229 results on '"Graves, Stephen E."'
Search Results
2. In Revision THA, Is the Re-revision Risk for Dislocation and Aseptic Causes Greater in Dual-mobility Constructs or Large Femoral Head Bearings? A Study from the Australian Orthopaedic Association National Joint Replacement Registry
- Author
-
Hoskins, Wayne, Rainbird, Sophia, Dyer, Chelsea, Graves, Stephen E., and Bingham, Roger
- Published
- 2022
- Full Text
- View/download PDF
3. Association between circulating 25-hydroxyvitamin D concentrations and hip replacement for osteoarthritis: a prospective cohort study
- Author
-
Hussain, Sultana Monira, Wang, Yuanyuan, Heath, Alicia K., Giles, Graham G., English, Dallas R., Eyles, Darryl W., Williamson, Elizabeth J., Graves, Stephen E., Wluka, Anita E., and Cicuttini, Flavia M.
- Published
- 2021
- Full Text
- View/download PDF
4. What Can We Learn From Surgeons Who Perform THA and TKA and Have the Lowest Revision Rates? A Study from the Australian Orthopaedic Association National Joint Replacement Registry
- Author
-
Hoskins, Wayne, Rainbird, Sophia, Lorimer, Michelle, Graves, Stephen E., and Bingham, Roger
- Published
- 2022
- Full Text
- View/download PDF
5. Is the Survivorship of Birmingham Hip Resurfacing Better Than Selected Conventional Hip Arthroplasties in Men Younger Than 65 Years of Age? A Study from the Australian Orthopaedic Association National Joint Replacement Registry
- Author
-
Stoney, James, Graves, Stephen E., de Steiger, Richard N., Rainbird, Sophia, Kelly BMath, Thu-Lan, and Hatton, Alesha
- Published
- 2020
- Full Text
- View/download PDF
6. What Is the Effect of Using a Competing-risks Estimator when Predicting Survivorship After Joint Arthroplasty: A Comparison of Approaches to Survivorship Estimation in a Large Registry
- Author
-
Cuthbert, Alana R., Graves, Stephen E., Giles, Lynne C., Glonek, Gary, and Pratt, Nicole
- Published
- 2021
- Full Text
- View/download PDF
7. Erratum to: Is Cemented or Cementless Femoral Stem Fixation More Durable in Patients Older than 75 Years of Age? A Comparison of the Best-performing Stems
- Author
-
Tanzer, Michael, Graves, Stephen E., Peng, Andrea, and Shimmin, Andrew J.
- Published
- 2020
- Full Text
- View/download PDF
8. Does Knee Prosthesis Survivorship Improve When Implant Designs Change? Findings from the Australian Orthopaedic Association National Joint Replacement Registry
- Author
-
Lewis, Peter L., Graves, Stephen E., de Steiger, Richard N., Campbell, David G., Peng, Yi, Hatton, Alesha, and Lorimer, Michelle
- Published
- 2020
- Full Text
- View/download PDF
9. What Is the Risk of Revision Surgery in Hydroxyapatite-coated Femoral Hip Stems? Findings From a Large National Registry
- Author
-
Inacio, Maria C., Lorimer, Michelle, Davidson, David C., De Steiger, Richard N., Lewis, Peter L., and Graves, Stephen E.
- Published
- 2018
- Full Text
- View/download PDF
10. Does the Risk of Rerevision Vary Between Porous Tantalum Cups and Other Cementless Designs After Revision Hip Arthroplasty?
- Author
-
Laaksonen, Inari, Lorimer, Michelle, Gromov, Kirill, Rolfson, Ola, Mäkelä, Keijo T., Graves, Stephen E., Malchau, Henrik, and Mohaddes, Maziar
- Published
- 2017
- Full Text
- View/download PDF
11. Increase in Total Joint Arthroplasty Projected from 2014 to 2046 in Australia: A Conservative Local Model With International Implications
- Author
-
Inacio, Maria C. S., Graves, Stephen E., Pratt, Nicole L., Roughead, Elizabeth E., and Nemes, Szilard
- Published
- 2017
- Full Text
- View/download PDF
12. Is Cemented or Cementless Femoral Stem Fixation More Durable in Patients Older Than 75 Years of Age? A Comparison of the Best-performing Stems
- Author
-
Tanzer, Michael, Graves, Stephen E., Peng, Andrea, and Shimmin, Andrew J.
- Published
- 2018
- Full Text
- View/download PDF
13. Unicompartmental Knee Arthroplasty Revision to TKA: Are Tibial Stems and Augments Associated With Improved Survivorship?
- Author
-
Lewis, Peter L., Davidson, David C., Graves, Stephen E., de Steiger, Richard N., Donnelly, William, and Cuthbert, Alana
- Published
- 2018
- Full Text
- View/download PDF
14. No increased risk of cancer associated with metal-on-metal or ceramic-on-ceramic procedures compared to other bearing surfaces in patients with total hip arthroplasty: A nationwide linked registry cohort analysis of 167,837 patients.
- Author
-
Pratt, Nicole L., Cicuttini, Flavia M., Wang, Yuanyuan, and Graves, Stephen E.
- Subjects
TOTAL hip replacement ,DISEASE risk factors ,PROSTATE ,HIP joint ,ARTHROPLASTY ,COHORT analysis ,RENAL cancer - Abstract
Objectives: Studies have identified increased cancer risk among patients undergoing total hip arthroplasty (THA) compared to the general population. However, evidence of all-cause and site-specific cancer risk associated with different bearing surfaces has varied, with previous studies having short latency periods with respect to use of modern Metal-on-Metal (MoM) bearings. Using the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) linked to Australasian Association of Cancer Registries data, our aim was to evaluate risk of all-cause and site-specific cancer according to bearing surfaces in patients undergoing THA for osteoarthritis and whether risk increased with MoM bearings. Methods: Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated by comparing number of observed cancer cases to expected number based on incidence rate in the Australian population. All-cause and site-specific cancer rates were calculated for all conventional stemmed THA (csTHA) and resurfacing THA (rsTHA) procedures performed for osteoarthritis. Cox proportional hazards models were used to compare cancer rates for MoM, ceramic-on-ceramic (CoC) and resurfacing procedures with a comparison group comprising metal-on-polyethylene (MoP) or ceramic-on-polyethylene (CoP) procedures. Results: There were 156,516 patients with csTHA procedures and 11,321 with rsTHA procedures for osteoarthritis performed between 1999 and 2012. Incidence of all-cause cancer was significantly higher for csTHA (SIR 1.24, 95% CI 1.22–1.26) and rsTHA (SIR 1.74, 95% CI 1.39–2.04) compared to the Australian population. For csTHA, there was no significant difference in all-site cancer rates for MoM (Hazard Ratio (HR) 1.01, 95%CI 0.96–1.07) or CoC (HR 0.98, 95%CI 0.94–1.02) compared to MoP and CoP bearings. Significantly increased risk of melanoma, non-Hodgkins lymphoma, myeloma, leukaemia, prostate, colon, bladder and kidney cancer was found for csTHA and, prostate cancer, melanoma for rsTHA procedures when compared to the Australian population, although risk was not significantly different across bearing surfaces. Conclusions: csTHA and rsTHA procedures were associated with increased cancer incidence compared to the Australian population. However, no excess risk was observed for MoM or CoC procedures compared to other bearing surfaces. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
15. Reduced Revision Rates in Total Shoulder Arthroplasty With Crosslinked Polyethylene: Results From the Australian Orthopaedic Association National Joint Replacement Registry.
- Author
-
Page, Richard S., Alder-Price, Angela C., Rainbird, Sophia, Graves, Stephen E., de Steiger, Richard N., Peng, Yi, Holder, Carl, Lorimer, Michelle F., and Gill, Stephen D.
