Introducción
El propósito de este estudio es determinar si los pacientes con artrosis severa intervenidos con artroplastia de rodilla o cadera ponen en riesgo su expectativa de vida.

Método
Se diseñó un estudio de sobrevida el cual fue aprobado por el comité de ética de nuestra institución. Los pacientes fueron incluidos si fueron intervenidos de artroplastia de rodilla y cadera por artrosis severa y tenían más de 50 años. Los pacientes fueron excluidos si la artroplastia se realizó por fractura, hemofilia o un tumor. Una regresión multiparamétrica de Weibull fue estimada, siendo reportado el hazard ratio. Un bootstrap de 200 repeticiones fue realizada para validación interna.

Resultados
Un total de 4094 artroplastias fueron incluidos. La curva de Kaplan-Meier estima una mayor sobrevida que la población general hasta los 12 años, luego de lo cual la mediana de sobrevida es menor que la de la población general. La regresión multiparamétrica de Weibull estimó hazard ratios de 1,53 (intervalo de confianza 95%: 1,27 a 1,84) en mujeres, de 1,09 (1,08 a 1,10) por cada año de edad y de 1,29 (1,07 a 1,53) en artroplastia de cadera.

Conclusión
La mortalidad después de una intervención de artroplastia de rodilla o cadera sigue un comportamiento bimodal respecto a la población general similar a series reportadas en Estados Unidos y Suecia. Inicialmente la sobrevida es mayor que la población general, pero es menor luego de 12 a 15 años.

Authors: Maximiliano Barahona[1], Cristian Barrientos[1,2], Álvaro Martinez[2], Julián Brañes[1,2], Juan Pablo Prieto[1], Jaime Hinzpeter[1]

Affiliation:
[1] Departamento de Ortopedia y Traumatología en Hospital Clínico Universidad de Chile, Santiago, Chile
[2] Departamento de Ortopedia y Traumatología en Hospital San José, Santiago, Chile

E-mail: maxbarahonavasquez@gmail.com

Author address:
[1] Santos Dumont 999, 3rd Floor, office 351
Postal code 8380456, Independencia, Santiago, Chile

Citation: Barahona M, Barrientos C, Martinez A, Brañes J, Prieto JP, Hinzpeter J. Mortality after hip or knee arthroplasty for osteoarthritis in Chile: A survival analysis. Medwave 2020;20(11):e8088 doi: 10.5867/medwave.2020.11.8088

