National Arthroplasty Registries Research Articles

Cost and resource comparison analysis for THA in Switzerland and Austria.

Total hip arthroplasty (THA) is an orthopedic intervention that generates substantial costs to national healthcare systems due to the number of interventions and the cost per intervention. We performed a cost comparison analysis in Austria and Switzerland. Data from the national joint arthroplasty register in Switzerland and internal information from the national healthcare services in Austria and Switzerland were compared for patient demographics, interventional characteristics, and costs adjusted for inflation and purchasing power from 2015 to 2021. The average age for primary THA in Austria was from 67.4 to 67.8years with 55.9-57.2 percent female patients and from 68.5 to 69.3years with 52.4-53.8 percent female patients in Switzerland. The annual incidence rate for primary THA rose from 210.28/100k to 216.6/100k in Austria and from 212/100k to 250/100k in Switzerland. After correction for inflation, costs were -1.91 percent lower in Austria in 2021 than in 2015 and -2.57 percent lower in Switzerland. After correction for purchasing power, costs were higher in Austria. The average hospital stay after THA in Austria was reduced by 20 percent (11.7days/2015 vs. 9.4days/2021) and 25 percent in Switzerland (8.4days/2015 vs. 6.4days/2021). Revision rate was 2.5-3.2 percent in Austria and 2.8-3.2 percent in Switzerland. The patient population was comparable while patients undergoing primary THA in Austria stay longer in hospital and have relatively higher costs when adjusted for currency, purchasing power, and inflation. The use of standardized registers would be helpful to compare outcomes and costs.

Correlation of revision rate of unicompartmental knee arthroplasty with total knee arthroplasty: a meta-analysis of clinical studies and worldwide arthroplasty registers.

The purpose of this study was to elucidate differences and similarities in revision rates amongst studies and national registers featuring total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). Thereby comparability and reproducibility between study and register findings should be created. Clinical studies published between 2004 and September 2023 involving TKA or UKA were reviewed for total arthroplasty numbers, revision rates and demographic data. Findings were calculated as "revisions per 100 component years (CY)" and divided according to the nationality of the center. National arthroplasty registers were searched for numbers of arthroplasties and revisions alongside with demographic data. Revision rates in registers were compared to one another and comparison to revision rates from collected studies was drawn. After evaluation, 98 studies and seven registers met our inclusion criteria and were included in this study. Cumulative percent revision rate in studies was 3.35% after a mean follow-up of 5.7years, corresponding to 0.71 revisions per 100 CY for TKA and 7.67% after a mean follow-up of 4.9years, corresponding to 1.3 revisions per 100 CY for UKA. Registers showed mean overall revision rates of 5.63% for TKA and 11.04% for UKA. A positive correlation of revision rates of TKA and UKA in studies and registers was found, with overall revision rates of UKA comparted to TKA being 2.29 times higher in clinical studies and 1.96 times higher in registers. Revision rates in registers were 1.56 times higher than presented in clinical studies.

Comparing optimum prosthesis combinations of total stemmed, stemless and reverse shoulder arthroplasty revision rates for men and women with glenohumeral osteoarthritis

