1. “EPIDEMIOLOGY OF REVISION ARTHROPLASTY ” SINGLE CENTRE STUDY Gp Capt V Kulshrestha, Col B Datta Lt Col Gaurav Mittal, Wg Cdr Santhosh Kumar Joint Replacement Centre, Army Hospital R & R Gp Capt V Kulshrestha, Col B Datta Lt Col Gaurav Mittal, Wg Cdr Santhosh Kumar Joint Replacement Centre, Army Hospital R & R

2. ARMY HOSPITAL R & R

3. Introduction  Arthroplasty – ‘Most successful surgical procedure’  Large numbers performed in our country since 2000  Exponential increase expected in near future  Rise in revisions and its socioeconomic burden  Western literature looks at the causes and volume  No Indian literature exists  Arthroplasty – ‘Most successful surgical procedure’  Large numbers performed in our country since 2000  Exponential increase expected in near future  Rise in revisions and its socioeconomic burden  Western literature looks at the causes and volume  No Indian literature exists

4. Introduction  Difference in practice from the west  Patient profile  Quality of Arthroplasty facility  Availability of modern designs  Select few government sponsored centres are co-located with tertiary care centres are offering affordable revision arthroplasty facility  AHRR is one such exclusive Joint Replacement Facility  Difference in practice from the west  Patient profile  Quality of Arthroplasty facility  Availability of modern designs  Select few government sponsored centres are co-located with tertiary care centres are offering affordable revision arthroplasty facility  AHRR is one such exclusive Joint Replacement Facility

5. Methodology  We have a ‘Joint Registry’ since 1997  We are now digitizing to allow data mining  After institutional Review Board approval  We looked at our institutional prospective Revision database started in Oct 2012 and also took out the patient records of 2011-12.  At our institution,  Data on revision cases - collected prospectively by a research fellow  With the assistance of the primary surgeon, the research fellow completes questionnaires related to the cause of failure and nature of intraoperative findings.  We have a ‘Joint Registry’ since 1997  We are now digitizing to allow data mining  After institutional Review Board approval  We looked at our institutional prospective Revision database started in Oct 2012 and also took out the patient records of 2011-12.  At our institution,  Data on revision cases - collected prospectively by a research fellow  With the assistance of the primary surgeon, the research fellow completes questionnaires related to the cause of failure and nature of intraoperative findings.

6. Methodology  We reviewed all patient records specifically looking at  Cause of revision in first time failures  Time to first failure  Patient profile (Age/ BMI/ Comorbidity / ASA)  We reviewed all patient records specifically looking at  Cause of revision in first time failures  Time to first failure  Patient profile (Age/ BMI/ Comorbidity / ASA)

7. Revision Arthroplasty : ‘Hip & Knee’ Total Arthroplasty: 4872

8. Revision Arthroplasty : Patients

9. Revision Total knee replacement

10. Revision TKR : Annual trend 2011- 2015 Total TKR : 4033

11. Revision TKR : 2011-2015 Trend PrimaryRevision% 2011393308 2012530367 2013747456 2014989808 201512331048 295

12. Revision TKR : Time to failure

13. Revision TKR : Causes

14. Revision TKR : Aseptic revisions Patients% Infection9971% Loosening1511% Instability139% Periprosthetic fracture54% Patella issues32% Quadriceps disruption21% Stiff knee43% UKA21% Metalosis11%

15. Aseptic Causes : Temporal profile earlymid termlate Infected592119 Loosening175 Instability634 Periprosthetic fracture400 Patella issues300 Quadriceps disruption020 Stiff knee400 Metalosis001

16. Revision TKR : Patient Profile ‘Age’ Age Distribution

17. Revision TKR : Patient Profile ‘FCI’ FCI

18. Revision TKR : Patient Profile ‘ASA’ ASA

19. Revision TKR : Patient Profile ‘BMI’ BMI

20. Revision Total Hip Replacement

21. Revision THR : Annual trend 2011- 2015 Total TKR : 4033

22. Revision THR : 2011-2015 Trend Primary procedure Revision procedure % 2011964446 20121142623 20131255040 20141457350 20151964824 241

23. Revision THR : Time to failure

24. Revision THR : Causes

25. Patients% Infected7856% Loosening4431% Implant failure (Broken stem)64% Implant failure (cup migration)64% Instability1410% Periprosthetic fracture139%

26. Revision THR Causes : Temporal profile CauseEarlyMidLate Infected232533 Loosening19815 Implant failure (Broken stem)221 Implant failure (cup migration)501 Instability1202 Periprosthetic fracture454

27. Revision THR : Patient Profile ‘Age’ Age Distribution

28. Revision THR : Patient Profile ‘FCI’ FCI

29. Revision THR : Patient Profile ‘ASA’ ASA

30. Revision THR : Patient Profile ‘BMI’ BMI

31. Revision volumes are increasing as predicted world over Unlike the west Infection remains the predominant cause Aseptic loosening and instability are second to infection Revision TKR is more common in 50 -70 age gp Hip revision workload is significantly more due to large volume of cemented and uncemented bipolars performed using poor quality implants Revision volumes are increasing as predicted world over Unlike the west Infection remains the predominant cause Aseptic loosening and instability are second to infection Revision TKR is more common in 50 -70 age gp Hip revision workload is significantly more due to large volume of cemented and uncemented bipolars performed using poor quality implants Conclusion