Background: Due to reported high rates of complications in Total Disc Replacement Swiss health care system demanded an obligatory national Health Technology Assessment-registry for Total Disc Replacement. Thus, SWISSspine was founded in 2003 to assess efficiency, cost effectiveness, safety and find predictors of co-morbidity for surgical outcome.

Study design and Methods: In an observational multi center mode data were collected from March 2005 to August 2008 with detailed frequency statistics. Preoperative assessment, 3 month and 1 year FU using EQ-5D, NASS-Instrument and co-morbidity-forms for patients were applied. The surgeons administered OR- and FU-forms. Statistics: multivariate regression analysis.

Patient sample: 427 interventions with 497 implants.

Results: A significant reduction of back pain: 71 to 31 (p< 0.001) and leg pain 54.7 to 20.7 (p< 0.001) was documented (VAS, 1year postop). Quality of life measured in EQ-5D increased from 0.32 to 0.73. Opiate-usage decreased from 31.7% to 7.7%. Increasing ROM and re-established lordosis were seen. Overall 19 complications occurred, 12 revisions were performed. It was revealed that medicamentous treated depression had a negative influence on the outcome.

Conclusions: SWISSspine as a mandatory instrument was successfully implemented in the treatment-program of degenerative lumbar disc-diseases. The results provide evidence for patients benefit. Back- as well as leg pain was reduced. Complication- and revision rates were low. Medicamentous treated depression seems to have a negative influence on postoperative pain outcome in TDR. Our results obtained from SWISSspine provide a reasonable potential supporting surgeon in decision making for TDR especially in patients with medicamen-tous treated depression.

Purpose: To assess patients quality of life, pain, and functional limitations with with endstage ankle arthritis (EAA) and compared this to a similar cohort of patients with endstage hip arthritis (EHA).

Methods: Preoperative data (Short Form SF36) was collected prospectively from patients (n=130) with end stage ankle arthritis and compared to a similar cohort of patients (n=130) with end stage hip arthritis. Patients with ankle arthritis were registered in the Canadian Orthopedic Foot and Ankle Society (COFAS) multi-center study investigating the clinical outcome of ankle arthroplasty and fusion and patients with hip arthritis were randomly selected from the Halifax Joint Replacement Registry Database.

Results: All symptom and functional SF36 subscales for patients with EAA or EHA, were approximately two standard deviations below normal population scores. All differences between ankle and hip SF36 subscales scores were less than 4 points (40% of STD) in both direct and adjusted comparisons. A direct comparison of SF36 scores revealed that patients with EAA had significantly worse mental health according to the SF36 Mental Component Summary Score (MCS) (p= 0.0059), physical limitations with work and daily activities - role physical score (p= < 0.0001), and general health (p= 0.0004). Patients with EHA reported poorer physical function (p= 0.0007) although the Physical Component Summary Score (PCS) for the SF36 was not significant (p= 0.0510). Total Summary SF36, Physical Component Summary (PCS), bodily pain, vitality, role-emotional, social functioning, and mental health subscales were all not significantly different between cohorts (p> 0.05).

Conclusions: Patients with EAA have devastating losses of quality of life, which are comparable to patients with EHA. These findings suggest that increased resources should be directed towards alleviating the severe pain and disability associated with ankle arthritis.