Centre of excellence of joint replacements

Transcription

1 REPORT 2005 Centre of excellence of joint replacements The Norwegian Arthroplasty Register The Norwegian Cruciate Ligament Register The Norwegian Hip Fracture Register Helse-Bergen HF, Department of Orthopaedic Surgery Haukeland University Hospital Report in Norwegian: ISBN-3: , ISBN-0: ISSN:

2

3 The Norwegian Arthroplasty Register Contents Preface The Norwegian Arthroplasty Register Hip prostheses Number of total hip replacements by year of operation Incidence of primary total hip replacements by gender and age (995, 2000) Hip disease 2 Patient age by year of operation 2 Reason for revision 3 Type of revision 4 Bone transplant 4 Operative approach 5 Trochanteric osteotomy 5 Systemic antibiotic prophylaxis 5 Cement 6 Cement and bone transplant in revisions 7 Cement brands 8 Common combinations of prosthesis brands (acetabulum and femur) 0 Prosthesis brands, acetabulum 3 Prosthesis brands, femur 5 Monoblock and modular caput 7 Caput diameter in modular prostheses 8 Prosthesis brands, modular caput 9 Kaplan-Meier survival curves by year of operation and use of cement 2 Knee prostheses Number of knee replacements by year of operation 23 Incidence of primary knee replacements by gender and age (995, 2000) 23 Number of knee replacements by year of operation and type of prosthesis 24 Knee disease 25 Cement 27 Prosthesis brands 29 Reason for revision 36 Patient age by year of operation 37 Type of revision 38 Kaplan-Meier survival curves by year of operation and type of prosthesis 4 Other prostheses Number of wrist replacements by year of operation 43 Number of elbow replacements by year of operation 43 Number of ankle replacements by year of operation 43 Number of finger joint replacements by year of operation 43 Number of carpometacarpal (CMC I) replacements by year of operation 44 Number of back joint replacements by year of operation 44 Number of shoulder replacements by year of operation 44 Number of toe joint replacements by year of operation 44 Kaplan-Meier survival curves 45 List of publications 47

4 Report 2005

5 The Norwegian Arthroplasty Register ANNUAL REPORT June 2005 THE NORWEGIAN ARTHROPLASTY REGISTER The Norwegian Arthroplasty Register started registration of total hip replacements in 987. In 994, registration was extended to include insertion of all types of artificial joints. The main reason for establishing a nation-wide register was that throughout the 970ies, new hip implants had been introduced without documentation from clinical studies. After being used for more than 0 years, several of the prostheses were identified with high failure rates, but had at the time already been used on large numbers of patients. The main purpose of the register is to function as a surveillance tool to identify inferior implants as early as possible. The orthopaedic surgeons provide information on all primary joint replacements, including an accurate description of the different parts of the implant. If the prosthesis is later revised (the implant is removed or exchanged), the register receives a new report with information about the reason for and the type of revision. Information regarding the two procedures is linked using the personal identification number assigned to all inhabitants of Norway. The quality of an implant can then be evaluated based on the time periods from implantation to revision. Throughout the registration period 987 to 2004, information has been registered on about hip replacements, knee replacements and more than prostheses in other joints than hip and knee. With 4.56 million inhabitants in 2003, the overall incidence per 00,000 persons was 52 primary total hip replacements and 67 primary knee replacements. CENTRE OF EXCELLENCE The Norwegian Ministry of Health approved the Norwegian Arthroplasty Register as a national centre of excellence of joint replacements in THE NORWEGIAN CRUCIATE LIGAMENT REGISTER The Norwegian Cruciate Ligament Register was established in June 2004 after an initiative from the Oslo Sports Trauma Research Center. The new register is located at the Norwegian Arthroplasty Register. There are large variations in how anterior cruciate ligament (ACL) injuries are treated and long-term outcomes are uncertain, especially when it comes to the effect of ACL surgery on the development of osteoarthritis in the knee. There is currently no agreement on whether an athlete should return to his or her sport after injury, or if returning, when this should happen. These are questions that may be answered based on information reported to the register.

6 Report 2005 THE NORWEGIAN HIP FRACTURE REGISTER About hip fractures are treated annually in Norway, but knowledge on outcome following the different treatment options is scarce. This was the background for establishing a national hip fracture register. The Norwegian Hip Fracture register is located at the Norwegian Arthroplasty Register and started collecting information January PUBLICATIONS Annual reports: The register publishes annual reports with mainly descriptive information regarding national data on operating volumes, use of different types of prostheses and cements, and other characteristics of the procedure. In addition, annual reports are sent to each hospital with confidential information on intern production and results from analyses showing the duration of the implants. The information is compared against the average results for all hospitals. Peer-reviewed papers: Comparative studies, for instance of the quality of different types of prostheses, are presented in scientific lectures and journals. A full list of our publications can be found in this report and on our web-site ( STAFF AND BOARDS Staff at the registers - Ove Furnes, head of the Arthroplasty register, orthopaedic surgeon, MD, PhD - Professor Leif Ivar Havelin, orthopaedic surgeon, MD, PhD - Professor Lars Birger Engesæter, orthopaedic surgeon, MD, PhD - Geir Hallan, orthopaedic surgeon, MD - Birgitte Espehaug, statistician, MSc, PhD - Anne Marie Fenstad, statistician, MSc - Stein Atle Lie, statistician, MSc, PhD - Kjersti Steindal, computer engineer, MSc - Tor Egil Sørås, computer engineer - Ingunn Vindenes, secretary (contact for the Arthroplasty register, hip) - Inger Skar, secretary (contact for the Arthroplasty register, knee and other joints) - Ruth Wasmuth, secretary (contact for the Cruciate ligament register) - Marianne Wiese, secretary - Lise Bjordal Kvamsdal, project coordinator (contact for the Hip fracture register) Leif I. Havelin, Ove Furnes, Lars B. Engesæter and Geir Hallan share a position as orthopaedic surgeon at the Arthroplasty register. Co-workers: Professor Stein Emil Vollset, MD, DrPH from the Division of epidemiology and medical statistics, Department of public health and primary health care, University of Bergen, provides counseling in statistics and scientific issues. The orthopaedic surgeons Jan Erik Gjertsen, Tarjei Vinje and Jonas Fevang works with the Hip fracture register, and Torbjørn Strand provides counseling at the Cruciate ligament register.