Submission date: 11/7/2020

Acceptance date: 3/11/2020

Publication date: 17/12/2020

Origin: Not commissioned

Type of review: Externally peer-reviewed by three reviewers, double-blind

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1. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019 Apr 27;393(10182):1745-1759. | CrossRef | PubMed |
2. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007 Oct 27;370(9597):1508-19. | CrossRef | PubMed |
3. Price AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A, et al. Knee replacement. Lancet. 2018 Nov 3;392(10158):1672-1682. | CrossRef | PubMed |
4. Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019 Feb 16;393(10172):647-654. | CrossRef | PubMed |
5. Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019 Feb 16;393(10172):655-663. | CrossRef | PubMed |
6. Bilal U, Alazraqui M, Caiaffa WT, Lopez-Olmedo N, Martinez-Folgar K, Miranda JJ, et al. Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis. Lancet Planet Health. 2019 Dec;3(12):e503-e510. | CrossRef | PubMed |
7. Maradit Kremers H, Larson DR, Noureldin M, Schleck CD, Jiranek WA, Berry DJ. Long-Term Mortality Trends After Total Hip and Knee Arthroplasties: A Population-Based Study. J Arthroplasty. 2016 Jun;31(6):1163-1169. | CrossRef | PubMed |
8. Robertsson O, Stefánsdóttir A, Lidgren L, Ranstam J. Increased long-term mortality in patients less than 55 years old who have undergone knee replacement for osteoarthritis: results from the Swedish Knee Arthroplasty Register. J Bone Joint Surg Br. 2007 May;89(5):599-603. | CrossRef | PubMed |
9. Pedersen AB, Baron JA, Overgaard S, Johnsen SP. Short- and long-term mortality following primary total hip replacement for osteoarthritis: a Danish nationwide epidemiological study. J Bone Joint Surg Br. 2011 Feb;93(2):172-7. | CrossRef | PubMed |
10. Villalon GC, Schneider SV, Ortega FC. Chile, tabla de vida por método de mortalidad óptima. Santiago, Chile: Instituto Nacional de Estadistica de Chile; 2016. [On line]. | Link |
11. Zimmer Z, Rubin S. Life Expectancy With and Without Pain in the U.S. Elderly Population. J Gerontol A Biol Sci Med Sci. 2016 Sep;71(9):1171-6. | CrossRef | PubMed |
12. Hall AJ, Stubbs B, Mamas MA, Myint PK, Smith TO. Association between osteoarthritis and cardiovascular disease: Systematic review and meta-analysis. Eur J Prev Cardiol. 2016 Jun;23(9):938-46. | CrossRef | PubMed |
13. Wang H, Bai J, He B, Hu X, Liu D. Osteoarthritis and the risk of cardiovascular disease: a meta-analysis of observational studies. Sci Rep. 2016 Dec 22;6:39672. | CrossRef | PubMed |
14. Barahona M, Martinez Á, Barrientos C, Cavada G, Brañes J, Palet M, et al. Survival Analysis after Hip Fracture in Chile in Patients Over 50 Years Old: A Comparative Analysis between a Private and a Public Health Center. SSRN Electron J. 2019. [On line]. | Link |
15. Weber M, Völlner F, Benditz A, Schwarz T, Wörner M, Craiovan B, et al. Kniegelenkersatz des älteren Menschen [Total knee arthroplasty in the elderly]. Orthopade. 2017 Jan;46(1):34-39. | CrossRef | PubMed |
16. Cnudde P, Rolfson O, Timperley AJ, Garland A, Kärrholm J, Garellick G, et al. Do Patients Live Longer After THA and Is the Relative Survival Diagnosis-specific? Clin Orthop Relat Res. 2018 Jun;476(6):1166-1175. | CrossRef | PubMed |
17. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty: Annual Report 2017. Adelaide: AOA; 2017. [On line]. | Link |
18. Karrholm J, Rogmark C, Nauclér E, Vinblad J, Mohaddes M, Rolfson O. Swedish Hip Arthroplasty Register: Annual Report 2018. 2018. [On line]. | Link |
19. National institute for health and Welfare. Finnish arthroplasty register. [On line]. | Link |
20. Aw D, Sahota O. Orthogeriatrics moving forward. Age Ageing. 2014 May;43(3):301-5. | CrossRef | PubMed |
21. Berend ME, Thong AE, Faris GW, Newbern G, Pierson JL, Ritter MA. Total joint arthroplasty in the extremely elderly: hip and knee arthroplasty after entering the 89th year of life. J Arthroplasty. 2003 Oct;18(7):817-21. | CrossRef | PubMed |
22. Fabre-Aubrespy M, Ollivier M, Pesenti S, Parratte S, Argenson JN. Unicompartmental Knee Arthroplasty in Patients Older Than 75 Results in Better Clinical Outcomes and Similar Survivorship Compared to Total Knee Arthroplasty. A Matched Controlled Study. J Arthroplasty. 2016 Dec;31(12):2668-2671. | CrossRef | PubMed |
23. Siman H, Kamath AF, Carrillo N, Harmsen WS, Pagnano MW, Sierra RJ. Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty for Medial Compartment Arthritis in Patients Older Than 75 Years: Comparable Reoperation, Revision, and Complication Rates. J Arthroplasty. 2017 Jun;32(6):1792-1797. | CrossRef | PubMed |

Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019 Apr 27;393(10182):1745-1759. | CrossRef | PubMed |

Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007 Oct 27;370(9597):1508-19. | CrossRef | PubMed |

Price AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A, et al. Knee replacement. Lancet. 2018 Nov 3;392(10158):1672-1682. | CrossRef | PubMed |

Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019 Feb 16;393(10172):647-654. | CrossRef | PubMed |

Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019 Feb 16;393(10172):655-663. | CrossRef | PubMed |

Bilal U, Alazraqui M, Caiaffa WT, Lopez-Olmedo N, Martinez-Folgar K, Miranda JJ, et al. Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis. Lancet Planet Health. 2019 Dec;3(12):e503-e510. | CrossRef | PubMed |

