Aims

Both anatomical and reverse total shoulder arthroplasty (aTSA and rTSA) provide functional improvements. A reported benefit of aTSA is better range of motion (ROM). However, it is not clear which procedure provides better outcomes in patients with limited foward elevation (FE). The aim of this study was to compare the outcome of aTSA and rTSA in patients with glenohumeral osteoarthritis (OA), an intact rotator cuff, and limited FE.

This is a retrospective review of the results of the Acclaim total elbow replacement in 11 older patients aged ≥ 65 years with primary osteoarthritis of the elbow, with a mean follow-up of 57.6 months (30 to 86.4). Significant reductions in pain and improvement in range of movement and function were recorded. Radiological review revealed two patients with 1 mm lucencies in a single zone, and one patient with 1 mm lucencies in two zones. No components required revision. There were no deep infections, dislocations or mechanical failures. Complications included one intra-operative medial condylar fracture and one post-operative transient ulnar neuropathy, which resolved. This study demonstrates that the Acclaim prosthesis provides good symptomatic relief and improvement of function in patients with primary osteoarthritis, with low rates of loosening or other complications. This prosthesis can therefore be considered for patients aged ≥ 65 years with primary osteoarthritis of the elbow

1. The venographic findings in clinical primary osteoarthritis are described. 2. Experimental venous engorgement, of the knee joint and of healing fibular fractures, results in accelerated bone formation and disturbed cartilage formation. 3. Changes in pH, ppCO. 2. , and PPO. 2. are indicated as the chemical means by which chondrogenesis and osteogenesis can be altered. 4. It is suggested that chronic venous stress in joints is a causal factor in primary osteoarthritis

1. The clinical and radiological results of seventy-one osteotomies for primary osteoarthritis of the hip performed with internal fixation have been examined two to eight years after operation. Advanced cases where osteotomy would have been purely a salvage procedure were excluded. 2. The hips were divided into two groups: one in a relatively early and the other in a later intermediate stage of the disease. The two criteria for inclusion in the "early" group were a) fiexion movement of 90 degrees or more, either with the patient conscious or completely relaxed under anaesthesia, and b) no collapse of bone seen in the radiograph. 3. The clinical results show that early osteotomy seldom fails to give relief of pain, which is closely correlated with improved function and a favourable assessment of the operation by the patient. A good range of flexion, not less than 70 degrees and frequently 90 degrees, is retained when the criteria mentioned above obtain. 4. The radiological assessment was based upon examination of the joint space, the cystic appearances and the degree of collapse of bone, if any, as seen in serial films. There was convincing evidence of regression indicating arrest of the arthritic process in 70 per cent of the "early" cases. 5. Regression after osteotomy appears to be a well-defined process which is more commonly observed and more complete when the osteotomy is performed sooner rather than at a later stage of the disease. With few exceptions a good radiological result is associated with a good clinical result. 6. Some of the possible causes of failure are discussed. Osteotomy is more likely to fail if delayed till stiffness is severe and collapse of bone has begun. Large cysts, rapid advance of the disease, and a valgus osteotomy in the presence of lateral subluxation may also prejudice the results. 7. This review offers good support for Nissen's suggestion that in primary osteoarthritis of the hip osteotomy should be performed early, while the joint is still mobile and capable of repair, in order to retain good function. 8. Relief from pain is not the only consideration in deciding when to operate; the prospects of arresting the disease and of stimulating a healing reaction in the disordered cancellous bone and articular cartilage by early osteotomy should always be kept in mind. 9. In many respects the findings of this review are complementary to those of Postel and Vaillant (1962) who reported excellent results from varus osteotomy of Pauwels' type in a series of cases of subluxation of the hip with pain but without frank secondary osteoarthritic change

During the 11-year-period from 1970 to 1980, 799 total hip arthroplasties with metal-on-plastic prostheses were performed for primary osteoarthritis. In all cases high viscosity cement was used, but not under pressure; acetabular cartilage was removed, but the femoral canal was not plugged. The rate of revision and risk factors were evaluated by survivorship analysis. The overall cumulative revision rates were 11%, 14% and 19% after 8, 10, and 14 years respectively. When prophylactic antibiotics were not used, there was a significant risk of revision for infection. The risk of revision for mechanical loosening of both the acetabular and femoral components was significantly increased for men, younger patients, and if a snap-fit prosthesis with a 35 mm head and short wedged stem was used. The survivorship findings were validated by multivariate statistical analysis

