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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
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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
Less detail

Improved outcome after hip fracture surgery in Norway.

https://arctichealth.org/en/permalink/ahliterature285316
Source
Acta Orthop. 2017 Oct;88(5):505-511
Publication Type
Article
Date
Oct-2017
Author
Jan-Erik Gjertsen
Eva Dybvik
Ove Furnes
Jonas M Fevang
Leif I Havelin
Kjell Matre
Lars B Engesæter
Source
Acta Orthop. 2017 Oct;88(5):505-511
Date
Oct-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - statistics & numerical data
Female
Femoral Neck Fractures - mortality - surgery
Hemiarthroplasty - statistics & numerical data
Hip Fractures - mortality - surgery
Humans
Male
Norway - epidemiology
Proportional Hazards Models
Quality Improvement - statistics & numerical data
Registries
Reoperation - statistics & numerical data
Treatment Outcome
Abstract
Background and purpose - The operative treatment of hip fractures in Norway has changed considerably during the last decade. We used data in the Norwegian Hip Fracture Register to investigate possible effects of these changes on reoperations and 1-year mortality. Patients and methods - 72,741 femoral neck (FFN) fractures and trochanteric fractures in patients 60 years or older were analyzed. The fractures were divided into 5 time periods (2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014). Cox regression models were used to calculate unadjusted and adjusted (age group, sex, and ASA class) relative risks (RRs) of reoperation and of 1-year mortality in the different time periods. Results - For undisplaced FFNs treatment with hemiarthroplasty increased from 2.1% to 9.7% during the study period. For displaced FFNs treatment with arthroplasty increased from 56% to 93%. The use of intramedullary nails increased from 9.1% to 26% for stable 2-fragment (AO/OTA A1) trochanteric fractures, from 15% to 33% for multifragment (AO/OTA A2) trochanteric fractures, and from 27% to 61% for intertrochanteric fractures (AO/OTA A3)/subtrochanteric fractures. Compared with the first time period the adjusted 1-year RR for reoperation was 0.43 (95% CI: 0.37-0.49) for displaced FFNs in the last time period. The adjusted 1-year mortality in the last time period was lower for all fractures (RR: 0.87 (0.83-0.91)), displaced FFNs (RR: 0.86 (0.80-0.93)), AO/OTA A1 trochanteric fractures (RR: 0.79 (0.71-0.88)), and AO/OTA A2 trochanteric fractures (RR: 0.87 (0.77-0.98)) when compared with the first study period. Interpretation - Hip fracture treatment in Norway has improved: The risk of reoperation and the 1-year mortality after displaced femoral neck fractures have decreased over a 10-year period. National registration is useful to monitor trends in treatment and outcomes after hip fractures.
Notes
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PubMed ID
28681677 View in PubMed
Less detail

Improved results of primary total hip replacement.

https://arctichealth.org/en/permalink/ahliterature139031
Source
Acta Orthop. 2010 Dec;81(6):649-59
Publication Type
Article
Date
Dec-2010
Author
Bjørg-Tilde S Fevang
Stein A Lie
Leif I Havelin
Lars B Engesaeter
Ove Furnes
Author Affiliation
Department of Rheumatology, Haukeland University Hospital, Norway. bjorg.tilde.svanes.fevang@helse-bergen.no
Source
Acta Orthop. 2010 Dec;81(6):649-59
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Hip - adverse effects
Female
Hip Prosthesis - adverse effects
Humans
Male
Middle Aged
Norway
Prosthesis Design
Prosthesis Failure
Registries
Reoperation
Risk factors
Treatment Outcome
Abstract
Over the past 20 years, several changes in treatment policy and treatment options have taken place regarding hip replacement. For this reason, we wanted to investigate the results after hip replacement in terms of revision rate, during a 21-year period among hip replacements reported to the Norwegian Arthroplasty Register.
110,882 primary total hip replacements were reported to the Norwegian Arthroplasty Register from 1987 through 2007. Risk of revision during the time periods 1993-1997, 1998-2002, and 2003-2007 was compared to that of the reference period 1987-1992. Adjusted Cox regression analyses were performed to compare the risk of revision in different time periods and extended analyses were done to investigate revision within the first postoperative year and after the first year.
There was an overall reduced risk of revision in the time periods 1993-1997, 1998-2002, and 2003-2007 compared to the reference period: RR = 0.81 (95% CI 0.77-0.86), 0.51 (CI 0.47-0.55), and 0.77 (CI 0.68-0.85), respectively. The improved results were due to a marked reduction in aseptic loosening of the femoral and acetabular components in all time periods and in all subgroups of prostheses. A change in the timing of revision took place, with more early revisions and fewer late revisions in the later time periods. Revision due to dislocation and infection increased over time.
The risk of revision decreased during the study period, due to fewer cases of aseptic loosening of prosthetic components. The best results were obtained with the use of cemented prostheses. Prevention of dislocation and infection should be a major goal in the future, as revision due to these causes increased during the study period.
Notes
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PubMed ID
21110699 View in PubMed
Less detail