- Subjects
TOTAL shoulder replacement ,ARTHROPLASTY ,POLYETHYLENE ,TOTAL hip replacement ,PROPORTIONAL hazards models ,SHOULDER ,TOTAL knee replacement ,PHENOLS ,ACQUISITION of data ,TREATMENT effectiveness ,OSTEOARTHRITIS ,BENZOPYRANS ,REOPERATION ,ORTHOPEDICS ,PROSTHESIS design & construction ,COMPLICATIONS of prosthesis - Abstract
Background: Loss of glenoid fixation is a key factor affecting the survivorship of primary total shoulder arthroplasty (TSA). It is not known whether the lower revision rates associated with crosslinked polyethylene (XLPE) compared with those of non-XLPE identified in hip and knee arthroplasty apply to shoulder arthroplasty.Questions/purposes: We used data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to compare the revision rates of primary stemmed anatomic TSA using XLPE to procedures using non-XLPE. In patients receiving a primary stemmed anatomic TSA for osteoarthritis, we asked: (1) Does the rate of revision or reason for revision vary between XLPE and non-XLPE all-polyethylene glenoid components? (2) Is there any difference in the revision rate when XLPE is compared with non-XLPE across varying head sizes? (3) Is there any difference in survival among prosthesis combinations with all-polyethylene glenoid components when they are used with XLPE compared with non-XLPE?Methods: Data were extracted from the AOANJRR from April 16, 2004, to December 31, 2020. The AOANJRR collects data on more than 97% of joint replacements performed in Australia. The study population included all primary, stemmed, anatomic TSA procedures performed for osteoarthritis using all-polyethylene glenoid components. Procedures were grouped into XLPE and non-XLPE bearing surfaces for comparison. Of the 10,102 primary stemmed anatomic TSAs in the analysis, 39% (3942 of 10,102) used XLPE and 61% (6160 of 10,102) used non-XLPE. There were no differences in age, gender, or follow-up between groups. Revision rates were determined using Kaplan-Meier estimates of survivorship to describe the time to the first revision, with censoring at the time of death or closure of the database at the time of analysis. Revision was defined as removal, replacement, or addition of any component of a joint replacement. The unadjusted cumulative percent revision after the primary arthroplasty (with 95% confidence intervals [CIs]) was calculated and compared using Cox proportional hazard models adjusted for age, gender, fixation, and surgeon volume. Further analyses were performed stratifying according to humeral head size, and a prosthesis-specific analysis adjusted for age and gender was also performed. This analysis was restricted to prosthesis combinations that were used at least 150 times, accounted for at least four revisions, had XLPE and non-XLPE options available, and had a minimum of 3 years of follow-up.Results: Non - XLPE had a higher risk of revision than XLPE after 1.5 years (HR 2.3 [95% CI 1.6 to 3.1]; p < 0.001). The cumulative percent revision at 12 years was 5% (95% CI 4% to 6%) for XLPE and 9% (95% CI 8% to 10%) for non-XLPE. There was no difference in the rate of revision for head sizes smaller than 44 mm. Non-XLPE had a higher rate of revision than XLPE for head sizes 44 to 50 mm after 2 years (HR 2.3 [95% CI 1.5 to 3.6]; p < 0.001) and for heads larger than 50 mm for the entire period (HR 2.2 [95% CI 1.4 to 3.6]; p < 0.001). Two prosthesis combinations fulfilled the inclusion criteria for the prosthesis-specific analysis. One had a higher risk of revision when used with non-XLPE compared with XLPE after 1.5 years (HR 3.7 [95% CI 2.2 to 6.3]; p < 0.001). For the second prosthesis combination, no difference was found in the rate of revision between the two groups.Conclusion: These AOANJRR data demonstrate that noncrosslinked, all-polyethylene glenoid components have a higher revision rate compared with crosslinked, all-polyethylene glenoid components when used in stemmed anatomic TSA for osteoarthritis. As polyethylene type is likely an important determinant of revision risk, crosslinked polyethylene should be used when available, particularly for head sizes larger than 44 mm. Further studies will need to be undertaken after larger numbers of shoulder arthroplasties have been performed to determine whether this reduction in revision risk associated with XLPE bears true for all TSA designs.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF
16. What Is the Outcome of the First Revision Procedure of Primary THA for Osteoarthritis? A Study From the Australian Orthopaedic Association National Joint Replacement Registry.
- Author
-
de Steiger, Richard N., Lewis, Peter L., Harris, Ian, Lorimer, Michelle F., and Graves, Stephen E.
- Subjects
ARTHROPLASTY ,PROPORTIONAL hazards models ,PERIPROSTHETIC fractures ,OSTEOARTHRITIS ,HIP surgery ,REOPERATION ,RADIOSTEREOMETRY ,TOTAL hip replacement ,BONE resorption ,ACQUISITION of data ,ARTIFICIAL joints ,TREATMENT effectiveness ,METALS ,KAPLAN-Meier estimator ,ORTHOPEDICS ,PROSTHESIS design & construction ,BONE fractures ,COMPLICATIONS of prosthesis ,DISEASE complications - Abstract
Background: Joint arthroplasty registries traditionally report survivorship outcomes mainly on primary joint arthroplasty. The outcome of first revision procedures is less commonly reported, because large numbers of primary procedures are required to analyze a sufficient number of first revision procedures. Additionally, adequate linkage of primary procedures to revisions and mortality is required. When undertaking revision hip surgery, it is important for surgeons to understand the outcomes of these procedures to better inform patients.Questions/purposes: Using data from a large national joint registry, we asked: (1) What is the overall rate of revision of the first aseptic revision procedure for a primary THA? (2) Does the rate of revision of the first revision vary by the diagnosis for the first revision? (3) What is the mortality after the first revision, and does it vary by the reason for first revision?Methods: The Australian Orthopaedic Association National Joint Replacement Registry longitudinally maintains data on all primary and revision joint arthroplasties, with nearly 100% capture. The analyses for this study were performed on primary THA procedures in patients with a diagnosis of osteoarthritis up to December 31, 2020, who had undergone subsequent revision. We excluded all primary THAs involving metal-on-metal and ceramic-on-metal bearing surfaces and prostheses with exchangeable necks because these designs may have particular issues associated with revisions, such as extensive soft tissue destruction, that are not seen with conventional bearings, making a comparative analysis of the first revision involving these bearing surfaces more complicated. Metal-on-metal bearing surfaces have not been used in Australia since 2017. We identified 17,046 first revision procedures from the above study population and after exclusions, included 13,713 first revision procedures in the analyses. The mean age at the first revision was 71 ± 11 years, and 55% (7496 of 13,713) of the patients were women. The median (IQR) time from the primary procedure to the first revision was 3 years (0.3 to 7.3), ranging from 0.8 years for the diagnosis of dislocation and instability to 10 years for osteolysis. There was some variation depending on the reason for the first revision. For example, patients undergoing revision for fracture were slightly older (mean age 76 ± 11 years) and patients undergoing revision for dislocation were more likely to be women (61% [2213 of 3620]). The registry has endeavored to standardize the sequence of revisions and uses a numerical approach to describe revision procedures. The first revision is the revision of a primary procedure, the second revision is the revision of the first revision, and so on. We therefore described the outcome of the first revision as the cumulative percent second revision. The outcome measure was the cumulative percent revision, which was defined using Kaplan-Meier estimates of survivorship to describe the time to the second revision. Hazard ratios from Cox proportional hazards models, adjusting for age and gender, were performed to compare the revision rates among groups. When possible, the cumulative percent second revision at the longest follow-up timepoint was determined with the available data, and when there were insufficient numbers, we used appropriate earlier time periods.Results: The cumulative percent second revision at 18 years was 26% (95% confidence interval [CI] 24% to 28%). When comparing the outcome of the first revision by reason, prosthesis dislocation or instability had the highest rate of second revision compared with the other reasons for first revision. Dual-mobility prostheses had a lower rate of second revision for dislocation or instability than head sizes 32 mm or smaller and when compared to constrained prostheses after 3 months. There was no difference between dual-mobility prostheses and head sizes larger than 32 mm. There were no differences in the rate of second revision when first revisions for loosening, periprosthetic fracture, and osteolysis were compared. If cemented femoral fixation was performed at the time of the first revision, there was a higher cumulative percent second revision for loosening than cementless fixation from 6 months to 6 years, and after this time, there was no difference. The overall mortality after a first revision of primary conventional THA was 1% at 30 days, 2% at 90 days, 5% at 1 year, and 40% at 10 years. A first revision for periprosthetic fracture had the highest mortality at all timepoints compared with other reasons for the first revision.Conclusion: Larger head sizes and dual-mobility cups may help reduce further revisions for dislocation, and the use of cementless stems for a first revision for loosening seems advantageous. Surgeons may counsel patients about the higher risk of death after first revision procedures, particularly if the first revision is performed for periprosthetic fracture.Level of Evidence Level III, therapeutic study. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF
17. Poor Knee-specific and Generic Patient-reported Outcome Measure Scores at 6 Months Are Associated With Early Revision Knee Arthroplasty: A Study From the Australian Orthopaedic Association National Joint Replacement Registry.
- Author
-
Ackerman, Ilana N., Harris, Ian A., Cashman, Kara, Rowden, Neville, Lorimer, Michelle, and Graves, Stephen E.
