National Joint Replacement Registry. Mortality following Primary Hip and Knee Arthroplasty
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1 National Joint Replacement Registry following Primary Hip and Knee Arthroplasty SUPPLEMENTARY REPORT 2014
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3 CONTENTS INTRODUCTION... 1 Analysis of... 1 Primary Hip Replacement... 2 Primary Knee Replacement... 6 i
4 LIST OF TABLES INTRODUCTION...1 Table M1: Commencement Date of Hip and Knee Replacement by State/Territory...1 Primary Hip Replacement...2 Table M2: following Primary Hip Replacement by Category...2 Table M3: Yearly Cumulative Percent Survival of Patients with Primary Hip Replacement by Category...2 Table M4: following Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF)...3 Table M5: Yearly Cumulative Percent Survival of Patients with Primary Partial Hip Replacement by Class (Primary Diagnosis FNOF)...3 Table M6: following Primary Unipolar Monoblock Hip Replacement by Type (Primary Diagnosis FNOF)...4 Table M7: Yearly Cumulative Percent Survival of Patients with Primary Unipolar Monoblock Hip Replacement by Type (FNOF)...4 Table M8: following Primary Total Hip Replacement by Class (Primary Diagnosis OA)...5 Table M9: Yearly Cumulative Percent Survival of Patients with Primary Total Hip Replacement by Class (Primary Diagnosis OA)...5 Primary Knee Replacement...6 Table M10: following Primary Knee Replacement by Category...6 Table M11: Yearly Cumulative Percent Survival of Patients with Primary Knee Replacement by Category...6 Table M12: following Primary Knee Replacement by Class (Primary Diagnosis OA)...7 Table M13: Yearly Cumulative Percent Survival of Patients with Primary Knee Replacement by Class (Primary Diagnosis OA)...7 LIST OF FIGURES Primary Hip Replacement...2 Figure M1: Cumulative Percent Survival of Patients with Primary Hip Replacement by Category...2 Figure M2: Cumulative Percent Survival of Patients with Primary Partial Hip Replacement by Class (Primary Diagnosis FNOF)...3 Figure M3: Cumulative Percent Survival of Patients with Primary Unipolar Monoblock Hip Replacement by Type (FNOF)...4 Figure M4: Cumulative Percent Survival of Patients with Primary Total Hip Replacement by Class (Primary Diagnosis OA)...5 Primary Knee Replacement...6 Figure M5: Cumulative Percent Survival of Patients with Primary Knee Replacement by Category...6 Figure M6: Cumulative Percent Survival of Patients with Primary Knee Replacement by Class (Primary Diagnosis OA)...7 ii
5 INTRODUCTION Data presented in this report have been submitted to the Registry by both public and private hospitals. Currently this involves 305 hospitals nationally but varies from time to time due to hospital closures, new hospitals or changes to services within hospitals. The Registry was implemented in a staged manner on a state-by-state basis. Implementation was completed nationally by mid 2002; therefore 2003 was the first year of complete national data. All hip and knee replacement procedures recorded by the Registry from the commencement date up to the 31 December 2013 have been included in this report. Table M1 shows the commencement date for each state/territory. Table M1: Commencement Date of Hip and Knee Replacement by State/Territory State/Territory Commencement Date South Australia September 1999 Queensland April 2000 Western Australia April 2000 Victoria July 2000 Tasmania September 2000 Northern Territory October 2000 Australian Capital Territory May 2001 New South Wales June 2001 Analysis of information has been obtained by matching all procedures reported to the Registry up and including the 31 st December 2013 with the National Death Index (NDI). The NDI is the national mortality database maintained by the Australian Institute of Health and Welfare (AIHW). Access to the data required approval of a formal ethics application to AIHW. Adjusted mortality is obtained after direct standardisation