Hip fracture is a common cause of hospital admission and is often followed by reduced quality of life, or by death. International experiences indicate there are many benefits to be gained from national hip fracture registries. This pilot project aims to implement a hip fracture registry at three sites, a large metropolitan public hospital (Flinders Medical Centre), a large metropolitan private hospital (Epworth HealthCare) and a rural regional hospital (Goulburn Valley Health) to assess the feasibility of establishing a national registry.

Patients undergoing surgery for a hip fracture will be recruited from the three participating hospitals between March and September 2009. A minimum data set will be collected at discharge, from hospital records. Items include patient demographics, fracture descriptors, length of stay, residential status, mobility, health status, surgical details and discharge destination. A phone interview at four months after surgery will measure outcomes by using the Extended Glasgow Outcomes Scale and documenting residential status, mobility, hip pain and readmissions. Re- operations, if any, will be collected. The availability of data from State Health Departments for validation of hospital case data will be reported.

The pilot study is in progress at the time of writing. Ethical approval has been obtained, data collection, transmission and storage systems have been developed and deployed, and case data collection is underway. Case data will be summarised to describe hip fracture at the participating hospitals. Analysis will review the data elements in the pilot data set and assess their priority for inclusion in a national register—taking account of the quality of the data obtained and the time and other resources required for their collection. We will also evaluate the four-month review process. Any potential obstacles to a national registry that are identified during the pilot will be described and ways to overcome them will be proposed.

A national hip fracture registry will improve the quality of care and safety of patients following hip fracture by developing an efficient mechanism to compare and improve the effectiveness of acute health care delivery by all hospitals involved in the management of hip fractures.

Introduction and aims: The extent of primary total hip and knee replacement revisions in the first 2 weeks following surgery is unknown. This study reports the incidence and reasons for revision of primary total hip and knee replacements within that period.

Method: Data was obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR). The AOA NJRR began data collection in September 1999, becoming national during 2002. This is an analysis of patients whose conventional primary total hip and/or primary total knee replacement and subsequent revision are recorded by the AOA NJRR with a procedure date on or before the 31st December 2006. Patient demographics, method of fixation used in the primary procedure as well as reasons for revision, and type of revision (major or minor) were analysed.

Results: The analysis involved 104,234 conventional primary THR and 134,799 primary TKR. There were 286 revisions (0.27%) of primary THRs and 102 revisions (0.076%) of primary TKRs in the first 2 weeks following surgery. The risk of revision was significantly higher for THR than TKR (P< 0.0001).

Dislocation (44.1%) was the main reason for revision of primary THR in the first 2 weeks after surgery followed by fracture (26.8%) and loosening (16%). The main reason for revision of primary TKR was infection (39%) followed by loosening (18%) and fracture (8.6%).

Most revisions of primary THRs in the first 2 weeks were major (66.4%). When only one major component was revised it was mainly the femoral stem (32.9% of all revisions). Almost all of these were cementless (94.7%). When a revision of a primary TKR occurred the majority were minor (69.6%) (p< 0.001). The insert (64.7% of all revisions) was the main component revised.

Risk factors associated with primary THR revision include a diagnosis of developmental dysplasia (P=0.030) and cementless procedures had a significantly higher risk of revision than either cemented (P< 0.0001) or hybrid (P< 0.0001) procedures. We did not identify any risk factors associated with primary TKR in the first 2 weeks following surgery.

Conclusions: The number of revisions of primary THR and TKR within the first 2 weeks of surgery remains small with approximately 1.6 per 1,000 procedures revised. The risk of revision was significantly greater for THR than TKR. Surgical technique was the main reason for revision of primary THR and infection for primary TKR.

Current evidence suggests that in Australia more than 80% of individuals are not receiving treatment for osteoporosis following an initial osteoporotic fracture. The earliest opportunity to identify many individuals with osteoporosis is following their first osteoporotic fracture, which is usually less severe than subsequent fractures. As these fractures are usually treated by orthopaedic surgeons it was decided to survey Australian orthopaedic surgeons to determine their understanding, attitudes and involvement in the management of osteoporosis.

Methods: The AOA in conjunction with the BJD distributed a questionnaire to 945 members. The results of 449 (48%) returned questionnaires were collated and sent to the Swedish National Competence Centre for Musculo-skeletal Disorders for analysis.

Results: Responding surgeons claimed to treat at least 24,000 osteoporotic fractures per year. Sixty per cent felt they had ‘none’ or ‘insufficient’ training in osteoporosis and considered they had ‘no’ or only ‘slight knowledge’ in managing the condition. Approximately 65% of surgeons either ‘never’ or only ‘sometimes’ initiated investigation or treatment of patients with osteoporotic fractures; only 11% ‘always’ or ‘very often’ initiated investigation or treatment. If an osteoporotic fracture is suspected most (70%) refer to a GP or osteoporosis specialist, with only 22% evaluating the condition themselves. Although 46% claimed that they referred patients for a BMD study always or most of the time, only 14% did so routinely. Fifty percent felt it was the GP’s responsibility to identify and initiate the evaluation of the underlying osteoporosis of patients with fragility fractures, compared with 29% who considered that this was the orthopaedic surgeon’s responsibility.

Eighty five per cent of the respondents do not prescribe any pharmacological treatment for osteoporosis management. Most commonly (36%) there was a preference for surgery rather than drug prescription. Twenty four percent had access to a specific osteoporosis team for treating osteoporosis. No experience with treating osteoporosis (23%) and no formal education in osteoporosis (16%) were other common reasons. Very few orthopaedic surgeons felt it was their responsibility to treat osteoporosis, however 52% were interested in attending a course on osteoporosis.

The findings are contrasted with those of an international study conducted by the Bone and Joint Decade and the International Osteoporosis Foundation, using the same questionnaire.

Conclusions: The evidence of under- treatment of osteoporosis after first fragility fractures, suggests that it may be necessary for orthopaedic surgeons to re-evaluate their approach to the management of osteoporosis, either by themselves or others. Further educational opportunities in this area should be considered.

Introduction: THR and TKR have been shown to be successful treatments for moderate to severe osteoarthritis of the hip and knee. The requirement for total joint replacement will increase as the population ages. This study reports on the incidence of THR and TKR in an Australian population.

Method: Age and gender specific numbers of THR and TKR for the Australian population, 1994–1998 were obtained from the Australian Institute of Health and Welfare. The same data for South Australia, 1988–1998 were obtained from the Department of Human Services Epidemiology Branch. The incidences were calculated and tested for changes over time.

Results: For the Australian population in 1994 there were 9,120 THR and by 1998 this had increased by 25.9% to 11,488 THR. There were 10,132 TKR in 1994 and by 1998 this had increased by 42.8% to 14,472 TKR. Stratified by age group changes in incidence rate with respect to time was statistically tested using regression analysis. For the eleven year data from South Australia there was a significant increase in the overall incidence of THR (p=0.012). There were significant increases in TKR incidence, although this increase was not uniform across all age groups (p< 0.001). The increase in TKR incidence was greater than that for THR. For both THR and TKR there were no significant differences on the basis of gender.

Conclusion: The incidence of THR is increasing in Australia and TKR incidence is increasing at a greater rate. Future projections must take into account these changing incidences as well as changes in population demographics.