- Subjects
ARTHROPLASTY ,REOPERATION ,LUMBAR pain ,KNEE ,KNEE pain ,PAIN measurement ,TOTAL knee replacement ,ACQUISITION of data ,TREATMENT effectiveness ,QUALITY of life ,QUESTIONNAIRES ,ORTHOPEDICS ,POSTOPERATIVE pain - Abstract
Background: The ability to identify which patients are at a greater risk of early revision knee arthroplasty has important practical and resource implications. Many international arthroplasty registries administer patient-reported outcome measures (PROMs) to provide a holistic assessment of pain, function, and quality of life. However, few PROM scores have been evaluated as potential indicators of early revision knee arthroplasty, and earlier studies have largely focused on knee-specific measures.Questions/purposes: This national registry-based study asked: (1) Which 6-month postoperative knee-specific and generic PROM scores are associated with early revision knee arthroplasty (defined as revision surgery performed 6 to 24 months after the primary procedure)? (2) Is a clinically important improvement in PROM scores (based on thresholds for the minimal important change) after primary knee arthroplasty associated with a lower risk of early revision?Methods: Preoperative and 6-month postoperative PROM scores for patients undergoing primary knee arthroplasty were sourced from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and Arthroplasty Clinical Outcomes Registry National. Between January 2013 and December 2020, PROM data were available for 19,402 primary total knee arthroplasties; these data were linked to AOANJRR data on revision knee arthroplasty. Of these, 3448 procedures were excluded because they did not have 6-month PROM data, they had not reached the 6-month postoperative point, they had died before 24 months, or they had received revision knee arthroplasty before the 6-month PROMs assessment. After these exclusions, data were analyzed for 15,954 primary knee arthroplasties. Associations between knee-specific (knee pain, Oxford Knee Score, and 12-item Knee injury and Osteoarthritis Outcome Score [KOOS-12]) or generic PROM scores (5-level EuroQol quality of life instrument [EQ-5D], EQ VAS, perceived change, and satisfaction) and revision surgery were explored using t-tests, chi-square tests, and regression models. Ninety-four revision procedures were performed at 6 to 24 months, most commonly for infection (39% [37 procedures]). The early revision group was younger than the unrevised group (mean age 64 years versus 68 years) and a between-group difference in American Society of Anesthesiologists (ASA) grade was noted. Apart from a small difference in preoperative low back pain for the early revision group (mean low back pain VAS 4.2 points for the early revision group versus 3.3 points for the unrevised group), there were no between-group differences in preoperative knee-specific or generic PROM scores on univariate analysis. As the inclusion of ASA grade or low back pain score did not alter the model results, the final multivariable model included only the most clinically plausible confounders (age and gender) as covariates. Multivariable models (adjusting for age and gender) were also used to examine the association between a clinically important improvement in PROM scores (based on published thresholds for minimal important change) and the likelihood of early revision.Results: After adjusting for age and gender, poor postoperative knee pain, Oxford, KOOS-12, EQ-5D, and EQ VAS scores were all associated with early revision. A one-unit increase (worsening) in knee pain at 6 months was associated with a 31% increase in the likelihood of revision (RR 1.31 [95% confidence interval (CI) 1.19 to 1.43]; p < 0.001). Reflecting the reversed scoring direction, a one-unit increase (improvement) in Oxford or KOOS-12 score was associated with a 9% and 5% reduction in revision risk, respectively (RR for Oxford: 0.91 [95% CI 0.90 to 0.93]; p < 0.001; RR for KOOS-12 summary: 0.95 [95% CI 0.94 to 0.97]; p < 0.001). Patient dissatisfaction (RR 6.8 [95% CI 3.7 to 12.3]) and patient-perceived worsening (RR 11.7 [95% CI 7.4 to 18.5]) at 6 months were also associated with an increased likelihood of early revision. After adjusting for age and gender, patients who did not achieve a clinically important improvement in PROM scores had a higher risk of early revision (RR 2.9 for the knee pain VAS, RR 4.2 for the Oxford Knee Score, RR 6.3 to 8.6 for KOOS-12, and RR 2.3 for EQ-5D) compared with those who did (reference group).Conclusion: Knee-specific and generic PROM scores offer an efficient approach to identifying patients at greater risk of early revision surgery, using either the 6-month score or the magnitude of improvement. These data indicate that surgeons can use single- and multi-item measures to detect a patient-perceived unsuccessful surgical outcome at 6 months after primary knee arthroplasty. Surgeons should be alert to poor PROM scores at 6 months or small improvements in scores (for example, less than 2 points for knee pain VAS or less than 10.5 points for Oxford Knee Score), which signal a need for direct patient follow-up or expedited clinical review.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF
18. The effect of surgeon’s preference for hybrid or cemented fixation on the long-term survivorship of total knee replacement
- Author
-
Vertullo, Christopher J, Graves, Stephen E, Peng, Yi, and Lewis, Peter L
- Subjects
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.
- Published
- 2018
19. Body weight at early and middle adulthood, weight gain and persistent overweight from early adulthood are predictors of the risk of total knee and hip replacement for osteoarthritis
- Author
-
Wang, Yuanyuan, Wluka, Anita E., Simpson, Julie A., Giles, Graham G., Graves, Stephen E., de Steiger, Richard N., and Cicuttini, Flavia M.
- Published
- 2013
- Full Text
- View/download PDF
20. The Association Between Preoperative Patient-Reported Health Status and Postoperative Survey Completion Following Arthroplasty: Registry-Based Cohort Study.
- Author
-
Harris, Ian A., Yi Peng, Ackerman, Ilana, and Graves, Stephen E.
- Published
- 2022
- Full Text
- View/download PDF
21. Does a Prescription-based Comorbidity Index Correlate with the American Society of Anesthesiologists Physical Status Score and Mortality After Joint Arthroplasty? A Registry Study.
- Author
-
Kerr, Mhairi M., Graves, Stephen E., Duszynski, Katherine M., Inacio, Maria C., de Steiger, Richard N., Harris, Ian A., Ackerman, Ilana N., Jorm, Louisa R., Lorimer, Michelle F., Gulyani, Aarti, and Pratt, Nicole L.
- Subjects
- *
PHARMACY databases , *ARTHROPLASTY , *ANESTHESIOLOGISTS , *COMORBIDITY , *RANK correlation (Statistics) - Abstract
Background: When analyzing the outcomes of joint arthroplasty, an important factor to consider is patient comorbidities. The presence of multiple comorbidities has been associated with longer hospital stays, more postoperative complications, and increased mortality. The American Society of Anesthesiologists (ASA) physical status classification system score is a measure of a patient's overall health and has been shown to be associated with complications and mortality after joint arthroplasty. The Rx-Risk score is another measure for determining the number of different health conditions for which an individual is treated, with a possible score ranging from 0 to 47.Questions/purposes: For patients undergoing THA or TKA, we asked: (1) Which metric, the Rx-Risk score or the ASA score, correlates more closely with 30- and 90-day mortality after TKA or THA? (2) Is the Rx-Risk score correlated with the ASA score?Methods: This was a retrospective analysis of the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) database linked to two other national databases, the National Death Index (NDI) database and the Pharmaceutical Benefits Scheme (PBS), a dispensing database. Linkage to the NDI provided outcome information on patient death, including the fact of and date of death. Linkage to the PBS was performed to obtain records of all medicines dispensed to patients undergoing a joint replacement procedure. Patients were included if they had undergone either a THA (119,076 patients, 131,336 procedures) or TKA (182,445 patients, 215,712 procedures) with a primary diagnosis of osteoarthritis, performed between 2013 and 2017. We excluded patients with missing ASA information (THA: 3% [3055 of 119,076]; TKA: 2% [4095 of 182,445]). This left 127,761 primary THA procedures performed in 116,021 patients (53% [68,037 of 127,761] were women, mean age 68 ± 11 years) and 210,501 TKA procedures performed in 178,350 patients (56% [117,337 of 210,501] were women, mean age 68 ± 9 years) included in this study. Logistic regression models were used to determine the concordance of the ASA and Rx-Risk scores and 30-day and 90-day postoperative mortality. The Spearman correlation coefficient (r) was used to estimate the correlation between the ASA score and Rx-Risk score. All analyses were performed separately for THAs and TKAs.Results: We found both the ASA and Rx-Risk scores had high concordance with 30-day mortality after THA (ASA: c-statistic 0.83 [95% CI 0.79 to 0.86]; Rx-Risk: c-statistic 0.82 [95% CI 0.79 to 0.86]) and TKA (ASA: c-statistic 0.73 [95% CI 0.69 to 0.78]; Rx-Risk: c-statistic 0.74 [95% CI 0.70 to 0.79]). Although both scores were strongly associated with death, their correlation was moderate for patients undergoing THA (r = 0.45) and weak for TKA (r = 0.38). However, the median Rx-Risk score did increase with increasing ASA score. For example, for THAs, the median Rx-Risk score was 1, 3, 5, and 7 for ASA scores 1, 2, 3, and 4, respectively. For TKAs, the median Rx-Risk score was 2, 4, 5, and 7 for ASA scores 1, 2, 3, and 4, respectively.Conclusion: The ASA physical status and RxRisk were associated with 30-day and 90-day mortality; however, the scores were only weakly to moderately correlated with each other. This suggests that although both scores capture a similar level of patient illness, each score may be capturing different aspects of health. The Rx-Risk may be used as a complementary measure to the ASA score.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
22. A Comparison of Revision Rates for Osteoarthritis of Primary Reverse Total Shoulder Arthroplasty to Primary Anatomic Shoulder Arthroplasty with a Cemented All-polyethylene Glenoid: Analysis from the Australian Orthopaedic Association National Joint Replacement Registry.
