TY - JOUR
T1 - Long-Term Mortality Trends After Total Hip and Knee Arthroplasties
T2 - A Population-Based Study
AU - Maradit Kremers, Hilal
AU - Larson, Dirk R.
AU - Noureldin, Mohamed
AU - Schleck, Cathy D.
AU - Jiranek, William A.
AU - Berry, Daniel J.
N1 - Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Background: Mortality after total hip and knee arthroplasty is lower than that in the general population, but it is unknown whether there are differences by surgery type, demographics, and calendar year. Our objective was to evaluate trends and determinants of long-term mortality among patients with total hip and knee arthroplasties. Methods: Using a historical cohort study design, we passively followed up population-based cohorts of total hip and total knee arthroplasty patients with degenerative arthritis who underwent surgery between January 1, 1969 and December 31, 2008. Patients were followed up until death or August 31, 2014. Observed and expected survival was compared using standardized mortality ratios (SMRs). Poisson regression models were used to examine relative mortality patterns by surgery type, age, sex, calendar year, and time since surgery. Results: The overall age- and sex-adjusted mortality was significantly lower than that in the general population after both total hip (SMR: 0.82, 95% CI: 0.76-0.88) and total knee (SMR = 0.80, 95% CI: 0.75-0.86) arthroplasties. Despite the low relative mortality within the first 8 years of surgery, we observed a worsening of relative mortality beyond 15 years after total knee arthroplasty surgery. Both short- and long-term mortality improved over calendar time, and the improvement occurred about a decade earlier in total knee arthroplasty than in total hip arthroplasty. Conclusion: Survival after total hip and total knee arthroplasties is better than that in the general population for about 8 years after surgery. Secular trends are encouraging and suggest that survival after both procedures has been improving even further in recent years.
AB - Background: Mortality after total hip and knee arthroplasty is lower than that in the general population, but it is unknown whether there are differences by surgery type, demographics, and calendar year. Our objective was to evaluate trends and determinants of long-term mortality among patients with total hip and knee arthroplasties. Methods: Using a historical cohort study design, we passively followed up population-based cohorts of total hip and total knee arthroplasty patients with degenerative arthritis who underwent surgery between January 1, 1969 and December 31, 2008. Patients were followed up until death or August 31, 2014. Observed and expected survival was compared using standardized mortality ratios (SMRs). Poisson regression models were used to examine relative mortality patterns by surgery type, age, sex, calendar year, and time since surgery. Results: The overall age- and sex-adjusted mortality was significantly lower than that in the general population after both total hip (SMR: 0.82, 95% CI: 0.76-0.88) and total knee (SMR = 0.80, 95% CI: 0.75-0.86) arthroplasties. Despite the low relative mortality within the first 8 years of surgery, we observed a worsening of relative mortality beyond 15 years after total knee arthroplasty surgery. Both short- and long-term mortality improved over calendar time, and the improvement occurred about a decade earlier in total knee arthroplasty than in total hip arthroplasty. Conclusion: Survival after total hip and total knee arthroplasties is better than that in the general population for about 8 years after surgery. Secular trends are encouraging and suggest that survival after both procedures has been improving even further in recent years.
KW - Cohort study
KW - Mortality
KW - Mortality trends
KW - Standardized mortality ratio
KW - Total hip arthroplasty
KW - Total knee arthroplasty
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U2 - 10.1016/j.arth.2015.12.010
DO - 10.1016/j.arth.2015.12.010
M3 - Article
C2 - 26777550
AN - SCOPUS:84952928582
SN - 0883-5403
VL - 31
SP - 1163
EP - 1169
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 6
ER -