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18 years of results with cemented primary hip prostheses in the Norwegian Arthroplasty Register: concerns about some newer implants.

https://arctichealth.org/en/permalink/ahliterature147752
Source
Acta Orthop. 2009 Aug;80(4):402-12
Publication Type
Article
Date
Aug-2009
Author
Birgitte Espehaug
Ove Furnes
Lars B Engesaeter
Leif I Havelin
Author Affiliation
The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway. birgitte.espehaug@helse-bergen.no
Source
Acta Orthop. 2009 Aug;80(4):402-12
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Arthroplasty, Replacement, Hip - adverse effects - methods
Bone Cements
Cementation
Follow-Up Studies
Hip Prosthesis - adverse effects
Humans
Norway
Outcome Assessment (Health Care)
Prosthesis Failure
Registries
Time Factors
Abstract
Few studies have compared the long-term survival of cemented primary total hip arthroplasties (THAs), and several prostheses have been used without adequate knowledge of their endurance. We studied long-term outcome based on data in the Norwegian Arthroplasty Register.
The 10 most used prosthesis brands in 62,305 primary Palacos or Simplex cemented THAs reported to the Register from 1987 through 2007 were included. Survival analyses with revision as endpoint (for any cause or for aseptic loosening) were performed using Kaplan-Meier and multiple Cox regression with time-dependent covariates. Revision rate ratios (RRs) were estimated for the follow-up intervals: 0-5, 6-10, and > 10 years.
5 prosthesis brands (cup/stem combinations) (Charnley, Exeter, Titan, Spectron/ITH, Link IP/Lubinus SP; n = 24,728) were investigated with 0-20 year follow-up (inserted 1987-1997). After 18 years, 11% (95% CI: 10.6-12.1) were revised for any cause and 8.4% (7.7-9.1) for aseptic loosening. Beyond 10 years of follow-up, the Charnley cup had a lower revision rate due to aseptic loosening than Exeter (RR = 1.8) and Spectron (RR = 2.4) cups. For stems, beyond 10 years we did not find statistically significant differences comparing Charnley with Titan, ITH, and SP stems, but the Exeter stem had better results (RR = 05). 10 prosthesis brands (9 cups in combination with 6 stems; n = 37,577) were investigated with 0-10 years of follow-up (inserted from 1998 through 2007). The Charnley cup had a lower revision rate due to aseptic loosening than all cups except the IP. Beyond 5 years follow-up, the Reflection All-Poly cup had a 14 times higher revision rate. For stems, beyond 5 years the Spectron-EF (RR = 6.1) and Titan (RR = 5.5) stems had higher revision rates due to aseptic loosening than Charnley. The analyses also showed a marked improvement in Charnley results between the periods 1987-1997 and 1998-2007.
We observed clinically important differences between cemented prosthesis brands and identified inferior results for previously largely undocumented prostheses, including the commonly used prosthesis combination Reflection All-Poly/ Spectron-EF. The results were, however, satisfactory according to international standards.
Notes
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PubMed ID
19857178 View in PubMed
Less detail

An economic model to evaluate cost-effectiveness of computer assisted knee replacement surgery in Norway.