- Author
-
Gill, David R. J., Page, Richard S., Graves, Stephen E., Rainbird, Sophia, Hatton, Alesha, and Page BMedSci, Richard S
- Subjects
PROPORTIONAL hazards models ,RHEUMATOID arthritis diagnosis ,GENDER ,OSTEOARTHRITIS ,PROSTHETICS ,RESEARCH ,BONE cements ,RESEARCH methodology ,POLYETHYLENE ,ACQUISITION of data ,MEDICAL cooperation ,EVALUATION research ,COMPARATIVE studies ,REOPERATION ,COMPLICATIONS of prosthesis - Abstract
Background: There has been decreased use of anatomic total shoulder arthroplasty (aTSA) because reverse TSA (rTSA) is increasingly being used for the same indications. Although short-term studies generally have not found survivorship differences between these implant designs, these studies are often small and their follow-up is limited to the short term. Likewise, the degree to which patient characteristics (such as gender, age, and American Society of Anesthesiologists [ASA] score) may or may not be associated with survivorship differences calls for larger and longer-term studies than is often possible in single-center designs. Large national registry studies may be able to help answer these questions.Questions/purposes: By analyzing a large Australian registry series of primary aTSAs with cemented all-polyethylene glenoids and rTSA for osteoarthritis (OA), we asked: (1) Is the revision risk for OA higher for aTSA with all-polyethylene glenoids or for rTSA, adjusting for patient characteristics such as age, gender, ASA score, and BMI? (2) Is the patient's gender associated with differences in the revision risk after controlling for the potentially confounding factors of age, ASA score, and BMI?Methods: In this comparative, observational registry study performed between January 1, 2015, and December 31, 2019, all primary aTSAs with all-polyethylene glenoids and rTSA for OA as determined by the treating surgeon and reported to our national registry formed two groups for analysis. The study period was set to time-match for the collection of ASA score and BMI in 2012 and 2015, respectively. Our registry enrolls more than 97% of all shoulder arthroplasties undertaken in Australia. There were 29,294 primary shoulder arthroplasties; 1592 hemiarthroplasties, 1876 resurfacing and stemless shoulders, 269 stemmed, and 11,674 reverse shoulder arthroplasties were excluded for other diagnoses. A total of 1210 metal-backed glenoids in stemmed aTSA for OA were excluded. A total of 3795 primary aTSAs with all-polyethylene glenoids and 8878 primary rTSAs for OA were compared. An aTSA with an all-polyethylene glenoid and rTSA were more likely to be performed in women (56% and 61% of patients, respectively). The mean age was 69 ± 8 years for aTSA with all-polyethylene glenoids and 74 ± 8 years for rTSA. One aTSA for OA was performed in a patient with an unknown glenoid type. The ASA score (n = 12,438) and BMI (n = 11,233) were also recorded. The maximum follow-up was 5 years for both groups, and the mean follow-up was 2.6 ± 1.4 years for aTSA with all-polyethylene glenoids and 2.1 ± 1.4 years for rTSA. The endpoint was time to revision (all causes), and the cumulative percent revision was determined using Kaplan-Meier estimates of survivorship (time to revision) and HRs from Cox proportional hazard models that were adjusted for age, gender, ASA score, and BMI category.Results: Overall, there were no differences in the 4-year cumulative percent revision between the groups; the 4-year cumulative percent revision was 3.5% for aTSA with all-polyethylene glenoids (95% CI 2.9%-4.2%) and 3.0% for rTSA (95% CI 2.6%-3.5%). There was an increased risk of revision of rTSA compared with aTSA using all-polyethylene glenoids in the first 3 months (HR 2.17 [95% CI 1.25-3.70]; p = 0.006, adjusted for age, gender, ASA score, and BMI). After that time, there was no difference in the rate of revision, with the same adjustments. In the first 3 months, men undergoing rTSA had a higher rate of revision than men with aTSA using all-polyethylene glenoids (HR 4.0 [95% CI 1.72-9.09]; p = 0.001, adjusted for age, BMI, and ASA). There was no difference between men in the two groups after that time. Women with aTSA using all-polyethylene glenoids were at a greater risk of revision than women with rTSA from 3 months onward (HR 2.77 [95% CI 1.55-4.92]; p < 0.001, adjusted for age, BMI, and ASA), with no difference before that time.Conclusion: Given the absence of survivorship differences at 4 years between rTSA and aTSA, but in light of the differences in the revision risk between men and women, surgeons might select an aTSA with an all-polyethylene glenoid to treat OA, despite the current popularity of rTSA. However, there are survivorship differences between genders. Future studies should evaluate whether our comparative findings are replicated in men and women undergoing aTSA with all-polyethylene glenoids and rTSA for primary diagnoses such as rheumatoid arthritis or post-traumatic arthritis, and whether there are functional differences between the two implant designs when used for OA.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
23. Heart failure after conventional metal-on-metal hip replacements
- Author
-
Gillam, Marianne H, Pratt, Nicole L, Inacio, Maria C S, Roughead, Elizabeth E, Shakib, Sepehr, Nicholls, Stephen J, and Graves, Stephen E
- Subjects
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.
- Published
- 2016
24. Evaluating Quality of Life in Hip and Knee Replacement: Psychometric Properties of the World Health Organization Quality of Life Short Version Instrument
- Author
-
ACKERMAN, ILANA N., GRAVES, STEPHEN E., BENNELL, KIM L., and OSBORNE, RICHARD H.
- Published
- 2006
25. Severely Compromised Quality of Life in Women and Those of Lower Socioeconomic Status Waiting For Joint Replacement Surgery
- Author
-
ACKERMAN, ILANA N., GRAVES, STEPHEN E., WICKS, IAN P., BENNELL, KIM L., and OSBORNE, RICHARD H.
- Published
- 2005
26. Are responders to patient health surveys representative of those invited to participate? An analysis of the Patient-Reported Outcome Measures Pilot from the Australian Orthopaedic Association National Joint Replacement Registry.
- Author
-
Harris, Ian A., Cashman, Kara, Lorimer, Michelle, Peng, Yi, Ackerman, Ilana, Heath, Emma, and Graves, Stephen E.
- Subjects
PATIENT reported outcome measures ,ARTIFICIAL joints ,KNEE ,PATIENT surveys ,TELEPHONE calls ,TOTAL shoulder replacement ,SHOULDER ,GENDER differences (Psychology) - Abstract
Background: Patient-reported outcome measures (PROMs) are commonly used to evaluate surgical outcome in patients undergoing joint replacement surgery, however routine collection from the target population is often incomplete. Representative samples are required to allow inference from the sample to the population. Although higher capture rates are desired, the extent to which this improves the representativeness of the sample is not known. We aimed to measure the representativeness of data collected using an electronic PROMs capture system with or without telephone call follow up, and any differences in PROMS reporting between electronic and telephone call follow up. Methods: Data from a pilot PROMs program within a large national joint replacement registry were examined. Telephone call follow up was used for people that failed to respond electronically. Data were collected pre-operatively and at 6 months post-operatively. Responding groups (either electronic only or electronic plus telephone call follow up) were compared to non-responders based on patient characteristics (joint replaced, bilaterality, age, sex, American Society of Anesthesiologist (ASA) score and Body Mass Index (BMI)) using chi squared test or ANOVA, and PROMs for the two responder groups were compared using generalised linear models adjusted for age and sex. The analysis was restricted to those undergoing primary elective hip, knee or shoulder replacement for osteoarthritis. Results: Pre-operatively, 73.2% of patients responded electronically and telephone follow-up of non-responders increased this to 91.4%. Pre-operatively, patients responding electronically, compared to all others, were on average younger, more likely to be female, and healthier (lower ASA score). Similar differences were found when telephone follow up was included in the responding group. There were little (if any) differences in the post-operative comparisons, where electronic responders were on average one year younger and were more likely to have a lower ASA score compared to those not responding electronically, but there was no significant difference in sex or BMI. PROMs were similar between those reporting electronically and those reporting by telephone. Conclusion: Patients undergoing total joint replacement who provide direct electronic PROMs data are younger, healthier and more likely to be female than non-responders, but these differences are small, particularly for post-operative data collection. The addition of telephone call follow up to electronic contact does not provide a more representative sample. Electronic-only follow up of patients undergoing joint replacement provides a satisfactory representation of the population invited to participate. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
27. 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.
