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Higher early mortality with simultaneous rather than staged bilateral TKAs: results from the Swedish Knee Arthroplasty Register.

https://arctichealth.org/en/permalink/ahliterature92677
Source
Clin Orthop Relat Res. 2008 Dec;466(12):3066-70
Publication Type
Article
Date
Dec-2008
Author
Stefánsdóttir Anna
Lidgren Lars
Robertsson Otto
Author Affiliation
Department of Orthopaedics and Clinical Sciences, Lund University Hospital, 22185, Lund, Sweden. anna.stefansdottir@med.lu.se
Source
Clin Orthop Relat Res. 2008 Dec;466(12):3066-70
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee - methods - mortality
Cause of Death
Female
Humans
Male
Middle Aged
Osteoarthritis, Knee - mortality - surgery
Registries
Survival Analysis
Sweden - epidemiology
Abstract
Patients with knee osteoarthritis (OA) often present with symptoms that warrant bilateral TKAs. There are potential benefits to operating on both knees on the same day, but the safety of simultaneous bilateral TKAs has been questioned. To evaluate whether there were any differences in 30-day mortality between patients having simultaneous bilateral TKAs and those having staged bilateral TKAs, we analyzed data from the Swedish Knee Arthroplasty Register and the Swedish Cause of Death Register. We included 48,931 patients with OA having 60,062 primary TKAs during 1985 to 2004; 1139 had surgery on both knees on the same day (simultaneous bilateral) and 3432 had surgery on both knees on two different occasions with less than 1 year between operations (staged bilateral). The 30-day mortality after simultaneous bilateral TKAs was 7.53 (confidence interval, 2.62-21.69) times higher than after the second of staged TKA and 3.77 (confidence interval, 2.04-6.98) times higher than after a primary unilateral TKA. Assuming the total risk for a staged procedure is twice that of a unilateral procedure, the risk of mortality within 30 days is 1.94 (confidence interval, 1.05-3.59) times higher with simultaneous than staged TKA. It is safer to operate on one knee at a time. Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
PubMed ID
18670832 View in PubMed
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Increased long-term mortality in patients less than 55 years old who have undergone knee replacement for osteoarthritis: results from the Swedish Knee Arthroplasty Register.

https://arctichealth.org/en/permalink/ahliterature163250
Source
J Bone Joint Surg Br. 2007 May;89(5):599-603
Publication Type
Article
Date
May-2007
Author
O. Robertsson
A. Stefánsdóttir
L. Lidgren
J. Ranstam
Author Affiliation
Swedish National Competence Centre for Musculoskeletal Disorders, Lund University Hospital, Lund, Sweden. otto.robertsson@med.lu.se
Source
J Bone Joint Surg Br. 2007 May;89(5):599-603
Date
May-2007
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee - mortality
Cardiovascular Diseases - mortality
Cause of Death
Female
Female Urogenital Diseases - mortality
Follow-Up Studies
Gastrointestinal Diseases - mortality
Humans
Male
Male Urogenital Diseases - mortality
Middle Aged
Osteoarthritis, Knee - mortality - surgery
Registries
Sweden - epidemiology
Abstract
Patients with osteoarthritis undergoing knee replacement have been reported to have an overall reduced mortality compared with that of the general population. This has been attributed to the selection of healthier patients for surgery. However, previous studies have had a maximum follow-up time of ten years. We have used information from the Swedish Knee Arthroplasty Register to study the mortality of a large national series of patients with total knee replacement for up to 28 years after surgery and compared their mortality with that of the normal population. In addition, for a subgroup of patients operated on between 1980 and 2002 we analysed their registered causes of death to determine if they differed from those expected. We found a reduced overall mortality during the first 12 post-operative years after which it increased and became significantly higher than that of the general population. Age-specific analysis indicated an inverse correlation between age and mortality, where the younger the patients were, the higher their mortality. The shift at 12 years was caused by a relative over-representation of younger patients with a longer follow-up. Analysis of specific causes of death showed a higher mortality for cardiovascular, gastrointestinal and urogenital diseases. The observation that early onset of osteoarthritis of the knee which has been treated by total knee replacement is linked to an increased mortality should be a reason for increased general awareness of health problems in these patients.
PubMed ID
17540743 View in PubMed
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Long-term mortality and causes of death among patients with a total knee prosthesis in primary osteoarthritis.

