Norwegian National Advisory Unit on Arthroplasty and Hip Fractures

273 Pages·2016·5.75 MB·English

RREEPPOORRTT
June 2015
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: 978-82-91847-20-7 ISSN:
1893-8906 (Printed version)
1893-8914 (Online)

CONTENTS
Introduction ................................................................................................................ 5
Norwegian Arthroplasty Register
Total hip replacement ...................................................................................... 7
Arthroplasty in knee and other joints
Knee prostheses ........................................................................................... 57
Elbow prostheses ...................................................................................... 107
Ankle prostheses ....................................................................................... 111
Finger joint prostheses ............................................................................ 113
Wrist prostheses ........................................................................................ 121
Carpometacarpal prostheses (CMC I) ............................................... 125
Lumbar disc prostheses ......................................................................... 127
Shoulder prostheses ................................................................................ 129
Toe joint prostheses ................................................................................. 139
Norwegian Hip Fracture Register .......................................................... 143
Norwegian Cruciate Ligament Register ........................................... 179
Norwegian Paediatric Hip Register ...................................................... 221
List of publications .......................................................................................... 231
Operation forms (in Norwegian)
Total hip prostheses ........................................................................................... 260
Knee and other joint prostheses......................................................................... 262
Hip fracture ......................................................................................................... 264
Cruciate ligament................................................................................................ 268
Cruciate ligament – KOOS ................................................................................. 260
Paediatric hip – New form from 2013 ................................................................. 272
Paediatric hip – Old form .................................................................................... 274
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Report 2015
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NORWEGIAN NATIONAL ADVISORY UNIT ON ARTHROPLASTY AND HIP
FRACTURES 2015 ANNUAL REPORT
This annual report presents results and descriptive statistics from our five registers.
The Paediatric Hip Register has recently received pre-national status and its finances are
ensured through funding from Helse Vest.
National medical quality registers must have a general manager employed by the hospital
where the register is located; in the case of our registers, this is Helse Bergen. Knut
Fjeldsgaard is now the general manager of the Cruciate Ligament Register.
As required by the Interregional Steering Committee for the National Service Centre for
Medical Quality Registers, the results at hospital level from the Hip Fracture Register were
published in autumn 2014 (http://www.kvalitetsregistre.no/resultater/). In the present annual
report, we publish for the first time, at hospital level, the ten-year survival rate of hip and knee
replacements, the ten-year survival rate of ACL graft surgery and the two-year implant
survival rate after hip fracture surgery. The results are presented with an explanation of the
limitations of our data, together with results of coverage analyses showing the proportion of
the operations notified to the Norwegian Patient Register (NPR) which were also reported to
our registers, and vice versa.
The completeness analyses were performed in collaboration with the National Service Centre
for Medical Quality Registers of the Centre for Clinical Documentation and Evaluation
(SKDE) and the NPR. The results of the completeness analyses for total hip and knee
arthroplasties, as well as for operations for hip fractures and knee ligament injuries, were also
published in last year’s report.
All orthopaedic surgeons should help to check the completeness in their own hospital. In
hospitals with poor completeness, the surgeons should review their procedures for collection
and submission of forms to the registers, and their present coding practice on operations on
the relevant joints in the administrative system of the hospital (to the NPR). In our reports, we
provide advice on the use of codes. The Directorate of Health and the Centre for Clinical
Documentation and Evaluation (SKDE) have made separate reports based on the completeness
analyses from our registers. These reports are available at http://www.kvalitetsregistre.no and
www.helsedirektoratet.no. We are now working on completeness analyses for prostheses in
other joints than the hip and knee and for the Paediatric Hip Register. We plan to repeat the
analyses every second year.
Norwegian orthopaedic surgeons have long been requesting a system of electronic reporting
to the registers. The National Service Environment for Medical Quality Registers is dealing
with this, but it has proved difficult to develop a system that is legal and as easy for surgeons
to use as the paper forms, and which enables reporting of implant data at a catalogue number
level. There is also ongoing work on a system of electronic recording and transmission of
patient-reported outcome measures (PROM) for the joint replacement registers and the
Cruciate Ligament Register. The systems should be compatible with the various electronic
recordkeeping and administrative systems used in hospitals, and should comply with
Norwegian regulations for electronic transmission of personally identifiable health
information. It remains uncertain when these tools will be ready for use.
The annual report is sent electronically to all Norwegian orthopaedic surgeons. Paper copies
can be obtained by contacting us. The Norwegian Arthroplasty Register 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.
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Report 2015
We mainly publish our findings on implants and surgical methods in scientific journals, where
we can explain materials and methods and discuss strengths and weaknesses and the
significance of the findings. We refer to the reference list at the end of the present report.
