In 1975, Sweden started registering primary knee replacement surgeries based on the personal identity number. Individual-based registrations of primary total hip replacements started in 1992 and for hemiarthroplasties the registration started in 2006. The completeness of these registrations is estimated at 98% during the last 10-year period. The long history and high completeness allow for accurate calculations of population-based prevalence of joint replacement and trends over time.

We used all data on primary joint replacements available in the Swedish Arthroplasty Register. The prevalence was calculated using number of alive patients with 1) at least one joint replacement 2) at least one hip replacement 3) at least one knee replacement at the end of each year from 2010 – 2021. Publicly available population numbers were retrieved from Statistics Sweden. We calculated total prevalence and prevalence per age in years.

By the end of 2021, 3.2% of the Swedish population had at least one hip or knee replacement. This was an increase from 2.5% in 2010. Among 80-year-old, the prevalence was 17.5% for any joint replacement. For both hip and knee replacement and all ages, the prevalence was higher for women. For knee replacement, the 2021 prevalence peaked at the age of 89 (9,4%) while the prevalence continuously increased with age for hip replacements.

A considerable proportion of the Swedish elderly population is living with at least one hip or knee replacement. The prevalence has increased during the last 12-year period for both hips and knees. An increasing prevalence may also affect the incidence of fractures and infections. Knowledge about the prevalence is fundamental for planning future demand for primary and revision hip and knee replacement.

Background

The modern modular implants allow surgeons to combine different combinations of components within the same brand of which some may have completely different design.

During 1999–2012 the same cemented femur component was used together with a cemented stemmed tibia baseplate and also against a cemented pegged tibia baseplate. We decided to compare the revision rate of total knee arthroplasties (TKAs) using these two tibia baseplates.

Aim

Patients reporting penicillin allergy do often receive clindamycin as systemic antibiotic prophylaxis. The effect of clindamycin has however not been compared to antibiotics with proven effect in joint arthroplasty surgery. The aim of the study was to reveal if there were differences in the rate of revision due to infection after total knee arthroplasty (TKA) depending on which antibiotic was used as systemic prophylaxis.

To reveal if patient reported knee-related pain, function, quality of life, general health and satisfaction at one year after primary total knee arthroplasty (TKA) is different between patients not being subject to revision surgery and those having had early treatment with open debridement and exchange of the tibial insert for postoperative PJI.

The Swedish Knee Arthroplasty Register was used to identify 50 patients in the region of Skane that had a primary TKA during the years 2008 – 2012 and within 6 months were revised with open debridement and exchange of the tibial insert due to suspected or verified PJI. Only patients without further revisions were included. Patient reported outcome measurements (PROM) were obtained preoperatively and 1 year postoperatively and included knee related pain, function, quality of life using the Knee injury and Osteoarthritis Outcome Score (KOOS), general health using the EQ-VAS as well as satisfaction with the surgery. The scores were compared to those reported by 3,913 patients having a TKA during the same time but not revised during the first year. Welch's t-test and the Chi2-test were used in statistical analysis.

Compared to the controls the infected patients were older (mean age 72 vs 69 years, p = 0.04) and were more morbid (ASA 3; 14/50 patients vs 14%, p = 0.02). The preoperative PROM data were similar. Complete 1 year PROM data was available for 31 of the patients. Those patients reported somewhat worse outcome one year postoperatively than the controls with statistically and clinically significant differences in general health (mean 61 vs 76, p=0.002), KOOS ADL (mean 65 vs 76, p=0.03) and knee related quality of life (mean 51 vs 63, p=0.02) with large variations on individual level. Just over half of the patients (17/29) treated for PJI were very satisfied or satisfied with the surgery compared to 79% of the controls.

Patients treated with open debridement and exchange of the tibial insert due to early PJI after primary TKA reported less beneficial postoperative outcome than those without revision surgery during the first postoperative year but with large individual variations.

We identified a group of patients from the Swedish Arthroplasty Register who reported no relief of pain or worse pain one year after a total knee replacement (TKR). A total of two different patient-reported pain scores were used during this process. We then evaluated how the instruments used to measure pain affected the number of patients who reported no relief of pain or worse pain, and the relative effect of potential risk factors.

Between 2008 and 2010, 2883 TKRs were performed for osteoarthritis in two Swedish arthroplasty units. After applying exclusion criteria, 2123 primary TKRs (2123 patients) were included in the study. The Knee injury and Osteoarthritis Outcome Score (KOOS) and a Visual Analogue Scale (VAS) for knee pain were used to assess patients pre-operatively and one year post-operatively.

Only 50 of the 220 patients (23%) who reported no pain relief on either the KOOS pain subscale or the VAS for knee pain did so with both of these instruments. Patients who reported no pain relief on either measure tended to have less pain pre-operatively but a higher degree of anxiety. Charnley category C was a predictor for not gaining pain relief as measured on a VAS for knee pain.