BackgroundThis study investigated prostheses from a large national arthroplasty registry with the lowest rates of revision, defined as optimum. We compared optimum shoulder arthroplasty revision rates for osteoarthritis (OA) to determine the most suitable/effective procedure for men and women. MethodsThere were three cohort groups of optimum primary shoulder arthroplasties for OA undertaken between 1st January 2008 and 31 December 2022: stemless shoulder arthroplasty with cemented polyethylene glenoids (slTSA), stemmed shoulder arthroplasty with modified central peg polyethylene glenoids (stTSA), and cementless reverse shoulder arthroplasty (rTSA). The cumulative percent revision (CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazard models adjusted for age, gender, humeral head/glenosphere size, polyethylene type, and surgeon volume. Possible interactions were examined. A sub-analysis from 1 January 2017 captured additional patient demographics, ASA score, BMI and glenoid morphology. ResultsThe CPR at 7 years was 4.0%(95% confidence interval (CI) 3.1, 5.1) for slTSA (n=3,041), 3.8%(95%CI 2.7, 5.5) for stTSA (n=1,259) and 4.1%(95%CI 3.7, 4.6) for rTSA (n=12,341). slTSA had a higher rate of revision compared to rTSA after the first 9 months (p<0.001). rTSA had a lower revision rate compared to stTSA from 3 months on (p=0.004). After adjusting for other confounders, prosthesis type and gender were associated with revision rates (p<0.001) whereas surgeon volume was not. Additionally, gender and prosthesis type strongly interacted (p=0.013) and the combined model exhibited greater predictive performance when including this interaction. Women had lower rates of revision than men for both stTSA and rTSA, but not slTSA. Most revisions were for infection in men, especially rTSA. After 3 months, the rate of revision for slTSA vs rTSA for women was increased (p<0.001) and revision rates for men did not significantly differ. However, in a sub-analysis of procedures in males since 2017 with additional adjustments, slTSA had a lower revision rate than stTSA (p=0.010). ConclusionsThe optimum shoulder arthroplasty revision rates vary for both the gender and implant type for the diagnosis of OA. A model combining optimum prostheses and gender predicted revision better than optimum implants alone. After 3 months, rTSA was associated with lower revision rates compared to slTSA in women, whereas there were no significant differences between optimum prostheses in men. However, surgeons may also consider lower revision risk of optimum slTSA at sub analysis and increased cumulative incidence of infection for rTSA requiring revision to resolve decision making for male patients.

Modeling highly crosslinked polyethylene vs. non–highly crosslinked polyethylene glenoid revision rates for anatomic shoulder arthroplasty in osteoarthritis including differing polyethylene glenoid fixation designs

BackgroundWe compared anatomic total shoulder arthroplasty (aTSA) for osteoarthritis to both highly crosslinked polyethylene (XLPE) and non–highly crosslinked polyethylene (non-XLPE) to determine the rate of revision for multiple patient and implant characteristics, modeling the effect of variation in glenoid fixation design (glenoid component type). MethodsData from a large national arthroplasty registry were analyzed for the period April 16, 2004, to December 31, 2022. The study population included all primary aTSA (stemmed and stemless shoulder arthroplasty) procedures with a primary diagnosis of osteoarthritis and performed using prostheses in current use. These procedures were grouped into 2 cohorts: all polyethylene-bearing glenoid components with either XLPE or non-XLPE. The cumulative percent revision was determined using Kaplan–Meier estimates of survivorship and hazard ratios from Cox proportional hazard models adjusted for age, sex, humeral head size, humeral fixation, type of primary (total stemmed or stemless anatomic), glenoid component type (modular and nonmodular metal-backed glenoid, cemented polyethylene glenoid, and polyethylene glenoid with modified central peg), and surgeon volume (after 2008). Possible interactions were examined. A subanalysis from January 1, 2017, captured the additional patient demographics of American Society of Anesthesiologists score, body mass index, and glenoid morphology. ResultsOf 11,003 aTSA procedures, the cumulative percent revision at 14 years for all XLPE glenoids (n = 3865) was 5.8% (95% confidence interval [CI] 3.9, 8.7), and 18.7% (95% CI 16.6, 21.0) for non-XLPE (n = 7138). XLPE had a lower rate of revision from 2 years (non-XLPE vs. XLPE 2 years + hazard ratio = 1.66, (95% CI 1.09, 2.53), P = .018) adjusting for age, sex, humeral head size, type of primary, humeral stem fixation, and glenoid component type. Overall, glenoid component type and polyethylene type were strongly associated (P < .001 and P = .021, respectively) with all-cause aTSA revision rates. The difference between non-XLPE and XLPE is observed across all polyethylene glenoid types. When considering procedures performed between 2017 and 2022, XLPE vs. non-XLPE rates of revision were not significantly different with extended adjustment at subanalysis, but loosening did not predominate for non-XLPE until year 6 of follow-up. ConclusionBoth the glenoid design and the type of polyethylene predict the revision rate for aTSA. However, the relative rates of revision between glenoid designs did not differ with polyethylene type. While the polyethylene type was not associated with aTSA revision rates in a more contemporary analysis, the incidence of loosening in non-XLPE prostheses combinations was higher from 6 years may explain this.

