The progression of end-stage osteoarthritis: analysis of data from the Australian and Norwegian joint replacement registries using a multi-state model

Jan 1, 2013Osteoarthritis and cartilage

How late-stage osteoarthritis develops based on joint replacement data from Australia and Norway

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Abstract

The estimated probability of receiving a knee replacement on the opposite side of an initial hip replacement after 5 years is more than 1.7 times that of receiving a knee replacement on the same side.

Hazard rates for subsequent knee replacements are higher for the opposite knee compared to the same knee after a hip replacement.
This pattern is particularly pronounced when the initial surgery is a hip arthroplasty.
After five years, patients are more likely to need a knee replacement on the opposite side if they had a hip arthroplasty.
There is an association between the side of the initial hip surgery and the side of subsequent knee surgeries.
Further research is needed to explore connections between hip replacements and factors influencing knee replacements.

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OBJECTIVE: The incidence of joint replacements is considered an indicator of symptomatic end-stage osteoarthritis (OA). We analysed data from two national joint replacement registries in order to investigate whether evidence of a pattern of progression of end-stage hip and knee OA could be found in data from large unselected populations.

DESIGN: We obtained data on 78,634 hip and 122,096 knee arthroplasties from the Australian Orthopaedic Association National Joint Replacement Registry and 19,786 hip and 12,082 knee arthroplasties from the Norwegian Arthroplasty Register. A multi-state model was developed where individuals were followed from their first recorded hip or knee arthroplasty for OA to receiving subsequent hip and/or knee arthroplasties. We used this model to estimate relative hazard rates and probabilities for each registry separately.

RESULTS: The hazard rates of receiving subsequent arthroplasties in non-cognate joints were higher on the contralateral side than on the ipsilateral side to the index arthroplasty, especially if the index was a hip arthroplasty. After 5 years, the estimated probabilities of having received a knee contralateral to the index hip were more than 1.7 times the probabilities of having received a knee ipsilateral to the index hip.

CONCLUSION: The results indicate that there is an association between the side of the first hip arthroplasty and side of subsequent knee arthroplasties. Further studies are needed to investigate whether increased risk of receiving an arthroplasty in the contralateral knee is related to having a hip arthroplasty and/or preoperative factors such as pain and altered gait associated with hip OA.

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The progression of end-stage osteoarthritis: analysis of data from the Australian and Norwegian joint replacement registries using a multi-state model

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