7 The Norwegian Arthroplasty Register Board of the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register - Professor Lars Birger Engesæter (head of the board) - Professor Leif Ivar Havelin - Professor Lars Nordsletten, orthopaedic surgeon, MD, PhD, Ullevål University Hospital, Oslo - Arild Aamodt, orthopaedic surgeon, MD, PhD, St. Olavs Hospital, Trondheim - Professor emeritus Einar Sudman, orthopaedic surgeon, MD, PhD, University of Bergen. Einar Sudmann was the initiator of the register and is an honorary member of the board Board of the Norwegian Cruciate Ligament Registry - Professor Lars Engebretsen (head of the board), orthopaedic surgeon, MD, PhD, Ullevål University Hospital, Oslo - Torbjørn Strand, orthopaedic surgeon, Haraldsplass diakonale hospital, Bergen - Torbjørn Grøntvedt, orthopaedic surgeon, MD, PhD, St. Olavs Hospital, Trondheim - Professor Arne Ekeland, orthopaedic surgeon, MD, PhD, Martina Hansens Hospital, Oslo - Professor Roald Bahr, MD, PhD, University of Sport and Physical Education, Oslo - Professor Ingar Holme, MD, PhD, University of Sport and Physical Education, Oslo ACKNOWLEDGMENTS The Norwegian Arthroplasty Register would like to thank orthopaedic surgeons at all hospitals in Norway, Helse Bergen and Helse Vest, all product distributors and the Norwegian Health Authorities, for their co-operation throughout the years the register has been in function. Thanks also to all co-operative partners at Locus for registry-based epidemiology, the University of Bergen, Oslo Sports Trauma Research Center at the Norwegian University of Sport and Physical Education, the Norwegian Patient Register and SINTEF Unimed. Bergen Ove Furnes Leif Ivar Havelin Birgitte Espehaug Head, chief surgeon Professor, chairman Statistician Anne Marie Fenstad Statistician Kjersti Steindal Computer engineer

8 Report 2005

9 The Norwegian Arthroplasty Register Hip prostheses Operation Primary operation % % 84.2% % % % % % Revision % % 5.8% % % % % % Registration complete from Number of operations Year of operation Primary operations Revisions 55.2% of the operations was performed on the right hip. 69.% of the operations were performed on females Mean age was 69.4 years. Incidence of primary hip prostheses Number of operations per inhabitants < > 79 Age Females 995 Females 2000 Males 995 Males 2000 Hip

10 Report 2005 Hip disease Hip disease Primary osteoarthritis Rheumatoid arthritis Fract. of the femoral neck Congenital dysplasia Congenital dislocation Epiphysiol./Perthes' disease Ankylosing spondylitis Acute fract. of the femur Other Missing information % % % % 272.8% 88.2% 6 0.4% % % 69.% % 70.8% % 3.3% %.6% % 7.0% % 0.6% %.3% % 0.5% % 0.7% % 3.3% %.% % % % % 3 0.5% 8.3% % % % % % % % 82.3% % % % % % % % % 69.0% % 77.% % % % % 8 0.3% 4 0.2% % % % 8 0.3% 86.4% 8 0.3% 86.4% % % % % % % 92.3% % % % % 9367 Age by year of operation Proportion (%) of primary operations Year of operation 2 Hip

11 The Norwegian Arthroplasty Register Reason for revision Reason for revision Acetabular loosening Femoral loosening Dislocation Deep infection Fracture of femur Pain Osteolysis, no loosening Polyethylene wear Previous Girdlestone Other Missing information Revision causes are not mutually exclusive Proportion (%) of revisions Year of operation Acetabular loosening Femoral loosening Dislocation Deep infection Fracture of femur Pain Osteolysis and w ear Other Hip 3

12 Report 2005 Type of revision Type of revision Exchange, acetabulum 2.7% 6.7% 0.3% 0.2% 4.6% 9.0% 2.9% Exchange, caput 0.% 0.4%.5% 2.5% 2.% 3.6% 4.% Exchange, caput and acetab. 0.7% 2.9% 4.4% 9.5% 4.4% 3.% 9.8% Exchange, PE liner 0.2% 0.5% 0.8% 0.6%.2%.% Exchange, PE liner and caput 0.3% 4.0% 5.% 5.9% 4.8% 4.9% Exchange, PE liner and femur 0.%.%.7%.8% 2.%.7% Exchange, femur 22.9% 26.2% 2.5% 2.0% 8.8% 7.% 3.7% Exchange, all components 58.6% 45.4% 37.4% 30.8% 3.2% 28.0% 29.2% Removal, femur 0.% 0.5% 0.3% 0.5% 0.% 0.2% Girdlestone 2.5% 4.3% 4.4% 4.8% 4.9% 6.% 7.9% Previous Girdlestone 0.6%.7% 3.6% 2.8% 2.5% 2.2% 2.% Other operation 0.7%.0%.0% 0.8% 2.4% 2.7%.7% Missing information.% 0.% 0.% 0.2% 0.5% %.4% 9.7% 0.5% 2.7% 0.8% 22.% 40.9% 0.3% 4.5% 2.3%.2% 0.3% 5349 Bone transplant Primary operation Bone transplant No 86.7% 9.3% 9.5% 89.7% 89.7% 90.5% 90.2% In acetabulum 7.0% 5.8% 5.7% 7.5% 6.9% 6.0% 5.7% In femur 3.%.2% 0.5% 0.4% 0.3% 0.3% 0.4% In acetabulum and femur 2.3% 0.9% 0.2% 0.2% 0.2% 0.% 0.% Bonepacking in acetabulum 0.5% 0.4% 0.7% 0.6% 0.9% Bonepacking in femur 0.% 0.% 0.% Bonepacking in acet. and fem. Missing information 0.9% 0.8%.4%.8% 2.0% 2.4% 2.6% % 6.2%.% 0.7% 0.3%.4% 9367 Revision Bone transplant No 63.0% 53.8% 39.0% 4.5% 47.3% 48.7% 44.6% In acetabulum 9.0% 8.4% 2.6% 2.7% 2.9% 2.6% 2.3% In femur 9.2% 3.8% 2.3% 8.8% 0.% 8.5% In acetabulum and femur 7.3%.6% 9.7% 7.0% 9.% 3.9% 4.6% Bonepacking in acetabulum 6.6% 9.2% 7.6% 2.0% 2.% Bonepacking in femur 0.%.%.2% 8.9% 7.0% 7.6% Bonepacking in acet. and fem. 6.3% 5.%.5% 2.7% 5.3% Missing information.5% 2.3% 2.3% 3.3% 3.9% 3.0% 4.9% % 5.2%.5% 9.0% 4.7% 5.8% 2.9% 2.6% Hip

