Young patients are at increased risk of revision after primary THA (THA). The bearing surface may be of importance for the longevity of the joint.

We aimed to compare the risk of revision of primary stemmed cementless THA with MoM and CoC with metal-on-highly-crosslinked-polyethylene (MoXLP) bearings in patients between 20–54 years.

From NARA, we included 2,153 MoM, 4,120 CoC and 10,329 MoXLP THA operated between 1995 and 2017. Kaplan-Meier estimator was used for calculation of THA survivorship and Cox regression to estimate the hazard ratio (HR) of revision (95% CI) due to any and specific causes. MoXLP was reference.

The median follow-up was 10.3 years for MoM, 6.6 years for CoC and 4.8 years for MoXLP. 15 years postoperatively the Kaplan-Meier survival estimates were 80% (78–83%) for MoM, 92% (91–93%) for CoC and 94% (93–95%) for MoXLP. The 0–2, 2–7 and 7–15 years adjusted HRs of revision by any cause were 1.4 (0.9–2.4), 3.2 (2.1–5.1) and 3.9 (1.9–7.9) for MoM and 1.1 (0.8–1.4), 1.0 (0.7–1.3) and 2.5 (1.3–4.8) for CoC bearings. After 7–15 years follow-up, the unadjusted HR of revision due to aseptic loosening was 5.4 (1.2–24) for MoM and 4.2 (0.9–20) for CoC THA. MoM and CoC had a 7–15 year adjusted HR of revision due to ‘other’ causes of 4.8 (1.6–14) and 2.1 (0.8–5.8).

MoXLP bearings were associated with better survival than MoM and CoC bearings, mainly because of lower risk of revision due to aseptic loosening and ‘other’ causes.

Surgery performed in low-volume centres has been associated with longer operating time, longer hospital stays, lower functional outcomes, and higher rates of revision surgery, complications, and mortality. This has been reported consistently in the arthroplasty literature, but there is a paucity of data regarding the relationship between surgical volume and outcome following anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the ACL reconstruction failure rate between hospitals performing different annual surgical volumes. The hypothesis was that ACL reconstructions performed at low-volume hospitals would be associated with higher failure rates than those performed at high-volume centres.

This level-II cohort study included all patients from the Norwegian Knee Ligament Registry that underwent isolated primary autograft ACL reconstruction between 2004 and 2016. Hospital volume was divided into quintiles based on the number of ACL reconstructions performed annually, defined arbitrarily as: 1–12 (V1), 13–24 (V2), 25–49 (V3), 50–99 (V4), and ≥100 (V5) annual procedures. Kaplan-Meier estimated survival curves and survival percentages were calculated with revision ACL reconstruction as the end point. Mean change in Knee Injury and Osteoarthritis Outcome Score (KOOS) Quality of Life and Sport subsections from pre-operative to two-year follow-up were compared using t-test.

19,204 patients met the inclusion criteria and 1,103 (5.7%) underwent subsequent revision ACL reconstruction over the study period. Patients in the lower volume categories (V1-3) were more often male (58–59% vs. 54–55% p=<0.001) and older (27 years vs. 24–25 years, p=<0.001) compared to the higher volume hospitals (V4-5). Concomitant meniscal injuries (52% vs. 40%) and participation in pivoting sports (63% vs. 56%) were most common in V5 compared with V1 (p=<0.001). Median operative time decreased as hospital volume increased, ranging from 90 minutes at V1 hospitals to 56 minutes at V5 hospitals (p=<0.005). Complications occurred at a rate of 3.8% at low-volume (V1) hospitals versus 1.9% at high-volume (V5) hospitals (p=<0.001). Unadjusted 10-year survival with 95% confidence intervals for each hospital volume category were: V1 – 95.1% (93.7–96.5%), V2 – 94.1% (93.1–95.1%), V3 – 94.2% (93.6–94.8%), V4 – 92.6% (91.8–93.4%), and V5 – 91.9% (90.9–92.9%). There was no difference in improvement between pre-operative and two-year follow-up KOOS scores between hospital volume categories.

Patients having ACL reconstruction at lower volume hospitals did not have inferior clinical or patient reported outcomes, and actually demonstrated a lower revision rate. Complications occurred more frequently however, and operative duration was longer. The decreased revision rate is an interesting finding that may be partly explained by the fact that patients being treated in these small, often rural hospitals, may be of lower demand as suggested by the increased age and decreased participation in pivoting sports. In addition, patients with more complicated pathology such as meniscal tears were more commonly treated in the larger volume hospitals. The most significant limitation of this study is that provider volume was not assessed, and the number of surgeons dividing up the surgical volume at each hospital is not known.

Introduction

Periprosthetic osteolysis resulting in aseptic loosening is a leading cause for total hip arthroplasty (THA) failure. Individuals vary in their susceptibility to osteolysis, and it is thought that heritable factors contribute to this variation. We conducted two genome-wide association studies to identify genetic risk loci associated with osteolysis and genetic risk loci associated with time to prosthesis failure due to osteolysis.

There is an ongoing discussion on what bearing surfaces to use in different age groups of total hip replacement patients.

We report results from uncemented total hip arthroplasty using ceramic on ceramic bearings reported to the Norwegian Arthroplasty Register in the period 1997–2014.