https://arctichealth.org/en/permalink/ahliterature112465
Source
BMC Musculoskelet Disord. 2013;14:202
Publication Type
Article
Date
2013
Author
Øystein Gøthesen
James Slover
Leif Havelin
Jan Erik Askildsen
Henrik Malchau
Ove Furnes
Author Affiliation
Department of Orthopaedic Surgery, Haugesund Hospital, Karmsundsgate 120, 5528, Haugesund, Norway. oystein.gothesen@helse-fonna.no
Source
BMC Musculoskelet Disord. 2013;14:202
Date
2013
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Knee - economics - methods
Cost-Benefit Analysis
Humans
Markov Chains
Middle Aged
Models, Economic
Norway
Prosthesis Failure
Quality of Life
Quality-Adjusted Life Years
Surgery, Computer-Assisted - economics
Survival Rate
Abstract
The use of Computer Assisted Surgery (CAS) for knee replacements is intended to improve the alignment of knee prostheses in order to reduce the number of revision operations. Is the cost effectiveness of computer assisted surgery influenced by patient volume and age?
By employing a Markov model, we analysed the cost effectiveness of computer assisted surgery versus conventional arthroplasty with respect to implant survival and operation volume in two theoretical Norwegian age cohorts. We obtained mortality and hospital cost data over a 20-year period from Norwegian registers. We presumed that the cost of an intervention would need to be below NOK 500,000 per QALY (Quality Adjusted Life Year) gained, to be considered cost effective.
The added cost of computer assisted surgery, provided this has no impact on implant survival, is NOK 1037 and NOK 1414 respectively for 60 and 75-year-olds per quality-adjusted life year at a volume of 25 prostheses per year, and NOK 128 and NOK 175 respectively at a volume of 250 prostheses per year. Sensitivity analyses showed that the 10-year implant survival in cohort 1 needs to rise from 89.8% to 90.6% at 25 prostheses per year, and from 89.8 to 89.9% at 250 prostheses per year for computer assisted surgery to be considered cost effective. In cohort 2, the required improvement is a rise from 95.1% to 95.4% at 25 prostheses per year, and from 95.10% to 95.14% at 250 prostheses per year.
The cost of using computer navigation for total knee replacements may be acceptable for 60-year-old as well as 75-year-old patients if the technique increases the implant survival rate just marginally, and the department has a high operation volume. A low volume department might not achieve cost-effectiveness unless computer navigation has a more significant impact on implant survival, thus may defer the investments until such data are available.
Notes
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PubMed ID
23829478 View in PubMed
Less detail

Better survival of hybrid total knee arthroplasty compared to cemented arthroplasty.

https://arctichealth.org/en/permalink/ahliterature271743
Source
Acta Orthop. 2015;86(6):714-20
Publication Type
Article
Date
2015
Author
Gunnar Petursson
Anne Marie Fenstad
Leif Ivar Havelin
Øystein Gøthesen
Stein Håkon Låstad Lygre
Stephan M Röhrl
Ove Furnes
Source
Acta Orthop. 2015;86(6):714-20
Date
2015
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Knee - methods
Bone Cements - therapeutic use
Female
Humans
Kaplan-Meier Estimate
Knee Prosthesis
Male
Norway - epidemiology
Proportional Hazards Models
Prosthesis Failure - etiology
Registries
Risk factors
Abstract
There have been few comparative studies on total knee replacement (TKR) with cemented tibia and uncemented femur (hybrid TKR). Previous studies have not shown any difference in revision rate between cemented and hybrid fixation, but these studies had few hybrid prostheses. We have evaluated the outcome of hybrid TKR based on data from the Norwegian Arthroplasty Register (NAR).
We compared 4,585 hybrid TKRs to 20,095 cemented TKRs with risk of revision for any cause as the primary endpoint. We included primary TKRs without patella resurfacing that were reported to the NAR during the years 1999-2012. To minimize the possible confounding effect of prosthesis brands, only brands that were used both as hybrids and cemented in more than 200 cases were included. Kaplan-Meier survival analysis and Cox regression analysis were done with adjustment for age, sex, and preoperative diagnosis. To include death as a competing risk, cumulative incidence function estimates were calculated.
Estimated survival at 11 years was 94.3% (95% CI: 93.9-94.7) in the cemented TKR group and 96.3% (CI: 95.3-97.3) in the hybrid TKR group. The adjusted Cox regression analysis showed a lower risk of revision in the hybrid group (relative risk = 0.58, CI: 0.48-0.72, p
Notes
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PubMed ID
26179889 View in PubMed
Less detail

Bone cement product and failure in total knee arthroplasty.