Hospital-based annual reports, with data from each hospital, will as before be sent to our
contact persons at the hospitals. We encourage our contacts to check the coverage analysis
and that the figures recorded from the hospital are correct, and to use the reports for local
quality control work.
Please remember that the Norwegian Data Protection Authority requires consent forms to be
signed by patients before operations are reported to the registers, and the declarations of
consent must be stored in the patient record in the hospital.
We would like to thank all orthopaedic surgeons in Norway for good reporting. We are also
grateful for good cooperation with Helse Bergen, Helse Vest, SKDE, the equipment suppliers,
the University of Bergen, 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, 03.06.2015
Leif I. Havelin Ove Furnes Lasse Engesæter
Consultant Orthopaedic Surgeon/ Consultant Orthopaedic Surgeon/ Professor/
Professor Professor Consultant Orthopaedic Surgeon
Head of Centre of Excellence
Anne Marie Fenstad Christoffer Bartz-Johannessen Knut Fjeldsgaard
Biostatistician Biostatistician Consultant Orthopaedic Surgeon,
Orthopaedic Department
Ola Wiig Eva Dybvik
Consultant Orthopaedic Surgeon Biostatistician
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The Norwegian Arthroplasty Register
CONTENTS
Norwegian Arthroplasty Register
Total Hip Replacement
Introduction ................................................................................................................ 9
Survival of total hip prostheses 1987–2014. Fixations ........................................... 12
Survival of total hip prostheses 2005–2014. Fixations ........................................... 13
Survival of total hip prostheses 2005–2014. Fixations and age ............................. 14
Last 10 years survival curves for all hospitals individually ...................................... 15
One stage bilateral hip prosthesis operations ......................................................... 16
Annual numbers and incidence of total hip replacements ...................................... 17
Reasons for primary operations .............................................................................. 18
Age by year of operation ......................................................................................... 18
Reasons for revisions .............................................................................................. 19
Reasons for revisions for patients under age 65 .................................................... 20
Reasons for revisions for patients between age 65 and 74 .................................... 20
Reasons for revisions for men and women 75 years old or older ........................... 21
Type of revision ....................................................................................................... 22
Bone transplantation in revisions ............................................................................ 23
Bone loss in revisions ............................................................................................. 24
Operative approach ................................................................................................. 25
Mini invasive surgery ............................................................................................... 25
Trochanteric osteotomy ........................................................................................... 26
Systemic antibiotic prophylaxis ............................................................................... 26
Use of cement in primary operations ...................................................................... 27
Use of cement in revisions ...................................................................................... 28
Use of cement and bone transplantation in revisions ............................................. 29
Cements .................................................................................................................. 30
Cemented primary prostheses ................................................................................ 31
Uncemented primary prostheses ............................................................................ 32
Hybrid primary prostheses ...................................................................................... 33
Acetabular prostheses ............................................................................................ 34
Femoral prostheses ................................................................................................ 36
Monoblock and modular caput ................................................................................ 38
Caput diameter ........................................................................................................ 39
Caput prostheses .................................................................................................... 40
Dual Mobility articulation ......................................................................................... 41
ASA classification .................................................................................................... 41
Thrombosis prophylaxis .......................................................................................... 42
Articulations (primary operations) All patients ......................................................... 44
Articulations (primary operations) Patients < 65 years ........................................... 45
Articulations (primary operations) Patients >= 65 years ......................................... 46
Results of total hip replacements at hospital level
Completeness of reporting....................................................................................... 47
Completeness of reporting for hospitals in Helse Sør-Øst ...................................... 48
Completeness of reporting for hospitals in Helse Vest ............................................ 49
Completeness of reporting for hospitals in Helse Midt-Norge ................................. 50
Completeness of reporting for hospitals in Helse Nord ........................................... 51
Completeness of reporting for private hospitals ...................................................... 52
Survival of total hip replacements in Norwegian hospitals ...................................... 53
Hip 7
Report 2015
8 Hip
The Norwegian Arthroplasty Register
THE HIP ARTHROPLASTY REGISTER
2015 ANNUAL REPORT
This year’s annual report contains data from 190 962 total hip replacement operations. In
2014, there were 8099 primary operations and 1284 revisions. The figures are similar to those
from 2013.
TRENDS AND RISK OF REVISION
Overall, there has been a positive development with improved results over time, but the risk
of early reoperation has increased in recent years, when there have also been changes in
surgeons’ choice of prostheses and operation techniques.
In recent years, uncemented prostheses have been more frequently used for elderly patients
than previously. This change in practice is not supported by the literature (Dale et al. 2012;
Mäkelä et al. 2014; Jämsen et al. 2014), and we see in this year’s report that the increased use
of uncemented femoral prostheses in elderly patients has now ended.