Kaplan Meier and Cox regression analysis adjusting for age, gender and diagnosis was used to assess prosthesis survival at 10 and 15 years after primary operation and to report relative risk of revision. Endpoint was any revision. Comparison with the cemented Charnley prosthesis (n=17180), with metal-on-polyethylene articulations from the same time period was done. Results in age groups <55, 55–64, 65–74, >=75 were investigated.

The following femur/cup combinations were used; Filler/Igloo (n=2590), Corail/Pinnacle (n=783), Corail/Duraloc (n=467), SCP Unique/Trilogy (n=363), Polar/R3 (n=253), ABGII/ABGII (n=131), other combinations (n=339). Alumina bearing was used in 3807 hips and Alumina-Zirconium composite bearings in 1119 hips. The overall ten and fifteen years unadjusted Kaplan Meier survivals were 94.8 % and 92.0 % respectively with no statistically significant difference between the brands. The cemented Charnley hip arthroplasty had 93.6 % survival at 15 years, and was not statistically significant different from the uncemented ceramic/ceramic group. The 10 years survival in the age groups <55, 55–64, 65–74, >=75 for the uncemented ceramic/ceramic group was 93.7%, 95.3%, 96.0% and 95.4% respectively with no difference between the uncemented brands and the cemented Charnley prosthesis. We found less revisions in patients >=75 in the Charnley group. In the ceramic on ceramic group 11 head fractures and 3 liner fractures were reported.

The 15 years result of uncemented hip replacement with ceramic on ceramic bearing was good, and not different from the Charnley cemented arthroplasty in the age groups <75 years.

Total hip replacement (THR) in children and very young teenagers is experimental since we do not know long-term results in these. We investigated the clinical and radiographic outcomes of THR performed in children and teenage patients identified in the Norwegian Arthroplasty Register

We included 111 patients (132 hips) who underwent THR before 20 years of age., together with information on the primary diagnosis, types of implants, and any revisions that required implant change. Radiographs and Harris hip score (HHS) were evaluated for patients that attended clinical follow-up.

The mean age at primary THR was 17 (11–19) years, 60% were girls. Mean follow-up time was 14 (3–26) years. The 10-year survival rate after primary THR (with endpoint any revision) was 70%. Survival was better for the patients operated after 1996 (10 y 50% vs 90%). 39 patients had at least 1 revision and 16 patients had 2 or more revisions. In the latest radiographs, osteolysis and atrophy were observed in 19% and 27% of the acetabulae and 21% and 62% of the femurs, respectively. The mean HHS at the final follow-up was 83 (15–100). EQ-5DVAS was 74 (82 in normal population).

The clinical scores after THR in these young patients were acceptable, but many revisions had been performed. The bone stock in many patients was poor, which could complicate future revisions.

Background

There are few studies of total knee replacements with cemented tibia and uncemented femur (hybrid). Previous studies have not shown any difference in revision rate between different fixation methods, but these studies had few hybrid prostheses. This study evaluates the results of hybrid knee replacements based on data from the Norwegian Arthroplasty Register (NAR).

Introduction: There is an increasing interest in surface replacement arthroplasty (SRA) as an alternative to conventional THA (cTHA) in young and active patients. However, there has been considerable variability in reported outcomes. National joint registry reports have shown increased revision rates compared to cTHA. We analysed outcome measured as non-septic revision rate within two years for SRA in the NARA data base (Nordic Arthroplasty Register Association).

Materials and Methods: 1638 SRA and 163802 cTHA with age up to 73 years and a non-fracture diagnosis, operated from 1995 to 2007, were compared using Cox multiple regression including age, gender, diagnosis, nation and prosthesis type with cTHA divided into cemented, uncemented, hybrid and reversed hybrid fixation. Men below 50 years of age (460 SRA and 7185 cTHA) were analysed as a subset. The SRA cohort with a mean follow-up 1,8 years was also analysed with the same method including age, gender, diagnosis, number of performed SRA per hospital and the four most commonly used prosthesis designs. In an additional analysis femoral head diameter was added, reducing the number of cases to 1552. results are presented as relative risk (RR) with 95 % confidence interval(CI).

Results: SRA had a more than twofold increased revision risk compared to cTHA, RR=2,50 (1,67–3,70), which increased to 3,63 (2,42–5,44) when compared with all cemented THA. In the subpopulation of men below 50 years of age, there was no difference between SRA and any of the cTHA cathegories. Within the SRA group RR was reduced by male gender, RR=0,46 (0,25–0,86), in hospital performing > 70 SRA (RR=0,26, 0,11–0,60) and with use of BHR (Birmingham Hip Resurfacing) compared to all other designs (RR=0,27, 0,12–0,61). The size of the femoral head diameter had no significant influence on the early revision rate.

Discussion and Conclusion: Surface replacement arthroplasty has an increased risk of early revision compared to conventional and cemented THA except for men below 50 years of age. There is a learning curve on the hospital level. Cases with secondary osteoarthritis were comparatively few and were mainly caused by pediatric hip disease. SRA might become an alternative for young men, but our follow up is too short to determine if this indication remains in the longer perspective.