36 results on '"Graves, Stephen E."'
Search Results
2. The effect of patient and prosthesis factors on revision rates after total knee replacement using a multi-registry meta-analytic approach
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Lewis, Peter L, primary, W-Dahl, Annette, additional, Robertsson, Otto, additional, Lorimer, Michelle, additional, Prentice, Heather A, additional, Graves, Stephen E, additional, and Paxton, Elizabeth W, additional
- Published
- 2022
- Full Text
- View/download PDF
3. International variation in distribution of ASA class in patients undergoing total hip arthroplasty and its influence on mortality: data from an international consortium of arthroplasty registries
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Silman, Alan J, primary, Combescure, Christophe, additional, Ferguson, Rory J, additional, Graves, Stephen E, additional, Paxton, Elizabeth W, additional, Frampton, Chris, additional, Furnes, Ove, additional, Fenstad, Anne Marie, additional, Hooper, Gary, additional, Garland, Anne, additional, Spekenbrink-Spooren, Anneke, additional, Wilkinson, J Mark, additional, Mäkelä, Keijo, additional, Lübbeke, Anne, additional, and Rolfson, Ola, additional
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- 2021
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4. The rate of 2nd revision for shoulder arthroplasty as analyzed by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR)
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Gill, David R J, primary, Page, Richard S, additional, Graves, Stephen E, additional, Rainbird, Sophia, additional, and Hatton, Alesha, additional
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- 2021
- Full Text
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5. The effect of surgeon’s preference for hybrid or cemented fixation on the long-term survivorship of total knee replacement
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Vertullo, Christopher J, Graves, Stephen E, Peng, Yi, and Lewis, Peter L
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Male ,Reoperation ,Australia ,Kaplan-Meier Estimate ,Middle Aged ,Prosthesis Design ,Prosthesis Failure ,Cohort Studies ,surgical procedures, operative ,Polyethylene ,Humans ,Knee ,Female ,Registries ,Practice Patterns, Physicians' ,Arthroplasty, Replacement, Knee ,Knee Prosthesis ,Cementation ,Aged - Abstract
Background and purpose — Recent direct comparative reports suggest that hybrid fixation may have a similar or superior outcome to cemented fixation in total knee replacement (TKR); however, a paucity of long-term data exists. To minimize the confounders of a direct comparison, we performed an instrumental variable analysis examining the revision rate of 2 cohorts of patients based on their surgeon’s preference for cemented or hybrid fixation. Methods — Registry data were obtained from 1999 until 2015 for 2 cohorts of patients who received minimally stabilized TKR, defined as those treated by high-volume hybrid fixation preferring surgeons, designated routinely hybrid (RH), and those treated by high-volume cemented fixation preferring surgeons, designated routinely cemented (RC). Results — At 13 years, the cumulative percentage revision of the RC cohort was 4.8% (CI 4.1–5.7) compared with 5.5% (CI 3.5–8.7) for the RH cohort. The revision risk for each cohort was the same for all causes (HR =1.0 (CI (0.84–1.20)), non-infective causes, and for infection. This finding was irrespective of patient age or sex, patella resurfacing, and with non-cross-linked polyethylene (NXLPE). The RH cohort who received cross-linked polyethylene (XLPE) had a lower revision risk than the RC cohort with XLPE (HR =0.57 (0.37–0.88), p = 0.01). Interpretation — The risk of revision for the patients of surgeons who prefer cemented fixation in minimally stabilized TKR is the same as for the patients of surgeons who prefer hybrid fixation, except when used with XLPE, where hybrid fixation has a lower revision risk.
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- 2018
6. Increases in the rates of primary and revision knee replacement are reducing: a 15-year registry study across 3 continents
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Lewis, Peter L, primary, Graves, Stephen E, additional, Robertsson, Otto, additional, Sundberg, Martin, additional, Paxton, Elizabeth W, additional, Prentice, Heather A, additional, and W-Dahl, Annette, additional
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- 2020
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- View/download PDF
7. Heart failure after conventional metal-on-metal hip replacements
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Gillam, Marianne H, Pratt, Nicole L, Inacio, Maria C S, Roughead, Elizabeth E, Shakib, Sepehr, Nicholls, Stephen J, and Graves, Stephen E
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musculoskeletal diseases ,Aged, 80 and over ,Heart Failure ,Male ,Hip ,Arthroplasty, Replacement, Hip ,Incidence ,Australia ,Prosthesis Design ,Prosthesis Failure ,Survival Rate ,Metal-on-Metal Joint Prostheses ,Humans ,Female ,Hip Prosthesis ,Registries ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
Background and purpose — It is unclear whether metal particles and ions produced by mechanical wear and corrosion of hip prostheses with metal-on-metal (MoM) bearings have systemic adverse effects on health. We compared the risk of heart failure in patients with conventional MoM total hip arthroplasty (THA) and in those with metal-on-polyethylene (MoP) THA. Patients and methods — We conducted a retrospective cohort study using data from the Australian Government Department of Veterans’ Affairs health claims database on patients who received conventional THA for osteoarthritis between 2004 and 2012. The MoM THAs were classified into groups: Articular Surface Replacement (ASR) XL Acetabular System, other large-head (LH) (> 32 mm) MoM, and small-head (SH) (≤ 32 mm) MoM. The primary outcome was hospitalization for heart failure after THA. Results — 4,019 patients with no history of heart failure were included (56% women). Men with an ASR XL THA had a higher rate of hospitalization for heart failure than men with MoP THA (hazard ratio (HR) = 3.2, 95% CI: 1.6–6.5). No statistically significant difference in the rate of heart failure was found with the other LH MoM or SH MoM compared to MoP in men. There was no statistically significant difference in heart failure rate between exposure groups in women. Interpretation — An association between ASR XL and hospitalization for heart failure was found in men. While causality between ASR XL and heart failure could not be established in this study, it highlights an urgent need for further studies to investigate the possibility of systemic effects associated with MoM THA.