In Table 26 and Figure 13 in this year’s report, we now see a clear reduction in the use of 22
and 28 mm head diameters, and increased use of 32 mm. This is probably beneficial, since 32
mm heads give a lower risk of dislocation. For articulation with highly crosslinked
polyethylene there is no evidence that 32 mm leads to increased wear. Larger heads than 32
mm would probably further reduce the dislocation risk, but heads of 36 mm or larger could
increase the risk of fretting (corrosion) on the taper joint between head and neck.
There have also been changes in the choice of surgical approach. The use of minimally
invasive anterior and anterolateral approaches has been increasing for several years, but this
has now levelled off. The use of posterior approaches has increased over the last seven years
and is still on the increase, at the expense of the direct lateral approach. This may be
beneficial, since Amlie et al. (2014) showed that with a direct lateral approach about 25% of
patients experienced limping after surgery. This was about twice as many as for patients who
underwent other surgical approaches.
We are not certain as to whether limping after a direct lateral approach has always been a
problem or whether this is due to changes in surgical technique or earlier postoperative weight
bearing than before. To gain a better overview of the problem, we ask all surgeons to report to
the Hip Register all reoperations involving muscle transposition or re-fixation of the gluteus
medius
Although early revisions have increased somewhat, hip replacement surgery shows good
results.
METAL ON METAL (MoM) PROSTHESIS
Please remember that hospitals have a duty to regularly monitor all patients with MoM
prostheses with a diameter of >32 mm for the rest of their lives, as recommended by the
Norwegian National Advisory Unit on Arthroplasty and Hip Fractures (http://
nrlweb.ihelse.net/ or http://www.haukeland.no/nrl/) and in line with similar
recommendations in other countries.
PUBLICATIONS:
From 1 January 2014 to date, the Register has published 17 papers dealing with total hip
arthroplasty. See the publication list later in the annual report and on the website of the
Register (http://www.haukeland.no/nrl/ or http://nrlweb.ihelse.net/).
Hip 9
Report 2015
SUMMARY OF SIGNIFICANT SCIENTIFIC FINDINGS LAST YEAR
Mäkelä et al. (BMJ) found in the NARA database that in patients over 65 years the results of
cemented hip prostheses were better than those of uncemented hip prostheses.
Pedersen et al. (Osteoarthritis Cartilage), in a study of NARA data on patients under 55 years,
found no overall difference between cemented and uncemented prostheses. Young patients
with uncemented prostheses had fewer revisions due to loosening, and more early revisions
due to dislocation, fracture and infection, than young patients with cemented prostheses.
Amlie E et al. (Acta Orthop) found that with a direct lateral surgical approach about twice as
many (roughly 25%) of patients reported limping after hip replacement surgery, compared to
those who had been operated on with a posterior or one of the anterior approaches.
Dybvik E. et al. (Acta Orthop) found that radiotherapy of patients with gynaecological cancer
did not increase the risk of hip arthroplasty surgery.
Thien TM et al. (J Bone Joint Surg Am), using NARA data, found a greater risk of
periprosthetic fracture with uncemented than with cemented prosthesis. With a cemented
prosthesis, the risk was greater with a short prosthesis with a smooth surface than with a
longer prosthesis with a non-smooth surface.
Stea S et al. (J Bone Joint Surg Am), in a study of the ICOR database (data from 6 registers),
concluded that the use of uncemented hip prostheses in patients older than 75 years should be
avoided.
Furnes O et al. (J Bone Joint Surg Am), in another ICOR study, found that total prostheses
with metal-on-metal articulation with large heads (>36 mm) had a greater risk of revision
after two years than prostheses with metal-on-cross-linked polyethylene articulation. ASR
prostheses were not included in this study.
Allepuz A et al. (J Bone Joint Surg Am), also using ICOR data, found no benefits in using
heads with a diameter greater than 32 mm, compared with heads of 32 mm diameter.
Paxton E et al. (J Bone Joint Surg Am), in an ICOR study with five-year follow-up, found no
difference in results between prostheses with cross-linked and conventional polyethylene.
Lutro O et al. (Adv Orthop) examined bacteria from operations for infected hip arthroplasty
from three five-year periods and found that the incidence of methicillin-resistant coagulase-
negative staphylococci increased from 54% in the first period to 84% in the final period.
Hailer NP et al. (Acta Orthop) analysed data on 116 069 uncemented hip prostheses in
NARA, and found that uncemented femoral prostheses without hydroxyapatite coating might
have as good results as uncemented femoral prostheses with hydroxyapatite coating.
Varnum C et al. (Acta Orthop), using NARA data, found an increased risk of revision for
uncemented femoral prostheses with metal-on-metal articulation compared with prostheses
with other articulations. ASR prostheses had the highest risk of revision.
Schrama JC et al. (Acta Orthop), also studying NARA data, found that prosthetic patients
with rheumatoid arthritis had a slightly greater risk of revision due to infection than prosthetic
10 Hip