Increased risk of revision in patients with non-traumatic femoral head necrosis.

https://arctichealth.org/en/permalink/ahliterature105529
Source
Acta Orthop. 2014 Feb;85(1):11-7
Publication Type
Article
Date
Feb-2014
Author
Camilla Bergh
Ann M Fenstad
Ove Furnes
Göran Garellick
Leif I Havelin
Søren Overgaard
Alma B Pedersen
Keijo T Mäkelä
Pekka Pulkkinen
Maziar Mohaddes
Johan Kärrholm
Author Affiliation
Institute of Clinical Sciences , Sahlgrenska Academy, University of Göteborg.
Source
Acta Orthop. 2014 Feb;85(1):11-7
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - adverse effects - methods
Female
Femur Head Necrosis - epidemiology - surgery
Hip Prosthesis
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Osteoarthritis, Hip - epidemiology - surgery
Periprosthetic Fractures - epidemiology - etiology
Postoperative Period
Prosthesis Failure
Prosthesis-Related Infections - epidemiology - etiology
Registries
Reoperation - statistics & numerical data
Risk Assessment - methods
Scandinavia - epidemiology
Treatment Outcome
Abstract
Previous studies of patients who have undergone total hip arthroplasty (THA) due to femoral head necrosis (FHN) have shown an increased risk of revision compared to cases with primary osteoarthritis (POA), but recent studies have suggested that this procedure is not associated with poor outcome. We compared the risk of revision after operation with THA due to FHN or POA in the Nordic Arthroplasty Register Association (NARA) database including Denmark, Finland, Norway, and Sweden.
427,806 THAs performed between 1995 and 2011 were included. The relative risk of revision for any reason, for aseptic loosening, dislocation, deep infection, and periprosthetic fracture was studied before and after adjustment for covariates using Cox regression models.
416,217 hips with POA (mean age 69 (SD 10), 59% females) and 11,589 with FHN (mean age 65 (SD 16), 58% females) were registered. The mean follow-up was 6.3 (SD 4.3) years. After 2 years of observation, 1.7% in the POA group and 3.0% in the FHN group had been revised. The corresponding proportions after 16 years of observation were 4.2% and 6.1%, respectively. The 16-year survival in the 2 groups was 86% (95% CI: 86-86) and 77% (CI: 74-80). After adjusting for covariates, the relative risk (RR) of revision for any reason was higher in patients with FHN for both periods studied (up to 2 years: RR = 1.44, 95% CI: 1.34-1.54; p
Notes
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PubMed ID
24359026 View in PubMed
Less detail

Influence of hospital volume on revision rate after total knee arthroplasty with cement.