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- 2016
8. An international comparison of THA patients, implants, techniques, and survivorship in Sweden, Australia, and the United States
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Paxton, Elizabeth W, primary, Cafri, Guy, additional, Nemes, Szilard, additional, Lorimer, Michelle, additional, Kärrholm, Johan, additional, Malchau, Henrik, additional, Graves, Stephen E, additional, Namba, Robert S, additional, and Rolfson, Ola, additional
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- 2019
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9. Lower prosthesis-specific 10-year revision rate with crosslinked than with non-crosslinked polyethylene in primary total knee arthroplasty
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de Steiger, Richard N, Muratoglu, Orhun, Lorimer, Michelle, Cuthbert, Alana R, and Graves, Stephen E
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musculoskeletal diseases ,Male ,Reoperation ,Time Factors ,technology, industry, and agriculture ,Age Factors ,Australia ,macromolecular substances ,Articles ,Middle Aged ,Osteoarthritis, Knee ,Prosthesis Failure ,Polyethylene ,Humans ,Female ,Registries ,Arthroplasty, Replacement, Knee ,Knee Prosthesis ,Aged - Abstract
Background and purpose — While highly crosslinked polyethylene has shown reduced in vivo wear and lower rates of revision for total hip arthroplasty, there have been few long-term studies on its use in total knee arthroplasty (TKA). We compared the rate of revision of non-crosslinked polyethylene to that of crosslinked polyethylene in patients who underwent TKA for osteoarthritis. Patients and methods — We examined data from the Australian Orthopaedic Association National Joint Replacement Registry on 302,214 primary TKA procedures with non-crosslinked polyethylene and 83,890 procedures with crosslinked polyethylene, all of which were performed for osteoarthritis. The survivorship of the different polyethylenes was estimated using the Kaplan-Meier method and was compared using proportional hazard models. Results — The 10-year cumulative revision rate for non-crosslinked polyethylene was 5.8% (95% CI: 5.7–6.0) and for crosslinked polyethylene it was 3.5% (95% CI: 3.2–3.8) (> 6.5-year HR = 2.2 (1.5–3.1); p < 0.001). There was no effect of surgical volume or method of prosthesis fixation on outcome. There were 4 different TKA designs that had a minimum of 2,500 procedures in at least 1 of the polyethylene groups and a follow-up of ≥ 5 years. 2 of these, the NexGen and the Natural Knee II, had a lower rate of revision for crosslinked polyethylene. The Scorpio NRG/Series 7000 and the Triathlon Knee did not show a lower rate of revision for crosslinked polyethylene. Interpretation — There is a lower rate of revision for crosslinked polyethylene in TKA, and this appears to be prosthesis-specific and when it occurs is most evident in patients < 65 years of age. The difference in revision rates was mainly due to revisions because of lysis and loosening.
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- 2015
10. Meta-analysis of individual registry results enhances international registry collaboration
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Paxton, Elizabeth W, primary, Mohaddes, Maziar, additional, Laaksonen, Inari, additional, Lorimer, Michelle, additional, Graves, Stephen E, additional, Malchau, Henrik, additional, Namba, Robert S, additional, Kärrholm, John, additional, Rolfson, Ola, additional, and Cafri, Guy, additional
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- 2018
- Full Text
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11. Trabecular metal acetabular components in primary total hip arthroplasty
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Laaksonen, Inari, primary, Lorimer, Michelle, additional, Gromov, Kirill, additional, Eskelinen, Antti, additional, Rolfson, Ola, additional, Graves, Stephen E, additional, Malchau, Henrik, additional, and Mohaddes, Maziar, additional
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- 2018
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12. Multi-state models and arthroplasty histories after unilateral total hip arthroplasties
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Gillam, Marianne H, Ryan, Philip, Salter, Amy, and Graves, Stephen E
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musculoskeletal diseases ,Aged, 80 and over ,Male ,Reoperation ,Arthroplasty, Replacement, Hip ,Australia ,Middle Aged ,Osteoarthritis, Knee ,Article ,Osteoarthritis, Hip ,Age Distribution ,Second-Look Surgery ,Humans ,Female ,Hip Prosthesis ,Sex Distribution ,Arthroplasty, Replacement, Knee ,Epidemiologic Methods ,Knee Prosthesis ,Aged - Abstract
Background and purpose An increasing number of patients have several joint replacement procedures during their lifetime. We investigated the use and suitability of multi-state model techniques in providing a more comprehensive analysis and description of complex arthroplasty histories held in arthroplasty registries than are allowed for with traditional survival methods. Patients and methods We obtained data from the Australian Orthopaedic Association National Joint Replacement Registry on patients (n = 84,759) who had undergone a total hip arthroplasty for osteoarthritis in the period 2002–2008. We set up a multi-state model where patients were followed from their first recorded arthroplasty to several possible states: revision of first arthroplasty, either a hip or knee as second arthroplasty, revision of the second arthroplasty, and death. The Summary Notation for Arthroplasty Histories (SNAH) was developed in order to help to manage and analyze this type of data. Results At the end of the study period, 12% of the 84,759 patients had received a second hip, 3 times as many as had received a knee. The estimated probabilities of having received a second arthroplasty decreased with age. Males had a lower transition rate for receiving a second arthroplasty, but a higher mortality rate. Interpretation Multi-state models in combination with SNAH codes are well suited to the management and analysis of arthroplasty registry data on patients who experience multiple joint procedures over time. We found differences in the progression of joint replacement procedures after the initial total hip arthroplasty regarding type of joint, age, and sex.
