Improved results of primary total hip replacement

Bjørg-Tilde S Fevang, Stein A Lie, Leif I Havelin, Lars B Engesaeter, Ove Furnes, Bjørg-Tilde S Fevang, Stein A Lie, Leif I Havelin, Lars B Engesaeter, Ove Furnes

Abstract

Background and purpose: Over the past 20 years, several changes in treatment policy and treatment options have taken place regarding hip replacement. For this reason, we wanted to investigate the results after hip replacement in terms of revision rate, during a 21-year period among hip replacements reported to the Norwegian Arthroplasty Register.

Methods: 110,882 primary total hip replacements were reported to the Norwegian Arthroplasty Register from 1987 through 2007. Risk of revision during the time periods 1993-1997, 1998-2002, and 2003-2007 was compared to that of the reference period 1987-1992. Adjusted Cox regression analyses were performed to compare the risk of revision in different time periods and extended analyses were done to investigate revision within the first postoperative year and after the first year.

Results: There was an overall reduced risk of revision in the time periods 1993-1997, 1998-2002, and 2003-2007 compared to the reference period: RR = 0.81 (95% CI 0.77-0.86), 0.51 (CI 0.47-0.55), and 0.77 (CI 0.68-0.85), respectively. The improved results were due to a marked reduction in aseptic loosening of the femoral and acetabular components in all time periods and in all subgroups of prostheses. A change in the timing of revision took place, with more early revisions and fewer late revisions in the later time periods. Revision due to dislocation and infection increased over time.

Interpretation: The risk of revision decreased during the study period, due to fewer cases of aseptic loosening of prosthetic components. The best results were obtained with the use of cemented prostheses. Prevention of dislocation and infection should be a major goal in the future, as revision due to these causes increased during the study period.

Figures

Figure 1.
Figure 1.
Number of hips inserted using Simplex, Palacos, or cement types resembling Palacos (green), in 4 time periods. Blue represents other cement types.
Figure 2.
Figure 2.
Numbers of revisions for different causes, in 4 time periods.
Figure 3.
Figure 3.
Kaplan-Meier survival plots. Revision for any cause in 4 time periods. A. All prostheses. B. All cemented prostheses. C. All uncemented prostheses. D. All hybrid prostheses.
Figure 4.
Figure 4.
Kaplan-Meier survival plot. Revision for any cause. A. 1987–2007. B. 1998–2007.
Figure 5.
Figure 5.
Kaplan-Meier survival plot for cemented hip prostheses: every hospital in Norway in 2 time periods. A. 1987–1997. B. 1998–2008.

