Trends in hip replacements between 1999 and 2012 in Sweden

Abstract

National Registers document changes in the circumstance, practice, and outcome of surgery with the passage of time. In the context of total hip replacement (THR), registers can help elucidate the relevant factors that affect the clinical outcome. We evaluated the evolution of factors related to patient, surgical procedure, socio‐economy, and various outcome parameters after merging databases of the Swedish Hip Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare. Data on 193,253 THRs (164,113 patients) operated between 1999 and 2012 were merged. We studied the evolution of surgical volume, patient demographics, socio‐economic factors, surgical factors, length‐of‐stay, mortality rate, adverse events, re‐operation and revision rates, and Patient Reported Outcome Measures (PROMs). Throughout this time period the majority of patients were operated on with a diagnosis of primary osteoarthritis. Comorbidity indices increased each year observed. The share of all‐cemented implants has dropped from 92% to 68%. More than 88% of the bearings were metal‐on‐polyethylene. Length‐of‐stay decreased by 50%. There was a reduction in 30‐ and 90‐day mortality. Re‐operation and revision rates at 2 years are decreasing. The post‐operative PROMs improved despite the observation of worse pre‐operative pain scores getting over time. The demographics of patients receiving a THR, their comorbidities, and their primary diagnosis are changing. Notwithstanding these changes, outcomes like mortality, re‐operations, revisions, and PROMs have improved. The practice of hip arthroplasty has evolved, even in a country such as Sweden that is considered to be conservative with regard taking on new surgical practices. © 2017 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:432–442, 2018.

Declining early mortality after hip and knee arthroplasty

“…Patients presenting for surgery in more recent years may be healthier, either because patients are generally healthier than in the past, or because the selection criteria have changed over time (not operating on patients at higher risk). However, this explanation is unlikely to be true because other studies have shown that the decrease in early post‐operative mortality has occurred despite a corresponding increase in comorbidities . Explanatory treatment factors may include pre‐operative interventions (e.g.…”

“…In a study using National Joint Registry data from England and Wales, early mortality after hip and knee replacement surgery for osteoarthritis fell by nearly 50% between 2003 and 2011 . A study from Denmark showed a decrease in 30‐day mortality of greater than 50% over a 15‐year period after hip and knee replacement and research from Sweden has shown a significant decrease in 30‐ and 90‐day mortality after hip replacement for osteoarthritis between 1999 and 2012 …”

“…Previous studies have shown 30‐day mortality after hip and knee arthroplasty to be a little less than 0.5% and approximately doubling at 90 days. There is evidence that these rates have been decreasing over time . Early post‐operative mortality rates are higher than the expected mortality without surgery, based on population norms .…”

“…There is evidence that these rates have been decreasing over time. [1][2][3][4][5][6][7] Early postoperative mortality rates are higher than the expected mortality without surgery, based on population norms. 8 Despite evidence that higher than expected post-operative mortality from hip and knee arthroplasty may extend to 90 days, the increase is greatest within the first 30 days, 8,9 so the commonly used 30-day mortality may be the most appropriate measure to capture early excess mortality as it will be subject to less 'noise' caused by deaths from other causes.…”

Dental Implant Quality Register—A possible tool to further improve implant treatment and outcome

“…The Swedish hip fracture register [http:// www.rikshoft.se] started in 1988. The Swedish Hip Arthroplasty Register (SHAR) has been important to identify implants that have not performed well, consequently, they have been removed from the market (Cnudde et al, 2016(Cnudde et al, , 2017. The hip replacement registry allowed researchers to study over time specific hip prostheses, including postmarket surveillance of individual implant performance, surgical procedures, and units were associated with the fewest reoperations (Ovretveit, Nelson & James, 2016).…”