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Mortality after hip or knee arthroplasty for osteoarthritis in Chile: A survival analysis
Maximiliano Barahona1, Cristian Barrientos2, Álvaro Martinez3
1Departamento de Ortopedia y Traumatología en Hospital Clínico Universidad de Chile, Santiago, Chile. Adress: Santos Dumont 999, 3rd Floor, office 351, Postal code 8380456, Independencia, Santiago, Chile. Email: maxbarahonavasquez@gmail.com. ORCID: 0000-0001-7878-8625.
Insights
Hip and knee arthroplasty patients in Chile initially show better survival than the general population. However, after 12 years, their life expectancy decreases, particularly for women and hip arthroplasty recipients.
Area of Science:
- Orthopedic Surgery
- Public Health
- Epidemiology
Background:
- Osteoarthritis (OA) affects numerous individuals globally.
- Hip and knee arthroplasty are common surgical interventions for advanced OA.
- Assessing long-term survival post-arthroplasty is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the impact of hip or knee arthroplasty on life expectancy in a Chilean population.
- To identify specific patient groups or factors associated with altered survival post-surgery.
Main Methods:
- Survival analysis utilizing a multiparametric Weibull regression model.
- Inclusion criteria: patients aged 50+ undergoing hip/knee arthroplasty for OA.
- Exclusion criteria: arthroplasty for fracture, hemophilia, or tumor; internal validity ensured by bootstrap analysis.
Main Results:
- Analysis included 4,094 arthroplasty procedures.
- Kaplan-Meier curves indicated superior survival initially, followed by decreased survival after 12 years.
- Hazard ratios revealed increased mortality risk for women (1.53), older age (1.09/year), and hip arthroplasty (1.29).
Conclusions:
- Mortality post-hip and knee arthroplasty in Chile exhibits a bimodal pattern.
- Initial survival is favorable, but long-term outcomes (12-15 years) show increased mortality compared to the general population.
- Findings align with international trends observed in the US and Europe.
Background:
The purpose of this study is to determine if patients with osteoarthritis that undergo hip or knee arthroplasty jeopardize their life expectancy in Chile.
Methods:
A survival analysis study was designed and approved by our institutional ethics review board. Patients were included if they underwent surgery for hip or knee osteoarthritis and were 50 years or older at the time of surgery. Patients were excluded if arthroplasty was performed for fracture, hemophilia arthropathy, or tumor. A multiparametric Weibull regression was estimated, and the hazard ratio was reported. For internal validity, a bootstrap of 200 repetitions was performed.
Results:
A total of 4 094 arthroplasties were included. The Kaplan-Meier curve estimates a higher survival than the general population up to 12 years, after which the median survival is less than the general population. The bootstrap multiparametric Weibull regression estimated a hazard ratio of 1.53 (95% confidence interval: 1.27 to 1.84) for women, 1.09 (1.08 to 1.10) for every year older, and 1.29 (1.07 to 1.53) for hip arthroplasty patients.
Conclusion:
Mortality after hip and knee arthroplasty in Chile follows a bimodal behavior similar to reports from the United States and Europe. At first, mortality is lower than the general population but worsens after 12 to 15 years of surgery.
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