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Multi-state models and arthroplasty histories after unilateral total hip arthroplasties: introducing the Summary Notation for Arthroplasty Histories.

Gillam MH, Ryan P, Salter A, Graves SE - Acta Orthop (2012)

Bottom Line: An increasing number of patients have several joint replacement procedures during their lifetime.At the end of the study period, 12% of the 84,759 patients had received a second hip, 3 times as many as had received a knee.We found differences in the progression of joint replacement procedures after the initial total hip arthroplasty regarding type of joint, age, and sex.

View Article: PubMed Central - PubMed

Affiliation: School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia. marianne.gillam@adelaide.edu.au

ABSTRACT

Background and purpose: An increasing number of patients have several joint replacement procedures during their lifetime. We investigated the use and suitability of multi-state model techniques in providing a more comprehensive analysis and description of complex arthroplasty histories held in arthroplasty registries than are allowed for with traditional survival methods.

Patients and methods: We obtained data from the Australian Orthopaedic Association National Joint Replacement Registry on patients (n = 84,759) who had undergone a total hip arthroplasty for osteoarthritis in the period 2002-2008. We set up a multi-state model where patients were followed from their first recorded arthroplasty to several possible states: revision of first arthroplasty, either a hip or knee as second arthroplasty, revision of the second arthroplasty, and death. The Summary Notation for Arthroplasty Histories (SNAH) was developed in order to help to manage and analyze this type of data.

Results: At the end of the study period, 12% of the 84,759 patients had received a second hip, 3 times as many as had received a knee. The estimated probabilities of having received a second arthroplasty decreased with age. Males had a lower transition rate for receiving a second arthroplasty, but a higher mortality rate.

Interpretation: Multi-state models in combination with SNAH codes are well suited to the management and analysis of arthroplasty registry data on patients who experience multiple joint procedures over time. We found differences in the progression of joint replacement procedures after the initial total hip arthroplasty regarding type of joint, age, and sex.

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Related in: MedlinePlus

Example of the multi-state model with SNAH code on a subsample of patients who received a left hip prosthesis as first arthroplasty, followed by another primary arthroplasty or a revision of the left hip. (Number of events is shown in parentheses).
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Figure 2: Example of the multi-state model with SNAH code on a subsample of patients who received a left hip prosthesis as first arthroplasty, followed by another primary arthroplasty or a revision of the left hip. (Number of events is shown in parentheses).

Mentions: Figure 2 shows an example of the multi-state model with the SNAH code on a subsample of patients who received a left hip as first arthroplasty. (We arbitrarily chose to show the number of subsequent right-knee primary arthroplasties after the first hip, but one could instead have chosen left knees or both left and right knees). State 6, for example, consists of 20 patients with histories of HL10/HL21/KR30/ and 9 patients with HL10/KR20/HL31/.


Multi-state models and arthroplasty histories after unilateral total hip arthroplasties: introducing the Summary Notation for Arthroplasty Histories.

Gillam MH, Ryan P, Salter A, Graves SE - Acta Orthop (2012)

Example of the multi-state model with SNAH code on a subsample of patients who received a left hip prosthesis as first arthroplasty, followed by another primary arthroplasty or a revision of the left hip. (Number of events is shown in parentheses).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369145&req=5

Figure 2: Example of the multi-state model with SNAH code on a subsample of patients who received a left hip prosthesis as first arthroplasty, followed by another primary arthroplasty or a revision of the left hip. (Number of events is shown in parentheses).
Mentions: Figure 2 shows an example of the multi-state model with the SNAH code on a subsample of patients who received a left hip as first arthroplasty. (We arbitrarily chose to show the number of subsequent right-knee primary arthroplasties after the first hip, but one could instead have chosen left knees or both left and right knees). State 6, for example, consists of 20 patients with histories of HL10/HL21/KR30/ and 9 patients with HL10/KR20/HL31/.

Bottom Line: An increasing number of patients have several joint replacement procedures during their lifetime.At the end of the study period, 12% of the 84,759 patients had received a second hip, 3 times as many as had received a knee.We found differences in the progression of joint replacement procedures after the initial total hip arthroplasty regarding type of joint, age, and sex.

View Article: PubMed Central - PubMed

Affiliation: School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia. marianne.gillam@adelaide.edu.au

ABSTRACT

Background and purpose: An increasing number of patients have several joint replacement procedures during their lifetime. We investigated the use and suitability of multi-state model techniques in providing a more comprehensive analysis and description of complex arthroplasty histories held in arthroplasty registries than are allowed for with traditional survival methods.

Patients and methods: We obtained data from the Australian Orthopaedic Association National Joint Replacement Registry on patients (n = 84,759) who had undergone a total hip arthroplasty for osteoarthritis in the period 2002-2008. We set up a multi-state model where patients were followed from their first recorded arthroplasty to several possible states: revision of first arthroplasty, either a hip or knee as second arthroplasty, revision of the second arthroplasty, and death. The Summary Notation for Arthroplasty Histories (SNAH) was developed in order to help to manage and analyze this type of data.

Results: At the end of the study period, 12% of the 84,759 patients had received a second hip, 3 times as many as had received a knee. The estimated probabilities of having received a second arthroplasty decreased with age. Males had a lower transition rate for receiving a second arthroplasty, but a higher mortality rate.

Interpretation: Multi-state models in combination with SNAH codes are well suited to the management and analysis of arthroplasty registry data on patients who experience multiple joint procedures over time. We found differences in the progression of joint replacement procedures after the initial total hip arthroplasty regarding type of joint, age, and sex.

Show MeSH
Related in: MedlinePlus