Total Hip Arthroplasty: Epidemiology and Causes

Registry (year)

Sweden (1979)

Finland (1980)

Norway (1987)

Denmark (1995)

Australia (1999)

NJR (2002)

THA primaries

267,714

206,379

190,298

149,154

437,863

992,090

THA revisions

24,447

40,649

31,515

23,430

66,467

27,605

Coverage

93%

95%

97.5%

98.8%

97%

Outcomes

Revision

Mortality

Infection

Dislocation

Periprosthetic fracture

PROMs

Readmission

Reoperation

Costs

Patients

Age

Gender

BMI

Diagnosis

Previous surgery

ASA

Charnley

Surgery

Type of hospital

Volume

Approach

Surg time

Antibiotics

Anticoagulation

Implant details

Fixation

Bearing surface

The “X” indicates which registries collected that variable

NRJ National Joint Registry of England, Wales, and Northern Ireland

Primary diagnosis affects the survivorship of THA. Development hip dysplasia, inflammatory degenerative arthritis, osteonecrosis, and femoral neck fracture show less favorable results than primary osteoarthritis (OA) [21]. Primary OA constitutes the main diagnosis in over 85% of patients who receive a total hip replacement. In OA, the age at the time of the index procedure is the key factor which predicts the lifetime risk of revision [22].

Implant selection plays a crucial role in joint survivorship. New implants have not always shown better results than existing ones. The Orthopedic Data Evaluation Panel provide records of implant survivorship at different times of follow-up, producing 3-, 5-, 7-, and 10-year revision rates. At present, it only provides revision rates pertaining to the constituent parts of the arthroplasty. The National Joint Registry of England, Wales, and Northern Ireland (NJR) found that 27% of hip implants introduced between 2003 and 2007 showed a higher revision rate than existing prostheses [23]. Registries allow the detection of suboptimal performance of new implants during the first years [19]. This monitoring helps prevent implant-related complications and aids the decision-making process when deciding which implant to use. Tables 4.2 and 4.3 summarize the best-performing cemented and uncemented hip implants.

Table 4.2

Cumulative percent of revision of primary total conventional hip replacement with cemented fixation in the NJR and AOANJRR: Revision risk (%) for implants with at least one registry reporting 10-year data

Stem-cup	Number	Registry	5 years	10 years
MS-30/low-profile Müller	3534	NJR	0.75 (0.4–1.1)	1.72 (1.1–2.6)
	721	AOANJRR	1.4 (0.7–2.7)	2.9 (1.7–4.8)
Exeter V40/contemporary	77,380	NJR	1.29 (1.2–1.3)	2.34 (2.1–2.5)
	5513	AOANJRR	3.6 (3.1–4.2)	6.3 (5.5–7.4)
Charnley/Charnley	4560	NJR	1.74 (1.3–2.1)	3.47 (2.9–4.1)
	591	AOANJRR	2.2 (1.2–3.8)	6.2 (4.4–8.8)
CPT/ZCA	14,872	NJR	2.02 (1.7–2.3)	3.62 (3.1–4.1)
	951	AOANJRR	2.8 (1.9–4.2)	5 (3.5–7.2)
Stanmore/Stanmore-Arcom	5382	NJR	1.54 (1.2–1.9)	2.42 (1.9–3)

Only data of stem-cup combinations that did not mix different manufacturers are displayed. The number of implants and revision risks at 5- and 10-year follow-up are presented

NRJ National Joint Registry of England, Wales, and Northern Ireland, AOANJRR Australian Orthopedic Association National Joint Replacement Registry

Table 4.3

Cumulative percent of revision of primary total conventional hip replacement with uncemented fixation in the NJR and AOANJRR: Revision risk (%) for implants with at least one registry reporting 10-year data

Stem-cup	Number	Registry	5 years	10 years
Taperloc/Exceed ABT	22,851	NJR	1.83 (1.6–2)	2.16 (1.9–2.4)
	2270	AOANJRR	2.4 (1.9–3.2)
Furlong/CSF	17,173	NJR	2.15 (1.9–2.3)	3.6 (3.3–3.9)
Summit/Pinnacle	4688	AOANJRR	2.3 (1.9–2.8)	3.3 (2.7–4.1)
Corail/Pinnacle	137,857	NJR	2.44 (2.3–2.5)	5.96 (5.7–6.2)
	42,405	AOANJRR	3.4 (3.2–3.6)	5.6 (5.1–6.4)
Accolade/Trident	26,073	NJR	2.61 (2.4–2.8)	4.46 (4–4.9)
	9288	AOANJRR	3.8 (3.4–4.2)	5.7 (5.2–6.2)
Synergy/Reflection	7966	AOANJRR	2.7 (2.4–3.1)	4.0 (3.6–4.5)
Alloclassic/Allofit	5791	AOANJRR	3.1 (2.7–3.6)	5.4 (4.8–6.1)
Securfit/Trident	9642	AOANJRR	3.4 (3.1–3.8)	4.6 (4.1–5.1)
SL Plus/Epifit	5402	NJR	3.78 (3.2–4.3)	5.83 (5.1–6.6)
	2300	AOANJRR	3.5 (2.8–4.3)	5.4 (4.5–6.5)

Only data of stem-cup combinations that did not mix different manufacturers are displayed. The number of implants and revision risk at 5- and 10-year follow-up are presented

NRJ National Joint Registry of England, Wales, and Northern Ireland, AOANJRR Australian Orthopedic Association National Joint Replacement Registry

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