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Partial knee replacement increased risk for long-term revision

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Partial knee replacement was associated with an excess risk for long-term revision compared with total knee replacement, but may lower risk for venous thromboembolism in the short term and lower risk for persistent pain after surgery, according to data presented at the EULAR Annual Congress.

“Our study clearly demonstrates significant short-term advantages of partial knee replacement over total knee replacement,” Edward Burn, PhD, of Centre for Statistics in Medicine, NDORMS at the University of Oxford in the U.K., said in a press release.

The researchers matched 32,379 partial knee replacement recipients and 250,377 patients who underwent total knee replacement. Data were culled from the IBM MarketScan Commercial Database (CCAE), the IBM MarketScan Medicare Supplemental Database (MDCR), the Optum de-identified Clinformatics Datamart, Extended Date of Death database (OPTUM), and a UK primary care electronic medical record database (THIN).

Results showed that short-term venous thromboembolism risk was lower among partial knee replacement recipients than those who underwent the total knee procedure. This outcome remained consistent across the four databases, ranging from an HR of 0.47 (95% CI, 0.32-0.71) in the MDCR to an HR of 0.76 (95% CI, 0.59-0.99) in the CCAE.

Patients receiving partial knee replacement, however, required higher rates of 5-year revision surgery, ranging from an HR of 1.51 (95% CI, 1.24-1.88) in the CCAE, to an HR of 2.16 (95% CI, 1.63-3.15) in the MDCR.

“Although the long-term risk of revision is higher for partial knee replacement, this is likely, at least partly, explained by a greater willingness to revise a partial knee replacement,” Burn said.

The two procedures yielded similar risks for other complications.

Opioid use within 3 to 12 months after surgery was also reduced in the partial replacement group. The largest reduction was seen in the THIN database (HR = 0.7; 95% CI, 0.57-0.9), while the reduction in the Optum database was nearly 15% (HR = 0.86; 95% CI, 0.78-0.96).

“The results of our study based on real-world data will complement those from a forthcoming randomized controlled trial comparing the two procedures,” Burn said. – by Rob Volansky

Reference:
Prieto-Alhambra D, et al. OP0174. Presented at: EULAR Annual Congress; June 12-15, 2019; Madrid.

Disclosure: Burn reports no relevant financial disclosures.