https://arctichealth.org/en/permalink/ahliterature280165
Source
Acta Orthop. 2017 Feb;88(1):75-81
Publication Type
Article
Date
Feb-2017
Author
Øystein Birkeland
Birgitte Espehaug
Leif I Havelin
Ove Furnes
Source
Acta Orthop. 2017 Feb;88(1):75-81
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Knee - methods
Bone Cements
Female
Follow-Up Studies
Humans
Incidence
Knee Prosthesis
Male
Middle Aged
Norway - epidemiology
Prosthesis Design
Prosthesis Failure - trends
Retrospective Studies
Time Factors
Abstract
Background and purpose - The bone cement market for total knee arthroplasty (TKA) in Norway has been dominated by a few products and distributors. Palacos with gentamicin had a market share exceeding 90% before 2005, but it was then withdrawn from the market and replaced by new slightly altered products. We have compared the survival of TKAs fixated with Palacos with gentamicin with the survival of TKAs fixated with the bone cements that took over the market. Patients and methods - Using data from the Norwegian Arthroplasty Register for the period 1997-2013, we included 26,147 primary TKAs in the study. The inclusion criteria were TKAs fixated with the 5 most used bone cements and the 5 most common total knee prostheses for that time period. 6-year Kaplan-Meier survival probabilities were established for each cement product. The Cox proportional hazards regression model was used to assess the association between bone cement product and revision risk. Separate analyses were performed with revision for any reason and revision due to deep infection within 1 year postoperatively as endpoints. Adjustments were made for age, sex, diagnosis, and prosthesis brand. Results - Survival was similar for the prostheses in the follow-up period, between the 5 bone cements included: Palacos with gentamicin, Refobacin Palacos R, Refobacin Bone Cement R (Refobacin BCR), Optipac Refobacin Bone Cement R (Optipac Refobacin BCR), and Palacos R?+?G. Interpretation - According to our findings, the use of the new bone cements led to a survival rate that was as good as with the old bone cement (Palacos with gentamicin).
PubMed ID
27841713 View in PubMed
Less detail

Comparison of the Norwegian knee arthroplasty register and a United States arthroplasty registry.

https://arctichealth.org/en/permalink/ahliterature127744
Source
J Bone Joint Surg Am. 2011 Dec 21;93 Suppl 3:20-30
Publication Type
Article
Date
Dec-21-2011
Author
Elizabeth W Paxton
Ove Furnes
Robert S Namba
Maria C S Inacio
Anne M Fenstad
Leif I Havelin
Author Affiliation
Department of Surgical Outcomes and Analysis, Kaiser Permanente, 3033 Bunker Hill Street, San Diego, CA 92109, USA. liz.w.paxton@kp.org
Source
J Bone Joint Surg Am. 2011 Dec 21;93 Suppl 3:20-30
Date
Dec-21-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee - adverse effects - methods - statistics & numerical data - utilization
Feasibility Studies
Female
Humans
International Cooperation
Knee Prosthesis - adverse effects - statistics & numerical data
Male
Middle Aged
Norway
Patient Selection
Product Surveillance, Postmarketing - statistics & numerical data
Prosthesis Design
Prosthesis Failure
Registries - statistics & numerical data
Reoperation
Survival Analysis
United States
Abstract
Several national total joint arthroplasty registries exist outside of the United States (U.S.) and have been used to compare rates and outcomes of total knee arthroplasty. Within the U.S., regional arthroplasty registries provide an opportunity to compare U.S. practices and outcomes with those of other countries. The purpose of this study was to compare the demographics, choice of implants, techniques, and outcomes of total knee arthroplasties in Norway to those from a large, U.S. integrated health-care system and to determine the feasibility of using aggregate-level data for international registry comparisons. The study sample consisted of 25,004 primary total knee arthroplasties performed in Norway and 56,208 from the Kaiser Permanente health-care system. Summary-level data were used to compare the two cohorts. At the time of the seven-year follow-up, the cumulative survival of the total knee prosthesis was 94.8% for the arthroplasties performed in Norway and 96.3% for those performed at Kaiser Permanente. The primary reasons for revision arthroplasty included infection, instability, pain, and aseptic loosening. Patient characteristics, selection of implants, surgical techniques, and outcomes differed between the cohorts. Harmonization of data elements and definitions is necessary for future international research.
PubMed ID
22262419 View in PubMed
Less detail

