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Type: Journal article
Title: Multi-state models and arthroplasty histories after unilateral total hip arthroplasties: Introducing the Summary Notation for Arthroplasty Histories
Author: Gillam, M.
Ryan, P.
Salter, A.
Graves, S.
Citation: Acta Orthopaedica, 2012; 83(3):220-226
Publisher: Taylor & Francis
Issue Date: 2012
ISSN: 1745-3674
Statement of
Marianne H Gillam, Philip Ryan, Amy Salter, Stephen E Graves
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.
Keywords: Humans
Osteoarthritis, Knee
Osteoarthritis, Hip
Arthroplasty, Replacement, Hip
Arthroplasty, Replacement, Knee
Second-Look Surgery
Epidemiologic Methods
Hip Prosthesis
Knee Prosthesis
Age Distribution
Sex Distribution
Aged, 80 and over
Middle Aged
Rights: Copyright status unknown
DOI: 10.3109/17453674.2012.684140
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