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- 2012
13. Perioperative mortality after hemiarthroplasty related to fixation method
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Costain, Darren J, Whitehouse, Sarah L, Pratt, Nicole L, Graves, Stephen E, Ryan, Philip, and Crawford, Ross W
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Aged, 80 and over ,Male ,Reoperation ,Hip Fractures ,Arthroplasty, Replacement, Hip ,Australia ,Article ,Prosthesis Failure ,Fracture Fixation, Internal ,Postoperative Complications ,Humans ,Female ,Hip Prosthesis ,Registries ,Cementation ,Aged - Abstract
Background and purpose The appropriate fixation method for hemiarthroplasty of the hip as it relates to implant survivorship and patient mortality is a matter of ongoing debate. We examined the influence of fixation method on revision rate and mortality. Methods We analyzed approximately 25,000 hemiarthroplasty cases from the AOA National Joint Replacement Registry. Deaths at 1 day, 1 week, 1 month, and 1 year were compared for all patients and among subgroups based on implant type. Results Patients treated with cemented monoblock hemiarthroplasty had a 1.7-times higher day-1 mortality compared to uncemented monoblock components (p < 0.001). This finding was reversed by 1 week, 1 month, and 1 year after surgery (p < 0.001). Modular hemiarthroplasties did not reveal a difference in mortality between fixation methods at any time point. Interpretation This study shows lower (or similar) overall mortality with cemented hemiarthroplasty of the hip.
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- 2011
14. Poor outcome of revised resurfacing hip arthroplasty
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de Steiger, Richard N, Miller, Lisa N, Prosser, Gareth H, Graves, Stephen E, Davidson, David C, and Stanford, Tyman E
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musculoskeletal diseases ,Reoperation ,Treatment Outcome ,Arthroplasty, Replacement, Hip ,Australia ,Humans ,Hip Prosthesis ,Registries ,Prosthesis Design ,Research Article ,Prosthesis Failure - Abstract
Background and purpose Recent years have seen a rapid increase in the use of resurfacing hip arthroplasty despite the lack of literature on the long-term outcome. In particular, there is little evidence regarding the outcome of revisions of primary resurfacing. The purpose of this analysis was to examine the survivorship of primary resurfacing hip arthroplasties that have been revised. Patients and methods Over 12,000 primary resurfacing hip arthroplasties were recorded by the Australian Orthopaedic Association National Joint Replacement Registry between September 1, 1999 and December 31, 2008. During this time, 397 revisions for reasons other than infection were reported for these primary resurfacings and classified as acetabular, femoral, or both acetabular and femoral revisions. The survivorship of the different types of revisions was estimated using the Kaplan-Meier method and compared using proportional hazard models. Additionally, the outcome of a femoral-only revision was compared to that of primary conventional total hip arthroplasty. Results Acetabular-only revision had a high risk of re-revision compared to femoral-only and both acetabular and femoral revision (5-year cumulative per cent revision of 20%, 7%, and 5% respectively). Femoral-only revision had a risk of re-revision similar to that of revision of both the acetabular and femoral components. Femoral-only revision had over twice the risk of revision of primary conventional total hip arthroplasty. Interpretation Revision of a primary resurfacing arthroplasty is associated with a major risk of re-revision. The best outcome is achieved when either the femoral-only or both the acetabular and femoral components are revised. Technically straightforward femoral-only revisions generally have a worse outcome than a primary conventional total hip arthroplasty.
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- 2010
15. Improvements in physical function and pain sustained for up to 10 years after knee or hip arthroplasty irrespective of mental health status before surgery
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(Geeske) Peeters, G M E E, primary, Rainbird, Sophia, additional, Lorimer, Michelle, additional, Dobson, Annette J, additional, Mishra, Gita D, additional, and Graves, Stephen E, additional
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- 2016
- Full Text
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16. Postoperative opioid use as an early indication of total hip arthroplasty failure
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Namba, Robert S, primary, Inacio, Maria C S, additional, Pratt, Nicole L, additional, Graves, Stephen E, additional, Roughead, Elizabeth E, additional, Craig Cheetham, T, additional, and Paxton, Elizabeth W, additional
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- 2016
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17. Lower prosthesis-specific 10-year revision rate with crosslinked than with non-crosslinked polyethylene in primary total knee arthroplasty
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Steiger, Richard N de, primary, Muratoglu, Orhun, additional, Lorimer, Michelle, additional, Cuthbert, Alana R, additional, and Graves, Stephen E, additional
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- 2015
- Full Text
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18. The next critical role of orthopedic registries
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Malchau, Henrik, primary, Graves, Stephen E, additional, Porter, Martyn, additional, Harris, William H, additional, and Troelsen, Anders, additional
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- 2015
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19. Improvements in physical function and pain sustained for up to 10 years after knee or hip arthroplasty irrespective of mental health status before surgery.
