Knee arthroplasty in Denmark, Norway and Sweden

Abstract

Background and purposeThe number of national arthroplasty registries is increasing. However, the methods of registration, classification, and analysis often differ.MethodsWe 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.ResultsThe 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).InterpretationWe 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.

Racial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national medicare data

“…In the UK, rates of THA doubled and TKA trebled from 1991 to 2006 3. Similar upward trends have been reported in registries from Denmark, Sweden and Norway 4. In the USA, 670 000 TKA and 427 000 THA procedures were performed in 2009 5.…”

Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview

“…In 2009 over a million of THA and TKA were carried out in the United States [1]. Osteoarthritis (OA) is the main clinical indication for which these procedures are performed [2]. Due to the ageing society as well as the obesity epidemic, the prevalence of OA is increasing [3].…”

Revision Surgery for Patellofemoral Problems: Should We Always Resurface?

“…A 2009 poll of American Association of Hip and Knee Surgeons found 76% of members resurface ''virtually all'' of their TKA cases, 16% resurface more than 90% of the time, and only 5% resurface fewer than 10% of their TKA cases [2]. While North American surgeons traditionally resurface the patella, the same is not true elsewhere; the registries of Norway and Sweden indicate resurfacing occurs less than 11% and 14% of the time, respectively [25]; the Australian registry notes a rate of 43% [10]; and Denmark's registry records a 76% rate of resurfacing in primary knee arthroplasty [25]. Thus, there does not appear to be agreement on whether to routinely resurface the patella and whether resurfacing or not results in better implant survival.…”