Aims

This study aimed to describe preoperative waiting times for surgery in hip fracture patients in Norway, and analyze factors affecting waiting time and potential negative consequences of prolonged waiting time.

Aims

The aim of this study was to describe variation in hip fracture treatment in Norway expressed as adherence to international and national evidence-based treatment guidelines, to study factors influencing deviation from guidelines, and to analyze consequences of non-adherence.

There is an ongoing discussion on what bearing surfaces to use in different age groups of total hip replacement patients.

We report results from uncemented total hip arthroplasty using ceramic on ceramic bearings reported to the Norwegian Arthroplasty Register in the period 1997–2014.

Kaplan Meier and Cox regression analysis adjusting for age, gender and diagnosis was used to assess prosthesis survival at 10 and 15 years after primary operation and to report relative risk of revision. Endpoint was any revision. Comparison with the cemented Charnley prosthesis (n=17180), with metal-on-polyethylene articulations from the same time period was done. Results in age groups <55, 55–64, 65–74, >=75 were investigated.

The following femur/cup combinations were used; Filler/Igloo (n=2590), Corail/Pinnacle (n=783), Corail/Duraloc (n=467), SCP Unique/Trilogy (n=363), Polar/R3 (n=253), ABGII/ABGII (n=131), other combinations (n=339). Alumina bearing was used in 3807 hips and Alumina-Zirconium composite bearings in 1119 hips. The overall ten and fifteen years unadjusted Kaplan Meier survivals were 94.8 % and 92.0 % respectively with no statistically significant difference between the brands. The cemented Charnley hip arthroplasty had 93.6 % survival at 15 years, and was not statistically significant different from the uncemented ceramic/ceramic group. The 10 years survival in the age groups <55, 55–64, 65–74, >=75 for the uncemented ceramic/ceramic group was 93.7%, 95.3%, 96.0% and 95.4% respectively with no difference between the uncemented brands and the cemented Charnley prosthesis. We found less revisions in patients >=75 in the Charnley group. In the ceramic on ceramic group 11 head fractures and 3 liner fractures were reported.

The 15 years result of uncemented hip replacement with ceramic on ceramic bearing was good, and not different from the Charnley cemented arthroplasty in the age groups <75 years.

Background: In the Norwegian Arthroplasty Register several uncemented femoral stems have proved good or excellent survivorship. The overall results of uncemented total hip arthroplasty however, have been disappointing due to inferior results of the metal backed acetabular cups. In this study we investigated the medium-term performance of primary uncemented metal backed acetabular cups exclusively.

Methods: 9 113 primary uncemented acetabular cups in 7 937 patients operated in the period 1987–2007 were included in a prospective, population-based observational study. All were modular, metal-backed uncemented cups with ultra-high molecular weight polyethylene liners and femoral heads made of steel, cobalt chrome, or Alumina ceramics. Thus 7 different cup designs were evaluated with the Kaplan-Meier method and Cox regression analyses.

Results: Most cups performed well up to 7 years. When the end-point was cup revision due to aseptic cup loosening, the cups had a survival of 87 to 100% at 10 years. However, when the end-point was cup revision of any reason, the survival estimates were 81 to 92% for the same cups at 10 years. Aseptic loosening, wear, osteolysis and dislocation were the main reasons for the relatively poor overall performance of the metal backed cups in this study. Prostheses with Alumina heads performed slightly better than those with steel- or cobalt chrome in sub-groups.

Conclusions: Whereas most cups performed well at 7 years, the survivorship declined with longer follow-up time. Fixation was generally good. None of the metal-backed uncemented acetabular cups with UHMWPE liners investigated in the present study had satisfactory long-term results due to high rates of wear, osteolysis, aseptic loosening and dislocation. Hopefully cross-linked liner inserts will improve long term outcome in the future.

Introduction: In an earlier publication we analysed short-term results of total hip arthroplasty (THA) with Ceramic-on-Ceramic (C-on-C) articulations, and we found that they did not perform better than the Charnley prosthesis with a metal-on-UHMWPE articulation.