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(Geeske) Peeters, G M E E, Rainbird, Sophia, Lorimer, Michelle, Dobson, Annette J, Mishra, Gita D, and Graves, Stephen E
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HEALTH surveys ,LONGITUDINAL method ,MENTAL health ,PAIN ,QUESTIONNAIRES ,TOTAL hip replacement ,TOTAL knee replacement - Abstract
Background and purpose — There are concerns that mental health (MH) may influence outcomes of total knee arthroplasty (TKA) or total hip arthroplasty (THA). We examined effects of poor MH before surgery on long-term outcomes of osteoarthritis-related TKA or THA in women. Patients and methods — The data were from 9,737 middle-aged participants (47–52 years) and 9,292 older participants (73–78 years) in the Australian Longitudinal Study on Women’s Health who completed surveys between 1998 and 2013. Dates of arthroplasties were obtained from the Australian Orthopaedics Association National Joint Replacement Registry. Participants without procedures were matched with participants with procedures. Trajectories of the Short-Form 36 scores for physical functioning, bodily pain, social functioning, and mental health based on mixed modeling were plotted for participants with and without surgery (stratified according to mental health, separately for TKA and THA, and for middle-aged and older participants). Results — In middle-aged women with poor and good MH, TKA improved physical function and reduced bodily pain, with improvements sustained up to 10 years after surgery. TKA contributed to restoration of social function in women with good MH, but this was less clear in women with poor MH. In both MH groups, mental health appeared to be unaffected by TKA. Similar patterns were observed after THA, and in older women. Interpretation — Recovery of physical and social function and reductions in pain were sustained for up to 10 years after surgery. Improvements in physical function and pain were also observed in women with poor mental health. Thus, in our view poor mental health should not be a contraindication for arthroplasty. [ABSTRACT FROM AUTHOR]
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- 2017
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20. Heart failure after conventional metal-on-metal hip replacements.
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GILLAM, Marianne H., PRATT, Nicole L., INACIO, Maria C. S., ROUGHEAD, Elizabeth E., SHAKIB, Sepehr, NICHOLLS, Stephen J., and GRAVES, Stephen E.
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HEART failure treatment ,OSTEOARTHRITIS treatment ,ACETABULUM (Anatomy) ,CONFIDENCE intervals ,FRACTURE fixation ,HEART failure ,HOSPITAL care ,ORTHOPEDIC apparatus ,EVALUATION of medical care ,METALS ,NOSOLOGY ,ORTHOPEDIC surgery ,ORTHOPEDICS ,RESEARCH funding ,SURGICAL instruments ,TOTAL hip replacement ,VETERANS' hospitals ,COMORBIDITY ,ACQUISITION of data ,PROPORTIONAL hazards models ,RETROSPECTIVE studies ,ANATOMY ,DIAGNOSIS - Abstract
Background and purpose - It is unclear whether metal particles and ions produced by mechanical wear and corrosion of hip prostheses with metal-on-metal (MoM) bearings have systemic adverse effects on health. We compared the risk of heart failure in patients with conventional MoM total hip arthroplasty (THA) and in those with metal-on-polyethylene (MoP) THA. Patients and methods - We conducted a retrospective cohort study using data from the Australian Government Department of Veterans' Affairs health claims database on patients who received conventional THA for osteoarthritis between 2004 and 2012. The MoM THAs were classified into groups: Articular Surface Replacement (ASR) XL Acetabular System, other large-head (LH) (> 32 mm) MoM, and small-head (SH) (≤ 32 mm) MoM. The primary outcome was hospitalization for heart failure after THA. Results - 4,019 patients with no history of heart failure were included (56% women). Men with an ASR XL THA had a higher rate of hospitalization for heart failure than men with MoP THA (hazard ratio (HR) = 3.2, 95% CI: 1.6-6.5). No statistically significant difference in the rate of heart failure was found with the other LH MoM or SH MoM compared to MoP in men. There was no statistically significant difference in heart failure rate between exposure groups in women. Interpretation - An association between ASR XL and hospitalization for heart failure was found in men. While causality between ASR XL and heart failure could not be established in this study, it highlights an urgent need for further studies to investigate the possibility of systemic effects associated with MoM THA. [ABSTRACT FROM AUTHOR]
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- 2017
- Full Text
- View/download PDF
21. Joint registry approach for identification of outlier prostheses
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Steiger, Richard N de, primary, Miller, Lisa N, additional, Davidson, David C, additional, Ryan, Philip, additional, and Graves, Stephen E, additional
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- 2013
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22. Different competing risks models applied to data from the Australian Orthopaedic Association National Joint Replacement Registry
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Gillam, Marianne H, primary, Salter, Amy, additional, Ryan, Philip, additional, and Graves, Stephen E, additional
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- 2011
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23. Competing risks survival analysis applied to data from the Australian Orthopaedic Association National Joint Replacement Registry
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Gillam, Marianne H, primary, Ryan, Philip, additional, Graves, Stephen E, additional, Miller, Lisa N, additional, de Steiger, Richard N, additional, and Salter, Amy, additional
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- 2010
- Full Text
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24. Outcome of primary resurfacing hip replacement: evaluation of risk factors for early revision
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Prosser, Gareth H, primary, Yates, Piers J, additional, Wood, David J, additional, Graves, Stephen E, additional, de Steiger, Richard N, additional, and Miller, Lisa N, additional
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- 2010
- Full Text
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25. The value of arthroplasty registry data
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Graves, Stephen E, primary
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- 2010
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26. Outcome of revision of unicompartmental knee replacement
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Hang, Jacqueline R, primary, Stanford, Tyman E, additional, Graves, Stephen E, additional, Davidson, David C, additional, de Steiger, Richard N, additional, and Miller, Lisa N, additional
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- 2010
- Full Text
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27. Early outcomes of patella resurfacing in total knee arthroplasty
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Clements, Warren J, primary, Miller, Lisa, additional, Whitehouse, Sarah L, additional, Graves, Stephen E, additional, Ryan, Philip, additional, and Crawford, Ross W, additional
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- 2009
- Full Text
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28. Early outcomes of patella resurfacing in total knee arthroplasty.
