Hip and Knee Arthroplasty - Surface Hippy Guide to Hip Resurfacing

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PRIMARY TOTAL KNEE REPLACEMENT This report is based on the analysis of 164,764 primary total knee replacements recorded in the Registry up to and including 31 st December 2007. This is an additional 29,965 primary total knee replacements compared to the 2007 Annual Report. Analysis of Knee Replacement Systems versus Individual Prosthesis Design As explained in last year’s report the Registry is able to present data on the different types of knee prostheses. Different knee prostheses however are generally available as part of a knee system. The systems may contain many alternative prostheses which may vary in design depending on numerous features including the method of fixation, stability, mobility, flexion capacity and the materials used, amongst others. Although possible, subdividing the prostheses based on each different design presents complexities and difficulties in providing a coherent presentation of the data. The Registry addresses this issue by providing information on all knee systems and then subdividing by fixation. Additionally, it provides analysis related to different design features which different individual knee systems have in common. Finally, analysis of the revision rates of individual prostheses looks at the catalogue ranges within a system in an attempt to highlight differences specific to a particular design within a system. Usage Primary total knee replacement is the most frequently used primary knee procedure. It has increased from 77.2% in 2003 to 82.0% of all knee procedures in 2007. There has been an increase in the proportion of total knee replacements in all states since 2003 except for Tasmania where there has been a decrease from 82.0% in 2003 to 79.4% in 2007 (Figure KG3). This year there is a difference in the way prostheses have been categorised to determine the most frequently used prostheses. The major difference has been an increase in the division of systems into the different prosthesis types. The most apparent impact on this table relates to the reporting of the Genesis II. In previous years the Genesis II included both cobalt chrome and oxinium femoral components in the one group. As a consequence it was reported as the most frequently used prosthesis in last year’s report. These two Genesis II prostheses are now considered separately which has resulted in an apparent difference in use compared to what was previously reported. This change has however been applied to the analysis of use across all years since the Registry commenced data collection and the use of both the cobalt chrome and oxinium femoral components can now be seen for each of the years reported. In 2007 the Nexgen total knee was the most used prosthesis and accounts for 13.5% of all primary total knee procedures during that year. The LCS, previously the most used prosthesis since the Registry commenced data collection, is used in 12.8% of procedures. The top five prostheses account for 55.1% of all primary total knee procedures, and the top ten prostheses account for 82.7% of all procedures in 2007 (Table KT1 and Figure KT1). There are 51 different knee systems recorded in the Registry for 2007, compared to 52 in 2006. Cemented systems have declined from 48 to 47 prostheses, hybrid systems have increased from 35 to 36 prostheses, and cementless systems have remained unaltered at 26 systems for 2007 (Tables KT1-KT4 and Figures KT1-KT4). Changes in use with Gender and Age Females continue to undergo primary total knee replacement more commonly (57.5% in 2007) than males. There has been little change in the proportion of males and females undergoing primary total knee replacement in the last five years (Table KT5). Almost 90% of primary total knee replacements are performed on individuals aged between 55 and 84 years (Table KT6). There has been little change in the proportion of individuals in the different age groups during the last five years. In particular, there is no evidence to suggest that there has been increased use of primary total knee replacement in younger patients. Fixation Cementing of one or both the femoral and tibial components continues to be the most common method of fixation (76.3%). Hybrid fixation is almost always cement fixation of the tibial component (24.9%) and only occasionally the femoral component (1.2%) (Table KT7). Nationally the use of cement fixation for both the tibial and femoral component has continued to increase. It now accounts for 54.2% of all primary total knee procedures. There has been no change in the use of cementless fixation during 2007 (23.3% of all primary total knee procedures). Hybrid fixation continues to 136
decrease in use and now accounts for 22.5% of all procedures. There is some state and territory variation in the approach to fixation. Queensland has a higher rate of cement fixation compared to all other states (77.6%) while in Tasmania cementless fixation is the most common approach (82.4%) (Figure KT5). Use of Patellar Resurfacing Just over half of primary total knee procedures in 2007 did not have the patella resurfaced. There has however been a small increase in the use of patellar resurfacing over the last two years, increasing from 41.5% in 2005 to 45.4% in 2007. There continues to be state and territory variation in the use of patellar resurfacing. In South Australia and Tasmania there was no patellar resurfacing in 83.3% of procedures. In NSW and Victoria patellar resurfacing is undertaken in the majority of procedures (53.5% and 53.0% respectively). When resurfacing the patella almost all patella prostheses are cemented (93.3%) (Table KT7 and Figure KT6). Outcomes of Primary Total Knee Replacement Effect of Age and Gender The risk of revision in primary total knee replacement significantly decreases with increasing age. The Registry has compared four different age groups (
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Hip and Knee Arthroplasty ANNUAL RE
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Australian Orthopaedic Association
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PRIMARY PARTIAL KNEE REPLACEMENT...
