Increased collection of patient-reported outcome measures (PROM) in registries enables international comparison of patient-centered outcomes after knee and hip replacement. We aimed to investigate 1) variations in PROM improvement, 2) the possible confounding factor of BMI, and 3) differences in comorbidity distributions between registries. Registries affiliated with the International Society of Arthroplasty Registries (ISAR) or OECD membership countries were invited to report aggregate EQ-5D, OKS, OHS, HOOS-PS and KOOS-PS values. Eligible patients underwent primary total, unilateral knee or hip replacement for osteoarthritis within three years and had completed PROMs preoperatively and either 6 or 12 months postoperatively, excluding patients with subsequent revisions. For each PROM cohort, Chi-square tests were performed for BMI distributions across registries and 12 predefined PROM strata (male/female, age 20-64/65-74/>75, high or low preoperative PROM scores). Comorbidity distributions were reported for available comorbidity indexes. Thirteen registries from 9 countries contributed data, n~130000 knee (range 140 to 79848) and n~113000 hip (range 137 to 85281). Mean EQ-5D index values (10 registries) ranged from 0.53 to 0.71 (knee) and 0.50 to 0.70 (hips) preoperatively and 0.78 to 0.85 (knee) and 0.83 to 0.87 (hip) postoperatively. Mean OKS (6 registries) ranged from 19.3 to 23.6 preoperatively and 36.2 to 41.2 postoperatively. Mean OHS (7 registries) ranged from 18.0 to 23.2 preoperatively and 39.8 to 44.2 postoperatively. Four registries reported KOOS-PS and three reported HOOS-PS. Proportions of patients with BMI >30 ranged from 35 to 62% (10 knee registries) and 16 to 43% (11 hip registries). For both knee and hip registries, distributions of patients across six BMI categories differed significantly among registries (p30 were for patients in the youngest age groups (20 to 64 and 65 to 74 years) with the lowest baseline scores. Additionally, females with lowest preoperative PROM scores had highest BMI. These findings were echoed for the OHS and OKS cohorts. Proportions of patients with ASA scores ≥3 ranged from 7 to 42% (9 knee registries) and 6 to 35% (8 hip registries). PROM-score improvement varies between international registries, which may be partially explained by differences in age, sex and preoperative scores. BMI and comorbidity may be relevant to adjust for

Aim. National Joint Replacement Registries, which are important sources for periprosthetic joint infection (PJI) data, report an average PJI incidence ranging from 0.5 to 2.0%. Unfortunately, national registries including the Dutch Arthroplasty Register (LROI), are not specifically designed to register PJI. In the Netherlands, the LROI is a nationwide population-based registry with an overall completeness of more than 95%. 3. To ensure usability and reliability of PJI data from the LROI, it is important to evaluate the quality and completeness of these data. From 2013 onwards, eight hospitals in the South-East of the Netherlands, collected their PJI data in a detailed regional infection cohort (RIC), specifically designed for this purpose. This study aimed to determine the accuracy and completeness of PJI registration (hip and knee arthroplasty) in the LROI, by comparing the LROI with the RIC. Method. All patients registered with an acute PJI in the RIC between 2014–2018 were selected for the study and were matched with the LROI. According to the Workgroup of American Musculoskeletal Infections Society (MSIS), an acute PJI was defined as at least two phenotypically identical pathogens, isolated in cultures from at least two separate tissues, obtained from the affected peri-prosthetic tissue during the DAIR treatment (debridement, antibiotics, irrigation, and retention). Only PJI occurring within 90 days after primary hip or knee arthroplasty were included. The LROI data and completeness was based on the entered procedures and documented reason for revision infection, which was not specially based on the MSIS criteria. After checks on missing and incorrectly data, the completeness of registration in the LROI was calculated by comparing the number of registrations in the LROI with data from the RIC (gold standard). Results. Of the 639 primary total hip and knee arthroplasty with a suspected PJI registered in the RIC between 2014–2018, 352 cases met the definition of acute PJI. The overall incidence was 1%. When compared with the LROI, 164 of these cases were also registered in the LROI as PJI revision, resulting in a 53% underestimation of PJI for the LROI. Conclusions. LROI data on acute PJI shows a significant underestimation, which is comparable to scarce other literature sources. To ensure reliability and usability of national PJI data, a specifically part of the LROI has to be designed for registering PJI similar to the regional cohort