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Clements, Warren J, Miller, Lisa, Whitehouse, Sarah L, Graves, Stephen E, Ryan, Philip, and Crawford, Ross W
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TOTAL knee replacement ,PATELLA ,PAIN management ,REOPERATION ,ORTHOPEDIC surgery - Abstract
Background Patella resurfacing in total knee arthroplasty is a contentious issue. The literature suggests that resurfacing of the patella is based on surgeon preference, and little is known about the role and timing of resurfacing and how this affects outcomes. Methods We analyzed 134,799 total knee arthroplasties using data from the Australian Orthopaedic Association National Joint Replacement Registry. Hazards ratios (HRs) were used to compare rates of early revision between patella resurfacing at the primary procedure (the resurfacing group, R) and primary arthroplasty without resurfacing (no-resurfacing group, NR). We also analyzed the outcomes of NR that were revised for isolated patella addition. Results At 5 years, the R group showed a lower revision rate than the NR group: cumulative per cent revision (CPR) 3.1% and 4.0%, respectively (HR = 0.75, p < 0.001). Revisions for patellofemoral pain were more common in the NR group (17%) than in the R group (1%), and “patella only” revisions were more common in the NR group (29%) than in the R group (6%). Non-resurfaced knees revised for isolated patella addition had a higher revision rate than patella resurfacing at the primary procedure, with a 4-year CPR of 15% and 2.8%, respectively (HR = 4.1, p < 0.001). Interpretation Rates of early revision of primary total knees were higher when the patella was not resurfaced, and suggest that surgeons may be inclined to resurface later if there is patellofemoral pain. However, 15% of non-resurfaced knees revised for patella addition are re-revised by 4 years. Our results suggest an early beneficial outcome for patella resurfacing at primary arthroplasty based on revision rates up to 5 years. [ABSTRACT FROM AUTHOR]
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- 2010
- Full Text
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29. Heart failure after conventional metal-on-metal hip replacements: A retrospective cohort study
- Author
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Marianne Gillam, Stephen J. Nicholls, Stephen Graves, Elizabeth E. Roughead, Sepehr Shakib, Maria C.S. Inacio, Nicole L. Pratt, Gillam, Marianne H, Pratt, Nicole L, Inacio, Maria CS, Roughead, Elizabeth E, Shakib, Sepher, Nicholls, Stephen J, and Graves, Stephen E
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musculoskeletal diseases ,medicine.medical_specialty ,heart failure ,Osteoarthritis ,metal particles ,Hip replacement (animal) ,03 medical and health sciences ,0302 clinical medicine ,Health claims on food labels ,medicine ,Orthopedics and Sports Medicine ,In patient ,030212 general & internal medicine ,Adverse effect ,Orthopedic surgery ,030222 orthopedics ,hip replacements ,business.industry ,Retrospective cohort study ,General Medicine ,Articular surface ,musculoskeletal system ,medicine.disease ,3. Good health ,Surgery ,surgical procedures, operative ,Heart failure ,business ,RD701-811 - Abstract
Background and purpose: It is unclear whether metal particles and ions produced by mechanical wear and corrosion of hip prostheses with metal-on-metal (MoM) bearings have systemic adverse effects on health. We compared the risk of heart failure in patients with conventional MoM total hip arthroplasty (THA) and in those with metal-on-polyethylene (MoP) THA. Patients and methods — We conducted a retrospective cohort study using data from the Australian Government Department of Veterans’ Affairs health claims database on patients who received conventional THA for osteoarthritis between 2004 and 2012. The MoM THAs were classified into groups: Articular Surface Replacement (ASR) XL Acetabular System, other large-head (LH) (> 32 mm) MoM, and small-head (SH) (≤ 32 mm) MoM. The primary outcome was hospitalization for heart failure after THA. Results: 4,019 patients with no history of heart failure were included (56% women). Men with an ASR XL THA had a higher rate of hospitalization for heart failure than men with MoP THA (hazard ratio (HR) = 3.2, 95% CI: 1.6–6.5). No statistically significant difference in the rate of heart failure was found with the other LH MoM or SH MoM compared to MoP in men. There was no statistically significant difference in heart failure rate between exposure groups in women. Interpretation: An association between ASR XL and hospitalization for heart failure was found in men. While causality between ASR XL and heart failure could not be established in this study, it highlights an urgent need for further studies to investigate the possibility of systemic effects associated with MoM THA. Refereed/Peer-reviewed
- Published
- 2017
30. Meta-analysis of individual registry results enhances international registry collaboration
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Ola Rolfson, Elizabeth W. Paxton, Guy Cafri, Inari Laaksonen, Robert S. Namba, Michelle Lorimer, John Kärrholm, Stephen E. Graves, Henrik Malchau, Maziar Mohaddes, Paxton, Elizabeth W, Mohaddes, Maziar, Laaksonen, Inari, Lorimer, Michelle, Graves, Stephen E, Malchau, Henrik, Namba, Robert S, Karrholm, John, Rolfson, Ola, and Cafri, Guy
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medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,International Cooperation ,data analysis ,data ownership ,Tantalum ,registry ,Prosthesis Design ,Medical Records ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Meta-Analysis as Topic ,medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Registries ,Social Behavior ,ta3126 ,Orthopedic surgery ,Sweden ,030222 orthopedics ,business.industry ,Australia ,General Medicine ,Medical research ,United States ,Prosthesis Failure ,Editorial ,Family medicine ,Meta-analysis ,Surgery ,Research-Article ,Hip Prosthesis ,business ,Porosity ,RD701-811 - Abstract