The number of patients who are not relieved of pain after a TKR differs considerably depending on the instrument used to measure pain.

Cite this article: Bone Joint J 2014;96-B:1222–6.

We are entering a new era with governmental bodies taking an increasingly guiding role, gaining control of registries, demanding direct access with release of open public information for quality comparisons between hospitals. This review is written by physicians and scientists who have worked with the Swedish Knee Arthroplasty Register (SKAR) periodically since it began. It reviews the history of the register and describes the methods used and lessons learned.

Cite this article: Bone Joint Res 2014;3:217–22.

Introduction: The C-stem (DePuy, Leeds, UK) is triple tapered, polished and collarless. These features can facilitate distal stem migration within the cement mantle, a phenomenon first noticed on radiographs and later confirmed by radiostrereometric analysis (RSA) for the double tapered polished Exeter stem (Stryker, Mahwah, NJ). Low revision rates are reported for the Exeter stem and the view that early migration predicts later failure has not been confirmed with double tapered designs. If a triple tapered stem has any advantages is however not known

Patients and methods: 33 primary hip arthroplasties with a median age of 66 (46–74) years were followed for 2 years with radiostereometric analysis (RSA) at 3 months, 6 months, 1, 2 and 3 years. The diagnosis was primary osteoarthrosis in all hips. Both migration and rotation were studied.

Results: All the stems migrated distally and posteriorly within the cement mantle. The median distal migration was 1.47 mm at 3 years and the median posterior migration was 1.56 mm at 3 years. All the stems rotated towards retroversion and median rotation at 3 years was 2.0°. For all the other directions the prosthesis was stable up to 3 years

Discussion: The C-stem migrates and rotates more than cemented prostheses of other designs. Compared with other tapered prostheses the distal migration is at the same level but posterior rotation is higher and furthermore it migrates posteriorly, which the other tapered stems do not. If this migration/rotation pattern is tolerable without risk of prosthetic failure needs to be studied further, but at present there is no indication from the available clinical results for the C-Stem that this pattern is deleterious.

We used roentgen stereophotogrammetric analysis to follow 33 C-stem femoral components for two years after primary total hip arthroplasty. All components migrated distally and posteriorly within the cement mantle. The mean distal migration was 1.35 mm (sd 0.62) at two years and the mean posterior migration was 1.35 mm (sd 0.69) at two years. All the femoral components rotated into retroversion with a mean rotation at two years of 1.9° (sd 1.1). For all other directions, the prosthesis was stable up to two years. Compared with other tapered prostheses, the distal migration of the C-stem is the same, but posterior rotation and posterior migration are greater.

Introduction The aim of this study was to describe the migration pattern of the Exeter stem after revision with morsellised allograft bone and cement, to evaluate if restricted weight bearing had any influence on migration, and to measure, before and after revision, the quality of life comparing it to primary cemented hip arthroplasties.

Methods Forty-one consecutive stem revisions were followed by radiostereometry (RSA, 1. Selvik 1989). The accuracy of the RSA set-up was between 0.3 mm and 0.7 mm. The surgical procedure described by the Exeter group (2. Gie 1993) was used. All were first time revisions for aseptic loosening and all patients had had their primary arthroplasty for osteoarthritis. Bone stock deficiency was classified according to Gustilo and Pasternak. Sixteen were type I, 20 type II, five type III but none was classified as type IV. The Nottingham Health Profile was used to measure quality of life before and after revision.

Results All stems migrated distally and most of them also migrated medially or laterally and posteriorly. Migration was still observed in one third of stems between 1.5 and two year follow-ups. At two years stem subsidence averaged 2.5 mm, medial or lateral migration averaged 1.2 mm and posterior migration averaged 2.9 mm. No correlation to the pre-operative bone stock deficiency was observed. Between two and five years only marginal migration occurred in 12 of the 15 stems followed for five years. No differences in the migration pattern were detected when free weight bearing was allowed immediately after revision in hips without intra-operative skeletal complications compared to when restricted weight bearing was practiced. Most migration occurs within the first two weeks after surgery. NHP scales for pain, physical mobility, sleep and energy scales improved significantly. NHP scores were in all six scales comparable to those of primary arthroplasties. No rerevision was performed and no stem had radiographic sings of loosening.

Conclusions Most migration occurred early after revision and decreased gradually. Marginal migration after two years does not deteriorate the results during the first five years after surgery. Quality of life (patient outcome) after revision with impacted morsellised allograft bone and cement was comparable to that of primary arthroplasties.

In relation to the conduct of this study, one or more of the authors is in receipt of a research grant from a non-commercial source.