https://arctichealth.org/en/permalink/ahliterature107141
Source
J Bone Joint Surg Am. 2013 Sep 18;95(18):e131
Publication Type
Article
Date
Sep-18-2013
Author
Mona Badawy
Birgitte Espehaug
Kari Indrekvam
Lars B Engesæter
Leif I Havelin
Ove Furnes
Author Affiliation
Kysthospital in Hagavik, Hagaviksbakken 25, 5217 Hagavik, Norway. E-mail address for M. Badawy: mona.badawy@helse-bergen.no. E-mail address for K. Indrekvam: kari.indrekvam@helse-bergen.no.
Source
J Bone Joint Surg Am. 2013 Sep 18;95(18):e131
Date
Sep-18-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee - adverse effects - methods - statistics & numerical data
Bone Cements - adverse effects
Female
Hospitals - statistics & numerical data
Humans
Male
Middle Aged
Norway
Prosthesis Failure
Reoperation - statistics & numerical data
Risk assessment
Risk factors
Survival Analysis
Treatment Outcome
Young Adult
Abstract
The number of total knee replacements has substantially increased worldwide over the past ten years. Several studies have indicated a correlation between high hospital procedure volume and decreased morbidity and mortality following total knee arthroplasty. The purpose of the present study was to evaluate whether there is a correlation between procedure volume and the risk of revision following total knee arthroplasty with use of hospital volume data from the Norwegian Arthroplasty Register.
Thirty-seven thousand, three hundred and eighty-one total knee arthroplasties that were reported to the Norwegian Arthroplasty Register from 1994 to 2010 were used to examine the annual procedure volume per hospital. Hospital volume was divided into five categories according to the number of procedures performed annually: one to twenty-four (low volume), twenty-five to forty-nine (medium volume), fifty to ninety-nine (medium volume), 100 to 149 (high volume), and =150 (high volume). Cox regression (adjusted for age, sex, and diagnosis) was used to estimate the proportion of procedures without revision and the risk ratio (RR) of revision. Analyses were also performed for two commonly used prosthesis brands combined.
The rate of prosthetic survival at ten years was 92.5% (95% confidence interval, 91.5 to 93.4) for hospitals with an annual volume of one to twenty-four procedures and 95.5% (95% confidence interval, 94.1 to 97.0) for hospitals with an annual volume of =150 procedures. We found a significantly lower risk of revision for hospitals with an annual volume of 100 to 149 procedures (relative risk = 0.73 [95% confidence interval, 0.56 to 0.96], p = 0.03) and =150 procedures (relative risk = 0.73 [95% confidence interval, 0.54 to 1.00], p = 0.05) compared with hospitals with an annual volume of one to twenty-four procedures. Similar results were found when we analyzed two commonly used prosthesis brands.
In the present study, there was a significantly higher rate of revision knee arthroplasties at low-volume hospitals as compared with high-volume hospitals.
PubMed ID
24048562 View in PubMed
Less detail

Is there still a place for the cemented titanium femoral stem? 10,108 cases from the Norwegian Arthroplasty Register.

https://arctichealth.org/en/permalink/ahliterature128447
Source
Acta Orthop. 2012 Feb;83(1):1-6
Publication Type
Article
Date
Feb-2012
Author
Geir Hallan
Birgitte Espehaug
Ove Furnes
Helge Wangen
Paul J Høl
Peter Ellison
Leif I Havelin
Author Affiliation
Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway. geir.hallan@helse-bergen.no
Source
Acta Orthop. 2012 Feb;83(1):1-6
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Hip - methods
Bone Cements
Cementation
Female
Femur Head
Hip Prosthesis - adverse effects
Humans
Kaplan-Meier Estimate
Male
Norway
Proportional Hazards Models
Prosthesis Design
Prosthesis Failure
Registries
Risk assessment
Risk factors
Titanium
Treatment Outcome
Abstract
Despite the fact that there have been some reports on poor performance, titanium femoral stems intended for cemented fixation are still used at some centers in Europe. In this population-based registry study, we examined the results of the most frequently used cemented titanium stem in Norway.
11,876 cases implanted with the cemented Titan stem were identified for the period 1987-2008. Hybrid arthroplasties were excluded, leaving 10,108 cases for this study. Stem survival and the influence of age, sex, stem offset and size, and femoral head size were evaluated using Cox regression analyses. Questionnaires were sent to the hospitals to determine the surgical technique used.
Male sex, high stem offset, and small stem size were found to be risk factors for stem revision, (adjusted RR = 2.5 (1.9-3.4), 3.3 (2.3-4.8), and 2.2 (1.4-3.5), respectively). Patients operated in the period 2001-2008 had an adjusted relative risk (RR) of 4.7 (95% CI: 3.0-7.4) for stem revision due to aseptic stem loosening compared to the period 1996-2000. Changes in broaching technique and cementing technique coincided with deterioration of the results in some hospitals.
The increased use of small stem sizes and high-offset stems could only explain the deterioration of results to a certain degree since the year 2000. The influence of discrete changes in surgical technique over time could not be fully evaluated in this registry study. We suggest that this cemented titanium stem should be abandoned. The results of similar implants should be carefully evaluated.
Notes
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PubMed ID
22206445 View in PubMed
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Knee arthroplasty in Denmark, Norway and Sweden. A pilot study from the Nordic Arthroplasty Register Association.