- Author
-
Silman, Alan J, Combescure, Christophe, Ferguson, Rory J, Graves, Stephen E, Paxton, Elizabeth W, Frampton, Chris, Furnes, Ove, Fenstad, Anne Marie, Hooper, Gary, Garland, Anne, Spekenbrink-Spooren, Anneke, Wilkinson, J Mark, Mäkelä, Keijo, Lübbeke, Anne, and Rolfson, Ola
- Subjects
REPORTING of diseases ,TOTAL hip replacement ,CONFIDENCE intervals ,POPULATION geography ,SURVIVAL analysis (Biometry) ,DESCRIPTIVE statistics ,COMORBIDITY - Abstract
Background and purpose — A challenge comparing outcomes from total hip arthroplasty between countries is variation in preoperative characteristics, particularly comorbidity. Therefore, we investigated between-country variation in comorbidity in patients based on ASA class distribution, and determined any variation of ASA class to mortality risk between countries. Patients and methods — All arthroplasty registries collecting ASA class and mortality data in patients with elective primary THAs performed 2012–2016 were identified. Survival analyses of the influence of ASA class on 1-year mortality were performed by individual registries, followed by meta-analysis of aggregated data. Results — 6 national registries and 1 US healthcare organization registry with 418,916 THAs were included. There was substantial variation in the proportion of ASA class III/IV, ranging from 14% in the Netherlands to 39% in Finland. Overall, 1-year mortality was 0.93% (95% CI 0.87–1.01) and increased from 0.2% in ASA class I to 8.9% in class IV. The association between ASA class and mortality measured by hazard ratios (HR) was strong in all registries even after adjustment for age and sex, which reduced them by half in all registries. Combined adjusted HRs were 2.0, 6.1, and 22 for ASA class II–IV vs. I, respectively. Associations were moderately heterogeneous across registries. Interpretation — We observed large variation in ASA class distribution between registries, possibly explained by differences in background morbidity and/or international variation in access to surgery. The similar, strong mortality trends by ASA class between countries enhance the relevance of its use as an indicator of comorbidity in international registry studies. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
28. The rate of 2nd revision for shoulder arthroplasty as analyzed by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR).
- Author
-
Gill, David R J, Page, Richard S, Graves, Stephen E, Rainbird, Sophia, and Hatton, Alesha
- Subjects
SHOULDER surgery ,CONFIDENCE intervals ,REVERSE total shoulder replacement ,RISK assessment ,TREATMENT failure ,TREATMENT effectiveness ,COMPARATIVE studies ,REOPERATION ,KAPLAN-Meier estimator ,HUMERUS ,DESCRIPTIVE statistics ,TOTAL shoulder replacement ,PROPORTIONAL hazards models - Abstract
Background and purpose — The increase in shoulder arthroplasty may lead to a burden of revision surgery. This study compared the rate of (2nd) revision following aseptic 1st revision shoulder arthroplasty, considering the type of primary, and the class and type of the revision. Patients and methods — All aseptic 1st revisions of primary total reverse shoulder arthroplasty (rTSA group) and of primary total stemmed and stemless total shoulder arthroplasty (non-rTSA group) procedures reported to our national registry between April 2004 to December 2018 were included. The rate of 2nd revision was determined using Kaplan–Meier estimates and comparisons were made using Cox proportional hazards models. Results — There was an increased risk of 2nd revision in the 1st month only for the rTSA group (n = 700) compared with the non-rTSA group (n = 991); hazard ratio (HR) = 4.8 (95% CI 2.2–9). The cumulative percentage of 2nd revisions (CPR) was 24% in the rTSA group and 20% in the non-rTSA group at 8 years. There was an increased risk of 2nd revision for the type (cup vs. head) HR = 2.2 (CI 1.2–4.2), but not class of revision for the rTSA group. Minor (> 3 months) vs. major class revision, and humeral revision vs. all other revision types were second revision risk factors for the non-rTSA group. Interpretation — The CPR of revision shoulder arthroplasty was > 20% at 8 years and was influenced by the type of primary, the class, and the type of revision. The most common reasons for 2nd revision were instability/dislocation, loosening, and infection. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
29. Performance of the HOOS-12 and KOOS-12 instruments for evaluating outcomes from joint replacement surgery.
- Author
-
Ackerman, I.N., Soh, S-E., Harris, I.A., Cashman, K., Heath, E., Lorimer, M., Graves, S.E., Ackerman, Ilana N, Soh, Sze-Ee, Harris, Ian A, Cashman, Kara, Heath, Emma, Lorimer, Michelle, and Graves, Stephen E
- Abstract
Objective: To evaluate the psychometric properties of the 12-item Hip disability and Osteoarthritis Outcome Score (HOOS-12) and Knee injury and Osteoarthritis Outcome Score (KOOS-12) for use in evaluating outcomes after joint replacement for osteoarthritis.Design: Patient-reported outcomes data collected by the Australian Orthopaedic Association National Joint Replacement Registry were used for this analysis. HOOS-12 and KOOS-12 domain (pain, function, quality of life) and summary impact data were available. The Oxford Hip Score (OHS), Oxford Knee Score (OKS) and EQ-5D-5L were used as comparators. Instruments were administered pre-operatively and at 6 months post-operatively. Internal consistency reliability, floor and ceiling effects, convergent validity, known groups validity, and responsiveness were evaluated using standard psychometric techniques.Results: Baseline HOOS-12 and KOOS-12 data were available for 3,023 patients undergoing primary total hip replacement and 4,010 patients undergoing primary total knee replacement. At baseline, high internal consistency was demonstrated for all domains and summary scores (Cronbach's alpha: HOOS-12 = 0.81-0.93; KOOS-12 = 0.82-0.92). Post-operative ceiling effects (>15% of patients scoring the best possible score) were identified for the HOOS-12 pain (46%), function (39%) and quality of life domains (26%) and summary score (17%), and for the KOOS-12 pain (21%) and function domains (18%). The HOOS-12 and KOOS-12 could differentiate between two known groups (lowest/highest OHS or OKS quartiles post-operatively; p < 0.001) and were highly responsive to change (effect sizes for HOOS-12: 2.20-2.83; KOOS-12: 1.82-2.35).Conclusion: The HOOS-12 and KOOS-12 have good psychometric properties for capturing joint replacement outcomes including excellent responsiveness, although ceiling effects may limit monitoring of post-operative improvement. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
30. Implications for research and clinical use from a Rasch analysis of the HOOS-12 and KOOS-12 instruments.
- Author
-
Soh, S-E, Harris, I.A., Cashman, K., Heath, E., Lorimer, M., Graves, S.E., Ackerman, I.N., Sze-Ee, Soh, Harris, Ian A, Cashman, Kara, Heath, Emma, Lorimer, Michelle, Graves, Stephen E, and Ackerman, Ilana N
- Abstract
Objective: To evaluate the structural validity of the 12-item Hip disability and Osteoarthritis Outcome Score (HOOS-12) and 12-item Knee injury and Osteoarthritis Outcome Score (KOOS-12) using Rasch analysis and consider psychometric implications for research and clinical use.Method: Individual-level HOOS-12 and KOOS-12 data from the Australian Orthopaedic Association National Joint Replacement Registry, collected before and after primary total hip and knee replacement, were used for this analysis. Using the Rasch analytic approach, overall model fit and item fit were examined, together with potential reasons for misfit including response threshold ordering, differential item functioning, internal consistency, unidimensionality and item targeting.Results: Overall misfit to the Rasch model was evident for both instruments. A degree of item misfit was also observed, although most items demonstrated logical sequencing of response options. Only two items (hip/knee pain frequency and awareness of hip/knee problems) displayed disordered response thresholds. The pain, function, and quality of life domains of the HOOS-12 and KOOS-12 demonstrated excellent internal consistency reliability (person separation index: 0.80-0.93) and unidimensionality. A mismatch between item difficulty and person ability scores at the highest end of the HOOS-12 and KOOS-12 scales contributed to post-operative ceiling effects (mean logit for HOOS-12: 3.57; KOOS-12: 2.58; ≈0 indicates well-targeted scale).Conclusion: We found evidence to support the structural validity of the three HOOS-12 and KOOS-12 domains for evaluating joint replacement outcomes. However, there may be missing content in both instruments particularly for high-functioning patients. Minor refinement of some response options may be warranted to improve item performance. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
31. Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006–7: Australian Orthopaedic Association National Joint Replacement Registry
- Author
-
Brennan Sharon L, Stanford Tyman, Wluka Anita E, Henry Margaret J, Page Richard S, Graves Stephen E, Kotowicz Mark A, Nicholson Geoffrey C, and Pasco Julie A
- Subjects
Hip joint replacement ,Socioeconomic status ,Utilization ,Australia ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background The utilization of total hip replacement (THR) surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES) within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD) of Victoria, Australia. Methods Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006–7, primary THR with a diagnosis of osteoarthritis (OA) among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk. Results Females accounted for 46.9% of the 642 primary THR performed during 2006–7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70–79 years (males 6.1, and females 5.4 per 1,000 person years). Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups. Conclusions Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.