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PRIMARY TOTAL HIP REPLACEMENT......
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PRIMARY TOTAL KNEE REPLACEMENT ....
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viii
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RIMARY TOTAL RESURFACING HIP REPLAC
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EXECUTIVE SUMMARY This executive su
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INTRODUCTION This is the eighth Ann
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supply aggregate data and negotiati
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PARTICIPATING HOSPITALS & COORDINAT
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VICTORIA PUBLIC HOSPITALS Austin He
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QUEENSLAND PUBLIC HOSPITALS Bundabe
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WESTERN AUSTRALIA PUBLIC HOSPITALS
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HIP REPLACEMENT GENERAL INTRODUCTIO
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difference is also evident when com
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Table HG2: Number of Hip Replacemen
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Table HG4: Primary Hip Replacement
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Table HG8: Primary Total Resurfacin
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The use of monoblock prostheses in
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PRIMARY PARTIAL HIP REPLACEMENT 1/9
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Table HP2: 10 Most Common Unipolar
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Table HP4: 10 Most Common Bipolar H
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Table HP6: Primary Partial Hip Repl
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Table HP14: Primary Partial Hip Rep
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Table HP15: Primary Unipolar Monobl
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Table HP19: Primary Bipolar Hip Rep
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Table HP24: Primary Unipolar Monobl
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Table HP32: Primary Unipolar Modula
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Primary Unipolar Modular Hip Replac
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Primary Bipolar Hip Replacement Pro
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PRIMARY TOTAL HIP REPLACEMENT The a
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Effect of Bearing Surface For the f
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since 2004. The three total resurfa
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combination has been used in 1,649
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Table HT2: Primary Conventional Tot
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Table HT6: 10 Most Common Femoral C
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Table HT8: 10 Most Common Femoral C
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Table HT10: 10 Most Common Acetabul
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Table HT12: 10 Most Common Primary
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Primary Conventional Total Hip Repl
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Table HT19: Primary Conventional To
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Figure HT18: Cumulative Percent Rev
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Page 101 and 102: Table HT31: Primary Conventional To
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Page 105 and 106: Primary Total Resurfacing Hip Repla
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Page 115 and 116: Figure HT34-43: Cumulative Percent
Page 117 and 118: Primary Total Resurfacing Hip Repla
Page 119 and 120: REVISION HIP REPLACEMENT This repor
Page 121 and 122: REVISION HIP REPLACEMENT 1/9/1999 -
Page 123 and 124: ‘Revision of Known Primary’ Hip
Page 125 and 126: Table HR10: Outcomes of ‘Revision
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Page 129 and 130: Table KG2: Number of Knee Replaceme
Page 131 and 132: Table KG4: Primary Knee Replacement
Page 133 and 134: PRIMARY PARTIAL KNEE REPLACEMENT Th
Page 135 and 136: Effect of Age and Gender The risk o
Page 137 and 138: Primary Partial Resurfacing Knee Re
Page 139 and 140: Table KP6: Primary Patella/Trochlea
Page 141 and 142: Table KP12: Primary Unicompartmenta
Page 149 and 150: Primary Patella/Trochlear Knee Repl
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Page 157 and 158: Table KT2: 10 Most Common Femoral C
Page 159 and 160: Table KT4: 10 Most Common Femoral C
Page 161 and 162: Figure KT5: Trends in Prosthesis Fi
Page 163 and 164: Table KT10: Primary Total Knee Repl
Page 165 and 166: Figure KT10: Primary Total Knee Rep
Page 171 and 172: Table KT23: Yearly Cumulative Perce
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Page 189 and 190: Figure KR1: Trends in Usage for Rev
Page 191 and 192: ‘Revision of Known Primary’ Kne
Page 193 and 194: Table KR10: Outcome of ‘Revision
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Page 197 and 198: CEMENT IN HIP AND KNEE REPLACEMENT
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Table C7: Yearly Cumulative Percent
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Table C11: Yearly Cumulative Percen
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MORTALITY FOLLOWING PRIMARY HIP AND
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Table M5: Mortality following Prima
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Appendices APPENDIX 1 Glossary of S
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APPENDIX 2 Patient Consent and Conf
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INTRODUCTION - about the Registry A
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APPENDIX 5 ICD-10-AM Codes PRIMARY
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Hip and Knee Arthroplasty - Surface Hippy Guide to Hip Resurfacing

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