Conversion from failed hemiarthroplasty to total hip arthroplasty: a Norwegian Arthroplasty Register analysis of 595 hips with previous femoral neck fractures.

https://arctichealth.org/en/permalink/ahliterature159074
Source
Acta Orthop. 2007 Dec;78(6):711-8
Publication Type
Article
Date
Dec-2007
Author
Wender Figved
Eva Dybvik
Frede Frihagen
Ove Furnes
Jan Erik Madsen
Leif Ivar Havelin
Lars Nordsletten
Author Affiliation
Orthopaedic Centre, Ullevål University Hospital, Oslo, Norway. wender@mac.com
Source
Acta Orthop. 2007 Dec;78(6):711-8
Date
Dec-2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip
Female
Femoral Neck Fractures - surgery
Follow-Up Studies
Humans
Male
Middle Aged
Norway
Prosthesis Failure
Registries
Reoperation
Risk factors
Treatment Outcome
Abstract
Conversion total hip replacement (THR) is a common procedure after failed hemiarthroplasty, but there have been few reports describing the long-term outcome of this procedure.
Between 1987 and 2004, 595 THRs were reported to the Norwegian Arthroplasty Register as conversion THR for failed hemiarthroplasty after a femoral neck fracture in patients aged 60 years and older. 122 operations left the femoral stem intact, whereas 473 were converted with exchange of the femoral stem.
We found a lower risk of failure (revision surgery for any reason) for the conversion procedures with stem exchange (RR=0.4; 95% CI: 0.25-0.81) than for the conversion procedures that retained the femoral stem. For the 473 conversion arthroplasties with exchange of the stem, we found no difference in risk of failure compared to all revision stems in the register, either for the complete prosthesis (RR=0.8; CI: 0.50- 1.20) or for the stem (RR=0.9; CI: 0.53-1.59). However, for the 122 conversion procedures in which the femoral stem was retained, we found a significantly increased risk of failure for both the complete prosthesis (RR=4.6; CI: 2.8-7.6) and for the acetabular cup (RR=4.8; CI: 2.3-10) compared to primary hip arthroplasties.
Our findings indicate that the seemingly easy operation of implanting an acetabular cup to convert a hemiarthroplasty to a total hip arthroplasty is an uncertain procedure and that the threshold for replacing the stem should be low.
PubMed ID
18236176 View in PubMed
Less detail

Countrywise results of total hip replacement. An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database.

https://arctichealth.org/en/permalink/ahliterature104675
Source
Acta Orthop. 2014 Apr;85(2):107-16
Publication Type
Article
Date
Apr-2014
Author
Keijo T Mäkelä
Markus Matilainen
Pekka Pulkkinen
Anne M Fenstad
Leif I Havelin
Lars Engesaeter
Ove Furnes
Søren Overgaard
Alma B Pedersen
Johan Kärrholm
Henrik Malchau
Göran Garellick
Jonas Ranstam
Antti Eskelinen
Author Affiliation
Department of Orthopaedics and Traumatology , Turku University Hospital.
Source
Acta Orthop. 2014 Apr;85(2):107-16
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Hip - statistics & numerical data
Denmark
Female
Finland
Hip Fractures - surgery
Hip Prosthesis - statistics & numerical data
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Norway
Osteoarthritis, Hip - surgery
Proportional Hazards Models
Prosthesis Failure
Registries
Reoperation - statistics & numerical data
Sweden
Treatment Outcome
Abstract
An earlier Nordic Arthroplasty Register Association (NARA) report on 280,201 total hip replacements (THRs) based on data from 1995-2006, from Sweden, Norway, and Denmark, was published in 2009. The present study assessed THR survival according to country, based on the NARA database with the Finnish data included.
438,733 THRs performed during the period 1995-2011 in Sweden, Denmark, Norway, and Finland were included. Kaplan-Meier survival analysis was used to calculate survival probabilities with 95% confidence interval (CI). Cox multiple regression, with adjustment for age, sex, and diagnosis, was used to analyze implant survival with revision for any reason as endpoint.
The 15-year survival, with any revision as an endpoint, for all THRs was 86% (CI: 85.7-86.9) in Denmark, 88% (CI: 87.6-88.3) in Sweden, 87% (CI: 86.4-87.4) in Norway, and 84% (CI: 82.9-84.1) in Finland. Revision risk for all THRs was less in Sweden than in the 3 other countries during the first 5 years. However, revision risk for uncemented THR was less in Denmark than in Sweden during the sixth (HR = 0.53, CI: 0.34-0.82), seventh (HR = 0.60, CI: 0.37-0.97), and ninth (HR = 0.59, CI: 0.36-0.98) year of follow-up.
The differences in THR survival rates were considerable, with inferior results in Finland. Brand-level comparison of THRs in Nordic countries will be required.
Notes
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PubMed ID
24650019 View in PubMed
Less detail

