National Joint Replacement Registry following Primary Hip and Knee Arthroplasty SUPPLEMENTARY REPORT 2014
CONTENTS INTRODUCTION... 1 Analysis of... 1 Primary Hip Replacement... 2 Primary Knee Replacement... 6 i
LIST OF TABLES INTRODUCTION...1 Table M1: Commencement Date of Hip and Knee Replacement by State/Territory...1 Primary Hip Replacement...2 Table M2: following Primary Hip Replacement by Category...2 Table M3: Yearly Cumulative Percent Survival of Patients with Primary Hip Replacement by Category...2 Table M4: following Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF)...3 Table M5: Yearly Cumulative Percent Survival of Patients with Primary Partial Hip Replacement by Class (Primary Diagnosis FNOF)...3 Table M6: following Primary Unipolar Monoblock Hip Replacement by Type (Primary Diagnosis FNOF)...4 Table M7: Yearly Cumulative Percent Survival of Patients with Primary Unipolar Monoblock Hip Replacement by Type (FNOF)...4 Table M8: following Primary Total Hip Replacement by Class (Primary Diagnosis OA)...5 Table M9: Yearly Cumulative Percent Survival of Patients with Primary Total Hip Replacement by Class (Primary Diagnosis OA)...5 Primary Knee Replacement...6 Table M10: following Primary Knee Replacement by Category...6 Table M11: Yearly Cumulative Percent Survival of Patients with Primary Knee Replacement by Category...6 Table M12: following Primary Knee Replacement by Class (Primary Diagnosis OA)...7 Table M13: Yearly Cumulative Percent Survival of Patients with Primary Knee Replacement by Class (Primary Diagnosis OA)...7 LIST OF FIGURES Primary Hip Replacement...2 Figure M1: Cumulative Percent Survival of Patients with Primary Hip Replacement by Category...2 Figure M2: Cumulative Percent Survival of Patients with Primary Partial Hip Replacement by Class (Primary Diagnosis FNOF)...3 Figure M3: Cumulative Percent Survival of Patients with Primary Unipolar Monoblock Hip Replacement by Type (FNOF)...4 Figure M4: Cumulative Percent Survival of Patients with Primary Total Hip Replacement by Class (Primary Diagnosis OA)...5 Primary Knee Replacement...6 Figure M5: Cumulative Percent Survival of Patients with Primary Knee Replacement by Category...6 Figure M6: Cumulative Percent Survival of Patients with Primary Knee Replacement by Class (Primary Diagnosis OA)...7 ii
INTRODUCTION Data presented in this report have been submitted to the Registry by both public and private hospitals. Currently this involves 305 hospitals nationally but varies from time to time due to hospital closures, new hospitals or changes to services within hospitals. The Registry was implemented in a staged manner on a state-by-state basis. Implementation was completed nationally by mid 2002; therefore 2003 was the first year of complete national data. All hip and knee replacement procedures recorded by the Registry from the commencement date up to the 31 December 2013 have been included in this report. Table M1 shows the commencement date for each state/territory. Table M1: Commencement Date of Hip and Knee Replacement by State/Territory State/Territory Commencement Date South Australia September 1999 Queensland April 2000 Western Australia April 2000 Victoria July 2000 Tasmania September 2000 Northern Territory October 2000 Australian Capital Territory May 2001 New