Search

Background: Well-validated data from arthroplasty registries provide an opportunity to understand contemporary use of revision hip replacement at a national level. Such information can underpin health-care resource allocation and surgical workforce planning. The purposes of the present study were to describe the demographic characteristics of patients managed with revision hip replacement surgery in Australia and to examine changes in the lifetime risk of revision hip replacement over a decade.Methods: Deidentified individual-level data on all revision hip replacement procedures performed in Australia from 2007 to 2017 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Life tables and population data were sourced from the Australian Bureau of Statistics. The lifetime risk of revision surgery each year was estimated with use of a standardized approach, with separate calculations for males and females.Results: A total of 46,086 revision hip replacement procedures were performed from 2007 to 2017. The median age at the time of surgery was 72 years (interquartile range, 63 to 80 years). While loosening or lysis became less frequent reasons for revision over time (from 51% in 2007 to 28% in 2017), revision hip replacement for infection became increasingly common (from 14% in 2007 to 25% in 2017). Revisions for metal-related pathology peaked in 2011. Utilization rates were highest for males ≥80 years of age (127.9 procedures per 100,000 population in 2017). Although a small rise was evident in 2011 and 2012 (to 2.39% and 2.22%, respectively), the lifetime risk of revision hip replacement in females decreased from 1.90% (95% confidence interval [CI], 1.82% to 1.99%) in 2007 to 1.74% (95% CI, 1.66% to 1.82%) in 2017. A similar pattern was evident for males; the lifetime risk was 1.78% (95% CI, 1.69% to 1.86%) in 2007 and 1.57% (95% CI, 1.49% to 1.65%) in 2017.Conclusions: These data enable us to understand the epidemiology of revision hip replacement in Australia, including the shifting clinical indications for this procedure. At a population level, the lifetime risk of revision hip replacement remains low at <1 in 50 people in 2017. These methods can be utilized for population-level surveillance of revision burden and to enable between-country benchmarking.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Periprosthetic infection following total knee replacement remains alarmingly frequent, is devastating for patients, and is an increasingly substantial public health burden. While both the prosthetic design elements and type of polyethylene used in total knee replacement can independently affect survivorship of the prosthesis, their influence on the risk of revision for infection is unknown. Therefore, we examined the effects of total knee prosthetic design and type of polyethylene bearing on the long-term revision risk for nonacute infection following total knee replacement by comparing 4 different cohorts: patients who had minimally stabilized total knee prostheses with crosslinked polyethylene (XLPE) bearing surfaces, minimally stabilized total knee prostheses with noncrosslinked polyethylene (NXLPE), posterior stabilized total knee prostheses with XLPE, and posterior stabilized total knee prostheses with NXLPE.Methods: National registry data on revision procedures for surgeon-reported infection following primary total knee replacement for osteoarthritis from September 1999 through December 2015 were obtained for 4 patient cohorts. The cohorts were defined by the total knee prosthetic design and polyethylene type used. Revisions at ≤6 months were censored to reduce confounding bias. Hazard ratios (HRs) were adjusted for age, sex, and antibiotic cement usage.Results: A total of 336,997 primary total knee prostheses were included, 1,651 (0.49%) of which underwent revision for periprosthetic infection. Compared with minimally stabilized total knee prostheses that had XLPE bearing surfaces, the revision risk for infection, adjusted for age, sex, and antibiotic cement usage, was 25% higher for minimally stabilized total knee prostheses with NXLPE bearing surfaces (HR = 1.25 [95% confidence interval (CI), 1.07 to 1.45]; p = 0.003), 89% higher for posterior stabilized total knee prostheses with XLPE (HR = 1.89 [95% CI, 1.52 to 2.35]; p < 0.001), and 102% higher for posterior stabilized total knee prostheses with NXLPE (HR = 2.02 [95% CI, 1.72 to 2.37]; p < 0.001). Posterior stabilized total knee prostheses with NXLPE had a 61% higher risk of infection compared with minimally stabilized total knee prostheses with NXLPE (HR = 1.61 [95% CI, 1.43 to 1.83]; p < 0.001). The revision risk for infection for posterior stabilized total knee prostheses with NXLPE was the same as that for posterior stabilized total knee prostheses with XLPE (HR = 1.08 [95% CI, 0.88 to 1.32]; p = 0.481).Conclusions: Minimally stabilized total knee prostheses with NXLPE bearing surfaces and posterior stabilized total knee prostheses, irrespective of bearing type, had a greater long-term revision risk for periprosthetic infection when compared with the revision risk for minimally stabilized total knee prostheses with XLPE bearing surfaces.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of Levels of Evidence. [ABSTRACT FROM AUTHOR]

