Stem revision with retention of the old cement mantle (cement-in-cement revision) in cases with an intact cement/bone interface is an appealing option. There has been an increasing use of this technique. In 2014 this cement-in- cement technique was used in 10% of all stem revisions reported to the Swedish Hip Arthroplasty Register (SHAR). We analysed the outcome of cement-in-cement stem revisions reported to the SHAR during years 2001–2014 Since 2001 1292 cement-in-cement revisions (study group), performed with a short (≤150 mm) Exeter stem (n=973) or a Lubinus stem (n=319) were reported to the SHAR. Stem revisions, using short Exeter and Lubinus stems without the use of the cement-in-cement technique (n=2893) acted as the control group in this analysis. Both groups were comparable regarding primary diagnosis. In the study group there were more females and the mean age (73 years) was 2 year older (p<0.001). The primary outcome was re-revision due to all causes (n=413). Re-revision of the stem due to all causes, infections excluded (n=212) was used as secondary outcome. Survival analysis using Kaplan-Meier was performed.Introduction
Patients/Materials & Methods
Dislocation as a primary cause of revision has been on the increase in Sweden (14% in 2014). The increasing use of Dual Mobility cups (DMC) could well be explained by the increased revision burden due to dislocation, patients undergoing revision having increased comorbidities and reports that dual articular cup designs reduce the risk of dislocation. The aim of this study was to analyze the change in utilization pattern of the dual articular designs used in acetabular revision surgery in Sweden. The short-term survival of DMC was compared to traditional designs. During years 2004–2014, 1111 (925 cemented) revisions performed with a DMC design were reported to SHAR. About half (n=426) of these cases were first time revisions performed due to dislocation. During the same time period 520 dislocations were revised for dislocation using a standard cemented cup. There was no differences regarding the age, gender and primary diagnosis (p≥0.12) between the two groups. A second cup revision for all reasons and specifically for dislocation was used as end-point. Kaplan-Meier analysis was performed.Introduction
Patients/Materials & Methods
The effects of surgical approach in total hip
replacement on health-related quality of life and long-term pain
and satisfaction are unknown. From the Swedish Hip Arthroplasty
Register, we extracted data on all patients that had received a
total hip replacement for osteoarthritis through either the posterior
or the direct lateral approach, with complete pre- and one-year
post-operative Patient Reported Outcome Measures (PROMs). A total
of 42 233 patients met the inclusion criteria and of these 4962
also had complete six-year PROM data. The posterior approach resulted in
an increased mean satisfaction score of 15 ( Cite this article:
While an increasing amount of arthroplasty articles
report comorbidity measures, none have been validated for outcomes.
In this study, we compared commonly used International Classification
of Diseases-based comorbidity measures with re-operation rates after
total hip replacement (THR). Scores used included the Charlson,
the Royal College of Surgeons Charlson, and the Elixhauser comorbidity
score. We identified a nationwide cohort of 134 423 THRs from the
Swedish Hip Arthroplasty Register. Re-operations were registered
post-operatively for up to 12 years. The hazard ratio was estimated
by Cox’s proportional hazards regression, and we used C-statistics
to assess each measure’s ability to predict re-operation. Confounding
variables were age, gender, type of implant fixation, hospital category,
hospital implant volume and year of surgery. In the first two years only the Elixhauser score showed any significant
relationship with increased risk of re-operation, with increased
scores for both one to two and three or more comorbidities. However,
the predictive C-statistic in this period for the Elixhauser score
was poor (0.52). None of the measures proved to be of any value between
two and 12 years. They might be of value in large cohort or registry
studies, but not for the individual patient. Cite this article:
We present the development and results of a nationwide, prospective, observational follow-up programme including patient-reported outcome measures (PROMs) for the Swedish Hip Arthroplasty Register. The programme started in 2002 and has gradually expanded to include all units performing total hip replacement in Sweden. The self-administered PROMs protocol comprises the EQ-5D instrument, the Charnley class categorisation and visual analogue scales for pain and satisfaction. These current analyses include 34 960 total hip replacements with complete pre- and one-year post-operative questionnaires. Patients eligible for total hip replacement generally report low health-related quality of life and suffer from pain. One year post-operatively the mean EQ-5D index increased to above the level of an age- and gender-matched population, with a considerable reduction of pain (p <
0.001). Females, younger patients and those with Charnley category C reported a lower EQ-5D index pre-operatively than males, older patients and Charnley category A or B, respectively (all p <
0.001). In a multivariable regression analysis Charnley category C, male gender and higher age were associated with less improvement in health-related quality of life (p <
0.001). Nationwide implementation of a PROMs programme requires a structured organisation and effective data capture. Patients’ response rates to the Registry are good. The continuous collection of PROMs permits local and national improvement work and allows for further health-economic evaluation.
Between 1999 and 2005, 10 264 patients who had undergone total hip replacement (THR) for subcapital fracture of the hip were compared with 76 520 in whom THR had been performed for other reasons. All the cases were identified through the Swedish Hip Arthroplasty Register. The THRs performed as primary treatment for fracture were also compared with those done after failure of internal fixation. After seven years the rate of revision was higher in THR after fracture (4.4% vs 2.9%). Dislocation and periprosthetic fracture were the most common causes of revision. The risk was higher in men than in women. The type of femoral component and the surgical approach influenced the risk. After correction for gender, type of component and the surgical approach the revision rates were similar in the primary and secondary fracture THR groups. Total hip replacement is therefore a safe method for both the primary and secondary management of fracture of the hip.
We enrolled 98 patients (107 hips) with a mean age of 47 years (SD 8.6) into a prospective study of the Madreporic Lord THR; 34 hips had primary and 73 secondary osteoarthritis. After ten years, the survival rate using revision as the endpoint for failure was 70% (±9) for the cup and 98% (±0.3) for the stem. The combined clinical and radiological survival rates were 46% (±11) and 81% (±10), respectively. Osteoporosis due to stress-shielding was observed in the proximal femur. Hips with radiologically dense bone postoperatively showed the most pronounced bone loss. We recommend continued radiological follow-up of patients with this type of implant to allow revision to be performed before there is severe bony destruction of the pelvis.