Current State of Knee Arthroplasty in Russia: Analysis of 36,350 Сases from the Register of the Vreden National Medical Research Center of Traumatology and Orthopedics

Abstract

Background. Nowadays the knee arthroplasty register of the Vreden National Medical Research Center of Traumatology and Orthopedics (hereinafter referred to as the Vreden Center) contains clinical and statistical data on more than 39,000 primary and revision knee replacements, that mimics current state of this kind of surgery in Russia.

Aim of the study — to analyze the last decade trends in primary knee arthroplasty in largest Russian arthroplasty center.

Methods. Data were obtained from the register of the Vreden Center for the period from 2011 to 2022. Information on knee arthroplasty included epidemiologic and numerous peri-operative data including type of surgery and implant, degree of constrain, primary patella resurfacing etc.

Results and discussion. From 2011 to 2022, 36,350 (92.3%) primary arthroplasties performed at the Vreden Center.

The number of interventions increased more than twice: from 1,678 in 2011 to 3,924 in 2022. Similar trends observed in Australia and Sweden, where the number of knee arthroplasties increased by 8.2% and 8% in 2021 compared to 2020, respectively. The frequency of primary patellar resurfacing at the Vreden Center was 2.2% over the entire period of observation. On the contrary, the rate of patella replacement increased from 41% in 2005 to 76.1% in 2021 in Australia and from 24.4% in 2015 to 31.9% in 2020 in Switzerland. The partial knee arthroplasty showed enormous growth — more than 14 times: from 0.3% in 2011 to 4.3% in 2022 at the Vreden Center. Worldwide unicompartmental knee replacement is still less popular than total and its number widely varies: 4.2% in the USA, 6.9% in Australia, 9.2% in Canada, 11.9% in Norway, 12.8% in Sweden, and 18.4% in Switzerland. Posterior cruciate ligament (PCL) retaining total knee arthroplasties (TKA) prevailed at the Vreden Center: 68.3%, while in other countries it utilize even more widely: 70.5% in Norway, 75% in New Zealand and 93.5% in Sweden.

The total length of hospital stay (LOS) decreased dramatically from 19.6 in 2011 to 8.6 in 2022 at the Vreden Center. Nevertheless, there are still opportunities to improve it: by the way in Canada the average LOS for TKA is 2.3 and the USA — 0.8 and 1.7 for partial and total arthroplasty, respectively.

Conclusion. The main current trends of knee arthroplasty in Russia are the following: increase the number of surgeries, reduced LOS, TKA without patella resurfacing and with PCL retention, finally the growth of partial knee arthroplasties.

Keywords

knee / arthroplasty register / total knee replacemet / partial knee arthroplasty

References

[1] Malchau H., Garellick G., Berry D., Harris W.H., Robertson O., Kärrlholm J. et al. Arthroplasty implant registries over the past five decades: Development, current, and future impact. J Orthop Res. 2018; 36(9):2319-2330. doi: 10.1002/jor.24014.

[2] Чёрный А.Ж., Кувакин В.И., Воронцова Т.Н., Вебер Е.В. Курчиков А.Г. Система учета пациентов, нуждающихся в эндопротезировании тазобедренного и коленного суставов. Вестник Российской военно-медицинской академии. 2015;(4):176-182.

[3] Cherniy A.J., Kuvakin V.I., Vorontsova T.N., Veber E.V., Kurchikov A.G. Registration of patients with need of hip and knee arthroplasty. Bulletin of the Russian Military Medical Academy. 2015;(4):176-182. (In Russian).

[4] Синеокий А.Д., Билык С.С., Близнюков В.В., Ефимов Н.Н., Коваленко А.Н., Бадмаев А.О. Кросс-культурная адаптация и валидизация русскоязычной версии анкеты Oxford Knee Score для пациентов с гонартрозом, ожидающих выполнения первичного эндопротезирования. Современные проблемы науки и образования. 2017;(2). Режим доступа: https://science-education.ru/ru/article/view?id=26312. doi: 10.17513/spno.26312.

[5] Sineokiy A.D., Bilyk S.S., Bliznyukov V.V., Efimov N.N., Kovalenko A.N., Badmaev A.O. Oxford knee score: cross-cultural adaptation and validation of the russian version in patients with osteoarthritis of the knee. Modern Problems of Science and Education. 2017;(2). (In Russian). Available from: https://science-education.ru/article/view?id=26312. doi: 10.17513/spno.26312.

[6] Yang X., Bi P., Kuang S. Fighting obesity: When muscle meets fat. Adipocyte. 2014;3(4):280-289. doi: 10.4161/21623945.2014.964075.

[7] Himanen A.K., Belt E.A., Lehto M.U., Hämäläinen M.M. A comparison of survival of moulded monoblock and modular tibial components of 751 AGC total knee replacements in the treatment of rheumatoid arthritis. J Bone Joint Surg Br. 2007;89(5):609-614. doi: 10.1302/0301-620X.89B5.17950.

[8] Gudnason A., Hailer N.P., W-Dahl A., Sundberg M., Robertsson O. All-Polyethylene Versus Metal-Backed Tibial Components-An Analysis of 27,733 Cruciate-Retaining Total Knee Replacements from the Swedish Knee Arthroplasty Register. J Bone Joint Surg Am. 2014;96(12):994-999. doi: 10.2106/JBJS.M.00373.

