Arthroplasty registries around the world: valuable sources of hip implant revision risk data
Purpose of Review
National and regional arthroplasty registries have proliferated since the Swedish Knee Arthroplasty Register was started in 1975. Registry reports typically present implant-specific estimates of revision risk and patient- and technique-related factors that can inform clinical decision-making about implants and techniques. However, annual registry reports are long and it is difficult for clinicians to extract comparable revision risk data. Since implants may appear in multiple registry reports, it is even more difficult to gather relevant data for clinical decision-making about implant selection. The purpose of this paper is to briefly describe arthroplasty registry concepts, international registries around the world, US registries, and provide a parsimonious summary of total hip arthroplasty (THA) implant revision risk reports across registries.
Revision risk data for conventional stem/cup combinations reported by the Australian, R.I.P.O. (Italian), Finnish, and Danish registries are summarized here. These registries were selected because they presented 10-year data on revision risk by stem/cup combination. Four tables of revision risk are presented based on fixation: cemented, uncemented, hybrid, and reverse hybrid. Review of these tables show there is wide variation in revision risk across conventional THA implants. It also demonstrates that some cemented implants have better 10-year risk than the best uncemented implants.
Many arthroplasty registries prepare annual reports that include revision risk data for implants and they are posted on the registry websites. Arthroplasty surgeons should stay current with these registry reports on implant performance and potential outliers and keep them in mind when making implant decisions.
KeywordsArthroplasty Registry Implants Revision Hip
The authors would like to thank Blue Cross and Blue Shield of Michigan and Blue Care Network for its support of this project.
Compliance with ethics guidelines
Conflict of interest
The authors report financial support for the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI). The work done that is reported in this manuscript was done as part of MARCQI, so BCBSM/BCN funds were used.
Human and animal rights and informed consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This work was done as part of the quality improvement work of MARCQI. Support for MARCQI is provided by Blue Cross and Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program.
Although Blue Cross Blue Shield of Michigan and MARCQI work collaboratively, the opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of BCBSM or any of its employees.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 6.Berry DJ, Kessler M, and Morrey BF. Maintaining a hip registry for 25 years. Mayo Clinic experience. Clin Orthop Relat R. 1997:61–68.Google Scholar
- 13.Allepuz A, Havelin L, Barber T, Sedrakyan A, Graves S, Bordini B, Hoeffel D, Cafri G, Paxton E. Effect of femoral head size on metal-on-HXLPE hip arthroplasty outcome in a combined analysis of six national and regional registries. J Bone Joint Surg Am. 2014;96(Suppl 1):12–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Bini SA, Chan PH, Inacio MC, Paxton EW, and Khatod M. Antibiotic cement was associated with half the risk of re-revision in 1,154 aseptic revision total knee arthroplasties. Acta Orthop. 2015:1–5.Google Scholar
- 15.O'Connor GT, Plume SK, Olmstead EM, Morton JR, Maloney CT, Nugent WC, Hernandez Jr F, Clough R, Leavitt BJ, Coffin LH, Marrin CA, Wennberg D, Birkmeyer JD, Charlesworth DC, Malenka DJ, Quinton HB, Kasper JF. A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. JAMA. 1996;275:841–6.CrossRefPubMedGoogle Scholar
- 19.Saleh K and Goldberg M. Joint registries and the lessons learned from MODEMS. AAOS Bulletin 2004.Google Scholar
- 23.American Joint Replacement Registry, 2014 Annual Report: Second AJRR Annual Report on Hip and Knee Arthroplasty. 2014.Google Scholar
- 24.• Kandala N-B, Connock M, Pulikottil-Jacob R, Sutcliffe P, Crowther MJ, Grove A, Mistry H, Clarke A. Setting benchmark revision rates for total hip replacement: analysis of registry evidence. Brit Med J. 2015; doi: 10.1136/bmj.h756. This paper supports the use of Kaplan-Meier estimates for up to 10 years post-surgery, which is useful for interpreting registry data that does not account for the competing risk of death. This paper also supports the move by the National Institute for Health and Care Excellence to lower their guideline from 10% to 5% at 10 years. PubMedGoogle Scholar
- 25.•• National Institute for Health and Care Excellence Total hip replacement and resurfacing arthroplasty for end-state arthritis of the hip. Technical appraisal guidance [TA304]. 2015. https://http://www.nice.org.uk/guidance/ta304. Accessed 1 December 2016. The National Institute for Health and Care Excellence guideline of 5% revision risk or lower at 10 years for THA implant revision risk is a useful benchmark for assessing implants and it a critcal part of the Orthopaedic Data Evaluation Panel (ODEP) process in the UK.
- 26.Australian Registry (2015) Australian Orthopaedic Association National Joint Replacement Registry annual report 2015. https://aoanjrr.sahmri.com/documents/10180/217745/Hip%20and%20Knee%20Arthroplasty. Accessed 18 July 2016.
- 27.National joint registry for England, Wales, Northern Ireland, and the Isle of Man (2015) National joint registry for England, Wales, Northern Ireland, and the Isle of Man 12th annual report, 2015. http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/12th%20annual%20report/NJR%20Online%20Annual%20Report%202015.pdf. Accessed 29 April 2016.
- 28.Regional register of orthopaedic implantology (2015) Report of R.I.P.O. overall data: hip, knee, and shoulder arthroplasty in Emilia-Romagna region (Italy). https://ripo.cineca.it/pdf/RIPO_REPORT_2015_english_rev1.pdf. Accessed 13 September 2016.
- 29.Finnish arthroplasty register (2016) Finnish arthroplasty register total hip and knee arthroplasty report 2015. https://www2.thl.fi/endo/report/#html/welcome. Accessed 20 September 2016.
- 30.Danish hip arthroplasty register (2016). Danish Hip Registry Annual Report 2006. http://www.dhr.dk/Ny%20mappe/rapporter/Dhr-rapport2006-UK.doc. Accessed 13 September 2016.
- 31.• de Steiger RN, Lorimer M, Solomon M. What is the learning curve for the anterior approach for Total hip arthroplasty? Clin Orthop Relat R. 2015;473:3860–6. This paper uses Australian registry data to investigate learning curve effects. It demonstrates the power of registry data, but it also highlights the importance of considering learning curve effects when interpreting registry reports of revision risk for novel technologies CrossRefGoogle Scholar