Does patella resurfacing really matter? Pain and function in 972 patients after primary total knee arthroplasty.

https://arctichealth.org/en/permalink/ahliterature145396
Source
Acta Orthop. 2010 Feb;81(1):99-107
Publication Type
Article
Date
Feb-2010
Author
Stein Håkon Låstad Lygre
Birgitte Espehaug
Leif Ivar Havelin
Stein Emil Vollset
Ove Furnes
Author Affiliation
The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Norway. stein.lygre@helse-bergen.no
Source
Acta Orthop. 2010 Feb;81(1):99-107
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee - adverse effects - methods
Female
Humans
Knee Prosthesis - adverse effects
Male
Middle Aged
Norway
Pain - etiology
Pain Measurement
Patella
Patient satisfaction
Prosthesis Design
Questionnaires
Registries
Treatment Outcome
Abstract
Resurfacing of the patella during primary total knee arthroplasty (TKA) is often recommended based on higher revision rates in non-resurfaced knees. As many of these revisions are insertions of a patella component due to pain, and since only patients with a non-resurfaced patella have the option of secondary resurfacing, we do not really know whether these patients have more pain and poorer function. The main purpose of the present paper was therefore to assess pain and function at least 2 years after surgery for unrevised primary non-resurfaced and resurfaced TKA, and secondary among prosthesis brands.
Information needed to calculate subscales from the knee injury and osteoarthritis outcome score (KOOS) was collected in a questionnaire given to 972 osteoarthritis patients with intact primary TKAs that had been reported to the Norwegian Arthroplasty Register. Pain and satisfaction on visual analog scales and improvement in EQ-5D index score DeltaEQ-5D) were also used as outcomes. Outcomes were measured on a scale from 0 to 100 units (worst to best). To estimate differences in mean scores, we used multiple linear regression with adjustment for possible confounders.
We did not observe any differences between resurfacing and non-resurfacing in any outcome, with estimated differences of 0.4. There was, however, a tendency of better results for the NexGen implant as compared to the reference brand AGC for symptoms (difference = 4.9, p = 0.05), pain (VAS) (difference = 8.3, p = 0.004), and satisfaction (VAS) (difference = 7.9, p = 0.02). However, none of these differences reached the stated level of minimal perceptible clinical difference.
Resurfacing of the patella has no clinical effect on pain and function after TKA. Differences between the brands investigated were small and they were assumed to be of minor importance.
Notes
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PubMed ID
20158405 View in PubMed
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Early failures among 7,174 primary total knee replacements: a follow-up study from the Norwegian Arthroplasty Register 1994-2000.