13 The Norwegian Arthroplasty Register Operative approach Approach Smith-Petersen 0.2% 0.4% 0.2% 0.2% 0.2% 0.2% 0.% Anterolateral 7.4% 5.7% 8.0% 7.7% 7.6% 9.2% 7.4% Lateral 62.5% 69.% 68.7% 69.0% 69.5% 68.7% 69.7% Posterolateral 29.% 24.2% 22.6% 22.3% 2.5% 20.8% 22.% Other 0.2% 0.2% 0.3% 0.4% 0.% 0.% Missing information 0.8% 0.5% 0.4% 0.7% 0.8%.0% 0.6% % 7.3% 67.9% 23.8% 0.2% 0.6% 0676 Trochanteric osteotomy Troc. osteotomy No 74.9% 86.2% 93.4% 94.7% 94.2% 94.3% 95.% Yes 23.8% 2.9% 5.6% 3.9% 4.2% 3.8% 3.2% Missing information.3% 0.9% 0.9%.4%.6%.9%.7% %.2% 0676 Systemic antibiotic prophylaxis Primary operation Systemic antibiotic No 9.6%.4% 0.% 0.2% 0.% Yes 90.3% 98.5% 99.8% 99.8% 99.9% 0 0 Missing information 0.2% 0.% % 97.9% 0.% 9367 Revision Systemic antibiotic No 4.9%.6% 0.6% 0.3%.% 0.8% 0.5% Yes 94.7% 98.2% 99.2% 99.6% 98.6% 98.5% 98.9% Missing information 0.5% 0.3% 0.% 0.% 0.3% 0.7% 0.5% % 98.2% 0.3% 5349 Hip 5

14 Report 2005 Use of cement in primary operations 00 % Proportion of primary operations 80 % 60 % 40 % 20 % 0 % Year of operation Cemented (containing antibiotic) Cemented (plain) Uncemented Hybrid, cemented femur Hybrid, cemented acetabulum Other/Missing information Use of cement in revisions Acetabulum Use of cement With antibiotic 66.5% 52.9% 59.0% 59.8% 64.7% 68.% 66.2% Without antibiotic 3.0%.7% 0.4% 2.6% 0.8% 0.5% 0.2% Uncemented 28.4% 44.4% 40.5% 37.5% 34.5% 3.4% 33.6% Missing information 2.2%.0% 0.2% 0.2% %.3% 38.% 0.7% 0392 Femur Use of cement With antibiotic 72.3% 62.6% 64.7% 59.5% 60.6% 60.3% 53.9% Without antibiotic 3.7% 4.2% 0.5%.3%.2% 0.4% Uncemented 20.3% 3.8% 34.4% 38.9% 38.2% 39.3% 46.% Missing information 3.7%.5% 0.5% 0.2% % 2.3% 32.%.3% Hip

15 The Norwegian Arthroplasty Register Use of cement and bone transplant in revisions Cemented acetabulum Bone transplant No 76.6% 69.% 5.7% 47.3% 52.3% 5.0% 45.0% Bone transplant 22.2% 29.4% 2.2% 9.9% 27.5% 8.0% 7.2% Bonepacking 0.2% 26.6% 3.4% 9.4% 30.% 36.3% Missing information.2%.4% 0.6%.4% 0.7% 0.9%.5% % 5.7%.0% 6362 Uncemented acetabulum Bone transplant No 33.8% 35.5% 4.0% 45.9% 56.% 59.8% 55.0% Bone transplant 64.9% 62.3% 49.% 45.0% 38.8% 35.3% 37.3% Bonepacking 0.% 8.6% 6.8% 3.3% 3.4% 4.8% Missing information.2% 2.%.3% 2.3%.9%.5% 2.9% % 53.2% 3.9%.7% 3959 Cemented femur Bone transplant No 92.% 78.9% 49.4% 53.2% 59.% 6.3% 47.% Bone transplant 6.2% 9.2% 7.2% 0.%.6% 0.7% 5.8% Bonepacking 0.% 32.6% 35.4% 26.3% 26.7% 45.8% Missing information.7%.8% 0.9%.3% 3.%.3%.3% % 4.2% 5.5%.5% 685 Uncemented femur Bone transplant No 3.0% 33.9% 26.7% 36.6% 4.9% % Bone transplant 68.4% 64.4% 55.6% 45.0% 50.5% 42.3% 37.6% Bonepacking 0.2% 6.% 5.8% 5.6% 6.2% 3.9% Missing information 0.5%.6%.6% 2.5% 2.0%.5% 2.9% % 57.0% 7.3%.6% 330 Hip 7