https://arctichealth.org/en/permalink/ahliterature145250
Source
Acta Orthop. 2010 Feb;81(1):82-9
Publication Type
Article
Date
Feb-2010
Author
Otto Robertsson
Svetlana Bizjajeva
Anne Marie Fenstad
Ove Furnes
Lars Lidgren
Frank Mehnert
Anders Odgaard
Alma Becic Pedersen
Leif Ivar Havelin
Author Affiliation
The Swedish Knee Arthroplasty Register, Dept of Orthopedics, Clinical Sciences, Lund, Lund University, Sweden. otto.robertsson@med.lu.se
Source
Acta Orthop. 2010 Feb;81(1):82-9
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee - methods - standards - statistics & numerical data
Denmark
Female
Humans
Knee Prosthesis
Male
Middle Aged
Norway
Pilot Projects
Registries
Sweden
Treatment Outcome
Abstract
The number of national arthroplasty registries is increasing. However, the methods of registration, classification, and analysis often differ.
We combined data from 3 Nordic knee arthroplasty registers, comparing demographics, methods, and overall results. Primary arthroplasties during the period 1997-2007 were included. Each register produced a dataset of predefined variables, after which the data were combined and descriptive and survival statistics produced.
The incidence of knee arthroplasty increased in all 3 countries, but most in Denmark. Norway had the lowest number of procedures per hospital-less than half that of Sweden and Denmark. The preference for implant brands varied and only 3 total brands and 1 unicompartmental brand were common in all 3 countries. Use of patellar button for total knee arthroplasty was popular in Denmark (76%) but not in Norway (11%) or Sweden (14%). Uncemented or hybrid fixation of components was also more frequent in Denmark (22%) than in Norway (14%) and Sweden (2%). After total knee arthroplasty for osteoarthritis, the cumulative revision rate (CRR) was lowest in Sweden, with Denmark and Norway having a relative risk (RR) of 1.4 (95% CI: 1.3-1.6) and 1.6 (CI: 1.4-1.7) times higher. The result was similar when only including brands used in more than 200 cases in all 3 countries (AGC, Duracon, and NexGen). After unicompartmental arthroplasty for osteoarthritis, the CRR for all models was also lowest in Sweden, with Denmark and Norway having RRs of 1.7 (CI: 1.4-2.0) and 1.5 (CI: 1.3-1.8), respectively. When only the Oxford implant was analyzed, however, the CRRs were similar and the RRs were 1.2 (CI: 0.9-1.7) and 1.3 (CI: 1.0-1.7).
We found considerable differences between the 3 countries, with Sweden having a lower revision rate than Denmark and Norway. Further classification and standardization work is needed to permit more elaborate studies.
Notes
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PubMed ID
20180723 View in PubMed
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Operating time and survival of primary total hip replacements: an analysis of 31,745 primary cemented and uncemented total hip replacements from local hospitals reported to the Norwegian Arthroplasty Register 1987-2001.

https://arctichealth.org/en/permalink/ahliterature177672
Source
Acta Orthop Scand. 2004 Oct;75(5):524-32
Publication Type
Article
Date
Oct-2004
Author
Arvid Småbrekke
Birgitte Espehaug
Leif I Havelin
Ove Furnes
Author Affiliation
Department of Orthopaedic Surgery, Hammerfest Hospital, Sykehusveien 35, NO-9600 Hammerfest, Norway. Smaabrekke@hammerfest-sykehus.no
Source
Acta Orthop Scand. 2004 Oct;75(5):524-32
Date
Oct-2004
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Hip - mortality
Cementation
Female
Humans
Male
Middle Aged
Norway - epidemiology
Reoperation
Time Factors
Treatment Outcome
Abstract
Some studies have found a significant decrease in operating time as a result of standardizing programs for hip surgery. To study the influence of operating time (skin to skin) on survival of total hip replacements, we investigated the operating time in local hospitals in Norway. We have found no other large published series of THRs investigating operating time and revision.
The study was based on 31,745 primary THRs reported to the Norwegian Arthroplasty Register from 47 local hospitals during 1987-2001. Operating time was divided into 7 categories, and for each category separate Kaplan-Meier curves and adjusted failure rate ratios were calculated.
The mean operating time for all local hospitals in Norway was 96 (68-130) min. Increasing operating volume from less than 10 THRs/hospital/year to more than 200 THRs/hospital/year was associated with a 25-min decrease in mean operating time in cemented THRs and a 35-min decrease in the case of uncemented THRs. With the operating time category of 71-90 min as reference category, cemented THRs that lasted more than 150 min had a two-fold increased (95% CI: 1.6-2.6) revision rate. For uncemented implants, the revision rate was 1.3 times higher (95% CI: 0.8-2.2). Cemented implants with operating time under 51 min and over 90 min were associated with an increased risk of revision due to aseptic loosening. Cemented implants with operating time over 150 min were associated with an increased risk of revision due to infection.
Hospitals with long operating times should consider the potential benefit of reducing these times, as this may lead to lower revision rates and increased operating volumes. Shorter operation times could be achieved by standardization programs, but one should bear in mind that for cemented implants very short operating times also increased revision risk due to aseptic loosening.
PubMed ID
15513482 View in PubMed
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