https://arctichealth.org/en/permalink/ahliterature278400
Source
Knee. 2016 Jan;23(1):162-6
Publication Type
Article
Date
Jan-2016
Author
Tuomo Visuri
Keijo Mäkelä
Pekka Pulkkinen
Mia Artama
Eero Pukkala
Source
Knee. 2016 Jan;23(1):162-6
Date
Jan-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee - mortality
Cause of Death - trends
Female
Finland - epidemiology
Forecasting
Humans
Knee Prosthesis
Male
Middle Aged
Osteoarthritis, Knee - mortality - surgery
Postoperative Complications - mortality
Registries
Retrospective Studies
Survival Rate - trends
Abstract
Short and midterm mortality of patients with osteoarthritis (OA) who have undergone total knee arthroplasty (TKA) is generally lower than that of the general population. Due to an increasing number of young patients who undergo TKA the expected lifetime of these patients is increasing. The purpose of this study was to assess the causes of death and long-term mortality among Finnish TKA patients.
Standardized mortality ratios (SMRs) for total and site specific causes of death were calculated for 9443 TKA patients operated on in 1980 to 1996 for OA and followed until 2012.
The mean follow-up time was 14 years (maximum 33 years). During follow-up, 77% of the patients had died. The all-cause SMR was 1.00. It was significantly lower than in the reference population (SMR 0.73) during the first 10 years after operation, but higher during the next 10 years (SMR 1.23), and even more after 20 years (SMR 1.95). The SMR for cardiovascular mortality was 1.03 and accounted for 52% of all deaths. Significant excess mortality was observed in diseases of the digestive tract (SMR 1.29). Deaths due to cardiovascular diseases, Alzheimer's disease and dementia comprised 68% of all deaths that took place 10 years or later after TKA.
The mortality of TKA patients with OA is significantly reduced during the first 10 postoperative years but exceeds the mortality of the general population after that. This trend should be taken into account when young patients undergo a TKA.
Observational study, III.
PubMed ID
26751980 View in PubMed
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Predictors of mortality following primary hip and knee replacement in the aged. A single-center analysis of 1,998 primary hip and knee replacements for primary osteoarthritis.

https://arctichealth.org/en/permalink/ahliterature118015
Source
Acta Orthop. 2013 Feb;84(1):44-53
Publication Type
Article
Date
Feb-2013
Author
Esa Jämsen
Timo Puolakka
Antti Eskelinen
Pirkko Jäntti
Jarkko Kalliovalkama
Jyrki Nieminen
Jaakko Valvanne
Author Affiliation
Coxa, Hospital for Joint Replacement, Finland. esa.jamsen@uta.fi
Source
Acta Orthop. 2013 Feb;84(1):44-53
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - mortality
Arthroplasty, Replacement, Knee - mortality
Female
Finland - epidemiology
Humans
Kaplan-Meier Estimate
Male
Osteoarthritis, Hip - mortality - surgery
Osteoarthritis, Knee - mortality - surgery
Proportional Hazards Models
Risk factors
Sex Factors
Time Factors
Treatment Outcome
Abstract
High age is associated with increased postoperative mortality, but the factors that predict mortality in older hip and knee replacement recipients are not known.
Preoperative clinical and operative data on 1,998 primary total hip and knee replacements performed for osteoarthritis in patients aged = 75 years in a single institution were collected from a joint replacement database and compared with mortality data. Average follow-up was 4.2 (2.2-7.6) years for the patients who survived. Factors associated with mortality were analyzed using Cox regression analysis, with adjustment for age, sex, operated joint, laterality, and anesthesiological risk score.
Mortality was 0.15% at 30 days, 0.35% at 90 days, 1.60% at 1 year, 7.6% at 3 years, and 16% at 5 years, and was similar following hip and knee replacement. Higher age, male sex, American Society of Anesthesiologists risk score of > 2, use of walking aids, preoperative walking restriction (inability to walk or ability to walk indoors only, compared to ability to walk > 1 km), poor clinical condition preoperatively (based on clinical hip and knee scores or clinical severity of osteoarthritis), preoperative anemia, severe renal insufficiency, and use of blood transfusions were associated with higher mortality. High body mass index had a protective effect in patients after hip replacement.
Postoperative mortality is low in healthy old joint replacement recipients. Comorbidities and functional limitations preoperatively are associated with higher mortality and warrant careful consideration before proceeding with joint replacement surgery.
Notes
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PubMed ID
23244785 View in PubMed
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