16 Report 2005 Cements used in primary operations and in revisions Acetabulum Cement Allofix-G w/gentamycin Boneloc CMW I CMW I w/gentamycin CMW II CMW III CMW III w/gentamycin % 6.0%.%.% 0.2%.5%.5% 0.% 2.8% 2.7% 0.3% Copal w/gentamycin+clindam 0.% Palacos 4.4% 3.8% 4.9%.4% 2.3% 0.% 0.% Palacos E-Flow 0.2% 0.2% Palacos w/gentamycin 46.5% 48.4% 73.4% 89.7% 90.6% 9.8% 82.0% Palamed G w/gentamycin 0.% Refobacin-Palacos 0.3% 0.% 0.2% 0.% 8.7% Simplex 7.7% 4.8% 3.5%.9% 2.0%.2% 5.4% Simplex w/erythr.+colistin.9% 0.6% 5.4% 6.4% 0.3% Simplex w/tobramycin 4.5% 6.5% 3.7% Smartset HV 0.% Sulfix-6 Missing information 0.2% 0.% 0.% 0.2% 0.% 0.% 0.% %.6% 5.9% 3.8%.2% 0.% 7.7% 0.% 66.8% 0.7% 8.5% 2.5%.% 0.% Hip

17 The Norwegian Arthroplasty Register Cements used in primary operations and in revisions Femur Cement Boneloc CMW 2000 CMW I CMW I w/gentamycin CMW II CMW III CMW III w/gentamycin % 5.9% 9.5%.% 0.2%.6%.% 6.8% 4.2% 0.8% Copal w/gentamycin+clindam Palacos 2.4% 2.6% 4.4%.3% 2.3% 0.% 0.% Palacos E-Flow 0.2% 0.2% Palacos w/gentamycin 47.5% 48.5% 73.4% 88.6% 90.3% 9.4% 8.% Palamed G w/gentamycin 0.% Refobacin-Palacos 0.3% 0.% 0.2% 0.% 9.% Simplex 7.% 5.3% 4.0% 2.6%.9%.2% 5.6% Simplex w/erythr.+colistin.7%.0% 6.0% 7.2% 0.4% 0.% 0.% Simplex w/tobramycin 4.7% 6.8% 3.9% Smartset HV 0.% Sulfix-6 Zimmer Missing information 0.3% 0.% 0.% 0.% 0.3% 0.2% % 5.2% 3.8% 2.3% 0.2% 7.0% 0.% 66.2% 0.7% 8.9% 2.9%.0% 0.% Hip 9

18 Report 2005 Cemented primary prostheses (n>50) 987- Acetabulum Femur CHARNLEY CHARNLEY EXETER EXETER TITAN TITAN REFLECTION (cem.) SPECTRON SPECTRON ITH SP SP KRONOS TITAN ELITE CHARNLEY REFLECTION (cem.) ITH REFLECTION (cem.) BIO-FIT ZCA CPT WEBER ALLO PRO MS ELITE TITAN SP IP LUBINUS ELITE ELITE TITAN FJORD SPECTRON SP 89 MODULAR HIP SYSTEM BIO-FIT SPECTRON TITAN CHARNLEY ELITE CHARNLEY C-STEM CHARNLEY EXETER PEARL TITAN OPERA SPECTRON MODULAR HIP SYSTEM ITH CONTEMPORARY EXETER SPECTRON BIO-FIT 37 LMT LMT 85 ELITE MS MÜLLER TYPE MÜLLER TYPE 53 ZCA CPS-PLUS PE-PLUS CPS-PLUS ELITE EXETER MODULAR HIP SYSTEM WATSON FARRAR LMT 83 SP ELITE CPT REFLECTION (cem.) TITAN ELITE C-STEM 5 3 EUROPEAN CUP SYSTEM LMT 62 ZCA TITAN MÜLLER MÜLLER TYPE V 66 ELITE SPECTRON EXETER CPS-PLUS SCAN HIP SCAN HIP TITAN CORAIL CHARNLEY CPT MÜLLER TYPE MÜLLER TYPE V Hip

19 The Norwegian Arthroplasty Register Uncemented primary prostheses (n>50) 987- Acetabulum Femur TROPIC CORAIL ATOLL CORAIL IGLOO FILLER TRILOGY CORAIL GEMINI PROFILE DURALOC PROFILE DURALOC CORAIL BICON-PLUS ZWEYMÜLLER TRILOGY SCP BICON-PLUS HACTIV REFLECTION (uncem.) CORAIL DURALOC SCP ENDLER ZWEYMÜLLER 242 EUROPEAN CUP SYSTEM LMT 88 LMT LMT 27 TI-FIT BIO-FIT 73 TITAN CORAIL SECURFIT OMNIFIT ABG I ABG I HARRIS/GALANTE HARRIS/GALAN 33 COXA FEMORA 20 PARHOFER PARHOFER ABG II ABG II OMNIFIT OMNIFIT TRILOGY BICONTACT IGLOO CORAIL TRI-LOCK PLUS PROFILE ABG II ABG I REFLECTION (uncem.) TI-FIT TRILOGY ANATOMIC HIP IGLOO KAREY OPTI-FIX TI-FIT TROPIC ZWEYMÜLLER PLASMACUP BICONTACT PCA PCA DURALOC ABG I Hip

20 Report 2005 Hybrid primary prostheses, cemented femur (n>50) Acetabulum Femur TROPIC TITAN MOSCHER MS ENDLER TITAN TRILOGY CHARNLEY TRILOGY EXETER DURALOC CHARNLEY REFLECTION (uncem.) BIO-FIT REFLECTION (uncem.) SPECTRON SP SP 84 ATOLL TITAN TRILOGY CPT HG II ANATOMIC CC GEMINI CHARNLEY TI-FIT BIO-FIT Hybrid primary prostheses, uncemented femur (n>50) 987- Acetabulum Femur ELITE CORAIL TITAN CORAIL REFLECTION (cem.) CORAIL EXETER ABG II Hip