- Published
- 2012
- Full Text
- View/download PDF
32. Trabecular metal acetabular components in primary total hip arthroplasty
- Author
-
Laaksonen, Inari, Lorimer, Michelle, Gromov, Kirill, Eskelinen, Antti, Rolfson, Ola, Graves, Stephen E, Malchau, Henrik, and Mohaddes, Maziar
- Subjects
musculoskeletal diseases ,Adult ,Male ,Reoperation ,Prosthesis-Related Infections ,genetic structures ,Adolescent ,Arthroplasty, Replacement, Hip ,Prosthesis Design ,Joint Diseases/surgery ,Young Adult ,Humans ,Registries ,Child ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,Sweden ,Hip ,Middle Aged ,Arthroplasty, Replacement, Hip/adverse effects ,Metals ,Prosthesis-Related Infections/epidemiology ,Female ,sense organs ,Hip Prosthesis ,Joint Diseases - Abstract
Background and purpose - Trabecular metal (TM) cups have demonstrated favorable results in acetabular revision and their use in primary total hip arthroplasty (THA) is increasing. Some evidence show that TM cups might decrease periprosthetic infection (PPI) incidence. We compared the survivorship of TM cups with that of other uncemented cups in primary THA, and evaluated whether the use of TM cups is associated with a lower risk of PPI. Patients and methods - 10,113 primary THAs with TM cup and 85,596 THAs with other uncemented cups from 2 high-quality national arthroplasty registries were included. The mean follow-up times were 3.0 years for the TM cups and 3.8 years for the other uncemented cups. Results - The overall survivorship up to 8 years for TM cups and other uncemented cups was 94.4% and 96.2%, respectively (p = < 0.001). Adjusting for relevant covariates in a Cox regression model the TM cups had a persistently higher revision risk than other uncemented cups (HR =1.5, 95% CI 1.4-1.7, p = < 0.001). There was a slightly higher, though not statistically significant, revision rate for PPI in the TM group (1.2, 95% CI 1.0-1.6, p = 0.09). Interpretation - Risk of revision for any reason was higher for the TM cup than for other uncemented cups in primary THA. In contrast to our hypothesis, there was no evidence that the revision rate for PPI was lower in the TM cup patients. Regardless of the promising early and mid-term results for TM cups in hip revision arthroplasty, we would like to sound a note of caution on the increasing use of the TM design, especially in uncomplicated primary THAs, where uncemented titanium cups are considered to provide a reliable outcome.
- Published
- 2018
33. Lower prosthesis-specific 10-year revision rate with crosslinked than with non-crosslinked polyethylene in primary total knee arthroplasty
- Author
-
de Steiger, Richard N, Muratoglu, Orhun, Lorimer, Michelle, Cuthbert, Alana R, and Graves, Stephen E
- Subjects
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.
- Published
- 2015
34. Early revision in anatomic total shoulder arthroplasty in osteoarthritis: a cross-registry comparison.
- Author
-
Dillon, Mark T, Page, Richard S, Graves, Stephen E, Lorimer, Michelle F, Prentice, Heather A, Harris, Jessica E, Paxton, Elizabeth W, and Navarro, Ronald A
- Subjects
ARTHROPLASTY ,SHOULDER ,ROTATOR cuff ,PERIPROSTHETIC fractures ,YEAR ,SHOULDER osteoarthritis - Abstract
Background: We evaluated anatomic total shoulders undergoing early revision (less than two years) in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and the Kaiser Permanente Shoulder Arthroplasty Registry (KPSAR). Methods: A cross-sectional comparison of both registries was performed between the years of 2009 and 2012. Only patients who underwent anatomic total shoulder arthroplasty for a primary diagnosis of osteoarthritis were included. Aggregate-level data of patients undergoing early revisions done within two years of index arthroplasty were evaluated, and descriptive analysis was conducted. Results: During the study period, 4614 patients were identified in the AOANJRR compared to 2036 in the KPSAR. Rotator cuff pathology, component loosening, and prosthetic instability were among the most common reasons for revision in both registries. A higher rate of revision in the AOANJRR was found to be secondary to the failure of one specific prosthesis, which has since been discontinued Discussion: Comparing reasons for early revision in total shoulder arthroplasty revealed several similarities between the AOANJRR and KPSAR. Differences were also noted, and this study served to highlight the importance prosthesis selection can play in determining outcomes. Cooperation among registries may allow for earlier identification of risk factors for failure in shoulder arthroplasty. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
35. Efficacy and safety of vertebroplasty for treatment of painful osteoporotic vertebral fractures: a randomised controlled trial [ACTRN012605000079640]
- Author
-
Wengier Lainie, Wriedt Chris J, Mitchell Peter, Wark John D, Ebeling Peter R, Osborne Richard H, Buchbinder Rachelle, Connell David, Graves Stephen E, Staples Margaret P, and Murphy Bridie
- Subjects
Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background Vertebroplasty is a promising but as yet unproven treatment for painful osteoporotic vertebral fractures. It involves radiographic-guided injection of various types of bone cement directly into the vertebral fracture site. Uncontrolled studies and two controlled quasi-experimental before-after studies comparing volunteers who were offered treatment to those who refused it, have suggested an early benefit including rapid pain relief and improved function. Conversely, several uncontrolled studies and one of the controlled before-after studies have also suggested that vertebroplasty may increase the risk of subsequent vertebral fractures, particularly in vertebrae adjacent to treated levels or if cement leakage into the adjacent disc has occurred. As yet, there are no completed randomised controlled trials of vertebroplasty for osteoporotic vertebral fractures. The aims of this participant and outcome assessor-blinded randomised placebo-controlled trial are to i) determine the short-term efficacy and safety (3 months) of vertebroplasty for alleviating pain and improving function for painful osteoporotic vertebral fractures; and ii) determine its medium to longer-term efficacy and safety, particularly the risk of further fracture over 2 years. Design A double-blind randomised controlled trial of 200 participants with one or two recent painful osteoporotic vertebral fractures. Participants will be stratified by duration of symptoms (< and ≥ 6 weeks), gender and treating radiologist and randomly allocated to either the treatment or placebo. Outcomes will be assessed at baseline, 1 week, 1, 3, 6, 12 and 24 months. Outcome measures include overall, night and rest pain on 10 cm visual analogue scales, quality of life measured by the Assessment of Quality of Life, Osteoporosis Quality of Life and EQ-5D questionnaires; participant perceived recovery on a 7-point ordinal scale ranging from 'a great deal worse' to 'a great deal better'; disability measured by the Roland-Morris Disability Questionnaire; timed 'Up and Go' test; and adverse effects. The presence of new fractures will be assessed by radiographs of the thoracic and lumbar spine performed at 12 and 24 months. Discussion The results of this trial will be of major international importance and findings will be immediately translatable into clinical practice. Trial registration Australian Clinical Trial Register # [ACTRN012605000079640]
- Published
- 2008
- Full Text
- View/download PDF
36. Increases in the rates of primary and revision knee replacement are reducing: a 15-year registry study across 3 continents.
- Author
-
Lewis, Peter L, Graves, Stephen E, Robertsson, Otto, Sundberg, Martin, Paxton, Elizabeth W, Prentice, Heather A, and W-Dahl, Annette
- Subjects
- *
TOTAL knee replacement , *PHYSICIAN practice patterns , *DISEASE incidence - Abstract
Background and purpose — Rates of knee replacement (KR) are increasing worldwide. Based on population and practice changes, there are forecasts of a further exponential increase in primary knee replacement through to 2030, and a corresponding increase in revision knee replacement. We used registry data to document changes in KR over the past 15 years, comparing practice changes across Sweden, Australia, and the United States. This may improve accuracy of future predictions. Patients and methods — Aggregated data from the Swedish Knee Arthroplasty Register (SKAR), the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and the Kaiser Permanente Joint Replacement Registry (KPJRR) were used to compare surgical volume of primary and revision KR from 2003 to 2017. Incidence was calculated using population census statistics from Statistics Sweden and the Australian Bureau of Statistics, as well as the yearly active membership numbers from Kaiser Permanente. Further analysis of KR by age < 65 and ≥ 65 years was carried out. Results — All registries recorded an increase in primary and revision KR, with a greater increase seen in the KPJRR. The rate of increase slowed during the study period. In Sweden and Australia, there was a smaller increase in revision surgery compared with primary procedures. There was consistency in the mean age at surgery, with a steady small decrease in the proportion of women having primary KR. The incidence of KR in the younger age group remained low in all 3 registries, but the proportional increases were greater than those seen in the ≥ 65 years of age group. Interpretation — There has been a generalized deceleration in the rate of increase of primary and revision KR. While there are regional differences in KR incidence, and rates of change, the rate of increase does not seem to be as great as previously predicted. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
37. Multi-state models and arthroplasty histories after unilateral total hip arthroplasties
- Author
-
Gillam, Marianne H, Ryan, Philip, Salter, Amy, and Graves, Stephen E
- Subjects
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.