Analysis of knee arthroplasty revision causes

Introduction Existing discrepancies in knee arthroplasty registries regarding the definition of indications for revision TKA lead to confusion related to the identification of the leading pathology. Many works indicate not only one but several reasons for revision which makes comparison difficult. Therefore, the issue of categorizing indications for revision TKA is a weak point of the available registries and of any large retrospective series.Purpose To systematize the etiology of pathological conditions leading to revision knee arthroplasty.Materials and methods The study included 361 revision knee arthroplasties. A comparative analysis of the etiology of complications of primary arthroplasty was carried out with data from national arthroplasty registries and clinical studies.Results The main indications for revision knee arthroplasty were infection in 48.2 % of cases (174/361), aseptic implant instability (osteolysis) in 38.2 % (138/361), and instability of the ligamentous apparatus in 4.2 % (15/361). In 98 cases (27.1 %), only one type of complication was identified, and in 263 (85.2 %) more than one. Infection prevailed among early complications (126/234, 54 %) and aseptic loosening (osteolysis) (69/127, 54 %) predominated among late complications.Discussion In our opinion, the indications for revision arthroplasty can be divided into three main etiological groups: periprosthetic infection (group I); conditions associated with a response to polyethylene wear products (osteolysis) (group 2); and biomechanical disorders, which include spatial malposition, incorrect implant sizes and all types of instability (group 3).Conclusion Our systematization of revision arthroplasty causes can help in further research and will be useful in creating a national registry of arthroplasties in Russia.

Septic complications are on the rise and aseptic loosening has decreased in total joint arthroplasty: an updated complication based analysis using worldwide arthroplasty registers.

A decade ago, a comprehensive study was conducted to investigate the reasons for revision surgeries and their respective frequencies in cases of total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on a complication-based analysis of joint replacement registries. The aim of the present study was to determine whether the causes and risks of their occurrence have changed over the last ten years and to present an updated analysis. A systematic review of national arthroplasty registries from seven countries examined the causes and rates of revisions of THA and TKA. The study focused on a descriptive analysis that provided an updated overview without statistical significance values. The most common causes for revisions of THA were aseptic loosening (35.1%), deep infection (18.2%), dislocation/instability (15.9%), and periprosthetic fractures (11.4%). The most common causes for revisions of TKA were deep infection (21.6%), aseptic loosening (18.3%), instability (14.1%), and pain (10.9%). The findings of this study revealed significant shifts in the underlying causes of revision surgeries in the last decade. Notably, septic complications emerged as the predominant reason for revision of primary TKA, while they also gained prominence as a cause of failure of THA. Although aseptic loosening remains the primary cause for re-operation of THA, the relative risk has decreased for both THA and TKA.

Periprosthetic Joint Infection After Total Knee Arthroplasty With or Without Antibiotic Bone Cement