https://arctichealth.org/en/permalink/ahliterature189653
Source
Acta Orthop Scand. 2002 Apr;73(2):117-29
Publication Type
Article
Date
Apr-2002
Author
Ove Furnes
Birgitte Espehaug
Stein Atle Lie
Stein Emil Vollset
Lars Birger Engesaeter
Leif Ivar Havelin
Author Affiliation
Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway. ove.furnes@haukeland.no
Source
Acta Orthop Scand. 2002 Apr;73(2):117-29
Date
Apr-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee - statistics & numerical data
Female
Follow-Up Studies
Fracture Fixation - statistics & numerical data
Humans
Male
Middle Aged
Norway - epidemiology
Patella - surgery
Proportional Hazards Models
Prosthesis Failure
Registries - statistics & numerical data
Time Factors
Abstract
We studied primary total knee replacements (TKRs), reported to the Norwegian Arthroplasty Register, operated on between 1994 and 2000. A Cox multiple regression model was used to evaluate differences in survival among the prosthesis brands, their types of fixation, and whether or not the patella was resurfaced. In Norway in 1999, the incidence of knee prosthesis operations was 35 per 100,000 inhabitants. Cement was used as fixation in 87% of the knees, 10% were hybrid and 2% uncemented implants. Bicompartmental (not resurfaced patella) prostheses were used in 65% of the knees. With all revisions as endpoint, no statistically significant differences in the 5-year survival were found among the cemented tricompartmental prostheses brands: AGC 97% (n 279), Duracon 99% (n 101), Genesis I 95% (n 654), Kinemax 98% (n 213) and Tricon 96% (n 454). The bicompartmental LCS prostheses had a 5-year survival of 97% (n 476). The type of meniscal bearing in LCS knees had no effect on survival. Survival with revision for all causes as endpoint showed no differences among types of fixation, or bi- or tricompartmental prostheses. Pain alone was the commonest reason for revision of cemented bicompartmental prostheses. The risk of revision because of pain was 5.7 times higher (p
PubMed ID
12079006 View in PubMed
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Early postoperative mortality after 67,548 total hip replacements: causes of death and thromboprophylaxis in 68 hospitals in Norway from 1987 to 1999.

https://arctichealth.org/en/permalink/ahliterature13940
Source
Acta Orthop Scand. 2002 Aug;73(4):392-9
Publication Type
Article
Date
Aug-2002
Author
Stein Atle Lie
Lars Birger Engesaeter
Leif Ivar Havelin
Ove Furnes
Stein Emil Vollset
Author Affiliation
Section for Medical Statistics, Armauer Hansens Hus, University of Bergen, Haukeland Hospital, Norway. Stein.Lie@smis.uib.no
Source
Acta Orthop Scand. 2002 Aug;73(4):392-9
Date
Aug-2002
Language
English
Publication Type
Article
Keywords
Aged
Anticoagulants - therapeutic use
Arthroplasty, Replacement, Hip - mortality
Cause of Death
Female
Humans
Male
Norway - epidemiology
Osteoarthritis, Hip - mortality - surgery
Postoperative Complications - mortality
Registries
Research Support, Non-U.S. Gov't
Survival Analysis
Thrombolytic Therapy
Venous Thrombosis - mortality - prevention & control
Abstract
Patients in the Norwegian Arthroplasty Register with a total hip replacement (THR) have a lower long-term mortality than the age- and gender-matched Norwegian population. We analyzed the early postoperative mortality after 67,548 THR operations in 68 hospitals reported to the Norwegian Arthroplasty Register between 1987 and 1999. Data on deaths and causes of death were obtained from from Statistics Norway, and on thromboprophylaxis from a separate questionnaire sent to all hospitals. During the years 1987-2000 the 68 hospitals reported use of 6 thromboprophylaxis drugs and 24 different combinations of drugs and stockings. In 1988, only 3 of 29 hospitals reported use of low molecular weight heparin (LMWH), but in 1999, 67 of the 68 hospitals used LMWH. In the first postoperative week, the daily mortality was about 2.5 deaths per 10,000 THR patients. By the 70th postoperative day, the daily mortality had declined to about 0.57 deaths per 10,000 patients. The daily mortality of the age- and gender-matched Norwegian population was 0.95 deaths per 10,000 individuals. Early postoperative mortality increased with age, was higher in men than women, and was usually due to vascular disease. We found only a slight reduction in the 60-day postoperative mortality during the period 1987-1999. All underlying diagnoses for a prosthesis operation had a higher 60-day postoperative mortality than primary osteoarthrosis.
PubMed ID
12358110 View in PubMed
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