Vaidlustus

Riigihanke „Traumatoloogia metallosteosünteesi vahendid ja liigeste endoproteesid“, viitenumber 295377 pakkuja teavitamine hankija otsustest Tere! 1. Hankekomisjoni 18.03.2026 otsusega kvalifitseeriti RHS § 104 lg 6 alusel hankepassi alusel:  Ortolink Invest OÜ osades 2, 6, 10, 12, 14, 16, 17, 18, 19, 20, 21, 22, 23;  OÜ WIMBERG osades 1, 3, 4, 5, 7, 11;  Johnson & Johnson AB Eesti filiaal osades 5, 8;  Orthotrade OÜ osades 16, 20;  OneMed OÜ osades 1, 2, 4, 5, 6, 9, 10, 11, 16, 17, 18, 19, 20, kuna hankepassis esitatud andmete alusel vastab pakkujate tehniline ja kutsealane pädevus riigihanke alusdokumentides esitatud kvalifitseerimise tingimustele. 2. Hankekomisjoni 18.03.2026 otsusega jäeti RHS § 104 lg 6 alusel kvalifitseerimata: - Kir-fix Oy osas 15; - AB Technology OÜ osas 16, kuna hankepassis esitatud andmete alusel ei vasta pakkujate tehniline ja kutsealane pädevus riigihanke alusdokumentides esitatud kvalifitseerimise tingimustele. 3. Hankekomisjoni 18.03.2026 otsusega tunnistati RHS § 114 lg 1 alusel vastavaks riigihanke alusdokumentides nõutud tingimustele:  Wimberg OÜ poolt esitatud pakkumus osades 1 ja 11;  Ortolink Invest OÜ poolt esitatud pakkumus osades 2, 6, 10, 12, 14, 17, 18, 19, 20, 21, 22;  Johnson & Johnson AB Eesti filial poolt esitatud pakkumus osades 5 ja 8;  OneMed OÜ poolt esitatud pakkumus osades 9, 10, 11 ja 16;  Orthotrade OÜ poolt esitatud pakkumus osades 16 ja 20, kuna need vastasid riigihanke alusdokumentides esitatud tingimustele. 4. Hankekomisjoni 18.03.2026 otsusega lükati RHS § 114 lg 2 alusel tagasi: Ortolink Invest OÜ pakkumus osas 16 ja 23; OÜ WIMBERG pakkumus osas 4 ja 5; Osa 4 - põlveliigese kondülaarne protees tagumise ristatisideme säilitamisega (ja võimalusega minna üle tagumise ristatisideme stabiliseerivale süsteemile) Nõue: 4.2. tsementeeritav ja mitte tsementeeritav võimalus Pakkumuses on märgitud: Jah Kontrollimise tulemus: puudub mitte-tsementeeritav variant. Nõue ei ole täidetud. Nõue: 5.3. parem ja vasakpoolne versioon Pakkumuses on märgitud: Universaalne protees, kuid vasaku ja parema poole lõikamiseks kasutatakse erinevaid instrumente Kontrollimise tulemus: puudub parem ja vasak pool, mis on vajalikud maksimaalse luulise kontakti ja anatoomia taastamise jaoks. Universaalne sirge disain ei võimalda piisavat anatoomia taastamist ja kasutusvõimalust keerulisema anatoomilise variatsiooni korral. Nõue ei ole täidetud. Osa 5 - tsementeeritav põlveprotees tagumise ristatisideme stabiliseerimisega Nõue: 4.3. reieosa nii tsementeeritava kui ka tsemendivaba variandina. Pakkumuses on märgitud: Reiekomponent ise on alati tsementeeritava pealispinnaga. Modulaarne varrepikendus on saadaval tsementeeritava- ja tsemendivabana Kontrollimise tulemus: puudub tsemendivaba reiekomponent. Nõue ei ole täidetud. Nõue: 5.3. sääreosa tagumist kallet võimalik reguleerida 0˚-7 ˚ vahel 1 ˚ sammuga. Kontrollimise tulemus: on olemas 0, 3 ja 5-kraadised lõikejuhikud, aga puudub võimalus 1- kraadi võrra korrigeerida. Nõue ei ole täidetud. Nõue: 7.3. vähemalt kahe erineva kujuga põlvekedra plastikprotees, mida on vähemalt 4 erineva diameetriga Pakkumuses on märgitud: LSK põlvekedra plastikprotees- 6 suurust; UHMWPE ja E-Dur materjal; Endo-Model põlvekedra plastikprotees – 3 suurust; UHMWPE Kontrollimise tulemus: Vastab osaliselt (Endo-Model variandil on 3 suurust) Kuna pakutud tooted ei vasta hanke tehnilises kirjelduses sätestatud tingimustele, tuleb pakkumus osades 4 ja 5 tagasi lükata. Võttes aluseks RHS § 114 lg 2 ning lähtudes ülaltoodust lükata Wimberg OÜ poolt osadele 4 ja 5 esitatud pakkumused tagasi, kuna need ei vasta riigihanke alusdokumentides nõutud tingimustele. OneMed OÜ pakkumus osas 1, 2, 4, 5, 6, 10, 11, 17, 18, 19 ja 20, kuna need ei vastanud riigihanke alusdokumentides esitatud tingimustele. 5. Sihtasutus Tartu Ülikooli Kliinikumi valdkonnajuhi korraldusega nr 1.5-2/20-V1 19.03.2026, tunnistati edukaks:  Wimberg OÜ osas 1 ja 11;  Ortolink Invest OÜ osades 2, 6, 10, 12, 14, 17, 18, 19, 21 ja 22;  Johnson & Johnson AB Eesti filial osades 5 ja 8;  OneMed OÜ osas 9;  Orthotrade OÜ osades 16 ja 20 6. Hankekomisjoni 19.03.2026 otsusega kvalifitseeriti edukaks tunnistatud pakkujad. Lepingu sõlmimiseks kohaldatud ooteaeg lõpeb 02.04.2026 Tänan hankekonkursil osalemise eest! Lugupidamisega Heli Vatman riigihangete spetsialist Zhang jt. BMC Musculoskeletal Disorders (2024) 25:336 BMC Musculoskeletal https://doi.org/10.1186/s12891-024-07466-2 Disorders TEADUSTÖÖ Avatud juurdepääs Asümmeetriliste ja sümmeetriliste säärekomponentide katvuse ja rotatsiooni võrdlus: süstemaatiline ülevaade ja metaanalüüs Ziming Zhang1,2† , Tiantian Zhang1† , Le Zhang2† , Zehua Chen3† , Haoming Zhao2 , Jianjun Kuang1* ja Liang Ou1* Kokkuvõte Taust: Säärekomponendi optimaalne sobivus resektsioonipinnaga ja õige pöördeline joondus on põlveliigese täieliku endoproteesimise (TKA) edukuse seisukohalt otsustava tähtsusega. Siiski valitseb endiselt erimeelsusi sümmeetrilise ja asümmeetrilise säärekomponendi ülemuslikkuse osas. Käesoleva süstemaatilise ülevaate ja metaanalüüsi eesmärk oli hinnata praeguseid tõendeid, võrreldes asümmeetrilise ja sümmeetrilise säärekomponendi katvust ja pöördelist joondust. Meetodid Otsisime potentsiaalselt asjakohaseid uuringuid andmebaasidest PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) ja China National Knowledge Infrastructure (CNKI) kuni 1. märtsini 2023. Andmete väljavõtte ja kvaliteedi hindamise viisid läbi kaks sõltumatut hindajat. Metaanalüüsi teostati programmi Review Manager 5.4 abil. Tulemused Leiti 16 artiklit. Võrreldes sümmeetrilise säärekomponendiga suurendas asümmeetriline säärekomponent proksimaalse sääre lõikepinna katvust (MD, -2,87; 95% CI, -3,45 kuni -2,28; P < 0,00001), parandas sääre alusplaadi allajäämise esinemissagedust (OR, 0,16; 95% CI, 0,07 kuni 0,33; P < 0,00001) ja valepöörde esinemissagedust (OR, 0,13; 95% CI, 0,02–0,90; P = 0,04) ning vähendas sääreosa komponendi pöörde ulatust (MD, -3,11; 95% CI, -5,76 kuni -0,47; P = 0,02). Kuid sääre alusplaadi üleulatusele ei olnud statistilist mõju (OR, 0,58; 95% CI, 0,08–3,97; P = 0,58). Lisaks ei olnud kaasatud uuringutes kahe säärekomponendi puhul toimunud ühtegi revisiooni. Järeldus: Praegused uuringutulemused näitavad, et asümmeetriline säärekomponent pakub täieliku põlveliigese asendamisel (TKA) katvuse ja pöörde osas eeliseid võrreldes sümmeetrilise säärekomponendiga. Märksõnad Põlveliigese täielik asendamine, asümmeetriline säärekomponent, sääre alusplaat, pöörlemisjoondus † Ziming Zhang, Tiantian Zhang, Le Zhang ja Zehua Chen andsid võrdse panuse käesolevasse töösse ja on ühiselt esimesed autorid. *Kirjavahetus: Jianjun Kuang [email protected] Liang Ou [email protected] Autorite täielik nimekiri on kättesaadav artikli lõpus © Autor(id) 2024. Avatud juurdepääs. Käesolev artikkel on litsentsitud Creative Commons Attribution 4.0 International litsentsi alusel, mis lubab selle kasutamist, jagamist, kohandamist, levitamist ja reprodutseerimist mis tahes meedias või formaadis, tingimusel et viitate asjakohaselt algsetele autoritele ja allikale, lisate lingi Creative Commonsi litsentsile ning märgite ära, kui on tehtud muudatusi. Käesolevas artiklis sisalduvad pildid või muu kolmanda osapoole materjal on hõlmatud artikli Creative Commonsi litsentsiga, kui materjali viites pole märgitud teisiti. Kui materjal ei ole hõlmatud artikli Creative Commonsi litsentsiga ja teie kavandatav kasutus ei ole seadusega lubatud või ületab lubatud kasutuspiire, peate hankima loa otse autoriõiguste omanikult. Selle litsentsi koopia vaatamiseks külastage veebilehte http://creativecommons.org/licenses/by/4.0/. Creative Commons Public Domain Dedication loobumisklausel (http://creativecom-mons.org/publicdomain/zero/1.0/) kehtib käesolevas artiklis kättesaadavaks tehtud andmete suhtes, kui andmete allikaviites ei ole märgitud teisiti. Zhang jt. BMC Musculoskeletal Disorders (2024) 25:336 Lehekülg2 13 Taust kaasatud uuringute viidete leidmiseks. Täpsed Täielik põlveliigese endoproteesimine (TKA) on levinud otsingustrateegiad on esitatud lisas 3. valikuline ortopeediline operatsioon, mis pakub patsientidele märkimisväärset keskpika ja pikaajalist kasu Uuringusse kaasamise kriteeriumid elukvaliteedi, valu leevendamise ja funktsionaalsuse osas Uuringusse kaasati võrdlusuuringud, sealhulgas [1]. Siiski jääb rahulolematus pärast põlveliigese randomiseeritud kontrollitud uuringud (RCT) või endoproteesimist ligikaudu 15–20% juurde [2]. TKA kohortuuringud, milles võrreldi ATC-d ja STC-d sääreluu kliinilistele tulemustele avaldavad mõju mitmed tegurid, osas. Kaasatud uuringud pidid vastama järgmistele millest eriti olulised on sääreproteesi valik ja ideaalne kriteeriumidele: paigutus. Praegu on saadaval kaks sääreproteesi disaini: (1) patsiendid, kellele tehti TKA operatsioon või ainult sümmeetriline sääreprotees (STC) ja asümmeetriline virtuaalne operatsioon pildistamisuuringute jaoks; (2) sääreprotees (ATC). võrdlusrühmad ATC ja STC vahel; (3) tulemused, Tibiaalse komponendi ja resekteeritud platoo täpne sealhulgas sääreproteesi katvus ja/või pöörlemine, või sobitamine ning tibiaalse komponendi õige rotatsiooniline revisioonimäär või kliinilised tulemused. Lisaks jäeti joondamine on TKA edu seisukohalt hädavajalikud. uuringud välja, kui need vastasid mõnele järgmistest Mitmed uuringud on jõudnud järeldusele, et STC ei pruugi kriteeriumidest: TKA revisioon, asümmeetriline sobida kõigile rassidele [3]. Hiljuti on TKA luukatte ja polüetüleen, lõplike elementide analüüs, loomade või rotatsioonilise joondamise parandamiseks turule toodud laipade uuringud, protokollid, juhtumiaruanded, ülevaated asümmeetrilised ja isegi märkimisväärselt anatoomilised ning artiklid, mille täistekst või andmed ei olnud disainilahendused, võttes arvesse asümmeetrilist kättesaadavad. proksimaalset tibiaalse lõikepinda. Kui palju ATC parandab luukatte ulatust, jääb ebaselgeks. Andmete väljavõtmine ATC pooldajad väidavad sageli, et ATC kasutamisel on Esmalt järgisid kaks sõltumatut hindajat eespool nimetatud palju eeliseid, sealhulgas parem sääreluu katvus väiksema otsingustrateegia ja kaasamiskriteeriumide kohaselt üleulatusega, lihtsam paigaldamine tänu säärekomponendi kirjanduse sõelumise standardprotsessi, mis hõlmas väiksemale sisemisele pöördele ning implantaadi pikem dubleeritud uuringute eemaldamist, ilmselgelt ebaoluliste kasutusiga [4, 5]. Vastupidiselt sellele toetavad mõned uuringute väljajätmist pealkirjade ja kokkuvõtete lugemise tõendid seda, et võrreldes STC-ga on sääreluu katvus vaid teel ning sobivate uuringute kaasamist pärast täisteksti veidi parem ning isegi STC on efektiivsem ideaalse sääreluu läbilugemist. Seejärel kogusid kaks hindajat kaasatud rotatsiooni tagamisel [6]. Objektiivselt vaadates on kahe uuringutest järgmise teabe: peamine autor, avaldamisaasta, sääreluu aluse disaini vahel röntgenoloogiliste ja kliiniliste uuringu läbiviimise riik, uuringu ülesehitus, patsientide ja tulemuste osas ühe ülekaal teise suhtes endiselt vaieldav. põlvede arv, vanus ja sugu, proteesi tüüp, jälgimisperioodi Seetõttu viisime läbi käesoleva süstemaatilise ülevaate ja pikkus ning tulemused. Lõpuks lahendati eespool metaanalüüsi, et võrrelda STC ja ATC katvust ja nimetatud protsessis tekkinud erimeelsused konsulteerides rotatsiooni ning kliinilisi tulemusi. kolmanda hindajaga. Meetodid Huvipakkuvad tulemused Kirjanduse otsing Keskendusime peamiselt sääreproteesi katvusele ja Käesolev süstemaatiline ülevaade ja metaanalüüs viidi läbi pööramisele, mis hõlmasid vastavalt katvusmäära, alajääki vastavalt süstemaatiliste ülevaadete ja metaanalüüside ja üleulatuva osa ning sääreproteesi valepööramist ja eelistatud aruandluselementide (PRISMA) juhistele [7] pööramisnurka. Lisaks võrdlesime kahe säärekomponendi (lisad 1 ja 2). Oleme registreerinud käesoleva ülevaate revisioonimäära ja kliinilisi tulemusnäitajaid. Katvusmäär rahvusvahelises süstemaatiliste ülevaadete registris määratleti sobiva suurusega alusplaadi koguristlõike (PROSPERO, identifikaator CRD42023418486). Otsisime pindalana, millest oli lahutatud alusplaadi üleulatuv osa, potentsiaalselt asjakohaseid uuringuid andmebaasidest jagatuna säärepinna koguristlõike pindalaga. Üleulatus PubMed, Web of Science, Embase, Cochrane Central Register määratleti kui sääreluu puudumine alusplaadi all vahetult of Controlled Trials (CENTRAL) ja China National pärast paigaldamist ning alulõik määratleti kui sääreluu Knowledge Infrastructure (CNKI) kuni 1. märtsini 2023. lõikepinna paljastumine. Üldiselt peeti optimaalseks Kasutati järgmisi otsingutermineid: põlveliigese täielik sobivuseks üleulatust alla 1 mm ja alulõiku alla 2 mm. endoproteesimine, TKA, asümmeetriline, anatoomiline, Seetõttu peeti üle 2 mm ulatuvat üleulatuks ja üle 3 mm sääreluu alusplaat, sääreluu alus ja sääreluu komponent jne, ulatuvat alalatuks, mis mõlemad olid vastuvõetamatud. mida otsiti Mesh-terminite ja vabade terminite Valepöörde all mõeldi implantaadi telje kõrvalekallet üle 5° kombinatsiooni abil. Lisaks tegime käsitsi otsingu neutraalsest sääreluu pöördeteljest. Zhang jt. BMC Musculoskeletal Disorders (2024) 25:336 Lehekülg3 13 Metodoloogia hindamine üks uuring Prantsusmaalt [25], Hollandist [10], Austraaliast Kaks uurijat hindasid sõltumatult RCT-de metoodilist [21], Poolast [24] ja Indiast [16]. 16 uuringust viidi 9 kvaliteeti, järgides Cochrane Collaborationi eelarvamuste uuringut tegelikult lõpule [10–15, 23–25], ülejäänud 7 riski tabelis soovitatud standardeid [8]. Eelarvamuste riski uuringus simuleeriti proteesi paigaldamist vaid kujutise hinnati järgmise seitsme aspekti alusel: juhusliku järjestuse töötlemise tarkvara abil [16–22]. Keskmiselt oli patsientide genereerimine, jaotuse varjamine, osalejate ja personali seas naiste osakaal suurem kui meeste oma. pimestamine, tulemuste hindamise pimestamine, Asümmeetriliste proteeside valimiseks kasutas kümme tulemuste andmete terviklikkus, tulemuste valikuline uuringut Persona [10, 12–15, 17–19, 24, 25], neli uuringut esitamine ja muud eelarvamused. Lisaks kasutati valisid Genesis II [16, 21–23] ja üks uuring valis MicroPort kohortuuringute metoodilise kvaliteedi hindamiseks Orthopedicsi toodetud Evolution medial pivot Newcastle–Ottawa skaalat, mis hõlmab kolme aspekti: [11] ning ühes uuringus ei täpsustatud, millist proteesi populatsiooni valik, võrreldavus ja tulemus [9]. kasutati [20]. NexGen oli üks enim kasutatud sümmeetrilisi proteese. Lisaks esitasid neli uuringut puusa-põlve-pahkluu Statistiline analüüs nurga ning näitasid, et haigestunud põlve keskmine Metaanalüüsid viidi läbi programmi RevMan (versioon 5.4, varusnurk jääb vahemikku 3,2–9,9° [13, 14, 19, 25]. Cochrane Collaboration) abil. Käesolevas ülevaates koondati ja analüüsiti pidevaid muutujaid, nagu katvuse Kvaliteedi hindamine protsent ja sääreproteesi pöördenurk, keskmise erinevuse RCT-uuringuid ja kohortuuringuid hinnati vastavalt (MD) ja 95% usaldusvahemiku (95% CI) abil, ning Cochrane’i koostöö rühma eelarvamuste riski tabeli ja dikotoomseid muutujaid, sealhulgas alariputust, üliriputust Newcastle–Ottawa skaala alusel. Viiest RCT-uuringust ja valepöördeid, koondati suhtelise riski (OR) ja 95% CI [10–12, 14, 16] näitasid kõik uuringud madalat riski seoses abil. Heterogeensust hinnati Higginsi I2 statistika abil, mille juhusliku järjestuse genereerimise, puudulike väärtus on vahemikus 0–100%. I2 > 50% näitab tulemusandmete, valikulise aruandluse ja muude märkimisväärset heterogeensust. Kuna uuringute vahel eelarvamustega ning ebaselget riski seoses rühmade jaotuse tuvastati kliinilist ja metodoloogilist heterogeensust, varjamise ja tulemuste hindamise pimestamisega. Ühes kasutati juhusliku efektiga mudelit. Tõhususe uuringus, mida kirjeldati kui patsiendile pimestatud [10], potentsiaalsete määravate tegurite kindlakstegemiseks viidi oli madal risk jaotuse varjamise osas, teistes tunnistati riski läbi alarühmade analüüsid. Samuti viidi läbi tundlikkuse ebaselgeks. Üheteistkümnest kohortuuringust [13, 15, 17– analüüs, et uurida uuringutevahelise heterogeensuse 25] said kaheksa 9 punkti ja kolm 7 punkti. Seega olid võimalikke allikaid. Lisaks koostati võimaluse korral uuringud suhteliselt kõrge kvaliteediga. Täpsed tulemused lehterdiagrammid, et hinnata avaldamisebiasit. Statistilise on esitatud tabelis 2 ja joonisel 2. olulisuse kindlaksmääramiseks kasutati P-väärtuse künnist 0,05. Katteala Katvuse määr Tulemused Seitsmes uuringus võrreldi kahe alusplaadi disaini sääreluu Otsingutulemused katvust [16–18, 20–22, 25]. Üldine metaanalüüs näitas, et Andmebaasidest leiti kokku 1175 potentsiaalselt sobivat ATC saavutas oluliselt suurema sääreluu katvuse kui STC kirjet. Pärast 525 dubleeritud kirje eemaldamist vaadati läbi (MD, -2,87; 95% CI, -3,45 kuni -2,28; P < 0,00001). 650 väljaande pealkirjad ja kokkuvõtted ning 603 neist jäeti Täiendav alarühma analüüs näitas, et ATC sääreluu välja. Läbi vaadati 47 kirje täistekstid ja 14 uuringut hinnati katvusmäär oli oluliselt kõrgem kui STC-l, sõltumata sobivuse seisukohast. Lisaks leiti kõigist kaasatud sellest, kas sääreprotees oli joondatud tuberkuli mediaalsele uuringutest 353 viidet ja 2 viidet hinnati sobivuse kolmandikule (MD, -2,95; 95% CI, -3,85 kuni -2,05; P < seisukohast. Lõpuks hõlmas käesolev ülevaade analüüsiks 0,00001) või paigutati maksimaalse katvuse saavutamiseks 16 artiklit [10–25] (tabel 1). Valiku üksikasjalik kulg on (MD, -3,02; 95% CI, -3,77 kuni -2,26; P < 0,00001) (joonis näidatud joonisel 1. 3). Lisaks sellele Operatsioonitüübi alarühma analüüs, kus operatsioonid Uuringu omadused jagati tegelikuks või simuleeritud põlveliigese Kokku kaasati 5 randomiseeritud kontrollitud uuringut ja 11 asendusoperatsiooniks, näitas, et ATC-l oli parem kohortuuringut. Viis uuringut pärinesid USAst [12, 17, 18, katvusmäär nii tegeliku põlveliigese asendusoperatsiooni 20, 22], kolm uuringut puhul (keskmine erinevus, Koreast [13–15] ja Jaapanist [11, 19, 23], ning iga -2,00; 95% CI, -3,71 kuni -0,29; P = 0,02) kui ka simuleeritud TKA puhul (MD, -2,94; 95% CI, -3,55 kuni -2,33; P < 0,00001) (täiendav joonis S1). Alajääk Kuue uuringu üldine metaanalüüs näitas, et ATC-l oli oluline eelis sääre alusplaadi puhul  Zhang jt. BMC Musculoskeletal Disorders Tabel 1 Metaanalüüsis hõlmatud uuringute kokkuvõte Uuring Riik Uuringu ülesehitus Proteesitüübid Operatsiooni tüüp Patsiendid/põlved Mehed/naised Vanus (aastat) Tulemused Keskmine Järel Asümmeetriline Sümmeetriline Jälgimine (kuud) Koster LA jt, Holland RCT Persona NexGen Tegelik TKA 31/31 13/19 63,8 ± 12,0 Revisioonide määr 24 2021 [10] 38/38 16/22 67,3 ± 8,0 Minoda Y jt, 2017 Jaapan RCT Eelnev Evolution Tegelik TKA 31/31a 2/29a 69 ± 13a Eenduv osa Puudub [11] mediaalne mediaalne pöördepunkt pöördtapp Indelli PF jt, USA RCT Persona NexGen Tegelik TKA 40/40 16/24 71(66–80)b Pöörlemine 24 2015 [12] 40/40 15/25 72(60–81)b sääreluu komponendi; R e v i s jonimäär; (2024) 25:336 Kliinilised tulemused (põlve eesmine valu, Oxfordi skaala, liigese liikuvus, üldine rahulolu, ellujäämus) Cho BW jt, Korea Retrospektiivne Persona NexGen Tegelik TKA 59/78 9/50 71,2 ± 5,7 Alajääv; 31,9 ± 5,8 2020 [13] kohort 58/74 4/54 71,1 ± 6,2 Üleulatus; 33,9 ± 11,5 Kordusoperatsioo nide määr; Kliinilised tulemused (VAS, KSS, WOMAC) Rhee SJ jt, 2018 Korea RCT Persona NexGen Tegelik TKA NR/50 4/46 67,3 ± 7,3 Pöörlemine 0,5 [14] NR/51 7/44 68,7 ± 7,2 sääreluu komponendi Jin C jt, 2016 [15] Korea Retrospektiivne Persona NexGen Tegelik TKA 100/100a 9/91a 71 (56–83) a, b Katvuse määr; Puudub kohort Alajääk; Ülejääk; Shaet jt, 2015 [16] India RCT Genesis II NexGen Virtuaalne TKA 150/300a 63/87a 35,5 (18–50) a, b Katvuse määr; Puudub Alajääk; Ülejääk; Meier M jt, USA Retrospektiivne Persona Sigma Virtuaalne TKA 100/100a 50/50a 65,6 (49–93) a,b Hõlmatuse määr Puudub 2018 [17] kohort Stulberg SD jt, 2015 USA Retrospektiivne Persona NexGen Virtuaalne TKA 91/100a 29/62a 66,4 (41–84) a,b Katvuse määr; Puudub [18] kohort S ä ä rekomp onendi pöörlemine; Valepöörlemin e 4/13 Lehekülg Ma Y jt, 2017 [19] Jaapan Retrospektiivne Persona NexGen Virtuaalne TKA 77/77a 15/62a NR Üleulatus; Puudub kohort säärekomponen di pöörlemine  Zhang jt. BMC Musculoskeletal Disorders Tabel 1 (jätkub) Uuring Riik Uuringu ülesehitus Proteesitüübid Operatsiooni tüüp Patsiendid/põlved Mehed/naised Vanus (aastat) Tulemused Keskmine Järel Asümmeetriline Sümmeetriline Jälgimine (kuud) Martin S jt, 2014 USA Retrospektiivne NR NR Virtuaalne TKA 30/30a NR NR Katvuse määr; Puudub (2024) 25:336 [20] kohort S äärekompo nendi pöörlemine; Valepöörlemin e Wernecke GC jt, Austraalia Retrospektiivne Genesis II NexGen Virtuaalne TKA 101/101a 74/27a 32(17–60) a,b Katvuse määr; Puudub 2012 [21] kohort Alajääk; Ülejääk; Clary C jt, 2014 [22] USA Retrospektiivne Genesis II Sigma Virtuaalne TKA 14 791/14 791a NR NR Hõlmatuse määr Puudub kohortuuring Miyatake N jt, Jaapan Retrospektiivne Genesis II NexGen Tegelik TKA NR/92 9/83 73,7 ± 6,7a Alajääv Puudub 2016 [23] kohort NR/586 111/475 Maciag BM jt, Poola Retrospektiivne Persona NexGen Tegelik TKA 39/39 13/26 68,6 ± 6,3 Alajääv; 1,5 2021 [24] kohort 34/34 12/22 69,5 ± 5,7 Üleulatus; Bizzozero P jt, Prantsusma Retrospektiivne Persona NexGen Tegelik TKA 33/33 15/17 77(57–92)b Hõlmatuse määr; 44 ± 5,4 a 2018 [25] kohort 33/33 15/17 75(66–89)b Üleulatus; 46 ± 5,7 säärekompone n d i pöörlemine; väärpöörlemine; RCT randomiseeritud kontrollitud uuring, NR andmed puuduvad, KSS põlveühingu skoor, ROM liigese liikuvusulatus, VAS visuaalne analoogskaala, WOMAC Lääne-Ontario ja McMasteri ülikoolide osteoartriidi kliinilisedindeks, TKA põlveliigese täielik proteesimine tulemused (KSS) a Väärtused on esitatud samade patsientide kohta ristuuringu disainis b Väärtused on esitatud keskmisena (vahemikuna) 5/13 Lehekülg Zhang jt. BMC Musculoskeletal Disorders (2024) 25:336 Lehekülg 6/13 Joonis 1. PRISMA vooskeem kirjanduse otsingu kohta underhang võrreldes STC-ga (OR, 0,16; 95% CI, 0,07–0,33; Siiski näitas alarühma analüüs, et ATC tagas simuleeritud P < 0,00001) [13, 15, 16, 21, 23, 24]. Edasine alarühm TKA-l parema rotatsioonilise joonduse (OR, 0,61; 95% CI, Rühmadevahelises analüüsis leiti, et nii sääreluu tagumise- 0,23–1,62; P = 0,33), kuid ei sisemise kui ka tagumise-külgmise alusplaadi allajäämine näidanud mingeid olulisi erinevusi tegelikus TKA-s (OR, esines ATC-ga võrreldes ATC-ga harvem (OR 0,14; 95% CI 0,06; 95% CI, 0,02–0,22; P < 0,0001) (joonis 6). 0,05–0,37; P < 0,0001) ja (OR 0,23; 95% CI 0,10–0,51; P = 0,0003) (joonis 4). Rotatsiooni ulatus Seitsme uuringu metaanalüüs, millest kuus hõlmasid Üleulatus maksimaalset katvust ja üks paigutust Install-joone piki, Kaheksas uuringus mõõdeti sääreplaadi üleulatuvust ning näitas, et ATC tekitas väiksema pöördeastme kui STC (MD, kahe sääreplaadi disaini vahel ei leitud olulisi erinevusi -3,11; 95% CI, -5,76 kuni -0,47; P = 0,02) (OR, 0,58; 95% CI, 0,08–3,97; P = 0,58) [12, 14, 18–20, 22, 25] (joonis 7). [11, 13, 15, 16, 19, 21, 24, 25], samuti alarühmade analüüsi tulemustega sääreluu tagumise-keskmise ja tagumise- Revisioonide sagedus külgmise alusplaadi üleulatuvuse kohta (OR, 0,78; 95% CI, Ainult neljas uuringus oli jälgimisperiood pikem kui 2 0,01–44,41; aastat [10, 12, 13, 15] ning neist kolmes märgiti, et P = 0,90) ja (OR, 0,52; 95% CI, 0,05–5,42; P = 0,58), kummagi rühma puhul ei olnud toimunud ühtegi (joonis 5). korduvoperatsiooni. Rotatsioon Kliinilised tulemused Väärrotatsioon Ainult kahes uuringus uuriti KSS-skoor, ning kahe Ainult kolmes uuringus kirjeldati sääreosa komponendi säärekomponendi vahel ei leitud olulist erinevust [13, 25]. valepööramist ning metaanalüüs näitas, et ATC-ga esines Ainult ühes uuringus teatati, et ATC-l oli statistiliselt valepööramist vähem kui STC-ga (OR, 0,13; 95% CI, 0,02– oluline vähenemine operatsioonijärgses põlve eesmises osas 0,90; P = 0,04) [18, 20, 25]. ning suurem keskmine liigese liikuvus [12]. Ja mitte  Zhang et al. BMC Musculoskeletal Disorders Tabel 2. Uuringute kvaliteedi hindamine Newcastle–Ottawa skaala alusel Uuring Valik Võrreldavus Kokkupuude Kokku Esinduslikkus Valiku Kindlakstegemin Näitamine Võrreldavus Uuringu Hindamine Järelkontroll Kokkupuuteg e kontrollid a mõjutatud mitte kokkupuute selle tulemuse kohortide mis tahes tulemuse piisavalt pikk jälgimise kokkupuutunud kohort huvipakkuv ei olnud uuringu tulemuste tulemuste kohordid (2024) 25:336 uuringu kavandamise ilmnemiseks tekkimiseks alguses olemas või analüüsi alus Cho BW jt, 2020 1 1 1 1 1 1 1 1 0 8 [13] Jin C jt, 2016 [15] 1 1 1 1 1 1 1 1 1 9 Meier M jt, 2018 1 1 1 1 1 1 1 1 1 9 [17] Stulberg SD 1 1 1 1 1 1 1 1 1 9 jt., 2015 [18] Ma Y jt, 2017 [19] 1 1 1 1 1 1 1 1 1 9 Martin S jt, 2014 1 1 1 1 1 1 1 1 1 9 [20] Wernecke GC jt, 1 1 1 1 1 1 1 1 1 9 2012 [21] Clary C jt, 2014 1 1 1 1 1 1 1 1 1 9 [22] Miyatake N jt, 2016 1 1 1 1 1 1 1 0 1 8 [23] Maciag BM jt, 2021 1 1 1 1 1 1 1 1 0 8 [24] Bizzozero P jt, 2018 1 1 1 1 1 1 1 1 1 9 [25] 7/13 Lehekülg Zhang jt. BMC Musculoskeletal Disorders (2024) 25:336 Lehekülg8 13 Joonis 2. Eelarvamuste riski graafik Zhang jt. BMC Musculoskeletal Disorders (2024) 25:336 Lehekülg9 13 Joonis 3. Metaanalüüs ja metaanalüüsi tulemuste kokkuvõte katvuse määra kohta Joonis 4. Metaanalüüs ja metaanalüüsi tulemuste graafik (forest plot) allapoole ulatuvate konstruktsioonide kohta Kahe erineva uuringu tulemusel leiti kahe konstruktsiooni Arutelu vahel olulist erinevust VAS-i, WOMAC-i, Oxfordi skooris, Sobiv säärekomponent on täieliku põlveliigese asendamise üldises rahulolus ja kaheaastases elulemuses [12, 13]. (TKA) puhul eriti oluline. Kuigi enamiku TKA-le minevate patsientide puhul kasutatakse standardseid säärekomponente (STC), ei taga praegused TKA- Avaldamisebias konstruktsioonid alati loomuliku liigese õiget kinemaatikat, Kuna meta-analüüsi hõlmatud uuringute arv ei ületa 10, ei mistõttu tundub soovitav implantaadi konstruktsiooni ole vaja teha lehvikdiagrammi analüüsi. edasi optimeerida. Üldiselt on asümmeetriliste ja sümmeetriliste komponentide kasutamise näidustused enamiku TKA-le minevate patsientide puhul samad, kuid mitte identsed. Seetõttu, kui valida erinevate Zhang jt. BMC Musculoskeletal Disorders (2024) 25:336 Lehekülg10 13 Joonis 5. Metaanalüüs ja metaanalüüsi tulemuste graafik üleulatuva osa kohta Joonis 6. Metaanalüüs ja metaanalüüsi tulemuste kokkuvõte liigese valest pööramisest Sõltuvalt sääreproteeside tüüpidest teeb kirurg valiku sääreluu alusplaadi üleulatus. Samal ajal leidsime, et ATC- vastavalt patsiendi konkreetsele olukorrale ja vajadustele, et süsteemil oli väiksem pöördeulatus, mis võiks selgitada saavutada parimad võimalikud operatsiooni- ja komponentide valepöörde madalamat esinemissagedust. operatsioonijärgsed tulemused. Käesolevas metaanalüüsis Lisaks ei olnud ühegi sääreluu komponendi puhul näitab hiljuti turule toodud ATC anatoomilise disaini toimunud ühtegi korduvoperatsiooni. Tuleb märkida, et me eeliseid. Uuringu tulemused viitasid sellele, et ATC ei viinud läbi kliiniliste tulemuste metaanalüüsi, kuna neid suurendas proksimaalse sääre lõikepinna katvust ja tulemusi kajastavate uuringute arv oli väiksem kui kaks. vähendas sääre alusplaadi allajäämise esinemissagedust. Kuid Optimeeritud sobivus sääreluu platool ja õige parandamisel ei olnud statistilist olulisust pöördejoondus võivad tuua kaasa paremaid tulemusi pärast Zhang jt. BMC Musculoskeletal Disorders (2024) 25:336 Lehekülg11 13 Joonis 7. Metaanalüüs ja metaanalüüsi tulemuste graafik pöörde ulatuse kohta TKA [26]. Säärekomponendi katvuse puhul peetakse Teine oluline põlveliigese endoproteesimise optimaalseks lahenduseks resektsioonijärgsete luupindade ebaõnnestumise põhjus on sääreosa komponendi vale võimalikult täpset sobitamist, nii et ei tekiks ei alajääki ega pöördeasend, mis põhjustab valu, jäikust ja varajast ülekatet. On leitud, et nii alajääk kui ka liigne ülekatte korduvoperatsiooni pärast põlveliigese endoproteesimist põhjustavad ebasoodsaid tulemusi, nagu komponendi [33]. Sääreosa komponendi pöördeasend tundus meile vajumine, pikaajaline aseptiline lahtitulek, pehmete kudede oluline proteesi kinemaatika ja põlveliigese liikumise ärritus ja valu [27]. Morfoloogiliselt on inimese optimeerimiseks. Siiski on sääre rotatsiooniline joondamine säärekomponent loomult asümmeetriline, kusjuures endiselt vastuoluline. Varasemate uuringute põhjal on mediaalne platoo on veidi suurem kui lateraalne [28]. Insalli joonel liigne välise rotatsiooni tendents. Kuigi Akagi Seetõttu põhjustab STC kasutamine sageli sääre mediaalse joon on praegu kõige tunnustatum anatoomiline telg, on platoo eesmise ja tagumise alajäägi ning posterolateraalset sellel siiski teatud sisemise rotatsiooni tendents. Lisaks üleulatuva osa [29]. Varem läbi viidud süstemaatilises mõõtis üks kaasatud uuringutest sääre alusplaadi ülevaates uuriti ATC kliinilisi tulemusi, kusjuures enamik rotatsioonilist joondamist seoses kirurgilise kaasatud uuringutest olid retrospektiivsed kohortuuringud transepikondülaarse teljega [12]. Ühes retrospektiivses ja juhtumiseeriad ning ainult 2 RCT-d võrdlesid ATC-d ja uuringus leiti, et välisrotatsioon võib olla kasulik, ning STC-d. Kaasatud uuringute madala kvaliteedi tõttu jõuti soovitati paigutada sääreosa 2–5° välisrotatsiooniga [34]. ülevaates madala tõendusjõuga järeldusele, et ATC Ühes hiljutises uuringus leiti samuti, et mõõdukas parandas sääreluu katvust ja alajääki [30], mis oli kooskõlas välisrotatsioon võib parandada kinemaatikat pärast TKA-d meie uuringu tulemustega. Väiksem alajääk võimaldab [35]. Käesolevas ülevaates määratleti kolmes kaasatud proteesil paremini sobida sääre välimise servaga ning uuringus välimine pöördenurk vahemikus -5° kuni 5° vähendab seeläbi luukadu ja osteofüütide teket. Siiski on valepöördena. Leidsime, et ATC maksimeerib katvust, kirjanduse andmed sääre alusplaadi üleulatuva osa kohta säilitades samal ajal pöörde 5° piires suuremas osas vastuolulised. Bonnin leidis oma seerias, kus kasutati juhtudest võrreldes STC-ga. Käesolevas uuringus sümmeetrilist sääreplaati, 87% patsientidest lateraalse koondasime seitse uuringut, et võrrelda kahe disaini üleulatuva osa [31]. Mõned uuringud viitasid, et ATC on pöördenurka. Välja arvatud Bizzozero P jt uuring, milles leitud optimeerima katvust ja vältima üleulatuvaid osi [4, pöörati erilist tähelepanu implantaadi paigutamisele Insalli 32]. Käesolevas ülevaates viisime läbi alarühma analüüsi joone järgi [25], pöörati kuues seitsmest uuringust sise- ja väliskülje sääreplaadi vahelise allapoole ulatuva ja maksimaalse katvuse saavutamiseks. See näitab, et isegi kui üleulatuva osa kohta ning leidsime, et nii sise- kui ka säärekomponent paigutatakse standardse pöördejoone väliskülje allapoole ulatuva osa esinemissagedus oli ATC järgi, ilmneb ikkagi valepööre. Samal ajal näitab see ka, et puhul madalam võrreldes STC-ga, samas kui sise- ja ATC optimeeris katvuse ja pöörde vahelist suhet. väliskülje üleulatuva osa puhul olulisi erinevusi ei Meie uuringul oli ka mõningaid piiranguid. Esiteks oli täheldatud. Üldiselt olid naiste sääreluud väiksemad kui kaasatud vähe randomiseeritud kontrolluuringuid, mistõttu meestel. 16 kaasatud uuringust täheldasid soolisi erinevusi lisasime ka asjakohaseid kohortuuringuid. Seetõttu tuleks kahe proteesi katvuse osas vaid Sourabh Shah DNB jt oma mõningaid järeldusi pidada esialgseteks. Teiseks, kuna uuringus ning leidsid, et nii ATC kui ka STC puhul oli käesolev uuring keskendus peamiselt kahe sääreluu pindala katvus naistel suurem kui meestel [16]. säärekomponendi katvusele ja rotatsioonilisele joondumisele, lisasime mõned uuringud, milles kasutati virtuaalset põlveliigese asendust või antropomeetrilisi uuringuid, kasutades CT- ja MRI-tehnoloogiat, kuigi patsiendid Zhang jt. BMC Musculoskeletal Disorders (2024) 25:336 Lehekülg12 13 nendes uuringutes ei teostatud põlveliigese täielikku Rahastamine Uuringut rahastasid Hunan Science and Technology Planning Project asendamist. See võib teataval määral põhjustada (2022JJ60076, 2023JJ60118) ja Changsha Science and Technology Bureau Project metoodilist heterogeensust, mistõttu me ei teostanud (kh2201063). täiendavat tundlikkuse analüüsi heterogeensuse allika Andmete ja materjalide kättesaadavus väljaselgitamiseks. Kolmandaks ei ole meil võimalik teha Käesolevas uuringus kasutatud andmekogumid on mõistliku taotluse korral alarühmade analüüsi, et uurida, kas erinevused sõltuvad saadaval vastutavalt autorilt. etnilisest kuuluvusest, kuna osa uuringutes osalenud patsientidest pärinesid erinevatelt kontinentidelt ning Deklaratsioonid kaasatud uuringutes ei analüüsitud erinevate rasside vahelisi erinevusi. Lõpuks, kuna uuringute arv, milles on Eetiline heakskiit ja osalemise nõusolek Ei kohaldata. kirjeldatud operatsioonijärgseid kliinilisi tulemusi, on piiratud, ei leidnud meie metaanalüüs, et ATC oleks Nõusolek avaldamiseks kliiniliste tulemuste poolest STC-st parem. Head Ei kohaldata. radioloogilised tulemused võivad omakorda mõjutada Konkurentsihuvid kliinilisi tulemusi teatud määral, kuid see ei tähenda Autorid kinnitavad, et neil puuduvad huvide konfliktid. tingimata proteesi pikaealisuse või funktsionaalsete Autorite andmed tulemuste olulist paranemist. Kliinilist tulemust mõjutab 1 Hunan Hiina meditsiini akadeemia, 58 Lushan Street, Changsha 410006, Hiina. 2 palju tegureid, nagu näiteks operatsioonijärgsed taastusravi Hunan Hiina meditsiini ülikool, Changsha, Hiina. 3 Ortopeedia osakond, Zhuzhou meetmed, patsiendi valulävi ja füüsiline seisund. linna Hiina meditsiini ortopeediahaigla, Zhuzhou, Hiina. Saadud: 7. oktoober 2023 Vastuvõetud: 22. aprill 2024 Järeldus Meie uuringu tulemused toetavad ATC kasutamist, mis võimaldab oluliselt parandada katvust ja pöörlemist ning Viited vähendada alajäägi arvu, ilma et suureneks üleulatus. Siiski 1. Canovas F, Dagneaux L. Elukvaliteet pärast põlveliigese täielikku asendamist. on ATC-d toetavad kliinilised tulemused ebapiisavad. Orthop Traumatol Surg Res. 2018;104(1S):S41–6. https://doi.org/10.1016/j.otsr. Seetõttu on vaja täiendavaid uuringuid, et võrrelda nende 2017.04.017. 2. Price AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A jt. Põlveliigese kahe erineva sääreplaadi disaini operatsioonijärgseid asendamine. Lancet. 2018;392(10158):1672–82. https://doi.org/10.1016/ funktsionaalseid tulemusi. S0140-6736(18)32344-4. 3. Yokhana SS, Hamilton DA, Stine SA, Stimson LN, Zalikha AK, Chen C jt. Põlve Lühendid tagakülje sääreluu alusplaadi üleulatuva osa esinemissagedus: anatoomiline TKA Täielik põlveliigese endoproteesimine kompuutertomograafia uuring. J Orthop. 2021;9(23):259–63. STC Sümmeetriline https://doi.org/10.1016/j.jor.2021. 02.002. säärekomponent ATC Asümmeetriline 4. Nedopil AJ, Zamora T, Delman C, Howell SM, Hull ML. Milline asümmeetriline säärekomponent ROM Liikumisulatus säärekomponent on optimaalselt kavandatud kaliibriga kinemaatiliselt VAS Visuaalne analoogskaala joondatud täieliku põlveliigese endoproteesimiseks? J Knee Surg. WOMAC Lääne-Ontario ja McMasteri ülikoolide osteoartriidi indeks 2022;35(14):1610–8. https://doi.org/10.1055/s-0041-1728815 . 5. Victor J. 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Kõik autorid https://doi.org/10. 1302/0301-620X.103B5.BJJ-2020-1575.R2. vaatasid käsikirja kriitiliselt läbi ja kiitsid selle heaks. Zhang jt. BMC Musculoskeletal Disorders (2024) 25:336 Lehekülg13 13 11. Minoda Y, Ikebuchi M, Mizokawa S, Ohta Y, Nakamura H. Asümmeetriline 28. Beckers L, Müller JH, Daxhelet J, Ratano S, Saffarini M, Aït-Si-Selmi T, säärekomponent parandas säärekomponendi katvust ja pöörlemist mediaalse et al. Sääreluu geomeetriliste suhete märkimisväärne individuaalne pöördepunktiga täieliku põlveliigese proteesis. J Knee Surg. 2018;31(5):416–21. varieeruvus muudab luu ja implantaadi sobimatuse vältimatuks https://doi.org/10.1055/s-0037-1604143. valmislahendustena kasutatavate täielike põlveliigese proteeside puhul: 12. Indelli PF, Graceffa A, Baldini A, Payne B, Pipino G, Marcucci M. Seos sääre süstemaatiline ülevaade ja metaanalüüs. 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Kui palju parandab Arthrosc. 2016;24(8):2532–40. https://doi.org/10 (Põlveliigese asendamise anatoomiline säärekomponent luukatte täieliku kirurgia: ülevaade). 1007/s00167-015-3512-0. põlveliigese täieliku endoproteesimise puhul? J Arthroplasty. 2017;32(6):1829– 32. Nedopil AJ, Zamora T, Shelton T, Howell SM, Hull M. Anatoomiliselt sobiva 33. https://doi.org/10. 1016/j.arth.2016.12.041. sääreluu alusplaadi paigutus kulgeb peaaegu paralleelselt painde- 16. Shah S, Agarwal N, Jain A, Srivastav S, Thomas S, Agarwal S. Viie põlveliigese pikenduse tasapinnaga ja katab suure osa sääreluu proksimaalsest osast. J proteesi sääreluu katvuse võrdlus MRI abil: antropomeetriline uuring indialaste Knee Surg. 2021;34(13):1486–94. https://doi.org/10.1055/s-0040-1710367 seas. J Arthroplasty. 2015;30(9):1643–6. https://doi.org/ 33. Abdelnasser MK, Adi MM, Elnaggar AA, Tarabichi S. 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Fang C, Luan Y, Wang Z, Shao L, Qu T, Cheng CK. Põlveliigese täieliku 1016/j.arth.2015.04.033. asendamise järel tekitab säärekomponendi mõõdukas välispööre 19. Ma Y, Mizu-Uchi H, Okazaki K, Ushio T, Murakami K, Hamai S jt. Sääreplaadi loomulikumat kinemaatikat kui sisepööre. Front Bioeng Biotechnol. kuju mõju pöördelisele joondamisele täieliku põlveliigese 2022;13(10):910311. https://doi.org/10.3389/fbioe.2022.910311. endoproteesimisel: kolmemõõtmeline kirurgiline simulatsioon osteoartriidiga põlvedel. Arch Orthop Trauma Surg. 2018;138(1):105–14. https://doi.org/10.1007/ s00402-017-2828-2. Kirjastaja märkus 20. Martin S, Saurez A, Ismaily S, Ashfaq K, Noble P, Incavo SJ. Sääreluu Springer Nature jääb neutraalseks seoses avaldatud kaartidel ja institutsiooniliste maksimaalne katmine kahjustab õiget rotatsioonilist joondumist. Clin Orthop kuuluvustega esitatud jurisdiktsiooniliste nõuetega. Relat Res. 2014;472(1):121–5. https://doi.org/10.1007/s11999-013-3047-y. 21. 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Kas põlveliigese täisproteesi anatoomiline disain võimaldab komponentide paremat sobivust võrreldes selle mitteanatoomilise eelkäijaga? Vastavuskohortuuring. Arthroplast Today. 2021;1(12):62–7. https://doi.org/10.1016/j.artd. 2021.09.001. 25. Bizzozero P, Bulaid Y, Flecher X, Ollivier M, Parratte S, Argenson JN. Morfomeetriline sääreluu implantaat vähendab tagumise üleulatuva osa esinemissagedust ja parandab kliinilisi tulemusi: prospektiivse, sobitatud kontrollitud uuringu tulemused. J Arthroplasty. 2018;33(9):2804–9. https://doi.org/10.1016/j.arth.2018.04 020. 26. Hartel MJ, Loosli Y, Delfosse D, Diel P, Thali M, Ross S jt. Sääreluu morfoloogia mõju anatoomilise sääreluu alusplaadi disainil i põlveliigese proteesi puhul. Knee. 2014;21(2):415–9. https://doi.org/10.1016/j.knee.2014.01.003 27. Wu K, Lv G, Yin P, Dong S, Dai Z, Li L jt. Sääreosa üleulatuva osa mõju elueale mediaalse liikuvlaagriga ühekompartmentaalses põlveliigese endoproteesimisel. Knee. 2022;37:188–95. https://doi.org/10.1016/j.knee. 2022.06.011. Annual report 2024 The Swedish Arthroplasty Register Annual report 2024 Annette W-Dahl Johan Kärrholm Cecilia Rogmark Oskar Johansson Perna Ighani Arani Maziar Mohaddes Ola Rolfson We cannot be held liable for any errors that may occur in printing, information and/or data files. Publisher: Ola Rolfson. ISSN 1654-5982 ISBN digital PDF 978-91-986612-8-6 Content Glossary 4 1. Introduction 9 2. Data quality 14 Completeness analysis 14 3. Demography 30 4. Epidemiology 42 Hip and Knee Replacement in Sweden 42 5. Hip replacement 52 5.1. Primary total hip replacement 52 5.2. Reoperation hip replacement 82 5.3. Reoperation within two years 90 5.4. Revision Hip Replacement 100 5.5. Evaluation of implants and implant combinations 128 5.6 Hip fracture treatment with hemiarthroplasty or total hip replacement 136 6. Knee replacement 145 6.1. Primary knee replacement 145 6.2. Reoperation of knee replacements regardless of diagnosis, cause, and previous surgeries 166 6.3. Reoperation within two years for TKR/OA 169 6.4. Revision knee replacement 173 6.5. Evaluation of implant 190 6.6. Knee Osteotomy 195 7. Adverse events 205 7.1. 