The importance of registries has been brought into focus by recent UK national reports focusing on implant (Cumberlege) and surgeon (Paterson) performance.
Since the introduction of the first
The purpose of this study was to validate the diagnosis of periprosthetic
joint infection (PJI) in the Danish Hip Arthroplasty Register (DHR). We identified a cohort of patients from the DHR who had undergone
primary total hip arthroplasty (THA) since 1 January 2005 and followed
them until first-time revision, death, emigration or until 31 December
2012. Revision for PJI, as registered in the DHR, was validated against
a benchmark which included information from microbiology databases,
prescription registers, clinical biochemistry registers and clinical
records. We estimated the sensitivity, specificity, positive predictive
value (PPV) and negative predictive value (NPV) for PJI in the DHR
alone and in the DHR when combined with microbiology databases.Aims
Patients and Methods
Aims. We aimed to assess the cumulative risk of total hip arthroplasty (THA) from in situ fixation for slipped capital femoral epiphysis (SCFE) after a follow-up of almost 50 years. Methods. In this study, 138 patients with 172 affected hips treated with in situ fixation were evaluated retrospectively. A total of 97 patients (70%) were male and the mean age was 13.6 years (SD 2.1); 35 patients (25%) had a bilateral disease. The median follow-up time was 49 years (interquartile range 43 to 55). Basic demographic, stability, and surgical details were obtained from patient records. Preoperative radiographs (slip angle; SA) were measured, and data on THA was gathered from the Finnish
Aims. The current evidence comparing the two most common approaches for reverse total shoulder arthroplasty (rTSA), the deltopectoral and anterosuperior approach, is limited. This study aims to compare the rate of loosening, instability, and implant survival between the two approaches for rTSA using data from the Dutch
This article considers some of the problems of the interpretation of information from other
We identified 1305 femoral impaction bone grafting revisions using the Exeter stem performed between 1989 and 2002 in 30 hospitals throughout Sweden. There were 1188 patients with a mean age of 71 years (29 to 94) followed up for between five and 18 years. The participating departments reported 70 further revisions in total, of which 57 could also be identified on the Swedish
We review the history and literature of hip resurfacing arthroplasty. Resurfacing and the science behind it continues to evolve. Recent results, particularly from the
Using a regional arthroplasty register, we assessed the outcome, at five years, of 1198 primary Charnley total hip replacements (THRs) undertaken across a single health region in England in 1990. An independent clinical and radiological assessment was completed for 497 operations, carried out in 18 different hospitals, under the care of 56 consultants and by differing grades of surgeon. The overall number of failures in this group was 44 (8.9%). We found that the risk of failure in patients operated on by a consultant whose firm carried out 60 or more THRs in 1990 was 25% of that of patients under the care of a consultant whose firm undertook less than 30, adjusting for a number of patient, surgeon and hospital characteristics (16% v 4%; p <
0.001 for linear trend). Our study shows that the early outcome of hip replacement surgery varies with the number of replacements undertaken by the consultant firm. A
The aim of this study was to estimate the 90-day periprosthetic joint infection (PJI) rates following total knee arthroplasty (TKA) and total hip arthroplasty (THA) for osteoarthritis (OA). This was a data linkage study using the New South Wales (NSW) Admitted Patient Data Collection (APDC) and the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), which collect data from all public and private hospitals in NSW, Australia. Patients who underwent a TKA or THA for OA between 1 January 2002 and 31 December 2017 were included. The main outcome measures were 90-day incidence rates of hospital readmission for: revision arthroplasty for PJI as recorded in the AOANJRR; conservative definition of PJI, defined by T84.5, the PJI diagnosis code in the APDC; and extended definition of PJI, defined by the presence of either T84.5, or combinations of diagnosis and procedure code groups derived from recursive binary partitioning in the APDC.Aims
Methods
The aim of this study was to estimate time to arthroplasty among patients with hip and knee osteoarthritis (OA), and to identify factors at enrolment to first-line intervention that are prognostic for progression to surgery. In this longitudinal register-based observational study, we identified 72,069 patients with hip and knee OA in the Better Management of Patients with Osteoarthritis Register (BOA), who were referred for first-line OA intervention, between May 2008 and December 2016. Patients were followed until the first primary arthroplasty surgery before 31 December 2016, stratified into a hip and a knee OA cohort. Data were analyzed with Kaplan-Meier and multivariable-adjusted Cox regression.Aims
Methods
Uncemented mobile bearing designs in medial unicompartmental knee arthroplasty (UKA) have seen an increase over the last decade. However, there are a lack of large-scale studies comparing survivorship of these specific designs to commonly used cemented mobile and fixed bearing designs. The aim of this study was to evaluate the survivorship of these designs. A total of 21,610 medial UKAs from 2007 to 2018 were selected from the Dutch Arthroplasty Register. Multivariate Cox regression analyses were used to compare uncemented mobile bearings with cemented mobile and fixed bearings. Adjustments were made for patient and surgical factors, with their interactions being considered. Reasons and type of revision in the first two years after surgery were assessed.Aims
Methods
The aim of this study was to use national registry database information to estimate cumulative rates and relative risk of revision due to infection after reverse shoulder arthroplasty. We included 17 730 primary shoulder arthroplasties recorded between 2004 and 2013 in The Nordic Arthroplasty Register Association (NARA) data set. With the Kaplan–Meier method, we illustrated the ten-year cumulative rates of revision due to infection and with the Cox regression model, we reported the hazard ratios as a measure of the relative risk of revision due to infection.Aims
Patients and Methods
The aim of this study was to give estimates of the incidence of component incompatibility in hip and knee arthroplasty and to test the effect of an online, real-time compatibility check. Intraoperative barcode registration of arthroplasty implants was introduced in Denmark in 2013. We developed a compatibility database and, from May 2017, real-time compatibility checking was implemented and became part of the registration. We defined four classes of component incompatibility: A-I, A-II, B-I, and B-II, depending on an assessment of the level of risk to the patient (A/B), and on whether incompatibility was knowingly accepted (I/II).Aims
Materials and Methods
Robotic-assisted unicompartmental knee arthroplasty (UKA) promises accurate implant placement with the potential of improved survival and functional outcomes. The aim of this study was to present the current evidence for robotic-assisted UKA and describe the outcome in terms of implant positioning, range of movement (ROM), function and survival, and the types of robot and implants that are currently used. A search of PubMed and Medline was performed in October 2018 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included “robotic”, “knee”, and “surgery”. The criteria for inclusion was any study describing the use of robotic UKA and reporting implant positioning, ROM, function, and survival for clinical, cadaveric, or dry bone studies.Aims
Materials and Methods
Femoral stems with exchangeable (modular) necks were introduced
to offer surgeons an increased choice when determining the version,
offset and length of the femoral neck during total hip arthroplasty
(THA). It was hoped that this would improve outcomes and reduce
complications, particularly dislocation. In 2010, the Australian Orthopaedic
Association National Joint Replacement Registry (AOANJRR) first
reported an increased rate of revision after primary THA using femoral
stems with an exchangeable neck. The aim of this study was to provide
a more comprehensive up-to-date analysis of primary THA using femoral
stems with exchangeable and fixed necks. The data included all primary THA procedures performed for osteoarthritis
(OA), reported to the AOANJRR between 01 September 1999 and 31 December
2014. There were 9289 femoral stems with an exchangeable neck and
253 165 femoral stems with a fixed neck. The characteristics of
the patients and prostheses including the bearing surface and stem/neck
metal combinations were examined using Cox proportional hazard ratios
(HRs) and Kaplan-Meier estimates of survivorship. Aims
Materials and Methods
This study evaluated the feasibility of using published data from more than one register to define the performance of different hip implants. In order to obtain estimates of performance for specific types of hip system from different register, we analysed data from the annual reports of five national and one Italian regional register. We extracted the number of implants and rates of implant survival at different periods of follow-up. Our aim was to assess whether estimates of cumulative survival rate were comparable with data from registers from different countries, and our conclusion was that such a comparison could only be performed incompletely.
Previous studies of failure mechanisms leading
to revision total knee replacement (TKR) performed between 1986 and
2000 determined that many failed early, with a disproportionate
amount accounted for by infection and implant-associated factors
including wear, loosening and instability. Since then, efforts have
been made to improve implant performance and instruct surgeons in
best practice. Recently our centre participated in a multi-centre evaluation
of 844 revision TKRs from 2010 to 2011. The purpose was to report
a detailed analysis of failure mechanisms over time and to see if
failure modes have changed over the past 10 to 15 years. Aseptic
loosening was the predominant mechanism of failure (31.2%), followed
by instability (18.7%), infection (16.2%), polyethylene wear (10.0%),
arthrofibrosis (6.9%) and malalignment (6.6%). The mean time to
failure was 5.9 years (ten days to 31 years), 35.3% of all revisions
occurred at less than two years, and 60.2% in the first five years.
With improvements in implant and polyethylene manufacture, polyethylene
wear is no longer a leading cause of failure. Early mechanisms of
failure are primarily technical errors. In addition to improving
implant longevity, industry and surgeons must work together to decrease
these technical errors. All reports on failure of TKR contain patients
with unexplained pain who not infrequently have unmet expectations.
Surgeons must work to achieve realistic patient expectations pre-operatively,
and therefore, improve patient satisfaction post-operatively. Cite this article: