R E P O R T June 17 Norwegian National Advisory Unit on Arthroplasty and Hip Fractures Norwegian Arthroplasty Register Norwegian Cruciate Ligament Register Norwegian Hip Fracture Register Norwegian Paediatric Hip Register Helse Bergen HF, Department of Orthopaedic Surgery, Haukeland University Hospital http://nrlweb.ihelse.net ISBN: 97--917--1 ISSN: 193-9 (Printed version) 193-91 (Online)
CONTENTS Introduction... 5 Norwegian Arthroplasty Register hip replacement... 7 Knee prostheses... 55 Elbow prostheses... 111 Ankle prostheses... 117 Finger joint prostheses... 11 Wrist prostheses... 17 Carpometacarpal prostheses (CMC I)... 131 Lumbar disc prostheses... 133 Shoulder prostheses... 135 Toe joint prostheses... 153 Norwegian Hip Fracture Register... 173 Norwegian Cruciate Ligament Register... 1 Norwegian Paediatric Hip Register... 55 List of publications... 7 Operation forms (in Norwegian) hip prosthesis... 9 Knee and other joint prostheses... 9 Hip fracture... 3 Hip fracture patient questionnaire months post-operative... 3 Cruciate ligament... 3 Cruciate ligament KOOS... 31 Paediatric hip... 31 3
NORWEGIAN NATIONAL ADVISORY UNIT ON ARTHROPLASTY AND HIP FRACTURES 17 ANNUAL REPORT This annual report presents results and descriptive statistics from our five registers. Results aimed at the general public are published in November of each year on the website of the National Service Centre for Medical Quality Registers (http://www.kvalitetsregistre.no/resultater/). Some of the results are included in this annual report. The Cruciate Ligament Register has tried out an electronic medical registration system (MRS) at Haukeland University Hospital, and is now ready to test it at other hospitals. A corresponding system of electronic registration of patient-reported outcome measures (PROM) for total hip arthroplasty has been created in the MRS and is currently being tested at Haukeland University Hospital. There are plans to start at other hospitals in 17. This annual report is sent electronically to all Norwegian orthopaedic surgeons. Paper copies can be obtained by contacting us. The National Advisory Unit website http://nrlweb.ihelse.net/ contains all our annual reports and references to all our scientific papers and presentations. Most of the papers are also available electronically from our website. Since we mainly publish findings from implants and surgical methods in scientific journals where we can account for materials and methods and discuss strengths and weaknesses and the significance of the findings, these are to be found in the reference lists at the end of this annual report. This year for the first time we present percentages of three- and ten-year durability of the most commonly used hip and knee prostheses in Norway. This is also available on the website of the National Service Centre. A completeness analysis is published for each of the registers. These analyses were conducted in cooperation with the National Service Centre and the Norwegian Patient Register. Hospitals with low reporting need to review their reporting routines. Please contact us and we will be happy to offer our assistance. The Norwegian Arthroplasty Register now has its own Facebook page https://www.facebook.com/leddregisteret/, which we hope you will visit. You will find a QR code on the back of this year s report. Hospital-based annual reports, with data from each hospital, will as before be sent to our contact persons at the hospitals and to the general manager. We encourage our contacts to pass on the reports to the hospital administration and to their colleagues, and to check that the figures recorded from the hospital are correct. The reports should be used for local improvement work. Please remember that the Norwegian Data Protection Authority requires statements of consent to be signed by patients before operations are reported to the registers, and the statements to be stored in locked archive cabinets or on a secure server at each hospital. We would like to thank Leif Ivar Havelin for thirty years work for the registers. He retired in 1. Geir Hallan has taken over as head of the Hip Arthroplasty Register. 5
May we remind you of the Hip Arthroplasty Register s 3-year anniversary celebration on - 9 September 17. Please remember to sign up. We would like to thank all orthopaedic surgeons in Norway for good reporting. We are also grateful for good cooperation with the Reference Group, Helse Bergen, Helse Vest, the Centre for Clinical Documentation and Evaluation (SKDE) via the National Service Centre for Medical Quality Registers, the equipment suppliers, the University of Bergen, the Norwegian Patient Register (NPR), the Norwegian Knowledge Centre for the Health Services, the Norwegian Institute of Public Health, the Office of the Auditor General, the Norwegian Board of Health Supervision, the Directorate of Health and the Ministry of Health and Care Services. Bergen, 17..17 Ove Furnes Chief Physician/Professor Head of National Advisory Unit on Arthroplasty and Hip Fractures Lasse Engesæter Professor/Chief Physician Geir Hallan Chief Physician/Professor Knut Fjeldsgaard Chief Physician Trude Gundersen Chief Physician Jan-Erik Gjertsen Chief Physician/Associate Professor Anne Marie Fenstad Biostatistician Eva Dybvik Biostatistician Christoffer Bartz-Johannessen Biostatistician
CONTENTS Norwegian Arthroplasty Register Hip Replacement Introduction... 9 Survival of total hip prostheses 197 1. Fixations... 1 Survival of total hip prostheses 1. Fixations... 13 Survival of total hip prostheses 1. Fixations, gender and age... 1 Survival hip prostheses. Access... 15 Survival hip prostheses. Metal on metal... 15 Last 1 years survival curves for all hospitals individually... 1 One stage bilateral hip prosthesis operations... 17 Number of primary operations in hip 1... 17 Percentage non-revised patients two years after operations in 1-1... 1 Percentage non-revised patients ten years after operations in 5-1... 19 How to interpret the hospital-based results... Durability of hip replacements 5-1... 1 How to interpret the prosthesis results... Annual numbers and incidence of total hip replacements... 3 Reasons for primary operations... Age by year of operation... Reasons for revisions... 5 Type of revision for patients aged 75 years or younger... Type of revision for patients over 75 years... 7 Bone transplantation in revisions... Bone loss in revisions... 9 Surgical approach... 3 Mini invasive surgery... 3 Trochanteric osteotomy... 3 Systemic antibiotic prophylaxis... 3 Fixation in primary operations... 33 Fixation in revisions... 35 Type of fixation and bone transplantation in revisions... 3 Cements... 37 Cemented primary prostheses... 3 Uncemented primary prostheses... 39 Hybrid primary prostheses... Acetabular prostheses... 1 Femoral prostheses... 3 Monoblock and modular caput... 5 Femoral head diameter... Femoral head prostheses... 7 Dual Mobility articulation... ASA classification... Thrombosis prophylaxis... 9 Articulations (primary operations) All patients... 51 Completeness analysis 13-1... 5 7
THE HIP ARTHROPLASTY REGISTER 17 ANNUAL REPORT This year s annual report contains data on 11 3 hip replacement operations. The milestone of 1 operations per year was reached in 1! 1 primary operations and 15 revisions were recorded; this is an increase of about 5 compared to 15. Thirty-two patients received two primary prostheses in the same session. Forty-one revisions were reported where the prosthetic parts were not changed. These were soft tissue debridement due to infection, osteosynthesis of periprosthetic fractures, muscle transposition and muscle reconstruction. These re-operations without replacement of prosthetic parts were added to the form in 15. Surgical approach has changed over the last five years. Anterior approaches now account for about % of primary operations and are used in fewer than 5% of revisions. The direct lateral approach is used less and less, having decreased from more than 7% 1 years ago to 1% in 1. In revision operations, this approach is also used less than previously, but still accounts for close to %. The posterior approach is becoming increasingly popular and was recorded for 5% of primary operations in 1. These changes are thought to be beneficial, since patient experience of direct lateral approach is inferior to that of other approaches (Amlie et al., 1). The posterior approach is also used more frequently in revisions (%). In patients operated since, we find no difference in prosthetic survival between the approaches (Figure r). Mjaaland et al. showed that overall prosthetic survival is similar in the different approaches, but that a lateral approach increased the chance of revision due to infection, while a posterior approach was associated with more dislocation (Mjaaland KE et al., 17). Fixation: Our register and all other registers have repeatedly shown poorer results with uncemented stems than with cemented stems in the oldest patients, especially in women. There are signs of increased use of cemented femoral stems over the last couple of years, especially in the form of classical hybrid fixation. About % of patients above 75 years now receive cemented stems, and we believe that this proportion should be further increased. In revisions, there has been a gradual increase in the use of uncemented fixation since 3. Both in the acetabulum and in the femur, three out of four revisions are currently uncemented. Bone impaction grafting with cement in the femur has been decreasing for the past ten years, and in 1, no cases with the use of this technique were recorded. Also in the acetabulum, there is less bone impaction grafting with cement than previously. The use of 3mm heads is increasing steadily (1: about 73%) and there has been a slight increase in the use of 3mm heads over the last 1 years (1: about 1%). Heads >3mm are no longer used, which we view as beneficial because it appears from some other registers that the larger heads lead to poorer prosthetic survival. Cross-linked polyethylene used with metal or ceramic heads predominates in the articulations (>9%) and we find good support for this in the literature. Metal-on-metal prostheses with heads larger than 3mm are no longer used in Norway. Survival rates for the 5 patients operated with these prostheses in Norway are somewhat worse than with conventional prostheses, see figure s. However, the main problem with these prostheses is 9
the risk of developing a pseudotumour, which can be a very serious complication. Please remember that hospitals have a duty to monitor all patients with such prostheses for the rest of their lives. Recommendations for monitoring are available here: http://nrlweb.ihelse.net. This year s report contains two figures (t and u) which illustrate to what degree each point on the registration form is completed. The Norwegian Arthroplasty Register (NRL) records a very high proportion of the arthroplasties performed in Norway. In order for an operation to be registered with us, we need the patient s date of birth, ID number, date of surgery, side (right or left), type of surgery and implant (using stickers) on the form. If any of this information is missing, the form is returned or a secretary from the Register will call the hospital to have it completed. If there is missing information on points other than these key points, the form is registered with missing data on those points. Some points often have missing data, as seen in the figure. Examples of points where information is commonly lacking are the registration of bone grafting (about 3%) and the degree of bone loss (more than 5%) in revisions. We hope that surgeons will take even greater care in completing the forms. One of the great advantages of the NRL over some other registries is the amount of detail, and it is therefore important that we have good reporting of details. The report from the Register on the website of the National Service Centre for Medical Quality Registers (https://kvalitetsregistre.no/registers/5/resultater) includes publication of prosthetic results as well as results at hospital level. These results must be seen in conjunction with the completeness of reporting of revisions. Results from hospitals with less than % completeness of reporting for revisions are excluded from these analyses. PUBLICATIONS SINCE 1 JANUARY 1 Johanson PE et al. (a NARA study) compared the risk of cup or liner revision in cup designs used with conventional and cross-linked plastic. For some cups (Reflection, ZCA), there were better results with cross-linked plastic, while for others there was no difference after ten years. Wangen H studied reverse hybrid hip replacements and compared these to cemented ones (NARA). There was a % greater risk of revision with a reverse hybrid hip replacement, and the risk was particularly high for periprosthetic fractures. Johnsen MB et al., in a gene study, showed that in smokers there is an inverse correlation between the level of smoking and the risk of hip or knee arthroplasty, and they argue that this is a causal relationship. Magnusson K et al. linked the Arthroplasty Register with the Twin Register, and found that the risk of hip arthroplasty was greatly influenced by genetic factors, while the risk of knee arthroplasty was more strongly associated with BMI. Junnila M et al. studied the most common cemented hip prostheses in NARA data and found differences in the results. Spectron EF/Reflection and Elite THA had the poorest results. 1
Tsukanaka M et al. studied results of hip arthroplasty in the youngest patients (< years) and found that 3% were revised within ten years and that the bone quality around the prosthesis was poor in many patients. Mjaaland KE et al. compared implant survival after mally invasive surgery or anterolateral surgical approach with posterior or direct lateral approach. Results from the Register show that overall prosthetic survival is similar in the different approaches, but there were more dislocations with the posterior approach and more infections with the lateral approach. Hellevik AI et al. studied the incidence of total hip and knee arthroplasty due to osteoarthritis and the association with thyroid function in a prospective cohort study with data from the NRL and the Health Survey in Nord-Trøndelag (HUNT). The study showed no association between thyroid function and the risk of hip or knee arthroplasty due to osteoarthritis. Johnsen MB et al., in a study using data from the NRL and HUNT, showed that increased recreational activity was associated with a greater risk of hip arthroplasty in women and men aged 5-59. The risk of knee arthroplasty increased for young women with high leisure-time activity, but not for men. Please also consult the list of publications in this report and on our website http://nrlweb.ihelse.net/ Thank you for good reporting, and we welcome suggestions for research projects. Bergen, 1..17 Geir Hallan Chief Physician/Professor Anne Marie Fenstad Biostatistician Irina Kvinnesland IT Consultant Christoffer Bartz-Johannessen Biostatistician 11
Survival of total hip prostheses 197-1 a) All b) Fixation 1-1 9 9-1 1999-3 9 Reverse hybrid Prosthesis survival (%) 7 5 197-9 1991-93 199-9 1999-3 - 9-1 RR (p-value) 1 1.7 (<,1).5 (<,1). (<,1). (<,1).3 (<,1) 199-9 1991-93 197-9 7 5 RR (p-value) Cemented 1 Uncmented 1.3 (<,1) Hybrid 1. (<,1) Reversed hybrid.7 (<,1) Uncmented Cemented Hybrid 5 1 15 5 3 5 1 15 5 3 c) Cemented d) Uncemented 1-1 - Prosthesis survival (%) 9 7 5 9-1 197-9 1991-93 199-9 1999-3 - 9-1 RR (p-value) 1 1.55 (<,1) 1.7 (.).9 (.).95 (.11) 1.1 (<,1) 1999-3 199-9 1991-93 197-9 9 7 5 9-1 197-9 1991-93 199-9 1999-3 - 9-1 RR (p-value) 1.9 (.1).53 (<,1).5 (<,1).3 (<,1). (<,1) 1999-3 199-9 1991-93 197-9 5 1 15 5 3 5 1 15 5 3 e) Hybrid f) Reversed hybrid 1 1 9 9-1 - 9 9-1 - -3 Prosthesis survival (%) 7 5 197-9 1991-93 199-9 1999-3 - 9-1 RR (p-value) 1 1 (.973). (.7).39 (<,1).35 (<,1).71 (.) 1999-3 199-9 1991-93 197-9 7 5-3 - 9-1 RR (p-value) 1 1. (.15).3 (.) 5 1 15 5 3 Years to failure 5 1 15 5 3 Years to failure Kaplan-Meier survival curves. Rate ratio (RR) is adjusted for age, gender and diagnosis. Survival estimate is given as long as more than 5 prostheses are at risk. 1
Survival of total hip prostheses -1 g) 1 Fixation Prosthesis survival (%) 9 7 Cemented Uncemented Hybrid Reverse hybrid RR (p-value) Cemented 1 Uncemented 1.1 (.1) Hybrid. (.3) Reversed hybrid.91 (.3) 1 h) 1 Cemented 1 i) Uncemented Prosthesis survival (%) 9 7 < 55 years 55 - years 5-7 years 75+ years < 55 years 55- years 5-7 years 75+ years RR (p-value) 1.7 (.31).77 (.51).7 (.7) 1 9 7 < 55 years 55 - years 5-7 years 75+ years < 55 years 55- years 5-7 years 75+ years RR (p-value) 1 1. (.).9 (.) 1.17 (.197) 1 j) 1 Hybrid 1 k) Reverse hybrid Prosthesis survival (%) 9 7 < 55 years 55 - years 5-7 years 75+ years < 55 years 55- years 5-7 years 75+ years RR (p-value) 1 1.9 (.139) 1. (.35) 1. (.317) 1 Years to failure Kaplan-Meier survival curves. Rate ratio (RR) is adjusted for age, gender and diagnosis. Survival estimate is given as long as more than 5 prostheses are at risk. 9 7 < 55 years 55 - years 5-7 years 75+ years < 55 years 55- years 5-7 years 75+ years RR (p-value) 1.9 (.55) 1.17 (.17) 1.5 (.) 1 Years to failure 13
l) 1 Different fixations men Under 5 years Survival of total hip prostheses -1 m) 1 Different fixations women Under 5 years Prosthesis survival (%) 9 7 Cemented Uncemented Reverse hybrid RR (p-value) Cemented 1 Uncemented 1. (.51) Reversed hybrid.3 (<,1) 9 7 Cemented Uncemented Reverse hybrid RR (p-value) Cemented 1 Uncemented.9 (.359) Reversed hybrid.7 (<,1) 1 1 n) 1 5-7 years 1 o) 5-7 years Prosthesis survival (%) 9 7 Cemented Uncemented Reverse hybrid RR (p-value) Cemented 1 Uncemented 1.15 (.3) Reversed hybrid.9 (.33) 9 7 Cemented Uncemented Reverse hybrid RR (p-value) Cemented 1 Uncemented 1.5 (.7) Reversed hybrid.99 (.7) 1 1 p) 1 Over 75 years q) 1 Over 75 years Prosthesis survival (%) 9 7 Cemented Uncemented Reverse hybrid RR (p-value) Cemented 1 Uncemented 1.7 (.51) Reversed hybrid.9 (.9) 9 7 Cemented Uncemented Reverse hybrid RR (p-value) Cemented 1 Uncemented 1.59 (<,1) Reversed hybrid 1.3 (.) 1 Years to failure Kaplan-Meier survival curves. Rate ratio (RR) is adjusted for age, gender and diagnosis. Survival estimate is given as long as more than 5 prostheses are at risk. 1 Years to failure 1
Survival hip prostheses r) 1 Access s) 1 Metal on metal (MoM) Prosthesis survival (%) 9 7 Frontal Lateral Posterolateral Frontal Lateral Posterolateral RR (p-value) 1 1.17 (.79) 1.5 (.3) Prosthesis survival (%) 9 7 MoM 1 1 t) Bone transplant, revisions - percent of cases with missing data Percentage 1 9 7 5 3 1 5 7 9 11 13 15 Acetabulum Femur u) Bone loss, revisions - percent of cases with missing data 1 Percentage Acetabulum Femur 5 7 9 11 13 15 15
hip arthroplasty Last 1 years survival curves for all hospitals 1 1 Percent prostheses intact 9 7 Endpoint all revisions Mean all hospitals All hospitals individually 9 7 Endpoint revision due to infection Mean all hospitals All hospitals individually in the period 7 1 in the period 7 1 1 1 1 9 Endepoint revision due to dislocation Mean all hospitals 7 All hospitals individually in the period 7 1 1 Years after primary operation 1
One stage bilateral hip prosthesis operations Year 197-5 7 9 1 11 1 13 1 15 1 Sum: Number of patients 1 1 15 13 19 15 15 1 3 3 3 A one stage bilateral operation is an operation where the patient is operated on both hips during the same operation or on the same day. Only primary operations are included. Figure Y: Number of primary THA operations, 1 Lovisenberg Diakonale Sykehus Martina Hansens Hospital Vestre Viken HF - Drammen sykehus Sykehuset i Vestfold HF - Larvik Sykehuset Østfold HF - Moss Akershus universitetssykehus HF Sykehuset Innlandet HF - Elverum Sørlandet sykehus HF - Arendal Sykehuset Innlandet HF - Tynset Diakonhjemmet sykehus Vestre Viken HF - Kongsberg sykehus Sørlandet sykehus HF - Kristiansand Sykehuset Innlandet HF - Kongsvinger Oslo universitetssykehus HF Ullevål - Ort. senter, Kirkeveien Vestre Viken HF - Bærum sykehus Vestre Viken HF - Ringerike sykehus Sykehuset Innlandet HF - Gjøvik Sykehuset Innlandet HF - Lillehammer Sykehuset Telemark HF - Skien Sørlandet sykehus HF - Flekkefjord Betanien hospital - Skien Sykehuset Telemark HF - Notodden Oslo universitetssykehus HF - Rikshospitalet Sykehuset Østfold Kalnes Sykehuset i Vestfold HF - Tønsberg Helse Bergen HF - Kysthospitalet i Hagevik Helse Stavanger HF - Stavanger Universitetssykehus Helse Førde HF - Førde sentralsjukehus Haraldsplass Diakonale Sykehus Helse Bergen HF - Haukeland universitetssjukehus Helse Fonna HF - Haugesund sjukehus Helse Bergen HF - Voss sjukehus Helse Fonna HF - Stord sjukehus Helse Førde HF - Lærdal sjukehus St. Olavs Hospital HF - universitetssykehuset i Trondheim St. Olavs Hospital HF - Orkdal sjukehus Helse Møre og Romsdal HF - Kristiansund Sjukehus Helse Møre og Romsdal HF - Volda sjukehus Helse Nord-Trøndelag HF - Sykehuset Namsos Helse Møre og Romsdal HF - Ålesund sjukehus Helse Nord-Trøndelag HF - Sykehuset Levanger Helse Møre og Romsdal HF - Molde Sjukehus Universitetssykehuset Nord-Norge HF - Avd. Tromsø Helgelandssykehuset HF - Mo i Rana Nordlandssykehuset HF - Bodø Universitetssykehuset Nord-Norge HF - Avd. Harstad Nordlandssykehuset HF - Vesterålen Helse Finnmark HF - Klinikk Hammerfest Helse Finnmark HF - Klinikk Kirkenes Universitetssykehuset Nord-Norge HF - Avd. Narvik Nordlandssykehuset HF - Lofoten Aleris Frogner Haugesund Sanitetsforenings Revmatismesykehus AS Norsk Idrettsmedisinsk Institutt ALERIS Drammen Volvat Medisinske Senter avd. Fredrikstad Privatsykehuset i Haugesund Volvat medisinske senter 35 97 79 1 59 3 1 15 15 15 15 17 133 13 11 97 91 3 7 199 15 115 111 73 5 15 15 13 115 113 1 9 177 1 99 5 3 1 1 159 3 17 15 5 3 331 79 1 1 3 5 Number of primary operations 7 1 Helse Sør-Øst Helse Vest Helse Midt-Norge Helse Nord Privat 17
Figure Z: Percentage non-revised patients two years after operations in 1-1 Universitetssykehuset Nord-Norge HF - Avd. Narvik (N = 13 ) Haraldsplass Diakonale Sykehus (N = 1 ) Universitetssykehuset Nord-Norge HF - Avd. Tromsø (N = 19 ) Norsk Idrettsmedisinsk Institutt (N = 9 ) ALERIS Drammen (N = 37 ) Universitetssykehuset Nord-Norge HF - Avd. Harstad (N = 37 ) Helse Bergen HF - Kysthospitalet i Hagevik (N = 3 ) Diakonhjemmet sykehus (N = 15 ) Martina Hansens Hospital (N = 379 ) Helse Finnmark HF - Klinikk Hammerfest (N = 39 ) Sykehuset Innlandet HF - Elverum (N = 1573 ) Helse Møre og Romsdal HF - Molde Sjukehus (N = 5 ) Sykehuset Telemark HF - Notodden (N = 17 ) Vestre Viken HF - Drammen sykehus (N = 9 ) Lovisenberg Diakonale Sykehus (N = 19 ) Nordlandssykehuset HF - Vesterålen (N = 9 ) Helse Fonna HF - Haugesund sjukehus (N = 73 ) Sykehuset Innlandet HF - Tynset (N = 13 ) Sykehuset i Vestfold HF - Tønsberg (N = 1 ) Sykehuset i Vestfold HF - Larvik (N = 1 ) Nordlandssykehuset HF - Lofoten (N = 17 ) Helse Møre og Romsdal HF - Ålesund sjukehus (N = 93 ) Helse Stavanger HF - Stavanger Universitetssykehus (N = 5 ) Helse Bergen HF - Haukeland universitetssjukehus (N = 9 ) Akershus universitetssykehus HF (N = 19 ) All hospitals (N = 51 ) Vestre Viken HF - Ringerike sykehus (N = 75 ) Volvat medisinske senter (N = 115 ) Sykehuset Telemark HF - Skien (N = ) Sykehuset Innlandet HF - Kongsvinger (N = 9 ) Helse Nord-Trøndelag HF - Sykehuset Levanger (N = 9 ) Helse Møre og Romsdal HF - Volda sjukehus (N = 5 ) Aleris Frogner (N = 7 ) Nordlandssykehuset HF - Bodø (N = 795 ) Vestre Viken HF - Kongsberg sykehus (N = 19 ) Sykehuset Innlandet HF - Lillehammer (N = ) Sørlandet sykehus HF - Kristiansand (N = 11 ) Sykehuset Østfold HF - Moss (N = 135 ) Helse Møre og Romsdal HF - Kristiansund Sjukehus (N = 9 ) Oslo universitetssykehus HF Ullevål - Ort. senter (N = 75 ) Sørlandet sykehus HF - Flekkefjord (N = 5 ) Helse Fonna HF - Stord sjukehus (N = 51 ) Helse Nord-Trøndelag HF - Sykehuset Namsos (N = 73 ) St. Olavs Hospital HF - universitetssykehuset i Tr (N = 13 ) Helse Bergen HF - Voss sjukehus (N = 1 ) Betanien hospital - Skien (N = 199 ) Oslo universitetssykehus HF - Rikshospitalet (N = 35 ) Sykehuset Innlandet HF - Gjøvik (N = 979 ) 97. % 7 % % 9 % 1 % Percentage non-reoperated primary operations in hip Kaplan-Meier estimates of percentage non-revised patients after two years with 95% confidence interval. Endpoint is all revisions. Reoperations, i.e. revision operations without insertion, removal or replacement of the prosthesis, are excluded. Included are all patients operated on in the years 1 to 1. Only hospitals with operations in 1 and with more than 5 operations from 1 to 1 are included. A further requirement is that the hospital must have at least 3 patients followed up for more than two years. Only hospitals with coverage of at least % for revisions from to 1 are included. 1
Figure Æ: Percentage non-revised patients ten years after operations in 5-1 Privatsykehuset i Haugesund (N = 1 ) Nordlandssykehuset HF - Vesterålen (N = 5 ) Helse Finnmark HF - Klinikk Hammerfest (N = ) Helse Stavanger HF - Stavanger Universitetssykehus (N = 33 ) Helse Møre og Romsdal HF - Kristiansund Sjukehus (N = 157 ) Helse Møre og Romsdal HF - Molde Sjukehus (N = 3 ) Helse Fonna HF - Haugesund sjukehus (N = 15 ) Universitetssykehuset Nord-Norge HF - Avd. Tromsø (N = 17 ) Haraldsplass Diakonale Sykehus (N = 195 ) Sykehuset i Vestfold HF - Tønsberg (N = 95 ) Helse Fonna HF - Stord sjukehus (N = 9 ) Sykehuset Innlandet HF - Kongsvinger (N = 135 ) Helse Møre og Romsdal HF - Ålesund sjukehus (N = 1 ) Sykehuset Telemark HF - Skien (N = 175 ) Helse Bergen HF - Haukeland universitetssjukehus (N = 11 ) Martina Hansens Hospital (N = 57 ) Akershus universitetssykehus HF (N = 1 ) Helse Nord-Trøndelag HF - Sykehuset Levanger (N = 19 ) Helse Møre og Romsdal HF - Volda sjukehus (N = 99 ) Diakonhjemmet sykehus (N = 5 ) Helse Nord-Trøndelag HF - Sykehuset Namsos (N = 119 ) Vestre Viken HF - Drammen sykehus (N = 357 ) Nordlandssykehuset HF - Bodø (N = 11 ) All hospitals (N = 5 ) Lovisenberg Diakonale Sykehus (N = 17 ) Sykehuset Innlandet HF - Elverum (N = 553 ) Sykehuset Innlandet HF - Lillehammer (N = 197 ) Helse Bergen HF - Kysthospitalet i Hagevik (N = 7 ) Vestre Viken HF - Ringerike sykehus (N = 1 ) Sykehuset Østfold HF - Moss (N = 91 ) Oslo universitetssykehus HF Ullevål - Ort. senter (N = 15 ) Universitetssykehuset Nord-Norge HF - Avd. Harstad (N = 9 ) Sørlandet sykehus HF - Flekkefjord (N = 1 ) Sykehuset Innlandet HF - Gjøvik (N = 151 ) Oslo universitetssykehus HF - Rikshospitalet (N = 717 ) Vestre Viken HF - Kongsberg sykehus (N = 1917 ) Sykehuset Telemark HF - Notodden (N = 9 ) Helse Bergen HF - Voss sjukehus (N = 73 ) Sørlandet sykehus HF - Kristiansand (N = 1595 ) St. Olavs Hospital HF - universitetssykehuset i Tr (N = 73 ) Sykehuset i Vestfold HF - Larvik (N = 33 ) Nordlandssykehuset HF - Lofoten (N = 1 ) Sykehuset Innlandet HF - Tynset (N = 157 ) Volvat medisinske senter (N = 7 ) 93 % 7 % % 9 % 1 % Percentage non-reoperated primary operations in hip Kaplan-Meier estimates of percentage non-revised patients after ten years with 95% confidence interval. Endpoint is all revisions. Reoperations, i.e. revision operations without insertion, removal or replacement of the prosthesis, are excluded. Included are all patients operated on in the years 5 to 1. Only hospitals with operations in 1 and with more than 5 operations from 5 to 1 are included. A further requirement is that the hospital must have at least 3 patients followed up for more than ten years. Only hospitals with coverage of at least % for revisions from to 1 are included. 19
How to interpret the hospital-based results: When hospitals are ranked by percentage of revisions, results must be interpreted with caution, as there may be many reasons for different revision percentages: 1. Hospitals that are more rigorous in reporting their complications and reoperations to the Register could have unfairly negative results in the analyses.. If surgeons at one hospital are more diligent in facilitating check-ups for patients than at other hospitals, and thus discover more complications, this could lead to unfortunate results despite the fact that this hospital in reality is doing a better job than other hospitals. 3. If the waiting time for reoperations is longer in some hospitals than others, the longer wait could erroneously lead to better results than those of hospitals with a short waiting time.. If the surgeons at one hospital have a higher threshold for recommending reoperation than at other hospitals and thus prolong patients problems, this will also give skewed results in the statistics. 5. Poor hospital results from an earlier period will remain with the hospital, even though the hospital may have acted upon previous problems by switching to better prostheses and improving procedures and surgical skills. There is also a statistical uncertainty in the ranking lists because the data from the NRL are poorly suited for such calculations. The NRL was designed to compare the results of implants and surgical procedures nationwide. To compare quality in hospitals is a complex matter, because some hospitals operate on more patients with poor prognosis than other hospitals, and because many hospitals, especially the small ones, have so few reoperations that the statistics are too weak, and are further weakened by the fact that the hospitals coverage (reporting rate) of reoperations varies from 1.7% to 1%. This issue is explained in detail in the following articles: Ranstam J, Wagner P, Robertsson O, Lidgren L. Health-care quality register outcomeorientated ranking of hospitals is unreliable. J Bone Joint Surg Br. and Ranstam J, Wagner P, Robertsson O, Lidgren L. Ranking in health care results in wrong conclusions. Läkartidningen. Aug 7-Sep ;15(35):313-. Moreover, it is a well-known phenomenon in quality assurance that if those who report their complications and errors the most accurately receive a lower ranking because of this, the reporting may eventually deteriorate. If league tables of hospitals are publicised, there is thus a danger that hospitals reporting of revisions may become poorer, leading to inferior quality of the registers. In order to achieve complete reporting of reoperations (revisions), reporting to the Register should be linked to performance-based financing, reporting should be made mandatory, and the requirement for the patient s written consent to reporting of the operation to the Register should be waived and replaced by presumed consent.
Figure Ø: Durability of hip replacements 5-1 Acetabulum component, femur component CONTEMPORARY-EXETER cemented ( N = 77 ) ELITE-CORAIL reversed hybrid ( N = 179 ) REFLECTION CEM. ALL POLY-CORAIL reversed hybrid ( N = 7 ) CHARNLEY-CHARNLEY cemented ( N = ) ELITE-EXETER cemented ( N = ) IGLOO-FILLER uncemented ( N = 3 ) IP-SP II cemented ( N = 9 ) EXETER-EXETER cemented ( N = 39 ) TITAN-CORAIL reversed hybrid ( N = ) KRONOS-TITAN cemented ( N = 79 ) REFLECTION CEM. ALL POLY-SPECTRON-EF cemented ( N = ) ELITE-TITAN cemented ( N = 373 ) TITAN-TITAN cemented ( N = 7 ) IP LUBINUS-SP II cemented ( N = 55 ) MARATHON-EXETER cemented ( N = 1 ) ELITE-CHARNLEY MODULAR cemented ( N = 5 ) KRONOS-CORAIL reversed hybrid ( N = 3 ) CONTEMPORARY-CORAIL reversed hybrid ( N = 37 ) REFLECTION UNCEMENTED-CORAIL uncemented ( N = 739 ) EXETER X3 RIMFIT-EXETER cemented ( N = 3959 ) TRILOGY-EXETER hybrid ( N = 71 ) MARATHON-CORAIL reversed hybrid ( N = 1 ) MARATHON-CHARNLEY MODULAR cemented ( N = 5 ) PINNACLE-CORAIL uncemented ( N = 15 ) TRILOGY-CORAIL uncemented ( N = 1 ) DURALOC-CORAIL uncemented ( N = ) CHARNLEY-CHARNLEY MODULAR cemented ( N = 1 ) REFLECTION UNCEMENTED-SECURFIT uncemented ( N = 5 ) 97.3 % 97.1 % 97.1 % 9.9 % 9. % 95. % 95.5 % 9.7 % 9.3 % 93.7 % 9.1 % 91. %.3 % Years: 3 1 9.7 % 9.5 % 9.5 % 9. % 99. % 97. % 9 % 9. % 97.1 % 97. % 9. % 9. % 97. % 1 % 99. % 99. % 99.1 % 9. % 9.7 % 9. % 9.5 % 9.5 % 97.9 % 97.7 % 97.5 % 97.3 % 9. % 95 % 7 % % 9 % 1 % Percentage non-reoperated prostheses after 3 and 1 years Figure Ø shows the estimated Kaplan-Meier percentage at three and ten years for different combinations of hip prostheses. We have only included combinations used in 5 or more operations in 5-1. A further requirement for inclusion in the figure is that there must still be at least 5 examples of the combination at three and ten years respectively. Only standard patients from 5 to 1 have been included, and the number of prostheses will therefore be below 5 in some cases. A standard patient is aged 55-5 years, has ASA class 1 or and was diagnosed with idiopathic osteoarthritis at primary surgery. Using standard patients provides a more homogenous group of patients, and we believe that this makes the results more comparable. Endpoint is all revision operations, except infections and reoperations without insertion, removal or replacement of the prosthesis. As recommended in Report No. / from the Norwegian Centre for Health Technology Assessment (SMM), Choice of Implants in Primary Arthroplasty in Norway, most health trusts will require ten-year documentation on the prosthesis. The combinations Reflection All Poly/Spectron EF (cemented) and Titan/Titan (cemented) are no longer in use. This is based on results in studies published by the Register (Espehaug B 9, Hallan G 7, Hallan G 1, Hallan G 1 and Kadar T 11), see our list of publications in the annual report http://nrlweb.ihelse.net/ The results in this report must be compared with results in our publications, where we can account for materials and methods and discuss strengths and weaknesses and the significance of the findings. 1
How to interpret the prosthesis results When prostheses are ranked by percentage of revisions, results must be interpreted with caution, as there may be many reasons for different revision percentages. We mainly publish prosthesis results in scientific journals and presentations where we account for materials and methods and discuss strengths and weaknesses and the significance of the findings (see the reference list in http://nrlweb.ihelse.net/rapporter/rapport17.pdf). In general, we can state the following: 1. A poor result for a particular prosthesis may be caused by a learning curve for its use, which means that some patients will be revised due to the lack of experience with the particular implant.. In our papers, we adjust for differences in patient groups such as age, gender, diagnosis, joint surface material and fixation. Some prostheses and materials tend to be used in younger and more active patients. Such patients may wear out the prosthesis faster. A prosthesis used in many such patients may have poorer results than a prosthesis used in older and less active patients. The degree of activity is not recorded in the registers. 3. A prosthesis may be used at few hospitals and in small numbers, which may mean that the revision percentage reflects the skill of the surgeon or the threshold for revision rather than the qualities of the prosthesis.. If a prosthesis is used in a large number of patients (>3) and in several hospitals (>5), we consider the results more reliable. 5. Scientific papers discuss the reason for revision of the prosthesis. If there is a natural biological or mechanical reason, we have more faith in the results, i.e. we consider a high revision rate to be due to qualities of the prosthesis rather than the surgeon.. National registers are observational studies and cannot normally explain the reasons for the results of a particular group of prostheses. The results must be compared with those of experimental studies and randomised controlled trials. Furthermore, the results must be reproduced in other studies and registers before being considered valid. Results of hip and knee arthroplasty in Norway are generally good and comparable to results in the other Nordic countries (Mäkelä K 1, Junnila M 1 and Robertsson O 1), see the reference list in our annual report. The two hip prostheses with poorest ten-year results (Titan/Titan and Reflection cemented/spectron EF) have been discontinued in Norway on the basis of results in our earlier publications (Espehaug B 1, Hallan 1 and Kadar T 11). This also applies to the Duracon knee prosthesis (Gøthesen 13).
TOTAL HIP ARTHROPLASTY The Norwegian Arthroplasty Register Table 1: Annual numbers of operations (Hemi prosthesis operations for hip fracture are not included here. These are found in tables of The Norwegian Hip Fracture Register) Year Primary operations * Reoperations ** Revisions 1 1 (5,%) 1 (,%) 1 33 (13,%) 1 355 15 3 (5,7%) 1 (,%) 1 39 (1,1%) 9 1 17 (,3%) 3 (,%) 1 9 (13,5%) 9 19 13 9 (,%) 15 (,%) 1 35 (13,9%) 9 1 1 7 (5,%) (,3%) 1 91 (1,1%) 9 11 11 7 3 (5,1%) 13 (,%) 1 7 (1,7%) 7 1 7 33 (5,%) 1 (,%) 1 57 (1,%) 5 9 7 11 (5,5%) 1 9 (1,5%) 33 (5,9%) 1 1 (1,1%) 7 97 7 (,%) 1 5 (13,%) 7 71 319 (,3%) 1 7 (13,7%) 7 3 5 597 (,%) 1 (,%) 1 5 (13,%) 7 5 1 (,9%) 9 (13,1%) 7 15 3 7 (7,7%) 99 (1,3%) 3 199-1 (5,%) 1 (,%) (1,%) 33 1993-97 7 (3,%) 1 (,%) 75 (1,%) 9 5 197-9 3 (,5%) 3 55 (13,5%) 51 11 (5,7%) 13 (,1%) 3 5 (1,%) 11 3 * In addition, there were reports on 13 primary hemi prostheses done for other reasons than hip fractures. ** Reoperations where prosthetic parts are not changed or removed (soft tissue debridements for infected prosthesis, soft tissue procedures for gluteal insufficiency etc.). Figure 1: Annual numbers of operations 1 Number of operations 1 197 199 1991 1993 1995 1997 1999 1 3 5 7 9 11 13 15 Primary operations Reoperations Revisions 5,9 % of all operations were performed on the right side. 7,1 % performed in women. Mean age at primary surgery was 9, years, 9,9 years for women and 7,1 years for men. Figure : Incidence of primary hip prostheses Number of operations per 1. inhabitants 11 1 9 7 5 3 1 Age: 1995 Women 1995 Men Women Men 5 Women 5 Men 1 Women 1 Men 15 Women 15 Men -39-9 5-59 -9 7-79 - Hip 3
Report 17 Reasons for primary operations Table : Year Primary osteoarthritis Rheumatoid arthritis Sequelae after hip fracture Congenital dysplasia Cong. dysplasia with dislocation Epiphysiol./Perthes' disease Spondyloarthropathy Acute fracture of the femoral neck Avascular necrosis of the femoral head Sequelae after acetabular fracture Other Missing information 1 75 13 351 11 15 19 3 33 5 15 15 777 1 331 57 1 1 1 31 1 199 7 1 393 115 35 7 1 7 5 17 9 13 15 351 1 1 115 31 17 9 19 3 1 1 157 3 15 1 9 5 1 1 1 11 577 13 373 573 9 19 13 1 17 3 1 573 13 355 59 3 11 151 1 191 5 9 5515 131 39 5 17 151 17 11 1 3 5359 1 3 9 5 99 1 19 15 19 1 7 51 1 75 57 1 159 17 11 15 19 17 5 17 3 131 17 19 1 13 5 597 1 55 37 9 7 1 13 1 17 1 11 53 1 17 5 97 11 1 1 3 3 53 171 5 511 9 5 9 35 9 5 11 199 99 51 91 37 11 39 15 3 39 51 37 1993 171 9 3133 179 1 39 11 11 17 99 15 197 15 9 333 37 1 319 15 55 7 1 5 1 135 157 139 151 35 71 379 59 9 3 971 Diseases are not mutually exclusive. More than one reason for operation is possible Figure 3: Age by year of operation 5 Proportion (%) of primary operations 3 1 197-9 1993-97 199-3- 9 1 11 1 13 1 15 1 Age: < 5 5-59 -9 7-79 > 79 Hip
The Norwegian Arthroplasty Register Reasons for revisions Table 3: Year of revision Loosening of acetabular component Loosening of femoral component Dislocation Deep infection Periprosthetic fracture Pain Osteolysis acet.,no loosening Osteolysis femur, no loosening 1 5 5 5 35 175 1 5 9 1 7 5 1 3 15 33 9 313 153 11 5 9 9 3 133 1 1 1 1 1 17 5 3 1 3 1 99 1 13 9 3 13 91 133 15 53 3 55 1 9 1 1 1 5 31 3 31 13 1 7 9 1 3 5 3 11 3 33 7 11 1 3 5 1 3 75 5 1 319 9 39 9 15 55 5 55 5 7 7 1 9 3 31 15 3 131 5 1 9 3 7 1 399 35 19 11 79 131 5 53 3 7 31 5 7 9 17 19 7 1 53 1 3 399 95 19 1 1 119 5 3 5 3 337 1 19 59 113 3 57 5 9 3 371 97 15 1 11 11 3 7 1 1 3 395 3 15 97 33 39 71 3 11 1 199-7 157 33 33 9 37 1 3 37 17 97 7 1993-97 7 9 3 3 3 3 7 17 7 11 197-9 1 7 179 3 15 3 5 3 11 3 13 1191 71 11 3 33 7 9 1 757 171 1 195 19 Polyethylene wear Previous Girdlestone Implant fracture Gluteal failure Other Missing information Revision causes are not mutually exclusive. More than one reason of revision is possible Figure : Missing Other 1 Pain Number of reasons for revisions 1 1 1 1 Osteolysis femur, no loosening Osteolysis acet, no loosening Osteolysis acet and femur, no loosening Dislocation Fracture of femur Loosening Deep infection Implant fracture 197 199 1991 1993 1995 1997 1999 1 3 5 7 9 11 13 15 Gluteal failure The graph is hierarchical, i.e. if a revision is marked both "Deep infection" and "Loosening", only "Deep infection" is counted. Hip 5
Report 17 Type of revision Table a: Age 75 years old or younger Year Exchange of femoral stem and head Exchange of stem, PE liner, head Exchange of acetabular cup Exchange of femoral head Exchange of femoral head and acetabular cup Exchange of all components Exchange of PE liner only Exchange of PE liner and femoral head Exchange of PE liner and femoral stem Removal of prosthesis or cement spacer Removal of prosthesis and insertion of cement spacer Insertion of new prosthesis (after Girdlestone) Soft tissue debridement of infected prosthesis Muscle resonance and transposition Osteosynthesis for fracture Other operation Missing information 1 71 1 91 39 195 1 1 3 7 7 75 1 9 5 7 3 15 9 13 113 33 1 13 3 59 5 5 1 3 1 1 115 33 1 1 3 9 13 7 1 1 1 7 13 77 93 3 1 13 3 5 15 73 15 73 1 9 9 15 1 3 5 17 7 1 3 19 5 73 11 3 1 7 157 1 3 9 9 5 1 3 5 735 1 9 11 173 17 1 37 3 15 5 7 11 7 9 5 57 39 17 5 5 3 1 7 75 3-3 9 5 15 97 93 35 9 31 35 1 1 7 3 199-9 3 37 1 3 95 39 15 13 1 11 9 1993-97 737 11 51 1 53 131 15 5 135 11 1 1 3117 197-9 7 353 19 1 3 11 15 1 9 73 91 1 53 31 53 11 9 9 7 57 91 3 1 9 3 13 133 Figure 5a: Age 75 years old or younger Removal of prosthesis and insertion of cement spacer,5 % Removal of prosthesis (Girdlestone or cement spacer), % Insertion of new prosthesis (after Girdlestone) 1, % Soft tissue debridement of infected prosthesis 1,7 % Other operation, % Missing information, % Exchange of femoral stem and head 1, % Exchange of PE liner and femoral stem,5 % Exchange of PE liner and femoral head 5, % Exchange of femoral stem, PE liner and head 1,1 % Exchange of acetabular cup 13, % Exchange of PE liner only, % Exchange of all components 31,9 % Exchange of femoral head 3, % Exchange of femoral head and acetabular cup 17, % Hip
The Norwegian Arthroplasty Register Table b: Age over 75 years old Year Exchange of femoral stem and head Exchange of stem, PE liner, head Exchange of acetabular cup Exchange of femoral head Exchange of femoral head and acetabular cup Exchange of all components Exchange of PE liner only Exchange of PE liner and femoral head Exchange of PE liner and femoral stem Removal of prosthesis or cement spacer Removal of prosthesis and insertion of cement spacer Insertion of new prosthesis (after Girdlestone) Soft tissue debridement of infected prosthesis 1 9 9 7 9 15 1 13 3 7 1 11 15 1 97 9 9 151 17 1 9 1 5 59 1 7 9 1 15 5 1 5 1 31 1 5 5 13 9 3 1 1 17 1 13 9 3 35 33 3 59 1 1 3 99 3 7 15 19 37 1 3 1 5 579 11 9 1 97 3 9 1 3 1 5 3 1 1 55 1 9 7 77 13 1 1 1 7 5 9 51 9 9 3 59 5 99 1 3 1 35 3 5 3-37 17 1 19 3 37 1 7 1 5 33 1 7 1 53 199-99 1 7 3 19 73 5 1 157 1993-97 51 3 11 75 9 13 197-9 7 3 1 9 7 3 13 11 335 1737 3 133 93 3 13 3 599 11 1 19 19 3 11755 Muscle resonance and transposition Osteosynthesis for fracture Other operation Missing information Figure 5b: Age over 75 years old Removal of prosthesis and insertion of cement spacer 1, % Removal of prosthesis (Girdlestone or cement spacer) 5, % Exchange of PE liner and femoral stem,3 % Exchange of PE liner and femoral head 1, % Exchange of PE liner only,3 % Insertion of new prosthesis (after Girdlestone) 1,3 % Exchange of all components 35,3 % Soft tissue debridement of infected prosthesis 1,7 % Other operation,5 % Missing information,5 % Exchange of femoral stem and head, % Exchange of femoral stem, PE liner and head, % Exchange of acetabular cup 15, % Exchange of femoral head 3,7 % Exchange of femoral head and acetabular cup 11,9 % Hip 7
Report 17 Bone transplantation in revisions Table 5: Acetabular cup Year Yes No 1 Bone impaction Missing 1 (, %) 99 (3 %) 95 (, %) 3 (5,9 %) 15 1 (7, %) 99 (, %) 9 (,5 %) 5 (17, %) 1 11 (,7 %) 55 (, %) 9 (7,3 %) 31 (17,9 %) 13 9 (,7 %) 9 (,3 %) 131 (9,9 %) 51 (19 %) 1 15 ( %) 3 (3,3 %) 13 (1,9 %) 35 (17,9 %) 11 11 (,7 %) 7 (,7 %) 11 (1,1 %) 17 (1,5 %) 1 131 (1, %) 77 (, %) 19 (15 %) 151 (1 %) 9 111 (9, %) 715 (59,1 %) 5 (,3 %) 13 (11, %) 11 (9, %) (59,5 %) 11 (1, %) 133 (11,9 %) 7 13 (1,5 %) 59 (5,5 %) 193 (1,3 %) 133 (1, %) 115 (11, %) 55 (55 %) 1 ( %) 137 (13, %) 5 11 (15, %) 5 (9, %) 3 (1, %) 1 (13, %) 11 (17,1 %) 57 (, %) 1 (17, %) 7 (5 %) 3 1 (1, %) 51 (5, %) 17 (1, %) 3 (3 %) 199-1 (1, %) 3 3 (, %) 55 (13,5 %) 13 (,7 %) 1993-97 1 337 (,1 %) 3 1 (, %) (, %) 117 (,5 %) 197-9 1 7 (, %) 75 (71,5 %) ( %) 7 (1, %) 5 1 (1, %) 19 179 (3,5 %) 3 19 (1, %) 757 (9,1 %) 1 7 1 1 9 1 3 1 315 1 7 1 5 1 9 1 1 1 5 1 7 1 57 9 99 5 755 3 55 3 1 Table : Femoral stem 1 Year Yes No Bone impaction Missing 1 3 (,9 %) 97 (, %) 3 (, %) 1 (3, %) 15 7 (5 %) 9 (9, %) 11 (, %) 37 (, %) 1 3 (,9 %) 79 ( %) 3 (, %) 37 (,9 %) 13 (, %) 1 (,7 %) (, %) 37 (,3 %) 1 1 (, %) 3 (3,7 %) 1 (1, %) 375 (,5 %) 11 11 (9 %) 1 (3, %) 9 (,3 %) 3 (5, %) 1 119 (9,5 %) 79 (3, %) (3,5 %) 97 (3, %) 9 19 (1,7 %) 75 (, %) 5 (3,7 %) 3 (3, %) 1 (1, %) 77 (,3 %) 9 (,1 %) 3 (,7 %) 7 15 (11,9 %) 1 (57,1 %) 7 (,7 %) 5 (,3 %) 15 (1, %) 59 (59, %) 1 ( %) 13 (1, %) 5 11 (17,1 %) 57 (53,9 %) (,1 %) (, %) 15 (13,3 %) 7 (, %) 119 (1,7 %) 9 (5, %) 3 137 (13, %) 7 (73,3 %) 97 (9, %) 3 (3 %) 199-971 ( %) 937 (, %) 7 (1,7 %) 13 (,7 %) 1993-97 1 3 (7,9 %) 991 (,9 %) 319 (,7 %) 117 (,5 %) 197-9 593 (15, %) 3 19 (, %) ( %) 7 (1, %) 5 (1, %) 19 3 (5,7 %) 1 1 ( %) (13,5 %) 1 7 1 1 9 1 3 1 315 1 7 1 5 1 9 1 1 1 5 1 7 1 57 9 99 5 755 3 55 3 1 1 Registration of "Bone impaction" started in 199. Hip
The Norwegian Arthroplasty Register Bone loss in revisions Table 7: Acetabular cup Year Type I Type IIA Type IIB Type IIC Type IIIA Type IIIB Missing 1 5 1 1 5 733 1 7 15 1 1 1 51 59 79 1 1 197 171 93 7 1 31 9 1 9 13 53 1 5 7 5 33 1 3 1 9 3 111 73 1 57 1 315 11 7 13 11 7 5 1 7 1 3 17 13 77 19 55 1 5 9 1 15 9 7 7 7 51 1 9 19 11 3 9 7 7 7 1 1 7 15 1 73 55 3 79 1 5 1 13 7 5 59 35 1 7 5 137 7 7 59 3 37 1 57 Bone loss in revision - acetabulum (Paprosky Classification): Type I: Hemispheric acetabulum without edge defects. Intact posterior and anterior column. Defects in anchoring holes that do not destroy the subchondral bone plate. Type IIA: Hemispheric acetabulum without major edge defects, intact posterior and anterior column, but with small metaphyseal fractures again. Type IIB: Hemispheric acetabulum without major edge defects, intact posterior and anterior column, but with small metaphyseal fractures again and some lack of support superiort. Type IIC: Hemispheric acetabulum without major edge defects, intact posterior and anterior column, but with defect in medial wall. Type IIIA: Significant component migration, osteolysis and bone loss. Bone loss from 1 o'clock until. Type IIIB: Significant component migration, osteolysis and bone loss. Bone loss from 9 o'clock until 5. Table : Femoral stem Year Type I Type II Type IIIA Type IIIB Type IV Missisng 1 5 151 977 1 7 15 13 7 17 1 9 1 1 1 19 7 13 3 9 1 9 13 3 153 7 3 1 3 1 5 19 7 1 1 315 11 177 15 77 1 7 1 7 1 195 15 7 1 17 1 5 9 155 11 9 1 1 9 15 177 1 11 1 7 1 1 7 1 19 1 1 91 1 5 17 151 5 5 1 7 5 1 15 7 3 1 59 1 57 Bone loss in revision - acetabulum (Paprosky Classification): Type I: Hemispheric acetabulum without edge defects. Intact posterior and anterior column. Defects in anchoring holes that do not destroy the subchondral bone plate. Type IIA: Hemispheric acetabulum without major edge defects, intact posterior and anterior column, but with small metaphyseal fractures again. Type IIB: Hemispheric acetabulum without major edge defects, intact posterior and anterior column, but with small metaphyseal fractures again and some lack of support superiort. Type IIC: Hemispheric acetabulum without major edge defects, intact posterior and anterior column, but with defect in medial wall. Type IIIA: Significant component migration, osteolysis and bone loss. Bone loss from 1 o'clock until. Type IIIB: Significant component migration, osteolysis and bone loss. Bone loss from 9 o'clock until 5. Registration of bone loss started in 5 Hip 9
Report 17 Surgical approach Table 9: In primary operations * Year Anterior Anterolateral Direct lateral Posterior Other Missing information 1 713 ( %) 1 13 (1,9 %) 1 5 (1 %) 5 13 (57, %) 5 (,1 %) 59 (5, %) 15 5 (, %) 1 17 (13, %) 3 (,5 %) 7 (,3 %) 3 ( %) 5 (5, %) 1 337 (,1 %) 1 57 (13 %) 3 173 (39 %) 3 1 (37,1 %) 17 (, %) 59 (,5 %) 13 3 (, %) 1 1 (13, %) 3 5 (, %) 7 (3,5 %) (,3 %) 55 (, %) 1 3 (5, %) 1 3 (13 %) 3 91 (9,9 %) 19 (7,9 %) 1 (, %) 3 (3, %) 11 9 (5, %) 7 (1, %) 3 97 (5,9 %) 1 (,3 %) 3 (, %) 175 (, %) 1 5 (,5 %) 7 (, %) 3 91 (53,5 %) 15 (9, %) (,7 %) 115 (1, %) 9 3 (, %) 3 (, %) 357 (1, %) 1 93 (7, %) 11 (, %) 117 (1, %) (1 %) 37 (5,7 %) 3 (3,7 %) 1 97 (,1 %) (,1 %) 9 (1, %) 7 1 (, %) (,1 %) 17 (,3 %) 1 711 (5,7 %) 1 (, %) 1 (1, %) ( %) 5 (7, %) 7 (7, %) 1 (3,5 %) 3 ( %) 11 (1,7 %) 5 7 (,1 %) 51 (7,9 %) 19 (7 %) 1 53 (3,3 %) (,1 %) 11 (1,7 %) (,1 %) (7, %) 5 (,9 %) 1 37 (3,1 %) (,1 %) (,3 %) 3 1 (, %) 591 (, %) (, %) 1 559 (,1 %) 3 ( %) 9 (, %) 199-9 (, %) 11 (7,3 %) 19 75 (,5 %) 79 (3,5 %) 3 (,1 %) 9 (,3 %) 1993-97 7 (,3 %) 1 (5,9 %) 1 71 (, %) 153 (,9 %) (,1 %) 9 (, %) 197-9 1 (, %) 1 7 (, %) 1 1 (5,7 %) 5 (,5 %) 13 (,1 %) 17 (,9 %) 1 (, %) 15 33 (,3 %) 5 97 (5,5 %) 5 7 (, %) 57 (,1 %) 3 53 ( %) 1 3 17 9 7 7 3 7 33 7 11 319 597 1 7 1 7 3 11 Figure : In primary operations * 1 % % % % % % % 197-9 199-1 1 1 1 Anterior Anterolateral Direct lateral Posterior Other Missing Table 1: Mini invasive surgery in primary surgery Year Yes No Missing 1 1 793 (,%) 53 (77,%) 35 (,%) 1 15 1 593 (1,9%) 533 (77,%) 31 (3,7%) 3 1 1 33 (1,%) 5 (,%) 71 (3,3%) 17 13 1 7 (17,%) 317 (7,%) 37 (,%) 9 1 1 37 (1,9%) 5 (7,7%) 59 (,%) 7 11 1 (13,%) 5 (1,%) 355 (,%) 7 3 1 93 (1,7%) 171 (,%) 5 (3,1%) 7 33 9 39 (5,%) 7 (93,%) (,%) 7 11 5 (,9%) 755 (9,%) (,%) 7 (,1%) 57 (9,%) 9 (1,3%) 5 (,9%) (95,%) 55 (,%) 319 5 1 (,%) 5 1 (,1%) 39 (9,7%) 597 * Anterior: Anterolateral: Direct lateral: Posterior: Operative approach between sartorius and tensor Operative approach between glut. medius and tensor Operative approach transgluteal Operative approach behind gluteus medius 3 Hip
The Norwegian Arthroplasty Register Table 11: In revisions * Year Anterior Anterolateral Direct lateral Posterior Other Missing information 1 7 (1, %) (3 %) 53 (3, %) 7 (7,5 %) 5 (3,7 %) (5, %) 15 (1,7 %) 35 (,5 %) 1 (,9 %) 57 (, %) 5 (3, %) (,7 %) 1 1 (1, %) 5 (1,9 %) 7 (59 %) (33 %) 3 (1, %) (3,1 %) 13 7 (,5 %) 31 (,3 %) 17 (1,9 %) 379 (,7 %) 33 (,5 %) 53 ( %) 1 11 (, %) 35 (,7 %) (3 %) 353 (, %) (3,5 %) (3, %) 11 9 (,7 %) ( %) 51 (,1 %) 335 ( %) 3 (,3 %) 3 (, %) 1 1 (1,1 %) 17 (1, %) 3 (7 %) 37 (7, %) 19 (1,5 %) 1 (1, %) 9 ( %) (3,5 %) 77 (3,7 %) 31 (, %) 1 (1 %) (1,7 %) 3 (,3 %) 5 (, %) 77 (7,1 %) 51 (, %) 1 (,9 %) 19 (1,7 %) 7 1 (,1 %) 55 (5, %) 7 (7,1 %) 73 ( %) (, %) 15 (1, %) 1 (,1 %) 1 (,1 %) 99 (9, %) 31 (,9 %) (, %) 13 (1,3 %) 5 3 (,3 %) (, %) 79 (7, %) 19 (1,7 %) 1 (1,3 %) 9 (,9 %) (, %) 5 (5,5 %) 731 (77, %) 13 (1,3 %) (, %) 19 ( %) 3 1 (,1 %) 5 (, %) 73 (7,5 %) 11 (11,5 %) (, %) (, %) 199-15 (,3 %) 39 (, %) 3 91 (7, %) 7 (13, %) (, %) 5 (1, %) 1993-97 5 (,1 %) 7 (5, %) 3 537 (7, %) 95 (1, %) 19 (, %) 5 (,5 %) 197-9 15 (, %) (,3 %) 3 (1,9 %) 1 179 (3, %) 7 (, %) (, %) 17 (, %) 1 51 (5 %) 159 (, %) 7 375 (, %) 39 (1, %) 57 (1,9 %) 1 7 1 1 9 1 3 1 315 1 7 1 5 1 9 1 1 1 5 1 7 1 57 9 99 5 755 3 55 3 1 Figure 7: In revisions * 1 % % % % % % % 197-9 199-1 1 1 1 Anterior Anterolateral Direct lateral Posterior Other Missing * Anterior: Anterolateral: Direct lateral: Posterior: Operative approach between sartorius and tensor Operative approach between glut. medius and tensor Operative approach transgluteal Operative approach behind gluteus medius Hip 31
Report 17 Trochanteric osteotomy Table 1: Primary operations Revisions Year No Yes Missing No Yes Missing 1 391 (9,5 %) (,3 %) (5, %) 1 (7, %) 91 (, %) 95 (, %) 15 7 597 (9 %) 9 (,3 %) 1 (9, %) 1 1 (5,3 %) 9 (, %) 111 (7,9 %) 1 7 39 (9,9 %) (, %) 71 (, %) 1 111 ( %) (5,1 %) 115 (,9 %) 13 7 (9,3 %) 5 (,7 %) 1 (1 %) 1 15 (7,7 %) 5 (,9 %) 97 (7,3 %) 1 7 (9, %) 37 (,5 %) 77 (9, %) 1 7 ( %) 111 (, %) 1 (9, %) 11 (9 %) 9 (, %) 77 (9, %) 1 (,7 %) 13 (9, %) 1 (7, %) 1 9 (91,3 %) 3 (,5 %) (, %) 1 1 (,3 %) 1 (, %) 91 (7, %) 9 5 (9,5 %) 59 (, %) 71 (, %) 1 13 (3, %) 11 (1 %) 75 (, %) (91, %) 59 (,9 %) 51 (7,9 %) 95 (5 %) 1 (9, %) (5,5 %) 7 15 (91,7 %) 75 (1,1 %) (7, %) 7 (, %) 11 (1, %) 73 (,9 %) 5 71 (9,5 %) 7 (1, %) 51 (,1 %) 3 (3 %) 1 (1,3 %) 7 (,7 %) 5 5 95 (9,7 %) 11 (1,7 %) 5 (7, %) (1,7 %) 1 (9, %) 91 (, %) 5 99 (9,5 %) 13 (,1 %) 9 (1, %) ( %) 99 (1,5 %) 33 (3,5 %) 3 7 (95,3 %) 13 (3 %) 11 (1,7 %) (7,1 %) 97 (9, %) 31 (3,1 %) 199-7 (95, %) 93 (3, %) 3 (1 %) 157 (5, %) 593 (1, %) 95 ( %) 1993-97 3 (9, %) 19 (,9 %) 17 (,7 %) 9 (,1 %) (1, %) 1 (1,3 %) 197-9 19 37 (7, %) 9 (, %) 33 (1,3 %) 93 (7,1 %) 73 (, %) (1, %) 1 355 9 9 19 9 1 9 11 7 5 33 7 97 7 71 7 3 7 5 7 15 3 33 9 5 51 13 5 (9, %) 9 7 (5 %) 3 (, %) 5 35 ( %) 3 5 (11,5 %) 1 371 (,5 %) 11 3 Antibiotic prophylaxis Table 13: Primary operations Year No Yes Missing No Revisions Yes Missing 1 3 ( %) (99, %) 5 (, %) (5, %) 1 33 (9,5 %) 9 ( %) 15 ( %) 399 (99,5 %) 39 (,5 %) 9 (, %) 1 37 (97,9 %) 1 (1,5 %) 1 1 ( %) (99,5 %) 3 (,5 %) (, %) 1 7 (9, %) (, %) 13 ( %) 57 (99,5 %) 37 (,5 %) (, %) 1 9 (9 %) 1 (1, %) 1 ( %) 7 1 (99,5 %) 3 (, %) 11 (, %) 1 91 (9, %) 13 (1 %) 11 (,1 %) 7 33 (99, %) (,3 %) 3 (3,3 %) 1 3 (9 %) (, %) 1 (,1 %) 7 97 (99,5 %) 7 (, %) 5 (3, %) 1 3 (95, %) 1 (, %) 9 3 (, %) 7 1 (99,5 %) 1 ( %) 37 (3,1 %) 1 17 (9, %) (, %) 39 (, %) (99, %) 5 (,1 %) 3 (3, %) 1 77 (9 %) 7 (, %) 7 7 (, %) (99,5 %) 7 (,1 %) 3 (,9 %) 1 15 (9,5 %) 7 (,7 %) 37 (, %) (99, %) ( %) (, %) 979 (97, %) ( %) 5 5 (, %) 57 (99, %) ( %) 1 (1,7 %) 1 39 (9,3 %) ( %) 1 ( %) 17 (1 %) ( %) (, %) 99 (9, %) 5 (,5 %) 3 1 ( %) 7 3 (1 %) 1 ( %) (, %) 975 (9,5 %) 7 (,7 %) 199-1 (,1 %) 793 (99, %) 7 ( %) 9 (, %) 9 (99,3 %) 7 (,1 %) 1993-97 19 (, %) 55 (99,5 %) 5 ( %) (,9 %) 79 (99 %) (,1 %) 197-9 1 7 (,9 %) 915 (9,9 %) (, %) 15 (3,9 %) 3 1 (95,5 %) (, %) 1 355 9 9 19 9 1 9 11 7 5 33 7 97 7 71 7 3 7 5 7 15 3 33 9 5 51 3 (1,1 %) 17 93 (9,7 %) 317 (, %) 59 ( %) 9 (97,5 %) 1 (, %) 11 3 3 Hip
The Norwegian Arthroplasty Register Fixation in primary operations Figure a: All patients 1 % Proportion of primary operations % % % % % 19 199 199 199 199 199 1 1 1 1 Figure b: Patients under 5 years old 1 % Proportion of primary operations % % % % % 19 199 199 199 199 199 1 1 1 1 Missing information / Other Hybrid (cemented femur) Reverse hybrid (cemented acetabulum) Uncemented acetabulum and femur Cemented acetabulum and femur without antibiotic Cemented acetabulum and femur with antibiotic Hip 33
Report 17 Fixation in primary operations (cont.) Figure c: Patients 5 years or older and under 75 years old 1 % Proportion of primary operations % % % % % 19 199 199 199 199 199 1 1 1 1 Figure d: Patients over 75 years old 1 % Proportion of primary operations % % % % % 19 199 199 199 199 199 1 1 1 1 Missing information / Other Hybrid (cemented femur) Reverse hybrid (cemented acetabulum) Uncemented acetabulum and femur Cemented acetabulum and femur without antibiotic Cemented acetabulum and femur with antibiotic 3 Hip
The Norwegian Arthroplasty Register Fixation in revisions Figure 9: Acetabular cup - All patients 1 % Proportion of primary operations % % % % % 197 199 1991 1993 1995 1997 1999 1 3 5 7 9 11 13 15 Cemented with antibiotics Cemented without antibiotics Uncemented Missing Figure 1: Femoral stem - All patients 1 % Proportion of primary operations % % % % % 197 199 1991 1993 1995 1997 1999 1 3 5 7 9 11 13 15 Cemented with antibiotics Uncemented Cemented without antibiotics Missing Hip 35
Report 17 Type of fixation and bone transplantation in revisions Table 1: Acetabular cup Bone impaction Cemented Bone transpl. No Missing Bone impaction Uncemented Bone transpl. No Missing 1 1% 7% 5% 19% 31 % 7% 7% 17% 15 1% 9% 3% 7% 3 5% 1% 9% 15% 3 1 % 1% 5% % 59 % 1% 7% 1% 593 13 31% 7% 5% 1% 37 % 11% 71% 13% 51 1 3% % % 1% 31 5% 1% 71% 11% 555 11 % 7% % % 377 % 1% 7% 13% 71 1 37% 1% 9% 5% 77 3% 3% % % 37 9 5% % 3% % 9 9% % % % 353 3- % 1% 3% % 5 7% 9% 59% 5% 1 5 199- % % 9% % 1 99 % 5% % 1% 1 13 1993-97 1% 7% 1% % 1 59 3% 57% 3% % 1 51 197-9 % 3% 7% 1% 1 % 5% 33% % 7 5% 17% 5% % 1 7 5% 3% 5% 7% 9 371 Table 15: Femoral stem Bone impaction Cemented Bone transpl. No Missing Bone impaction Uncemented Bone transpl. No Missing 1 % 1% 77% 3% 1 1% 7% 75% 17% 15 % % % 1% 117 % 9% 7% 1% 7 1 3% 3% 3% 3% 11 % 13% 7% 1% 375 13 % % % 7% 95 % 1% 7% 1% 57 1 13% % % 3% 1 1% 15% 71% 13% 3 11 % % 5% % 1 % % 5% 11% 39 1 9% 5% 5% % 1 % % % % 39 9 % 5% 5% 17% 113 1% 5% % 1% 375 3-35% % 53% % 1 17 % 35% 55% % 1 31 199-3% 15% % 1% 1 1 1% 5% 33% 1% 1 13 1993-97 11% % % % 1 7% 3% 9% 1% 1 31 197-9 % % 9% % 39 % 5% 3% 1% 51 17% 13% 7% % 3 % 3% 53% 7% 7 73 Registration of "Bone impaction" started in 199 3 Hip
The Norwegian Arthroplasty Register Cements used in the acetabulum Figure 11: In primary- and revision surgeries 7 Other/Missing Boneloc Cemex System Genta Cemex System Genta FAST 5 CMW I CMW I w/gentamycin CMW III Copal G+ V Optipac Refobacin Bonecement R 3 Palacos Palacos w/gentamycin Palacos MV without gentamicin Palacos R + G Refobacin Bone Cement R 1 Refobacin Revision Refobacin-Palacos 197 199 1991 1993 1995 1997 1999 1 3 5 Year of operation 7 9 11 13 15 Simplex Simplex w/erythr+colistin Simplex w/tobramycin Simplex unknown SmartSet GHV SmartSet GHV Genta Smartmix Cements used in the femur Figure 1: In primary- and revision surgeries 7 Other/Missing Boneloc Cemex System Genta Cemex System Genta FAST 5 CMW I CMW I w/gentamycin CMW III Copal G+ V Optipac Refobacin Bonecement R 3 Palacos Palacos LV + G Palacos w/gentamycin Palacos R + G Refobacin Bone Cement R 1 Refobacin Revision Refobacin-Palacos 197 199 1991 1993 1995 1997 1999 1 3 5 Year of operation 7 9 11 13 15 Simplex Simplex w/erythr+colistin Simplex w/tobramycin Simplex unknown SmartSet GHV SmartSet GHV Genta Smartmix Hip 37
Report 17 Cemented primary prostheses Table 1: (The 5 most common combinations of cup and stem) Cup Stem 197-9 1 11 1 13 1 15 1 CHARNLEY CHARNLEY 3979 35 3 115 11 5 39 37 EXETER EXETER 117 577 9 155 5 19 REFLECTION CEM. ALL POLY SPECTRON-EF 3 5 13 11 5 33 1 973 TITAN TITAN 79 15 7 955 EXETER X3 RIMFIT EXETER 5 9 1173 115 135 133 IP LUBINUS SP II 3 59 7 55 71 15 79 3 1 531 CONTEMPORARY EXETER 31 71 73 7 1 1 5 1 3 737 SPECTRON ITH 5 5 MARATHON CHARNLEY MODULAR 1 33 3 19 5 13 5 159 KRONOS TITAN 113 5 1 13 ELITE TITAN 115 39 1 ELITE CHARNLEY 93 1 937 REFLECTION CEM. ALL POLY ITH 9 9 REFLECTION CEM. ALL POLY BIO-FIT 9 9 WEBER ALLO PRO MS-3 13 13 ELITE EXETER 77 9 31 1 77 LUBINUS LUBINUS SP II 13 15 17 5 1 77 ZCA CPT 75 75 CHARNLEY CHARNLEY MODULAR 5 19 1 1 1 MARATHON EXETER 1 17 1 7 9 1 1 3 IP LUBINUS 57 57 ELITE ELITE 577 1 1 579 CHARNLEY EXETER 571 571 TITAN FJORD 53 53 ELITE CHARNLEY MODULAR 19 111 53 57 3 1 51 SPECTRON SP I 3 3 MODULAR HIP SYSTEM BIO-FIT 3 3 SPECTRON TITAN 11 11 CHARNLEY C-STEM 37 37 CHARNLEY ELITE 375 375 OPERA SPECTRON-EF 355 1 35 ELITE MS-3 331 331 AVANTAGE EXETER 3 1 9 37 1 7 1 37 3 39 PEARL TITAN 5 5 MODULAR HIP SYSTEM ITH 77 77 MARATHON LUBINUS SP II 1 11 11 3 11 SPECTRON BIO-FIT IP SP I 1 1 MARATHON C-STEM 7 1 9 1 17 LMT LMT 191 191 ELITE CPT 11 1 1 1 ZCA CPS-PLUS 1 1 MÜLLER TYPE MÜLLER TYPE 1 1 PE-PLUS CPS-PLUS 159 5 1 ELITE C-STEM 11 11 3 Hip
The Norwegian Arthroplasty Register Uncemented primary prostheses Table 17: (The 5 most common combinations of cup and stem) Cup Stem 197-9 1 11 1 13 1 15 1 REFLECTION UNCEMENTED CORAIL 9 9 5 59 7 75 5 19 7 IGLOO FILLER 157 1 9 1 171 13 15 3355 PINNACLE CORAIL 37 91 11 9 55 357 31 33 71 TRILOGY CORAIL 3 1 1 1 1 7 35 75 TROPIC CORAIL 59 59 ATOLL CORAIL 1 1 DURALOC CORAIL 19 1 3 7 13 Continuum Acetabular System CORAIL 17 3 33 19 R3 CORAIL 1 1 11 91 1 BICON-PLUS ZWEYMÜLLER 57 1 5 TRIDENT CORAIL 13 3 17 7 11 5 5 REFLECTION UNCEMENTED SECURFIT 33 3 1 1 91 3 513 TRILOGY SCP/UNIQUE 5 3 3 1 59 TRILOGY HACTIV 33 57 3 1 7 TRIDENT ACCOLADE II 75 173 1 1 GEMINI PROFILE 7 7 R3 POLARSTEM 1 5 9 9 391 BICON-PLUS HACTIV 3 3 DURALOC PROFILE 33 33 REFLECTION UNCEMENTED HACTIV 1 9 3 117 13 313 REFLECTION UNCEMENTED OMNIFIT 153 7 7 3 DURALOC SCP/UNIQUE 7 7 TRILOGY FILLER 5 33 5 3 1 1 ENDLER ZWEYMÜLLER 7 7 EUROPEAN CUP SYSTEM TAPERLOC REFLECTION UNCEMENTED SCP/UNIQUE 1 3 13 1 1 5 13 1 PLASMACUP BICONTACT 3 3 LMT TAPERLOC TRIDENT ABG II 9 5 1 1 R3 FILLER 3 9 TI-FIT BIO-FIT 175 175 REFLECTION UNCEMENTED SL-PLUS MIA 1 157 19 SECURFIT OMNIFIT 1 1 ABG I ABG I 15 15 HARRIS/GALANTE HARRIS/GALANTE 15 15 ABG II ABG II 155 155 COXA FEMORA 155 155 PARHOFER PARHOFER 15 15 BICON-PLUS CORAIL 137 9 1 1 15 REFLECTION UNCEMENTED PROFEMUR GLADIATOR 3 37 37 1 13 AVANTAGE CORAIL 5 19 1 1 3 13 TRILOGY OMNIFIT 1 3 9 13 TRIDENT POLARSTEM 3 5 1 1 TITAN CORAIL 11 11 REFLECTION UNCEMENTED BICONTACT 11 11 Hip 39
Report 17 Hybrid primary prostheses Table 1: Hybrid primary prostheses. (The most common) Cup (uncemented) Stem (cemented) 197-9 1 11 1 13 1 15 1 TRILOGY EXETER 37 9 53 1 3 3 11 TROPIC TITAN 9 9 MORSCHER MS-3 1 3 5 7 TRILOGY CHARNLEY 3 3 ENDLER TITAN 33 33 R3 LUBINUS SP II 1 1 11 REFLECTION UNCEMENTED LUBINUS SP II 1 3 7 1 1 DURALOC CHARNLEY 153 153 TRIDENT EXETER 9 17 1 1 1 1 3 151 REFLECTION UNCEMENTED BIO-FIT 1 1 REFLECTION UNCEMENTED SPECTRON-EF 19 11 1 1 1 AVANTAGE EXETER 17 7 1 15 3 113 ATOLL TITAN 15 15 IP SP I 11 11 TRILOGY CPT 9 9 REFLECTION UNCEMENTED C-STEM 1 1 HG II ANATOMIC CC GEMINI CHARNLEY 77 77 TI-FIT BIO-FIT 53 53 TROPIC EXETER 7 7 Table 19: Reverse hybrid primary prostheses. (The most common) Cup (cemented) Stem (uncemened) 197-9 1 11 1 13 1 15 1 MARATHON CORAIL 7 39 117 1757 735 935 7 377 19 ELITE CORAIL 151 33 9 7 5 7 3 7 REFLECTION CEM. ALL POLY CORAIL 7 193 15 5 1 3 9 177 TITAN CORAIL 5 11 13 1 93 CONTEMPORARY CORAIL 51 13 3 1 1 KRONOS CORAIL 7 11 9 7 33 REFLECTION CEM. ALL POLY HACTIV 5 3 9 91 1 75 EXETER X3 RIMFIT CORAIL 1 5 7 19 3 EXETER X3 RIMFIT ACCOLADE II 59 9 119 11 3 REFLECTION CEM. ALL POLY FILLER 11 1 1 3 19 1 33 IP CORAIL 75 7 3 1 11 3 5 EXETER CORAIL 1 5 173 EXETER ABG II 17 17 REFLECTION CEM. ALL POLY TAPERLOC 155 155 EXETER X3 RIMFIT ABG II 1 9 17 AVANTAGE CORAIL 5 15 3 11 15 19 13 1 11 EXETER X3 RIMFIT FILLER 1 3 3 5 11 CHARNLEY CORAIL 1 1 1 117 ELITE SCP/UNIQUE 3 1 9 OPERA CORAIL 5 9 Hip
The Norwegian Arthroplasty Register Acetabular cups in primary operations Table : (The 5 most common) Cup 197-9 1 11 1 13 1 15 1 CHARNLEY 153 9 3 117 11 39 MARATHON 3 59 155 139 37 3317 31 3 9 REFLECTION CEM. ALL POLY 1173 9 37 193 3 1 53 3 33 113 EXETER 115 5 5 15 1 13519 TITAN 3 11 1 1 ELITE 5 15 391 3 1 11 9 75 EXETER X3 RIMFIT 1 71 75 113 139 13 159 113 731 REFLECTION UNCEMENTED 1537 511 97 77 933 97 79 33 77 IP 31 3 715 559 1 313 711 TRILOGY 3 55 3 3 9 39 59 517 57 51 CONTEMPORARY 39 91 957 9 195 11 5 1 3 5513 TROPIC 33 33 SPECTRON 35 35 IGLOO 7 15 11 3 9 11 17 13 19 359 PINNACLE 77 11 15 3 35 33 397 517 9 KRONOS 13 1 119 7 193 DURALOC 131 5 7 5 7 193 TRIDENT 1 3 33 53 11 3 1 5 177 ATOLL 191 191 R3 75 57 1 3 1 1 BICON-PLUS 11 5 1 1 113 AVANTAGE 97 1 19 119 13 11 9 15 11 ZCA 17 9 1 MODULAR HIP SYSTEM 7 7 Continuum Acetabular System 191 319 35 55 MORSCHER 75 37 3 WEBER ALLO PRO 3 3 LUBINUS 31 1 15 1 51 13 79 ENDLER BIRMINGHAM HIP RESURFACING 7 13 7 1 5 GEMINI 51 51 OPERA 51 57 POLARCUP 3 5 5 79 9 37 EUROPEAN CUP SYSTEM 33 33 TI-FIT 31 31 PEARL 7 7 PLASMACUP 3 3 LMT (Uncemented) 75 75 HARRIS/GALANTE 5 5 PE-PLUS 1 7 MÜLLER TYPE ABG II 3 3 EXCEED ABT RINGLOC-X 3 7 7 39 37 7 COXA LMT (Cemented) Hip 1
Report 17 Acetabular cups in revisions Table 1: (The 5 most common) Cup 197-9 1 11 1 13 1 15 1 CHARNLEY 5 5 17 9 5 3 TROPIC 1 1 15 ELITE 19 55 33 19 1 1 AVANTAGE 559 151 19 19 1 15 77 15 TRILOGY 9 9 3 7 5 51 5 5 5 157 TRABECULAR METAL 3 5 97 11 11 1 1 19 15 PINNACLE 3 93 97 117 97 11 97 EXETER 91 1 1 1 3 9 REFLECTION CEM. ALL POLY 79 5 3 11 7 3 915 MARATHON 3 135 13 1 13 5 9 1 POLARCUP 1 1 5 11 11 133 11 73 REFLECTION UNCEMENTED 73 7 9 3 7 3 59 IGLOO 3 17 15 15 5 5 TITAN 9 11 57 ATOLL 39 39 TRIDENT 3 11 9 3 9 37 IP 1 1 7 1 3 3 5 CONTEMPORARY 57 5 9 3 3 KRONOS 13 5 CHRISTIANSEN 19 19 SPECTRON 19 19 EXETER X3 RIMFIT 3 3 5 9 9 1 DURALOC 75 11 1 1 5 11 9 17 Continuum Acetabular System 13 51 13 OPERA 9 7 11 R3 7 1 1 HARRIS/GALANTE 99 99 ZCA 95 1 9 MODULAR HIP SYSTEM 95 95 CAPTIV 71 7 7 EUROPEAN CUP SYSTEM 73 73 LMT (Uncemented) 7 7 ENDLER BICON-PLUS 1 3 1 57 HG II 53 53 MORSCHER 3 51 GEMINI 7 7 SECURFIT 5 5 OCTOPUS 37 3 REGENEREX RINGLOC 9 13 7 39 TI-FIT 3 3 PARHOFER 35 35 PCA 33 1 3 S-ROM 7 7 ORIGINAL M.E. MÜLLER 5 5 COXA 5 5 Hip
The Norwegian Arthroplasty Register Femoral stems in primary operations Table : (The 5 most common) Stem 197-9 1 11 1 13 1 15 1 CORAIL 139 9 357 31 9 31 7 5 75 7 CHARNLEY 11 359 33 117 11 7 3 59 EXETER 151 11 155 155 11 159 1 19 15 77 TITAN 1193 5 3 3 11 SPECTRON-EF 97 57 15 119 9 37 1 3 1 155 LUBINUS SP II 59 5 55 519 1 53 77 73 773 FILLER 11 1 95 95 31 373 37 59 7 53 ITH 373 373 CHARNLEY MODULAR 77 35 39 35 5 37 1 153 3 BIO-FIT 1993 1993 MS-3 11 35 7 1 17 1 1915 HACTIV 11 1 79 5 1 3 9 15 7 1 SCP/UNIQUE 113 5 3 15 33 3 7 3 131 CPT 159 3 1 1 1 111 ZWEYMÜLLER 13 9 5 11 ELITE 119 1 3 1 13 OMNIFIT 73 113 7 9 PROFILE 9 9 ACCOLADE II 11 137 313 3 ABG II 399 15 9 7 1 3 C-STEM 51 19 9 1 75 3 1 SP I 779 1 7 TAPERLOC (Uncemented) 7 3 771 FJORD 51 1 5 LUBINUS POLARSTEM 3 11 3 1 1 1 9 15 SECURFIT 35 91 13 17 9 3 555 CPS-PLUS 7 7 9 TAPERLOC (Cemented) 5 5 BICONTACT 3 3 ABG I 3 3 KAR/Corail Revision 11 11 15 1 3 9 95 TI-FIT 1 1 MÜLLER TYPE 13 13 FEMORA 1 1 SL-PLUS MIA 1 15 177 BI-METRIC 35 33 15 5 3 7 1 17 HARRIS/GALANTE 19 19 PROFEMUR GLADIATOR 71 3 15 PARHOFER 159 159 KAREY 13 13 MÜLLER TYPE V 13 13 ECHELON 115 11 ECHO- Bi-Metric 7 3 59 1 ANATOMIC CC 113 113 Hip 3
Report 17 Femoral stems in revisions Table 3: (The 5 most common) Stem 197-9 1 11 1 13 1 15 1 CHARNLEY 99 11 1 1 1 1 93 KAR/Corail Revision 1791 175 13 157 13 17 1 13 1 9 EXETER 15 1 7 7 3 77 77 5 CORAIL 1 3 5 3 5 51 5 13 TITAN 531 5 1 1 53 RESTORATION 95 39 57 7 3 7 55 53 CPT 5 7 7 7 5 7 51 FJORD 75 1 7 FILLER 3 17 19 19 15 1 1 1 19 39 SPECTRON-EF 31 1 13 1 3 3 375 TTHR 39 1 71 5 3 3 37 ELITE 3 3 1 1 353 REEF 5 3 1 3 5 3 LUBINUS SP II 15 3 3 9 3 15 9 37 ANATOMIC BR 19 19 ITH 19 19 BIO-FIT 17 17 MP RECONSTRUCTION 3 1 1 1 17 1 1 BI-METRIC 55 1 1 15 1 1 1 13 HACTIV 1 7 1 13 9 13 REVITAN 1 7 7 3 31 1 REACTIV 7 9 9 3 19 13 11 TAPERLOC (Uncemented) 115 115 ARCOS 1 3 11 17 7 33 9 ZWEYMÜLLER 1 3 Profemur 1 1 11 1 5 77 ECHELON 57 5 5 1 SP I SCAN HIP 59 59 LUBINUS 51 51 Securus 15 11 19 51 RECLAIM 1 13 9 1 1 7 HARRIS/GALANTE FEMORA 3 3 PARHOFER 3 3 CHARNLEY MODULAR 15 3 3 3 3 3 3 5 AURA 7 11 3 PROFEMUR GLADIATOR 1 19 9 3 3 MS-3 3 3 1 3 LANDOS (Reconstruction) 33 33 MÜLLER TYPE 3 3 OMNIFIT 31 1 3 C-STEM 13 1 3 1 9 PRIUS 11 1 9 CPS-PLUS Hip
The Norwegian Arthroplasty Register Monoblock and modular femoral head Table : Primary operations and revisions - Cemented stem Caput 197-9 1 11 1 13 1 15 1 Monoblock 3 3 3 113 11 7 1 1 777 Modular 5 393 3 75 1 57 9 973 31 7999 Missing 1 1 13 1 3 3 3 1 173 13 3 35 1 57 37 73 977 3 17 Table 5: Primary operations and revisions - Uncemented stem Caput 197-9 1 11 1 13 1 15 1 Monoblock 3 1 7 Modular 51 37 57 913 579 595 597 597 3 193 Missing 9 1 1 3 3 3 3 17 53 31 91 5793 5955 5913 597 39 39 Hip 5
Report 17 Femoral head diameter Table : In primary operations and revisions Year mm mm mm 3 mm 3 mm 3 mm >3 mm Other Missing 1 1 1 9 1 7 3 1 171 1 5 37 1 15 7 1 7 95 5 3 5 9 1 97 3 1 5 5 3 9 1 13 15 3 5 1 3 7 3 3 9 1 1 51 3 3 53 71 5 5 7 9 11 1 5 57 7 5 5 1 53 1 3 5 57 3 1 1 1 5 399 9 9 5 719 1 1 35 115 53 15 71 5 79 13 3 7 757 7 1 9 5 3 1 111 3 7 51 1 31 5 15 3 3 5 5 3 7 139 5 1 5 9 5 5 5 1 9 7 5 1 9 5 7 393 3 7 95 3 5 13 13 39 3 1 1 7 777 19 1 3 7 1 1 1 33 1 3 9 317 3 1 3 15 39 3 5 37 9 3 7 1999 5 3 1 337 19 7 199 5 3 3 35 5 13 1997 7 97 1 7 199 1 7 1 7 3 1 15 5 5 5 1995 3 11 1 1 3 73 7 5 5 3 199 39 13 1 7 359 5 7 5 33 1993 5 7 1 3 39 1 5 11 5 3 199 771 1 5 1 33 7 5 31 1991 77 1 7 3 1 1 133 7 199 731 117 7 39 1 77 1 1 5 17 199 75 5 5 151 1 757 3 1 5 77 19 1 133 1 1 1 33 15 71 3 3 197 77 1 1 359 13 1 15 51 7 1 3 97 17 9 3 1 7 91 1 1 3 37 Figure 13: In primary operations and revisions 11 Number of modular prostheses with modular femoral head 1 9 7 5 3 1 197 199 1991 1993 1995 1997 1999 1 3 5 7 9 11 13 15 Year of operation mm mm mm 3mm 3mm 3mm >3mm Other Missing Hip
The Norwegian Arthroplasty Register Femoral head prostheses Table 7: In primary operations and revisions (The 5 most common) Prosthesis 197-9 1 11 1 13 1 15 1 EXETER 177 15 171 11 7 7 5 79 7 57 LANDOS 1 1199 1157 71 7 7 15 171 CERAMTEC 1735 113 1797 57 1 1 1739 UNIVERSAL 1571 5 19 175 19 1 5 3 35 1715 CORAIL 7 151 5 153 3 77 9 31 1519 FJORD 939 1 7 51 3 11773 SP II 59 17 95 5 5 5 19 3 31 LFIT ANATOMIC 33 5 5 77 7 13 1 1 191 775 ELITE 19 355 9 191 15 195 1 13 19 IGLOO 175 173 5 5 7 17 9 3 SCANOS 119 15 1 3 1 3 11 31 7 PROTEK 19 3 1 195 PINNACLE 1 3 17 15 3 3 1 5 1773 PLUS ENDO 139 1 13 3 9 3 3 1 1 15 CPT 153 1 3 11 7 9 1 11 PROFILE 1 1 9 1 1 19 HIPBALL PREMIUM 35 3 75 13 1 35 1 13 11 1117 TAPERLOC 1 1 MALLORY-HEAD 5 55 3 3 17 9 13 BIOTECHNI 57 5 9 1 157 OXINIUM 33 7 17 73 7 5 1 113 HARRIS/GALANTE 9 7 OMNIFIT 31 73 5 3 19 1 9 " OSTEONICS Heads", C-taper head 197 15 1 1 9 15 ZIRCONIA 73 73 BICONTACT 1 3 1 3 5 BIRMINGHAM HIP RESURFACING 5 77 73 39 5 ABG I 31 11 9 7 3 7 1 BIOBALL 9 19 5 9 1 5 391 VERSYS 3 1 1 5 1 3 9 1 377 SURGIVAL 37 37 ZWEYMÜLLER 3 3 FURLONG 7 71 9 CERAMIC OSTEO STRYKER Heads 3 1 15 3 1 1 FEMORA 13 13 PARHOFER 11 1 1 1 1 TI-FIT 131 7 3 11 SMITH & NEPHEW CERAMIC HEADS 1 1 CHRISTIANSEN 1 1 PCA 1 1 3 1 1 11 BIOLOX DELTA 1 5 3 1 7 BIRMINGHAM HIP MODULAR 5 9 3 1 5 ABG II ASR MODULAR 3 5 LINK Rippensystem 3 3 MUTARS 1 1 1 1 3 AURA II 1 9 HASTINGS HIP 9 9 WEBER Hip 7
Report 17 Dual Mobility articulation Table In primary operation Prosthesis 197-9 1 11 1 13 1 15 1 AVANTAGE 33 95 1 19 11 1 19 9 1 111 POLARCUP 3 5 5 7 59 5 5 3 TRIDENT 1 13 CAPTIV 1 1 Restoration ADM 1 1 1 5 1 GYROS Table 9 In revisions Prosthesis 197-9 1 11 1 13 1 15 1 AVANTAGE 5 19 19 19 17 15 9 91 159 POLARCUP 1 1 5 1 119 1 13 9 Restoration ADM 1 1 1 17 5 TRIDENT 3 7 9 11 3 GYROS 1 1 CAPTIV 9 9 ASA classification Figure 1: Primary operations Figure 15: Revisions 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 11 13 15 Missing ASA 5 ASA ASA 3 ASA ASA 1 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 11 13 15 ASA 1 = Healthy patients who smoke less than 5 cigarettes a day. ASA = Patients with an asymptomatic condition who are kept under medical control (f.ex. hypertension), or with diet (f. ex. diabetes mellitus type ), and otherwise healthy patients who smoke five cigarettes or more daily. ASA 3 = Patients having a condition that can cause symptoms. However, patients are kept under medical control (f. ex. moderate angina pectoris and mild asthma). ASA = Patients with a condition that is out of control (f. ex. heart failure and asthma). ASA 5 = A moribund patient who is not expected to survive the operation. Registration of ASA classification started in 5 Hip
The Norwegian Arthroplasty Register Thrombosis prophylaxis Table 3: Primary operations * Year 1 3 Missing 1 79 (9%) 999 (79%) 95 (11%) 71 (1%) 5 (1%) 1 15 1 (13%) 7 (7%) 95 (11%) 57 (1%) 9 (1%) 3 1 1113 (1%) 59 (73%) 9 (1%) 31 (%) 75 (1%) 17 13 131 (17%) 533 (7%) 19 (13%) 1 (%) 3 (1%) 9 1 15 (%) 53 (%) 13 (17%) 9 (%) (1%) 7 11 (3%) 3 (5%) 795 (11%) 3 (%) 3 (1%) 73 1 35 (3%) 3 (59%) 1 (%) (%) 3 (1%) 733 9 (37%) 31 (5%) 57 (%) 3 (%) (1%) 711 313 (%) 359 (5%) 57 (%) (%) 75 (1%) 7 35 (53%) 3 (37%) 53 (%) 1 (%) 1 (%) 397 (%) 15 (%) 7 (11%) 15 (%) 155 (%) 319 5 393 (7%) 79 (1%) 193 (17%) (%) (%) 597 Table 31: Revisions * Year 1 3 Missing 1 3 (1%) 15 (7%) 13 (11%) 7 (%) 7 (%) 17 15 (1%) 119 (7%) 133 (9%) 1 (1%) (%) 1 1 (17%) 91 (71%) 11 (9%) 9 (1%) (%) 19 13 3 (17%) 91 (9%) 151 (11%) (%) (%) 13 1 (1%) 3 (3%) 1 (1%) 1 (1%) (%) 1315 11 31 (5%) 75 (59%) 1 (1%) (1%) 19 (1%) 17 1 3 (35%) 3 (5%) 15 (1%) (%) 1 (1%) 15 9 1 (35%) 9 (5%) 1 (1%) 5 (%) (1%) 19 77 (3%) 531 (7%) 9 (%) 5 (%) 15 (1%) 11 7 51 (%) 9 (39%) 1 (1%) 1 (%) 35 (3%) 15 57 (5%) 73 (7%) 1 (1%) (%) 1 (%) 17 5 7 (7%) 11 (11%) 1 (15%) (%) (%) 157 Figure 1: Primary operations 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 11 13 15 * 1 = Yes - Medication started preoperatively = Yes - Medication started postoperatively 3 = Yes - Missing information on medication start = No Registration of thrombosis prophylaxis started in 5 Missing 3 1 Figure 17: Revisions 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 11 13 15 Hip 9
Report 17 Thrombosis prophylaxis Table 3: All operations Drugs 5-7 9 1 11 1 13 1 15 1 Acetylsalicylsyre (Albyl-E, Globoid, Acetyratio, Magnyl E),1 %,1 %,1 %, %, %, % Apixiban (Eliquis),1 % 1, % 1,5 % 1,5 % 1,5 % Dabigatranetixalat (Re-Novate, Pradaxa),9 %, %, %,1 %,1 % Dalteparin (Fragmin) 9,7 % 1, % 5,7 % 3, % 5,1 % 3,1 % 5,1 % 51, % 5,5 % 1, % Dekstran (Macrodex, Dextran),1 %,1 %,3 %,1 %,1 %,1 % Enoksaparin (Klexane),5 % 35,1 %, % 31,5 % 5,5 %, % 7,9 % 31, %, %, % Rivaroksaban (Xarelto),3 %,9 %, %,3 %, % 1,5 % 1,5 % Warfarin (Marevan),1 %,1 %,1 %,1 %,1 %,1 % Ximelagatran (Exanta, Malagatran), %,1 %,1 %,1 % Other,1 %,1 %,1 % Combination of drugs 1,1 % 1, % 3,3 % 3,9 % 5, %, % 1,7 % 1, % 11,5 % 1, % Clinical study, % 1,1 %,7 %,1 % Unknown,1 %,1 % No drugs,1 %,1 % Missing, %,9 %,7 %,7 %,9 % 1,5 % 1, %, %, %, % 9 797 33 591 5 9177 95 9 97 137 Figure 1: Drugs - All operations 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 1 11 1 13 1 15 1 Missing No drugs Unknown Clinical study Combination of drugs Other Ximelagatran Warfarin Rivaroksaban Enoksaparin Dekstran Dalteparin Dabigatranetixalat Apixiban Acetylsalicylsyre Table 33: Duration - All operations Year Days: 1-7 -1 15-1 - 9-35 >35 No drugs Missing 1 115 35 111 7 3 1 137 15 135 75 91 337 151 97 1 1397 7 577 93 93 5 133 9 13 1 1 597 1 33 3 15 95 1 113 1595 73 195 391 3 19 9177 11 7 17 95 1397 319 1 5 5 1 75 17 3 17 315 77 591 9 75 37 37 9 33 37 79 77 71 1 1 5 71 797 7 7 13 3 931 771 97 9 193 7 173 111 13 73 5 13 73 13 33 11 31 133 75 Registration of thrombosis prophylaxis started in 5 5 Hip
The Norwegian Arthroplasty Register Articulations Table 3: In primary operations - All patients Cup + Femoral head 197-9 1 11 1 13 1 15 1 UHMWPE + Steel 1 191 151 7 3 153 9 5 719 UHMWPE + Cobalt-chrome 379 135 17 11 3 5 3 1 1 3353 Highly crosslinked PE + Cobalt-chrome 97 95 1157 1 7 35 155 77 5171 533 Highly crosslinked PE + Alumina 1 1 15 1511 11 191 177 15 113 179 UHMWPE + Alumina 95 35 93 1 191 Highly crosslinked PE + Steel 9 15 533 5 75 71 3 91 55 Highly crosslinked PE + Alumina/Zirconium¹ 9 3 51 1 5 55 31 9 Alumina + Alumina 39 7 3 3 1 1 7 37 UHMWPE + Titanium 197 19 1 1 199 Alumina/Zirconium + Alumina/Zirconium¹ 7 7 9 15 197 19 319 33 179 UHMWPE + Missing 1717 5 1 1 17 UHMWPE + Zirconium 1 1 Cobalt-chrome + Cobalt-chrome 755 17 9 37 17 15 1 1135 Steel + Cobalt-Chrome 11 5 9 95 1 13 15 157 9 Highly crosslinked PE + Oxinium 5 15 19 5 1 51 39 3 771 Missing + Cobalt-chrome 5 9 1 9 1 13 1 11 3 Missing + Missing 51 9 13 1 5 Steel + Steel 53 3 39 3 37 3 7 3 Missing + Steel 7 11 11 5 3 5 33 UHMWPE + Alumina/Zirconium¹ 137 1 1 3 1 Missing + Alumina 175 1 7 9 1 3 3 Missing + Titanium 15 3 1 5 15 Titanium + Cobalt-chrome 1 3 31 3 1 1 33 1 Titanium + Alumina/Zirconium¹ 3 11 1 7 17 3 15 Highly crosslinked PE + Titanium 1 13 1 15 1 1 9 1 117 UHMWPE + Oxinium 75 1 7 Highly crosslinked PE + Missing 1 9 17 7 3 3 Titanium + Alumina 3 1 1 1 51 Other (n<5) 1 3 31 7 9 19 3 1175 711 733 73 7 9 17 3 1 11 Figure 19: In primary operations 9 7 5 3 1 197 199 1991 1993 1995 1997 1999 1 3 5 7 9 11 13 15 UHMWPE + Metal UHMWPE + Ceramic Cobalt-chrome + Cobalt-chrome Ceramic + Ceramic Highly crosslinked PE + Metal Highly crosslinked PE + Ceramic ¹Alumina/Zirconium = Aluminum oxide and zirconium oxide composite. Hip 51
Completeness of reporting analysis for the Hip Arthroplasty Register, 13-1 A completeness of reporting analysis for the Hip Arthroplasty Register has been conducted by combining the data in the Register with data from the Norwegian Patient Register (NPR). The report and analysis were prepared by the NPR in collaboration with the Hip Arthroplasty Register (NAR). A report on the implementation and results will be published on www.helsedirektoratet.no. There are separate statistics on primary operations and revisions. NCSP codes for combining data from NPR hospital stays and the Hip Arthroplasty Register Type Code Description Primary operation NFB Primary total prosthetic replacement of hip joint not using cement NFB 3 Primary total prosthetic replacement of hip joint using hybrid technique NFB Primary total prosthetic replacement of hip joint using cement NFB 99 Other primary prosthetic replacement of hip joint Reoperation NFC * Secondary implantation of total prosthesis in hip joint not using cement NFC 3* Secondary implantation of total prosthesis in hip joint using hybrid technique NFC * Secondary implantation of total prosthesis in hip joint using cement NFC 99 Other secondary prosthetic replacement in hip joint NFU 1* Removal of total prosthesis from hip joint The completeness of reporting rate for the Hip Arthroplasty Register was calculated as follows: (Only NAR + Inclusion in both registers) (Only NPR + Only NAR + Inclusion in both registers) Completeness of reporting for the NPR was calculated in a similar way: (Only NPR + Inclusion in both registers) (Only NAR + Only NPR + Inclusion in both registers) Primary operations. In 13 and 1, 1 1 primary hip replacements were reported to one or both of the registers. 9.7% of these were reported to the NAR while 97.% were reported to the NPR. Completeness of reporting by hospital is divided into health regions and shows a completeness of reporting rate for the NAR ranging from 79.1% to 1% between the different hospitals. For hospitals with a low completeness of reporting rate for the Hip Arthroplasty Register, either the form was not sent to the NAR or other interventions than hip arthroplasties were incorrectly coded with NFB /3//99 (There were only 7 operations in the category NFB 99 during the period). Procedure codes to be used for primary operations: NFB - NFB 3 - NFB - NFB 99 Revision operations. In 13 and 1, 93 revisions were reported to one or both of the registers. 9.% of these were reported to the NAR while.% were reported to the NPR (revision level 1). Completeness of reporting by hospital shows that the completeness of reporting rate for the NAR varied between 55.% and 1% in the various hospitals. A low completeness of reporting rate may mean that the revision form was not sent to the NAR, or that other interventions than removal, replacement or insertion of a secondary prosthesis were incorrectly coded with NFC /3//99 or NFU1. The analysis shows that a number of revision forms are missing in cases where the prosthesis was removed without a new one being inserted in the same operation; in such cases, a form should be submitted both when the prosthesis is removed and when any new insertion is performed. Procedure codes to be used for revision operations: NFC*- NFC3*- NFC*- NFC99 - NFU1* New: From 1, revisions due to infection, even where parts of the prosthesis are not removed or replaced, are to be reported on the form to the NAR. These must be coded NFS 19 or NFS 9 with the additional code NFW 9. 5
Completeness of reporting for primary and revision operations, hip prosthesis 13-1 Volvat Medisinske Senter Helse Møre og Romsdal HF - Volda sjukehus Helse Nord-Trøndelag HF - Sykehuset Namsos Helse Møre og Romsdal HF - Molde sjukehus Helse Bergen HF - Voss sjukehus Helse Bergen HF - Hagevik Martina Hansens hospital Lovisenberg diakonale sykehus Sykehuset Innlandet HF - Gjøvik Sørlandet sykehus HF - Flekkefjord Nordlandssykehuset HF - Bodø Universitetssykehuset i Nord-Norge HF - Tromsø Sykehuset Innlandet HF - Kongsvinger Diakonhjemmet Helse Fonna HF - Haugesund Sykehuset i Vestfold HF Vestre Viken HF - Ringerike Sykehuset Telemark HF - Skien Vestre Viken HF - Kongsberg Helse Stavanger HF - Stavanger universitetssykehus St. Olavs hospital HF - Trondheim Helse Fonna HF - Stord Helse Møre og Romsdal HF - Ålesund sjukehus Oslo universitetssykehus HF Sykehuset Østfold HF Akershus universitetssykehus HF Helse Nord-Trøndelag HF - Sykehuset Levanger Helse Bergen HF - Haukeland universitetssykehus Haraldsplass diakonale sykehus Sykehuset Innlandet HF - Lillehammer Sørlandet sykehus HF - Kristiansand Vestre Viken HF - Drammen Aleris Helse - Oslo Sykehuset Innlandet HF - Elverum Helse Møre og Romsdal HF - Kristiansund sjukehus Sykehuset Innlandet HF - Tynset Vestre Viken HF - Bærum Sørlandet sykehus HF - Arendal St. Olavs hospital HF - Orkdal Helgelandssykehuset, Rana Helse Førde HF - Førde Helse Førde HF - Lærdal Haugesund san.for. revmatismesykehus Helse Finnmark HF - Klinikk Kirkenes Nordlandssykehuset HF - Lofoten Sykehuset Telemark HF - Rjukan Sykehuset Telemark HF - Notodden Helse Finnmark HF - Klinikk Hammerfest Nordlandssykehuset HF - Vesterålen Norsk idrettsmedisinsk institutt* Privatsykehuset i Haugesund* Universitetssykehuset i Nord-Norge HF - Harstad* Teres Drammen* Betanien hospital Telemark* Universitetssykehuset i Nord-Norge HF - Narvik* 9. 9.7 Primary Revision 1 (51) 1 (1) 99.5 (1) 1 (3) 9. (75) 1 (1) 93. (91) 1 (1) 93.1 (1) 1 (7) 99 (7) 9.7 (19) 99. (1115) 9. (13) 99. (13) 9.9 (193) 9. (39) 9.3 (5) 99.3 (13) 9. () 93. (35) 9.1 (1) 9.7 (313) 95. (7) 97. (7) 93. (3) 97. (3) 93.7 (95) 9.3 (3) 93.3 (3) 99.1 () 93.1 (1) 9. (3) 9.3 (13) 97 (3) 91.9 () 99. (7) 91.7 (1) 97. (71) 9. (9) 9 (73) 9.3 (77) 99. (133) 9 (1) 99.7 (3) 9. (59) 5.1 (3) 9. (9) 9.5 ().1 () 97. (97) 7. (111) 9.5 (7) 7. (7) 9.7 (11).1 (137) 9.9 (3) 5.7 (1) 91.7 (5) 5.3 (75) 9 ().5 (97) 95. () 3. (13) 9.3 (17) 3.3 () 9.3 (73).3 (113) 95.7 (77).1 (39) 9.1 (13) (5) 93.7 (3) 7. () 95.3 () 7.3 () 99 (95) 75 () 5. (13) 71. (7). (5) 7. (37).5 (137).7 (3) 1.3 ().7 (3) 79.1 (7) 5 () 1 (7) (1) 9. () (1) 97. () () 97.5 (11) (3) 9. (9) (1) 1 () - (-) 1 (3) - (-) 1 (9) - (-) 97. (117) - (-) 95. (5) - (-) 91.7 () - (-) 1 Dark blue bars and first number to the right of the bars gives completeness of reporting for primary operations. Light blue bars and second number to the right of the bars gives completeness of reporting for revision operations (level 1). The numbers in brackets gives the number of operations registered at both NAR and NPR. Vertical lines shows the national averages. * Have no registered revisions in NAR or NPR. 53
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CONTENTS Knee prostheses Introduction... 57 Survival curves for knee prostheses. 199-1... Survival curves for knee prostheses. 199-1. Fixation... 1 Survival curves for knee prostheses. 199-1. Age... Survival curves for knee prostheses. With and without patella... 3 Survival curves for knee prostheses without patella 199-1... Last 1 years survival curves for all hospitals individually... 5 One stage bilateral knee prosthesis operations... Number of primary operations in knee 1... 7 Percentage non-revised patients two years after operations in 1-1... Percentage non-revised patients ten years after operations in 1-1... 9 Percentage non-reoperated prostheses after 3 and 1 years in 5-1... 7 Annual numbers and incidence of knee prostheses... 71 Age by year of primary operation... 7 Types of knee prostheses... 7 Classification in primary total prostheses... 7 Reasons for primary operations... 75 Use of cement... 77 The 7 most common primary total prostheses without patella component 13-1 79 Knee prostheses... 3 Reasons for revisions... Type of revision... 9 ASA classification... 9 Thrombosis prophylaxis... 93 Fibrinolysis Inhibitor... 95 Peroperative complications... 95 Previous operation in relevant joints... 95 Mini-invasive surgery... 9 Computernavigation... 97 Cement... 9 Systemic antibiotic prophylaxis... 1 Patient specific instruments... 11 Drain... 11 Completeness analysis 13-1... 1 55
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ARTHROPLASTY OF THE KNEE AND OTHER JOINTS 17 ANNUAL REPORT In the period 199-1, 1 knee replacements, 73 shoulder replacements and 977 replacements of other joints than the hip, knee and shoulder were recorded. There has been an increase of 5% in primary knee replacements since 15. The number of unicondylar knee replacements has also risen in the past year. Osteoarthritis is the dominant cause of knee arthroplasties. The number of primary shoulder prostheses has increased by 3% since 15. A comparative study of the lifetime risk of knee arthroplasty in the Nordic countries and Australia showed that Norway had the lowest risk in 13 (Ackerman IN 17). A report from the Centre for Clinical Documentation and Evaluation (SKDE) Indicators for the Measurement of Unwarranted Variation, using figures from our registers, reveals differences between health trusts in the number of knee arthroplasties, but the differences are small. The Nordland and Finnmark health trusts have the lowest numbers of knee replacements. NEW FIGURES FOR KNEE PROSTHESES We have created some new figures showing prosthesis survival rates for selected groups of knee prostheses and/or patients. These are described in the text under each figure. QUALITY OF ARTHROPLASTY IN NORWAY Survival curves show a gradual improvement since 199 in results of total knee prostheses, when the endpoint is revision surgery. In a study based on our register data, hospitals that performed more than 1 knee arthroplasties per year had fewer reoperations than hospitals with a lower number of such operations (Badawy M 13). Unicondylar knee replacements should be concentrated at a smaller number of hospitals (Badawy 1) to decrease the number of reoperations. In a study published in 17 (Dyrhovden G 17), the periods 199- and 5-15 were compared. Here, we showed an improvement in results in the later period for total knee replacements, but not for unicondylar knee replacements. There is still considerable room for improvement in both prosthesis design and surgery, and there are a particularly large number of revisions for infection, loosening, displaced components, instability and pain. For ankle prostheses, recent results are poorer. More ankle arthroplasties are being performed on patients with osteoarthritis and after injuries. These patients are younger and more often male than previously, when rheumatic patients dominated. There is a need for RCTs to clarify which patients should have ankle prostheses and which patients should have spinal fusion surgery. SHOULDER FRACTURES Several RCTs have shown that the outcomes of conservative treatment and hemiarthroplasties are equally good for dislocated three or four fragment fractures. We see a decrease in the use of hemiprostheses in acute fractures. There is an increase in the use of reverse shoulder prostheses in acute fractures, which may partly be due to an ongoing RCT. There is a need for more RCTs to study the efficacy of this type of prosthesis in comparison with non-operative treatment. KNEE ARTHROPLASTY REVISIONS There were 51 knee arthroplasty revisions reported to the Register in 1. PhD candidate Tesfaye Leta defended her thesis on knee arthroplasty revisions on 7.3.17. In the first published article (Leta T 15), we found no statistically significant improvement in knee arthroplasty revisions in 57
recent years, but a tendency towards better results with longer follow-up. Revision of the whole prosthesis gave better results than revision of individual components. % of the revisions were operated again after 1 years, and half of the revisions took place within two years. Most early revisions are due to infection and instability. Results for reoperations are significantly worse than for primary operations. We find that the use of a stem is often not checked on the form. When a stem is used, it must be indicated whether it was a tibial or femoral stem, and a sticker must be attached to the back of the form. Some prostheses use both a femoral and tibial stem, and if this is not checked, we have no way of knowing where the stem was used. In knee arthroplasty revisions involving only insertion of the patellar component due to pain, patients quality of life improved slightly. The effect was most pronounced in the patients with the most pain before the revision. In one-third of patients, the surgery had no effect (Leta T 15). arthroplasty revision was technically more challenging than revision of unicondylar knee prostheses to total knee arthroplasty, using more bone packing and stems, and with a higher infection rate. However, no difference was found in pain, quality of life, functioning or survival between total revision and unicondylar revision arthroplasty (Leta T 1). COMPLETENESS ANALYSIS In this report, we show completeness for primary operations and revisions for -1. The national average is good for primary knee arthroplasties (95.3%) and for revisions (9%). Some hospitals have low reporting of revisions in particular. This may result in too low revision rates at these hospitals. In some hospital results, we remove hospitals with lower than % completeness of revisions. We encourage hospitals to review their reporting routines if their completeness is low. Reporting is worse for finger, wrist and back prostheses. HOSPITAL RESULTS We present some hospital results. Durability of prostheses inserted at individual hospitals after two and ten years. Unadjusted figures. A complete report is available on the website of the National Service Centre for Medical Quality Registers (http://www.kvalitetsregistre.no/resultater/). PROSTHESES RESULTS We present three- and ten-year durability for the most commonly used knee prostheses in Norway (more than 5 prostheses in use). None of those used today have poor results, but few prostheses have ten-year results from Norway. However, there are ten-year results for most prostheses from other countries. SUMMARY OF THE MOST IMPORTANT SCIENTIFIC FINDINGS LAST YEAR New bone cements used since 5 have yielded the same results as Palacos cement used before 5. There is no difference in the risk of knee arthroplasty revision between the original Palacos cement with gentamicin (Heraeus) and the copy Refobacin Bone Cement (Biomet) (Birkeland Ø 17). The incidence of knee arthroplasty was lowest in Norway of all the Nordic countries in 1997-1, but has increased in all the countries (Niemelainen MJ 17). A comparison of the lifetime risk of knee arthroplasty in the Nordic countries and Australia for 3 and 13 showed an increase in all the countries. Lifetime risk was highest for women in Australia (1.1%) and Finland (.%) and lowest in Norway (9.7%) (Ackerman IN 17). We have contributed to an international consensus report on post-operative knee fibrosis (Kalson NS 1). 5
We have published two studies on computer-navigated knee arthroplasty. One is a register-based study from Norway with years of follow-up. Here, no difference was found between computernavigated and conventional knee arthroplasty, but there were more revisions due to displaced components in conventional arthroplasty (Dyrhovden G 1). In a randomised RSA study (radiostereometric analysis), no difference in migration was found after two years between computer-navigated and conventional knee arthroplasty (Petursson 17). The four Nordic countries (Nordic Arthroplasty Register Association) have begun to collaborate on shoulder prosthesis studies, and the first study has now been published (Rasmussen J 1). Shoulder arthroplasty has increased in all the countries, mostly due to osteoarthritis (3%) and fractures (3%). Especially arthroplasty for osteoarthritis has increased. The incidence of shoulder arthroplasty was lower in Norway than in Denmark and Sweden. Results for the Delta Xtend reverse prosthesis were significantly better than for the Delta III, but the surgery took place in different periods. Hemiarthroplasty using a stem and reverse total arthroplasty for acute proximal humerus fractures were compared in a Nordic study. There was no difference with all revisions as endpoint, but reverse total arthroplasty had a higher risk of revision due to infection (Brorson 17). We now have an interesting partnership with Oslo University Hospital and the Norwegian University of Science and Technology (NTNU), with a link between HUNT (the Nord-Trøndelag Health Study) and the Hip and Knee Arthroplasty Registers. Marianne Bakke Johnsen and Alf Inge Hellevik are the PhD candidates involved. Johnson (1) showed that high levels of physical activity in leisure time increased the risk of total hip arthroplasty in both men and women, but for knee arthroplasty, this effect was only seen in women. In an interesting study using Mendelian randomisation and DNA analysis, we found (Johnsen 17) that smoking may have a causal relationship with reduced risk of knee arthroplasty. Does nicotine have a protective effect on the cartilage? Karin Magnussen has published a study linking the Hip and Knee Arthroplasty Registers with the Twin Register. In a study published in 17, she finds that genetic factors contribute more to the risk of total hip arthroplasty due to osteoarthritis than to the risk of knee replacement. Congratulations to Mona Badawy and Tesfaye Leta for successful defence of their PhD theses. The theses are available on our website. Thank you for good reporting and we welcome suggestions for research projects. Bergen, 5..17 Ove Furnes Anne Marie Fenstad Yngvar Krukhaug Chief Physician/Professor Biostatistician Chief Physician Knee Surgery Hand and Finger Surgery Irina A Kvinnesland Christoffer Bartz-Johannessen Randi Hole IT Consultant Biostatistician Chief Physician Shoulder Surgery 59
Prosthesis survival (%) Prosthesis survival (%) Survival curves for knee prosthesis 1 9 a) All 1-1 9-11 - 3-5 - 1997-99 1 9 b) Unicondylar 1-1 9-11 1997-99 199-9 - 199-9 7 199-9 1997-99 - 3-5 - 9-11 1-1 RR (p-value) 1.5 (.3).75 (<,1).71 (<,1). (<,1). (<,1).5 (<,1) 5 1 15 7 199-9 1997-99 - 3-5 - 9-11 1-1 RR (p-value) 1.99 (.99).93 (.) 1.13 (.397) 1.13 (.7).1 (.1).59 (.) - 3-5 5 1 15 1 9 c) 1-1 with patella 9-11 - 3-5 - 1997-99 1 9 d) without patella 1-1 9-11 - 3-5 - 1997-99 199-9 199-9 7 199-9 1997-99 - 3-5 - 9-11 1-1 RR (p-value) 1. (.1).77 (.1). (.).3 (.1).5 (.5).5 (.51) 5 1 15 Years to failure 7 199-9 1997-99 - 3-5 - 9-11 1-1 RR (p-value) 1.1 (.9).3 (<,1). (<,1).5 (<,1).59 (<,1).51 (<,1) 5 1 15 Years to failure Survival curves estimated by the Kaplan-Meier method. Survival estimate is given as long as > 5 prostheses are at risk. Risk ratio (RR) estimates adjusted for age, sex and diagnosis.
Prosthesis survival (%) Prosthesis survival (%) Survival curves for knee prosthesis - Fixation 199-1 1 e) prosthesis 1 f) Unicondylar 9 9 7 Cemented Uncemented Hybrid Cemented Uncemented Hybrid (uncem. proximal part, cem. distal part) RR (p-value) 1.95 (.9). (<,1) 5 1 15 Cemented 7 5 1 15 1 g) with patella 1 h) without patella 9 9 7 Cemented Uncemented Hybrid Cemented Uncemented Hybrid (uncem. proximal part, cem. distal part) RR (p-value) 1 1. (.3).9 (.773) 5 1 15 Years to failure 7 Cemented Uncemented Hybrid Cemented Uncemented Hybrid (uncem. proximal part, cem. distal part) RR (p-value) 1.7 (.93). (<,1) 5 1 15 Years to failure Kaplan-Meier survival curves. Survival estimate is given as long as > 5 prostheses are at risk. Risk ratio (RR) estimates adjusted for age, sex and diagnosis. 1
Prosthesis survival (%) Prosthesis survival (%) Survival curves for knee prosthesis - Age 199-1 1 i) prosthesis 1 j) Unicondylar 9 9 7 <= years, 199-5 <= years, -1 > years, 199-5 > years, -1 RR (p-value) 1.3 (.). (<,1). (<,1) 5 1 15 7 <= years, 199-5 <= years, -1 > years, 199-5 > years, -1 RR (p-value) 1.79 (.1).51 (<,1).7 (<,1) 5 1 15 1 k) with patella 1 l) without patella 9 9 7 <= years, 199-5 <= years, -1 > years, 199-5 > years, -1 5 1 15 Years to failure RR (p-value) 1.3 (.75). (<,1). (<,1) 7 <= years, 199-5 <= years, -1 > years, 199-5 > years, -1 5 1 15 Years to failure RR (p-value) 1. (.31).7 (<,1).3 (<,1) Survival curves estimated by the Kaplan-Meier method. Survival estimate is given as long as > 5 prostheses are at risk. Risk ratio (RR) estimates adjusted for age, sex and diagnosis.
Prosthesis survival (%) Prosthesis survival (%) Survival curves for knee prostheses 199-1 1 o), -1 1 p) Patellofemoral 9 9 7 <= years, with patella > years, with patella <= years, without patella > years, without patella 5 1 15 Years to failure RR (p-value) 1. (.9) 1. (.). (.5) 7 <= years > years 5 1 15 Years to failure RR (p-value) 1.1 (.15) 1 q) prostheses without patella were insertion of patella dont count as a revision 9 7 <= years > years RR (p-value) 1.51 (<,1) 5 1 15 Years to failure Survival curves estimated by the Kaplan-Meier method. Survival estimate is given as long as > 5 prostheses are at risk. Risk ratio (RR) estimates adjusted for age, sex and diagnosis. 3
Prosthesis survival (%) Prosthesis survival (%) Survival curves for total prostheses in knee without patella 199-1 1 r) Men, under years 1 s) Men, over years 9 9 7 Cemented, 199-5 Uncemented, 199-5 Hybrid, 199-5 Cemented, -1 Uncemented, -1 Hybrid, -1 RR (p-value) 1 1.3 (.39).9 (.17).9 (.5).77 (.39).75 (.1) 7 Cemented, 199-5 Uncemented, 199-5 Hybrid, 199-5 Cemented, -1 Uncemented, -1 Hybrid, -1 RR (p-value) 1 1.5 (.353).71 (.1).9 (.7). (.1).5 (.3) 5 1 15 5 1 15 1 t) Women, under years 1 u) Women, over years 9 9 7 Cemented, 199-5 Uncemented, 199-5 Hybrid, 199-5 Cemented, -1 Uncemented, -1 Hybrid, -1 RR (p-value) 1 1. (.75). (.395).93 (.5).9 (.9).57 (.) 7 Cemented, 199-5 Uncemented, 199-5 Hybrid, 199-5 Cemented, -1 Uncemented, -1 Hybrid, -1 RR (p-value) 1 1.5 (.151). (.155).93 (.).1 (.13).5 (<,1) 5 1 15 Years to failure 5 1 15 Years to failure Kaplan-Meier survival curves. Survival estimate is given as long as > 5 prostheses are at risk. Risk ratio (RR) estimates adjusted for age, sex and diagnosis.
1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 Endpoint all revisions Mean all hospitals All hospitals individually in the period 199 Percent knee arthroplasties intact 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 Endpoint all revisions Mean all hospitals All hospitals individually in the period 7 1 Years after primary operation 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 1 7 9 1 Endpoint revision due to infection Mean all hospitals All hospitals individually in the period 7 1 Percent knee arthroplasties intact Years after primary operation Survival curves for all hospitals individually total and unicondylar knee arthroplasties 5
One stage bilateral knee prosthesis operations Year 199-5 7 9 1 11 1 13 1 15 1 Sum: Number of patients 3 3 1 1 9 7 A one stage bilateral operation is an operation where the patient is operated on both knees during the same operation or on the same day. Only primary operations are included.
Figure Y: Number of primary operations in knee, 1 Lovisenberg Diakonale Sykehus Martina Hansens Hospital Sykehuset i Vestfold HF - Larvik Akershus universitetssykehus HF Sykehuset Østfold HF - Moss Diakonhjemmet sykehus Sørlandet sykehus HF - Arendal Sykehuset Innlandet HF - Elverum Sykehuset Innlandet HF - Tynset Sørlandet sykehus HF - Kristiansand Vestre Viken HF - Drammen sykehus Vestre Viken HF - Ringerike sykehus Sykehuset Innlandet HF - Kongsvinger Sørlandet sykehus HF - Flekkefjord Sykehuset Innlandet HF - Gjøvik Betanien hospital - Skien Oslo universitetssykehus HF Ullevål - Ort. senter, Kirkeveien Vestre Viken HF - Kongsberg sykehus Sykehuset Telemark HF - Skien Sykehuset Innlandet HF - Lillehammer Vestre Viken HF - Bærum sykehus Sykehuset Telemark HF - Notodden Oslo universitetssykehus HF - Rikshospitalet Sykehuset Østfold Kalnes Helse Førde HF - Lærdal sjukehus Helse Bergen HF - Kysthospitalet i Hagevik Helse Stavanger HF - Stavanger Universitetssykehus Haraldsplass Diakonale Sykehus Helse Fonna HF - Haugesund sjukehus Helse Bergen HF - Voss sjukehus Helse Bergen HF - Haukeland universitetssjukehus Helse Førde HF - Førde sentralsjukehus Helse Fonna HF - Stord sjukehus St. Olavs Hospital HF - universitetssykehuset i Trondheim Helse Møre og Romsdal HF - Kristiansund Sjukehus Helse Møre og Romsdal HF - Ålesund sjukehus St. Olavs Hospital HF - Orkdal sjukehus St. Olavs Hospital HF - Røros sjukehus Helse Nord-Trøndelag HF - Sykehuset Namsos Helse Møre og Romsdal HF - Volda sjukehus Helse Nord-Trøndelag HF - Sykehuset Levanger Universitetssykehuset Nord-Norge HF - Avd. Harstad Nordlandssykehuset HF - Bodø Helgelandssykehuset HF - Mo i Rana Universitetssykehuset Nord-Norge HF - Avd. Tromsø Nordlandssykehuset HF - Vesterålen Helse Finnmark HF - Klinikk Hammerfest Universitetssykehuset Nord-Norge HF - Avd. Narvik Helse Finnmark HF - Klinikk Kirkenes Aleris Frogner Haugesund Sanitetsforenings Revmatismesykehus AS Norsk Idrettsmedisinsk Institutt Privatsykehuset i Haugesund Ringvoll Klinikken - Oslo ALERIS Drammen Volvat Medisinske Senter avd. Fredrikstad Volvat medisinske senter 33 5 1 173 19 15 15 17 13 9 3 3 7 5 57 15 1 7 1 7 1 17 19 153 111 1 7 7 7 9 7 5 5 31 1 1 7 3 19 1 9 3 3 33 37 9 1 3 5 Number of primary operations 53 Helse Sør-Øst Helse Vest Helse Midt-Norge Helse Nord Privat 7
Figure Z: Percentage non-revised patients two years after operations in 1-1 Universitetssykehuset Nord-Norge HF - Avd. Harstad (N = 77 ) Helse Finnmark HF - Klinikk Kirkenes (N = 11 ) Sykehuset i Vestfold HF - Larvik (N = 157 ) Martina Hansens Hospital (N = 75 ) Helse Fonna HF - Haugesund sjukehus (N = 51 ) Sykehuset Telemark HF - Skien (N = 5 ) Helse Bergen HF - Kysthospitalet i Hagevik (N = 119 ) Universitetssykehuset Nord-Norge HF - Avd. Tromsø (N = 35 ) Nordlandssykehuset HF - Vesterålen (N = ) Vestre Viken HF - Drammen sykehus (N = 33 ) Helse Fonna HF - Stord sjukehus (N = 15 ) ALERIS Drammen (N = 7 ) Sykehuset Innlandet HF - Kongsvinger (N = 5 ) Lovisenberg Diakonale Sykehus (N = 359 ) Haraldsplass Diakonale Sykehus (N = ) Sykehuset Innlandet HF - Gjøvik (N = 515 ) Helse Stavanger HF - Stavanger Universitetssykehus (N = 11 ) Helse Finnmark HF - Klinikk Hammerfest (N = 3 ) Akershus universitetssykehus HF (N = 133 ) Helse Møre og Romsdal HF - Volda sjukehus (N = 33 ) Betanien hospital - Skien (N = 3 ) Sørlandet sykehus HF - Arendal (N = 937 ) Sykehuset Østfold HF - Moss (N = 1 ) All hospitals (N = 3119 ) Aleris Frogner (N = 39 ) Haugesund Sanitetsforenings Revmatismesykehus AS (N = 1 ) Sørlandet sykehus HF - Kristiansand (N = 15 ) Vestre Viken HF - Kongsberg sykehus (N = 515 ) Norsk Idrettsmedisinsk Institutt (N = 97 ) Vestre Viken HF - Bærum sykehus (N = ) Helse Møre og Romsdal HF - Ålesund sjukehus (N = ) Sykehuset Innlandet HF - Elverum (N = 5 ) Oslo universitetssykehus HF - Rikshospitalet (N = 17 ) St. Olavs Hospital HF - Røros sjukehus (N = 39 ) Helgelandssykehuset HF - Mo i Rana (N = 333 ) Helse Nord-Trøndelag HF - Sykehuset Levanger (N = 1 ) Sørlandet sykehus HF - Flekkefjord (N = 3 ) Vestre Viken HF - Ringerike sykehus (N = 7 ) Oslo universitetssykehus HF Ullevål - Ort. senter (N = 7 ) St. Olavs Hospital HF - universitetssykehuset i Tr (N = 1 ) Diakonhjemmet sykehus (N = 1337 ) Helse Bergen HF - Haukeland universitetssjukehus (N = 37 ) Helse Bergen HF - Voss sjukehus (N = ) Helse Møre og Romsdal HF - Kristiansund Sjukehus (N = 9 ) Volvat medisinske senter (N = ) 97.1 % 7 % % 9 % 1 % Percentage non-reoperated primary operations in knee Kaplan-Meier estimates of percentage non-revised patients after two years with 95% confidence interval. Endpoint is all revisions. Reoperations, i.e. revision operations without insertion, removal or replacement of the prosthesis, are excluded. Included are all patients operated on in the years 1 to 1. Only hospitals with operations in 1 and with more than 5 operations from 1 to 1 are included. A further requirement is that the hospital must have at least 3 patients followed up for more than two years. Only hospitals with coverage of at least % for revisions from to 1 are included.
Figure Æ: Percentage non-revised patients ten years after operations in 5-1 Helse Fonna HF - Haugesund sjukehus (N = 1 ) Sykehuset Innlandet HF - Kongsvinger (N = 1175 ) Lovisenberg Diakonale Sykehus (N = 755 ) Helse Møre og Romsdal HF - Volda sjukehus (N = 3 ) Sykehuset i Vestfold HF - Larvik (N = 19 ) Nordlandssykehuset HF - Vesterålen (N = 31 ) Universitetssykehuset Nord-Norge HF - Avd. Tromsø (N = 7 ) Haugesund Sanitetsforenings Revmatismesykehus AS (N = 3 ) Privatsykehuset i Haugesund (N = 11 ) Helse Stavanger HF - Stavanger Universitetssykehus (N = 159 ) Helse Møre og Romsdal HF - Ålesund sjukehus (N = 93 ) Sørlandet sykehus HF - Arendal (N = 1335 ) Helse Bergen HF - Kysthospitalet i Hagevik (N = 1 ) Martina Hansens Hospital (N = 1 ) Volvat medisinske senter (N = 3 ) Sykehuset Telemark HF - Skien (N = 111 ) Sørlandet sykehus HF - Kristiansand (N = 11 ) All hospitals (N = 77 ) 9. % Vestre Viken HF - Drammen sykehus (N = 95 ) Helse Finnmark HF - Klinikk Hammerfest (N = 1 ) Sykehuset Østfold HF - Moss (N = 15 ) Oslo universitetssykehus HF - Rikshospitalet (N = 37 ) Vestre Viken HF - Kongsberg sykehus (N = 3 ) Helgelandssykehuset HF - Mo i Rana (N = 51 ) Haraldsplass Diakonale Sykehus (N = 137 ) Sykehuset Innlandet HF - Elverum (N = 135 ) Helse Bergen HF - Voss sjukehus (N = 15 ) Sykehuset Innlandet HF - Gjøvik (N = 79 ) Helse Nord-Trøndelag HF - Sykehuset Levanger (N = 97 ) Helse Bergen HF - Haukeland universitetssjukehus (N = 53 ) Vestre Viken HF - Ringerike sykehus (N = 97 ) Helse Møre og Romsdal HF - Kristiansund Sjukehus (N = 15 ) Oslo universitetssykehus HF Ullevål - Ort. senter (N = 7 ) Vestre Viken HF - Bærum sykehus (N = 97 ) Akershus universitetssykehus HF (N = 19 ) St. Olavs Hospital HF - Røros sjukehus (N = 5 ) St. Olavs Hospital HF - universitetssykehuset i Tr (N = 19 ) Diakonhjemmet sykehus (N = 197 ) 7 % % 9 % 1 % Percentage non-reoperated primary operations in knee Kaplan-Meier estimates of percentage non-revised patients after ten years with 95% confidence interval. Endpoint is all revisions. Reoperations, i.e. revision operations without insertion, removal or replacement of the prosthesis, are excluded. Included are all patients operated on in the years 5 to 1. Only hospitals with operations in 1 and with more than 5 operations from 5 to 1 are included. A further requirement is that the hospital must have at least 3 patients followed up for more than ten years. Only hospitals with coverage of at least % for revisions from to 1 are included. 9
Figure Ø: Percentage non-reoperated prostheses after 3 and 1 years, 5-1 Femur - tibia PROFIX - CR porous usementert - Non porous sementert hybrid ( N = 19 ) PROFIX - CR non-porous sementert - Non porous sementert cemented ( N = 335 ) NexGen - CR Option - Option sementert cemented ( N = 35 ) LCS Complete cemented ( N = 55 ) AGC cemented ( N = 157 ) PROFIX - CR porous usementert - Porous w/o hole usementert uncemented ( N = 7 ) PFC Sigma - CR sementert - With keel MBT sementert cemented ( N = 17 ) NexGen - CR-flex - Option Precoat PMMA stemmed sementert cemented ( N = ) PFC Sigma - CR usementert - With keel MBT usementert uncemented ( N = 519 ) NexGen - CR Option - Precoat PMMA stemmed sementert cemented ( N = 19 ) Legion CR - usementert hybrid ( N = 971 ) Vanguard TM cemented ( N = 55 ) Triathlon cemented ( N = 199 ) Duracon cemented ( N = 1 ) 9 % 9. % 9.1 % 95. % 9. % Years: 3 1 9. % 97.9 % 97.3 % 97.7 % 97.9 % 1 % 99.5 % 99.3 % 9. % 9. % 9. % 97. % 9.9 % 95.1 % 7 % % 9 % 1 % Percentage non-reoperated prostheses after 3 and 1 years Figure Ø shows the estimated Kaplan-Meier percentage at three and ten years for different combinations of knee prostheses. We have only included combinations used in 5 or more operations in 5-1. A further requirement for inclusion in the figure is that there must still be at least 5 examples of the combination at three and ten years respectively. Only standard patients from 5 to 1 have been included, and the number of prostheses will therefore be below 5 in some cases. A standard patient is aged 55-5 years, has ASA class 1 or and was diagnosed with idiopathic osteoarthritis at primary surgery. Using standard patients provides a more homogenous group of patients, and we believe that this makes the results more comparable. Endpoint is all revision operations, except infections and reoperations without insertion, removal or replacement of the prosthesis. Duracon knee prosthesis is no longer in use (Gøthesen Ø 13) See section How to interpret the prosthesis results page. 7
KNEE PROSTHESES Table 1: Annual numbers of operations Year The Norwegian Arthroplasty Register Primary operations Reoperations * Revisions 1 (91,%) 1 (,1%) 53 (,3%) 7 59 15 1 (91,7%) 9 (,1%) 55 (,%) 1 5 (91,9%) 7 (,1%) 91 (,%) 11 13 5 5 (91,3%) (,1%) 7 (,%) 5 55 1 91 (9,9%) 7 (,1%) (9,%) 5 9 11 55 (91,3%) (,%) 9 (,%) 97 1 (91,5%) (,%) 11 (,5%) 11 9 (91,1%) (,%) 3 (,9%) 9 3 99 (91,%) (,%) 37 (,%) 357 7 3 5 (9,3%) (,%) 31 (7,7%) 3 9 3 19 (9,1%) (,%) 7 (7,9%) 3 37 5 3 5 (9,%) (,%) 51 (7,%) 3 55 9 (9,%) (,%) 317 (9,%) 3 3 3 3 37 (9,%) (,%) 5 (7,%) 3 7 7 (91,3%) (,%) 1 (,7%) 9 1 37 (91,%) (,%) (,%) 37 199-9 (91,7%) (,%) (,3%) 1 13 75 9 (91,%) 1 (,%) 7 (,%) 1 * Reoperation where prosthetic parts were not changed or removed (soft tissue debridements for infected prosthesis, prosthetic parts were not changed) Figure 1: Annual numbers of operations Number of operations 5 55 5 5 35 3 5 15 1 5 199 199 199 1 1 1 1 Primary operations Reoperations Revisions 53, % of all operations were performed on the right side. 3,5 % performed in women. Mean age at primary surgery was, years, 9, years for women and 7, years for men. Mean age at primary surgery was 7, years in 199, 7, years for women and,3 years for men. Mean age at primary surgery was,1 years in 1,,5 years for women and 7,5 years for men. Figure : Incidence of primary knee prostheses Number of operations per 1. inhabitants 7 5 3 1 Age: 1995 Women 1995 Men 5 Women 5 Men 1 Women 1 Men 15 Women 15 Men -39-9 5-59 -9 7-79 - Knee 71
Report 17 Figure 3: Age at the insertion of primary total knee prostheses 5 Proportion (%) of primary total knee prostheses 3 1 199-7 9 1 11 1 13 1 15 1 Year of operation Age: < 5 5-59 -9 7-79 > 79 Figure : Age at the insertion of primary unicondylar knee prostheses Proportion (%) of primary unicondylar knee prostheses 5 3 1 199-7 9 1 11 1 13 1 15 1 Year of operation Age: < 5 5-59 -9 7-79 > 79 7 Knee
Figure 5: Age and sex at the insertion of primary total knee prostheses 5 The Norwegian Arthroplasty Register Proportion (%) of primary total knee prostheses 3 1 Women Men Age: < 5 5-59 -9 7-79 > 79 Figure : Age and sex at the insertion of primary unicondylar knee prostheses Proportion (%) of primary unicondylar knee prostheses 5 3 1 Women Men Age: < 5 5-59 -9 7-79 > 79 Knee 73
Report 17 Types of knee prostheses Table : Primary operations Year with patella Figure 7: Primary operations without Patellofemoramental Bicompart- Hinged * patella Unicondylar prostheses Missing 1 (3,%) 5 9 (1,9%) 5 (13,3%) 7 (1,%) (,%) 15 1 (,%) 5 13 (,%) 7 (1,%) 39 (,%) 31 (,5%) 1 1 113 (,%) 5 (,%) 59 (1,%) 3 (,7%) (,1%) 5 13 93 (1,9%) 1 (7,%) 7 (9,5%) 3 (,%) (,1%) (,%) 5 5 1 99 (,%) 97 (7,%) 73 (9,%) 33 (,7%) 1 (,%) (,%) 91 11 (1,9%) 3 977 (7,5%) 39 (9,7%) 9 (,%) 1 (,3%) 55 1 (,%) 3 7 (7,9%) 1 (9,%) 3 (,5%) (,%) 9 9 (,1%) 3 7 (7,%) 3 (1,%) 19 (,%) 1 (,%) (,%) 115 (,9%) 3 13 (5,5%) (11,%) 1 (,5%) 1 (,%) 3 99 199-7 3 7 (1,7%) 53 (7,9%) 3 1 (1,%) 5 (,%) 1 (,%) (,%) 1 (,%) 9 91 1 (,%) 1 395 (1,%) 55 (11,3%) 37 (,5%) 3 (,%) 19 (,1%) 5 (,%) 75 9 * Indicated by the surgeon on the report form Proportion (%) of primary operations 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 199 199 199 1 1 1 1 Missing Hinged prostheses Bi-compartmental Patellofemoral Unicondylar without patella with patella Table 3: Classification of stability and modularity in primary total prostheses Year ---------- MS ---------- ----------- PS ----------- Rotating All poly MT All poly MT CCK platform Hinged * prostheses 1 353 55 1 1 35 9 5 5 15 359 33 1 399 33 5 317 1 333 13 1 1 973 13 31 53 5 1 5 9 55 1 5 5 3 1 1 17 1 11 5 537 1 9 1 5 19 9 1 3 5 1 5 1 3 957 9 3 53 9 1 1 5 3 973 1 1 5 3 1 3 3 53 7 195 1 1 1 3 111 13 1 1 5 95 5 117 11 1 15 3 77 157 3 91 1 3 3 17 7 77 1 551 153 1 7 3 1 97 1 133 1 1 7 3 1 953 199-3 9 33 11 1 377 1 3 MS = Minimally stabilized = Posterior cruciate retaining prosthesis and deep dish PS = Posterior cruciate stabilizing prostheses CCK = Constrained Condylar Knee = high level stabilized MT = Metal backed tibia All poly = All polyethylene tibial component * Information taken from the catalogue number of prostheses 7 Knee
The Norwegian Arthroplasty Register Reasons for primary operations - knee prostheses Table : Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Sequelae, meniscal tear Acute fracture Sequelae, infection Psoriasis arthritis 1 5 1 13 117 1 3 35 9 3 13 77 15 7 15 11 1 199 31 1 1 3 1 13 1 9 1 1 1 37 3 7 3 1 9 13 73 1 95 11 173 3 1 1 9 9 1 1 3 9 1 11 15 1 33 13 33 11 1 11 3 17 11 11 1 13 1 1 35 1 5 1 3 55 15 11 13 117 17 1 5 7 5 3 9 3 57 17 11 11 11 13 5 7 1 3 15 19 15 1 11 19 3 9 3 1 5 7 719 1 95 17 9 1 11 17 11 1 35 13 11 1 9 17 1 3 11 5 5 3 1 15 13 9 155 11 19 7 53 1 19 13 7 59 9 15 1 5 1 3 17 17 9 9 9 9 11 1 79 5 1 1 79 7 5 9 3 1 1 5 5 1 1 5 157 75 5 35 9 1 11 7 3 1 3 151 79 35 9 3 1 9 3 1999 1 1 1 5 9 73 3 13 5 5 3 199 1 33 177 55 3 15 7 5 5 3 3 1997 97 17 9 3 1 3 1 1 5 37 9 199 75 15 1 9 1 1 3 1995 735 15 39 13 1 199 173 5 15 9 1 57 733 3 5 5 1 9 3 3 1 1 1 1 Diseases are not mutually exclusive. More than one reason for operation is possible Osteonecrosis Other Missing Figure : 1 Proportion (%) of primary operations Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb Bechterew Sequelae, ligament tear Sequelae, meniscal tear Acute fracture Sequelae, infection Psoriasis arthritis Osteonecrosis Other Missing 199 199 199 1 1 1 1 Year of operation Knee 75
Report 17 Reasons for primary operations - Unicondylar knee prostheses Table 5: Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Sequelae, meniscal tear Sequelae, infection 1 1 1 1 5 1 1 13 15 7 5 7 11 1 1 5 9 13 13 5 1 1 55 1 5 1 1 1 13 11 1 1 1 5 3 7 1 1 391 3 1 33 3 9 35 1 5 1 5 1 1 3 7 7 7 3 7 1 37 39 1 5 5 1 5 9 3 7 3 3 1 1 11 1 1 7 5 1 3 3 5 3 7 1 1 51 3 3 1 13 1 1 1 1 1 17 5 1999 15 3 1 1 5 199 71 1 1 1997 53 1 3 199 7 1995 91 9 7 3 199 9 1 1 7 91 15 71 7 3 73 19 1 3 Diseases are not mutually exclusive. More than one reason for operation is possible Osteonecrosis Other Missing Figure 9: 1 Proportion (%) of primary operations Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb Bechterew Sequelae, ligament tear Sequelae, meniscal tear Acute fracture Sequelae, infection Osteonecrosis Other Missing 199 199 199 1 1 1 1 Year of operation 7 Knee
The Norwegian Arthroplasty Register Use of cement - Primary total knee prostheses Figure 1: Femur Proportion (%) of primary operations 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 199 199 199 1 1 1 1 Figure 11: Tibia Proportion (%) of primary operations 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 199 199 199 1 1 1 1 Figure 1: Patella Proportion (%) of primary operations 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 199 199 199 1 1 1 1 Cemented with antibiotic Cemented without antibiotic Uncemented Missing Knee 77
Report 17 Use of cement in total knee prostheses Figure 13: Primary operations Proportion (%) of primary operations 1 % % % % % % 199 199 199 1 1 1 1 Figure 1: Revisions 1 % Hybrid Reversed hybrid Cemented Uncemented Missing Proportion (%) of revisions % % % % % 199 199 199 1 1 1 1 Hybrid Cemented Uncemented Missing Use of cement in unicondylar knee prostheses Figure 15: Primary operations Proportion (%) of primary operations 1 % % % % % % 199 199 199 1 1 1 1 Hybrid Cemented Uncemented Missing 7 Knee
The Norwegian Arthroplasty Register The 7 most common primary total prostheses without patella component in 13-1 Table : Product NexGen LCS Complete PFC-Sigma Legion Triathlon PROFIX Vanguard TM Cemented * Uncemented * Rotating Stabilization Hybrid All poly platform HXLPE MS PS CCK 7 95 35 79 13 3 7 115 9 391 37 5 37 3 7 1 17 3 3 5 3 3 915 1 37 5 31 5 5 31 1 7 7 1 1 13 7 1 1 9 7 17 317 1171 1 171 33 3 1 33 Hybrid = Uncemented femur and cemented tibia All poly = All polyethylene tibial component HXLPE = Highly cross linked polyethylene MS = Minimally stabilized = Posterior cruciate retaining prostheses and deep dish PS = Posterior cruciate stabilizing prostheses CCK = Constrained Condylar Knee = high level stabilized * Surgeon's report for fixation Table A: Femur component Product: NexGen ( 31 ) Stabilization Product Category Cemented * Uncemented * MS PS CCK CR Option 5 973 597 5 97 CR-flex porous uncemented 39 1 CR-flex Option 791 791 791 CR-flex gender 7 7 7 CR Porous uncemented 3 75 39 39 LPS-flex porous standard 3 3 LPS Option 9 9 9 CR Precoat 17 1 171 171 LCCK Option 11 11 11 LPS-flex Option 13 5 1 1 CR-flex porous 3 3 LPS-flex Other 5 1 1 11 Unknown 9 11 Product: PROFIX ( 35 ) Stabilization Product Category Cemented * Uncemented * MS PS CCK CR non-porous cemented CR porous uncemented 9 57 555 555 CR Oxinium 5 5 5 Other Unknown 5 1 7 Product: LCS Complete ( ) Stabilization Product Category Cemented * Uncemented * MS PS CCK Cemented 31 3 Uncemented 3 37 Other Unknown 3 3 3 Knee 79
Report 17 Product: Product Category PFC-Sigma ( 9 ) Cemented* Uncemented * Stabilization MS PS CCK CR cemented 1 597 1 1 CR uncemented 1 3 19 1 9 PS 5 5 5 Other Unknown 3 3 Product: Product Category Triathlon ( 5 ) Cemented* Uncemented * Stabilization MS PS CCK CR cemented 1 7 3 133 1 33 Beaded CR uncemented 5 19 195 195 PS cemented TS cemented 13 13 13 Unknown Product: Product Category Legion ( ) Cemented* Uncemented * Stabilization MS PS CCK CR uncemented 1 1 35 139 1 39 CR cemented 1 PS cemented 5 71 71 CR Oxinium cemented 1 1 1 PS Oxinium cemented 9 1 1 Other 1 3 5 Unknown 1 1 Product: Product Category Vanguard TM ( 7 ) Cemented* Uncemented * Stabilization MS PS CCK CR Anatomic interlok cemented 3 3 3 PS Anatomic interlok cemented 15 15 15 Other 3 1 3 Unknown 1 1 MS = Minimally stabilized = Posterior cruciate retaining prostheses and deep dish PS = Posterior cruciate stabilizing prostheses CCK = Constrained Condylar Knee = high level stabilized * Surgeon's report for fixation Table B: Tibia Product: NexGen ( 31 ) Product Category Cemented * Uncemented * All poly Option cemented 5 7 9 5 775 Precoat PMMA stemmed cemented 1 Trabecular metal uncemented 3 Precoat AP wedge stemmed 15 1 1 Unknown 1 1 Product: PROFIX ( 35 ) Product Category Cemented * Uncemented * All poly Non porous cemented 93 3 9 Porous w/o hole uncemented 1 1 19 Porous uncemented 31 31 Other Unknown 3 3 Knee
The Norwegian Arthroplasty Register Table B: Tibia Product: LCS Complete ( ) Product Category Cemented * Uncemented * All poly No keel MBT* cemented 75 1 77 No keel MBT* uncemented 1 5 57 MBT* revision 1 1 Other Unknown 3 3 * MBT = Mobile bearing tray Product: PFC-Sigma ( 9 ) Product Category Cemented * Uncemented * All poly With keel MBT* cemented 1 73 1 737 With keel MBT* uncemented 11 51 No keel MBT* cemented 1 1 MBT* revision 7 15 Unknown 1 7 * MBT = Mobile bearing tray Product: Triathlon ( 5 ) Product Category Cemented * Uncemented * All poly Cemented 1 11 1 1 1 PA uncemented 7 7 Universal cemented 7 7 Unknown Product: Legion ( ) Product Category Cemented * Uncemented * All poly Male tapered cemented 3 5 35 All poly CR Unknown 5 5 Product: Vanguard TM ( 7 ) Product Category Cemented * Uncemented * All poly Highly polished modular PCR 99 99 Interlok Monobloc PCR cemented 15 15 Other All poly = All polyethylene tibial component MS = Minimally stabilized = Posterior cruciate retaining prostheses and deep dish PS = Posterior cruciate stabilizing prostheses CCK = Constrained Condylar Knee = high level stabilized * Surgeon's report for fixation Knee 1
Report 17 Table C: Foring Tibia Insert Product: NexGen ( 31) Rotating Stabilization Product Category platform HXLPE MS PS CCK CR-Flex 797 7 97 LPS-FlexFixed 71 71 CR-Prolong 9 9 9 LCCK 79 79 CR 1 1 Other Unknown Product: PROFIX ( 35) Rotating Stabilization Product Category platform HXLPE MS PS CCK Conforming PCR 1 1 Conforming+ 11 11 Unknown Product: LCS Complete ( ) Rotating Stabilization Product Category platform HXLPE MS PS CCK Rotating platform RP Unknown 5 Product: PFC-Sigma ( 9) Rotating Stabilization Product Category platform HXLPE MS PS CCK Rotating platform RP-CV Revision STB 5 5 Other 3 1 3 Unknown 5 Product: Triathlon ( 5) Rotating Stabilization Product Category platform HXLPE MS PS CCK CR-X3 HXLPE 1 1 1 CS-X3 HXLPE 19 19 19 PS-X3 HXLPE 1 1 1 PS 13 13 CR 1 1 TS-X3 HXLPE Unknown Product: Legion ( ) Rotating Stabilization Product Category platform HXLPE MS PS CCK CR standard 1 1 Dished 979 979 PS high flex 59 59 59 PS CR-highflex HXLPE 5 5 5 Other 1 1 3 Unknown Product: Vanguard TM ( 7) Rotating Stabilization Product Category platform HXLPE MS PS CCK Arcom CR Arcom PS 1 1 Other 1 1 Unknown 1 HXLPE = Highly cross linked polyethylene MS = Minimally stabilized = Posterior cruciate retaining prostheses and deep dish PS = Posterior cruciate stabilizing prostheses CCK = Constrained Condylar Knee = high level stabilized Knee
The Norwegian Arthroplasty Register Table 7: Femoral prostheses in primary operations Prosthesis 199-7 9 1 11 1 13 1 15 1 Profix 751 197 11 1155 119 13 139 131 1 17 LCS Complete 53 1315 137 1 191 1 71 75 1 17 NexGen 97 17 5 51 1 5 159 1 11 AGC 335 35 31 9 7 7 LCS 1 1 Genesis I 393 393 Duracon 15 3 5 7 39 11 753 PFC-Sigma 1 3 1 53 77 79 75 Triathlon 51 17 1 7 39 5 9 97 9 3 Legion 3 13 73 753 757 3 Tricon -C with Pro-Fit 15 15 Vanguard TM 1 3 1 19 19 17 5 5 E-motion 3 9 1 Kinemax 11 11 Tricon M 337 337 Advance 79 15 3 9 3 51 1 311 Journey II BCS 7 7 5 133 Scorpio 7 1 17 NexGen Rotating Hinge 5 3 1 1 1 19 9 1 Interax I.S.A. 1 1 Attune AGC Dual 3 3 Search Kotz 33 33 Evolution Medial-Pivot 1 19 9 GMK Sphere 1 1 RT-Plus Modular 1 1 1 Andre (n<15) 31 3 5 5 19 1 1 357 39 393 77 5 5 9 531 55 37 Table : Femoral prostheses in revisions Prosthesis 199-7 9 1 11 1 13 1 15 1 NexGen 9 3 9 17 1 1 1 717 Profix 393 53 5 7 3 LCS Complete 1 71 1 57 31 1 3 57 NexGen Rotating Hinge 19 9 1 9 1 17 1 7 53 7 3 Genesis I 11 11 LCS 11 11 Triathlon 1 1 17 9 3 3 1 15 Legion 1 7 1 3 119 Scorpio 11 1 19 5 1 7 9 PFC-Sigma 1 1 3 7 AGC 5 7 1 3 1 3 Duracon 3 9 17 5 5 7 Vanguard TM 1 17 3 1 3 7 AGC Dual Dual Articular 7 3 3 RT-Plus Modular 3 1 1 9 9 1 S-ROM Rotat. Hinge 3 7 1 1 Tricon -C with Pro-Fit Kinemax 1 1 E-motion 5 1 1 Legion Hinge Knee 1 7 1 Andre (n<15) 59 7 3 7 5 3 9 13 193 5 31 37 3 7 5 7 359 Knee 3
Report 17 Table 9: Tibial prostheses in primary operations Prosthesis 199-7 9 1 11 1 13 1 15 1 Profix 75 197 11 1155 119 13 139 131 1 17 LCS Complete 9 137 137 119 191 1 71 75 19 1379 NexGen 97 17 5 51 1 5 159 1 11 AGC 3395 351 31 9 7 7 75 LCS 9 Genesis I 393 393 Duracon 15 3 5 7 39 11 753 PFC-Sigma 1 3 1 53 77 73 79 Triathlon 51 17 1 7 39 5 9 97 9 3 Legion 3 13 73 753 757 3 Tricon II 117 117 Vanguard TM 1 3 1 19 1 1 5 5 7 E-motion 3 9 1 Kinemax 11 11 LCS Universal 373 373 Advance 79 15 3 9 3 51 1 311 Journey II BCS 7 7 5 133 Scorpio 7 1 17 NexGen Rotating Hinge 5 3 1 1 1 19 9 1 Interax I.S.A. 1 1 Attune Search Kotz 33 33 Evolution Medial-Pivot 1 19 9 AGC Dual 7 7 GMK Sphere 1 1 RT-Plus Modular 1 1 1 Andre (n<15) 37 1 5 3 19 7 357 39 39 7 5 9 531 55 9 Table 1: Tibial prostheses in revisions Prosthesis 199-7 9 1 11 1 13 1 15 1 NexGen 7 33 3 1 111 19 1 11 739 Profix 9 7 53 5 5 7 1 1 9 LCS Complete 135 1 9 73 1 55 5 5 3 Genesis I 5 1 59 NexGen Rotating Hinge 19 9 1 1 1 1 7 51 5 37 LCS 3 3 Triathlon 1 1 1 31 35 1 1 Duracon 1 1 1 1 1 11 7 11 Legion 1 7 1 39 3 11 Scorpio 11 1 19 17 1 9 PFC-Sigma 1 33 9 AGC 7 7 1 5 Tricon II 71 71 Vanguard TM 17 1 3 7 AGC Dual 59 59 Dual Articular 3 9 RT-Plus Modular 3 1 1 9 9 1 Maxim 1 1 E-motion 1 1 1 Kinemax 17 17 Legion Hinge Knee 1 7 1 Andre (n<15) 3 5 3 9 3 7 17 15 7 51 33 5 9 5 3917 Knee
Unicondylar knee prostheses Table 11: Femoral prostheses in primary operations Prosthesis The Norwegian Arthroplasty Register 199-7 9 1 11 1 13 1 15 1 Oxford UNI (III) 559 1 33 33 19 19 537 Oxford Partial Knee 1 1 5 371 51 31 1 Genesis UNI 3 1 1 3 Miller/Galante UNI 1 9 MOD III Preservation 17 7 11 15 LINK Schlitten UNI 9 3 1 13 17 17 93 Duracon 5 5 Journey Uni 7 1 3 3 1 7 Oxford UNI (II) 5 5 Sigma High Performance Uni 11 9 3 3 ZUK (Unicondylar) 9 7 3 1 Other (n<15) 3 1 31 3 1 39 73 75 59 7 5 Table 1: Tibial prostheses in primary operations Prosthesis 199-7 9 1 11 1 13 1 15 1 Oxford UNI (III) 55 399 1 33 3 3 19 1 5375 Oxford Partial Knee 1 1 37 51 17 Genesis UNI 3 1 1 3 Miller/Galante UNI 79 1 93 MOD III 1 1 Preservation 17 7 11 15 LINK Schlitten UNI 9 3 1 13 17 17 93 Duracon 5 5 Journey Uni 7 1 3 3 1 7 Oxford UNI (II) 5 1 Sigma High Performance Uni 11 9 3 3 ZUK (Unicondylar) 9 7 3 1 Other (n<15) 1 3 31 3 1 39 73 75 595 7 5 5 519 Patellofemoral prostheses Table 13: Femoral prostheses in primary operations Prosthesis 199-7 9 1 11 1 13 1 15 1 Journey PFJ 3 1 1 1 5 1 1 7 17 11 NexGen PFJ Gender 19 1 1 3 7 13 Patella Mod III / II 33 33 LCS PFJ 17 1 1 Legion 1 1 Other (n<5) 3 5 1 5 1 19 3 9 33 3 3 39 7 37 Table 1: Patella prostheses in primary operations Prosthesis 199-7 9 1 11 1 13 1 15 1 Journey PFJ 3 1 1 1 5 1 1 7 31 173 NexGen PFJ Gender 19 1 1 31 13 Patella Mod III / II 33 33 LCS PFJ 17 17 Other (n<5) 3 5 1 1 1 15 5 19 19 3 9 33 3 3 39 7 37 Knee 5
The Norwegian Arthroplasty Register Reasons for revisions Table 15: Reasons for revisions of total knee prostheses with patella Year of 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 1 1 1 1 1 1 1 1 3 1 1 15 3 1 1 1 3 1 1 1 1 1 3 5 13 1 1 1 1 1 1 5 3 3 3 11 3 1 3 1 1 5 1 3 1 1 3 9 5 5 1 1 7 3 7 1 1 5 5 1 7 7 1 7 1 3 1 1 5 3 1 5 3 7 3 3 5 1 1 1 5 1 1 1 3 7 1 1 3 13 3 1 3 1 1 7 5 1 1 1 3 5 7 3 1 1 1 1 1 1 3 3 1 1999 7 3 3 1 1 3 5 1 3 199 3 5 1 1 1997 3 3 1 1 199 3 1 1 3 1995 1 199 1 9 11 7 1 3 75 1 9 7 3 Revision causes are not mutually exclusive. More than one reason for revision is possible Other Missing Figure 1: Reasons for revisions of total knee prostheses with patella Number of operations 5 3 1 199 199 199 1 1 1 1 Year of revision Missing Other Defect polyethylene Pain Fracture (near implant) Deep infection Malalignment Instability Dislocation (not patella) Dislocation of patella Loose patella component Loose distal component Loose proximal component Knee
Report 17 Reasons for revisions Table 1: Reasons for revisions of total knee prostheses without patella Year of revision Loose proximal comp. Loose distal comp. Dislocation of patella Dislocation (not patella) Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene Progression of osteoarthritis 1 1 3 3 3 33 7 1 91 1 3 15 15 3 3 73 3 7 9 1 3 1 1 7 31 1 13 15 5 1 5 9 3 5 1 11 1 1 7 5 7 77 9 3 1 11 1 5 5 3 9 17 3 1 7 3 31 1 1 1 51 3 19 3 5 5 9 3 1 7 5 71 1 1 15 39 3 3 19 3 9 11 7 13 33 3 1 19 1 5 7 53 5 1 3 5 1 9 5 13 1 5 13 3 17 13 3 9 7 19 3 1 7 51 11 1 3 3 1 3 1 9 15 3 1 3 1 3 7 1 35 3 1 3 1 3 1 11 3 1 3 1 9 1 5 11 1 3 1 3 1 1999 5 5 1 199 3 7 3 3 13 1 1997 1 1 13 1 1 199 1 1 1 1 13 1995 3 1 1 1 7 199 1 1 7 53 53 119 1 7 13 37 3 Revision causes are not mutually exclusive. More than one reason for revision is possible Other Missing Figure 17: Reasons for revisions of total knee prostheses without patella Number of revisions 5 35 3 5 15 1 5 199 199 199 1 1 1 1 Year of revision Missing Other Progression of osteoarthritis Defect polyethylene Pain Fracture (near implant) Deep infection Malalignment Instability Dislocation (not patella) Dislocation of patella Loose distal component Loose proximal component Knee 7
The Norwegian Arthroplasty Register Reasons for revisions Table 17: Reasons for revisions of unicondylar knee prostheses Year of revision Loose proximal comp. Loose distal comp. Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene Progression of osteoarthritis 1 9 9 7 5 1 5 3 9 15 5 1 9 37 5 7 1 1 15 3 15 37 33 7 13 1 1 7 33 9 17 7 1 13 1 7 3 1 3 11 3 11 15 1 1 3 1 3 1 1 1 7 15 5 9 1 11 7 9 19 1 3 9 7 1 57 1 1 1 1 9 5 7 5 5 7 11 1 5 5 9 1 1 9 1 5 1 7 1 1 5 5 1 13 1 3 5 5 5 1 3 1 1 1 1 3 3 3 1 3 9 1 1 1 3 1 5 1 1 9 1 5 1 3 1 1 1 5 5 3 1 3 1 1999 5 1 1 1 199 1997 3 1 199 1 1995 1 3 15 19 55 9 5 3 511 1 7 7 Revision causes are not mutually exclusive. More than one reason for revision is possible Other Missing Figure 1: Reasons for revisions of unicondylar knee prostheses Number of revisions 1 1 1 1 1995 1997 1999 1 3 5 7 9 11 13 15 Year of revision Missing Other Progression of osteoarthritis Defect polyethylene Pain Fracture (near implant) Deep infection Malalignment Instability Dislocation Loose distal component Loose proximal component Knee
Report 17 Type of revision Table 1: knee prostheses with patella Year of primary operation Exchange of distal Exchange of distal+tibial plastic Exchange of distal+ proximal Exchange of whole prosthesis Exchange of patella Exchange of tibial plastic Exchange of proximal Exchange of proximal+tibial Removal of whole prosthesis Removal of prosthetic part(s) 1 5 5 15 1 1 1 1 1 1 1 1 1 1 11 1 1 1 1 3 9 1 1 1 1 1 7 1 1 1 1 1 3 5 1 1 1 1 1 5 1 3 1 1 3 1 1 1 13 1 3 1 1 1 13 1 1 3 1 1 1 3 5 1 3 1 1 1999 5 3 1 35 199 3 1 7 1 1 35 1997 5 1 1 3 1 9 1 35 199 1 1 3 7 39 1995 1 7 1 1 9 199 1 1 15 1 1 1 3 Other Missing 33 1 3 7 1 55 5 11 7 1 9 3 Figure 19: knee prostheses with patella Other 1,5 % Missing, % Exchange of distal 9,7 % Exchange of proximal 1,5 % Removal of all components, % Removal of prosthetic part(s) 3,5 % Exchange of proximal+tibial plastic 3, % Exchange of all components 5,7 % Exchange of distal+tibial plastic 3,5 % Exchange of distal+proximal, % Exchange of tibial plastic 1, % Exchange of patella,9 % Knee 9
Type of revision Table 19: knee prostheses without patella Year of primary operation Exchange of distal Exchange of distal+tibial plastic Exchange of whole prosthesis Exchange of tibial plastic+inns. patella Exchange of tibial plastic Exchange of proximal Exchange of proximal+tibial Removal of whole prosthesis The Norwegian Arthroplasty Register Removal of prosthetic part(s) 1 1 3 1 1 1 15 5 9 5 39 1 1 1 11 55 1 1 1 15 1 157 13 1 9 39 1 1 17 175 1 1 19 13 7 5 15 13 1 3 11 1 3 17 5 5 1 9 1 1 135 5 1 33 1 3 9 13 1 9 9 1 19 9 1 19 19 5 1 9 1 1 33 7 1 13 13 9 1 1 19 1 15 5 11 3 3 15 1 9 1 3 15 1 19 5 11 3 13 19 1 9 11 3 3 5 9 3 1 11 3 5 7 7 1 1 9 13 1 17 9 11 59 7 5 1 7 1 15 1 1 1 1 1 1 7 1 5 3 7 1 1 1 1 11 13 1999 1 1 1 1 5 1 3 7 3 1 199 1 9 5 1 5 79 1997 1 1 5 1 7 7 1 91 199 5 3 3 1 5 3 9 1995 3 5 1 1 1 1 75 199 3 3 1 3 1 5 1 3 91 93 7 1 9 59 1 119 53 77 Insertion of patella Other Missing 33 Figure : knee prostheses without patella Removal of all components 3,3 % Removal of prosthetic part(s),7 % Other 7, % Missing,7 % Exchange of distal, % Exchange of proximal,3 % Insertion of patella 1, % Exchange of all components,7 % Exchange of tibial plastic+insertion of patella, % Exchange of proximal+tibial plastic 1,1 % Exchange of distal+tibial plastic 5,7 % Exchange of tibial plastic 1, % Knee 9
Report 17 Type of revision Table : Unicondylar prostheses Year of primary operation Exchange of distal Exchange of whole prosthesis Exchange of tibial plastic Exchange of proximal Removal of whole prosthesis Removal of prosthetic part(s) 1 1 1 11 15 1 11 5 17 1 13 1 13 1 9 1 1 9 1 3 11 1 1 3 1 39 1 1 5 9 11 1 1 59 1 59 7 7 7 7 1 9 1 7 7 1 1 3 5 5 7 1 1 95 9 5 9 3 11 7 1 7 1 3 1 7 1 7 3 1 5 1 5 5 1 1 1 3 1999 1 3 199 1 1 1 1997 1 1 15 199 9 1 1 11 1995 1 3 199 1 1 1 3 Other Missing 7 75 15 17 1 113 Figure 1: Unicondylar prostheses Removal of all components 1,5 % Removal of prosthetic part(s),1 % Other, % Missing, % Exchange of distal, % Exchange of proximal,7 % Exchange of tibial plastic 11,3 % Exchange of all components 79,3 % Knee 91
The Norwegian Arthroplasty Register ASA classification all knee prostheses Table 1: Primary operations all knee prostheses Year ASA 1 ASA ASA 3 ASA ASA 5 Missing 1 73 355 1 3 1 1 15 1 1 1 7 7 1 1 5 3 9 1 5 7 5 13 59 3 59 9 5 1 9 5 5 1 7 3 7 91 91 11 5 3 19 73 5 55 1 1 5 797 7 9 9 3 7 793 95 75 35 75 1 79 3 99 7 77 79 7 3 5 79 1 71 51 1 1 7 3 19 5 913 1 55 559 1 3 53 Table : Revisions Year ASA 1 ASA ASA 3 ASA ASA 5 Missing 1 7 351 1 33 593 15 35 313 1 7 19 55 1 5 9 137 13 9 13 5 9 133 1 1 5 7 135 3 1 93 11 5 9 119 9 31 1 77 199 11 1 13 11 9 93 1 117 1 15 3 1 1 13 37 7 73 11 9 1 31 57 13 57 15 7 5 1 9 7 51 Figure : Primary operations Figure 3: Revisions 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 11 13 15 Missing ASA 5 ASA ASA 3 ASA ASA 1 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 11 13 15 ASA 1 = Healthy patients who smoke less than 5 cigarettes a day. ASA = Patients with an asymptomatic condition who are kept under medical control (f.ex. hypertension), or with diet (f. ex. diabetes mellitus type ), and otherwise healthy patients who smoke five cigarettes or more daily. ASA 3 = Patients having a condition that can cause symptoms. However, patients are kept under medical control (f. ex. moderate angina pectoris and mild asthma). ASA = Patients with a condition that is out of control (f. ex. heart failure and asthma). ASA 5 = A moribund patient who is not expected to survive the operation. Registration of ASA classification started in 5 Knee 9
Report 17 Thrombosis prophylaxis Table 3: Primary operations Year Preoperatively Postoperatively Unknown* No Missing pre / post 1 33 7 7 5 9 15 93 95 1 9 5 1 1 79 73 5 5 13 9 3 3 71 1 55 5 5 1 1 131 79 71 7 91 11 1 7 953 9 55 1 1 1 533 39 9 1 7 3 1 1 1 1 3 13 3 3 99 7 1 7 1 59 1 5 3 3 5 1 75 57 1 3 19 5 1 3 7 135 3 5 Table : Revisions Year Preoperatively Postoperatively Unknown* No Missing pre / post 1 9 1 7 7 593 15 11 5 55 1 9 35 7 7 5 9 13 75 317 77 5 1 15 111 3 93 11 97 9 1 3 31 1 17 7 7 1 11 9 93 7 5 3 1 1 7 37 7 1 9 9 31 139 5 3 9 7 5 13 3 5 15 51 * Missing information on medication start Figure : Primary operations 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 11 13 15 Registration of thrombosis prophylaxis started in 5 Missing No Unknown pre / post Postoperatively Preoperatively Figure 5: Revisions 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 11 13 15 Knee 93
The Norwegian Arthroplasty Register Thrombosis prophylaxis Table 5: Drugs - All operations Drugs 5-7 9 1 11 1 13 1 15 1 Apixiban (Eliquis) 1,% 1,1%,9% 1,% Dalteparin (Fragmin) 9,% 5,1% 57,% 5,%,%,% 59,% 5,1% 5,% 5,3% 5,5% Enoksaparin (Klexane),5% 39,% 3,% 3,% 3,%,% 9,% 3,% 3,%,7%,5% Rivaroksaban (Xarelto),1%,%,%,5% 1,% 1,% 1,1% Ximelagatran (Exanta, 1,% Malagatran) No drugs,%,%,5%,3%,3%,%,%,3%,5%,%,9% Clinical study,1%,7% 1,1% Combination of drugs 1,% 1,3% 1,%,1% 3,1% 3,5% 7,3% 1,1% 1,% 1,% 1,1% Other,5%,%,3%,1%,1%,1%,%,%,%,5%,7% Missing 3,% 1,9% 1,7% 1,5% 1,1% 1,% 1,3% 1,% 1,% 1,5% 1,% Figure : Drugs Number of drugs 35 3 5 15 1 5 Enoksaparin (Klexane) Dalteparin (Fragmin) Apixiban (Eliquis) Rivaroksaban (Xarelto) No drugs Clinical study Ximelagatran (Exanta, Malagatran) Other Combination of drugs Missing 5 7 9 1 11 1 13 1 15 1 Table : Duration - All operations Year Days: 1-7 -1 15-1 - 9-35 >35 No drugs Missing 1 1 17 3 1 55 313 713 3 5 1 7 7 59 15 1 11 37 977 3 5 13 913 1 95 1 795 1 37 1 5 153 3 73 11 13 7 1 59 1 5 39 99 1 1 5 5 55 1 5 1 33 1 335 9 95 13 55 5 9 11 9 1 35 1 377 3 79 11 1 53 97 1 3 1 3 1 31 39 779 5 1 71 11 9 39 1 5 1 1 71 1 75 9 1 55 17 751 31 7 357 7 9 1 177 797 119 7 9 5 3 9 1 1 3 57 11 53 9 17 3 37 5 57 1 1 111 53 9 1 555 3 55 Registration of thrombosis prophylaxis started in 5 Knee 9
Report 17 Fibrinolysis Inhibitor Table 7: Drugs - Primary operations Drugs 1 11 1 13 1 15 1 Cyclokapron (Tranexamic acid) 137 3 395 7 531 5711 Missing 7 153 11 11 7 3 1 335 1 53 577 Registration of fibrinolysis inhibitor started in 11 Perioperative complications Table : For primary total prostheses (the 1 most common complications) Type 199-7 9 1 11 1 13 1 15 1 Patella tendon rupture / Avulsion fractures / 1 1 1 1 13 1 1 1 17 15 15 ligament rupture / tendon injury Fracture 3 9 7 1 7 5 5 9 115 Rupture / damage MCL (medial colateral 1 7 1 5 1 1 5 5 1 71 ligament) Technical problem with cement 1 1 1 5 Failure of instruments 1 7 3 3 5 3 7 1 1 5 Blood torniquet failing 1 1 5 3 1 7 Fracture of proximal bone 13 3 3 3 1 5 3 3 Adm. failure (missing comp. etc.) 17 1 7 7 Problem due to difficult anatomy 3 7 5 3 3 5 5 3 Anestesiproblemer 5 7 7 1 3 Other periop. compl. 9 19 5 5 7 33 3 7 3 Previous operation in relevant joint Table 9: For primary total prostheses Type 199-7 9 1 11 1 13 1 15 1 Meniscus 3 31 11 511 5 7 7 77 757 7 Osteotomy 1 11 1 11 11 11 11 135 119 13 53 Synovectomy 77 7 1 5 5 39 13 Osteosynthesis of intraarticular joint 577 7 9 77 7 97 9 97 137 fracture Ligament 119 1 13 1 1 3 5 17 59 Artrodesis 1 1 3 Other previous op. 13 13 13 17 7 3 7 3 33 31 3 Knee 95
The Norwegian Arthroplasty Register Mini-invasive surgery Table 3: Primary operations - knee prostheses Year Yes No Missing 1 9 (%) 95 (9%) 5 (1%) 5 5 15 5 (%) 9 (%) 5 (1%) 5 9 1 (%) 3 (7%) (13%) 97 13 11 (%) 3 777 (%) 715 (1%) 53 1 1 (%) 3 95 (%) 5 (1%) 39 11 15 (%) 3 5 (%) (11%) 5 1 1 (1%) 3 79 (95%) 15 (5%) 3 955 9 5 (1%) 3 793 (95%) 15 (%) 3 93 1 (%) 3 357 (95%) 157 (%) 3 5 7 (1%) 91 (95%) 19 (%) 3 11 3 (%) 5 (9%) 115 (%) 9 5 5 (%) (9%) 3 (11%) 79 Table 31: Primary operations - Unicondylar knee prostheses År Yes No Missing 1 313 (3%) (57%) 59 (7%) 5 15 3 (3%) 39 (53%) 9 (9%) 7 1 3 (%) 73 (%) 5 (1%) 59 13 3 (7%) 17 (35%) (1%) 7 1 199 (%) (7%) 5 (11%) 73 11 19 (5%) 191 (%) 5 (1%) 39 1 19 (7%) 5 (5%) 13 (3%) 1 9 93 (3%) 11 (35%) 9 (%) 3 3 (5%) (%) (1%) 7 155 (33%) 99 (%) 1 (3%) 1 (%) 7 (9%) 19 (5%) 399 5 179 (39%) (5%) 33 (7%) 5 Figure 7: Primary operations - Unicondylar knee prostheses 1 % % % % % Missing No Yes % 5 7 9 1 11 1 13 1 15 1 Registration of MIS started in 5 Knee 9
Report 17 Computernavigation Table 3: Primary operations - knee prostheses Year Yes Missing 1 575 (1%) 3 (%) 55 (1%) 5 5 15 71 (9%) 19 (79%) 5 (1%) 5 9 1 33 (9%) 3 9 (7%) 7 (13%) 97 13 31 (%) 3 (7%) 7 (1%) 53 1 1 (9%) 3 9 (75%) (1%) 39 11 3 (11%) 3 17 (7%) (11%) 5 1 59 (17%) 3 111 (79%) 15 (5%) 3 955 9 71 (19%) 3 (77%) 1 (%) 3 93 7 (1%) (75%) 1 (%) 3 5 7 37 (1%) 19 (%) 119 (%) 3 11 5 (9%) 335 (7%) 19 (%) 9 5 15 (7%) 33 (%) 7 (1%) 79 No Figure : Primary operations - knee prostheses 1 % % % % % Missing No Yes % 5 7 9 1 11 1 13 1 15 1 Table 33: Primary operations - Unicondylar knee prostheses Year Yes Missing 1 795 (93%) 3 (7%) 5 15 3 (%) 77 (91%) (9%) 7 1 51 (%) (1%) 59 13 3 (%) (1%) 7 1 17 (%) 5 (1%) 73 11 1 (%) 37 (%) 51 (1%) 39 1 7 (%) 39 (95%) 13 (3%) 1 9 3 (1%) 5 (9%) (%) 3 15 (3%) 1 (95%) 9 (%) 7 (1%) (9%) 1 (3%) 15 (%) 3 (91%) (5%) 399 5 (%) 19 (9%) 35 (%) 5 No Registration of CAOS started in 5 Knee 97
The Norwegian Arthroplasty Register Cements used in total knee prostheses Table 3: Primary operations - Femur Cement 199-7 9 1 11 1 13 1 15 1 Palacos R + G 15 1779 1 131 17 15 19 179 1 15 Palacos w/gentamicin 177 177 Optipac Refobacin Bonecement R 159 79 11 13 131 13 173 15 15 1113 Refobacin Bone Cement R 911 531 3 1 397 39 35 15 51 1 Cemex w/gentamycin 11 11 173 19 1 9 1 19 19 Refobacin-Palacos 1577 1577 SmartMix Cemvac + SmartSet GHV Genta 3 37 7 19 13 9 7 13 Simplex w/tobramycin 337 9 17 7 7 Palacos Cemex System Genta FAST 3 13 3 Simplex 1 1 CMW I w/gentamicin 19 19 CMW I 53 53 Other (n<5) 11 1 9 3 7 7 1 19 19 Missing information 5 1 9 15 939 73 335 333 375 337 3 5 51 1 55137 Table 35: Primary operations - Tibia Cement 199-7 9 1 11 1 13 1 15 1 Palacos R + G 3 17 19 195 1953 131 19 1 Palacos w/gentamicin 1779 1779 Optipac Refobacin Bonecement R 1 77 117 11 17 171 197 31 1955 11 Refobacin Bone Cement R 33 953 5 393 7 7 39 377 171 55 7 Cemex w/gentamycin 59 11 11 11 11 19 1 15 15 51 Refobacin-Palacos 1 1 SmartMix Cemvac + SmartSet GHV Genta 37 7 19 1 9 9 7 131 Simplex w/tobramycin 35 19 77 79 Palacos 5 5 Cemex System Genta FAST 55 11 1 3 13 3 CMW I w/gentamicin 19 1 1 19 Simplex 1 1 CMW I 5 5 Other (n<5) 133 13 1 1 3 5 9 7 17 Missing information 5 1 9 3 3 1 1 73 3391 393 3 59 973 519 51 71 Knee 9
Report 17 Cements used in unicondylar knee prostheses Table 3: Primary operations - Femur Cement 199-7 9 1 11 1 13 1 15 1 Palacos R + G 39 1 3 5 7 31 35 39 Palacos w/gentamicin 1 1 Optipac Refobacin Bonecement R 7 1 11 159 1 15 17 3 133 Refobacin Bone Cement R 11 5 9 1 5 1 9 Refobacin-Palacos 9 9 Simplex w/tobramycin 15 11 3 1 3 Cemex w/gentamycin 5 3 3 Cemex System Genta FAST 7 7 SmartSet GHV 11 9 Simplex Other (n<) 1 3 7 3 7 9 31 5 1 1 3 73 7 55 7 5 Table 37: Primary operations - Tibia Cement 199-7 9 1 11 1 13 1 15 1 Palacos R + G 5 7 3 1 5 35 5 37 3 Palacos w/gentamicin 199 199 Optipac Refobacin Bonecement R 7 1 17 159 1 15 1 137 Refobacin Bone Cement R 31 1 55 9 1 5 1 915 Refobacin-Palacos Simplex w/tobramycin 1 9 3 1 15 Cemex w/gentamycin 5 3 3 Cemex System Genta FAST 7 5 7 1 SmartSet GHV 11 9 Simplex 39 39 Other (n<) 5 3 7 3 7 3 3 13 39 73 73 5 7 1 39 Knee 99
The Norwegian Arthroplasty Register Antibiotic prophylaxis Table 3: Primary operations Drugs 199-7 9 1 11 1 13 1 15 1 Cefalotin (Keflin) 37 37 39 3 3731 39 1 91 55 55 1 Cefuroksim (Zinacef, Cefuroxim, Lifurox) 99 1 11 17 5 1 9 1 1 39 Kloksacillin (Ekvacillin) 771 13 9 3 5 15 13 7 3 Klindamycin (Dalacin, Clindamycin) 31 99 15 11 1 15 7 1 31 339 91 Dikloksacillin (Diclocil, Dicillin) 17 11 7 13 7 17 1 3 1 Imipenem (Tienam) 51 51 Cefazolin (Cephazolin) 3 5 1 1 1 Cefaleksin (Keflex, Cefalexin) 19 1 1 1 Benzylpenicillin (Penicillin G) 17 1 1 1 Erytromycin (Ery-max, Abboticin) 1 1 17 Ciprofloksasin (Ciproxin) 5 1 1 1 1 Combination of drugs 7 17 1 175 15 71 73 3 35 51 93 Other (n<1) 1 5 1 3 1 Missing 135 51 3 3 57 5 3 51 991 399 55 91 55 5 1 759 Table 39: Revisions Drugs 199-7 9 1 11 1 13 1 15 1 Cefalotin (Keflin) 1 5 1 75 71 91 3 9 31 39 9 Cefuroksim (Zinacef, Cefuroxim, Lifurox) 5 1 1 1 1 1 3 Klindamycin (Dalacin, Clindamycin) 93 1 1 17 7 3 7 5 9 Dikloksacillin (Diclocil, Dicillin) 15 15 3 1 3 5 9 Kloksacillin (Ekvacillin) 77 5 3 19 9 1 1 19 15 19 Vankomycin (Vancomycin, Vancocin) 35 1 1 1 11 13 1 19 1 11 Benzylpenicillin (Penicillin G) 15 5 3 3 Ampicillin (Pentrexyl, Pondocillin, Doktacilin) 1 1 13 Ciprofloksasin (Ciproxin) 7 1 1 1 1 Combination of drugs 11 31 3 71 13 97 1 157 137 17 Other (n<1) 15 1 1 1 1 1 1 35 Missing 7 3 9 19 3 5 7 3 37 3 11 31 93 9 55 593 913 Knee 1
Report 17 Patient specific instruments Table : Year Yes No Missing 1 5 973 1 135 113 15 1 1 1 51 7 7 1 55 1 57 7 77 13 5 1 7 73 1 1 1 959 11 5 193 11 5 99 Registration started in 11 Drain Table 1: Year Yes No Missing 1 35 5 99 113 15 77 3 7 7 7 1 399 9 7 77 13 7 333 1 5 73 1 7 1 1 11 1 95 117 3 77 5 99 Registration started in 11 Knee 11
Completeness of reporting analysis for the Knee Arthroplasty Register, 13-1 A completeness of reporting analysis for the Knee Arthroplasty Register has been conducted by combining the data in the Register with data from the Norwegian Patient Register (NPR). The report and analysis were prepared by the NPR in collaboration with the Knee Arthroplasty Register (NAR). A report on the implementation and further results will be published on www.helsedirektoratet.no. There are separate statistics on primary operations and revisions. Some hospitals have few knee arthroplasty operations and the completeness of reporting rate must be seen in this light. NCSP codes for combining data from NPR hospital stays and the Knee Arthroplasty Register Type Code Description Primary operation NGB * Primary partial prosthetic replacement of knee joint not using cement NGB 1* Primary partial prosthetic replacement of knee joint using cement NGB Primary total prosthetic replacement of knee joint not using cement NGB 3 Primary total prosthetic replacement of knee joint using hybrid technique NGB Primary total prosthetic replacement of knee joint using cement NGB 99 Other primary prosthetic replacement of knee joint Reoperation NGC * Secondary implantation of partial prosthesis in knee joint not using cement NGC 1* Secondary implantation of partial prosthesis in knee joint using cement NGC * Secondary implantation of total prosthesis in knee joint not using cement NGC 3* Secondary implantation of total prosthesis in knee joint using hybrid technique NGC * Secondary implantation of total prosthesis in knee joint using cement NGC 99 Other secondary prosthetic replacement in knee joint NGU * Removal of partial prosthesis from knee joint NGU 1* Removal of total prosthesis from knee joint The completeness of reporting rate for the Knee Arthroplasty Register was calculated as follows: (Only NAR + Inclusion in both registers) (Only NPR + Only NAR + Inclusion in both registers) Completeness of reporting for the NPR was calculated in a similar way: (Only NPR + Inclusion in both registers) (Only NAR + Only NPR + Inclusion in both registers) Primary operations. In 13 and 1, 11 11 primary knee replacements were reported to one or both of the registers. 95.3% of these were reported to the NAR, while 97.9% were reported to the NPR. The analysis by hospital shows a completeness of reporting rate for the NAR ranging from 77.1% to 1% between the different hospitals. For hospitals with a low completeness of reporting rate for the Knee Arthroplasty Register, either the form was not sent in or other interventions than knee arthroplasties were incorrectly coded with NGB */NGB 1*/NGB /NGB 3/NGB (There were only 9 operations in the category NGB 99 during the period). Procedure codes to be used for primary operations: NGB * - NGB 1* - NGB - NGB 3 - NGB Revision operations. In 13 and 1, 197 revisions were reported to one or both of the registers. 9.% of these were reported to the NAR, while.% were reported to the NPR (revision level 1). The completeness of reporting by hospital shows that the completeness of reporting rate for the NAR varied between.1% and 1%. A low completeness of reporting rate may mean that the form was not sent in. It appears that a number of revision forms are missing in cases where the prosthesis was removed without a new one being inserted in the same operation; in such cases, a form should be submitted both when the prosthesis is removed and when any new insertion is performed. Procedure codes to be used for revision operations: NGC * - NGC 1* - NGC * - NGC 3* - NGC * - NGC 99 - NGU * - NGU 1* New: From 1, revisions due to infection, even where parts of the prosthesis are not removed or replaced, are to be reported on the form to the NAR. These must be coded NGS 19 or NGS 9 with the additional code NGW 9. 1
Completeness of reporting for primary and revision operations, knee prosthesis 13-1 Privatsykehuset i Haugesund Volvat Medisinske Senter St. Olavs hospital HF - Røros Sykehuset i Vestfold HF Vestre Viken HF - Ringerike Helse Møre og Romsdal HF - Volda sjukehus Helse Bergen HF - Hagevik Martina Hansens hospital Vestre Viken HF - Kongsberg Helse Fonna HF - Haugesund Helse Fonna HF - Stord Haraldsplass diakonale sykehus Helse Nord-Trøndelag HF - Sykehuset Levanger Universitetssykehuset i Nord-Norge HF - Harstad Betanien hospital Telemark Helse Stavanger HF - Stavanger universitetssykehus Haugesund san.for. revmatismesykehus Lovisenberg diakonale sykehus Sykehuset Østfold HF Diakonhjemmet Vestre Viken HF - Drammen Helse Møre og Romsdal HF - Kristiansund sjukehus Helse Bergen HF - Haukeland universitetssykehus Sørlandet sykehus HF - Kristiansand Sykehuset Innlandet HF - Kongsvinger Sørlandet sykehus HF - Arendal St. Olavs hospital HF - Trondheim Akershus universitetssykehus HF Universitetssykehuset i Nord-Norge HF - Tromsø Helse Bergen HF - Voss sjukehus Sørlandet sykehus HF - Flekkefjord Vestre Viken HF - Bærum Sykehuset Telemark HF - Skien Sykehuset Innlandet HF - Gjøvik Sykehuset Innlandet HF - Elverum Oslo universitetssykehus HF Helse Møre og Romsdal HF - Ålesund sjukehus Sykehuset Innlandet HF - Lillehammer Sykehuset Innlandet HF - Tynset Nordlandssykehuset HF - Bodø Helse Nord-Trøndelag HF - Sykehuset Namsos St. Olavs hospital HF - Orkdal Helse Førde HF - Førde Helse Førde HF - Lærdal Helse Finnmark HF - Klinikk Kirkenes Nordlandssykehuset HF - Vesterålen Helgelandssykehuset, Rana Norsk idrettsmedisinsk institutt* Ringvollklinikken* Nordlandssykehuset HF - Lofoten* Sykehuset Telemark HF - Rjukan* Teres Drammen* Aleris Helse - Oslo* Helse Finnmark HF - Klinikk Hammerfest* Sykehuset Telemark HF - Notodden* Universitetssykehuset i Nord-Norge HF - Narvik* 9. 95.3 Primary Revision 1 (1) 1 (1) 1 (7) 1 (1) 1 (9) 1 (1) 99. (7) 1 (1) 99.5 (1) 1 (3) 99 (1) 1 () 9.9 (3) 1 (9) 9. (7) 1 () 9. (1) 1 (5) 9. (1) 1 (9) 9.1 (5) 1 (1) 97. (5) 1 (15) 97.3 () 1 (1) 9.7 (15) 1 () 9. (1) 1 () 9 (39) 1 () 77.1 (7) 1 (5) 99 (97) 9.7 (75) 97. (31) 97. (3) 9.3 () 9. (5) 97.7 (17) 9.3 (35) 97. (31) 9 (5) 93. (11) 9 (5) 9. (1) 9. (7) 9.9 (1) 9.9 (11) 95.3 (5) 9 () 95.3 () 9.9 (1) 97.7 () 9.3 () 9.9 (1).9 (3) 93.3 (13).9 (9) 1 (59) 7.5 () 9. (15). () 95. (1). (13) 9. (1). (13) 9.7 () 3. (37). (1) 3. (15) 9.1 (1) 1.5 (7) 7. (133) 75 () 9.5 (315).7 (3) 95. (1) 5 () 99. (177) 5 () 9.7 (1) 5 () 7. (7) 5 () 73. (55).1 (9) 95.3 (3) () 9. (9) (1) 9.3 (1) (1) 1 (3) - (-) 1 (1) - (-) 1 (3) - (-) 1 (9) - (-) 9.7 (77) - (-) 9.1 (17) - (-). () - (-). (17) - (-) (1) - (-) 1 Dark blue bars and first number to the right of the bars gives completeness of reporting for primary operations. Light blue bars and second number to the right of the bars gives completeness of reporting for revision operations (level 1). The numbers in brackets gives the number of operations registered at both NAR and NPR. Vertical lines shows the national averages. * Have no registered revisions in NAR or NPR. 13
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CONTENTS Prostheses in other joints Survival of joint prostheses... 17 Survival of shoulder prostheses... 19 Elbow prostheses Annual number of prostheses... 111 Elbow disease in primary operations... 11 Use of cement... 113 Prostheses... 11 Reasons for revisions... 115 Ankle prostheses Annual number of prostheses... 117 Ankle disease in primary operations... 117 Use of cement... 11 Prostheses... 119 Reasons for revisions... 1 Finger joint prostheses Annual number of prostheses... 11 Reasons for primary operations... 1 Use of cement... 13 Prostheses... 15 Reasons for revisions... 1 Wrist prostheses Annual number of prostheses... 17 Wrist disease in primary operations... 17 Use of cement... 1 Prostheses... 19 Reasons for revisions... 19 Carpometacarpal prostheses (CMC I) Annual number of prostheses... 131 Carpometacarpal disease in primary operations... 131 Use of cement... 13 Prostheses... 13 Reasons for revisions... 13 Lumbar disc prostheses Annual number of prostheses... 133 Back disease in primary operations... 133 Use of cement... 13 Prostheses... 13 Shoulder prostheses Annual number of prostheses... 135 Reasons for primary operations... 13 Use of cement... 11 Prostheses... 1 Reasons for revisions... 19 Toe joint prostheses Annual number of prostheses... 153 Toe disease in primary operations... 153 Use of cement... 15 Prostheses... 155 Reasons for revisions... 155 15
1 Completeness analysis Completeness of reporting total prosthesis in elbow... 15 Completeness of reporting prosthesis in ankle... 15 Completeness of reporting prosthesis in finger... 11 Completeness of reporting prosthesis in wrist... 13 Completeness of reporting prosthesis in shoulder... 1 Completeness of reporting prosthesis in toe... 19
Prosthesis survival (%) Prosthesis survival (%) Prosthesis survival (%) Survival curves for joint prosthesis a) 1 prosthesis in elbow* b) Ankle, without rheumatoid arthritis 1 9 9 7 7 199-99 -5-1 5 1 15 199-99 -5-1 5 1 15 b) 1 Ankle, only rheumatoid arthritis c) 1 Wrist 9 9 7 7 199-99 -5-1 5 1 15 199-99 -5-1 5 1 15 d) 1 Carpometacarpal (CMC I) e) 1 Finger (MCP) 9 9 7 7 199-99 -5-1 5 1 15 Years to failure *Caput radii prosthesis for acute fracture is not included. Kaplan-Meier survival curves. Survival estimate is given as long as > 5 prostheses are at risk. 199-99 -5-1 5 1 15 Years to failure 17
Survival curves for joint prosthesis f) 1 Toe 9 7 199-99 -5-1 5 1 15 Years to failure Kaplan-Meier survival curves. Survival estimate is given as long as > 5 prostheses are at risk. 1
Prosthesis survival (%) Prosthesis survival (%) Prosthesis survival (%) Prosthesis survival (%) Prosthesis survival (%) Prosthesis survival (%) Survival curves - Shoulder arthroplasty a) 1 Hemi standard with stem b) 1 Anatomical total standard with stem 9 9 7 7 Age <= years Age > years Age <= years Age > years 5 1 15 5 1 15 c) 1 Reverse total standard with stem d) 1 Hemi standard with stem 9 9 7 Age <= years Age > years 5 1 15 7 199-99 -5-11 1-1 5 1 15 e) 1 Anatomical total standard with stem f) 1 Reverse total standard with stem 9 9 7 199-99 -5-11 1-1 5 1 15 Years after primary operation 7 199-99 -5-11 1-1 5 1 15 Years after primary operation Kaplan-Meier survival curves. Survival estimates are given as long as >5 prostheses are at risk. 19
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The Norwegian Arthroplasty Register ELBOW PROSTHESES Table 1: Annual number of prostheses Year Hemi prosthesis Primary operations prosthesis Radius head Reoperations * Revisions 1 3 (3,3%) (,9%) 1 (1,3%) 3 (39,5%) 7 15 (37,7%) 3 (33,3%) (9,%) 9 1 (3,%) 19 (3,%) 1 (5,%) 5 (,3%) 13 5 (,7%) (3,%) 19 (5,3%) 1 (1,3%) (3,7%) 75 1 (,%) 17 (7,9%) 1 (9,5%) 1 11 9 (5,%) 17 (9,3%) 1 (1,7%) 11 (19,%) 5 1 3 (7,9%) 15 (1,1%) (31,%) 71 9 3 (5,3%) 11 (1,7%) 3 (,%) 75 (9,1%) 7 (1,3%) (3,%) 57 7 35 (,9%) 11 (1,1%) 3 (1,%) 7 3 (3,%) 11 (1,9%) 31 (1,9%) 7 5 39 (5,%) 1 (15,%) 7 (3,%) 7 33 (55,%) (,7%) 3 (3,3%) 3 (7,%) (1,%) 9 (15,3%) 59 (,1%) 7 (13,%) 1 (3,9%) 5 1 37 (71,%) (3,%) 13 (5,%) 5 199-353 (79,5%) (,5%) 71 (1,%) 7 (,5%) (5,%) (1,%) 3 (,%) 31 (,7%) 153 * Reoperation where prosthetic parts were not changed or removed (soft tissue debridements for infected prosthesis, prosthetic parts were not changed) Figure 1: Annual numbers of operations 1 Number of operations Revision Hemi prosthesis Radius head prosthesisprimary 199 199 199 1 1 1 1 Year of operation 53,1 % of all operations were performed on the right side. 7, % performed in women. Mean age: years. Elbow 111
Report 17 Table : Elbow disease in primary operations - prostheses Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Sequelae after infection Other Missing 1 3 1 3 5 15 1 13 1 13 5 3 13 9 1 7 3 1 1 1 5 1 11 1 3 1 1 19 5 9 1 1 1 7 1 1 19 1 1 1 7 3 3 19 9 1 5 9 3 1 1 3 3 5 3 3 1 1 1 1 33 1 1 1 199-1 37 1 1 5 51 5 3 5 3 7 Diseases are not mutually exclusive. More than one reason for operation is possible. Table 3: Elbow disease in primary operations - Hemiprostheses Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture 1 1 13 1 Sequelae after infection Other Missing 1 1 Diseases are not mutually exclusive. More than one reason for operation is possible. Table : Elbow disease in primary operations - Radius head prostheses (Caput radii) Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Sequelae after infection Other Missing 1 19 1 15 5 1 1 1 3 1 13 1 19 1 1 3 13 11 13 1 13 9 11 5 7 11 5 5 1 5 1 1 1 1 1 3 1 5 1 1 1 1 199-13 5 9 13 3 1 11 1 Diseases are not mutually exclusive. More than one reason for operation is possible. 11 Elbow
The Norwegian Arthroplasty Register Use of cement in elbow prostheses Table 5: Primary operations - Humerus Year Cement with antibiotics Cement without antibiotics Uncemented Missing 1 3 (1, 15 5 (9,%) 1 (3,%) 1 1 (5,7%) 3 (1,3%) 13 7 (93,1%) 1 3 (,5%) (,9%) 3 (11,5%) 11 (9,7%) 1 (3,%) (,9%) 1 3 (,%) (11,%) 9 9 (5,3%) (11,%) 1 (,9%) (5,7%) (7,1%) (7,1%) 7 31 (,%) (75,%) 5 3 (59,%) 1 (,5%) 3 5 (5,%) 3 (,%) (11,%) (5,%) 1 (1,%) 17 (51,5%) 1 (3,%) 1 (,%) 3 (11,5%) 1 (3,5%) 1 (3,%) 1 1 (3,%) 3 (,1%) (59,5%) 199-19 (55,%) (,%) 7 (19,%) 3 (,%) 5 (,%) 95 (11,%) 1 (1,%) 1 (1,%) 9 3 1 9 9 3 3 35 3 39 33 37 353 Table : Primary operations - Ulna/radius Year Cement with antibiotics Cement without antibiotics Uncemented Missing 1 3 (,5%) 15 31 (3,3%) 1 (37,5%) 1 (3,7%) 1 1 (3,%) 1 (3,%) 9 (7,3%) (,1%) 13 3 (53,5%) 1 (55,%) (,5%) 19 (,%) 11 (7,%) (,7%) (,3%) 1 (9,%) 1 (,%) (,%) 9 37 (,%) (13,3%) (,%) 9 (,9%) (11,%) (5,7%) 7 (91,3%) 3 (,5%) 1 (,%) 35 (1,%) 5 (,%) (75,7%) (1,%) 9 (17,%) 9 (,3%) 3 1 (,%) (,%) (,%) 1 (,%) 1 (3,%) 3 (9,1%) 1 3 (7,9%) 3 (7,7%) 9 (7,3%) (15,%) 199-5 (,%) (3,1%) 9 (7,%) (,5%) 77 (7,%) 97 (9,1%) 17 (1,%) 1 (1,5%) 1 3 9 33 3 3 9 5 35 3 51 37 5 33 39 373 Elbow 113
Report 17 Prostheses used in elbow prostheses - prostheses Table 7: Primary operations - Humerus Prostheses 199-7 9 1 11 1 13 1 15 1 Discovery 9 1 1 1 19 9 1 11 Norway 1 Kudo 1 IBP 11 3 5 3 1 GSB III 3 9 7 5 3 3 1 NES 7 1 Nexel 1 Mark II 1 1 1 1 IBP Reconstruction 5 Coonrad/Morrey 1 1 1 Other (n < 5) 1 1 5 599 3 3 9 19 3 19 1 1 13 77 5 1 5 5 9 Table : Primary operations - Ulna/radius Prostheses 199-7 9 1 11 1 13 1 15 1 Discovery 9 1 1 1 19 9 1 11 Norway 179 Kudo 1 IBP 11 3 5 3 1 GSB III 3 9 7 5 3 3 1 NES 7 7 1 Nexel 1 Mark II 1 1 1 1 IBP Reconstruction 5 Coonrad/Morrey 1 1 1 Other (n < 5) 1 1 3 599 3 3 9 17 3 19 179 1 13 77 55 1 5 5 7 Prostheses used in elbow prostheses - Hemiprostheses Table 9: Primary operations - Humerus Prostheses 199-7 9 1 11 1 13 1 15 1 Latitude Anatomic hemi 5 5 7 7 11 Elbow
The Norwegian Arthroplasty Register Prostheses used in elbow prostheses - Radius head prostheses Table 1: Primary operations - Radius Prostheses 199-7 9 1 11 1 13 1 15 1 rhead 9 9 9 1 Acumed anatomic radial head 1 11 1 5 13 1 Radial Head 1 1 5 Explor 3 5 7 1 Silastic H.P. 1 Link radius 1 3 Evolve 1 Other (n < 5) 1 1 1 73 7 11 15 17 17 19 1 3 9 9 1 5 3 Reasons for revisions in elbow prostheses Table 11: Year Loose proximal comp. Loose distal comp. Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene 1 9 1 1 1 5 5 15 5 1 1 1 7 1 1 5 5 1 1 3 1 13 3 1 1 1 1 1 3 1 7 1 5 11 3 5 1 1 3 3 1 1 3 3 7 9 11 3 5 5 11 5 1 5 3 7 5 1 1 1 1 5 1 11 13 3 1 3 1 7 1 5 11 9 1 1 5 3 3 11 3 3 5 3 3 1 3 1 1 7 1 3 5 1 3 1 1 7 1 1 1 1 1 1 199-35 3 5 13 1 11 1 More than one reason for revision is possible 1 17 9 19 71 1 5 9 7 Other Missing Elbow 115
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The Norwegian Arthroplasty Register ANKLE PROSTHESES Table 1: Annual number of operations Year Primary operations Revisions 1 9 (71,9%) 3 (,1%) 1 15 9 (7,1%) 3 (9,9%) 17 1 7 (,5%) 3 (31,5%) 1 13 9 (71,9%) 3 (,1%) 1 1 (7,7%) 3 (9,3%) 11 11 9 (5,%) (3,%) 13 1 79 (79,%) (,%) 99 9 95 (79,%) (,%) 119 (,5%) 1 (19,5%) 7 5 (,%) 1 (19,%) 7 3 (,3%) 1 (13,7%) 73 5 (,%) 1 (,%) 5 39 (3,%) (17,%) 7 3 5 (7,1%) 7 (1,9%) 3 3 (,%) 9 (,%) 5 1 3 (,9%) (11,1%) 3 199-7 (7,9%) 1 (1,1%) 99 1139 (7,%) 3 (,%) 199 Figure 1: Annual numbers of operations Number of operations 15 1 5 199 199 199 1 1 1 1 Year of operation Revisions Primary operations 57, % of all operations were performed on the right side. 5,5 % performed in women. Mean age: 59, years. Table : Ankle disease in primary operations Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Sequelae of infection 1 13 7 1 3 5 15 1 5 1 11 1 1 11 7 1 1 5 13 3 5 1 1 1 1 1 9 11 3 1 35 5 1 3 1 9 9 5 9 31 7 13 1 1 15 7 7 13 1 19 1 5 5 5 15 9 1 3 1 1 17 1 3 1 3 7 11 1 7 1 1 5 1 7 1 9 1 199-11 7 1 1 31 Diseases are not mutually exclusive. More than one reason for operation is possible. 3 3 11 133 Other Missing Ankle 117
Report 17 Use of cement in ankle prostheses Table 3: Primary operations - Tibia Year Cement with antibiotics Cement without antibiotics Uncemented Missing 1 9 (1,%) 15 9 (1,%) 1 7 (1,%) 13 91 (1,%) 1 (1,%) 11 9 (1,%) 1 79 (1,%) 9 5 (5,3%) (9,%) (,1%) 1 (1,5%) 1 (9,%) (,1%) 7 5 (1,%) 3 (1,%) 5 1 (,5%) 39 (97,5%) 39 (1,%) 3 1 (,%) (9,%) 3 (1,%) 1 3 (1,%) 19 (1,%) 1999 (1,%) 199 (1,%) 1997 3 (37,5%) 5 (,5%) 199 7 (1,%) 3 (17,%) 7 (1,%) 1995 5 (,5%) 3 (37,5%) 199 (5,5%) (3,%) 1 (9,1%) 9 9 7 91 9 79 95 5 3 39 5 3 3 19 17 11 9 (,5%) 1 (,9%) 1 9 (9,%) 7 (,%) 1 13 Table : Primary operations - Talus Year Cement with antibiotics Cement without antibiotics Uncemented Missing 1 9 (1,%) 15 9 (1,%) 1 7 (1,%) 13 91 (1,%) 1 (1,%) 11 9 (1,%) 1 79 (1,%) 9 5 (5,3%) (9,%) (,1%) 1 (1,5%) 1 (9,%) (,1%) 7 5 (1,%) 1 (1,%) (9,%) 5 1 (,5%) 39 (97,5%) 39 (1,%) 3 1 (,%) 1 (,%) 3 (9,%) 3 (1,%) 1 3 (1,%) 19 (1,%) 1999 (1,%) 199 (1,%) 1997 3 (37,5%) 5 (,5%) 199 7 (1,%) 3 (17,%) 7 (1,%) 1995 5 (,5%) 3 (37,5%) 199 7 (3,%) (3,%) 9 9 7 91 9 79 95 5 3 39 5 3 3 19 17 11 31 (,7%) 11 (1,%) 1 9 (95,%) (,5%) 1 13 11 Ankle
The Norwegian Arthroplasty Register Prostheses used in ankle prostheses Table 5: Primary operations - Tibia Prostheses 199-7 9 1 11 1 13 1 15 1 Link S.T.A.R. 33 59 57 5 39 3 1 Salto Talaris 5 7 Mobility CCI Norwegian TPR 5 1 1 15 3 1 13 17 1 11 9 TM Ankle 3 3 1 Rebalance Salto Mobile Hintegra AES 9 1 1 3 7 3 95 79 9 91 7 9 9 11 1 1 9 1 7 3 15 1 11 3 113 Table : Primary operations - Talus Prostheses 199-7 9 1 11 1 13 1 15 1 Link S.T.A.R. 33 59 57 5 39 3 1 Salto Talaris 1 75 Mobility CCI Norwegian TPR 5 1 1 15 3 1 13 17 1 11 9 TM Ankle 3 3 1 Rebalance Salto Mobile Hintegra 9 1 1 7 Salto XT 1 1 1 AES 3 3 95 79 9 91 7 9 9 11 1 1 1 7 3 15 1 11 7 3 113 Ankle 119
Report 17 Reasons for revisions in ankle prostheses Table 7: Year Loose proximal comp. Loose distal comp. Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene 1 1 1 1 13 15 1 7 1 1 1 1 11 1 1 1 9 13 3 1 5 9 3 1 1 17 3 1 7 1 3 1 1 9 3 11 9 1 7 5 1 17 1 1 1 3 3 1 1 3 3 9 7 3 1 5 7 3 1 9 3 1 5 1 3 7 1 1 7 3 1 3 1 1 1 5 1 3 1 1 1 1 5 1 1 1 1 1 3 3 3 1 1 1 1 1 1 1 1 199-9 7 1 1 More than one reason for revision is possible 95 7 37 5 11 11 7 9 Other Missing 1 Ankle
The Norwegian Arthroplasty Register FINGER JOINT PROSTHESES Table 1: Annual number of operations - MCP Year Primary operations Revisions 1 59 (7,%) (3,%) 7 15 51 (57,3%) 3 (,7%) 9 1 (75,%) 1 (5,%) 5 13 55 (7,9%) (3,1%) 1 1 7 (5,9%) (9,1%) 53 11 57 (,3%) 9 (33,7%) 1 59 (7,%) 1 (3,%) 77 9 (,%) 3 (3,%) 1 (7,%) 3 (3,%) 1 7 (1,5%) 55 (3,5%) 13 1 (77,%) 3 (,%) 13 5 11 (7,7%) (7,3%) 15 11 (,%) 5 (3,%) 153 3 15 (3,%) (1,%) 173 11 (71,%) (,%) 15 1 11 (79,7%) 3 (,3%) 177 199-151 (9,5%) 19 (1,5%) 15 95 (,%) 73 (19,%) 3 Table : Annual number of operations - PIP Year Primary operations Revisions 1 1 (1,%) 1 15 5 (1,%) 5 1 (1,%) 13 (1,%) 11 3 (1,%) 3 1 (1,%) 9 3 (1,%) 3 (57,1%) 3 (,9%) 7 7 (5,7%) 1 (1,3%) 7 7 (7,5%) 1 (1,5%) 5 (5,7%) 1 (1,3%) 7 7 (7,5%) 1 (1,5%) 3 1 (1,%) 1 (1,%) 1 (1,%) 199-3 (79,3%) (,7%) 9 9 (,%) 1 (13,%) 13 Figure 1: Annual number of operations Number of operations 3 1 199 199 199 1 1 1 1 MCP Revisions MCP Primary operations Year of operation 1, % of all operations were performed on the right side. 7, % performed in women. Mean age: 1,3 years. Finger 11
Report 17 Reasons for primary operations Table 3: MCP prostheses - Finger disease Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Sequelae of infection 1 55 15 5 3 1 1 33 1 13 53 1 3 1 5 1 1 11 1 5 1 3 53 1 9 1 1 7 5 1 1 91 1 1 3 5 9 91 9 1 3 1 5 95 1 1 3 1 13 3 9 13 1 5 13 5 9 1 1 3 1999 9 3 199 1 13 1 1 5 1 1997 3 15 5 199 11 1 5 1995 1 3 9 199 33 5 More than one reason for primary operation is possible Table : PIP prostheses - Finger disease 7 779 1 1 1 1 3 9 3 Other Missing Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Sequelae of infection 1 1 15 3 1 3 1 13 1 5 11 1 1 1 1 9 1 1 1 7 3 1 1 1 3 5 1 1 1 3 1 1 1 3 1999 1 1 199 199 1 1 1 1995 1 1 199 1 More than one reason for primary operation is possible 35 3 11 1 1 Other Missing 1 Finger
The Norwegian Arthroplasty Register Use of cement in MCP prostheses Table 5: Primary operations - Proximal Year Cement with antibiotics 1 (3,%) Cement without antibiotics Uncemented Missing 57 (9,%) 15 1 (,%) (9,1%) (3,9%) 1 1 (97,%) 1 (,%) 13 5 (9,1%) 1 (1,9%) 1 11 1 9 1 (1,%) 7 7 (1,%) 57 (1,%) 59 (1,%) (1,%) 3 (9,%) (1,%) 13 (99,%) 1 (1,%) 5 (1,%) 19 (97,3%) 1 (,9%) 1 (1,%) 3 1 (99,%) 15 (1,%) 1 (99,1%) 1 (,9%) 1 1 (,7%) 1999 199 1 (99,3%) 19 (1,%) 53 (1,%) (1,%) 1997 1 (9,%) 3 (1,%) 199 1995 17 (1,%) 3 (1,%) 199 3 (99,%) (,%) 59 51 53 7 57 59 1 11 11 15 19 11 19 53 19 17 3 3 (,%) (,1%) 99 (99,3%) 1 (,%) 99 Table : Primary operations - Distal Year Cement with antibiotics Cement without antibiotics Uncemented Missing 1 1 11 1 9 7 5 3 1 199 1995 (1,%) 1 (1,%) (1,%) 1 (1,%) 1 (1,%) (1,%) (1,%) 7 (1,%) (1,%) 1 (1,%) 1 (1,%) 5 (1,%) 1 (1,%) 1 (1,%) (1,%) (1,%) 1 1 1 7 1 1 5 1 1 37 (1,%) 37 Finger 13
Report 17 Use of cement in PIP prostheses Table 7: Primary operations - Proximal Year 1 15 1 Cement with antibiotics Cement without antibiotics Uncemented Missing 1 (1,%) 5 (1,%) (1,%) 13 5 (3,3%) 1 (1,7%) 11 (,7%) 1 (33,3%) 1 9 (1,%) 3 (1,%) (1,%) 7 5 (3,3%) 1 (1,7%) 5 1 1999 199 199 1995 199 7 (1,%) (1,%) 7 (1,%) (1,%) (1,%) (1,%) 7 (1,%) (1,%) 5 (1,%) (1,%) 1 (1,%) 1 5 3 3 7 7 7 5 1 (9,%) 3 (3,%) 9 Table : Primary operations - Distal Year 1 11 1 7 Cement with antibiotics Cement without antibiotics Uncemented Missing 1 (1, (1, (1, 1 (1, (1, (,%) 1 (,%) 5 199 1995 5 (1, 5 (1, 1 (1, 3 (1, 1 (1, 1 1 5 5 5 1 3 1 7 (9,%) 1 (3,%) 1 Finger
The Norwegian Arthroplasty Register Finger prostheses Table 9: MCP prostheses in primary operations - Proximal Prostheses 199-7 9 1 11 1 13 1 15 1 Silastic HP 1 17 1 1 53 9 7 5 5 1 Avanta 55 1 1 NeuFlex 193 1 Silastic HP 1 II 1 5 5 Ascension MCP 3 1 1 1 MCS SR Avanta Moje 1 51 59 57 7 53 51 59 197 55 19 17 3 1 99 Table 1: MCP prostheses in primary operations - Distal Prostheses 199-7 9 1 11 1 13 1 15 1 Ascension MCP 1 1 1 1 MCS Moje 1 1 1 1 3 1 37 Table 11: PIP prostheses in primary operations - Proximal Prostheses Silastic HP 1 1 199-7 9 1 11 1 13 1 15 1 SR Avanta 3 3 1 1 1 5 1 Ascension MCP 17 1 NeuFlex 7 Ascension PIP PyroCarbon MCS Avanta 3 Moje 1 1 57 3 3 5 1 1 7 3 1 7 5 1 9 Table 1: PIP prostheses in primary operations - Distal Prostheses 199-7 9 1 11 1 13 1 15 1 Ascension MCP 17 1 Ascension PIP PyroCarbon MCS Moje 1 1 5 3 1 1 9 Finger 15
Report 17 Finger prostheses - Reasons for revisions Table 13: MCP prostheses - Reasons for revisions Year Loose proximal comp. Loose distal comp. Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene Fractured/defect component 1 5 5 1 1 9 5 7 15 1 15 9 1 1 1 5 13 13 13 1 1 1 1 1 13 1 11 13 1 1 1 1 3 1 3 9 1 3 3 5 1 15 13 5 1 5 7 3 11 1 1 39 1 1 7 11 1 5 5 1 5 5 1 3 5 3 1 1 9 1 17 3 1 7 15 7 1 3 3 7 11 3 9 1 1 1 5 1 1999 1 3 7 1 199 1 1 3 5 1 11 1 1997 1 3 1 11 1 199 13 7 1995 7 1 13 5 199 1 1 1 1 7 95 11 19 5 13 7 3 11 Revision reasons are not mutually exclusive. More than one reason for revision is possible Other Missing Table 1: PIP prostheses - Reasons for revisions Year Loose proximal comp. Loose distal comp. Dislocation Instability Malalignment Deep infection Fracture (near implant) 1 1 1 1 1 Pain Defect polyethylene Fractured/defect component 7 1 1 1 5 1 1 1 3 1 1 199 1 1 1997 199 1 3 1 3 1 Revision reasons are not mutually exclusive. More than one reason for revision is possible Other Missing 1 Finger
WRIST PROSTHESES The Norwegian Arthroplasty Register Table 1: Annual number of operations Year Figure 1: Annual number of operations Primary operations Revisions 1 17 (7,%) 7 (9,%) 15 33 (,%) 5 (13,%) 3 1 7 (,%) 5 (15,%) 3 13 19 (7,%) (,%) 5 1 1 (5,7%) (1,3%) 1 11 (,7%) (33,3%) 1 1 1 (93,3%) 1 (,7%) 15 9 3 (,1%) 5 (17,9%) 11 (1,1%) 7 (3,9%) 1 7 1 (51,%) 15 (,%) 31 3 (7,%) 9 (,%) 1 5 15 (3,3%) 3 (1,7%) 1 (7,7%) 3 (7,3%) 11 3 1 (75,%) (5,%) 1 (,%) 1 (,%) 5 1 1 (,%) 3 (15,%) 19 199- (93,%) 5 (7,%) 71 333 (79,7%) 5 (,3%) 1 Number of operations 5 3 1 199 199 1 1 1 1 Year of operation Revisions Primary operations 57, % of all operations were performed on the right side.3, % performed in women Mean age: 5,1 years. Table : Wrist disease in primary operations Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Sequelae after infection Other Missing 1 1 1 15 13 1 7 1 7 1 11 9 3 13 3 5 3 1 3 1 3 5 1 11 1 3 1 9 5 9 1 1 1 7 1 1 5 19 1 3 5 5 3 1 5 3 3 1 1 199-59 1 5 1 77 1 1 3 1 Diseases are not mutually exclusive. More than one reason for operation is possible. Wrist 17
Report 17 Use of cement in wrist prostheses Table 3: Primary operations - Proximal Year Cement with antibiotics Cement without antibiotics Uncemented Missing 1 17 (1,%) 15 31 (9,9%) 1 (3,1%) 1 7 (1,%) 13 19 (1,%) 1 11 (91,7%) 1 (,3%) 11 (1,%) 1 1 (1,%) 9 1 (91,3%) (,7%) 1 (1,%) 7 1 (1,%) 3 (1,%) 5 15 (1,%) (5,%) (75,%) 3 1 (,3%) 11 (91,7%) (1,%) 1 1 (,3%) 1 (,3%) 1 (7,5%) 3 (17,%) 1 (,%) 1999 9 (9,7%) 1 (3,3%) 199 13 (1,%) 1995 (1,%) 199 (1,%) 17 3 7 19 1 1 3 1 1 3 15 1 1 17 3 13 7 (,1%) 1 (,3%) 31 (9,1%) 5 (1,5%) 331 Table : Primary operations - Distal Year Cement with antibiotics Cement without antibiotics Uncemented Missing 1 15 1 13 1 11 1 17 (1,%) 33 (1,%) 7 (1,%) 19 (1,%) 1 (1,%) (1,%) 1 (1,%) 9 (95,%) 1 (,%) 9 (1,%) 7 15 (1,%) 3 (1,%) 5 15 (1,%) (5,%) (5,%) 3 3 (5,%) 9 (75,%) 3 (1,%) 1 1 (,7%) 1 (93,3%) 1 (5,9%) 1 (9,1%) 1999 3 (1,%) 199 13 (1,%) 17 33 7 19 1 1 1 9 15 3 15 1 3 15 17 3 13 9 (,%) 31 (9,9%) 1 (,3%) 3 1 Wrist
The Norwegian Arthroplasty Register Reoperasjonsårsaker Wrist prostheses ved håndleddsproteser Table 5: Primary operations - Proximal Prostheses 199-7 9 1 11 1 13 1 15 1 Motec Wrist 7 9 1 1 5 5 9 17 7 Biax 9 Remotion Wrist 3 3 1 13 13 5 Elos¹ 3 Scheker Radio-ulnar 1 1 1 3 3 1 3 Uhead (Druj) 3 1 Silastic ulnar head 7 Eclypse radio-ulnar TMW 1 19 1 3 1 1 19 7 3 17 13 9 7 3 13 1 7 1 331 Table : Primary operations - Distal Prostheses 199-7 9 1 11 1 13 1 15 1 Motec Wrist 7 9 1 1 5 5 9 17 7 Biax 9 Remotion Wrist 3 3 1 13 1 5 Elos¹ 3 Scheker Radio-ulnar 1 3 3 1 3 Uhead (Druj) 3 1 TMW 1 1 9 1 1 1 19 7 33 17 13 9 3 11 1 1 3 Table 7: Reasons for revisions Year Loose proximal comp. Loose distal comp. Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene Other Missing 1 1 1 1 7 15 1 1 1 1 1 7 1 1 1 1 3 13 1 1 1 3 1 1 1 1 3 11 1 1 1 1 1 9 1 1 1 3 1 1 1 7 1 1 5 3 1 19 3 5 1 11 5 1 3 1 1 1 7 3 1 1 1 1 1 1 1 1 1 1999 1 1 1 1 1995 1 1 199 1 1 5 3 3 5 13 1 5 3 1 11 Revision reasons are not mutually exclusive. More than one reason for revision is possible ¹Elos are 3 different development models of Motec Wrist. Motec Wrist was previously sold under the name Gibbon. Wrist 19
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Year The Norwegian Arthroplasty Register CARPOMETACARPAL PROSTHESES (CMC I) Table 1: Annual number of operations Primary operations Revisions 1 (,%) 5 (71,%) 7 15 (1,3%) (1,%) 3 1 7 (,%) 5 (15,%) 3 13 3 (1,1%) 7 (1,9%) 37 1 1 (73,7%) 5 (,3%) 19 11 7 (75,%) 9 (5,%) 3 1 1 (5,%) 7 (1,%) 9 9 (9,5%) (7,5%) 53 (,%) 5 (,%) 5 7 3 (5,%) (1,%) 7 1 (95,5%) 1 (,5%) 5 19 (7,%) (9,%) 7 3 (7,%) (5,%) 31 3 31 (9,9%) 1 (3,1%) 3 (9,3%) 1 (3,7%) 7 1 35 (7,5%) 5 (1,5%) 199-17 (9,%) 19 (9,%) 1 (5,7%) 1 (1,3%) 71 Figure 1: Annual number of operations Number of operations 5 3 1 199 199 199 1 1 1 1 Revisions Primary operations Year of operation 7, % of all operations were performed on the right side. 3 % performed in women. Mean age:, years. Table : Carpometacarpal disease in primary operations Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Sequelae of infection Other Missing 1 15 1 1 1 1 13 3 5 1 1 1 13 1 11 1 1 37 9 7 1 17 3 7 17 1 15 5 1 1 1 3 3 5 3 5 1 1 5 1 1 199-1 59 3 7 7 19 3 5 1 1 Diseases are not mutually exclusive. More than one reason for operation is possible. Carpometacarpal 131
Report 17 Use of cement in carpometacarpal prostheses Table 3: Primary operations - Proximal (Single-component) Year Cement with antibiotics Cement without antibiotics Uncemented Missing 1 (1,%) 15 (1,%) 1 (9,3%) 1 (3,7%) 13 3 (1,%) 1 1 (1,%) 11 7 (1,%) 1 (97,%) 1 (,%) 9 (91,7%) (,3%) (1,%) 7 3 (1,%) 1 (1,%) 5 19 (1,%) 3 (1,%) 3 1 (3,%) 3 (9,%) 1 (3,%) 5 (9,%) 1 35 (1,%) 199-1 (,5%) 15 (9,9%) 1 (,5%) 3 (,5%) 59 (9,3%) 7 (1,%) 7 3 1 7 1 3 1 19 3 31 35 17 Carpometacarpal prostheses - Prosthesis brand Table : Primary operations - Proximal (Single-component) Prostheses 199-7 9 1 11 1 13 1 15 1 Silastic Trapezium 1 17 1 11 9 Swanson Titanium Basal 71 1 Motec 1 17 15 Elektra 3 1 1 3 5 5 Motec II 1 1 1 1 Avanta Trapezium 1 Custom made 5 35 1 7 1 3 7 3 7 55 5 7 7 5 Reasons for revisions Table 5: Year Loose proximal Loose distal comp. Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene 1 1 1 15 1 1 1 3 1 1 13 3 1 1 1 1 11 7 1 5 1 3 1 3 9 1 1 1 7 1 3 1 1 5 1 7 1 1 3 1 3 1 1 1 1 1 1 199-1 1 5 9 3 11 1 11 1 Revision reasons are not mutually exclusive. More than one reason for revision is possible Other Missing 13 Carpometacarpal
The Norwegian Arthroplasty Register LUMBAR DISC PROSTHESES Table 1: Annual number of operations Year Primary operations Revisions 1 (1,%) 15 5 (1,%) 5 1 7 (1,%) 7 13 1 (1,%) 1 1 9 (1,%) (1,%) 11 11 1 (1,%) 1 1 (1,%) 9 (9,9%) (9,1%) 1 (1,%) 1 7 1 (1,%) 1 5 (9,%) 1 (1,%) 55 5 (9,%) 1 (1,%) 1 (1,%) 3 9 (1,%) 9 3 (1,%) 3 333 (9,%) (1,%) 339 Figure 1: Annual number of operations 1 Number of operations 1 1 1 1 Revisions Primary operations Year of operation 59, % performed in women. Mean age: 3,5 years. Table : Back disease - Primary operations Year Idiopathic osteoarthritis Sequelae after fracture Spondylitis Sequelae after prolapse surgery Disc degeneration Sequelae of infection 1 1 15 5 1 5 13 1 9 1 9 11 1 1 1 9 1 1 1 7 1 11 1 5 1 5 19 17 1 9 1 15 3 3 1 1 t 11 1 11 3 1 1 Diseases are not mutually exclusive. More than one reason for operation is possible. Other Missing Lumbar disc 133
Report 17 Use of cement in lumbar disc prostheses Table 3: Primary operations - Proximal Year Cement with antibiotics Cement without antibiotics Uncemented Missing 1 (1,%) 15 5 (1,%) 5 1 7 (1,%) 7 13 1 (1,%) 1 1 9 (1,%) 9 11 1 (1,%) 1 1 (1,%) 9 (1,%) 1 (1,%) 1 7 1 (1,%) 1 5 (1,%) 5 5 (1,%) (1,%) 3 9 (1,%) 9 3 (1,%) 3 333 (1,%) 333 Table : Primary operations - Distal Year Cement with antibiotics Cement without antibiotics Uncemented Missing 1 15 1 13 1 11 1 9 (,%) (1,%) 5 (1,%) 7 (1,%) 1 (1,%) 9 (1,%) 1 (1,%) (1,%) (1,%) (,%) 7 11 (91,7%) 1 (,3%) 1 (1,9%) 5 (9,3%) 1 (1,9%) 5 (1,%) (1,%) 3 9 (1,%) 3 (1,%) 3 (,9%) 3 (9,5%) (,%) 333 5 7 1 9 1 1 1 5 9 3 Lumbar disc prostheses - Prosthesis brand Table 5: Primary operations - Proximal Prostheses -7 9 1 11 1 13 1 15 1 Prodisc 1 1 9 1 7 5 Charité 3 t 1 1 9 1 7 5 73 335 Table : Primary operations - Distal Prostheses -7 9 1 11 1 13 1 15 1 Prodisc 1 1 9 1 7 5 Charité 3 1 1 9 1 7 5 73 335 13 Lumbar disc
SHOULDER PROSTHESES The Norwegian Arthroplasty Register Table 1: Annual number of operations in shoulder prostheses Year Primary operations Reoperations * Revisions 1 3 (9,%) 7 (9,%) 735 15 (91,7%) 5 (,3%) 7 1 59 (9,%) 1 (,%) (7,5%) 3 13 517 (9,9%) (,%) 5 (,%) 59 1 5 (9,1%) 1 (,%) (1,7%) 51 11 1 (9,5%) 39 (7,5%) 5 1 7 (91,%) 3 (,%) 9 9 39 (9,7%) (9,3%) 3 3 (9,9%) 3 (1,1%) 33 199-7 (91,5%) (,5%) 5 9 (91,%) (,1%) (,7%) 73 * Reoperation where prosthetic parts were not changed or removed (soft tissue debridements for infected prosthesis, prosthetic parts were not changed) Figure 1: Annual number of operations - All prostheses Number of operations 199 199 199 1 1 1 1 Year of operation Revisions Primary operations 53, % of all operations were performed on the right side. 71, % performed in women. Mean age: 9, years. Table : Annual number of operations - Stemmed shoulder hemiprostheses Year Primary operations Revisions 1 (,%) 19 (17,%) 17 15 111 (5,%) 19 (1,%) 13 1 13 (93,%) 9 (,%) 13 13 1 (5,7%) 1 (1,3%) 1 1 1 (91,7%) 15 (,3%) 11 11 177 (9,7%) 1 (7,3%) 191 1 17 (9,%) 1 (7,%) 19 9 11 (91,5%) 15 (,5%) 17 137 (9,5%) (5,5%) 15 199-7 19 (9,9%) 13 (7,1%) 1 95 (91,9%) 1 (,1%) 3 Table 3: Annual number of operations - Anatomic stemmed total shoulder prostheses Year Primary operations Revisions 1 17 (91,%) 15 (,%) 1 15 139 (9,5%) 5 (3,5%) 1 1 1 (93,%) (,3%) 1 13 99 (9,1%) (3,9%) 13 1 1 (95,3%) 3 (,7%) 11 79 (9,%) 5 (,%) 1 9 (9,%) 7 (9,%) 7 9 5 (9,%) 1 (1,%) 57 37 (97,%) 1 (,%) 3 199-7 99 (,5%) 1 (17,5%) 1 9 (93,%) 7 (7,%) 99 Shoulder 135
Report 17 Table : Annual number of operations - Resurfacing shoulder hemiprostheses Year Primary operations Revisions 1 11 (1,%) 11 15 (,%) 5 (71,%) 7 1 11 (1,%) 11 13 9 (5,9%) (7,1%) 17 1 1 (3,5%) 13 (5,5%) 3 11 (71,%) (,%) 1 5 (71,%) 1 (,%) 35 9 53 (,1%) 1 (15,9%) 3 3 (1,1%) 1 (1,9%) 53 199-7 (97,1%) (,9%) 7 (,%) 9 (1,%) 5 Table 5: Annual number of operations - Resurfacing total shoulder prostheses Year Primary operations Revisions 1 1 (1,%) 1 11 1 (1,%) 1 9 (1,%) 1 (5,%) 1 (5,%) 199-7 5 (3,3%) 1 (1,7%) 1 (3,3%) (1,7%) 1 Table : Annual number of operations - Reversed stemmed total shoulder prostheses Year Primary operations Reoperations * Revisions 1 371 (9,9%) (5,1%) 391 15 35 (9,3%) 9 (7,7%) 379 1 3 (9,1%) 19 (5,9%) 33 13 5 (95,1%) 13 (,9%) 5 1 1 (9,%) 1 (,%) (9,%) 39 11 11 (95,%) 7 (,%) 1 1 131 (93,%) 9 (,%) 1 9 1 (9,%) (7,%) 1 75 (9,%) (7,%) 1 199-7 39 (,%) 3 (11,%) 37 9 (9,%) 1 (,%) 17 (7,1%) Table 7: Annual number of operations - Non stemmed hemiprostheses Year Primary operations Reoperations * Revisions 1 1 (75,%) (5,%) 1 15 1 (7,7%) (7,3%) 1 3 (,1%) 1 (3,%) (1,3%) 13 (1,%) 1 3 (,1%) 5 (17,9%) 11 1 (95,5%) 1 (,5%) 1 33 (1,%) 33 9 5 (1,%) 5 159 (,3%) 1 (,%) (11,1%) 1 * Reoperation where prosthetic parts were not changed or removed (soft tissue debridements for infected prosthesis, prosthetic parts were not changed) 13 Shoulder
The Norwegian Arthroplasty Register Table : Annual number of operations - Non stemmed total shoulder prostheses Year Primary operations Revisions 1 1 (5,7%) 3 (1,3%) 1 15 15 (75,%) 5 (5,%) 1 1 (95,5%) 1 (,5%) 13 1 (1,%) 1 1 (,%) 5 (,%) 5 11 15 (1,%) 15 1 (1,%) 9 (1,%) 3 (1,%) 3 1 (9,%) 1 (1,%) 1 Table 9: Annual number of operations - Reversed non stemmed total shoulder prostheses Year Primary operations Revisions 15 3 (1,%) 3 1 1 (1,%) 1 (1,%) Reasons for primary operations Table 1: Shoulder disease in primary operations - Stemmed shoulder hemiprostheses Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Sequelae after infection Rotarcuff arthropathy 1 1 1 9 1 5 3 15 1 1 15 1 1 5 1 1 15 13 1 1 7 1 77 3 1 3 13 1 11 3 115 3 1 35 1 19 9 9 7 11 1 3 Other Missing 1 13 9 1 9 199-7 3 33 13 55 7 3 79 53 5 1 9 137 11 1 Diseases are not mutually exclusive. More than one reason for operation is possible. Table 11: Shoulder disease in primary operations - Anatomic stemmed total shoulder prostheses Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Sequelae after infection Rotarcuff arthropathy Other Missing 1 13 7 1 1 15 1 3 7 1 1 1 9 5 1 3 3 13 3 1 1 1 1 1 5 1 1 11 3 1 1 1 5 3 3 1 9 3 5 11 1 1 3 1 3 199-7 1 1 1 1 1 1 1 1 79 5 9 1 11 5 7 Diseases are not mutually exclusive. More than one reason for operation is possible. Shoulder 137
Report 17 Table 1: Shoulder disease in primary operations - Resurfacing shoulder hemiprostheses Year Idiopathic osteoarthritis 15 Rheumatoid arthritis Sequelae after fracture Mb. Bechterew 13 1 1 Sequelae ligament tear Acute fracture Sequelae after infection Rotarcuff arthropathy 1 11 1 1 1 1 1 17 3 3 Other Missing 9 33 13 5 1 1 3 1 1 199-7 17 7 3 3 1 3 3 11 5 9 3 5 1 3 5 1 3 Diseases are not mutually exclusive. More than one reason for operation is possible. Table 13: Shoulder disease in primary operations - Resurfacing total shoulder prostheses Year Idiopathic osteoarthritis 1 1 11 1 9 1 Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Sequelae after infection Rotarcuff arthropathy 199-7 Diseases are not mutually exclusive. More than one reason for operation is possible. Other Missing 9 Table 1: Shoulder disease in primary operations - Reversed stemmed total shoulder prostheses Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Sequelae after infection Rotarcuff arthropathy 1 117 7 1 13 1 1 1 15 13 3 3 1 17 77 5 3 1 11 5 1 3 13 13 7 37 1 7 1 5 1 1 19 5 3 33 1 Other Missing 11 1 3 1 9 3 1 35 9 1 1 1 7 5 1 1 1 9 19 15 1 1 9 13 19 19 1 1 5 1 7 199-7 9 17 1 7 31 3 1 7 357 1 9 1 5 3 115 3 Diseases are not mutually exclusive. More than one reason for operation is possible. 13 Shoulder
The Norwegian Arthroplasty Register Table 15: Shoulder disease in primary operations - Non stemmed shoulder hemiprostheses Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Sequelae after infection Rotarcuff arthropathy 1 7 1 1 15 13 3 1 1 1 1 1 13 3 1 1 15 3 3 1 11 13 1 1 3 3 7 1 9 1 1 Other Missing 11 13 3 1 Diseases are not mutually exclusive. More than one reason for operation is possible. Table 1: Shoulder disease in primary operations - Non stemmed total shoulder prostheses Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Sequelae after infection Rotarcuff arthropathy 1 1 1 1 15 13 1 1 1 1 3 13 15 1 1 1 17 1 1 1 11 13 1 1 1 9 5 1 1 Diseases are not mutually exclusive. More than one reason for operation is possible. Other Missing 11 7 1 5 1 Table 17: Shoulder disease in primary operations - Reversed non stemmed total shoulder prostheses Year Idiopathic osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture 15 1 1 1 Diseases are not mutually exclusive. More than one reason for operation is possible. Sequelae after infection Rotarcuff arthropathy Other Missing Shoulder 139
Report 17 Use of cement in shoulder prostheses Table 1: Stemmed shoulder hemiprostheses - Primary operations - Humerus Year Cem. with antib. Cem. without antib. Uncemented Missing 1 9 (55,7%) 39 (,3%) 15 (1,3%) 1 (3,9%) (1,%) 1 (,3%) 3 (9,3%) 3 (,%) 13 (7,1%) (5,9%) 1 1 (,3%) (15,7%) 11 13 (73,%) 1 (,%) 37 (,9%) 9 (5,1%) 1 135 (7,7%) 3 (,5%) 5 (,%) 9 117 (7,7%) 33 (,5%) 11 (,%) 7 (3,5%) (1,5%) 3 (,3%) 1 (,%) 199-7 1 (1,%) 39 (,3%) 17 (3,3%) (,1%) 1 93 (5,5%) (1,%) 99 (31,5%) (1,5%) 95 111 13 1 1 177 17 11 137 1 9 Table 19: Anatomic stemmed total shoulder prostheses - Primary operations - Glenoid Year Cem. with antib. Cem. without antib. Uncemented Missing 1 153 (91,%) 15 15 (9,9%) 1 (,%) 1 (1,1%) 1 99 (,5%) 1 (15,%) 3 (,5%) 13 77 (79,%) (,%) 1 5 (3,3%) 1 (1,7%) 11 5 (,3%) 1 (17,7%) 1 57 (,%) 11 (15,9%) 1 (1,%) 9 (71,%) 15 (,%) 1 (1,%) 3 (1,1%) (5,%) 5 (13,5%) 199-7 3 (,3%) 3 (3,1%) 51 (5,%) 739 (,%) 3 (,3%) 19 (1,3%) 1 (1,1%) 91 17 139 1 97 79 9 5 37 97 Table : Anatomic stemmed total shoulder prostheses - Primary operations - Humerus Year Cem. with antib. Cem. without antib. Uncemented Missing 1 17 (1,%) 15 (17,3%) 15 (9,%) 115 (,7%) 1 (,%) 93 (7,%) (1,7%) 13 5 (5,%) 1 (1,%) 1 5 (73,%) 15 (,%) 1 (1,%) 11 5 (7,%) (5,%) 1 5 (1,%) 11 (1,7%) 1 (1,5%) 9 3 (9,1%) 1 (9,1%) 1 (1,%) (75,7%) 3 (,1%) (1,%) 199-7 3 (5,%) 1 (1,%) (,%) 39 (,9%) 1 (,1%) 5 (55,%) 11 (1,%) 97 17 139 119 99 1 7 55 37 Table 1: Resurfacing shoulder hemiprostheses - Primary operations - Humerus Year Cem. with antib. Cem. without antib. Uncemented Missing 15 (1, 13 9 (1, 1 1 (1, 11 (1,%) 17 (5,%) 1 (5,%) 1 1 (,%) (,%) (,%) 9 (3,%) 9 (17,%) 15 (3,9%) (5,1%) 199-7 5 (1,%) 1 (1,%) 1 (,%) (,9%) 19 (39,5%) 5 (59,3%) 9 1 5 53 3 1 Shoulder
The Norwegian Arthroplasty Register Table : Resurfacing total shoulder prostheses - Primary operations - Glenoid Year Cem. with antib. Cem. without antib. Uncemented Missing 11 1 (1, 199-7 (1, 1 (33,3%) (,7%) 3 1 Table 3: Resurfacing total shoulder prostheses - Primary operations - Humerus Year Cem. with antib. Cem. without antib. Uncemented Missing 1 1 (1, 11 1 (1, 9 (1, 1 (1, 199-7 5 (1, (,%) (,%) 1 1 1 1 5 Table : Reversed stemmed total shoulder prostheses - Primary operations - Glenoid Year Cem. with antib. Cem. without antib. Uncemented Missing 1 1 (,3%) 37 (99,7%) 15 3 (,9%) 3 (9,9%) 1 (,3%) 1 9 (3,%) 95 (97,%) 13 (,%) 5 (99,%) 1 1 (,5%) 1 (,5%) 13 (9,%) 1 (,5%) 11 1 (,%) 1 (,%) 15 (9,1%) 1 (,%) 1 (,%) 1 (,%) 1 (93,1%) (1,5%) 9 (,%) 97 (97,%) 1 (1,%) 1 (1,3%) 5 (,7%) 9 (1,%) 199-7 (7,9%) 1 (,3%) 31 (91,%) 5 (,3%) (,%) 17 (9,9%) 15 (,7%) 371 35 3 5 1 11 131 1 75 3 Table 5: Reversed stemmed total shoulder prostheses - Primary operations - Humerus Year Cem. with antib. Cem. without antib. Uncemented Missing 1 39 (,%) 15 15 (1,%) 13 (35,%) 135 (3,%) 1 1 (59,%) 119 (39,1%) 5 (1,%) 13 13 (5,7%) 17 (,5%) (,%) 1 1 (,%) 7 (35,%) 11 99 (1,5%) (37,3%) (1,%) 1 7 (55,%) 57 (3,5%) (1,5%) 9 5 (5,%) 9 (9,%) 1 (1,%) 51 (,%) 1 (1,3%) (1,7%) 199-7 1 (3,3%) 1 (,3%) 1 (1,1%) 1 (,3%) 1 315 (57,%) 1 (,%) 95 (1,%) 1 (,9%) 9 371 35 3 5 1 11 131 1 75 39 Table : Non stemmed shoulder hemiprostheses - Primary operations - Humerus Year Cem. with antib. Cem. without antib. Uncemented Missing 1 9 (1, 15 5 (1, 1 1 (9,3%) 1 (7,7%) 13 11 (1, 1 1 (7,1%) 13 (9,9%) 11 1 (1, 1 1 (3,3%) 9 (9,7%) 9 5 (1, 1 (1,%) 1 (1,%) 1 (97,1%) 1 (1,%) 13 9 5 13 11 1 1 3 5 Shoulder 11
Report 17 Table 7: Non stemmed total shoulder prostheses - Primary operations - Glenoid Year Cem. with antib. Cem. without antib. Uncemented Missing 1 1 (1, 15 15 (1, 1 1 (1, 13 1 (77,%) (,%) 1 1 (9,%) 1 (5,%) 1 (5,%) 11 1 (93,3%) 1 (,7%) 1 (75,%) (5,%) 9 3 (,9%) (57,1%) 3 (1, 19 (7,%) 1 (11,%) (1,%) 15 1 15 1 1 15 7 3 Table : Non stemmed total shoulder prostheses - Primary operations - Humerus Year Cem. with antib. Cem. without antib. Uncemented Missing 1 (11,1%) 1 (,9%) 15 1 (1,%) 9 (9,%) 1 1 (5,9%) 1 (9,1%) 13 (1,5%) 13 (1,3%) 1 (,3%) 1 (11,%) 15 (,%) 11 1 (7,1%) 13 (9,9%) 1 1 (1,5%) 7 (7,5%) 9 (1, 3 (1, 1 (9,%) 1 (9,1%) 1 (,9%) 111 1 1 17 1 17 1 3 Table 9: Reversed non stemmed total shoulder prostheses - Primary operations - Glenoid Year Cem. with antib. Cem. without antib. Uncemented Missing 15 3 (1, 3 1 1 (1, 1 (1,% Table 3: Reversed non stemmed total shoulder prostheses - Primary operations - Humerus Year Cem. with antib. Cem. without antib. Uncemented Missing 15 3 (1, 1 1 (1, 3 (75,%) 1 (5,%) 3 1 1 Shoulder
The Norwegian Arthroplasty Register Prosthesis brand Stemmed hemiprostheses shoulder Table 31: Primary operations- Caput humeri Prostheses 199-7 9 1 11 1 13 1 15 1 Bio - Modular 1 1 3 13 1 Global Advantage 33 55 53 5 3 3 1 Global Fx 5 1 9 7 5 17 1 13 11 Global Nottingham 155 7 7 3 3 EPOCA 7 1 5 Delta I Global Unite 1 11 1 Promos standard 13 1 11 Aequalis 5 9 5 7 Nottingham 1 1 1 1 15 Aequalis-Fracture 3 3 7 7 3 3 1 1 Modular 33 Bigliani/Flatow 1 1 3 1 Comprehensive 13 JR-Vaios Anatomic 1 7 9 Global unite anatomic 3 3 9 Aequalis Ascend Flex Anatomic 3 Other (n < 1) 1 1 1 3 1555 133 1 17 177 15 1 13 111 753 73 77 3 15 57 5 37 3 33 9 7 19 15 15 1 79 Table 3: Primary operations - Humerus Prostheses 199-7 9 1 11 1 13 1 15 1 Bio - Modular 5 1 1 3 13 1 Global Advantage 17 37 5 1 35 3 33 1 Global Fx 3 1 53 5 1 1 1 11 Global 1 Nottingham 153 1 1 7 EPOCA 7 1 1 5 Delta I 3 Global Unite 1 11 1 Scan Shoulder 5 Promos standard 13 1 11 Neer II 5 Aequalis 5 5 7 5 Aequalis-Fracture 3 7 5 7 7 3 1 1 Modular 33 Nottingham 1 1 15 1 Bigliani/Flatow 15 1 3 1 JR-Vaios Anatomic 1 7 9 Comprehensive Fracture 1 3 Global unite anatomic 3 3 9 Aequalis Ascend Flex Anatomic 3 Monosperical 13 1 Comprehensive 1 Other (n < 1) 1 1 1 3 19 137 11 17 177 1 1 13 111 7 53 75 1 1 1 3 57 5 5 7 33 3 3 19 1 15 15 1 1 1 95 Shoulder 13
Report 17 Anatomic stemmed total shoulder prostheses Table 33: Primary operations - Glenoid Prostheses 199-7 9 1 11 1 13 1 15 1 Aequalis 1 31 51 51 3 3 3 Global unite anatomic 3 1 1 Aequalis Ascend Flex Anatomic 11 15 9 Global 1 1 1 3 9 1 Global Advantage 1 7 1 Bio - Modular 9 1 JR-Vaios Anatomic 11 Bigliani/Flatow 1 1 1 Promos standard 1 3 Anatomical shoulder 5 1 Nottingham 13 Other (n < 1) 1 1 3 1 97 37 5 9 79 97 1 139 17 1 13 1 9 5 31 1 1 13 91 Table 3: Primary operations - Caput humeri Prostheses 199-7 9 1 11 1 13 1 15 1 Aequalis 1 31 51 51 33 3 Global Advantage 13 19 1 1 1 31 7 17 Global unite anatomic 3 1 1 Aequalis Ascend Flex Anatomic 1 5 1 9 Bio - Modular 35 1 JR-Vaios Anatomic 11 Promos standard 1 Bigliani/Flatow 1 1 1 Anatomical shoulder 5 Nottingham 15 Other (n < 1) 1 1 3 1 5 37 5 9 79 1 99 1 139 17 19 1 1 3 31 1 1 17 15 31 913 Table 35: Primary operations - Humerus Prostheses 199-7 9 1 11 1 13 1 15 1 Aequalis 1 31 51 51 33 3 Global unite anatomic 3 1 1 Global Advantage 1 1 1 1 1 31 7 1 Aequalis Ascend Flex Anatomic 1 3 1 9 Bio - Modular 3 1 JR-Vaios Anatomic 3 11 Promos standard 1 Bigliani/Flatow 1 1 1 Anatomical shoulder 5 1 Nottingham 15 Other (n < 1) 3 1 1 7 1 37 55 7 1 99 119 139 17 1 1 11 35 3 1 1 1 15 35 97 1 Shoulder
The Norwegian Arthroplasty Register Resurfacing shoulder hemiprostheses Table 3: Primary operations - Humerus Prostheses 199-7 9 1 11 1 13 1 15 1 Copeland 15 35 1 Global C.A.P. 11 1 11 EPOCA Resurfacing 3 7 Aequalis Resurfacing 1 Other (n < 1) 1 3 53 5 1 9 9 9 1 13 5 Resurfacing total shoulder prostheses Table 37: Primary operations - Glenoid Prostheses 199-7 9 1 11 1 13 1 15 1 Copeland Aequalis Resurfacing 1 1 1 3 Table 3: Primary operations - Humerus Prostheses 199-7 9 1 11 1 13 1 15 1 Copeland 5 1 Aequalis Resurfacing 1 1 1 1 5 1 1 1 1 Reversed stemmed total shoulder prostheses Table 39: Primary operations - Glenoid Prostheses 199-7 9 1 11 1 13 1 15 1 Delta Xtend 15 9 91 11 17 1 17 Delta III 37 5 1 1 Tess Reversed 15 3 31 3 3 3 39 Aequalis Ascend Flex Reverse 17 3 7 Promos Reverse 9 1 1 1 1 17 Aequalis Reversed II 1 1 3 11 13 5 Comprehensive Reverse 1 1 1 3 5 9 Aequalis-Reversed 5 3 7 JRI-Vaios Inverse 9 5 3 SMR Axioma reversed 11 Trebecular Metal Reverse Shou 1 1 1 1 3 Anatomical shoulder Reversed 5 5 3 75 1 131 11 1 5 3 35 371 1 31 7 1 7 31 1 17 11 1 Shoulder 15
Report 17 Table : Primary operations - Caput humeri Prostheses 199-7 9 1 11 1 13 1 15 1 Delta Xtend 15 9 91 115 17 1 17 Delta III 3 5 1 1 Tess Reversed 15 9 31 7 3 3 3 39 Aequalis Ascend Flex Reversed 17 1 3 Promos Reverse 9 1 1 1 1 17 Aequalis Reversed Fracture 3 15 1 11 Aequalis-Reversed 3 5 3 1 13 Comprehensive Reverse 1 1 1 3 5 9 JRI-Vaios Inverse 9 5 3 SMR Axioma reversed 11 Aequalis Reversed II Trebecular Metal Reverse Shoulder 1 1 1 3 Anatomical shoulder Reversed 5 5 31 75 99 131 11 15 51 3 35 371 15 37 5 13 7 53 5 1 17 1 1 1 75 Table 1: Primary operations - Humerus Prostheses 199-7 9 1 11 1 13 1 15 1 Delta Xtend 15 9 91 115 17 1 17 Delta III 3 5 1 1 Tess Reversed 15 3 31 7 3 3 3 39 Aequalis Ascend Flex Reversed 17 1 3 Promos Reverse 9 1 1 1 1 17 Aequalis-Reversed 5 3 1 19 Aequalis Reversed Fracture 3 15 1 11 Comprehensive Reverse 1 1 1 3 5 7 JRI-Vaios Inverse 9 5 3 SMR Axioma reversed 11 Trebecular Metal Reverse Shoulder 1 1 1 1 3 Anatomical shoulder Reversed 5 5 Other (n < 1) 5 39 75 1 131 11 1 5 3 35 371 15 315 13 7 1 53 3 1 17 11 1 9 9 Non stemmed shoulder hemiprostheses Table : Primary operations - Caput humeri Prostheses 199-7 9 1 11 1 13 1 15 1 Tess-Anatomic 5 3 1 13 7 7 3 5 ECLIPSE TM 3 5 9 15 1 11 3 Andre (n < 1) 1 5 33 1 3 3 1 1 5 17 159 Table 3: Primary operations - Humerus Prostheses 199-7 9 1 11 1 13 1 15 1 Tess-Anatomic 5 3 1 13 7 7 3 5 Other (n < 1) 1 5 3 1 1 11 13 5 9 17 13 1 Shoulder
The Norwegian Arthroplasty Register Non stemmed total shoulder prostheses Table : Primary operations - Glenoid Prostheses 199-7 9 1 11 1 13 1 15 1 Tess-Anatomic 3 7 1 7 3 3 3 Aequalis Ascend Flex Anatomic 13 7 1 Simpliciti 1 1 ECLIPSE TM 1 3 5 Other (n < 1) 3 1 3 7 15 1 1 15 1 5 3 15 15 Table 5: Primary operations - Caput humeri Prostheses 199-7 9 1 11 1 13 1 15 1 Tess-Anatomic 3 1 7 3 3 Simpliciti 1 1 13 7 1 ECLIPSE TM 1 3 5 Andre (n < 1) 1 3 15 1 1 15 1 5 5 15 3 1 Table : Primary operations - Humerus Prostheses 199-7 9 1 11 1 13 1 15 1 Simpliciti 1 1 1 7 1 Tess-Anatomic 3 1 7 3 3 Other (n < 1) 3 1 17 1 17 1 1 55 5 111 Reversed stemmed total shoulder prostheses Table 7: Primary operations - Glenoid Prostheses 199-7 9 1 11 1 13 1 15 1 Comprehensive Nano Stemless 3 Comprehensive Reverse 1 1 3 3 1 Table : Primary operations - Caput humeri Prostheses 199-7 9 1 11 1 13 1 15 1 Comprehensive Nano Stemless Reverse 3 Comprehensive Reverse 1 1 3 3 1 Table 9: Primary operations - Humerus Prostheses 199-7 9 1 11 1 13 1 15 1 Comprehensive Nano Stemless Reverse 1 3 1 3 Shoulder 17
Report 17 Reasons for revisions Table 5: Stemmed shoulder hemiprostheses Year Loose proximal Loose distal comp Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene 1 1 1 3 1 1 1 7 7 15 1 1 3 1 1 1 1 1 13 5 3 1 1 1 1 1 5 5 1 11 3 3 1 3 3 1 1 9 5 9 1 3 3 1 1 1 1 5 1 7 1 1 1 3 1 1 3 1 1 5 1 1 1 3 5 3 1 5 3 5 5 3 1 1 3 1 5 1 1 1 1 1 1 1 1 1999 1 5 1 199 1 1 3 1 1997 1 1 199 1 1 1995 1 1 1 3 35 9 1 13 3 7 Revision reasons are not mutually exclusive. More than one reason for revision is possible. All revisions were included. Other Missing Table 51: Anatomic stemmed total shoulder prostheses Year Loose proximal Loose distal comp Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene 1 1 7 3 1 15 1 1 1 1 1 3 3 13 3 1 1 1 11 1 1 3 1 1 1 1 1 9 1 1 1 1 1 1 3 1 1 1 1 1 1 1 1 1999 1 1 199 1 1 1 1997 1 1 199 1 1 1995 1 1 199 1 1 13 1 11 1 17 1 3 1 Revision reasons are not mutually exclusive. More than one reason for revision is possible. All revisions were included. Other Missing 1 Shoulder
The Norwegian Arthroplasty Register Table 5: Resurfacing shoulder hemiprostheses Year Loose proximal Loose distal comp Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene 1 3 1 7 3 15 1 1 1 1 1 1 1 3 13 1 7 1 1 1 1 3 11 1 5 1 9 1 9 9 1 1 7 1 1 1 1 1 1 1 5 1 1 1 1 7 1 1 Revision reasons are not mutually exclusive. More than one reason for revision is possible. All revisions were included. Other Missing Table 53: Resurfacing total shoulder prostheses Year Loose proximal Loose distal comp Dislocation Instability Malalignment Deep infection Fracture (near implant) 1 5 1 1 Pain Defect polyethylene 1 1 1 Revision reasons are not mutually exclusive. More than one reason for revision is possible. All revisions were included. Other Missing Table 5: Reversed stemmed total shoulder prostheses Year Loose proximal Loose distal comp Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene 1 3 1 9 1 15 1 1 1 3 1 1 3 1 13 3 3 1 1 1 5 1 7 1 11 1 1 1 3 1 1 3 1 1 1 3 9 1 1 3 1 1 7 3 7 1 1 1 1 1 1 1 1 5 1 1 1 3 3 1 3 3 1 1 1 1 1 1 3 1 1 1 1999 1 199 1 1 199 1 1995 1 5 35 13 3 11 1 7 1 1 Revision reasons are not mutually exclusive. More than one reason for revision is possible. All revisions were included. Other Missing Shoulder 19
The Norwegian Arthroplasty Register Table 55: Non stemmed shoulder hemiprostheses Year Loose proximal Loose distal comp Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene 1 1 3 15 3 3 1 1 1 1 1 1 11 1 1 1 1 11 9 Revision reasons are not mutually exclusive. More than one reason for revision is possible. All revisions were included. Other Missing Table 5: Non stemmed total shoulder prostheses Year Loose proximal Loose distal comp Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene 1 1 1 1 1 15 1 3 1 1 1 1 1 3 1 7 1 1 7 1 Revision reasons are not mutually exclusive. More than one reason for revision is possible. All revisions were included. Other Missing Shoulder 15
151
Report 17 15 Shoulder
TOE JOINT PROSTHESES The Norwegian Arthroplasty Register Table 1: Annual number of operations Year Primary operations Revisions 1 17 (5,%) 3 (15,%) 15 33 (7,%) 1 (9,%) 7 1 19 (7,%) (9,%) 7 13 (,%) 5 (17,%) 9 1 (,%) 5 (17,%) 9 11 3 (7,%) 1 (,%) 5 1 3 (75,%) 11 (,%) 5 9 35 (7,3%) 17 (3,7%) 5 37 (1,7%) 3 (3,3%) 7 7 (7,1%) (9,9%) 7 75 (79,%) 19 (,%) 9 5 (79,%) 17 (1,%) 1 5 (,%) 1 (15,%) 3 (71,%) 19 (,%) 7 7 (79,%) 17 (,%) 1 1 (3,%) 1 (1,%) 73 199-5 (5,7%) 5 (1,3%) 593 115 (,%) 97 (,%) 1 Figure 1: Annual number of operations Number of operations 1 199 199 199 1 1 1 1 Table : Toe disease in primary operations Year Year of operation Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae ligament tear Acute fracture Revisions Primary operations 5, % of all operations were performed on the right side. 3,7 % performed in women. Mean age:, years. Idiopathic osteoarthritis Sequelae of infection 1 1 3 1 15 5 1 1 9 13 11 11 1 1 1 15 9 11 1 1 1 13 1 1 1 1 1 9 1 1 9 7 13 1 1 1 5 31 9 1 1 13 37 5 3 1 1 3 53 1 1 51 3 1 199-5 35 3 1 3 5 Diseases are not mutually exclusive. More than one reason for operation is possible. 35 19 1 1 Other Missing Toe joint 153
Report 17 Use of cement in toe joint prostheses Table 3: Primary operations - Proximal Year Cement with antibiotics Cement without antibiotics Uncemented Missing 1 17 (1,%) 15 3 (97,%) 1 (3,%) 1 19 (1,%) 13 (1,%) 1 (1,%) 11 35 (9,1%) 3 (7,9%) 1 3 (1,%) 9 35 (1,%) 37 (1,%) 7 (1,%) 7 (9,7%) 1 (1,3%) 5 (1,%) 1 (1,9%) 53 (9,1%) 3 1 (,1%) 7 (97,9%) 1 (1,5%) 5 (97,%) 1 (1,5%) 1 1 (1,%) (9,%) (3,%) (97,%) 1999 75 (1,%) 199 5 (1,%) 1997 9 (1,%) 199 79 (1,%) 1995 71 (1,%) 199 1 (97,%) (,%) 17 33 19 3 3 35 37 75 5 7 1 75 5 9 79 71 3 (,5%) 1 17 (9,%) (,7%) 1 1 Table : Primary operations - Distal Year Cement with antibiotics Cement without antibiotics Uncemented Missing 15 13 1 11 1 9 7 5 1 1 (9,1%) 1 (,7%) 1999 1 (9,1%) 199 1 (1,%) 1 (1,%) 1 (1,%) (1,%) 5 (1,%) 7 (1,%) (1,%) 5 (1,%) 13 (1,%) (1,%) 7 (1,%) (1,%) 1 (9,9%) 1 (93,3%) 1 (9,9%) (1,%) 3 (3,%) 9 (9,%) 95 1 1 1 5 7 5 13 7 11 15 11 15 Toe joint
The Norwegian Arthroplasty Register Toe joint prostheses Table 5: Primary operations - Proximal Prostheses 199-7 9 1 11 1 13 1 15 1 Silastic HP 1 77 3 5 1 13 11 11 5 LPT 9 3 3 1 9 1 1 Toefit-plus 31 7 5 1 1 1 Sutter Biomet Toe 5 Moje 1 LaPorta 1 Swanson Titanium Epyc 1 93 37 35 3 3 19 33 17 1 99 11 5 5 1 1 5 1 11 Table : Primary operations - Distal Prostheses 199-7 9 1 11 1 13 1 15 1 Toefit-plus 31 7 5 1 1 1 Biomet Toe 5 Moje 1 7 7 5 1 1 1 5 5 1 95 Reasons for revisions Table 7: Year Loose proximal Loose distal comp. Dislocation Instability Malalignment Deep infection Fracture (near implant) 1 1 1 Pain Defect polyethylene 15 1 5 5 3 1 1 1 13 3 1 1 3 11 3 1 7 1 5 1 3 3 3 9 1 3 7 3 5 1 1 13 1 7 3 1 3 1 1 1 1 1 1 1 5 1 1 1 7 1 5 3 7 3 1 1 9 1 1 1 5 7 3 1 3 5 1 1 1 1 1999 3 1 199 1 1 3 5 1 1997 1 3 1 1 199 1 1 3 1995 1 5 1 199 1 1 3 1 5 3 7 1 7 3 13 3 9 9 Revision reasons are not mutually exclusive. More than one reason for revision is possible Other Missing Toe joint 155
Completeness of reporting analysis for total elbow arthroplasty, -1 A completeness of reporting analysis has been conducted by combining the data in the Register with data from the Norwegian Patient Register (NPR). The report and analysis were prepared by the NPR in collaboration with the Norwegian Arthroplasty Register (NAR). There are separate statistics on primary operations and revisions. Some hospitals have few total elbow arthroplasties and the completeness of reporting rate must be seen in this light. NCSP codes for combining data from NPR hospital stays and total elbow arthroplasties Type Code Description Primary operation NCB Primary total prosthetic replacement of elbow joint not using cement NCB 3 Primary total prosthetic replacement of elbow joint using hybrid technique NCB Primary total prosthetic replacement of elbow joint using cement With and without NCB 99 Other primary prosthetic replacement of elbow joint Revision level 1 Revision level NCC y NCC 3y NCC y NCC 99 NCU 1y NCC 59 NCS 19 NCS 9 NCW 9 NCH y T 1.* T.* Secondary implantation of total prosthesis in elbow joint not using cement Includes: Of component of total prosthesis Secondary implantation of total prosthesis in elbow joint using hybrid technique Includes: Of component of total prosthesis Secondary implantation of total prosthesis in elbow joint using cement Includes: Of component of total prosthesis Other secondary prosthetic replacement in elbow joint Removal of total prosthesis from elbow joint Secondary implantation of interposition prosthesis in elbow joint Incision and debridement of infection of elbow joint Incision and debridement of infection of elbow joint with introduction of therapeutic agent Reoperation for deep infection in surgery of elbow or forearm For infection at the site of target structures Reduction of dislocation of prosthesis of elbow joint Complications of procedures, not elsewhere classified Complications of internal orthopaedic prosthetic devices, implants and grafts Primary operations. From to 1, primary total elbow arthroplasties were reported to one or both of the registers. 7.3% were reported to the NAR while 95.3% were reported to the NPR. Completeness of reporting by hospital shows a rate for the NAR ranging from % to 1% between the different hospitals. For hospitals with a low completeness of reporting rate for the NAR, either the form was not sent, or other interventions than elbow arthroplasties were incorrectly coded with NCB */NCB 3*/NCB *. (There were only 1 operations in the category NCB 99 during the period). Procedure codes to be used for primary operations: NCB */NCB 3*/NCB * Revision operations. From to 1, 19 revisions were reported to one or both of the registers..% of these were reported to the NAR, while 9.5% were reported to the NPR (revision level 1). The completeness of reporting by hospital shows that the completeness of reporting rate for the NAR varied between % and 1%. A low completeness of reporting rate may mean that the form was not sent in. It appears that a number of revision forms are missing in cases where the prosthesis was removed without a new one being inserted in the same operation; in such cases, a form should be submitted both when the prosthesis is removed and when any new insertion is performed. Procedure codes to be used for revision operations, level 1: NCC * - NCC 3* - NCC * and possibly NCU 1* and NCC 99. 15
Completeness of reporting for primary and revision operations, elbow total prosthesis -1 7.3. Primary Revision Martina Hansens hospital 1 (5) 1 (1) Sykehuset Innlandet HF - Kongsvinger 1 (7) 1 () Betanien hospital Telemark.9 (9) 1 (1) Helse Førde HF - Førde 37.5 (9) 1 () Diakonhjemmet 9.1 (119) 9.7 (1) Helse Bergen HF - Haukeland universitetssykehus 9.9 ().7 (15) Helse Møre og Romsdal HF - Ålesund sjukehus.9 (1) (5) St. Olavs hospital HF - Trondheim 1. (11) (15) Oslo universitetssykehus HF () 1 (1) Haugesund san.for. revmatismesykehus 1 (5) (1) Universitetssykehuset i Nord-Norge HF - Tromsø 33.3 (3) () Helse Nord-Trøndelag HF - Sykehuset Levanger (1) (3) Sykehuset Østfold HF () () Helse Førde HF - Lærdal* 1 (1) - (-) Akershus universitetssykehus HF* 1 (1) - (-) Helse Stavanger HF - Stavanger universitetssykehus* (1) - (-) Vestre Viken HF - Ringerike* (1) - (-) 1 Dark blue bars and first number to the right of the bars gives completeness of reporting for primary operations. Light blue bars and second number to the right of the bars gives completeness of reporting for revision operations (level 1). The numbers in brackets gives the number of operations registered at both NAR and NPR. Vertical lines shows the national averages. * Have no registered revisions in NAR or NPR. 157
Completeness of reporting analysis for ankle arthroplasty, -1 A completeness of reporting analysis has been conducted by combining the data in the Register with data from the Norwegian Patient Register (NPR). The report and analysis were prepared by the NPR in collaboration with the Norwegian Arthroplasty Register (NAR). There are separate statistics on primary operations and revisions. Some hospitals have few ankle arthroplasties and the completeness of reporting rate must be seen in this light. NCSP codes for combining data from NPR hospital stays and ankle arthroplasties Type Code Description Primary operation NHB y NHB 1y NHB Primary partial prosthetic replacement of ankle joint not using cement Primary partial prosthetic replacement of ankle joint using cement Primary total prosthetic replacement of ankle joint not using cement NHB 3 Primary total prosthetic replacement of ankle joint using hybrid technique NHB Primary total prosthetic replacement of ankle joint using cement With and without NHB 99 Other primary prosthetic replacement of joint of ankle or foot Revision level 1 Revision level NHC y NHC 1y NHC y NHC 3y NHC y NHU y NHU 1y NHC 59 NHS 19 NHS 9 NHW 9 NHC 99 NHH y T 1.* T.* Secondary implantation of partial prosthesis in ankle joint not using cement Excludes: Of component of total prosthesis Secondary implantation of partial prosthesis in ankle joint using cement Excludes: Of component of total prosthesis Secondary implantation of total prosthesis in ankle joint not using cement Includes: Of component of total prosthesis Secondary implantation of total prosthesis in ankle joint using hybrid technique Includes: Of component of total prosthesis Secondary implantation of total prosthesis in ankle joint using cement Removal of partial prosthesis from ankle joint Removal of total prosthesis from ankle joint Secondary implantation of interposition prosthesis in ankle joint Incision and debridement of infection of joint of ankle or foot Incision and debridement of infection of joint of ankle or foot with introduction of therapeutic agent Reoperation for deep infection in surgery of ankle or foot For infection at the site of target structures Other secondary prosthetic replacement in joint of ankle or foot Reduction of dislocation of joint prosthesis of ankle or foot Complications of procedures, not elsewhere classified Complications of internal orthopaedic prosthetic devices, implants and grafts Primary operations. From to 1, 3 primary ankle arthroplasties were reported to one or both of the registers. 9.% were reported to the NAR, while 97.% were reported to the NPR. Completeness of reporting by hospital shows a rate for the NAR ranging from % to 1% between the different hospitals. For hospitals with a low completeness of reporting rate for the NAR, either the form was not sent, or other interventions than ankle arthroplasties were incorrectly coded with NHB */NHB 1*/NHB /NHB 3/NHB. (There were only 13 operations in the category NHB 99 during the period). Procedure codes to be used for primary operations: NHB * - NHB 1* - NHB - NHB 3 - NHB Revision operations. From to 1, 75 revisions were reported to one or both of the registers. 77.1% of these were reported to the NAR, while 9.5% were reported to the NPR (revision level 1). The completeness of reporting by hospital shows that the completeness of reporting rate for the NAR varied between 1.7% and 1%. A low completeness of reporting rate may mean that the form was not sent in. It appears that a number of revision forms are 15
missing in cases where the prosthesis was removed without a new one being inserted in the same operation; in such cases, a form should be submitted both when the prosthesis is removed and when any new insertion is performed. Procedure codes to be used for revision operations: NHC * - NHC 1* - NHC * - NHC 3* - NHC * - NHC 99 - NHU * - NHU 1* 159
Completeness of reporting for primary and revision operations, ankle prosthesis -1 77.1 9. Primary Revision Helse Møre og Romsdal HF - Ålesund sjukehus 5.7 (7) 1 (3) Sørlandet sykehus HF - Kristiansand Helse Bergen HF - Voss sjukehus (1) 1 (1) 95.1 (1) 9. (7) Diakonhjemmet 97. (3) 9. (153) Helse Bergen HF - Haukeland universitetssykehus St. Olavs hospital HF - Trondheim 9. (9) 3.3 ().7 () 75 () Betanien hospital Telemark 1 (5) 73.3 (15) St. Olavs hospital HF - Orkdal Sykehuset Innlandet HF - Kongsvinger 1 (9) (5) 9 (1) (5) Sykehuset Østfold HF (3) 1.7 () Sykehuset i Vestfold HF Oslo universitetssykehus HF 1 (5) () (5) (3) Universitetssykehuset i Nord-Norge HF - Tromsø () (1) Helse Nord-Trøndelag HF - Sykehuset Levanger Helse Stavanger HF - Stavanger universitetssykehus (1) (1) () (1) Lovisenberg diakonale sykehus () (1) Akershus universitetssykehus HF Sykehuset Innlandet HF - Lillehammer () (3) (1) (1) Norsk idrettsmedisinsk institutt* 1 (9) - (-) Helse Møre og Romsdal HF - Kristiansund sjukehus* 1 (1) - (-) Haugesund san.for. revmatismesykehus* St. Olavs hospital HF - Røros* 1 () - (-) 9.3 (13) - (-) Nordlandssykehuset HF - Vesterålen* (1) - (-) Helse Møre og Romsdal HF - Volda sjukehus* Haraldsplass diakonale sykehus* (1) - (-) () - (-) Helse Førde HF - Lærdal* (11) - (-) Helse Førde HF - Førde* Sykehuset Innlandet HF - Tynset* () - (-) (1) - (-) 1 Dark blue bars and first number to the right of the bars gives completeness of reporting for primary operations. Light blue bars and second number to the right of the bars gives completeness of reporting for revision operations (level 1). The numbers in brackets gives the number of operations registered at both NAR and NPR. Vertical lines shows the national averages. * Have no registered revisions in NAR or NPR. 1
Completeness of reporting analysis for finger arthroplasty, -1 A completeness of reporting analysis has been conducted by combining the data in the Register with data from the Norwegian Patient Register (NPR). The report and analysis were prepared by the NPR in collaboration with the Norwegian Arthroplasty Register (NAR). There are separate statistics on primary operations and revisions. Some hospitals have few finger arthroplasties and the completeness of reporting rate must be seen in this light. NCSP codes for combining data from NPR hospital stays and finger arthroplasties Type Code Description Primary operation NDB y Primary prosthetic replacement of joint of finger or metacarpal With and without NDB 99 Other primary prosthetic replacement of joint of wrist or hand Revision level 1 NDC y NDU y Secondary prosthetic replacement in joint of finger or metacarpal Removal of prosthesis from other joint of hand Revision level NDS 19 NDS 9 NDW 9 NDC 99 NDH y T 1.* T.* Incision and debridement of infection of joint of wrist or hand Incision and debridement of infection of joint of wrist or hand with introduction of therapeutic agent Reoperation for deep infection in surgery of wrist or hand For infection at the site of target structures Other secondary prosthetic replacement in joint of wrist or hand Reduction of dislocation of joint prosthesis of wrist or hand Complications of procedures, not elsewhere classified Complications of internal orthopaedic prosthetic devices, implants and grafts Primary operations. From to 1, 13 primary finger arthroplasties were reported to one or both of the registers. 5.% were reported to the NAR, while 9.1% were reported to the NPR. Completeness of reporting by hospital shows a rate for the NAR ranging from % to 1% between the different hospitals. For hospitals with a low completeness of reporting rate for the NAR, either the form was not sent, or other interventions than finger arthroplasties were incorrectly coded with NDB y (There were operations in the category NDB 99 during the period). Procedure code to be used for primary operations: NDB y Revision operations. From to 1, 11 revisions were reported to one or both of the registers. 51.% of these were reported to the NAR, while 9.1% were reported to the NPR (revision level 1). The completeness of reporting by hospital shows that the completeness of reporting rate for the NAR varied between % and 1%. A low completeness of reporting rate may mean that the revision form was not sent in. It appears that a number of revision forms are missing in cases where the prosthesis was removed without a new one being inserted in the same operation; in such cases, a form should be submitted both when the prosthesis is removed and when any new insertion is performed. Procedure codes to be used for revision operations: NDC y - NDU y 11
Completeness of reporting for primary and revision operations, finger prosthesis -1 5. 51. Primary Revision Sykehuset Innlandet HF - Lillehammer 33.3 () 1 (1) Diakonhjemmet. (91) 5.7 (3) Sykehuset Innlandet HF - Kongsvinger 73.3 (15) (5) Haugesund san.for. revmatismesykehus 9.7 (19). (1) Helse Nord-Trøndelag HF - Sykehuset Levanger 1 () 5 () Martina Hansens hospital.9 (1) 5 () Betanien hospital Telemark 3. (9) 5 () Universitetssykehuset i Nord-Norge HF - Tromsø (5) 5 (9) St. Olavs hospital HF - Trondheim 39.3 () (5) Sykehuset Østfold HF 17.5 () 11.1 (3) Nordlandssykehuset HF - Bodø 1 (3) (1) Sørlandet sykehus HF - Kristiansand 1 (1) (1) Sykehuset Telemark HF - Skien 5 () (1) Oslo universitetssykehus HF 19 (3) (7) Helse Førde HF - Førde (13) () Helse Møre og Romsdal HF - Ålesund sjukehus* (5) - (-) St. Olavs hospital HF - Orkdal* (1) - (-) Helse Bergen HF - Haukeland universitetssykehus* (1) - (-) 1 Dark blue bars and first number to the right of the bars gives completeness of reporting for primary operations. Light blue bars and second number to the right of the bars gives completeness of reporting for revision operations (level 1). The numbers in brackets gives the number of operations registered at both NAR and NPR. Vertical lines shows the national averages. * Have no registered revisions in NAR or NPR. 1
Completeness of reporting analysis for wrist/carpus/distal radioulnar joint (DRUJ), - 1 A completeness of reporting analysis has been conducted by combining the data in the Register with data from the Norwegian Patient Register (NPR). The report and analysis were prepared by the NPR in collaboration with the Norwegian Arthroplasty Register (NAR). There are separate statistics on primary operations and revisions. Some hospitals perform few of these arthroplasties and the completeness of reporting rate must be seen in this light. NCSP codes for combining data from NPR hospital stays and wrist/carpus/druj Type Code Description Primary operation NDB y NDB 1y NDB y Primary partial prosthetic replacement of joint of wrist not using cement Primary partial prosthetic replacement of joint of wrist using cement Primary total prosthetic replacement of joint of wrist not using cement NDB 3y Primary total prosthetic replacement of joint of wrist using hybrid technique With and without NDB y NDB 5y NDB 99 Primary total prosthetic replacement of joint of wrist using cement Primary prosthetic interposition arthroplasty of joint of wrist Other primary prosthetic replacement of joint of wrist or hand Revision level 1 With and without Revision level NDC y NDC 1y NDC y NDC 3y NDC y NDC 5y NDU y NDU 1y NDU y NDC 99 NDS 19 NDS 9 NDW 9 NDH y T 1.* T.* Secondary implantation of partial prosthesis in joint of wrist not using cement Excludes: Of component of total prosthesis Secondary implantation of partial prosthesis in joint of wrist using cement Excludes: Of component of total prosthesis Secondary implantation of total prosthesis in joint of wrist not using cement Includes: Of component of total prosthesis Secondary implantation of total prosthesis in joint of wrist using hybrid technique Includes: Of component of total prosthesis Secondary implantation of total prosthesis in joint of wrist using cement Secondary implantation of interposition prosthesis in joint of wrist Removal of partial prosthesis from joint of wrist Removal of total prosthesis from joint of wrist Removal of prosthesis from other joint of hand Other secondary prosthetic replacement in joint of wrist or hand Incision and debridement of infection of joint of wrist or hand Incision and debridement of infection of joint of wrist or hand with introduction of therapeutic agent Reoperation for deep infection in surgery of wrist or hand For infection at the site of target structures Reduction of dislocation of joint prosthesis of wrist or hand Complications of procedures, not elsewhere classified Complications of internal orthopaedic prosthetic devices, implants and grafts Primary operations. From to 1, 5 primary wrist/carpus/druj arthroplasties were reported to one or both of the registers. 7.3% were reported to the NAR while.% were reported to the NPR. Completeness of reporting by hospital shows a rate for the NAR ranging from % to 1% between the different hospitals. (There were 9 operations in the category NDB 99 during the period). Procedure codes to be used for primary operations: NDB * - NDB 1* - NDB * - NDB 3* - NDB * - NDB 5* Revision operations. From to 1, 17 revisions were reported to one or both of the registers..9% of these were reported to the NAR, while.1% were reported to the NPR (revision level 1). The completeness of reporting by hospital shows that the completeness of reporting rate for the NAR varied between % and 91.7%. A low completeness of reporting rate may mean that the form was not sent in. It appears that a number of revision forms are missing in 13
cases where the prosthesis was removed without a new one being inserted in the same operation; in such cases, a form should be submitted both when the prosthesis is removed and when any new insertion is performed. Procedure codes to be used for revision operations: NDC * - NDC 1* - NDC * - NDC 3* - NDC * - NDB 5* 1
Completeness of reporting for primary and revision operations, hand prosthesis -1.9 7.3 Primary Revision Sykehuset Østfold HF (1) 91.7 () Diakonhjemmet 9. () 5 () Betanien hospital Telemark 5.9 (5) 75 () Martina Hansens hospital 77. (9) 7 (1) Oslo universitetssykehus HF 7. (133).9 () Helse Førde HF - Førde 7.3 (5) 1. (15) Helse Bergen HF - Haukeland universitetssykehus 1 (13) () Universitetssykehuset i Nord-Norge HF - Tromsø 5 () (1) St. Olavs hospital HF - Trondheim 3. (11) (1) Sykehuset Telemark HF - Notodden 33.3 (3) (1) Sykehuset Innlandet HF - Kongsvinger 5 () (3) Helse Nord-Trøndelag HF - Sykehuset Levanger (1) () St. Olavs hospital HF - Orkdal (1) (1) Helse Stavanger HF - Stavanger universitetssykehus () () Akershus universitetssykehus HF (1) (7) Sykehuset Telemark HF - Skien (3) (5) Volvat Medisinske Senter* 1 (1) - (-) Nordlandssykehuset HF - Bodø* 1 (5) - (-) Haraldsplass diakonale sykehus* (1) - (-) Haugesund san.for. revmatismesykehus* (1) - (-) Helse Bergen HF - Hagevik* (1) - (-) Lovisenberg diakonale sykehus* (5) - (-) Sørlandet sykehus HF - Kristiansand* () - (-) Vestre Viken HF - Ringerike* () - (-) Vestre Viken HF - Bærum* (1) - (-) Sykehuset Innlandet HF - Lillehammer* () - (-) 1 Dark blue bars and first number to the right of the bars gives completeness of reporting for primary operations. Light blue bars and second number to the right of the bars gives completeness of reporting for revision operations (level 1). The numbers in brackets gives the number of operations registered at both NAR and NPR. Vertical lines shows the national averages. * Have no registered revisions in NAR or NPR. 15
Completeness of reporting analysis for shoulder arthroplasty, -1 A completeness of reporting analysis has been conducted by combining the data in the Register with data from the Norwegian Patient Register (NPR). The report and analysis were prepared by the NPR in collaboration with the Norwegian Arthroplasty Register (NAR). There are separate statistics on primary operations and revisions. Some hospitals perform few shoulder arthroplasties and the completeness of reporting rate must be seen in this light. NCSP codes for combining data from NPR hospital stays and shoulder arthroplasties Type Code Description Primary operation NBB y NBB 1y NBB Primary partial prosthetic replacement of humero-scapular joint not using cement Primary partial prosthetic replacement of humero-scapular joint using cement Primary total prosthetic replacement of humero-scapular joint not using cement NBB 3 Primary total prosthetic replacement of humero-scapular joint using hybrid technique NBB Primary total prosthetic replacement of humero-scapular joint using cement With and without NBB 99 Other primary prosthetic replacement of joint of shoulder Revision level 1 Revision level NBC y NBC 1y NBC y NBC 3y NBC y NBC 99 NBU y NBU 1y NBC 59 NBS 19 NBS 9 NBW 9 NBH y T 1.* T.* Secondary implantation of partial prosthesis in humero-scapular joint not using cement Excludes: Of component of total prosthesis Secondary implantation of partial prosthesis in humero-scapular joint using cement Excludes: Of component of total prosthesis Secondary implantation of total prosthesis in humero-scapular joint not using cement Includes: Of component of total prosthesis Secondary implantation of total prosthesis in humero-scapular joint using hybrid technique Includes: Of component of total prosthesis Secondary implantation of total prosthesis in humero-scapular joint using cement Other secondary prosthetic replacement in joint of shoulder Removal of partial prosthesis from humero-scapular joint Removal of total prosthesis from humero-scapular joint Secondary implantation of interposition prosthesis in humero-scapular joint Incision and debridement of infection of joint of shoulder Incision and debridement of infection of joint of shoulder with introduction of therapeutic agent Reoperation for deep infection in surgery of shoulder or upper arm For infection at the site of target structures Reduction of dislocation of prosthesis of humero-scapular joint Complications of procedures, not elsewhere classified Complications of internal orthopaedic prosthetic devices, implants and grafts Primary operations. From to 1, 35 primary shoulder arthroplasties were reported to one or both of the registers. 9.% were reported to the NAR, while 9.9% were reported to the NPR. Completeness of reporting by hospital shows a rate for the NAR ranging from % to 1% between the different hospitals. For hospitals with a low completeness of reporting rate for the NAR, either the form was not sent, or other interventions than shoulder arthroplasties were incorrectly coded with NBB */NBB 1*/NBB /NBB 3/NBB. (There were only 1 operations in the category NBB 99 during the period). Procedure codes to be used for primary operations: NBB * - NBB 1* - NBB - NBB 3 - NBB Revision operations. From to 1, revisions were reported to one or both of the registers. 7.7% of these were reported to the NAR, while 9.% were reported to the NPR (revision level 1). The completeness of reporting by hospital shows that the completeness of reporting rate for the NAR varied between 1.7% and 1%. A low completeness of reporting rate may mean that the form was not sent in. It appears that a number of revision forms are 1
missing in cases where the prosthesis was removed without a new one being inserted in the same operation; in such cases, a form should be submitted both when the prosthesis is removed and when any new insertion is performed. Procedure codes to be used for revision operations: NBC * - NBC 1* - NBC * - NBC 3* - NBC * - NBC 99 - NBU * - NBU 1* 17
Completeness of reporting for primary and revision operations, shoulder prosthesis -1 Norsk idrettsmedisinsk institutt St. Olavs hospital HF - Orkdal 7.7 9. Primary Revision 1 (9) 1 (1) 9. (5) 1 () Haugesund san.for. revmatismesykehus 9. (53) 1 (3) Betanien hospital Telemark 9.1 (119) 1 () Sørlandet sykehus HF - Arendal 5.7 (1) 1 (1) Sykehuset Østfold HF 1. (15) 1 (1) Diakonhjemmet 9.1 (3) 99 (1) Sykehuset Innlandet HF - Kongsvinger 9.9 (17) 95. (1) Martina Hansens hospital 9.1 (15) 9.1 (17) Sørlandet sykehus HF - Kristiansand 9 (13) 93.3 (15) Nordlandssykehuset HF - Bodø 95. () 9 (1) Vestre Viken HF - Drammen 9. (19) 9 (1) Helse Bergen HF - Haukeland universitetssykehus 9.7 (31) 3.9 (31) St. Olavs hospital HF - Trondheim 1 (1) 7.7 (3) Helse Bergen HF - Hagevik 97. (91) 7.5 (17) Lovisenberg diakonale sykehus 97.1 () 7.1 (7) Oslo universitetssykehus HF (155) 7.9 () Haraldsplass diakonale sykehus 9.5 ().5 () Vestre Viken HF - Bærum.5 (11).5 () Helse Nord-Trøndelag HF - Sykehuset Namsos 93 (3) (5) Helse Møre og Romsdal HF - Ålesund sjukehus 91.3 (1) 5.3 (1) Vestre Viken HF - Ringerike 1 () 5 () Universitetssykehuset i Nord-Norge HF - Tromsø 91. (79) 5 () Akershus universitetssykehus HF 5. (113). (9) Sykehuset Telemark HF - Skien 1 () (5) Sykehuset Innlandet HF - Tynset 91. (3) 33.3 (3) Helse Nord-Trøndelag HF - Sykehuset Levanger 9.1 (5) (5) Helse Fonna HF - Haugesund 9.9 (39) () Helse Førde HF - Førde 7.5 (1) (1) Helse Førde HF - Lærdal 3.3 () (1) Helse Finnmark HF - Klinikk Hammerfest 77. (9) (1) Sykehuset Innlandet HF - Elverum 7.9 (13) () Sykehuset i Vestfold HF 7. (79) () Helse Møre og Romsdal HF - Kristiansund sjukehus.9 (37) (1) Helse Stavanger HF - Stavanger universitetssykehus 5.3 (3) () Ringvollklinikken* 1 () - (-) Teres Drammen* 1 () - (-) St. Olavs hospital HF - Røros* 1 () - (-) Helse Førde HF - Nordfjord* 1 (3) - (-) Helse Bergen HF - Voss sjukehus* 1 () - (-) Sykehuset Innlandet HF - Gjøvik* 9.1 () - (-) Sykehuset Innlandet HF - Lillehammer*.1 (3) - (-) Sykehuset Telemark HF - Notodden* 3.3 () - (-) Universitetssykehuset i Nord-Norge HF - Harstad* (5) - (-) Helse Fonna HF - Odda* 5 () - (-) Vestre Viken HF - Kongsberg* 5 () - (-) Sørlandet sykehus HF - Flekkefjord* (1) - (-) 1 Dark blue bars and first number to the right of the bars gives completeness of reporting for primary operations. Light blue bars and second number to the right of the bars gives completeness of reporting for revision operations (level 1). The numbers in brackets gives the number of operations registered at both NAR and NPR. Vertical lines shows the national averages. * Have no registered revisions in NAR or NPR. 1
Completeness of reporting analysis for toe joint replacements, -1 A completeness of reporting analysis has been conducted by combining the data in the Register with data from the Norwegian Patient Register (NPR). The report and analysis were prepared by the NPR in collaboration with the Norwegian Arthroplasty Register (NAR). There are separate statistics on primary operations and revisions. Some hospitals perform few toe joint replacements and the completeness of reporting rate must be seen in this light. NCSP codes for combining data from NPR hospital stays and toe joint replacements Type Code Description Primary operation NHB y NHB 7y NHB y Primary prosthetic replacement of first metatarsophalangeal joint Primary prosthetic replacement of other metatarsophalangeal joint Primary prosthetic replacement of other joint of foot NHB 99 Other primary prosthetic replacement of joint of ankle or foot Revision level 1 Revision level NHC y NHC 7y NHC y NHC 99 NHU y NHS 19 NHS 9 NHW 9 NHH y T 1.* T.* Secondary prosthetic replacement of first metatarsophalangeal joint Secondary prosthetic replacement of other metatarsophalangeal joint Secondary prosthetic replacement in other joint of foot Other secondary prosthetic replacement in joint of ankle or foot Removal of prosthesis from other joint of foot Incision and debridement of infection of joint of ankle or foot Incision and debridement of infection of joint of ankle or foot with introduction of therapeutic agent Reoperation for deep infection in surgery of ankle or foot For infection at the site of target structures Reduction of dislocation of joint prosthesis of ankle or foot Complications of procedures, not elsewhere classified Complications of internal orthopaedic prosthetic devices, implants and grafts Primary operations. From to 1, 51 primary toe joint replacements were reported to one or both of the registers. 79.3% were reported to the NAR, while 9.% were reported to the NPR. Completeness of reporting by hospital shows a rate for the NAR ranging from % to 1% between the different hospitals. For hospitals with a low completeness of reporting rate for the NAR, either the form was not sent, or other interventions than toe joint replacements were incorrectly coded with NHB y/nhb 7y/NHB y. Procedure codes to be used for primary operations: NHB y - NHB 7y - NHB y Revision operations. From to 1, 15 revisions were reported to one or both of the registers. 53.3% of these were reported to the NAR, while 9.1% were reported to the NPR (revision level 1). The completeness of reporting by hospital shows that the completeness of reporting rate for the NAR varied between % and 1%. A low completeness of reporting rate may mean that the form was not sent in. It appears that a number of revision forms are missing in cases where the prosthesis was removed without a new one being inserted in the same operation; in such cases, a form should be submitted both when the prosthesis is removed and when any new insertion is performed. Procedure codes to be used for revision operations: NHC y - NHC 7y - NHC y - NHU y 19
Completeness of reporting for primary and revision operations, toe prosthesis -1 53.3 79.3 Primary Revision Vestre Viken HF - Drammen 5 () 1 (1) Sykehuset Innlandet HF - Kongsvinger 9 (1) 3.3 (1) Diakonhjemmet 91. (57) 3 (53) Sykehuset Østfold HF. (7) 53. (13) Helse Bergen HF - Voss sjukehus 7.9 (33) 5 () Helse Bergen HF - Haukeland universitetssykehus (1) 5 () Martina Hansens hospital 5.7 (7).9 () Helse Møre og Romsdal HF - Ålesund sjukehus 93. (1) (1) Vestre Viken HF - Kongsberg 1 () (5) Sørlandet sykehus HF - Kristiansand 1 () () St. Olavs hospital HF - Røros 7.9 (13) (1) Oslo universitetssykehus HF.7 (3) (3) St. Olavs hospital HF - Trondheim 5 () (3) Medi3 (1) (3) St. Olavs hospital HF - Orkdal (1) (1) Helse Førde HF - Førde () (1) Akershus universitetssykehus HF (1) (3) Universitetssykehuset i Nord-Norge HF - Tromsø* 1 (1) - (-) Haraldsplass diakonale sykehus* (5) - (-) Teres Tromsø* () - (-) Nordlandssykehuset HF - Vesterålen* (1) - (-) Helse Førde HF - Nordfjord* (1) - (-) Helse Fonna HF - Stord* (1) - (-) Lovisenberg diakonale sykehus* (3) - (-) Sykehuset Telemark HF - Notodden* (1) - (-) 1 Dark blue bars and first number to the right of the bars gives completeness of reporting for primary operations. Light blue bars and second number to the right of the bars gives completeness of reporting for revision operations (level 1). The numbers in brackets gives the number of operations registered at both NAR and NPR. Vertical lines shows the national averages. * Have no registered revisions in NAR or NPR. 17
CONTENTS Norwegian Hip Fracture Register Introduction... 173 Survival of hip fracture implants 5-1... 17 Annual numbers of operations... 177 Age by primary operation (in 7, 11 and 15)... 177 Time from fracture to operation in hours (primary operations)... 17 Cognitive impairment... 179 Type of anaesthesia... 1 ASA classification... 11 Type of primary operations... 13 Type of primary operations all fractures... 1 Type of primary operations per type of primary fracture... 1 Time trend for treatment... 17 Reoperations all fractures... 1 Reasons for reoperation per type of primary fracture... 19 Type of reoperation... 19 Reoperation with primary screw osteosynthesis... 191 Reoperation with primary uni/bipolar hemiprosthesis... 19 Hemiprostheses... 193 Screws... 197 Hip compression screws... 197 Intramedullary nails... 197 Fixation of hemiprostheses... 197 Time trend for fixation... 19 Type of cement... 19 Hydroxyapatite... 19 Pathological fractures... 199 Surgical approach used in hemiarthroplasty... 199 Intraoperative complications... Antibiotic prophylaxis... Pharmacological antithrombotic prophylaxis... Duration of surgery... PROM (Patient Reported Outcome Measures)... 5 Hospital data... 1 Completeness analysis 13-1... 15 171
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NORWEGIAN HIP FRACTURE REGISTER ANNUAL REPORT 17 The Norwegian Hip Fracture Register (NHFR) now contains data from almost 1 primary operations and over 1 revisions. Last year, primary operations and 9 reoperations were reported to the Register. The number of reoperations has increased in the last two years; today, about 1% of operations in the NHFR are now reoperations. An increase in the number of revisions is worrying and needs to be investigated further. One explanation may be better reporting of revisions to the Register, meaning that the actual number of annual revisions has not necessarily changed. Quality of hip fracture surgery in Norway Survival curves for hip fractures show a gradual improvement in treatment of displaced femoral neck fractures in that the risk of revision has decreased. The reason is probably that treatment for these fractures has changed from screw fixation to arthroplasty surgery. In most studies, arthroplasty surgery has shown a significantly lower revision risk than screw fixation. As shown later in this annual report, an increasing proportion of intertrochanteric and subtrochanteric fractures have been treated with intramedullary nails in recent years. This is in line with the results of a previous study from the Register (Matre, 13), which found a lower risk of revision when an intramedullary nail was used compared with a sliding hip screw for these fractures. It is therefore surprising to find no improvement in results, nor any reduced revision risk for such fractures. Completeness Completeness analyses of reporting to the NHFR compared to the Norwegian Patient Register (NPR) for 13-1 indicate good completeness for both osteosyntheses (.%) and hemiarthroplasty (93.%), but, surprisingly, somewhat lower completeness for total hip arthroplasty (3.9%). The completeness rate for all types of revisions is lower (9.5%). Calculation of completeness for reoperations has been a challenging process, since coding of reoperations reported to the NPR is in many cases unclear or incorrect. The NPR also lacks specification of right or left side, which leads to uncertainty in the analysis. It is important to report reoperations and we urge everyone to ensure that these are also reported to the Register. Completeness analyses are presented at the end of this year s report from the NHFR. Results by hospital The Centre for Clinical Documentation and Evaluation (SKDE) at the National Service Centre for Medical Quality Registers requires annual reporting from the NHFR. We are required by SKDE to publish data for each hospital. This year s report includes an extract from the 173
hospital results. The complete annual reports from the Hip Fracture Register to SKDE with all hospital results can be read at https://www.kvalitetsregistre.no/registers/nasjonalthoftebruddregister. In 1, SKDE evaluated the NHFR as being at Stage 3 of. This is excellent. In order to achieve the highest level, Stage, which only the Norwegian Stroke Register has achieved, the NHFR must publish online updated data for all participating units. We are therefore planning an online presentation of hospital results. This will reveal whether individual hospitals follow current professional knowledge in the treatment of hip fractures (using so-called process indicators ). Some performance indicators will also be published. The process indicators and performance indicators will together enable an assessment of the treatment of hip fractures at each hospital; here, the process indicators will show the potential for improvement where the results are poor. We plan to publish interactive results at www.kvalitetsregistre.no during autumn 17. We are now in the process of selecting indicators that may be useful in assessing treatment at the various hospitals. Process indicators must reflect treatment that is widely accepted as best practice. It is therefore very important that the indicators have a broad scientific basis in orthopaedics. Patient-reported outcomes Patient-reported outcomes (PROMs) have been recorded in the NHFR since 5. But in this year s report, these data is presented in more detail. The fact that we have patient-reported data makes the NHFR unique. The Norwegian Cruciate Ligament Register also records PROMs and the Norwegian Arthroplasty Register is in the process of establishing electronic PROM registration. PROM registration is useful in providing important additional information on treatment. In the Hip Fracture Register, we have so far used EQ-5D-3L (three possible responses to each question). We are considering changing to EQ-5D-5L (five options for each question), which can better differentiate between small differences in the functional level of patients. Summary of scientific activity in 1 The year 1 was a successful scientific year. Four articles were published: Marit Bakken et al. published an article in collaboration with the Norwegian Prescription Database and the Norwegian Hip Fracture Register, showing an association between the use of antipsychotics and a doubled risk of a hip fracture. Jan-Erik Gjertsen et al., in a study of PROM data, showed that hip fractures have a dramatic impact on patients functioning and that reduced functioning is also present one year postoperatively and in patients with no loss of functioning pre-operatively. 17
Sunniva Leer-Salvesen et al. studied the use of thrombosis prophylaxis in hemiarthroplasty for hip fractures. The results showed increased mortality if thrombosis prophylaxis was started after surgery, compared to starting it before surgery. Torbjørn Kristensen et al. compared surgical approaches in hemiarthroplasty. The posterior approach was associated with less pain, better patient satisfaction and better quality of life than the lateral approach. Revision operations were similar for the two approaches. The Norwegian Hip Fracture Register cooperates with a number of hospitals on studies of national and local results. We are very pleased that the huge amount of data in the Register is being used in research and we encourage all researchers who wish to use data from the Register to contact us. Thank you all for good reporting and we look forward to continued fruitful cooperation! Bergen 1..17 Lars B Engesæter Jan-Erik Gjertsen Irina Kvinnesland Professor, Chief Physician Chief Physician, Associate Professor IT Consultant Head of the Hip Fracture Register Lise B Kvamsdal Advisor Eva Dybvik Biostatistician 175
Survival of hip fracture implants 5 1 1 1 9 9 Percent implants intact 7 Percent implants intact 7 5 7, n = 397 1, n = 3799 5 7, n = 1 1, n = 977 11 13, n = 3713 11 13, n = 11 5 1 1, n = 373 5 1 1, n = 15 Years after surgery Years after surgery a) Intracapsular fracture, undisplaced b) Intracapsular fracture, displaced 1 1 9 9 Percent implants intact 7 Percent implants intact 7 5 7, n = 9 1, n = 799 5 7, n = 117 1, n = 19 11 13, n = 7 11 13, n = 11 5 1 1, n = 779 5 1 1, n = 17 Years after surgery Years after surgery c) Trochanteric fractures 17 d) Sub /intertrochanteric fractures
The Norwegian Hip Fracture Register HIP FRACTURES Numbers of operations Table 1: Annual numbers of operations Year Primary operation Reoperation 1 15 1 13 1 11 1 9 7 5 ( 9,9% ) 9 ( 1,1% ) ( 9,3% ) 95 ( 9,7% ) 177 ( 91,% ) 77 (,% ) 39 ( 9,% ) 5 ( 9,% ) 35 ( 9,5% ) 5 ( 9,5% ) 599 ( 9,% ) 91 ( 9,% ) 33 ( 9,% ) 5 ( 9,3% ) 5 ( 9,% ) 9 ( 1,% ) 3 ( 9,% ) 93 ( 1,% ) 77 ( 9,% ) 93 ( 1,% ) 7517 ( 9,% ) 9 ( 1,% ) 579 ( 9,9% ) 1 ( 1,1% ) 9597 ( 9,% ) * 15 ( 9,% ) ** 1711 93 9311 97 919 93 959 915 9 99 7 5 9% of primary operations were on the right side. 7% of primary operations were performed on women. Mean age at primary surgery was years: years for women and 77 years for men. * 59 (3%) were primary operations with total hip prostheses from the Norwegian Arthroplasty Register. ** 3 (33%) were reoperations with total hip prostheses from the Norwegian Arthroplasty Register. Figure 1: Annual numbers of operations 1 Number of hips 5 7 9 1 11 1 13 1 15 1 Primary operations Reoperations Figure : Age by primary operation (in 7, 11 and 15) Number 3 5 15 1 5 < - 9 7-79 - 9 > 9 Age (in years) Women in 7 Women in 11 Women in 15 Men in 7 Men in 11 Men in 15 Hip Fracture 177
Report 17 Time from fracture to operation in hours - primary operations Table : Time from fracture to operation in hours* - > - 1 >1 - > - > Missing 1 99 ( 3,7% ) 19 ( 13,% ) 5 ( 35,3% ) 15 ( 9,9% ) 13 ( 15,1% ) 1 (,3% ) 15 39 ( 3,% ) 1 ( 13,% ) 35 ( 37,% ) 33 (,% ) 11 ( 13,7% ) 3 (,5% ) 1 3 (,1% ) 115 ( 1,7% ) 995 ( 3,% ) 1 ( 7,7% ) 15 ( 13,% ) 17 (,3% ) 13 31 ( 3,9% ) 119 ( 1,1% ) 93 ( 3,% ) 1 (,% ) 119 ( 15,% ) 177 (,% ) 1 31 ( 3,% ) 117 ( 1,% ) 93 ( 35,7% ) 39 (,1% ) 13 ( 1,1% ) 171 (,1% ) 11 313 ( 3,7% ) 1 ( 1,3% ) 3 ( 33,% ) 19 (,% ) 11 ( 1,9% ) 5 (,% ) 1 355 (,3% ) 11 ( 1,9% ) ( 35,1% ) 1 ( 7,% ) 13 ( 1,3% ) 19 (,3% ) 9 35 (,% ) 19 ( 15,9% ) 57 ( 35,3% ) 1 (,3% ) 13 ( 1,1% ) 15 (,% ) 35 (,7% ) 13 ( 1,1% ) 35 ( 3,5% ) 1 (,% ) 19 ( 15,7% ) 17 (,% ) 7 5 ( 5,9% ) 13 ( 1,% ) 1 ( 33,% ) 17 (,3% ) 11 ( 15,% ) 155 (,% ) 5 (,3% ) 1 (,% ) 7 ( 35,9% ) 13 (,% ) 93 ( 13,3% ) 115 ( 1,% ) 5 5 ( 7,7% ) 19 (,% ) 197 ( 3,% ) 117 ( 19,9% ) 9 ( 1,% ) 15 ( 1,% ) 333 (,% ) 1 ( 15,% ) 3319 ( 35,5% ) 519 (,% ) 135 ( 15,1% ) 9 (,% ) 9 77 7 1 5 7 1 11 7711 731 577 * hip prostheses are not counted Figure 3: Time from fracture to operation - grouped in hours (n=9) Proportion (%) of hip operations 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 1 11 1 13 1 15 1 Missing > > - > 1 - > - 1 - Figure : Time from fracture to operation - continuous (n=7151) Number of hip operations 5 15 1 5 1 11 1 1 31 3 1 51 5 1 71 7 1 91 9 Hours Mean time from fracture to operation was 3 hours (median 1 hours). 17 Hip Fracture
The Norwegian Hip Fracture Register Cognitive impairment Table 3: Cognitive impairment - primary operations* No Yes Uncertain Missing 1 519 ( 3,3% ) 11 (,% ) 31 ( 7,% ) 19 (,7% ) 77 15 53 (,% ) 1919 ( 3,7% ) 1 ( 7,% ) 1 (,% ) 1 5133 ( 5,1% ) 1933 (,5% ) (,1% ) 1 (,3% ) 7 13 53 ( 5,% ) 193 (,% ) 75 (,% ) 13 (,% ) 1 1 51 ( 3,5% ) 7 (,% ) 1 ( 1,% ) 17 (,1% ) 5 11 537 ( 3,% ) 199 ( 3,7% ) 91 ( 1,7% ) 19 (,% ) 7 1 5 ( 3,7% ) 1917 ( 3,% ) 3 ( 1,% ) 9 (,% ) 9 5157 ( 3,7% ) 19 ( 3,3% ) 3 ( 1,3% ) 1 (,7% ) 1 51 ( 3,% ) (,7% ) 79 ( 9,7% ) 5 (,5% ) 11 7 3 (,7% ) 173 (,3% ) 3 ( 1,% ) 1 (,% ) 7711 5 ( 5,% ) 175 (,7% ) 7 ( 9,% ) 11 ( 1,9% ) 731 5 31 (,5% ) 13 (,% ) 9 ( 11,% ) 131 (,3% ) 577 (,1% ) 7 (,1% ) 93 ( 9,5% ) 1 (,3% ) 9 Figure 5: Cognitive impairment - primary operations* 1 % Proportion (%) of patients 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 1 11 1 13 1 15 1 Missing Uncertain Yes No * hip prostheses are not counted Hip Fracture 179
Report 17 Type of anaesthesia Table : Type of anaesthesia - primary operations* General anaesthesia Spinal Other Missing 1 ( 9,9% ) 91 ( 5,% ) ( 3,5% ) ( 1,% ) 7 15 75 ( 9,% ) 737 ( 7,1% ) 5 (,% ) (,% ) 1 73 ( 9,3% ) 7 ( 7,3% ) 3 (,% ) (,% ) 7 13 5 ( 7,3% ) 795 (,% ) 5 ( 3,% ) 73 (,9% ) 1 1 5 (,% ) 73 ( 9,5% ) 19 (,7% ) ( 1,% ) 5 11 5 ( 7,% ) 75 ( 9,3% ) 19 (,% ) 9 ( 1,1% ) 7 1 55 (,9% ) 731 ( 9,3% ) 19 (,% ) 1 ( 1,5% ) 9 5 (,% ) 7 ( 9,5% ) 1 (,3% ) 1 ( 1,% ) 1 591 ( 7,% ) 797 (,9% ) 1 (,% ) 11 ( 1,7% ) 11 7 55 ( 7,1% ) 5 (,9% ) 17 (,% ) 1 ( 1,% ) 7711 7 (,% ) 3 ( 9,9% ) 137 ( 1,9% ) 1 ( 1,9% ) 731 5 33 ( 5,% ) 5 ( 9,% ) 13 (,1% ) 1 ( 1,% ) 577 75 ( 7,5% ) 339 (,% ) 15 (,% ) 13 ( 1,3% ) 97 Figure : Type of anaesthesia in primary operations* Proportion (%) of operations 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 1 11 1 13 1 15 1 Missing Other Spinal General anaesthesia * hip prostheses are not counted 1 Hip Fracture
The Norwegian Hip Fracture Register ASA classification (ASA = American Society of Anesthesiologists) Table 5: ASA classification - primary operations ASA 1 ASA ASA 3 ASA ASA 5 Missing 1 7 79 7 1 9 ( 3,1% ) ( 31,7% ) ( 55,% ) (,% ) (,1% ) ( 1,1% ) 15 3 7 55 1 9 ( 3,% ) ( 33,9% ) ( 53,% ) ( 7,% ) (,1% ) ( 1,1% ) 1 55 73 7 1 1 ( 3,1% ) ( 33,% ) ( 5,7% ) ( 7,% ) (,% ) ( 1,% ) 13 37 39 33 9 17 3 (,5% ) ( 3,% ) ( 5,% ) ( 7,3% ) (,% ) ( 1,% ) 1 35 33 57 59 97 (,% ) ( 33,% ) ( 53,9% ) ( 7,% ) (,1% ) ( 1,1% ) 11 3 77 1 55 11 ( 5,1% ) ( 33,5% ) ( 53,% ) (,5% ) (,1% ) ( 1,3% ) 1 93 1 9 1 1 ( 5,9% ) ( 33,% ) ( 5,7% ) (,% ) (,% ) ( 1,7% ) 9 59 7 39 5 1 1 (,% ) ( 3,9% ) ( 5,% ) (,% ) (,1% ) ( 1,% ) 77 5 17 57 9 119 (,1% ) ( 3,% ) ( 9,9% ) (,3% ) (,1% ) ( 1,% ) 7 71 77 3 51 7 19 ( 9,1% ) ( 35,% ) (,5% ) ( 5,7% ) (,1% ) ( 1,% ) 77 7 39 37 13 11 ( 1,3% ) ( 3,5% ) (,5% ) (,9% ) (,% ) ( 1,% ) 5 39 1 31 13 15 ( 1,9% ) ( 3,% ) (,% ) ( 5,% ) (,% ) (,1% ) 1 177 39 35 599 33 5 3 77 7517 579 5797 359 53 5 135 1337 9597 (,% ) ( 3,% ) ( 51,% ) (,7% ) (,1% ) ( 1,% ) Hip Fracture 11
Report 17 Figure 7: ASA classification - primary operations Proportion (%) of operations 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 1 11 1 13 1 15 1 Missing ASA 5 ASA ASA 3 ASA ASA 1 ASA 1: Healthy patients who smoke less than 5 cigarettes a day. ASA : Patients with an asymptomatic condition who are kept under medical control (f.ex. hypertension), or with diet (f. ex. diabetes mellitus type ), and otherwise healthy patients who smoke five cigarettes or more daily. ASA 3: Patients having a condition that can cause symptoms. However, patients are kept under medical control (f. ex moderate angina pectoris and mild asthma). ASA : Patients with a condition that is out of control (f. ex. heart failure and asthma). ASA 5: A moribund patient who is not expected to survive the operation. 1 Hip Fracture
The Norwegian Hip Fracture Register Primary operations Table : Type of fracture (reason for primary operation) Type 1 Type Type 3 Type Type 5 Type Type 7 Type Type 9 Annet Missing 1 19 351 3 133 139 1,7% 1,7%,7% 1,% 15,5% 5,5% 31,%,% 1 1,9% 9 1,1%,1% 15 1153 339 3 1335 15 13,7% 39,%,9% 15,9% 1,9% 5,3% 3 3,%,%,7% 77,9% 1,% 1 15 3331 7 133 13 1,%,7% 3,5% 1,3% 15,% 5,1% 7 3,5%,% 11,% 3,% 1,% 177 13 1171 39 13 177 7 1,1% 39,7% 3,1% 15,7% 15,% 5,% 93 3,5%,% 17,% 91 1,1% 1,% 39 1 1 371 177 171 7 1,5% 1,1% 3,1% 15,1% 15,1% 5,5% 7,5% 3,% 173,1% 75,9% 3,% 35 11 131 33 7 13 1393 39 15,3%,% 3,% 15,7% 1,%,% 1,%,% 1 1,9% 73,%,% 599 1 19 37 31 1313 13 31 1,9% 39,3% 3,% 15,7% 1,3% 5,% 11 1,9%,% 17,%,%,% 33 9 13 33 39 13 111 5 1,9%,%,% 15,% 1,7% 5,1% 151 1,% 7,1% 19 1,% 7,%,1% 5 131 3 351 175 1 39 15,7% 3,5%,% 17,% 1,% 5,% 19 1,%,% 3 1,% 1,% 3,% 3 7 11 993 391 1353 15 3 1,% 3,% 5,% 17,% 13,% 5,% 15,% 1,%,%,%,% 77 1 33 1311 11 1 1,7% 37,5%,% 17,% 13,% 5,5% 131 1,7% 5,1%,% 71,9%,1% 7517 5 173 91 7 111 757 31 1,3% 39,%,7% 17,% 1,9% 5,% 1 1,7% 3,1%,% 35,% 13,% 579 11 337 359 1559 131 599 9 39 15 1 9597 15,% 39,7% 3,7% 1,1% 1,9% 5,3%,%,% 1,5%,9%,% Type 1: Intracapsular fracture, undisplaced Type : Intracapsular fracture, displaced Type 3: Basocervical fracture Type : Trochanteric fracture ( fragments) Type 5: Trochanteric fracture (multifragment) Type : Subtrochanteric fracture Type 7: Intracapsular fracture unspecified (from the Norwegian Arthroplasty Register) Type : Trochanteric fracture unspecified (from the Norwegian Arthroplasty Register) Type 9: Intertrochanteric fracture (The registration started in ) Hip Fracture 13
Report 17 Table 7: Type of primary operations - all fractures T1 T T3 T T5 T T7 T T9 T1 T11 T1 T13 T1 1 11 39 3 13 51 19 15 11 35 135 13,%,5%,7%,% 1,%,1%,%,% 9,7%,1% 7,%,1% 1,%,% 15 1 3 33 19 1 757 59 3 11 1 1,%,% 3,%,% 17,% 7,9%,%,% 9,%,1%,1% 3,9% 1,%,% 1 117 31 31 1 1551 9 17 73 7 17 9 1 177 13,%,% 39,%,% 19,%,%,%,% 9,%,1% 5,1% 3,5% 1,%,% 13 19 3 31 3 19 79 77 3 97 1 39 15,5%,% 37,3%,% 1,% 9,%,%,% 9,%,% 5,% 3,% 1,7%,% 1 155 7 3137 5 13 1 19 35 33 1 1 35 17,%,3% 37,%,1% 19,3% 1,1%,%,% 7,5%,1% 3,9%,5% 1,5%,% 11 19 5 33 19 197 7 1 5 1 1 19 15 599 19,%,% 3,9%,% 19,7% 1,1%,%,1% 7,7%,% 3,3%,% 1,%,% 1 11 3 71 9 1733 99 17 571 13 17 33 19,3% 1,% 33,3%,3%,7% 1,7%,%,%,%,% 3,3% 1,9%,%,% 9 1 1 755 175 7 5 9 15 1 5,% 1,% 33,% 1,% 1,% 9,5%,%,% 5,9%,1%,% 1,9%,%,% 193 39 7 17 9 1 151 193 3 3,%,% 9,%,% 1,3%,3%,%,%,%,1% 3,% 1,%,3%,% 7 11 5 115 1 3 3 157 159 175 1 77 7,7%,%,9%,% 3,7%,%,%,5% 5,5%,1%,%,%,%,% 13 3 191 1 3 7 17 13 11 1 7517 3,%,% 1,9%,5% 5,%,%,%,% 3,%,1% 1,7% 1,%,%,% 5 15 5 111 19 9 1 11 3 55 15 171 579 3,%,9% 1,9%,% 5,%,%,%,5% 3,%,1%,9% 1,%,9%,% 1995 5 3199 319 19773 5 5 339 73 7 39 59 199 5 9597,7%,% 33,1%,3%,5%,7%,%,% 7,%,1% 3,%,%,%,% T1: Two screws or pins T: Three screws or pins T3: Bipolar hemiprosthesis T: Unipolar hemiprosthesis T5: Hip compression screw and plate T: Hip compression screw with lateral support plate T7: Angle plate T: Short intramedullary nail without distal locking T9: Short intramedullary nail with distal locking T1: Long intramedullary nail without distal locking T11: Long intramedullary nail with distal locking T1: hip prosthesis T13: Other * T1: Missing * Proportion (%) of operations with combination: Hip compression screw and additional anti-rotational screw is 1,% 1 Hip Fracture
The Norwegian Hip Fracture Register Figure : Type of primary operations - all fractures Proportion (%) of operations 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 1 11 1 13 1 15 1 T13 T1 T11 T1 T9 T T T5 T T3 T T1 T1: Two screws or pins T: Three screws or pins T3: Bipolar hemiprosthesis T: Unipolar hemiprosthesis T5: Hip compression screw and plate T: Hip compression screw with lateral support plate T7: Angle plate T: Short intramedullary nail without distal locking T9: Short intramedullary nail with distal locking T1: Long intramedullary nail without distal locking T11: Long intramedullary nail with distal locking T1: hip prosthesis T13: Other * T1: Missing * Proportion (%) of operations with combination: Hip compression screw and additional anti-rotational screw is 1, % Hip Fracture 15
Report 17 Table : Type of primary operation per type of primary fracture Type of primary fracture T1 T T3 T T5 T T7 T T9 T1 T11 T1 T13 T1 Intracapsular fracture, undisplaced 131 1 31 9,5% 1,% 5,%,%,%,% 1,% 7,%,1%,%,%,% 7,%,% 17 Intracapsular fracture, displaced 579 39 3 333 17,1% 1,% 79,%,%,9%,%,%,% 3,1%,% 1,%,% 93,% 1,% 3535 Basocervical fracture 19 37 1 77 3,1%,% 7,3%,3% 7,% 1,% 1,% 9,7% 3 7,7% 1,% 19,5%,% 15,%,% 7 Trochanteric fracture ( fragments) 1 3 113 97,1%,%,%,% 9,5% 5,7%,% 35 1,5% 7 17,7%,% 19 1,%,% 35,%,% 1579 Trochanteric fracture (multifragment) 3 1 9 9 513,%,%,%,% 33,% 35,% 1,% 5,% 35 1,3% 5,% 7 5,3%,% 3,%,% 151 Subtrochanteric fracture 3 1 35 9 11,1%,%,7%,% 17,%,%,%,1% 35,5% 5,9% 15,%,% 1,% 1,% 5117 Intracapsular fracture, unspecified *,%,%,%,%,%,%,%,%,%,%,% 9 1,%,%,% 9 Trochanteric fracture unspecified *,%,%,%,%,%,%,%,%,%,%,% 39 1,%,%,% 39 Intertrochanteric fracture ** 1 1 7,%,%,7%,% 1,%,%,% 3,% 3 15,% 5,3% 31,1%,% 31,1%,% 155 Other 11 19 19 17 1,%,% 1,%,% 1,3%,%,% 1,1%,9% 5,% 197 1,9%,% 9 1,9%,% 91 Missing 5 5 1 7 1,%,% 51,%,% 1,3%,1%,%,%,1%,%,%,% 3,1% 1,% 9 1995 5 3199 319 19773 5 5 339 73 7 39 59 199 5 979,%,% 3,%,3%,%,%,%,3% 7,%,1% 3,%,% 1,9%,% T1: Two screws or pins T: Three screws or pins T3: Bipolar hemiprosthesis T: Unipolar hemiprosthesis T5: Hip compression screw and plate T: Hip compression screw with lateral support plate T7: Angle plate T: Short intramedullary nail without distal locking T9: Short intramedullary nail with distal locking T1: Long intramedullary nail without distal locking T11: Long intramedullary nail with distal locking T1: hip prosthesis T13: Other *** T1: Missing * hip prostheses reported to the Norwegian Arthroplasty Register ** The registration started in *** Proportion (%) of operations with combination: Hip compression screw and additional anti-rotational screw is 1,% 1 Hip Fracture
The Norwegian Hip Fracture Register Figure 9a: Time trend for treatment of displaced femoral neck fractures 1 % % % % % % % 5 7 9 1 11 1 13 1 15 1 Tw o screw s or pins Unipolar or bipolar hemiprosthesis hip prosthesis* * hip prostheses for femoral neck fracture were reported to the Norwegian Arthroplasty Register without information about displacement of fracture Figure 9b: Time trend for treatment of trochanteric* fractures 1 % % % % % % % 5 7 9 1 11 1 13 1 15 1 Intramedullary nail Hip compression screw w ith lateral support plate Hip compression screw * Trochanteric fracture '(AO OTA type A1 and A) Figure 9c: Time trend for treatment of inter-* and subtrochanteric fractures 1 % % % % % % % 5 7 9 1 11 1 13 1 15 1 Intramedullary nail Hip compression screw w ith lateral support plate Hip compression screw * Intertrochanteric fracture '(AO OTA type A3) Hip Fracture 17
Report 17 Reoperations Table 9: Reasons for reoperation - all fractures (more than one reason is possible) R1 R R3 R R5 R R7 R R9 R1 R11 R1 R13 R1 1 11 1 7 9 1,7%,3% 1,%,%,7%,% 19 17,3% 17 1,5% 3,9% 3 3,1% 73,% 13 1,% 3,% 1 37,% 1113 15 1 71 3 5 1 1,%,% 3,1% 5,9%,7%,9% 175 15,% 1 1,% 35 3,% 33 3,% 3 7,5% 11 1,% 7,% 359 3,% 119 1 111 5 31 5 7 1,%,3% 3,% 5,%,%,% 1 1,1% 1 1,5%,%,% 7,% 17 1,% 3,5% 353 3,3% 9 13 11 57 33 7 5 1 13,% 5,% 3,1% 7,1%,5% 1,% 15 15,1% 15 1,%,7%,1% 7 7,% 7,7% 7,5% 37 35,% 19 1 153 5 37 75 1 9 1,%,1% 3,5% 7,1% 1,7%,% 13 17,% 15 1,% 3 3,%,1% 3 5,9%,% 3,% 3 3,% 13 11 157 75 59 1 5 1,% 7,1% 5,% 7,7% 1,1%,5% 17 13,% 1 1,1% 1 3,9% 3,% 7,3%,% 33 3,1% 31 3,1% 1 1 17 79 79 11 11 17,% 7,%,% 7,% 1,1% 1,1% 19 1,% 1 1,%,%,% 5 5,7% 1 1,% 37 3,7%,5% 11 9 1 9 59 95 1 19,%,5% 5,%,%,7% 1,% 15 13,% 7,% 3 3,% 3 3,% 9,3% 9,% 57 5,% 9,1% 113 5 1 3 11 1 1,3% 9,5% 5,7% 9,%,9%,9% 1 9,5% 1,% 39 3,% 3,% 57 5,% 1,9% 33 3,% 59 3,% 197 7 7 13 5 111 1 1 5,1% 11,% 7,% 9,7%,9%,9% 7,% 13 1,1% 3,% 39 3,%,% 9,% 31,7% 51,% 11 31 15 11 7 3,7% 1,1%,% 9,7%,7%,% 77 7,% 1,9% 1,% 3,9% 33 3,% 7,7% 1,% 19,7% 13 5 1 17 71 5 9 1 3,% 13,1%,7% 1,% 1,1% 1,5% 5,1% 1,% 5 3,1% 7 3,3% 33,%,% 3,% 7 9,3% 17 3 117 99 113 11 1597 11 39 35 7 17 37 3557 155 19,%,1%,% 7,9%,9%,9% 1,7% 1,% 3,1%,% 5,%,9% 3,5%,3% R1: Osteosynthesis failure R: Nonunion R3: Avascular necrosis (segmental collaps) R: Local pain due to osteosynthesis material R5: Malunion R: Infection - superficial R7: Infection - deep R: Haematoma R9: Dislocation of hemiprosthesis R1: Cutout of osteosynthesis material through caput R11: New fracture around implant R1: Loosening of hemiprosthesis R13: Other R1: Reported reoperations to the Norwegian Arthroplasty Register except Deep infection which is included in R7: Infection deep. 1 Hip Fracture
The Norwegian Hip Fracture Register Table 1: Reasons for reoperation per type of primary fracture (more than one reason is possible) ** Type of primary fracture R1 R R3 R R5 R R7 R R9 R1 R11 R1 R13 Intracapsular fracture, undisplaced 59 3 1 33,5% 13,% 1,% 1,% 1,%,% 1,% 13,% 1,% 51 3,% 157 9,% 5,3% 91 5,% 17 Intracapsular fracture, displaced 3 9 155 5,%,% 5,%,%,7%,1% 9 9,% 1 3,3% 31 1,% 51 1,% 197,3%,1% 9,9% 31 Basocervical fracture 115 55 55 1 3,5% 1,% 7,% 1,%,1%,3% 3 1,1% 1,1% 1,7% 3,% 11,9%,5% 5,3% 377 Trochanteric fracture ( fragments) 135 5 1 5 13,5%,% 3,5% 11,%,5% 1,% 7 1,9% 1 3,1%,% 9,%,%,% 5,% 51 Trochanteric fracture (multifragment) 7 11 7 9 1 1 7,3% 11,%,7% 9,% 1,% 1,%,% 5,5% 9,9% 1,1%,% 3,3% 3,3% 1 Subtrochanteric fracture 135 7 3 3 9,% 15,%,% 1,%,% 1,3% 95,% 1,7%,9% 1 3,5% 3,5% 3,% 3 9,3% Intertrochanteric fracture* 7 1 3 1 1 35,3% 9,%,3% 1,%,%,% 3 17,3% 5 3,% 1,5% 9,%,%,% 7 5,3% 133 Other 1 9 3 3,% 1,1%,% 3,%,% 3,% 1,%,% 3 3,% 7 7,9% 9,%,% 1 13,5% 9 Missing 1 5,%,%,%,%,%,% 1 5,%,%,%,%,%,%,% 19 7 77 9 11 15 175 3 93 519 1 37 733,1% 1,7% 5,7% 1,% 1,% 1,%,1%,%,9%,% 7,% 1,1% 5,% R1: Osteosynthesis failure R: Nonunion R3: Avascular necrosis (segmental collaps) R: Local pain due to osteosynthesis material R5: Malunion R: Infection - superficial R7: Infection - deep R: Haematoma R9: Dislocation of hemiprosthesis R1: Cutout of osteosynthesis material through caput R11: New fracture around implant R1: Loosening of hemiprosthesis R13: Other * The registration started in ** hip prostheses are not counted Hip Fracture 19
Report 17 Table 11: Type of reoperation (more than one reason is possible) R1 R R3 R R5 R R7 R R9 R1 1 1 3 17 1 19 7,% 3,3% 13,%,% 9,7% 13,% 1 1,3% 7,% 15 1,5% 395 3,1% 193 15 3 11 115 13,5% 3,% 17,3%,% 11,% 1,% 19 1,%,% 1 1,1% 3 33,% 17 1 157 11 5,3% 3,% 1,1%,% 9,7% 1,9% 7,%,5% 99 11,% 333 3,% 13 7 3 159 119 11 7,% 3,% 15,9%,% 11,9% 11,% 1 1,% 7,7% 117 11,7% 33 3,% 997 1 73 1 91 137 7,3%,% 1,9%,% 9,% 13,% 1 1,% 9,9% 19 11,% 331 33,3% 99 11 71 3 1 9 15 7,% 3,% 1,1%,% 9,7% 1,% 19 1,9% 13 1,3% 113 11,% 35 3,1% 11 1 91 15 9,%,% 3,1%,% 9,5% 11,% 15 1,% 11 1,% 13 1,% 1 9,5% 95 9 1 5 97 19 11,% 3,%,%,% 9,% 1,3% 1 1,% 11 1,% 9 9,% 9,% 19 111 317 1 3 11,%,% 31,%,1%,5%,% 1 1,% 15 1,5% 91 9,% 55 5,3% 19 7 11 31 371 1 7 7 1,% 3,% 37,%,1% 7,9%,% 5,5% 11 1,1%,5% 3,% 9 97 37 371 3 1,5%,%,%,%,%,%,9% 5,5% 5,% 3 1,9% 9 5 5 3 35 39 1,% 3,% 7,% 5,1%,7% 5,7% 9 1,3% 7 1,%,1% 7 11,% 5 13 19 91 5 193 135 1 1 119 3 111,% 3,% 5,%,% 9,% 1,% 1,%,9% 1,3% 9,% R1: Removal of implant (when only procedure) R: Girdlestone (= Removal of implant/hemiprosthesis and caput) R3: Bipolar hemiprosthesis R: Unipolar haemiprosthesis R5: Re-osteosynthesis R: Drainage of haematoma or infection R7: Closed reduction of dislocated hemiprosthesis R: Open reduction of dislocated hemiprosthesis R9: Other R1: hip prosthesis 19 Hip Fracture
The Norwegian Hip Fracture Register Table 1: Reoperation with primary screw osteosynthesis (reasons are not mutually exclusive) R1 R R3 R R5 R R7 R R9 R1 1 33 9 7 3 1,1%,7% 17,9%,% 9,9% 1,1%,%,% 1,5% 155 5,% 73 15 5 3 5 3 9,% 1,% 5,%,%,7% 1,%,% 1,% 7,% 1 5,% 5 1 1 7 5 3,%,% 7,9%,% 1,% 1,%,%,% 3 1,% 13 53,% 51 13 3 7 35 1 11,9%,7% 5,%,% 1,%,3%,% 1,3%,7% 139,% 1 31 1 9 7 1,% 3,3% 3,%,%,9% 1,3%,%,% 3 1,% 131 3,1% 3 11 37 9 113 3 11,%,7% 3,%,% 7,%,%,%,% 7,1% 139,1% 33 1 3 11 113 1 13,% 3,% 3,%,3%,%,%,%,% 1,% 15 3,5% 35 9 5 15 15 7 1,%,% 3,5%,%,1% 1,9%,%,% 5 1,% 137 37,% 3 53 1 11 1 3 13,7% 3,1% 1,5%,% 5,%,%,%,% 3,% 135 3,% 3 7 19 1 15 1 1,% 1,% 5,7%,% 3,5%,%,%,% 5 1,% 11 3,% 33 3 5 193 5 1,% 1,3% 9,9% 1,3% 5,%,5%,%,%,5% 15 3,3% 37 5 1 1 1,9%,9% 59,% 5,%,9% 1,9%,%,% 1,9% 3,1% 39 7 131 19 3 35 9 1537 31 11,5%,% 3,3%,5%,9%,9%,%,1% 1,3%,% R1: Removal of implant (when only procedure) R: Girdlestone (= Removal of implant/hemiprosthesis and caput) R3: Bipolar hemiprosthesis R: Unipolar hemiprosthesis R5: Re-osteosynthesis R: Drainage of haematoma or infection R7: Closed reduction of dislocated hemiprosthesis R: Open reduction of dislocated hemiprosthesis R9: Other R1: hip prosthesis Hip Fracture 191
Report 17 Table 13: Reoperation with primary uni/bipolar hemiprosthesis (reasons are not mutually exclusive) R1 R R3 R R5 R R7 R R9 R1 1 1,%,% 7,%,%,% 9,5% 9 3,3%,% 9 35,% 15,5% 71 15 5 1 1 5,%,%,%,%,%,% 1 7,1% 1,% 7 3,7%,% 1 9 19 3,%,% 1,%,% 1,% 5,% 5,7%,% 1 3,% 37 19,9% 1 13 11 15,%,9%,7%,%,9% 3,5% 9,% 1,% 77 3,5% 37 1,% 3 1 11 3 55,% 5,7% 11,9%,%,%,% 1 5,%,1% 5,9% 31 1,% 19 11 1 1 1,%,7%,%,%,5%,% 1 7,% 3,% 7 33,% 3 15,% 11 1 17 3 5,%,%,9%,% 1,% 3,5% 1 5,3% 9,7% 35,% 17,9% 19 9 9 1,%,1%,%,%,% 9,7% 7,7% 9,1% 9 33,1% 13,5% 1 1 7,%,%,%,% 1,% 31,3% 5 3,% 1,% 5 3,% 13,% 17 7 5 9 7,% 5,% 9,%,%,% 7,% 3 3,% 1 1,% 35 35,% 11 11,% 1,% 7,3%,%,%,% 3,1%,9% 3 3,7% 9 35,% 1 1,% 5 1 1 1,%,9%,9%,%,% 3,3% 3,% 3,% 13 37,1% 5,7% 35 97 155 1 591 97 77 73 35 13,%,% 7,7%,%,9% 9,% R1: Removal of implant (when only procedure) R: Girdlestone (= Removal of implant/hemiprosthesis and caput) R3: Bipolar hemiprosthesis R: Unipolar hemiprosthesis R5: Re-osteosynthesis R: Drainage of haematoma or infection R7: Closed reduction of dislocated hemiprosthesis R: Open reduction of dislocated hemiprosthesis R9: Other R1: hip prosthesis Table 1: Specification of R9 - Others,% 3,% 33,% 15,% 5-7 Cable Ready plate + cerclage 5 1 1 1 Cement spacer 19 1 1 1 3 3 Cerclage 17 1 1 1 3 3 Dall Miles plate + cerclage 19 1 3 3 1 3 Drainage of haematoma 1 3 5 1 3 1 1 Exchange of caput/bipolar head 5 7 7 35 5 5 7 3 55 7 Exchange of caput/bipolar head + 5 1 1 1 osteosynthesis with plate/cerclage Suture of muscle/fascie 9 1 1 3 1 1 Unspecified plate + cerclage 1 1 1 3 5 Other (n<5) 9 1 3 5 1 1 73 35 5 9 7 5 77 1 7 9 9 1 11 1 13 1 15 1 19 Hip Fracture
The Norwegian Hip Fracture Register Implants Table 15: Cemented hemiprostheses - primary operations Femur Caput Bipolar head 5-7 Charnley Hastings bipolar head 7 1319 39 3 9 13 1 9 1 Charnley Elite Hastings bipolar head 17 17 1 7 1 1 15 1 Modular Charnley Modular Charnley Modular Charnley Modular Elite Landos bipolar cup (DePuy) 15 5 Elite Self-centering bipolar (DePuy) 7 3 31 3 3 55 1 5 71 Unknown caput Hastings bipolar head 1 5 1 1 1 Corail Articul/Eze CoCr Self-centering bipolar 3 1 1 9 51 75 11 93 (DePuy) Corail Articul/Eze CoCr Vario-Cup (Link) 1 1 35 7 3 Corail Articul/Eze Ultamet (M-Spec) Self-centering bipolar (DePuy) 1 5 1 Corail Cobalt chrome (DePuy) Landos bipolar cup (DePuy) 1 1 1 Corail Cobalt chrome (DePuy) Self-centering bipolar (DePuy) 77 1 1 31 9 CPS-PLUS Metal Ball Head Bipolar Ball Head 3 1 1 19 C-Stem Articul/Eze CoCr Self-centering bipolar 93 5 (DePuy) C-Stem Articul/Eze Ultamet (M-Spec) Self-centering bipolar (DePuy) 11 1 9 Elite Elite Hastings bipolar head 3 5 1 1 ETS 31 1 71 79 3 1 3 1 Exeter/V Exeter/V Self-centering bipolar (DePuy) 7 1 7 31 9 5 17 Exeter/V Exeter/V UHR 113 19 7 75 5 1139 11 1 131 15 1557 Exeter/V Exeter/V Unknown bipolar head 33 5 3 1 MS-3 Femoral head Self-centering bipolar 57 11 (VerSys co.cr) (DePuy) MS-3 Protasul/Metasul UHR 1 1 SP II (Link) Articul/Eze CoCr Self-centering bipolar 31 1 1 9 3 (DePuy) SP II (Link) CoCrMo (Link) Self-centering bipolar 7 9 7 9 (DePuy) SP II (Link) CoCrMo (Link) UHR 71 1 57 SP II (Link) CoCrMo (Link) Vario-Cup (Link) 1937 15 1 9 79 51 33 3 71 9 111 Spectron Cobalt Chrom (S&N) Biarticular cup (Permedica) 33 5 17 7 Spectron Cobalt Chrom (S&N) HIP Bipolar Cup 119 1 19 9 1 1 19 15 Spectron Cobalt Chrom (S&N) Landos bipolar cup (DePuy) 11 99 1 1 Spectron Cobalt Chrom (S&N) Self-centering bipolar 3 7 1 9 (DePuy) Spectron Cobalt Chrom (S&N) Tandem 19 37 1 7 1 95 5 Spectron Cobalt Chrom (S&N) Universal bipolar 17 17 Spectron Cobalt Chrom (S&N) Unknown bipolar head 11 3 1 3 Spectron Cobalt Chrom (S&N) Vario-Cup (Link) 1 1 13 Spectron Cobalt chrome Landos bipolar cup (DePuy) 1 1 (DePuy) Titan Alumina Biolox Landos bipolar cup (DePuy) 11 11 (DePuy) Titan Articul/Eze CoCr Landos bipolar cup (DePuy) 15 15 Titan Articul/Eze CoCr Self-centering bipolar 15 1 1 (DePuy) Titan Cobalt chrome Landos bipolar cup (DePuy) 7 1 19 1 (DePuy) Titan Cobalt chrome Self-centering bipolar 7 55 135 3 1 (DePuy) (DePuy) Titan Unknown caput Landos bipolar cup (DePuy) 15 13 Other (n < 1) 75 5 1 3 19 1 Unknown 3 13 1 1 3 7 1 77 5 193 193 1 37 5 75 9 1 11 1 13 1 15 1 Hip Fracture 193
Report 17 Table 1: Uncemented hemiprostheses - primary operations Femur Caput Bipolar head 5-7 Accolade II Exeter/V Vario-Cup (Link) 5 11 Corail Alumina Biolox Self-centering bipolar 11 (DePuy) (DePuy) 9 1 11 1 1 3 Corail Alumina Biolox Vario-Cup (Link) 1 1 9 (DePuy) Corail Articul/Eze Biolox Self-centering bipolar 1 Forte (DePuy) (DePuy) 1 3 1 3 7 Corail Articul/Eze CoCr Bipolar Ball Head 17 39 Corail Articul/Eze CoCr Landos bipolar cup (DePuy) 11 7 3 5 1 Corail Articul/Eze CoCr Self-centering bipolar 3195 (DePuy) 13 1 15 3 7 3 53 71 9 Corail Articul/Eze CoCr UHR 375 17 9 75 Corail Articul/Eze CoCr Vario-Cup (Link) 159 1 37 3 7 17 Corail Articul/Eze Ultamet Self-centering bipolar 5 (M-Spec) (DePuy) Corail Cobalt Chrom (S&N) Self-centering bipolar 37 (DePuy) 1 3 Corail Cobalt Chrom (S&N) Vario-Cup (Link) 13 13 Corail Cobalt chrome Landos bipolar cup (DePuy) 779 57 1 1 7 (DePuy) Corail Cobalt chrome Self-centering bipolar 11 (DePuy) (DePuy) 1 13 1 9 1 1 33 33 3 31 1 Corail Cobalt chrome Tandem 11 1 (DePuy) Corail Cobalt chrome UHR 1 3 3 5 (DePuy) Corail Metal Ball Head Bipolar Ball Head 5 1 5 19 Corail Modular Cathcart 1 (Fracture head hip ball) Corail Unknown caput Landos bipolar cup (DePuy) 1 3 3 Corail Unknown caput Unknown bipolar head 15 3 5 1 1 1 Filler Biotechni fem. head Biarticular cup (Permedica) 1 1 Filler Cobalt Chrom (S&N) Biarticular cup (Permedica) 19 1 Filler Hipball Premium Biarticular cup (Permedica) 197 9 71 5 7 Filler Hipball Premium HIP Bipolar Cup 599 33 95 19 1 99 37 Filler Hipball Premium UHR 1 1 Furlong Furlong UHR 7 1 HACTIV HACTIV head Moonstone HACTIV HACTIV head Tandem 19 9 1 1 HACTIV HACTIV head UHR 3 1 Polarstem Cobalt Chrom (S&N) Tandem 13 1 7 39 1 Polarstem Cobalt Chrom (S&N) UHR 5 3 SL-PLUS HACTIV head Bipolar Ball Head 1 1 SL-PLUS Metal Ball Head Bipolar Ball Head 155 3 3 7 Other (n < 1) 3 3 1 13 1 13 1 Unknown 1 1 19 9 3 1 79 79 113 939 73 19 Hip Fracture
The Norwegian Hip Fracture Register Table 17: Cemented hemiprostheses - reoperations Femur Caput Bipolar head 5-7 Charnley Hastings bipolar head 9 99 5 5 3 3 Charnley Modular Charnley Modular Charnley Modular Elite Hastings bipolar head 19 13 17 1 11 Elite Landos bipolar cup (DePuy) 7 5 Elite Self-centering bipolar (DePuy) Corail Articul/Eze CoCr Self-centering bipolar 3 (DePuy) 35 9 1 11 1 13 1 15 1 3 7 1 1 1 5 7 Corail Articul/Eze CoCr Vario-Cup (Link) 1 3 1 Corail Cobalt chrome Self-centering bipolar 11 (DePuy) (DePuy) 5 CPS-PLUS Metal Ball Head Bipolar Ball Head 1 3 CPS-PLUS Rev. stem Metal Ball Head Bipolar Ball Head 7 5 1 1 C-Stem Articul/Eze CoCr Self-centering bipolar 5 (DePuy) C-Stem Articul/Eze Ultamet Self-centering bipolar 5 (M-Spec) (DePuy) Elite Elite Hastings bipolar head 5 1 ETS 3 15 3 1 Exeter/V Exeter/V Self-centering bipolar 5 (DePuy) 1 3 7 1 11 Exeter/V Exeter/V UHR 777 7 57 55 5 7 73 Exeter/V Exeter/V Unknown bipolar head 1 1 1 1 Fjord Cobalt chrome Landos bipolar cup (DePuy) 7 1 (DePuy) MS-3 Protasul/Metasul UHR 5 5 Restoration Modular (femur) Restoration Modular (femur) Exeter/V Self-centering bipolar (DePuy) 11 3 3 1 1 1 Exeter/V UHR 11 SP II (Link) CoCrMo (Link) Self-centering bipolar 1 (DePuy) SP II (Link) CoCrMo (Link) UHR 1 15 SP II (Link) CoCrMo (Link) Vario-Cup (Link) 15 35 1 11 1 19 1 7 Spectron Cobalt Chrom (S&N) HIP Bipolar Cup 5 1 3 1 Spectron Cobalt Chrom (S&N) Landos bipolar cup (DePuy) 11 5 Spectron Cobalt Chrom (S&N) Tandem 1 1 3 5 11 1 Spectron Cobalt Chrom (S&N) Universal bipolar 9 9 Titan Cobalt chrome Landos bipolar cup (DePuy) 135 11 17 (DePuy) Titan Cobalt chrome Self-centering bipolar 19 (DePuy) (DePuy) 1 5 9 3 1 Other (n < 5) 9 37 1 9 7 3 3 Unknown 5 3 1 1 195 9 7 13 1 1 133 1 11 13 1 3 Hip Fracture 195
Report 17 Table 1: Uncemented hemiprostheses - reoperations Femur Caput Bipolar head Arcos Modular Head Self-centering bipolar 11 (Biomet) (DePuy) 5-7 Corail Articul/Eze CoCr Landos bipolar cup (DePuy) 3 1 11 Corail Articul/Eze CoCr Self-centering bipolar 1 (DePuy) 9 1 11 1 13 1 15 5 19 1 15 19 1 1 Corail Articul/Eze CoCr UHR 1 3 Corail Articul/Eze Ultamet Self-centering bipolar 31 (M-Spec) (DePuy) Corail Cobalt chrome Landos bipolar cup (DePuy) 9 75 13 (DePuy) Corail Cobalt chrome Self-centering bipolar 75 (DePuy) (DePuy) 5 17 1 Corail Cobalt chrome UHR 1 1 1 1 (DePuy) Filler Biotechni fem. head Biarticular cup (Permedica) 1 1 Filler Cobalt chrome Biarticular cup (Permedica) (DePuy) Filler Cobalt chrome Landos bipolar cup (DePuy) 5 5 (DePuy) Filler Hipball Premium Biarticular cup (Permedica) 57 3 1 7 13 1 Filler Hipball Premium HIP Bipolar Cup 1 7 13 1 HACTIV HACTIV head Moonstone 7 7 KAR Articul/Eze CoCr Self-centering bipolar 7 (DePuy) KAR Articul/Eze Ultamet Self-centering bipolar 7 (M-Spec) (DePuy) KAR Cobalt chrome Landos bipolar cup (DePuy) 1 1 1 (DePuy) KAR Cobalt chrome Self-centering bipolar 1 (DePuy) (DePuy) REEF Cobalt chrome Self-centering bipolar (DePuy) (DePuy) Restoration- HA C-Taper Head Landos bipolar cup (DePuy) 7 1 5 1 1 3 SL-PLUS Metal Ball Head Bipolar Ball Head 1 1 1 3 3 1 3 TTHR Articul/Eze CoCr UHR 1 TTHR CoCrMo (Link) UHR 7 1 TTHR TETE Inox Self-centering bipolar 5 (DePuy) 1 Other (n < 5) 1 3 1 13 9 1 1 9 7 1 Unknown 3 3 75 1 71 7 79 79 55 57 3 5 19 Hip Fracture
The Norwegian Hip Fracture Register Table 19: Screws - primary operations Product 5-7 9 1 11 1 13 1 15 1 Asnis III 13 315 75 9 1 177 15 15 11 1 11 Hansson pin system (LIH) 971 53 35 1 11 9 1 9 Olmed 1 3 13 113 79 75 53 19 Richards CHP 715 17 5 35 57 733 597 593 57 1 593 Other (n<1) 3 1 57 971 1 177 17 199 1 131 115 17 1179 Table : Hip compression screws - primary operations Product 5-7 9 1 11 1 13 1 15 1 DHS 9 19 337 1 5 13 5 5 LCP DHS 5 3 75 7 5 5 135 115 Omega 111 9 3 1 3 Richards CHS 133 1 151 1 199 175 15 773 9 Swemac CHS System 13 5 Other (n<1) 7 1 1 1 99 7 553 3 57 1 1 Table 1: Intramedullary nails - primary operations Product 5-7 9 1 11 1 13 1 15 1 ACE 9 3 1 7 Gamma 3 5 53 5 55 5 7 57 75 79 7 IMHS 7 3 1 1 IMHS CP 1 1 LFN 9 3 1 1 7 3 PFN PFNA 91 7 39 1 3 91 13 117 17 1 T 13 1 3 1 T recon 3 1 1 19 3 9 1 33 T-Gamma 5 3 3 1 Trigen Intertan 99 19 15 133 19 1 19 5 735 Trigen TAN/FAN 37 79 5 35 17 1 3 Other (n<1) 11 5 1 1 11131 1373 1 77 7 95 995 1 117 19 15 Fixation of hemiprostheses Table : Primary operations Cement with Uncemented antibiotics Cement without antibiotics Missing 1 ( 19,9% ) 75 (,1% ) (,% ) (,1% ) 33 15 7 (,% ) 51 ( 79,% ) 1 (,% ) (,% ) 335 1 11 ( 5,% ) 3 ( 7,% ) 3 (,1% ) 1 (,5% ) 319 13 91 ( 9,7% ) 15 ( 9,% ) (,% ) (,9% ) 313 1 1 ( 33,% ) 1959 (,3% ) 11 (,3% ) 11 ( 3,5% ) 31 11 97 ( 3,% ) 195 ( 3,7% ) (,% ) 15 ( 3,5% ) 33 1 37 ( 9,% ) 19 ( 7,% ) 7 (,% ) 71 (,5% ) 11 9 5 (,% ) 17 ( 7,% ) (,3% ) 7 ( 3,1% ) 37 399 ( 15,9% ) 1 (,1% ) (,3% ) 9 ( 3,7% ) 59 7 37 ( 17,9% ) 17 ( 79,% ) 1 (,% ) 9 (,3% ) 13 33 ( 19,3% ) 1331 ( 79,% ) 3 (,% ) ( 1,% ) 177 5 33 (,5% ) ( 77,% ) (,% ) 17 ( 1,5% ) 113 779 (,% ) 37 ( 73,5% ) 5 (,% ) 3 ( 1,9% ) 3 Hip Fracture 197
Report 17 Figure 1: Time trend for fixation of primary hemiprostheses 1 % % % % % % Uncemented Cemented % 5 7 9 1 11 1 13 1 15 1 Table 3: Type of cement - primary operations Product Manufacturer 5-7 9 1 11 1 13 1 15 1 Cemex w/gentamycin Alere 5 5 1 11 1 71 11 Cemex System Genta FAST Alere 39 5 11 1 3 7 9 Alere 1 1 Copal G+ V Heraeus 1 1 Optipac Refobacin Bonecement R Biomet 1 3 51 71 79 75 911 1 139 Optipac Refobacin Revision Biomet 1 1 5 7 Palacos w/gentamicin Heraeus/Sc 353 353 Palacos R + G Heraeus 17 17 15 1375 993 71 9 9 957 997 Heraeus 9 1 9 Refobacin Bone Cement R Biomet 3 1 55 39 357 3 39 3 19 3 Refobacin Revision Biomet 1 1 Refobacin-Palacos Biomet 31 31 Simplex w/tobramycin Stryker 1 1 Simplex unknown Stryker 75 5 15 13 SmartMix Cemvac + SmartSet GHV Genta Ortomedic 17 33 9 3 3 Missing information 31 3 3 3 51 3 13 5 31 9 37 3939 1 17 19 195 1959 15 3 51 75 Table : Hydroxyapatite (HA) - uncemented prostheses With HA Without HA Missing 1 75 ( 99,% ) 5 (,7% ) (,3% ) 15 ( 99,% ) 3 (,% ) (,% ) 1 5 ( 99,3% ) 5 (,% ) 1 (,1% ) 13 9 ( 99,9% ) 1 (,1% ) (,% ) 1 1 ( 99,% ) (,% ) (,% ) 11 9 ( 99,9% ) 1 (,1% ) (,% ) 1 ( 9,% ) 13 ( 1,% ) (,% ) 9 5 ( 9,3% ) ( 7,7% ) (,% ) 3 ( 9,7% ) 37 ( 9,3% ) (,% ) 7 351 ( 9,7% ) 3 ( 9,3% ) (,% ) ( 7,9% ) 39 ( 1,1% ) (,% ) 5 19 (,% ) 1 ( 17,% ) (,% ) 79 ( 97,1% ) 7 (,9% ) 3 (,% ) 779 7 11 91 1 97 37 5 399 37 33 33 19 Hip Fracture
Pathological fractures The Norwegian Hip Fracture Register Table 5: Pathological fracture (osteoporotic fracture not included) - primary operations * No Yes Missing 1 97 (,5% ) 117 ( 1,% ) 973 ( 1,% ) 15 77 ( 7,% ) 117 ( 1,% ) 9 ( 11,% ) 1 917 ( 7,7% ) ( 1,% ) 91 ( 11,3% ) 13 97 ( 7,% ) 133 ( 1,7% ) 9 ( 11,1% ) 1 7191 ( 7,% ) 1 ( 1,3% ) 9 ( 11,3% ) 11 75 ( 9,% ) 135 ( 1,% ) 77 ( 9,% ) 1 711 ( 9,% ) 93 ( 1,1% ) 9 (,% ) 9 737 ( 9,% ) 17 ( 1,3% ) (,5% ) 73 ( 9,% ) 1 ( 1,% ) 71 (,% ) 7 95 ( 9,% ) 93 ( 1,% ) (,% ) 53 ( 9,1% ) 91 ( 1,% ) 37 (,% ) 5 5135 (,9% ) 5 ( 1,1% ) 57 ( 9,9% ) 395 ( 9,% ) 139 ( 1,3% ) 913 ( 9,7% ) 9 * Patients operated with total hip prostheses were excluded 77 7 1 5 7 1 11 7711 731 577 Surgical approach used in hemiarthroplasty Table : Surgical approach used in hemiarthroplasty Anterior Anterolateral Direct lateral Posterior Other Missing 1 11 (,3% ) 9 (,1% ) 9 ( 7,% ) 5 ( 1,1% ) (,% ) 3 ( 1,% ) 15 1 (,% ) 3 ( 7,% ) 5 ( 7,% ) 37 ( 1,% ) 1 (,% ) 57 ( 1,% ) 1 3 (,1% ) 5 ( 7,9% ) 5 (,3% ) 91 ( 9,1% ) 1 (,% ) 3 (,% ) 13 (,3% ) 55 (,% ) 53 ( 1,% ) ( 7,% ) (,% ) 7 (,5% ) 1 (,% ) 3 ( 7,% ) 535 (,% ) 7 (,% ) 1 (,% ) (,7% ) 11 11 (,% ) ( 7,5% ) 3 (,% ) 9 ( 9,% ) (,% ) 51 ( 1,7% ) 1 1 (,5% ) 1 ( 5,1% ) 391 ( 5,1% ) 3 (,% ) (,% ) 3 ( 1,% ) 9 1 (,5% ) 17 ( 5,% ) 1 (,% ) ( 7,% ) (,% ) 35 ( 1,% ) 1 (,% ) 155 (,% ) 13 ( 5,% ) 17 ( 7,% ) (,% ) 3 ( 1,% ) 7 (,% ) 1 ( 7,5% ) 1777 (,% ) 1 ( 9,3% ) (,% ) 3 ( 1,1% ) 1 (,1% ) ( 1,5% ) 1 ( 73,% ) 19 ( 11,3% ) (,% ) 19 ( 1,1% ) 5 (,% ) 131 ( 11,5% ) ( 7,1% ) 13 ( 1,% ) (,% ) 5 (,% ) 333 335 319 313 31 33 11 37 59 13 177 113 3 (,3% ) 395 ( 7,% ) 15 ( 1,1% ) 37 ( 9,% ) 3 (,% ) 51 ( 1,7% ) 31 Figure 11: Surgical approach used in hemiarthroplasty 1 % Proportion (%) of operations 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 1 11 1 13 1 15 1 Missing Other Posterior Direct lateral Anterolateral Anterior Definition of operative approach: Anterior (between sartorius and tensor) Anterolateral (between gluteus medius and tensor) Direct lateral (transgluteal) Posterior (behind the gluteus medius) Hip Fracture 199
Report 17 Intraoperative complications Table 7: Intraoperative complications - primary operations Yes No Missing 1 15 1 13 1 11 1 9 7 5 Antibiotic prophylaxis 33 ( 3,9% ) 731 ( 93,% ) 59 ( 3,1% ) 35 ( 3,% ) 77 ( 9,9% ) 9 ( 3,5% ) 3 ( 3,% ) 75 ( 9,7% ) 7 ( 3,5% ) 3 ( 3,7% ) 77 ( 93,% ) 57 ( 3,1% ) 3 (,% ) 777 ( 9,1% ) 35 ( 3,9% ) 353 (,1% ) 7959 ( 9,% ) 7 ( 3,3% ) 3 ( 3,9% ) 77 ( 9,% ) 79 ( 3,3% ) 3 ( 3,7% ) 7 ( 93,1% ) 7 ( 3,3% ) 35 (,% ) 77 ( 9,% ) 71 ( 3,% ) 73 ( 3,5% ) 7359 ( 93,5% ) 3 ( 3,% ) ( 3,3% ) 7 ( 93,% ) 53 ( 3,% ) 1 ( 3,% ) 5557 ( 9,5% ) 13 (,3% ) 177 39 35 599 33 5 3 77 7517 579 33 ( 3,% ) 93 ( 93,% ) 315 ( 3,3% ) 9597 Table : Screw - primary fixation Yes No Missing 1 1113 ( 9,1% ) 3 ( 5,3% ) 7 (,% ) 113 15 115 ( 91,3% ) 1 (,% ) 9 (,7% ) 17 1 9 ( 5,3% ) 1 ( 1,% ) (,7% ) 115 13 1 ( 7,3% ) 37 ( 3,% ) (,5% ) 131 1 11 (,% ) 55 ( 3,7% ) 11 (,7% ) 1 11 1 ( 5,9% ) (,1% ) 17 ( 1,% ) 199 1 95 ( 5,% ) 71 (,% ) ( 1,5% ) 199 9 5 ( 5,% ) 59 (,% ) 5 ( 1,% ) 179 93 (,3% ) 15 ( 5,3% ) 7 ( 1,3% ) 7 7 95 (,% ) 13 ( 5,3% ) ( 1,% ) 31 1 ( 3,1% ) 13 ( 5,% ) 51 (,% ) 5 5 533 (,% ) 1 ( 73,7% ) 7 (,1% ) 1137 ( 55,% ) 99 ( 3,7% ) ( 1,3% ) 557 Table 9: Hemiprosthesis - primary operations Yes No Missing 1 15 1 13 1 11 1 9 7 5 3 ( 99,5% ) 3 (,1% ) 15 (,% ) 37 ( 99,% ) (,1% ) 5 (,% ) 313 ( 99,% ) (,% ) (,% ) 39 ( 99,% ) (,1% ) 9 (,3% ) 313 ( 99,7% ) (,% ) (,1% ) 39 ( 99,% ) (,1% ) 9 (,3% ) 3 ( 99,% ) (,1% ) 3 (,1% ) ( 99,% ) (,3% ) 3 (,1% ) 7 ( 99,1% ) 13 (,5% ) 9 (,% ) 15 ( 99,% ) 7 (,3% ) (,3% ) 15 ( 99,3% ) 9 (,5% ) 3 (,% ) 119 ( 99,% ) (,% ) 5 (,% ) 3 33 319 313 31 3 1 37 59 13 177 113 3111 ( 99,% ) (,% ) 75 (,% ) 3 Hip Fracture
The Norwegian Hip Fracture Register Table 3: Hip compression screw and plate (including angle plate) - primary operations Yes No Missing 1 171 ( 99,5% ) 1 (,1% ) (,% ) 1 15 15 ( 99,% ) 3 (,1% ) 5 (,% ) 1 1 7 ( 99,% ) 7 (,3% ) (,3% ) 13 39 ( 99,7% ) (,% ) (,1% ) 5 1 ( 99,% ) 1 (,% ) 5 (,% ) 1 11 57 ( 9,% ) ( 1,1% ) 1 (,5% ) 57 1 53 ( 9,1% ) 37 ( 1,% ) 1 (,5% ) 3 9 9 ( 97,5% ) 53 (,1% ) 1 (,% ) 553 377 ( 9,% ) 3 ( 3,% ) 1 (,% ) 7 7 31 ( 9,% ) 13 ( 5,5% ) 13 (,5% ) 51 33 ( 93,% ) 11 (,% ) 1 (,% ) 5 5 13 ( 9,9% ) 11 (,% ) 1 (,9% ) 19 757 ( 97,3% ) 5 (,3% ) 13 (,% ) 3 Table 31: Intramedullary nail - primary operations 1 15 1 13 1 11 1 9 7 5 Yes No Missing 1 ( 99,5% ) 1 (,1% ) (,% ) 17 ( 99,% ) (,5% ) (,3% ) 1157 ( 9,% ) 5 (,% ) 11 (,9% ) 111 ( 9,3% ) 15 ( 1,% ) 5 (,% ) 935 ( 9,1% ) 53 ( 5,3% ) (,% ) ( 9,5% ) 9 ( 9,9% ) 5 (,5% ) 79 ( 91,3% ) ( 7,% ) (,9% ) 71 ( 91,9% ) 5 ( 7,5% ) 5 (,% ) 91 ( 9,1% ) 15 ( 1,% ) 7 (,7% ) 573 ( 91,1% ) 5 (,% ) (,3% ) 397 ( 9,% ) ( 1,% ) 1 (,% ) 3 ( 79,5% ) 5 ( 1,9% ) 5 ( 1,7% ) 153 1 1173 11 99 95 7 775 1 9 97 19 ( 9,3% ) 55 ( 5,1% ) 5 (,% ) 11119 Table 3: Reoperations Yes 1 15 1 13 1 11 1 9 7 5 No Missing 7 ( 7,% ) 1 ( 11,% ) 11 ( 1,% ) 31 ( 91,% ) 3 ( 7,% ) 11 ( 1,% ) 7 ( 9,3% ) ( 5,5% ) (,3% ) 9 ( 91,% ) ( 7,5% ) 1 ( 1,1% ) 3 ( 9,7% ) 7 (,% ) (,7% ) (,% ) 9 ( 1,1% ) 1 ( 1,5% ) 73 ( 5,7% ) 111 ( 13,% ) 11 ( 1,3% ) 793 (,% ) 151 ( 15,7% ) 1 ( 1,9% ) 73 (,% ) 131 ( 1,1% ) 1 ( 1,7% ) 797 ( 5,7% ) 15 ( 13,% ) (,9% ) 753 (,% ) 1 ( 13,5% ) 17 ( 1,9% ) 55 (,5% ) 1 ( 1,3% ) ( 1,% ) 91 ( 7,% ) 1191 ( 11,3% ) 13 ( 1,3% ) 15 9 95 77 5 5 91 5 9 93 93 9 1 Hip Fracture 1
Report 17 Table 33: Type of antibiotics - primary operations (n=7) Antibiotics (generic name) Ampicillin (Pentrexyl, Pondocillin, Doktacilin) 5-7 9 1 11 1 13 1 15 1,3%,%,1%,5%,1%,1%,19%,%,1%,9% Benzylpenicillin (Penicillin G),15%,13%,17%,5%,3%,%,3%,%,35%,33% Cefalotin (Keflin) 73,% 75,37% 7,% 77,1% 73,% 73,7% 7,73% 77,7% 7,1%,% Cefotaksim (Claforan),3%,1%,%,%,33%,31%,3%,%,19%,% Cefuroksim (Zinacef, Cefuroxim, Lifurox) 5,%,55% 3,% 3,1% 3,7%,31%,1%,97%,33%,% Ciprofloksasin (Ciproxin),9%,5%,15%,1%,19%,19%,1%,7%,1%,3% Dikloksacillin (Diclocil, Dicillin),9%,9% 3,% 1,59%,1%,5% 1,5%,%,19%,15% Gentamicin (Garamycin, Gensumycin) Klindamycin (Dalacin, Clindamycin),%,15%,%,%,13%,1%,%,1%,13%,1% 1,71%,3%,%,9% 3,% 3,3% 3,% 3,7% 3,91%,3% Kloksacillin (Ekvacillin),1% 1,1%,13%,31% 5,9%,73% 5,7% 5,9% 5,5%,5% Mecillinam (Selexid),%,3%,%,%,1%,9%,1%,1%,1%,7% Metronidasol (Flagyl, Metronidazol, Elyzol),%,%,%,7%,1%,13%,9%,3%,%,5% Piperacillin\Tazobactam (Tazocin),1%,3%,1%,%,%,%,9%,%,%,1% Other,3%,1%,17%,1%,7%,3%,3%,31%,1%,7% Missing information,3%,3%,%,31%,5%,1%,5%,3%,3%,9% Pharmacological antithrombotic prophylaxis Table 3: Primary operation Yes No Missing 1 15 1 13 1 11 1 9 7 5 7 ( 97,5% ) 1 ( 1,9% ) 3 (,% ) ( 97,% ) 1 ( 1,% ) 3 (,% ) 79 ( 97,% ) 191 ( 1,9% ) (,7% ) 1 ( 9,% ) 139 ( 1,3% ) (,% ) 3 ( 9,5% ) 15 ( 1,1% ) (,% ) ( 9,7% ) 9 ( 1,% ) 19 (,3% ) 3 ( 9,5% ) 9 ( 1,1% ) 31 (,% ) 15 ( 9,7% ) 7 (,9% ) 3 (,% ) 1 ( 9,3% ) 11 ( 1,3% ) 3 (,% ) 777 ( 97,9% ) 135 ( 1,7% ) (,% ) 77 ( 9,% ) 197 (,% ) (,% ) 573 ( 97,% ) 117 (,% ) (,% ) 177 39 35 599 33 5 3 77 7517 579 95 ( 9,% ) 13 ( 1,7% ) 31 (,3% ) 9597 Hip Fracture
The Norwegian Hip Fracture Register Table 35: Number of drugs in antithrombotic prophylaxis One drug Two drugs 1 15 1 13 1 11 1 9 7 5 31 ( 97,9% ) 17 (,1% ) 7957 ( 97,% ) 7 ( 3,% ) 775 ( 97,3% ) 17 (,7% ) 79 ( 9,% ) ( 3,% ) 13 ( 97,9% ) 17 (,1% ) ( 99,% ) ( 1,% ) ( 99,% ) 3 (,% ) 13 ( 99,% ) 1 (,% ) ( 99,% ) 1 (,% ) 79 ( 99,% ) 15 (,% ) 759 ( 99,% ) 15 (,% ) 5715 ( 99,% ) 1 (,% ) 7 79 1 3 3 15 1 777 77 573 93375 ( 9,% ) 179 ( 1,% ) 95 Table 3: Antithrombotic prophylaxis if one drug - primary operation (n=9337) 5-7 9 1 11 1 13 1 15 1 Dalteparin (Fragmin) 51,% 3,7% 51,9% 1,3%,97%,93% 53,35% 51,3% 59,%,9% Enoksaparin (Klexane) 7,9% 35,9% 7,7% 3,37% 3,% 3,33% 5,%,% 39,11% 3,13% Other,%,13%,1%,1%,9%,5%,%,37%,%,% Missing information,19%,1%,17%,1%,31%,7%,%,5%,%,% Table 37: Time of first dose in antithrombotic prophylaxis - primary operation 1 15 1 13 1 11 1 9 7 5 Preoperatively Postoperatively Missing 51 ( 31,5% ) 77 ( 57,% ) 9 ( 11,% ) 33 ( 3,1% ) 93 ( 57,% ) 7 ( 1,7% ) 1 ( 3,9% ) 75 ( 5,% ) 9 ( 1,9% ) 19 ( 3,% ) 351 ( 53,3% ) 99 ( 1,1% ) 31 ( 37,% ) 13 ( 9,% ) 1 ( 1,9% ) 33 ( 39,% ) ( 7,% ) 11 ( 9,% ) 339 (,% ) 355 ( 3,5% ) 13 ( 1,5% ) 37 (,% ) 3 ( 37,% ) 13 ( 1,1% ) 359 (,7% ) 973 ( 3,% ) 173 ( 1,3% ) 95 ( 3,% ) 9 ( 3,5% ) 11 ( 17,% ) 931 (,% ) 5 (,3% ) 5 ( 19,% ) 1 ( 3,7% ) (,% ) 35 (,7% ) 79 1 3 3 15 1 777 77 573 3573 ( 37,7% ) 19 ( 3,% ) 17 ( 1,9% ) 955 Hip Fracture 3
Report 17 DURATION OF SURGERY Figure 13: Duration of surgery for the different types of operations 1 Mean duration of operations (minutes) 1 1 1 hip prosthesis Long intramedullary nail with distal locking Short intramedullary nail with distal locking Hip compression screw with lateral support plate Hip compression screw and plate Bipolar hemiprosthesis Two screws or pins Table 3: Duration of surgery for the different types of operations Type of operations Two screws or pins Bipolar hemiprosthesis Hip compression screw and plate Hip compression screw with lateral support plate Short intramedullary nail with distal locking Long intramedullary nail with distal locking hip prosthesis Mean duration of operations (minutes) 1915 3735 7 1 5 17 75 5 5 351 9 97 Standard deviation 13 5 7 3 5 5 31 Hip Fracture
The Norwegian Hip Fracture Register PROM (Patient Reported Outcome Measures) Table 39: Number of issued and answered patient questionnaires months * Issued Answered (%) 1 months * Issued Answered (%) 3 months * Issued Answered (%) Issued Answered (%) 1 71 395 ( 5,% ) 77 351 ( 53,5% ) 31 ( 55,% ) 1799 953 ( 55,1% ) 15 919 39 ( 57,5% ) 5 357 ( 55,7% ) 35 39 ( 5,5% ) 171 99 ( 5,% ) 1 1 35 ( 5,1% ) 3 37 ( 5,5% ) 33 35 ( 5,% ) 17153 97 ( 55,1% ) 13 9 3955 ( 57,3% ) 9 3515 ( 57,7% ) 3 39 ( 5,9% ) 173 999 ( 5,% ) 1 7575 ( 55,5% ) 7 31 ( 5,3% ) 179 15 ( 5,7% ) 11 9 ( 5,% ) 11 59 3555 ( 55,% ) 5553 311 ( 5,1% ) 111 1 ( 57,% ) 133 79 ( 55,% ) 1 95 ( 5,7% ) 13 ( 57,% ) 375 13 ( 5,9% ) 111 ( 57,% ) 9 55 1 ( 5,1% ) 3 133 ( 57,% ) 95 7 ( 53,9% ) 99 55 ( 5,1% ) 73 135 ( 57,% ) 19 1 ( 57,% ) 31 117 ( 57,1% ) 7357 ( 57,% ) 7 353 197 ( 5,% ) 59 37 ( 5,% ) 57 ( 5,% ) 1 37 ( 5,% ) 77 ( 57,5% ) 11 39 ( 5,1% ) 5 17 11 ( 5,3% ) 17 11 ( 5,3% ) 393 335 ( 5,7% ) 5 91 ( 5,1% ) 31593 175 ( 55,5% ) 137 31 ( 5,% ) * The register sends questionnaires to patients, 1 and 3 months post-operatively Hip Fracture 5
Figures 13- present patient-reported data collected on questionnaires, 1, and 3 months postoperative. Figure 13: Mean EQ-5D-3L index score for different fracture types. An index score of 1 represents the best possible health state and represents a health state similar to death. 1..9. EQ-5D-3L index score All hip fractures Intracapsular fractures, undisplaced Intracapsular fractures, displaced (+total hip prosthesis) Basocervical fractures Trochanteric fractures Intertrochanteric fractures Subtrochanteric fractures Mean EQ5D index score.7..5..3..1. Prior to surgery mth after surgery 1 yr after surgery 3 yrs after surgery Figure 1: Mean EQ-5D-3L index score for different operation methods. An index score of 1 represents the best possible health state and represents a health state similar to death. 1..9. All primary operation methods Skrews Hemiprosthesis Hip compression screw and plate EQ-5D-3L index score Hip compression screw with lateral support plate Intramedullary nail hip prosthesis Mean EQ5D index score.7..5..3..1. Prior to surgery mth after surgery 1 yr after surgery 3 yrs after surgery
Figure 15: Walking ability derived from the first dimension of EQ-5D-3L for different fracture types. The figure shows the proportion of patients reporting «I have some problems in walking about» or «I am confined to bed» at different follow-ups. 1 Mobility 9 % with problems in walking about 7 5 3 1 All hip fractures Intracapsular fractures, undisplaced Intracapsular fractures, displaced (+total hip prosthesis) Basocervical fractures Trochanteric fractures Intertrochanteric fractures Subtrochanteric fractures Prior to surgery mth after surgery 1 yr after surgery 3 yrs after surgery Figure 1: Walking ability derived from the first dimension of EQ-5D-3L for different operation methods. The figure shows the proportion of patients reporting «I have some problems in walking about» or «I am confined to bed» at different follow-ups. 1 Mobility 9 % with problems in walking about 7 5 3 1 All primary operation methods Skews Hemiprosthesis Hip compression screw and plate Hip compression screw with lateral support plate Intramedullary nail hip prosthesis Prior to surgery mth after surgery 1 yr after surgery 3 yrs after surgery 7
Figure 17: Pain derived from the fourth dimension of EQ-5D-3L for different fracture types. The figure shows the proportion of patients reporting «I have moderate pain or discomfort» or «I have extreme pain or discomfort» at different follow-ups. 1 Pain or discomfort 9 % reporting pain or discomfort 7 5 3 1 All hip fractures Intracapsular fractures, undisplaced Intracapsular fractures, displaced (+total hip prosthesis) Basocervical fractures Trochanteric fractures Intertrochanteric fractures Subtrochanteric fractures Prior to surgery mth after surgery 1 yr after surgery 3 yrs after surgery Figure 1: Pain derived from the fourth dimension of EQ-5D-3L for different operation methods. The figure shows the proportion of patients reporting «I have moderate pain or discomfort» or «I have extreme pain or discomfort» at different follow-ups. 1 Pain or discomfort 9 % reporting pain or discomfort 7 5 3 1 All primary operation methods Skrews Hemiprosthesis Hip compression screw and plate Hip compression screw with lateral support plate Intramedullary nail hip prosthesis Prior to surgery mth after surgery 1 yr after surgery 3 yrs after surgery
Figure 19: Satisfaction with the result of the operation for different fracture types at different follow-ups. The figure shows the proportion of patients reporting to be satisfied or very satisfied (- points on a visual analogue scale where the value indication very satisfied and 1 indicating very dissatisfied). 1 Satisfaction 9 % satisfied or very satisfied 7 5 3 1 All hip fractures Intracapsular fractures, undisplaced Intracapsular fractures, displaced (+total hip prosthesis) Basocervical fractures Trochanteric fractures Intertrochanteric fractures Subtrochanteric fractures mth after surgery 1 yr after surgery 3 yrs after surgery Figure : Satisfaction with the result of the operation for different operation methods at different follow-ups. The figure shows the proportion of patients reporting to be satisfied or very satisfied (- points on a visual analogue scale where the value indication very satisfied and 1 indicating very dissatisfied). 1 Satisfaction 9 % satisfied or very satisfied 7 5 3 1 All primary operation methods Skrews Hemiprosthesis Hip compression screw and plate Hip compression screw with lateral support plate Intramedullary nail hip prosthesis mth after surgery 1 yr after surgery 3 yrs after surgery 9
Hospital data The Norwegian Hip Fracture register is required to publish hospital data. These data are presented in the annual report to SKDE which is available on www.kvalitetsregistre.no. Figures 1 to 5 present updated results for the different hospitals for operations performed in the period 1-1. Figure 1: Number of primary operations in 1 Akershus universitetssykehus HF Sykehuset Østfold Kalnes Diakonhjemmet sykehus Sykehuset i Vestfold HF - Tønsberg Vestre Viken HF - Bærum sykehus Oslo universitetssykehus HF Ullevål - Ort senter, Kirkeveie Sykehuset Telemark HF - Skien Sykehuset Innlandet HF - Gjøvik Sykehuset Innlandet HF - Elverum Vestre Viken HF - Drammen sykehus Sørlandet sykehus HF - Kristiansand Vestre Viken HF - Ringerike sykehus Sørlandet sykehus HF - Arendal Sykehuset Innlandet HF - Kongsvinger Sykehuset Innlandet HF - Lillehammer Vestre Viken HF - Kongsberg sykehus Sykehuset Telemark HF - Notodden Sørlandet sykehus HF - Flekkefjord Sykehuset Innlandet HF - Tynset Sykehuset Østfold HF - Moss Oslo universitetssykehus HF Ullevål, Ort.senter, Storgata Oslo universitetssykehus HF - Rikshospitalet Helse Bergen HF - Haukeland universsjukehus Helse Stavanger HF - Stavanger Universitetssykehus Helse Fonna HF - Haugesund sjukehus Haraldsplass Diakonale Sykehus Helse Førde HF - Førde sentralsjukehus Helse Bergen HF - Voss sjukehus Helse Fonna HF - Stord sjukehus St. Olavs Hospital HF - universitetssykhehuset i Trondheim Helse Nord-Trøndelag HF - Sykehuset Levanger Helse Møre og Romsdal HF - Ålesund sjukehus St. Olavs Hospital HF - Orkdal sjukehus Helse Møre og Romsdal HF - Kristiansund Sjukehus Helse Møre og Romsdal HF - Volda sjukehus Helse Nord-Trøndelag HF - Sykehuset Namsos Helse Møre og Romsdal HF - Molde Sjukehus Nordlandssykehuset HF - Bodø Universitetssykehuset Nord-Norge HF - Avd Harstad Helgelandssykehuset HF - Mo i Rana Universitetssykehuset Nord-Norge HF - Avd Tromsø Helse Finnmark HF - Klinikk Hammerfest Nordlandssykehuset HF - Vesterålen Helse Finnmark HF - Klinikk Kirkenes Universitetssykehuset Nord-Norge HF - Avd Narvik Nordlandssykehuset HF - Lofoten 3 1 7 3 55 7 5 15 1 15 13 157 15 99 3 7 5 9 19 1 1 1 11 13 11 157 13 19 17 7 19 1 11 33 39 33 9 1 51 53 1 3 5 Antall Primary primæroperasjoner operations in 1 i 1 Helse Sør-Øst Helse Vest Helse Midt-Norge Helse Nord 1
Figure : Treatment of displaced femoral neck fracture in patients over 7 years of age. The figure shows the proportion of patients treated with screw osteosynthesis/hemiprosthesis/total hip prosthesis at each hospital in the period 1-1. Hospitals with n<1 have been excluded. Universitetssykehuset Nord-Norge HF - Avd Narvik (N=1) Helse Nord-Trøndelag HF - Sykehuset Namsos (N=5) Universitetssykehuset Nord-Norge HF - Avd Tromsø (N=19) Helgelandssykehuset HF - Mo i Rana (N=11) Sørlandet sykehus HF - Flekkefjord (N=) Sykehuset Innlandet HF - Tynset (N=7) St. Olavs Hospital HF - Orkdal sjukehus (N=1) Nordlandssykehuset HF - Lofoten (N=) Helse Finnmark HF - Klinikk Hammerfest (N=) Sørlandet sykehus HF - Arendal (N=179) Haraldsplass Diakonale Sykehus (N=3) Helse Nord-Trøndelag HF - Sykehuset Levanger (N=) Helse Møre og Romsdal HF - Kristiansund Sjukehus (N=1) Helse Fonna HF - Haugesund sjukehus (N=7) Helse Stavanger HF - Stavanger Universitetssykehus (N=73) Nordlandssykehuset HF - Bodø (N=9) Vestre Viken HF - Ringerike sykehus (N=1) Sykehuset i Vestfold HF - Tønsberg (N=35) Universitetssykehuset Nord-Norge HF - Avd Harstad (N=1) Helse Møre og Romsdal HF - Ålesund sjukehus (N=) Vestre Viken HF - Drammen sykehus (N=9) Helse Førde HF - Førde sentralsjukehus (N=131) Sykehuset Innlandet HF - Elverum (N=3) Helse Finnmark HF - Klinikk Kirkenes (N=3) Akershus universitetssykehus HF (N=5) Sykehuset Telemark HF - Notodden (N=17) Vestre Viken HF - Bærum sykehus (N=33) Sykehuset Innlandet HF - Kongsvinger (N=1) Sykehuset Innlandet HF - Lillehammer (N=1) Helse Fonna HF - Stord sjukehus (N=9) Helse Bergen HF - Haukeland universsjukehus (N=39) Helse Møre og Romsdal HF - Volda sjukehus (N=1) Helse Bergen HF - Voss sjukehus (N=17) St. Olavs Hospital HF - universitetssykhehuset i Trondheim (N=3) Helse Møre og Romsdal HF - Molde Sjukehus (N=7) Sørlandet sykehus HF - Kristiansand (N=31) Vestre Viken HF - Kongsberg sykehus (N=11) Sykehuset Østfold HF - Fredrikstad (N=39) Oslo universitetssykehus HF Ullevål - Ort senter, Kirkeveie (N=) Sykehuset Telemark HF - Skien (N=7) Sykehuset Innlandet HF - Gjøvik (N=317) Diakonhjemmet sykehus (N=1) Sykehuset Østfold Kalnes (N=) Nordlandssykehuset HF - Vesterålen (N=5) % 5% 5% 75% 1% Behandling Treatment skruer screws Hemiprotese Hemiprosthesis protese hip prosthesis 11
Figure 3: Reoperations after all types of hip fractures 1-1. The figure shows the proportion of patients not reoperated at each hospital. Hospitals with n<1 have been excluded. Helse Møre og Romsdal HF - Molde Sjukehus (N=) Helse Finnmark HF - Klinikk Hammerfest (N=1) Sykehuset Telemark HF - Notodden (N=) Sykehuset Innlandet HF - Lillehammer (N=379) St. Olavs Hospital HF - universitetssykhehuset i Trondheim (N=19) Helse Finnmark HF - Klinikk Kirkenes (N=7) Haraldsplass Diakonale Sykehus (N=5) Sykehuset Østfold Kalnes (N=35) Sykehuset Østfold HF - Fredrikstad (N=11) Nordlandssykehuset HF - Bodø (N=5) Helse Nord-Trøndelag HF - Sykehuset Namsos (N=3) Nordlandssykehuset HF - Vesterålen (N=1) Oslo universitetssykehus HF Ullevål - Ort senter, Kirkeveien (N=) Helse Fonna HF - Haugesund sjukehus (N=59) Helse Møre og Romsdal HF - Ålesund sjukehus (N=) Universitetssykehuset Nord-Norge HF - Avd Tromsø (N=375) Vestre Viken HF - Ringerike sykehus (N=5) Sykehuset Innlandet HF - Gjøvik (N=779) Sykehuset i Vestfold HF - Tønsberg (N=15) Akershus universitetssykehus HF (N=17) Sykehuset Telemark HF - Skien (N=73) Sykehuset Innlandet HF - Elverum (N=75) Universitetssykehuset Nord-Norge HF - Avd Harstad (N=5) Hele landet (N=95) Helse Møre og Romsdal HF - Kristiansund Sjukehus (N=37) Diakonhjemmet sykehus (N=153) Helse Bergen HF - Haukeland universsjukehus (N=1131) Vestre Viken HF - Bærum sykehus (N=9) Sørlandet sykehus HF - Kristiansand (N=71) Vestre Viken HF - Kongsberg sykehus (N=33) Helse Fonna HF - Stord sjukehus (N=1) Sykehuset Innlandet HF - Tynset (N=11) Helse Møre og Romsdal HF - Volda sjukehus (N=3) Sykehuset Telemark HF - Rjukan (N=15) Helse Førde HF - Førde sentralsjukehus (N=) Helse Nord-Trøndelag HF - Sykehuset Levanger (N=53) St. Olavs Hospital HF - Orkdal sjukehus (N=3) Helse Bergen HF - Voss sjukehus (N=33) Sørlandet sykehus HF - Arendal (N=7) Sørlandet sykehus HF - Flekkefjord (N=) Vestre Viken HF - Drammen sykehus (N=717) Helse Stavanger HF - Stavanger Universitetssykehus (N=173) Nordlandssykehuset HF - Lofoten (N=5) Helgelandssykehuset HF - Mo i Rana (N=33) Sykehuset Innlandet HF - Kongsvinger (N=537) Universitetssykehuset Nord-Norge HF - Avd Narvik (N=7) 9, % 75 % % 5 % 9 % 95 % 1 % Andel ikke-reopererte brudd Percent not reoperated 1
Figure : Reoperations after displaced femoral neck fractures in patients over 7 years of age, regardless of type of primary operation. The figure shows the proportion of patients not reoperated at each hospital. Hospitals with n<1 have been excluded. Helse Finnmark HF - Klinikk Kirkenes (N=3) Nordlandssykehuset HF - Bodø (N=5) Sykehuset Innlandet HF - Tynset (N=5) Helse Finnmark HF - Klinikk Hammerfest (N=) Helse Møre og Romsdal HF - Ålesund sjukehus (N=3) Sykehuset Innlandet HF - Lillehammer (N=157) Helse Møre og Romsdal HF - Molde Sjukehus (N=9) Nordlandssykehuset HF - Vesterålen (N=) Helse Fonna HF - Haugesund sjukehus (N=37) Sykehuset Telemark HF - Notodden (N=1) Oslo universitetssykehus HF Ullevål - Ort senter, Kirkeveien (N=35) St. Olavs Hospital HF - universitetssykhehuset i Trondheim (N=59) Nordlandssykehuset HF - Lofoten (N=) Sykehuset Østfold Kalnes (N=93) Sykehuset Østfold HF - Fredrikstad (N=5) Sykehuset Telemark HF - Skien (N=31) Universitetssykehuset Nord-Norge HF - Avd Harstad (N=197) Haraldsplass Diakonale Sykehus (N=57) Vestre Viken HF - Drammen sykehus (N=3) Universitetssykehuset Nord-Norge HF - Avd Tromsø (N=1) Helse Stavanger HF - Stavanger Universitetssykehus (N=55) Vestre Viken HF - Bærum sykehus (N=39) Sørlandet sykehus HF - Kristiansand (N=371) Helse Fonna HF - Stord sjukehus (N=13) Hele landet (N=111) Helse Møre og Romsdal HF - Kristiansund Sjukehus (N=171) Diakonhjemmet sykehus (N=7) Vestre Viken HF - Ringerike sykehus (N=7) Akershus universitetssykehus HF (N=79) Sykehuset i Vestfold HF - Tønsberg (N=551) Sykehuset Innlandet HF - Elverum (N=35) St. Olavs Hospital HF - Orkdal sjukehus (N=11) Vestre Viken HF - Kongsberg sykehus (N=1) Helse Bergen HF - Haukeland universsjukehus (N=5) Sørlandet sykehus HF - Arendal (N=) Helse Nord-Trøndelag HF - Sykehuset Namsos (N=3) Helgelandssykehuset HF - Mo i Rana (N=15) Sykehuset Innlandet HF - Gjøvik (N=3) Helse Førde HF - Førde sentralsjukehus (N=15) Helse Møre og Romsdal HF - Volda sjukehus (N=11) Helse Nord-Trøndelag HF - Sykehuset Levanger (N=51) Sørlandet sykehus HF - Flekkefjord (N=95) Helse Bergen HF - Voss sjukehus (N=19) Sykehuset Innlandet HF - Kongsvinger (N=35) Universitetssykehuset Nord-Norge HF - Avd Narvik (N=) 93, % % 7 % % 9 % 1 % Andel ikke-reopererte brudd Percent not reoperated 13
Figure 5: Waiting time from fracture to surgery. The figure shows waiting time, sorted by proportion of fractures treated within hours after the fracture at the different hospitals in the period 1-1. Hospitals with n<1 have been excluded. Universitetssykehuset Nord-Norge HF - Avd Narvik (N=3) Sykehuset Telemark HF - Rjukan (N=1) Sykehuset Innlandet HF - Tynset (N=153) Helse Møre og Romsdal HF - Volda sjukehus (N=9) Sørlandet sykehus HF - Arendal (N=3) Helse Møre og Romsdal HF - Kristiansund Sjukehus (N=35) Helse Møre og Romsdal HF - Molde Sjukehus (N=1) Vestre Viken HF - Bærum sykehus (N=77) Sørlandet sykehus HF - Flekkefjord (N=19) Sykehuset Innlandet HF - Gjøvik (N=717) Helse Førde HF - Førde sentralsjukehus (N=) Vestre Viken HF - Kongsberg sykehus (N=3) Helse Finnmark HF - Klinikk Hammerfest (N=173) Helse Møre og Romsdal HF - Ålesund sjukehus (N=) Sykehuset Innlandet HF - Kongsvinger (N=51) Helse Finnmark HF - Klinikk Kirkenes (N=) Helse Nord-Trøndelag HF - Sykehuset Namsos (N=5) Sykehuset Telemark HF - Notodden (N=3) Helse Stavanger HF - Stavanger Universitetssykehus (N=1115) Diakonhjemmet sykehus (N=1) Vestre Viken HF - Drammen sykehus (N=79) St. Olavs Hospital HF - Orkdal sjukehus (N=333) Nordlandssykehuset HF - Lofoten (N=55) Universitetssykehuset Nord-Norge HF - Avd Harstad (N=93) Sykehuset Innlandet HF - Lillehammer (N=39) Nordlandssykehuset HF - Bodø (N=1) Nordlandssykehuset HF - Vesterålen (N=135) Sykehuset Innlandet HF - Elverum (N=7) Vestre Viken HF - Ringerike sykehus (N=533) Helgelandssykehuset HF - Mo i Rana (N=31) Haraldsplass Diakonale Sykehus (N=) Sykehuset Telemark HF - Skien (N=9) Sykehuset i Vestfold HF - Tønsberg (N=11) Helse Nord-Trøndelag HF - Sykehuset Levanger (N=57) Helse Fonna HF - Stord sjukehus (N=19) Helse Fonna HF - Haugesund sjukehus (N=3) Sørlandet sykehus HF - Kristiansand (N=9) Oslo universitetssykehus HF Ullevål - Ort senter, Kirkeveien (N=71) Helse Bergen HF - Haukeland universsjukehus (N=15) St. Olavs Hospital HF - universitetssykhehuset i Trondheim (N=9) Sykehuset Østfold HF - Fredrikstad (N=979) Sykehuset Østfold Kalnes (N=) Helse Bergen HF - Voss sjukehus (N=5) Akershus universitetssykehus HF (N=1573) Universitetssykehuset Nord-Norge HF - Avd Tromsø (N=3) % 5% 5% 75% 1% Tid Time fra from brudd fracture til operasjon to surgery - - timer hours - timer hours Mer More enn than timer hours 1
Completeness analysis for the Norwegian Hip Fracture Register, 13-1 A completeness analysis has been conducted for the Norwegian Hip Fracture Register (NHFR) for primary operations (osteosynthesis, partial and total arthroplasty) and revisions (following primary osteosynthesis, partial and total arthroplasty for hip fractures) performed in the period 13-1. A report and analysis have been prepared by the Norwegian Patient Register (NPR) in cooperation with the NHFR. A report on the implementation and results will be published at www.helsedirektoratet.no. Formulae for completeness rates: Completeness rate NHFR Completeness rate NPR = = Only NHFR + Inclusion in both registers Only NPR + Only NHFR + Inclusion in both registers Only NPR + Inclusion in both registers Only NHFR + Only NPR + Inclusion in both registers For details of the NSCP and ICD-1 codes used when extracting data from the NPR for comparison of primary and revision surgery in the NHFR and for the complete results, please consult the Completeness Analysis Report, which will be published at www.helsedirektoratet.no. Primary hip fracture surgery. Information in the NHFR showed a high degree of agreement with the information in the NPR. Completeness for osteosynthesis was.%, for hemiarthroplasty 93.% and for total arthroplasty 3.9%. However, there are considerable variations in completeness between hospitals. Over 1/3 of hospitals have under %, which we consider very low. One explanation for low completeness rates in NHFR may be patients not giving consent to registration of the data. The differences between rates for primary osteosynthesis, hemiarthroplasty and total arthroplasty show that this cannot be the only cause and that hospitals must improve their reporting of primary hip fracture surgery with the correct diagnostic and procedure codes. Completeness for primary total hip arthroplasty for fractures is lower than completeness for all total arthroplasties reported to the Norwegian Arthroplasty Register (NAR). We believe that part of the reason is coding practices and we are currently investigating this further. Revisions. The information in the NHFR did not agree with NPR data as well as for primary surgery. Completeness for reoperations after osteosynthesis was 5.%, after hemiarthroplasty 7.9%, and after total arthroplasty 9.1%. The overall rate for reoperations was 9.5%. It has been particularly challenging to perform completeness analyses for reoperations. The fact that the NPR does not specify left or right side leads to some uncertainty in the analysis. Furthermore, coding of revisions reported to the NPR is often imprecise or incorrect. Low completeness may mean that the revision form was not sent to the NHFR or that the surgery was incorrectly coded in the NPR. We would like to point out that all revisions of partial and total arthroplasty due to infection (including those where prosthetic parts are not changed or removed) must be reported on a form to the NHFR or NRL. These must be given the codes NFS 19, NFS 9 or NFW 9. The following pages show the hospital-based completeness analysis for primary operations and reoperations. We urge hospitals with low completeness to review their coding practices and routines in reporting to the registers. 15
Completeness analysis for primary operations for Hip Fractures 13-1 Sykehuset Innlandet HF - Kongsvinger Universitetssykehuset i Nord-Norge HF - Harstad Helse Stavanger HF - Stavanger universitetssykehus St. Olavs hospital HF - Orkdal Helse Fonna HF - Haugesund Vestre Viken HF - Kongsberg Helse Møre og Romsdal HF - Volda sjukehus Nordlandssykehuset HF - Vesterålen Sykehuset Østfold HF - Kalnes/Fredrikstad Sykehuset Innlandet HF - Gjøvik Vestre Viken HF - Ringerike Sykehuset i Vestfold HF Helse Bergen HF - Haukeland universitetssykehus Haraldsplass diakonale sykehus Diakonhjemmet Sykehuset Telemark HF - Skien Sykehuset Innlandet HF - Elverum Helse Møre og Romsdal HF - Molde sjukehus Helse Finnmark HF - Klinikk Hammerfest Sykehuset Telemark HF - Notodden Helse Nord-Trøndelag HF - Sykehuset Levanger Akershus universitetssykehus HF Helse Bergen HF - Voss sjukehus Sykehuset Innlandet HF - Tynset Vestre Viken HF - Drammen Helse Møre og Romsdal HF - Ålesund sjukehus Vestre Viken HF - Bærum Sørlandet sykehus HF - Kristiansand Helse Fonna HF - Stord Helse Nord-Trøndelag HF - Sykehuset Namsos Nordlandssykehuset HF - Lofoten Helse Møre og Romsdal HF - Kristiansund sjukehus Nordlandssykehuset HF - Bodø Sørlandet sykehus HF - Flekkefjord Universitetssykehuset i Nord-Norge HF - Narvik Sørlandet sykehus HF - Arendal St. Olavs hospital HF - Trondheim Oslo universitetssykehus HF Universitetssykehuset i Nord-Norge HF - Tromsø Oslo universitetssykehus HF - Ullevål Sykehuset Telemark HF - Rjukan Helgelandssykehuset - Mo i Rana Helse Førde HF - Førde Helgelandssykehuset - Sandnessjøen Helse Finnmark HF - Klinikk Kirkenes Sykehuset Innlandet HF - Lillehammer Helse Fonna HF - Odda Oslo universitetssykehus HF - Rikshospitalet Helse Bergen HF - Hagevik Martina Hansens hospital Osteosynthesis Hemiarthroplasty hip arthroplasty 99.1 (1) 97.7 (177) 97. (5) 9. (19) 9. (7) 95 (11) 9.7 (133) 9.1 (51) 9 () 9 (1) 93. (1) 9.3 () 9.1 () 91.1 (35) 91 (55) 9.9 (9) 9.1 (93) 9. (15) 9 (1).9 (5). (33). (75) 7. (197) 7. (95) 7. (31) 7.1 (1) 7 (3) 5. ().1 (17) 3. (13) 3.3 ().1 (173).7 (33).3 (117) 7. (7) 7 () 75. (31) 7.1 (15) 73. (35) 73. (19) 9. (9) 7. (195). (9) 3. (19) 1.7 () 3. () 1.3 (1) (1) - (-) - (-) 1 (19) 1 (7) 1 (19) 1 (9) 9.5 (197) 1 (9) 9.7 (75) 95. () 97. (5) 9.1 (17) 1 (13) 95.3 (3) 9. (75) 9.9 (13) 95.5 (397) 9.3 (17) 9.1 (7) 9. (7) 97. () 1 (5) 9.3 (119) 93. (517) 9. (1) 9.9 (3) 9. (17) 97.9 (15) 9. (5) 9 (1) 9.3 (39) 1 () 9.5 (1). (91) 95. (135) 97. () 1. (11) 91.5 (11) 9.1 (33) 9. (11) 9.7 (75) 93.1 (11) 1 (15) 9. () 77. (1) - (-) 7.3 (3). (15) - (-) 1 (1) - (-) - (-) 1 (9) 1 () 3 (11) 1 (1) 1 () 91.7 (1) 1 (1) 1 (1) 95. (1) 1 (1) 7.5 (1).7 (3).9 (1) 9 (1) 7.7 (3) 9.5 (19) 91. (3) 7.5 () 1 (3).7 (3) 5.7 (7) 93. () 9.9 (11) 1 (7) 93. (1) 1 (). (13) (1) 1 (5).7 (3) 1 (1) 5.5 (11).7 (1) - (-) 5 () 7.7 (11).7 (53) (15) 1 () 9. () - (-). (1) 5 () - (-) 75 () 9. (3) - (-) 1 (1) 1 (1) 1 (1) 1 Dark blue bars and first number to the right of the bars gives completeness of reporting for osteosynthesis. Medium blue bars and second number to the right of the bars gives completeness of reporting for hemiarthroplasty. Light blue bars and third number to the right of the bars gives completeness of reporting for total hip arthroplasty. The numbers in parenthesis gives the number of operations 1 registered at both NHFR and NPR. Vertical lines shows the national averages.