of the crude cumulative mortality data by five year age intervals and gender to the Estimated Resident Population Status based on the 2001 census. As the total population has a younger age structure than the population of the Registry, the adjusted mortality is substantially lower than the crude mortality. By minimising the effects of age and gender differences within groups, the adjusted measure may be used to compare the mortality of different procedures and is useful when comparing mortality over time. The rate per 100 person years has been calculated from the date of first joint procedure to either the date of death or the end of study (31/12/2013). This provides a true rate. End Data Period: 31 Dec 2013 Page 1
6 PRIMARY HIP REPLACEMENT Table M2: following Primary Hip Replacement by Category Hip Category N Death N Patients % Deaths Rate per 100 Person Yrs (95% CI) Partial (21.32, 21.75) Total (2.51, 2.57) TOTAL (4.80, 4.87) Table M3: Yearly Cumulative Percent Survival of Patients with Primary Hip Replacement by Category Partial 72.2 (71.8, 72.5) 51.8 (51.4, 52.2) 36.6 (36.2, 37.1) 26.0 (25.5, 26.4) 16.1 (15.7, 16.5) 10.8 (10.1, 11.4) Total 98.2 (98.2, 98.3) 94.6 (94.5, 94.7) 90.1 (90.0, 90.2) 84.6 (84.4, 84.8) 75.3 (75.0, 75.6) 65.6 (65.0, 66.1) Figure M1: Cumulative Percent Survival of Patients with Primary Hip Replacement by Category Partial Total Partial vs Total 0-2Wk: HR=9.50 (8.61, 10.48),p< Wk - 1Mth: HR=11.98 (10.63, 13.50),p< Mth - 3Mth: HR=10.18 (9.43, 10.99),p< Mth - 6Mth: HR=6.47 (6.00, 6.97),p< Mth - 1Yr: HR=5.19 (4.88, 5.51),p< Yr - 1.5Yr: HR=4.34 (4.08, 4.61),p< Yr - 2.5Yr: HR=3.93 (3.76, 4.11),p< Yr - 4Yr: HR=3.49 (3.36, 3.63),p< Yr - 5.5Yr: HR=3.26 (3.12, 3.40),p< Yr - 6.5Yr: HR=2.79 (2.63, 2.96),p< Yr - 7.5Yr: HR=2.53 (2.36, 2.71),p< Yr - 8.5Yr: HR=2.39 (2.21, 2.59),p< Yr - 9Yr: HR=2.06 (1.80, 2.35),p< Yr Yr: HR=1.93 (1.76, 2.13),p< Yr+: HR=1.55 (1.36, 1.78),p<0.001 Partial Total Page 2
7 Table M4: following Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF) Partial Hip Class N Death N Patients % Deaths Rate per 100 Person Yrs (95% CI) Unipolar Monoblock (29.13, 29.98) Unipolar Modular (17.58, 18.26) Bipolar (14.47, 15.19) TOTAL (21.30, 21.74) Table M5: Yearly Cumulative Percent Survival of Patients with Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF) Unipolar Monoblock 64.3 (63.6, 64.9) 41.1 (40.4, 41.7) 25.5 (24.9, 26.1) 16.1 (15.6, 16.6) 8.4 (7.9, 8.9) 5.1 (4.5, 5.6) Unipolar Modular 77.5 (76.9, 78.0) 58.7 (58.0, 59.5) 43.7 (42.9, 44.5) 32.7 (31.8, 33.6) 22.2 (21.0, 23.4) Bipolar 80.0 (79.2, 80.7) 63.1 (62.1, 64.0) 49.4 (48.3, 50.4) 37.5 (36.4, 38.5) 25.4 (24.3, 26.4) 17.6 (15.9, 19.4) Figure M2: Cumulative Percent Survival of Patients with Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF) Unipolar Monoblock Unipolar Modular Bipolar Unipolar Monoblock vs Bipolar 0-2Wk: HR=1.61 (1.49, 1.74),p< Wk - 1Mth: HR=2.01 (1.84, 2.20),p< Mth - 3Mth: HR=1.76 (1.65, 1.88),p< Mth - 2Yr: HR=1.60 (1.53, 1.67),p< Yr - 4Yr: HR=1.63 (1.56, 1.72),p< Yr - 5Yr: HR=1.57 (1.45, 1.70),p< Yr+: HR=1.43 (1.35, 1.51),p<0.001 Unipolar Modular vs Bipolar Entire Period: HR=1.08 (1.05, 1.12),p<0.001 Unipolar Monoblock vs Unipolar Modular 0-2Wk: HR=1.48 (1.37, 1.60),p< Wk - 1Mth: HR=1.86 (1.70, 2.03),p< Mth - 3Mth: HR=1.62 (1.53, 1.73),p< Mth - 2Yr: HR=1.47 (1.42, 1.53),p< Yr - 3.5Yr: HR=1.49 (1.41, 1.57),p< Yr - 4Yr: HR=1.57 (1.42, 1.74),p< Yr - 4.5Yr: HR=1.39 (1.24, 1.54),p< Yr - 6Yr: HR=1.42 (1.32, 1.53),p< Yr+: HR=1.30 (1.21, 1.39),p<0.001 Unipolar Monoblock Unipolar Modular Bipolar End Data Period: 31 Dec 2013 Page 3
