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AUSTRALIAN ORTHOPAEDIC ASSOCIATION -
NATIONAL JOINT REPLACEMENT REGISTRY
2008 ANNUAL REPORT
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Highlights of report by Patricia Walter 9/29/08
The analysis for this Report is based on 135,799 primary
total hip replacements reported to the Registry up to and
including 31st December 2007. This is an increase of 22,472
primary total hip procedures reported in the 2007 Annual
Report. In this category of hip replacement there are
125,004 conventional total hip replacements, 10,623 total
resurfacing hip replacements and 172 thrust plate hip
replacements.
Primary Total Resurfacing Hip Replacement
For the second consecutive year the number of total resurfacing hip replacements has not only declined as a proportion of all hip procedures but also in terms of the absolute number. There was no change in the number of different types of total resurfacing prostheses used in 2007compared to 2006. The 10 most frequently used total resurfacing prostheses were used in 99.7%of all procedures in 2007.
The BHR remains the most used prosthesis accounting for 54.5% of all total resurfacing procedures in 2007. The number of procedures
using this prosthesis has declined in recent years as a consequence of increased use of other total resurfacing systems. The Mitch TRH is now the second most used total resurfacing system and is one of the few that has increased in usage.
The ASR, Durom and Adept total resurfacing systems make up the top five in
2007 and have all declined in use since 2006 (Table HT10).
Gender and Age
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
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
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<0.001). At seven years
the cumulative percent revision is 4.6% for total
resurfacing hip replacement compared to 3.4% for
conventional total hip replacement (Table s HT13 and HT14 ).
Effect of Age and Gender
The cumulative percentage revision for resurfacing hip
replacement increases with increasing age (Figure HT28).
At five years the cumulative percent revision for patients
aged <55 years is 3.1%, 55-64 years is 4.1%, 65-74 years is
5.0% and ≥75 years is 9.9% (Table HT36). At five years
the cumulative percent revision for females (6.5%) is two
and half times higher than males (2.6%) (Table HT38). As
there are only a small number of total resurfacing
procedures in the older age group the Registry has combined
those aged 65 and older into one age group (≥65) to analyse
differences between age and gender. Both genders demonstrate
an increased revision rate with age. Males have a lower risk
of revision per 100 observed component years compared to
females in each of the three age groups (Table HT39). The
five year cumulative percent revision for females aged <55
years is 5.2% increasing to 9.2% for females ≥65 years.
Males <55 years of age have a five year cumulative percent
revision of 2.2% increasing to 4.7% for males ≥65 years
(Table HT40).
Effect of Fixation
No comparative data are presented for the outcome of
total resurfacing hip replacement by fixation as most
procedures use hybrid fixation. There are a number of
prostheses that utilize cementless femoral component
fixation, the outcomes of the individual resurfacing systems
are listed in Tables HT45 and HT46. The most commonly
used cementless resurfacing system is the Cormet, which has
three varieties, one of which is no longer used. The other
major cementless resurfacing system is the Bionik.
Gender
The effect of femoral component head size is evident in
both males and females. There is no significant
difference in the risk of revision between males and females
after adjusting for femoral component head size. Males and
females with a femoral component head size greater than 50mm
have a similar seven year cumulative percent revision (2.1%
and 2.0% respectively). The same is seen for males and
females with a femoral component head size less than 50mm
(seven year cumulative percent revision is 5.5% and 7.3%
respectively). The risk of revision for females with a
femoral component head size less than 50mm is significantly
higher than for females with a femoral component head size
greater than 50mm ((age adjusted) HR=3.22; 95% CI (2.47,
4.21) p<0.001). A similar situation applies to males with a
femoral component head size less than 50mm having a
significantly higher revision rate compared to males with a
femoral component head size greater than 50mm ((age
adjusted) HR=2.69; 95% CI (1.91, 3.79) p<0.001).
Total Resurfacing Hip Replacement
In the 2007 Annual Report the Registry identified
the ASR, Cormet 2000 HAP and the Durom as having a higher
than anticipated rate of revision.
The same three prostheses have been reidentified this
year. The Cormet 2000 HAP is no longer used, however the
ASR and Durom continue to be used, although the number is
declining. All three prostheses have more than twice the
risk of revision compared to all other total resurfacing
prostheses combined (Tables HT50-HT52).
Prosthesis Specific Outcomes
The three total resurfacing systems with over 1,000
observed component years are the BHR, ASR and Durom. The
number of revisions per 100 observed component years for BHR
is 0.8, for ASR is 2.6 and for Durom is 2.3. The three
year cumulative percent revision for BHR is 2.5% and for ASR
is 6.0% and for Durom is 5.8%. This year the Registry is
able to report a seven year cumulative percent revision for
the BHR (4.6%) (Table HT46).
Tables listed below:
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