Epidemiological factors associated with revision of total joint replacement surgery: A nested case-control study

Abstract Background: Total Joint Replacement (TJR) is the most effective treatment for patients with end-stage joint pathologies, such as osteoarthritis (OA). However, this procedure can result in prosthesis failure, consequently requiring an early revision. These revision surgeries come at a high cost to the healthcare system and increase morbidity to patients. Therefore, it is crucial to identify factors associated with revisions to inform surgical decision-making. Methods: This study was a nested-case control study utilizing participants recruited in the he Newfoundland Osteoarthritis Study (NFOAS), initiated in 2011. Study participants were patients who underwent TJR (hip/knee) due to various pathologies, with OA accounting for a large proportion of cases. Revision status was collected through a chart review on the Eastern Health Meditech Health Care Information System. Seventy-two variables collected by general health questionnaires and medical reports were examined for associations with revisions. Results: A total of 1086 patients were recruited in the study; 810 patients were included (41.5% hip and 58.5% knee) in the final analysis; 30 of them underwent revision surgery. Seven factors were identified to be associated with revision status (number of live births, hysterectomy, hypertension, lateral epicondylitis, back pain that radiates to legs, more than five comorbidities, and the surgeon; all p<0.05). Of these variables, patients requiring revisions were more likely to have had lateral epicondylitis or their primary surgery conducted by the surgeon coded E5. In contrast, non-revision patients were associated with more live births, more than five comorbidities, hysterectomy, hypertension, or back pain that radiated to their legs.Conclusions: Our data suggested that surgeon and patients' health factors were associated with the odds of requiring revision surgery. Therefore, patients' risk of revision surgery could theoretically be calculated prior to TJR, better informing patient treatment decisions.