Background and purpose: Although common in medical research, meta-analysis has not been widely adopted in registry collaborations. A meta-analytic approach in which each registry conducts a standardized analysis on its own data followed by a meta-analysis to calculate a weighted average of the estimates allows collaboration without sharing patient-level data. The value of meta-analysis as an alternative to individual patient data analysis is illustrated in this study by comparing the risk of revision of porous tantalum cups versus other uncemented cups in primary total hip arthroplasties from Sweden, Australia, and a US registry (2003-2015). Patients and methods - For both individual patient data analysis and meta-analysis approaches a Cox proportional hazard model was fit for time to revision, comparing porous tantalum (n = 23,201) with other uncemented cups (n = 128,321). Covariates included age, sex, diagnosis, head size, and stem fixation. In the meta-analysis approach, treatment effect size (i.e., Cox model hazard ratio) was calculated within each registry and a weighted average for the individual registries' estimates was calculated. Results - Patient-level data analysis and meta-analytic approaches yielded the same results with the porous tantalum cups having a higher risk of revision than other uncemented cups (HR (95% CI) 1.6 (1.4-1.7) and HR (95% CI) 1.5 (1.4-1.7), respectively). Adding the US cohort to the meta-analysis led to greater generalizability, increased precision of the treatment effect, and similar findings (HR (95% CI) 1.6 (1.4-1.7)) with increased risk of porous tantalum cups. Interpretation - The meta-analytic technique is a viable option to address privacy, security, and data ownership concerns allowing more expansive registry collaboration, greater generalizability, and increased precision of treatment effects. Refereed/Peer-reviewed
- Published
- 2018
31. Postoperative opioid use as an early indication of total hip arthroplasty failure
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Elizabeth W. Paxton, Stephen E. Graves, T. Craig Cheetham, Nicole L. Pratt, Robert S. Namba, Maria C.S. Inacio, Elizabeth E. Roughead, Namba, Robert S, Inacio, Maria CS, Pratt, Nicole L, Graves, Stephen E, Roughead, Elizabeth E, Cheetham, T Craig, and Paxton, Elizabeth W
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,total hip arthroplasty (THA) ,Osteoarthritis, Hip ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Orthopedic surgery ,Survivorship curve ,medicine ,Confidence Intervals ,Humans ,Orthopedics and Sports Medicine ,Revision rate ,030212 general & internal medicine ,Aged ,Retrospective Studies ,030222 orthopedics ,Pain, Postoperative ,opioid use ,business.industry ,THA failure ,Opioid use ,Retrospective cohort study ,General Medicine ,Articles ,Middle Aged ,Confidence interval ,Surgery ,Prosthesis Failure ,Analgesics, Opioid ,lcsh:RD701-811 ,Quartile ,Female ,business ,Total hip arthroplasty ,Cohort study - Abstract
Background and purpose — A criticism of total hip arthroplasty (THA) survivorship analysis is that revisions are a late and rare outcome. We investigated whether prolonged opioid use is a possible indicator of early THA failure. Patients and methods — We conducted a cohort study of THAs registered in a total joint replacement registry from January 2008 to December 2011. 12,859 patients were evaluated. The median age was 67 years and 58% were women. Opioid use in the year after surgery was the exposure of interest, and the cumulative daily amounts of oral morphine equivalents (OMEs) were calculated. Post-THA OMEs per 90 day periods were categorized into quartiles. The endpoints were 1- and 5-year revisions. Results — After the first 90 days, 27% continued to use opioids. The revision rate was 0.9% within a year and 1.7% within 5 years. Use of medium-low (100–219 mg), medium-high (220–533 mg), and high (≥ 534 mg) amounts of OMEs in days 91–180 after surgery was associated with a 6 times (95% confidence interval (CI): 3–15), 5 times (CI: 2–13), and 11 times (CI: 2.9–44) higher adjusted risk of 1 year revision, respectively. The use of medium-low and medium-high amounts of OMEs in days 181–270 after surgery was associated with a 17 times (CI: 6–44) and 14 times (95% CI: 4–46) higher adjusted risk of 1-year revision. There was a similar higher risk of 5-year revision. Interpretation — Persistent postoperative use of opioids was associated with revision THA surgery in this cohort, and it may be an early indicator of potential surgical failures. Refereed/Peer-reviewed
- Published
- 2016
32. Multi-state models and arthroplasty histories after unilateral total hip arthroplasties
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Amy Salter, Stephen E. Graves, Marianne Gillam, Philip Ryan, Gillam, Marianne H, Ryan, Philip, Salter, Amy, and Graves, Stephen E
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joint replacement ,medicine.medical_specialty ,Multi state ,Joint replacement ,business.industry ,medicine.medical_treatment ,Total hip replacement ,General Medicine ,Osteoarthritis ,medicine.disease ,Arthroplasty ,Joint replacement registry ,medicine ,Second Look Surgery ,Physical therapy ,arthroplasty ,Orthopedics and Sports Medicine ,Surgery ,business ,Total hip arthroplasty - Abstract
Background and purpose: An increasing number of patients have several joint replacement procedures during their lifetime. We investigated the use and suitability of multi-state model techniques in providing a more comprehensive analysis and description of complex arthroplasty histories held in arthroplasty registries than are allowed for with traditional survival methods. Patients and methods: We obtained data from the Australian Orthopaedic Association National Joint Replacement Registry on patients (n = 84,759) who had undergone a total hip arthroplasty for osteoarthritis in the period 2002–2008. We set up a multi-state model where patients were followed from their first recorded arthroplasty to several possible states: revision of first arthroplasty, either a hip or knee as second arthroplasty, revision of the second arthroplasty, and death. The Summary Notation for Arthroplasty Histories (SNAH) was developed in order to help to manage and analyze this type of data. Results: At the end of the study period, 12% of the 84,759 patients had received a second hip, 3 times as many as had received a knee. The estimated probabilities of having received a second arthroplasty decreased with age. Males had a lower transition rate for receiving a second arthroplasty, but a higher mortality rate. Interpretation: Multi-state models in combination with SNAH codes are well suited to the management and analysis of arthroplasty registry data on patients who experience multiple joint procedures over time. We found differences in the progression of joint replacement procedures after the initial total hip arthroplasty regarding type of joint, age, and sex. Refereed/Peer-reviewed