The Canadian Institute for Health Information (CIHI) and the Organisation for Economic Co-operation and Development (OECD) have partnered to advance international patient-reported outcome measures (PROMs) collection and reporting standards for hip and knee arthroplasty. This project is part of the OECD's Patient-Reported Indicator Survey (PaRIS) initiative, which aims to address the need for internationally comparable patient-reported outcome and experience measures in order to better monitor health system performance and drive continuous improvement. PROMs are in varying stages of implementation across OECD health systems, with differences in collection and reporting practices across existing programs. CIHI and the OECD are leading an international working group for PROMs in hip and knee replacement surgery in order to build consensus on PROMs data collection standards and develop indicators for international reporting. Working group members include patient representatives, clinicians, national arthroplasty registries, the International Society of Arthroplasty Registries (ISAR), experts in PROMs measurement, and government representatives of several OECD member countries. Activities of the working group focus on two main priorities: 1) Use existing PROMs programs to maximize pilot comparable reporting in OECD's Health at a Glance 2019 report, and 2) Advance new PROMs standards and data collection to maximize comparable reporting beyond Health at a Glance 2019. An environmental scan of PROMs in hip and knee arthroplasty found that a number of countries are collecting this data, however, there are variations in survey instruments as well as administration and reporting methods within and across countries. As part of priority 1, the working group has achieved consensus on a number of aspects around pilot reporting. The project is compiling data from existing PROMs programs in order to report results in the Health at a Glance 2019 publication. For priority 2, the most notable challenge is establishing an agreement across countries on common survey tools, as well as a minimum data set that works for all, given the disparities of existing collection across countries. Many international programs lack the flexibility to change PROMs tools or collections methods, and have concerns regarding the break in trend for PROMs data within their own countries if they were to change methods. The project is exploring the use of crosswalks and other opportunities for comparable reporting, such as the use of single-item anchor questions. To date, the working group continues to develop consensus on international standards for PROMs collection and reporting. Results of the international consensus building and work to date will be shared. PROMs incorporate the patient's perspective into the delivery of treatments and care – such as hip and knee arthroplasty – that aim to improve a patient's quality of life. Alignment of standards in PROMs collection across countries will make comparable data available for reporting, in order to inform quality improvement initiatives within health systems to provide better care for patients. CIHI and the OECD will continue to work with member countries to develop international data collection and reporting standards for PROMs, and encourage the adoption of common approaches across countries

The surgical treatment of young adults with end-stage hip disease has been a challenge. Inferior THA survival in the young, perceived advantages of hip resurfacing versus THA and advancements in tribology, led to the introduction of 3rd generation Metal-on-Metal-Hip-Resurfacing-Arthroplasty (MoMHRA). To-date, thousands of such prostheses have been implanted worldwide in younger patients, yet little is known regarding long-term outcome. The only studies reporting greater than 10 year outcome come from designer centres with survivorship varying between 88.5–96% at 12 years. Arthroplasty Registries (AR) have reported less favourable survivorships with female gender and size having a negative effect on survival. In our independent hip resurfacing centre in Ghent, Belgium, a single surgeon