Knee Arthroplasties in Turkey: A Study from a Health Management Perspective

Year 2023, , 93 - 99, 30.08.2023

Hüseyin Aslan

https://doi.org/10.54537/tusebdergisi.1335429

Abstract

Objective: In this study, it was aimed to investigate the increase rate of primary and revision knee arthroplasty procedures performed in Turkey between 2013-2017 and the reasons for revision arthroplasty. Materials and Methods: The data include Primary Arthroplasty of Knee and Revision Arthroplasty of Knee procedures performed in public hospitals of Turkey. This research is a retrospective study covering Primary and Revision Knee Arthroplasty procedures between 2013-2017. The data were obtained in Microsoft Excel format and made ready for analysis by making the necessary arrangements on Excel. 2x2 χ² test and independent-sample t-test were used in comparisons of two groups. Binary logistic regression analysis was performed to determine the reasons for patients to undergo the revision procedure. Data analysis was done with IBM SPSS statistics 23 program. The significance level was used as 0.05 and the confidence interval as 95% in the analyzes. Results: A total of 219,607 arthroplasty of knee procedures, including 210,519 primary arthroplasty of the knee and 8,939 revision arthroplasty of knee procedures, were performed over a five-year period. Revision arthroplasty of knee procedure, it has been found that revision arthroplasty of the knee is performed nearly 1.5 times more in males than females, approximately 1000 times more in patients with mechanical complications of the implant, approximately 500 times more in patients with infection complications, approximately 1.3 times more in patients tension disease, and approximately 4.7 times more in patients without hip implants. Conclusion: Determining the health service needs for the coming years and planning the health service delivery, is an important issue for public health in Turkey. It is thought that performing projection studies will be beneficial in terms of making health service planning more accurate.

Keywords

Knee Arthroplasty, Revision Ratio, Causes of Revision Arthroplasty, Turkey

Türkiye'de Diz Artroplastileri: Sağlık Yönetimi Açısından Bir Araştırma

Abstract

Amaç: Bu araştırmada 2013-2017 yılları arasında Türkiye'de yapılan primer ve revizyon diz artroplasti işlemi artış oranını ve revizyon artroplastilerin nedenlerinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Veriler, Türkiye'deki kamu hastanelerinde gerçekleştirilen Primer Diz Artroplastisi ve Revizyon Diz Artroplastisi prosedürlerini içermektedir. Bu araştırma 2013-2017 yılları arasındaki Primer ve Revizyon Diz Artroplastisi işlemlerini kapsayan retrospektif bir çalışmadır. Veriler Microsoft Excel formatında elde edilmiş ve Excel üzerinde gerekli düzenlemeler yapılarak analize hazır hale getirilmiştir. İki grubun karşılaştırılmasında 2x2 χ² testi ve bağımsız örneklem t testi kullanıldı. Hastaların revizyon prosedürüne girme nedenlerini belirlemek için ikili lojistik regresyon analizi yapılmıştır. Verilerin analizi IBM SPSS statistics 23 programı ile yapılmıştır. Analizlerde anlamlılık düzeyi 0,05 ve güven aralığı %95 olarak kullanılmıştır. Bulgular: Beş yıllık bir süre içinde 210.519 primer diz artroplastisi ve 8.939 diz revizyon artroplastisi prosedürü dahil olmak üzere toplam 219.607 diz artroplastisi prosedürü gerçekleştirildi. Revizyon diz artroplasti işleminin; erkeklerde kadınlara göre yaklaşık 1.5, implantın mekanik komplikasyonu olanlarda yaklaşık 1000, implantın enfeksiyon komplikasyonu olanlarda yaklaşık 500, tansiyon hastalığı olmayanlarda yaklaşık 1.3 ve kalça implantı olmayan hastalarda yaklaşık 4,7 kat fazla yapıldığı bulunmuştur. Sonuç: Önümüzdeki yıllar için sağlık hizmeti ihtiyacının belirlenmesi ve sağlık hizmeti sunumunun planlanması, Türkiye'de halk sağlığı açısından önemli bir konudur. Projeksiyon çalışmalarının yapılması sağlık hizmet planlamasının daha doğru yapılabilmesi açısından faydalı olacağı düşünülmektedir.