8 Table M6: following Primary Unipolar Monoblock Hip Replacement by Type (Primary Diagnosis Fractured NOF) Monoblock N Death N Patients % Deaths Rate per 100 Person Yrs (95% CI) Austin-Moore Type (30.33, 31.38) ETS (22.61, 25.46) Thompson Type (26.82, 28.45) TOTAL (29.13, 29.98) Table M7: Yearly Cumulative Percent Survival of Patients with Primary Unipolar Monoblock Hip Replacement by Type (Primary Diagnosis Fractured NOF) Austin-Moore Type 62.2 (61.5, 63.0) 39.3 (38.5, 40.1) 24.0 (23.3, 24.7) 14.9 (14.3, 15.5) 7.8 (7.3, 8.3) ETS 70.7 (68.6, 72.7) 50.2 (47.7, 52.6) 34.5 (31.8, 37.1) 25.0 (22.1, 28.0) Thompson Type 67.8 (66.5, 69.0) 43.3 (41.9, 44.6) 27.4 (26.1, 28.7) 17.6 (16.5, 18.8) 9.1 (8.1, 10.1) Figure M3: Cumulative Percent Survival of Patients with Primary Unipolar Monoblock Hip Replacement by Type (Primary Diagnosis Fractured NOF) Austin-Moore Type vs ETS Entire Period: HR=1.31 (1.23, 1.39),p<0.001 Thompson Type vs ETS Entire Period: HR=1.18 (1.11, 1.27),p<0.001 Austin-Moore Type vs Thompson Type 0-2Yr: HR=1.17 (1.12, 1.22),p< Yr+: HR=1.03 (0.98, 1.08),p= Austin-Moore Type ETS Thompson Type Austin-Moore Type ETS Thompson Type Page 4
9 Table M8: following Primary Total Hip Replacement by Class (Primary Diagnosis OA) Total Hip Class N Death N Patients % Deaths Rate per 100 Person Yrs (95% CI) Total Resurfacing (0.34, 0.42) Total Conventional (2.38, 2.44) TOTAL (2.22, 2.28) Table M9: Yearly Cumulative Percent Survival of Patients with Primary Total Hip Replacement by Class (Primary Diagnosis OA) Total Resurfacing 99.8 (99.8, 99.9) 99.4 (99.2, 99.5) 98.7 (98.5, 98.9) 97.7 (97.4, 98.0) 95.8 (95.3, 96.3) 94.1 (92.9, 95.1) Total Conventional 98.8 (98.8, 98.9) 95.6 (95.5, 95.7) 91.2 (91.0, 91.3) 85.4 (85.2, 85.6) 75.5 (75.1, 75.8) 64.9 (64.3, 65.5) Figure M4: Cumulative Percent Survival of Patients with Primary Total Hip Replacement by Class (Primary Diagnosis OA) 10 9 Total Conventional vs Total Resurfacing Entire Period: HR=1.70 (1.53, 1.90),p< Total Resurfacing Total Conventional Total Resurfacing Total Conventional End Data Period: 31 Dec 2013 Page 5
10 PRIMARY KNEE REPLACEMENT Table M10: following Primary Knee Replacement by Category Knee Category N Death N Patients % Deaths Rate per 100 Person Yrs (95% CI) Partial (1.40, 1.50) Total (2.19, 2.24) TOTAL (2.09, 2.14) Table M11: Yearly Cumulative Percent Survival of Patients with Primary Knee Replacement by Category Partial 99.6 (99.5, 99.6) 97.8 (97.6, 97.9) 95.2 (94.9, 95.4) 92.0 (91.6, 92.3) 85.1 (84.5, 85.6) 76.7 (75.5, 77.8) Total 99.1 (99.0, 99.1) 96.4 (96.3, 96.4) 92.3 (92.1, 92.4) 86.8 (86.6, 86.9) 76.1 (75.8, 76.4) 64.3 (63.8, 64.9) Figure M5: Cumulative Percent Survival of Patients with Primary Knee Replacement by Category Total vs Partial 0-1.5Yr: HR=1.56 (1.37, 1.77),p< Yr - 3Yr: HR=1.13 (1.02, 1.24),p= Yr - 3.5Yr: HR=1.36 (1.15, 1.60),p< Yr+: HR=1.30 (1.25, 1.36),p< Partial Total Partial Total Page 6
11 Table M12: following Primary Knee Replacement by Class (Primary Diagnosis OA) Knee Class N Death N Patients % Deaths Rate per 100 Person Yrs (95% CI) Partial Resurfacing (0.07, 1.06) Unispacer (0.00, 0.99) Patella/Trochlear (0.86, 1.27) Unicompartmental (1.42, 1.52) Bicompartmental (0.28, 1.99) Total Knee (2.16, 2.21) TOTAL (2.06, 2.11) Table M13: Yearly Cumulative Percent Survival of Patients with Primary Knee Replacement by Class (Primary Diagnosis OA) Patella/Trochlear 99.7 (99.2, 99.8) 97.7 (96.8, 98.3) 95.8 (94.6, 96.7) 93.7 (92.1, 95.0) 87.3 (84.3, 89.8) Unicompartmental 99.5 (99.5, 99.6) 97.7 (97.6, 97.9) 95.1 (94.9, 95.4) 91.9 (91.5, 92.2) 84.9 (84.4, 85.5) 76.4 (75.1, 77.5) Total Knee 99.1 (99.1, 99.1) 96.4 (96.4, 96.5) 92.4 (92.3, 92.5) 86.9 (86.8, 87.1) 76.3 (76.0, 76.6) 64.6 (64.0, 65.2) Figure M6: Cumulative Percent Survival of Patients with Primary Knee Replacement by Class (Primary Diagnosis OA) Patella/Trochlear vs Unicompartmental Entire Period: HR=1.35 (1.11, 1.63),p=0.002 Total Knee vs Unicompartmental 0-1.5Yr: HR=1.50 (1.32, 1.71),p< Yr - 3.5Yr: HR=1.15 (1.06, 1.26),p< Yr+: HR=1.29 (1.23, 1.34),p<0.001 Total Knee vs Patella/Trochlear Entire Period: HR=0.95 (0.79, 1.14),p= Patella/Trochlear Unicompartmental Total Knee Patella/Trochlear Unicompartmental Total Knee End Data Period: 31 Dec 2013 Page 7
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