- Published
- 2012
38. Perioperative mortality after hemiarthroplasty related to fixation method
- Author
-
Costain, Darren J, Whitehouse, Sarah L, Pratt, Nicole L, Graves, Stephen E, Ryan, Philip, and Crawford, Ross W
- Subjects
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.
- Published
- 2011
39. Poor outcome of revised resurfacing hip arthroplasty
- Author
-
de Steiger, Richard N, Miller, Lisa N, Prosser, Gareth H, Graves, Stephen E, Davidson, David C, and Stanford, Tyman E
- Subjects
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.
- Published
- 2010
40. What Is the Risk of Repeat Revision When Patellofemoral Replacement Is Revised to TKA? An Analysis of 482 Cases From a Large National Arthroplasty Registry.
- Author
-
Lewis, Peter L., Graves, Stephen E., Cuthbert, Alana, Parker, David, and Myers, Peter
- Subjects
- *
PROPORTIONAL hazards models , *PLICA syndrome , *ARTHROPLASTY - Abstract
Background: Patellofemoral replacements (PFRs) have a higher rate of revision than unicompartmental knee arthroplasty or TKA. However, there is little information regarding why PFRs are revised, the components used for these revisions, or the outcome of the revision procedure. Some contend that PFR is a bridging procedure that can easily be revised to a TKA with similar results as a primary TKA; however, others dispute this suggestion.Questions/purposes: (1) In the setting of a large national registry, what were the reasons for revision of PFR to TKA and was the level of TKA constraint used in the revision associated with a subsequent risk of rerevision? (2) Is the risk of revision of the TKA used to revise a PFR greater than the risk of revision after a primary TKA and greater than the risk of rerevision after revision TKA?Methods: Data were obtained from the Australian Orthopaedic Association Joint Replacement Registry through December 31, 2016, for TKA revision procedures after PFR. Because revisions for infection may be staged procedures resulting in further planned operations, for the revision analyses, these were excluded. There were 3251 PFRs, 482 of which were revised to TKA during the 17-year study period. The risk of second revision was calculated using Kaplan-Meier estimates of survivorship for PFRs revised to TKAs, and that risk was compared with the risk of first revision after TKA and also with the risk of a second revision after revision TKA. Hazard ratios (HRs) from Cox proportional hazards models were used to compare second revision rates among the different levels of prosthesis constraint used in the index revision after PFR (specifically, cruciate-retaining versus cruciate-substituting).Results: The main reasons for revising a PFR to TKA were progression of disease (56%), loosening (17%), and pain (12%). With the numbers available for analysis, there was no difference in the risk of a second revision when a PFR was revised to a cruciate-retaining TKA than when it was revised to a cruciate-substituting TKA (HR, 1.24 [0.65-2.36]; p = 0.512). A total of 204 (42%) of the PFR revisions had the patella component revised when the PFR was converted to a TKA. There difference in rates of second revision when the patella component was revised or not revised (HR, 1.01 [0.55-1.85]; p = 0.964). When we eliminated the devices that ceased to be used before 2005 (older devices), we found no change in the overall risk of repeat revision. The risk of a PFR that was revised to a TKA undergoing a second revision was greater than the risk of TKA undergoing a first revision (HR, 2.39 [1.77-3.24]; p < 0.001), but it was less than the risk of a revision TKA undergoing a second revision (HR, 0.60 [0.43-0.81]; p = 0.001).Conclusions: The risk of second revision when a PFR is revised is not altered if cruciate-retaining or posterior-stabilized TKA is used for the revision nor if the patella component is revised or not revised. The risk of repeat revision after revision of a PFR to a TKA was much higher than the risk of revision after a primary TKA, and these findings did not change when we analyzed only devices in use since 2005. When PFR is used for the management of isolated patellofemoral osteoarthritis, patients should be counselled not only about the high revision rate of the primary procedure, but also the revision rate after TKA. Further studies regarding the functional outcomes of these procedures may help clarify the value of PFRs and subsequent revisions.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
41. How Does Mortality Risk Change Over Time After Hip and Knee Arthroplasty?
- Author
-
Harris, Ian A., Hatton, Alesha, Pratt, Nicole, Lorimer, Michelle, Naylor, Justine M., de Steiger, Richard, Lewis, Peter, and Graves, Stephen E.
- Subjects
TOTAL hip replacement ,DEATH rate ,MORTALITY ,LIFE tables ,PATIENT selection ,TOTAL ankle replacement - Abstract
Background: Mortality after THA and TKA is lower than expected for several years after surgery when compared with age- and sex-adjusted population data. With long-term followup (beyond approximately 10 years), some evidence has suggested that this trend reverses, such that postsurgical mortality is higher than expected as more time passes. However, the degree to which this may be the case has not been clearly established.Questions/purposes: In this large-registry study, we asked: What is the long-term mortality after THA and TKA compared with the expected mortality, adjusted for age, sex, and calendar year.Methods: Using data on 243,057 THAs and 363,355 TKAs performed for osteoarthritis from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 2003 to 2016, and life tables from the Australian Bureau of Statistics the Standardised Mortality Ratio (SMR), relative mortality and excess mortality (relative to the expected mortality for people of the same sex and age in the same country) was calculated separately for hips and knees. The AOANJRR contains near-complete (98%-100%) data from all hospitals in Australia performing arthroplasty but does not include followup data on people who have left the country. Followup was from the date of surgery to 13 years, mean 5.8 years.Results: We found a lower-than-expected mortality for THA and TKA in the early years after surgery. This association diminished over time and the mortality became higher than expected after 12 years for both THA and TKA. For THA, the excess mortality (per thousand people) increased from 11 fewer deaths (95% CI, 10-11 fewer) after 1 year to four more deaths (95% CI, 0-9 more) in the 13th year, and the SMR increased from 0.50 (95% CI, 0.48-0.52) after 1 year to 1.07 (95% CI, 0.99-1.14) in the 13th year. For TKA, the excess mortality (per thousand people) increased from 12 fewer deaths (95% CI, 12-13 fewer) after 1 year to five more deaths (95% CI 2-9 more) in the 13th year, and the SMR increased from 0.39 (95% CI, 0.37-0.40) after 1 year to 1.09 (95% CI, 1.03-1.15) in the 13th year.Conclusions: Mortality after hip and knee arthroplasty is lower than expected (based on population norms) in the first 8 years to 9 years but gradually increases over time, becoming higher than expected after 12 years. The lower-than-expected mortality in the early years after surgery is likely the result of patient selection with patients undergoing primary arthroplasty having better health at the time of surgery than that of the age- and sex-matched population. The increasing mortality over time cannot be regression to the mean, as late mortality is higher than expected, moving beyond the mean. It is important to understand if there are modifiable factors associated with this increased mortality. The reasons for the change are uncertain. Factors to consider in future research include determining the effect of different patient factors on late mortality. Some of these included higher obesity rates for joint replacement patients and the association or causal impact of osteoarthritis and/or its treatment to increase late mortality in a similar manner to other forms of arthritis. There is also a possibility that the arthroplasty device itself may affect late mortality.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
42. An international comparison of THA patients, implants, techniques, and survivorship in Sweden, Australia, and the United States.