90-day mortality 205 7.2. Adverse events 208 8. Patient-Reported Outcome Measures 221 9. In-Depth Analyses 259 9.1. Custom made cups 259 9.2 SPII stem 130 or 150 mm? 264 9.3 Choice of fixation related to age 269 Swedish Arthroplasty Register and clinical research 279 ABOGRAFT – Bone grafts treated with antibiotics to reduce the risk of infection in hip replacement surgery 281 International work 283 Publications 2021–2024 284 Thank you to contact secretaries and contact surgeons 290 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Glossary Expression Definition Adverse event An unexpected negative event, in this case, as a consequence of joint replacement surgery, for example an infection. Ahlbäck classificationen Radiological classification of knee osteoarthritis ASA class American Society of Anesthesiologist physical status classification: classification of patients regarding medical comorbidity. The higher the ASA class, the grater the degee of comorbidity Aseptic loosening Loosening of prosthesis component(s) without proven infection. Bilateral prosthesis Prosthesis in both right and left hip/knee respectively. Bipolar head Composite femoral head used for hemiarthroplasty where a smaller head is fixated on the prosthesis cone, and a larger head is snapped on to the smaller head. The result is that movement can take place in two joints, one between the smaller and the larger head, and one between the larger head and the acetabulum. BMI Body mass index= weight divided by length squared (kg/m²). Case-mix profile Case-mix or distribution of patient characteristics at each unit respectively. CE Conformité Européenne (in free translation: European conformity). Charnley class Classification of comorbidity that mainly relates to mobility. Class A refers to unilateral hip/knee disease, class B refers to bilateral hip/knee disease, and class C refers to multiple joint disease or other medical conditions that affect the walking ability. Closed reduction Return body part or fracture to proper position without surgical incision. Computer assisted surgery (CAS) A surgical concept and set of methods that use computer technology for surgical planning and for guiding or performing surgical interventions. Confidence Interval (CI) An estimate of a calculated value´s uncertainty indicating the lower and upper limit. Consumption Refers to the number of hip/knee replacements per 100,000 inhabitants regardless of where the surgery has been performed. Cox regression Regression model used for investigating the effect of several variables upon the time a specified event takes to happen. CPUA Central Personal Data Controller Cruciate retaining (CR) Minimally stabilizing, posterior cruciate retaining type of prosthesis. Custom made instruments Instruments or saw blocks specially made for the patient based on MRI or CT. DAIR Debridement, Antibiotics, Implant Retention; Surgical procedure in case of deep infection if the implant is stable, with the aim to retain the prosthesis by debridement, rinsing and administrating antibiotics to heal the infection. Dislocation For hip prostheses, this means that the joint head jumps out of the center of the joint cup. For knee prostheses, this usually means that the patella jumps to the side, but it does occur also that the prosthetic components of the femur and lower leg separate from each other. DMC Dual Mobility Cup have two points of articulation, one between the shell and the polyethylene (external bearing) and one between the polyethylene and the femoral head. 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Expression Definition Elective surgery Planned surgery. EQ-5D A standardized instrument, questionnaire, to measure general health. European standard A theoretical population used to be able to compare information from different countries. population (ESP) Fast track Care consept based on accurate preoperative information, early mobilization and effective pain relief to minimize length of stay while maintain high quality of care. HA Hydroxyapatite Hardinge approach Direct lateral approach in supine position. Hazard ratio (HR) Ratio of the hazard rates corresponding to the conditions described by two levels of an explanatory variable in a survival analysis. Hinged prosthesis Knee prosthesis that only allow for flexion and extension through a fixed axis. HKA (hip-knee-ankle) angle A measure of lower limb alignment from x-ray, defined as the angle between the mechanical axes of the femur and the tibia. HOOS Hip dysfunction and Osteoarthritis Outcome Score. A standardized instrument, questionnaire, to measure knee-related pain, function and quality of life. Hybrid prosthesis Total hip prosthesis with uncemented cup and cemented stem or knee prosthesis with uncemented tibial plate and cemented femur. ICD-10 The 10th edition of the International Statistical Classification of Diseases and Related Health Problems governed by World Health Organisation Incidence The number of events in a given population over a limited period of time. ISAR International Society of Arthroplasty Registries. Kaplan-Meier Statistical method for estimating the probability of not having experienced a specific event (eg. death or revision)at a certain given time. Knee osteotomy Re-angeling of the knee joint to unload the diseased/injured part of the knee. Joint preserving surgery. KOOS Knee injury and Osteoarthritis Outcome Score. A standardized instrument, questionnaire, to measure hip related pain, function and quality of life. KVÅ Swedish Classification system of surgical procedures based on the Nordic Medico-Statistical Com- mittee (NOMESCO) classification of surgical procedures. Lateral position Side position during surgery. Likert A scale where the responder's different attitudes are measured Linkert scales usually have five levels, but seven levels also exist. Linked knee implants (Linked/Rotating hinge) Have a mechanical coupling between the femoral and tibial components allowing for flexion and extension as well as for a varying amount of rotation. Local infiltration analgesia (LIA) A multimodal concept for postoperative local pain relief. 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Expression Definition Logrank-test Statistical method to compare the difference between two or several survival distributions (Kaplan-Meier) where the hypothesis is that the distributions are equal. MDR Medical Device Regulation. Regulation on medical devices within the EU. Minimal invasive surgery (MIS) This implies a (small) arthrotomy used to gain access to the joint without the patella having to be everted. NARA The Nordic Arthroplasty Register Association. NOAK Non vitamin-k Orala AntiKoagulantia NPO A national program for knowledge management. One-stage surgery An operation performed in one occation. Osteoarthritis (OA) Osteoarthritis is a joint disease that affects the entire joint. The division in primary and secondary osteoarthritis is questionable as osteoarthritis is a complex condition that can have many contributing factors. Osteolysis Loosening of bone tissue. Osteosynthesis Repair a fracture with, for example, plates, screws, nails or steel wire. NPR (PAR) The national patient register of the National Board of Health and Welfare. Partial knee resurfacing “Buttons” that only replace a part of a knee compartment. implant (PRKA) Patello-femoral knee A replacement which resurfaces the patello-femoral compartment. replacement (PF) Posterior stabilized knee A type of stabilizing knee prostesis that requires resection of the posterior cruciate ligament. replacement (PS) PPFF Periprosthetic femoral fracture. Prevalence Refers to the proportion of individuals who suffer from a certain disease or having a certain condition. Production Refers to the number of total hip/knee replacements per 100,000 inhabitants regardless of where the patient being operated lives. PROM Patient-Reported Outcome Measurement p-value Measure that indicate the probability that, for example, two mean values differ. Given that the hypothesis that two or more groups have the same mean is true, the p-value is the probability to have an outcome at least as extreme as the outcome that is actually observed. Reoperation Reoperation includes all kinds of surgical intervention that can be directly related to an inserted hip/knee arthroplasty irrespective of whether the prosthesis or one of its parts has been exchanged, removed or left untouched. For knee replacements this also includes mobilisation under anaesthesia. Reverse hybride Total hip prosthesis with cemented cup and uncemented stem or knee prosthesis with cemented tibial plate and uncemented femur. 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Expression Definition Revision Exchange, addition or extraction of one or more inserted prosthesis components (including arthrodesis and amputation). Rheumatoid arthritis (RA) Inflammatory joint disease Risk ratio (RR) The probability that some event will be observed in one group relative to the probability that it will be observed in another group. SALAR (SKR) Swedish Association of Local Authorities and Regions. SD Standard deviation. Sequelae Impairment after disease, injury or trauma. SHAR Swedish Hip Arthroplasty Register SKAR Swedish Knee Arthroplasty Register SOASP Supported OsteoArthritis Self-management Programme. A structured way of conveying fist-line treatment for osteoarthritis, which means information and exercise. Stabilized knee prosthesis The term stabilizing is used only for a group of TKA-type prostheses that use the shape of the femur and the tibial component to restrict movement in the varus / valgus and rotation. Standard patient Male or female 55-85 years with primary osteoarthritis, ASA class I–II and BMI less than 30 operated on with a primary hip replacement. Swedish Arthroplasty Register Merger of the Swedish Hip Arthroplasty Register and the Swedish Knee Arthroplasty Register. (SAR) THR Total hip replacement TKR Total knee replacement TKR revision models TKRs that are mainly used for revision or severe primary cases. Two-stage surgery An operation performed in two occations. Unicompartmental knee Provide only the medial or lateral femorotibial compartment (medial UKR and lateral UKR replacement (UKR) respectively). Unilateral prothesis Prosthesis only in one hip/knee. Unipolar head Femoral head that is fixated to the prosthesis cone, which articulates against acetabulum. Unit Clinic Vancouver classification Classification system for periprosthetic fractures. Type A: Trochanteric fractures that do not affect the prosthesis. Type B: F racture in direct proximity to the prosthesis, subdivided into B1 (good bone-anchoring), B2 (loosening of the prosthesis), and B3 (loosening of the prosthesis and/or osteolysis). Type C: Fracture distally of the prosthesis. VAS Visual analogue scale. A 100 mm long horizontal scale where the value for a condition is given. Instrument for self-assessment. Watson-Jones surgical A type of antero-lateral surgical approach. approach 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Significant increase in joint replacement surgeries, but despite this, long waiting times for sick and complex patients. 1. Introduction Despite the number of primary hip and knee replace- Additionally, 2,459 reoperations for hip replacements and ments in 2023 having increased by nearly 20% compared 1,439 reoperations for knee replacements were recorded. to the year before the pandemic, Swedish orthopedics is In total, 52,092 prosthetic surgeries were registered, of struggling with long waiting times for joint replacement which 48,350 were primary operations. For primary surgery and a shortage of hospital beds and staff. This is operations, this represents an increase of 13% compared particularly true for patients with comorbidities and those to the previous year. We continue to see a recovery effect requiring more advanced surgery—revisions and complex following the pandemic. primary operations. An increasing proportion of patients are being operated on by privately run healthcare provid- The total number of registered primary hip and knee ers. It is, of course, good that the capacity to perform joint replacements in the registry’s database amounted to replacement surgeries is increasing. Unfortunately, the 936,618, with 366,809 knee replacements from 1975 shift to more surgeries being performed by privately run through 2023 and 569,809 hip replacements (both total units has resulted in the public healthcare system being and hemi) from 1979 through 2023. The corresponding drained of resources to such an extent that the sickest number for reoperations was 131,194, of which 97,943 and those in need of advanced surgery have suffered from were reoperations after hip replacement and 33,251 were unreasonably long waits for surgery. reoperations after knee replacement (Figures 1.1–1.6). This year’s production—another Stepwise introduction of robot-assisted record year joint replacement surgery The Swedish Arthroplasty Registers Annual Report 2024 In 2022, the first robot-assisted knee replacement sur- includes data on surgeries performed until December 31, geries were performed in Sweden. As part of a research 2023. During the operational year 2023, 22,581 total collaboration between Sahlgrenska University Hospital hip replacements, 5,145 hemiarthroplasties, 20,624 knee and Örebro University Hospital, the first surgeries were replacements, and 127 knee osteotomies were registered. conducted in Mölndal and Lindesberg. This is a good 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 example of the stepwise introduction of new technology New reference prostheses in joint replacement surgery. In 2023, Capio Ortopediska Huset began performing robot-assisted knee replace- In the sections evaluating hip and knee implants, we ment surgery. By the end of the year, a total of 156 knee have made several changes to the selection of reference replacement surgeries had been performed with robotic prostheses. These changes reflect shifts in the usage of assistance in Sweden. prosthesis models. For uncemented cups, Trilogy was pre- viously the reference. However, since the use of Trilogy has significantly decreased over the past decade, we have PROM via 1177 chosen to use Trident Hemi as the reference prosthesis. In the spring of 2023, the procedure for sending out For uncemented stems, we have now separated the stan- follow-up questionnaires was changed. All patients con- dard version of Corail into collarless and collared versions, nected to 1177 now receive an invitation to respond to using the latter as the reference prosthesis. For total knee PROM (Patient-Reported Outcome Measures) follow-ups prostheses, we have switched from PFC Sigma MBT to via the messaging service in 1177. The system ensures that NexGen MBT. This change is mainly due to the planned those who are not connected to 1177, or those who do discontinuation of the PFC Sigma system within a few not respond via 1177, receive a paper version by mail. years. Regarding unicompartmental knee replacements, This significantly reduces the administrative burden on we have chosen to use the uncemented Oxford model as the units. In 2023, 33,517 preoperative questionnaires the reference, as it accounts for 75% of all unicompart- and 51,307 follow-up questionnaires were registered. mental knee replacements over the past decade. New principles for disclosure control Completeness and adverse events Disclosure refers to the situation where an external person Unfortunately, the National Board of Health and Welfare gains new knowledge about a specific characteristic of were not able to deliver the completeness analysis and an individual. Disclosure can occur, for example, when adverse events data for this year’s Swedish report. How- information about an individual is revealed in a table or ever, in this English version, we have received data for when someone compiles statistical material and other 2023 and included them. For 2023, the Swedish Arthro- information that could reveal details about that indi- plasty Register continued to have very high completeness vidual. The term “disclosure control” primarily refers to for primary procedures, with 98% for both knee replace- statistical disclosure control, which involves methods to ments and total hip prostheses. ensure that information about individuals cannot be iden- tified in presented statistics or statistical material. SAR has always prioritized disclosure control in the presentation In-depth analyses of statistics in our annual reports. For example, we have The report’s section on in-depth analyses often attracts not presented data at the unit level for units with few considerable attention. The increasing proportion of unce- registrations during a period. mented fixation in total hip replacements has prompted an in-depth analysis regarding the choice of fixation in In 2024, Registercentrum Västra Götaland introduced different age groups. We have also examined differences new principles for disclosure control to be applied to all in revision outcomes between the standard length and affiliated registries. The principle is that all numbers should shorter version of the most commonly used cemented be rounded to the nearest ten, numbers between one and stem in Sweden, Lubinus SPII. four are indicated as zero, and five events are rounded to ten. However, SAR has chosen to modify the disclosure control principles, where we state that the number is less Continued high research production than five (<5) or equal to zero. Furthermore, data is not In 2023, 17 scientific papers were published, and three presented for units with fewer than 15 operations during PhD students, whose theses were based wholly or in part a given time period. Otherwise, actual numbers are pre- on data from what is now the Swedish Arthroplasty Reg- sented. As a consequence of these principles, for example, ister, successfully defended their theses. It is particularly it is not possible for us to present demographic data for gratifying that we have scientific collaborations with lateral unicompartmental knee replacements. all medical faculties in Sweden and many international research partnerships. 1 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 The Autumn Meeting – contact Physician Thanks to contact secretaries and Meeting with the Swedish Hip and Knee contact surgeons Association A key requirement for the register to function is that units On November 9–10, the “Autumn Meeting” was held register and provide the necessary information. We greatly for the second consecutive year in collaboration with appreciate all the dedication and work that contact sec- the Swedish Hip and Knee Association. The traditional retaries and contact physicians across the country put in. “Contact Physician Meeting” was incorporated into the At the end of the report, you will find a list of all contact program, which also featured research presentations and physicians and contact secretaries. We look forward to engaging symposia on current topics in joint replacement continued good cooperation in the future. A big thank surgery. In 2024, the meeting took place on October you for all your contributions over the past year! 17–18 in Stockholm with the international guest speakers Fares Haddad, Søren Overgaard, and Harvey Sandhu. February 2025, Register Management © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 1.1 Primary total hip replacement surgery 1968–2023 Figure 1.2 Primary knee replacement surgery 1975–2023 1 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 1.3 All hip replacements 2005–2023. Figure 1.4 All knee replacements 2005–2023. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 1.5 All hip revisions 1979–2023. Figure 1.6 All knee revisions 1975–2023. 1 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 High data quality is crucial for drawing reliable conclusions, providing accurate recommendations, and achieving successful outcomes in clinical improvement work. 2. Data quality Completeness analysis Authors: Annette W-Dahl and Ola Rolfson An important part of the validation work is the annual registration process includes the input of information completeness analysis, conducted through a cross-check from labels on prosthetic components during both pri- with the Patient Register of the National Board of Health mary surgeries and revisions. Additionally, medical records and Welfare. By comparing the number of care episodes are submitted for reoperations. However, some units may and assuming that the true number of episodes is the fail to register operations in both the Swedish Arthroplasty combined total from both registers, completeness can Register and the Patient Register, and some entries in the be estimated. The method is explained in Table 2.1. The Patient Register might involve operations on individuals analysis covers all primary surgeries, divided into total with coordination numbers that the Swedish Arthroplasty and hemi arthroplasty, knee replacements, as well as hip Register does not record. One identified source of error is and knee revisions. The Patient Register includes Swed- that procedure codes for revisions have been reported to ish personal identification numbers and coordination the Patient Register when, in fact, the operation was not numbers, while the Swedish Arthroplasty Register only a revision but another type of reoperation. In such cases, includes Swedish personal identification numbers. This the operation appears as a revision in the Patient Register year, we received the completeness analysis for 2023 in but not in the Swedish Arthroplasty Register. time for the English version of the annual report and data for 2023 is presented. To examine trends in reporting frequency, we have com- piled data for the past twelve years (2012–2023). The The accuracy of data entered into quality registers and completeness for total hip replacements during this period health data registers is essential for ensuring that results has been 98%, and in 2023, it was 98.5% (Figure 2.1a). and analyses are of high quality and reliability, which in For hemi arthroplasties, the completeness in 2022 was turn enables better and fairer performance monitoring. 97.5%, with the reporting frequency over the twelve-year For the operations recorded in the Swedish Arthroplasty period ranging between 94% and 98%. For knee replace- Register, we can say with a high degree of certainty that ments, the completeness in 2023 was 97.8%, with the they involve hip or knee replacement surgeries. We reporting frequency over the twelve-year period ranging also know which procedure has been reported, as the between 97% and 98% (Figure 2.1b). 1 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 2.1a. Completeness for hip replacement 2012–2023. Figure 2.1b. Completeness for knee replacement 2012–2023. The completeness for hip and knee revisions is presented 2.5) and knee revisions (Table 2.6) by unit. Please note based on surgeries classified as revisions, which include that percentage figures for units with a small number of the removal, replacement, or addition of any prosthetic operations can be misleading. Under “Other Units,” we component. The Classification of Care Measures (KVÅ) categorize operations where the unit is not specified in the for revisions is presented in Table 2.1. From 2012 to information from the Swedish National Board of Health 2023, the completeness for hip revisions ranged between and Welfare or where operations performed at a specific 92% and 94%, and in 2023 it was 93.6% (Figure 2.1a). unit are reported as being performed by a hospital oper- For knee revisions, the completeness during this period ator responsible for several hospitals. Some units do not varied between 92% and 94%, and it was 93.7% in report to the Patient Register but do report to the Swedish 20223 (Figure 2.1b). In this completeness analysis, we Arthroplasty Register, meaning that a completeness anal- have attempted to compensate for the error where reop- ysis for these clinics is not possible. If the completeness erations (other procedures than revisions) are registered is below 96%, it is marked in red. For units with low as revisions in the Patient Register. However, in the past registration rates, it is important to investigate whether years it has been observed that units performing few or the reporting of operations has been missed and whether no knee revisions have sometimes reported significant the surgical coding of procedures is accurate, ensuring that numbers of revisions (27 to 39 revisions) to the Patient revision codes are only used for revisions and not for reop- Register. We have investigating this issue more closely erations that do not involve the removal, replacement, or together with these units and the Patient Register and addition of prosthetic components. found that the Patient Register have used the KVÅ code NGB59 (addition of patella in primary surgery) as a revi- sion code. Removing this code, resulted in a completeness Reporting frequency of PROM more in line with our view and other means of checking The PROM (Patient-Reported Outcome Measures) pro- the completeness previously used for knee revisions. grams for hip and knee replacements differ from each other. For hip replacements, PROM is tracked on a per-person basis, whereas for knee replacements, it is tracked on a Coverage analysis (completeness) by unit per-operation basis (see Chapter 8). For hip replacements, Completeness is presented for primary total hip replace- individuals who have undergone reoperation or surgery ments (Table 2.2), hemi arthroplasties (Table 2.3), knee on the other hip during the follow-up year are excluded. replacements (Table 2.4), as well as hip revisions (Table In contrast, knee replacements are followed up one year 1 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 postoperatively, regardless of whether a reoperation has knee replacements are now monitored. This year’s report occurred during the follow-up year. When the two regis- includes the response rates for the past five years (Table tries were merged into the Swedish Arthroplasty Register, 2.7) and shows that the response rate has fluctuated over the PROM questionnaires for hip and knee replacement the years, with a decrease observed from 2020 to 2022 surgeries have been harmonized. This has led to some for knee replacements. The decrease may be attributed delays in the PROM questionnaires for operations per- to the impact of both the merge and the pandemic on formed in 2021, particularly for knee replacements where PROM management. most changes have occurred (see Chapter 8). The knee replacement questionnaire consists of 24 questions, while For 2023, only preoperative responses are available, with the questionnaire for hip replacement patients consists a response rate for knee replacements of 65%, which is of 25 questions. Additionally, a question on satisfaction lower than the 74% response rate for hip replacements. with the surgery is included in the postoperative forms This lower rate is likely due to several units that had not for both hip and knee procedures. Hip replacements previously participated in the knee replacement PROM have been monitored nationally since 2008, while knee program not being fully operational yet, presenting an replacements have been tracked at participating units opportunity for improvement in the future. since 2009. Since the merge on September 1, 2021, all Description of the completeness analysis Completeness Primary hip replacements (total and hemi), primary knee replacements and hip and knee revisions in the Swedish Arthroplasty Register (SAR) are compared with corresponding in the National Patient Register (NPR), in 2020 and 2021. The completeness is calculated as a percentage of: Nominator All replacements/revisions in the SAR, performed in the current year. Denominator The total number of replacements/revisions either in the SAR or in the NPR, performed in the current year. A maximum of one procedure per individual and date has been included. Selection from the Swedish Arthroplasty Register Hip and knee replacement surgeries and revisions of hip and knee replacements, performed in the current year. Selection from the National Patient Register Hip and knee replacements and revisions of hip and knee replacements registered in the NPR inpatient care, performed in the current year. Registrations with procedure codes for each type of surgery were included; primary total hip replacements NFB29, NFB39, NFB49, NFB62 or NFB99 primary hemi hip replacements NFB09 or NFB19 primary knee replacements NGB09, NGB19,NGB29,NGB39,NGB49,NGB53,NGB59 or NGB99 revisions of hip replacements NFC, NFU09 or NFU19 revision of knee replacements NGC, NGU03, NGU09, NGU19 or NGU59 Maximum one procedure per individual and date has been included. Matching criterion Operations in the SAR were matched against the NPR by the unique personal identification number and procedure date +/- 7 days. More about the processing Information on the unit was obtained primarily from the SAR and secondary from the NPR. Only registrations with a Swedish personal identification number or temporary number were included in the sample selection from each register.Operations classified as hip or knee revisions in the NPR but as other reoperations for knee and hip replacements in the SAR were excluded as they were probably misclassified. Table 2.1. Description of the completeness analysis. 1 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Completeness for primary hip replacement 2023 Total number SAR % PAR % Riket 21 015 97,9 92,8 Akademiska sjukhuset 303 94.7 98.3 Aleris Malmö Arena 266 100 98.5 Aleris specialistvård Nacka 664 99.1 83.1 Aleris Specialistvård Renmarkstorget, Umeå 45 100 2.2 Aleris specialistvård Ängelholm 685 96.9 93.3 Art Clinic Göteborg 443 100 99.8 Art Clinic Jönköping 262 98.1 99.6 Arvika 295 97.3 97.6 Bollnäs 384 99.2 95.8 Borås - Skene 430 98.1 98.4 Capio Artro Clinic / Sophiahemmet 611 100 88.2 Capio Movement Halmstad 416 98.8 100 Capio Ortho Center Göteborg 253 99.2 98.8 Capio Ortho Center Stockholm 903 100 99.9 Capio Ortho och Spine Center Skåne 260 96.9 98.8 Capio Ortopedi Motala 420 100 99 Capio Ortopediska Huset 778 98.3 94.6 Capio S:t Görans 425 98.6 99.3 Capio Spine Center Göteborg 67 100 76.1 Carlanderska 699 98.4 90.4 Danderyds 252 97.2 95.6 Eksjö 310 99.7 99.7 Enköping 543 99.6 99.3 Eskilstuna 80 97.5 98.8 Falun 198 97.5 97 Frölundaortopeden 11 100 0 Gällivare 94 100 100 Gävle 184 95.7 92.9 Halmstad - Varberg 270 94.4 98.1 Helsingborg 76 98.7 97.4 Hermelinen 38 100 0 Hudiksvall 76 97.4 90.8 Hässleholms 767 100 99.9 Jönköping 245 98.4 97.6 Kalmar 122 99.2 97.5 Karlshamn–Karlskrona 356 98.9 98.9 Karlstad 128 97.7 97.7 Karolinska Huddinge 243 92.2 95.9 Karolinska Solna 66 84.8 98.5 Kristianstad 17 100 100 Table continued on next page. 1 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Completeness for primary hip replacement 2023, cont. Total number SAR % PAR % Kullbergska sjukhuset 426 100 99.8 Kungälv - Alingsås 360 97.2 98.3 Ledplastikcentrum Bromma 809 99.1 97.3 Lidköping - Skävde 442 98.2 98 Linköping 98 94.9 96.9 Ljungby 144 97.2 100 Lycksele 306 97.7 97.4 Mora 326 99.4 97.9 Norrköping 240 99.2 99.2 Norrtälje 170 98.2 100 Uddevalla 394 99.5 99.2 Nyköping 168 98.2 98.8 Ortopediskt Center, Sophiahemmet 262 100 0.4 Oskarshamns 380 100 98.9 Piteå 440 98.2 98.9 Skellefteå 147 100 99.3 Sollefteå 428 99.5 98.8 Specialistcenter S:t Johanniskliniken 10 100 0 Specialistcenter Scandinavia Eskilstuna 208 100 0 Specialistcenter Scandinavia Malmö 122 100 0 SU/Mölndal 452 98.2 97.6 Sunderby 73 91.8 91.8 Sundsvall 68 92.6 95.6 SUS/Lund 106 99.1 95.3 SUS/Malmö 13 76.9 92.3 Södersjukhuset 258 99.6 99.6 Södertälje 174 99.4 100 Torsby 163 100 99.4 Trelleborg 401 99.5 98.3 Umeå 60 81.7 96.7 Visby 149 98.7 98 Värnamo 173 98.8 97.1 Västervik 167 98.8 96.4 Västerås 658 99.1 98.8 Växjö 223 99.6 96 Ystad 11 100 100 Örebro - Lindesberg - Karlskoga 676 99 99 Örnsköldsvik 169 97.6 98.8 Östersund 253 98.4 97.2 Other units 16 31 100 Table 2.2. The completeness for primary total hip replacement per unit 2023. 1 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Completeness for primary hemiarthroplasty hip 2023 Total number SAR % PAR % Country 5,279 97.5 94.2 Akademiska sjukhuset 179 92.2 98.3 Borås - Skene 93 98.9 90.3 Capio S:t Göran 176 93.2 96 Danderyd 257 98.1 97.3 Eksjö 52 100 92.3 Eskilstuna 103 100 97.1 Falun 117 100 97.4 Gällivare 43 100 97.7 Gävle 135 99.3 78.5 Halmstad - Varberg 205 97.1 97.1 Helsingborg 187 97.3 96.3 Hudiksvall 63 95.2 92.1 Jönköping 64 100 96.9 Kalmar 120 96.7 95.8 Karlshamn - Karlskrona 95 97.9 80 Karlstad 148 100 95.3 Karolinska Huddinge 127 98.4 93.7 Karolinska Solna 33 87.9 87.9 Kristianstad 146 98.6 91.8 Kungälv - Alingsås 121 99.2 90.1 Lidköping - Skövde 142 96.5 93 Linköping 172 98.3 95.3 Ljungby 19 100 94.7 Lycksele 22 95.5 100 Table continued on next page. 1 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Completeness for primary hemiarthroplasty hip 2023, cont. Total number SAR % PAR % Mora 78 93.6 87.2 Norrköping 86 98.8 97.7 Norrtälje 35 100 94.3 Nyköping 47 97.9 89.4 Skellefteå 56 100 94.6 SU/Mölndal 292 99 94.5 Sunderby 126 88.9 96.8 Sundsvall 97 97.9 94.8 SUS/Lund 183 99.5 90.2 SUS/Malmö 198 95.5 92.4 Södersjukhuset 282 99.6 98.9 Södertälje 7 100 100 Torsby 29 100 93.1 Uddevalla 215 98.6 95.8 Umeå 109 100 96.3 Visby 39 89.7 82.1 Värnamo 45 100 91.1 Västervik 54 100 92.6 Västerås 13 100 84.6 Växjö 64 98.4 92.2 Ystad 117 97.4 97.4 Örebro - Lindesberg - Karlskoga 151 96.7 94.7 Örnsköldsvik 66 97 98.5 Östersund 63 98.4 95.2 Other units 8 25 100 Table 2.3. The completeness for primary hemiarthroplasty hip per unit 2023. 2 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Completeness for primary knee replacement 2023 Total number SAR % PAR % Country 20,864 97.8 93 Akademiska sjukhuset 127 97.6 99.2 Aleris Malmö Arena 292 100 99 Aleris specialistvård Nacka 744 98.4 78.1 Aleris Specialistvård Ängelholm 7 0 100 Art clinic Göteborg 488 99.8 99.6 Art Clinic Jönköping 332 99.1 99.1 Arvika 260 94.2 95 Bollnäs 437 98.9 96.8 Borås - Skene 319 97.5 97.8 Capio Artro Clinic / Sophiahemmet 1 167 99.9 67.3 Capio Movement Halmstad 703 95.7 96.4 Capio Ortho Center Göteborg 327 99.7 99.1 Capio Ortho Center Stockholm 854 99.6 100 Capio Ortho och Spine Center Skåne 371 93.8 98.1 Capio Ortopedi Motala 674 98.1 99.6 Capio Ortopediska huset 887 98.3 96.1 Capio S:t Göran 358 96.6 98 Capio Spine Center Göteborg 9 100 66.7 Carlanderska 725 96.4 87.2 Danderyd 135 96.3 97.8 Eksjö 349 100 100 Enköping 541 98.3 98.3 Eskilstuna 48 93.8 100 Falun 198 98 96 Frölundaortopeden 14 100 0 Gällivare 45 100 100 Gävle 69 94.2 97.1 Halmstad - Varberg 266 90.2 96.6 Hermelinen 37 100 0 Hudiksvall 46 97.8 93.5 Hässleholm 934 98.5 98.6 Kalmar 93 97.8 97.8 Karlshamn 309 98.7 99 Karlstad 24 91.7 100 Karolinska Huddinge 147 96.6 98 Karolinska Solna 47 78.7 97.9 Table continued on next page. 2 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Completeness for primary knee replacement 2023 cont. Total number SAR % PAR % Kullbergska sjukhuset 434 100 100 Kungälv - Alingsås 362 98.1 96.7 Ledplastikcentrum Bromma 910 95.1 97.9 Lidköping - Skövde 266 98.1 98.1 Lindesberg 449 99.3 99.8 Ljungby 126 90.5 98.4 Lycksele 199 98.5 100 Mora 285 97.5 99.3 Norrköping 163 97.5 100 Norrtälje 199 99 98.5 Nyköping 95 98.9 97.9 Ortopediskt Center Sophiahemmet Oskarshamn 400 98.3 99 Piteå 425 98.1 97.6 Skellefteå 68 95.6 100 Sollefteå 193 98.4 98.4 Specialistcenter S:t Johanniskliniken 152 98.7 81.6 Specialistcenter Scandinavia Eskilstuna 167 100 0 Specialistcenter Scandinavia Malmö 202 100 0 Specialisthuset Sundsvall AB 26 100 0 SU/Mölndal 299 98 99 Sundsvall 57 86 96.5 SUS/Lund 22 90.9 95.5 Södersjukhuset 107 98.1 100 Södertälje 141 97.2 97.2 Torsby 127 99.2 99.2 Trelleborg 412 98.3 98.8 Uddevalla 198 99.5 98 Umeå Visby 97 96.9 97.9 Värnamo 237 97 100 Västervik 119 93.3 98.3 Västerås 290 99.3 99 Växjö 140 95.7 97.9 Ängelholm - Helsingborg 726 98.5 91.6 Örnsköldsvik 213 100 97.7 Östersund 163 95.1 96.9 Other units 12 25 100 Table 2.4. The completeness for primary knee replacement per unit 2023. 2 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Completeness for hip revisions 2023 Total number SAR % PAR % Country 2,392 93.6 87.6 Akademiska sjukhuset 137 96.4 94.2 Borås - Skene 54 96.3 92.6 Capio Ortopedi Motala 21 100 85.7 Capio S:t Göran 75 84 81.3 Danderyd 200 96.5 92 Eksjö 27 100 88.9 Eskilstuna 54 96.3 88.9 Falun 48 100 89.6 Gällivare 9 100 66.7 Gävle 62 95.2 79 Halmstad - Varberg 67 80.6 88.1 Helsingborg 78 98.7 78.2 Hässleholm 46 97.8 87 Jönköping 38 94.7 81.6 Kalmar 24 95.8 91.7 Karlshamn - Karlskrona 44 90.9 100 Karlstad 71 95.8 95.8 Karolinska Huddinge 123 88.6 87 Karolinska Solna 26 50 92.3 Kristianstad 11 63.6 72.7 Kungälv - Alingsås 36 94.4 66.7 Lidköping - Skövde 67 95.5 83.6 Linköping 57 98.2 86 Table continued on next page. 2 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Completeness for hip revisions 2023, cont. Total number SAR % PAR % Ljungby 21 95.2 66.7 Mora 14 78.6 42.9 Norrköping 20 90 90 Norrtälje 12 83.3 100 Nyköping 29 93.1 82.8 Ortopediskt Center, Sophiahemmet 6 100 0 Piteå 75 100 96 Skellefteå 16 81.3 87.5 SU/Mölndal 155 97.4 92.3 Sunderby 9 55.6 77.8 Sundsvall 31 93.5 71 SUS/Lund 113 99.1 89.4 Södersjukhuset 61 100 95.1 Trelleborg 29 100 96.6 Uddevalla 52 98.1 92.3 Umeå 33 90.9 93.9 Visby 19 73.7 68.4 Värnamo 9 88.9 55.6 Västervik 26 88.5 80.8 Västerås 82 95.1 87.8 Växjö 27 88.9 81.5 Örebro - Lindesberg - Karlskoga 81 95.1 98.8 Örnsköldsvik 10 90 80 Östersund 55 96.4 83.6 Other units 32 71.8 78.1 Table 2.5. The completeness for hip revisions per unit 2023. 2 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Completeness for knee revisions 2023 Total number SAR % PAR % Country 1,279 93.7 85 Akademiska sjukhuset 55 98.2 90.9 Bollnäs 12 100 100 Borås - Skene 26 96.2 88.5 Capio Ortopedi Motala 83 97.6 91.6 Capio Artro clinic / Sophiahemmet 20 100 20 Capio Movement 7 100 71.4 Capio Ortho Center Stockholm 14 100 100 Capio Ortopediska huset 10 100 30 Capio S:t Göran 45 86.7 86.7 Danderyd 66 92.4 84.8 Eksjö 41 100 92.7 Enköping 7 100 100 Eskilstuna 31 96.8 96.8 Falun 39 94.9 89.7 Gällivare 7 100 57.1 Gävle 29 96.6 62.1 Halmstad - Varberg 33 81.8 84.8 Hässleholm 101 93.1 91.1 Kalmar 16 93.8 75 Karlshamn 18 94.4 88.9 Karlstad 9 88.9 77.8 Karolinska Huddinge 27 85.2 70.4 Karolinska Solna 10 40 100 Table continued on next page. 2 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Completeness for knee revisions 2023, cont. Total number SAR % PAR % Kungälv - Alingsås 16 100 75 Ledplastikcentrum Bromma 8 75 100 Lidköping - Skövde 23 95.7 91.3 Lindesberg 44 100 79.5 Lycksele 4 100 50 Mora 20 80 50 Norrköping 10 90 100 Norrtälje 14 100 78.6 Piteå 25 92 100 Skellefteå 12 83.3 41.7 SU/Mölndal 73 94.5 93.2 Sundsvall 11 81.8 45.5 SUS/Lund 52 96.2 88.5 Södersjukhuset 26 96.2 96.2 Södertälje 11 90.9 100 Torsby 11 100 100 Trelleborg 20 100 95 Uddevalla - NÄL 17 100 100 Umeå 15 80 93.3 Visby 4 100 100 Värnamo 11 90.9 54.5 Västerås 39 100 97.4 Växjö 11 100 63.6 Ängelholm - Helsingborg 21 100 85.7 Östersund 26 96.2 84.6 Other units 49 87.7 67.3 Tabell 2.6. The completeness for knee revisions per unit 2023. 