ArticleThe Lancet. Rheumatology2021
How long do revised and multiply revised knee replacements last? An analysis of the National Joint Registry.
Article in The Lancet. Rheumatology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 23 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Low confidence in the cumulative evidence for the existence of a volume-outcome relationship after revision total knee replacement: A systematic review and meta-analysis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Pooled it
- Patient-relevant outcomes following elective, aseptic revision knee arthroplasty: a systematic review.Systematic reviews · 2023Pooled it
- Clinical effectiveness of patellar resurfacing, no resurfacing and selective resurfacing in primary total knee replacement: systematic review and meta-analysis of interventional and observational evidence.BMC musculoskeletal disorders · 2022Pooled it
- Metal-backed patella: a reasonable alternative in a bone-preserving approach in revision TKA.Musculoskeletal surgery · 2026Article
- High early complication risk but low risk of re-revision beyond 5 years following revision knee arthroplasty in the elderly: An analysis of 2833 cases using real-world data from an international database.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- High failure rates and poor quality of life after modular non-fusion knee arthrodesis following failed total knee arthroplasty: a multicenter retrospective study of 85 patients.Arthroplasty (London, England) · 2026Article
- Natural Biomaterials for Osteochondral Repair: From Source to Strategy.Advanced healthcare materials · 2026Review
- Similar incidence and implant survival of multiply revised knee arthroplasties in Norway and Denmark: a register study of the Danish and Norwegian Knee Arthroplasty registries from 1998-2021.Acta orthopaedica · 2026Observational
- Longitudinal association of frailty levels with knee osteoarthritis in middle-aged and elderly chinese: a longitudinal cohort study.Scientific reports · 2026Article
- Article
- Higher hospital volume reduces early failure rates in single-stage revision TKR for infection: An analysis of the United Kingdom National Joint Registry and National Administrative Databases.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Observational
- The downstream risk of multiple revisions following a prior TKA revision due to infection is higher compared to an aseptic TKA revision: A nationwide register study.Journal of experimental orthopaedics · 2025Article
- Biomimetic optimization of silicone breast implant integration: insights into wound healing and the foreign body response.Frontiers in bioengineering and biotechnology · 2025Review
- Mechanical and Physical Characterization of a Biphasic 3D Printed Silk-Infilled Scaffold for Osteochondral Tissue Engineering.ACS biomaterials science & engineering · 2024Article
- Validity evaluation of a rat model of monoiodoacetate-induced osteoarthritis with clinically effective drugs.BMC musculoskeletal disorders · 2024Article
- Recurrent patellar dislocation: personalised therapy or operative treatment? The REPPORT randomised trial protocol.BMJ open · 2024Article
- Incidence and survival of multiply revised knee arthroplasties in Denmark 1998-2021: a nationwide register-based study.Acta orthopaedica · 2024Observational
- Identification of ZNF652 as a Diagnostic and Therapeutic Target in Osteoarthritis Using Machine Learning.Journal of inflammation research · 2024Article
- How long do revised and multiply revised hip replacements last? A retrospective observational study of the National Joint Registry.The Lancet. Rheumatology · 2022Article
Corrections and comments
- Erratum issued
Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundKnee replacements are common and effective operations but patients that undergo this intervention are at risk of needing subsequent costly and often complex revision surgery with poorer outcomes than primary surgery. The treatment pathway over the life of the patient in terms of risk of revision and re-revision(s) is poorly described. We aim to provide detailed information on the longevity of revision surgery.
methodsThis was a retrospective observational registry-based study of the National Joint Registry. Kaplan-Meier estimates were used to determine the cumulative probability of revision and subsequent re-revision(s) following primary knee replacement. Analyses were stratified by age and gender and the influence of time from first to second revision on the risk of further revision was explored.
findingsThere were 33,292 revision knee replacements with a linked primary episode. Revision rates of revision knee replacements were higher in males and younger patients. 19·9% of revisions were revised again within 13 years, 20·7% of second revisions were revised again within 5 years and 20·7% of third revisions were revised again within 3 years. A shorter time between revision episodes was associated with earlier subsequent revision.
interpretationMales and younger patients are at higher risk of multiple revisions. Patients who undergo a revision have steadily increasing risk of further revision the more procedures they undergo, and each subsequent revision lasts for approximately half the time of the previous one.
fundingThis study was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston National Health Service Foundation Trust and the University of Bristol. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also supported by funding from Healthcare Quality Improvement Partnership and the National Joint Registry. Posts of authors of this work are part funded by a grant from the National Joint Registry to conduct statistical analysis for the National Joint Registry. AS was funded by a Medical Research Council Strategic Skills Fellowship MR/L01226X/1.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.