has implanted more than 3500 HRA over more than 12 years. A cohort of 149 patients who received a Birmingham Hip Resurfacing (BHR) at a mean age of 50 years at surgery have now reached a minimum 10 years follow-up. The overall 12-year survival in these young adults is 93.1% (95% CI: 88.3–98.0), 99% in males and 87.3% in females. These survivorship data are superior to registry reported figures of THA amongst young patients and correspond well with previous reports from designer centres. The long-term survivorship and clinical outcome of the BHR are excellent in men, uninfluenced by preoperative diagnosis or age. However, survivorship in women is inferior and usually related to increased wear and reactions to metal debris. Malpositioning of components with associated wear-induced soft tissue fluid collections is the most frequent factor leading to failure of a HRA. In our experience, mid-term outcome following revision is good and complication and re-revision rates can be low. Surgical experience, early intervention in cases of mal-positioned implants, clinical use of ion levels, implantation of larger ceramic-on-ceramic THA femoral heads and patient education are factors in improving outcome and reducing complication and re-revisions following HRA revision

Introduction. Hip resurfacing (HRA) designer centres have reported survivorships between 88.5–96% at 12 years. Arthroplasty Registries (AR) reported less favourable results especially in females gender and small sizes. The aim of this study was to evaluate the minimum 10-year survival and outcome of the Birmingham Hip Resurfacing (BHR) from an independent specialist centre. Methods. Since 1998, 1967 BHRs have been implanted in our centre by a single hip resurfacing specialist. The first 249 BHR, implanted between 1999 and 2001 in 232 patients (17 bilateral) were included in this study. The majority of the patients were male (163; 69%). The mean age at surgery was 50.6 years (range: 17–76), with primary OA as most common indication (201; 81%), followed by avascular necrosis (23; 9.2%) and hip dysplasia (11; 4.4%). Mean follow up was 10.2 years (range: 0.1 (revision) to 13.1). Implant survival was established with revision as the end point. Harris Hip Scores (HHS), radiographs and metal ion levels were assessed in all patients. Sub-analysis was performed by gender, diagnosis and femoral component size (Small: <50 mm; Large: ≥50 mm). Results. Of the 232 patients, 15 were deceased (4 bilateral BHR), 16 lost to follow-up and 9 revised. 205 BHR were evaluated at minimum 10 years postoperatively. Failure modes included 2 component malpositioning, 2 loose femoral heads, 1 fracture, 1 metal sensitivity, 2 impingement and 1 with high metal ions. The overall survival was 95.1% (95% CI: 93.6–96.6) at 12.8 years. The mean HHS was 97.8 (range: 65–100). Survivorship in men was 98.6% (95%CI: 97.4–99.8%) at 13 years. Survivorship in women was inferior to men (log rank = 0.003): 87.9% (95%CI: 84.3–91.5%) at 12 years. There was no difference in HHS between genders in the non-revised cases (p = 0.46). There was no difference in survivorship with different pre-operative diagnosis (log-rank = 0.83) but a significant difference in 12-year survivorship between Small (90.1%) and Large components (97.2%) (log rank = 0.01). After adjusting for head size, the difference in survival between males and females was no longer significant (log-rank = 0.125). The median ion levels were Cr:2.0μg/l; Co:1.0μg/l. In 24 patients the ion levels were undetectable. Four patients (1.9%) had ions above the upper acceptable limits of Cr:4.6μg/l;Co:4.0μg/l for unilateral or Cr:7.4μg/l;Co:5.0μg/l for bilateral HRA. In 67 patients with consecutive ion measurements, levels decreased significantly with time with a mean decrease of 0.97μg/l for Cr and 0.60μg/l for Co. Discussion. This study reports the more than 10-year survival of BHR and reflects an experienced specialist's practice, including his learning curve of the procedure. The overall 12.8-year survival was superior to registry reported figures of THA amongst young patients and corresponded well with reports from designer centres. Survivorship and clinical outcome were excellent in men. In women survivorship was significantly inferior and related to smaller component sizes, but the >10-year clinical outcome in non-revised cases was excellent. In well-functioning BHR, the metal ions decrease significantly with time. The results of this study support the use of HRA with a good design