Purpose: To examine mid-term results of THA with Con-C articulations, and to compare their results with the most commonly used cemented prosthesis in our register, the Charnley.

Materials and Methods: All THAs with C-on-C articulations were uncemented and they constituted 2506 THAs.

194 of the THAs had articulations with an Alumina liner and a femoral head made of a composite of Alumina and Zirconium oxide ceramic (Biolox delta). This group had a median follow-up of only 1.1 years, and the group was therefore not included in the survival analyses.

2312 of the THAs were uncemented prostheses with Alumina-on-Alumina articulations, with a follow-up of 0–11 years (median 4.3 years). For further analyses we included only patients under the age of 80 years (n = 2209).

We compared the two most common C-on-C cup/stem combinations: Igloo/Filler (n=1402) and Trilogy/SCP (n=363), and a group of others (n= 547). Further we compared the C-on-C prostheses with cemented Charnley prostheses in patients under the age of 80 years, operated during the same time-period. We also compared the C-on-C prostheses with Charnley prostheses in a group limited to patients under the age of 60 years. Prosthesis survival was estimated by Kaplan-Meier and Cox regression analyses adjusted for age and gender.

Results: In patients under the age of 80 years the Charnley prostheses had a statistically significant higher survival than the C-on-C prostheses at 7 years (97.1% and 95.7% respectively, p=0.04). In patients under 60 years of age these analyses gave similar results, although with no statistical significant difference between Charmley and the C-on-C prostheses (p=0.06). There was no statistically significant difference in revision risk among Igloo/Filler, Trilogy/SCP, and a group of all other combinations of cup/stem with a C-on-C articulation. The most common causes for revision of the C-on-C hips were dislocation (n=18) and deep infection (n=16). 3 were revised due to a broken liner and 4 due to a broken head. Of the 194 articulations with Alumina liner and Biolox delta head, one had been revised due to fractured head.

Conclusion: With a follow up of 0–11 years, we did not find superior results of the C-on-C prostheses compared to the Charnley prosthesis. Few revisions were clearly related to failure of the articulations.

Background: About 60% of all cancer patients survive at least 5 years, and therefore have a risk to develop long-term effects after cancer treatment. Most research, the later years, on long-term effects after cancer treatment, has focused on cardiovascular side effects and side effects in the pelvic region. On the other hand, hardly any focus has been on possible side effects on the musclo-skeletal system, though there are multiple reasons that surviving cancer patients may develop such problems.

Aim: To determine whether cancer patients have an increased risk for receiving a total hip replacement compared to the population of Norway. Analyses are based on a linkage between The Cancer Register of Norway and The Norwegian Arthroplasty Register.

Materials and Methods: By linking these two registers we have connected all cancer diagnosis, all total hip arthroplasties and information about time of death for each patient. Data refers to 741,901 patients, divided into three groups; 652,197 patients with at least one cancer diagnose but none hip arthroplasties. 72,469 patients with at least one hip arthroplasty but no cancer diagnose. The last group of 17,235 patients have at least one cancer diagnose and at least one hip arthroplasty. From the last group 8,629 patients received a cancer diagnoses first and a total hip arthroplasty second. Statistical methods in this study were the Kaplan-Meier method, Cox regression and Standardized Incidence Ratio (SIR).

Results: Cancer patients had a slight increased risk to receive a total hip arthroplasty compared to the Norwegian population (SIR=1.13 (95% CI, 1.10–1.15)). For cancer located proximal to the pelvic area there were no significant increase in risk for hip arthroplasty, except for breast cancer (SIR=1.12 (95% CI 1.07–1.17)). Cancer located to the pelvic area (SIR=1.18 (95% CI 1.14–1.22)), lymphoma (SIR=1.29 (95% CI 1.14–1.45)) and leukaemia (SIR=1.16 (95% CI 1.17–1.31)) had an increased risk for receiving a total hip arthroplasty.

Conclusion: We found a small increase in risk for receiving total hip arthroplasty after cancer diagnose. Treatment type may affect these results. Radiation dose to the pelvic area may affect the bone structure and increase the need of arthroplasty. Future studies on effect of radiation doses and risk of receiving hip arthroplasty are planed.