- Published
- 2012
33. Different competing risks models applied to data from the Australian Orthopaedic Association National Joint Replacement Registry
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Philip Ryan, Amy Salter, Marianne Gillam, Stephen E. Graves, Gillam, Marianne H, Salter, Amy, Ryan, Philip, and Graves, Stephen E
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,arthroplasty registry data ,Association (object-oriented programming) ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,statistical models ,Competing risks ,Prosthesis Design ,Article ,Risk Factors ,Outcome Assessment, Health Care ,Medicine ,Prosthesis design ,Humans ,Orthopedics and Sports Medicine ,Registries ,Aged ,Probability ,Aged, 80 and over ,Models, Statistical ,business.industry ,Hip Fractures ,Australia ,Regression analysis ,General Medicine ,Arthroplasty ,Surgery ,Prosthesis Failure ,Joint replacement registry ,Family medicine ,Regression Analysis ,Registry data ,Female ,Hip Prosthesis ,business - Abstract
Purpose: Here we describe some available statistical models and illustrate their use for analysis of arthroplasty registry data in the presence of the competing risk of death, when the influence of covariates on the revision rate may be different to the influence on the probability (that is, risk) of the occurrence of revision. Patients and methods: Records of 12,525 patients aged 75–84 years who had received hemiarthroplasty for fractured neck of femur were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. The covariates whose effects we investigated were: age, sex, type of prosthesis, and type of fixation (cementless or cemented). Extensions of competing risk regression models were implemented, allowing the effects of some covariates to vary with time. Results The revision rate was significantly higher for patients with unipolar than bipolar prostheses (HR = 1.38, 95% CI: 1.01– 1.89) or with monoblock than bipolar prostheses (HR = 1.45, 95% CI: 1.08–1.94). It was significantly higher for the younger age group (75–79 years) than for the older one (80–84 years) (HR = 1.28, 95% CI: 1.05–1.56) and higher for males than for females (HR = 1.37, 95% CI: 1.09–1.71). The probability of revision, after correction for the competing risk of death, was only significantly higher for unipolar prostheses than for bipolar prostheses, and higher for the younger age group. The effect of fixation type varied with time; initially, there was a higher probability of revision for cementless prostheses than for cemented prostheses, which disappeared after approximately 1.5 years. Interpretation: When accounting for the competing risk of death, the covariates type of prosthesis and sex influenced the rate of revision differently to the probability of revision. We advocate the use of appropriate analysis tools in the presence of competing risks and when covariates have time-dependent effects. Refereed/Peer-reviewed
- Published
- 2011
34. Outcome of revision of unicompartmental knee replacement
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Tyman E Stanford, Jacqueline R Hang, Richard de Steiger, David C Davidson, Lisa N Miller, Stephen E. Graves, Hang, Jacqueline R, Stanford, Tyman E, Graves, Stephen E, Davidson, David C, De Steiger, Richard N, and Miller, Lisa N
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,business.industry ,Chirurgie orthopedique ,medicine.medical_treatment ,Total knee arthroplasty ,Australian Orthopaedic Association National Joint Replacement Registry ,General Medicine ,Unicompartmental knee replacement ,musculoskeletal system ,Surgery ,Knee prosthesis ,Joint replacement registry ,knee replacement ,Survivorship curve ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,Unicompartmental knee arthroplasty ,business - Abstract
Background and purpose: Despite concerns regarding a higher risk of revision, unicompartmental knee arthroplasty (UKA) continues to be used as an alternative to total knee arthroplasty (TKA). There are, however, limited data on the subsequent outcome when a UKA is revised. We examined the survivorship for primary UKA procedures that have been revised. Methods: We used data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to analyze the survivorship of 1,948 revisions of primary UKA reported to the Registry between September 1999 and December 2008. This was compared to the results of revisions of primary TKA reported during the same period where both the femoral and tibial components were revised. The Kaplan-Meier method for modeling survivorship was used. Results: When a primary UKA was revised to another UKA (both major and minor revisions), it had a cumulative per cent revision (CPR) of 28 and 30 at 3 years, respectively. The CPR at 3 years when a UKA was converted to a TKA was 10. This is similar to the 3-year CPR (12) found earlier for primary TKA where both the femoral and tibial components were revised. Interpretation When a UKA requires revision, the best outcome is achieved when it is converted to a TKA. This procedure does, however, have a major risk of re-revision, which is similar to the risk of re-revision of a primary TKA that has had both the femoral and tibial components revised. Refereed/Peer-reviewed
- Published
- 2010
35. Improvements in physical function and pain sustained for up to 10 years after knee or hip arthroplasty irrespective of mental health status before surgery.
