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Background: Anterior approach total hip arthroplasty (THA) decreases the rate of dislocation but increases femoral-sided complications in the way of periprosthetic fractures and component loosening. A cemented prosthesis may reduce femoral-sided complications and improve the risk:benefit profile of anterior approach THA. Methods: Data from the Australian National Joint Replacement Registry were analysed for patients undergoing primary THA via the anterior or posterior approach using a cemented polished femoral stem from January 2015 to December 2021. The primary outcome measure was the cumulative percent revision (CPR) for all causes and CPR for femoral component loosening and fracture. The CPR for the primary outcome measures were compared between the anterior and posterior approach and adjusted for age, sex, ASA score, BMI and femoral head size. Results: The study included 60,739 THAs with cemented stems (10,742 anterior, 49,997 posterior). The rate of revision of the anterior versus the posterior approach did not significantly differ (HR 0.87 (95% CI, 0.74–1.03), p = 0.100). Anterior approach THA had a significantly higher rate of revision for femoral component loosening (HR 5.06 [95% CI, 3.08–8.30], p < 0.001); and a decreased rate of revision for infection (HR 0.59 [95% CI, 0.43–0.81], p = 0.001) and dislocation/instability (HR 0–3 months 0.48 [95% CI, 0.27–0.83], p = 0.008; HR >3 months 0.30 [95% CI, 0.15–0.61], p < 0.001). There was no difference in the rate of revision surgery for fracture between the 2 approaches (HR 1.01 [95% CI, 0.71–1.43]), p = 0.975). Conclusions: There is no significant difference in overall revision rates with cemented femoral fixation performed with an anterior or posterior approach. Cemented fixation performed with the anterior approach partly mitigates femoral complications with no difference in the revision rate for fracture but an increased rate of femoral component loosening. [ABSTRACT FROM AUTHOR]

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]

Introduction: Breakage of the femoral stem component of a total hip replacement is now uncommon but continues to be seen with certain stem designs and in certain patient groups. Data previously published on this topic has been limited, either gathered from a single surgeon or centre, or included only a single stem design. Methods: We reviewed the data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), identified and analysed 143 stem breakages over a period of 16 years, covering 44 different stem designs. Results: Our data confirms previously published findings that risk factors for stem breakage include patient age at implantation of under 70, male gender, as well as the use of exchangeable necks. We found no association with initial diagnosis, or type of acetabular component implanted. We did however also find, excluding exchangeable neck designs, that after 4.5 years a cemented stem had a significantly higher risk of breakage then a cementless stem. Discussion: To our knowledge this is the 1st paper to suggest cemented fixation as a specific risk factor for stem breakage. The analysis of rare complications such as stem breakage is only possible through large data collection systems such as the AOANJRR. Whilst there have been recent advances in materials and manufacturing techniques, we recommend that surgeons are aware of all the specific risks when considering implant choices for individual patients. [ABSTRACT FROM AUTHOR]

Introduction: Periprosthetic joint infection (PJI) is a serious complication after total hip arthroplasty (THA) and bearing material's associations to PJI prevalence is largely unknown. The main purposes of this study were to determine if revision for infection varied depending on the type of bearing surface used in primary THA and to study whether patient or implant related factors had an effect on this variation. Methods: A total of 177,237 primary THA procedures from the Australian Registry (AOANJRR) were analysed. 3 bearing surfaces were compared. Metal-on-highly cross-linked polyethylene (MoXP) bearing had been used in 95,129 hips, ceramic-on-highly cross-linked polyethylene (CoXP) in 24,269 hips, and ceramic-on-ceramic (CoC) in 57,839 hips. Revision rates for infection were compared between the 3 groups. Results: Both MoXP and CoXP had a higher revision rate for infection compared to CoC hips (hazard ratio [HR] 1.46 (1.25, 1.72), p < 0.001) and HR 1.42 (1.15, 1.75), p = 0.001 respectively). Patients aged 70 years or less had a lower revision rate for infection when a CoC bearing was used. This difference was independent of sex, and prostheses selection. No difference was evident if the femoral component was cemented or a head size of 28 mm was used. Discussion: In this registry-based material, use of a CoC bearing was associated with a lower risk of revision for infection in patients younger than 70 years when cementless femoral components were used. Further studies are needed to verify this finding. [ABSTRACT FROM AUTHOR]