Starting in the 1970s, long-term survivorship of total hip and knee arthroplasty has been under investigation for the Scandinavian population with the aid of implants registries. In the United States, no national arthroplasty registry currently exists. Nationwide inpatient discharge databases in the United States have proven useful when comparing the revision burden in the United States and Scandinavia. For this study, we compared the implant survivorship in the Medicare population with contemporaneous registry-based data from well-established and validated Scandinavian arthroplasty registries. The 5% systematic sample of Medicare claims from 1997 to 2004 were examined for primary and revision THA and TKA claims. The Medicare beneficiary ID was used to follow patients longitudinally between primary and revision surgery. De-identified data from the Norwegian and Swedish national hip and knee registry were also obtained for the same time period. During the 8-year study period, 30,583 and 62,878 elective primary total hip or knee replacements, respectively, were extracted from the Medicare data. In the same time period, 41,823 and 15,927 primary total hips or knees replacements were identified from the Norwegian registry. 82,037 primary total hips were identified from the Swedish registry. Survivorship was assessed by the Kaplan-Meier method, and Cox regression was used to evaluate the effect of patient attributes and cross-country comparisons. The K-M estimate showed that 8 years post-primary surgery, 93.6% of THA and 96.2% of TKA remained revision-free among the elderly Medicare population. By comparison, among Norwegians aged 65 and above, 96.0% of THA and 93.6% of TKA remained revision-free. In the US, men had a significantly higher risk of knee revision than women, but no significant gender difference among hip revision. In Norway, men had a significantly higher risk of hip revision, but no differences in knee revisions. In Sweden, men had a significantly higher risk of hip revision (5.4% vs. 3.3%). Older patients had a reduced risk of revision as compared with younger patients, in both the US and in Norway. The survival of THA is significantly better in Norway than in the US with a hazard ratio of 1.64 (p< 0.05). On the other hand, TKA had a better survival experience in the US than in Norway, with a hazard ratio of 0.55 (p< 0.05). This is the first study to evaluate the utility of Medicare as a source of THA and TKA survivorship data and to compare prosthesis outcomes in Medicare with those from Scandinavian arthroplasty registries. Unlike the Norwegian and Swedish registry data, the reasons for revision (e.g., femoral loosening) are not captured and thus greatly limited the value of the Medicare data as a tool to understand the need for revision, thereby helping to improve implant longevity and to reduce the associated cost and burden to the patient and care provider.

There has been no general agreement about the use of uncemented hip prostheses in patients with rheumatoid arthritis (RA). In the present study we compared the results for the cemented and uncemented stem that most commonly had been used in RA patients in the Norwegian Arthroplasty Register.

MATERIAL AND Methods: All hospitals in the country participate and report their primary and revision operations of RA patients to the register. This group constitutes 3.5% of the patients in the register. For the present study we included primary prosthesis operations in RA patients during 1987–2005, where either the Corail or the Charnley stem, the most commonly used uncemented and cemented stems, had been used. We calculated survival by the Kaplan-Meier method and by Cox multiple regression with adjustment for age and gender.

Results: The 10 years survival of the total hip prostheses were 81 % in the uncemented group and 89 % in the cemented group. However, the revisions of the uncemented prostheses were mainly performed due to cup problems. With revision of stem for any reason as end-point, the 10-year survival was 98% for the fully HA-coated uncemented Corail stem and 91% for the cemented Charnley stem. In the Cox regression, the risk for revision of the Charnley stem was 3.4 times increased compared to the Corail (95% CI: 1.43–8.06. P< 0.006). Also revision due to aseptic stem loosening was statistically significant increased for the Charnley stem, whereas there was no significant difference concerning revision due to dislocation or periprosthetic fracture.

Conclusions: Both stems had a 10-years survival better than 90%, and the uncemented stem had excellent results in RA patients. However, the uncemented total hip prostheses had inferior results compared to the cemented total hip prostheses due to problems with the uncemented cups that had been used in association with this uncemented stem.