Hip and Knee Arthroplasty - Surface Hippy Guide to Hip Resurfacing

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ASR, Durom and Adept total resurfacing systems make up the top five in 2007 and have all declined in use since 2006 (Table HT12 and Figure HT10). Changes in use with Gender and Age There are differences in gender and age between primary conventional and total resurfacing hip replacements. In 2007 primary conventional total hip replacement was more common in females (55.6%) than males (44.4%). Most primary conventional total hip replacements are undertaken on individuals 65 years or older (64.6% in 2007) (Tables HT2 and HT4). The use of primary total resurfacing procedures in females declined from 28.8% of all total resurfacing procedures in 2003 to 23.6% in 2007 (Table HT3). Most total resurfacing procedures are undertaken in patients less than 65 years of age (91.9% in 2007) (Table H5). Fixation There continues to be variation in the use of cementless, hybrid and cemented conventional primary total hip replacements by state/territory. In recent years there has been a trend towards increasing use of cementless hip prostheses but this trend has slowed in 2007 (Figure HT2). In 2007, 95.1% of total resurfacing procedures used hybrid fixation, this has declined from 97.5% in 2003. Cementless fixation, although uncommon has increased from 2.3% to 4.7% over the same period. Cement fixation is rarely used and accounted for only 0.2% of primary total resurfacing procedures in 2007 (Figure HT3). Outcome of Primary Total Hip Replacement Total resurfacing hip replacement has a significantly higher revision rate compared to conventional total hip replacement (hazard ratio (adjusted for sex and age) (Adj HR)= 1.42; 95% CI (1.24, 1.63) p
Effect of Bearing Surface For the first time the Registry is reporting the effect of bearing surface on the early to mid term outcomes of primary conventional total hip replacement. The Registry would advise caution in the interpretation of these initial analyses. The relationship between bearing surface and other factors known to be important to the outcome of joint replacement is complex. The current period of follow up is short and the Registry is yet to examine many of these factors. The Registry has classified bearing surface into four categories; ceramic on polyethylene, ceramic on ceramic, metal on polyethylene and metal on metal. There is a fifth category that relates to a small number of procedures where the bearing surface is yet to be classified by the Registry. This type of generic analysis is dependent on the Registry being able to define the required feature (attribute) of each individual prosthesis. The Registry is working to classify the remaining prostheses to complete this process, however it is labour intensive and takes time, particularly for those prostheses that are no longer used. As the majority of prostheses have been classified and the outcome of the unclassified group does not vary considerably from the defined categories, it was decided to present these initial analyses rather than wait until classification has been completed. The bearing surface with the highest seven year cumulative percent revision is metal on metal (4.4%), followed by ceramic on polyethylene (3.5%), metal on polyethylene (3.3%) and ceramic on ceramic (3.1%). After adjusting for age and gender metal on polyethylene bearing surface has a significantly lower risk of revision compared to the other three bearing surfaces (Tables HT25 and HT26 and Figure HT21). Bearing surfaces have differences in the risk of revision depending on head size. For femoral component head size less than or equal to 28mm, metal on polyethylene has the lowest cumulative percent revision at seven years (3.4%). Compared to metal on polyethylene, ceramic on polyethylene and ceramic on ceramic have a significantly higher risk of revision, however metal on metal is not significantly different (Tables HT27 and HT28 and Figure HT22). For femoral component head sizes greater than 28mm, metal on polyethylene and ceramic on polyethylene have the lowest cumulative percent revision at three years (1.4% and 1.3% respectively). Metal on metal has a significantly higher revision rate compared to the other three bearing surfaces. Ceramic on ceramic has a significantly higher revision rate compared to metal on polyethylene and ceramic on polyethylene (Tables HT27 and HT28 and Figure HT23). The Registry has also compared revision rates by femoral component head size for each bearing surface. Femoral components greater than 28mm have significantly lower revision rates compared to femoral components less than or equal to 28mm for all bearing surfaces with the exception of metal on metal. For metal/metal bearing surfaces there is no significant difference in the rate of revision between femoral component head sizes (Figures HT24-HT27). Prosthesis Specific Outcomes The outcomes of the most commonly used stem and acetabular combinations for primary conventional total hip replacement are listed in Tables HT29-HT34. There are two tables for cemented, cementless and hybrid (femoral cemented) prosthesis combinations with over 300 procedures. The first table provides information on the number of procedures, the number of revisions and the revisions per 100 observed component years. The second table provides the yearly cumulative percent revision. It is not possible or meaningful to present the outcomes of all recorded combinations as many combinations involve small numbers of procedures. There are 1,249 combinations for primary conventional total hip replacement recorded by the Registry (128 more combinations than recorded last year). Of these, 69 stem and acetabular combinations have over 300 procedures reported. Although the listed combinations are only a small proportion of the possible combinations, they represent 77.9% of all primary conventional total hip replacements. These tables allow comparison of outcomes for the most commonly used combinations by Australian surgeons. It is worthwhile noting that the group ‘other’ is the combined outcome of all prosthesis combinations with less than 300 procedures. There are 11 primary conventional total hip stem/acetabular combinations with greater than 300 procedures using cement fixation. All have over 1,000 observed component years and the number of revisions per 100 observed component years varies from 0.1 to 0.9 (Table HT29). Of those with a seven year cumulative percent revision the least revised combinations are the MS 30/Low Profile Cup (0.8%), the Exeter/Exeter (3.0%) and the Spectron EF/Reflection (3.0%) (Table HT30). Regardless of fixation, the MS 30/Low Profile cup has the lowest seven year 55
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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
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 and 32: HIP REPLACEMENT GENERAL INTRODUCTIO
Page 33 and 34: difference is also evident when com
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: PRIMARY TOTAL HIP REPLACEMENT The a
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
Page 85 and 86: Table HT12: 10 Most Common Primary
Page 87 and 88: Primary Conventional Total Hip Repl
Page 89 and 90: Table HT19: Primary Conventional To
Page 93 and 94: Figure HT18: Cumulative Percent Rev
Page 105 and 106: Primary Total Resurfacing Hip Repla
Page 107 and 108: Table HT39: Primary Total Resurfaci
Page 113 and 114: Table HT48: Yearly Cumulative Perce
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
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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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