2 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 PROM, response rate Surgical year 2019 2020 2021 2022 2023 Avaliable data for all elective total hip replacements Total number of replacements 17,518 13,137 15,325 18,512 20,297 Deceased within one year (as first event), n 144 105 114 157 Reopererated within one year (as first event) , n 217 150 181 245 Included in the one-year follow-up, n 17,157 12,882 15,030 18,110 20,297 Preoperative response, n 14,117 10,093 11,629 14,435 15,019 Proportion of all, % 81 77 76 78 74 One-year postoperative response, n 13,633 9,993 12,306 14,274 Proportion of those included in the follow-up routine, % 80 78 82 79 Pre- and one-year postoperative resopnde, n 11,011 7,616 9,542 11,483 Proportion of those included in the follow-up routine, % 64 59 64 63 Available data for all knee replacements Total number of replacements for units included in the 9,365 6,565 9,489 17,193 20,690 PROM project Deceased within one year (as first event), number 41 23 61 111 70 Included in the one-year follow-up, number 9,324 6,542 9,428 17,082 20,620 Preoperative response, number 8,002 5,075 6,090 11,410 13,388 Proportion of all, % 86 78 65 67 65 One-year postoperative response, n 6,868 5,741 7,526 9,703 Proportion of those included in the follow-up routine, % 84 88 80 57 Pre- and one-year postoperative resopnde, n 6,120 4,021 5,007 7,001 Proportion of those included in the follow-up routine, % 74 61 53 41 Table continued on next page. 2 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 PROM, response rate, cont. Surgical year 2019 2020 2021 2022 2023 Available data for total knee replacements Total number of replacements for units included in the 8,242 5,748 8,158 15,002 18,148 PROM project Deceased within one year (as first event), number 34 18 55 98 63 Included in the one year follow-up, n 8 208 5,730 8,103 14,904 18,085 Preoperative response, n 7 108 4,497 5,178 10,018 11,815 Proportion of all, % 87 78 64 67 65 One-year postoperative response, n 6 102 5,070 6,508 8,537 Proportion of those included in the follow-up routine, % 74 88 80 57 Preoperative and one year postoperative response, n 5 123 3,595 4,268 6,171 Proportion of those included in the follow-up routine, % 62 63 53 41 Available data in unicompartmental knee replacements Total number of replacements for units included in the 876 770 1,252 2,119 2,390 PROM project Deceased within one year (as first event), number 2 2 3 9 6 Included in the one year follow-up, n 874 768 1,249 2,110 2,384 Preoperative response, n 735 556 880 1,354 1,493 Proportion of all, % 81 84 70 64 63 One-year postoperative response, n 722 648 967 1,131 Proportion of those included in the follow-up routine, % 83 84 77 54 Pre- and one-year postoperative response, n 577 412 718 808 Proportion of those included in the follow-up routine, % 66 54 57 38 Table 2.7. PROM, response rate 2019–2023. 2 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Demography (from the Greek words démos – people, and gráfo to write) is the science of studying the distribution, size, and composition of a population. 3. Demography Authors: Annette W-Dahl and Ola Rolfson All hip and knee replacement surgeries In 2023, the following surgeries were reported 20,297 pri- This is also true for total knee replacement (TKR) (Figure mary elective hip replacements 7,258 primary hip replace- 3.3a). For unicompartmental knee replacement (UKR), ments due to fracture, 20,622 primary knee replacements the mean age has increased by about three years for both 2,142 hip revisions and 1,079 knee revisions. males and females (Figure 3.3b). In 2006, the mean age for primary hip replacement due to fracture was 80 years for males and 82 years for females, and it has remained Sex relatively stable for both sex since then (Figure 3.4). The Females receive primary hip or knee replacements more fre- mean age for hip revision was nearly five years higher quently than males. The proportion of females receiving a than for primary elective hip replacement, and for knee primary elective hip replacement has remained stable since revision, it was nearly one year higher than for primary 2006, varying between 56% and 58% (Figure 3.1a). How- knee replacement in 2023. ever, the percentage of females receiving a hip replacement due to fracture has decreased from 73% in 2006 to 62% in For primary elective hip replacement, there have been 2023 (Figure 3.1b). The proportion of females undergoing relatively minor changes in age group distribution from primary knee replacement surgery has decreased from 60% 2006–2007 to 2022–2023. There has been a slight in 2006 to 56% in 2023 (Figure 3.1c). The proportion of decrease in the 55–64 year age group and an increase females was slightly lower than males for hip revisions, but in the 75–84 year age group (Figure 3.5a). For primary higher for knee revisions (Table 3.1). hip replacement due to fracture, approximately 80% are 75 years and older. Since 2006–2007, there has been a shift in the older age groups, with a decrease in the pro- Age portion of those aged 75–84 years and ≥ 85 years, and The mean age was 69 years for primary elective hip replace- an increase of nearly 3% in the 65–74 year age group ments, 81.4 years for hip replacements due to fracture, (Figure 3.5b). For primary TKR, the proportion of those and 69.4 years for all primary knee replacements in 2023 under 65 years has decreased from 29% in 2006 to 28% (Table 3.1). The mean age for both males and females has in 2023, and for primary UKR, the proportion under 65 remained largely unchanged from 2006 to 2023 for pri- years has decreased from 57% in 2006–2007 to 42% in mary elective hip and knee replacements (Figures 3.2a–b). 2022–2023 (Figures 3.5c–d). 3 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 BMI The mean BMI for primary hip replacement is lower (BMI 27.4) compared to primary knee replacement (BMI 28.7) (Table 3.1). The proportion classified as obese (BMI ≥30) according to WHO’s classification is significantly higher for primary knee replacement (36.6%) than for primary elective hip replacement (26.9%) and for hip replacements due to fracture (8.3%) (Table 3.1). In pri- mary elective hip replacement, males are overrepresented © 2024 The Swedish Arthroplasty Register in the BMI category of 25–29.9 (overweight), and the proportion of obese individuals is also higher for males compared to females (Figure 3.6a). For hip replacement due to fracture, males are similarly overrepresented in the BMI category of 25–29.9, while the proportion of obese individuals is roughly the same (Figure 3.6b). For primary knee replacements, males are also overrepresented in the BMI category of 25–29.9 (overweight), but the proportion of obese individuals is higher among females than males (Figure 3.6c). For both hip and knee revisions, the proportion of obese individuals is approximately the Figure 3.1a. Proportion of females in elective primary same as for primary elective hip and knee replacement hip replacement 2005–2023. (Table 3.1). © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 3.1b. Proportion of females in primary hip replacement due Figure 3.1c. Proportion of females in primary knee replacement to fracture 2005–2023. 2005–2023. 3 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Demography in hip and knee replacements 2023 Elective primary Primary hip total hip fracture Revision hip Primary knee Revision knee Number 20,367 7,264 2,149 20,622 1,081 Females n (%) 11,791 (57,9) 4,524 (62,3) 1,012 (47,1) 11,450 (55,5) 558 (51,6) Mean age (SD) 69.0 (10.5) 81.4 (9.1) 73.7 (10.9) 69.4 (9.0) 70.3 (9.5) Age group n (%) < 45 years 325 (1.6) 15 (0.2) 19 (0.9) 76 (0.4) 10 (0.9) 45-54 years 1,586 (7.8) 34 (0.5) 104 (4.8) 1,048 (5.1) 52 (4.8) 55-64 years 4,662 (22.9) 269 (3.7) 298 (13.9) 4,989 (24.2) 232 (21.5) 65-74 years 6,804 (33.4) 1,115 (15.3) 581 (27.0) 7,925 (38.4) 383 (35.4) 75-84 years 6,077 (29.8) 2,973 (40.9) 847 (39.4) 6,010 (29.1) 359 (33.2) ≥85 years 913 (4.5) 2,858 (39.3) 300 (14.0) 574 (2.8) 45 (4.2) Mean BMI (SD) 27.4 (4.5) 24.1 (4.2) 27.2 (4.9) 28.7 (4.3) 29.1 (4.72) BMI n (%) < 18.5 163 (0.8) 487 (7.6) 37 (1.8) 44 (0.2) <5 18.5-24.9 6,197 (30.7) 3,530 (55.1) 689 (33.7) 3,940 (19.3) 186 (17.7) 25-29.9 8,365 (41.5) 1,854 (28.9) 765 (37.5) 8,987 (43.9) 458 (43.6) 30-34.5 4,320 (21.4) 436 (6.8) 420 (20.6) 5,845 (28.6) 289 (27.5) 35-39.9 988 (4.9) 82 (1.3) 102 (5.0) 1,472 (7.2) 91 (8.7) ≥ 40 128 (0.6) 16 (0.2) 29 (1.4) 171 (0.8) 23 (2.2) ASA-class n (%) ASA I 3,617 (17.8) 206 (2.9) 110 (5.2) 2,977 (14.5) 73 (6.8) ASA II 12,791 (63.0) 2,343 (33.0) 997 (46.9) 13,865 (67.5) 630 (58.7) ASA III 3,809 (18.8) 4,015 (56.5) 939 (44.2) 3,676 (17.9) 355 (33.1) ASA IV 73 (0.4) 537 (7.6) 80 (3.8) 34 (0.2) 16 (1.5) Diagnosis n (%) Osteoarthritis 18,980 (94.6) 20,117 (97.7) Acute hip fracture 6,912 (95.2) Sequele fracture/trauma 352 (4.8) 98 (0.5) Osteonecrosis 702 (3.5) 133 (0.6) Sequele childhood hip disease 266 (1.3) Inflamatory joint disease 38 (0.2) 182 (0.9) Tumor 0 (0.0) 8 (0.0) Acute trauma 63 (0.3) 46 (0.2) Other joint diseases 9 (0.0) 7 (0.0) Table 3.1. Demography in elective primary hip replacement, hip replacement due to fracture, knee replacement, hip revision and knee revision 2023. 3 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 3.2a. Mean age in elective primary hip replacement Figure 3.2b. Mean age in primary knee replacement 2005–2023. 2005–2023. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 3.3a. Mean age in primary TKR 2005–2023. Figure 3.3b. Mean age in primary UKR 2005–2023. 3 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 ASA classification The proportion of patients classified as ASA III–IV for primary elective hip replacement (19.2%) and primary knee replacement (18.1%) is relatively similar. However, the proportion for hip replacements due to fracture is significantly higher at 64.1%. The proportion of ASA © 2024 The Swedish Arthroplasty Register III–IV classification is slightly higher for males than for females in both primary hip and knee replacement (Fig- ures 3.7a and 3.7c). For hip replacement due to fracture, the proportion of ASA III–IV is higher for males (69.6%) compared to females (60.7%) (Figure 3.7b). For hip revi- sions, the proportion of ASA III–IV is more than twice as high as for primary elective replacements, and nearly twice as high for knee revisions compared to primary knee replacements (Table 3.1). Diagnosis Osteoarthritis is the most common diagnosis for primary elective hip and knee replacements, accounting for 94.6% Figure 3.4. Mean age in primary hip replacement due to fracture 2005–2023. and 97.7% of cases, respectively. For primary elective hip replacement, osteoarthritis is followed by osteonecrosis (3.5%) and inflammatory joint disease (0.9%) for knee five years, with a slightly higher proportion during the prostheses (Table 3.1). pandemic years. However, the proportion in 2023 is the same as in 2019, while the proportion of osteoarthritis The proportion of patients undergoing primary hip has increased slightly from 2019 to 2023, with a lower replacement due to osteoarthritis has increased slightly proportion during the pandemic years (Table 3.2). The since 2006–2007 for females and has remained relatively proportion of osteoarthritis as a reason for primary knee stable for males. For primary knee replacements, the replacement has remained largely unchanged over the past proportion of osteoarthritis cases has increased from the five years (Table 3.3). 2006–2007 period to the 2022–2023 period for both females and males (Figures 3.8a–b, 3.9a–b). For primary hip replacement, the proportion of osteoar- thritis as a reason decreases with increasing age starting The proportion of primary hip replacements performed from the 55–64 year age group. The highest proportion due to acute hip fractures has remained relatively stable is in the 55–64 year age group (87.4%) and the lowest from 2006–2007 to 2022–2023 and is more common is in the ≥ 85 year age group (18.6%). Sequelae from among females than males. The proportion of acute hip childhood diseases are most common in the youngest age fractures has decreased slightly for females from 31.4% in groups, < 55 years. For acute hip fractures, the pattern is 2006–2007 to 27.1% in 2022–2023 but has increased for reversed, with a higher proportion in older age groups, the males from 18.7% to 23% over the same period (Figures lowest proportion in the < 45 and 45–54 year age groups 3.8a-b). (1.8%), and the highest proportion in the ≥ 85 year age group (76.2%) (Table 3.4). Inflammatory joint disease, including rheumatoid arthri- tis, as a reason for primary hip and knee replacement has For primary knee replacements, the proportion of osteo- decreased with the introduction of modern medical treat- arthritis as the reason for surgery increases with age, while ments, as reflected by the lower proportion in 2022–2023 the proportion of inflammatory joint disease and sequelae compared to 2006–2007 (Figures 3.8a–b, 3.9a–b). from fractures/trauma decreases with increasing age. Acute trauma as a reason for primary knee prosthesis surgery is The proportion of acute hip fractures as a reason for pri- rare, with just over 125 surgeries (0.2%) reported in the mary hip replacement has varied somewhat over the past past five years (Table 3.5). 3 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 3.5a. Distribution of age groups in elective primary hip Figure 3.5b. Distribution of age groups in primary hip replacement replacement 2006–2023. due to fracture 2006–2023. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 3.5c. Distribution of age groups in primary TKR 2006–2023. Figure 3.5d. Distribution of age groups in primary UKR 2006–2023. 3 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 3.6a. Distribution of BMI class and sex in elective primary Figure 3.6b. Distribution of BMI class and sex in primary hip re- hip replacement 2006–2023. placement due to fracture 2006–2023. © 2024 The Swedish Arthroplasty Register Figure 3.6c. Distribution of BMI class and sex in primary knee replacement 2006–2023. 3 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 3.7a. Distribution of ASA class and sex in elective primary Figure 3.7b. Distribution of ASA class and sex in primary hip hip replacement 2006–2023. replacement due to fracture 2006–2023. © 2024 The Swedish Arthroplasty Register Figure 3.7c. Distribution of ASA class and sex in primary knee replacement 2006–2023. 3 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 3.8a. Distribution of diagnoses in elective primary hip Figure 3.8b. Distribution of diagnoses in elective primary hip re- replacement 2006–2023 – males. placement 2006–2023 – females. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 3.9a. Distribution of diagnoses in primary knee replace- Figure 3.9b. Distribution of diagnoses in primary knee replace- ment 2006–2023 – males. ment 2006–2023 – females. 3 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Diagnosis in primary hip replacement 2019 2020 2021 2022 2023 Total Number 24,188 19,730 21,917 25,600 27,726 119,161 Diagnosis n (%) Osteoarthritis 16,088 (66.5) 12,058 (61.1) 14,130 (64.5) 17,256 (67.4) 18,980 (68.5) 78,512 (65.9) Acute hip fracture 6,072 (25.1) 6,103 (30.9) 6,101 (27.8) 6,639 (25.9) 6,912 (24.9) 31,827 (26.7) Sequele fracture/trauma 460 (1.9) 375 (1.9) 376 (1.7) 364 (1.4) 352 (1.3) 1,927 (1.6) Osteonecrosis 539 (2.2) 488 (2.5) 589 (2.7) 614 (2.4) 704 (2.5) 2,934 (2.5) Sequele childhood hip disease 376 (1.6) 256 (1.3) 234 (1.1) 280 (1.1) 266 (1.0) 1,412 (1.2) Inflamatory joint disease 111 (0.5) 73 (0.4) 66 (0.3) 43 (0.2) 38 (0.1) 331 (0.3) Tumor 130 (0.5) 104 (0.5) 104 (0.5) 71 (0.3) 84 (0.3) 493 (0.4) Acute trauma 50 (0.2) 37 (0.2) 63 (0.3) 57 (0.2) 69 (0.2) 276 (0.2) Other joint diseases 360 (1.5) 234 (1.2) 252 (1.1) 273 (1.1) 309 (1.1) 1,428 (1.2) Table 3.2. Diagnosis in elective primary hip replacement 2019–2023. Diagnosis in primary knee replacement 2019 2020 2021 2022 2023 Total Number 16,985 11,816 12,809 17,074 20,622 79,306 Diagnosis n (%) Osteoarthritis 16,493 (97.2) 11,461 (97.0) 12,417 (97.1) 16,623 (97.6) 20,117 (97.7) 77,111 (97.4) Sequele fracture/trauma 107 (0.6) 62 (0.5) 78 (0.6) 89 (0.5) 98 (0.5) 434 (0.5) Osteonecrosis 148 (0.9) 110 (0.9) 97 (0.8) 109 (0.6) 133 (0.6) 597 (0.8) Inflamatory joint disease 211 (1.2) 155 (1.3) 163 (1.3) 174 (1.0) 182 (0.9) 885 (1.1) Tumor 5 (0.0) 8 (0.1) 9 (0.1) 9 (0.1) 8 (0.0) 39 (0.0) Acute trauma 12 (0.1) 15 (0.1) 26 (0.2) 28 (0.2) 46 (0.2) 127 (0.2) Other joint diseases <5 <5 <5 7 (0.0) 7 (0.0) 23 (0.0) Table 3.3. Diagnosis in primary knee replacement 2019–2023. 3 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Diagnosis in age groups in primary hip replacement < 45 years 45-54 years 55-64 years 65-74 years 75-84 years ≥85 years Number 1,647 7,664 20,287 34,877 37,234 17,452 Diagnosis n (%) 17,735 27,684 22,632 Osteoarthritis 776 (47.2) 6,440 (84.0) 3,245 (18.6) (87.4) (79.4) (60.8) 12,353 13,294 Acute hip fracture 29 (1.8) 135 (1.8) 1,007 (5.0) 5,009 (14.4) (33.2) (76.2) Sequele fracture/trauma 50 (3.0) 86 (1.1) 251 (1.2) 409 (1.2) 675 (1.8) 456 (2.6) Osteonecrosis 188 (11.4) 247 (3.2) 510 (2.5) 846 (2.4) 884 (2.4) 259 (1.5) Sequele childhood hip disease 295 (17.9) 447 (5.8) 353 (1.7) 211 (0.6) 93 (0.2) 13 (0.1) Inflamatory joint disease 38 (2.3) 44 (0.6) 66 (0.3) 123 (0.4) 50 (0.1) 10 (0.1) Tumor 27 (1.6) 26 (0.3) 77 (0.4) 186 (0.5) 133 (0.4) 44 (0.3) Acute trauma <5 9 (0.1) 28 (0.1) 58 (0.2) 114 (0.3) 64 (0.4) Other joint diseases 238 (14.5) 230 (3.0) 255 (1.3) 342 (1.0) 296 (0.8) 67 (0.4) Table 3.4. Distribution of diagnosis by age group in primary hip replacement 2019–2023. Diagnosis in age groups in primary knee replacement < 45 år 45– 54 år 55– 64 år 65– 74 år 75– 84 år ≥ 85 år Number 311 4,502 19,504 30,794 21,923 2,272 Diagnosis n (%) Osteoarthritis 221 (77.3) 4,299 (96.1) 18,978 (97.4) 30,007 (97.5) 21,410 (97.7) 2,196 (96.7) Sequele fracture/trauma 9 (3.1) 50 (1.1) 143 (0.7) 151 (0.5) 65 (0.3) 16 (0.7) Osteonecrosis 9 (3.1) 34 (0.8) 132 (0.7) 236 (0.8) 158 (0.7) 28 (1.2) Inflamatory joint disease 26 (9.1) 76 (1.7) 205 (1.1) 321 (1.0) 239 (1.1) 18 (0.8) Tumor 19 (6.6) 6 (0.1) <5 5 (0.0) 7 (0.0) 0 (0.0) Acute trauma <5 9 (0.2) 27 (0.1) 47 (0.2) 30 (0.1) 12 (0.5) Other joint diseases <5 <5 <5 <5 7 (0.0) 5 (0.0) Table 3.5. Distribution of diagnosis by age group in primary knee replacement 2019–2023. 4 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 In the entire Swedish population, 3.4% have undergone at least one hip or knee replacement. 4. Epidemiology Authors: Annette W-Dahl and Ola Rolfson Hip and Knee Replacement in Sweden Prevalence When the proportion of individuals who have undergone By the end of 2023, 363,384 individuals had a hip or hip or knee replacement is related to the total population, knee replacement, 226,163 had a hip replacement, and it is referred to as the prevalence of people with a hip or 164,701 had a knee replacement. This means that 3.4% knee replacement. of the population has a hip or knee replacement, 2.1% have at least one hip replacement, and 1.6% have at least For individuals who have undergone hip replacement one knee replacement. Among those with hip and knee since 1991, we include data starting from 1992, when replacements, 9.3% were bilaterally operated, 27.4% of the registry began recording prostheses at the individual those with hip replacement were bilaterally operated, and level. For knee prostheses, which have been recorded at 33.5% of those with knee replacement. the individual level since the start of the register in 1975, all records are included. Table 4.1 shows the number Prevalence is highest in the age groups 65–84 years for of individuals in each age group, as well as males and both hip and knee replacements, with a higher prevalence females in each age group, with hip or knee replacement, in females compared to males. either unilateral or bilateral. Corresponding figures for individuals with bilateral hip and knee replacements, hip The prevalence per 100,000 inhabitants of having a hip replacements, or knee replacement are displayed in Table or knee replacement has increased from 2.6% in 2012 4.2. These tables also show prevalence per 100,000 inhab- to 3.4% in 2023. This increase is similar for females and itants at the end of each year, 2013 and 2023. males, with female’s prevalence rising from 3.2% in 2012 to 4.0% in 2023, and male’s rising from 2.1% to 2.9% (Figure 4.1 a). Over 20% (22.1%) of all 85-year-olds in 4 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 4.1 a. Prevalence of at least one hip or knee replacement Figure 4.1 b. Prevalence of at least one hip or knee replacement in the population 2012–2023 in the population on 31 December 2023 divided by age. Sweden have a hip or knee replacement, with a higher the number of individuals. In 2023, 27,726 primary hip prevalence among 85-year-old females (24.4%) compared replacements were registered, including 20,367 primary to 85-year-old males (19.1%) (Figure 4.1 b). total hip replacements, and 20,622 primary knee replace- ments. This results in incidences of 224 per 100,000 for Prevalence per 100,000 inhabitants of having at least one hip replacements, 203 per 100,000 for total hip replace- hip replacement in the population has increased from ments, and 196 per 100,000 for knee replacements. 1.7% to 2.1% between 2012 and 2023. The increase has Compared to 2022, the incidence of primary total hip been slightly greater for knee replacement, rising from replacements and knee replacements increased, while the 1.1% to 1.6%. The increase has been similar for both incidence for hip replacements decreased in 2023. females and males for both hip and knee replacement (Figures 4.2 a and 4.3 a). Over the years, the incidence has increased for both hip and knee replacements. The sharp increase in knee In 2023, 14.8% of all 85-year-olds had at least one hip replacements in the late 1980s has somewhat plateaued replacement, and 9.6% had at least one knee replacement. since 2009. For hip replacements, the increase has also Females had a higher prevalence of both hip and knee slowed, and the incidence has remained relatively stable. replacements compared to males, with 16.7% of females having a hip replacement and 10.4% having a knee As hip and knee replacements are primarily used for older replacement, compared to 12.1% and 8.7% for males, individuals, a portion of the increase over time can be respectively (Figures 4.2 b and 4.3 b). attributed to the aging population. Because incidence is age-dependent and age structures can vary across regions or countries, comparisons are challenging without some Incidence form of age standardization. The “European Standard The number of primary replacements implanted in a Population” has been used to make comparisons feasible. year in relation to the population size, is referred to as This standardization describes how the incidence would the national incidence of the procedure. Note that the be for a given region or country if all regions/countries incidence of hip and knee replacements is calculated based had the same age distribution. on the number of procedures, while prevalence pertains to 4 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 4.2 a. Prevalence of at least one hip replacement in the Figure 4.2 b. Prevalence of at least one hip replacement in the population 2012–2023. population on 31 December 2023 divided by age. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 4.3 a. Prevalence of at least one knee replacement in the Figure 4.3 b. Prevalence of at least one knee replacement in the population 2012–2023. population on 31 December 2023 divided by age. 4 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 In international comparisons, Sweden had a higher inci- The maps of Sweden illustrate the distribution of pro- dence of hip replacements than the USA, Australia, and duction and consumption for hip replacements (4.4 a the UK, but lower than Denmark, Norway, Finland, and and 4.5 a) and knee replacements (4.4 b and 4.5 b) per Germany in 2019 (OECD does not have current figures 100,000 inhabitants in the 21 regions. Tables 4.3 and beyond the pandemic years). For knee replacements, 4.4 show production and consumption with incidence Sweden has a higher incidence than Norway but lower rates and age-standardized incidence (European Standard than Denmark, Finland, the USA, Australia, the UK, and population) for hip replacements, total hip replacements, Germany (OECD Health Statistics 2023). and knee replacements across the regions. For production, the age-standardized incidence varies Regional differences from 193 to 299 for hip replacements (129 to 246 for According to the Health Care Act (SFS 2017:30), the total hip replacements) and from 90 to 262 for knee goal of healthcare is “… to ensure good health and care replacements. Södermanland has the highest production on equal terms for the entire population. Care should incidence for hip replacement surgeries, while Stockholm be provided with respect for all people’s equal worth leads for knee replacements. Conversely, Dalarna has the and individual dignity. Those with the greatest need for lowest incidence for hip replacements, and Västerbotten healthcare should be given priority in receiving care.” has the lowest for knee replacements. Production rates are nearly twice as high in Södermanland compared to An important aspect of equity is the geographical varia- Dalarna for total hip replacement surgeries and almost tion in how healthcare is provided and delivered across three times higher in Stockholm compared to Västerbot- the country. Equity, in a broad sense, can relate to where ten for knee replacement surgeries. a patient lives within the country. The 21 regions have autonomy over their healthcare services but must adhere Differences in age-standardized incidence for consump- to the Health Care Act. tion range from 195 to 283 for hip replacements (164 to 253 for total hip replacements) and from 125 to 280 for knee replacements. For hip replacements, Blekinge has Production and consumption the lowest consumption, at nearly 50% of the incidence Production and consumption are based on data from the compared to Västernorrland, which has the highest con- Swedish Arthroplasty Register, Statistics Sweden’s pop- sumption. For total hip replacements, Östergötland has ulation statistics, and the Swedish Tax Agency’s address the lowest consumption at just over 50% compared to register. Production refers to the number of hip replace- Västernorrland, which again has the highest. For knee ment, total hip replacement, and knee replacement sur- replacements, Kronoberg has the highest consumption, geries performed, regardless of where the patient resides. with an incidence more than twice that of Västerbotten, It is presented per 100,000 inhabitants, indicating the which has the lowest. volume of surgeries performed within a region. Consump- tion refers to the number of hip replacement, total hip These variations underscore significant disparities in both replacement, and knee replacement surgeries performed, the provision and access to hip and knee replacement regardless of where the surgery took place. It is presented surgeries between regions and across different years. The per 100,000 inhabitants, reflecting the availability of these differences in age-standardized incidence highlight the surgeries to the residents of a region, regardless of where inconsistencies in how care is distributed and accessed, the surgery is conducted. Consumption calculations are reflecting potential inequalities in healthcare delivery. based on data from the Tax Agency regarding the region of residence at the time of the operation. 4 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 4.4 a. Production elective hip replacement. Figure 4.4 b. Production knee replacement. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 4.5 a. Consumption elective hip replacement. Figure 4.5 b. Consumption knee replacement. 4 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Number of individuals with at least one total hip replacement or knee replacement Hip or Knee Hip Knee Number per age group 2013 2023 2013 2023 2013 2023 < 45 years 2,255 2,185 1,911 1,887 389 332 45-54 years 9,100 10,411 6,274 7,324 3,039 3,280 55-64 years 34,136 45,907 19,701 26,708 15,566 20,896 65-74 years 79,972 98,263 48,963 54,843 35,403 49,673 75-84 years 85,753 138,359 55,702 87,105 36,823 63,704 ≥85 years 49,817 68,259 36,110 48,296 17,419 26,816 Total 261,033 363,384 168,661 226,163 108,639 164,701 Prevalence per 100,000 2,706 3,444 1,749 2,143 1,126 1,561 Males < 45 years 1,120 1,136 961 980 159 156 45-54 years 4,541 5,157 3,358 3,825 1,183 1,332 55-64 years 16,210 22,558 9,645 13,554 6,565 9,004 65-74 years 37,123 47,485 21,708 25,089 15,415 22,396 75-84 years 34,899 62,319 20,970 35,119 13,929 27,200 ≥85 years 14,487 23,160 9,749 14,356 4,738 8,804 Total 108,380 161,815 66,391 92,923 41,989 68,892 Prevalence per 100,000 2,251 3,046 1,379 1,749 872 1,297 Females < 45 years 1 ,180 1,083 950 907 230 176 45-54 years 4,772 5,447 2,916 3,499 1,856 1,948 55-64 years 19,057 25,046 10,056 13,154 9,001 11,892 65-74 years 47,243 57,031 27,255 29,754 19,988 27,277 75-84 years 57,626 88,490 34,732 51,986 22,894 36,504 ≥85 years 39,042 51,952 26,361 33,940 12,681 18,012 Total 168,920 229,049 102,270 133,240 66,650 95,809 Prevalence per 100,000 3,497 4,372 2,117 2,543 1,380 1,829 Table 4.1. Number of individuals in each age group and males and females in each age group with hip replacement or knee replacement, unilaterally or bilaterally operated. 4 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Number of individuals with hip or knee replacement, bilaterally operated Hip and Knee Hip Knee Number per age group 2013 2023 2013 2023 2013 2023 < 45 years 14 9 388 350 55 41 45-54 years 29 34 1,302 1,600 593 631 55-64 years 141 159 4,524 6,901 4,071 5,716 65-74 years 440 781 12,533 15,288 10,843 16,981 75-84 years 639 1,548 13,535 25,081 12,210 23,148 ≥85 years 278 832 6,569 12,725 5,631 9,874 Total 1,541 3,363 38,851 61,945 33,403 56,391 Prevalence per 100,000 16 32 403 587 346 534 Table 4.2. Number of individuals in each age group and males and females in each age group with hip replacement or knee replacement, bilaterally operated. 4 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Production in the regions Hip Knee Age Age standardized Age standardized incidence standardized Region Incidence incidence Incidence total hip Incidence incidence Blekinge 282 228 206 173 192 161 Dalarna 246 193 157 129 164 135 Gotland 298 226 221 172 154 118 Gävleborg 291 234 199 164 190 156 Halland 252 222 183 166 266 243 Jämtland 241 196 158 130 117 96 Jönköping 309 288 247 235 247 234 Kalmar 339 270 260 213 241 192 Kronoberg 218 195 143 132 189 175 Norrbotten 316 253 221 182 204 168 Skåne 247 243 181 181 211 214 Stockholm 263 298 212 239 230 262 Sörmland 341 299 275 246 246 217 Uppsala 251 261 185 194 200 211 Värmland 266 215 177 149 146 121 Västerbotten 262 245 178 170 95 90 Västernorrland 336 273 254 212 197 161 Västmanland 239 208 158 143 103 94 Västra Götaland 247 242 180 180 167 167 Örebro 264 240 191 177 146 134 Östergötland 213 199 149 143 174 167 Country 263 252 195 190 197 192 Table 4.3. Production with incidence and age-standardized incidence (European Standard Population) for hip replacements, total hip replacements and knee replacements in the regions. 4 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Consumption in the regions Hip Knee Age Age standardized Age standardized incidence standardized Region Incidence incidence Incidence total hip Incidence incidence Blekinge 231 194 216 182 215 181 Dalarna 307 254 279 234 269 225 Gotland 288 226 261 207 246 194 Gävleborg 273 227 242 203 238 198 Halland 221 198 195 177 266 242 Jämtland 308 263 273 236 284 245 Jönköping 235 221 200 191 175 165 Kalmar 263 214 245 201 238 191 Kronoberg 274 250 203 190 298 280 Norrbotten 314 257 266 221 262 218 Skåne 209 207 183 183 203 206 Stockholm 179 202 152 171 171 194 Sörmland 269 239 236 211 243 215 Uppsala 214 224 191 201 185 194 Värmland 257 218 227 195 199 168 Västerbotten 224 212 206 197 129 125 Västernorrland 340 283 299 253 218 179 Västmanland 254 228 222 203 199 184 Västra Götaland 208 205 174 174 171 171 Örebro 277 254 226 210 158 146 Östergötland 207 195 171 164 199 193 Country 224 216 194 189 196 192 Table 4.4. Consumption with incidence and age-standardized incidence (European Standard Population) for hip replacements, total hip replacements and knee replacements in the regions. 5 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Since the start in 1979 until December 2023, a total of 570,000 primary hip replacements and 97,886 reoperations have been registered in 474,250 individuals. 5. Hip replacement 5.1. Primary total hip replacement Author: Maziar Mohaddes In 2023, a total of 27,726 primary hip replacements were Table 5.1.3 provides the case-mix of units with demo- reported, including 42 performed due to tumors and 5,145 graphic data for patients operated on at each unit. Notably, hemiarthroplasties. Among the 22,539 primary total hip the proportion of patients with a BMI 35 and above varies replacements, 2,172 were performed on patients with hip between 0% and 16%. The corresponding proportion for fractures or sequelae from hip fractures (Figure 5.1.1). This patients with ASA class III and IV ranges from 0% to 76%. chapter excludes primary hip replacements performed due Please note that the percentage figures for units with few to tumors, fractures, or sequelae from fractures. operations may be misleading. Among the 20,367 primary elective total hip replacements reported in 2023, the indication for surgery was osteoar- Summary thritis in 18,980 cases and other diagnoses in 1,387 cases The reduction in the number of reported total (Figure 5.1.1). This represents a 10% increase in reported replacements during the pandemic years has primary elective total hip replacements compared to the been reversed. In 2023, 22,539 primary total hip previous year. The increase is likely due to several hospitals replacements were reported. A continued high ramping up production to address the growing backlogs proportion of surgeries are performed by private caused by the COVID-19 pandemic. Since both private providers. In 2023, nearly 39% of the reported and public providers have increased their production, surgeries were conducted by private entities. the distribution between them has remained largely unchanged from the previous year. In 2023, private pro- viders accounted for 39% of all elective primary total hip Surgical approach replacements, the same proportion as in 2022. Since 2003, the posterior and direct lateral incisions in the supine or lateral position have been the dominant tech- Over the past four years, the proportion of patients under niques in Sweden. In 2023, these two types of incisions 45 years of age has slightly decreased, while the age dis- accounted for 99% of all procedures. The posterior incision tribution has remained relatively constant (Table 5.1.2). remains the most common (66%). In recent years, the The proportion of patients in different BMI categories has proportion of patients undergoing surgery with a posterior also remained relatively stable (Table 5.1.2). The change incision has increased. The direct lateral incision in the observed during the pandemic years, where there was an lateral position was used in 28% of cases, and the direct increase in the proportion of healthy patients (ASA class lateral incision in the supine position in 5%. Mini-inci- I), has reversed, and in 2023, the majority of operated sions, Watson-Jones incisions, and direct lateral/posterior patients were classified as ASA class II (63%) (Table 5.1.2). incisions combined with trochanteric osteotomy were used 5 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Selections groups in primary hip replacements, 2023 All primary hip prosthesis n = 27,726 Indication tumor n = 42 Hemiarthroplasty n = 5,145 Primary total hip prosthesis n = 22,539 Hip fracture treatment with total or hemi prosthesis Indication acute fracture n = 7,317 n = 1,867 Indication sequele fracture n = 305 Elective primary total hip prosthesis n = 20,367 Other indications n = 1,387 Total hip prosthesis, due to OA n = 18,980 Not standard patient n = 9,000 Standard patient n = 9,980 Figure 5.1.1. Flow-chart, based on diagnostic indication and type of prosthesis, shows the different selections groups in primary hip replacements 2023 used in the annual report. only sporadically (Figure 5.1.3). The distribution among Fixation the three most commonly used incisions shows no signif- Fully cemented fixation is reported more frequently for icant difference between the sex (Figure 5.1.3). In recent surgeries in females, whereas fully uncemented fixation years, the use of the posterior incision has increased slightly is more common in surgeries in males (Figure 5.1.4). (Figure 5.1.2). This figure should be interpreted with the understanding that other factors, such as the age and bone quality of the patient, may influence the choice of fixation. Poor Surgical approach and operating time outcomes with uncemented fixation in the 1990s led to Table 5.1.4 presents the proportion of surgeries using the an increase in fully cemented fixation, reaching a peak of posterior incision and the median operation time for elec- 93% around the turn of the millennium. Since then, the tive total hip replacements in 2023. There are differences proportion of patients undergoing cemented fixation has in the proportion of patients undergoing surgery with a decreased each year until 2020 (Figure 5.1.5 a). In 2023, posterior incision among various units. At 24 units, the the proportion of fully cemented prostheses was 51%. posterior incision was used in all cases (5,274 surgeries), with a median operating time of 76 minutes. At 12 units, Fully uncemented fixation has become increasingly com- 100% of the surgeries were performed using incisions mon over the past 20 years. In 2003, fully uncemented other than the posterior incision (1,752 surgeries), with a prostheses accounted for 5% of all reported surgeries. reported median operating time of 86 minutes. By 2023, this proportion had risen to just over 34% (Figure 5.1.5 a). The increase in uncemented fixation has primarily 5 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 occurred in age groups younger than 65 years and in the 65–74 age group, but not in the two oldest age groups (Figures 5.1.5 b–g). Since 2012, the proportion of reversed hybrids (cemented cup, uncemented stem) has decreased. Hybrid prostheses (uncemented cup, cemented stem) have been rare over the past decade, at around 1.5% during 2007–2010, but have increased to nearly 10% in 2023 (Figure 5.1.5 a). Previous reports have indicated regional differences in fixation choices. This year’s report details © 2024 The Swedish Arthroplasty Register the use of various fixation methods across units in Sweden (Figure 5.1.6). Regional differences persist when compar- ing different units. Cemented fixation is used in between 0% and 88% of reported surgeries at various units. The corresponding proportions for uncemented fixation range from 4% to 96%, and for hybrid fixation from 0% to 59%. Some of the differences in fixation methods can likely be explained by variations in patient groups treated at different units, while local traditions and the surgeon’s experience and preferences may contribute significantly to these differences. Figure 5.1.3. Time trend for surgical approach. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.1.2. Distribution of surgical approach, sex. Figure 5.1.4. Distribution of fixation, sex. 5 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.1.5 a. Time trend for fixation method 2004–2023. Figure 5.1.5 b. Time trend for fixation method, < 45 years. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.1.5 c. Time trend for fixation method, 45–54 years. Figure 5.1.5 d. Time trend for fixation method, 55–64 years. 5 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.1.5 e. Time trend for fixation method, 65–74 years. Figure 5.1.5 f. Time trend for fixation method, 75–84 years. Summary Cemented fixation remains the most commonly used fixation method. Over the past decade, the proportion of patients undergoing cemented fixa- tion has decreased. Significant variations in fixation choices exist between different units. Given the existing evidence, the register continues to encour- © 2024 The Swedish Arthroplasty Register age the use of cemented fixation, particularly on the stem side, for patients over 75 years of age. Figure 5.1.5 g. Time trend for fixation method, ≥ 85 years. 5 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 5.1.6. Use of fixation method per unit. 5 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Implant choice The most commonly used prostheses are detailed in Tables At the group level, cemented fixation of the stem for 5.1.5–5.1.11. In 2023, the five most commonly used patients aged 75 and older has proven to be safer, as the cemented cups accounted for approximately 90% of all risk of complications, particularly fractures around the cups of their type. For stems, Lubinus SPII, Exeter, and stem, is lower compared to uncemented fixation. There- MS30 dominate, representing 99% of all cemented stems. fore, cemented fixation is recommended for this age group, The variety of uncemented cups is greater, with the top five though deviations from this recommendation may be justi- accounting for only about 76% of all uncemented cups. fied in individual cases. Figure 5.1.9 shows the proportion Diversification in uncemented stems is less pronounced of cemented and uncemented stems by unit for patients compared to cups. Since 2009, the Corail stem has been aged 75 and older. Over 95% of units use a cemented stem the most frequently used uncemented stem. In 2023, the in more than 80% of cases in this age group. Corail stem constituted 51% of all uncemented stems reported to the register. Since 2018, the article numbers for cement type and mixing systems have been recorded for hip replacements. In 2023, highly cross-linked polyethylene was used in 92% The pre-filled systems Optipac Refobacin Bone Cement of all hip replacements. Ceramic head-polyethylene articu- R and Palacos R+G Pro have been used for the majority of lation was used in 24% of surgeries. The previously noted cemented prostheses reported to the register over the past increases in the use of highly cross-linked polyethylene and three years. In 2023, one of these two systems was used in ceramic head-polyethylene articulation have plateaued. approximately 70% of reported cases. Detailed informa- During 2023, a 32 mm head diameter was used in 82% tion on cement types is presented in Tables 5.1.12 a–d. of operations, while a 36 mm head diameter was used in 13% of operations. Time trends regarding articulation choice and head diameter are illustrated in Figures 5.1.7 and 5.1.8. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.1.7. Time trend for articulation, 2004–2023. Figure 5.1.8. Time trend for head size, 2004–2023. 5 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 5.1.9. Proportion of total hip replacement with cemented stem in patients ≥ 75 years per unit in 2023. 5 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 All primary replacements per unit and year Unit 2002–2019 2020 2021 2022 2023 Akademiska sjukhuset 3,090 71 151 187 188 Aleris Malmö Arena 31 266 Aleris Specialistvård Nacka 2,034 303 393 537 658 Aleris Specialistvård Renmarkstorget, Umeå <5 45 Aleris Specialistvård Ängelholm 676 327 449 516 421 Alingsås 3,344 126 114 190 185 Art Clinic Göteborg 348 212 317 276 443 Art Clinic Jönköping 483 172 297 265 257 Arvika 2,700 132 287 305 288 Bollnäs 2,670 242 362 349 384 Borås 2,331 42 38 69 93 Capio Artro Clinic 1,010 517 641 713 612 Capio Movement 3,391 428 478 473 411 Capio Ortho Center Göteborg 1,870 295 318 309 251 Capio Ortho Center Stockholm 7,233 732 816 859 904 Capio Ortho och Spine Center Skåne 206 251 Capio Ortopedi Motala 354 295 356 453 420 Capio Ortopediska Huset 7,330 609 776 802 778 Capio S:t Göran 7,445 313 343 358 362 Capio Spine Center Göteborg <5 67 Capio Sports Medicine Umeå AB 5 Carlanderska 2,259 497 557 361 446 Carlanderska-SportsMed 220 239 Danderyd 4,865 105 121 216 146 Eksjö 3,465 154 250 307 288 Enköping 4,905 409 463 532 549 Eskilstuna 1,113 62 71 59 51 Falköping 2,220 42 Falun 4,694 57 99 169 156 Frölundaortopeden 37 10 16 13 11 Gällivare 1,493 72 46 41 77 Gävle 2,393 118 63 97 127 Halmstad 3,211 151 116 142 85 Helsingborg 1,157 46 55 56 44 Hermelinen 106 21 30 38 38 Table continued on next page. 6 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 All primary replacements per unit and year, cont. Unit 2002–2019 2020 2021 2022 2023 Hudiksvall 1,858 53 54 69 53 Hässleholm 13,148 608 641 633 769 Jönköping 2,939 49 57 150 196 Kalmar 2,640 74 59 89 104 Karlshamn 3,792 209 176 283 305 Karlskrona 207 16 10 14 16 Karlstad 3,050 49 44 40 53 Karolinska Huddinge 3,482 149 194 300 178 Karolinska Solna 2,620 30 37 39 44 Kristianstad 25 <5 <5 <5 Kullbergska sjukhuset 4,104 225 318 356 429 Kungälv 3,001 68 57 105 117 Ledplastikcentrum Bromma 260 819 Lidköping 3,100 163 108 215 325 Lindesberg 4,569 343 410 412 575 Linköping 1,136 76 92 85 78 Ljungby 2,370 93 103 105 105 Lycksele 4,842 287 233 230 290 Mora 3,307 206 207 254 296 Norrköping 3,073 132 132 143 197 Norrtälje 1,940 107 125 150 148 Nyköping 2,218 86 110 128 132 NÄL 14 7 <5 <5 7 Ortopediskt Center - Sophiahemmet 0 292 262 Oskarshamn 4,085 281 303 422 379 Piteå 5,702 322 344 396 422 Skellefteå 1,822 99 96 137 121 Skene 1,999 120 125 225 259 Skövde 2,086 13 26 47 41 Sollefteå 2,825 203 379 379 426 Sophiahemmet 3,869 214 257 Specialistcenter S:t Johanniskliniken 10 Specialistcenter Scandinavia Malmö 122 122 Specialistcenter Scandinavia, Eskilstuna 5 10 99 124 208 SU/Mölndal 5,113 238 230 436 334 Table continued on next page. 6 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 All primary replacements per unit and year, cont. Unit 2002–2019 2020 2021 2022 2023 Sunderby sjukhus 533 5 <5 <5 Sundsvall 2,143 7 8 13 36 SUS/Lund 1,268 44 44 30 32 SUS/Malmö 642 <5 <5 Södersjukhuset 4,675 95 64 142 135 Södertälje 1,983 97 105 103 116 Torsby 1,598 74 168 125 152 Trelleborg 9,692 286 376 276 385 Uddevalla 5,347 197 244 320 337 Umeå 1,015 37 39 60 27 Varberg 3,645 175 155 189 125 Visby 1,852 112 127 110 133 Värnamo 2,230 103 174 156 158 Västervik 1,898 89 132 116 150 Västerås 4,443 212 268 348 441 Växjö 1,951 114 84 187 179 Ystad 310 <5 Ängelholm 1,791 134 118 186 239 Örebro 2,014 <5 <5 <5 <5 Örnsköldsvik 2,629 89 83 157 148 Östersund 3,798 175 79 194 201 Riket 228,138 13,168 15,325 18,512 20,367 Table 5.1.1. Number of primary operations per unit and year. Units with fewer than 20 primary replacements are excluded. 6 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Demography 2020–2023 2020 2021 2022 2023 Number 13,138 15,325 18,512 20,367 Mean age (SD) 67.8 (10.8) 68.5 (10.8) 69.0 (10.8) 69.0 (10.5) Age group n (%) < 45 years 268 (2.0) 281 (1.8) 329 (1.8) 325 (1.6) 45-54 years 1,320 (10.0) 1,403 (9.2) 1,500 (8.1) 1,586 (7.8) 55-64 years 3,090 (23.5) 3,407 (22.2) 4,166 (22.5) 4,662 (22.9) 65-74 years 4,622 (35.2) 5,254 (34.3) 6,068 (32.8) 6,804 (33.4) 75-84 years 3,356 (25.5) 4,333 (28.3) 5,573 (30.1) 6,077 (29.8) ≥85 years 482 (3.7) 647 (4.2) 876 (4.7) 913 (4.5) Females n (%) 7,482 (56.9) 8,845 (57.7) 10,576 (57.1) 11,791 (57.9) BMI n (%) < 18.5 90 (0.7) 118 (0.8) 141 (0.8) 163 (0.8) 18.5-24.9 4,082 (31.4) 4,807 (31.6) 5,790 (31.6) 6,197 (30.7) 25-29.9 5,485 (42.2) 6,352 (41.8) 7,679 (42.0) 8,365 (41.5) 30-34.5 2,609 (20.1) 3,088 (20.3) 3,700 (20.2) 4,320 (21.4) 35-39.9 629 (4.8) 727 (4.8) 862 (4.7) 988 (4.9) ≥ 40 89 (0.7) 96 (0.6) 122 (0.7) 128 (0.6) ASA-class n (%) ASA I 2,896 (22.3) 3,053 (20.0) 3,364 (18.3) 3,617 (17.8) ASA II 7,979 (61.3) 9,510 (62.3) 1,1396 (61.9) 12,791 (63.0) ASA III 2,103 (16.2) 2,648 (17.4) 3,585 (19.5) 3,809 (18.8) ASA IV 34 (0.3) 48 (0.3) 76 (0.4) 73 (0.4) Table 5.1.2. Demography, 2023. 6 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Case-mix per unit 2023 < 55 BMI ASA-class Standard Unit Number Females % years % Charnley C % ≥ 35 % III–IV % patient % Akademiska sjukhuset 188 38.8 19.7 29.3 7.0 30.9 32.6 Aleris Malmö Arena 266 36.5 9.4 0.0 1.5 3.0 65.0 Aleris Specialistvård Nacka 658 44.2 12.2 30.1 2.7 5.2 56.9 Aleris Specialistvård Renmarkstorget, 45 64.4 6.7 15.6 4.7 6.7 65.1 Umeå Aleris Specialistvård Ängelholm 421 43.2 7.8 27.1 2.4 12.6 56.5 Alingsås 185 37.8 11.4 38.4 5.5 22.7 42.6 Art Clinic Göteborg 443 38.6 6.8 30.7 1.6 2.9 68.1 Art Clinic Jönköping 257 40.5 10.1 22.2 1.2 7.8 61.9 Arvika 288 39.9 7.6 27.4 1.8 16.1 51.2 Bollnäs 384 40.1 8.3 31.5 1.6 9.6 56.5 Borås 93 39.8 4.3 30.1 15.1 60.2 16.1 Capio Artro Clinic 612 36.8 15.8 25.0 2.5 0.8 63.1 Capio Movement 411 43.8 8.8 5.8 2.9 17.0 58.6 Capio Ortho Center Göteborg 251 51.4 17.9 17.5 2.8 5.6 59.6 Capio Ortho Center Stockholm 904 41.7 13.7 27.2 4.2 5.0 59.4 Capio Ortho och Spine Center Skåne 251 51.8 15.5 16.7 2.0 9.2 53.4 Capio Ortopedi Motala 420 41.9 4.5 27.6 4.1 21.0 60.0 Capio Ortopediska Huset 778 38.7 10.5 26.5 1.7 0.0 69.0 Capio S:t Göran 362 39.0 3.3 37.0 4.2 52.6 34.5 Capio Spine Center Göteborg 67 38.8 9.0 19.4 0.0 1.5 64.2 Capio Sports Medicine Umeå AB 5 40.0 20.0 0.0 0.0 0.0 60.0 Carlanderska 446 40.4 6.7 16.4 0.9 4,0 66.6 Carlanderska-SportsMed 239 66.9 25.5 9.2 8.5 2.9 54.0 Danderyd 146 43.8 8.9 13.7 11.2 59.6 20.3 Eksjö 288 39.6 8.0 27.1 3.0 19.4 53.2 Enköping 549 37.0 4.6 20.4 4.6 18.3 55.2 Eskilstuna 51 41.2 15.7 45.1 9.8 49.0 27.5 Falun 156 40.4 9,0 30.1 15.8 32.7 34.9 Frölundaortopeden 11 54.5 27.3 18.2 0.0 9.1 45.5 Gällivare 77 45.5 3.9 26.0 7.9 32.9 46.7 Gävle 127 46.5 6.3 27.6 11.0 38.6 18.9 Halmstad 85 41.2 9.4 30.6 8.8 23.8 39.0 Helsingborg 44 50.0 9.1 31.8 15.9 72.7 9.1 Hermelinen 38 55.3 26.3 10.5 2.6 0.0 44.7 Hudiksvall 53 47.2 7.5 30.2 4.0 41.5 26.0 Hässleholm 769 39.7 8.6 35.6 5.5 19.8 47.9 Jönköping 196 42.3 8.2 29.1 4.8 34.7 38.8 Kalmar 104 56.7 4.8 31.7 2.9 32.7 33.7 Table continued on next page. 6 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Case-mix per unit 2023, cont. < 55 BMI ASA-class Standard Unit Number Females % years % Charnley C % ≥ 35 % III–IV % patient % Karlshamn 305 45.6 8.2 29.5 9.8 10.5 53.8 Karlskrona 16 43.8 12.5 6.2 12.5 68.8 0.0 Karlstad 53 41.5 13.2 35.8 15.4 26.4 15.4 Karolinska Huddinge 178 44.4 12.9 23.0 14.8 48.9 17.0 Karolinska Solna 44 43.2 9.1 9.1 3.4 59.5 11.1 Kristianstad <5 Kullbergska sjukhuset 429 45.0 6.8 35.0 6.5 12.4 53.8 Kungälv 117 43.6 12.8 41.9 14.7 27.4 23.3 Ledplastikcentrum Bromma 819 38.2 8.8 10.5 3.1 0.1 67.8 Lidköping 325 46.5 7.1 35.1 8.7 35.6 31.3 Lindesberg 575 40.0 7.8 20.2 7.8 24.7 41.5 Linköping 78 50.0 34.6 28.2 9.1 15.4 29.9 Ljungby 105 42.9 7.6 35.2 8.6 25.7 44.8 Lycksele 290 38.3 11.7 35.2 6.9 21.0 43.1 Mora 296 43.6 7.4 33.1 11.1 28.4 46.3 Norrköping 197 43.7 7.6 26.9 5.1 23,0 41.3 Norrtälje 148 41.2 4.7 33.1 6.1 37.2 41.9 Nyköping 132 44.7 6.8 32.6 6.1 21.2 50.0 NÄL 7 57.1 0.0 14.3 0.0 71.4 0.0 Ortopediskt Center - Sophiahemmet 262 55.7 12.6 27.5 4.6 7.6 61.5 Oskarshamn 379 46.7 7.7 36.9 6.9 12.9 55.7 Piteå 422 42.9 7.8 34.4 9.5 29.8 41.9 Skellefteå 121 36.4 2.5 11.6 5.0 25.4 49.1 Skene 259 42.9 7.7 20.8 5.8 14.8 47.4 Skövde 41 36.6 7.3 29.3 0.0 7.3 70.7 Sollefteå 426 41.1 7.5 34.7 7.1 19.6 50.6 Specialistcenter S:t Johanniskliniken 10 30.0 0.0 0.0 0.0 0.0 80.0 Specialistcenter Scandinavia Malmö 122 45.1 5.7 20.5 4.1 4.3 66.1 Specialistcenter Scandinavia, Eskilstu- 208 44.2 11.5 27.4 2.6 0.5 62.4 na SU/Mölndal 334 39.5 16.8 29.6 6.9 31.7 31.4 Sunderby sjukhus <5 Sundsvall 36 38.9 8.3 33.3 13.8 51.5 18.5 SUS/Lund 32 53.1 6.2 40.6 9.4 68.8 0.0 SUS/Malmö <5 Södersjukhuset 135 38.5 3.7 27.4 16.4 75.6 8.2 Södertälje 116 43.1 10.3 29.3 6.9 35.3 29.3 Torsby 152 44.7 7.2 13.8 7.9 32.9 42.4 Trelleborg 385 39.5 10.1 44.7 10.4 39.0 25.5 Table continued on next page. 6 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Case-mix per unit 2023, cont. < 55 BMI ASA-class Standard Unit Number Females % years % Charnley C % ≥ 35 % III–IV % patient % Uddevalla 337 37.7 8.3 38.3 8.3 41.8 34.8 Umeå 27 48.1 18.5 29.6 0.0 12.5 40.9 Varberg 125 44.8 5.6 28.0 9.7 20.8 46.0 Visby 133 40.6 6.8 40.6 3.9 13.6 55.0 Värnamo 158 43.7 7.6 41.1 3.2 24.7 45.6 Västervik 150 42.0 10.7 26.0 3.4 10.7 55.4 Västerås 441 42.4 7.5 28.3 8.3 39.8 33.3 Växjö 179 44.1 8.4 0.0 7.3 30.7 45.5 Ängelholm 239 39.7 6.7 32.2 9.7 25.5 43.7 Örebro <5 Örnsköldsvik 148 47.3 4.1 38.5 9.5 38.5 38.5 Östersund 201 35.3 5.0 38.8 6.3 37.0 40.7 RIKET 20,367 42.1 9.4 27.0 5.5 19.1 49.7 Table 5.1.3. Case-mix per unit 2023. Units with fewer than 20 primary replacements are excluded. Note that percentages for units with few operations may be misleading. Surgical approach and operating time per unit 2023 Number Complete Posterior Unit of reports reports % approach % Median op-time Country 20 468 99.4 66.4 68 University units Akademiska 188 100.0 1.1 61 Karolinska Huddinge 178 94.9 93.3 102 Karolinska Solna 44 70.5 65.9 117 Linköping 78 100.0 97.4 80 SU/Mölndal 336 99.7 56.6 84 SUS/Lund 32 100.0 98.9 102 SUS/Malmö <5 Umeå 27 96.3 100.0 85 Örebro <5 Privately run units Aleris Specialistvård Malmö Arena 267 100.0 100.0 54 Aleris Specialistvård Nacka 659 99.7 98.9 28 Aleris Specialistvård Renmarkstorget, Umeå 45 91.1 100.0 75 Aleris Specialistvård Ängelholm 421 100.0 100.0 41 Art Clinic Göteborg 443 99.8 85.8 58 Art Clinic Jönköping 257 100.0 35.0 77 Capio Artro Clinic 614 100.0 57.8 55 Table continued on next page. 6 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Surgical approach and operating time per unit 2023, cont. Number Complete Posterior Unit of reports reports % approach % Median op-time Capio Movement 412 100.0 83.7 47 Capio Ortho Center Göteborg 252 100.0 56.8 83 Capio Ortho Center Stockholm 909 100.0 75.1 61 Capio Ortho och Spine Center Skåne 251 98.8 99.6 56 Capio Ortopedi Motala 421 95.5 100.0 61 Capio Ortopediska Huset 778 99.9 29.1 44 Capio Spine Center Göteborg 68 100.0 98.5 59 Capio Sports Medicine Umeå AB 5 100.0 100.0 84 Capio S:t Göran 368 100.0 14.4 83 Carlanderska 446 100.0 36.3 68 Carlanderska-SportsMed 239 97.1 4.6 53 Frölundaortopeden 13 100.0 0.0 59 Hermelinen 38 100.0 100.0 48 Ledplastikcentrum Bromma 832 100.0 84.7 52 Ortopedisk Center Sophiahemmet 262 100.0 100.0 50 Specialistcenter Scandinavia Eskilstuna 208 99.0 48.6 54 Specialistcenter Scandinavia Johanniskliniken 10 100.0 70.0 30 Specialistcenter Scandinavia Malmö 122 99.2 100.0 58 Other units Alingsås 185 100.0 17.3 99 Arvika 290 99.0 0.0 93 Bollnäs 388 100.0 93.8 64 Borås 93 100.0 2.2 97 Danderyd 147 100.0 91.8 85 Eksjö 305 99.0 100.0 79 Enköping 550 99.3 40.7 65 Eskilstuna 51 100.0 0.0 89 Falun 156 99.4 36.5 110 Gällivare 77 100.0 97.4 103 Gävle 127 100.0 82.7 79 Halmstad 85 94.1 10.6 74 Helsingborg 46 93.5 100.0 74 Hudiksvall 53 100.0 100.0 134 Hässleholm 770 100.0 100.0 54 Jönköping 197 99.5 97.5 100 Kalmar 104 100.0 96.2 73 Karlshamn 305 100.0 100.0 76 Karlskrona 16 100.0 93.8 84 Karlstad 53 100.0 0.0 125 Table continued on next page. 6 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Surgical approach and operating time per unit 2023, cont. Number Complete Posterior Unit of reports reports % approach % Median op-time Kristianstad <5 Kullbergska sjukhuset 432 100.0 1,0 77 Kungälv 118 100.0 0.0 92 Lidköping 325 99.7 100.0 78 Lindesberg 575 100.0 99.8 90 Ljungby 105 100.0 0.0 54 Lycksele 290 100.0 100.0 91 Mora 309 100.0 0.0 79 Norrköping 197 98.5 0.0 101 Norrtälje 153 100.0 37.3 76 Nyköping 132 100.0 38.6 81 NÄL Trollhättan 7 100.0 0.0 93 Oskarshamn 379 100.0 4.2 67 Piteå 425 100.0 100.0 78 Skellefteå 121 92.6 100.0 126 Skene 260 99.6 5.0 89 Skövde 41 100.0 100.0 55 Sollefteå 428 100.0 99.8 96 Sunderby sjukhus <5 Sundsvall 36 86.1 100.0 114 Södersjukhuset 135 100.0 45.9 97 Södertälje 122 100.0 0.0 80 Torsby 152 0.0 27.6 100 Trelleborg 385 100.0 91.4 79 Uddevalla 337 100.0 0.0 82 Varberg 125 100.0 99.2 69 Visby 133 99.3 33.1 110 Värnamo 158 100.0 100.0 70 Västervik 150 100.0 0.0 83 Västerås 442 100.0 100.0 64 Växjö 179 99.4 98.3 49 Ängelholm 240 100.0 99.2 64 Örnsköldsvik 148 100.0 100.0 91 Östersund 201 92.5 100.0 80 Tabell 5.1.4. Surgical approach and operating time per unit 2023. 6 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Most common implants Year 2012-2023 2012-2021 2022 2023 Number 188,516 150,721 18,358 19,437 Implant, stem (cup), n (%) (SPII 150 mm) Lubinus X-link 39,266 (20.8) 31,017 (20.6) 3,954 (21.5) 4,295 (22.1) (Exeter 150 mm) Exeter Rim-fit 14,814 (7.9) 11,477 (7.6) 1,551 (8.4) 1,786 (9.2) (SPII) Lubinus 13,569 (7.2) 12,266 (8.1) 623 (3.4) 680 (3.5) (Corail standard) Pinnacle W/Gription 8,607 (4.6) 6,332 (4.2) 1,059 (5.8) 1,216 (6.3) (Exeter 150 mm) Marathon 7,568 (4.0) 7,112 (4.7) 326 (1.8) 130 (0.7) (MS30) Exeter Rim-fit 4,978 (2.6) 4,505 (3.0) 238 (1.3) 235 (1.2) (MS30) ZCA XLPE 4,812 (2.6) 4,675 (3.1) 137 (0.7) 0 (0.0) (Corail high offset) Pinnacle W/Gription 100 3,283 (1.7) 2,466 (1.6) 364 (2.0) 453 (2.3) (CLS) Trilogy 3,070 (1.6) 3,009 (2.0) 61 (0.3) 0 (0.0) (Accolade II) Trident hemi 2,997 (1.6) 1,923 (1.3) 570 (3.1) 504 (2.6) (Corail standard) Pinnacle 100 2,923 (1.6) 2,238 (1.5) 383 (2.1) 302 (1.6) (Exeter 150 mm) Trident hemi 2,848 (1.5) 2,456 (1.6) 233 (1.3) 159 (0.8) (Corail standard) Lubinus x-link 2,590 (1.4) 1,920 (1.3) 363 (2.0) 307 (1.6) (SP II <150/>150 mm) Lubinus x-link 2,571 (1.3) 1,839 (1.2) 367 (2.0) 365 (1.9) (Corail coxa vara) Pinnacle W/Gription 2,507 (1.3) 1,556 (1.0) 419 (2.3) 532 (2.7) Other 72,113 (38.3) 55,930 (37.1) 7,710 (42.0) 8,473 (43.6) Table 5.1.5. Most common implants, 2012–2023. Most common cemented implants Year 2012-2023 2012-2021 2022 2023 Number 104,988 85,667 9,495 9,826 Implant, stem (cup), n (%) (SPII 150 mm) Lubinus X-link 39,266 (37.4) 31,017 (36.2) 3,954 (41.6) 4,295 (43.7) (Exeter 150 mm) Exeter Rim-fit 14,814 (14.1) 11,477 (13.4) 1,551 (16.3) 1,786 (18.2) (SPII) Lubinus old poly 13,569 (12.9) 12,266 (14.3) 623 (6.6) 680 (6.9) (Exeter 150 mm) Marathon 7,568 (7.2) 7,112 (8.3) 326 (3.4) 130 1.3) (MS30) Exeter Rim-fit 4,978 (4.7) 4,505 (5.3) 238 (2.5) 235 (2.4) (MS30) ZCA XLPE 4,812 (4.6) 4,675 (5.5) 137 (1.4) 0 (0.0) (SP II <150/>150 mm) Lubinus x-link 2,571 (2.4) 1,839 (2.1) 367 (3.9) 365 (3.7) (SPII 150 mm) IP Link 2,133 (2.0) 1,632 (1.9) 268 (2.8) 233 (2.4) (MS30) Exceed ABT without flange 1,900 (1.8) 1,053 (1.2) 368 (3.9) 479 (4.9) (MS30) Lubinus X-link 1,572 (1.5) 37 (0.0) 866 (9.1) 669 (6.8) (Exeter 150 mm) Contemporary Hooded Duration 1,360 (1.3) 1,360 (1.6) 0 (0.0) 0 (0.0) (Exeter </> 150 mm) Exeter Rim-fit 1,228 (1.2) 1,063 (1.2) 78 0.8) 87 (0.9) (SPII 150 mm) Marathon 1,180 (1.1) 846 (1.0) 143 (1.5) 191 (1.9) (SPII 150 mm) Avantage 1,007 (1.0) 821 (1.0) 93 (1.0) 93 (0.9) (MS30) ZCA old poly 869 (0.8) 836 (1.0) 33 (0.3) 0 (0.0) Other 6,161 (5.9) 5,128 (6.0) 450 (4.7) 583 (5.9) Table 5.1.6. Most common cemented implants, 2012–2023. 6 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Most common uncemented implants Year 2012-2023 2012–2021 2022 2023 Number 53,228 40,089 6,195 6,944 Implant, stem (cup), n (%) 44038 (Corail standard) Pinnacle W/Gription 8,607 (16.3) 6,332 (15.8) 1,059 (17.1) 1,216 (18.3) 46038 (Corail high offset) Pinnacle W/Gription 100 3,283 (6.2) 2,466 (6.2) 364 (5.9) 453 (6.8) 3097 (CLS) Trilogy 3,070 (5.8) 3,009 (7.5) 61 (1.0) 0 (0.0) 63057 (Accolade II) Trident hemi 2,997 (5.7) 1,923 (4.8) 570 (9.2) 504 (7.6) 44035 (Corail standard) Pinnacle 100 2,923 (5.5) 2,238 (5.6) 383 (6.2) 302 (4.5) 45038 (Corail coxa vara) Pinnacle W/Gription 2,507 (4.7) 1,556 (3.9) 419 (6.8) 532 (8.0) 3081 (CLS) Continuum 1,651 (3.1) 1,617 (4.0) 22 (0.4) 12 (0.2) 45035 (Corail coxa vara) Pinnacle 100 1,597 (3.0) 993 (2.5) 319 (5.2) 285 (4.3) 156132 (Echo-Bimetric (FPP) G7 PPS 1,572 (3.0) 906 (2.3) 353 (5.7) 313 (4.7) 158121 (Bi-Metric X por HA NC) Exceed ABT Rinblock 1,375 (2.6) 1,375 (3.4) 0 (0.0) 0 (0.0) 19038 (M/L Taper) Pinnacle W/Gription 1,272 (2.4) 541 (1.4) 368 (6.0) 363 (5.5) 44125 (Corail standard) Pinnacle W/Gription Sector 1,259 (2.4) 845 (2.1) 175 (2.8) 239 (3.6) 19081 (M/L Taper) Continuum 1,167 (2.2) 977 (2.49 88 (1.4) 102 (1.5) 158098 (Bi-Metric X por HA NC) Trilogy IT 926 (1.8) 926 (2.3) 0 (0.0) 0 (0.0) 11081 (Wagner Cone) Continuum 887 (1.7) 831 2.1) 34 (0.6) 22 (0.3) Other 17,790 (33.6) 13,520 (33.8) 1,966 (31.8) 2,304 (34.7) Table 5.1.7 Most common uncemented implants, 2012–2023. Most common hybrid implants, cup/stem Year 2012-2023 2012–2021 2022 2023 Number 11,435 7,946 1,611 1,878 Implant, stem (cup), n (%) (Exeter 150 mm) Trident hemi 2,848 (24.9) 2,456 (30.9) 233 (14.5) 159 (8.5) (MS30) Pinnacle W/Gription 100 1,303 (11.4) 631 (7.9) 393 (24.4) 279 (14.9) (Exeter <150/>150 mm) Trident hemi 964 (8.4) 839 10.6) 61 (3.8) 64 (3.4) (SPII 150 mm) Pinnacle Sector 489 (4.3) 288 (3.6) 66 (4.1) 135 (7.2) (MS30) Pinnacle W/Gription Sector 375 (3.3) 227 (2.9) 86 (5.3) 62 (3.3) (SPII 150 mm) Pinnacle W/Gription 100 331 (2.9) 150 (1.9) 58 (3.6) 123 (6.5) (Exeter 150 mm) Trident II 324 (2.8) 81 (1.0) 54 (3.4) 189 (10.1) (Exeter 150 mm) Trident AD LW 322 (2.8) 221 (2.8) 55 (3.4) 46 (2.4) (Exeter 150 mm) Pinnacle W/Gription Sector 286 (2.5) 201 (2.5) 36 (2.2) 49 (2.6) (SPII 150 mm) Pinnacle W/Gription Sector 266 (2.3) 39 (0.5) 106 (6.6) 121 (6.4) (SPII 150 mm) Trilogy 250 (2.2) 250 (3.1) 0 (0.0) 0 (0.0) (SPII 150 mm) Trilogy IT 248 (2.2) 195 (2.5) 19 (1.2) 34 (1.8) (Exeter 150 mm) Tritanium 234 (2.0) 213 (2.7) 15 (0.9) 6 (0.3) (SPII 150 mm) Continuum 179 (1.6) 127 (1.6) 28 (1.7) 24 (1.3) (Exeter 150 mm) Pinnacle W/Gription 100 161 (1.4) 99 (1.2) 21 (1.3) 41 (2.2) Other 2,855 (25.0) 1,929 (24.3) 380 (23.6) 546 (29.1) Table 5.1.8. Most common hybrid implants, 2012–2023. 7 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Most common reverse hybrid implants, cup/stem Year 2012-2023 2012–2021 2022 2023 Number 19,210 17,053 1,071 1,086 Implant, stem (cup), n (%) (Corail standard) Lubinus x-link 2,590 (13.5) 1,920 (11.3) 363 (33.9) 307 (28.3) (Corail standard) Exeter Rim-fit 2,327 (12.1) 2,292 (13.4) 13 (1.2) 22 (2.0) (Corail standard) Marathon 1,649 (8.6) 1,597 (9.4) 22 (2.1) 30 (2.8) (Corail standard) Lubinus old poly 1,219 (6.3) 1,119 (6.6) 44 (4.1) 56 (5.2) (M/L Taper) Exeter Rim-fit 866 (4.5) 841 (4.9) 18 (1.7) 7 (0.6) (Corail coxa vara) Lubinus x-link 866 (4.5) 675 (4.0) 79 (7.4) 112 (10.3) (ABG II HA) Marathon 842 (4.4) 842 (4.9) 0 (0.0) 0 (0.0) (Corail high offset) Marathon 825 (4.3) 787 (4.6) 17 (1.6) 21 (1.9) (M/L Taper) Lubinus x-link 824 (4.3) 346 (2.0) 312 (29.1) 166 (15.3) (Corail high offset) Exeter Rim-fit 722 (3.8) 712 (4.2) 4 (0.4) 6 (0.6) (Bi-Metric X por HA NC) Marathon 582 (3.0) 582 (3.4) 0 (0.0) 0 (0.0) (Bi-Metric por HA NC) Lubinus x-link 552 (2.9) 552 (3.2) 0 (0.0) 0 (0.0) (Corail high offset) Lubinus x-link 415 (2.2) 336 (2.0) 32 (3.0) 47 (4.3) (Corail coxa vara) Lubinus old poly 342 (1.8) 325 (1.9) 9 (0.8) 8 (0.7) (Corail standar) ZCA XLPE 326 (1.7) 326 (1.9) 0 (0.0) 0 (0.0) Other 4,263 (22.2) 3,801 (22.3) 158 (14.8) 304 (28.0) Table 5.1.9. Most common reverse hybrid implants, 2012–2023. Most common cup components All 2012–2021 2022 2023 Number 190,132 151,253 18,512 20,367 Implant, n (%) Lubinus x-link 50,401 (26.5) 37,942 (25.1) 6,087 (33.1) 6,372 (31.5) Pinnacle W/Cripton 100 17,724 (9.3) 11,913 (7.9) 2,695 (14.6) 3,116 (15.4) Exeter Rim-fit 25,896 (13.6) 21,498 (14.2) 1,974 (10.7) 2,424 (12.0) Trident hemi 8,662 (4.6) 6,530 (4.3) 1,067 (5.8) 1,065 (5.3) G7 PPS 3,549 (1.9) 1,434 (0.9) 990 (5.4) 1,125 (5.6) Pinnacle 100 5,745 (3.0) 4,092 (2.7) 880 (4.8) 773 (3.8) Lubinus 16,678 (8.8) 15,149 (10.0) 746 (4.1) 783 (3.9) Marathon 13,765 (7.3) 12,812 (8.5) 539 (2.9) 414 (2.0) Pinnacle W/Gription Sector 3,,083 (1.6) 1,853 (1.2) 536 (2.9) 694 (3.4) Exceed ABT E-poly without flange (cem) 2,344 (1.2) 1,472 (1.0) 389 (2.1) 483 (2.4) IP Link 2,606 (1.4) 1,795 (1.2) 345 (1.9) 466 (2.3) Continuum 5,670 (3.0) 5,265 (3.5) 215 (1.2) 190 (0.9) Trilogy IT 2,404 (1.3) 2,150 (1.4) 149 (0.8) 105 (0.5) ZCA XLPE 6,635 (3.5) 6,498 (4.3) 137 (0.7) 0 (0.0) Trilogy 4,349 (2.3) 4,268 (2.8) 81 (0.4) 0 (0.0) Other 20,341 (10.7) 16,533 (10.9) 1,581 (8.6) 2,227 (11.0) Table 5.1.10. Most common cup components, 2012 –2023. 7 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Most common stem components All 2012–2021 2022 2023 Number 190,132 151,253 18,512 20,367 Implant, n (%) SPII standard 66,246 (34.9) 52,847 (35.0) 6,197 (33.5) 7,202 (35.4) Exeter standard 32,999 (17.4) 27,454 (18.2) 2,630 (14.2) 2,915 (14.3) Corail standard 24,586 (12.9) 19,806 (13.1) 2,270 (12.3) 2,510 (12.3) MS-30 polished 16,979 (8.9) 12,654 (8.4) 2,273 (12.3) 2,052 (10.1) Accolade II 6,733 (3.5) 4,175 (2.8) 1,160 (6.3) 1,398 (6.9) Corail coxa vara 7,765 (4.1) 5,429 (3.6) 1,043 (5.6) 1,293 (6.4) M/L Taper 5,430 (2.9) 3,264 (2.2) 1,045 (5.6) 1,121 (5.5) Corail high offset 7,518 (4.0) 6,078 (4.0) 651 (3.5) 789 (3.9) CLS 7,654 (4.0) 6,758 (4.5) 473 (2.6) 423 (2.1) Echo Bi-Metric (FPP) 2,312 (1.2) 1,490 (1.0) 478 (2.6) 344 (1.7) CPT 579 (0.3) 436 (0.3) 74 (0.4) 69 (0.3) Wagner Cone 1,544 (0.8) 1,398 (0.9) 79 (0.4) 67 (0.3) Accolade straight 637 (0.3) 635 (0.4) 0 (0.0) 2 (0.0) Bi-Metric X por HA NC 4,799 (2.5) 4,799 (3.2) 0 (0.0) 0 (0.0) ABG II HA 1,260 (0.7) 1,260 (0.8) 0 (0.0) 0 (0.0) Other 3,012 (1.6) 2,723 (1.8) 137 (0.7) 152 (0.7) Table 5.1.11. Most common stem components, 2012–2023. 7 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Number and proportion of replacements per type of stem cement All 2021 2022 2023 Number 32,602 9,126 11,209 12,267 Stem cement, n (%) Optipac Refobacin 17,918 (55.0) 4,950 (54.2) 6,937 (61.9) 6,031 (49.2) Palacos R+G Pro 7,626 (25.3) 2,311 (25.3) 2,409 (21.5) 2,906 (23.7) Palacos R+G (genta) 3,073 (8.7) 796 (8.7) 969 (8.6) 1,308 (10.7) CMV 2,510 (8.3) 762 (8.3) 774 (6.9) 974 (7.9) Refobacin Bone Cement (genta) 1,082 (2.3) 208 (2.3) 5 (0.0) 869 (7.1) Copal (genta + clinda) 219 (.4) 35 (0.4) 67 (0.6) 117 (1.0) Copal (genta + vanco) 94 (0.3) 25 (0.3) 33 (0.3) 36 (0.0) Refobacin Revision Cement (genta + clinda) 35 (0.1) 11 (0.1) 5 (0.0) 19 (0.0) Smartset GHV (genta) 21 (0.0) 5 (0.0) 9 (0.0) 7 (0.0) Other 24 (0.0) 23 (0.2) <5 0 (0.0) Table 5.1.12 a. Number and proportion of replacements per type of stem cement and year, 2021–2023. Number and proportion of replacements per type of cup cement All 2021 2022 2023 Number 31,150 9,115 10,635 11,400 Cup cement, n (%) Optipac Refobacin 16,032 (51.5) 4,766 (52.3) 6,090 (57.3) 5,176 (45.4) Palacos R+G Pro 6,958 (22.3) 2,024 (22.2) 2,241 (21.1) 2,693 (23.6) CMV 3,901 (12.5) 1,357 (14.9) 1,235 (11.6) 1,309 (11.5) Palacos R+G (genta) 3,047 (9.8) 671 (7.4) 962 (9.0) 1,414 (12.4) Refobacin Bone Cement (genta) 864 (2.8) 229 (2.5) 5 (0.0) 630 (5.5) Copal (genta + clinda) 219 (0.7) 36 (0.4) 65 (0.6) 118 (1.0) Copal (genta + vanco) 68 (0.2) 21 (0.2) 21 (0.2) 26 (0.2) Refobacin Revision Cement (genta + clinda) 42 (0.1) 9 (0.1) 8 (0.1) 25 (0.2) Smartset GHV (genta) 19 (0.1) <5 8 (0.1) 9 (0.1) Table 5.1.12 b. Number and proportion of replacements per type of cup cement and year, 2021–2023. 7 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Number and proportion of replacements per type of the combination of stem and cup cement All 2021 2022 2023 Number 36,000 10,341 12,282 13,377 Combination of stem and cup, n (%) Optipac Refobacin 18,966 (52.7) 5,425 (52.5) 7,347 (59.8) 6,194 (46.3) Palacos R+G Pro 7,858 (21.8) 2,398 (23.2) 2,440 (19.9) 3,020 (22.6) CMV 3,434 (9.5) 1,199 (11.6) 1,052 (8.6) 1,183 (8.8) Palacos R+G (genta) 3,305 (9.2) 756 (7.3) 1,084 (8.8) 1,465 (11.0) Different cement stem/cup 1,126 (3.1) 249 (2.4) 240 (2.0) 637 (4.8) Refobacin Bone Cement (genta) 912 (2.5) 219 (2.1) 3 (0.0) 690 (5.2) Copal (genta + clinda) 224 (0.6) 35 (0.3) 68 (0.6) 121 (0.9) Copal (genta + vanco) 98 (0.3) 26 (0.3) 36 (0.3) 36 (0.3) Refobacin Revision Cement (genta + clinda) 36 (0.1) 10 (0.1) <5 22 (0.2) Smartset GHV (genta) 17 (0.0) <5 7 (0.1) 9 (0.1) Other 24 (0.1) 23 (0.2) <5 0 (0.0) Table 5.1.12 c. Number and proportion of replacements per type of the combination of stem and cup cement and year, 2021–2023. Number and proportion of replacements per type of the combination of stem and cup and type of fixation 2021 2022 2023 Reverse Reverse Reverse All Hybrid hybrid Cemented Hybrid hybrid Cemented Hybrid hybrid Cemented Number 36,000 1,224 1,215 7,902 1,641 1,065 9,576 1,964 1,110 10,303 Combination of stem and cup, (%) Optipac 18,966 681 522 4,222 1,271 570 5,506 1,256 492 4,446 Refobacin (52.7) (55.6) (43.0) (53.4) (77.5) (53.5) (57.5) (64.0) (44.3) (43.2) 7,858 404 175 1,819 212 77 2,151 328 119 2,573 Palacos R+G Pro (21.8) (33.0) (14.4) (23.0) (12.9) (7.2) (22.5) (16.7) (10.7) (25.0) 3,434 6 442 751 9 278 765 11 219 953 CMV (9.5) (0.5) (36.4) (9.5) (0.5) (26.1) (8.0) (0.6) (19.7) (9.2) Palacos R+G 3,305 89 46 621 128 132 824 81 200 1,184 (genta) (9.2) (7.3) (3.8) (7.9) (7.8) (12.4) (8.6) (4.1) (18.0) (11.5) Different cement 1,126 0 0 249 0 0 240 0 0 637 stem/cup (3.1) (0.0) (0.0) (3.2) (0.0) (0.0) (2.5) (0.0) (0.0) (6.2) Refobacin Bone 912 10 25 184 0 262 68 360 <5 <5 Cement (genta) (2.5) (0.8) (2.1) (2.3) (0.0) (13.3) (6.1) (3.5) Copal 224 33 62 9 5 107 <5 <5 <5 <5 (genta + clinda) (0.6) (0.4) (0.6) (0.5) (0.5) (1.0) Copal 98 6 17 15 18 12 23 <5 <5 <5 (genta + vanco) (0.3) (0.5) (0.2) (0.9) (0.2) (0.6) (0.2) Refobacin Revi- 36 0 6 5 13 sion Cement <5 <5 <5 <5 <5 (0.1) (0.0) (0.1) (0.3) (0.1) (genta + clinda) Smartset GHV 17 0 0 0 0 7 0 7 <5 <5 (genta) (0.0) (0.0) (0.0) (0.0) (0.0) (0.1) (0.0) (0.1) 24 23 0 0 0 0 0 0 0 Other <5 (0.1) (1.9) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) Table 5.1.12 d. Number and proportion of replacements per type of the combination of stem and cup cement and type of fixation, 2021–2023. 7 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Prophylactic antibiotics Thromboprophylaxis Prophylactic antibiotics began to be reported for hip There is a discrepancy in national and international guide- replacements following the merger in 2021 and are lines for the initiation, choice of medication, and duration reported for the first time in this year’s report for elec- of thromboprophylaxis which is partly reflected in the data tive total hip replacements. Indicators for prophylactic presented in Table 5.1.14. The columns show the respec- antibiotics (Table 5.1.13) are based on the PRISS project tive proportions of elective total hip replacement where recommendations for 2023. Due to the higher risk of revi- thromboprophylaxis was planned to start postoperatively, sion due to infection in patients who received clindamycin where NOACs were planned, and where the planned treat- compared to those who received cloxacillin (Robertsson et ment duration was 15 days or longer. It was most common al. 2017), the recommendations for penicillin allergy have to start thromboprophylaxis postoperatively. In 56% of been revised. The updated recommendation (April 2023) surgeries, only NOACs are planned, while a combination is available at www.patientforsakringen.se. All units report of injections and NOACs was reported for just over 10% using cloxacillin as the first-choice preparation. Dalacin of surgeries. For 66% of surgeries, thromboprophylaxis is was reported in 3.5% of surgeries and Cefotaxim in 1.5%. planned for 15 days or longer. The proportion of surgeries The recommended dose of each antibiotic was used in 93% reported to have a shorter prophylaxis (1–7 days) was just of surgeries. Since cloxacillin has a short half-life, it is cru- over 10%, while the proportion reported to have no pro- cial that it is administered within the correct time interval. phylaxis at all was 4%. The proportion of surgeries where In just under 55% of surgeries, the preoperative dose was patients had an on-going long-term treatment was 7%. reported to be administered 45–30 minutes before the start of the operation. Only five units have successfully imple- mented the latest recommendation. Just over 78% are reported to have received their preoperative dose according to the previous recommendation of 45–15 minutes before the start of the operation. 7 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Prophylactic antibiotics per unit 2023 Percent having Percent having Cloxacillin, dosage 2 g × 3, Percent AB Percent AB Number Complete Cefotaxim or 2 g x 2 or ime within time within Unit of reports reports % Clindamycin % 600 mg x 2 % (45–15 min) % (45–30 min) % Country 20,468 93.7 98.8 93.2 78.2 54.7 University units Akademiska 188 98.9 98.9 87.2 88.3 44.2 Karolinska Huddinge 178 88.8 98.3 80.3 73.6 44.4 Karolinska Solna 44 22.7 29.6 31.8 20.5 18.2 Linköping 78 82.1 94.9 89.7 70.5 57.7 SU/Mölndal 336 97.9 98.8 94.4 70.2 55.4 SUS/Lund 32 93.8 93.8 81.3 78.1 46.9 SUS/Malmö <5 Umeå 27 51.9 85.2 40.7 33.3 18.5 Örebro <5 Privately run units Aleris Specialistvård 267 98.9 99.6 97.8 79.4 23.6 Malmö Arena Aleris Specialistvård Nacka 659 98.8 98.9 97.4 87.9 62.1 Aleris Specialistvård 45 35.6 97.8 33.3 66.7 48.9 Renmarkstorget, Umeå Aleris Specialistvård Ängelholm 421 99.1 99.1 97.9 93.8 22.6 Art Clinic Göteborg 443 98.4 98.7 98.7 95.5 42.0 Art Clinic Jönköping 257 99.6 100.0 98.8 98.8 50.6 Capio Artro Clinic 614 99.2 99.5 96.1 64.3 61.9 Capio Movement 412 97.8 99.0 98.8 51.9 46.6 Capio Ortho Center Göteborg 252 86.1 98.8 80.2 65.1 59.9 Capio Ortho Center Stockholm 909 99.9 100.0 97.9 95.3 92.3 Capio Ortho och 251 98.8 100.0 99.6 66.5 46.2 Spine Center Skåne Capio Ortopedi Motala 421 94.8 99.5 93.4 86.0 78.2 Capio Ortopediska Huset 778 99.0 99.9 99.1 73.0 46.5 Capio Spine Center Göteborg 68 95.6 98.5 97.1 72.1 64.7 Capio Sports Medicine Umeå AB 5 100.0 100.0 100.0 100.0 100.0 Capio S:t Göran 368 98.4 98.9 95.1 53.5 42.4 Carlanderska 446 89.5 99.8 96.9 93.5 49.8 Carlanderska-SportsMed 239 82.3 91.2 96.2 85.4 45.2 Frölundaortopeden 13 100.0 100.0 100.0 100.0 69.2 Hermelinen 38 100.0 100.0 100.0 89.5 13.2 Table continued on next page. 7 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Prophylactic antibiotics per unit 2023, cont. Percent having Percent having Cloxacillin, dosage 2 g × 3, Percent AB Percent AB Number Complete Cefotaxim or 2 g x 2 or ime within time within Unit of reports reports % Clindamycin % 600 mg x 2 % (45–15 min) % (45–30 min) % Ledplastikcentrum Bromma 832 95.9 96.4 98.7 88.1 71.5 Ortopedisk Center 262 98.9 98.9 98.9 89.3 80.2 Sophiahemmet Specialistcenter Scandinavia 208 95.2 99.0 89.4 74.5 27.4 Eskilstuna Specialistcenter Scandinavia 10 90.0 100.0 80.0 70.0 60.0 Johanniskliniken Specialistcenter Scandinavia 122 96.7 98.4 97.5 68.9 23.0 Malmö Other units Alingsås 185 98.9 100.0 96.8 76.8 68.1 Arvika 290 53.8 99.3 54.5 81.7 73.5 Bollnäs 388 98.7 99.7 99.0 80.7 55.9 Borås 93 100.0 100.0 96.8 72.0 43.0 Danderyd 147 82.3 95.2 63.3 60.5 42.9 Eksjö 305 38.0 29.7 37.4 77.1 70.8 Enköping 550 99.1 99.1 98.7 89.3 70.7 Eskilstuna 51 98.0 98.0 100.0 82.4 49.0 Falun 156 90.4 100.0 89.7 85.9 43.0 Gällivare 77 100.0 98.7 98.7 63.6 26.0 Gävle 127 98.4 99.2 87.4 81.9 41.7 Halmstad 85 94.1 100.0 92.9 80.0 52.9 Helsingborg 46 100.0 100.0 97.8 71.7 58.7 Hudiksvall 53 96.2 98.1 96.2 77.4 52.8 Hässleholm 770 100.0 99.9 98.7 87.3 56.2 Jönköping 197 91.4 97.5 89.3 82.7 71.1 Kalmar 104 100.0 100.0 98.1 83.7 51.9 Karlshamn 305 99.7 99.7 98.4 87.5 59.3 Karlskrona 16 93.6 93.8 87.5 68.8 56.3 Karlstad 53 100.0 100.0 98.1 66.0 54.7 Kristianstad <5 Kullbergska sjukhuset 432 98.8 99.8 98.2 82.4 63.2 Kungälv 118 100.0 100.0 98.3 41.5 33.9 Lidköping 325 100.0 100.0 97.9 84.6 69.5 Lindesberg 575 99.5 99.7 95.0 56.7 41.2 Ljungby 105 100.0 100.0 93.3 89.5 79.1 Table continued on next page. 7 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Prophylactic antibiotics per unit 2023, cont. Percent having Percent having Cloxacillin, dosage 2 g × 3, Percent AB Percent AB Number Complete Cefotaxim or 2 g x 2 or ime within time within Unit of reports reports % Clindamycin % 600 mg x 2 % (45–15 min) % (45–30 min) % Lycksele 290 99.3 100.0 99.3 61.7 46.9 Mora 309 98.1 98.4 98.4 84.1 76.4 Norrköping 197 0.0 100.0 96.5 0.0 0.0 Norrtälje 153 97.4 99.4 98.0 73.2 60.8 Nyköping 132 100.0 100.0 97.7 81.1 52.3 NÄL Trollhättan 7 100.0 100.0 100.0 71.4 28.6 Oskarshamn 379 98.7 100.0 100.0 90.0 66,0 Piteå 425 98.1 98.8 98.1 83.5 70.6 Skellefteå 121 92.6 100.0 96.7 52.9 36.4 Skene 260 95.0 99.6 94.6 74.2 46.9 Skövde 41 97.6 100.0 95.1 87.8 70.7 Sollefteå 428 97.9 99.3 98.1 93.2 53.0 Sunderby sjukhus <5 Sundsvall 36 83.3 100.0 88.9 50.0 38.9 Södersjukhuset 135 88.2 91.1 58.5 67.4 25.9 Södertälje 122 98.4 100.0 97.5 82.8 33.6 Torsby 152 97.4 100.0 98.7 92.8 87.5 Trelleborg 385 100.0 100.0 98.4 85.5 48.3 Uddevalla 337 98.5 96.1 92.3 61.7 49.6 Varberg 125 0.0 99.2 1.0 0.0 0.0 Visby 133 93.2 98.5 96.2 75.2 52.6 Värnamo 158 98.7 100.0 99.4 82.9 58.2 Västervik 150 92.7 97.3 94.0 78.7 41.3 Västerås 442 97.7 99.3 92.3 79.4 45.9 Växjö 179 95.5 100.0 98.9 78.2 30.2 Ängelholm 240 98.3 98.8 99.2 80.4 25.8 Örnsköldsvik 148 98.0 98.7 94.6 78.4 60.1 Östersund 201 54.2 98.0 58.2 71.1 49.3 Table 5.1.13. Prophylactic antibiotics per unit 2023. 