Annually about 75000 hip arthroplasties are performed in Italy, which corresponds to 125 primary operations per 100.000 inhabitants. These numbers are constantly growing, as well as the amount of economical resources dedicated to this surgery. There are many types of pros-theses, and techniques, but basically no control on their efficacy and effectiveness is applied. So born in Apulia during 2001 the pilot project of Register for Apulia. The specific aims of Register are:
describe the current practeses in hip replacement, providing accurate information on the use of different types of prostheses in both primary and revision joint replacements; collect data for the evaluate the importance of patient-related factors on survival of implants; control the incidence of intra and post-operative complications; assess patient outcomes in medium ( 6 month ) and long term ( 12 month ); describe the different parts of the implant; Five thousand four hundred forms have been collected during the last three years. 55% of the Apulian Hospitals were involved in 2001, 77% in 2003. The average age of the patients undergoing surgery was 67 for the total hip replacement, 80 for the partial hip replacement and 70 for implant revision. 66% of the operations were performed on women. We recorded an increase in the use of antibiotic-containing cement. Systemic antibiotic prophylaxis has been used in almost every operation, e.g. teicoplanina (18% ). In 2003 we recorded 56 deaths (SMR 0.03) with a higher risk for revision of hip prostheses in younger compared to older patients and in men compared to women. During the first 60 post operative days we observed a statistically significant increase in mortality for all patients. During the study 37 types of cups and 53 types of stems have been registered. The 28mm head was used in 90% of cases. Most patients with primary osteoarthritis do not received cemented prostheses. The use of the bone impaction grafting technique has increased. Primary prostheses is the main indication for coxartrosi while hemiarthro-plasties for femoral neck fractures. Aseptic loosening is the most frequent diagnosis for revision. In Apulia hip arthroplasties are predominant in central and university hospitals. University hospitals and private clinics have proportionally revised younger patients. The number of revisions is increasing. The follow-up is limited (30%). All the orthopaedic departments involved are participating in the study on a voluntary basis. The data forms we have used, are suitable for an observational study. The Register has evolved to be an essential part of the quality improvement programs in Apulia’s health care structures. The Register gives important information for the decision-making process and facilitates quality improvement. The Register has the potential to bring problems to attention long before they may be reported and acknowledged by traditional clinical research methods.
