analyses. Other known factors such as gender or diabetes status could ponderate or mask the effect of BMI on implant survival.HYPOTHESIS: Our hypothesis was BMI influenced hip and knee arthroplasty survival, when results were made independent of gender and diabetes status.PATIENT AND METHODS: A registry study was designed on 30733 Total Hip Arthroplasties (THA), 28483 Total Knee Arthroplasties (TKA), 3754 Uni compartmental Knee Arthroplasties (UKA) and 649 Hinged Knee arthroplasties (HK), from 01/01/2003 to 31/12/2015. Mean follow-up was 5.5 years. Diabetes status was added to the model. Each arthroplasty survival was tested for age at implantation, gender, diabetes status, implant characteristics and specifically BMI, taking into account gender and diabetes status.RESULTS: Gender had a strong influence on arthroplasty results. Age also influenced arthroplasty survival, especially aseptic loosening; a young age would lower implant survival. Diabetes had an influence in hip survival, but its influence on septic loosenings in TKA wasn't proven (p=0.065). A mobile liner and/or a cruciate retaining knee were factors increasing the risk of revision. Weight influenced THA survival, especially aseptic loosening, but didn't have a measurable effect in any other arthroplasty. BMI was not found to influence any arthroplasty survival, whatever the endpoint, when diabetes and gender were taken into account.DISCUSSION: Gender, age and diabetes influenced survival of the lower limb arthroplasties, whereas BMI did not. Only weight did influence THA results and should be used instead of BMI.CONCLUSION: Studies on arthroplasty survival should systematically mention gender and diabetes status and beware of potential group incomparability.LEVEL OF EVIDENCE: III, cohort study.",

keywords = "Arthroplasty survival, BMI, Diabetes, Gender, Hip, Knee, Registry",

author = "Bertrand Boyer and Barbara Bordini and Dalila Caputo and Thomas Neri and Susanna Stea and Aldo Toni",

year = "2019",

month = nov,

doi = "10.1016/j.otsr.2019.07.020",

language = "English",

volume = "105",

pages = "1251--1256",

journal = "Orthopaedics and Traumatology: Surgery and Research",

issn = "1877-0568",

publisher = "Elsevier Masson",

number = "7",

}

TY - JOUR

T1 - What are the influencing factors on hip&knee arthroplasty survival? Prospective cohort study on 63619 arthroplasties

AU - Boyer, Bertrand

AU - Bordini, Barbara

AU - Caputo, Dalila

AU - Neri, Thomas

AU - Stea, Susanna

AU - Toni, Aldo

PY - 2019/11

Y1 - 2019/11

N2 - BACKGROUND: Body mass index is used by the World Health Organization to classify obesity. While obesity influences the onset of arthritis and type-2 diabetes, its effect on implant survival is still open to debate, with conflicting results from clinical and registry studies, as well as meta-analyses. Other known factors such as gender or diabetes status could ponderate or mask the effect of BMI on implant survival.HYPOTHESIS: Our hypothesis was BMI influenced hip and knee arthroplasty survival, when results were made independent of gender and diabetes status.PATIENT AND METHODS: A registry study was designed on 30733 Total Hip Arthroplasties (THA), 28483 Total Knee Arthroplasties (TKA), 3754 Uni compartmental Knee Arthroplasties (UKA) and 649 Hinged Knee arthroplasties (HK), from 01/01/2003 to 31/12/2015. Mean follow-up was 5.5 years. Diabetes status was added to the model. Each arthroplasty survival was tested for age at implantation, gender, diabetes status, implant characteristics and specifically BMI, taking into account gender and diabetes status.RESULTS: Gender had a strong influence on arthroplasty results. Age also influenced arthroplasty survival, especially aseptic loosening; a young age would lower implant survival. Diabetes had an influence in hip survival, but its influence on septic loosenings in TKA wasn't proven (p=0.065). A mobile liner and/or a cruciate retaining knee were factors increasing the risk of revision. Weight influenced THA survival, especially aseptic loosening, but didn't have a measurable effect in any other arthroplasty. BMI was not found to influence any arthroplasty survival, whatever the endpoint, when diabetes and gender were taken into account.DISCUSSION: Gender, age and diabetes influenced survival of the lower limb arthroplasties, whereas BMI did not. Only weight did influence THA results and should be used instead of BMI.CONCLUSION: Studies on arthroplasty survival should systematically mention gender and diabetes status and beware of potential group incomparability.LEVEL OF EVIDENCE: III, cohort study.

AB - BACKGROUND: Body mass index is used by the World Health Organization to classify obesity. While obesity influences the onset of arthritis and type-2 diabetes, its effect on implant survival is still open to debate, with conflicting results from clinical and registry studies, as well as meta-analyses. Other known factors such as gender or diabetes status could ponderate or mask the effect of BMI on implant survival.HYPOTHESIS: Our hypothesis was BMI influenced hip and knee arthroplasty survival, when results were made independent of gender and diabetes status.PATIENT AND METHODS: A registry study was designed on 30733 Total Hip Arthroplasties (THA), 28483 Total Knee Arthroplasties (TKA), 3754 Uni compartmental Knee Arthroplasties (UKA) and 649 Hinged Knee arthroplasties (HK), from 01/01/2003 to 31/12/2015. Mean follow-up was 5.5 years. Diabetes status was added to the model. Each arthroplasty survival was tested for age at implantation, gender, diabetes status, implant characteristics and specifically BMI, taking into account gender and diabetes status.RESULTS: Gender had a strong influence on arthroplasty results. Age also influenced arthroplasty survival, especially aseptic loosening; a young age would lower implant survival. Diabetes had an influence in hip survival, but its influence on septic loosenings in TKA wasn't proven (p=0.065). A mobile liner and/or a cruciate retaining knee were factors increasing the risk of revision. Weight influenced THA survival, especially aseptic loosening, but didn't have a measurable effect in any other arthroplasty. BMI was not found to influence any arthroplasty survival, whatever the endpoint, when diabetes and gender were taken into account.DISCUSSION: Gender, age and diabetes influenced survival of the lower limb arthroplasties, whereas BMI did not. Only weight did influence THA results and should be used instead of BMI.CONCLUSION: Studies on arthroplasty survival should systematically mention gender and diabetes status and beware of potential group incomparability.LEVEL OF EVIDENCE: III, cohort study.

KW - Arthroplasty survival

KW - BMI

KW - Diabetes

KW - Gender

KW - Hip

KW - Knee

KW - Registry

U2 - 10.1016/j.otsr.2019.07.020

DO - 10.1016/j.otsr.2019.07.020

M3 - Article

C2 - 31615748

SN - 1877-0568

VL - 105

SP - 1251

EP - 1256

JO - Orthopaedics and Traumatology: Surgery and Research

JF - Orthopaedics and Traumatology: Surgery and Research

IS - 7

ER -

What are the influencing factors on hip&knee arthroplasty survival? Prospective cohort study on 63619 arthroplasties

Abstract

Keywords

Access to Document

Fingerprint

Cite this