21 The Norwegian Arthroplasty Register Prosthesis ABG I Acetabular prostheses in primary operations ABG II ATOLL BICON-PLUS CHARNLEY CONTEMPORARY COXA DURALOC ELITE ENDLER EUROPEAN CUP SYSTEM EXETER GEMINI HARRIS/GALANTE HG II IGLOO KRONOS LMT LMT (cem.) MODULAR HIP SYSTEM MOSCHER MÜLLER MÜLLER TYPE OMNIFIT OPERA OPTI-FIX PARHOFER PCA PEARL PE-PLUS PLASMACUP 2 REFLECTION REFLECTION (cem.) SCAN HIP 58 3 SECURFIT SHP SP SPECTRON TI-FIT TITAN TRI-LOCK PLUS 57 4 TRILOGY TROPIC WATSON FARRAR 87 3 WEBER ALLO PRO ZCA Missing/Uncommon (n<50) Hip 3

22 Report 2005 Prosthesis Acetabular prostheses in revisions ABG II ATOLL AVANTAGE BICON-PLUS CAPTIV 2 2 CHARNLEY CHRISTIANSEN COXA DURALOC ELITE ENDLER EUROPEAN CUP SYSTEM EXETER GEMINI HARRIS/GALANTE HG II IGLOO KRONOS LMT LMT (cem.) MODULAR HIP SYSTEM MÜLLER TYPE OCTOPUS OMNIFIT 6 4 OPERA OPTI-FIX ORIGINAL M.E. MÜLLER PARHOFER PCA PEARL REFLECTION REFLECTION (cem.) SCAN HIP SECURFIT SP SPECTRON S-ROM TI-FIT 3 5 TITAN TRI-LOCK PLUS 6 9 TRILOGY TROPIC WEBER ALLO PRO ZCA Missing/Uncommon (n<5) Not revised Hip

23 The Norwegian Arthroplasty Register Prosthesis ABG I Femoral prostheses in primary operations ABG II ANATOMIC HIP BICONTACT BI-METRIC BIO-FIT BIO-FIT (cem.) CENTRALIGN CHARNLEY CORAIL CPS-PLUS CPT C-STEM ELITE EXETER FEMORA 4 4 FILLER FJORD HACTIV HARRIS/GALANTE 38 3 IP LUBINUS ITH KAR KAREY LONGEVITY MS MÜLLER TYPE MÜLLER TYPE V OMNIFIT PARHOFER PCA PROFILE SCAN HIP SCP SP SPECTRON TAPERLOC TAPERLOC (cem.) TI-FIT TITAN ZWEYMÜLLER Missing/Uncommon (n<50) Previous femur prosthesis Hip 5

24 Report 2005 Prosthesis Femoral prostheses in revisions ANATOMIC BR BI-METRIC BIO-FIT 39 BIO-FIT (cem.) CENTRALIGN 0 2 CHARNLEY CORAIL CPT ECHELON ELITE EXETER FEMORA 37 6 FILLER FJORD HARRIS/GALANTE IP LUBINUS ITH KAR LANDOS (Reconstruction) MS MÜLLER TYPE MÜLLER TYPE V OMNIFIT PARHOFER PROFILE REEF SCAN HIP SP SPECTRON TAPERLOC TAPERLOC (cem.) TI-FIT TITAN ZWEYMÜLLER Missing/Uncommon (n<5) Not revised Hip

25 The Norwegian Arthroplasty Register Monoblock and modular caput Cemented femur Caput Monoblock Modular Missing information Uncemented femur Caput Monoblock Modular Missing information Proportion (%) of femoral prostheses Year of operation % Modular in cemented femur % Modular in uncemented femur Hip 7

26 Report 2005 Caput diameter in modular prostheses Diameter mm mm mm mm mm mm Other Missing information Proportion (%) of femoral prostheses with modular caput Year ofoperation 26mm 28mm 30mm 32mm Other/Missing information 8 Hip

27 The Norwegian Arthroplasty Register Prosthesis Modular caput prostheses, all operations ABG I ABG II ALLO PRO 3 3 BICONTACT BIOLOX BIOTECHNI CERAMIC OSTEO CERAMTEC CHRISTIANSEN CPT ELITE EXETER FEMORA FJORD HARRIS/GALANTE HASTINGS HIP IGLOO KOTZ LANDOS LINK Rippensystem 20 8 MALLORY-HEAD OMNIFIT PARHOFER PCA PE-PLUS PLUS ENDO PROFILE PROTEK SCANOS SP SURGIVAL TAPERLOC TI-FIT UNIVERSAL VERSYS WEBER 9 8 ZIRCONIA ZWEYMÜLLER Missing/Uncommon (n<5) Not revised Hip 9

28 Report Hip

29 The Norwegian Arthroplasty Register ALL PROSTHESES CEMENTED Prosthesis survival (%) RR (p-value) Prosthesis survival (%) RR (p-value) (<0.00) 0.9 (<0.00) (<0.00). (0.09) (<0.00) (<0.00) (<0.00) (0.04) Years to failure Years to failure UNCEMENTED HYBRID CEMENTATION Prosthesis survival (%) RR (p-value) Prosthesis survival (%) Cemented femur RR (p-value) Cem. acetabulum (Few obs. before 2000) Cem. femur (0.00) 0.5 (<0.00) 0.3 (<0.00) (0.7) 0.8 (0.) 0.7 (0.05) (<0.00) (0.7) Years to failure Risk ratio (RR) adjusted for age and gender Years to failure 25 Hip 2

30 Report Hip

31 The Norwegian Arthroplasty Register Knee prostheses Operation Primary operation % % % % % % % Revision 60 7.% % % % % % % Number of operations Year of operation Primary operations Reoperations 54.3% of the operations was performed on the right hip. 70.6% of the operations was performed on females. Mean age was 69.8 years. Incidence of primary knee prostheses 350 Number of operations per inhabitants < > 79 Age Females 995 Males 995 Females 2000 Males 2000 Knee 23

