| 1. |
- Johanson, Per-Erik, et al.
(author)
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Outcome in design-specific comparisons between highly crosslinked and conventional polyethylene in total hip arthroplasty.
- 2017
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In: Acta orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 88:4, s. 363-369
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Journal article (peer-reviewed)abstract
- Background and purpose - Most registry studies regarding highly crosslinked polyethylene (XLPE) have focused on the overall revision risk. We compared the risk of cup and/or liner revision for specific cup and liner designs made of either XLPE or conventional polyethylene (CPE), regarding revision for any reason and revision due to aseptic loosening and/or osteolysis. Patients and methods - Using the Nordic Arthroplasty Register Association (NARA) database, we identified cup and liner designs where either XLPE or CPE had been used in more than 500 THAs performed for primary hip osteoarthritis. We assessed risk of revision for any reason and for aseptic loosening using Cox regression adjusted for age, sex, femoral head material and size, surgical approach, stem fixation, and presence of hydroxyapatite coating (uncemented cups). Results - The CPE version of the ZCA cup had a risk of revision for any reason similar to that of the XLPE version (p = 0.09), but showed a 6-fold higher risk of revision for aseptic loosening (p < 0.001). The CPE version of the Reflection All Poly cup had an 8-fold elevated risk of revision for any reason (p < 0.001) and a 5-fold increased risk of revision for aseptic loosening (p < 0.001). The Charnley Elite Ogee/Marathon cup and the Trilogy cup did not show such differences. Interpretation - Whether XLPE has any advantage over CPE regarding revision risk may depend on the properties of the polyethylene materials being compared, as well as the respective cup designs, fixation type, and follow-up times. Further research is needed to elucidate how cup design factors interact with polyethylene type to affect the risk of revision.
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| 2. |
- Kreipke, Rasmus, et al.
(author)
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Dual Mobility Cups : Effect on Risk of Revision of Primary Total Hip Arthroplasty Due to Osteoarthritis: A Matched Population-Based Study Using the Nordic Arthroplasty Register Association Database
- 2019
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In: The Journal of bone and joint surgery. American volume. - 1535-1386. ; 101:2, s. 169-176
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Journal article (peer-reviewed)abstract
- BACKGROUND: The dual mobility acetabular cup (DMC) was designed to reduce prosthetic instability and has gained popularity for both primary and revision total hip arthroplasty (THA). We compared the risk of revision of primary THA for primary osteoarthritis between patients treated with a DMC and those who received a metal-on-polyethylene (MoP) or ceramic-on-polyethylene (CoP) bearing. METHODS: A search of the Nordic Arthroplasty Register Association (NARA) database identified THAs performed with a DMC during 1995 to 2013. With use of propensity score matching, 2,277 of these patients were matched (1:1), with regard to sex, age, component fixation, and year of surgery, with patients with an MoP or CoP bearing. We estimated the cumulative incidence of revision taking death as a competing risk into consideration and performed competing risk regression with revision or death as end points. RESULTS: There was no difference in the overall risk of revision between the DMC group and the propensity-score-matched MoP/CoP group (adjusted hazard ratio [HR] = 1.18; 95% confidence interval [95% CI] = 0.87 to 1.62). Patients with a DMC bearing had a lower risk of revision due to dislocation (adjusted HR = 0.09; 95% CI = 0.03 to 0.29) but a higher risk of revision caused by infection (adjusted HR = 3.20; 95% CI = 1.49 to 6.85). CONCLUSIONS: There was no difference in overall risk of revision between the DMC and MoP/CoP groups. The DMCs protected against revision due to dislocation but THAs performed with this bearing were more commonly revised because of infection. There may have been a selection bias toward placing DMC implants in patients with greater frailty as the mortality rates were higher in the DMC group than in the age and sex-matched MoP/CoP group. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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| 3. |
- Robertsson, Otto, et al.
(author)
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Knee arthroplasty in Denmark, Norway and Sweden. A pilot study from the Nordic Arthroplasty Register Association
- 2010
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 81:1, s. 82-89
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Journal article (peer-reviewed)abstract
- Background and purpose The number of national arthroplasty registries is increasing. However, the methods of registration, classification, and analysis often differ. Methods We combined data from 3 Nordic knee arthroplasty registers, comparing demographics, methods, and overall results. Primary arthroplasties during the period 1997-2007 were included. Each register produced a dataset of predefined variables, after which the data were combined and descriptive and survival statistics produced. Results The incidence of knee arthroplasty increased in all 3 countries, but most in Denmark. Norway had the lowest number of procedures per hospital-less than half that of Sweden and Denmark. The preference for implant brands varied and only 3 total brands and 1 unicompartmental brand were common in all 3 countries. Use of patellar button for total knee arthroplasty was popular in Denmark (76%) but not in Norway (11%) or Sweden (14%). Uncemented or hybrid fixation of components was also more frequent in Denmark (22%) than in Norway (14%) and Sweden (2%). After total knee arthroplasty for osteoarthritis, the cumulative revision rate (CRR) was lowest in Sweden, with Denmark and Norway having a relative risk (RR) of 1.4 (95% CI: 1.3-1.6) and 1.6 (CI: 1.4-1.7) times higher. The result was similar when only including brands used in more than 200 cases in all 3 countries (AGC, Duracon, and NexGen). After unicompartmental arthroplasty for osteoarthritis, the CRR for all models was also lowest in Sweden, with Denmark and Norway having RRs of 1.7 (CI: 1.4-2.0) and 1.5 (CI: 1.3-1.8), respectively. When only the Oxford implant was analyzed, however, the CRRs were similar and the RRs were 1.2 (CI: 0.9-1.7) and 1.3 (CI: 1.0-1.7). Interpretation We found considerable differences between the 3 countries, with Sweden having a lower revision rate than Denmark and Norway. Further classification and standardization work is needed to permit more elaborate studies.
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