Completeness analysis for reoperations after Hip Fractures 13-1 Lovisenberg diakonale sykehus Oslo universitetssykehus HF - Rikshospitalet Privatsykehuset i Haugesund Aleris Helse - Oslo Aleris Helse - Drammen Helse Stavanger HF - Stavanger universitetssykehus Sykehuset Innlandet HF - Tynset Haraldsplass diakonale sykehus Universitetssykehuset i Nord-Norge HF - Narvik Sykehuset Innlandet HF - Kongsvinger Sørlandet sykehus HF - Kristiansand Universitetssykehuset i Nord-Norge HF - Harstad Helse Bergen HF - Hagevik Vestre Viken HF - Kongsberg Sørlandet sykehus HF - Flekkefjord Sykehuset Telemark HF - Rjukan Helse Bergen HF - Haukeland universitetssykehus Sykehuset i Vestfold HF Helse Bergen HF - Voss sjukehus St. Olavs hospital HF - Trondheim Helse Møre og Romsdal HF - Molde sjukehus Diakonhjemmet Helse Nord-Trøndelag HF - Sykehuset Levanger Helse Fonna HF - Stord Helse Møre og Romsdal HF - Kristiansund sjukehus Akershus universitetssykehus HF Nordlandssykehuset HF - Bodø Helse Førde HF - Førde Vestre Viken HF - Ringerike Sykehuset Telemark HF - Notodden Universitetssykehuset i Nord-Norge HF - Tromsø Sørlandet sykehus HF - Arendal Sykehuset Innlandet HF - Lillehammer Helse Nord-Trøndelag HF - Sykehuset Namsos Nordlandssykehuset HF - Vesterålen Vestre Viken HF - Drammen Oslo universitetssykehus HF - Ullevål Helse Fonna HF - Haugesund Sykehuset Østfold HF - Kalnes/Fredrikstad Helse Møre og Romsdal HF - Volda sjukehus St. Olavs hospital HF - Orkdal Sykehuset Telemark HF - Skien Oslo universitetssykehus HF Sykehuset Innlandet HF - Elverum Sykehuset Innlandet HF - Gjøvik Helse Møre og Romsdal HF - Ålesund sjukehus Sykehuset Østfold HF - Moss Martina Hansens hospital Helgelandssykehuset - Mo i Rana Helse Finnmark HF - Klinikk Kirkenes Vestre Viken HF - Bærum Helse Finnmark HF - Klinikk Hammerfest Nordlandssykehuset HF - Lofoten Helgelandssykehuset - Mosjøen St. Olavs hospital HF - Røros Helse Fonna HF - Odda Osteosynthesis Hemiarthroplasty hip arthroplasty 1 (1) 1 (5) 1 (1) 1 (1) - (-) 1 (1) 1 (1) - (-) - (-) 1 (1) - (-) - (-) 1 (3) - (-) - (-) 93. (17) 71. (1) (5).9 (9) 1 () - (-) 3.9 (31) 5 () - (-) 3.3 (1) - (-) - (-) 1.5 (7). (19) - (-) 1.1 (37) 73.7 (19) 1 (1) (1) 1 (1) - (-) (15) - (-) - (-) 7.9 () - (-) - (-) 75 () (5) - (-) 75 () - (-) - (-) 7.7 (99) 9.1 (51) 1 () 7. (5) (5) - (-) 7. () 1 () - (-).9 (7).7 () 1 (7). (1) (5) - (-). (7) 7.1 (31) - (-).1 (7) 5 () - (-) 7.9 () 5 () - (-).7 () (5) 1 (1) (153) 1. (3) - (-) 5. () 5.5 (11) 1 (1) 3. () 33.3 () 1 (1) 3 (7) 5.7 (7) - (-).5 () 71. (7) - (-).5 () (5) 1 (1).9 () 5.3 (1) - (-).7 (). (9) - (-) (1) 1 () - (-) (5) () - (-) 57. (59) 7.9 () 1 (3) 57. (33).7 (1) 1 (1) 57.5 () 3.3 () - (-) 5.9 (5) 7. (33) - (-) 5.5 (11) 5 () - (-) 5 (5) 5 () - (-) 53.7 (7) 7. (17) - (-) 51.9 (7) 7.5 (17) 75 () 5 () 57.9 (19) - (-) (5) (15) 1 (1) 5 () 33.3 () 1 (3). (9) - (-) - (-) 3. (1) 1 (1) - (-).9 () () - (-) (1) 33.3 (3) 1 (1) 3. () 7.7 () - (-) 5 () (5) - (-) 1.7 () 5 () - (-) () (1) - (-) (17) () - (-) (1) - (-) - (-) 1 Dark blue bars and first number to the right of the bars gives completeness of reporting for osteosynthesis. Medium blue bars and second number to the right of the bars gives completeness of reporting for hemiarthroplasty. Light blue bars and third number to the right of the bars gives completeness of reporting for total hip arthroplasty. The numbers in parenthesis gives the number of operations registered at both NHFR and NPR. Vertical lines shows the national averages. 17
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CONTENTS Norwegian Cruciate Ligament Register Introduction... 1 Survival for cruciate ligament operations... KOOS by primary ACL reconstructions... 5 KOOS by revisions... Annual numbers of cruciate ligament primary operations in 1... 7 All categories of operations Annual numbers of operations... 9 Distribution of hospitals by surgery volume... 9 Incidence of primary reconstruction of cruciate ligament for 5, 1 and 15. 3 Distribution of other procedures... 3 Intraoperative complications... 3 Primary reconstrucion of cruciate ligament Age by primary operation... 33 Activity that lead to injury... 33 Actual injury... 3 Additional injuries... 3 Choice of graft... 35 Fixation... 37 Meniscal lesion... 3 Fixation... 39 Cartilage lesion... 39 Cartilage injuries... Outpatient surgery... 1 Intraoperative complications... 1 Systemic antibiotic prophylaxis... 1 Thrombosis prophylaxis... NSAID s... 3 Revision reconstruction Age by revision... Activity that lead to injury... Actual injury... 5 Additional injuries... 5 Reason for revision reconstruction... Choice of graft... Fixation... Meniscal lesion... 9 Fixation... 5 Cartilage lesion... 5 Cartilage injuries... 51 Outpatient surgery... 53 Intraoperative complications... 53 Systemic antibiotic prophylaxis... 53 Thrombosis prophylaxis... 5 NSAID s... 5 19
NORWEGIAN CRUCIATE LIGAMENT REGISTER 17 ANNUAL REPORT SKDE (The Centre for Clinical Documentation and Evaluation) has a strong influence on our everyday work. SKDE requires an annual report with results from the various hospitals to be published on the website of the Service Centre and easily available to anyone who wishes to consult it (https://www.kvalitetsregistre.no/registers/nasjonalt-korsbandregister). The challenge here may be to explain certain results that seem somehow unrelated. In the information on the number of ACL reconstructions, quite a few hospitals report between two and nine ACL reconstructions per year. This figure is so low that it is probably not advisable to operate on so few patients, and referring these patients to a higher volume hospital should be considered. There has been a great deal of discussion about the publication of results. This should be now be laid to rest; it has been decided that results are to be published and in the future we should concentrate on providing the public with good information and helpful responses to queries, and pursuing any questions that may arise. We live in an age of openness and should definitely view this in a positive light. SKDE will probably also require revision rates, infection rates and KOOS scores to be published from the various hospitals. Only our register has good information on revision rates. The same procedure code is used for reconstruction of ACL and revision of ACL. For this reason, NPR will not receive details of the revisions. We therefore do not know compliance for revisions. We have received an inquiry about this and I have stated that it is desirable to have a separate procedure code for revisions of ACL. At Haukeland University Hospital, we have begun electronic registration of the ACL form filled out by doctors. In order to enter the correct fixation devices, we use a barcode scanning system that works very well. For authentication, we use either an SMS code or identification with a chip in the ID card, which is also used for e-prescriptions. Authentication via SMS is only possible if the person has his or her own mobile phone. When logging in, the person receives a four-digit code to be used for access and to enter the data. This also works well. When the data have been entered, they are collated, and the forms can be submitted to the database. Work on the electronic form has taken somewhat longer than expected, partly to correct mistakes discovered, but also to wait for the website to be produced in new versions. The scanning system has not yet been fully clarified with the supplier. The biggest change in the Cruciate Ligament Register is that efforts are now being made to include non-operated patients. This is the so-called non-op study by Guri Ekås. This is a multi-centre study that follows patients with ACL ruptures to see how they manage in the future. When the electronic form for non-operated patients has been produced, the electronic registration pilot will be expanded to centres that have considerable primary contact with ACL injuries. Injuries within the past six months will be recorded and the patients followed in the same way as primary operated patients, using KOOS. With regard to the KOOS forms, it has been unclear how these have been sent out in relation to revisions. If a revision of an ACL reconstruction is reviewed, the KOOS forms should be 1
sent out again after the revision at, 5 and 1 year intervals. It is emphasised that this takes place from the date of the revision. Then the forms will not be sent out after the original ACL reconstruction. Here routines must be changed and improved. In the presentation of the results, we have changed the diagrams to bar charts, which are easier to view and relate to. In 1, a total of 15 primary ACL reconstructions and 195 revisions were performed. Socalled other procedures are treatments after a primary reconstruction; there were 1 of these. There has obviously been underreporting here. The explanation is probably that these operations are performed in places and under circumstances where those involved are not so concerned that the patient has had a previous ACL reconstruction. This is a general problem in corresponding registers. It also means that important information is lacking. We have regularly had information in Norsk ortopedpost in the form of News from the Cruciate Ligament Register. This is general information about what is happening in the Register, and we find it a useful place to provide such information. Our coverage rate has been just under %. That is not satisfactory, and we must attempt to raise this. Patient consent is an absolute requirement. The patient must fill out the consent form and the form must be stored outside the hospital s patient record. We have been in contact with lawyers from the Data Protection Office, and the requirement is that the statement of consent must not be kept in the patient record. It must be stored separately, in a secure, lockable cabinet inside a locked door. The statement of consent must be available on request. This is until now an absolute requirement. The operation forms are required to be submitted to the Register. Please refer to bestillingsdokumentet (ordering document) from the Ministry of Health and Care Services, and if this has not been done, the hospital director must be contacted. It is optional for the patient to give consent for a form to be filled out. There are currently many national and international projects based on the Cruciate Ligament Register. A follow-up study from previous two-year results in a Scandinavian cohort is now including results after five and ten years for ACL reconstructed patients with knees with simultaneous meniscus and cartilage damage. There will be a study of risk of revision in relation to activity at the time of injury, while another project is looking into the significance of BMI and graft thickness for revision risk in hamstring ACLR. Another study is exploring re-revisions and the effect of possible predictors of this. In an REK-approved student thesis at the University of Bergen, data is being collected for the validation of data in the Cruciate Ligament Register and KOOS results. In addition, the Register is collaborating with the Swedish register on a study of revision factors and predictors of patient-related outcomes, and also on a comparison of baseline data between a number of ACL registers, led by Kaiser Permanente (USA).
Endre Søreide et al. have published an article in AJSM concerning revision risk in relation to reported use of NSAIDs. Jon H Røtterud et al. have published an article in AJSM, where they examine two-year follow-up of a cohort of ACL patients from Norway and Sweden. Svend Ulstein et al. have published an article showing no negative effect on PROMs for simultaneous cartilage injuries 5-9 years after ACLR. Many thanks to all of you who send in the form regularly. Bergen, 1..17 Lars Engebretsen Chairman of the Steering Committee Knut Fjeldsgaard Chief Physician Irina Kvinnesland IT Consultant Stein Håkon Låstad Lygre Biostatistician 3
Mean 1 9 7 KOOS with primary ACL reconstruction without additional injury Before years 5 years 5 3 Pain Symptoms ADL Sport QOL Mean 1 9 7 KOOS with primary ACL reconstruction with additional injury Before years 5 years 5 3 Pain Symptoms ADL Sport QOL 5
KOOS with revision reconstructions Mean with 95% CI 1 9 7 5 Before years 3 Pain Symptoms ADL Sport QOL
Annual numbers of cruciate ligament primary operations in 1 Oslo universitetssykehus HF Ullevål, Ort. senter, Storgata Martina Hansens Hospital Lovisenberg Diakonale Sykehus Akershus universitetssykehus HF Vestre Viken HF - Drammen sykehus Sykehuset Innlandet HF - Elverum Sykehuset i Vestfold HF - Larvik Vestre Viken HF - Bærum sykehus Sykehuset Innlandet HF - Gjøvik Sykehuset Telemark HF - Porsgrunn Sørlandet sykehus HF - Kristiansand Sykehuset Østfold HF - Moss Sykehuset Telemark HF - Notodden Vestre Viken HF - Ringerike sykehus Sørlandet sykehus HF - Arendal Sykehuset Innlandet HF - Lillehammer Oslo universitetssykehus HF Ullevål - Ort. senter, Kirkeveien Sykehuset Telemark HF - Skien Aker Universitetssykehus HF - Ski Sykehuset Innlandet HF - Kongsvinger Sykehuset Østfold Kalnes Haraldsplass Diakonale Sykehus Helse Bergen HF - Haukeland universitetssjukehus Helse Stavanger HF - Stavanger Universitetssykehus Helse Fonna HF - Haugesund sjukehus Helse Førde HF - Lærdal sjukehus Helse Førde HF - Førde sentralsjukehus St. Olavs Hospital HF - universitetssykehuset i Trondheim Helse Møre og Romsdal HF - Kristiansund Sjukehus Helse Møre og Romsdal HF - Ålesund sjukehus St. Olavs Hospital HF - Røros sjukehus Helse Nord-Trøndelag HF - Sykehuset Levanger Helse Nord-Trøndelag HF - Sykehuset Namsos Universitetssykehuset Nord-Norge HF - Avd. Tromsø Nordlandssykehuset HF - Bodø Helse Finnmark HF - Klinikk Hammerfest Helgelandssykehuset HF - Mo i Rana Universitetssykehuset Nord-Norge HF - Avd. Narvik Aleris Rosenborg Idrettens Helsesenter Aleris Frogner Aleris Hinna Park Aleris Tromsø Ringvoll Klinikken - Hobøl ALERIS Drammen Norsk Idrettsmedisinsk Institutt Ringvoll Klinikken - Oslo Volvat medisinske senter Aleris Nesttun Oslofjordklinikken Aleris Colosseum Olso Aleris Solsiden Aleris Colosseum Stavanger Ringvoll Klinikken - Askim 5 1 3 111 1 5 1 39 5 15 3 1 1 1 13 1 1 9 7 9 39 31 31 3 3 53 775 5 9 17 117 13 1 7 5 1 15 5 Helse Sør-Øst Helse Vest Helse Midt-Norge Helse Nord Privat 7
The Norwegian Cruciate Ligament Register Cruciate Ligament All categories of operations Table 1: Annual numbers of operations 1 15 1 13 1-11 Primary reconstruction Revision reconstruction Only other procedures 15 ( 1,% ) 195 (,% ) 1 ( 9,% ) 177 (,% ) ( 1,% ) 11 ( 7,5% ) 173 ( 1,% ) 51 ( 11,% ) 17 (,9% ) 1773 (,1% ) 7 ( 9,% ) 19 (,1% ) 173 ( 3,% ) ( 1,3% ) 13 (,1% ) 1555 ( 7,7% ) 97 (,% ) 7 ( 5,5% ) 3 157 13 19 133 1311 1 ( 5,5% ) 9 (,3% ) 151 (,% ) 57 Registration complete from 5. 9,% of the operations were performed on the right side. 3,% of the operations were performed on females. 7,3% of the patients had a previous ACL/PCL-injury in the opposite knee. (11,% was missing). Mean age was,7 years, 7, years for women and 9, years for men. Standard deviation of age was 1, years, 11,1 years for women and 9,9 years for men. Median value for duration of primary ACL reconstruction was 71 minutes. Figure 1: Distribution of hospitals by surgery volume, primary ACL reconstructions Number of hospitals 15 1 5 1-5 -1 11-1- 1-1- 1-1 > 1 5 1 1 13 1 15 1 Figure : Distribution of hospitals by surgery volumes, revision reconstructions ACL Number of hospitals 15 1 5 1-3-5-1 11-1- 1-5 1 1 13 1 15 1 Cruciate Ligament 9
Report 17 Figure 3: Incidence of primary reconstruction of cruciate ligament for 5, 1 and 15 Number of operations per 1, inhabitants 1 1 1 Women - 5 Men - 5 Women - 1 Men - 1 Women - 15 Men - 15 1-19 -9 3-39 -9 5-59 -9 Age Distribution of other procedures Table : The number of other procedures for all categories of surgeries Artrodesis Osteosynthesis Bone resection (Notch plasty) Osteotomy Bone transplantation Removal of implants Surgery due to infection Mobilizing in narcosis Arthroscopic debridement Synovectomy Cartilage surgery Meniscus surgery 1 1 51 7 11 9 5 19 7 15 11 5 3 3 7 51 31 5 31 5 1 9 1 3 1 9 1 13 79 13 5 1 31 1 1 913 77 9 75 1 9 55 5 1 3 1-11 599 19 9 33 93 15 13 7 17 175 9 77 93 77 51 31 5 3 3 Cruciate Ligament
The Norwegian Cruciate Ligament Register Table 3: Distribution of other procedures in combination with primary reconstruction of cruciate ligament Table : Distribution of other procedures in combination with primary reconstruction of cruciate ligament 1 13 1 17 15 7 59 9 1 1 13 11 1 x Meniscus surgery x x x Cartilage surgery Synovectomy Arthroscopic debridement Removal of implants x x x x x x x x x x x Bone resection (Notch plasty) x x x x x x x x x x x x x x x x x 71 11 3 7 15 1 11 x Meniscus surgery Cartilage surgery x x x x Removal of implants Bone transplantation x x x x x x x x x x Bone resection (Notch plasty) x x x x x x x x X indicates applied procedure and each row gives the number of operations that is carried out with this combination of procedures. The table shows only combinations that have a number of ten or more. X indicates applied procedure and each row gives the number of operations that is carried out with this combination of procedures. The table shows only combinations that have a number of ten or more. Cruciate Ligament 31
Report 17 Table 5: Distribution of other procedures when this is the only procedure Bone transplantation Removal of implants Surgery due to infection Mobilizing in narcosis Arthroscopic debridement Synovectomy Cartilage surgery Meniscus surgery 51 x 17 x 9 x 5 x 5 55 x x x 1 x 35 x x 9 x x x x x x x x 17 15 1 1 13 1 1 11 11 11 1 x x x x x x x x x x x x x x x x x x x x x x x x X indicates applied procedure and each row gives the number of operations that is carried out with this combination of procedures. The table shows only combinations that have a number of ten or more. Intraoperative complications Table : Intraoperative complications for all categories of surgeries 1 15 1 13 1-11 Yes No Missing 9 (,% ) 1 ( 95,1% ) (,7% ) (,9% ) 35 ( 9,3% ) (,% ) 59 (,% ) 1995 ( 93,% ) ( 3,% ) (,% ) 195 ( 93,% ) (,% ) (,1% ) ( 95,9% ) 3 (,% ) 7 ( 3,3% ) 1357 ( 9,9% ) ( 1,9% ) 3 157 13 19 133 1311 71 ( 3,% ) 3737 ( 9,7% ) 597 (,% ) 57 3 Cruciate Ligament
The Norwegian Cruciate Ligament Register Primary reconstruction of cruciate ligament Figure : Age by primary operation 5 5 Number of patients 35 3 5 15 1 Number in 11 Number in 1 Number in 13 Number in 1 Number in 15 Number in 1 Mean number * 5 7-7 5-9 - 55-59 5-5 5-9 - 35-39 3-3 5-9 - 15-19 okt.1 * Mean number of primary operations for - 1 Figure 5: Activity that lead to injury 1 % % % % % % 1 1 1 1 Activities (total < 15) Alpine (incl twin tip) Other physical activity Other team sports Other ski activities Other Work Basketball Fall/jump/violence/playing Soccer Handball Martial art Snowboard Traffic Unknown/Missing Cruciate Ligament 33
Report 17 Actual injury Table 7: Actual injury* ACL PCL MCL LCL PLC Cartilage Meniscus 1 1 1 51 19 9 15 15 175 5 17 35 995 1 1713 5 171 35 3 931 13 1755 3 19 5 3 379 1 17 3 15 3 1 379 93-11 13 33 79 179 1 313 1 111 57 15 391 53 191 * More than one type of injury can be given for each form Additional injuries Table : ACL with additional injuries Number ACL PCL MCL LCL PLC Meniscus Cartilage 7797 x 73 x x 7 x x x 137 x x 5 x x 15 x x x 5 x x x x 15 x x x 1 x x 7 x x x x x x 1 x x x x 7 x x 1 x x x x x x indicates registered injury and each row tell the number of incidences of different combination of injuries. The first row gives the number of records where ACL where the only injury. The table shows only combinations that have a number of or more. 3 Cruciate Ligament
The Norwegian Cruciate Ligament Register Table 9: PCL with additional injuries Number ACL PCL MCL LCL PLC Meniscus Cartilage 99 x 7 x x x 1 x x x x 35 x x x x x x 7 x x 3 x x x x x 1 x x 1 x x x 1 x x x x 15 x x x x 13 x x x 1 x x x x x x 1 x x x x indicates registered injury and each row tell the number of incidences of different combination of injuries. The first row gives the number of records where PCL where the only injury. The table shows only combinations that have a number of 1 or more. Choice of graft for injuries registered in primary reconstructions Table 1: BPTB ACL PCL MCL LCL PLC 1 11 15 97 1 1 73 1 13 57 1 5 1-11 359 1 75 7 1 Table 11: HAMSTRING ACL PCL MCL LCL PLC 1 55 3 15 5 15 7 9 17 3 1 95 19 7 13 11 1 1 7 1 17 1 3 3-11 71 1 1 11 9 Table 1: ALLOGRAFT 13 3 191 5 31 ACL PCL MCL LCL PLC 1 7 15 5 1 1 1 3 1 13 7 1 5 1 1-11 37 13 5 7 3 Cruciate Ligament 35
Report 17 Table 13: Suture ACL PCL MCL LCL PLC 1 1 1 15 1 7 3 1 1 1 1 13 7 3 1 3-11 3 7 7 1 1 1 99 53 Table 1: Other ACL PCL MCL LCL PLC 1 1 15 37 1 1 1 17 5 13 3 1 1 1 1-11 1 7 5 19 3 1 There are 1 forms where there are registered product for ACL and 3 forms for PCL but not checked for choice of graft. Figure : Choice of graft for all injuries in primary reconstructions Proportion (%) of operations 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 1 1 1 1 Other Suture Allograft HAMSTRING BPTP 3 Cruciate Ligament
The Norwegian Cruciate Ligament Register Fixation Table 15: Femur ACL (The 5 most common) Product -11 1 13 1 15 1 Profile Interference Scr 3 5 5 55 53 9 ToggleLoc 9 1 115 157 71 7 Endobutton CL BTB 3 1 5 1 11 1 9 SoftSilk 597 119 135 1 39 Endobutton CL Ultra 9 933 99 75 5 33 Table 1: Tibia ACL (The 5 most common) Product -11 1 13 1 15 1 Biosure PK 51 117 7 133 13 5 7 Intrafix Screw 15 11 153 97 9 39 Biosure HA Interferenc 195 71 31 3 17 SoftSilk 35 11 1 35 33 53 57 RCI Screw 93 799 1 77 Table 17: Femur PCL (The 5 most common) Product -11 1 13 1 15 1 Sheated Cannulated Int 5 1 Guardsman Femoral 3 1 Peek Interference Scre 1 3 5 3 1 RCI Screw 3 19 5 SoftSilk 3 7 1 1 Endobutton CL Ultra 199 95 1 19 15 Table 1: Tibia PCL (The 5 most common) Product -11 1 13 1 15 1 Biosure HA Interferenc 3 3 5 7 BioRCI-HA 5 5 3 3 SoftSilk 1 3 1 AO Skrue 7 5 7 1 5 7 RCI Screw 39 17 11 9 9 19 15 Table 19: Femur and tibia ACL (The 5 most common) Femur Tibia -11 1 13 1 15 1 Endobutton CL Ultra Biosure PK 11 7 11 1 51 15 Endobutton CL BTB SoftSilk 57 1 3 193 17 Endobutton CL Ultra Biosure HA 17 59 31 73 1 1 1 Interference screw Endobutton CL Ultra RCI Screw 9 999 5 1 39 175 17 SoftSilk SoftSilk 111 11 1 97 359 Cruciate Ligament 37
Report 17 Meniscal lesion Table : Actual treatment of meniscal lesion Resection OLD Partial Suture 1 Lateral 313 3 1 Medial 9 31 35 15 Lateral 3 3 1 15 Medial 3 39 1 Lateral 9 13 1 Medial 7 3 3 13 Lateral 9 99 13 Medial 7 3 1 1 Lateral 1 3 9 1 Medial 1 9 33 17-11 Lateral 19 1 1 35-11 Medial 353 175 759 11 9 351 91 Synthetic Meniscus fixation Transplant. Trepanation None 9 59 7 5 3 7 9 3 1 7 1 11 9 3 5 3 1 1 57 9 3 1 5 3 3 91 59 7 57 5 1 57 5 59 31 79 3 9 153 13 It became possible to register "Trepanation" and "None" from 1.1.5. There have been forms where this has been an additional information. This information have been registered, but the registration is not complete before 5. In table 7: Actual injury has less. The reason for this is that we distinguish between the lateral and medial injury and some injuries are registreded in both groups. The value in OLD Resection are the forms that are registered before the new forms were introduced in autumn 11. and Partial Resection values are the new forms were introduced in autumn 11. Figure 7: Treatment of meniscal lesions in primary reconstructions Proportion (%) of operations 1 % 9 % % 7 % % 5 % % 3 % % 1 % % 1 1 1 1 None Trepanation Meniscus Transplant. Synthetic fixation Suture Resection 3 Cruciate Ligament
The Norwegian Cruciate Ligament Register Fixation Table 1: Synthetic Product 5 7 Contour Meniscus arrow 13 7 3 5 1 FAST-FIX 17 1 7 3 1 5 Meniscal Dart 19 3 Meniscal Dart Stick 7 1 5 1 Meniscus arrow 31 1 1 1 1 Unknown 3 3 11 1 9 9 7 39 3 17 3 1 7 5 9 1 1 9 1 11 1 13 1 15 1 Table : Suture Product 5 7 ANNET FAST-FIX 7 5 1 99 11 17 19 3 319 39 Meniscal Dart Stick 1 1 Meniscus arrow 7 3 Rapidloc 7 9 1 19 Unknown 39 1 1 3 3 3 9 5 5 71 9 3 1 13 13 39 373 5 9 1 11 1 13 1 15 1 Cartilage lesion all localizations Table 3: ICRS Grade Definition of ICRS Grade: 1. Nearly normal: Superficial lesions, soft indentation and/or superficial fissures and cracks.. Abnormal: Lesions extending down to <5% of cartilage depth. 3. Severely abnormal: Cartilage defects extending down >5% of cartilage depth as well as down to calcified layer.. Severely abnormal: Osteochondral injuries, lesions extending just through the subchondral boneplate or deeper defects down into trabecular bone. Code 1 Code Code 3 Code Missing 1 37,9%,3% 1,1% 3,%,% 15 31,% 3,5% 19,1% 5,%,3% 1 3,% 5,5% 17,% 5,% 1,7% 13 5,1% 5,%,%,%,3% 1,% 7,3%,7% 5,1%,% -11 3,1% 1,% 15,1%,3% 1,5% Table : Treatment codes for all localizations Debridement Micro fracture No treatment Other Missing 1 9,1% 1,9% 77,3% 11,% 15 1,3% 3,%,1% 3,9% 1 13,3% 3,% 77,%,9%,% 13 19,7% 3,9% 73,1%,% 3,% 1 1,5% 5,1% 7,%,%,9% -11 1,3%,9% 5,% 1,3% 7,1% Cruciate Ligament 39
Report 17 Cartilage injuries registered in primary reconstructions Figure : All Cartilage injuries (total),9% 1,5% 35,% Medial Lateral Lateral Medial 9,97% 7,% 1,1% 1,5% Figure 9: All Cartilage injuries with area greater than cm² and ICRS equal 3 or (total) 11,1% 9,% 7,3% Medial Lateral Lateral Medial,75% 5,5% 7,% 11,5% Cruciate Ligament
The Norwegian Cruciate Ligament Register Outpatient surgery Table 5: Outpatient surgery 1 15 1 13 1-11 Yes No Missing 19 ( 71,1% ) 517 (,3% ) 1 (,5% ) 1 ( 7,% ) 515 ( 9,1% ) 13 (,7% ) 11 ( 7,1% ) 55 ( 3,% ) 1 (,9% ) 11 (,5% ) 1 ( 3,7% ) 13 (,7% ) 1 (,9% ) 553 ( 31,% ) (,1% ) 5777 (,% ) 71 ( 53,5% ) (,5% ) 15 177 173 1773 173 1555 1157 ( 55,3% ) 975 (,% ) 11 (,5% ) 1 Intraoperative complications Table : Intraoperative complications 1 15 1 13 1-11 Yes No Missing (,3% ) 1735 ( 95,1% ) (,% ) 5 ( 3,% ) 173 ( 9,% ) 5 (,5% ) 55 ( 3,% ) 1 ( 93,3% ) 1 ( 3,5% ) 53 ( 3,% ) 157 ( 93,5% ) 3 ( 3,% ) 39 (,% ) 1711 ( 9,% ) 33 ( 1,9% ) 3 ( 3,% ) 1191 ( 9,9% ) ( 1,% ) 15 177 173 1773 173 1555 ( 3,1% ) 3 ( 9,7% ) 7 (,% ) 1 Systemic antibiotic prophylaxis Table 7: Systemic antibiotic prophylaxis 1 15 1 13 1-11 Yes No Missing 13 ( 99,9% ) (,% ) (,1% ) 177 ( 99,7% ) 1 (,1% ) (,% ) 1735 ( 99,% ) 1 (,1% ) (,1% ) 17 ( 99,% ) (,1% ) 9 (,5% ) 1777 ( 99,7% ) 5 (,3% ) 1 (,1% ) 1 ( 99,% ) 93 (,7% ) 3 (,3% ) 15 177 173 1773 173 1555 19 ( 99,3% ) 1 (,5% ) 5 (,% ) 1 Cruciate Ligament 1
Report 17 Table : Drug -11 1 13 1 15 1 Benzylpenicillin (Penicillin G),11%,% Cefaleksin (Keflex, Cefalexin),% Cefalotin (Keflin) 9,% 9,5% 9,91% 9,5% 9,5% 9,9% Cefotaksim (Claforan),17% Cefuroksim (Zinacef, Cefuroxim, Lifurox),5%,5%,5%,3%,5% Ciprofloksasin (Ciproxin),1%,% Dikloksacillin (Diclocil, Dicillin),1%,9%,91%,75%,%,1% Doksysyklin (Vibramycin, Dumoxin, Doxylin),1% Erytromycin (Ery-max, Abboticin),%,% Gentamicin (Garamycin, Gensumycin),%,1% Klindamycin (Dalacin, Clindamycin),% 1,97%,1%,7% 1,3%,3% Kloksacillin (Ekvacillin),99%,5%,7% 3,3% 3,11%,33% Linkomycin (Lincocin),1% Oxacillin (Unspecified),17%,17% Tobramycin (Nebcina, Nebcin, Tobi),11% Missing,1%,51%,75%,%,7% Thrombosis prophylaxis Table 9: Thrombosis prophylaxis 1 15 1 13 1 5-11 Yes No Missing 191 ( 1,7% ) 3 ( 17,9% ) (,% ) 15 (,% ) ( 13,5% ) (,% ) 1 (,% ) 31 ( 17,3% ) 9 (,5% ) 19 (,% ) 7 ( 15,% ) 1 (,% ) 173 (,% ) 3 ( 17,3% ) (,1% ) 93 (,3% ) 13 ( 1,1% ) ( 1,9% ) 15 177 173 1773 173 117 13 ( 1,5% ) 3575 ( 17,3% ) 59 ( 1,3% ) 77 There are 33 old forms that are filled out so that thrombosis prophylaxis can not be registered. These are added to missing. Table 3: Use of drugs One drug Two drugs 1 15 1 13 1 5-11 173 ( 9,% ) 1 ( 1,% ) 1519 ( 99,% ) 9 (,% ) 11 ( 99,% ) 1 (,% ) 1 ( 9,% ) 1 ( 1,% ) 17 ( 99,% ) 3 (,% ) 9379 ( 99,% ) 55 (,% ) 191 15 1 19 173 93 175 ( 99,3% ) 11 (,7% ) 13 Cruciate Ligament
The Norwegian Cruciate Ligament Register Table 31: Drug 5-11 1 13 1 15 1 Acetylsalicylsyre (Albyl-E, Globoid, Acetyratio, Magnyl E),7%,7% Dabigatranetixalat (Re-Novate, Pradaxa),1%,7% Dalteparin (Fragmin),5% 7,9%,% 5,3% 5,%,1% Dekstran (Macrodex, Dextran),3%,7%,7%,35%,%,7% Enoksaparin (Klexane) 35,5% 31,3% 3,3% 1,95% 39,9% 37,3% Heparin (Heparin),1% Rivaroksaban (Xarelto),1%,1%,7%,7%,7% Warfarin (Marevan),1%,1%,% Ximelagatran (Exanta, Malagatran),3% Missing,7% No drugs 3,75%,7% Missing,17%,1%,3%,%,59%,% Two drugs,5%,% 1,1%,%,59% 1,1% NSAID's Table 3: NSAID's 1 15 1 13 1 11 1 9 7 Yes No Missing 9 ( 9,5% ) 77 (,1% ) (,% ) 7 (,7% ) 9 ( 51,% ) 37 (,1% ) 715 ( 1,1% ) 97 ( 5,% ) 7 (,7% ) 757 (,7% ) 955 ( 53,9% ) 1 ( 3,% ) 5 ( 5,1% ) 9 ( 51,9% ) 5 (,9% ) 9 (,1% ) ( 7,% ) 3 (,5% ) 73 ( 3,% ) 9 (,3% ) 17 ( 1,1% ) 31 (,7% ) 39 ( 3,% ) 3 (,9% ) 57 ( 3,% ) 1 (,7% ) 9 ( 1,3% ) 9 ( 5,% ) 7 (,7% ) 13 ( 9,% ) 15 177 173 1773 173 159 17 15 1 133 71 (,5% ) 7 (,% ) 37 ( 17,% ) 1773 Table 33: Drug 7-11 1 13 1 15 1 Celecoksib (Celebra) 1,% 1,% 5,%,9%,73%,33% Diklofenak (Voltaren, Diclofenac, Cataflam) 9,5% 93,17%,79%,1% 5,% 57,7% Etoricoksib (Arcoxia),%,37%,11% 1,% 37,97% 3,% Ibuprofen (Ibux, Ibumetin) 1,5%,37%,79%,9% 1,9% 3,5% Ketorolak (Toradol),7% 3,73% 3,9%,3% 3,% 1,99% Naproksen (Vimovo),1%,%,% Parecoksib (Dynastat),%,%,11% Piroxicam (Brexidol),1%,1% Missing 1,7%,37% 1,% 1,% 1,1% 1,% Cruciate Ligament 3
Report 17 Revision reconstruction Figure 1: Age by primary operation Number of patients 7 5 3 1 Number in 11 Number in 1 Number in 13 Number in 1 Number in 15 Number in 1 Mean number * 5-9 - 55-59 5-5 5-9 - 35-39 3-3 5-9 - 15-19 okt.1 * Mean number of primary operations for - 1 Figure 11: Activity that lead to injury 1 % % % % % Alpine (incl twin tip) Other physical activity Other team sports Other ski activities Other Work Basketball Fall/jump/violence/playing Soccer Handball Martial art Motor sport Snowboard Traffic Unknown/Missing % 1 1 1 1 Cruciate Ligament
The Norwegian Cruciate Ligament Register Actual injury Table 3: Actual injury* ACL PCL MCL LCL PLC Cartilage Meniscus 1 1 3 3 99 15 15 7 3 73 91 1 195 3 1 59 13 1 3 5 3 1 1 195 71-11 95 9 9 9 37 33 11 39 51 1 71 7 * More than one type of injury can be given for each form Figure 1: Actual injury 1 % Proportion (%) of injuries 9 % % 7 % % 5 % % 3 % % 1 % % 5 7 9 1 11 1 13 1 15 1 ACL PCL MCL LCL PLC Cartilage Meniscus Additional injuries Table 35: ACL with additional injuries Number ACL PCL MCL LCL PLC Meniscus Cartilage 71 x 35 x x 31 x x x x x 1 x x x x x x indicates registered injury and each row tell the number of incidences of different combination of injuries. The first row gives the number of records where ACL where the only injury. The total number will be identical to the total number of registered ACL injuries. The table shows only combinations that have a number of more than 5. Cruciate Ligament 5
Report 17 Table 3: PCL with additional injuries Number ACL PCL MCL LCL PLC Meniscus Cartilage 11 x x x x x x x 3 x x x x indicates registered injury and each row tell the number of incidences of different combination of injuries. The first row gives the number of records where PCL where the only injury. The total number will be identical to the total number of registered PCL injuries. The table shows only combinations that have a number of more than. Reason for revision reconstruction Table 37: Reason for revision reconstruction Cause 1 Cause Cause 3 Cause Cause 5 Cause Other 1 9 5 17 75 1 1 15 1 3 11 1 1 1 19 1 3 1 19 1 37 13 1 11 1 13 7 5 1 1 1 3 95 99 3 1-11 9 3 7 3 7 7 5 31 7 7 9 5 35 173 Cause 1: Infection Cause : Fixation failure Cause 3: Untreated ligamentinjury Cause:: Graft failure Cause 5: New trauma Cause : Pain Choice of graft for injuries registered in revision reconstructions Table 3: BPTB ACL PCL MCL LCL PLC 1 3 15 9 1 1 13 91 1 11-11 35 39 Table 39: HAMSTRING ACL PCL MCL LCL PLC 1 3 1 1 1 15 5 1 1 1 5 1 1 13 5 1 1 1 53 1-11 97 1 1 73 7 1 1 Cruciate Ligament
The Norwegian Cruciate Ligament Register Table : ALLOGRAFT ACL PCL MCL LCL PLC 1 1 1 1 3 15 7 3 1 7 1 1 1 13 3 1 1 1 5-11 3 1 5 5 3 1 1 1 Table 1: Suture / Other ACL PCL MCL LCL PLC 1 7 15 15 1 13 1 13 3 1 1 15-11 19 3 7 3 1 1 It was registered direct suture for two cases (PLC, MCL). Figure 13: Choice of graft for all injuries in revision reconstruction 1 % Proportion (%) of operations % % % % Suture / Other Allograft Hamstring BPTP % 1 1 1 1 Cruciate Ligament 7
Report 17 Fixation Table : Femur ACL (The 5 most common) Product -11 1 13 1 15 1 Profile Interference Screw 3 1 5 3 Sheated Cannulated Interference 5 1 13 1 13 15 Screw Endobutton CL BTB 11 9 3 17 13 Endobutton CL Ultra 39 1 5 9 3 SoftSilk 17 53 1 Table 3: Femur PCL (The 5 most common) Product -11 1 13 1 15 1 EndoButton CL Guardsman Femoral 1 Propel Cannulated ComposiTCP 3+ 1 1 SoftSilk 1 1 RCI Screw 11 1 1 Endobutton CL Ultra 1 3 3 Table : Tibia ACL (The 5 most common) Product -11 1 13 1 15 1 Sheated Cannulated Interference 5 1 11 11 11 Screw Propel Cannulated 9 3 1 1 7 9 Biosure HA Interference screw 191 39 9 3 9 RCI Screw 3 3 1 1 1 11 15 SoftSilk 3 17 5 59 39 5 Table 5: Tibia PCL (The 5 most common) Product -11 1 13 1 15 1 BioRCI-HA 1 1 Intrafix Screw 1 1 Propel Cannulated 3 1 AO Skrue 3 1 RCI Screw 1 1 1 Table : Femur and tibia ACL (The 5 most common) Femur Tibia -11 1 13 1 15 1 Endobutton CL BTB Propel Cannulated 31 1 7 Sheated Cannulated Sheated Cannulated 1 1 11 11 Interference Screw Interference Screw Endobutton CL Ultra RCI Screw 11 71 1 1 1 7 Endobutton CL Ultra Biosure HA 137 15 7 3 31 1 Interference screw SoftSilk SoftSilk 35 11 7 3 5 33 1 Cruciate Ligament
The Norwegian Cruciate Ligament Register Meniscal lesion Table 7: Actual treatment of meniscal lesion Resection OLD Partial Suture 1 Lateral 1 1 1 Medial 35 13 15 Lateral 19 15 Medial 39 17 1 Lateral 1 1 Medial 9 17 13 Lateral 9 13 Medial 3 1 1 Lateral 1 1 Medial 1 1-11 Lateral 5 1 7 15-11 Medial 19 3 1 3 7 9 13 Synthetic Meniscus fixation Transplant. Trepanation None 1 1 11 17 1 3 1 1 1 1 7 1 13 5 73 3 71 3 1 5 3 15 7 9 11 1 1 173 9 It became possible to register "Trepanation" and "None" from 1.1.5. There have been forms where this has been an additional information. This information have been registered, but the registration is not complete before 5. In table 3: Actual injury has less. The reason for this is that we distinguish between the lateral and medial injury and some injuries are registreded in both groups. The value in OLD Resection are the forms that are registered before the new forms were introduced in autumn 11. and Partial Resection values are the new forms were introduced in autumn 11. Figure 1: Treatment of meniscal lesions in revision reconstructions 1 % 9 % Proportion (%) of operations % 7 % % 5 % % 3 % % 1 % % 1 1 1 1 None Trepanation Meniscus Transplant. Synthetic fixation Suture Resection Cruciate Ligament 9
Report 17 Fixation Table : Synthetic Product 5 7 9 1 11 1 13 1 15 1 Contour Meniscus arrow 3 1 Meniscus arrow 1 1 Unknown 1 3 3 1 1 3 Table 9: Suture Produktnavn 5 7 ANNET 1 1 FAST-FIX 11 3 5 5 1 1 19 1 1 Meniscus arrow 1 1 Rapidloc 1 1 Unknown 39 1 1 5 9 13 157 7 5 9 15 1 5 5 9 1 11 1 13 1 15 1 Cartilage lesion all localizations Table 5: ICRS Grade Definitjon av ICRS Grade: 1. Nearly normal: Superficial lesions, soft indentation and/or superficial fissures and cracks.. Abnormal: Lesions extending down to <5% of cartilage depth. 3. Severely abnormal: Cartilage defects extending down >5% of cartilage depth as well as down to calcified layer.. Severely abnormal: Osteochondral injuries, lesions extending just through the subchondral boneplate or deeper defects down into trabecular bone. Code 1 Code Code 3 Code Missing 1 3,%,7% 1,%,7%,5% 15 9,7%,3%,9%,% 1,1% 1 1,%,% 3,9% 3,5% 1,% 13,% 7,% 3,1% 3,7% 1,5% 1 1,3% 5,% 31,7% 7,1% 1,% -11 1,1% 5,1% 1,%,5% 1,% Table 51: Treatment codes for all localizations Debridement Micro fracture No treatment Other Missing 1,% 1,%,% 3,% 15 1,%,% 7,% 1,7% 5,7% 1 3,5%,% 3,3% 1,% 7,% 13 1,7%,% 71,% 7,5% 1 1,3% 3,% 7,%,% -11 5,7%,% 7,7% 1,5%,9% 5 Cruciate Ligament
The Norwegian Cruciate Ligament Register Cartilage injuries registered in revision reconstructions Figure 15: All Cartilage injuries (total),% 1,71% 3,% Medial Lateral Lateral Medial 9,7%,3% 1,3% 17,% Figure 1: All Cartilage injuries with area greater than cm² (total),31% 11,71% 9,3% Medial Lateral Lateral Medial 7,1%,91% 1,11% 1,9% Cruciate Ligament 51
Report 17 Figure 17: All Cartilage injuries with area greater than cm² and ICRS equal 3 or (total) 11,5% 1,7% 39,3% Medial Lateral Lateral Medial 7,3%,3% 7,3% 17,7% 5 Cruciate Ligament
The Norwegian Cruciate Ligament Register Outpatient surgery Table 5: Outpatient surgery 1 15 1 13 1-11 Yes No Missing 9 ( 5,% ) 15 ( 53,% ) 1 (,5% ) 117 ( 5,% ) 11 ( 5,1% ) (,7% ) 15 ( 9,% ) 1 ( 9,% ) (,% ) 9 (,% ) 1 ( 51,% ) 5 (,% ) 1 ( 5,5% ) 99 ( 5,% ) 1 (,5% ) 355 ( 3,5% ) 13 ( 3,1% ) (,% ) 195 51 7 97 9 ( 3,% ) 11 ( 55,5% ) 19 (,9% ) 9 Intraoperative complications Table 53 : Intraoperative complications 1 15 1 13 1-11 Yes No Missing ( 3,1% ) 1 ( 95,% ) 3 ( 1,5% ) ( 3,% ) ( 9,% ) 1 (,5% ) 3 ( 1,% ) 35 ( 93,% ) 13 ( 5,% ) 7 ( 3,% ) 19 ( 91,3% ) 11 ( 5,3% ) 5 (,3% ) ( 9,5% ) 7 ( 3,% ) (,1% ) 91 ( 93,% ) (,3% ) 195 51 7 97 9 ( 3,3% ) 193 ( 93,5% ) ( 3,% ) 9 Systemic antibiotic prophylaxis Table 5: Systemic antibiotic prophylaxis 1 15 1 13 1-11 Yes No Missing 1 ( 95,% ) ( 3,1% ) 3 ( 1,5% ) ( 9,% ) 3 ( 1,3% ) 1 (,% ) 9 ( 99,% ) (,% ) ( 9,% ) ( 1,% ) 1 (,5% ) 1 ( 9,% ) 3 ( 1,% ) 1 (,5% ) 95 ( 9,% ) 11 ( 1,1% ) 3 (,3% ) 195 51 7 97 33 ( 9,3% ) 7 ( 1,3% ) 9 (,% ) 9 Table 55: Drug -11 1 13 1 15 1 Benzylpenicillin (Penicillin G),% Cefalotin (Keflin) 93,11%,3% 91,7% 9,7% 9,73% 9,39% Ceftriakson (Rocefalin),% Cefuroksim (Zinacef, Cefuroxim, Lifurox),%,% Ciprofloksasin (Ciproxin),% Dikloksacillin (Diclocil, Dicillin),%,93% 1,7%,% Gentamicin (Garamycin, Gensumycin),% Klindamycin (Dalacin, Clindamycin),19%,17% 3,3% 3,1% 3,1% 1,1% Kloksacillin (Ekvacillin) 1,%,3%,5%,%,7% Oxacillin (Unspecified),% Vankomycin (Vancomycin, Vancocin),1% Missing,31%,%,9%,% 1,% Cruciate Ligament 53
Report 17 Thrombosis prophylaxis Table 5: Thrombosis prophylaxis Yes No Missing 1 13 (,7% ) 57 ( 9,% ) (,1% ) 195 15 17 ( 7,% ) 7 ( 1,% ) 1 (,% ) 1 1 (,1% ) 9 ( 19,5% ) 1 (,% ) 51 13 173 ( 3,% ) 3 ( 15,5% ) ( 1,% ) 7 1 13 ( 3,% ) 3 ( 1,% ) 1 (,5% ) 5-11 71 (,1% ) 171 ( 1,5% ) 15 ( 1,% ) 97 1 ( 79,% ) 39 ( 19,% ) ( 1,% ) There are old forms that are filled out so that thrombosis prophylaxis can not be registered. These are added to missing. There are 7 forms with two drugs and 11 forms with one drug. Table 57: Drug 5-11 1 13 1 15 1 Apixiban (Eliquis),5% Dalteparin (Fragmin) 5,5% 7,1% 73,1% 5,1% 5,5% 5,1% Dekstran (Macrodex, Dextran),13%,5% Enoksaparin (Klexane) 31,9% 3,79% 5,3% 39,3%,1%,3% Rivaroksaban (Xarelto),5% Warfarin (Marevan),57% Ximelagatran (Exanta, Malagatran),% No drugs 1,9% Missing,13% 1,%,75% Two drugs,7%,5%,5%,57%,75% NSAID's Table 5: NSAID's 1 15 1 13 1 7-11 Yes No Missing 7 ( 3,% ) 11 (,5% ) 1 ( 5,1% ) ( 3,% ) 135 (,3% ) 7 ( 3,1% ) ( 31,9% ) 17 (,5% ) ( 1,% ) (,% ) 119 ( 57,5% ) ( 1,9% ) ( 3,% ) 13 ( 59,1% ) (,7% ) 17 ( 7,5% ) 33 (,5% ) 13 (,% ) 5 ( 3,9% ) 999 ( 5,% ) 19 ( 1,9% ) 1777 195 51 7 Table 59: Drug Celecoksib (Celebra),53%,3% 7-11 1 13 1 15 1 Diklofenak (Voltaren, Diclofenac, Cataflam) 9,51% 9,% 73,1%,75% 5,1%,% Etoricoksib (Arcoxia) 1,% 1,19% 17,5% 3,59%,7% Ibuprofen (Ibux, Ibumetin) 1,% 1,9% Ketorolak (Toradol),% 9,5% 19,5% 1,%,% 1,9% Parecoksib (Dynastat) 1,19% Piroxicam (Brexidol),53% Missing,53%,3% 3,75% 1,% 1,9% 5 Cruciate Ligament
CONTENTS Norwegian Paediatric Hip Register Introduction... 57 Number of treated patients... 5 Hip dysplasia... 59 Epifysiolysis Capitis Femoris... Calvè-Legg-Perthes... 55
5
PAEDIATRIC HIP REGISTER 1 ANNUAL REPORT The Paediatric Hip Register is now in its sixth year of operation, and we are very pleased to have obtained the status of a national quality register. This means that all hospitals that treat children with the relevant hip disorders are now required to report to our register. In addition, we are now ensured more funding for future data collection, which also involves stricter requirements for good organisation and reporting in our register. Anne Kristin Reve, PhD candidate and assistant doctor at the Orthopaedic Department of Stavanger University Hospital has completed a coverage analysis in cooperation with the Norwegian Patient Register (NPR) of data in the register. Much effort has gone into this analysis, and it has been especially difficult to obtain reliable figures on patients who were only outpatients. The analysis therefore focused most strongly on operated patients. The figures show that we still need to get more reports in and we will therefore conduct a new analysis in two years time. For the past two years, we have been cooperating with Swedish paediatric orthopaedists, who have now established their own paediatric orthopaedic register. We aim to use as similar parameters as possible in the two national registers to enable data to be compared and used in larger studies. In this regard, we will also cooperate on joint Patient-Recorded Outcome Measures (PROMs) to be used in both registers. We have started to translate PROMIS Ped into Norwegian; this is validated for children from -17 years, with a separate version for children as young as four. With regard to open and arthroscopic hip surgery in young adults, a group has been formed to draft a new form for these operations, to ensure that the most useful parameters are recorded. For this part of the register, we plan to use IHOT 1, a questionnaire containing 1 questions which is a simplified version of IHOT 33. IHOT 1 has now been translated and is ready for use. The collection of radiographs of children in the Register is functioning satisfactorily, and work is now well underway to clean the files and measure the radiographs. Ola Wiig has leave from his post as a chief physician this spring, specifically to undertake this work. To improve reporting to the registry, we have started planning electronic registration forms. We have got the green light to begin this work, and hope to have completed it during 17. Trude Gundersen Haukeland University Hospital General Manager Ola Wiig Oslo University Hospital Head of the Steering Committee 57
Number of treated patients registered in the Paediatric Hip Register 1 15 Year of primary operation 1 13 1 11 Open Hip Surgery Slipped Capital Femoral Epiphysis Perthes Disease Hip Dysplasia 1 1 1 Number of patients 5
PAEDIATRIC HIP DISEASE Hip Dysplasia The Norwegian Paediatric Hip Register Table 1: HD - New cases per year Year diagnosed Unilateral Bilateral Missing 1 1 1 33 15 37 1 51 1 5 1 1 13 51 19 7 1 7 31 15 11 19 5 1 9 1 17 9 1 7 7 1 1 5 1 1 1 1 1 Unknown 3 3 3 55 19 1 1 Table : HD - Earlier treatment Treatment year None Pillow / abd. orthosis Other Missing 1 31 9 7 15 3 15 15 1 3 1 11 13 9 1 9 39 93 1 1 13 11 1 9 97 1 13 17 Unknown 1 11 75 More than one form for patient per side is possible. Table 3: HD - Hip status Year treated Located Partially dislocated Luksert Missing 1 9 1 7 7 15 53 17 9 15 1 15 35 11 13 5 1 17 93 1 1 3 13 13 11 5 13 3 7 97 1 3 9 9 17 Unknown 1 1 1 19 55 75 More than one form for patient per side is possible Paediatric Hip 59
Report 17 Table : HD - Acetabular index Year diagnosed < 15 < < 5 < 3 < 35 < < 5 >= 5 Missing 1 5 5 11 33 15 1 3 13 7 1 7 51 1 1 3 1 5 1 1 13 1 1 1 1 7 1 5 11 1 1 13 15 11 1 3 11 5 11 5 1 3 5 3 5 1 1 1 13 17 9 1 3 3 7 1 1 7 1 1 1 1 5 1 1 1 1 1 1 1 Unknown 5 7 3 1 1 3 5 1 17 73 59 13 1 1 Mean number used for both hips for bilateral HD, Table 5: HD - Non-operative treatment Treatment year Pillow Plaster Abduction orthosis Closed reduction No treatment/ obs. Missing 1 9 1 7 1 3 5 15 5 3 9 3 1 13 1 7 3 7 13 7 9 3 1 1 3 7 1 5 13 11 1 3 5 9 1 3 5 9 1 13 9 1 1 3 1 7 3 1 1 5 5 1 1 Unknown 1 1 1 3 15 9 9 3 5 Table : HD - Reduction - Surgical Treatment year Yes 1 15 1 1 1 13 1 1 11 1 1 1 7 Paediatric Hip
The Norwegian Paediatric Hip Register Table 7: HD - Femoral osteotomy Treatment year Varising Rotation Shortening 1 5 11 15 5 3 1 1 1 1 13 5 3 1 1 11 3 1 1 1 3 1 5 3 19 7 9 Table : HD - Pelvic osteotomy Treatment year Salter Periacetab. Dega Triple Periacetab. osteotomy Other 1 1 7 1 9 15 5 7 3 15 1 1 13 1 1 3 3 11 1 5 1 1 1 1 3 1 3 5 Table 9: HD - Tenotomi Treatment year Psoas tenotomy Adductor tenotomy 1 15 1 1 1 13 1 1 5 5 1 11 3 3 1 5 13 3 7 Paediatric Hip 1
Report 17 Slipped Capital Femoral Epiphysis (ECF) Table 1: ECF - New cases per year Year diagnosed Unilateral Bilateral 1 5 9 15 1 7 3 1 1 3 13 17 11 1 1 5 1 11 9 35 1 1 7 9 7 1 3 1 1 5 1 1 1 1 Unknown 15 1 5 17 5 5 Table 11: ECF - Classification Year diagnosed Acute Chronic Acute on chronic Stable (Able to bear weight) Unstable (Unable to ambulate) 1 5 1 1 1 15 5 1 19 1 1 1 13 9 13 3 1 5 19 5 1 9 5 1 5 11 1 7 1 1 3 17 7 9 1 1 1 1 5 1 1 Unknown 11 1 1 9 113 3 131 Table 1: ECF - Symptoms duration Year diagnosed < weeks - weeks 9 - weeks 7-5 weeks > 5 weeks 1 1 1 15 1 1 1 1 1 13 1 3 3 9 1 3 3 1 11 11 5 3 3 1 1 3 1 7 1 1 Unknown 1 1 1 5 7 Paediatric Hip
The Norwegian Paediatric Hip Register Table 13: ECF - Degree of slippage Year diagnosed < 3 3-5 > 5 1 11 1 7 15 1 1 9 7 13 11 11 1 7 3 5 15 11 11 7 1 15 7 5 1 1 Unknown 3 5 1 3 5 3 17 Table 1: ECF - Type of primary operation Year treated Screw osteosynthesis Femoral osteotomy Pin osteosynthesis 1 31 5 3 15 3 1 1 3 1 3 13 3 11 3 1 1 9 3 11 1 15 1 1 13 3 9 1 1 175 3 7 5 Table 15: ECF - Primary operation - Osteosynthesis with screws Year treated ------------- Number of screws ------------- ------------------- Brand ------------------- 1 screw screws > screws Olmed Richards Smith+N. 1 7 1 3 13 1 1 15 1 1 11 3 1 3 5 1 3 13 1 1 1 7 1 1 1 3 7 11 15 3 1 1 19 3 13 9 1 1 Smith+N. = Smith and Nephew 19 1 5 9 Table 1: ECF - Primay operation - Osteosynthesis with pins ------------ Number of pins ------------ ------------------ Diameter ------------------ Year treated 1 3 > 3,3,5, 3, 3, 1 1 3 1 1 15 5 3 1 1 1 1 13 1 1 1 7 1 5 1 11 1 3 5 1 1 1 1 1 1 9 1 1 5 9 35 1 Paediatric Hip 3
Report 17 Perthes Disease (CLP) Table 17: CLP - Number of new cases per year Year diagnosed Unilateral Bilateral 1 1 1 15 3 7 1 35 1 3 13 39 1 1 3 5 11 1 59 1 71 9 1 3 7 3 3 1 1 5 1 1 3 5 5 1 1 1 Unknown 35 1 9 3 33 Table 1: CLP - Catterall Year diagnosed I/II III/IV Missing 1 5 1 3 1 15 9 17 1 7 5 3 13 11 3 1 1 5 5 11 11 1 1 1 7 71 9 1 3 7 1 3 1 1 5 1 1 1 1 3 1 5 1 3 1 1 1 1 1 Unknown 1 1 31 1 13 7 33 I/II = < 5 % caput necrosis III/IV = < 5 % caput necrosis Paediatric Hip
The Norwegian Paediatric Hip Register Table 19: CLP - Treatment Year treated None/ physiotherapy Abduction orthosis Femoral osteotomy Salter Dega Periacetabular Other pelvic osteotomy 1 17 19 1 37 15 9 1 3 1 3 11 9 13 3 13 5 1 3 3 3 11 31 15 1 1 5 1 3 31 Table : CLP - Plates and screws Year treated Prebent plate Angel plate Special plate Normal screws Angle-stable screws 1 13 5 15 15 1 1 1 1 7 13 1 9 3 1 1 1 7 11 19 5 9 1 1 7 3 5 3 7 1 9 3 5 Paediatric Hip 5
PUBLICATIONS Doctoral thesis (3 in total) Norwegian Arthroplasty Register (1 in total) Havelin LI. Hip arthroplasty in Norway 197-199. The Norwegian Arthroplasty Register [dissertation]. Bergen, Norway: University of Bergen, 1995. Espehaug B. Quality of total hip replacements in Norway 197-199. The Norwegian Arthroplasty Register [dissertation]. Bergen, Norway: University of Bergen, 199. Furnes O. Hip and knee replacement in Norway 197-. The Norwegian Arthroplasty Register [dissertation]. Bergen, Norway: University of Bergen,. Lie SA. Survival studies of total hip replacements and postoperative mortality [dissertation]. Bergen, Norway: University of Bergen,. Flugsrud GB. Risk factors for disabling osteoarthritis of the hip and for revision hip surgery. An epidemiological investigation [dissertation]. Oslo, Norway: University of Oslo, 5. Hallan G. Wear, fixation, and revision of total hip prostheses [dissertation]. Bergen, Norway: University of Bergen, 7. Monstad K. Essays on the Economics of health and fertility [dissertation]. Bergen, Norway: The Norwegian school of economics and business administration, 7. Arthursson AJ. Surgical approach and muscle strength in total hip arthroplasty [dissertation]. Bergen, Norway: University of Bergen,. Lygre SH. Pain, function and risk of revision after primary knee arthroplasty [dissertation]. 1 University of Bergen; Bergen, Norway. Lehmann TG. Slipped capital femoral epiphysis. Diagnostics, treatment and long-term outcome [dissertation]. 13 University of Bergen; Bergen, Norway. Dale H. Infection after primary hip arthroplasty. Epidemiology, time trends and risk factors in data from national health registers [dissertation]. 13 University of Bergen; Bergen, Norway. Engesæter IØ. Hip dysplasia in young adults [dissertation]. 13 University of Bergen; Bergen, Norway. Gøthesen Ø. Computer navigation in total knee replacement surgery. Effect on outcome [dissertation]. 13 University of Bergen; Bergen, Norway. Lindalen E. Reverse hybrid total hip replacement: Wear, fixation and bone remodeling [dissertation]. 13 University of Oslo; Oslo, Norway. Gillam MH. Time to event analysis of arthroplasty registry data [dissertation]. 13 The University of Adelaide; Australia. Schrama JC. Infected hip and knee arthroplasties in rheumatoid arthritis [dissertation]. 1 7
University of Bergen; Bergen, Norway. Pankewitsch K. Modellierung eines Monitoringsystems zur Risikosteuerung in der Hűftendoprothetik [dissertation]. 1 der Juristischen und Wirtschaftswissenschaftlichen Fakultät, der Martin-Luther-Universität; Halle-Wittenberg, Deutschland. ISBN 97-3-3-77-. Hilde Apold. Modifiable risk factors for severe osteoarthritis in the hip and knee [dissertation]. 15 University of Oslo; Oslo, Norway Dybvik E. Cancer and total hip replacement [dissertation]. 15 University of Bergen; Bergen, Norway. Badawy M. Influence of hospital procedure volume on the risk of revision in knee arthroplasty surgery [dissertation]. 1 University of Bergen; Bergen, Norway. Leta TH. Revision knee arthroplasty in Norway 199-11 [dissertation]. 17 University of Bergen; Bergen, Norway. Norwegian Hip Fracture Register ( in total) Gjertsen JE. Surgical treatment of hip fractures in Norway [dissertation]. Bergen, Norway: University of Bergen, 9. Matre K. Treatment of trochanteric and subtrochanteric hip fractures. Sliding hip screw or intramedullary nail? [dissertation]. 13 University of Bergen; Bergen, Norway. Bakken M. Barriers for improving medication in older adults [dissertation]. 15 University of Bergen; Bergen, Norway Talsnes Ove. Femoral neck fractures treated with hemiprosthesis: Comorbidity, organ affection and bone cement. On the quest for factors affecting mortality [dissertation]. 1 University of Oslo; Oslo, Norway. Norwegian Cruciate Ligament Register ( in total) Granan LP. Development of a national knee ligament registry [dissertation]. 9 University of Oslo; Oslo, Norway. Moksnes H. Functional and radiological outcomes following a non-operative treatment algorithm after ACL injuries in skeletally immature children [dissertation]. 13 University of Oslo; Oslo, Norway. Gifstad T. Results after ACL reconstruction Clinical and registry-based studies [dissertation]. 1 University of Trondheim; Trondheim, Norway. Røtterud JH. Focal cartilage lesions in anterior cruciate ligament-injured knees. Incidence, risk, prognosis and treatment [dissertation]. 15 University of Oslo; Oslo, Norway. Norwegian National Advisory Unit on Arthroplasty and Hip Fractures (5 in total) Figved PW. Hemiarthroplasty and femoral neck fractures [dissertation]. 1 University of Oslo; Oslo, Norway.