32 Report 2005 Knee prostheses Insertion of total prostheses with patella Operation Primary operation Insertion of total protheses without patella Operation Primary operation Insertion of unicondylar prostheses Operation Primary operation Insertion of patellofemoral prostheses Operation Primary operation Reoperation with removal of all prosthesis components Operation Revision Proportion (%) of primary operations Year of operation w ith patella w ithout patella Unicondylar Patellofemoral 24 Knee

33 The Norwegian Arthroplasty Register Knee disease in primary total knee prostheses Knee disease Primary osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Sequelae, meniscal tear Acute fracture Sequelae, infection Other Missing information Operation causes are not mutually exclusive. 00 Proportion (%) of primary operations Year of operation Primary osteoarthritis Rheumatoid arthritis Sequelae after fracture Ankylosing spondylitis Sequelae, ligament tear Sequelae, meniscal tear Acute fracture Sequelae, infection Other Missing information Knee 25

34 Report 2005 Knee disease in primary unicondylar knee prostheses Knee disease Primary osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Sequelae, meniscal tear Sequele, infection Other Missing information Operation causes are not mutually exclusive. 00 Proportion (%) of primary operations Year of operation Primary osteoarthritis Sequelae after fracture Sequelae, meniscal tear Other Missing information 26 Knee

35 The Norwegian Arthroplasty Register Use of cement in primary total knee prostheses Femur Use of cement With antibiotic Without antibiotic Uncemented Missing information 69.5% 85.0% 85.5% 83.% 87.0% 84.7% 83.4% 5.9% 3.% 2.6% 2.4% 0.5% 3.5% 4.2%.7%.9% 4.4% 2.5% 5.2% 2.9% 0.4% 0.2% 0.% 0.% 0.% 0.% Tibia Use of cement With antibiotic 78.6% 95.0% 96.5% 96.3% 98.2% 98.8% 94.6% Without antibiotic 6.5% 3.0% 2.5% 2.% 0.4% 3.5% Uncemented 4.4%.8% 0.9%.5%.0%.%.7% Missing informationr 0.5% 0.2% 0.2% 0.% 0.4% 0.% 0.2% Patella Use of cement With antibiotic Without antibiotic Uncemented Missing information 72.7% 92.2% 90.7% 86.3% 92.4% 80.3% 87.3% 3.0% 5.2% 6.3%.0% 4.6% 6.7% 4.7% 3.6% 7.4% 6.6% 9.7% 7.9% 0.6% 0.% 0.4% 0.2% Knee 27

36 Report 2005 Use of cement in revision total knee prostheses Femur Use of cement With antibiotic Without antibiotic Uncemented Missing information 88.4% 92.% 92.2% 93.5% 9.9% 94.6% 92.4% 5.8%.9%.9%.% 0.8%.6% 4.3% 5.4% 5.8% 5.4% 7.3% 5.4% 5.6%.4% 0.6% 0.4% Tibia Use of cement With antibiotic Without antibiotic Uncemented Missing information 92.% 96.5% 98.2% 97.3% 98.6% 99.4% 97.3% 3.9% 2.7% 0.9% 0.9% 0.7%.6%.3% 0.3% 0.9% 0.3% 2.6% 0.5% 0.9% 0.9% 0.7% 0.6% 0.8% Patella Use of cement With antibiotic Without antibiotic Uncemented Missing information 83.6% 96.6% 98.4% 98.2% 98.6% 98.7% 95.9% 5.5% 2.2%.4%.8% 5.5%.%.6%.3%.5% 5.5%.8% 0.8% Knee

37 The Norwegian Arthroplasty Register knee prostheses Femoral prostheses inserted in primary operations Prosthesis Advance AGC Dual Articular 2000 Duracon E-motion Freemann/Samuelson Genesis I Interax I.S.A Kinemax Kotz LCS LCS Complete LCS Universal 3 Maxim MG II NexGen PFC-Sigma Profix SCAN Search Tricon -C Tricon M Knee 29

38 Report 2005 knee prostheses Femoral prostheses inserted in revisions Prosthesis Accord 7 8 AGC Blauth 2 3 Dual Articular Duracon Genesis I Guepar 2 2 Interax I.S.A. 3 3 Kinemax Kinemax Rotat. Hinge 2 3 Kotz LCS LCS Complete 6 6 LCS Universal Link endo-model 4 4 Modular Rotat. Hinge 2 NexGen Profix Search S-ROM Rotat. Hinge 3 Tricon -C Tricon M Tricon revision Knee

39 The Norwegian Arthroplasty Register knee prostheses Tibial prostheses inserted in primary operations Prosthesis Advance AGC Dual Articular 2000 Duracon E-motion Freemann/Samuelson Genesis I Interax I.S.A Kinemax Kotz LCS LCS Complete LCS Universal Maxim 2 MG II NexGen PCA-Duracon PFC-Sigma Profix SCAN Search Tricon -C 6 6 Tricon II Knee 3

40 Report 2005 knee prostheses Tibial prostheses inserted in revisions Prosthesis Accord AGC Dual Articular Duracon Genesis I Guepar Interax I.S.A. 3 3 Kinemax Kotz 2 5 LCS LCS Complete 6 6 LCS Universal 4 7 Maxim Modular Rotat. Hinge 2 NexGen PCA-Duracon 3 3 Profix Search S-ROM Rotat. Hinge 3 Tricon II Knee

41 The Norwegian Arthroplasty Register knee prostheses Patella prostheses inserted in primary operations Prostheses Advance 2 AGC Duracon Freemann/Samuelson Genesis I Kinemax Kotz LCS LCS Complete 7 7 NexGen Profix Tricon II Patella prostheses inserted in revisions Prostheses Accord 5 5 Advance 2 2 AGC Blauth 2 Duracon Genesis I Kinemax Kotz 2 2 LCS LCS Complete 4 4 LCS Universal 2 NexGen PCA-Duracon Profix Tricon II Knee 33