Introduction. Fracture around the knee can lead to posttraumatic osteoarthritis (PTOA) of the knee. Malunion, malalignment, intra-articular osseous defects, retained internal fixation devices, and compromised soft tissues may affect the outcome of total knee replacement (TKR). On average, the posttraumatic patient subsets were 10.4 years younger than those for primary knee OA. Recently, there were several studies reporting the outcome of THA for posttraumatic OA hip. However, no current literature defines the comparative functional outcome between PTOA and primary OA knee. The purpose of our study was to compare the midterm outcomes of patients undergoing TKR following periarticular knee fractures/ligamentous injuries versus primary osteoarthritis (PO) of the knee. Materials and methods. Retrospective chart reviews of patients underwent TKR between 2008 and 2013 were identified. 136 patients underwent open reduction and internal fixation with plate and screws or ligament reconstruction while 716 patients were primary OA. Mean follow up time was comparable in both groups. Demographic data, medical comorbidities, WOMAC, visual analogue scale, and complications were recorded. Results. There were significantly different in age (56.5 vs 63.8 years, p<0.0001), gender (48.5% vs 63.1% of female, p=0.0014), and obese (62.3% vs 76.0%, p=0.025) between PTOA and PO groups, respectively. The PO group had higher comorbidities than PTOA group including anticoagulant usage (51% vs 30.9%, p=0.0002), number of disease ≥ 4 (69.6% vs 45.3%, p<0.0001), ASA class ≥3 (38.8% vs 21.6%, p<0.0001), and Charlson Comorbidity Index (3.6 vs 2.8, p<0.0001). The PTOA group had longer operative time (110.9 vs 100.1 minutes, p<0.0001) than PO group. Preoperatively anatomical axis of the knee was approximately valgus in PTOA but varus alignment in PO group (p<0.0001). However, postoperatively anatomical and mechanical axis was comparable in both groups. Postoperative VAS (1.8 vs 1.2, p=0.002) at 1 year follow up and pain component of WOMAC (77.8 vs 85.7, p=0.013) in PTOA group was worse than PO group, respectively. On the contrary, there was no difference in postoperative complication and readmission rate between groups. Conclusion. Total knee replacement for Post-traumatic OA was associated with poorer functional outcome compared to those for primary osteoarthritis in midterm follow up

Introduction and Objective. Evidence in literature is contradicting regarding outcomes of total knee arthroplasty (TKA) in post-traumatic osteoarthritis (PTOA) and whether they are inferior to TKA in primary osteoarthritis (OA). The aim of this review was to find out if any difference exists in the results of TKA between the two indications. Materials and Methods. The electronic databases MEDLINE, EMBASE, The Cochrane Collaboration, and PubMed were searched and screened in duplicate for relevant studies. The selected studies were further subjected to quality assessment using the modified Coleman method. The primary outcome measure was patient reported outcome, and secondary outcome measures were infection, revision, stiffness, and patella tendon rupture. Results. A total of 18 studies involved 1129 patients with a mean age of 60.6 years (range 45.7–69) and follow up of 6.3 years. The time interval from index injury to TKA was 9.1 years. Knee Society Score (KSS) in PTOA reported in 12/18 studies showed functional improvement from 42.5 to 70 post-TKA exceeding minimally clinically important difference. In TKA for primary OA vs PTOA, deep peri-prosthetic joint infection (PJI) was reported in 1.9% vs 5.4% of patients, whilst revision of prosthesis at an average of 6 years post-operatively was performed in 2.6 vs 9.7% of patients. Conclusions. TKA is a successful treatment option for PTOA. However, the risk of significant complications like PJI and implant failure requiring revision is higher than primary OA cases. Patients should be counselled about those risks. Further well-designed comparative cohort-matched studies are needed to compare outcomes between the two populations