Despite increased use of antibiotic-loaded bone cement (ALBC) in joint arthroplasty over recent decades, current evidence for prophylactic use of ALBC to reduce risk of periprosthetic joint infection (PJI) is insufficient. To compare the rate of revision attributed to PJI following primary total knee arthroplasty (TKA) using ALBC vs plain bone cement. This international cohort study used data from 14 national or regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, New Zealand, Norway, Romania, Sweden, Switzerland, the Netherlands, the UK, and the US. The study included primary TKAs for osteoarthritis registered from January 1, 2010, to December 31, 2020, and followed-up until December 31, 2021. Data analysis was performed from April to September 2023. Primary TKA with ALBC vs plain bone cement. The primary outcome was risk of 1-year revision for PJI. Using a distributed data network analysis method, data were harmonized, and a cumulative revision rate was calculated (1 - Kaplan-Meier), and Cox regression analyses were performed within the 10 registries using both cement types. A meta-analysis was then performed to combine all aggregated data and evaluate the risk of 1-year revision for PJI and all causes. Among 2 168 924 TKAs included, 93% were performed with ALBC. Most TKAs were performed in female patients (59.5%) and patients aged 65 to 74 years (39.9%), fully cemented (92.2%), and in the 2015 to 2020 period (62.5%). All participating registries reported a cumulative 1-year revision rate for PJI of less than 1% following primary TKA with ALBC (range, 0.21%-0.80%) and with plain bone cement (range, 0.23%-0.70%). The meta-analyses based on adjusted Cox regression for 1 917 190 TKAs showed no statistically significant difference at 1 year in risk of revision for PJI (hazard rate ratio, 1.16; 95% CI, 0.89-1.52) or for all causes (hazard rate ratio, 1.12; 95% CI, 0.89-1.40) among TKAs performed with ALBC vs plain bone cement. In this study, the risk of revision for PJI was similar between ALBC and plain bone cement following primary TKA. Any additional costs of ALBC and its relative value in reducing revision risk should be considered in the context of the overall health care delivery system.

Projected volume of primary total joint arthroplasty in the USA from 2019 to 2060.

The global incidence of total joint arthroplasty (TJA) has consistently risen over time, and while various forecasts differ in magnitude, future projections suggest a continued increase in these procedures. Differences in future United States projections may arise from the modeling method selected, the nature of the national arthroplasty registry employed, or the representativeness of the specific hospital discharge records utilized. In addition, many models have not accounted for ambulatory surgery as well as all payer types. Therefore, to attempt to make a more accurate model, we utilized a national representative sample that included outpatient arthroplasties and all insurance types to predict the volumes of primary TJA in the USA from 2019 to 2060. A national, all-payer database was queried. All patients who underwent primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) from January 1, 2010, to December 31, 2019, were identified using international classification of disease Ninth Revision (9) and Tenth Revision (10) codes and current procedure terminology codes. Absolute frequencies and incidence rates were calculated per 100,000 for both THA and TKA procedures, with 95% confidence intervals. Mean growth in absolute frequency and incidence rates were calculated for each procedure from 2010 to 2014, and 2010 to 2019, with 95% confidence intervals (CI). The overall increase in THA and TKA procedures are expected to grow + 10 and + 36%, respectively, using linear regressions and + 9 and + 37%, respectively. The most positive mean growth in procedure frequency occurred from 2010 to 2014 for THA (+ 24, 95% Confidence Interval (CI): + 21, + 27) and 2010-2019 for TKA (+ 11%, 95% CI: + 9, + 14). There positive trend patterns in incidence rate growth for both procedures, with similar 2010-2019 incidence rates + 6%) for THA (+ 3%, 95% CI: + 0, + 6%) and TKA (+ 3%, 95% CI: + 1%, + 6%). Utilizing a nationally representative database, we demonstrated that TJA procedures would continue with an increased growth pattern to 2060, though slightly decreased from the surge from 2014 to 2019. While this finding applies to the representativeness of the population at hand, the inclusion of outpatient arthroplasty and all payer types validates an approach that has not been undertaken in previous projection studies.

The Cost-Effectiveness of Computer-Assisted Compared with Conventional Total Knee Arthroplasty: A Payer's Perspective.