- Author
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Geeske Peeters GM, Rainbird S, Lorimer M, Dobson AJ, Mishra GD, and Graves SE
- Subjects
- Aged, Australia, Female, Humans, Longitudinal Studies, Middle Aged, Osteoarthritis, Hip physiopathology, Osteoarthritis, Hip psychology, Osteoarthritis, Knee physiopathology, Osteoarthritis, Knee psychology, Pain, Pain Measurement, Prognosis, Social Behavior, Surveys and Questionnaires, Treatment Outcome, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Mental Health, Osteoarthritis, Hip surgery, Osteoarthritis, Knee surgery, Recovery of Function
- Abstract
Background and purpose - There are concerns that mental health (MH) may influence outcomes of total knee arthroplasty (TKA) or total hip arthroplasty (THA). We examined effects of poor MH before surgery on long-term outcomes of osteoarthritis-related TKA or THA in women. Patients and methods - The data were from 9,737 middle-aged participants (47-52 years) and 9,292 older participants (73-78 years) in the Australian Longitudinal Study on Women's Health who completed surveys between 1998 and 2013. Dates of arthroplasties were obtained from the Australian Orthopaedics Association National Joint Replacement Registry. Participants without procedures were matched with participants with procedures. Trajectories of the Short-Form 36 scores for physical functioning, bodily pain, social functioning, and mental health based on mixed modeling were plotted for participants with and without surgery (stratified according to mental health, separately for TKA and THA, and for middle-aged and older participants). Results - In middle-aged women with poor and good MH, TKA improved physical function and reduced bodily pain, with improvements sustained up to 10 years after surgery. TKA contributed to restoration of social function in women with good MH, but this was less clear in women with poor MH. In both MH groups, mental health appeared to be unaffected by TKA. Similar patterns were observed after THA, and in older women. Interpretation - Recovery of physical and social function and reductions in pain were sustained for up to 10 years after surgery. Improvements in physical function and pain were also observed in women with poor mental health. Thus, in our view poor mental health should not be a contraindication for arthroplasty.
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- 2017
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- View/download PDF
36. Joint registry approach for identification of outlier prostheses.
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de Steiger RN, Miller LN, Davidson DC, Ryan P, and Graves SE
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- Aged, Aged, 80 and over, Arthroplasty statistics & numerical data, Australia, Female, Humans, Joint Prosthesis adverse effects, Male, Registries, Risk Factors, Treatment Outcome, Arthroplasty adverse effects, Joint Prosthesis statistics & numerical data, Prosthesis Failure
- Abstract
Background and Purpose: Joint Replacement Registries play a significant role in monitoring arthroplasty outcomes by publishing data on survivorship of individual prostheses or combinations of prostheses. The difference in outcomes can be device- or non-device-related, and these factors can be analyzed separately. Although registry data indicate that most prostheses have similar outcomes, some have a higher than anticipated rate of revision when compared to all other prostheses in their class. This report outlines how the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) has developed a method to report prostheses with a higher than expected rate of revision. These are referred to as "outlier" prostheses., Material and Methods: Since 2004, the AOANJRR has developed a standardized process for identifying outliers. This is based on a 3-stage process consisting of an automated algorithm, an extensive analysis of individual prostheses or combinations by registry staff, and finally a meeting involving a panel from the Australian Orthopaedic Association Arthroplasty Society. Outlier prostheses are listed in the Annual Report as (1) identified but no longer used in Australia, (2) those that have been re-identified and that are still used, and (3) those that are being identified for the first time., Results: 78 prostheses or prosthesis combinations have been identified as being outliers using this approach (AOANJRR 2011 Annual Report). In addition, 5 conventional hip prostheses were initially identified, but after further analysis no longer met the defined criteria. 1 resurfacing hip prosthesis was initially identified, subsequently removed from the list, and then re-identified the following year when further data were available. All unicompartmental and primary total knee prostheses identified as having a higher than expected rate of revision have continued to be re-identified., Interpretation: It is important that registries use a transparent and accountable process to identify an outlier prosthesis. This paper describes the development, implementation, assessment, and impact of the approach used by the Australian Registry.
- Published
- 2013
- Full Text
- View/download PDF
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