We compared inflammation in the knee after total knee replacement (TKR) for primary osteoarthritis between two groups of patients undergoing joint replacement with and without synovectomy. A total of 67 patients who underwent unilateral TKR were randomly divided into group I, TKR without synovectomy, and group II, TKR with synovectomy. Clinical outcomes, serial serum inflammatory markers (including interleukin-6 (IL-6), CRP and ESR) and the difference in temperature of the skin of the knee, compared with the contralateral side, were sequentially evaluated until 26 weeks after surgery. Pre-operatively, there were no statistically different clinical parameters between groups I and II. At the 26-week follow-up, both groups had a similarly significantly improved American Knee Society clinical score (p < 0.001) and functional score (p < 0.001) with no differences between the groups. Similar changes in serial inflammatory markers were found in both groups, including mean peak levels of IL-6 (189 pg/ml (. sd. 53.4) versus 201 pg/ml (. sd. 49.4) for groups I and II, respectively) and CRP (91 mg/L (. sd. 24.1) versus 88 mg/L (. sd. 23.4), respectively) on the first post-operative day, returning to pre-operative values at two and six weeks, respectively. The mean peak level of ESR for the respective two groups was 46 mm/hr versus 48 mm/hr at two weeks, which had still not returned to its pre-operative mean value at 26 weeks. The elevation in the skin temperature appeared to mirror the peak elevation of the ESR, with a range of 2.5° C to 4.5° C with some reduction at 26 weeks but still exceeding the pre-operative value. We concluded that synovectomy at the time of TKR does not provide any benefit to the clinical outcome or shorten the duration of the inflammatory response after surgery

Aims. The aim of this study was to evaluate the clinical and radiological outcome of using an anatomical short-stem shoulder prosthesis to treat primary osteoarthritis of the glenohumeral joint. Patients and Methods. A total of 66 patients (67 shoulders) with a mean age of 76 years (63 to 92) were available for clinical and radiological follow-up at two different timepoints (T1, mean 2.6 years, . sd. 0.5; T2, mean 5.3 years,. sd. 0.7). Postoperative radiographs were analyzed for stem angle, cortical contact, and filling ratio of the stem. Follow-up radiographs were analyzed for timing and location of bone adaptation (cortical bone narrowing, osteopenia, spot welds, and condensation lines). The bone adaptation was classified as low (between zero and three features of bone remodelling around the humeral stem) or high (four or more features). Results. The mean Constant score improved significantly from 28.5 (. sd. 11.6) preoperatively to 75.5 (. sd. 8.5) at T1 (p < 0.001) and remained stable over time (T2: 76.6, . sd. 10.2). No stem loosening was seen. High bone adaptation was present in 42% of shoulders at T1, with a slight decrease to 37% at T2. Cortical bone narrowing and osteopenia in the region of the calcar decreased from 76% to 66% between T1 and T2. Patients with high bone adaptation had a significantly higher mean filling ratio of the stem at the metaphysis (0.60, . sd. 0.05 vs 0.55, . sd. 0.06; p = 0.003) and at the diaphysis (0.65 . sd. 0.05 vs 0.60 . sd. 0.05; p = 0.007). Cortical contact of the stem was also associated with high bone adaptation (14/25 shoulders, p = 0.001). The clinical outcome was not influenced by the radiological changes. Conclusion. Total shoulder arthroplasty using a short-stem humeral component resulted in good clinical outcomes with no evidence of loosening. However, approximately 40% of the shoulders developed substantial bone loss in the proximal humerus at between four and seven years of follow-up. Cite this article: Bone Joint J 2018;100-B:603–9

Background: According to the mid-term results obtained from the previous registry-based studies, survival of cementless stems for aseptic loosening in younger patients with primary osteoarthritis has been better than the survival of cemented stems. However, it has not been clear if the endurance against aseptic loosening of cementless cups is comparable to that of cemented cups. The aim of the present study was to analyze population-based long-term survival rates of the cemented and cementless total hip replacements in patients under the age of fifty-five years with primary osteoarthritis in Finland. Patients and Methods: Between 1980 and 2006, a total of 7310 primary total hip replacements performed for primary osteoarthritis in patients under the age of fifty-five years were entered in the Finnish Arthroplasty Registry. 4,032 of them fulfilled our inclusion criteria and were subjected to analysis. The implants included were classified in one of the three following groups: implants with a cementless, straight, proximally circumferentially porous-coated stem and a porous-coated press-fit cup (cementless group #1); implants with a cementless, anatomic, proximally circumferentially porous-coated and/ or hydroxyapatite-coated stem with a porous-coated and/or hydroxyapatite-coated press-fit cup (cementless group #2); and a cemented stem combined with a cemented all-polyethylene cup (the cemented group). Results: Cementless total hip replacements, as well as cementless stems and cups analyzed separately, had a significantly reduced risk of revision for aseptic loosening compared with cemented hip replacements. The 15-year survivorship of cementless stem groups for aseptic loosening was higher than that of cemented stems (89% and 90% vs. 72%). The 15-year survivorship of cementless press-fit porous-coated cups for aseptic loosening was higher than that of cemented cups (80% vs. 71%). When revision for any reason was the end point in survival analyses, however, there were no significant differences among the groups. Conclusions: Both cementless stems and cementless cups have better resistance to aseptic loosening than cemented implants in long term follow-up in younger patients. Even if liner-exchange revisions are taken into account, the long-term survival of cementless total hip replacements is comparable to that of cemented implants

We report the long-term clinical and radiological outcomes of the Aequalis total shoulder replacement with a cemented all-polyethylene flat-back keeled glenoid component implanted for primary osteoarthritis between 1991 and 2003 in nine European centres. A total of 226 shoulders in 210 patients were retrospectively reviewed at a mean of 122.7 months (61 to 219) or at revision. Clinical outcome was assessed using the Constant score, patient satisfaction score and range of movement. Kaplan-Meier survivorship analysis was performed with glenoid revision for loosening and radiological glenoid loosening (. sd. ) as endpoints. The Constant score was found to improve from a mean of 26.8 (. sd. 10.3) pre-operatively to 57.6 (. sd. 20.0) post-operatively (p < 0.001). Active forward flexion improved from a mean of 85.3° (. sd. 27.4) pre-operatively to 125° (. sd. 37.3) postoperatively (p < 0.001). External rotation improved from a mean of 7° (. sd. 6.5) pre-operatively to 30.3° (. sd. 21.8°) post-operatively (p < 0.001). Survivorship with revision of the glenoid component as the endpoint was 99.1% at five years, 94.5% at ten years and 79.4% at 15 years. Survivorship with radiological loosening as the endpoint was 99.1% at five years, 80.3% at ten years and 33.6% at 15 years. Younger patient age and the curettage technique for glenoid preparation correlated with loosening. The rate of glenoid revision and radiological loosening increased with duration of follow-up, but not until a follow-up of five years. Therefore, we recommend that future studies reporting radiological outcomes of new glenoid designs should report follow-up of at least five to ten years

Results in patients undergoing total hip arthroplasty (THA) for femoral head osteonecrosis (ON) when compared with primary osteoarthritis (OA) are controversial. Different factors like age, THA type or surgical technique may affect outcome. We hypothesized that patients with ON had an increased revision rate compared with OA. We analysed clinical outcome, estimated the survival rate for revision surgery, and their possible risk factors, in two groups of patients. In this retrospective cohort analysis of our prospective database, we assessed 2464 primary THAs implanted between 1989 and 2017. Patients with OA were included in group 1, 2090 hips; and patients with ON in group 2, 374 hips. In group 2 there were more men (p<0.001), patients younger than 60 years old (p<0.001) and with greater physical activity (p<0.001). Patients with lumbar OA (p<0.001) and a radiological acetabular shape type B according to Dorr (p<0.001) were more frequent in group 1. Clinical outcome was assessed according to the Harris Hip Score and radiological analysis included postoperative acetabular and femoral component position and hip reconstruction. Kaplan-Meier survivorship analysis was used to estimate the cumulative probability of not having revision surgery for different reasons. Univariate and multivariate Cox regression models were used to assess risk factors for revision surgery. Clinical improvement was better in the ON at all intervals. There were 90 hips revised, 68 due to loosening or wear, 52 (2.5%) in group 1, and 16 (4.3%) in group 2. Overall, the survival rate for revision surgery for any cause at 22 years was 88.0 % (95% CI, 82-94) in group 1 and 84.1% (95% CI, 69 – 99) in group 2 (p=0.019). Multivariate regression analysis showed that hips with conventional polyethylene (PE), compared with highly-cross linked PEs or ceramic-on-ceramic bearings, (p=0.01, Hazard Ratio (HR): 2.12, 95% CI 1.15-3.92), and cups outside the Lewinnek´s safe zone had a higher risk for revision surgery (p<0.001, HR: 2.57, 95% CI 1.69-3.91). Modern highly-cross linked PEs and ceramic-on-ceramic bearings use, and a proper surgical technique improved revision rate in patients undergoing THA due to ON compared with OA