Recent evidence showing that computer-assisted total knee arthroplasty (TKA) is associated with better outcomes compared with conventional TKA for patients with end-stage knee osteoarthritis has not been included in economic evaluations of computer-assisted TKA, which are needed to support coverage decisions. This study evaluated the cost-effectiveness of computer-assisted TKA from a payer's perspective, incorporating recent evidence. We compared computer-assisted TKA with conventional TKA with regard to costs (in 2022 U.S. dollars) and quality-adjusted life-years (QALYs) using Markov models for elderly patients (≥65 years of age) and patients who were not elderly (55 to 64 years of age). Costs and QALYs were estimated in the lifetime for elderly patients and in the short term for patients who were not elderly, under a bundled payment program and a Fee-for-Service program. Transition probabilities, costs, and QALYs were retrieved from the literature, a national knee arthroplasty registry, and the National Center for Health Statistics. Threshold and probabilistic sensitivity analyses were conducted to examine the robustness of key estimates used in the base-case analysis. Using projected estimates of TKA utilization, the total cost savings of performing computer-assisted TKA rather than conventional TKA were estimated. Compared with conventional TKA, computer-assisted TKA was associated with higher QALYs and lower costs for both elderly patients and patients who were not elderly, regardless of payment programs, making computer-assisted TKA a favorable treatment option. Widespread adoption of computer-assisted TKA in all U.S. patients would result in an estimated total cost saving of $1 billion for payers. Compared with conventional TKA, computer-assisted TKA reduces costs to payers while providing favorable outcomes. Payers may consider providing additional payment incentives to providers for performing computer-assisted TKA, to achieve outcome improvement and cost control by facilitating widespread adoption of computer-assisted TKA. Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.

Comparison of revision rates and epidemiological data of a single total knee arthroplasty system of different designs (cruciate retaining, posterior stabilized, mobile bearing, and fixed bearing): a meta-analysis and systematic review of clinical trials and national arthroplasty registries

BackgroundThis study aimed to meta-analyze epidemiological data, revision rates, and incidences of different designs of a single Total Knee Arthroplasty System and compare these factors across different countries.MethodsA systematic review was conducted on clinical studies and arthroplasty registries of ATTUNE TKA from 1999 to 2020. The main endpoints analyzed were revision rates and epidemiological data.ResultsThe average age of patients was 67.8 years, with a gender distribution of 60% female and 40% male. The pooled average BMI was 29.4 kg/m2. Eight clinical studies showed a pooled revision rate per 100 observed CY of 0.5 (n = 1343 cases). Cumulative revision rates after 1, 3, and 5 years varied among registries, with the Swiss registry having the highest revision data (after 5 years: 6.3%) and the American registry having the lowest revision data (after 5 years: 1.7%). A comparison of the revision rates of mobile bearing and fixed bearing (41,200 cases) as well as cruciate retaining and posterior stabilized (n = 123,361 cases) showed no significant advantage in the first 5 years after implantation.ConclusionIn conclusion, pooled data from 41,200 cases of TKA with a single Total Knee Arthroplasty System in two arthroplasty registries revealed that there was no significant difference in revision rates between the mobile bearing and fixed bearing design within the first 5 years after implantation. In addition, a comparison of the revision rates in n = 123,361 cases showed no significant advantage for cruciate retaining or posterior stabilized in the first 5 years after implantation.

Comparable low revision rates of stemmed and stemless total anatomic shoulder arthroplasties after exclusion of metal-backed glenoid components: a collaboration between the Australian and Danish national shoulder arthroplasty registries

