Validation of reoperations due to infection in the Swedish Hip Arthroplasty Register

Abstract

BackgroundComplete or almost complete recording of reoperations is essential to enable a correct interpretation of data in arthroplasty registers. The completeness of recordings due to infection is unknown in the Swedish Hip Arthroplasty Register (SHAR). We therefore used a combination of data from the Swedish Prescribed Drug Register (SPDR) and studies of medical records to validate the data of reoperations due to infection in the SHAR.MethodsAll patients registered for a primary Total Hip Replacement (THR) in the SHAR between July 1, 2005 and December 31, 2008 were selected for the study (45,531 patients with 49,219 THRs) and were matched with the SPDR. All patients with a minimum of 4 weeks of continuous outpatient antibiotic treatment within 2 years after their primary THR (1,989 patients, with 2,219 THRs) were selected for a medical records review to find the THRs reoperated due to infection.Results599 (1.3%) of the THRs had been reoperated within 2 years after the index operation and in 47.4% of these the prosthesis had been revised or extracted. 400 of the THRs were registered for a reoperation in the SHAR resulting in a completeness of 67%.ConclusionsThe completeness of registration due to early infection after THR questions whether the SHAR reoperation data can be used in order to evaluate changes in postoperative infection rates.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-384) contains supplementary material, which is available to authorized users.

Periprosthetic Joint Infection Is the Main Cause of Failure for Modern Knee Arthroplasty: An Analysis of 11,134 Knees

“…However, such registries lack clinical and radiologic data, making accurate analysis of revision indications difficult. Additionally, some studies show registry capture of certain revision indications is poor [12,28]. In the current study, we combined local hospital data with national joint registry data to provide more-complete followup of patients who have undergone TKA during a long period and to allow accurate clinical and radiographic analyses of these indications.…”

“…National joint registries from Australia, United Kingdom, Sweden, and New Zealand all show aseptic loosening to be the most-common failure mechanism after primary TKA but capture of revision surgery resulting from infection often is poor [10,15,23,28]. Lindgren et al [12] reported a capture rate of 67% by the Swedish Hip Arthroplasty Register for reoperation resulting from PJI after THA. Zhu et al [28] reported the New Zealand Joint Registry was 63% accurate in detecting reoperations for PJI (in hip and knee arthroplasties) when compared with data from the International Classification of Diseases, 9th and 10th editions, revision codes.…”

“…There are some potential reasons for this. First, in our study, many revisions for PJI were performed in an acute setting, where different staffing may compromise reporting protocols to national registries [12]. Second, registry data sheets typically are collected at the time of revision surgery, before culture results are available, and such data sheets do not apply standardized definitions of PJI such as the MSIS criteria used in our study.…”

One-year incidence of prosthetic joint infection in total hip arthroplasty: a cohort study with linkage of the Danish Hip Arthroplasty Register and Danish Microbiology Databases

“…However, none of the national arthroplasty register studies on the incidence of PJI included data from microbiology databases. Furthermore, relying solely on national arthroplasty registers in the analysis of PJI trends may be questionable because studies have shown that these registers underestimate the incidence of PJI by up to 40% 9,10 .…”

The Role of Highly Selective Implant Retention in the Infected Hip Arthroplasty

“…Periprosthetic infection occurs in 0.22% to 3% of patients who undergo arthroplasty [3,4,8,9,15,21], and it is always devastating. Several techniques have been applied in an attempt to completely eradicate infection [14].…”