We report the technique and results of a new method of debridement arthroplasty for advanced primary osteoarthritis of the elbow. Triceps and the periosteum of the olecranon are reflected towards the ulnar side and the joint is opened by dividing the radial collateral ligament. Osteophytes are removed, the olecranon and coronoid fossae are deepened and the fibrosed anterior joint capsule is excised. The degenerative changes are always more advanced on the radial side, with erosion of the capitellum, and it is usually necessary to remodel the head of the radius. In 29 elbows reviewed at a mean of 64 months, the average gain of range of motion was 34 degrees, with good pain relief and improved grip in most patients. Two elbows required reoperation but there were no other serious complications

Salvage Total Hip Arthroplasty (THA) presents a viable solution following failed treatment of a hip fracture. Several studies have suggested higher complication rate including high dislocation rate associated with salvage THA. The present study evaluates the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of a hip fracture and comparison made to Primary THA in osteoarthritis (OA). Between 1992 and 2007, 53 patients with a mean age of seventy years were treated with THA after the failed treatment of a hip fracture under the care of a single surgeon. The indication for conversion arthroplasty was Avascular necrosis head – 24(45.3%), screw cut out – 6 (11.3%), non-union – 2(3.8%), Displaced fracture – 2(3.8%), Secondary OA – 19 (35.8%). The implants retrieved were Cannulated screws – 3, Sliding plate and screw – 46, Spline plate – 2, Smith Petersons nail – 1, Martin Plate – 1. This group of patients were matched for age, sex, side, and ASA grading with a group of 59 patients who underwent THA for primary osteoarthritis (THA-OA group). Posterior approach was used in all cases. Four patients (7.5%) required grafting of cup and 21 patients (39.6%) required soft tissue release. The average blood loss was 555 ml, mean duration of surgery was 85.5 min, average inpatient stay was 6.7 days. Cemented THA was used in 43 patients and Cementless THA in 10 patients. At one year follow up there were no dislocations, one patient had an undisplaced femoral fracture treated in Spica. Three patients had broken screws; one patient with shortening > 1 inch. There was one revision for deep infection. The mean Harris Hip Score (HHS) improved from 28.4 to 82.5 at one year, while the Oxford Hip score (OHS) improved from 50.9 to 21.9 (Old system). When the scores were compared to the THA-OA group there was no difference in the oxford hip scores and the the mean one year HHS in the THA-OA group was slightly higher than the group with salvage THA, but the difference was not statistically significant. Hip arthroplasty is an effective salvage procedure in patients with prior surgery for hip fracture. Most patients have good pain relief and functional improvement. Despite the operative challenges, remarkably few serious orthopaedic complications were associated with this procedure in the present study

Corrosion and wear of total hip (THA) and knee (TKA) prostheses extricate metallic particles and soluble metallic compounds. The oncogenic risk of these products should be known. Material and methods: Three Nordic cohorts of total hip (THA) and total knee arthroplasty (TKA) patients operated on for primary osteoarthrosis during 1967–1995 were combined for meta-analysis. The number of THA patients was 49,000 and TKA patients 24,000 totaling 497,000 person years. The mean follow-up time was 6.8 years. Standardized incidence ratios (SIRs) with 95% conþdence intervals (95% CI) were calculated for the observed and expected number of cancers. The expected numbers were based on national incidence rates. Results: The allover SIRs as well as the site-speciþc cancer incidences were similar for the THA and TKA patients. The observed number of all site cancers was 7639 and 8202 expected (SIR 0.93, 95% CI 0.91–0.95). The SIR for lung cancer (0.69, 0.64–0.75) was reduced. The incidence was also low for cancers of the stomach (SIR 0.76, 0.67–0.84), colon (SIR 0.86, 0.79–0.93) and rectum (SIR 0.89, 0.80–0.98). Slightly elevated SIRs were seen among TKA patients in cancer of the endometrium and prostate and among both THA and TKA patients in skin melanoma. Conclusions: Total cancer risk was signiþcantly reduced among THA and TKA patients due to decrease of respiratory and gastrointestinal cancers. The present results do not suggest any oncogenic risk of the components of hip and knee prostheses and their degradation products