South Wales June 2001 Analysis of information has been obtained by matching all procedures reported to the Registry up and including the 31 st December 2013 with the National Death Index (NDI). The NDI is the national mortality database maintained by the Australian Institute of Health and Welfare (AIHW). Access to the data required approval of a formal ethics application to AIHW. Adjusted mortality is obtained after direct standardisation of the crude cumulative mortality data by five year age intervals and gender to the Estimated Resident Population Status based on the 2001 census. As the total population has a younger age structure than the population of the Registry, the adjusted mortality is substantially lower than the crude mortality. By minimising the effects of age and gender differences within groups, the adjusted measure may be used to compare the mortality of different procedures and is useful when comparing mortality over time. The rate per 100 person years has been calculated from the date of first joint procedure to either the date of death or the end of study (31/12/2013). This provides a true rate. End Data Period: 31 Dec 2013 Page 1
PRIMARY HIP REPLACEMENT Table M2: following Primary Hip Replacement by Category Hip Category N Death N Patients % Deaths Rate per 100 Person Yrs (95% CI) Partial 38495 59881 64.3 30.8 178790 21.53 (21.32, 21.75) Total 33023 233543 14.1 5.0 1300912 2.54 (2.51, 2.57) TOTAL 71518 293424 24.4 6.4 1479702 4.83 (4.80, 4.87) Table M3: Yearly Cumulative Percent Survival of Patients with Primary Hip Replacement by Category Partial 72.2 (71.8, 72.5) 51.8 (51.4, 52.2) 36.6 (36.2, 37.1) 26.0 (25.5, 26.4) 16.1 (15.7, 16.5) 10.8 (10.1, 11.4) Total 98.2 (98.2, 98.3) 94.6 (94.5, 94.7) 90.1 (90.0, 90.2) 84.6 (84.4, 84.8) 75.3 (75.0, 75.6) 65.6 (65.0, 66.1) Figure M1: Cumulative Percent Survival of Patients with Primary Hip Replacement by Category 10 9 8 7 1 Partial Total Partial vs Total 0-2Wk: HR=9.50 (8.61, 10.48),p<0.001 2Wk - 1Mth: HR=11.98 (10.63, 13.50),p<0.001 1Mth - 3Mth: HR=10.18 (9.43, 10.99),p<0.001 3Mth - 6Mth: HR=6.47 (6.00, 6.97),p<0.001 6Mth - 1Yr: HR=5.19 (4.88, 5.51),p<0.001 1Yr - 1.5Yr: HR=4.34 (4.08, 4.61),p<0.001 1.5Yr - 2.5Yr: HR=3.93 (3.76, 4.11),p<0.001 2.5Yr - 4Yr: HR=3.49 (3.36, 3.63),p<0.001 4Yr - 5.5Yr: HR=3.26 (3.12, 3.40),p<0.001 5.5Yr - 6.5Yr: HR=2.79 (2.63, 2.96),p<0.001 6.5Yr - 7.5Yr: HR=2.53 (2.36, 2.71),p<0.001 7.5Yr - 8.5Yr: HR=2.39 (2.21, 2.59),p<0.001 8.5Yr - 9Yr: HR=2.06 (1.80, 2.35),p<0.001 9Yr - 10.5Yr: HR=1.93 (1.76, 2.13),p<0.001 10.5Yr+: HR=1.55 (1.36, 1.78),p<0.001 Partial 59881 39753 23424 13166 6927 2036 140 Total 233543 208660 163017 120228 82591 35002 2615 Page 2
Table M4: following Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF) Partial Hip Class N Death N Patients % Deaths Rate per 100 Person Yrs (95% CI) Unipolar Monoblock 18961 23415 81.0 24.3 64160 29.55 (29.13, 29.98) Unipolar Modular 10733 21935 48.9 23.8 59888 17.92 (17.58, 18.26) Bipolar 6653 11312 58.8 23.3 44870 14.83 (14.47, 15.19) TOTAL 36347 56662 64.1 25.3 168918 21.52 (21.30, 21.74) Table M5: Yearly Cumulative Percent Survival of Patients with Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF) Unipolar Monoblock 64.3 (63.6, 64.9) 41.1 (40.4, 41.7) 25.5 (24.9, 26.1) 16.1 (15.6, 16.6) 8.4 (7.9, 8.9) 5.1 (4.5, 5.6) Unipolar Modular 77.5 (76.9, 78.0) 58.7 (58.0, 59.5) 43.7 (42.9, 44.5) 32.7 (31.8, 33.6) 22.2 (21.0, 23.4) Bipolar 80.0 (79.2, 80.7) 63.1 (62.1, 64.0) 49.4 (48.3, 50.4) 37.5 (36.4, 38.5) 25.4 (24.3, 26.4) 17.6 (15.9, 19.4) Figure M2: Cumulative Percent Survival of Patients with Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF) 10 9 8 7 1 Unipolar Monoblock Unipolar Modular Bipolar Unipolar Monoblock vs Bipolar 0-2Wk: HR=1.61 (1.49, 1.74),p<0.001 2Wk - 1Mth: HR=2.01 (1.84, 2.20),p<0.001 1Mth - 3Mth: HR=1.76 (1.65, 1.88),p<0.001 3Mth - 2Yr: HR=1.60 (1.53, 1.67),p<0.001 2Yr - 4Yr: HR=1.63 (1.56, 1.72),p<0.001 4Yr - 5Yr: HR=1.57 (1.45, 1.70),p<0.001 5Yr+: HR=1.43 (1.35, 1.51),p<0.001 Unipolar Modular vs Bipolar Entire Period: HR=1.08 (1.05, 1.12),p<0.001 Unipolar Monoblock vs Unipolar Modular 0-2Wk: HR=1.48 (1.37, 1.60),p<0.001 2Wk - 1Mth: HR=1.86 (1.70, 2.03),p<0.001 1Mth - 3Mth: HR=1.62 (1.53, 1.73),p<0.001 3Mth - 2Yr: HR=1.47 (1.42, 1.53),p<0.001 2Yr - 3.5Yr: HR=1.49 (1.41, 1.57),p<0.001 3.5Yr - 4Yr: HR=1.57 (1.42, 1.74),p<0.001 4Yr - 4.5Yr: HR=1.39 (1.24, 1.54),p<0.001 4.5Yr - 6Yr: HR=1.42 (1.32, 1.53),p<0.001 6Yr+: HR=1.30 (1.21, 1.39),p<0.001 Unipolar Monoblock 23415 14442 8358 4558 2403 716 52 Unipolar Modular 21935 14880 8089 3944 1657 340 23 Bipolar 11312 8375 5694 3876 2448 843 53 End Data Period: 31 Dec 2013 Page 3
Table M6: following Primary Unipolar Monoblock Hip Replacement by Type (Primary Diagnosis Fractured NOF) Monoblock N Death N Patients % Deaths Rate per 100 Person Yrs (95% CI) Austin-Moore Type 13415 15818 84.8 25.5 43481 30.85 (30.33, 31.38) ETS 1105 1953 56.6 17.2 4604 24.00 (22.61, 25.46) Thompson Type 4441 5644 78.7 20.7 16075 27.63 (26.82, 28.45) TOTAL 18961 23415 81.0 24.3 64160 29.55 (29.13, 29.98) Table M7: Yearly Cumulative Percent Survival of Patients with Primary Unipolar Monoblock Hip Replacement by Type (Primary Diagnosis Fractured NOF) Austin-Moore Type 62.2 (61.5, 63.0) 39.3 (38.5, 40.1) 24.0 (23.3, 24.7) 14.9 (14.3, 15.5) 7.8 (7.3, 8.3) ETS 70.7 (68.6, 72.7) 50.2 (47.7, 52.6) 34.5 (31.8, 37.1) 25.0 (22.1, 28.0) Thompson Type 67.8 (66.5, 69.0) 43.3 (41.9, 44.6) 27.4 (26.1, 28.7) 17.6 (16.5, 18.8) 9.1 (8.1, 10.1) Figure M3: Cumulative Percent Survival of Patients with Primary Unipolar Monoblock Hip Replacement by Type (Primary Diagnosis Fractured NOF) 10 9 8 7 Austin-Moore Type vs ETS Entire Period: HR=1.31 (1.23, 1.39),p<0.001 Thompson Type vs ETS Entire Period: HR=1.18 (1.11, 1.27),p<0.001 Austin-Moore Type vs Thompson Type 0-2Yr: HR=1.17 (1.12, 1.22),p<0.001 2Yr+: HR=1.03 (0.98, 1.08),p=0.256 1 Austin-Moore Type ETS Thompson Type Austin-Moore Type 15818 9559 5641 3139 1703 540 37 ETS 1953 1237 627 279 85 0 0 Thompson Type 5644 3646 2090 1140 615 176 15 Page 4
Table M8: following Primary Total Hip Replacement by Class (Primary Diagnosis OA) Total Hip Class N Death N Patients % Deaths Rate per 100 Person Yrs (95% CI) Total Resurfacing 345 12353 2.8 3.0 92227 0.37 (0.34, 0.42) Total Conventional 25771 193196 13.3 4.0 1069326 2.41 (2.38, 2.44) TOTAL 26116 205549 12.7 3.8 1161553 2.25 (2.22, 2.28) Table M9: Yearly Cumulative Percent Survival of Patients with Primary Total Hip Replacement by Class (Primary Diagnosis OA) Total Resurfacing 99.8 (99.8, 99.9) 99.4 (99.2, 99.5) 98.7 (98.5, 98.9) 97.7 (97.4, 98.0) 95.8 (95.3, 96.3) 94.1 (92.9, 95.1) Total Conventional 98.8 (98.8, 98.9) 95.6 (95.5, 95.7) 91.2 (91.0, 91.3) 85.4 (85.2, 85.6) 75.5 (75.1, 75.8) 64.9 (64.3, 65.5) Figure M4: Cumulative Percent Survival of Patients with Primary Total Hip Replacement by Class (Primary Diagnosis OA) 10 9 Total Conventional vs Total Resurfacing Entire Period: HR=1.70 (1.53, 1.90),p<0.001 8 7 1 Total Resurfacing Total Conventional Total Resurfacing 12353 12060 11260 9572 7159 2974 81 Total Conventional 193196 172893 134288 98341 67146 28405 2214 End Data Period: 31 Dec 2013 Page 5
PRIMARY KNEE REPLACEMENT Table M10: following Primary Knee Replacement by Category Knee Category N Death N Patients % Deaths Rate per 100 Person Yrs (95% CI) Partial 3477 34946 9.9 3.4 239740 1.45 (1.40, 1.50) Total 33982 287885 11.8 9.1 1532531 2.22 (2.19, 2.24) TOTAL 37459 322831 11.6 8.8 1772270 2.11 (2.09, 2.14) Table M11: Yearly Cumulative Percent Survival of Patients with Primary Knee Replacement by Category Partial 99.6 (99.5, 99.6) 97.8 (97.6, 97.9) 95.2 (94.9, 95.4) 92.0 (91.6, 92.3) 85.1 (84.5, 85.6) 76.7 (75.5, 77.8) Total 99.1 (99.0, 99.1) 96.4 (96.3, 96.4) 92.3 (92.1, 92.4) 86.8 (86.6, 86.9) 76.1 (75.8, 76.4) 64.3 (63.8, 64.9) Figure M5: Cumulative Percent Survival of Patients with Primary Knee Replacement by Category 10 9 8 7 Total vs Partial 0-1.5Yr: HR=1.56 (1.37, 1.77),p<0.001 1.5Yr - 3Yr: HR=1.13 (1.02, 1.24),p=0.015 3Yr - 3.5Yr: HR=1.36 (1.15, 1.60),p<0.001 3.5Yr+: HR=1.30 (1.25, 1.36),p<0.001 1 Partial Total Partial 34946 33070 28845 23514 17536 8171 455 Total 287885 256327 195240 140061 93012 37127 2537 Page 6
Table M12: following Primary Knee Replacement by Class (Primary Diagnosis OA) Knee Class N Death N Patients % Deaths Rate per 100 Person Yrs (95% CI) Partial Resurfacing 3 157 1.9 0.9 829 0.36 (0.07, 1.06) Unispacer 0 38 0.0 0.0 374 0.00 (0.00, 0.99) Patella/Trochlear 108 1870 5.8 2.9 10276 1.05 (0.86, 1.27) Unicompartmental 3311 32339 10.2 3.3 224656 1.47 (1.42, 1.52) Bicompartmental 5 120 4.2 1.1 587 0.85 (0.28, 1.99) Total Knee 32548 280460 11.6 3.4 1489934 2.18 (2.16, 2.21) TOTAL 35975 314984 11.4 3.3 1726655 2.08 (2.06, 2.11) Table M13: Yearly Cumulative Percent Survival of Patients with Primary Knee Replacement by Class (Primary Diagnosis OA) Patella/Trochlear 99.7 (99.2, 99.8) 97.7 (96.8, 98.3) 95.8 (94.6, 96.7) 93.7 (92.1, 95.0) 87.3 (84.3, 89.8) Unicompartmental 99.5 (99.5, 99.6) 97.7 (97.6, 97.9) 95.1 (94.9, 95.4) 91.9 (91.5, 92.2) 84.9 (84.4, 85.5) 76.4 (75.1, 77.5) Total Knee 99.1 (99.1, 99.1) 96.4 (96.4, 96.5) 92.4 (92.3, 92.5) 86.9 (86.8, 87.1) 76.3 (76.0, 76.6) 64.6 (64.0, 65.2) Figure M6: Cumulative Percent Survival of Patients with Primary Knee Replacement by Class (Primary Diagnosis OA) 10 9 8 7 Patella/Trochlear vs Unicompartmental Entire Period: HR=1.35 (1.11, 1.63),p=0.002 Total Knee vs Unicompartmental 0-1.5Yr: HR=1.50 (1.32, 1.71),p<0.001 1.5Yr - 3.5Yr: HR=1.15 (1.06, 1.26),p<0.001 3.5Yr+: HR=1.29 (1.23, 1.34),p<0.001 Total Knee vs Patella/Trochlear Entire Period: HR=0.95 (0.79, 1.14),p=0.579 1 Patella/Trochlear Unicompartmental Total Knee Patella/Trochlear 1870 1691 1327 946 637 245 18 Unicompartmental 32339 30681 26888 22069 16593 7803 426 Total Knee 280460 249683 189994 136126 90236 35862 2429 End Data Period: 31 Dec 2013 Page 7