7 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Thromboprophylaxis per unit 2023 Percent Percent Number Complete starting having Percent treated Unit of reports reports % postop % NOAC % for 8–14 days % Country 20,468 99.4 85.8 66.0* 69.1 University units Akademiska 188 100.0 81.9 79.3* 86.6 Karolinska Huddinge 178 99.4 77.0 77.5 77.2 Karolinska Solna 44 36.4 27.3 25.0 13.6 Linköping 78 88.5 39.7 0.0 1.3 SU/Mölndal 336 100.0 83.9 80.1 84.5 SUS/Lund 32 100.0 62.5 0.0 21.9 SUS/Malmö <5 Umeå 27 81.5 70.4 70.4 77.8 Örebro <5 Privately run units Aleris Specialistvård Malmö Arena 267 100.0 94.0 95.5 0.0 Aleris Specialistvård Nacka 659 100.0 97.4 98.5 98.5 Aleris Specialistvård Renmarkstorget, Umeå 45 95.6 88.9 91.1 86.8 Aleris Specialistvård Ängelholm 421 99.8 91.7 92.2 1.0 Art Clinic Göteborg 443 99.3 97.8 97.3 97.1 Art Clinic Jönköping 257 100.0 97.3 95.7 97.3 Capio Artro Clinic 614 100.0 98.9 99.5 98.9 Capio Movement 412 98.8 91.0 8.7* 2.2 Capio Ortho Center Göteborg 252 99.2 100.0 99.2 99.2 Capio Ortho Center Stockholm 909 100.0 99.1 98.9 99.0 Capio Ortho och Spine Center Skåne 251 99.6 99.2 98.8 1.2 Capio Ortopedi Motala 421 99.8 80.5 0.0 80.1 Capio Ortopediska Huset 778 100.0 98.8 99.4 98.2 Capio Spine Center Göteborg 68 100.0 92.7 95.6 67.7 Capio Sports Medicine Umeå AB 5 100.0 80.0 100.0 100.0 Capio S:t Göran 368 100.0 68.5 44.3* 27.6 Carlanderska 446 99.6 94.0 94.4 93.2 Carlanderska-SportsMed 239 99.6 94.1 95.4 90.2 Frölundaortopeden 13 100.0 76.9 76.9 76.9 Hermelinen 38 100.0 97.4 100.0 100.0 Ledplastikcentrum Bromma 832 99.3 99.2 99.3 98.3 Ortopedisk Center Sophiahemmet 262 100.0 100.0 100.0* 99.6 Table continued on next page. 7 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Thromboprophylaxis per unit 2023, cont. Percent Percent Number Complete starting having Percent treated Unit of reports reports % postop % NOAC % for 8–14 days % Specialistcenter Scandinavia Eskilstuna 208 98.1 90.9 91.4* 82.4 Specialistcenter Scandinavia 10 100.0 100.0 100.0 30.0 Johanniskliniken Specialistcenter Scandinavia Malmö 122 100.0 97.5 99.2 88.5 Other units Alingsås 185 100.0 97.3 0.5 97.3 Arvika 290 99.7 81.4 80.3 80.9 Bollnäs 388 100.0 90.2 93.0 93.3 Borås 93 100.0 80.7 86.0 76.7 Danderyd 147 97.3 73.5 0.0 82.3 Eksjö 305 99.3 29.5 0.0 1.7 Enköping 550 99.8 88,0 88.6 87.9 Eskilstuna 51 100.0 68.3 72.6 74.5 Falun 156 97.4 95.5 0.0 0.0 Gällivare 77 100.0 90.9 88.3 90.9 Gävle 127 100.0 80.3 78.0 82.7 Halmstad 85 100.0 94.1 1.2 1.2 Helsingborg 46 100.0 60.9 60.9 56.8 Hudiksvall 53 100.0 83.0 0.0 84.9 Hässleholm 770 100.0 86.8 0.0 6.8 Jönköping 197 98.0 50.8 0.5 19.7 Kalmar 104 100.0 60.6 0.0 60.6 Karlshamn 305 100.0 94.4 93.4 93.4 Karlskrona 16 93.8 75.0 25.0 81.3 Karlstad 53 100.0 92.5 90.6 94.3 Kristianstad <5 Kullbergska sjukhuset 432 100.0 91.9 91.4 92.4 Kungälv 118 98.3 83.1 84.6 85.2 Lidköping 325 100.0 83.7 84.3 83.1 Lindesberg 575 100.0 86.3 74.8 88.4 Ljungby 105 100.0 86.7 87.6 87.6 Lycksele 290 99.3 26.2 33.1 99.0 Mora 309 99.4 87.1 87.4 88.0 Norrköping 197 100.0 48.7 0.0 1.5 Norrtälje 153 100.0 86.3 0.7 79.0 Table continued on next page. 8 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Thromboprophylaxis per unit 2023, cont. Percent Percent Number Complete starting having Percent treated Unit of reports reports % postop % NOAC % for 8–14 days % Nyköping 132 99.2 90.2 90.2 87.1 NÄL Trollhättan 7 100.0 71.4 0.0 71.4 Oskarshamn 379 100.0 55.4 0.3 53.4 Piteå 425 100.0 75.5 91.3* 90.1 Skellefteå 121 100.0 100.0 100.0 100.0 Skene 260 97.7 88.9 89.6 89.1 Skövde 41 100.0 95.1 97.6 100.0 Sollefteå 428 99.8 88.3 87.9 88.4 Sunderby sjukhus <5 Sundsvall 36 100.0 88.9 63.9 83.3 Södersjukhuset 135 99.3 83.0 16.3* 25.9 Södertälje 122 100.0 80.3 0.8 80.3 Torsby 152 100.0 88.8 87.5 90.1 Trelleborg 385 100.0 96.9 0.0 3.9 Uddevalla 337 100.0 82.5 83.1* 83.9 Varberg 125 100.0 88.8 0.0 0.0 Visby 133 99.3 92.5 91.0 92.1 Värnamo 158 100.0 23.4 0.0 3.2 Västervik 150 94.7 22.0 0.0 19.7 Västerås 442 100.0 94.8 1.0* 4.8 Växjö 179 100.0 89.4 89.9 89.7 Ängelholm 240 100.0 86.7 89.1 88.7 Örnsköldsvik 148 100.0 88.5 81.1 86.5 Östersund 201 97.5 86.1 0.0 4.9 Table 5.1.14. Thromboprophylaxis per unit 2023. * Includes a combination of injection and NOAC 8 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 5.2. Reoperation hip replacement Author: Johan Kärrholm Reoperation encompasses all types of surgical procedures primarily due to a significant increase in the number of directly related to a previously implanted hip prosthe- primary operations. In absolute terms, the two periods dif- sis, whether the prosthesis or any of its components are fer by only 62 reoperations (approximately 20 per year). If replaced, extracted, or left untouched. This section covers two-stage operations are considered as a single treatment all types of reoperations following the insert of primary (one operation), the relative proportion of reoperations total hip replacement. is reduced to 13.1% during the period 2003–2005 and to 8.9% for the period 2021–2023. Between 2003 and 2010, the number of reoperations increased from 2,108 to 2,455. Over the following five The number of reported reoperations has not increased years, the number remained relatively constant, ranging despite the rise in the number of primary prostheses per- from 2,379 to 2,474, before slowly decreasing back to formed. However, it should be noted that the complete- 1,833 by 2020. In the past three years, the number has ness for revisions is around 94%, and for reoperations, again increased, with 2,208 reoperations reported in 2023 it is likely somewhat lower. Previous studies have shown (Figure 5.2.1). Despite these fluctuations, the proportion that procedures without implant extraction or exchange of reoperations relative to the total number of primary are reported less frequently than operations where the and reoperations of total hip replacement has gradually implant is replaced or removed. It is likely that this is decreased since the three-year period from 2000 to 2002. partly because these procedures are sometimes performed During those years, reoperations accounted for 14.0%. In by surgeons who do not typically carry out hip replacement the most recent period, 2021–2023, this proportion has surgeries. Inadequate information or inadequate impact of decreased to 9.3% (Figure 5.2.2). The observed reduc- the information coming from the register also likely plays tion between the periods 2003–2005 and 2021–2023 is a role. Accurate coding of the procedures performed is, of © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.2.1. Number of primary and reoperations per year in Figure 5.2.2. The distribution between reoperations (revisions and 2003–2023. other reoperations) and primary hip replacements in 1997–2023 divided in three-years periods. The y-axis scale is adjusted and starts at 75%. 8 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 5.2.3 The distribution of primary replacements and reopera- tions per operating units in Sweden 2023. course, a prerequisite for effective reporting. Another factor The ratio of reoperations to primary operations provides to be aware of when interpreting the data presented is that, some insight into the extent to which reoperations strain despite the best efforts of the register coordinators, report- healthcare resources for hip replacement surgery within a ing lags behind, which often affects reoperations, including country or region. However, it is not a suitable measure revisions. Although the number of such cases is not large, for other purposes due to its sensitivity to fluctuations this means that data may vary between subsequent annual in the number of primary operations performed. The reports, particularly regarding data for the most recent year. ratio is also influenced by many other factors, such as However, the variation is usually minor and generally does patient flows between healthcare regions, the medical not affect the overall picture. profession's attitude towards performing reoperations, 8 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Distribution of sex, age, BMI, and ASA-class in all types of reoperations Reoperation Reoperation Reoperation Primary operation 2011–2013 2015–2017 2021–2023 2021–2023 Number 7,153 7,078 6,249 60,741 Mean age (SD) 71.6 (11.5) 72.0 (11.2) 72.8 (11.1) 69.4 (10.7) Age group n (%) < 55 years 568 (8) 541 (8) 418 (7) 5,598 (9) 55–64 years 1,061 (15) 1,027 (15) 963 (15) 12,871 (21) 65–74 years 2,394 (34) 2,451 (35) 1,734 (28) 20,333 (34) 75–84 years 2,311 (32) 2,212 (31) 2,325 (32) 18,754 (31) ≥85 years 819 (11) 847 (12) 809 (13) 3,185 (5) Females n (%) 3,629 (51) 3,615 (51) 3,205 (51) 35,223 (58) BMI n (%) < 18.5 93 (2) 90 (1) 89 (2) 766 (1) 18.5–24.9 1,965 (33) 2,216 (35) 1,892 (32) 20,247 (34) 25–29.9 2,437 (41) 2,401 (37) 2290 (39) 24,153 (41) 30–34.5 1,002 (17) 1,212 (19) 1,171 (20) 11,436 (19) 35–39.9 321 (5) 356 (6) 335 (6) 2,610 (4) ≥ 40 104 (2) 106 (2) 89 (2) 348 (1) Missing 1,231 697 383 1,181 ASA-class n (%)* ASA I 763 (12) 590 (9) 363 (6) 10,532 (17) ASA II 3,327 (51) 3,352 (50) 2,942 (48) 36,814 (61) ASA III 2,325 (35) 2,608 (39) 2,647 (43) 12,696 (21) ASA IV 133 (2) 172 (3) 158 (3) 364 (1) Missing 605 356 137 335 Table 5.2.1. Distribution of sex, age, BMI, and ASA-class in all types of reoperations in selected three-year periods 2011–2023. Data for primary operations 2021–2023 are shown for comparison. * percentages exclude missing observations and the duration for which hip replacement surgery Distribution of reoperations between units has been practiced within a healthcare region. As noted In 2023, the proportion of reoperations performed at uni- above, reporting of reoperations is less thorough than for versity hospitals and private units continued to decrease. primary operations, which is important to consider when During this year (with data for 2022 in parentheses), interpreting the data presented. Cross-referencing with 25.4% (28.0%) of reoperations for total hip replacements the Patient Register is an option to capture more cases were performed at university hospitals, 70.2% (66.2%) but is complicated by the fact that procedure codes are at other regional units, and 4.4% (5.8%) at private units. sometimes too nonspecific. We would like to highlight The number of units performing ten or fewer reopera- this issue to emphasize the importance of using accurate tions in 2023 was marginally lower (n=25) compared to codes for both diagnosis and procedure. the previous year (n=27). Similarly, the number of units 8 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 performing between 11 and 25 reoperations (2023: n=16; Reason for reoperation 2022: n=14, Figure 5.2.3) was relatively similar. In both 2023 and 2022, 23 units performed between 26 and 99 Since 2016, the Swedish Arthroplasty Register has recorded reoperations, and four units performed more than 100 the reason or reasons for a reoperation using two variables: reoperations. Thus, the number of units performing ten a primary reason and, if applicable, an additional reason or fewer reoperations per year remains notably high (see (secondary reason). For total hip replacements, there are also Chapter 5.3 for a more detailed analysis based on 35 predefined reasons, which are often condensed into performed revisions). main categories in reports. For example, three different rea- sons—loosening, osteolysis, and wear—are often reported under the main category of loosening. For patients reop- Demographics erated before 2016, secondary reasons are provided when This year's report compares reoperations performed during relevant information has been converted and extracted three periods: 2011–2013, 2015–2017, and 2021–2023. from one or more variables. Additionally, demographic data for primary hip replace- ments operated on during the most recent three-year Figure 5.2.4 presents the reasons for reoperation grouped period are presented. Table 5.2.1 shows that the average into combined main categories, and Table 5.2.2 provides a age at reoperation exhibits a slight tendency to increase. more detailed breakdown of the primary reasons for reop- During the most recent three-year period, it was over three eration related to the last two decades. The table distin- years higher than at primary hip replacement surgery. The guishes between first-time reoperations and reoperations proportion of females undergoing reoperation decreased that have been preceded by at least one previous reoper- by about 2.5% between the periods 2015–2017 and ation. Since the database had significantly more reasons 2021–2023. During the latest period, 2021–2023, the until 2015, these data have been classified according to proportion of females undergoing reoperation was nearly the new categorization as much as possible. In some cases, 10% lower than the proportion of females who received information in the old database was likely missing. Table primary operations, reflecting the fact that males are more 5.2.2 also includes some simplification, such as combining frequently affected by various prosthetic complications all types of osteolyses into a single group regardless of that lead to surgical intervention. localization. In addition to the primary reason, a second- ary reason may also be recorded if deemed relevant but less Patients who underwent reoperation from 2021 to 2023 significant. These data are not presented here. had, on average, a slightly higher BMI than those who underwent primary prosthesis surgery. Between the first Since the period 1997–1999, the proportion of reopera- and most recent three-year periods, the proportion of tions due to loosening has gradually decreased until the reoperated patients with ASA class III–V increased sig- period 2015–2017 and has since remained relatively con- nificantly from 34.4% to 44.9%. For reoperations in stant between 35% and 37% per three-year period. The 2021–2023, the corresponding proportion for primary proportion of reoperations due to infection has increased operations was half as large, at 21.4%. from just over 9% during the first period shown (1997– 1999) to 30.5% in the most recent period (2021–2023). In summary, males are more frequently affected by reop- The proportion of dislocations rose towards the end of the erations than expected based on the sex distribution at 1990s and the early 2000s up to and including the period primary operations. Patients undergoing reoperation also 2006–2008. In the following periods, this proportion tend to be somewhat older, have a higher BMI, and a decreased to around 12%, but there is a tendency for it significantly higher degree of comorbidity compared to to increase again. Between 2020 and 2022, an increase those undergoing primary operations. Additionally, par- of approximately 1% per year (from 11.3% to 13.5%) ticularly the level of comorbidity—and to a lesser extent, was observed, reaching 13.9% in 2023. The proportion of reported BMI and age—tends to have gradually increased periprosthetic fractures continuously increased from 6.7% for patients undergoing reoperation. (n=95) in 1997 to 16.2% (n=382) in 2010. During the period 2012–2014, there was a reduction, possibly due to incomplete reporting. In the most recent period 2021– 2023, their proportion had again increased to 14.5%. 8 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Detailed main reason for reoperation in the two last ten-year periods 2003–2012 2013– 2023 At least one previous At least one previous First reoperation First reoperation reoperation reoperation Reason Number % Number % Number % Number % Total 14,825 100.0 6,620 100.0 14,592 100.0 6,377 100.0 Loosening (regardless of time 7,198 48.6 1,914 28.9 6,074 41.6 1,385 21.7 after op) Fracture femur 2,273 15.3 740 11.2 2,296 15.7 602 9.4 Dislocation, instability, 1,807 12.2 1,064 16.1 1,781 12.2 813 12.7 subdislocation Infection 1,718 11.6 2,237 33.8 3,038 20.8 3,112 48.8 Osteolysis acetabulum and/or femur 742 5.0 111 1.7 255 1.7 27 0.4 Cup or liner wear 413 2.8 50 0.8 256 1.8 31 0.5 Implant fracture (including plate) 186 1.3 96 1.5 128 0.9 76 1.2 Unclear pain 126 0.8 70 1.1 158 1.1 64 1.0 Trocanteric problems, limp, gluteus 56 0.4 21 0.3 99 0.7 11 0.2 medius rupture Incorrectly inserted implant 44 0.3 14 0.2 40 0.3 8 0.1 (eg.penetration) Heterotopic bone formation 34 0.2 15 0.2 43 0.3 17 0.3 ALVAL/pseudotumor 24 0.2 5 0.1 111 0.8 20 0.3 Bleeding, hematoma 24 0.2 38 0.6 39 0.3 43 0.7 Loose implant part 24 0.2 13 0.2 8 0.1 6 0.1 Other left material 23 0.2 51 0.8 7 0.0 10 0.2 Difference in leg length 20 0.1 5 0.1 16 0.1 7 0.1 Cement problem (loose pice of ce- 20 0.1 8 0.1 29 0.2 6 0.1 ment, inadequate cementation etc.) Wound complication (wound 20 0.1 17 0.3 20 0.1 16 0.3 rupture, wound granuloma) Delayed fracture healing 12 0.1 94 1.4 6 0.0 37 0.6 Elevated metal ions/corrosion 11 0.1 <5 0.0 61 0.4 8 0.1 Fracture under resurfacing 10 0.1 <5 0.0 19 0.1 0 0.0 prosthesis Malignant or benign tumor 6 0.0 <5 0.0 9 0.1 5 0.1 Cyst/bursa 5 0.0 <5 0.0 10 0.1 <5 0.0 Fracture acetabulum <5 0.0 <5 0.0 26 0.2 15 0.2 Allergy (suspected or known) 0 0.0 <5 0.0 <5 0.0 <5 0.0 Dislocation/fracture spacer 0 0.0 40 0.6 <5 0.0 33 0.5 Nerve or vascular injury 0 0.0 <5 0.0 <5 0.0 0 0.0 Per operative fracture (previous op) 0 0.0 0 0.0 8 0.1 5 0.1 Other reason (including technical) 25 0.2 8 0.1 46 0.3 16 0.3 Not availiable 1 0.0 <5 0.0 0 0.0 0 0.0 Table 5.2.2. Detailed primary reason for reoperation during the last two ten-year periods, divided into first-time reoperations and procedures preceded by at least one previous reoperation. The primary reason for performing the surgery is indicated here. Additional specified reasons are reported in 14.5% of reoperations performed from 2004 to 2013, and in 11.5% of reoperations performed from 2014 to 2023. 8 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Among the reasons that are usually not presented except The highest number of reoperations due to pseudotumor as part of a main group, it can be noted that the number (ALVAL, Aseptic Lymphocyte-dominated Vasculitis-As- of reoperations due to wear and osteolysis has decreased, sociated Lesions, or ALTR, Adverse Local Tissue Reac- likely as a result of the increasing use of highly cross-linked tion) was recorded during the last year of the first period polyethylene. The length of the periods is intended to (2013). In that year, 48 reoperations were performed make it easier to assess data concerning rare reasons, which where pseudotumor (ALVAL) or elevated metal ions results in some lag. For example, in the previous year’s were cited as the primary or secondary reason (see Figure report, it was noted that reoperations due to unclear pain 5.2.5). After that, the number decreased to ten or fewer and trochanteric problems were higher in the later than in 2021–2022. In 2023, 20 cases were reported. Of these, in the earlier decade, despite these reasons significantly 16 cases were noted as pseudotumor. Among the 20 pros- decreasing towards the end of the period. In this year’s theses reoperated in 2023, five were surface replacement report, these reasons are still more common in first-time prostheses, an additional seven had metal–metal bearings reoperations during the most recent period, but the differ- (of which four had a surface replacement cup), and eight ences have decreased. During the period 2021–2023, four were standard prostheses. Although complications caused to six first-time reoperations per year were reported due by increased metal release are rare, it can be valuable to to pain and one to five due to trochanteric problems. The consider this complication in cases with unclear hip pain. corresponding numbers for reoperations not performed for the first time ranged from two to three for pain and zero to one for trochanteric problems. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.2.5. Incidence of reoperations where pseudotumor (ALVAL) or elevated metal ions were the main reason or a contributing reason for the surgery. The report begins 2013, when the highest number was recorded since the start of the Swedish Arthroplasty Figure 5.2.4. Reason for reoperation 1997–2023 divided into Register, and extends to 2023. The data differs from table 5.2.2, three-year periods. where only the main reason is reported. 8 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 The distribution of reasons for reoperation primarily provides an understanding of the distribution of pros- thesis-related problems that lead to surgical intervention. However, it gives a very limited view of how the quality of primary prostheses may change over time, measured as the proportion that ends with a reoperation. To better illustrate this, Figure 5.2.6 shows the proportion of reop- erations within ten years for primary prostheses inserted © 2024 The Swedish Arthroplasty Register during three-year periods from 1997 to 2014, ensuring that all primary surgeries within the group have been observed for ten years. As shown in the figure, the overall percentage of primary prostheses that are re-operated on has gradually decreased over the period. During the first period, 7.5% of re-operations were reported, whereas only 4.3% were reported in the last period. However, as previously noted (see Figure 5.2.8), there is a change in the underlying causes of re-operations over time. Changes in surgical indications, shifts in the type and occurrence of infectious agents over time, the introduction of new materials and prosthesis designs, and, not least, a more stringent selection of implants may have contributed to Figure 5.2.6. Primary hip replacements operated on during con- secutive three-year periods starting from 1997 to 1999 and until this development. the period 2012-2014, covering the years 1996 to 2013, where all hip replacements were followed up to reoperation if it occurred within 10 years after the primary operation, or to potential death within the same period, or if neither of these occurred, until 10 years after the primary operation. The figure illustrates how the proportion of patients reoperated within a ten-year period has gradually decreased. In addition to the proportion of reopera- tions, the reason of the reoperations is also indicated. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.2.7. The most common procedures in reoperations Figure 5.2.8. The distribution of the main procedures exchange/ without exchange or extraction of implant parts, divided into insertion, extraction and other open procedures without implant three-year periods between 2003 and 2023. exchange or extraction in three-year periods 2032–2023. 8 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Reoperation without implant exchange/extraction Summary Reoperations without the exchange or extraction of The proportion of reoperations relative to the total implant components are most often performed due number of hip related surgeries has decreased over to infection or fracture (see Figure 5.2.7). In the early the past two decades, from 14.0% to around 9.3% 2000s, dislocation was also one of the dominant reasons during the 2021–2023 period. This decline is but has decreased in frequency. This is likely because it primarily due to the increased number of primary has become increasingly rare to perform only an open surgeries. reduction without exchanging components such as the liner and head or conducting a more extensive proce- Reoperations due to infection have risen in absolute dure like cup exchange and possible stem revision. terms, while those due to loosening have decreased. During the 1990s and until 2004, approximately 50 It is unclear whether the increased number of operations per year involved fastening a cup augment reoperations for infection is due to a more active to the existing cup to prevent dislocation. Following a approach to surgical treatment or a real increase in review of the disappointing Swedish results, the number infections, though it is likely that both factors have of such procedures decreased significantly and almost contributed. ceased altogether from 2013–2014 (included in “other measures” in Figure 5.2.8). The proportion of reoper- Males experience reoperations more frequently than ations without implant exchange or extraction (other expected based on the sex distribution at primary open procedures in Figure 5.2.8) increased up until the surgeries. Patients undergoing reoperations are older 2012–2014 period due to a rise in procedures such as and have a higher degree of comorbidity compared synovectomy/debridement for infection, and to a lesser to those undergoing primary surgeries. Over the extent, fracture reconstruction. Since then, the number past decade, the level of comorbidity, and to some of reoperations for infection without implant exchange extent BMI and age, has increased among patients has decreased, which is a positive development, especially who require reoperation. as these procedures have been replaced by interventions involving the exchange of the head and possibly the liner, It is important to report all reoperations, includ- which have been shown to have a higher likelihood of ing those where no prosthetic components are healing. Between the 2012–2014 period and the most exchanged. The frequency of reoperations is one of recent period, the visualized decrease in the percentage our most crucial quality parameters. of total synovectomy/debridement procedures translates to a reduction in the annual number from approximately 250 to about 70. The figure also shows an increase in the number of fracture reconstructions without implant exchange until the years 2009, 2010, and 2011. After that, the number declined significantly. This could be due to a greater tendency to revise these patients, though it is more likely that the primary reason is underreporting, as data up to 2011 partially rely on targeted linkage with the patient register as part of a dissertation project. Soft tissue interventions, particularly with re-suturing or mus- cle/tendon repair mainly due to limping and trochanteric problems, as well as overall reoperations, have significantly reduced since the 2012–2014 period. 8 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 5.3. Reoperation within two years Author: Johan Kärrholm The proportion of primary surgeries that result in a It is well-known that the type and extent of perioperative reoperation within two years is an important quality and postoperative complications can vary significantly indicator. This is because the most common reason of depending on the primary diagnosis. Since diagnoses early reoperation—such as infection, dislocation, fracture, such as acute fracture, residual conditions after previous and early loosening—are modifiable factors that reflect trauma, and tumor diagnoses are so unevenly distributed existing routines, their adherence, surgical technique, and across different units, these have been excluded. Therefore, the unit’s patient demographics. data for reoperation within two years are based only on patients with a diagnosis of osteoarthritis or “other hip Reoperation within two years includes all forms of diseases.” Nationwide, this proportion in 2023 was 5.6%, additional surgery directly related to a previous total hip with just over half (54.1%) diagnosed with idiopathic replacement. This outcome measure primarily reflects necrosis, followed by residual conditions from childhood early and serious complications. The indicator is quickly diseases and 18.9% without known trauma. Over the past available and easier to use for clinical improvement efforts four periods, the proportion of reoperations within two compared to the cumulative revision risk at ten years. years has remained relatively constant, slightly above two However, this parameter is also significant as it more percent for the country as a whole (Tables 5.3.1 and 5.3.2). accurately reflects how choices regarding fixation and For units that performed at least 500 surgeries in the most components, and their positioning, affect the risk of com- recent period, the variation in the proportion of reopera- plications leading to surgical treatment. Patient selection, tions within two years was substantial, ranging from 0.5% healthcare processes, and implant choices often undergo to 4.6%. For units reporting 1,000 or more surgeries, the more or less extensive changes over a ten-year period. This range was marginally narrower (0.5% to 4.2%). means that outcomes may be difficult to interpret from an improvement perspective based on the current situation. Since 2006–2007, there has been a clear shift in the reason of early reoperation. The relative proportion of reopera- Reoperation within two years has been selected by Swed- tions due to infection has increased by approximately 20%, ish Association of Local Authorities and Regions and the mainly at the expense of dislocation and periprosthetic National Board of Health and Welfare as a national qual- fracture, whose proportions have decreased from nearly ity indicator. The indicator is considered one of the most 23.7% to around 15.1% and from 18.5% to 10.4%, important and influential outcome measures reported by respectively (Figure 5.3.2). Proportions in the categories the Arthroplasty Register. The proportion of reoperations of loosening and other reasons have also decreased, though during the third year is not included in this quality indi- to a lesser extent (from 7.0% to 5.4% and from 8.5% cator but is shown for increased transparency. to 6.1%, respectively). The increase in infections is likely due to several factors. It most probably reflects a more The reason a patient undergoes hip replacement varies proactive approach to surgical treatment when an infection significantly between university hospitals, privately driven is suspected. The observed increase might also be due to a units, and other units. In 2023, 24.3% of primary surger- real rise in the selection of more antibiotic-resistant strains ies at university hospitals were performed due to a diag- over time and/or a greater awareness that reoperations nosis of osteoarthritis. This proportion increases to 49.1% without implant exchange should also be recorded. Likely, when including surgeries conducted at external units but all these factors contribute to varying degrees. managed under the university hospital’s auspices. For other public units, the proportion of osteoarthritis cases The likelihood of undergoing reoperation within the first was 78.5%, and for privately driven units, it was even three years after a primary surgery is highest during the higher at 97.5% (Figure 5.3.1 a-d). first year (Figure 5.3.3). The cause of reoperation varies 9 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.3.1 a–d. Distribution of the diagnoses OA, other hip diseases without known trauma, and tumors at university hospitals (a), university hospitals including associated units (b), other public units (c), and privately run units (d). 9 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.3.2. Distribution of the most common reasons for Figure 5.3.3. The proportion of reoperations during the first, reoperation within two years during two-year periods from 2006 second, and third years after primary surgery related to the time to 2023. The proportion of reoperations due to infection has period of prosthesis insertion. Trauma and tumor diagnoses have increased, while the other reason groups, especially dislocation been excluded. and periprosthetic fracture, have decreased. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.3.4 a–b. Most common reasons for reoperation per year up to 15 years after primary surgery for first-time reoperations (a) and after at least one previous reoperation for comparison (b). All diagnoses are included. The diagrams are based on primary surgeries (a) and reoperations (b) performed from 2005 to 2023. 9 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 depending on the time after the previous primary or reoperation. To present the most clinically relevant data Summary possible, the following report includes all reoperations, regardless of diagnosis. In the overall group of total hip Reoperations within two years are a crucial quality replacements, infection is by far the most common reason indicator as they partly reflect existing routines, of reoperation in the first year after surgery, accounting for their adherence, and surgical techniques. However, 40% of reoperations at the first revision during the period the reported data may be misleading if the varia- from 2005 to 2023 (Figure 5.3.4 a). tion in complication risk based on the unit’s patient demographics is not considered. In the case of multiple revisions, the proportion of infections is significantly higher (68.7%, Figure 5.3.4 b). In recent years, the proportion of reoperations If trauma and tumor diagnoses are excluded from the within two years has been at 2.2% for the country first-time revisions, this proportion decreases to 37%. For as a whole. For units that performed at least 500 first-time revisions, aseptic loosening becomes the most surgeries, the proportion of reoperations within two common reason already by the second year (36.4%). years during the most recent period has varied from Over the following years, the proportion of loosening half a percent to nearly five percent. gradually increases until about 10 years have elapsed after the primary surgery. The proportion of revisions due to Since 2005–2006, the relative proportion of reop- dislocation increases until the second year (18.4%) and erations due to infection has doubled, mainly at the then slowly decreases to under 10% after about 10 years. expense of dislocation and periprosthetic fracture. Reoperations due to of periprosthetic fracture show a Infection is by far the most common reason of similar pattern. reoperation in the first year after elective total hip prosthesis surgery. In the subsequent years, loos- In multiple revisions, the pattern is similar, but the pro- ening becomes the predominant reason, with its portion of reoperations due to infection is significantly proportion gradually increasing over time. Among higher, and this reason remains the most common all patients undergoing total hip replacement, the during the first four years after the primary operation. proportion reoperated due to dislocation decreases Even during the subsequent period of 5–11 years, the slowly after the second year, and due to peripros- proportion of reoperations due to infection constitutes 24 thetic fracture after the third year. Excluding trauma to 30% of cases. Aseptic loosening is the most common and tumor diagnoses, the overall pattern remains reason after four years but increases more slowly compared largely unchanged, though the proportion of deep to the situation in first-time revisions and reaches a pro- infections, dislocations, and periprosthetic fractures portion of 60% after 15 years. decreases by up to nearly three percent in certain periods, while the proportion of reoperations due The distribution of reasons over time partially reflects the to loosening increases. choice of implants, cement, and surgical technique. For example, the risk of periprosthetic fracture and possibly also The distribution of reasons for reoperation over time infection might look somewhat different if Sweden used to a certain extent reflects the choice of implants even more uncemented implants. Finally, the distribution and surgical techniques during the evaluated period. is also influenced by the length of the time window. 9 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Reoperations within two years per unit based on primary total hip replacements performed due to osteoarthritis Primary Reoperation Revision Deep infection Dislocation Fracture Other Unit n n % n n % n % n % n % University units Akademiska sjukhuset 597 10 1.9 9 9 1.7 1 0.2 0 0.0 0 0.0 Karolinska Huddinge 821 14 1.7 10 10 1.2 2 0.2 2 0.2 0 0.0 Karolinska Solna 150 6 5.9 6 2 1.4 2 2.2 0 0.0 1 1.5 Linköping 331 4 1.2 4 3 0.9 1 0.3 0 0.0 0 0.0 SU/Mölndal 1,238 48 4.2 43 27 2.3 11 1.0 4 0.3 5 0.5 SUS/Lund 150 7 5.8 7 3 2.6 3 2.3 1 1.0 0 0.0 Umeå 163 4 2.5 0 2 1.2 0 0.0 0 0.0 2 1.3 Privately run units Aleris Specialistvård 1,713 34 2.4 34 17 1.1 7 0.5 3 0.2 7 0.6 Ängelholm Aleris Specialistvård Nacka 1,891 18 1.2 16 8 0.4 7 0.5 0 0.0 3 0.2 Art Clinic Göteborg 1,248 13 1.2 13 5 0.5 4 0.3 2 0.2 2 0.2 Art Clinic Jönköping 991 8 0.9 0 7 0.8 0 0.0 1 0.1 0 0.0 Capio Artro Clinic 2,483 59 2.7 53 33 1.4 6 0.3 6 0.2 13 0.6 Capio Movement 1,790 19 1.2 19 4 0.3 5 0.3 8 0.5 2 0.1 Capio Ortho Center 1,173 39 3.7 38 30 2.9 2 0.2 4 0.4 3 0.3 Göteborg Capio Ortho Center 3,311 55 1.9 51 26 0.9 10 0.4 7 0.2 12 0.5 Stockholm Capio Ortopedi Motala 1,524 27 1.9 26 20 1.4 0 0.0 2 0.1 5 0.4 Capio Ortopediska Huset 2,965 59 2.4 54 33 1.2 3 0.1 11 0.4 11 0.6 Capio S:t Göran 1,376 23 1.8 22 12 0.9 5 0.4 0 0.0 5 0.5 Carlanderska 1,861 27 1.7 26 18 1.1 2 0.1 4 0.3 3 0.2 Frölundaortopeden 50 1 2.0 0 1 2.0 0 0.0 0 0.0 0 0.0 Hermelinen 127 1 0.8 0 1 0.8 0 0.0 0 0.0 0 0.0 Sophiahemmet 471 7 1.5 0 3 0.6 2 0.4 0 0.0 2 0.4 Specialistcenter 441 6 2.1 0 2 0.5 3 1.3 1 0.3 0 0.0 Scandinavia, Eskilstuna Other units Alingsås 615 17 3.2 15 13 2.3 2 0.4 0 0.0 2 0.5 Ängelholm 677 6 0.9 6 2 0.3 3 0.5 0 0.0 1 0.2 Arvika 1,012 17 2.0 15 11 1.1 1 0.2 2 0.3 3 0.4 Bollnäs 1,337 18 1.7 17 11 0.9 3 0.3 2 0.2 2 0.3 Borås 242 3 1.3 0 3 1.3 0 0.0 0 0.0 0 0.0 Danderyd 589 21 4.3 19 13 2.5 4 1.1 0 0.0 0 0.0 Table continued on next page. 9 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Reoperations within two years per unit based on primary total hip replacements performed due to osteoarthritis, cont. Primary Reoperation Revision Deep infection Dislocation Fracture Other Unit n n % n n % n % n % n % Eksjö 999 21 2.3 20 19 2.1 2 0.2 0 0.0 0 0.0 Enköping 1,953 57 3.4 51 27 1.5 15 0.9 4 0.2 11 0.9 Eskilstuna 243 8 3.5 8 5 2.2 2 0.9 1 0.4 0 0.0 Falköping 42 1 2.4 1 1 2.4 0 0.0 0 0.0 0 0.0 Falun 481 9 2.3 8 5 1.1 3 1.0 0 0.0 1 0.2 Gällivare 236 1 0.4 0 0 0.0 0 0.0 0 0.0 1 0.4 Gävle 405 8 2.5 8 3 0.8 0 0.0 0 0.0 5 1.7 Halmstad 495 10 2.1 10 8 1.6 0 0.0 0 0.0 2 0.5 Hässleholm 2,651 30 1.2 25 23 0.9 3 0.1 2 0.1 2 0.1 Helsingborg 201 8 4.6 8 3 1.5 3 1.6 0 0.0 2 1.5 Hudiksvall 228 2 1.3 2 1 0.4 1 0.9 0 0.0 0 0.0 Jönköping 452 7 1.9 0 4 0.9 2 0.5 0 0.0 1 0.5 Kalmar 326 4 1.3 0 4 1.3 0 0.0 0 0.0 0 0.0 Karlshamn 973 17 1.9 17 6 0.7 7 0.8 2 0.2 2 0.2 Karlskrona 56 2 4.9 2 2 4.9 0 0.0 0 0.0 0 0.0 Karlstad 186 5 3.1 5 1 0.5 3 2.0 1 0.5 0 0.0 Kullbergska sjukhuset 1,328 29 2.5 28 21 1.7 4 0.3 1 0.1 3 0.4 Kungälv 347 12 3.6 12 10 3.0 1 0.3 0 0.0 1 0.3 Lidköping 811 8 1.2 8 5 0.6 2 0.4 1 0.1 0 0.0 Lindesberg 1,740 8 0.5 6 4 0.2 1 0.1 1 0.1 2 0.1 Ljungby 406 10 2.7 10 5 1.2 4 1.2 0 0.0 1 0.2 Lycksele 1,040 11 1.1 10 5 0.5 1 0.1 1 0.1 4 0.5 Mora 963 11 1.4 10 10 1.2 0 0.0 0 0.0 1 0.2 Norrköping 604 4 0.8 4 3 0.5 0 0.0 0 0.0 1 0.3 Norrtälje 530 23 4.6 22 13 2.5 5 1.0 2 0.4 3 0.7 Nyköping 456 16 4.3 16 11 2.6 3 1.0 1 0.3 1 0.4 Örnsköldsvik 477 6 1.4 6 4 1.0 1 0.2 0 0.0 1 0.2 Oskarshamn 1,385 26 2.0 26 23 1.7 1 0.1 1 0.1 1 0.1 Östersund 649 15 2.6 15 9 1.6 4 0.6 1 0.2 1 0.2 Piteå 1,484 22 1.8 20 7 0.5 7 0.5 1 0.1 6 0.5 Skellefteå 453 4 1.3 0 0 0.0 0 0.0 0 0.0 4 1.3 Skene 729 10 1.7 8 8 1.4 0 0.0 1 0.1 1 0.2 Skövde 127 4 5.0 4 3 4.2 0 0.0 1 0.8 0 0.0 Södersjukhuset 436 7 1.8 6 5 1.2 1 0.2 1 0.3 0 0.0 Table continued on next page. 9 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Reoperations within two years per unit based on primary total hip replacements performed due to osteoarthritis, cont. Primary Reoperation Revision Deep infection Dislocation Fracture Other Unit n n % n n % n % n % n % Södertälje 421 8 1.9 0 7 1.7 0 0.0 1 0.2 0 0.0 Sollefteå 1,387 20 1.6 20 18 1.4 1 0.1 0 0.0 1 0.1 Sundsvall 64 2 3.2 0 1 1.7 1 1.6 0 0.0 0 0.0 Torsby 519 9 2.0 8 3 0.6 1 0.3 4 0.8 1 0.2 Trelleborg 1,323 20 1.7 20 8 0.7 6 0.5 4 0.3 2 0.2 Uddevalla 1,098 24 2.5 22 16 1.7 0 0.0 6 0.6 2 0.2 Varberg 644 7 1.1 6 2 0.3 1 0.2 2 0.3 1 0.2 Värnamo 591 19 3.6 16 11 2.2 2 0.3 1 0.2 4 0.7 Västerås 1,269 43 4.1 43 24 2.1 8 0.7 2 0.2 9 1.1 Västervik 487 15 3.3 14 11 2.3 1 0.2 0 0.0 3 0.8 Växjö 564 13 2.4 13 10 1.9 3 0.5 0 0.0 0 0.0 Visby 482 9 2.3 8 4 0.9 0 0.0 2 0.5 3 0.9 Country 64,121 1,177 2.1 1,049 703 1.2 189 0.4 105 0.2 168 0.4 Table 5.3.1. Reoperations within two years per unit based on primary total hip replacements due to OA 2020-2023. Units with fewer than 20 primary replacements in the current period are excluded. The number of patients with short-term complications may differ from the sum of the number of complications, as each patient may have more than one type of complication. All proportions are calculated using competing risk analysis. 