JOA - 2026-06-25 - Journal Article
Temporal Trends in Revision Burden Ratio for Hip and Knee Arthroplasty: A Comparative Analysis of Large National Registries.
de Geofroy B, Argenson JN, Sculco PK, Gonzalez JF, Lustig S, Micicoi G
Topics
Key Takeaway
The knee-to-hip revision burden ratio increased significantly across three of four national registries at 3.63 percentage points per year (R²=0.876), driven by declining hip RBR and rising knee RBR, with infection now the predominant TKA failure mechanism.
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Summary
This registry-based study analyzed temporal trends in revision burden ratios (RBR) for THA and TKA using publicly available annual reports from four national registries over approximately one decade. Hip RBR declined (β = -0.165, P=0.006) while knee RBR increased (β = 0.207, P<0.001), producing a significant rise in the knee-to-hip RBR (β = 3.63 pp/year, R²=0.876, P<0.001). Aseptic loosening declined as a revision cause while infection and periprosthetic fracture increased, particularly after TKA, with the US registry showing no significant temporal trend.
Key Limitation
Aggregate registry data without patient-level variables prevents determination of whether the rising infection RBR reflects true incidence increases, improved diagnostic ascertainment, or shifts in the underlying patient risk profile over time.
Original Abstract
BACKGROUND
The proportion of revision surgeries among all arthroplasties performed annually suggests a higher revision burden for total knee arthroplasty (TKA) than for total hip arthroplasty (THA). This study analyzed temporal trends in the knee-to-hip (K/H) revision burden ratio (RBR) over the past decade; evaluated hip and knee RBRs separately; compared trends across four national arthroplasty registries; and assessed changes in revision causes for THA and TKA over time.
METHODS
A retrospective, registry-based observational study was conducted using publicly available annual reports from four national arthroplasty registries in the United Kingdom (UK), Australia, the United States, and Sweden. Annual numbers of primary and revision THA and TKA procedures were extracted. Hip and knee Revision Burden Ratios (RBR) and Knee to Hip Revision Burden Ratios (K/H RBR) were calculated annually. Temporal trends were assessed using linear regression, and revision causes common to all registries were analyzed for the 2018 to 2023 period.
RESULTS
Across registries, primary arthroplasty volumes increased substantially, with knee procedures exceeding hip procedures. Globally, the K/H RBR increased significantly (β = 3.63 percentage points/year, R 2 = 0.876, P < 0.001), driven by a decrease in hip RBR (β = -0.165, P = 0.006) and an increase in knee RBR (β = 0.207, P < 0.001). Similar trends were observed in the UK, Australia, and Sweden, whereas no significant temporal change was identified in the United States. The proportion of revisions due to aseptic loosening declined significantly, whereas infection and periprosthetic fractures increased over time, particularly after TKA.
CONCLUSION
Revision burden is progressively shifting from hip to knee arthroplasty, driven by declining aseptic loosening and a concomitant rise in infection-related revisions, particularly after TKA, where infection is becoming the predominant failure mechanism. These findings have major implications for clinical practice and highlight the need for infection-focused prevention and treatment strategies.