BackgroundThe stemmed anatomical total shoulder arthroplasty is the gold standard in the treatment of glenohumeral osteoarthritis. However, the use of stemless total shoulder arthroplasties has increased in recent years. The number of revision procedures are relatively low and therefore it has been recommended that national joint replacement registries should collaborate when comparing revision rates. Therefore, we aimed to compare the revision rates of stemmed and stemless TSA used for the diagnosis of glenohumeral osteoarthritis using data from both the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and the Danish Shoulder Arthroplasty Registry (DSR). MethodsWe included all patients who were registered in the AOANJRR and the DSR from January 1 2012 to December 2021 with an anatomical total shoulder arthroplasty used for osteoarthritis. Revision for any reason was used as the primary outcome. We used the Kaplan-Meier method to illustrate the cumulative revision rates and a multivariate cox regression model to calculate the hazard ratios. All analyses were performed separately for data from AOANJRR and DSR, and the results were then reported using a qualitative approach. Results13066 arthroplasties from AOANJRR and 2882 arthroplasties from DSR were included. The hazard ratio for revision of stemmed TSA with stemless TSA as reference, adjusted for age and gender, was 1.67 (95% CI 1.34-2.09, p<0.001) in AOANJRR and 0.57 (95% CI 0.36-0.89, p=0.014) in DSR. When including glenoid type and fixation, surface bearing (only in AOANJRR) and hospital volume in the cox regression model the hazard ratio for revision of stemmed TSA compared to stemless TSA was 1.22 (95% CI 0.85-1.75, p=0.286) in AOANJRR and 1.50 (95% CI 0.91-2.45, p=0.109) in DSR. The adjusted hazard ratio for revision of total shoulder arthroplasties with metal backed glenoid components compared to all-polyethylene glenoid components was 2.54 (95% CI 1.70-3.79, p < 0.001) in AOANJRR and 4.1 (95% CI 1.92-8.58, p<0.001) in DSR. ConclusionBased on data from two national shoulder arthroplasty registries, we found no significant difference in risk of revision between stemmed and stemless total shoulder arthroplasties after adjusting for the type of glenoid component. We advocate that metal-backed glenoid components should be used with caution and not on a routine basis.

Why are Joint Replacement Registries Needed?

Summary. Joint replacement registries are well established and have an important impact on decision making and clinical practice. The objective of this article was to review orthopedic registries to examine aspects of patient demographics, implant use, and revision outcomes in relation to knee replacement surgery. Six national arthroplasty registries with more than 10 years of data were selected for a review. Despite the geographic diversity, the demographics of patients referred for surgery and subcategories of surgery were remarkably similar. For cemented total knee replacement, minimally stabilized devices have been preferred in most countries, and a revision-free result can be expected in more than 94% of cases after 10 years. Partial replacements were used in 6% to 15% of primary cases and had higher revision rates than total replacements, but had lower postoperative mortality and fewer infectious complications. Patellofemoral replacements are used in 1% or less of cases and have a high revision rate.

First knee for pain and function versus second knee for quality of life.

The aim of this study was to describe and compare joint-specific and generic health-related quality of life outcomes of the first versus second knee in patients undergoing staged bilateral total knee arthroplasty (BTKA) for osteoarthritis. This retrospective cohort study used Australian national arthroplasty registry data from January 2013 to January 2021 to identify participants who underwent elective staged BTKA with six to 24 months between procedures. The primary outcome was Oxford Knee Score (OKS) at six months postoperatively for the first TKA compared to the second TKA, adjusted for age and sex. Secondary outcomes compared six-month EuroQol five-dimension five-level (EQ-5D-5L) domain scores, EQ-5D index scores, and the EQ visual analogue scale (EQ-VAS) between knees at six months postoperatively. The cohort included 635 participants (1,270 primary procedures). Preoperative scores were worse in the first knee compared to the second for all instruments; however, comparing the first knee at six months postoperatively with the second knee at six months postoperatively, the mean between-knee difference was minimal for OKS (-0.8 points; 95% confidence interval (CI) -1.4 to -0.2), EQ-VAS (3.3; 95% CI 1.9 to 4.7), and EQ-5D index (0.09 points; 95% CI 0.07 to 0.12). Outcomes for the EQ-5D-5L domains 'mobility', 'usual activities', and 'pain/discomfort' were better following the second TKA. At six months postoperatively, there were no clinically meaningful differences between the first and second TKA in either the joint-specific or overall generic health-related quality of life outcomes. However, individual domain scores assessing mobility, pain, and usual activities were notably higher after the second TKA, likely reflecting the cumulative improvement in quality of life after both knees have been replaced.

Local Validation of a National Orthopaedic Registry.