9 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Reoperations within two years per unit, trend 2017–2023 2017–2020 2018–2021 2019–2022 2020–2023 Unit Proportion Proportion Proportion Proportion University units Akademiska sjukhuset 3.6 3.3 2.8 1.9 Karolinska Huddinge 2.8 2.5 1.7 1.7 Karolinska Solna 6.3 5.9 5.1 5.9 Linköping 4.6 4 3.8 1.2 SU/Mölndal 3.0 3.7 4.5 4.2 SUS/Lund 2.5 3.8 4.0 5.8 SUS/Malmö * * * * Umeå 3.1 4.2 2.3 2.5 Örebro 2.0 2.6 * * Privately run units Capio Ortopediska Huset 1.5 2.0 2.4 2.4 Capio Movement 1.9 1.8 1.4 1.2 Aleris Specialistvård Nacka 1.4 1.4 1.4 1.2 Capio Ortho Center Stockholm 1.7 1.9 1.8 1.9 Capio Ortho Center Göteborg 2.0 2.3 3.2 3.7 Aleris Specialistvård Motala 1.5 1.4 1.0 Aleris Specialistvård Ängelholm 2.9 2.7 2.9 2.4 Art Clinic Jönköping 0.4 0.6 0.7 0.9 Aleris Specialistvård Bollnäs 1.1 1.0 0.4 Hermelinen 0.0 1.0 0.9 0.8 Art Clinic Göteborg 0.8 1.0 1.1 1.2 Frölundaortopeden 2.3 2.0 0.0 2.0 Capio Artro Clinic 2.8 2.9 2.7 Capio Ortopedi Motala 2.2 2.1 1.9 1.9 Specialistcenter Scandinavia, Eskilstuna 2.1 Sophiahemmet 1.7 1.7 1.9 1.5 Carlanderska 1.2 1.2 1.4 1.7 Capio S:t Göran 1.9 1.7 1.8 1.8 Other units Halmstad 2.6 2.3 1.3 2.1 Falköping 2.0 2.0 2.0 2.4 Kullbergska sjukhuset 3.3 2.8 2.8 2.5 Helsingborg 6.6 6.4 4.2 4.6 Table continued on next page. 9 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Reoperations within two years per unit, trend 2017–2023, cont. 2017–2020 2018–2021 2019–2022 2020–2023 Unit Proportion Proportion Proportion Proportion Skene 2.2 2.5 1.8 1.7 Piteå 1.0 1.2 1.7 1.8 Sunderby sjukhus * * * * Hässleholm 1.5 1.1 1.2 1.2 Jönköping 2.4 2.3 1.3 1.9 Kalmar 1.0 1.4 0.8 1.3 Karlskrona 6.7 6.2 2.3 4.9 Karlstad 4.7 4.8 3.4 3.1 Kristianstad * * * * Borås 1.6 1.9 1.2 1.3 Norrköping 0.7 0.8 0.8 0.8 Skövde 6.0 7.4 7.1 5.0 Danderyd 3.8 4.2 3.7 4.3 Sundsvall 2.0 1.9 3.3 3.2 Södersjukhuset 3.0 2.6 2.8 1.8 Trelleborg 1.4 1.4 1.4 1.7 Uddevalla 1.9 1.9 2.1 2.5 Varberg 1.0 1.1 1.4 1.1 NÄL * * * * Västervik 1.8 2.2 3.6 3.3 Västerås 4.2 4.8 4.4 4.1 Eksjö 3.7 2.9 2.1 2.3 Växjö 4.2 5.4 3.4 2.4 Ystad * * * Ängelholm 1.5 1.8 1.8 0.9 Östersund 3.1 3.0 3.7 2.6 Lidköping 2.1 1.8 1.6 1.2 Hudiksvall 1.1 1.1 1.3 1.3 Eskilstuna 2.9 3.3 4.1 3.5 Oskarshamn 1.5 1.9 2.1 2.0 Nyköping 3.7 3.5 4.1 4.3 Bollnäs 2.3 2.0 1.6 1.7 Visby 2.1 2.4 2.3 2.3 Torsby 4.3 3.7 3.2 2.0 Table continued on next page. 9 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Reoperations within two years per unit, trend 2017–2023, cont. 2017–2020 2018–2021 2019–2022 2020–2023 Unit Proportion Proportion Proportion Proportion Enköping 2.3 2.5 3.0 3.4 Falun 4.0 3.2 1.8 2.3 Södertälje 1.5 0.8 0.7 1.9 Norrtälje 2.8 3.1 4.1 4.6 Värnamo 2.8 3.4 3.8 3.6 Kungälv 3.7 4.6 4.5 3.6 Arvika 4.7 3.2 2.2 2.0 Alingsås 2.3 3.1 2.9 3.2 Karlskoga 0.0 * Lindesberg 1.2 1.2 0.9 0.5 Mora 1.4 1.2 1.1 1.4 Gällivare 0.0 0.0 0.0 0.4 Ljungby 1.2 1.3 1.8 2.7 Örnsköldsvik 1.2 0.9 1.6 1.4 Sollefteå 1.1 1.1 1.2 1.6 Gävle 2.1 2.2 1.8 2.5 Lycksele 1.4 1.3 1.2 1.1 Skellefteå 1.1 0.5 1.5 1.3 Karlshamn 2.3 2.3 2.1 1.9 Country 2.1 2.1 2.1 2.1 Table 5.3.2. Reoperations within two years per unit based on primary elective total hip replacements performed 2016-2023. Patients operated on due to acute fracture, sequele fracture/trauma or with a tumor diagnosis have been excluded. All proportions are calculated using compet- ing risk analysis at two-years follow-up. – ) No primary replacements reported. *) Fewer than 20 operations in the period. 9 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 5.4. Revision Hip Replacement Author: Johan Kärrholm This section covers the revision of total hip replacement Figure 5.4.1 illustrates that of the patients who received regardless of the primary diagnosis. A revision of a hip a primary hip replacement in 1994, 79.7% retained their replacement involves replacing or removing all or part of replacement for life, and an additional 5.4% of the patients the prosthesis due to a complication. If the prosthesis or were still alive with their original replacement, which had any of its parts is first removed and later re-implanted— been implanted at least 19 years earlier. Meanwhile, 14.7% such as when waiting for an infection to heal (a two-stage had undergone at least one revision, with 5.3% of these procedure)—these two interventions are recorded as a patients still alive at the end of 2023. The closer one looks single procedure unless otherwise specified. For example, at more recent years in the diagram, the more patients if a primary replacement is revised in two stages, the are still alive and retain their primary replacement. For extraction date is recorded as the time of revision for the patients who were operated on in 2013, roughly 10 years primary prosthesis operation, while the re-implantation ago, 24.6% had died with their primary replacement intact, date marks the start of ongoing observation of a first-time 68.8% were still living with their primary replacement, revision. If the replacement is permanently removed (with 1.0% had died after at least one revision, and 2.6% were no re-implantation registered by the final observation alive after undergoing at least one revision. date, which is December 31, 2023, in this year’s report), the extraction is classified as permanent. The absence of The proportion of revisions in relation to the total num- a reported re-implantation after a prior extraction is thus ber of hip replacements has decreased over the past two critical in determining whether the extraction is consid- decades. Between the periods 2003–2005 and 2021– ered permanent. Some extractions performed in the latter 2023, the number of primary operations increased from part of 2023, where re-implantation is planned for 2024, an average of 13,356 to 20,246 per year (see Figures 5.4.2 may have been incorrectly classified as permanent. and 5.4.3). The number of revisions during the first three- year period was 1,596 per year, accounting for 10.7% Since 1979, revisions (and other reoperations) have been of all total hip replacements during that time. During reported at the individual level, allowing for the collection the most recent period (2021–2023), the total number of extensive data spanning more than 40 years. However, of revisions per year was slightly higher at 1,756, which primary replacements were classified at the aggregated corresponded to about 8.0% of all total hip replacements unit level until 1991, and it wasn’t until 1992 that indi- during the period. vidual-based registration linked to personal identification numbers began. In 1999, a more detailed registration of Given that the proportion of elderly people and the num- components used in both primary replacements and revi- ber of individuals with hip replacement in the population sions was introduced. are increasing, one might expect the number of revised hips to also rise. An increasing number of first-time Many patients wonder how long their replacement will and multiple revisions were reported during the 1980s, last. One way to describe this is by reporting the propor- 1990s, and early 2000s. The highest number was recorded tion of patients who still have their replacement at a cer- between 2009 and 2011, with 1,402 first-time revisions tain time after the primary operation, with some retaining and 420 multiple revisions per year. Since then, the num- their replacement for life. Over time, the proportion ber of both first-time and multiple revisions has remained of revised primary replacement from a given year will relatively constant and, if anything, has tended to decrease. increase, while the corresponding proportion of patients During the 2021–2023 period, 1,368 first-time and 388 still alive will decrease. The vast majority of patients will multiple revisions were reported annually, representing a not require a revision during their remaining lifetime. slight reduction. At the same time, the number of primary total replacements increased by 4,367 per year between the 2009–2011 and 2021–2023 periods. So far, this has not resulted in an increased number of revisions. 1 0 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Patients undergoing revision, like those undergoing reop- eration, differ demographically from patients receiving a primary replacement. This is a natural consequence of patients with risk factors for revision being gradually selected into the revision groups as they undergo addi- tional revisions. Generally, these patients are older, more often male, and have a higher degree of comorbidities (as © 2024 The Swedish Arthroplasty Register shown in Table 5.4.1). The proportion of patients with an osteoarthritis diagnosis decreases with an increasing num- ber of revisions. At the time of primary surgery, 81.6% of patients had this diagnosis, but among those who had undergone at least two revisions, the proportion had decreased to 64.3%. A corresponding increase in relative numbers is seen mainly for diagnoses such as inflammatory joint disease, sequelae of hip disease during childhood, and complications or sequelae after trauma. However, the proportion with acute hip fracture is lower in the revision groups (5–6%) than in the primary group (9.2%). High comorbidity, increased mortality, and lower activity levels in this group are most likely contributing factors. Figure 5.4.1. Distribution of patients with primary hip replacement and revision having surgery 1994–2023 divided into those who were alive and those who had died 31st of December 2023. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.2 Number of primary hip replacements, first and Figure 5.4.3. Proportion of primary hip replacements, first and multiple-time revisions respectively in 2003–2023. The figure multiple-time revisions in 2001–2022. The proportion of revisions shows the number of replacements as mean per year calculated decreased from 10.7% in the period 2003–2005 to 8.0% in the in three-year periods. Over the time, the number of primary period 2021–2023. replacements increase considerably more than the number of revision surgeries. 1 0 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Demography in first, second and multiple-time revision and primary hip replacement 2014–2023 Previous revisions, Previous revisions, Previous revisions, Primary replacement none 2014–2023 one 2014–2023 >=2 2014–2023 2014–2023 Number 13,591 2,759 1,163 182,903 Mean age (SD) 72.2 (11.0) 72.3 (10.4) 71.9 (10.8) 69.1 (10.7) Age group n (%) <45 199 ( 1.5) 27 ( 1.0) 11 ( 0.9) 3,356 ( 1.8) 45-54 759 ( 5.6) 135 ( 4.9) 84 ( 7.2) 14,822 ( 8.1) 55-64 2,028 (14.9) 417 (15.1) 167 (14.4) 37,726 (20.6) 65-74 4,375 (32.2) 919 (33.3) 384 (33.0) 65,946 (36.1) 75-84 4,715 (34.7) 963 (34.9) 389 (33.4) 51,609 (28.2) ≥ 85 1,515 (11.1) 298 (10.8) 128 (11.0) 9,444 ( 5.2) Females n (%) 6,856 (50.5) 1,343 (48.7) 558 (48.3) 106,046 (58.0) BMI n (%) <18.5 163 ( 1.3) 31 ( 1.2) 25 ( 2.3) 2,171 ( 1.2) 18.5-24.9 4,135 (32.2) 866 (33.2) 358 (32.8) 59,009 (33.2) 25-29.9 5,186 (40.3) 1,014 (38.9) 407 (37.2) 73,254 (41.2) 30-34.9 2,485 (19.3) 478 (18.3) 198 (18.1) 33,775 (19.0) 35-39.9 707 ( 5.5) 156 ( 6.0) 80 ( 7.3) 8,151 ( 4.6) ≥40 180 ( 1.4) 63 ( 2.4) 25 ( 2.3) 1,289 ( 0.7) ASA-class n (%) ASA I 1,173 ( 8.8) 159 ( 5.9) 49 ( 4.3) 35,098 (19.4) ASA II 6,967 (52.4) 1,317 (48.9) 464 (41.2) 107,996 (59.7) ASA III 4,879 (36.7) 1,141 (42.3) 587 (52.1) 36,718 (20.3) ASA IV 279 ( 2.1) 78 ( 2.9) 27 ( 2.4) 1,144 ( 0.6) Table 5.4.1. Demography in first, second and multiple-time revisions from 2014. Corresponding variables are shown for primary hip replacements for comparison. 1 0 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Revision Volume per Unit Risk of Revision Related to Operating Unit For several years, we have monitored the distribution of The outcome for individual units regarding the risk of surgery volumes and noted that some units perform only a revision after primary surgery is influenced by many few revisions per year. In 2023, primary total replacements factors, such as the determination of indications, patient were performed at 89 facilities in Sweden, of which 63 composition, degree of preoperative optimization, choice reported at least one revision. Twenty-five of these units of implant, surgical environment, and several other more performed between one and ten revisions per year, 13 or less known factors. Additionally, there is a random vari- performed between 11 and 25, 12 performed between 26 ation. Nevertheless, it is important to identify and visualize and 50, ten performed between 51 and 100, and three differences, as they have proven to be an excellent basis for (Akademiska Sjukhuset, Danderyd, SU Mölndal) per- further analysis and potential improvement efforts. formed between 116 and 163 revisions. The year before (2022), the number of units in the group with the lowest Table 5.4.2 shows the number of primary hip replace- volume (up to 10 per year) was about the same (n=24), ments performed for osteoarthritis at each unit during and in the group with the second-lowest volume (11–25 the analyzed five-year period (2018–2023) and how revisions per year) was slightly higher (n=16). Eleven units many of these have been revised. Table 5.4.3 presents the performed 26–50 revisions, eight performed 51–100, and corresponding data for a ten-year period (2013–2023). four units (Akademiska Sjukhuset, Danderyd, Karolinska This is followed by RR (relative revision risk) with a 95% Huddinge, SU Mölndal) performed between 114 and 124 confidence interval. Here, unit effects on revision risk are revisions. Figures 5.4.4 and 5.4.5 show the distribution of estimated relative to the national average and have been primary replacements and revision surgeries per unit in calculated as in previous years using the “shared gamma the group of total replacements during 2022 and 2023. frailty model.” Finally, the unit’s observed rank is shown The total number of these operations is also provided to along with a 95% confidence interval for the ranking, cal- assess the relevance of the percentage distribution. culated using the Monte Carlo method. Only units that performed more than 50 primary replacements during A few of the units reporting ten or fewer revisions per the period are included in the analysis. Units that are year may have issues with poor reporting, but in the significantly better or worse than the national average are majority of cases, the reported numbers are likely accu- marked in green and red, respectively. rate. Altogether, these units performed 82 first-time and 13 multiple revisions in 2023. The most common causes Since the analysis window only shifts one year forward were infection (n=42), followed by dislocation (n=21), for each annual report, no dramatic changes from year to loosening (n=12), or periprosthetic fracture (n=6). The year should be expected. However, over a five-year period, most common procedures were head replacement (n=46), the variation can become more pronounced. Of the ten stem replacement (n=16), cup/liner replacement (n=14), units with a significantly increased revision risk at five and head/liner replacement (n=8). In the remaining cases, years and for which ten-year data are also available, six a cup/liner + stem replacement or prosthesis extraction show a significantly increased and none show a signifi- was performed. In two cases, no information on the pro- cantly decreased revision risk in the ten-year data analysis. cedure was provided. Among the 13 units with a significantly decreased risk at five years, eight units also show a continued decreased risk In summary, the number of units with small revision at ten years, and none show an increased risk. volumes per year has remained relatively constant. We believe it is advantageous to maintain a certain volume Figure 5.4.6 shows CRR after ten years (including pri- of revisions, particularly as determining indications and mary replacements from 2013–2023). Units with fewer choosing techniques can be challenging, and intraop- than 50 primary operations over the past five or ten years erative complications and unexpected findings during are not reported. revision surgery are not uncommon. In these cases, it is important to have experienced and specially trained staff, as well as access to special instruments, bone bank, and a sufficiently large range of implants. 1 0 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 5.4.4. Distribution of primary total hip replacements and revisions of total hip replacements per unit in 2022. Total number of primaries and revisions are shown in parentheses. 1 0 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 5.4.5. Distribution of primary total hip replacements and revisions of total hip replacements per unit in 2023. Total number of primaries and revisions are shown in parentheses. 1 0 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 5.4.6. Cumulative risk of revision per unit based on replacements performed 2013–2023. Patients with a diagnosis of trauma (acute or sequele) and tumor have been excluded. The cumulative risk of revision at 10 years has been adjusted for differences in distribution of diagnosis, age, sex and year of surgery. 1 0 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Relative risk of revision per unit, five years Unit Number Revised RR RR 95 % CI Rank Rank 95 % CI Art Clinic Jönköping 1,317 10 0.44 0.26; 0.72 1 1–24 Norrköping 981 7 0.44 0.25; 0.78 2 1–29 Gällivare 429 2 0.47 0.23; 0.98 3 1–46 Hässleholm 4,247 44 0.49 0.37; 0.65 4 2–17 Aleris Specialistvård Nacka 2,394 22 0.49 0.34; 0.72 5 1–23 Lindesberg 2,966 33 0.52 0.37; 0.71 6 2–22 Varberg 1,130 12 0.54 0.33; 0.87 7 1–37 Hudiksvall 384 3 0.58 0.29; 1.15 8 1–57 Eksjö 1,454 17 0.59 0.39; 0.90 9 2–40 Aleris Specialistvård Bollnäs 608 9 0.61 0.36; 1.04 10 2–50 Carlanderska 2,518 35 0.63 0.46; 0.86 11 5–36 Sophiahemmet 1,001 19 0.65 0.43; 0.97 12 4–45 Hermelinen 172 1 0.65 0.29; 1.44 13 1–70 Örnsköldsvik 732 9 0.67 0.40; 1.13 14 3–56 Lycksele 1,587 23 0.68 0.47; 0.99 15 5–47 Capio Movement 2,481 37 0.69 0.51; 0.93 16 7–42 Mora 1,432 20 0.69 0.47; 1.02 17 5–49 Kalmar 622 9 0.73 0.43; 1.23 18 4–61 Södertälje 701 10 0.73 0.44; 1.21 19 4–60 Sollefteå 2,010 30 0.74 0.53; 1.04 20 8–50 Skellefteå 688 10 0.75 0.46; 1.25 21 5–62 Capio S:t Göran 2,457 40 0.77 0.57; 1.03 22 11–49 Karolinska Huddinge 1,155 18 0.77 0.51; 1.16 23 7–58 Trelleborg 2,678 48 0.77 0.59; 1.01 24 12–48 Art Clinic Göteborg 1,451 21 0.78 0.53; 1.15 25 9–57 Borås 479 7 0.78 0.45; 1.38 26 4–68 Aleris Specialistvård Motala 700 16 0.8 0.52; 1.22 27 8–61 Capio Ortho Center Stockholm 4,834 87 0.8 0.65; 0.98 28 16–47 Piteå 2,447 44 0.8 0.60; 1.06 29 13–52 Lidköping 1,213 19 0.81 0.54; 1.20 30 9–60 Skene 1,084 18 0.81 0.54; 1.22 31 9–61 Capio Ortopediska Huset 4,286 77 0.81 0.65; 1.01 32 17–48 Bollnäs 1,394 21 0.82 0.56; 1.21 33 10–60 Ängelholm 1,044 18 0.83 0.55; 1.26 37 10–63 Falköping 149 3 0.88 0.44; 1.76 34 4–78 Table continued on next page. 1 0 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Relative risk of revision per unit, five years, cont. Unit Number Revised RR RR 95 % CI Rank Rank 95 % CI Oskarshamn 2,066 42 0.92 0.69; 1.23 35 20–62 Uddevalla 1,837 37 0.93 0.69; 1.27 36 20–63 Södersjukhuset 849 17 0.94 0.62; 1.42 37 14–70 Visby 733 16 0.97 0.63; 1.49 38 16–72 Ljungby 744 17 0.97 0.64; 1.48 39 16–72 Karlshamn 1,561 34 0.99 0.72; 1.35 40 23–67 Jönköping 815 17 0.99 0.65; 1.50 41 17–72 Alingsås 980 21 0.99 0.67; 1.45 42 19–71 Frölundaortopeden 75 2 0.99 0.47; 2.06 43 6–82 Falun 765 16 1 0.65; 1.54 44 17–73 Halmstad 868 21 1.01 0.69; 1.48 45 20–72 Gävle 638 14 1.01 0.65; 1.59 46 17–75 Kullbergska sjukhuset 1,914 45 1.1 0.83; 1.46 47 33–71 Capio Ortho Center Göteborg 1,712 48 1.11 0.85; 1.46 48 34–71 Sundsvall 102 3 1.13 0.57; 2.26 49 11–83 Akademiska sjukhuset 803 21 1.16 0.79; 1.70 50 30–78 Capio Artro Clinic 3,235 83 1.16 0.94; 1.44 51 42–71 Umeå 277 9 1.19 0.71; 2.01 52 22–82 Aleris Specialistvård Ängelholm 2,008 50 1.2 0.92; 1.56 53 41–74 Enköping 2,817 75 1.23 0.99; 1.54 54 45–74 Västervik 767 23 1.27 0.88; 1.85 55 37–80 Arvika 1,458 40 1.28 0.95; 1.71 56 43–78 Torsby 738 22 1.31 0.90; 1.91 57 39–81 Eskilstuna 379 13 1.33 0.84; 2.11 58 34–83 Danderyd 976 30 1.34 0.96; 1.86 59 44–80 Linköping 484 18 1.34 0.89; 2.03 60 39–82 Värnamo 869 27 1.35 0.95; 1.91 61 43–81 Karlskrona 78 4 1.39 0.72; 2.66 62 24–84 Östersund 1,162 39 1.41 1.05; 1.90 63 50–81 SU/Mölndal 2,197 73 1.42 1.13; 1.78 64 55–79 Nyköping 711 24 1.42 0.99; 2.05 65 46–82 Skövde 209 10 1.58 0.95; 2.61 66 44–84 Table continued on next page. 1 0 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Relative risk of revision per unit, five years, cont. Unit Number Revised RR RR 95 % CI Rank Rank 95 % CI Karlstad 408 18 1.61 1.07; 2.43 67 52–84 Växjö 814 31 1.64 1.18; 2.27 68 58–84 SUS/Lund 247 13 1.71 1.08; 2.71 69 52–84 Västerås 2,015 78 1.74 1.40; 2.17 70 68–83 Helsingborg 241 12 1.75 1.09; 2.81 71 53–84 Kungälv 699 31 1.75 1.26; 2.43 72 63–84 Karolinska Solna 270 16 1.79 1.17; 2.75 73 58–84 Norrtälje 848 39 1.89 1.40; 2.54 74 69–84 Table 5.4.2. Relative risk of revision per unit, five years. Units that are significantly better or worse than the national average have been highlighted with green and red respectively. 1 0 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Relative risk of revision per unit, ten years Unit Number Revised RR RR 95 % CI Rank Rank 95 % CI Norrköping 2,000 23 0.48 0.34; 0.69 1 1–16 Eksjö 2,458 32 0.56 0.41; 0.77 2 1–24 Kalmar 1,324 18 0.57 0.39; 0.85 3 1–34 Hässleholm 8,033 127 0.61 0.52; 0.73 4 3–20 Lindesberg 4,581 66 0.61 0.49; 0.77 5 2–25 Alingsås 1,974 30 0.63 0.46; 0.87 6 2–36 Aleris Specialistvård Sabbatsberg 340 6 0.64 0.37; 1.11 7 1–58 Mora 2,532 41 0.67 0.50; 0.89 8 3–39 Hermelinen 231 2 0.68 0.35; 1.32 9 1–72 Sophiahemmet 2,124 49 0.69 0.53; 0.90 10 4–39 Karolinska Huddinge 2,086 37 0.7 0.52; 0.95 11 4–44 Karlskoga 628 13 0.71 0.46; 1.10 12 2–57 Carlanderska 3,307 56 0.71 0.56; 0.92 13 5–41 Lidköping 2,526 47 0.74 0.57; 0.97 14 6–46 Örnsköldsvik 1,496 27 0.74 0.53; 1.04 15 4–53 Aleris Specialistvård Nacka 3,319 54 0.75 0.58; 0.97 16 7–46 Gällivare 817 15 0.75 0.49; 1.14 17 3–60 Sollefteå 2,857 46 0.75 0.58; 0.99 18 6–48 Piteå 4,223 82 0.77 0.62; 0.94 19 9–44 Falun 2,105 44 0.77 0.58; 1.01 20 7–50 Hudiksvall 875 17 0.77 0.51; 1.15 21 3–61 Oskarshamn 3,463 67 0.77 0.62; 0.98 22 9–47 Örebro 351 8 0.78 0.47; 1.29 23 2–71 Capio S:t Göran 4,79 93 0.78 0.64; 0.95 24 11–44 Aleris Specialistvård Motala 3,464 88 0.8 0.65; 0.98 25 12–48 Trelleborg 5,909 135 0.82 0.69; 0.97 26 15–47 Sundsvall 494 12 0.83 0.53; 1.30 27 4–71 Frölunda Specialistsjukhus 257 7 0.85 0.50; 1.45 28 3–79 Skellefteå 1,238 26 0.87 0.62; 1.22 29 9–66 Aleris Specialistvård Bollnäs 2,046 56 0.87 0.68; 1.12 30 14–59 Borås 1,026 22 0.87 0.61; 1.26 31 8–69 Capio Ortho Center Göteborg 2,44 58 0.87 0.68; 1.12 32 15–59 Capio Ortopediska Huset 6,583 144 0.88 0.75; 1.04 33 21–53 Lycksele 3,135 73 0.88 0.71; 1.10 34 17–58 Varberg 2,147 49 0.89 0.68; 1.16 35 15–62 Table continued on next page. 1 1 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Relative risk of revision per unit, ten years, cont. Unit Number Revised RR RR 95 % CI Rank Rank 95 % CI Halmstad 1,801 44 0.89 0.68; 1.18 36 14–63 Visby 1,293 29 0.9 0.65; 1.24 37 11–68 Bollnäs 1,394 21 0.93 0.64; 1.35 38 11–74 Jönköping 1,524 35 0.93 0.69; 1.26 39 15–69 Falköping 149 3 0.94 0.51; 1.76 40 3–87 Skene 1,76 41 0.94 0.71; 1.26 41 18–69 Capio Ortho Center Stockholm 7,318 175 0.97 0.84; 1.12 42 31–60 Södersjukhuset 2,313 61 0.97 0.76; 1.23 43 23–67 Gävle 1,401 38 1 0.75; 1.34 44 21–74 Capio Movement 3,802 98 1.04 0.86; 1.26 45 34–70 Spenshult 335 14 1.05 0.68; 1.61 46 15–84 Ängelholm 1,53 38 1.05 0.78; 1.41 47 26–77 Södertälje 1,233 34 1.08 0.79; 1.46 48 27–80 Uddevalla 3,608 101 1.08 0.89; 1.31 49 38–72 Ljungby 1,452 44 1.1 0.84; 1.45 50 32–79 Karlshamn 2,744 78 1.11 0.90; 1.38 51 39–76 Karolinska Solna 884 32 1.12 0.81; 1.53 52 29–82 Värnamo 1,52 45 1.14 0.87; 1.50 53 35–81 Västervik 1,305 39 1.16 0.86; 1.55 54 35–83 Kullbergska sjukhuset 3,073 89 1.18 0.96; 1.45 55 45–79 Östersund 2,382 78 1.21 0.97; 1.50 56 46–81 Enköping 4,589 133 1.21 1.02; 1.43 57 50–78 Torsby 1,263 39 1.23 0.92; 1.64 58 41–85 SU/Mölndal 4,440 147 1.24 1.06; 1.46 59 53–80 Eskilstuna 691 23 1.25 0.87; 1.79 60 36–87 Aleris Specialistvård Ängelholm 2,381 62 1.25 0.99; 1.59 61 47–84 Linköping 711 27 1.3 0.92; 1.82 62 41–88 Helsingborg 652 24 1.3 0.91; 1.85 63 41–88 Nyköping 1,262 44 1.34 1.02; 1.76 64 50–87 SUS/Lund 779 32 1.35 0.99; 1.86 65 48–88 Akademiska sjukhuset 1,649 64 1.36 1.07; 1.71 66 55–87 Växjö 1,339 48 1.4 1.07; 1.83 67 55–88 Arvika 2,402 83 1.41 1.15; 1.74 68 60–87 Skövde 852 39 1.44 1.08; 1.93 69 55–89 Västerås 3,487 131 1.49 1.26; 1.77 70 69–88 Table continued on next page. 1 1 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Relative risk of revision per unit, ten years, cont. Unit Number Revised RR RR 95 % CI Rank Rank 95 % CI Karlstad 1,176 54 1.51 1.17; 1.94 71 63–89 Danderyd 2,277 95 1.52 1.25; 1.85 72 68–88 Umeå 500 24 1.52 1.07; 2.17 73 55–89 Karlskrona 113 7 1.55 0.92; 2.63 74 41–89 Norrtälje 1,447 59 1.58 1.24; 2.02 75 67–89 Kungälv 1,554 73 1.67 1.34; 2.09 76 74–89 Table 5.4.3. Relative risk of revision per unit, ten years. Units that are significantly better or worse than the national average have been highlighted with green and red respectively. Cause of Revision Between 2003 and 2023, aseptic loosening (50.9%), and/or wear. The latter two causes are also included in this infection (18.8%), dislocation (14.3%), and peripros- group. Dislocation ranked second (11.7%), followed by thetic fracture (9.9%) have been the most common periprosthetic fracture (8.0%) and infection (2.7%). For reasons for revision, regardless of whether there was a multiple revisions during the same period, the proportion previous revision or not. However, the distribution of of revisions due to infection and dislocation was higher causes has changed over time (Figure 5.4.7 a and b). at the expense of a decreasing share of revisions due to For first-time revisions, 64.4% of surgeries performed loosening (loosening: 50.5%, dislocation: 19.8%, peri- between 2003 and 2005 were due to loosening, osteolysis, prosthetic fracture: 7.9%, infection: 6.0%). © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.7 a–b. Distribution of reasons in first time (a) and multiple-time revisions (b) in three-year periods between 2003 and 2023. 1 1 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Until the period 2021–2023, this distribution grad- An exception to the rule that the specific cause of revision ually changes in both groups. For first-time revisions, often remains the same if a patient is revised multiple times loosening still dominates but has decreased to 42.9%, is the patient group that is revised due to periprosthetic followed by infection (21.2%), dislocation (13.7%), and fracture. In these cases, the most common cause of a sub- periprosthetic fracture (12.5%). During the same period, sequent revision is dislocation, followed by loosening and infection became the most common cause of multiple infection, after both first and second revisions. Regardless revisions (33.8%), followed by loosening (26.5%), dislo- of the reason for the revision, the risk of needing a re-re- cation (17.8%), and periprosthetic fracture (6.2%). The vision due to infection is elevated after a first-time revi- total number of revisions, whether first-time or multiple sion compared to the situation after a primary operation. revisions, due to loosening decreased from 986 per year The difference in risk is lowest when comparing primary during the period 2003–2005 to 693 per year during replacements and first-time revision due to loosening. 2021–2023. During the same periods, there was a signif- Nevertheless, the proportion of first-time revisions that icant increase in revisions due to infection, from 136 per are re-revised due to infection is twice as high compared to year in the first period to 511 per year in the most recent the proportion of primary operations revised for the same period. For dislocation, the change was more modest, reason. After a revision due to infection, the proportion with a slight increase from 218 per year in 2003–2005 that is re-revised for the same reason is more than ten to 258 per year in 2020–2022. Regarding periprosthetic times greater than after a primary operation, regardless of fractures treated with revision, the relative change was whether it is a first or subsequent revision. somewhat larger, increasing from 130 to 196 per year. The number of reported periprosthetic fractures increased from 123 in 2003 to 182 in 2010. Since then, the num- Prosthesis Extraction Without ber has fluctuated from 169 (in 2013) to 218 (in 2022) Subsequent Insertion of a New Prosthesis without a clear pattern. It is not possible, based on registry data alone, to deter- mine with complete certainty whether an extraction is The cause of revision differs between sex. During the permanent or not. A large proportion of the patients period 2021–2023, loosening was the most com- who underwent extraction in the latter part of 2023 are mon cause of revision for both males and females highly likely to be provided with a prosthesis during 2023. (38.7%/41.2%). Infection was significantly more com- Additionally, a small number of patients who underwent mon among males (34.8%/24.0%), while dislocation was prosthesis extraction earlier may also receive a new pros- more common among females (11.4%/18.4%). Revisions thesis. It is estimated that this could involve around thirty due to periprosthetic fracture were evenly distributed cases, based on the additional number of cases reported in (11.4%/11.2%). All percentages include both first-time 2023 (2023: 70 cases; average for the period 2018–2022 and multiple revisions. = 42). Due to the uncertainty in this estimate, this loss has not been considered here. Cause of Re-revision Related to Previous Throughout the period from 2003 to 2023, the proportion Revision Cause of revisions that resulted in definitive complete or partial The reason for a patient’s first revision influences the prosthesis extraction was 1.9% (an average of 25 per year) cause profile for a potential second revision (Table 5.4.4). for first-time revisions and 6.2% (24 per year) for multiple Whether a patient undergoes a first or second revision and revisions. The number has varied between 129 and 172 then needs another revision, it is highly likely that the next over a three-year period (Figure 5.4.8). The most common revision will be performed for the same reason as the pre- causes were deep infection (62.3%), followed by dislocation vious one. This is especially evident in cases of loosening/ (19.8%), loosening (10.6%), and periprosthetic fracture osteolysis, infection, or dislocation, where 5.3%, 14.8%, (5.9%). During this period, there was a gradual increase in and 6.4%, respectively, were revised a second time for definitive extractions due to infection, while the proportions the same reason during the period 2005 to 2023. If you for other causes decreased. Between 2018 and 2020, when it also include patients who were treated with permanent can be assumed that the majority of planned replacements extraction, these percentages increase to 5.7%, 21%, and were registered, 68.2% of extractions were due to infection, 8.9% for first-time revisions and to 8.2%, 29.7%, and 12.9% due to loosening, 9.1% due to dislocation, and 8.3% 14.7% for second-time revisions. due to periprosthetic fracture. 1 1 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Reason for re-revision grouped by reason why the previous proucedure was performed Periprosthetic Loosening Infection fracture Dislocation Other/missing Primary replacement 2005-2023 n = 319,683 First revision, % 1.3 1.2 0.5 0.7 0.3 No revision, % 96.1 Second revision 2005-2023 n = 25,648 No reported incision, % 0.4 6.2 1.5 2.5 0.5 Loosening, % 5.3 1.6 2.8 1.6 4.3 Infection, % 2.4 14.8 3.3 5.7 3.9 Periprosthetic fracture, % 1.2 0.5 0.9 0.9 1.2 Dislocation, % 2.2 1.7 3.6 6.4 3.8 Other/missing, % 1.0 0.5 0.7 0.7 2.0 No re-revision, % 87.8 74.7 87.2 82.1 84.3 Third revision 2005–2023 n = 5,328 No reported incision, % 1.3 10.5 2.5 4.5 1.1 Loosening, % 6.9 1.4 4.5 2.8 6.0 Infection, % 3.7 19.2 3.8 6.4 4.2 Periprosthetic fracture, % 1.4 0.4 0.7 1.6 0.7 Dislocation, % 3.1 2.9 6.8 10.2 4.2 Other/missing, % 0.8 0.8 0.9 1.00 2.5 No re-revision, % 82.8 64.8 80.9 73.8 81.3 Table 5.4.4. Distribution of reason for second-time and third-time revisions in percentage, grouped by the reason of the most recent previous revision. Includes patients who underwent primary surgery or revision between 2005 and 2023. The group loosening includes osteolysis and wear. For two-stage operations, the reason listed is that relevant to the first stage (extraction). Prosthesis extraction not followed by insertion is listed as a separate group. For a small portion of these, prosthesis insertion may be planned for 2024. Patients who undergo permanent prosthesis extraction Revision Procedure are somewhat older than those who are revised for other reasons (average age for permanent extraction/other pro- Since 2003, replacing both the cup and/or liner and stem cedures: 76.0/71.6 years). They are more likely to have a has been the most common procedure for both first-time diagnosis other than osteoarthritis (39.1% versus 23.9%) and multiple revisions (Figure 5.4.10 a and b). However, and a higher degree of comorbidity. In the group that the replacement of both the cup/liner and stem has underwent permanent extraction, 73.5% had an ASA class decreased in both absolute and relative terms for both of III or higher, whereas in the group that was revised first-time and multiple revisions. Instead, replacement of for other reasons, this proportion was 37.5%. However, the head and/or liner has increased, as DAIR (Debride- 34.8% and 24.7% of observations are missing as the ASA ment, Antibiotics, Implant Retention) procedures have class was not reported at the beginning of the period. The become more common. It is also not surprising that the mortality rate among these patients is high, particularly proportion of extractions without recorded replacement initially (Figure 5.4.9). During the observation period constitutes a significantly larger percentage of multiple from 2003 to 2023, 77.2% of patients who underwent revisions compared to first-time revisions. permanent extraction died. The corresponding proportion among those revised for other reasons was 42.3%. 1 1 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.8. Number of total and partial extractions per three- Figure 5.4.9. Cumulative risk of mortality in patients treated year period where there is no report on a subsequent insertion of with definitive prosthesis extraction and in patients revised with a new prosthesis or prosthesis component(s). prosthesis exchange in one or more stages. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.10 a–b. Number of different procedures at first (a) and multiple revisions (b) in three-year periods from 2003 to 2023. 1 1 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Choice of procedure related to 1,047 uncemented stems reported. For multiple revisions, reason for revision the peak occurred in 2009–2011, with 379 uncemented The type of procedure varies depending on the reason for stems (see figures 5.4.13 a and b). Since then, the relative revision. As noted elsewhere in this section, “exchange/ use of uncemented stems in first-time revisions has only insertion” indicates that the patient may have undergone shown marginal fluctuations, ranging from 46% to 48%. a two-stage procedure. Extractions followed by recorded In multiple revisions, the percentage varied between 53% prosthesis insertion have therefore been excluded. Figures and 58% since the 2006–2008 period. In the most recent 5.4.11 a and b illustrate the relative distribution of proce- period (2021–2023), the proportion was 54.4%. In sum- dures related to the reason for revision for first-time and mary, uncemented cups were more frequently used in both multiple revisions performed from 2018 to 2023. first-time and multiple revisions over the last three years. Cemented stems were more common in first-time revisions, For aseptic loosening in first-time revisions, the predomi- while uncemented stems dominated in multiple revisions. nant procedure is exchange of the cup/liner, with or without stem exchange. In multiple revisions, it is relatively more Bone grafts were used more often in cup than stem revi- common to only revise the stem and possibly also change sions, particularly with cemented fixation. From 2021 the liner. In cases of deep infection, exchange of the head to 2023, bone grafts were utilized in 23.9% of first-time and/or liner is dominant for both first-time and multiple revisions involving cemented cups and 37.3% for unce- revisions. As expected, the relative proportion of definitive mented cups. For multiple revisions, these proportions extractions increases significantly if the hip replacement has were slightly lower, at 35.5% and 31.3%, respectively. In been revised at least once before. The majority of peripro- first-time stem revisions, bank bone was used in 7.5% of thetic fractures are revised with stem exchange, while cup cemented and 6.0% of uncemented stem procedures. For exchange is performed in 29.1% of first-time revisions and multiple stem revisions, the figures were 8.4% and 6.7%, 27.1% of cases in multiple revisions. respectively. The use of bone grafts in cup insertions has decreased since the 2006–2008 period, from 37.0% to In the few cases where only the cup/liner was exchanged 23.9% in first-time revisions, regardless of fixation type. (18 first-time revisions and 6 multiple revisions), it A similar decrease was observed in multiple revisions, involved a periacetabular fracture with a fixed stem in 18 dropping from 31.3% to 14.9%. The use of bone grafts of the cases. In the remaining 6 cases, there was a femoral in stem revisions has declined even more in relative terms, fracture fixed with a plate, with the cup being exchanges. from 16.3% to 5.1% for first-time revisions between The most common procedure for first-time revisions 2003–2005 and 2021–2023. In multiple revisions, the due to dislocation is cup exchange with or without stem reduction was slightly lower, from 14.7% to 5.4%. exchange (75.4% for first-time, 55.1% for multiple revi- sions). Only exchange of the head/liner was performed in In revision surgery, the terms “fully cemented,” “fully 18.4% and 31.0% of cases, respectively. uncemented,” “hybrid,” and “reverse hybrid” can be difficult to interpret, depending on whether the entire prosthesis or only parts are replaced. Here, we have chosen Choice of Fixation to reflect only the first option—cases where all prosthesis The shift towards increased use of uncemented fixation components were replaced, regardless of whether the occurred somewhat earlier in revision surgeries compared procedure was performed in one or two stages. to primary operations. On the acetabular side, an increase in uncemented fixation was observed in first-time revisions Between 2003 and 2023, both the number and propor- until the 2012–2014 period, and in multiple revisions tion of complete exchange/insertion of both the cup and until the 2009–2011 period (see figures 5.4.12 a and stem decreased. The number of reported cases fluctuated b). After these peaks, the total number of cup revisions over the years but showed a trend towards fewer cases began to decline. From 2021 to 2023, uncemented cups overall. The highest and lowest counts were recorded in were used in 61.3% of first-time revisions and 58.4% of 2009 and 2020, with 709 and 504 cases, respectively. multiple revisions. A similar pattern can be seen on the After 2020, there was a slight increase, reaching 555 cases stem side. The highest number of uncemented stems in by 2023. first-time revisions was recorded during 2012–2014, with 1 1 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.11 a–b. Relative distribution of procedures grouped by reason for revision at first (a) and multiple revisions (b) during the period 2018-2023. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.12 a–b. Distribution of cemented and uncemented fixation of the cup at first (a) and multiple revisions (b) in three-year periods from 2003 to 2023. 1 1 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.13 a–b. Distribution of cemented and uncemented fixation of the stem at first (a) and multiple revisions (b) in three-year periods from 2003 to 2023. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.14 a–b. Number of revisions and choice of fixation in cases where all prosthesis components are exchanged at first (a) and multiple revisions (b) in three-year periods from 2003 to 2023. 1 1 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 In the early 2000s, cemented fixation was by far the repositioning. However, snap-fit cups were eventually most common option for first-time revisions (Figure discontinued as they were believed to increase the risk 5.4.14 a). However, the use of uncemented and hybrid of loosening. A more effective way to secure the femoral fixation increased over time, while fully cemented fixation head in the cup is through the use of a “constrained liner,” decreased. Since the 2018–2020 period, the number of which remains in limited use today, likely due to similar cemented, uncemented, and hybrid fixation procedures issues observed with the snap-fit cups, despite mixed has been relatively balanced. Reverse hybrid fixation results in the literature. Dual Mobility Cup (DMC) were increased modestly until 2012–2014 but then declined. In first reported in 2002 (a single revision case) and have seen the most recent period, reverse hybrid fixation accounted increasing use since then. In 2023, 529 revision cases were for just under 12%, while the other three methods reported, meaning that DMCs were used in 46.2% of all (cemented, uncemented, and hybrid) each made up about cup revisions. That same year, DMCs were used in 6.2% 28–30% of the total. A similar pattern can be observed of all primary surgeries, regardless of diagnosis. in multiple revisions concerning the use of cemented and uncemented fixation, although hybrid fixation tends to Cemented fixation has been far more common than be slightly less common in these cases (Figure 5.4.14 b). uncemented in cases where standard revision cups were used. From 2021 to 2023, cemented DMCs were used in 485 first-time revisions and 123 second-time revisions. Choice of liner and dual articulation In comparison, uncemented DMCs were used in 129 Over the past two decades, the use of cup or liner designs and 24 cases, respectively. When including cases where aimed at reducing the risk of dislocation has become a DMC was cemented into an uncemented cup shell, as increasingly common (Figures 5.4.15 a and b). Liner well as cases where an uncemented cup was converted to designs with features such as elevated rims, increased a DMC, the uncemented group expands to 540 first-time inclination, or similar characteristics were introduced as revisions and 192 second-time revisions. This makes the early as the 1980s. At that time, some cemented cups were uncemented group larger than the group where the DMC available with a “snap-fit” feature, where the cup open- was cemented directly to the bone, whether it was a first- ing was slightly smaller than the femoral head, requiring or multiple-time revision. some force to push the head back into the cup during © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.15 a–b. Use of liner type in first (a) and multiple revisions (b) from 2003 to 2023, aimed at stabilizing the femoral head to prevent dislocation. 1 1 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Choice of femoral head The choice of stem The selection of femoral heads for standard cups, exclud- Since 2003, the number of stem revisions has shown a ing those with double-articulating joints, is discussed here. tendency to decrease. During the 2003–2005 period, Femoral heads are routinely replaced in nearly all revisions. there were 2,834 reported revisions where the stem was Since 2003, information on the inserted femoral head is replaced, either with or without simultaneous cup/liner available for 91.6% of all revisions. In the remaining cases, revision. In the following three-year periods, the number the head either was not replaced or the replacement was of stem revisions fluctuated between 2,773 and 2,991. not reported. Figures 5.4.17 a and b show how the choice However, starting from the 2015–2017 period, the of femoral head size has changed from 2003–2005 for number of revisions began to decline, and in the most both first-time and repeat revisions. Over time, there has recent period (2021–2023), 2,628 stem revisions were been a transition towards 32 mm and 36 mm heads, due reported—about 200 fewer than during 2003–2005. This to the introduction of highly cross-linked polyethylene reduction was fairly evenly distributed between first-time and the desire to reduce dislocation risk. For both first- and repeat revisions. time and repeat revisions, 32 mm heads have become the most common, used in 61.8% of first revisions and 49.4% For this report, the classification of stems was updated to of repeat revisions during the 2021–2023 period. When better reflect current practices while maintaining clarity. excluding cases where this information is missing, these In cemented fixation, standard-length stems (≤ 15 cm) proportions increase to 64.4% and 57.2%, respectively. were predominantly used in both first-time and repeat The use of 36 mm heads has increased during the entire revisions, though more frequently in first-time revisions period for first-time revisions and accounted for approx- (figures 5.4.18 a and b). During the 2021–2023 period, imately one-quarter (24.1%, including missing data) of 49.7% of first-time revisions with a standard stem involved all cases from 2021–2023. In repeat revisions, the use of a “cement-in-cement” revision. The corresponding figure 36 mm heads peaked in 2015–2017 at 24.3%, followed for repeat revisions was slightly lower at 42.1%. by a slight decline in the most recent period. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.16 a–b. Variations in dual-mobility joint at first (a) and multiple revisions (b), divided into three-year periods from 2016 to 2023. 1 2 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.17 a–b. Choice of femoral head size in first (a) and multiple revisions (b) from 2003 to 2023. Prostheses with dual-mobility cups have been excluded. Cemented modular stems have been used infrequently, For cemented cups, three of the most-used options were but their use has increased over time. Only seven cases double-articulating, though the Exeter Rim Fit cup was were reported in the 2003–2005 period, but by 2021– the most common. In 2023, more than half (52.3%) of 2023, there were 43 cases, with 26 of these being first-time cemented cup revisions involved a DM cup. For unce- revisions. Among uncemented stems, modular designs mented cup revisions, the most popular options in both have become the dominant choice, particularly in repeat 2022 and 2023 were the Tritanium and TMT revision revisions (figures 5.4.18 c and d). Their use increased cups. These were often used with DM articulation, either until 2012–2014 for first-time revisions and until through the use of metal liners or by cementing a DM cup 2015–2017 for repeat revisions, after which it stabilized into a metal shell. In 2023, of all uncemented cup revi- at around 80% for first-time revisions and just over 85% sions with DM articulation, 17.1% (111 cases) involved for repeat revisions. a metal liner, 12.6% (82 cases) involved cementing a DM cup into an uncemented shell, and 7.9% (51 cases) involved the use of an uncemented DM cup. Choice of Specific Implants Table 5.4.5 details the most commonly used cemented and For cemented fixation of the stem, the Exeter standard uncemented cups and stems for 2022, 2023, and 2013, (15 cm long) or SPII (130 or 150 cm) were the most with annual updates. The stem classification adjustment frequently used in all three reported years (2013, 2022, revealed that some MP stems had been mistakenly cate- and 2023). Between 2013 and 2023, the majority of revi- gorized as uncemented, which affected the distribution of sions using the Exeter standard stem involved either a the top five most-used revision stems in 2022. cement-in-cement revision (50.0% of operations) or bone transplantation (25.8%). For revisions with the SPII stem, the corresponding rates were 21.0% for cement-in-ce- ment and 20.9% for the use of bone allografts (excluding cortical grafts). 1 2 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.18 a–d. Distribution of cemented (a-b) and uncemented (c-d) stem types in first (a and c) and multiple revisions (b and d) from 2003 to 2023. 1 2 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 The shorter Exeter stem was above all used for cement-in- The reason for revision also affects the likelihood of fur- cement revisions, accounting for at least 89.9% of cases. ther revisions. The cumulative risk of re-revision is highest In 6.6% of the cases, information on this variable was within the first few years after the index revision, especially missing, meaning the actual percentage could be even for cases due to infection or dislocation, as shown in Fig- higher. Over the period, the use of the short Exeter stem ures 5.4.21 a and b. Early revisions tend to occur shortly decreased by more than half, from 72 in 2013 to 33 in after the index operation, with infection and dislocation 2023, while the use of the Exeter standard and SPII stems being common reasons. However, after four to five years, (≤150 cm) increased from 156 to 180 and from 129 to the curves for different revision causes diverge, primarily 161 per year, respectively. because the risk of re-revision due to infection decreases. This group also experiences high mortality, and many hips For uncemented revision stems, modular stems were used revised due to infection undergo prosthesis extraction. in just under 80% of all cases with uncemented fixation during both 2022 and 2023. The four designs currently Over the past 25–30 years, the outcomes of primary hip in use, which are also four of the five most-used according replacement surgery, measured as the risk of revision, have to Table 5.4.5, are Restoration, MP, Arcos, and Revitan. gradually improved, and the same trend is observed for In 2023, a long uncemented revision stem was used in revisions. While the risk of early re-revision after first-time 11.0% of cases, with the Corail Revision stem being the revisions has increased, long-term results have improved most dominant, accounting for 8.4% of all uncemented (Figure 5.4.22). The increase in early revisions can partly revision stems (36 out of 47 revisions with long unce- be attributed to a growing number of revisions due to mented stems). infection (Figure 5.4.23). Increased use of uncemented fixation, which carries a higher risk of early periprosthetic fractures, may also have played a role. The reasons for Results the improved outcomes over the long term, when the The risk of revision surgery increases progressively with revision risk curves begin to converge and eventually cross, each hip revision. The cumulative 15-year risk for pri- are less clear. As noted, the number of revisions due to mary total hip replacements (THRs) performed from loosening has decreased over the past two decades, likely 2003 onwards is 7.9% ± 0.2% (39,620 observations at due to the transition from older plastic types to more 15 years). This risk increases significantly with subsequent wear-resistant plastics with extra crosslinking. Increased revisions: 22.2% ± 0.8% after the first revision (2,294 use of uncemented fixation, which may reduce the risk observations), 27.4% ± 1.8% after the second revision of loosening in the long run, may also have contributed, (446 observations), and 35.5% ± 3.4% for hips revised although further evidence is needed to confirm this. at least twice previously (116 observations). These risks are depicted in Figure 5.4.19. The risk data are also bro- For second-time revisions, a similar pattern emerges ken down by gender in Figure 5.4.20, but only up to 13 regarding how the cumulative risk of re-revision has years, as only 87 male and 116 female hip replacements changed over time. Initially, the risk is elevated for the remained at that point. Males generally have a higher periods 2006–2014 and 2015–2023. However, after seven cumulative revision risk for primary, first, and second to eight years, the revision risk decreases, and the lines revision surgeries. representing the 1997–2005 and 2006–2014 periods cross each other (Figure 5.4.24). For patients operated The prognosis worsens with each additional revision, as on between 2015 and 2023, the number of observa- the risk of re-revision increases. Cox regression analysis, tions drops below 100 just before the eight-year mark. adjusted for factors such as age, sex, primary diagnosis, Regarding patients who have undergone at least two prior and year of operation, shows that the cumulative revision revisions, a similar trend is observed. Patients re-revised risk from 2003 to 2023 was 3.8 times higher after a first between 2006 and 2014 show a lower long-term risk com- revision compared to a primary surgery (95% confidence pared to those re-revised between 1997 and 2005 (Figure interval: 3.7–4.0). The risk increases to 5.5 times for sec- 5.4.25). Whether multiple revisions performed after 2014 ond revisions (CI: 5.2–5.9) and 7.8 times higher for hips will show better long-term outcomes compared to earlier revised at least twice previously (CI: 7.2–8.5). Overall, the periods remains uncertain. The limited number of obser- risk is about 38% higher in males compared to females vations and the uncertainty of long-term trends make it (hazard ratio: 1.38, CI: 1.34–1.41). difficult to draw definitive conclusions at this stage. 1 2 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Most used cup and stem 2013 2022 2023 Name % Name % Name % Cup, Cemented, n 644 Cup, Cemented, n 419 Cup, Cemented, n 386 Avantage 23.9 Avantage 24.3 Exeter Rim-fit 23.6 Exeter Rim-fit 23.0 Exeter Rim-fit 23.2 Avantage 21.2 Marathon 14.1 Lubinus x-link 16.0 BiMobile shell 17.6 Lubinus x-link 11.5 BiMobile shell 11.2 Lubinus x-link 11.1 Lubinus 5.9 Polarcup cemented 11.0 Polarcup cemented 10.4 Other 21.6 Other 14.3 Other 12.1 Cup, Uncemented, n 573 Cup, Uncemented, n 598 Cup, Uncemented, n 679 TMT revision 26.4 Tritanium revision (trident) 23.4 Tritanium revision (trident) 23.6 Continuum 17.8 TMT revision 20.6 TMT revision 17.1 Trilogy 8.6 Continuum 7.0 G7 OsseoTi 9.0 TMT modular 5.6 Pinnacle W/Gription 100 6.7 Pinnacle W/Gription 100 8.2 Mallory Head 5.4 G7 OsseoTi 6.4 Pinnacle 100 6.5 Other 36.3 Other 36.0 Other 35.6 Stem, Cemented, n 481 Stem, Cemented, n 477 Stem, Cemented, n 484 Exeter standard 32.4 SPII standard (≤15 cm) 36.5 Exeter standard 37.2 SPII standard (≤15 cm) 26.8 Exeter standard 34.4 SPII standard (≤15 cm) 33.3 Exeter short revision stam 15.0 Exeter long 9.6 Exeter long 7.6 Exeter long 6.7 Exeter short revision stam 7.1 Exeter short revision stam 6.8 MS-30 polished 4.6 MP cemented 2.9 MP cemented 3.5 Other 14.6 Other 9.4 Other 11.6 Stem, Uncemented, n 447 Stem, Uncemented, n 391 Stem, Uncemented, n 428 MP 43.8 Restoration 37.1 Restoration 34.1. Restoration 21.3 MP 19.7 MP 21.5 Revitan 13.2 Arcos 15.9 Arcos 19.6 Arcos 4.3 Revitan 7.2 Corail revision 8.4 Bi-Metric X por HA NC 4.0 Corail revision 6.9 Revitan 5.1 Other 13.4 Other 13.3 Other 11.7 Table 5.4.5. The five most commonly used cemented and uncemented cups and stems in revision surgery, expressed as a percentage of the total number reported in 2013, 2022, and 2023. Includes both first-time and multiple revisions. 1 2 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 5.4.19. Cumulative risk of revision until 15 years, regard- less of sex, based on the outcome of revision for any reason. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.20 a–b. Cumulative risk of revision in males (a) and females (b) until 13 years. Includes revisions regardless of reason and procedure for primary total hip replacement, first- and second-time revisions, as well as revisions of hip replacements that have undergone at least two previous revisions. Revisions performed from 2003 onwards are included. 1 2 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.21 a–b. Cumulative risk of revision in males (a) and females (b), divided by reason for revision and based on the outcome of revision regardless of reason, procedure, or the number of previous revisions. Revisions performed from 2003 onwards are included. The curves are truncated at 13 years, as the number of observations in the smallest group falls below 100 thereafter. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.4.22. Cumulative risk of re-revision for all reasons and Figure 5.4.23. Cumulative risk of re-revision for all reasons and procedures following first-time revisions performed regardless of procedures following first-time revisions performed due to infec- reason during the periods 1997-2005, 2006-2014, and 2015- tion during the periods 1997-2005, 2006-2014, and 2015-2023. 2023. Calculations are terminated when fewer than 100 obser- Calculations are terminated when fewer than 100 observations vations remain (for the periods 2006-2014 and 2015-2023) or remain. after 20 years (for the period 1997-2005). 1 2 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  Summary Revision of a hip replacement involves a patient who has previously undergone hip replacement undergoing an additional operation where the entire prosthesis or parts of it are replaced or extracted. Since the period 2003 to 2005, the proportion of revisions out of the total number of primary and © 2024 The Swedish Arthroplasty Register revision surgeries has decreased from 10.7% to 8.0% during 2021 to 2023. Since 2003, loosening has been the predominant cause of first-time and multiple revisions, but its relative proportion has gradually decreased. Instead, the proportion of revisions due to infection has increased and become the most common reason for revision in cases that have been revised at least once before. Figure 5.4.24. Cumulative risk of re-revision for all reasons and procedures following second-time revisions performed Patients undergoing revision are generally older, regardless of reason during the periods 1997-2005, 2006-2014, more often male, and have more often diagnoses and 2015-2023. Calculations are terminated when fewer than 100 observations remain. other than osteoarthritis, as well as a higher degree of comorbidity compared to those undergoing pri- mary prosthesis surgery. Long-term outcomes after primary and first-time revision, measured as the risk of further revision, have improved. However, in the first few years fol- lowing the index operation, the risk of re-revision has increased due to a growing number of re-revi- sions caused by infection. The risk of experiencing additional revisions increases with the number of previous revisions. The © 2024 The Swedish Arthroplasty Register prognosis is worst for revisions due to infection, fol- lowed by revisions due to dislocation. Therefore, the importance of optimizing outcomes at the primary surgery cannot be overstated. Figure 5.4.25. Cumulative risk of re-revision for all reasons and procedures following revisions that were preceded by at least two previous revisions and performed regardless of reason during the periods 1997-2005, 2006-2014, and 2015-2023. Calculations are terminated when fewer than 100 observations remain. 1 2 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 5.5. Evaluation of implants and implant combinations Author: Johan Kärrholm Regulations for medical devices From 1993 to 2017, implants in the EU were regulated There has been some criticism of the MDR as the regu- under a directive (Medical Device Directive, MDD) lation leaves the choice of study design to manufactur- aimed at harmonizing laws and regulations across the ers, national regulations, and organizations designated EU. To comply with the then-current regulations, man- within a country to assess products and determine what ufacturers had to ensure that their products met relevant type of evidence is required for an implant to be consid- health, environmental, and safety requirements, which ered effective and safe. In 2020, the EFORT Patient & was achieved through external assessment by a designated Implant Safety Initiative (IPSI) was initiated by EFORT, organization (notified body). The resulting CE marking resulting in an initial consensus document on how the (CE = Conformité Européenne) indicated that the prod- introduction of joint prostheses should occur within uct could be used on the European market. CE marking MDR 2017/745. This work was followed by a more for implants did not require evidence of acceptable results comprehensive study, divided into 32 different areas, from well-designed clinical studies but assessed the prod- all related to implants and implant evaluation, with uct more from a material perspective. each area being highlighted by a selected expert group (www.researchgate.net/publication/376751347). In 2017, a new, more ambitious regulatory framework was introduced, the Medical Device Regulation (MDR, Reg- In principle, the new regulation is beneficial as patient ulation (EU) 2017/745), which came into effect on May benefits are significant. The level of safety will be higher, 26, 2021. Transitional provisions apply to certain types and the risk of future implant-related problems will be of implants. The regulation is extensive and emphasizes reduced. However, the regulation also makes it more com- the importance of clinically demonstrable benefits related plicated, time-consuming, and likely more expensive to to the level of risks, unique identification of implants, introduce new implants and innovations. On the other and post-market surveillance. The regulation applies not hand, the need for well-designed clinical studies will also only to entirely new implants but can also pertain to a increase. Reasonably, prices will also be affected, but the new size of an existing prosthesis. The manufacturer must extent of this remains unclear. demonstrate that the new prosthesis provides clear clinical patient benefits combined with a low risk of complica- tions. In practice, this means that unrestricted clinical Situation in Sweden use cannot be permitted until a sufficiently large patient In Sweden, there has long been a cautious stance regard- population has been followed for a sufficient period. ing the replacement of standard implants. This attitude is Additionally, the clinical outcome based on patient-re- likely the main reason why Sweden has among the lowest ported data must meet current standards, and the risk of revision rates in the world. The clinical outcomes for the complications must be low. Although the key parts of the majority of new implants have often been comparable to, regulation have been implemented, some transitional pro- and in several cases worse than, existing ones. In some visions will remain in effect until December 31, 2028. The cases, this cautious attitude may have resulted in implants concept also includes the creation of a database (European with better characteristics than the current standard being Databank on Medical Devices, EUDAMED) where all introduced late into Swedish healthcare. However, this information about a current prosthesis will be collected disadvantage is relatively minor compared to the good and to which complications can be reported. The data- results noted for the most commonly used prosthesis base is still under development. It will provide a unique types in Sweden, as well as the sometimes catastrophic product identification (unique device identifier – UDI), consequences that can arise when a new and unknown information on clinical trials, and will serve, among other implant is used on a large number of patients. things, for safety monitoring and market control. 1 2 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Currently, there are no preclinical tests that can reliably illustrate that the procedure for implant evaluation is not determine whether a new prosthesis functions better or entirely simple or obvious. Most registers use the outcome worse than existing ones. Since the prostheses currently of revision, regardless of the reason or which component used in Sweden generally meet high standards, further is revised. Some registers multiply the number of observed implant development is expected to make a difference components by the number of observation years, which mainly in selected patient groups. Replacing standard means they do not account for the fact that the causes of implants also involves some risk because new procedures revision vary over time. To the extent that comparisons must be learned. Given this, it is clear that implant with other prostheses are made, the comparison group changes should only be made when there is a clinical need can correspond to all other implants, all other implants and the replacement implant has documented advantages. in the same product category, a selected reference group, Service and pricing also matter, although the price usually or a reference implant. Sometimes a fixed threshold, such represents a minor part of the total cost. as 5% cumulative revision risk after 10 years, is used. To date, there has been no established standard. Such a The merged hip and knee arthroplasty registers in Sweden standard is not easy to achieve since the conditions vary have a long history, the longest in the world. Continu- between different registers concerning the total number ous feedback of results has meant that, in general, only of observations, the number of different implants used well-documented implants are routinely used. Despite this, within the register’s coverage, the length of follow-up differences in the risk of revision exist among the implant time, and the extent of the individual register’s data combinations used. When assessing these differences, it capture. Additionally, the thresholds set for acceptable is important to relate them to a clinical reality. If a refer- revision risk are constructed at a specific point in time. ence implant experiences one revision per 1,000 inserted What constitutes an acceptable standard today may not prostheses over a ten-year period, and another implant always hold true. experiences two revisions per 1,000 inserted prostheses, the risk for the latter implant is doubled. The risk also doubles if the reference implant experiences one revision Selection of outcome and control group per 100 inserted prostheses and the other implant expe- Cemented and uncemented implants have been separated, riences two revisions per 100 inserted prostheses. Despite which may be questioned (see separate in-depth analysis). the same increase in risk, case two results in ten times more However, the indication for choosing fixation varies, patients needing revision over a ten-year period. When which may support a division based on fixation type. evaluating the clinical significance of an increased risk, it When evaluating the risk of revision for the cup versus is therefore of great interest to assess how common it is the stem, we have chosen outcomes such as cup or stem for the reference implant to undergo revision. revision caused by non-infectious complications, regardless of the cause. For cups, the outcome is thus cup revision This year’s evaluation of cemented and uncemented cups including liner revision, provided that the revision was not and stems includes surgeries performed between 2013 due to infection. For stems, the corresponding outcome is and 2023. Surgeries caused by acute or previous trauma non-infectious stem revision. In both cases, revisions where (such as fractures/dislocations or residual conditions after other components have also been replaced or extracted are these injuries) and tumor diagnoses have been excluded. included. To report data, the number of observed implants The risk of revision is adjusted for differences in the must exceed 100. distribution of diagnosis, age, sex, and year of surgery. As mentioned above, increased or decreased risk should In each of the four analyses (cemented cup, uncemented be evaluated against the absolute number of revisions in cup, cemented stem, uncemented stem), a comparison is the reference group. One should also consider that the made against a reference implant. The selection criteria analyses presented are more or less affected by partially for the reference implant are based on sufficiently high unknown factors such as patient and provider selection. and continuous usage during the analyzed period. The Many factors must be taken into account when interpret- advantage of a reference implant is that the data may be ing the results. easier to interpret. A possible disadvantage is that the reference implant may need to be changed over time if it In previous annual reports, we have briefly summarized is modified or its relative use decreases or ceases, which in how other prosthesis registers evaluate implants to this year’s analysis applies to the Trilogy cup. This year’s 1 2 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 analysis is based on components inserted from 2013 to in 2023. For this year’s report, a different reference cup, 2023 with follow-up until December 31, 2023. When Trident Hemi, which previously showed a risk for cup evaluating cups, hip replacements with both cemented revision not significantly different from Trilogy, has been and uncemented stems are included. Similarly, cases with chosen. During the period 2013 to 2023, the number of both cemented and uncemented cups are included in the inserted Trident Hemi cups increased from 302 in 2013 stem analysis. This procedure is not obvious because, for to 1,029 in 2023, totaling 8,378 over the entire period. example, the risk of cup revision may be influenced by Most of the Trident Hemi cups have been inserted with the choice of stem fixation. Uncemented stems are more some type of liner with dislocation protection, and a few likely to experience early periprosthetic fractures. During (n=34) with a metal insert and dual-articulating joint. revision, it may also be necessary to replace the cup to Sixteen of the 24 cups presented in Table 5.5.2 have been avoid dislocation. However, we believe that this bias is used only with highly cross-linked polyethylene liners. In relatively limited. Different types of bias and random five of these (Pinnacle W/Gription 100, Pinnacle 100, variations should be considered especially carefully if the Allofit, Regenerex, TMT revision), liners of older polyeth- implant group of focus is below 500 to 1,000 observations ylene types have been used in a few cases (up to 5 cases). and the number of revisions is not notably high. Ceramic liners occur in up to 2.6% (Pinnacle Sector) among the cups that may have different types of inserts. Among those that can be converted to dual-articulating Cemented cup function, this function has been utilized in up to 9% In the group of cemented cups, Marathon has been used (Tritanium Revision, G7 OsseoTi). as the reference. This cup was introduced in 2008. The polyethylene is irradiated with 5 MRad. Between 2013 In Table 5.5.2, none of the uncemented cups significantly and 2023, the number of reported insertions decreased differ from the reference cup due to a lower revision risk. progressively from 1,816 in 2013 to 393 in 2023. In Table Thirteen cups have a significantly increased risk of cup 5.5.1, we see that none of the cups used during the period revision, nine of which also showed increased risk in the have a significantly lower risk than the Marathon cup for previous year’s report when compared to the Trilogy cup. non-infectious cup revision. As in previous years, there The risk increase for some of these cups, especially those are four cups that show an increased risk. Three of them used more frequently, is in many cases doubled and in are made from polyethylene materials that were standard some cases even tripled. All but Trilogy IT and Pinnacle for cemented cups in Sweden until the first decade of W/Gription Sector show a marginally to slightly increased the 2000s (Lubinus, Contemporary Hooded Duration, risk of cup revision due to loosening (Pinnacle Sector: ZCA). In all these cases, these cups are revised more often 0.4%, Pinnacle W/Gription 100: 0.4%, Pinnacle 100: due to loosening (percentage of cup revisions during the 0.5%, Trident AD LW: 0.5%, TMT Revision: 0.6%, ref- period: 0.8%, 1.7%, 2.0%; reference - Marathon 0.6%) erence - Trident Hemi: 0.2%). For some cups, the differ- and less frequently due to dislocation (0.4%, 0.6%, 0.6%; ence is more pronounced (Delta-TT: 0.7%, Continuum: reference - Marathon 0.3%). ZCA XLPE, made of highly 0.7%, BHR: 1.7%, Avantage Reload: 2.5%), but the cross-linked polyethylene, is revised more often than the number of observations for the last two is small. All cups Marathon cup, mainly due to dislocation (0.8%). The with increased revision risk are revised more often due to Contemporary Hooded Duration cup is also notably dislocation except for G7 PPS. The highest frequency of revised more often due to periprosthetic fractures of the revision due to dislocation occurs after the insertion of femur or acetabulum (1.1%; reference - Marathon 0.5%). Continuum, Trilogy IT, and TMT Revision (1.4–2.5%), while the increase for others is more moderate (0.5 to 0.9%; reference - Trident Hemi: 0.3%). In three cases, Uncemented cup the cup has been revised more often in connection with The first version of the Trilogy cup has been used as the revision due to periprosthetic fracture (Avantage Reload, reference until the previous year’s report. This cup has Trident AD LW, Trilogy IT, all 0.8%; reference - Trident been used in Sweden since 1994. Between 2012 and Hemi: 0.3%). 2021, the number of reported Trilogy cups varied from 331 to 672. In 2022, 81 cases were registered, and none 1 3 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Hazard ratio for cemented cup revision with Marathon cup as the reference Revisions Number Number Follow-up* HR (95% CI) p Marathon 11,457 82 10 Reference Lubinus x-link 48,894 307 10 1.16 (0.91;1.49) 0.23 Exeter Rim-fit 24,533 144 10 1.03 (0.78;1.35) 0.84 Lubinus 13,074 146 10 1.71 (1.30;2.24) <0.01 ZCA XLPE 4,808 73 10 1.96 (1.43;2.69) <0.01 IP Link 2,594 13 9 1 (0.56;1.81) 0.99 Exceed ABT E-poly without flange (cem) 2,266 10 10 0.98 (0.51;1.9) 0.96 Avantage 1,826 14 10 1.32 (0.74;2.35) 0.34 Contemporary Hoded Duration 1,306 32 10 2.89 (1.92;4.36) <0.01 ZCA 1,135 27 9 2.89 (1.87;4.48) <0.01 Polarcup cemented 317 <5 8 0.61 (0.09;4.43) 0.63 BiMobile shell 293 <5 2 2.5 (0.61;10.29) 0.20 FAL 161 <5 10 2.1 (0.66;6.67) 0.21 FAL x-link 153 0 10 Low profile cup 137 <5 9 1.78 (0.44;7.25) 0.42 Other 379 7 10 2.62 (1.21;5.67) 0.01 Diagnosis (OA) 0.48 (0.39;0.59) <0.01 Increasing age (per year) 0.97 (0.97;0.98) <0.01 Sex (female) 0.9 (0.78;1.03) 0.12 Later surgical year (per year) 1.06 (1.03;1.09) <0.01 Table 5.5.1. Hazard ratio (HR) with 95% confidence interval for undergoing cup revision with the use of cemented fixation. The Marathon cup serves as the reference (value 1). To be included in the analysis, at least 100 observations are required. Implants with no reported cup revisions are indicated in italics. The reported hazard ratios are adjusted for diagnosis, age, sex, and year of surgery. Follow-up time is reported until fewer than 20 observations remain. Red text indicates a statistically significant increased risk of revision (the lower limit of the confidence interval is above 1.0). Green text indicates a statistically significant decreased risk of revision (the upper limit of the confidence interval is below 1.0). *) Time point in years after the primary surgery when the number of remaining observations is at least 20. 