42 Report 2005 Unicondylar knee prostheses Femoral prostheses inserted in primary operations Prostheses "Marmor-protese" Duracon Genesis UNI LINK Schlitten UNI Miller/Galante UNI MOD III Oxford UNI (II) Oxford UNI (III) Patella Mod III / II Preservation Tibial prostheses inserted in primary operations Prostheses Duracon Genesis UNI LINK Schlitten UNI Miller/Galante UNI MOD III Oxford UNI (II) Oxford UNI (III) Preservation Knee

43 The Norwegian Arthroplasty Register Patellofemoral prostheses Femoral prostheses inserted in primary operations Prostheses LCS PFJ 2 3 Link Lubinus patella 2 3 Patella Mod III / II Patella prostheses inserted in primary operations Prostheses LCS PFJ 2 3 Link Lubinus patella 2 3 Patella Mod III / II Knee 35

44 Report 2005 Reason for revision of total knee prostheses with patella by year of primary operation Reason for revision Loose proximal comp. Loose distal comp. Loose patella comp. Dislocation of patella Dislocation (not patella) Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene Other Missing information Revision causes are not mutually exclusive Reason for revision of total knee prostheses without patella by year of primary operation Reason for revision Loose proximal comp. Loose distal comp. Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene Other Missing information Revision causes are not mutually exclusive Knee

45 The Norwegian Arthroplasty Register Reason for revision of unicondylar knee prostheses by year of primary operation Reason for revision Loose proximal comp. Loose distal comp. Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene Other Missing information Revision causes are not mutually exclusive. Age by year of operation 60 Proportion (%) of primary operations Year of operation Knee 37

46 Report 2005 Type of reoperation among total knee prostheses with patella by year of primary operation Type of reoperation Exchange, distal Exchange, proximal Exchange, whole prosthesis Exchange, patella Exchange, tibial ins. Exchange, distal+proximal Exchange, distal+tibial ins. Exchange, distal+patella Exchange, proximal+tibial ins. Exchange, patella+tibial ins. Removal, prosthetic part(s) Removal, whole prosthesis Amputation Arthrodesis Other operation Missing information % 5 % 22 % 3 % % % 3 % 3 % 4 % 5 % % Exchange, distal Exchange, whole prosthesis Exchange, tibial insert Exchange, proximal+tibial insert Removal, w hole prosthesis Missing information Exchange, proximal Exchange, patella Exchange, distal+proximal Removal, prosthetic part(s) Other operation 38 Knee

47 The Norwegian Arthroplasty Register Type of reoperation among total knee prostheses without patella by year of primary operation Type of reoperation Exchange, distal Exchange, proximal Exchange, whole prosthesis Exchange, tibial ins. Exchange, distal+proximal Exchange, distal+tibial ins. Exchange, proximal+tibial ins. Exchange, tibial ins.+ins.patella Insertion of patella Removal, prosthetic part(s) Removal, whole prosthesis Arthrodesis Other operation Missing information % 3 % 9 % % 3 % 4 % 4 % 2 % 38 % % 3 % 3 % Exchange, distal Exchange, whole prosthesis Exchange, distal+tibial insert Exchange, tibial insert+ins. of patella Removal, prosthetic part(s) Other operation Exchange, proximal Exchange, tibial insert Exchange, proximal+tibial insert Insertion of patella Removal, w hole prosthesis Missing information Knee 39

48 Report 2005 Type of revision among unicondylar knee prostheses by year of primary operation Type of revision Exchange, distal Exchange, proximal Exchange, whole prosthesis Exchange, tibial ins. Exchange, distal+proximal Exchange, distal+tibial ins. Exchange, proximal+tibial ins. Removal, whole prosthesis Other operation Missing information % 4 % 5 % 3 % 4 % 3 % 75 % Exchange, distal Exchange, w hole prosthesis Removal, w hole prosthesis Missing information Exchange, proximal Exchange, tibial insert Other operation 40 Knee

49 The Norwegian Arthroplasty Register ALL PROSTHESES TOTAL WITH PATELLA Prosthesis survival (%) Prosthesis survival (%) Years to failure Years to failure TOTAL WITHOUT PATELLA UNICONDYLAR Prosthesis survival (%) Prosthesis survival (%) Years to failure Years to failure 25 Knee 4

50 Report Knee

51 The Norwegian Arthroplasty Register Wrist prostheses Operation Primary operation Elbow prostheses Operation Primary operation Finger joint prostheses 87.0% 82.4% 75.0% 6.% 84.7% 6.0% 79.5% Revision % 7.6% 25.0% 38.9% 5.3% 39.0% 20.5% Ankle prostheses Operation Primary operation % 87.2% 88.9% 8 78.% 83.0% 84.6% Revision % 2.8%.% 2 2.9% 7.0% 5.4% MCP Operation 75.0% 95.2% 82.4% % 72.7% 88.3% Revision % 4.8% 7.6% 2 4.3% 27.3%.7% Primary operation % % % % % % % Revision % 48.8% 36 2.% % 28 6.% % % PIP Operation Primary operation 3 0.5% 20.6% 2.2% 6 3.8% 0.6% 8 4.9% 40.6% Revision 6 0.5% 0.6% 0.6% 8 0.3% Other 43

52 Report 2005 Carpometacarpal prostheses (CMC I) Operation Primary operation Shoulder prostheses 95.7% 89.3% 87.5% 96.3% 96.9% 74.% 90.% Revision % 0.7% 2.5% 3.7% 3.% 25.9% 9.9% Back joint prostheses Operation Primary operation No revisions have been reported. Operation Primary operation % % 9.8% 34 2.% % % % Revision 8 3.% 7 2.2% 7 4.3% 3.9% 9 4.7% 2 5.7% % Hemi Operation Primary operation % % % % % % % Revision 9 3.5% % 8 5.0% 7 4.3% 6 3.% 8 3.8% 9 5.2% Toe joint prostheses Operation Primary operation % 83.5% 83.6% 83.8% 7.6% 83.% 84.% Revision % 6.5% 6.4% 6.3% 28.4% 6.9% 5.9% Other