Registries are limited by the quality of the data they collect. We aimed to measure the data entry error rate at a regional orthopaedic unit in a national arthroplasty registry and to assess a proposed intervention of restricting data entry to senior trainees. A total of 200 primary and revision arthroplasty cases (119 hips, 81 knees) were randomly selected from a single year, 2020. The Irish National Orthopaedic Registry was examined for the grade of the trainee that populated the form and the accuracy of 24 parameters by comparison with data recorded elsewhere in the patient record. The mean number of errors per form was 2.17 (95% confidence interval (CI): 1.95-2.39), giving an overall error rate of 9% (95% CI: 8%-10.0%). Eighty-seven percent of forms examined contained inaccuracies, ranging from one to nine errors (4%-38%). Some parameters were more prone to errors, ranging from 1% to 28%. There was no evidence of total errors varying by trainee grade (analysis of variance (ANOVA) p-value: 0.34). Error rates were in line with the literature. Results did not support restricting data entry to senior trainees.

Initial experience with Bulgarian Arthroplasty Register.

National arthroplasty registries date back to 1975, when the Swedish Knee Arthroplasty Register was founded. This method of database collecting has since been employed for both patient follow-up and the creation of annual statistical reports. In Bulgaria, there is currently no state-approved software that offers these features.

Outcomes of total ankle replacement – Current evidence

Total ankle replacement surgery is gaining popularity and is beginning to establish itself as a viable alternative to arthrodesis in the treatment of end-stage ankle arthritis. Only a few studies exist directly comparing these 2 techniques. Also lacking are the long-term outcome studies of ankle replacement surgery. A better understanding of clinical and patient-reported outcome measures after ankle fusion and replacement will enable the surgeon to better counsel the patient and help choose the right treatment. This article will summarise the reported clinical outcomes after total ankle replacements and survivorship analysis from the various national arthroplasty registers.

Why are Joint Replacement Registries Needed? Part 2. Overview of Several National Registries of Knee Arthroplasty

Summary. Joint replacement registries are well established and have an important impact on decision making and clinical practice. The objective of this article is to review orthopedic registries to examine aspects of patient demographics, implant use, and revision outcomes in relation to knee replacement surgery. Six best known national arthroplasty registries with more than 10 years of data were selected for a review. Despite the geographic diversity, the demographics of patients referred for surgery and subcategories of surgeries were remarkably similar. For a cemented total knee replacement, minimally stabilized devices have been preferred in most countries, and a revision-free result can be expected in more than 94% of cases after 10 years. Partial replacement (lateral lateral or medial unicompartmental) was used in 6% to 15% of primary cases and had higher revision rates than total replacement, but had lower postoperative mortality and fewer infectious complications. Patellofemoral replacements are used in 1% or less of cases and have a high revision rate.

In situ fixation of slipped capital femoral epiphysis carries a greater than 40% risk of later total hip arthroplasty during a long-term follow-up.

We aimed to assess the cumulative risk of total hip arthroplasty (THA) from in situ fixation for slipped capital femoral epiphysis (SCFE) after a follow-up of almost 50 years. In this study, 138 patients with 172 affected hips treated with in situ fixation were evaluated retrospectively. A total of 97 patients (70%) were male and the mean age was 13.6 years (SD 2.1); 35 patients (25%) had a bilateral disease. The median follow-up time was 49 years (interquartile range 43 to 55). Basic demographic, stability, and surgical details were obtained from patient records. Preoperative radiographs (slip angle; SA) were measured, and data on THA was gathered from the Finnish National Arthroplasty Register. The preoperative SA was a mean of 39° (SD 19°). At follow-up, 56 of the patients had undergone THA for a hip previously fixed in situ for SCFE (41%) and 64 of all affected hips had been replaced (37%). Kaplan-Meier analysis gave a median prosthesis-free postoperative survival of 55 years (95% confidence interval (CI) 45 to 64) for the affected hips. In a multivariate analysis, female patients had a two-fold risk for THA (hazard ratio (HR) 2.42 (95% CI 1.16 to 5.07)) and a greater preoperative SA increased the risk of THA (HR 1.03 for every increment of 1° (95% CI 1.01 to 1.05)), while patient age at surgery, slip laterality, stability of slip, or diagnostic delay did not have a statistically significant effect on the risk of THA. SCFE treated primarily with in situ fixation may lead to THA in more than 40% of affected hips at a near 50-year follow-up. This risk is approximately 15-times the reported lifetime risk in the Finnish general population. Female sex and increasing preoperative SA significantly predicted higher risk of THA.