Laborie LB. Hip Dysplasia and femoroacetabular impingement. Studies in newborns and young adults with focus on radiology and clinical epidemiology [dissertation]. 13 University of Bergen; Bergen, Norway. Young S. Orthopaedic trauma surgery in low-income countries. Follow-up, infections and HIV [dissertation]. 1 University of Bergen; Bergen, Norway. Kadar TK. Wear and migration in cemented total hip arthroplasty [dissertation]. 1 University of Bergen; Bergen, Norway. Blomquist J. Surgical treatment of shoulder instability in Norway [dissertation]. 1 University of Bergen; Bergen, Norway. Articles ( in total) Norwegian Arthroplasty Register (157 in total) Engesæter LB, Havelin LI, Espehaug B, Vollset SE. [Artificial hip joints in Norway. A national registry of total hip arthroplasties.] Tidsskr Nor Laegefor 199;11:7-5. Havelin LI, Espehaug B, Vollset SE, Engesæter LB, Langeland N. The Norwegian Arthroplasty Register. A survey of 17, total hip replacements. Acta Orthop Scand 1993;:5-51. Havelin LI, Espehaug B, Vollset SB, Engesæter LB. Early failures among 1,9 cemented and 1,3 uncemented prostheses for primary coxarthrosis. The Norwegian Arthroplasty Register, 197-199. Acta Orthop Scand 199;5:1-. 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 1995;77-B:11-7. Havelin LI, Espehaug B, Vollset SE, Engesaeter LB. The effect of cement type on early revision of Charnley total hip prostheses. A review of,579 primary arthroplasties from the Norwegian Arthroplasty Register. J Bone Joint Surg 1995;77-A:153-5. Havelin LI, Vollset SE, Engesæter LB. Revision for aseptic loosening of uncemented cups in.35 primary total hip prostheses. A report from the Norwegian Arthroplasty Register. Acta Orthop Scand 1995;:9-5. Espehaug B, Havelin LI, Engesæter LB, Vollset SE, Langeland N. Early revision among 1,179 hip prostheses. A comparison of 1 different prosthesis brands reported to the Norwegian Arthroplasty Register, 197-1993. Acta Orthop Scand 1995;:7-93. Engesæter LB, Furnes A, Havelin LI, Lie SA, Vollset SE. [The hip registry. Good economy for society.] Tidsskr Nor Lægefor 199;11:35-7. 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 199;11:19-51. Furnes A, Lie SA, Havelin LI, Engesæter LB, Vollset SE. The economic impact of failures in total hip replacement surgery. The Norwegian Arthroplasty Register 197-1993. Acta Orthop Scand 199;7:115-1. 9
Furnes A, Lie SA, Havelin LI, Engesæter LB. [Quality control of prosthetic replacements of knee, ankle, toe, shoulder, elbow and finger joints in Norway 199. A report after the first year of registration of joint prostheses in the national registry.] Tidsskr for Nor Lægefor 199;11:1777-1. Reigstad A. [Joint prostheses-development, quality and public regulation]. Tidsskr Nor Lægefor 199 Oct ;11(5):99-1. 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 1997;:7-15. Espehaug B, Engesæter LB, Vollset SE, Havelin LI, Langeland N. Antibiotic prophylaxis in total hip arthroplasty. Review of 1,95 primary cemented total hip replacements reported to the Norwegian Arthroplasty Register, 197-1995. J Bone Joint Surg 1997;79-B:59-5. Furnes O, Lie SA, Havelin LI, Vollset SE, Engesæter LB. Exeter and Charnley arthroplasties with Boneloc or high viscosity cement. Comparison of 117 arthroplasties followed for 5 years in the Norwegian Arthroplasty Register. Acta Orthop Scand 1997;:515-. Espehaug B, Havelin LI, Engesæter LB, Langeland N, Vollset SE. Patient satisfaction and function after primary and revision total hip replacement. Clin Orthop 199;351:135-. 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 39,55 primary total hip replacements reported to the Norwegian Arthroplasty Register, 19-199. Acta Orthop Scand 1999;7:1-. Havelin LI. The Norwegian Joint Registry. Bull Hosp Jt Dis. 1999;5:139-. Havelin LI, Espehaug B, Lie SA, Engesæter LB, Furnes O, Vollset SE. The Norwegian Arthroplasty Register. 11 years and 73, arthroplasties. Acta Orthop Scand ;71:337-53. Lie SA, Havelin LI, Engesæter LB, Gjessing HK, Vollset SE. Mortality after total hip replacement: - 1 year follow-up of 39,53 patients in the Norwegian Arthroplasty Register. Acta Orthop Scand ;71:19-7. Lie SA. [Mortality after total hip replacements]. Nordisk Geriatrik ;:7. Furnes O, Lie SA, Espehaug B, Vollset SE, Engesæter LB, Havelin LI. Hip disease and the prognosis of total hip replacements. A review of 53 9 primary total hip replacements reported to the Norwegian Arthroplasty Register 197-1999. J Bone Joint Surg 1;3-B:579-. Espehaug B, Furnes O, Havelin LI, Engesæter LB, Vollset SE. The type of cement and failure of total hip replacements. J Bone Joint Surg ;-B:3-. Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Meyer HE. Risk factors for total hip replacement due to primary osteoarthritis: a cohort study in 5,3 persons. Arthritis Rheum ;:75-. Furnes O, Espehaug B, Lie SA, Vollset SE, Engesæter LB, Havelin LI. Early failures among 717 primary total knee replacements. A follow-up study from The Norwegian Arthroplasty Register 199-. Acta Orthop Scand ;73:117-9. Lie SA, Engesæter LB, Havelin LI, Furnes O, Vollset SE. Early postoperative mortality after 7,5 total hip replacements. Causes of death and tromboprophylaxis in hospitals in Norway from 197 to 1999. Acta Orthop Scand ;73:39-9. Havelin LI, Espehaug B, Engesæter LB. The performance of two hydroxyapatite- coated acetabular cups compared with Charnley cups. From the Norwegian Arthroplasty Register. J Bone 7
Joint Surg ;-B:39-5. Lie SA. [Patients in the Norwegian Arthroplasty Register]. Revmatikeren 3;5:1-9. Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Meyer HE. Weight change and the risk of total hip replacements. Epidemiology 3;1:57-. Furnes O, Havelin LI, Espehaug B, Engesæter LB, Lie SA, Vollset SE. [The Norwegian registry of joint prostheses--15 beneficial years for both the patients and the health care]. Tidsskr Nor Lægeforen 3;13:137-9. Engesæter LB, Lie SA, Espehaug B, Furnes O, Vollset SE, Havelin LI. Antibiotic prophylaxis in total hip arthroplasty: effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of,17 primary hip replacements followed -1 years in the Norwegian Arthroplasty Register. Acta Orthop Scand 3;7:-51. Byström S, Espehaug B, Furnes O, Havelin LI. Femoral head size is a risk factor for total hip luxation: a study of,97 primary hip arthroplasties from the Norwegian Arthroplasty Register. Acta Orthop Scand 3;7:51-. Lie SA. Havelin LI, Engesæter LB, Furnes O, Vollset SE. Failure rates for 7 revision total hip arthroplasties in the Norwegian Arthroplasty Register. J Bone Joint Surg ;-B:5-9. Lie SA, Furnes O, Havelin LI, Espehaug B, Engesæter LB, Vollset SE. [The Norwegian Arthroplasty Register. Beneficial for the patients and the Norwegian health care system]. The Norwegian Journal of Epidemiology ;1:57-3. Lie SA, Havelin LI, Engesæter LB, Gjessing HK, Vollset SE. Dependency issues in survival analyses of 557 primary hip replacements from 7355 patients. Stat Med ;3:37-. Småbrekke A, Espehaug B, Havelin LI, Furnes O. Operating time and survival of primary total hip replacements. A review of 31,75 primary cemented and uncemented total hip replacements from local hospitals reported to the Norwegian Arthroplasty Register 197-1. Acta Orthop Scand ;75:5-3. Furnes O. Hofteproteser og sementer. Tidsskr Nor Lægeforen ;1:55. Aamodt A, Nordsletten L, Havelin LI, Indrekvam K, Utvåg SE, Hviding K. Documentation of hip prostheses used in Norway. A critical review of the literature from 199-. Acta Orthop Scand ;75:3-7. Arthursson AJ, Furnes O, Espehaug B, Havelin LI, Søreide JA. Validation of data in the Norwegian Arthroplasty Register and the Norwegian Patient Register. 513 primary total hip arthroplasties and revisions operated at a single hospital between 197 and 3. Acta Orthop 5;7:3-. Espehaug B, Furnes O, Havelin LI, Engesæter LB, Vollset SE, Kindseth O. Registration completeness to the Norwegian Arthroplasty Register. Acta Orthop ;77:9-5. Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Engeland A, Meyer HE. The impact of body mass index on later osteoarthritis of the hip varies with age at screening. A cohort study in 1. million persons. Arthritis Rheum ;5:-7. Lie SA. Early mortality after elective hip surgery [guest editorial]. Acta Orthop ;77:35-. Engesæter LB, Espehaug B, Lie SA, Furnes O, Havelin LI. Does cement increase the risk for infection in primary total hip arthroplasty. Revision rates in 575 cemented and uncemented 71
primary THAs followed for -1 years in the Norwegian Arthroplasty register. Acta Orthop ; 77:351-. Lohmander LS, Engesæter LB, Herberts P, Ingvarsson T, Lucht U, Puolakka TJS. Standardized incidence rates of total hip replacement for primary hip osteoarthritis in the 5 Nordic countries:similarities and differences. Acta Orthop ;77:733- Slover J, Espehaug B, Havelin LI, Engesæter LB, Furnes O, Tomek I, Tosteson A. Costeffectiveness of unicompartmental and total knee arthroplasty in elderly low-demand patients. J Bone Joint Surg ;-A:3-55. Furnes O, Espehaug B, Lie SA, Vollset SE, Engesæter LB, Havelin LI. Failure mechanisms after unicompartmental and tricompartmental primary knee replacement with cement. J Bone Joint Surg 7;9-A:519-55. Fevang BT, Lie SA, Havelin LI, Engesæter LB, Furnes O. Reduction in orthopedic surgery among patients with chronic inflammatory joint disease in Norway, 199-. Arthritis Rheum 7;57:59-3. Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Meyer HE. The effect of middle-age body weight and physical activity on the risk for early revision hip arthroplasty. A cohort study in 1535 persons. Acta Orthop 7;7:99-17. Lie SA, Hallan G, Engesæter LB, Havelin LI, Furnes O. Isolated acetabular liner exchange compared with complete acetabular component revision in revision of primary uncemented acetabular components. A study of 19 revisions from the Norwegian Arthroplasty register. J Bone Joint Surg 7;9-B:591-. Kurtz S, Ong K, Scheimer J, Mowat F, Kaled S, Dybvik E, Kärrholm J, Garellick G, Havelin LI, Furnes O, Malchaug H, Lau E. Future clinical and economic impact of revision THA and TKA. J Bone Joint Surg 7;9-B(Suppl 3):1-51. Fevang BT, Lie SA, Havelin LI, Brun JG, Skredderstuen A, Furnes O. 57 ankle arthroplasties performed in Norway between 199 to 5. Acta Orthop 7;7:575-3. Figved W, Dybvik E, Frihagen F, Furnes O, Madsen JE, Havelin LI, Nordsletten L. Conversion from failed hemiarthroplasties to total hip arthroplasty. A Norwegian Arthroplasty Register analysis of 595 hips with previous femoral neck fractures. Acta Orthop 7;7:711-. Arthursson A, Furnes O, Espehaug B, Havelin LI, Søreide JA. Prosthesis survival after total hip arthroplasty - does surgical approach matter? Analysis of 193 Charnley and Exeter primary total hip arthroplasties reported to the Norwegian Arthroplasty Register. Acta Orthop 7;7:719-9. Hallan G, Furnes O, Lie SA, Engesæter LB, Havelin LI. Medium and long-term performance of 11 51 uncemented primary femoral stems from the Norwegian Arthroplasty register. J Bone Joint Surg 7;9-B:157-. Engesæter LB, Furnes O, Havelin LI. Developmental dysplasia of the hip good results of later total hip Arthroplasty: 7135 primary total hip arthroplasties after developmental dysplasia of the hip compared with 5977 total hip arthroplasties in idiopathic coxarthrosis followed for to 15 years in the Norwegian Arthroplasty Register. J Arthroplasty ;3:35-. Reigstad O, Siewers P, Røkkum M, Espehaug B. Excellent long-term survival of an uncemented press-fit stem and screw cup in young patients. Follow-up of 75 hips for 15-1 years. Acta Orthop ;79:19-. 7
Engesæter IØ, Lie SA, Lehmann TG, Furnes O, Vollset SE, Engesæter LB. Neonatal hip instability and risk of total hip replacement in younger adulthood. Follow-up of,1,59 newborns from the Medical Birth Registry of Norway in the Norwegian Arthroplasty Register. Acta Orthop Jun;79(3):31-. Hulleberg G, Aamodt A, Espehaug B, Benum P. A clinical and radiographic 13-year follow-up study of 13 Charnley hip arthroplasties in patients 5-7 years old. Comparison of university hospital data and registry data. Acta Orthop ; 79:1-9. Fevang BT, Lie SA, Havelin LI, Skredderstuen A, Furnes O. Risk factors for revision after shoulder arthroplasty. 15 shoulder arthroplasties from the Norwegian Arthroplasty Register. Acta Orthop 9;:1,3-91. Fevang BT, Lie SA, Havelin LI, Skredderstuen A, Furnes O. Results after 5 total elbow replacements: A report from the Norwegian Arthroplasty Register. J Shoulder Elbow Surg. 9 May-June;1(3):9-5. Cummins JS, Tomek IM, KantorSR, Furnes O, Engesæter LB, Finlayson SR. Cost-effectiveness of antibiotic-impregnated bone cement used in primary total hip arthroplasty. J Bone Joint Surg Am. 9;91(3):3-1. Espehaug B, Furnes O, Engesæter LB, Havelin LI. 1 years of results with cemented primary hip prostheses in the Norwegian Arthroplasty Register: concerns about some newer implants. Acta Orthop 9;:,-1. Havelin LI, Fenstad AM, Salomonsson R, Mehnert F, Furnes O, Overgaard S, Pedersen AB, Herberts P, Kärrholm J, Garellick G. The Nordic Arthroplasty Register Association. A unique collaboration between 3 national hip arthroplasty registries with, 1 THRs. Acta Orthop 9;:,393-1. Dybvik E, Furnes O, Fosså SD, Trovik C, Lie SA. Long-term risk of receiving a total hip replacement in cancer patients. Cancer Epidemiol 9 Oct;33(3-):35-1. Dale H, Hallan G, Espehaug B, Havelin LI, Engesæter LB. Increasing risk of revision due to deep infection after hip Arthroplasty. Acta Orthop 9;():39-5 Lie SA, Pratt N, Ryan P, Engesæter LB, Havelin LI, Furnes O, Graves S. Duration of the increase in early postoperative mortality after elective hip and knee replacement. J Bone Joint Surg Am 1;9(1):5-3 Hallan G, Dybvik E, Furnes O, Havelin LI. Metal-backed acetabular components with conventional polyethylene: A review of 9113 primary components with a follow-up of years. J Bone Joint Surg Br 1 Feb;9():19-1 Lygre SH, Espehaug B, Havelin LI, Vollset SE, Furnes O. Does patella resurfacing really matter? Pain and function in 97 patients after primary total knee arthoplasty. An observational study from the Norwegian Arthroplasty Register. Acta Orthop 1 Feb;1(1):99-17. Robertsson O, Bizjajeva S. Fenstad AM, Furnes O, Lidgren L, Mehnert F, Odgaard A, Pedersen AB, Havelin LI. Knee arthroplasty in Denmark, Norway and Sweden. Acta Orthop 1;1(1):- 9. Schrama JC, Espehaug B, Hallan G, Engesæter LB, Furnes O, Havelin LI, Fevang BT. Risk of revision for infection in primary total hip and knee arthroplasty in patients with rheumatoid arthritis: A prospective, population-based study on 1,7 hip and knee joint arthroplasties from the Norwegian Arthroplasty Register. Arthritis Care & Research 1 April;():73-79. 73
Johanson P-E, Fenstad AM, Furnes O, Garellick G, Havelin LI, Overgaard S, Pedersen AB, Kärrholm. Inferior outcome after hip resurfacing arthroplasty than after conventional arthroplasty. Evidence from the Nordic Arthroplasty Register Association (NARA) database, 1995 to 7. Acta Orthop 1;1(5):535-1. Jämsen E, Furnes O, Engesæter LB, Konttinen YT, Odgaard A, Stefánsdόttir A, Lidgren L. Prevention of deep infection in joint replacement surgery. Acta Orthop 1;1():-. Fevang BT, Lie SA, Havelin LI, Engesæter LB, Furnes O. Improved results of primary total hip replacement. Results from the Norwegian Arthroplasty Register, 197-7. Acta Orthop 1;1():9-59. Lygre SH, Espehaug B, Havelin LI, Furnes O, Vollset SE. Pain and function in patients after primary unicompartmental and knee arthroplasty. J Bone Joint Surg Am 1;9:9-97. Engesæter IØ, Lehmann T, Laborie LB, Lie SA, Rosendahl K, Engesæter LB. hip replacement in young adults with hip dysplasia. Age at diagnosis, previous treatment, quality of life, and validation of diagnoses reported to the Norwegian Arthroplasty Register between 197 and 7. Acta Orthop 11 Apr;():19-5. Gøthesen Ø, Espehaug B, Havelin LI, Petursson G, Furnes O. Short-term outcome of 1,5 computer-navigated primary total knee replacements 5-. Acta Orthop 11 May;(3):93-3. Apold H, Meyer HE, Espehaug B, Nordsletten B, Havelin LI, Flugsrud GB. Weight gain and the risk of total hip replacement. A population-based prospective cohort study of 5,75 individuals. Osteoarthritis Cartilage 11 Jul;19(7):9-15. Engesæter LB, Dale H, Schrama JC, Hallan G, Lie SA. Surgical procedures in the treatment of 7 infected THAs reported to the Norwegian Arthroplasty Register. Best survival with -stage exchange revision, but also good results with debridement and retention of the fixed implant. Acta Orthop 11;(5):53-37. Ranstam J, Kärrholm J, Pulkkinen P, Mäkelä K, Espehaug, B, Pedersen AB, Mehnert F, Furnes O. Statistical analysis of artrhoplasty data. I. Introduction and background. Acta Orthop 11 May;(3):53-57. Ranstam J, Kärrholm J, Pulkkinen P, Mäkelä K, Espehaug, B, Pedersen AB, Mehnert F, Furnes O. Statistical analysis of arthroplasty data. II. Guidelines. Acta Orthop 11 May;(3):5-7. Lygre SH, Espehaug B, Havelin LI, Vollset SE, Furnes O. Failure of total knee arthroplasty with or without patella resurfacing. A study from the Norwegian Arthroplasy Register with -15 years of follow-up. Acta Orthop 11 Jun;(3):-9. Krukhaug Y, Lie SA, Havelin LI, Furnes O, Hove LM. Results of 19 wrist replacements. A report from the Norwegian Arthroplasty Register. Acta Orthop 11 June;():5-9. Espehaug B, Furnes O, Engesæter LB, Havelin LI. Hip arthroplasty in Norway 199-. Tidsskr Nor Legeforen 11 Aug;131(1):153-. Engesæter LB, Dale H, Schrama JC, Hallan G, Lie SA. Surgical procedures in the treatment of 7 infected THAs reported to the Norwegian Arthroplasty Register. Best survival with -stage exchange revision, but also good results with debridement and retention of the fixed implant. Acta Orthop 11;(5):53-37. Lindalen E, Havelin LI, Nordsletten L, Dybvik E, Fenstad AM, Hallan G, Furnes O, Høvik Ø, Röhrl SM. Is reverse hybrid hip replacement the solution? 3,93 primary hip replacements with cemented 7
cup and uncemented stem, from the Norwegian Arthroplasty Register. Acta Orthop 11 Dec;():39-5. Dale H, Skråmm I, Løwer HL, Eriksen HM, Espehaug B, Furnes O, Skjeldestad FE, Havelin LI, Engesæter LB. Infection after primary hip arthroplasty. A comparison of 3 Norwegian health registers. Acta Orthop 11 Dec;():-5. Lehmann T, Engesæter IØ, Laborie LB, Lie SA, Rosendahl K, Engesæter LB. hip arthroplasty in young adults, with focus on Perthes` disease and slipped capital femoral epiphysis. Acta Orthop 11;3():159-. Paxton EW, Furnes O, Namba RS, Inacio MCS, Fenstad AM, Havelin LI. Comparison of the Norwegian Knee Arthroplasty Register and a United States Arthroplasty Registry. J Bone Joint Surg Am 11;93:Suppl 3(E):-3. Havelin LI, Robertsson O, Fenstad AM, Overgaard S, Garellick G, Furnes O. A Scandinavian experience of register collaboration: The Nordic Arthroplasty Register Assosiation (NARA). J Bone Joint Surg Am 11;93:Suppl 3(E):13-9. Hallan G, Espehaug B, Furnes O, Wangen H, Høl PJ, Ellison P, Havelin LI. Is there still a place for the cemented titanium femoral stem? 1,1 cases from the Norwegian Arthroplasty Register. Acta Orthop 1;3(1):1-. Ellison P, Hallan G, Høl PJ, Gjerdet NR, Havelin LI. Coordinating retrieval and register studies improves postmarket surveillance. Clin Orthop Relat Res. 1 Nov;7(11):995-3. Rasmussen JV, Olsen BS, Fevang BT, Furnes O, Skytta ET, Rahme H, Salomonsen B, Mohammed KD, Page RS, Carr AJ. A review of national shoulder and elbow joint replacement registries. J Shoulder Elbow Surg 1 Oct;1(1):13-35. Kadar T, Dybvik E, Hallan G, Furnes O, Havelin LI. Head material influences of a cemented total hip prosthesis in the Norwegian Arhthroplasty Register. Clin Orthop Relat Res. 1 Nov;7(11):37-13. Fevang BT, Lygre SH, Bertelsen G, Skredderstuen A, Havelin LI, Furnes O. Good function after shoulder arthroplasty. 1,17 patients with different diagnoses from the Norwegian Arthroplasty Register. Acta Orthop 1;3(5):7-73. Engesæter LB, Engesæter IØ, Fenstad AM, Havelin LI, Kärrholm J, Garellick G, Pedersen AB, Overgaard S. Low revision rate after total hip arthroplasty in patients with pediatric hip diseases. Evaluation of 1,3 THAs due to DDH, SCFE or Perthes` disease and,35 THAs due to primary osteoarthritis in the Danish, Norwegian and Swedish Hip Arthroplasty Registers (NARA). Acta Orthop 1;3(5):3-1. Dale H, Fenstad AM, Hallan G, Havelin LI, Furnes O, Overgaard S, Pedersen AB, Kärrholm J, Garellick G, Pulkkinen P, Eskelinen A, Mäkelä K, Engesæter LB. Increasing risk of prosthetic joint infection after total hip arthroplasty.,77 revisions due to infection after 3,1 primary THAs in the Nordic Arthroplasty Register Association (NARA). Acta Orthop 1;3(5):9-5. Schrama JC, Lutro O, Langvatn H, Hallan G, Espehaug B, Sjursen H, Engesæter LB, Fevang BT. Bacterial findings in infected hip joint replacements in patients with rheumatoid arthritis and osteoarthritis: A study of 31 revisions for infection reported to the Norwegian Arthroplasty Register. International Scholarly Research Network Vol. 1; pages. Fevang BT, Lygre SH, Bertelsen G, Skreddertstuen A, Havelin LI, Furnes O. Pain and function in eight hundred and fifty nine patients comparing shoulder hemiprostheses, resurfacing prostheses, 75
reversed total and conventional total prostheses. Int Orthop 13 Jan;37(1):59-. Gilliam MH, Lie SA, Salter A, Furnes O, Graves SE, Havelin LI, Ryan P. The progression of endstage osteoarthritis: analysis of data from the Australian and Norwegian joint replacements registries using a multi-state model. Osteoarthritis Cartilage. 13 Mar;1(3):5-1. Monstad K, Engesæter LB, Espehaug B. Waiting time and socioeconomic status an individuallevel analysis. Health Econ 13:1-1. Gøthesen Ø. Espehaug B, Havelin LI, Petursson G, Lygre SH, Ellison P, Hallan G, Furnes O. Survival rates and causes of revision in cemented primary total knee replacement. A report from the Norwegian Arthroplasty Register 199-9. Bone Joint J 13;95-B:3-. Gøthesen Ø, Slover J, Havelin LI, Askildsen JE, Malchau H, Furnes O. An economic model to evaluate the cost-effectiveness of computer assisted knee replacement surgery in Norway. BMC Musculoskeletal Disord. 13;1:. Badawy M, Espehaug B, Indrekvam K, Engesæter LB, Havelin LI, Furnes O. Influence of hospital volum on revision rate after total knee arthroplasty with cement. J Bone Joint Surg Am 13;95:e131:1-. Nystad TW, Furnes O, Havelin LI, Skreddertsuen AK, Lie SA, Fevang BT. Hip replacement surgery in patients with ankylosing spondylitis. Ann Rheum Dis. 1 Jun;73():119-7. Bergh C, Fenstad AM, Furnes O, Garellick G, Havelin LI, Overgaard S, Pedersen AB, Mäkelä K, Pulkkinen P, Mohaddes M, Kärrholm J. Increased risk of revision in patients with non-traumatic femoral head necrosis. Acta Orthop. 1 Feb;5(1):11-7. Mäkelä KT, Matilainen M, Pulkkinen P, Fenstad AM, Havelin L, Engesæter LB, Furnes O, Pedersen AB, Overgaard S, Kärrholm J, Malchau H, Garellick G, Ranstam J, Eskelinen A. Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations. BMJ 1 Jan 13;3:f759. Mäkelä K, Matilainen M, Pulkinnen P, Fenstad AM, Havelin LI, Engesæter LB, Furnes O, Overgaard S, Pedersen AB, Kärrholm J, Malchau H, Garellick G, Ranstam J, Eskelinen A. Countrywise results of total hip replacement. An analysis of 3,733 hips based on the Nordic Arthroplasty register Association database. Acta Orthop 1 Apr;5():17-11. Apold H, Meyer HE, Nordsletten L, Furnes O, Baste V, Flugsrud GB. Weight gain and the risk of knee replacement due to primary osteoarthritis. a population based, prospective cohort study of 5,9 individuals. Osteoarthritis Cartilage;1 May;(5):5-. Krukhaug Y, Lie SA, Havelin LI, Furnes O, Hove LM, Hallan G. The result of 79 thumb carpometacarpal joint replacements reported in the Norwegian Arthroplasty Register. The Journal of Hand Surgery 1 Oct;39():19-5. Pedersen AB, Mehnert F, Havelin LI, Furnes O, Herberts P, Kärrholm J, Garellick G, Mäkela, Eskelinen A, Overgaard S. Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association. Osteoarthitis Cartilage. 1 May;(5):59-7. Badawy M, Espehaug B, Indrekvam K, Havelin LI, Furnes O. Higher revision risk for unicompartmental knee arthroplasty in low-volume hospitals. Data from 5,791 cases in the Norwegian Arthroplasty Register. Acta Orthop. 1;5():3-7. Apold H, Meyer HE, Nordsletten L, Furnes O, Baste V, Flugsrud GB. Risk factors for knee replacement due to primary osteoarthritis, a population based prospective cohort study of 315,95 7
individuals. BMC Musculoskeletal Disord. 1;15:17. Borgquist L, Dahl AW, Dale H, Lidgren L, Stefánsdóttir A. Prosthetic joint infections a need for health economy studies. Guest editorial. Acta Orthop. 1;5(3)1-. Amlie E, Havelin LI, Furnes O, Baste V, Nordsletten L, Høvik Ø, Dimmen S. Worse patientreported outcome after lateral approach than after anterior and posterolateral approach in primary hip arthroplasty. A cross-sectional questionnaire study of 1,7 patients 1-3 years after surgery. Acta Orthop. 1;5(5):3-9. Dybvik E, Furnes O, Fosså SD, Trovik C, Lie SA. Pelvic irradiation does not increase the risk of hip replacement in patients with gynecological cancer. A cohort study based on,57 patients. Acta Orthop. 1 Dec;5():5-. Thien TM, Chatziagorou G, Garellick G, Furnes O, Havelin LI, Mäkelä K, Overgaard S, Pedersen A, Eskelinen A, Pulkkinen P, Kärrholm J. Periprosthetic femoral fracture within two years after total hip replacement. Analysis of 37,9 operations in the Nordic Arthroplasty Register Assosiation database. J Bone Joint Surg Am. 1 Oct 1;9(19):e17. Comfort T, Baste V, Froufe MA, Namba R, Bordini B, Robertsson O, Cafri G, Paxton E, Sedrakyan A, Graves S. International comparative evaluation of fixed-bearing non- posterior- stabilized and posterior-stabilized total knee replacements. J Bone Joint Surg Am. 1 Dec 17;9 Suppl 1:5-7. Graves S, Sedrakyan A, Baste V, Gioe TJ, Namba R, Cruz OM, Paxton E, Banerjee S, Isaacs AJ, Robertsson O. International comparative evaluation of knee replacement with fixed or mobilebearing posterior-stabilized prostheses. J Bone Joint Surg Am. 1 Dec 17;9 Suppl 1:59-. Namba R, Graves S, Robertsson O, Furnes O, Stea S, Puig-Verdié L, Hoeffel D, Cafri F, Paxton E, Sedrakyan A. International comparative evaluation of knee replacement with fixed or mobile nonposterior-stabilized implants. J Bone Joint Surg Am. 1 Dec 17;9 Suppl 1:5-. Stea S, Comfort T, Sedrakyan A, Havelin LI, Marinelli M, Barber T, Paxton E, Isaacs AJ, Graves S. Multinational comprehensive evaluation of the fixation method used in hip replacement: interaction with age in context. J Bone Joint Surg Am. 1 Dec 17;9 Suppl 1:-51. Furnes O, Paxton E, Cafri G, Graves S, Bordini B, Comfort T, Rivas MC, Banerjee S, Sedrakyan. Distributed analysis of hip implants using six national and regional registries: comparing metal-onmetal with metal-on-highly crossed-linked polyethylene bearings in cementless total hip arthroplasty in young patients. J Bone Joint Surg Am. 1 Dec 17;9 Suppl 1:5-33. Sedrakyan A, Graves S, Bordini B, Pons M, Havelin LI, Mehle S, Paxton E, Barber T, Cafri G. Comparative effectiveness of ceramic-on-ceramic implants in stemmed hip replacement. J Bone Joint Surg Am. 1 Dec 17;9 Suppl 1:3-1. Allepuz A, Havelin LI, Barber T, Sedrakyan A, Graves S, Bordini B, Hoeffel D, Cafri G, Paxton E. Effect of femoral head size on metal-on-hxlpe hip arthroplasty outcome in a combined analysis of six national and regional registries. J Bone Joint Surg Am. 1 Dec 17;9 Suppl 1:1-. Paxton E, Cafri G, Havelin L, Stea S, Palliso F, Graves S, Hoeffel D, Sedrakyan A. Risk of revision following total hip arthroplasty: Metal-on-conventional polyethylene compared with metal-on-highly cross-linked polyethylene bearing surfaces. J Bone Joint Surg Am. 1 Dec 17;9 Suppl 1:19-. Lutro O, Langvatn H, Dale H, Schrama JC, Hallan G, Espehaug B, Sjursen H, Engesæter LB. Increasing resistance of coagulase-negative staphylococci in total hip arthroplasty infections: 7 THA-revisions due to infection reported to the Norwegian Arthroplasty Register from 1993 to 7. Adv Orthop. 1;1-7. 77
Hailer NP, Lazarinis S, Mäkelä KT, Eskelinen A, Fenstad AM, Hallan G, Havelin LI, Overgaard S, Pedersen AB, Mehnert F, Kärrholm J. Hydroxyapatite coating does not improve uncemented stem survival after total hip arthroplasty! An analysis of 11,9 THAs in the Nordic Arthroplasty Register Association (NARA) database. Acta Orthop. 15;(1):1-5. Fevang BT, Nystad TW, Skredderstuen A, Furnes O, Havelin LI. Improved survival for anatomic total shoulder prostheses. Results of,173 shoulder arthroplasties reported to the Norwegian Arthroplasty Register from 199 through 1. Acta Ortop. 15 Feb;(1):3-7. Lie SA, Havelin LI, Fenstad AM, Espehaug B, Dybvik E, Baste V, Engesæter LB, Skredderstuen A, Dale H, Fevang JM, Fevang BT, Hallan G, Gjertsen JE, Furnes O. Re: a statistical analysis of ankle prosthesis from the Norwegian Arthroplasty Register. Arch Orthop Trauma Surg. 15 Jan;135(1):17-. Leta TH, Lygre SHL, Skredderstuen A, Hallan G, Furnes O. Failure of aseptic revision total knee arthroplasties. 15 revision failures from the Norwegian Arthroplasty Register, 199-11. Acta Orthop. 15 Feb;(1):-57. Varnum C, Pedersen AB, Mäkelä K, Eskelinen A, Havelin LI, Furnes O, Kärrholm G, Garellick G, Overgaard S. Increased risk of revision of cementless stemmed total hip arthroplasty with metalon-metal bearings. Data from the Nordic Arthroplasty Register Association. Acta Orthop. 15;():91-97. Schrama JC, Fenstad AM, Dale H, Havelin LI, Hallan G, Overgaard S, Pedersen AB, Kärrholm G, Garellick G, Pulkkinen P, Eskelinen A, Mäkelä K, Engesæter LB, Fevang BT. Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacement. A study of 39,71 primary arthroplasties from the Nordic-Arthroplasty Register Association. Acta Ortop. 15;():91-97. Badawy M, Fenstad AM, Indrekvam K, Havelin LI, Furnes O. The risk of revision in total knee arthroplasty is not affected by previous high tibial osteotomy. A 15- year follow-up of 3,7 total knee arthroplasties in the Norwegian Arthroplasty Register. Acta Orthop. 15 Jun 1:1-. Cafri G, Banerjee S, Sedrakyan A, Paxton L, Furnes O, Graves S, Marinac-Dabic D. Meta-analysis of survival curve data using distributed health data networks: application to hip arthroplasty studies of the International Consortium of Orthopaedic Registries. Res Synth Methods. 15 June 9: 1-1. Nystad TW, Fenstad AM, Furnes O, Havelin LI, Skredderstuen AK, Fevang BT. Reduction in orthopaedic surgery in patients with rheumatoid arthritis: a Norwegian register-based study. Scand J Rheumatol. 15 Aug 5:[Epub ahead of print] Langvatn H, Lutro O, Dale H, Schrama JC, Hallan G, Espehaug B, Sjursen H, Engesæter LB. Bacterial and hematological findings in infected total hip arthroplasties in Norway assessment of 7 revisions due to infection in the Norwegian arthroplasty register. 15 sep 3;9:5-9 Glassou EN, Hansen TB, Mäkelä K, Havelin LI, Furnes O, Badawy M, Kärrholm J, Garrelic G, Eskelinen A, Pedersen AB. Association between hospital procedure volume and risk of revision after total hip arthroplasty: a population-based study within the Nordic Arthroplasty Register Association database. Osteoarthritis Cartilage. 15 Oct 1;(3):19- Leta TH, Lygre SH, Skredderstuen A, Hallan G, Gjertsen JE, Rokne B, Furnes O. Secondary patella resurfacing in painful non-resurfaced total knee arthroplasties: A study of survival and clinical outcome from the Norwegian Arthroplasty Register (199-11). Int Orthop (SICOT). 15 Oct 3;():715-7
Blågestad T, Nordhus IH, Grønli J, Engesæter LB, Ruths S, Ranhoff AH, Bjorvatn B, Pallesen S. Prescription trajectories and effect of total hip arthroplasty on the use of analgesics, hypnotics, antidepressants and anxiolytics: Results from a population of total hip arthroplasty patients. Pain. 15 Nov 1;157(3):3-51 Petursson G, Fenstad AM, Havelin LI, Gøthesen Ø, Lygre SH, Röhrl SM, Furnes O. Better survival of hybrid knee arthroplasty compared to cemented arthroplasty. A report from the Norwegian Arthroplasty Register 1999-1. Acta Orthop. 15 Dec;():71- Busch VJ, Verschueren J, Adang EM, Lie SA, Havelin LI, Schreurs BW. A cementeted cup with acetabular impaction bone grafting is more cost-effective than an uncemented cup in patientes under 5 years. Hip Int. 15 Dec;(1):3-9 Johnsen MB, Hellevik AI, Baste V, Furnes O, Langhammer A, Flugsrud G, Nordsletten L, Zwart JA, Storheim K. Leisure time physical activity and the risk of hip or knee replacement due to primary osteoarthritis: a population based cohort study (The HUNT study). BMC Musculoskelet Disord. 1 Feb 1;17(1): Leta TH, Lygre SH, Skredderstuen A, Hallan G, Gjertsen JE, Rokne B, Furnes O. Outcomes of unicompartmental knee arthroplasty after aseptic revision to total knee arthroplasty: A comparative study of 7 TKAs and 57 UKAs revised to TKAs from the Norwegian arthroplasty register (199 to 11). JBJS. 1 Mar 1;9():31- Rasmussen JV, Brorson S, Hallan G, Dale H, Äärimaa V, Mokka J, Jensen SL, Fenstad AM, Salomonsson B. Is it feasible to merge data from national shoulder registries? A new collaboration within the Nordic arthroplasty register association. J shoulder elbow surg. 1 Apr ;5(1):e39-e377 Tsukanaka M, Halvorsen V, Nordsletten L, Engesæter I.Ø, Engesæter L.B, Fenstad A.M, Röhrl S.M. Implant survival and radiographic outcome of total hip replacement in patients less than years old Acta Orthop. 1 Jul ; 7(5):79- Junnila M, Laaksonen I, Eskelinen A, Pulkkinen P, Havelin LI, Furnes O, Fenstad AM, Pedersen AB, Overgaard S, Kärrholm J, Garellick G, Malchau H, Mäkelä KT. Implant survival of the most common cemented total hip devices from the Nordic arthroplasty register association database. Acta Orthop. 1 Aug 3;7():5-553 Dyrhovden GS, Fenstad AM, Furnes O, Gøthesen Ø. Survivorship and relative risk of revision in computer-navigated versus conventional total knee replacement at year follow-up. Acta Orthop. 1 Oct ;7():59-599 Birkeland Ø, Espehaug B, Havelin LI, Furnes O. Bone cement product and failure in total knee arthroplasty. Acta Orthop. 1 Nov 1;(1):75-1 Ackerman IN, Bohensky MA, de Steiger R, Brand CA, Eskelinen A, Fenstad AM, Furnes O, Garellick G, Graves SE, Haapakoski J, Havelin LI, Mäkelä K, Mehnert F, Becic Pedersen A, Robertsson O. Substantial rise in the lifetime risk of primary total knee replacement surgery for osteoarthritis from 3 to 13: an international, population-level analysis. Osteoarthritis Cartilage. 1 Nov 1;5():55-1 Magnusson K, Scurrah K, Ystrom E, Ørstavik RE, Nilsen T, Steingrimsdòttir ÒA, Ferreira P, Fenstad AM, Furnes O, Hagen KB. Genetic factors contribute more to hip than knee surgery due to osteoarthritis a population-based twin registry study of joint arthropalsty. Osteoarthritis Cartilage. 1 Dec 13;5():7- Johnsen MB, Vie GÅ, Winsvold BS, Bjørngaard JH, Åsvold BO, Gabrielsen ME, Pedersen LM, Hellevik AI, Langhammer A, Furnes O, Flugsrud GB, Skorpen F, Romundstad PR, Storheim K, 79
Nordsletten L, Zwart JA. The causal role of smoking on the risk of hip or knee replacement due to primary osteoarthritis: a Mendelian randomisation analysis of the HUNT study. Osteoarthritis Cartilage. 17 Jan 1;5():17-3 Niemelälnen MJ, Mäkelä KT, Robertsson O, W-Dahl A, Furnes O, Fenstad AM, Pedersen AB, Schrøder HM, Huhtala H, Eskelinen A. Different incidences of knee arthroplasty in the Nordic countries. Acta Orthop. 17 Jan ;():173-17 Wangen H, Havelin LI, Fenstad AM, Hallan G, Furnes O, Pedersen AB, Overgaard S, Kärrholm J, Garellick G, Mäkelä K, Eskelinen A, Nordsletten L. Reverse hybrid total hip arthroplasty. Acta Orthop. 17 Jan 1;(3):-5 Dyrhovden GS, Lygre SH, Badawy M, Gøthesen Ø, Furnes O. Have the causes of revision for total and unicompartmental knee arthroplasties changed during the past two decades? Clin Orthop Relat Res. 17 Mar 15;75(7):17-1 Brorson S, Salomonsson B, Jensen SL, Fenstad AM, Demir Y, Rasmussen JV. Revision after shoulder replacement for acute fracture of the proximal humerus. Acta Orthop. 17 Mar :1-5 [Epub ahead of print] Johanson PE, Furnes O, Havelin LI, Fenstad AM, Pedersen AB, Overgaard S, Garellick G, Mäkelä K, Kärrholm J. Outcome in design-specific comparisons between highly crosslinked and conventional polyethylene in total hip arthroplasty. Acta Orthop. 17 Apr :1-7 [Epub ahead of print] Mjaaland KE, Svenningsen S, Fenstad AM, Havelin LI, Furnes O, Nordsletten L. Implant survival after minimally invasive anterior or anteriolateral Vs. conventional posterior or direct lateral approach: An analysis of 1, total hip arthroplasties from the Norwegian Arthroplasty Register ( to 13). J Bone Joint Surg Am. 17 May 17;99(1):-7 Hellevik AI, Johnsen MB, Langhammer A, Fenstad AM, Furnes O, Storheim K, Zwart JA, Flugsrud G, Nordsletten L. Incidence of total hip or knee replacement due to osteoarthritis in relation to thyroid function: a prospective cohort study (The Nord-Trøndelag Health Study). BMC Musculoskelet Disord. 17 May 1;1(1):1 Norwegian Hip Fracture Register ( in total) Gjertsen JE, Fevang J, Vinje T, Engesæter LB, Steindal K, Furnes O. Nasjonalt hoftebruddregister. Norsk Epidemiologi ;1:9-9. Gjertsen JE, Lie SA, Fevang J, Vinje T, Engesæter LB, Havelin LI, Furnes O. hip replacement after femoral neck fractures in elderly patients: results of,577 fractures reported to the Norwegian Arthroplasty Register. Acta Orthop 7;7:91-7. Gjertsen JE, Engesæter LB, Furnes O, Havelin LI, Steindal K, Vinje T, Fevang J. The Norwegian Hip Fracture Register. Experiences after the first years and 15 57 reported operations. Acta Orthop. ;79:53-593 Gjertsen JE, Vinje T, Lie SA, Engesæter LB, Havelin LI, Furnes O, Fevang J. Patient satisfaction, pain and quality of life months after displaced femoral neck fracture. Acta Orthop ;79:59-1 Gjertsen JE, Vinje T, Engesæter LB, Lie SA, Havelin LI, Furnes O, Fevang JM. Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients. A national register based study on 1,31 patients. J Bone Joint Surg Am 1
Mar;9-A(3):19-. Gjertsen JE, Fevang JM, Matre K, Vinje T, Engesæter LB. Clinical outcome after undisplaced femoral neck fractures. A prospective comparison of 1,757 undisplaced and displaced fractures reported to the Norwegian Hip Fracture Register. Acta Orthop 11;(3):-7. Gjertsen JE, Vinje T, Engesæter LB, Hallan G, Furnes O, Lie SA. More re-operations after uncemented than cemented hemiarthroplasty used in the treatment of displaced fractures of the femoral neck. An observational study of 11 11 hemiarthroplasties from a national register. J Bone Joint Surg Br 1;9-A:1113-19. Matre K, Havelin LI, Gjertsen JE, Espehaug B, Fevang JM. Intramedullary nails result in more reoperations than sliding hip screws in two-part intertrochanteric fractures. Clin Orthop Relat Res. 13 Apr;71():1379-. Matre K, Havelin LI, Gjertsen Jan-Erik, Vinje T, Espehaug B, Fevang JM. Sliding hip screw versus IM nail reverse oblique trochanteric and subtrochanteric fractures. A study of 71 patients in the Norwegian Hip Fracture Register. Injury, Int. J. Care Injur. 13 Jun;()735-. Matre K, Havelin LI, Gjertsen JE, Espehaug B, Fevang JM. Reply to letter to the editor: Intramedullary nails result in more reoperations than sliding hip screws in two-part interochanteric fractures. Clin Orthop Relat Res. 13 Mar. 5. Bakken MS, Engeland A, Engesæter LB, Ranhoff AH, Hunskaar S, Ruths S. Increased risk of hip fracture among older people using antidepressant drugs: data from the Norwegian Prescription Database and the Norwegian Hip Fracture Registry. Age and Ageing 13 Jul;():51-. Talsnes O, Vinje T, Gjertsen JE, Dahl OE, Engesæter LB, Baste V, Pripp AH, Reikerås O. Perioperative mortality in hip fracture patients treated with cemented and uncemented hemiprosthesis: a register study of 11,1 patients. Int Orthop. 13 Jun;37()1135-. Gjertsen JE, Lie SA, Vinje T, Engesæter LB, Hallan G, Matre K, Furnes O. Authors` reply Cobb correspondence: J-E Gjertsen, SA. Lie, T. Vinje, et al. More re-operations after uncemented than cemented hemiarthroplasty used in the treatment of displaced fractures of the femoral neck: An observational study of 11 11 hemiarthroplasties from a national register. Bone Joint J. 13 Jun;95-B():. Rogmark C, Fenstad AM, Leonardsson O, Engesæter LB, Kärrholm J, Furnes O, Garellick G, Gjertsen JE. Posterior approach and uncemented stems increases the risk of reoperations after hemiarthroplasties in elderly hip fracture patients. An analysis of 33,5 procedures in the Norwegian and Swedish national registries. Acta Orthop. 1;5(1):1-5. Gjertsen JE, Fenstad AM, Leonardsson O, Engesæter LB, Kärrholm J, Furnes O, Garellick G, Rogmark C. Hemiarthroplasties after hip fractures in Norway and Sweden: a collaboration between the Norwegian and Swedish national registries. Hip Int 1 May-Jun;(3):3-3. Bakken MS, Engeland A, Engesæter LB, Ranhoff AH, Hunskaar S, Ruths S. Risk of hip fracture among older people using anxiolytic and hypnotic drugs: a nationwide prospective cohort study. Eur J Clin Pharmacol. 1;7:73-. Ruths S, Bakken MS, Ranhoff AH, Hunskaar S, Engesæter LB, Engeland A. Risk of hip fracture among older people using antihypertensive drugs: a nationwide cohort study. BMC Geriatr. 15 Dec 1;15:153. Bakken MS, Schjøtt J, Engeland A, Engesæter LB, Ruths S. Antipsychotic drugs and risk of hip fracture in people aged and older in Norway. J Am Geriatr Soc 1 Jun;():13-9 1
Gjertsen JE, Baste V, Fevang JM, Furnes O, Engesæter LB. Quality of life following hip fractures: results from the Norwegian hip fracture register. BMC Musculoskelet Disord. 1 Jul 7;17:5 Leer-Salvesen S, Dybvik E, Dahl OE, Gjertsen JE, Engesæter LB. Postoperative start compared to preoperative start of low-molecular-weight heparin increases mortality in patients with femoral neck fractures. Acta Orthop. 1 Sep 3;(1):-5 Kristensen TB, Vinje T, Havelin LI, Engesæter LB, Gjertsen JE. Posterior approach compared to direct lateral approach resulted in better patient-reported outcome after hemiarthroplasty for femoral neck fracture. Acta Orthop. 1 Nov ;(1):9-3 Leer-Salvesen S, Dybvik E, Dahl OE, Gjertsen JE, Engesæter LB. Correspondence. Thromboprophylaxis for venous thromboembolism prevention in hip fracture patients. Acta Orthop. 17 Jan 9;():3-37 Kristensen TB, Vinje T, Havelin LI, Engesæter LB, Gjertsen JE. Correspondence. Posterior approach compared to direct lateral approach resulted in better patient-reported outcome after hemiarthroplasty for femoral neck fracture. Acta Ortop. 17 Jan 5;():3-3 Kristensen TB, Vinje T, Havelin LI, Engesæter LB, Gjertsen JE. Correspondence. Posterior approach compared to direct lateral approach resulted in better patient-reported outcome after hemiarthroplasty for femoral neck fracture. Acta Ortop. 17 Mar ;(3):31-3 Norwegian Cruciate Ligament Register (9 in total) Granan LP, Engebretsen L, Bahr R. Kirurgi ved fremre korsbåndskader i Norge. Tidsskr Nor Legeforen ;1:9-3. Granan LP, Engebretsen L, Bahr R. Kirurgi ved fremre korsbåndskader i Norge - sett fra et idrettsmedisinsk perspektiv. Norsk Idrettsmedisin ;:3-. Solumshengslet K, Granan LP, Furnes O, Steindal K, Engebretsen L. Registreringsgrad i Nasjonalt Korsbåndregister. Norsk Idrettsmedisin 7;:7,9-11. Granan LP, Bahr R, Steindal K, Furnes O, Engebretsen L. Development of a national cruciate ligament surgery registry the Norwegian National Knee Ligament registry. Am J Sports Med ;3:3-15. Moksnes H, Engebretsen L, Risberg MA. Performance-baced functional outcome for children 1 years or younger following anterior cruciate ligament injury: a two to nine-year follow-up study. Knee Surg Sports Traumatol Arthrosc, Mar;1(3):1-3. Årøen A, Hjermundrud V, Kvist T, Engebretsen L, Risberg MA. Preoperatively no significant difference in functional scoring (KOOS) in anterior cruciate ligament-injured knees with and without a full-thickness cartilage lesion. BJSM The Journal of Sport and Exercise Medicine, June ; Vol., No.. Engebretsen L, Forssblad M. Why knee ligament registries are important. Kne Surg Sports Traumatol Arthrosc 9 Feb;17():115-. Granan LP, Bahr R, Lie SA, Engebretsen L. Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: a cohort study based on the Norwegian National Knee Ligament Registry. Am J Sports Med 9 May;37(5):955-1. Granan LP, Forssblad M, Lind M, Engebretsen L. The Scandinavian ACL registries -7:
baseline epidemiology. Acta Orthop 9 Oct;(5):53-7. Magnussen RA, Granan LP, Dunn WR, Amendola A, Andrish JT, Brophy R, Carey JL,Flanigan D, Huston LJ, Jones M, Kaeding CC, McCarty EC, Marx RG, Matava MJ, Parker RD, Vidal A, Wolcott M, Wolf BR, Wright RW, Spindler KP, Engebretsen L. Cross-cultural comparison of patients undergoing ACL reconstruction in the United States and Norway. Knee Surg Sports Traumatol Arthrosc 1 Jan;1(1):9-15. Heir S, Nerhus TK, Røtterud JH, Løken S, Ekeland A, Engebretsen L, Årøen A. Focal cartilage defects in the knee impair quality of life as much as severe osteoarthritis: a comparison of knee injury and osteoarthritis outcome score in patient categories scheduled for knee surgery. Am J Sports Med 1 Feb; 3();31-7. Hjermundrud V, Bjune TK, Risberg MA, Engebretsen L, Arøen A. Full-thickness cartilage lesion do not affect knee function in patients with ACL injury. Knee Surg Sports Traumatol Arthrosc 1 Mar;1(3):9-33. Ytterstad K, Granan LP, Engebretsen L. The Norwegian Cruciate Ligament Registry has a high degree of completeness. Tidsskr Nor Legeforen 11 Feb;131(3):-5. Maletis GB, Granan LP, Inacio MCS, Funahashi TT, Engebretsen L. Comparison of communitybased ACL Reconstruction Registries in the U.S and Norway. J Bone Joint Surg Am 11;93:Suppl 3(E):31-. Røtterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Årøen A. Effect of gender and sports on the risk of full-thickness articular cartilage lesions in anterior cruciate ligament -injured knees: a nationwide cohort study from Sweden and Norway of 15 73 patients. Am J Sports Med. 11 Jul;39(7):137-9. Røtterud JH, Risberg MA, Engebretsen L, Arøen A. Patients with focal full-thickness cartilage lesions benefit less from ACL reconstruction at -5 years follow-up. Knee Surg Sports Traumatol Arthrosc. 1 Aug;():1533-9. Ytterstad K, Granan LP, Ytterstad B, Steindal K, Fjeldsgaard K, Furnes O, Engebretsen L. Registration rate in the Norwegian Cruciate Ligament Register: large-volume hospitals perform better. Acta Orthop. 1 Apr;3():17-. Granan LP, Inacio MC, Maletis GB, Funahashi TT, Engebretsen L. Intraoperative findings and procedures in culturally and geographically different patient and surgeon populations: an anterior cruciate ligament reconstruction registry comparison between Norway and the USA. Acta Orthop. 1 Dec;3():577-. Getgood A, Collins B, Slynarski K, Kurowska E, Parker D, Engebretsen L, MacDonald PB, Litchfield R. Short-term safety and efficacy of a novel high tibial osteotomy system: a case controlled study. Knee Surg Sports Traumatol Arthrosc. 13 Jan;1(1):-9. Røtterud JH, Sivertsen E, Forssblad M, Engebretsen L, Årøen A. Effect of meniscal and focal cartilage lesions on patient-reported outcome after anterior cruciate ligament reconstruction : A aationwide cohort study from Norway and Sweden of 7 patients with -Year follow-up. Am J Sports Med. 13 Mar;1(3):535-3. Øiestad BE, Holm I, Engebretsen L, Aune AK, Gunderson R, Risberg MA. The prevalence of patellofemoral osteoarthritis 1 years after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 13 Apr;1():9-9. Aga C, Rasmussen MT, Smith SD, Jansson KS, LaPrade RF, Engebretsen L, Wijdicks CA. Biomechanical comparison of interference screws and combination screw and sheath devices for 3
soft tissue anterior cruciate ligament reconstruction on the tibial side. Am J Sports med. 13 Apr;1():1-. Arøen A, Sivertsen EA, Owesen C, Engebretsen L, Granan LP. An isolated rupture of the posterior cruciate ligament results in reduced preoperative knee function in comparison with an anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 13 May;1(5):117-. Moksnes H, Engebretsen L, Eitzen I, Risberg MA. Functional outcomes following a non-operative treatment algorithm for anterior cruciate ligament injuries in skeletally immature children 1 years and younger : A prospective cohort with years follow-up. Br J Sports Med. 13 May;7():- 9. Goldsmith MT, Jansson KS, Smith SD, Engebretsen L, LaPrade RF, Wijdicks CA. Biomechanical comparison of anatomic single- and double-bundle anterior cruciate ligament reconstructions: an in vitro study. Am J Sports Med. 13 Jul;1(7):1595-. Moksnes H, Engebretsen L, Risberg MA. Prevalence and incidence of new meniscus and cartilage injuries after a nonoperative treatment algorithm for ACL tears in skeletally immature children : A prospective MRI study. Am J Sports Med. 13 Aug;1():1771-9. Andersen CA, Clarsen B, Johansen TV, Engebretsen L. High prevalence of overuse injury among iron-distance triathletes. Br J Sports Med. 13 Sep;7(13):57-1. Ekeland, AE, Engebretsen L, Heir S. Sekundær ACL rekonstruksjon hos fotballspillere, håndballspillere og alpine skiløpere. Norsk idrettsmedisin 13 (3):1. Granan LP, Inacio MC, Maletis GB, Funahashi TT, Engebretsen L. Sport-spesific injury pattern recorded during anterior cruciate ligament reconstruction. Am J Sports Med. 13 Dec;1(1):1-. Kennedy NI, Wijdicks CA, Goldsmith MT, Michalski MP, Devitt BM, Årøen A, Engebretsen L, LaPrade RF. Kinematic analysis of the posterior cruciate ligament, part 1: The individual and collective function of the anterolateral and posteromedial bundles. Am J Sports Med. 13 Dec;1(1):-3. Wijdicks CA, Kennedy NI, Goldsmith MT, Devitt BM, Michalski MP, Årøen A, Engebretsen L, LaPrade RF. Kinematic analysis of the posterior cruciate ligament, part : A comparison of anatomic single- versus double-bundle reconstruction. Am J Sports Med. 13 Dec;1(1):39-. Wijdicks CA, Michalski MP, Rasmussen MT, Goldsmith MT, Kennedy NI, Lind M, Engebretsen L, LaPrade RF. Superficial medial collateral ligament anatomic augmented repair versus anatomic reconstruction: an in vitro biomechanical analysis. Am J Sports Med. 13 Dec;1(1):5-. Engebretsen L. ACL surgery is not for all patients, nor for all surgeons. Knee Surg Sports Traumatol Arthrosc. 1 Jan;(1):1-. Persson A, Fjeldsgaard K, Gjertsen JE, Kjellsen AB, Engebretsen L, Hole RM, Fevang JM. Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction. A study of 1,3 patients from the Norwegian Cruciate Ligament Registry, -1. Am J Sports Med. 1 Feb;():5-91. Gifstad T, Foss OA, Engebretsen L, Lind M, Forssblad M, Albrektsen G, Drogset JO. Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 5,99 primary ACL reconstructions in Scandinavia. Am J Sports Med. 1 Oct;(1):319-.
Grindem H, Granan LP, Risberg MA, Engebretsen L, Snyder-Mackler L, Eitzen I. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction years after surgery? A comparison between patients in the Deleware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med. 15 Mar;9():35-9. Lynch AD, Logerstedt D, Grindem H, Eitzen I, Hicks GE, Axe MJ, Engebretsen L, Risberg MA, Snyder-Mackler L. Consensus criteria for defining successful outcome after ACL injury and reconstruction: a Delaware-Oslo ACL cohort investigation. Br J Sports Med. 15 Mar;9(5):335-. Granan LP, Baste V, Engebretsen L, Inacio MC. Associations between inadequate knee function detected by KOOS and prospective graft failure in an anterior cruciate ligament-reconstructed knee. Knee Surg Sports Traumatol Arthrosc. 15 Apr;3():1135-. Engebretsen L, Forssblad M, Lind M. Why registries analysing cruciate ligament surgery are important. Br J Sports Med. 15 May;9(1):3- LaPrade CM, Dornan GJ, Granan LP, LaPrade RF, Engebretsen L. Outcomes after anterior cruciate ligament reconstruction using the Norwegian knee ligament registry of 91 patients: How does meniscal repair or resection affect short-term outcomes? Am J Sports Med. 15 Jul;3(7):1591-7. Ingelsrud LH, Granan LP, Engebretsen L, Roos E. Proportion of patients reporting acceptable symptoms or treatment failure and their associated KOOS values at to months after anterior cruciate ligament reconstruction. Am J Sports Med. 15 Aug;3():19-7. Owesen C, Sivertsen EA, Engebretsen L, Granan LP, Årøen A. Patients with isolated PCL injuries improve from surgery as much as patients with ACL injuries after years. Ortop J Sports Med. 15 Aug 19;3():3597115599539. Magnussen RA, Trojani C, Granan LP, Neyret P, Colombet P, Engebretsen L, Wright RW, Kaeding CC, MARS Group, SFA Revision ACL Group. Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian and North American cohorts. Knee Surg Sports Traumatol Arthrosc. 15 Aug;3():339-. Owesen C, Sandven-Thrane S, Lind M, Forssblad M, Granan LP, Årøen A. Epidemiology of surgically treated posterior cruciate ligament injuries in Scandinavia. Knee Surg Sports Traumatol Arthrosc. 15 Sep 19. [Epub ahead of print] Persson A, Kjellsen AB, Fjeldsgaard K, Engebretsen L, Espehaug B, Fevang JM. Registry data highlight increased revision rates for endobutton/biosure HA in ACL reconstruction with hamstring tendon autograft. A nationwide cohort study from the Norwegian Knee Ligament Registry, - 13. Am J Sports Med. 15 Sep;3(9):1-. Røtterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Årøen A. Effect on patient-reported outcomes of debridement or microfracture of concomitant full-thickness cartilage lesions in anterior curciate ligamet-reconstructed knees: A nationwide cohort study from Norway and Sweden of 357 patients with -year follow-up. Am J Sports Med. 1 Feb;():337- Moksnes H, Engebretsen L, Seil R. The ESSKA paediatric anterior cruciate ligament monitoring initiative. Knee Surg Sports Traumatol Arthrosc. 1 Mar;(3):-7. Ulstein S, Bredland K, Årøen A, Engebretsen L, Røtterud JH. No negative effect on patientreported outcome of concomitant cartilage lesions 5-9 years after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 1 May 19;5(5):1-1 5
Soreide E, Granan LP, Hjorthaug GA, Espehaug B, Dimmen S, Nordsletten L. The effect of limited perioperative nonsteroidal anti-inflammatory drugs on patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med. 1 Dec;(1):3111-311. Clinical trials relatet to the Norwegian National Advisory Unit on Arthroplasty and Hip Fractures (3 in total) Hallan G, Lie SA, Havelin LI. High wear rates and extensive osteolysis in 3 types of uncemented total hip arthroplasty: a review of the PCA, the Harris Galante and the Profile/Tri-Lock Plus arthroplasties with a minimum of 1 years median follow-up in 9 hips. Acta Orthop ;77:575-. Hallan G, Aamodt A, Furnes O, Skredderstuen A, Haugan K, Havelin LI. Palamed G compared with Palacos R with gentamicin in Charnley total hip replacement. A randomised, radiostereometric study of hips. J Bone Joint Surg ;-B:113- Kadar T, Hallan G, Aamodt A, Indrekvam K, Badawy M, Skredderstuen A, Havelin LI, Stokke T, Haugan K, Espehaug B, Furnes O. Wear and migration of highly crossed-linked and conventional cemented polyethylene cups with cobalt chrome or Oxinum femoral heads: a randomized radiostereometric study of 15 patients. J Orthop Res 11 Aug;9():1-9. Ravnskog FA, Espehaug B, Indrekvam K. Randomised clinical trial comparing Hydrofiber and alginate dressings post-hip replacement. J Wound Care. 11 Mar;(3):13-. Laborie LB, Lehmann TG, Engesæter IØ, Eastwood, DM, Engesæter LB, Rosendahl K. Prevalence of radiographic findings thought to be associated with femoroacetabular impingement in a population-based cohort of 1 healthy young adults. Radiology 11 Aug;():9-5. Engesæter IØ, Laborie LB, Lehmann TG, Sera F, Fevang JM, Pedersen D, Morcuende J, Lie SA, Engesæter LB, Rosendahl K. Radiological findings for hip dysplasia at skeletal maturity. Validation of digital and manual measurement techniques. Skeletal Radiol 11;1(7):-5. Young S, Lie SA, Hallan G, Lewis GZ, Engesæter LB, Havelin LI. Low infection rates after 3,31 intramedullary nail operations in 55 low- and middle-income countries. Validation of the Surgical Implant Generation Network (SIGN) Online Surgical Database. Acta Orthop 11;():737-73. Kadar T, Hallan G, Aamodt A, Indrekvam K, Badawy M, Havelin LI, Stokke T, Haugan K, Espehaug B, Furnes O. A randomized study on migration of the Spectron EF and the Charnley flanged cemented femoral components using radiostereometric analysis at years. Acta Orthop 11 Oct;(5):53-. Kadar T, Furnes O, Aamodt A, Indrekvam K, Havelin LI, Haugan K, Espehaug B, Hallan G. The influence of acetabular inclination angle on the penetration of polyethylene and migration of the acetabular component. A prospective, radiostereometric study on cemented acetabular components. J Bone Joint Surg Br 1;9-B:3-7. Blomquist J, Solheim E, Liavaag S, Schroeder CP, Espehaug B, Havelin LI. Shoulder instability surgery in Norway. The first report from a multicentre register, with 1-year follow-up. Acta Orthop 1;3():15-17.