Keywords

Diz Artroplastisi, Revizyon Oranı, Revizyon Artroplasti Nedenleri, Türkiye

References

• Healthcare Cost and Utilization Project (HCUP). Retrieved December 1, 2020. Available from: https://www.hcupus.ahrq. gov/faststats/NationalProceduresServlet?year1=2015&charac teristic1=0&included1=0&year2=&characteristic2=0&included 2=1&expansionInfoState=hide&dataTablesState=hide&definiti onsState=hide&exportState=hide
• Hamilton DF, Howie CR, Burnett R, Simpson AH, Patton JT. Dealing with the predicted increase in demand for revision total knee arthroplasty: Challenges, risks and opportunities. Bone Joint J 2015;97(6):723-8. https://doi.org/10.1302/0301- 620X.97B6.35185
• Bhandari M, Smith J, Miller LE, Block JE. Clinical and economic burden of revision knee arthroplasty. Clin Med Insights Arthritis Musculoskelet Disord 2012;5:89-94. https://doi.org/10.4137/ CMAMD.S10859
• Ong KL, Mowat FS, Chan N, Lau E, Halpern MT, Kurtz SM. Economic burden of revision hip and knee arthroplasty in medicare enrollees. Clin Orthop Relat Res 2006;446:22-8. https://doi.org/10.1097/01.blo.0000214439.95268.59
• Hardeman F, Londers J, Favril A, Witvrouw E, Bellemans J, Victor J. Predisposing factors which are relevant for the clinical outcome after revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012;20(6):1049-56. https://doi. org/10.1007/s00167-011-1624-8
• Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. (2005). Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg 2005;87:1487-97. https://doi. org/10.2106/00004623-200507000-00010
• Rosso F, Cottino U, Dettoni F, Bruzzone M, Bonasia DE, Rossi R. Revision total knee arthroplasty (TKA): Mid-term outcomes and bone loss/quality evaluation and treatment. J Orthop Surg Res 2019;14(1):1-9. https://doi.org/10.1186/s13018-019- 1328-1
• Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the u.s., 2014 to 2030. J Bone Joint Surg 2018;100(17):1455-60. https://doi.org/10.2106/ JBJS.17.01617
• Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg 2007;89(4):780-5. https://doi.org/10.2106/00004623-200704000-00012
• Ceyhan E, Gursoy S, Akkaya M, Ugurlu M, Koksal I, Bozkurt M. Toward the Turkish national registry system: A prevalence study of total knee arthroplasty in Turkey. J Arthroplasty 2016;31(9):1878-84. https://doi.org/10.1016/j. arth.2016.02.033
• Klug A, Gramlich Y, Rudert M, Drees P, Hoffmann R, Weißenberger M, et al. The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years. Knee Surg Sports Traumatol Arthrosc 2021;29:3287-98. https://doi. org/10.1007/s00167-020-06154-7
• Rolfson O, Nåtman J, Rogmark C, Sundberg M, Mohaddes M, Kärrholm J, W-Dahl A. The prevalence of joint replacement in Sweden. Orthop Proc 2023;105(12):87. https://doi. org/10.1302/1358-992X.2023.12.087
• Patel A, Pavlou G, Mújica-Mota RE, Toms AD. The epidemiology of revision total knee and hip arthroplasty in England and Wales: A comparative analysis with projections for the United States. A study using the national joint registry dataset. Bone Joint J 2015;97(8):1076-81. https://doi.org/10.1302/0301- 620X.97B8.35170
• Dy CJ, Marx RG, Bozic KJ, Pan TJ, Padgett DE, Lyman S. Risk factors for revision within 10 years of total knee arthroplasty. Clin Orthop Relat Res 2014;472(4):1198-207. https://doi. org/10.1007/s11999-013-3416-6
• Lizaur-Utrilla A, Martinez-Mendez D, Miralles-Muñoz FA, Marco-Gómez L, Lopez-Prats FA. Comparable outcomes after total knee arthroplasty in patients under 55 years than in older patients: A matched prospective study with minimum follow-up of 10 years. Knee Surg Sports Traumatol Arthrosc 2017;25(11):3396-402. https://doi.org/10.1007/s00167-016- 4406-5
• Gu A, Wei C, Robinson HN, Sobrio SA, Liu J, Sculco TP, Sculco PK. Postoperative complications and impact of diabetes mellitus severity on revision total knee arthroplasty. J Knee Surg Sports Traumatol Arthrosc 2020;33(3):228-34. https://doi. org/10.1055/s-0038-1677542
• Koh CK, Zeng I, Ravi S, Zhu M, Vince KG, Young SW. Periprosthetic joint infection is the main cause of failure for modern knee arthroplasty: An analysis of 11,134 knees. Clin Orthop Relat Res 2017;475(9):2194-201. https://doi.org/10.1007/s11999- 017-5396-4
• Lewis PL, Robertsson O, Graves SE, Paxton EW, Prentice HA, W-Dahl A. Variation and trends in reasons for knee replacement revision: A multi-registry study of revision burden. Acta Orthop 2021;92(2):182-8. https://doi.org/10.1080/17453674.2020.1853 340