Background: The effect of alternative bearing materials on the risk of revision due to infection after total knee replacement remains uncertain. By reducing the immunomodulating polyethylene wear-particle burden and with different substrate bacterial adhesion properties, Oxinium oxidized zirconium and cross-linked polyethylene (XLPE) could alter infection risk. The purpose of the current study was to analyze the risk of revision for infection in 3 comparisons of bearing combinations.Methods: To evaluate the risk of revision for infection with XLPE, cobalt-chromium (CoCr) on XLPE was compared with CoCr on non-cross-linked polyethylene (NXLPE). To evaluate Oxinium, Oxinium-NXLPE was compared with CoCr-NXLPE, and to evaluate the possibility of an additional beneficial effect of Oxinium on XLPE, Oxinium-XLPE was compared with CoCr-XLPE. The cumulative percent revision (CPR) and hazard ratio (HR) for revision for infection in primary total knee replacement for osteoarthritis were determined from registry data from September 1, 1999, to December 31, 2015. Revisions within 6 months following the primary surgery were censored from the analysis, while procedures with posterior stabilized or fully stabilized total knee replacements as well as prostheses with a known higher risk of revision were excluded. Analyses were stratified by age, sex, and fixation type.Results: Of the 326,603 included primary total knee replacements, 1,511 (0.46%) were revised for infection. The risk of revision for infection was lower for CoCr-XLPE compared with CoCr-NXLPE (HR = 0.74; 95% confidence interval [CI] = 0.65 to 0.84; p < 0.001). This effect was apparent for both male and female patients overall, all fixation types, antibiotic cement use, those <65 years of age, and male patients ≥65 years of age. However, for female patients ≥65 years of age, there was no difference. Overall, Oxinium-NXLPE had the same revision risk as CoCr-NXLPE regardless of fixation; however, for cemented fixation, subanalysis showed a lower risk for Oxinium-NXLPE compared with CoCr-NXLPE (HR = 0.69; 95% CI = 0.51 to 0.94; p = 0.018). Oxinium-XLPE had the same revision risk for infection as CoCr-XLPE overall, among male patients, and when cemented fixation had been used.Conclusions: In this registry analysis, CoCr-XLPE had a 26% lower risk of revision for infection than CoCr-NXLPE, suggesting a reduction of wear particle-induced immunomodulation with XLPE. Oxinium-XLPE had the same risk as CoCr-XLPE. Overall, Oxinium did not reduce the infection risk.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Articular Surface Replacement (ASR) hip prostheses, which have metal-on-metal bearing surfaces, were manufactured by DePuy Orthopaedics (Warsaw, Indiana) for use in both conventional total hip arthroplasty and hip resurfacing. Both the ASR XL Acetabular System and the ASR Hip Resurfacing System were recently recalled worldwide by the manufacturer. This report summarizes an analysis by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of the outcome of arthroplasties involving the ASR prostheses. Methods: The first recorded use of the ASR XL Acetabular System in Australia occurred in 2004, and the Registry recorded 4406 procedures involving this system through December 31, 2009. The first recorded use of the ASR Hip Resurfacing System in Australia occurred in 2003, and the Registry recorded 1167 procedures through December 31, 2009. The Kaplan-Meier method and proportional-hazard modeling were used to compare the revision rate of primary total hip arthroplasties involving the ASR XL Acetabular System with that of arthroplasties involving all other conventional prostheses as well as with that of arthroplasties involving all other conventional prostheses with a metal-on-metal-articulation. In addition, the revision rate of primary arthroplasties involving the ASR Hip Resurfacing System was compared with that of arthroplasties involving all other hip resurfacing prostheses. Patient demographics, prosthesis characteristics, and information regarding the type of revision and the reason for revision were also compared. Results: Arthroplasties involving both ASR designs had a significantly greater revision rate compared with those involving all other prostheses. The cumulative revision rate of arthroplasties involving the ASR XL Acetabular System at five years postoperatively was 9.3% (95% confidence interval [CI], 7.3% to 11.9%) compared with 3.4% (95% CI, 3.3% to 3.5%) for total hip arthroplasties involving all other conventional prostheses. The cumulative revision rate of arthroplasties involving the ASR Hip Resurfacing System at five years postoperatively was 10.9% (95% CI, 8.7% to 13.6%) compared with 4.0% (95% Cl, 3.7% to 4.5%) for arthroplasties involving all other resurfacing prostheses. Arthroplasties involving the ASR XL Acetabular System had a greater rate of revision due to implant loosening and/or osteolysis and due to metal sensitivity compared with total hip arthroplasties involving all other conventional prostheses. Arthroplasties involving the ASR XL Acetabular System also had a significantly greater revision rate compared with total hip arthroplasties involving all other conventional metal-on-metal prostheses. Arthroplasties involving the ASR Hip Resurfacing System had a greater rate of revision due to metal sensitivity compared with total hip arthroplasties involving all other resurfacing prostheses. Conclusions: ASR prostheses used in conventional hip arthroplasty and in hip resurfacing exhibited a greater revision rate compared with other prostheses in the AOANJRR. These results are consistent with those derived from other registries and from published studies of individual cohorts. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]