- Author
-
Paxton, Elizabeth W, Cafri, Guy, Nemes, Szilard, Lorimer, Michelle, Kärrholm, Johan, Malchau, Henrik, Graves, Stephen E, Namba, Robert S, and Rolfson, Ola
- Subjects
ARTIFICIAL joints ,CHI-squared test ,HIP joint diseases ,OSTEOARTHRITIS ,PATIENTS ,COMPLICATIONS of prosthesis ,REOPERATION ,SURGERY ,COMORBIDITY ,TOTAL hip replacement ,TREATMENT effectiveness ,DESCRIPTIVE statistics ,KAPLAN-Meier estimator ,EVALUATION ,EQUIPMENT & supplies - Abstract
Background and purpose — International comparisons of total hip arthroplasty (THA) practices and outcomes provide an opportunity to enhance the quality of care worldwide. We compared THA patients, implants, techniques, and survivorship in Sweden, Australia, and the United States. Patients and methods — Primary THAs due to osteoarthritis were identified using Swedish (n = 159,695), Australian (n = 279,693), and US registries (n = 69,641) (2003–2015). We compared patients, practices, and implant usage across the countries using descriptive statistics. We evaluated time to all-cause revision using Kaplan–Meier survival curves. We assessed differences in countries' THA survival using chi-square tests of survival probabilities. Results — Sweden had fewer comorbidities than the United States and Australia. Cement fixation was used predominantly in Sweden and cementless in the United States and Australia. The direct anterior approach was used more frequently in the United States and Australia. Smaller head sizes (≤ 32 mm vs. ≥ 36 mm) were used more often in Sweden than the United States and Australia. Metal-on-highly cross-linked polyethylene was used more frequently in the United States and Australia than in Sweden. Sweden's 5- (97.8%) and 10-year THA survival (95.8%) was higher than the United States' (5-year: 97.0%; 10-year: 95.2%) and Australia (5-year: 96.3%; 10-year: 93.5%). Interpretation — Patient characteristics, surgical techniques, and implants differed across the 3 countries, emphasizing the need to adjust for demographics, surgical techniques, and implants and the need for global standardized definitions to compare THA survivorship internationally. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
43. Meta-analysis of individual registry results enhances international registry collaboration.
- Author
-
Paxton, Elizabeth W, Mohaddes, Maziar, Laaksonen, Inari, Lorimer, Michelle, Graves, Stephen E, Malchau, Henrik, Namba, Robert S, Kärrholm, John, Rolfson, Ola, and Cafri, Guy
- Subjects
HIP joint diseases diagnosis ,OSTEOARTHRITIS diagnosis ,TOTAL hip replacement ,AGE distribution ,BONE cements ,CONFIDENCE intervals ,REPORTING of diseases ,HIP joint diseases ,INTERPROFESSIONAL relations ,META-analysis ,ORTHOPEDIC implants ,OSTEOARTHRITIS ,REOPERATION ,RISK assessment ,SEX distribution ,STATISTICS ,DATA analysis ,EFFECT sizes (Statistics) ,PROPORTIONAL hazards models ,ODDS ratio ,EQUIPMENT & supplies - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
44. Effect of Aspirin vs Enoxaparin on 90-Day Mortality in Patients Undergoing Hip or Knee Arthroplasty: A Secondary Analysis of the CRISTAL Cluster Randomized Trial.
- Author
-
Sidhu, Verinder S., Kelly, Thu-Lan, Pratt, Nicole, Graves, Stephen E., Buchbinder, Rachelle, Adie, Sam, Cashman, Kara, Ackerman, Ilana N., Bastiras, Durga, Brighton, Roger, Burns, Alexander W. R., Chong, Beng Hock, Clavisi, Ornella, Cripps, Maggie, Dekkers, Mark, de Steiger, Richard, Dixon, Michael, Ellis, Andrew, Griffith, Elizabeth C., and Hale, David
- Published
- 2023
- Full Text
- View/download PDF
45. What is the Benefit of Optimum Prosthesis Combination Selection in Total Knee Replacement? An Analysis of 482373 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry
- Author
-
Vertullo, Christopher, Graves, Stephen E., Peng, Yi, and Lewis, Peter L.
- Published
- 2018
- Full Text
- View/download PDF
46. The Effect of Knee Replacement Design & Polyethylene Type on Revision Risk for Infection. An Analysis from the AOANJRR.
- Author
-
Vertullo, Christopher, Lorimer, Michelle, Peng, Yi, Lewis, Peter L., de Steiger, Richard, and Graves, Stephen E.
- Published
- 2018
- Full Text
- View/download PDF
47. Lifetime Risk of Primary Total Hip Replacement Surgery for Osteoarthritis From 2003 to 2013: A Multinational Analysis Using National Registry Data.
- Author
-
Ackerman, Ilana N., Bohensky, Megan A., Steiger, Richard, Brand, Caroline A., Eskelinen, Antti, Fenstad, Anne Marie, Furnes, Ove, Graves, Stephen E., Haapakoski, Jaason, Mäkelä, Keijo, Mehnert, Frank, Nemes, Szilard, Overgaard, Søren, Pedersen, Alma B., Garellick, Göran, de Steiger, Richard, Mäkelä, Keijo, Overgaard, Søren, and Garellick, Göran
- Subjects
HIP joint diseases diagnosis ,OSTEOARTHRITIS diagnosis ,DATABASES ,HIP joint diseases ,INTERNATIONAL relations ,LONGEVITY ,OSTEOARTHRITIS ,RISK assessment ,TOTAL hip replacement ,ACQUISITION of data - Abstract
Objective: To compare the lifetime risk of total hip replacement (THR) surgery for osteoarthritis (OA) between countries, and over time.Methods: Data on primary THR procedures performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland, Norway, and Sweden. Life tables and population data were also obtained for each country. Lifetime risk of THR was calculated for 2003 and 2013 using registry, life table, and population data.Results: In 2003, lifetime risk of THR ranged from 8.7% (Denmark) to 15.9% (Norway) for females, and from 6.3% (Denmark) to 8.6% (Finland) for males. With the exception of females in Norway (where lifetime risk started and remained high), lifetime risk of THR increased significantly for both sexes in all countries from 2003 to 2013. In 2013, lifetime risk of THR was as high as 1 in 7 women in Norway, and 1 in 10 men in Finland. Females consistently demonstrated the highest lifetime risk of THR at both time points. Notably, lifetime risk for females in Norway was approximately double the risk for males in 2003 (females 15.9% [95% confidence interval (95% CI) 15.6-16.1], males 6.9% [95% CI 6.7-7.1]), and 2013 (females 16.0% [95% CI 15.8-16.3], males 8.3% [95% CI 8.1-8.5]).Conclusion: Using representative, population-based data, this study found statistically significant increases in the lifetime risk of THR in 5 countries over a 10-year period, and substantial between-sex differences. These multinational risk estimates can inform resource planning for OA service delivery. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
48. 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
-
(Geeske) Peeters, G M E E, Rainbird, Sophia, Lorimer, Michelle, Dobson, Annette J, Mishra, Gita D, and Graves, Stephen E
- Subjects
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]
- Published
- 2017
- Full Text
- View/download PDF
49. Heart failure after conventional metal-on-metal hip replacements.
- Author
-
GILLAM, Marianne H., PRATT, Nicole L., INACIO, Maria C. S., ROUGHEAD, Elizabeth E., SHAKIB, Sepehr, NICHOLLS, Stephen J., and GRAVES, Stephen E.
- Subjects
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]
- Published
- 2017
- Full Text
- View/download PDF
50. Few geographic and socioeconomic variations exist in primary total shoulder arthroplasty: a multi-level study of Australian registry data.
- Author
-
Brennan-Olsen, Sharon L., Page, Richard S., Lane, Stephen E., Lorimer, Michelle, Buchbinder, Rachelle, Osborne, Richard H., Pasco, Julie A., Wluka, Anita E., Sanders, Kerrie M., Ebeling, Peter R., and Graves, Stephen E.
- Subjects
ARTHROPLASTY ,JOINT surgery ,PLASTIC surgery ,SHOULDER surgery ,SHOULDER joint surgery ,AGE distribution ,OSTEOARTHRITIS ,SEX distribution ,SOCIOECONOMIC factors ,ACQUISITION of data - Abstract
Background: Associations between socioeconomic position (SEP) and the uptake of primary total shoulder arthroplasty (TSA) is not well understood in the Australian population, thus potentially limiting equitable allocation of healthcare resources. We used the Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR) to examine whether geographic or socioeconomic variations exist in TSA performed for a diagnosis of osteoarthritis 2007-11 for all Australians aged ≥40 years.Methods: Primary anatomical and reverse TSA data were extracted from the AOA NJRR which captures >99 % of all TSA nationally. Residential addresses were cross-referenced to Australian Bureau of Statistics 2011 Census data to identify SEP measured at the area-level (categorised into deciles), and geographic location defined as Australian State/Territory of residence. We used a Poisson distribution for the number of TSA over the study period, and modelled the effects of age, SEP and geographic location using multilevel modelling.Results: During 2007-11, we observed 6,123 TSA (62.2 % female). For both sexes, TSA showed a proportional increase with advancing age. TSA did not vary by SEP or geographic location, with the exception of greater TSA among men in New South Wales.Conclusions: Using a national registry approach we provide the first reliable picture of TSA at a national level. The uptake of TSA was equitable across SEP; however, there was some variation between the States/Territories. With an aging population, it is imperative that monitoring of major surgical procedures continues, and be focused toward determining whether TSA uptake correlates with need across different social and area-based groups. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.