Shoulder Arthritis / Rotator Cuff Tears: causes of shoulder pain: What factors lower revision rate in a joint replac...

Shoulder Arthritis / Rotator Cuff Tears: causes of shoulder pain: What factors lower revision rate in a joint replac...: Surgeon, Implant, and Patient Variables May Explain Variability in Early Revision Rates Reported for Unicompartmental Arthroplasty As po...
What factors lower revision rate in a joint replacement arthroplasty? 4Ps

Surgeon, Implant, and Patient Variables May Explain Variability in Early Revision Rates Reported for Unicompartmental Arthroplasty



As pointed out previously on this blog, the quality of the surgical result depends on the 4 Ps: the problem, the patient, the procedure and the physician performing the surgery. These authors support this view with their study of the reported revision rates for cemented unicompartmental knee arthroplasties. They studied the effect of implant selection, patient characteristics, and surgeon characteristics on revision risk in 1746 unicompartmental knee arthroplasties performed in their health-care system from 2002 to 2009 with a median follow-up time of 2.6 years with an overall revision rate of 4.98% - this amounts to an annualized revision rate of 2% per year.

The Problem: These authors did not study the effect of the type of arthritis, possibly because unicompartmental arthroplasties are performed for osteoarthritis. They did not study the effect of the extent of the preoperative deformity or the presence or absence of instability.

The Patient: Patient age <55 years of age compared with patients more than sixty-five years and an ASA score <3 points compared with ASA score > 3 were associated with higher failure rates.

The Procedure: In comparison to a modern, fixed, metal-backed tibial bearing prosthesis the revision rate was significantly higher for an all-polyethylene tibial tray.

The physician: 12 or fewer unicompartmental knees per year compared with more than 12 per year were associated with increased revision risk.

This study supports the view that documenting the type of procedure, the type of patient and the type of surgeon are important in studies of the rate of revision in prosthetic arthroplasty.