Maradit Kremers H, Larson DR, Noureldin M, Schleck CD, Jiranek WA, Berry DJ. Long-Term Mortality Trends After Total Hip and Knee Arthroplasties: A Population-Based Study. J Arthroplasty. 2016 Jun;31(6):1163-1169. | CrossRef | PubMed |

Robertsson O, Stefánsdóttir A, Lidgren L, Ranstam J. Increased long-term mortality in patients less than 55 years old who have undergone knee replacement for osteoarthritis: results from the Swedish Knee Arthroplasty Register. J Bone Joint Surg Br. 2007 May;89(5):599-603. | CrossRef | PubMed |

Pedersen AB, Baron JA, Overgaard S, Johnsen SP. Short- and long-term mortality following primary total hip replacement for osteoarthritis: a Danish nationwide epidemiological study. J Bone Joint Surg Br. 2011 Feb;93(2):172-7. | CrossRef | PubMed |

Villalon GC, Schneider SV, Ortega FC. Chile, tabla de vida por método de mortalidad óptima. Santiago, Chile: Instituto Nacional de Estadistica de Chile; 2016. [On line]. | Link |

Zimmer Z, Rubin S. Life Expectancy With and Without Pain in the U.S. Elderly Population. J Gerontol A Biol Sci Med Sci. 2016 Sep;71(9):1171-6. | CrossRef | PubMed |

Hall AJ, Stubbs B, Mamas MA, Myint PK, Smith TO. Association between osteoarthritis and cardiovascular disease: Systematic review and meta-analysis. Eur J Prev Cardiol. 2016 Jun;23(9):938-46. | CrossRef | PubMed |

Wang H, Bai J, He B, Hu X, Liu D. Osteoarthritis and the risk of cardiovascular disease: a meta-analysis of observational studies. Sci Rep. 2016 Dec 22;6:39672. | CrossRef | PubMed |

Barahona M, Martinez Á, Barrientos C, Cavada G, Brañes J, Palet M, et al. Survival Analysis after Hip Fracture in Chile in Patients Over 50 Years Old: A Comparative Analysis between a Private and a Public Health Center. SSRN Electron J. 2019. [On line]. | Link |

Weber M, Völlner F, Benditz A, Schwarz T, Wörner M, Craiovan B, et al. Kniegelenkersatz des älteren Menschen [Total knee arthroplasty in the elderly]. Orthopade. 2017 Jan;46(1):34-39. | CrossRef | PubMed |

Cnudde P, Rolfson O, Timperley AJ, Garland A, Kärrholm J, Garellick G, et al. Do Patients Live Longer After THA and Is the Relative Survival Diagnosis-specific? Clin Orthop Relat Res. 2018 Jun;476(6):1166-1175. | CrossRef | PubMed |

Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty: Annual Report 2017. Adelaide: AOA; 2017. [On line]. | Link |

Karrholm J, Rogmark C, Nauclér E, Vinblad J, Mohaddes M, Rolfson O. Swedish Hip Arthroplasty Register: Annual Report 2018. 2018. [On line]. | Link |

National institute for health and Welfare. Finnish arthroplasty register. [On line]. | Link |

Aw D, Sahota O. Orthogeriatrics moving forward. Age Ageing. 2014 May;43(3):301-5. | CrossRef | PubMed |

Berend ME, Thong AE, Faris GW, Newbern G, Pierson JL, Ritter MA. Total joint arthroplasty in the extremely elderly: hip and knee arthroplasty after entering the 89th year of life. J Arthroplasty. 2003 Oct;18(7):817-21. | CrossRef | PubMed |

Fabre-Aubrespy M, Ollivier M, Pesenti S, Parratte S, Argenson JN. Unicompartmental Knee Arthroplasty in Patients Older Than 75 Results in Better Clinical Outcomes and Similar Survivorship Compared to Total Knee Arthroplasty. A Matched Controlled Study. J Arthroplasty. 2016 Dec;31(12):2668-2671. | CrossRef | PubMed |

Siman H, Kamath AF, Carrillo N, Harmsen WS, Pagnano MW, Sierra RJ. Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty for Medial Compartment Arthritis in Patients Older Than 75 Years: Comparable Reoperation, Revision, and Complication Rates. J Arthroplasty. 2017 Jun;32(6):1792-1797. | CrossRef | PubMed |