Comparing Alberta Hip and Knee Arthroplasty Revision Rates and Reasons for Revision to the Canadian Joint Replacement Registry (Cjrr)

Arthroplasty is one of the most common and successful surgical treatments for osteoarthritis of the hip and knee. As the volume of arthroplasty increases in the context of an aging population with greater life expectancy, the need for revision arthroplasty surgical care will continue to rise. The Alberta Bone and Joint Health Institute (ABJHI), established in 2004, is an independent not-for-profit organization dedicated to improving care for individuals with bone and joint health conditions in Alberta, Canada. ABJHI operates a comprehensive data repository under formal affiliation agreements with over 100 custodians of health data, including Alberta Health Services (AHS), orthopedic surgeons, and physicians of other specialties. Through comprehensive data sharing agreements, ABJHI captures all primary and revision hip and knee arthroplasty patient care data throughout Alberta. This paper will analyze the revision rates and reasons for revision of two commonly performed joint replacement surgeries within Alberta over a ten-year time horizon. Comparing provincial trends to national trends can help optimize surgical results by adjusting factors affecting success, benefiting the healthcare system through lower revision rates, reduced wait times, decreased costs, fewer emergency room visits, and improved patient experiences. How do revision rates and reasons for revision following primary hip and knee arthroplasties performed in Alberta compare to the rates published in the Canadian Joint Replacement Registry (CJRR) over a ten-year time horizon? This retrospective cohort study uses patient data from ABJHI and compares it with published data from the Canadian Joint Replacement Registry. For statistical analysis, a t-test was conducted to compare the total hip and knee revision rates across each year. A Pearson's chi-squared test was used to analyze the reasons for knee revision. For the reasons for hip revision, a Fisher's exact test was applied to the count data with a simulated p-value generated from 2,000 replicates, due to expected counts being less than five for some revision reasons. The analysis shows comparable revision total knee arthroplasty (TKA) rates between the two groups over a ten-year period. However, it reveals that Alberta experiences higher-than-anticipated early revision total hip arthroplasty (THA) rates within the first three years post-operatively compared to the Canadian CJRR data, with these rates stabilizing after the third year. While infection as a cause for revision in hip and knee arthroplasty is statistically significantly lower in the Alberta data, there is a higher-than-expected incidence of periprosthetic fractures following THA as a reason for revision. Additionally, there is a higher rate of TKA revision due to arthritis in an unresurfaced compartment and patellar maltracking. All differences were statistically significant. Figure 1: Figures compare total revision rates for hip and knee surgeries comparing Alberta and Canadian registry data. Alberta dataset for Total Knee Arthroplasty (TKA) spans from April 1, 2005- March 31, 2021. Total Hip Arthroplasty (THA) data covers April 1, 2009- March 31, 2021. Data for the Canadian dataset was captured from the 2021–2022 Canadian Joint Replacement Registry (CJRR) Report which encompassed Ontario, Manitoba and British Colombia data only. A t-test showed all values are statistically significant (p < 0 .05). This study provides a detailed comparison of hip and knee arthroplasty datasets from Alberta and Canada, offering important insights into regional outcomes. Quality improvement initiatives will be directed by these findings. For any figures or tables, please contact the authors directly.