Objective: To investigate the clinical outcome of debridement arthroplasty using medial approach for the osteoarthritis of the elbows.

Methods: 40 elbows in 36 patients with osteoarthritis of the elbow were reviewed retrospectively. All of the patients were men and the mean age at the time of surgery was 60.0 years. The mean duration of follow-up was 35 months. All elbows were managed operatively with debridement arthroplasty. This procedure consisted of removal of free bodies, resection of inflammatory synovia, and resection of osteophytes. Medial approach with medial epicondylectomy was applied for all cases. In 10 elbows, posterior approach was used additionally for the debridement of posterior compartment.

Results: 23 elbows (57.5 %) had an excellent result, 11 elbows (27.5 %) had a good result, and six (15 %) had a fair result. 10 elbows (25%) had complete relief of pain while the other 30 elbows (75 %) had partial relief. Remaining pain was mostly located at the lateral aspect in patients with severe radiohumral arthritis. Flexion was improved from 106.5 degrees to 121.5 degrees.

Conclusion: This procedure is effective for patients with osteoarthritis of the elbow which is localized in ulnohumeral joint. Total elbow arthroplasty must be considered for the severe radiohumeral arthritis. Careful selection of patients is essential for successful outcome.

We have analysed from the Finnish Arthroplasty Register the long-term survivorship of the 12 most commonly-used cemented implants between 1980 and 2005 in patients aged 55 years or older with osteoarthritis.

Only two designs of femoral component, the Exeter Universal and the Müller Straight femoral component had a survivorship of over 95% at ten years with revision for aseptic loosening as the endpoint. At 15 years of the femoral and acetabular component combinations, only the Exeter Universal/Exeter All-poly implant had a survival rate of over 90% with revision for aseptic loosening as the endpoint. In the subgroup of patients aged between 55 and 64 years, survivorship overall was less than 90% at ten years.

The variation in the long-term rates of survival of different cemented hip implants was considerable in patients aged 55 years or older. In those aged between 55 and 64 years, none of the cemented prostheses studied yielded excellent long-term survival rates (≥ 90% at 15 years).

From 1996, we were added fenestration between coronoid fossa, and olecranon fossa at the time of debridement arthroplasty termed extensive debridement arthroplasty with medial and lateral approach.The purpose of this study is to investigate clinical results of extensive debridement arthroplasty.

17 cases could be followed more than two years. Their averaged age was 57.3 years old. Two elbows had a previous history of debridement arthroplasty. In preoperative averaged flexion angle was 105 and averaged extension was 28C Clinical evaluation was performed with the elbow score of Japanese Orthopedic Association Preoperative averaged JOA score was 54.6 points In ray study we investigated whether the fenestration was open or closed.

In all cases, their symptoms improved D All patients returned to their former occupations satisfied with the clinical results Infection postoperative fracture and ectopic ossification were not observed.The averaged JOA score was 91 points Postoperative averaged flexion was 127 averaged extention was 12_Improvement of extension was 16 and that of flexion was 22 Closure of the fenestration was observed in five elbows Osteophyte formations of the coronoid process and olecranon was seen in 4 elbows

The JOA score of pain and ROM of these results were superior compared with any reports of debridement arthroplasty.The JOA score and results of ROM were superior when the fenestration was open.To maintain the fenestration hole open some modification will be necessary

Short term results of extensive debridement arthroplasty showed satisfactory results in terms of pain relief and Improvement of ROM, especially in extension.

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.