Development of application and surgical technique of total knee arthroplasties: a systematic comparative analysis using worldwide registers

PurposeThe aim was to compare total knee arthroplasty (TKA) between countries with regard to epidemiologic data and surgical technique by the use of worldwide registers and compare findings with a previous report after one decade.MethodsA systematic search was carried out in November 2022 and compared to previous reports from 2010. We extracted data regarding implanted TKAs, patients’ age distribution, procedure types, fixation and revision rates. After identification of 28 national arthroplasty registers, 8of them, namely Australia, Canada, Denmark, England and Wales, New Zealand, Norway, Scotland and Sweden, offered sufficient data and were included in final analysis.ResultsA large variation was found in the annual number of implantations per 100,000 inhabitants with a range from 77 to 210.2 (mean 132.8). The fixation type varied strongly as well, e.g. over 95% of totally cemented TKAs in Sweden versus 61.2% cemented fixation in Denmark. Another significant difference was the use of patellar resurfacing in TKA, ranging from 47.3% (Canada) using a patellar button in TKA to less than 5% (Sweden). Within the period of one decade, the mean overall number of annual implantations increased (10%), whilst relative number of revisions decreased, the use of cemented TKA decreased from 87 to 74%, and the use of patella button remained largely inhomogeneous.ConclusionComparison of arthroplasty registers revealed large differences regarding the annual number of primary TKAs per inhabitant as well as primary TKA procedure types with an increase of annual implantations, decrease of relative number of revisions, and a decrease of the use of cemented systems over the period of one decade.

Implant breakage after shoulder arthroplasty: a systematic review of data from worldwide arthroplasty registries and clinical trials

BackgroundImplant breakage after shoulder arthroplasty is a rare complication after aseptic loosening, infection or persistent pain, resulting in malfunction of the components requiring revision surgery. This correlates with a high burden for the patient and increasing costs. Specific data of complication rates and implant breakage are available in detailed arthroplasty registries, but due to the rare occurrence and possibly underestimated value rarely described in published studies. The aim of this systematic review was to point out the frequency of implant breakage after shoulder arthroplasty. We hypothesized that worldwide arthroplasty registry datasets record higher rates of implant breakage than clinical trials.MethodsPubMed, MEDLINE, EMBASE, CINHAL, and the Cochrane Central Register of Controlled Trials database were utilized for this systematic review using the items “(implant fracture/complication/breakage) OR (glenoid/baseplate complication/breakage) AND (shoulder arthroplasty)” according to the PRISMA guidelines on July 3rd, 2023. Study selection, quality assessment, and data extraction were conducted according to the Cochrane standards. Case reports and experimental studies were excluded to reduce bias. The breakage rate per 100,000 observed component years was used to compare data from national arthroplasty registries and clinical trials, published in peer-reviewed journals. Relevant types of shoulder prosthetics were analyzed and differences in implant breakage were considered.ResultsData of 5 registries and 15 studies were included. Rates of implant breakage after shoulder arthroplasty were reported with 0.06–0.86% in registries versus 0.01–6.65% in clinical studies. The breakage rate per 100,000 observed component years was 10 in clinical studies and 9 in registries. There was a revision rate of 0.09% for registry data and 0.1% for clinical studies within a 10-year period. The most frequently affected component in connection with implant fracture was the glenoid insert.ConclusionClinical studies revealed a similar incidence of implant failure compared to data of worldwide arthroplasty registries. These complications arise mainly due to breakage of screws and glenospheres and there seems to be a direct correlation to loosening. Periprosthetic joint infection might be associated with loosening of the prosthesis and subsequent material breakage. We believe that this analysis can help physicians to advise patients on potential risks after shoulder arthroplasty.Level of evidenceIII.