Hip and Knee Arthroplasty - Surface Hippy Guide to Hip Resurfacing

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and 79.7% for thrust plate). Over one quarter of revision procedures are undertaken on individuals less than 65 years of age (26.5%) (Table HG2). There has been little change in the proportion of younger individuals (less than 65 years) receiving the different categories of primary hip replacement during the last five years (Figure HG2). Diagnosis The diagnosis for almost all primary partial hips is fractured neck of femur (94.0%). Osteoarthritis is the major reason for most primary conventional total hip replacements (88.3%) and total resurfacing replacements (94.0%). The principal cause for revision of hip replacement is aseptic loosening (45.7%). The reason for revision of primary procedures recorded by the Registry is different when compared to the reason for revision of all revision procedures. This is because early to mid term revisions are compared to all revision procedures recorded by the Registry, many of which have been undertaken on procedures performed prior to the Registry collecting data. These differences are also dependent on the class of prostheses used for the primary procedure. Dislocation (31.5%) is the most common reason for revision of known primary conventional total hip replacements. Fractured neck of femur (41.1%) is the most common reason for revision of total resurfacing hip replacement. Use of different Categories of Hip Replacement The most common hip procedure is a primary total hip (70.8% of all hip replacement procedures). Primary partial hip replacement accounts for 16.7% and revisions 12.4% of all hip procedures (Table HG1). During the last five years, the proportion of primary total hip replacement has increased from 70.1% (2003) to 72.5% (2007). The proportion of primary partial hips has declined from 17.0% (2003) to 16.1% (2007). Revision procedures have also declined as a proportion of all hip replacements from 13.0% (2003) to 11.4% (2007). It is important to appreciate that the change in the proportion of revision procedures is not necessarily indicative of a reduction in the rate of revision. It is a measure of the number of revision procedures as a percentage of all hip replacement procedures and therefore is affected by the number of other types of hip replacements undertaken. State and Territory Variation in Use There is variation in the number of hip replacement by state in most categories. In 2007, South Australia had the highest percentage of partial hip replacement (18.2%) and ACT/NT the lowest (12.5%). In 2007 the ACT/NT had the highest percentage of primary total hip replacement (75.3%) and Queensland the lowest (69.8%) (Figure HG3). The percentage of revision procedures also varies with Queensland having the highest percentage (12.7%) and South Australia the lowest (9.1%) in 2007 (Figure HG3). Queensland and WA were the only states that had an increase in the percentage of revision procedures from 2006 to 2007 ,however the percentage of revisions in WA remains low compared to most other states (11.7%) for 2007 (Figure HG3). Bilateral Primary Hip Replacement For the purpose of this report, the definition of a bilateral primary procedure is when an individual has undergone hip replacement in both hips regardless of the type of primary hip replacement and the timing of the second primary hip procedure. Bilateral hip replacement is not uncommon with 12.5% of patients having bilateral hip replacement within five years. The Registry has recorded 16,122 individuals having undergone bilateral primary hip replacement. The most common type of bilateral primary hip replacement is bilateral primary conventional total hip (83.4% of all bilateral procedures) followed by bilateral primary total resurfacing hip replacement (7.9%) (Table HG3). Same day bilateral procedures are much less common in hip replacement compared to knee replacement and account for 5.4% of all bilateral hip procedures recorded by the Registry. Of those individuals who have had bilateral primary conventional total hip replacement, 4.6% were undertaken on the same day. Same day bilateral total resurfacing accounts for 18.2% of all bilateral total resurfacings (Table HG3). General Comparison of Outcomes The main outcome of the Registry is the time to first revision of a primary hip replacement. The outcomes of procedures are measured in two ways; using the number of revisions per 100 observed component years and using the cumulative percent revision at specified time points (see Appendix 1 for the full definition). Primary conventional total hip replacement has the lowest revision rate compared to total resurfacing and partial hip replacement (0.8, 1.0 and 1.5 respectively) (Table HG4). This 16
difference is also evident when comparing the seven year cumulative percent revision for each of these procedures (4.2%, 5.4% and 5.9% respectively) (Table HG5). Thrust plate procedures, because they are quite different in design from the other types of primary hip replacement, are considered separately. Only a small number (172) of these procedures have been recorded by the Registry. The number of revisions per 100 observed component years for this procedure is 0.6 and the cumulative percent revision at 7 years is 3.0% (Tables HG4 and HG5). Outcome by Primary Diagnosis This year the Registry is presenting outcomes stratified by primary diagnosis for the first time. These analyses are presented for primary conventional and resurfacing total hip replacement only. These procedure types have been selected as enough procedures have been undertaken with a variety of different diagnoses. Primary partial hips have not been included because almost all of these have been undertaken for fractured neck of femur. The Registry has classified 11 different primary diagnoses for primary conventional total hip replacement (Tables HG6 and HG7 and Figure HG4). The outcomes of the five most common diagnoses were compared using osteoarthritis (OA) as the comparator diagnosis. Fractured neck of femur, avascular necrosis (AVN) and rheumatoid arthritis all have a significantly higher risk of revision compared to those undertaken for OA. There is no significant difference between OA and developmental dysplasia of the hip (DDH) for conventional primary total hip replacement. Three diagnoses were compared for primary resurfacing hip replacement (Tables HG8 and HG9 and Figure HG5). Both AVN and DDH have a significantly higher risk of revision compared to resurfacing procedures undertaken for OA. The five year cumulative percent revision for DDH is four times greater when a total resurfacing procedure is used compared to a primary conventional total hip replacement (12.0% compared to 3.0%). 17
Page 1 and 2: Hip and Knee Arthroplasty ANNUAL RE
Page 3: Australian Orthopaedic Association
Page 6 and 7: PRIMARY PARTIAL KNEE REPLACEMENT...