53 The Norwegian Arthroplasty Register ELBOW ANKLE Prosthesis survival (%) Prosthesis survival (%) Years to failure Years to failure FINGER (MCP) CARPOMETACARPAL (CMC I) Prosthesis survival (%) Prosthesis survival (%) Years to failure Years to failure SHOULDER TOE Prosthesis survival (%) Hemi Prosthesis survival (%) Years to failure Years to failure 25 Other 45

54 Report Other

55 The Norwegian Arthroplasty Register PUBLICATIONS Theses, The Norwegian Arthroplasty Register. Havelin LI. Hip arthroplasty in Norway The Norwegian Arthroplasty Register. Bergen, Norway: University of Bergen, Espehaug B. Quality of total hip replacements in Norway The Norwegian Arthroplasty Register. Bergen, Norway: University of Bergen, Furnes O. Hip and knee replacement in Norway The Norwegian Arthroplasty Register. Bergen, Norway: University of Bergen, Lie SA. Survival studies of total hip replacements and postoperative mortality. Bergen, Norway: University of Bergen, Flugsrud GB. Risk factors for disabling osteoarthritis of the hip and for revision hip surgery. An epidemiological investigation. Oslo, Norway: University of Oslo, Papers, The Norwegian Arthroplasty Register. Engesæter LB, Havelin LI, Espehaug B, Vollset SE. [Artificial hip joints in Norway. A national registry of total hip arthroplasties.] Tidsskr Nor Laegefor 992;2: Havelin LI, Espehaug B, Vollset SE, Engesæter LB, Langeland N. The Norwegian Arthroplasty Register. A survey of 7,444 total hip replacements. Acta Orthop Scand 993;64: Havelin LI, Espehaug B, Vollset SB, Engesæter LB. Early failures among 4,009 cemented and,326 uncemented prostheses for primary coxarthrosis. The Norwegian Arthroplasty Register, Acta Orthop Scand 994;65: Havelin LI, Espehaug B, Vollset SE, Engesæter LB. Early aseptic loosening of uncemented femoral components in primary total hip replacement. A review based on the Norwegian Arthroplasty Register. J Bone Joint Surg (Br) 995;77B: Havelin LI, Espehaug B, Vollset SE, Engesaeter LB. The effect of cement type on early revision of Charnley total hip prostheses. A review of 8,579 primary arthroplasties from the Norwegian Arthroplasty Register. J Bone Joint Surg (Am) 995;77A: Havelin LI, Vollset SE, Engesæter LB. Revision for aseptic loosening of uncemented cups in primary total hip prostheses. A report from the Norwegian Arthroplasty Register. Acta Orthop Scand 995;66: Espehaug B, Havelin LI, Engesæter LB, Vollset SE, Langeland N. Early revision among 2,79 hip prostheses. A comparison of 0 different prosthesis brands reported to the Norwegian Arthroplasty Register, Acta Orthop Scand 995;66:

56 Report Engesæter LB, Furnes A, Havelin LI, Lie SA, Vollset SE. [The hip registry. Good economy for society.] Tidsskr Nor Lægefor 996;6: Skeide BE, Lie SA, Havelin LI, Engesæter LB. [ hip arthroplasty after femoral neck fractures. Results from the national registry on joint prostheses.] Tidsskr Nor Lægefor 996;6: Furnes A, Lie SA, Havelin LI, Engesæter LB, Vollset SE. The economic impact of failures in total hip replacement surgery. The Norwegian Arthroplasty Register Acta Orthop Scand 996;67:5-2.. Furnes A, Lie SA, Havelin LI, Engesæter LB. [Quality control of prosthetic replacements of knee, ankle, toe, shoulder, elbow and finger joints in Norway 994. A report after the first year of registration of joint prostheses in the national registry.] Tidsskr for Nor Lægefor 996;6: Espehaug B, Havelin LI, Engesæter LB, Langeland N, Vollset SE. Patient-related risk factors for early revision of total hip replacements - A population register-based case-control study. Acta Orthop Scand 997;68: Espehaug B, Engesæter LB, Vollset SE, Havelin LI, Langeland N. Antibiotic prophylaxis in total hip arthroplasty. Review of 0,905 primary cemented total hip replacements reported to the Norwegian Arthroplasty Register, J Bone Joint Surg (Br) 997;79B: Furnes O, Lie SA, Havelin LI, Vollset SE, Engesæter LB. Exeter and Charnley arthroplasties with Boneloc or high viscosity cement. Comparison of 27 arthroplasties followed for 5 years in the Norwegian Arthroplasty Register. Acta Orthop Scand 997;68: Espehaug B, Havelin LI, Engesæter LB, Langeland N, Vollset SE. Patient satisfaction and function after primary and revision total hip replacement. Clin Orthop 998;35: Havelin LI. The Norwegian Arthroplasty Register. In: Jacob RP, Fulford P, Horan F, editors. European Instructional Course Lectures, Volume 4, 999. London: The British Society of Bone and Joint Surgery, 999: Espehaug B, Havelin LI, Engesæter LB, Vollset SE. The effect of hospital-type and operating volume on the survival of hip replacements. A review of 39,505 primary total hip replacements reported to the Norwegian Arthroplasty Register, Acta Orthop Scand 999;70: Havelin LI. The Norwegian Joint Registry. Bull Hosp Jt Dis. 999;58: Havelin LI, Espehaug B, Lie SA, Engesæter LB, Furnes O, Vollset SE. The Norwegian Arthroplasty Register. years and 73,000 arthroplasties. Acta Orthop Scand 2000;7: Lie SA, Havelin LI, Engesæter LB, Gjessing HK, Vollset SE. Mortality after total hip replacement: 0-0 year follow-up of 39,543 patients in the Norwegian Arthroplasty 48