Engesæter IØ, Laborie LB, Lehmann TG, Fevang JM, Lie SA, Engesæter LB, Rosendahl K. Prevalence of radiographic findings associated with hip dysplasia in a population-based cohort of 119-year-old Norwegians. Bone Joint J 13 Feb;95-B():79-5. Lehmann TG, Vetti N, Laborie LB, Engesæter IØ, Engesæter LB, Rosendahl K. Intra- and interobserver repeatability of radiographic measurements for previously slipped capital femoral epiphysis at skeletal maturity. Acta Radiol 13 Feb:1-5. Young S, Lie SA, Hallan G, Zirkle LG, Engesæter LB, Havelin LI. Risk factors for infection after,113 intramedullary nail operations in low- and middle-income countries. World J Surg. 13 Feb;37():39-55. Lehmann TG, Engesæter IØ, Laborie LB, Lie SA, Rosendahl K, Engesæter LB. Radiological findings that may indicate a prior silent slipped capital femoral epiphysis in a cohort of 7 young adults. Bone Joint J. 13 Apr;95-B():5-. Matre K, Vinje T, Havelin LI, Gjertsen JE, Furnes O, Espehaug B, Kjellevold SH, Fevang JM. Trigen intertan intramedullary nail versus sliding hip screw. A prospective, randomized multicenter study on pain, function and complications in patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up. J Bone Joint Surg A. 13;95:-. Østerås N, Risberg MA, Kvien TK, Engebretsen L, Nordsletten L, Bruusgaard D, Skjervheim UB, Haugen IK, Hammer HB, Provan SA, Øiestad BE, Semb AG, Rollefstad SCG, Hagen KB, Uhlig T, Slatkowsky-Christensen B, Flugsrud GB, Kjeken I, Grotle M, Sessing S, Edvardsen H, Natvig B. Hand, hip and knee osteoarthritis in a Norwegian population-based study - The MUST protocol. BMC Musculoskelet Disord. 13 Jul 5;1:1. Laborie LB, Engesæter IØ, Lehmann TG, Sera F, Dezateux C, Engesæter LB, Rosendahl K. Radiographic measurements of hip dysplasia at skeletal maturity-new reference intervals based on,3 19-year-old Norwegians. Skeletal Radiol 13 Jul;(7):95-35. Laborie LB, Lehmann TG. Engesæter IØ, Engesæter LB, Rosendahl K. Is a positive femoroacetabular impingement test a common finding in healthy young adults? Clin Orthop Relat Res.13 Jul;71(7):7-77. Young S, Banza LN, Hallan G, Beniyasi F, Kumbukani GM, Munthali BS, Dybvik E, Engesæter LB, Havelin LI. Complications after intramedullary nailing of femoral fractures in low-income country. A prospective study of follow-up, HIV infection, and microbial infection rates after IM nailing of 11 femoral fractures at a central hospital in Malawi. Acta Orthop. 13;(5):-7. Dyrhovden GS, Gøthesen Ø, Lygre SH, Fenstad AM, Sørås TE, Halvorsen S, Jellestad T, Furnes O. Is the use of computer navigation in total knee arthroplasty improving implant positioning and function? A comparative study of 19 knees operated at a Norwegian district hospital. BMC musculoskeletal Disord. 13;1:31. Laborie LB, Engesæter IØ, Lehmann TG, Eastwood DM, Engesæter LB, Rosendahl K. Screening strategies for hip dysplasia: long-term outcome of a randomized controlled trial. Pediatrics. 13 Sept;13(3):9-51. Laborie LB, Markestad TJ, Davidsen H, Brurås KR, Aukland SM, Bjørlykke JA, Reigstad H, Indrekvem K, Lehmann TG, Engesæter IØ, Engesæter LB, Rosendahl K. Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991-. Pediatr Radiol. 1 Apr;():1-. Gøthesen Ø, Espehaug B, Havelin LI, Petursson G, Hallan G, Strøm E, Dyrhovden G, Furnes O. Functional outcome and alignment in computer-assisted and conventionally operated total knee 7
replacement. Bone Joint J 1;9-B:9-1. Laborie LB, Lehmann TG, Engesæter IØ, Engesæter LB, Rosendahl K. The alpha angle in camtype femoroacetabular impingement New reference intervals based on 3 healthy young adults. Bone Joint J. 1 Apr;9-B():9-5. Hermansen E, Moen G, Fenstad AM, Birketvedt R, Indrekvam K. Spinous process osteotomy to facilitate the access to the spinal canal when decompressing the spinal canal in patients with lumbar spinal stenosis. Asian spine J 1;():13-1. Grosse S, Haugland HK, Lilleng P, Ellison P, Hallan G, Høl PJ. Wear particles and ions from cemented and uncemented titanium-based hip prostheses a histological and chemical analysis of retrieval material. J Biomed Mater Res B Appl Biomater. 15 Apr;13(3):79-17. Løwer HL, Dale H, Eriksen HM, Aavitsland P, Skjeldestad FE. Surgical site infections after hip arthroplasty in Norway, 5-11: Influence of duration and intensity of postdischarge surveillance. American journal of infection control 15;3:33-. Løwer HL, Dale H, Eriksen HM, Aavitsland P, Skjeldestad FE. Response to letter to the editor regarding: «Surgical site infections after hip arthroplastry in Norway, 5-11: Influence of duration and intensity of postdischarge surveillance». American journal of infection control 15;3:1-5. Nygard H, Matre K, Fevang JM. Evaluation of timed up and go test as a tool to measure postoperative function and prediction of one year walking ability for patients with hip fracture. Clin Rehabil. 15 Jun ;3(5):7-. Jonsson BA, Kadar T, Havelin LI, Haugan K, Espehaug B, Indrekvam K, Furnes O, Hallan G. Oxinium modular femoral heads do not reduce polyethylene wear in cemented total hip arthroplasty at five years: a randomised trial of 1 hips using radiostereometric analysis. Bone Joint J.15 Nov;97-B(11):13-9. Strand LI, Olsen AL, Nygard H, Furnes O, Magnussen LH, Lygren H, Sundal MA, Skjaerven LH. Basic body awareness therapy and patient education in hip osteoarthritis: a multiple case study. European journal of physiotherapy. 1;Volum 1():11-15 Kalson NS, Borthwick LA, Mann DA, Deehan DJ, Lewis P, Mann C, Mont MA, Morgan-Jones R, Oussedik S, Williams FM, Toms A, Argenson JN, Bellemans J, Bhave A, Furnes O, Gollwitzer H, Haddad FS, Hofmann S, Krenn V. International consensus on the definition and classification of fibrosis of the knee joint. Bone Joint J. 1 Nov;9-B(11):179-. Petursson G, Fenstad AM, Gøthesen Ø, Haugan K, Dyrhovden GS, Hallan G, Röhrl SM, Aamodt A, Nilsson KG, Furnes O. Similar migration in computer-assisted and conventional total knee arthroplasty. Acta Orthop. 1 Dec ;():1-17 Wangen H, Nordsletten L, Boldt JG, Fenstad AM, Beverland DE. The Corail stem as a reverse hybrid survivorship and x-ray analysis at 1 years. Hip Int. 17 Feb 7. [Epub ahead of print]
Oral presentations/abstracts/posters 1-17 ( in total) Norwegian Arthroplasty Register (5 in total) Leta TH, Lygre SHL, Skredderstuen A, Hallan G, Gjertsen JE, Rokne B, Furnes O. The outcome of unicompartmental knee arthroplasties after aseptic revision into total knee arthroplasties. A comparative study of 7 total knees and 57 uni knees revised to total knees reported to the Norwegian arthroplasty register (199-11). 5 th Nordic orthopaedic federation congress; 1 7-9 April; Linköping, Sweden. Furnes O, Dybvik E, Småbrekke A, Fenstad AM, Hallan G, Havelin L. Ceramic on ceramic articulation in 9 uncemented total hip replacements with up to 15 years follow up reported to the Norwegian arthroplasty register. Poster presented at the 5 th Nordic Orthopaedic Federation Congress; 1 7-9 April; Linköping, Sweden. Lie SA. Co-occurring competing risk illustrated using data from two different hip implants with two different bone cements. The 7 TH International Conference Methodological Issues in Oral Health Research; 1 11-13 May; Bergen, Norway Furnes O. Report from Norwegian shoulder arthroplasty registry. The 7 th Triennial Nordic shoulder and elbow conference; 1 1-13. May; Odense, Denmark Furnes O. The learning curve of surgical procedures Influence on education. The 7 th Triennial Nordic shoulder and elbow conference; 1 1-13 may; Odense, Denmark Dyrhovden G, Furnes O, Gøthesen Ø, Badawy M, Lygre SH. Time trends in causes of revision in unicompartmental and total knee replacement 199-1. Poster presented at the 5 th International Congress of Arthroplasty Registries (ISAR); 1-3 May; Manchester, UK. Junnila M, Laaksonen I, Eskelinen A, Pulkkinen P, Havelin L, Furnes O, Fenstad AM, Pedersen AB, Overgaard S, Kärrholm J, Garellick G, Malchau H, Mäkelä K. Implant survival of the most common cemented total hip devices from the Nordic arthroplasty register association (ISAR). 5 th International Congress of Arthroplasty registries; 1-3 May; Manchester, UK. Ackerman IN, Bohensky MA, Brand CA, Eskelinen A, Fenstad AM, Furnes O, Garellick G, Graves SE, Haapakoski J, Havelin L, Mäkelä K, Mehnert F, Pedersen AB, Robertsson O, Steiger RD. Using international registry data to quantify the lifetime risk of primary total knee replacement surgery (ISAR). 5 th International Congress of Arthroplasty registries; 1-3 May; Manchester, UK. Leta TH, Lygre SHL, Skredderstuen A, Hallan G, Gjertsen JE, Rokne B, Furnes O. The outcome of unicompartmental knee arthroplasties after aseptic revision into total knee arthroplasties. A comparative study of 7 total knees and 57 uni knees revised to total knees reported to the Norwegian arthroplasty register (199-11) (ISAR). 5 th International Congress of Arthroplasty registries; 1-3 May; Manchester, UK. Furnes O, Dybvik E, Småbrekke A, Fenstad AM, Hallan G, Havelin L. Ceramic on ceramic articulation in 9 uncemented total hip replacements with up to 15 years follow up reported to the Norwegian arthroplasty register (ISAR). 5 th International Congress of Arthroplasty registries; 1-3 May; Manchester, UK. Dyrhovden GS, Fenstad AM, Furens O, Gøthesen Ø. Eight years survivorship of computer navigated total knee replacement reported to the Norwegian arthroplasty register (ISAR). 5 th International Congress of Arthoplasty registries; 1-3 May; Manchester, UK. Johansson PE, Furnes O, Havelin L, Fenstad AM, Pedersen A, Overgaard S, Garellic G, Mäkelä 9
K, Kärrholm J. Mixed outcome in a design-specific comparison between highly cross-linked and conventional polyethylene in total hip arthroplasty, 133 THR in the Nordic arthroplasty register association database with 5-11 years follow up (ISAR). 5 th International Congress of Arthroplasty registries; 1-3 May; Manchester, UK. Kreipke R, Pedersen AB, Rogmark C, Kärrholm J, Hallan G, Havelin L, Mäkelä K, Overgaard S. Revision risks of dual mobility cups in total hip arthroplasty A matched register-based study from the Nordic arthroplasty register association (ISAR). 5 th International Congress of Arthoplasty registries; 1-3 May; Manchester, UK. Niemeläinen M, Mäkelä K, Pulkkinen P, Robertsson O, Dahl AW, Furnes O, Fenstad AM, Pedersen AB, Troelsen A, Schrøder H, Eskelinen A. Ageing generation responsible for high incidences of knee arthroplasties. A population based study from Nordic arthroplasty register association (ISAR). 5 th Congress of Arthroplasty registries; 1-3 May; Manchester, UK. Niemeläinen M, Mäkelä K, Pulkkinen P, Robertsson O, Dahl AW, Furnes O, Fenstad AM, Pedersen AB, Troelsen A, Schrøder H, Eskelinen A. Failure rate of cemented and uncemented total knee replacement in working-age population: A register study of combined Nordic database of four nations (ISAR). 5 th Congress of Arthroplasty registries; 1-3 May; Mancheter, UK. Furnes O, Dybvik E, Småbrekke A, Fenstad AM, Hallan G, Havelin L. Ceramic on ceramic articulation in 9 uncemented total hip replacements with up to 15 years follow up reported to the Norwegian arthroplasty register. 17 th EFFORT Congress; 1 1-3 June; Geneva, Switzerland. Leta TH, Lygre SH, Skredderstuen A, Hallan G, Gjertsen JE, Rokne B, Furnes O. The outcome of unicompartmental knee arthroplasties after aseptic revision into total knee arthroplasties. A comparative study of 7 total knees and 57 uni knees revised to total knees reported to the Norwegian arthroplastry register (199-11). 17 th EFFORT Congress; 1 1-3 June; Geneva, Switzerland. Brüggermann H, Hallan G, Fenstad AM, Havelin LI, Fosse L. Risk factors for intraoperative proximal femoral fractures (IPFF) during primary hip arthroplasty: 17 IPFFs were reported to the Norwegian arthroplasty register (NRL) between 197 to 1. 17 th EFFORT Congress; 1 1-3 June; Geneva, Switzerland. Havelin LI. The truth of cemented versus uncemented. 17 th EFFORT Congress; 1 1-3 June; Geneva, Switzerland. Brorson S, Salomonsson B, Jensen SL, Fenstad AM, Demir Y, Rasmussen J. Risk of revision and reasons for revision after shoulder replacement for acute fracture of the proximal humerus: A Nordic registry-based study of,7 cases. 17 th EFFORT Congress; 1 1-3 June; Geneva, Switzerland. Fenstad AM, Badawy M, Bartz-Johannessen C, Indrekvam K, Havelin L, Robertsson O, W-Dahl A, Eskelinen A, Mäkelä K, Pedersen AB, Schrøder H, Furnes O. How is revision rates influenced by hospital procedure volume for the Oxford unicomparmental knee arthroplasty? 3 rd Conference of the Norwegian Association of Epidemiology, 1-7 Sep; Bergen, Norway Furnes O. Innføring av PROM I leddproteseregisteret. Presentert på symposium på høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Gøthesen Ø, Lygre SH, Lorimer M, Graves S, Furnes O. Økt risiko for aseptisk løsning for 555 roterende platform totalproteser i kne. En kombinert rapport fra norsk og australsk leddregister, 3-1. Høstmøtet i Norsk Ortopedisk forening; 1.-. oktober; Oslo Dyrhovden GS, Lygre SHL, Badawy M, Gøthesen Ø, Furnes O. Proteseoverlevelse og revisjonsårsaker for unikondylære og totale kneproteser 199-15. Høstmøtet i Norsk Ortopedisk 9
forening; 1.-. oktober; Oslo Furnes O, Dybvik E, Småbrekke A, Fenstad AM, Hallan G, Havelin LI. Keramikk-keramikk artikulasjon i 9 usementerte totalproteser med opp til 15 års oppfølging rapportert til Nasjonalt register for leddproteser. Høstmøtet i Norsk Ortopedisk forening; 1.-. oktober; Oslo Langvatn H, Engesæter LB, Schrama JC, Lingaas E, Dale H. Ventilasjon av operasjonsstuer og revisjonsrisiko på grunn av infeksjon etter total hofteprotesekirurgi; Høstmøtet i Norsk Ortopedisk forening; 1.-. oktober; Oslo Engesæter LB, Dale H. Fortsatt økning i rapporterte revisjoner av infeksjoner til hofteproteseregisteret. Høstmøtet i Norsk Ortopedisk forening; 1.-. oktober; Oslo Lindalen E, Bartz-Johannessen CA, Fenstad AM, Furnes O, Uppheim G. Patellofemoral protese - resultater fra Nasjonalt register for leddproteser. Høstmøtet i Norsk Ortopedisk forening; 1.-. oktober; Oslo Hellevik AI, Johnsen MB, Langhammer A, Fenstad AM, Furnes O, Stroheim K, Zwart JA, Flugsrud G, Nordsletten L. Hormonelle faktorer og reproduktiv historie som risikofaktorer for hofte eller kneprotese på grunn av primær artorse; En prospektiv kohortstudie. Høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Furnes O. Experiences from the Norwegian Hip arthroplasty register 197-1. Invited speaker 3 rd annual meeting of Japanese Hip Society, Kyoto th November 1. Furnes O. Hofteprotesens historie. LINKademy, kurs i sementert hofteprotese; 1 1.-. desember; Bergen Furnes O. Spiller det noen rolle hvilken sement jeg bruker? LINKademy, kurs i sementert hofteprotese; 1 1.-. desember; Bergen Furnes O. Nytt fra Nasjonalt register for leddproteser. Videokonferanse; 17 1 januar; Bergen Eskelinen A, Furnes O, Garellick G, Havelin LI, Kärrholm JN, Laaksonen I, Mäkelä K, Malchau H, Overgaard S. Implant survival of the most common cemented total hip devices from the Nordic arthroplasty register association database. Annual AAOS meeting; 17 March 1 1; San Diego, USA Gøthesen Ø, Lygre SH, Graves S, Furnes O, Lorimer M. Higher risk of aseptic loosening in mobile non-posterior-stabilized total knee arthroplasty. Annual AAOS meeting; 17 March 1 1; San Diego, USA Furnes O, Dyrhovden G, Badawy M, Lygre SH, Gøthesen Ø. Improved survival for uni and total knee arthroplasty the last decade, but more early infections in total knee arthroplasty. Annual AAOS meeting; 17 March 1 1; San Diego, USA Kreipke R, Hallan G, Havelin LI, Kärrholm JN, Mäkelä K, Overgaard S, Pedersen AB, Rogmark C. Revision risks of dual mobility cups in total hip arthroplasty a study from the Nordic arthroplasty register association. Poster presented at the Annual AAOS meeting; 17 March 1 1; San Diego, USA Engesæter I, Engesæter LB, Halvorsen VB, Nordsletten L, Røhrl S, Tsukanaka M. hip replacement in young patients under years of age: Survival, revisions, and quality of life. Poster presented at the Annual AAOS meeting; 17 March 1 1; San Diego, USA Fenstad AM. Statistikk- et nyttig verktøy! ENT3R- elevkveld; 17 April ; Universitetet i Bergen 91
Fenstad AM. Multippel testing. Kurs i analyse av registerdata; 17 April -; Tromsø Wilkinson M, Bartz-Johannessen C, Furnes O, Havelin L, Fenstad AM, Lie SA, Pedersen A, Overgaard S, Kärrholm J, Garellick G, Nemes S, Malchau H, Mäkelä KT, Eskelinen A, Wilkinson JM. Risk stratification algorithms for hip replacement outcomes: An evaluation of the heterogeneity in prosthesis survivorship between Scandinavian countries using the NARA database. th International Congress of Arthroplasty Registries; 17 May ; San Francisco, USA Dybvik E, Furnes O, Havelin LI, Fosså SD, Trovik C, Lie SA. Increased risk of cancer for uncemented total hip replacementes. A study of.37 patients in the Norwegian arthroplasty register linked to the Cancer registry of Norway. th International Congress of Arthroplasty Registries; 17 May ; San Francisco, USA Dale H, Børsheim S, Gjertsen JE, Hallan G, Fenstad AM, Fevang JM, Havelin LI, Furnes O. Fixation in contemporary primary total hip arthroplasty- Is cemented still better? th International Congress of Arthroplasty Registries; 17 May ; San Francisco, USA Steiger R, Ackerman IN, Bohensky MA, Brand CA, Eskelinen A, Fenstad AM, Furnes O, Graves SE, Haapakoski J, Havelin LI, Mäkelä K, Mehnert F, Nemes S, Overgaard S, Pedersen AB, Garellick G. Liftime risk of primary total hip replacement surgery for osteoarthritis from 3-13: A multi-national analysis using national registry data. th International Congress of Arthroplasty Registries; 17 May ; San Francisco, USA Furnes O, Gøthesen Ø, Lygre SH, Lorimer M, Graves S. Risk of aseptic loosening for 355 rotating platform total knee replacements. A combined registry study from Norway and Australia, 3-1. th International Congress of Arthroplasty Registries; 17 May ; San Francisco, USA Havelin LI. Translating registry findings into clinical practice. NAR, Norwegian. th International Congress of Arthroplasty Registries; 17 May ; San Francisco, USA Furnes O, Leeuwe M. Data completeness and validity of outcome presentation of registry data. th International Congress of Arthroplasty Registries; 17 May ; San Francisco, USA Badawy M, Espehaug B, Fenstad AM, Indrekvam K, Dale H, Havelin LI, Furnes O. Does procedure duration affect the revision risk due to deep infection in total knee arthroplasty? th International Congress of Arthroplasty Registries; 17 May ; San Francisco, USA Tsikandylakis G, Kärrholm J, Hailer NP, Eskelinen A, Mäkelä K, Hallan G, Furnes O, Pedersen AB, Overgaard S, Mohaddes M. Should 3 mm heads be used to reduce the risk of revision due to dislocation after total hip arthroplasty? An analysis of 3,715 procedures in the Nordic arthroplasty registry association. th International Congress of Arthroplasty Registries; 17 May ; San Francisco, USA Lehtimäki K, Rasmussen J, Mokka J, Salomonsson B, Hole R, Jensen SL, Äärimaa V. Risk factors for revision after reverse shoulder arthroplasty Nordic arthroplasty registry study. th International Congress of Arthroplasty Registries; 17 May ; San Francisco, USA Norwegian Hip Fracture Register (11 in total) Gjertsen JE, Dybvik E, Furnes O, Fevang JM, Havelin LI, Matre K, Engesæter LB. Improved outcome after hip fracture surgery in Norway. 1 years results from the Norwegian hip fracture register. 5 TH FFN Global Congress; 1 1-3 september; Rome, Italy Gjertsen JE. Hip fracture care in Scandinavia. QIST conference; 1 1 october; Newcastle, UK 9
Gjertsen JE. SSI in hip fracture. QIST conference; 1 19 october; Newcastle, UK Kristensen TB, Dybvik EH, Furnes O, Engesæter LB, Gjertsen JE. Overlevelse for sementerte hemiprotesestammer. Rapport fra Nasjonalt hoftebruddregister. Høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Gjertsen JE, Dybvik E, Furnes O, Fevang JM, Havelin LI, Matre K, Engesæter LB. Mindre reoperasjoner etter hoftebruddskirurgi i Norge. Resultater fra Nasjonalt hoftebruddregister 5-1. Høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Råen V, Arnason OT, Kjærner-Semb Ø, Jahnsen E, Leer-Salvesen S, Engesæter LB. Validering av rapportering av primæropererte hoftebrudd til Norsk Pasientregister. Høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Kjærner-Semb Ø, Arnason OT, Jahnsen E, Råen V, Leer-Salvesen S, Engesæter LB. Enkel metode for å finne antall primær operasjoner for hoftebrudd. Høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Jahnsen E, Arnason OT, Kjærner-Semb Ø, Leer-Salvesen S, Råen V, Engesæter LB. Validering av rapporteringen av primær operasjoner for hoftebrudd til Nasjonalt hoftebruddregister ved åtte sykehus i Norge. Høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Vinje T, Engesæter L, Gjertsen JE. Tid frå skade til operasjon og død for pasientar med hoftefraktur - ein nasjonal kohortstudie med propensity score matching. Høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Gjertsen JE, Dybvik E, Furnes O, Fevang JM, Havelin LI, Matre K, Engesæter LB. Improved outcome after hip fracture surgery in Norway. 1-years results from the Norwegian hip fracture register. th International Congress of Arthroplasty Registries; 17 May ; San Francisco, USA Kristensen TB, Dybvik E, Furnes O, Engesæter LB, Gjertsen JE. Stem survival of cemented hemiarthroplasty for femoral neck fractures. A report from the Norwegian hip fracture register. th International Congress of Arthroplasty Registries; 17 May ; San Francisco, USA Norwegian Cruciate Ligament Register (5 in total) Fjeldsgaard K. Status for elektronisk rapportering. Presentert på symposium på høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Persson A, Fjeldsgaard K, Gjertsen JE, Engebretsen L, Kjellsen AB, Fevang JM. New trauma is the most common cause of revision after primary anterior cruciate ligament reconstruction - a study from the Norwegian knee ligament registry -15. Høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Aga C, Granan LP, Kartus J, Lind M, Maletis G, Engebretsen L. No difference in revision rates or treatment failures between single bundle and double bundle anterior cruciate ligament reconstruction, A register study. Høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Gifstad T, Inderhaug E, Drogset JO. Grafttykkelse og kroppsmasseindeks i det norske korsbåndregisteret. Høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Ekås GR, Engebretsen L. Korsbåndregisteret er i endring i form av registrering av ikke opererete 93
korsbåndspasienter; Prosjektpresentasjon og demonstrasjon av elektronisk skjema. Høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Norwegian Paediatric Hip Register ( in total) Wiig O. Introduksjon og status for barnehofteregisteret. Presentert på symposium på høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo Reve AK. Hva kan gjøres for å øke compliance? Presentert på symposium på høstmøtet i Norsk Ortopedisk Forening; 1.-. oktober; Oslo 9
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9.1.15 Nasjonalt Register for Leddproteser Ortopedisk klinikk, Helse Bergen HF Haukeland universitetssjukehus, Postboks 1 Møllendalsbakken 11, 51 BERGEN Tlf 559737/5597373 HOFTEPROTESER F.nr. (11 sifre)... Navn:... (Skriv tydelig ev. pasientklistrelapp spesifiser sykehus.) Sykehus:... Alle totale hofteproteseoperasjoner og hemiproteser på annen indikasjon enn fraktur/fraktursekvele registreres her (hemiprotese for fraktur/fraktursekvele registreres på Hoftebruddskjema). Alle reoperasjoner skal registreres: skifte/fjerning av protesedeler, kantplastikk, bløtdelsdebridement, og operasjoner for protesenær fraktur eller gluteal svikt. TIDLIGERE OPERASJON I AKTUELLE HOFTE (ev. flere kryss) Nei 1 Osteosyntese for fraktur i prox. femurende Hemiprotese pga. fraktur 3 Osteotomi Artrodese 5 protese(r) Annen operasjon. AKTUELLE OPERASJON (ett kryss) 1 Primæroperasjon (også hvis hemiprotese tidligere) Reoperasjon (totalprotese tidligere) 3 Primær hemiprotese for annen indikasjon enn fraktur/fraktursekvele OPERASJONSDATO (dd.mm.åå) AKTUELLE SIDE (ett kryss) (Bilateral opr.= skjema) 1 Høyre Venstre ÅRSAK TIL AKTUELLE OPERASJON (KRYSS AV ENTEN I A ELLER B) A. Primæroper. pga (ev. flere kryss) B. Reoper. pga (ev. flere kryss) 1 Idiopatisk coxartrose 1 Løs acetabularkomponent Rheumatoid artritt Løs femurkomponent 3 Sekvele etter frakt. colli. fem. 3 Luksasjon Sekv. dysplasi Dyp infeksjon 5 Sekv. dysplasi med total luksasjon 5 Fraktur i acetabulum Sekv. Perthes Fraktur av femur 7 Sekv. epifysiolyse Vancouverklassifikasjon, se bakside. Mb. Bechterew A B1 B B3 C 9 Akutt fraktura colli femoris 7 Smerter 1 Annet... Osteolyse i acetab. uten løsning (f.eks caputnekrose, tidl. artrodese o.l) 9 Osteolyse i femur uten løsning 1 Implantatfraktur femurdel 11 Implantatfraktur caput 1 Implantatfraktur kopp 13 Implantatfraktur liner 1 Implantatfraktur annet:...... 15 Gluteal svikt 1 Annet. (f.eks Girdlestone etter tidl. infisert protese) REOPERASJONSTYPE (ev. flere kryss) 1 Bytte av femurkomponent Bytte av acetabularkomponent 3 Bytte av hele protesen Fjernet protese og satt inn sementspacer 5 Fjernet sementspacer og satt inn ny protese Fjernet protese (Girdlestone eller fjerning av sementspacer) Angi hvilke deler som ble fjernet 7 Bytte av plastforing Bytte av caput 9 Bløtdelsdebridement 1 Ny protese etter Girdlestone 11 Resutur av muskel 1 Transposisjon av muskel 13 Osteosyntese for fraktur 1 Konvertering til hemiprotese 15 Andre operasjoner.. TILGANG (ett kryss) 1 Fremre (Mellom sartorius og tensor) Anterolateral (Mellom glut. medius og tensor) 3 Direkte lateral (Transgluteal) Bakre (Bak gluteus medius) 5 Annen BENTRANSPLANTASJON (ev. flere kryss) Acetabulum Nei 1 Ja Benpakking Femur Nei 1 Ja Benpakking a.m. Ling/Gie BENTAP VED REVISJON (Paprosky s klassifikasjon se baksiden) Acetabulum 1 I IIA 3 IIB IIC 5 IIIA IIIB Femur 1 I II 3 IIIA IIIB 5 IV PROTESEKOMPONENTER (Bruk klistrelapp på baksiden, eller skriv REF.NR.) Acetabulum Navn/Type ev. REF.NR... Med hydroksylapatitt Uten hydroksylapatitt 1 Sement med antibiotika Navn. Sement uten antibiotika Navn. 3 Usementert Femur (+ ev. trokanterdel) Navn/Type... ev. REF.NR...... Med hydroksylapatitt Uten hydroksylapatitt 1 Sement med antibiotika Navn. Sement uten antibiotika Navn. 3 Usementert Caput (+ ev. halsdel) 1 Fastsittende caput Separat caput - Navn/Type ev. REF. NR... Diameter.. ANTIBIOTIKAPROFYLAKSE Nei 1 Ja Navn Dosering Varighet i timer Medikament 1...... Medikament...... Medikament 3........ timer.. timer.. timer TROMBOSEPROFYLAKSE Nei 1 Ja: Første dose 1 Preoperativt Postoperativt Medikament 1...Dosering opr.dag. Dosering videre...varighet.... døgn Medikament.. Dosering...Varighet.... døgn FAST TROMBOSEPROFYLAKSE Nei 1 Ja, type:... FIBRINOLYSEHEMMER Nei 1 Ja, medikament:.. Dosering. OPERASJONSSTUE 1 Green house Operasjonsstue med laminær luftstrøm 3 Vanlig operasjonsstue OPERASJONSTID (hud til hud) min PEROPERATIV KOMPLIKASJON Nei 1 Ja,hvilke(n)... ASA KLASSE (se baksiden for definisjon) 1 Frisk Asymptomatisk tilstand som gir økt risiko 3 Symptomatisk sykdom Livstruende sykdom 5 Moribund MINIINVASIV KIRURGI (MIS) Nei 1 Ja LEIE Sideleie 1 Rygg TROCHANTEROSTEOTOMI 9 Nei 1 Ja Lege... Legen som har fylt ut skjemaet (navnet registreres ikke i databasen).
RETTLEDNING TIL HOFTEPROTESER Registreringen gjelder innsetting, skifting og fjerning av totalproteser i hofteledd, samt kantplastikk, bløtdelsrevisjon for infisert protese og hemiproteser på annen indikasjon enn fraktur/fraktursekvele. Hemiprotese for fraktur/ fraktursekvele registreres på Hoftebruddskjema. Ett skjema fylles ut for hver operasjon. Fødselsnummer (11sifre) og sykehusnavn må påføres. Aktuelle ruter markeres med kryss. På eget Samtykkeskjema skal pasienten gi samtykke til rapportering til Leddregisteret. Samtykkeskjema skal lagres i pasientjournal. AKTUELLE OPERASJON Primæroperasjoner: Første totalproteseoperasjon, og første hemiprotese hvis denne settes inn på annen indikasjon enn fraktur. Hemiprotese for fraktur/fraktursekvele registreres på Hoftebruddskjema. Reoperasjon (totalprotese tidligere): Fjerning av protesedeler (f.eks. Girdlestone) må registreres. Kantplastikk (f. eks. PLAD), bløtdelsrevisjoner for infeksjon, osteosyntese, resutur av muskel og muskeltransposisjon registreres selv om protesedeler ikke skiftes. ÅRSAK TIL AKTUELLE OPERASJON Kryss av under A ved primæroperasjoner og under B ved reoperasjoner. I B må du krysse av for alle årsakene til reoperasjon, eller forklare med fritekst. REOPERASJONSTYPE Fjerning av protesedeler (f.eks. Girdlestone) må registreres. Kantplastikk (f. eks. PLAD), bløtdelsrevisjoner for infeksjon, osteosyntese, resutur av muskel og muskeltransposisjon registreres selv om protesedeler ikke skiftes. BENTRANSPLANTASJON Benpropp som sementstopper regnes ikke som bentransplantat. Vi skiller mellom benpakking og transplantasjon. PROTESEKOMPONENTER: Acetabulum - Femur - Caput - Trokanterdel og hals hvis disse er separate deler Bruk klistrelappene som følger med protesen. Lim disse på baksiden av skjema. Alternativt, skriv inn protesenavn + REF.NR., materiale, overflatebelegg og design. Sementnavn må anføres (bruk klistrelapp). KOMPLIKASJONER Også operasjoner hvor pasienter dør på operasjonsbordet eller rett etter operasjon skal meldes. Ved stor blødning, angi mengde. ASA-KLASSE (ASA=American Society of Anesthesiologists) ASA-klasse 1: Friske pasienter som røyker mindre enn 5 sigaretter daglig. ASA-klasse : Pasienter med en asymptomatisk tilstand som behandles medikamentelt (f.eks hypertensjon) eller med kost (f.eks diabetes mellitus type ) og ellers friske pasienter som røyker 5 sigaretter eller mer daglig. MINIINVASIV KIRURGI (MIS = Minimally Invasive Surgery) når det er brukt spesialinstrument laget for MIS. ASA-klasse 3: Pasienter med en tilstand som kan gi symptomer, men som holdes under kontroll medikamentelt (f.eks moderat angina pectoris og mild astma). ASA-klasse : Pasienter med en tilstand som ikke er under kontroll (f.eks hjertesvikt og astma). ASA-klasse 5: Moribund/døende pasient. ANTIBIOTIKAPROFYLAKSE Før på antibiotikum som er benyttet i forbindelse med operasjonen, f.eks.: Medikament 1: Keflin g x, med varighet,5 timer. TROMBOSEPROFYLAKSE Medikament, dose og antatt varighet av profylaksen skal angis separat for operasjonsdagen og senere. Det skal også oppgis om pasienten står fast på tromboseprofylakse (AlbylE, Marevan, Plavix ol). FIBRINOLYSEHEMMER Her føres det på om en benytter blødningsreduserende legemidler i forbindelse med operasjonen (f.eks. Cyklokapron). BEINTAP VED REVISJON Femur (Paprosky`s klassifikasjon) Acetabulum (Paprosky`s klassifikasjon) Type I: Minimalt tap av metafysært ben og intakt diafyse. Type I: Hemisfærisk acetabulum uten kantdefekter. Intakt bakre og fremre kolonne. Type II: Stort tap av metafysært ben, men intakt diafyse. Defekter i forankringshull som ikke ødelegger subchondral benplate. Type IIIA: Betydelig tap av metafysært ben uten mulighet for proximal mekanisk Type IIA: Hemisfærisk acetabulum uten store kantdefekter, intakt bakre og fremre støtte. Over cm intakt corticalis i isthmusområdet. kolonne, men med lite metafysært ben igjen. Type IIIB: Betydelig tap av metafysært ben uten mulighet for proximal mekanisk Type IIB: Hemisfærisk acetabulum uten store kantdefekter, intakt bakre og fremre støtte. Under cm intakt corticalis i isthmusområdet. kolonne, men med lite metafysært ben igjen og noe manglende støtte superiort. Type IV: Betydelig tap av metafysært ben uten mulighet for proximal mekanisk Type IIC: Hemisfærisk acetabulum uten store kantdefekter, intakt bakre og fremre støtte. Bred isthmus med liten mulighet for cortical støtte. kollonne, men med defekt i medial vegg. Type IIIA: Betydelig komponentvandring, osteolyse og bentap. Bentap fra kl.1 til. Type IIIB: Betydelig komponentvandring, osteolyse og bentap. Bentap fra kl. 9 til 5. Kopi beholdes til pasientjournalen, originalen sendes Haukeland universitetssjukehus. PROTESENÆR FRAKTUR Kontaktpersoner vedrørende registreringsskjema er Vancouverklassifikasjon Seksjonsoverlege Leif Ivar Havelin, tlf. 55 97 5 7 og overlege Ove Furnes, tlf. 55 97 5 9 Ortopedisk klinikk, Haukeland universitetssjukehus. Besøksadresse: Møllendalsbakken 11. Sekretærer i Nasjonalt Register for Leddproteser, Ortopedisk klinikk, Helse Bergen: Ingunn Vindenes, tlf. 55 97 37 3 og Merete Husøy, tlf. 55 97 53 Epost nrl@helse-bergen.no Internett: http://nrlweb.ihelse.net/ Skjema revidert i november 15. Type A Type B1 Type B Type B3 Type C Legeforlaget AS 97
19.1.15 Nasjonalt Register for Leddproteser Ortopedisk klinikk, Helse Bergen HF Haukeland universitetssjukehus, Postboks 1 Møllendalsbakken 11, 51 BERGEN Tlf 559737/5597373 KNEPROTESER og andre leddproteser F.nr. (11 sifre)... Navn:... (Skriv tydelig ev. pasientklistrelapp spesifiser sykehus.) Sykehus:... Innsetting, skifting eller fjerning av protese eller protesedeler, samt bløtdelsrevisjoner for infisert protese. LOKALISASJON, AKTUELL OPERASJON 1 Kne Håndledd Ankel 7 Fingre (angi ledd). 3 Tær (angi ledd).. Annet.. Skulder 9 Rygg (angi nivå).. 5 Albue AKTUELLE SIDE (ett kryss) (Bilateral opr. = skjema) 1 Høyre Venstre TIDLIGERE OPERASJON I AKTUELLE LEDD (ev. flere kryss) Nei 1 Osteosyntese for intraartikulær/leddnær fraktur Osteotomi 3 Artrodese Protese 5 Synovectomi Annet (f.eks menisk og leddbåndsop.). AKTUELLE OPERASJON (ett kryss) 1 Primæroperasjon Reoperasjon (protese tidligere) OPERASJONSDATO (dd.mm.åå) ÅRSAK TIL AKTUELLE OPERASJON (KRYSS AV ENTEN I A ELLER B) A. Primæroper. pga (ev. flere kryss) B. Reoper. pga (ev. flere kryss) 1 Idiopatisk artrose 1 Løs prox.protesedel Rheumatoid artritt Løs distal protesedel 3 Fraktursequele 3 Løs patellaprotese Mb. Bechterew Luksasjon av patella 5 Sequele ligamentskade 5 Luksasjon (ikke patella) Sequele meniskskade Instabilitet 7 Akutt fraktur 7 Aksefeil Infeksjonssequele Dyp infeksjon 9 Spondylose 9 Fraktur av bein (nær protesen) 1 Sequele prolaps kirurgi 1 Smerter 11 Degenerativ skivesykdom 11 Slitt eller defekt plastforing 1 Rotarcuff artropati Hvilken. 13 Annet 1 Progresjon av artrose 13 Annet (f.eks tidl fjernet protese)... REOPERASJONSTYPE (ev. flere kryss) 1 Bytte el. innsetting av distal komponent 9 Fjernet protesedeler (inkl. Bytte el. innsetting av proximal protesedel sementspacer) 3 Bytte el. innsetting av hele protesen Angi hvilke deler.. Innsetting av patellakomp.... 5 Bytte av patellaprotese 1 Bløtdelsdebridement for Bytte av plastforing infisert protese 7 Artrodese 11 Annet.. Amputasjon BENTRANSPLANTASJON (ev. flere kryss) Proximalt Nei 1 Ja Benpakking Distalt Nei 1 Ja Benpakking ANTIBIOTIKAPROFYLAKSE Nei 1 Ja Navn Dosering Varighet i timer Medikament 1..... Medikament..... Medikament 3....... timer.. timer.. timer TROMBOSEPROFYLAKSE Nei 1 Ja: Første dose 1 Preoperativt Postoperativt Medikament 1...Dosering opr.dag. Dosering videre...varighet.. døgn Medikament.. Dosering...Varighet.. døgn FAST TROMBOSEPROFYLAKSE Nei 1 Ja, type:.. FIBRINOLYSEHEMMER Nei 1 Ja, medikament:.. Dosering. DREN Nei 1 Ja. Antatt varighet døgn OPERASJONSTID (hud til hud) minutter PEROPERATIV 9 KOMPLIKASJON Nei 1 Ja,hvilke(n):... MINI INVASIV KIRURGI (MIS) Nei 1 Ja COMPUTERNAVIGERING (CAOS) Nei 1 Ja Type:.. PASIENTTILPASSEDE INSTRUMENTER Nei 1 Ja Type:.. ASA KLASSE (se baksiden for definisjon) 1 Frisk Asymptomatisk tilstand som gir økt risiko 3 Symptomatisk sykdom Livstruende sykdom 5 Moribund PROTESE KNE (Bruk klistrelapper på baksiden, eller spesifiser nøyaktig) PROTESETYPE 1 prot. m/patella. Patellofemoralledd prot. prot. u/patella 5 Bi-compartmental Hengslet protese 3 Unicondylær prot Medial Lateral 7 Annet. FEMURKOMPONENT Navn/Type/Str... ev. katalognummer. Sentral stamme Nei 1 Ja, ev. lengde.mm Metallforing Nei 1 Ja Stabilisering Nei 1 Ja, bakre Ja, annen 1 Sement med antibiotika Navn. Sement uten antibiotika Navn. 3 Usementert TIBIAKOMPONENT (metallplatå) Navn/Type/Str... ev. katalognummer.. Forlenget sentral stamme Nei 1 Ja, ev. lengde mm Metallforing Nei 1 Ja 1 Sement med antibiotika Navn.. Sement uten antibiotika Navn.. 3 Usementert TIBIAKOMPONENT (plastkomponent) Navn/Type/Str... ev. katalognummer... Tykkelse.. mm Stabilisering Nei 1 Ja, bakre Ja, annen PATELLAKOMPONENT Navn/Type/Str... ev. katalognummer... Metallrygg Nei 1 Ja 1 Sement med antibiotika Navn.. Sement uten antibiotika Navn.. 3 Usementert KORSBÅND Intakt fremre korsbånd før operasjon Nei 1 Ja Intakt fremre korsbånd etter operasjon Nei 1 Ja Intakt bakre korsbånd før operasjon Nei 1 Ja Intakt bakre korsbånd etter operasjon Nei 1 Ja PROTESE ANDRE LEDD (Bruk klistrelapper på baksiden, eller spesifiser nøyaktig) PROTESETYPE 1 protese Hemiprotese 3 Enkomponentprotese Annet.. PROKSIMAL KOMPONENT Navn/Type/Str... ev. katalognummer... 1 Sement med antibiotika Navn.. Sement uten antibiotika Navn...... 3 Usementert DISTAL KOMPONENT Navn/Type/Str... ev. katalognummer... 1 Sement med antibiotika Navn.. Sement uten antibiotika Navn.. 3 Usementert INTERMEDIÆR KOMPONENT (f.eks. caput humeri) Navn/Type/Str/Diameter... ev. katalognummer... Lege... Legen som har fylt ut skjemaet (navnet registreres ikke i databasen).
RETTLEDNING KNEPROTESER og andre leddproteser Registreringen gjelder innsetting, skifting eller fjerning av protese i kne, skuldre og andre ledd med unntak av hofter som har eget skjema. Ett skjema fylles ut for hver operasjon. Pasientens fødselsnummer (11 sifre) og sykehus må være påført. Aktuelle ruter markeres med kryss. På eget Samtykkeskjema skal pasienten gi samtykke til rapportering til Leddregisteret. Samtykkeskjemaet skal lagres i pasientjournal. Kommentarer til de enkelte punktene AKTUELLE OPERASJON Primæroperasjon: Dette er første totalproteseoperasjon. Kryss av enten i A eller i B. Kryss av for alle årsakene til operasjonen. Bløtdelsrevisjon for infeksjon skal registreres selv om protesedeler ikke skiftes. REOPERASJONSTYPE Fjerning av protesedeler må spesifiseres og føres opp, også fjerning ved infeksjon. BENTRANSPLANTASJON Påsmøring av benvev rundt protesen regnes ikke som bentransplantat. ANTIBIOTIKAPROFYLAKSE Medikament, dose og varighet av profylaksen skal angis f.eks. slik: Medikament: Keflin, Dosering: g x, med varighet,5 timer. TROMBOSEPROFYLAKSE Medikament, dose og antatt varighet av profylaksen skal angis separat for operasjonsdagen og senere. Det skal også oppgis om pasienten står fast på tromboseprofylakse (AlbylE, Marevan, Plavix ol). FIBRINOLYSEHEMMER Her føres det på om en benytter blødningsreduserende legemidler i forbindelse med operasjonen (f.eks. Cyklokapron). PEROPERATIV KOMPLIKASJON Dersom det foreligger komplikasjon i form av stor blødning, må mengden angis. Dersom pasienten dør under eller like etter operasjonen, ønsker vi likevel melding om operasjonen. ASA-KLASSE (ASA=American Society of Anesthesiologists) ASA-klasse 1: Friske pasienter som røyker mindre enn 5 sigaretter daglig. ASA-klasse : Pasienter med en asymptomatisk tilstand som behandles medikamentelt (f.eks. hypertensjon) eller med kost (f.eks. diabetes mellitus type ) og ellers friske pasienter som røyker 5 sigaretter eller mer daglig. ASA-klasse 3: Pasienter med en tilstand som kan gi symptomer, men som holdes under kontroll medikamentelt (f.eks. moderat angina pectoris og mild astma). ASA-klasse : Pasienter med en tilstand som ikke er under kontroll (f.eks. hjertesvikt og astma). ASA-klasse 5: Moribund/døende pasient PROTESETYPE Dersom det er gjort revisjon av totalprotese uten patellakomponent og REOPERASJONSTYPE er innsetting av patellakomponent, skal det krysses av for pkt. 1: protese med patellakomponent (dvs. protesen har nå blitt en totalprotese med patellakomponent). Ved revisjon av unicondylær protese til totalprotese brukes enten pkt. 1 eller. PROTESEKOMPONENTER Her anføres kommersielle navn, materiale, størrelse og design. Alternativt kan en føre opp protesenavn og katalognummer eller benytte klistrelapp som følger med de fleste protesene. Denne kan limes på baksiden av skjemaet (vennligst ikke plasser klistrelapper på markeringskryss, som brukes ved scanning av skjema). Navnet på sementen som evt. brukes må anføres, f.eks. Palacos R+G. (Bruk helst klistrelapp) Under femurkomponent skal evt. påsatt femurstamme anføres med lengde. Med metallforing under femur- og tibiakomponent menes bruk av en eller flere separate metallkiler (wedges) som erstatning for manglende benstøtte. Stabilisering er bruk av proteser med stabilisering som kompensasjon for sviktende båndapparat. Forlenget sentral stamme under tibiakomponent (metallplatå) skal bare anføres ved bruk av en lengre påsatt stamme enn standardkomponenten. ANDRE LEDD. PROTESETYPE Ved bruk av hemiprotese med bare en komponent, f.eks. resurfacing i skulder, skrives dette på DISTAL KOMPONENT. Enkomponent-protese i finger/tå, skrives på PROKSIMAL KOMPONENT. COMPUTERNAVIGERING (CAOS = Computer Aided Orthopaedic Surgery) Angi firmanavn på computersystem. MINIINVASIV KIRURGI (MIS = Minimally Invasive Surgery) Her menes at kirurgen har brukt kort snitt og at det er brukt spesialinstrument laget for MIS. PASIENTTILPASSEDE INSTRUMENTER Her menes kutteblokker eller instrumenter som lages etter MR eller CT bilder tatt av pasienten før operasjonen. Oppgi navn på systemet. Kopi beholdes til pasientjournalen, originalen sendes Haukeland universitetssjukehus. Kontaktpersoner vedrørende registreringsskjema er Overlege Ove Furnes, tlf. 55 97 5 9 og seksjonsoverlege Leif Ivar Havelin, tlf. 55 97 5 7. Ortopedisk klinikk, Haukeland universitetssjukehus. Besøksadresse: Møllendalsbakken 11. Sekretærer i Nasjonalt Register for Leddproteser, Ortopedisk klinikk, Helse Bergen: Randi Furnes, tlf. 55 97 37 og Ingunn Vindenes, tlf. 55 97 37 3. Epost: nrl@helse-bergen.no Internett: http://nrlweb.ihelse.net/ Skjema revidert i november 15. 99
HOFTEBRUDD NASJONALT HOFTEBRUDDREGISTER Nasjonalt Register for Leddproteser Helse Bergen HF, Ortopedisk klinikk Haukeland universitetssjukehus Møllendalsbakken 11 51 BERGEN Tlf: 55975 F.nr. (11 sifre)... Navn:... (Skriv tydelig ev. pasientklistrelapp spesifiser sykehus.) Sykehus:... PRIMÆRE OPERASJONER PÅ BRUDD I PROKSIMALE FEMURENDE og ALLE REOPERASJONER, inkludert lukket reponering av hemiproteser. Ved primæroperasjon med totalprotese og ved reoperasjon til totalprotese brukes kun hofteproteseskjema. Alle produktklistrelapper settes i merket felt på baksiden av skjemaet. AKTUELLE OPERASJON 1 Primæroperasjon Reoperasjon SIDE (ett kryss) (Bilateral opr.= skjema) 1 Høyre Venstre OPR TIDSPUNKT (dd.mm.åå) kl BRUDD TIDSPUNKT (dd.mm.åå) kl Dersom det er usikkerhet om bruddtidspunkt, fyll ut neste punkt. TID FRA BRUDD TIL OPERASJON I TIMER 1 - >-1 3 >1- >- 5 > KOGNITIV SVIKT Nei 1 Ja (Se test på baksiden) Usikker ASA-KLASSE (se bakside av skjema for definisjon) 1 Frisk Asymptomatisk tilstand som gir økt risiko 3 Symptomatisk sykdom Livstruende sykdom 5 Moribund TYPE PRIMÆRBRUDD (ÅRSAK TIL PRIMÆROPERASJON) (Kun ett kryss) Se baksiden for klassifikasjon 1 Lårhalsbrudd udislokert (Garden 1 og ) Lårhalsbrudd dislokert (Garden 3 og ) 3 Lateralt lårhalsbrudd Pertrokantært tofragment (AO klassifikasjon A1) 5 Pertrokantært flerfragment (AO klassifikasjon A) 9 Intertrokantært (AO klassifikasjon A3) Subtrokantært 7 Annet, spesifiser. TYPE PRIMÆROPERASJON (Kun ett kryss) (Fylles ut bare ved primæroperasjon - eget skjema for totalproteser) (Fest produktklistrelapp på baksiden eller spesifiser nøyaktig produkt) 1 To skruer eller pinner Tre skruer eller pinner 3 Bipolar hemiprotese Unipolar hemiprotese 5 Glideskrue og plate Glideskrue og plate med trokantær støtteplate 7 Vinkelplate Kort margnagle uten distal sperre 9 Kort margnagle med distal sperre 1 Lang margnagle uten distal sperre 11 Lang margnagle med distal sperre 1 Annet, spesifiser....... Navn / størrelse og katalognummer.. ÅRSAK TIL REOPERASJON (Flere enn ett kryss kan brukes) 1 Osteosyntesesvikt/havari Ikke tilhelet brudd (non-union/pseudartrose) 3 Caputnekrose (segmentalt kollaps) Lokal smerte pga prominerende osteosyntesemateriale 5 Brudd tilhelet med feilstilling Sårinfeksjon overfladisk 7 Sårinfeksjon dyp Hematom 9 Luksasjon av hemiprotese 1 Osteosyntesematerialet skåret gjennom caput 11 Nytt brudd rundt implantat 1 Løsning av hemiprotese 13 Annet, spesifiser.... 3 TYPE REOPERASJON (Flere enn ett kryss kan brukes) (Fest produktklistrelapp på baksiden eller spesifiser nøyaktig produkt) 1 Fjerning av implantat (Brukes når dette er eneste prosedyre) Girdlestone (= fjerning av implantat og caput) 3 Bipolar hemiprotese Unipolar hemiprotese 5 Re-osteosyntese Debridement for infeksjon 7 Lukket reposisjon av luksert hemiprotese Åpen reposisjon av luksert hemiprotese 9 Annet, spesifiser.. Navn / størrelse og katalognummer.. FIKSASJON AV HEMIPROTESE (For totalprotese sendes eget skjema til hofteproteseregisteret) 1 Usementert 1 med HA uten HA Sement med antibiotika Navn.. 3 Sement uten antibiotika Navn.. PATOLOGISK BRUDD (Annen patologi enn osteoporose) Nei 1 Ja, type...... TILGANG TIL HOFTELEDDET VED HEMIPROTESE (Kun ett kryss) 1 Fremre (mellom sartorius og tensor) Anterolateral (mellom gluteus medius og tensor) 3 Direkte lateral (transgluteal) Bakre (bak gluteus medius) 5 Annet, spesifiser........ ANESTESITYPE 1 Narkose Spinal 3 Annet, spesifiser.... PEROPERATIVE KOMPLIKASJONER Nei 1 Ja, hvilke(n)..... OPERASJONSTID (hud til hud)...minutter. ANTIBIOTIKAPROFYLAKSE Nei 1 Ja Navn Dosering Varighet i timer Medikament 1... Medikament... Medikament 3... TROMBOSEPROFYLAKSE Nei 1 Ja: Første dose Medikament 1... Medikament... 1 Preoperativt Postoperativt.....timer.....timer....timer Dosering opr.dag.. Dosering videre Varighet døgn Dosering.... Varighet døgn FAST TROMBOSEPROFYLAKSE Nei 1 Ja, type:... FIBRINOLYSEHEMMER Nei 1 Ja, medikament :... Dosering.. OPERATØRERFARING Har en av operatørene mer enn 3 års erfaring i hoftebruddkirurgi? Nei 1 Ja Lege... Legen som har fylt ut skjemaet (navnet registreres ikke i databasen).
RETTLEDNING Registreringen gjelder alle operasjoner for hoftebrudd (lårhals, pertrokantære og subtrokantære) og alle reoperasjoner, også reposisjoner, på pasienter som er primæroperert og reoperert for hoftebrudd. Ved primæroperasjon med totalprotese og ved reoperasjon til totalprotese sendes bare skjema til hofteproteseregisteret. Ett skjema fylles ut for hver operasjon. Originalen sendes Haukeland universitetssjukehus og kopien lagres i pasientens journal. Pasientens fødselsnummer (11 sifre) og sykehuset må være påført. Aktuelle ruter markeres med kryss. Pasienten skal på eget skjema gi samtykke til registrering i Nasjonalt hoftebruddregister og samtykkeerklæringen lagres i pasientens journal på sykehuset. Kommentarer til enkelte punkt: OPERASJONS- OG BRUDDTIDSPUNKT Operasjonstidspunkt (dato og klokkeslett) må føres opp på alle primæroperasjoner. Det er også sterkt ønskelig at dato og klokkeslett for bruddtidspunkt føres opp. Dette bl.a. for å se om tid til operasjon har effekt på prognose. (Hvis en ikke kjenner klokkeslettet for bruddtidspunkt lar en feltet stå åpent. En må da prøve å angi omtrentlig tidsrom fra brudd til operasjon på neste punkt). Ved reoperasjon er ikke klokkeslett nødvendig. KOGNITIV SVIKT Kognitiv svikt kan eventuelt testes ved å be pasienten tegne klokken når den er 1 over 11. En pasient med kognitiv svikt vil ha problemer med denne oppgaven. ASA-KLASSE (ASA=American Society of Anesthesiologists) ASA-klasse 1: Friske pasienter som røyker mindre enn 5 sigaretter daglig. ASA-klasse : Pasienter med en asymptomatisk tilstand som behandles medikamentelt (f.eks hypertensjon) eller med kost (f.eks diabetes mellitus type ) og ellers friske pasienter som røyker 5 sigaretter eller mer daglig. ASA-klasse 3: Pasienter med en tilstand som kan gi symptomer, men som holdes under kontroll medikamentelt (f.eks moderat angina pectoris og mild astma). ASA-klasse : Pasienter med en tilstand som ikke er under kontroll (f.eks hjertesvikt og astma). ASA-klasse 5: Moribund/døende pasient GARDENS KLASSIFISERING AV LÅRHALSBRUDD Garden 1: Ikke komplett brudd av lårhalsen (såkalt innkilt) Garden : Komplett lårhalsbrudd uten dislokasjon Garden 3: Komplett lårhalsbrudd med delvis dislokasjon. Fragmentene er fortsatt i kontakt, men det er feilstilling av lårhalsens trabekler. Caputfragmentet ligger uanatomisk i acetabulum. Garden : Komplett lårhalsbrudd med full dislokasjon. Caputfragmentet er fritt og ligger korrekt i acetabulum slik at trabeklene er normalt orientert. AO KLASSIFIKASJON AV TROKANTÆRE BRUDD A1: Pertrokantært tofragment brudd A: Pertrokantært flerfragment brudd A3: Intertrokantært brudd Subtrokantært brudd* *Subtrokantært brudd: Bruddsentrum er mellom nedre kant av trokanter minor og 5 cm distalt for denne. REOPERASJONSÅRSAK Dyp infeksjon defineres som infeksjon som involverer fascie, protese, ledd eller periprotetisk vev. IMPLANTAT Implantattype må angis entydig. Produktklistrelapp er ønskelig for å angi katalognummer for osteosyntesematerialet eller protesen som er brukt. PEROPERATIVE KOMPLIKASJONER Vi ønsker også å få meldt dødsfall på operasjonsbordet og peroperativ transfusjonstrengende blødning. ANTIBIOTIKAPROFYLAKSE Her føres det på hvilket antibiotikum som er blitt benyttet i forbindelse med operasjonen. Det anføres dose, antall doser og profylaksens varighet. F.eks. Medkament 1: Keflin g x, med varighet,5 timer. TROMBOSEPROFYLAKSE Medikament, dose og antatt varighet av profylaksen skal angis separat for oprerasjonsdagen og senere. Det skal også oppgis om pasienten står fast på tromboseprofylakse (AlbylE, Marevan, Plavix ol). FIBRINOLYSEHEMMER Her føres det på om en benytter blødningsreduserende legemidler i forbindelse med operasjonen (f.eks. Cyklokapron). Kontaktpersoner vedrørende registreringsskjema er: Overlege Jan-Erik Gjertsen, Ortopedisk klinikk, Haukeland universitetssjukehus. Tlf. 55 97 5 7 (email: jan-erik.gjertsen@helse-bergen.no) Professor Lasse Engesæter, Ortopedisk klinikk, Haukeland universitetssjukehus. Tlf. 55 97 5 Prosjektkoordinator Nasjonalt Hoftebruddregister: Lise B. Kvamsdal. Tlf. 55 97 5 (email: nrl@helse-bergen.no) Internett: http://nrlweb.ihelse.net/ PRODUKTKLISTRELAPPER: 31
NASJONALT HOFTEBRUDDREGISTER Nasjonalt Register for Leddproteser Helse Bergen HF, Ortopedisk klinikk Haukeland Universitetssykehus Møllendalsbakken 11 51 BERGEN PASIENTSPØRRESKJEMA NASJONALT HOFTEBRUDDREGISTER 1. Dato for utfylling av skjema:. Spørreskjemaet er besvart av: 1 Meg selv eller ved hjelp av.(kryss av i ruten som gjelder) Slektning (ektefelle, barn) 3 God venn eller annen nærstående Annen privat person 5 Hjemmesykepleier/hjemmehjelp Annen person, angi hvem: 3
NASJONALT HOFTEBRUDDREGISTER Nasjonalt Register for Leddproteser Helse Bergen HF, Ortopedisk klinikk Haukeland Universitetssykehus Møllendalsbakken 11 51 BERGEN I de neste 5 spørsmålene ønsker vi å vite hvordan livssituasjonen din var FØR du fikk hofte/lårhalsbruddet som du ble operert for. 3. Hvordan opplevde du gangevnen din? 1 Jeg hadde ingen problemer med å gå omkring Jeg hadde litt problemer med å gå omkring 3 Jeg var sengeliggende. Hvordan klarte du personlig stell? 1 Jeg hadde ingen problemer med personlig stell Jeg hadde litt problemer med å vaske meg eller kle meg 3 Jeg klarte ikke å vaske meg eller kle meg 5. Hvordan klarte du dine vanlige gjøremål (f.eks. arbeid, studier, husarbeid, familie- og fritidsaktiviteter)? 1 Jeg hadde ingen problemer med å utføre mine vanlige gjøremål Jeg hadde litt problemer med å utføre mine vanlige gjøremål 3 Jeg var ute av stand til å utføre mine vanlige gjøremål. Smerter eller ubehag? 1 Jeg hadde verken smerte eller ubehag Jeg hadde moderat smerte eller ubehag 3 Jeg hadde sterk smerte eller ubehag 7. Angst eller depresjon? 1 Jeg var verken engstelig eller deprimert Jeg var noe engstelig eller deprimert 3 Jeg var svært engstelig eller deprimert 33
NASJONALT HOFTEBRUDDREGISTER Nasjonalt Register for Leddproteser Helse Bergen HF, Ortopedisk klinikk Haukeland Universitetssykehus Møllendalsbakken 11 51 BERGEN I de 5 neste spørsmålene ønsker vi å vite hvordan livssituasjonen din er NÅ:. Hvordan opplever du gangevnen din? 1 Jeg har ingen problemer med å gå omkring Jeg har litt problemer med å gå omkring 3 Jeg er sengeliggende 9. Hvordan klarer du personlig stell? 1 Jeg har ingen problemer med personlig stell Jeg har litt problemer med å vaske meg eller kle meg 3 Jeg klarer ikke å vaske meg eller kle meg 1. Hvordan klarer du dine vanlige gjøremål (f.eks. arbeid, studier, husarbeid, familie- og fritidsaktiviteter)? 1 Jeg har ingen problemer med å utføre mine vanlige gjøremål Jeg har litt problemer med å utføre mine vanlige gjøremål 3 Jeg er ute av stand til å utføre mine vanlige gjøremål 11. Smerter eller ubehag? 1 Jeg har verken smerte eller ubehag Jeg har moderat smerte eller ubehag 3 Jeg har sterk smerte eller ubehag 1. Angst eller depresjon? 1 Jeg er verken engstelig eller deprimert Jeg er noe engstelig eller deprimert 3 Jeg er svært engstelig eller deprimert 3
NASJONALT HOFTEBRUDDREGISTER Nasjonalt Register for Leddproteser Helse Bergen HF, Ortopedisk klinikk Haukeland Universitetssykehus Møllendalsbakken 11 51 BERGEN 13. Din helsetilstand i dag. For å hjelpe folk til å si hvor god eller dårlig en helsetilstand er, har vi laget en skala (omtrent som et termometer) hvor den beste tilstanden du kan tenke deg er merket 1 og den verste tilstanden du kan tenke deg er merket. Vi vil gjerne at du viser på denne skalaen hvor god eller dårlig helsetilstanden din er i dag, etter din oppfatning. Vær vennlig å gjøre dette ved å trekke en linje fra boksen nedenfor til det punktet på skalaen som viser hvor god eller dårlig din helsetilstand er i dag. Best tenkelige helsetilstand 1 9 7 Din egen helsetilstand i dag 5 3 1 Verst tenkelige helsetilstand 35
NASJONALT HOFTEBRUDDREGISTER Nasjonalt Register for Leddproteser Helse Bergen HF, Ortopedisk klinikk Haukeland Universitetssykehus Møllendalsbakken 11 51 BERGEN SMERTE 1. Sett ett kryss på den streken som du synes tilsvarer din gjennomsnittlige smerteopplevelse fra den opererte hoften den siste måneden: Ingen smerte Maksimal smerte lett moderat middels sterk uutholdelig TILFREDSHET 15. Sett ett kryss på den streken som du synes tilsvarer hvor fornøyd du er med operasjonsresultatet: Fornøyd Misfornøyd svært fornøyd fornøyd middels fornøyd misfornøyd svært misfornøyd 3
NASJONALT HOFTEBRUDDREGISTER Nasjonalt Register for Leddproteser Helse Bergen HF, Ortopedisk klinikk Haukeland Universitetssykehus Møllendalsbakken 11 51 BERGEN 1. Har du besvær fra den andre hoften? 1 Ja Nei 17. Er det andre årsaker til at du har problemer med å gå? (For eksempel smerter fra andre ledd, ryggsmerter, hjerte-karsykdom eller andre sykdommer som påvirker gangevnen din) 1 Ja Nei 1. Har du hatt nye operasjoner i den samme hoften som ble operert for hoftebrudd? 1 Ja Nei Takk for at du tok deg tid til å svare på spørsmålene. Dine svar er svært nyttige for oss. Vennligst send spørreskjemaet i retur til oss i den ferdig frankerte svarkonvolutten. 37
11 KORSBÅND NASJONALT KORSBÅNDSREGISTER Nasjonalt Register for Leddproteser Helse Bergen HF, Ortopedisk klinikk Haukeland universitetssjukehus Møllendalsbakken 11, 51 BERGEN Tlf: 55975 F.nr. (11 sifre)... Navn... Sykehus... (Skriv tydelig evt. pasientklistrelapp spesifiser sykehus.) KORSBÅNDSOPERASJONER OG ALLE REOPERASJONER på pasienter som tidligere er korsbåndsoperert. Alle klistrelapper (med unntak av pasientklistrelapp) settes i merket felt på baksiden av skjemaet. (Bilateral operasjon = skjema) AKTUELLE SIDE (ett kryss) Høyre MOTSATT KNE TIDLIGERE OPERASJON I SAMME KNE Nei 1 Venstre Normalt 1 Tidligere ACL/PCL-skade 1 Ja SKADEDATO FOR AKTUELL SKADE (mm.åå) AKTIVITET SOM FØRTE TIL AKTUELLE SKADE Fotball 7 Annen lagidrett 1 Håndball Motor- og bilsport Snowboard 9 Annen fysisk aktivitet 3 Alpint (inkl. twin tip) 1 Arbeid Annen skiaktivitet 11 Trafikk 5 Kampsport 1 Fall/hopp/vold/lek Basketball 9 Annet. AKTUELLE SKADE (Registrer alle skader også de som ikke opereres) ACL MCL PLC Med. menisk PCL LCL Brusk Lat. menisk Annet. YTTERLIGERE SKADER (evt. flere kryss) Nei, hvis ja spesifiser under Karskade Hvilken:. Nerveskade N. tibialis 1 N. peroneus Fraktur Femur 1 Tibia Fibula 3 Patella Usikker Ruptur i ekstensorapparatet Quadricepssenen 1 Patellarsenen OPERASJONSDATO (dd.mm.åå) AKTUELLE OPERASJON (ett kryss) Primær rekonstruksjon av korsbånd 1 Revisjonskirurgi, 1. seanse Revisjonskirurgi,. seanse 3 Annen knekirurgi (Ved kryss her skal andre prosedyrer fylles ut) ÅRSAK TIL REVISJONSREKONSTRUKSJON (evt. flere kryss) Infeksjon Graftsvikt Fiksasjonssvikt Nytt traume Ubehandlede andre ligamentskader Smerte Annet.. ANDRE PROSEDYRER (evt. flere kryss) Nei, hvis ja spesifiser under Meniskoperasjon Osteosyntese Synovektomi Bruskoperasjon Mobilisering i narkose Artroskopisk debridement Fjerning av implantat Operasjon pga infeksjon Benreseksjon (Notch plastikk) Bentransplantasjon Osteotomi Artrodese Annet.. GRAFTVALG BPTB Hamstring Allograft Direkte sutur Annet ACL PCL MCL LCL PLC GRAFTDIAMETER (oppgi største diameter på graftet).. mm FIKSASJON Sett klistrelapp på merket felt på baksiden av skjemaet Skill mellom femur og tibia AKTUELL BEHANDLING AV MENISKLESJON Partiell Syntetisk Menisk- Sutur reseksjon reseksjon fiksasjon* transpl. Trepanering Ingen Medial Lateral * Sett klistrelapp på merket felt på baksiden BRUSKLESJON (evt. flere kryss) Areal (cm²) > ICRS Grade* 1 3 Artrose Behandlings-kode** Ja Nei 1 3 Spesifiser annet Patella MF.... Patella LF.... Trochlea fem..... Med.fem. cond..... Med. tib. plat..... Lat.fem. cond..... Lat. tib. plat..... *ICRS Grade: 1 Nearly normal: Superficial lesions, soft indentation and/or superficial fissures and cracks; Abnormal: Lesions extending down to <5% of cartilage depth; 3 Severely abnormal: Cartilage defects extending down >5% of cartilage depth as well as down to calcified layer; Severely abnormal: Osteochondral injuries, lesions extending just through the subchondral boneplate or deeper defects down into trabecular bone. **Behandlingskoder: 1 Debridement; Mikrofraktur; 3 Ingen behandling; Annet. DAGKIRURGISK OPERASJON Nei 1 Ja PEROPERATIVE KOMPLIKASJONER Nei 1 Ja, hvilke(n)... OPERASJONSTID (hud til hud)...min SYSTEMISK ANTIBIOTIKA Nei 1 Ja 1 Profylakse Behandling Medikament 1... Dosering... Varighet...timer Eventuelt i kombinasjon med medikament... TROMBOSEPROFYLAKSE Nei 1 Ja: Første dose Medikament 1... 1 Preoperativt Postoperativt Dosering opr.dag.. Dosering videre.... Varighet døgn Medikament... Anbefalt total varighet av tromboseprofylakse... NSAIDs Nei 1 Ja, hvilken type.. Anbefalt total varighet av NSAIDs-behandling HØYDE...cm VEKT...kg RØYK SNUS Nei 1 Av og til Daglig Nei 1 Av og til Daglig Ved bruk av double bundle-teknikk: 3 AM: mm PL: mm TILGANG FOR FEMURKANAL 1 Anteromedial Transtibial 3 Annet... Lege:... Legen som har fylt ut skjemaet (navnet registreres ikke i databasen).
RETTLEDNING Registreringen gjelder ALLE fremre og bakre korsbåndsoperasjoner. Registreringen gjelder ALLE kneoperasjoner på pasienter som tidligere er korsbåndsoperert. Ett skjema fylles ut for hvert kne som blir operert. Aktuelle ruter markeres med kryss. Stiplet linje fylles ut der dette er aktuelt. Pasienten skal på eget skjema gi samtykke til registrering. KOMMENTARER TIL DE ENKELTE PUNKTENE FORKORTELSER SOM ER BRUKT PÅ SKJEMAET ACL: Fremre korsbånd PCL: Bakre korsbånd MCL: Mediale kollateralligament LCL: Laterale kollateralligament PLC: Popliteus kompleks/bicepssene kompleks BPTB; Patellarsene autograft AM: Anteromediale bunt av ACL PL: Posterolaterale bunt av ACL SKADEDATO FIKSASJON Skriv inn skadedatoen så eksakt som mulig. Ved ny skade av tidligere operert korsbånd, skriv inn den nye skadedatoen. Angi hvilken fiksasjonstype som er brukt ved å feste klistrelapp på baksiden. Husk å skille mellom femur og tibia for graftfiksasjon, og mellom medial og lateral side for meniskfiksasjon. PEROPERATIVE KOMPLIKASJONER Ved en ruptur/kontaminering av høstet graft e.l. skal det opprinnelige graftet anføres her. Andre peroperative komplikasjoner skal også fylles inn her. SYSTEMISK ANTIBIOTIKA Her føres det på hvilket antibiotikum som er blitt benyttet i forbindelse med operasjonen. Det anføres dose, antall doser og profylaksens varighet. F.eks. Medikament 1: Keflin g x, med varighet 1 timer. TROMBOSEPROFYLAKSE Type, dose og antatt varighet av profylaksen skal angis separat for operasjonsdagen og senere. Kopi beholdes i pasientjournalen, originalen sendes til Nasjonalt Korsbåndsregister. Kontaktpersoner vedrørende registreringsskjema er Professor Lars Engebretsen, Ortopedisk avdeling, Oslo Universitetssykehus e-post: lars.engebretsen@medisin.uio.no Overlege Knut Andreas Fjeldsgaard, Haukeland universitetssjukehus e-post: knut.andreas.fjeldsgaard@helse-bergen.no Sekretær i Nasjonalt Korsbåndsregister, Ortopedisk avd., Helse Bergen Merete Husøy, tlf.: 55 97 5, faks: 55 97 37 9 e-post: korsband@helse-bergen.no GRAFTFIKSASJON MENISKFIKSASJON FEMUR TIBIA MEDIAL LATERAL
KOOS Spørreskjema for knepasienter. NASJONALT KORSBÅNDSREGISTER Nasjonalt Register for Leddproteser Helse Bergen HF, Ortopedisk klinikk Haukeland universitetssjukehus Møllendalsbakken 11 51 BERGEN Tlf: 55975 Veiledning: Dette spørreskjemaet inneholder spørsmål om hvordan du opplever kneet ditt før operasjonen. Informasjonen vil hjelpe oss til å følge med i hvordan du har det og fungerer i ditt daglige liv. Besvar spørsmålene ved å krysse av for det alternativ du synes stemmer best for deg (kun ett kryss ved hvert spørsmål). Hvis du er usikker, kryss likevel av for det alternativet som føles mest riktig. KRYSS AV FOR RIKTIG KNE (NB: Ett skjema for hvert kne): 1 VENSTRE HØYRE Røyker du? Nei 1 Av og til Daglig Hvis du røyker daglig hvor mange sigaretter per dag: DATO: OPERASJONSDATO: FØDSELSNR (11 siffer): NAVN: SYKEHUS: Vekt: kg Høyde : cm Symptom Tenk på symptomene du har hatt fra kneet ditt den siste uken når du besvarer disse spørsmålene. S1. Har kneet vært hovent? Aldri Sjelden I blant Ofte Alltid 1 3 S. Har du følt knirking, hørt klikking eller andre lyder fra kneet? Aldri Sjelden I blant Ofte Alltid 1 3 S3. Har kneet haket seg opp eller låst seg? Aldri Sjelden I blant Ofte Alltid 1 3 S. Har du kunnet rette kneet helt ut? Alltid Ofte I blant Sjelden Aldri 1 3 S5. Har du kunnet bøye kneet helt? Alltid Ofte I blant Sjelden Aldri 1 3 Stivhet De neste spørsmålene handler om leddstivhet. Leddstivhet innebærer vanskeligheter med å komme i gang eller økt motstand når du bøyer eller strekker kneet. Marker graden av leddstivhet du har opplevd i kneet ditt den siste uken. S. Hvor stivt er kneet ditt når du nettopp har våknet om morgenen? Ikke noe Litt Moderat Betydelig Ekstremt 1 3 S7. Hvor stivt er kneet ditt senere på dagen etter å ha sittet, ligget eller hvilt? Ikke noe Litt Moderat Betydelig Ekstremt 1 3 31
Smerte P1. Hvor ofte har du vondt i kneet? Aldri Månedlig Ukentlig Daglig Hele tiden 1 3 Hvilken grad av smerte har du hatt i kneet ditt den siste uken ved følgende aktiviteter? P. Snu/vende på belastet kne Ingen Lett Moderat Betydelig Svært stor 1 3 P3. Rette kneet helt ut Ingen Lett Moderat Betydelig Svært stor 1 3 P. Bøye kneet helt Ingen Lett Moderat Betydelig Svært stor 1 3 P5.Gå på flatt underlag Ingen Lett Moderat Betydelig Svært stor 1 3 P. Gå opp eller ned trapper Ingen Lett Moderat Betydelig Svært stor 1 3 P7. Om natten (smerter som forstyrrer søvnen) Ingen Lett Moderat Betydelig Svært stor 1 3 P. Sittende eller liggende Ingen Lett Moderat Betydelig Svært stor 1 3 P9. Stående Ingen Lett Moderat Betydelig Svært stor 1 3 Funksjon i hverdagen De neste spørsmålene handler om din fysiske funksjon. Angi graden av vanskeligheter du har opplevd den siste uken ved følgende aktiviteter på grunn av dine kneproblemer. A1. Gå ned trapper Ingen Lett Moderat Betydelig Svært stor 1 3 A. Gå opp trapper Ingen Lett Moderat Betydelig Svært stor 1 3 A3. Reise deg fra sittende stilling Ingen Lett Moderat Betydelig Svært stor 1 3
Angi graden av vanskeligheter du har opplevd ved hver aktivitet den siste uken. A. Stå stille Ingen Lett Moderat Betydelig Svært stor 1 3 A5. Bøye deg, f.eks. for å plukke opp en gjenstand fra gulvet Ingen Lett Moderat Betydelig Svært sto 1 3 A. Gå på flatt underlag Ingen Lett Moderat Betydelig Svært stor 1 3 A7. Gå inn/ut av bil Ingen Lett Moderat Betydelig Svært stor 1 3 A. Handle/gjøre innkjøp Ingen Lett Moderat Betydelig Svært stor 1 3 A9. Ta på sokker/strømper Ingen Lett Moderat Betydelig Svært stor 1 3 A1. Stå opp fra sengen Ingen Lett Moderat Betydelig Svært stor 1 3 A11. Ta av sokker/strømper Ingen Lett Moderat Betydelig Svært stor 1 3 A1. Ligge i sengen (snu deg, holde kneet i samme stilling i lengre tid) Ingen Lett Moderat Betydelig Svært stor 1 3 A13. Gå inn/ut av badekar/dusj Ingen Lett Moderat Betydelig Svært stor 1 3 A1. Sitte Ingen Lett Moderat Betydelig Svært stor 1 3 A15. Sette deg og reise deg fra toalettet Ingen Lett Moderat Betydelig Svært stor 1 3 A1. Gjøre tungt husarbeid (måke snø, vaske gulv, støvsuge osv.) Ingen Lett Moderat Betydelig Svært stor 1 3 A17. Gjør lett husarbeid (lage mat, tørke støv osv.) Ingen Lett Moderat Betydelig Svært stor 1 3 31
Funksjon, sport og fritid De neste spørsmålene handler om din fysiske funksjon. Angi graden av vanskeligheter du har opplevd den siste uken ved følgende aktiviteter på grunn av dine kneproblemer. SP1. Sitte på huk Ingen Lett Moderat Betydelig Svært stor 1 3 SP. Løpe Ingen Lett Moderat Betydelig Svært stor 1 3 SP3. Hoppe Ingen Lett Moderat Betydelig Svært stor 1 3 SP. Snu/vende på belastet kne Ingen Lett Moderat Betydelig Svært stor 1 3 SP5. Stå på kne Ingen Lett Moderat Betydelig Svært stor 1 3 Livskvalitet Q1. Hvor ofte gjør ditt kneproblem seg bemerket? Aldri Månedlig Ukentlig Daglig 1 3 Q. Har du forandret levesett for å unngå å overbelaste kneet? Ingenting Noe Moderat Betydelig 1 3 Q3. I hvor stor grad kan du stole på kneet ditt? Fullstendig I stor grad Moderat Til en viss grad 1 3 Alltid Fullstendig Ikke i det hele tatt Q. Generelt sett, hvor store problemer har du med kneet ditt? Ingen Lette Moderate Betydelige Svært store 1 3 Takk for at du tok deg tid og besvarte samtlige spørsmål!
53 Bergen Grafisk as - 3.13 BARNEHOFTEREGISTERET Nasjonalt Register for Leddproteser Helse Bergen HF, Ortopedisk klinikk Haukeland universitetssjukehus Møllendalsbakken 11, 51 Bergen BARNEHOFTESYKDOM HOFTEDYSPLASI (Dysplasi på rtg bekken hos barn eldre enn 3 mnd) BEHANDLINGSDATO. /..... SIDE Hø Ve (Ett kryss. Bilateral = skjema) FØRSTE GANG DIAGNOSTISERT.../...... (Fylles ut første gang det sendes inn skjema) TIDLIGERE BEHANDLING Ingen Pute/abduksjonsortose PLATE Annen, spesifiser:......... Forbøyd plate SKRUER Vanlige skruer Vinkelstabile skruer TILGANG Fremre Lateral Annen:......... POSTOPERATIV HOFTEGIPS REOPERASJONSTYPE Vinkelplate Reosteosyntese Spesialplate, fabrikat:... BEKKENOSTEOTOMI Salter Dega Trippel Takplastikk Antall uker... POSTOPERATIV RØNTGEN (ETTER BEKKENOSTEOTOMI) Bløtdelsrevisjon Fjerne ostemat. REOPERASJONSÅRSAK Osteosyntesesvikt Infeksjon Pseudartrose ANNEN OPERASJON N J Spesifiser:... KNIVTID FOR OPERATIV BEHANDLING:..... min. EPIFYSIOLYSIS CAPITIS FEMORIS OPERASJONSDATO... /...... SIDE Hø Ve (Ett kryss. Bilateral skjema) HØYDE OG VEKT SYMPTOMVARIGHET Kronisk (> 3 uker) Akutt (< 3 uker) Akutt på kronisk STABILITET OPERASJON Høyde:..... cm Stabil (klarer belaste) Primæroperasjon Reoperasjon Profylaktisk REOPERASJONSÅRSAK Feilplass. av osteosynt. Osteosyntesesvikt Infeksjon KNIVTID FOR OPERATIV BEHANDLING:... min. Vekt:..... kg Ustabil (klarer ikke belaste) RØNTGEN < 3º 3-5º > 5º (Glidningsvinkel i sideplan) REOPERASJONSTYPE Reosteosyntese Bløtdelsrevisjon Fjerne ostemat. Ved operativ behandling (artroskopisk eller åpen) for impingement etter SCFE: fyll ut rubrikken ÅPNE OG ARTROSKOPISKE HOFTEOPERASJONER 31 Dato:... Lege:... Legen som har fylt ut skjemaet (Navnet registreres ikke i databasen) F.nr. (11 sifre):... Navn:... Sykehus:... (Skriv tydelig eller bruk pasientklistrelapp. Husk sykehus!) CALVÉ-LEGG-PERTHES FØRSTE GANG DIAGNOSTISERT.../...... (Fylles ut første gang det sendes inn skjema) SYMPTOMVARIGHET...... mnd HALTING SMERTE Ingen Lett Betydelig CATTERALL I / II III / IV BEHANDLINGSTRENGENDE DYSPLASI I FAMILIE N J BEHANDLING Ingen (fysioterapi) Abduksjonsortose SYMPTOMVARIGHET (>1 år). mnd FEMUROSTEOTOMI Varisering Valgisering Rotasjon IMPINGEMENT TEST (>1 år) Høyre: Neg. Pos. Venstre: Neg. Pos. PLATE Forbøyd plate Vinkelplate Spesialplate, fabrikat:... RØNTGEN FØR BEHANDLING SKRUER Vanlige skruer Vinkelstabile skruer Acetabular indeks (<=1 år) Hø... Ve... CE vinkel (>1 år) Hø... Ve... BEKKENOSTEOTOMI Salter Dega Takplastikk Cross-over tegn (>1 år) Hø: Neg. Pos. Ve: Neg. Pos. Annen, spesifiser:...... Spina ischiadica projisert medialt for linea terminales? (>1 år) Hø: N J Ve: N J ANNEN OPERATIV BEHANDLING Trochanter transposisjon Trochanter apofysiodese Bruskhøyde (>1 år) (mm i øvre vektbærende del av leddet i AP projeksjon): < -3 >3 Annen, spesifiser:...... HOFTE I ledd Subluksert Luksert REOPERASJONSTYPE Reosteosyntese Bløtdelsrevisjon Fjerne ostemat. LATERALE HJØRNE Normalt Avrundet/ defekt Annen:....... CAPUTKJERNE Normal Forsinket Ikke tilstede Caputnekrose REOPERASJONSÅRSAK Osteosyntesesvikt Blødning Infeksjon BEHANDLING Ingen (obs.) Pute Abduksjonsortose Lukket repos. Hoftegips Pseudartrose Annen:... ÅPEN REPOSISJON N J KNIVTID FOR OPERATIV BEHANDLING:... min. TENOTOMI Psoastenotomi Adduktortenotomi Ved artroskopi eller hoftedislokasjon for sequele etter CLP: fyll ut rubrikken ÅPNE OG ARTROSKOPISKE HOFTEOPERASJONER FEMUROSTEOTOMI Varisering Rotasjon Forkortning Periacetabular osteotomi Acetabular indeks (<=1 år) Hø... Ve... PRIMÆROPERASJONSTYPE Kirurgisk hofte-dislokasjon: N Femurosteotomi: Annen operasjon: Fiksasjon in-situ: N Collumosteotomi: N Peroperativ reposisjon: N Spesifiser:...... Skrueosteosyntese: N J Antall skruer:... Fabrikat:... Pinnefiskasjon: Platefiksasjon: N N N N J J J J J N Annen:...... J Annen:...... Blødning Annen:...... Antall pinner:... Diameter:.... mm Spesifiser:...... Spesifiser:............ Annen, spesifiser:.......... Blødning CE vinkel (>1 år) Hø... Ve... FØRSTE GANG DIAGNOSTISERT.../...... (Fylles ut første gang det sendes inn skjema) Annen:...... J J J BEHANDLINGSDATO.. /...... SIDE Hø Ve (Ett kryss. Bilateral = skjema) ÅPNE OG ARTROSKOPISKE HOFTEOPERASJONER BEHANDLINGSDATO. /...... SIDE Hø Ve (Ett kryss. Bilateral = skjema) OPERASJON Primæroperasjon Reoperasjon Kun diagnostisk uten intervensjon SYMPTOMVARIGHET. mnd TIDLIGERE HOFTELIDELSE SCFE CLP DDH DIAGNOSE Cam impingement Pincer impingement Kombinert impingement PREOPERATIVE FUNN Impingement test Høyre: Neg. Pos. Venstre: Neg. Halting: N J CE-vinkel Hø... Ve... Rtg Alfavinkel sideplan: Hø... Ve... frontplan: Hø... Ve... Spina ischiadica projisert medialt for linea terminales? Bruskhøyde (mm i øvre vektbærende del av leddet i AP projeksjon): MR funn: Labrumskade Paralabral cyste Effekt av lokalbedøvelse i leddet: N Ikke aktuelt Hø: N Subchondral cyste Ve: N KIRURGISK TILGANG Artroskopisk Kirurgisk dislokasjon Konvertering til åpen tilgang Tilgang ved åpen kirurgi: Lateral Annen:.... Fiksasjonsmetode ved trochanter osteotomi:.... Portaler: Anterior Anterolateral Posterolateral Distal anterior Proximal anterior Perifere kompartment først PEROPERATIVE FUNN Labrum: Normal Degen. forandret Forbenet Partiell ruptur Gjennomgående ruptur Bruskskade acetabulum: N J Grad: 1 3 Lokalisasjon: 1 3 5 Ligamentum teres skade: N Partiell ruptur Frie legemer: N J Perifert Sentralt N J Andre:......... Annen:............ J Cross-over tegn Hø: Neg. Pos. Ve: Neg. Lokalisasjon: 1 3 5 ruptur Os acetabuli: N J Som forbening av labrum Som del av leddflaten Synovitt: N KIRURGISK BEHANDLING Labrumruptur: Debridement Sutur. Antall ankre:... Type ankre:... Labrumrekonstruksjon, spesifiser:... (Klistrelapp på baksiden) Bruskskade: Ingen beha. Debridement Mikrofraktur Annen:... Pincerlesjon: Ingen beha. Reseksjon. Dybde max... mm Lengde... mm Camlesjon: Ingen beha. Reseksjon Ligamentum teres: Ingen beha. Debridement Annen:... Os acetabuli: Ingen beha. Fjerning Fiksering Annen:... Frie legemer fjernet: N J Synovectomi: N J Knivtid... min. Reoperasjonsårsak, spesifiser:... J < -3 >3 Bruskskade caput femoris: N J Areal:.... mm Dybde (ICRS): 1 3 J N Sentrale kompartment først J J Pos. Pos. J
RETTLEDNING 1. HOFTEDYSPLASI Kriterier: AI > mean + SD for aktuell alder (Se figur) Alle barn som på røntgen bekken får påvist hoftedysplasi etter 3 måneders alder skal registreres. Barn som er diagnostisert før 3 måneders alder (putebehandlet) registreres hvis de fortsatt har dysplasi på røntgen bekken på kontroll etter 3 måneders alder. Barn med nevroortopediske lidelser skal ikke registreres. - Registreres første gang ved diagnose (røntgen bekken)/primærbehandling - Registreres ved senere behandling som krever anestesi/ sedasjon Lukket reposisjon/ hoftegips, åpen reposisjon, tenotomier, femur-/bekkenosteotomier, reoperasjoner. Operativ behandling (periacetabulære osteotomier, takplastikk og lignende) hos ungdommer og voksne skal også registreres. CAPUTKJERNE: Ved unilateral sammenlign med frisk side.. CALVÉ-LEGG-PERTHES - Registreres første gang ved diagnose/primærbehandling - Registreres ved senere behandling som krever anestesi (Femur-/bekkenosteotomier, reoperasjoner) CATTERALL: I/II = <5 % caputnekrose. III/IV = >5 % caputnekrose 3. EPIFYSIOLYSIS CAPITIS FEMORIS - Registreres første gang ved diagnose/primærbehandling - Registreres ved senere behandling som krever anestesi Osteosyntese, femurosteotomier, reoperasjoner.. ÅPNE OG ARTROSKOPISKE HOFTEOPERASJONER Alle pasienter (uavhengig av alder) som gjennomgår åpen eller artroskopisk hofteoperasjon, unntatt fraktur-, proteseog tumor-operasjoner, skal registreres. Bruskskade i acetabulum Grade: Bruskskade i acetabulum og på caput femoris Lokalisasjon: =Normal. 1-: Fortil, -5: Baktil 1=Loss of fixation to the subchondral bone resulting in a wave sign, defined as occuring when the capsular side of the labrum is pushed inwards with the probe resulting in bulging of the adjacent articular cartilage. =Presence of cleavage tear with obvious separation at the chondrolabral junction. 3=Delamination of the articular cartilage. =Presence of exposed bone in the acetabulum. Venstre hofte Høyre hofte Bruskskade på caput femoris Dybde (ICRS): 1=Nearly normal: Superficial lesions, soft identation and/or superficial fissures and cracks. =Abnormal: Lesions extending down to <5% of cartilage depth. 3=Severely abnormal: Cartilage defects extending down to >5% of cartilage depth as well as down to calcified layer. =Severely abnormal: Osteochondral injuries, lesions extending just through the sub chondral boneplate or deeper defects down into trabecular bone. KONTAKTPERSONER VEDRØRENDE REGISTRERINGSSKJEMA Overlege Ola Wiig, Ortopedisk avd. Oslo universitetssykehus, Tlf. 95 1 3, e-post: ola.wiig@ous-hf.no Overlege Anders Wensaas, Ortopedisk avd, Oslo universitetssykehus, Tlf: 97 15 3 39, e-post: anders.wensaas@ous-hf.no Ass.lege Trude Gundersen Lehmann, Ortopedisk klinikk, Haukeland universitetssjukehus, Tlf: 9 5 3 13, e-post: trude.gundersen.lehmann@helse-bergen.no Sekretær Marianne Wiese, Barnehofteregisteret, Tlf. 55 97 5, e-post: marianne.wiese@helse-bergen.no Internett: http://nrlweb.ihelse.net Versjon 1331