Page 8 and 9: PRIMARY TOTAL HIP REPLACEMENT......
Page 10 and 11: PRIMARY TOTAL KNEE REPLACEMENT ....
Page 12 and 13: viii
Page 14 and 15: RIMARY TOTAL RESURFACING HIP REPLAC
Page 17 and 18: EXECUTIVE SUMMARY This executive su
Page 19 and 20: INTRODUCTION This is the eighth Ann
Page 21 and 22: supply aggregate data and negotiati
Page 23 and 24: PARTICIPATING HOSPITALS & COORDINAT
Page 25 and 26: VICTORIA PUBLIC HOSPITALS Austin He
Page 27 and 28: QUEENSLAND PUBLIC HOSPITALS Bundabe
Page 29 and 30: WESTERN AUSTRALIA PUBLIC HOSPITALS
Page 31: HIP REPLACEMENT GENERAL INTRODUCTIO
Page 35 and 36: Table HG2: Number of Hip Replacemen
Page 37 and 38: Table HG4: Primary Hip Replacement
Page 39 and 40: Table HG8: Primary Total Resurfacin
Page 41 and 42: The use of monoblock prostheses in
Page 43 and 44: PRIMARY PARTIAL HIP REPLACEMENT 1/9
Page 45 and 46: Table HP2: 10 Most Common Unipolar
Page 47 and 48: Table HP4: 10 Most Common Bipolar H
Page 49 and 50: Table HP6: Primary Partial Hip Repl
Page 51 and 52: Table HP14: Primary Partial Hip Rep
Page 53 and 54: Table HP15: Primary Unipolar Monobl
Page 55 and 56: Table HP19: Primary Bipolar Hip Rep
Page 57 and 58: Table HP24: Primary Unipolar Monobl
Page 61 and 62: Table HP32: Primary Unipolar Modula
Page 65 and 66: Primary Unipolar Modular Hip Replac
Page 67 and 68: Primary Bipolar Hip Replacement Pro
Page 69 and 70: PRIMARY TOTAL HIP REPLACEMENT The a
Page 71 and 72: Effect of Bearing Surface For the f
Page 73 and 74: since 2004. The three total resurfa
Page 75 and 76: combination has been used in 1,649
Page 77 and 78: Table HT2: Primary Conventional Tot
Page 79 and 80: Table HT6: 10 Most Common Femoral C
Page 81 and 82: Table HT8: 10 Most Common Femoral C
Page 83 and 84:
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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Primary Total Resurfacing Hip Repla
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Table HT39: Primary Total Resurfaci
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Table HT48: Yearly Cumulative Perce
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Figure HT34-43: Cumulative Percent
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Primary Total Resurfacing Hip Repla
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REVISION HIP REPLACEMENT This repor
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REVISION HIP REPLACEMENT 1/9/1999 -
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‘Revision of Known Primary’ Hip
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Table HR10: Outcomes of ‘Revision
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knee increased from 29.4% in 2003 t
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Table KG2: Number of Knee Replaceme
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Table KG4: Primary Knee Replacement
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PRIMARY PARTIAL KNEE REPLACEMENT Th
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Effect of Age and Gender The risk o
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Primary Partial Resurfacing Knee Re
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Table KP6: Primary Patella/Trochlea
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Table KP12: Primary Unicompartmenta
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Primary Patella/Trochlear Knee Repl
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Figure KP11-14: Cumulative Percent
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decrease in use and now accounts fo
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as having a higher than anticipated
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Table KT2: 10 Most Common Femoral C
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Table KT4: 10 Most Common Femoral C
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Figure KT5: Trends in Prosthesis Fi
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Table KT10: Primary Total Knee Repl
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Figure KT10: Primary Total Knee Rep
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Table KT23: Yearly Cumulative Perce
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Table KT30: Primary Unicompartmenta
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Figure KT24-KT33: Cumulative Percen
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REVISION KNEE REPLACEMENT This repo
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p
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Figure KR1: Trends in Usage for Rev
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‘Revision of Known Primary’ Kne
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Table KR10: Outcome of ‘Revision
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Table KR14: Outcome of ‘Revision
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CEMENT IN HIP AND KNEE REPLACEMENT
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CEMENT IN HIP AND KNEE REPLACEMENT
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Table C3: Top 10 Cements used in Re
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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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