[9] Kremers H.M., Sierra R.J., Schleck C.D., Berry D.J., Cabanela M.E., Hanssen A.D. et al. Comparative Survivorship of Different Tibial Designs in Primary Total Knee Arthroplasty. J Bone Joint Surg Am. 2014;96(14):e121. doi: 10.2106/JBJS.M.00820.

[10] Baldini A., Castellani L., Traverso F., Balatri A., Balato G., Franceschini V. The difficult primary total knee arthroplasty: a review. Bone Joint J. 2015;97-B(10 Suppl A):30-39. doi: 10.1302/0301-620X.97B10.36920.

[11] Australian Orthopaedic Association, National Joint Replacement Registry. Annual Report. 2022:172-281. Available from: https://aoanjrr.sahmri.com/documents/10180/732916/AOA+2022+AR+Digital/f63ed890-36d0-c4b3-2e0b-7b63e2071b16.

[12] The Swedish Arthroplasty Register. Annual Report. 2022:125-169. Available from: https://registercentrum.blob.core.windows.net/refdocs/10.18158/BklrLg8NOo.pdf

[13] National Joint Registry for England, Wales, Northern Ireland and Istle of Man. 19th Annual Report.2022: 133210. Available from: https://reports.njrcentre.org.uk/Portals/0/PDFdownloads/NJR%2019th%20Annual%20Report%202022.pdf.

[14] Norwegian National Advisory unit on Arthroplasty and Hip Fractures. Annual Report. 2021:71-214. Available from: www.researchgate.net/publication/356998659_Annual_report_2021_Norwegian_National_Advisory_Unit_on_Arthroplasty_and_Hip_Fractures_Norwegian_Arthroplasty_Register_Norwegian_Cruciate_Ligament_Register_Norwegian_Hip_Fracture_Register_Norwegian_Pae. doi: 10.13140/RG.2.2.34266.26566.

[15] The New Zealand Joint Registry Twenty-two Year Report January 1999 to December 2020. Annual Report. 2021:78-120. Available from: www.nzoa.org.nz/sites/default/files/NZJR_22_Year_Report_Final.pdf.

[16] Swiss National Joint Registry, SIRIS Report 2021. Annual Report. 2021:100-147. Available from: https://www.swiss-medtech.ch/sites/default/files/2021-12/211130_SIRIS-Report%202021_online.pdf

[17] Canadian Institute for Health Information, Canadian Joint Replacement Registry. Annual Report. 2022:1-98. Available from: https://www.cihi.ca/sites/default/files/document/hip-knee-replacements-in-canada-cjrr-annual-report-2020-2021-en.pdf.

[18] 8th AJRR Annual Report. on Hip and Knee Arthroplasty Data. Annual Report. 2021:64-97. Available from: https://www.aaos.org/registries/publications/ajrr-annual-report/

[19] Рязанцев С.В., Архангельский В.Н., Воробьева О.Д., Гневашева В.И., Доброхлеб В.Г., Иванова А.Е. и др. Демографическое развитие России: тенденции, прогнозы, меры. Национальный демографический доклад. Москва: Объединенная редакция; 2020. 156 с. doi: 10.25629/HC.2020.13.01.

[20] Ryazantsev S.V., Arkhangel’skii V.N., Vorob’eva O.D., Gnevasheva V.I., Dobrokhleb V.G., Ivanova A.E. et al. Demographic development of Russia: trends, forecasts, measures. National Demographic Report. Moscow: United Edition LLC; 2020. 156 p. (In Russian). doi: 10.25629/HC.2020.13.01.

[21] Parvizi J., Gehrke T., Chen A.F. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J. 2013;95-B(11):1450-1452. doi: 10.1302/0301-620X.95B11.33135.

[22] Hussey D.K., Madanat R., Donahue G.S., Rolfson O., Bragdon C.R., Muratoglu O.K. et al. Scoring the Current Risk Stratification Guidelines in Follow-up Evaluation of Patients After Metal-on-Metal Hip Arthroplasty: A Proposal for a Metal-on-Metal Risk Score Supporting Clinical Decision-Making. J Bone Joint Surg Am. 2016;98(22):1905-1912. doi: 10.2106/JBJS.15.00685.

[23] Marculescu C.E., Berbari E.F., Hanssen A.D., Steckelberg J.M., Osmon D.R. Prosthetic joint infection diagnosed postoperatively by intraoperative culture. Clin Orthop Relat Res. 2005;439:38-42. doi: 10.1097/01.blo.0000183091.83509.d8.

[24] Trampuz A., Piper K.E., Jacobson M.J., Hanssen A.D., Unni K.K., Osmon D.R. et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357(7):654-663. doi: 10.1056/NEJMoa061588.

[25] Howard J.L., Kudera J., Lewallen D.G., Hanssen A.D. Early results of the use of tantalum femoral cones for revision total knee arthroplasty. J Bone Joint Surg Am. 2011;93(5):478-84. doi: 10.2106/JBJS.I.01322.

[26] Meneghini R.M., Ford K.S., McCollough C.H., Hanssen A.D., Lewallen D.G. Bone remodeling around porous metal cementless acetabular components. J Arthroplasty. 2010;25(5):741-747. doi: 10.1016/j.arth.2009.04.025.

[27] Meneghini R.M., Lewallen D.G., Hanssen A.D. Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. Surgical technique. J Bone Joint Surg Am. 2009;91 Suppl 2 Pt 1:131-138. doi: 10.2106/JBJS.H.01061.

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