Background: The number of revision total knee arthroplasties (TKAs) in Asian countries is projected to increase with the rapid growth of primary TKA. We investigated the factors associated with the incidence of revision TKA using a nationally representative database.
Methods: Data collected by the Health Insurance Review Agency of Korea, from 260,068 TKA patients between 2007 and 2012, were used to estimate the incidence rate and cumulative incidence of revision TKA according to age, gender, and hospital TKA and prosthesis manufacturer volume. Age, hospital, and manufacturer volume were categorized into three groups. The incidence rates and cumulative incidences of revision TKA were computed by combining age and gender, and by combining hospital and prosthesis manufacturer volume.
Results: Incidence rates per 100,000 person-years were as follows: 1) by age: < 65 years, 447.2; 65-74 years, 363.7; ≥ 75 years, 270.9, 2) by gender: male, 537.8; female, 346.1; 3) by hospital volume (procedures/year): < 20, 536.9; 20-199, 432.3; ≥ 200, 300.1; and 4) by manufacturer volume (prostheses/year): < 1500, 772.3; 1500-3999, 453.9; ≥ 4000, 345.6. The revision TKA incidence rate in young males was significantly higher compared to that in elderly females. The difference in cumulative incidence, between hospitals with an annual volume of < 20 procedures and those with a volume of 20-199 procedures, was reduced for manufacturers with an annual volume of ≥ 4000. Similarly, the difference in cumulative incidence between manufacturers with an annual volume of <1500 prostheses and those with a volume of 1500-3999 prostheses was reduced in hospitals with an annual volume of ≥ 200.
Conclusion: Revision TKA incidence varied according to age, gender, and hospital and manufacturer volume. This data could inform clinical decisions and healthcare strategies.