References

    1. Arthursson AJ, Furnes O, Espehaug B, Havelin LI, Soreide JA. Prosthesis survival after total hip arthroplasty—does surgical approach matter? Analysis of 19,304 Charnley and 6,002 Exeter primary total hip arthroplasties reported to the Norwegian Arthroplasty Register. Acta Orthop. 2007;78((6)):719–29.
    1. Berry DJ, von Knoch M, Schleck CD, Harmsen WS. Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg (Am) 2005;87((11)):2456–63.
    1. Bystrom S, Espehaug B, Furnes O, Havelin LI. Femoral head size is a risk factor for total hip luxation: a study of 42,987 primary hip arthroplasties from the Norwegian Arthroplasty Register. Acta Orthop Scand. 2003;74((5)):514–24.
    1. Dale H, Hallan G, Espehaug B, Havelin LI, Engesaeter LB. Increasing risk of revision due to deep infection after hip arthroplasty. Acta Orthop. 2009;80((6)):639–45.
    1. Engesaeter LB, Lie SA, Espehaug B, Furnes O, Vollset SE, Havelin LI. Antibiotic prophylaxis in total hip arthroplasty: effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of 22,170 primary hip replacements followed 0-14 years in the Norwegian Arthroplasty Register. Acta Orthop Scand. 2003;74((6)):644–51.
    1. Espehaug B, Engesaeter LB, Vollset SE, Havelin LI, Langeland N. Antibiotic prophylaxis in total hip arthroplasty. Review of 10,905 primary cemented total hip replacements reported to the Norwegian arthroplasty register, 1987 to 1995. J Bone Joint Surg (Br) 1997;79((4)):590–5.
    1. Espehaug B, Furnes O, Havelin LI, Engesaeter LB, Vollset SE. The type of cement and failure of total hip replacements. J Bone Joint Surg (Br) 2002;84((6)):832–8.
    1. Espehaug B, Furnes O, Havelin LI, Engesaeter LB, Vollset SE, Kindseth O. Registration completeness in the Norwegian Arthroplasty Register. Acta Orthop. 2006;77((1)):49–56.
    1. Espehaug B, Furnes O, Engesaeter LB, Havelin LI. 18 years of results with cemented primary hip prostheses in the Norwegian Arthroplasty Register. Acta Orthop. 2009;80((4)):402–12.
    1. Furnes O, Lie SA, Havelin LI, Vollset SE, Engesaeter LB. Exeter and charnley arthroplasties with Boneloc or high viscosity cement. Comparison of 1,127 arthroplasties followed for 5 years in the Norwegian Arthroplasty Register. Acta Orthop Scand. 1997;68((6)):515–20.
    1. Furnes O, Espehaug B, Lie SA, Vollset SE, Engesaeter LB, Havelin LI. Early failures among 7,174 primary total knee replacements: a follow-up study from the Norwegian Arthroplasty Register 1994-2000. Acta Orthop Scand. 2002;73((2)):117–29.
    1. Hallan G, Lie SA, Furnes O, Engesaeter LB, Vollset SE, Havelin LI. Medium- and long-term performance of 11,516 uncemented primary femoral stems from the Norwegian arthroplasty register. J Bone Joint Surg (Br) 2007;89((12)):1574–80.
    1. Havelin LI, Espehaug B, Vollset SE, Engesaeter LB. Early aseptic loosening of uncemented femoral components in primary total hip replacement. A review based on the Norwegian Arthroplasty Register. J Bone Joint Surg (Br) 1995a;77((1)):11–7.
    1. Havelin LI, Espehaug B, Vollset SE, Engesaeter LB. The effect of the type of cement on early revision of Charnley total hip prostheses. A review of eight thousand five hundred and seventy-nine primary arthroplasties from the Norwegian Arthroplasty Register. J Bone Joint Surg (Am) 1995b;77((10)):1543–50.
    1. Havelin LI, Vollset SE, Engesaeter LB. Revision for aseptic loosening of uncemented cups in 4,352 primary total hip prostheses. A report from the Norwegian Arthroplasty Register. Acta Orthop Scand. 1995c;66((6)):494–500.
    1. Havelin LI, Engesaeter LB, Espehaug B, Furnes O, Lie SA, Vollset SE. The Norwegian Arthroplasty Register: 11 years and 73,000 arthroplasties. Acta Orthop Scand. 2000;71((4)):337–53.
    1. Havelin LI, Espehaug B, Engesaeter LB. The performance of two hydroxyapatite-coated acetabular cups compared with Charnley cups. From the Norwegian Arthroplasty Register. J Bone Joint Surg (Br) 2002;84((6)):839–45.
    1. Herberts P, Malchau H. How outcome studies have changed total hip arthroplasty practices in Sweden. Clin Orthop. 1997;((344)):44–60.
    1. Herberts P, Malchau H. Long-term registration has improved the quality of hip replacement: a review of the Swedish THR Register comparing 160,000 cases. Acta Orthop Scand. 2000;71((2)):111–21.
    1. Ingvarsson T, Hagglund G, Jonsson H, Jr., Lohmander LS. Incidence of total hip replacement for primary osteoarthrosis in Iceland 1982-1996. Acta Orthop Scand. 1999;70((3)):229–33.
    1. Kavanagh BF, Dewitz MA, Ilstrup DM, Stauffer RN, Coventry MB. Charnley total hip arthroplasty with cement. Fifteen-year results. J Bone Joint Surg (Am) 1989;71((10)):1496–503.
    1. Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg (Am) 2005;87((7)):1487–97.
    1. Kurtz SM, Ong KL, Schmier J, Mowat F, Saleh K, Dybvik E, et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg (Am) (Suppl 3) 2007;89:144–51.
    1. Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty. 2008;23((7)):984–91.
    1. Liu SS, Gonzalez Della Valle A, Besculides MC, Gaber LK, Memtsoudis SG. Trends in mortality, complications, and demographics for primary hip arthroplasty in the United States. Int Orthop. 2008;33((3)):643–51.
    1. Pedersen AB, Johnsen SP, Overgaard S, Soballe K, Sorensen HT, Lucht U. Total hip arthroplasty in Denmark: incidence of primary operations and revisions during 1996-2002 and estimated future demands. Acta Orthop. 2005;76((2)):182–9.
    1. Phillips JE, Crane TP, Noy M, Elliott TS, Grimer RJ. The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg (Br) 2006;88((7)):943–8.
    1. Schulte KR, Callaghan JJ, Kelley SS, Johnston RC. The outcome of Charnley total hip arthroplasty with cement after a minimum twenty-year follow-up. The results of one surgeon. J Bone Joint Surg (Am) 1993;75((7)):961–75.
    1. Wells VM, Hearn TC, McCaul KA, Anderton SM, Wigg AE, Graves SE. Changing incidence of primary total hip arthroplasty and total knee arthroplasty for primary osteoarthritis. J Arthroplasty. 2002;17((3)):267–73.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa