The Norwegian Arthroplasty Register: 11 years and 73,000 arthroplasties

Abstract

In 1985, the Norwegian Orthopaedic Association decided to establish a national hip register, and the Norwegian Arthroplasty Register was started in 1987. In January 1994, it was extended to include all artificial joints. The main purpose of the register is to detect inferior results of implants as early as possible. All hospitals participate, and the orthopedic surgeons are supposed to report all primary operations and all revisions. Using the patient's unique national social security number, the revision can be linked to the primary operation, and survival analyses of the implants are done. In general, the survival analyses are performed with the Kaplan-Meier method or using Cox multiple regression analysis with adjustment for possible confounding factors such as age, gender, and diagnosis. Survival probabilities can be calculated for each of the prosthetic components. The end-point in the analyses is revision surgery, and we can assess the rate of revision due to specific causes like aseptic loosening, infection, or dislocation. Not only survival, but also pain, function, and satisfaction have been registered for subgroups of patients.We receive reports about more than 95% of the prosthesis operations. The register has detected inferior implants 3 years after their introduction, and several uncemented prostheses were abandoned during the early 1990s due to our documentation of poor performance. Further, our results also contributed to withdrawal of the Boneloc cement. The register has published papers on economy, prophylactic use of antibiotics, patients' satisfaction and function, mortality, and results for different hospital categories.In the analyses presented here, we have compared the results of primary cemented and uncemented hip prostheses in patients less than 60 years of age, with 0-11 years' follow-up. The uncemented circumferentially porous-or hydroxyapatite (HA)-coated femoral stems had better survival rates than the cemented ones. In young patients, we found that cemented cups had better survival than uncemented porous-coated cups, mainly because of higher rates of revision from wear and osteolysis among the latter. The uncemented HA-coated cups with more than 6 years of follow-up had an increased revision rate, compared to cemented cups due to aseptic loosening as well as wear and osteolysis.We now present new findings about the six commonest cemented acetabular and femoral components. Generally, the results were good, with a prosthesis survival of 95% or better at 10 years, and the differences among the prosthesis brands were small.Since the practice of using undocumented implants has not changed, the register will continue to survey these implants. We plan to assess the mid-and long-term results of implants that have so far had good short-term results.n

Custom Cementless Stem Improves Hip Function in Young Patients at 15-year Followup

“…loosening as much as 7% at midterm followup has been reported (Table 3) [1,11,20,28,41]. Distally supported prostheses have been introduced to increase initial and long-term stability [22,39] but may increase the risk of proximal osteopenia [46], whereas proximally fitting designs may lead to subsidence and early loosening [37,46].…”

Risk of revision for infection in primary total hip and knee arthroplasty in patients with rheumatoid arthritis compared with osteoarthritis: A prospective, population‐based study on 108,786 hip and knee joint arthroplasties from the Norwegian Arthroplasty Register

“…Data concerning the identity of the patient, the diagnosis (indication), the date of surgery, whether the operation was primary or a revision, the cause of revision, the type of prosthesis, whether bone cement was used and the type of cement, the use of thrombosis prophylaxis, and antibiotics were registered in a form filled in by the operating surgeon (2,25). Using the unique identification number assigned to each resident of Norway, information from revision procedures involving exchange or removal of implants was linked to the corresponding primary operation.…”

“…The Scandinavian arthroplasty registers have shown that 3-15% of all prosthetic joint replacements in the hips and knees were done in RA patients (1)(2)(3)(4)(5)(6)(7). Replacements of other joints (e.g., elbows, wrists, fingers, and ankles) are predominantly performed in RA patients.…”

Early Mortality after Modern Total Hip Arthroplasty

“…For nearly 50 years, THA has been one of the most effective and economical interventions in orthopaedic surgery [5,10,19] having a perioperative mortality rate usually less than 1% [2,3,6,8,23,[26][27][28][29]37]. Emerging demographic and epidemiologic studies are projecting large increases in the demand for primary and revision arthroplasty over the next two decades [14][15][16].…”