1 3 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Hazard ratio for uncemented cup revision with Trident Hemi as the reference Proportion with liner of Revisions Number standard type % Number Follow-up* HR (95 % CI) p Trident Hemi 8,378 9.8 39 10 Reference Pinnacle W/Gription 100 17,502 75.2 168 10 2.36 (1.66;3.35) <0.01 Pinnacle 100 5,398 41 65 10 2.67 (1.80;3.98) <0.01 Continuum 5,280 62.1 101 10 3.15 (2.17;4.57) <0.01 Trilogy 3,676 1.7 15 10 0.68 (0.38;1.24) 0.21 G7 PPS 3,531 22.7 24 8 2.25 (1.34;3.78) <0.01 Pinnacle W/Gription Sector 3,077 73.3 31 10 2.60 (1.62;4.18) <0.01 Trilogy IT 2,375 22.8 47 10 3.57 (2.33;5.47) <0.01 Pinnacle sector 1,946 77.1 19 10 2.11 (1.22;3.65) 0.008 Exceed ABT Ringlock 1,593 1.8 15 10 1.40 (0.77;2.55) 0.275 Trident AD LW 1,459 1.3 16 10 2.15 (1.20;3.85) 0.01 Trident II 1,150 8.3 <5 5 1.43 (0.51;4.03) 0.501 Tritanium 1,018 26.5 8 10 1.42 (0.66;3.05) 0.364 Trident AD WHA 1,001 19 6 10 1.08 (0.46;2.56) 0.857 Allofit 793 17 5 10 1.09 (0.43;2.79) 0.85 Delta-TT 698 73.4 9 10 2.09 (1.01;4.32) 0.047 Regenerex 614 0.3 6 10 1.36 (0.57;3.22) 0.489 TMT revision 360 5.3 9 10 3.72 (1.79;7.74) <0.01 Tritanium revision (trident) 146 2.1 <5 6 1.62 (0.22;11.84) 0.635 BHR 120 - 5 10 4.94 (1.92;12.72) <0.01 Avantage Reload 118 - <5 8 4.49 (1.38;14.59) 0.012 Delta Motion 116 -# <5 10 0.91 (0.12;6.68) 0.927 G7 OsseoTi 110 67.3 <5 8 4.74 (1.14;19.66) 0.03 R3 107 97.2 <5 10 1.16 (0.16;8.48) 0.882 Delta-PF 100 96 <5 9 2.94 (0.71;12.20) 0.138 Other 743 35.7 23 10 5.13 (3.04;8.65) <0.01 Diagnosis (OA) 0.68 (0.54;0.86) <0.01 Increasing age (per year) 1.00 (0.99;1.00) 0.2 Sex (female) 0.95 (0.81;1.11) 0.53 Later surgical year (per year) 0.99 (0.96;1.02) 0.51 Table 5.5.2. Hazard ratio (HR) with 95% confidence interval for undergoing cup revision with the use of uncemented fixation. The proportion of cups inserted with a standard liner is reported separately. The Trident Hemi cup serves as the reference (value 1). To be included in the analysis, at least 100 observations are required. The reported hazard ratios are adjusted for diagnosis, age, sex, and year of surgery. Follow-up time is reported until fewer than 20 observations remain. Red text indicates a statistically significant increased risk of revision (the lower limit of the confidence interval is above 1.0). Green text indicates a statistically significant decreased risk of revision (the upper limit of the confidence interval is below 1.0). *) Time point in years after the primary surgery when the number of remaining observations is at least 20. #) Monoblock cup with a ceramic bearing surface -) Shell for dual mobility cup or surface replacement cup 1 3 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Cemented stem In the analysis of cemented stems, the SPII stem 150 mm Five of the seven cemented stem types reported (MS30, has been used as the reference. This choice is based on a Exeter 150, Exeter 125, SPI 130, Exeter stem length large number of observations and long-term documenta- unknown) have an increased risk of stem revision during tion. Previous reports have shown a low risk of revision the current period. All except Exeter 150 mm show a more for the SPII stem, with some reservation for the smallest than doubled risk. CPT 130 mm also has a doubled risk, size (extra narrow, size 01). Size 01 constitutes 2.4% of but unlike the previous year, the difference is not statisti- the reference group. In the Swedish Arthroplasty Register’s cally significant. MS30, Exeter 150 mm, Exeter 125 mm, database, the length of a relatively large proportion of and the Exeter group with unknown stem length all show Exeter stems (18.6%) is missing. In the previous year’s an increased proportion revised due to periprosthetic frac- analysis, these were combined with Exeter stems of length ture (all 0.3 to 0.4%; reference - SPII 150 mm: <0.05%). 150 mm. This year, the group with unknown stem length MS30 is also relatively more often revised due to dislo- is reported separately (“Exeter stem length unknown,” cation (0.2%; reference stem <0.05%). The short Exeter Table 5.5.3). stem is revised more frequently due to implant fracture (0.07%; reference stem: 0.002%). Regarding Lubinus 130 mm, it is revised twice as often due to loosening compared to the two-centimeter longer stem of the same design (see separate in-depth analysis). Hazard ratio for cemented stem revision with SPII 150 mm as the reference Revisions Number Number Follow-up* HR (95 % CI) p SPII 150 mm 56 472 214 10 Referens MS30 15 588 116 10 2,42 (1,93;3,04) <0,01 Exeter 150 mm 21 422 121 10 1,42 (1,13;1,74) <0,01 Exeter 125 mm# 2 805 21 10 2,42 (1,53;3,84) <0,01 CPT 130 mm 508 <5 8 2,02 (0,63;6,44) 0,213 SPII 130 mm 3 610 29 10 2,72 (1,83;4,04) <0,01 Exeter stamlängd okänd 5 676 45 10 2,32 (1,63;3,24) <0,01 SPII 170 mm 129 0 1 Övriga 413 6 10 2,32 (1,03;5,44) 0,038 Diagnos (artros) 0,42 (0,33;0,64) <0,01 Ökande ålder (per år) 0,92 (0,93;1,04) 0,61 Kön (kvinna) 0,42 (0,33;0,44) <0,01 Senare operationsår (per år) 1,02 (0,93;1,04) 0,37 Table 5.5.3. Hazard ratio (HR) with 95% confidence interval for undergoing stem revision with the use of cemented fixation. The SPII stem 150 mm serves as the reference (value 1). To be included in the analysis, at least 100 observations are required. The reported hazard ratios are adjusted for diagnosis, age, sex, and year of surgery. Follow-up time is reported until fewer than 20 observations remain. Red text indicates a statistically significant increased risk of revision (the lower limit of the confidence interval is above 1.0). Green text indicates a statistically significant decreased risk of revision (the upper limit of the confidence interval is below 1.0). Italic text indicates that the data set is insufficient for analysis. *) Time point in years after the primary surgery when the number of remaining observations is at least 20. #) Includes short revision stems 1 3 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Uncemented stem In this year’s analysis, Corail standard with collar has the relative proportion of Corail standard stems with a been used as the reference. In previous reports, standard collar increased, and by 2020, the ratio of collared to stems with and without collars were grouped together. In collarless stems was reversed (64.9% collared stems). 2013, the collarless variant was more common, account- Since then, their proportion has continued to rise, and ing for about two-thirds of all reported standard stems by 2023, 89.1% of the reported Corail standard stems (64.5%). However, a change occurred in 2018, when were collared. Hazard ratio for revision of uncemented stem with Corail standard with collar as the reference Revisions Number Number Follow-up* HR (95 % CI) p Corail standard with collar 11,848 73 10 Reference Corail standard without collar 11,180 94 10 1.10 (0.80;1.50) 0.555 Corail coxa vara 7,422 27 10 0.55 (0.36;0.86) 0.009 Corail high offset 7,002 83 10 1.67 (1.21;2.31) <0.01 CLS 6,924 60 10 1.26 (0.89;1.79) 0.197 Accolade II 6,451 28 10 0.72 (0.46;1.11) 0.134 M/L Taper 5,383 44 10 1.52 (1.04;2.22) 0.03 Bi-Metric X por HA NC 4,059 61 10 1.71 (1.20;2.46) <0.01 Echo-Bimetric (FPP) 2,312 14 9 1.14 (0.64;2.03) 0.659 Wagner Cone 1,417 20 10 2.00 (1.21;3.33) 0.007 ABG II HA 1,062 29 10 3.23 (2.07;5.03) <0.01 Accolade Straight 415 <5 10 0.54 (0.13;2.20) 0.386 SP-CL 393 <5 8 1.24 (0.39;3.93) 0.72 Echo-Bimetric (RPP) 333 <5 9 1.55 (0.49;4.93) 0.457 Bi-Metric por HA 223 <5 7 0.59 (0.08;4.23) 0.597 ANATO 151 <5 9 4.03 (1.47;11.04) 0.007 Fitmore 147 <5 10 0.75 (0.10;5.45) 0.779 CFP 125 <5 10 3.56 (1.29;9.86) 0.015 Other 638 7 10 1.47 (0.67;3.21) 0.333 Diagnosis (OA) 0.79 (0.59;1.07) 0.127 Increasing age (per year) 1.02 (1.01;1.03) <0.01 Sex (female) 0.93 (0.78;1.10) 0.399 Later surgical year (per year) 1.00 (0.97;1.04) 0.917 Table 5.5.4. Hazard ratio (HR) with 95% confidence interval for undergoing stem revision with the use of uncemented fixation. The Corail stem with standard offset and 135° CCD angle with collar serves as the reference (value 1). To be included in the analysis, at least 100 observations are required. The reported hazard ratios are adjusted for diagnosis, age, sex, and year of surgery. Follow-up time is reported until fewer than 20 observations remain. Red text indicates a statistically significant increased risk of revision (the lower limit of the confidence interval is above 1.0). Green text indicates a statistically significant decreased risk of revision (the upper limit of the confidence interval is below 1.0). *) Time point in years after the primary surgery when the number of remaining observations is at least 20. 1 3 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Of the seven stems that show an increased risk of stem revision, five of them have a higher risk for revision due to Summary loosening. For the M/L Taper, which in previous years was not associated with a significant increase in revision risk, The European Union’s Medical Device Regulation the increase is marginal (0.3%, compared to the reference (MDR) came into effect at the end of May 2021. Corail standard with collar: 0.2%). The M/L Taper stem This new regulation requires that the clinical benefit also shows a marginally increased risk for revision due to of orthopedic implants, combined with a low risk periprosthetic fracture (0.3%, reference: 0.2%). The other of complications, must be demonstrated before an stems that exhibit higher frequencies of revision due to implant can be marketed. This means that unre- loosening include: Corail High Offset and ABG II HA stricted clinical use cannot be permitted until a suf- (both 0.7%), Wagner Cone (1.0%), ANATO (2.0%), CFP ficiently large patient population has been followed (3.2%). Aside from M/L Taper (0.3%, reference: 0.2%), up for a sufficient period of time. Transitional rules ABG II HA (1.5%) also shows an increased frequency of apply until 2028. revision due to periprosthetic fracture, as does Bi-Metric X por HA NC (1.2%) and Corail High Offset (0.4%). Wag- In the evaluation of implants inserted from 2013 ner Cone, ABG II HA, and ANATO have also been revised to 2023, no specific design, except for the Corail more frequently due to dislocation (Wagner Cone: 0.3%, Coxa Vara stem, showed a significantly lower risk ABG II HA: 0.5%, ANATO: 0.7%; reference: 0.1%). for non-infectious cup or stem revision compared to the selected reference implants after adjusting for As noted, interpreting the clinical significance of increased age, sex, and diagnosis. However, several implants or decreased revision risk can be challenging. More showed an increased risk, which could be attributed detailed data are often required to assess the extent to to implant-specific factors. Other factors, such as which patient selection, hip anatomy, and factors such as the choice of articulation, surgical technique, and the care process and surgical technique have influenced comorbidities, may also have influenced the results, the results. Factors that might have relatively greater especially in cases with a limited number of obser- influence, especially when the number of observations vations. is relatively small, need to be considered. For implants used in thousands and showing increased revision risk over ongoing years, the likelihood that the observed risk increase is at least partially attributable to the implant itself is higher. However, biases might still exist, such as with stems primarily used for patients with unusual hip anatomy or cups that are almost exclusively used with standard liners compared to those used with liners or inserts that offer increased protection against dislocation. 1 3 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 5.6 Hip fracture treatment with hemiarthroplasty or total hip replacement Author: Cecilia Rogmark In 2023, the number of individuals treated with a prosthe- In 2023, the Swedish Fracture Register reported 15,363 sis for hip fractures continued to increase, reaching 7,264. hip fractures in adults. Considering the known complete- ness of the register, this figure would correspond to nearly This chapter covers both hemiarthroplasty and total hip 17,000 hip fractures. No exact number can be drawn from replacement as methods of fracture treatment, which are the National Patient Register (NPR), as the same fracture the most common approaches for displaced femoral neck can be registered multiple times and right/left codes are fractures. Other types of hip fractures are typically treated sparse used. Adding to the uncertainty about the exact with internal fixation. Over 40% of patients undergoing number of hip fractures, a recently published epidemi- surgery for a hip fracture receive a hip prosthesis. ological study indicates that only 13,929 hip fractures occurred in people over 50 years of age in Sweden in 2019 (Michaëlsson et al. Sci Re. 2024 Jan 6;14(1):706). This Demography in hip arthroplasty as fracture treatment 2019 2020 2021 2022 2023 Number 6,532 6,478 6,477 7,003 7,264 Mean age (SD) 81.6 (9.3) 81.4 (9.5) 81.4 (9.3) 81.2 (9.3) 81.4 (9.1) Age group n (%) < 45 years 11 (0.2) 17 (0.3) 14 (0.2) 22 (0.3) 15 (0.2) 45-54 years 51 (0.8) 44 (0.7) 50 (0.8) 42 (0.6) 34 (0.5) 55-64 years 239 (3.7) 248 (3.8) 234 (3.6) 268 (3.8) 269 (3.7) 65-74 years 1,046 (16.0) 1,068 (16.5) 1,026 (15.8) 1,163 (16.6) 1,115 (15.3) 75-84 years 2,442 (37.4) 2,422 (37.4) 2,445 (37.7) 2,746 (39.2) 2,973 (40.9) ≥85 years 2,743 (42.0) 2,679 (41.4) 2,708 (41.8) 2,762 (39.4) 2,858 (39.3) Females n (%) 4,216 (64.5) 4,047 (62.5) 4,180 (64.5) 4,461 (63.7) 4,524 (62.3) BMI n (%) < 18.5 364 (7.0) 341 (6.7) 410 (7.7) 423 (7.1) 487 (7.6) 18.5-24.9 2,888 (55.6) 2,918 (57.3) 2,918 (54.7) 3,303 (55.1) 3,530 (55.1) 25-29.9 1,516 (29.2) 1,431 (28.1) 1,529 (28.7) 1,750 (29.2) 1,854 (28.9) 30-34.5 362 (7.0) 332 (6.5) 383 (7.2) 431 (7.2) 436 (6.8) 35-39.9 52 (1.0) 64 (1.3) 75 (1.4) 71 (1.2) 82 (1.3) ≥ 40 14 (0.3) 9 (0.2) 19 (0.4) 18 (0.3) 16 (0.2) ASA-class n (%) ASA I 235 (3.7) 161 (2.6) 199 (3.1) 213 (3.1) 206 (2.9) ASA II 2,258 (35.7) 2,138 (34.1) 2,170 (34.3) 2,302 (33.6) 2,343 (33.0) ASA III 3,428 (54.2) 3,542 (56.5) 3,492 (55.2) 3,878 (56.5) 4,015 (56.5) ASA IV 399 (6.3) 426 (6.8) 463 (7.3) 466 (6.8) 537 (7.6) Table 5.6.1. Demography in fracture related hip arthroplasty. 1 3 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 The most common stem components in fracture patients 2013 2022 2023 Number 6,241 7,003 7,264 Implant, n (%) SPII standard 2,751 (44.1) 4,547 (65.4) 4,938 (68.5) Exeter standard 2,057 (33.0) 1,703 (24.5) 1,615 (22.4) MS-30 polished 325 (5.2) 393 (5.7) 338 (4.7) Covision straight 373 (6.0) 145 (2.1) 148 (2.1) CPT 382 (6.1) 9 (0.1) 7 (0.1) Corail standard 104 (1.7) 16 (0.2) 23 (0.3) Exeter long 34 (0.5) 19 (0.3) 16 (0.2) Restoration 16 (0.3) 26 (0.4) 26 (0.4) MP proximal standard 20 (0.3) 15 (0.2) 15 (0.2) Bi-Metric X por HA NC 46 (0.7) 0 (0.0) 0 (0.0) Corail coxa vara 16 (0.3) 11 (0.2) 6 (0.1) Wagner Cone 29 (0.5) <5 <5 Corail high offset 6 (0.1) 10 (0.1) 10 (0.1) Accolade II <5 10 (0.1) 11 (0.2) Other 79 (1.3) 29 (0.4) 26 (0.4) Unknown 0 (0.0) 19 (0.3) 26 (0.4) Table 5.6.2. The most common stem components in fracture patients. analysis, based on the NPR and not considering national rates but are also more complex. It is assumed that there quality registers, concludes that the number of fractures is a learning curve of around 100 surgeries before master- has decreased and will continue to decrease. While this ing the technique. This makes the anterior approach less message is encouraging for both individuals and society, suitable for low-volume surgeons, and its use for fracture the discrepancy between various calculations and sources patients in Sweden remains low. This year, the number remains frustrating. of hemiarthroplasties and total hip replacements with DM cups continues to increase, while the number of In 2023, there was a shift in the age demographics for hip conventional total hip replacements remains unchanged fracture patients, with the 75–84 age group becoming (Figure 5.6.5). the largest. Previously, those aged 85 and older had con- stituted the largest group. This change reflects the large Regarding femoral stems, the use of Lubinus SPII stems cohorts born from 1945 onward. At the same time, there has further increased, with 68% of patients receiving is a slight increase in the proportion of patients who are this type in 2023. The Exeter stem was used for 22% of significantly ill (ASA class 3 and 4). Other demographic fracture patients. Including MS-30 and Covision straight factors remain unchanged (Table 5.6.1). stems, nearly 98% of patients are now treated with these cemented stems (Table 5.6.2). These four types show The rising number of individuals treated with hip pros- relatively similar rates of revision surgery (Figure 5.6.2 thesis due to fracture has led to an increase in direct lateral b-e). Lubinus SPII and Exeter stems can now be followed approach, but the ratio of surgical approaches remains up to 15 years, with a revision rate of just under 7%. relatively stable (Figure 5.6.1). Internationally, various The MS-30 stem shows a slightly higher rate at 14 years anterior approaches have gained increased interest. These (9%), while Covision straight has a revision rate around approaches have some advantages in terms of dislocation 4% at 11 years. 1 3 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Sweden exhibits a uniquely low use of uncemented stems for fracture surgery. The most common uncemented stem, Corail, has a higher revision rate compared to cemented stems, with a rate of just over 12% at 14 years (Figure 5.6.2 a). Surgeons have the option to choose between a hemiarthro- © 2024 The Swedish Arthroplasty Register plasty or a total hip replacement with an acetabular cup. These options contribute to a wider variety of implant models regarding articulation (Table 5.6.3) compared to the stem options. The unipolar prosthetic head remains the most common choice, followed by the relatively new Modular Trauma Head (unipolar) and the bipolar UHR Universal Head. When an acetabular cup is used, Lubinus X-link is the most common. The proportion of DM cups is slightly increasing, with Avantage being the most common choice. The direct lateral approach has a lower revision rate Figure 5.6.1. Choice of surgical approach in fracture related hip arthroplasty. throughout the entire 15-year period compared to the posterior (Figure 5.6.3). © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.6.2 a. Cumulative risk of revision for the uncemented Figure 5.6.2 b. Cumulative risk of revision for the cemented Corail stem. Lubinus II stem. 1 3 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.6.2 c. Cumulative risk of revision for the cemented Figure 5.6.2 d. Cumulative risk of revision for the cemented MS30 Exeter standard stem. polished stem. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.6.2e. Cumulative risk of revision for the cemented Figure 5.6.3. Cumulative risk of revision related to surgical approach. Covision straight stem. 1 3 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Among the four articulation types, the cumulative revi- • Avoid hemiarthroplasty for active and cognitively sion rates are similar (Figure 5.6.4). Total hip replace- intact individuals who walk outdoors (without walking ments have a lower revision rate in the initial years, but aids) and can perform daily activities independently, after 3 to 4 years, no significant difference is observed. The to reduce the risk of acetabular erosion and subsequent DM cups follow similar trends to the other articulation osteoarthritis. types. However, revision rates do not fully capture the overall clinical picture; a significant proportion of patients • Avoid hemiarthroplasty for patients with symptomatic who experience complications are treated either with less arthritis or osteoarthritis in the affected hip. invasive interventions or non-operatively, and their com- plications are not reflected in this analysis. • Avoid total hip replacement for patients with cognitive impairment, those who need walking aids for daily activities, or those with a short expected lifespan, to New national recommendations reduce the risk of dislocation. The recommended treatment for femoral neck fractures is outlined in the National Guidelines for Hip Fractures Considering the fact that most patients with hip fracture published in 2024 (vardpersonal.1177.se/globalassets/ are frail and have reduced function before their injury, nkk/nationell/media/dokument/kunskapsstod/vardpro- these recommendations should lead to a decrease in the gram/nationellt-vardprogram-for-hoftfraktur.pdf ). number of total hip replacements and an increase in hemiarthroplasties. For undisplaced femoral neck fractures, the new rec- ommendation is that most patients, regardless of age The guidelines also mentions that direct lateral approach or functional ability, should undergo internal fixation is the preferred choice for hip replacement due to hip with 2–3 parallel pins or screws, or alternatively a slid- fracture and that a DM cup may reduce the risk of dislo- ing screw plate. Prosthesis surgery can be considered for cation after total hip replacement; for hemiarthro­plasty, older patients with fracture angulation in the lateral plane soft-tissue preserving surgical techniques may have a greater than 20 degrees backward. The latter could lead beneficial effect. to a slight increase in the number of hip replacements performed. Early reoperations For undisplaced fractures, the Swedish orthopedic com- Early complications such as deep infection, dislocation, munity is also awaiting the results of the register-based and periprosthetic fracture are the most common amongst randomized HipSTHeR study, which compares internal people who had their arthroplasty due to acute fracture. If fixation with prosthesis surgery in patients over 75 years there are reasons to avoid revision surgery, the physician of age, regardless of lateral plane angulation. may opt for other, less invasive procedures. Therefore, both major and minor secondary procedures are reported For displaced femoral neck fractures, internal fixation is in Table 5.6.4 “Reoperations within six months”. This advised against for older patients who are deemed capa- table should be interpreted with caution: if a hospital does ble of undergoing prosthesis surgery. However, internal not manage registry work satisfactorily, a low number here fixation should be offered to younger, healthier, and more may indicate poor reporting practices. active individuals, despite a higher risk of reoperations. This aligns with current practice in Swedish hospitals, The national average result is 3% early reoperations. where a (biological) age threshold between “younger” and Among the 16 units with reoperation rates over 4%, there “older” is set at 60–65 years. are some small units where individual cases significantly impact the outcomes, as well as units with atypical case The choice between hemiarthroplasty and total hip mixes. A high frequency of early reoperations may also replacement varies significantly between hospitals. The reflect a proactive approach to addressing issues such as national recommendations are: dislocation surgically. Nonetheless, units with high reop- eration rates are recommended to conduct local quality improvement efforts. 1 4 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 5.6.4. Cumulative risk of revision related to type of Figure 5.6.5. Choice of prosthesis in fracture related hip arthroplasty. prosthesis. The most common cup/head components 2013 2022 2023 Number 6,241 7,003 7,264 Implant, n (%) Unipolar femoral head 1,557 (24.9) 1,669 (23.8) 1,809 (24.9) Modular Trauma Heads 0 (0.0) 1,182 (16.9) 1,391 (19.1) UHR Universal Head 670 (10.7) 914 (13.1) 954 (13.1) Lubinus x-link 250 (4.0) 613 (8.8) 600 (8.3) Unitrax modular endohead 564 (9.0) 404 (5.8) 318 (4.4) Avantage 203 (3.3) 331 (4.7) 346 (4.8) Exeter Rim-fit 151 (2.4) 309 (4.4) 305 (4.2) Lubinus 446 (7.1) 178 (2.5) 118 (1.6) Marathon 393 (6.3) 154 (2.2) 161 (2.2) Covision unipolar 376 (6.0) 144 (2.1) 148 (2.0) MultiPolar Bipolar Cup 126 (2.0) 184 (2.6) 176 (2.4) Vario cup 186 (3.0) 126 (1.8) 136 (1.9) V40 unipolar 367 (5.9) 0 (0.0) <5 BiMobile shell 0 (0.0) 160 (2.3) 196 (2.7) Polarcup cemented 76 (1.2) 142 (2.0) 115 (1.6) Other 876 (14.0) 493 (7.0) 490 (6.7) Table 5.6.3. The most common cup/head components in fracture patients. 1 4 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Reoperations within six months per unit Number of Number of Unit primary operations1 reoperations2 Proportion (%)3 University units Akademiska sjukhuset 769 16 2.1 Karolinska Huddinge 430 17 4.2 Karolinska Solna 40 1 2.6 Linköping 540 19 3.7 SU/Mölndal 1,174 31 2.8 SUS/Lund 641 15 2.4 SUS/Malmö 659 28 4.4 Umeå 365 8 2.3 Örebro 110 4 4.1 Privately run units Capio S:t Göran 628 16 2.7 Other units Alingsås 159 12 7.8 Borås 422 7 1.8 Danderyd 966 31 3.3 Eksjö 198 11 6.0 Eskilstuna 362 16 4.6 Falun 455 15 3.4 Gällivare 175 11 6.6 Gävle 501 11 2.3 Halmstad 385 8 2.2 Helsingborg 609 26 4.5 Hudiksvall 231 2 0.9 Hässleholm 26 0 0.0 Jönköping 267 6 2.4 Kalmar 341 3 0.9 Karlskoga 368 10 2.9 Karlskrona 429 5 1.2 Karlstad 584 20 3.6 Kristianstad 441 17 4.0 Kungälv 287 8 2.9 Lindesberg 212 2 1.0 Lidköping 134 2 1.5 Table continued on next page. 1 4 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Reoperations within six months per unit, cont. Number of Number of Unit primary operations1 reoperations2 Proportion (%)3 Ljungby 139 6 4.4 Lycksele 82 1 1.2 Mora 252 6 2.5 Norrköping 328 2 0.6 Norrtälje 156 7 4.6 Nyköping 221 7 3.2 NÄL 816 25 3.2 Piteå 34 2 6.1 Skellefteå 225 7 3.3 Skövde 492 20 4.3 Sunderby sjukhus 513 6 1.2 Sundsvall 362 6 1.8 Södersjukhuset 1 095 23 2.2 Södertälje 221 2 1.0 Torsby 100 2 2.2 Trelleborg 45 4 9.7 Varberg 380 8 2.1 Visby 160 7 4.5 Värnamo 165 7 4.4 Västerås 589 15 2.7 Växjö 314 10 3.3 Ystad 316 11 3.6 Örnsköldsvik 232 1 0.4 Östersund 310 9 2.9 Country 20,747 579 2.9 Table 5.6.4. Reoperations within six months per unit. 1) Number of primary operations for fracture patients 2021–2023. Units with less than 20 operations in the period are excluded. 2) Number of re-operations within six months. 3) Proportion of reoperations calculated using competing risk analysis at six months’ follow-up. 1 4 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Since its start in 1975 until December 2023, a total of 365,252 primary knee replacements and 31,640 reoperations have been registered in 275,835 individuals. 6. Knee replacement 6.1. Primary knee replacement Authors: Annette W-Dahl and Perna Ighani Arani In 2023, 20,622 primary knee replacements were regis- The mean age for primary knee replacement in 2023 was tered, an increase of over 3,600 compared to 2022, repre- 69.4 years, similar to 2022 (69.2 years). Historically, the senting a 17% rise. The standard treatment for a primary mean age has increased from slightly over 65 years in 1975 knee replacement is a total knee replacement (TKR), to just over 71 years in 1994. This increase was primarily which accounted for 88% of the procedures in 2023. due to the largest rise in the number of operations among The proportion of unicompartmental knee replacement older age groups. A likely explanation for this trend is (UKR) is slightly lower than in 2022, with 11.6% of oper- improved anesthesiology techniques, which increased ations being UKRs, of which 2.5% were lateral UKRs. safety for older patients, along with shifts in the popula- Other types of replacements (patellofemoral prostheses tion’s age structure. After 1994, the proportion of patients and partial prostheses) were reported in limited numbers under 65 years slightly increased, resulting in a decrease (see Figure 6.1.1). A total of 80 units reported to the regis- in the mean age. However, this trend has not continued ter during the year, including all those performing elective in recent years, with the exception of the pandemic years knee replacement surgeries. It should be noted that the 2020 and 2021, when many older patients did not receive number of replacements may vary slightly between anal- care to the same extent as before. The age group 65–74 yses as the data were extracted at different time points. years constitutes the largest portion of patients, at 38.4%, Table 6.1.1 shows the demographics for primary knee followed by the age group 75–84 years, which accounts replacements divided into TKR and medial UKR. for 29.1%. Slightly more than one fourth (26.7%) of primary knee replacements were performed on patients under 65 years. 1 4 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Flow-chart knee replacements 2023 All types of primary knee replacements, n = 20,622 Partial replacements (PR) n=8 Patellofemoral replacements (PF) n = 66 Stabilized prosthesis n = 68 Primary knee replacements n = 20,480 Total knee Medial unicompartmental Lateral unicompartmental replacements (TKR) knee replacement knee replacement n = 18,081 n = 2,329 n = 60 Unicompartmental Other diagnosis knee replacement (UKR) n = 426 n = 2,389 Other diagnosis n = 37 TKR due to OA UKR due to OA n = 17,655 n = 2,352 Figure 6.1.1 Flow-chart knee replacements 2023. The mean age of patients undergoing medial UKR is The registration of BMI and ASA class for knee replace- about 3 years younger than those undergoing TKR (66.6 ments was initiated in 2009. The proportion of primary years vs. 69.8 years). In contrast, the mean age for patients knee replacements on individuals with obesity (BMI ≥ 30) undergoing lateral UKR is about two years older than remains largely the same from 2009/2010 (just over 37%) for those undergoing medial UKR (68.5 years). In 2023, to 2023 (36.3%). However, the proportion of individuals slightly more than one fourth (27.9%) of TKRs were per- with a BMI ≥ 35 has decreased from 11% to 7%. The formed on patients aged 65 years or younger, compared proportion of primary TKR procedures for individuals to 41.8% of those undergoing medial UKR and 38.3% with obesity (BMI ≥ 30) is slightly higher (37%) com- of those undergoing lateral UR. pared to those receiving UKR (32%). Just over 28% of patients undergoing lateral UKR have obesity, compared Knee replacement surgery is more common among to approximately one-third of those undergoing medial females than males. In the early 1980s, 70% of the surger- UKR. The corresponding proportions for those with BMI ies were performed on females. Since then, the proportion ≥ 35 are 8.3% for TKR, 6.1% for medial UKR, and 1.7% of surgeries performed on males has gradually increased, for lateral UKR. reaching just over 44.6% in 2023. A higher proportion of females undergo TKR (56.2%). In medial UKR, the In 2023, the proportion of primary surgeries performed proportion of males is higher (51.2%) compared to TKR on individuals classified as ASA class III–IV was slightly and lateral UKR (33.3%). higher (18%) compared to 2009/2010 (15.2%). Among 1 4 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Demography TKR and UKR 2021–2023 2021 2022 2023 TKR UKR medial TKR UKR medial TKR UKR medial Number 11,146 1,619 15,013 2,054 18,289 2,335 Mean age (SD) 69.1 (9.1) 65.9 (9.0) 69.7 (8.9) 66.1 (9.0) 69.8 (8.8) 66.58 (8.85) Age group, n (%) < 45 years 46 (0.4) 9 (0.6) 53 (0.4) 10 (0.5) 50 (0.3) 9 (0.4) 45-54 years 638 (5.7) 160 (9.9) 735 (4.9) 207 (10.1) 820 (4.5) 208 (8.9) 55-64 years 2,784 (25.0) 538 (33.2) 3,469 (23.1) 659 (32.1) 4,228 (23.1) 758 (32.5) 65-74 years 4,224 (37.9) 608 (37.6) 5,828 (38.8) 791 (38.5) 7,071 (38.7) 874 (37.4) 75-84 years 3,125 (28.0) 283 (17.5) 4,483 (29.9) 350 (17.0) 5,571 (30.5) 456 (19.5) ≥85 years 329 (3.0) 21 (1.3) 445 (3.0) 37 (1.8) 549 (3.0) 30 (1.3) Females, n(%) 6,284 (56.4) 773 (47.7) 8,428 (56.1) 988 (48.1) 10,282 (56.2) 1,139 (48.8) BMI, n(%) < 18.5 22 (0.2) <5 31 (0.2) <5 41 (0.2) <5 18.5-24.9 2,114 (19.1) 298 (18.5) 2,926 (19.7) 374 (18.4) 3,467 (19.1) 462 (19.9) 25-29.9 4,833 (43.7) 793 (49.2) 6,455 (43.4) 969 (47.6) 7,890 (43.5) 1,107 (47.7) 30-34.5 3,160 (28.6) 436 (27.1) 4,258 (28.6) 585 (28.7) 5,241 (28.9) 609 (26.2) 35-39.9 849 (7.7) 77 (4.8) 1,078 (7.2) 100 (4.9) 1,342 (7.4) 130 (5.6) ≥ 40 90 (0.8) 5 (0.3) 127 (0.9) 8 (0.4) 160 (0.9) 11 (0.5) ASA-class, n(%) I 1,689 (15.3) 389 (24.2) 2,439 (13.9) 465 (22.7) 2,439 (13.5) 500 (21.6) II 7,478 (67.7) 1,044 (64.8) 9,880 (66.8) 1,304 (63.7) 12,178 (67.5) 1,565 (67.6) III-V 1,874 (17.0) 177 (11.0) 2,861 (19.3) 279 (13.6) 3,418 (18.9) 251 (10.9) Diagnosis, n (%) Osteoarthritis 10,801 (97.0) 1,584 (97.8) 14,607 (97.5) 2,021 (98.4) 17,833 (97.6) 2,299 (98.5) Acute trauma 23 (0.2) <5 26 (0.2) <5 43 (0.2) <5 Osteonecrosis 67 (0.6) 30 (1.9) 80 (0.5) 28 (1.4) 102 (0.6) 29 (1.2) Inflamatory joint disease 161 (1.4) 0 (0.0) 173 (1.2) <5 180 (1.0) <5 Sequele fracture/trauma 75 (0.7) 0 (0.0) 88 (0.6) <5 98 (0.5) 0 (0.0) Tumor 6 (0.1) 0 (0.0) 9 (0.1) 0 (0.0) 8 (0.0) 0 (0.0) Other joint diseases <5 <5 6 (0.0) <5 5 (0.0) <5 Table 6.1.1. Demography in TKR and UKR 2023. 1 4 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 those who underwent TKR, a larger proportion was clas- cannot be generalized for university hospitals, privately sified as ASA III–IV (18.9%) compared to those receiving run units, or other types of units. medial UKR (10.8%) and lateral UKR (18.3%). It was reported that 15% of the knee replacements involved Osteoarthritis was the predominant indication for pri- a previous surgery on the same knee (not shown in the mary knee replacement for TKR (97.6%), medial UKR table). Meniscus surgery was the most common (6%), (98.5%), and lateral UKR (98.3%). The number of sur- followed by arthroscopy (3.5%), cruciate ligament surgery geries for inflammatory joint diseases, primarily rheuma- (2.6%), osteosynthesis (0.9%), osteotomy (0.8%), and toid arthritis, has decreased, particularly in recent years, other surgeries (1.3%). For 3% of the knee replacements, possibly due to advancements in medical treatment. more than one previous surgery was reported. This data Osteonecrosis was a more common diagnosis for medial provides an overview of known prior procedures at the UKR (1.3%) compared to TKR (0.6%). time of the current surgery but does not offer a detailed account of past interventions. In 2023, 78 stabilized prostheses, 66 patellofemoral pros- theses, and 8 partial prostheses were reported. The mean age was 68.6 years for those who received a stabilized Prophylactic antibiotics prosthesis, 59.4 years for those with a patellofemoral pros- The indicators for prophylactic antibiotic (Table 6.1.3) are thesis, and 41.0 years for those with a partial prosthesis. based on the recommendations from the PRISS project More females than males were reported for both stabilized reported for 2023. Due to a Swedish study (Robertsson et prostheses (59/19) and patellofemoral prostheses (54/12). al. 2017) which demonstrated an increased risk of revision due to infection in patients who received clindamycin compared to those given cloxacillin, the recommenda- Case mix tions for penicillin-allergic patients have been revised. Table 6.1.2 shows the proportion of surgeries performed The revised recommendation, effective from April 2023, due to osteoarthritis (OA), the proportion of females, the is available at www.patientforsakringen.se. proportion under 55 years of age, the proportion with a BMI of 35 or above, and the proportion classified as ASA The columns “% receiving Cloxacillin/Cefotaxime/ III or higher for each unit. Dalacin”, “% receiving dose 2 g × 3/2 g × 2/600 mg × 2”, and “% with AB timing (45–30 min)” indicate the University hospitals had a higher proportion of diagno- proportion of surgeries where antibiotics were admin- ses other than OA and ASA class ≥III compared to the istered according to the PRISS recommendations. The national average. University hospitals generally have a column “% with AB timing (45–15 minutes)” shows the higher proportion of patients under 55 years of age. Pri- proportion of reported operations where the preoperative vately run units typically report a lower proportion of ASA dose was administered 45–15 minutes before the start of ≥III compared to the national average, with exceptions the surgery, which was the previously recommended time including Capio Movement, Capio Orthopedics Motala, interval and has been reported in previous annual reports. and St. Görans Hospital. All units report that they used cloxacillin or an equivalent as Regionally run units that are not categorized as univer- the first choice. The use of Dalacin as prophylaxis decreased sity hospitals show minimal differences from the national from 7.5% in 2017 to 3.6% in 2023. Cefotaxime was average, with some exceptions. For instance, the propor- reported in 1.9% of operations. Due to the short half-life tion of patients with BMI ≥35 is up to three times higher of cloxacillin, it is crucial that it is administered within in Borås, Gävle, Kungälv, and Varberg. Borås, Danderyd, the right time interval. A study from the register showed and Södersjukhuset have three times the national average inadequate routines when administering prophylactic proportion of patients with ASA ≥III, while Helsingborg, antibiotics in knee replacement surgery (Stefánsdóttir A Kalmar, Norrtälje, Södertälje, Trelleborg, and Västerås et al. 2009). There has been a gradual improvement since have more than double the national average. In contrast, the register began recording the timing of the first dose in Karlshamn and Västervik have approximately half the 2009. The proportion within the 45–15 minute time inter- proportion of ASA ≥III compared to the national average. val increased to 88% in the following two years. However, The variation between units in case-mix is substantial and from 2013 to 2023, this proportion decreased to 81%. 1 4 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 In 2023, only 52% of operations had the preoperative tourniquet, drains, and LIA with or without a remaining antibiotic dose administered 45–30 minutes before the catheter, as well as the median operating time for each start of the operation. Only Capio Ortho Center Stock- unit. Spinal anesthesia was the most common reported holm, Ljungby, and Torsby have succeeded in implement- form of anesthesia (55%). The proportion of general ing the latest recommendation, reporting that 85% or anesthesia had stagnated before the pandemic at 32.4% more receive the preoperative dose within 45–30 min in 2019. During the pandemic years, the proportion of before the start of surgery. general anesthesia increased slightly (34.6% in 2020 to 38.9% in 2021). In 2023, general anesthesia was reported for 36.7% of the surgeries, with 16 units reported more Thromboprophylaxis than 80% of their surgeries in general anesthesia. The Since there are no national or international guidelines use of drains has decreased from 26% in 2011 to 0.1% or best practices regarding the start, choice of drug, and in 2023. In 2023, there was a slightly lower proportion duration of thromboprophylaxis, the choices presented in of surgeries performed without a tourniquet compared to Table 6.1.4 are based on what was commonly reported 2022. Thus, the proportion of surgeries performed using at the start of the register in 2009, with the exception tourniquet decreased from 90% in 2011 to just under of the proportion of NOAC (Non-vitamin K antagonist 25% in 2023. LIA, with or without a remaining catheter, oral anticoagulants) which has been changed from the continues to be used in the majority of surgeries. proportion of drug for injection (Dalteparin, Tinzaparin or Enoxaparin) in last year’s report. The median operating time for a primary knee replace- ment (not considering the type of prosthesis and fixation) The columns show the proportion of knee replacement varied between units, ranging from 26 to 148 minutes. surgeries where thromboprophylaxis was planned to Nationally, the median time for TKR was 64 minutes, for start postoperatively, the proportion of surgeries where UKR 51 minutes, for patellofemoral prostheses 64 min- NOACs were planned, and the proportion with a planned utes, for partial prostheses 53 minutes, and for stabilized treatment duration of 8–14 days. The table shows that prostheses 140 minutes. Since 2009, the median opera- it was most common to start thromboprophylaxis post- tion time for TKR has varied between 64 and 82 minutes, operatively, with Lycksele being the only unit reporting and for UKR between 50 and 80 minutes. Bone grafting a higher frequency of preoperative start. In 55.2% of occurs rarely in primary surgeries and was almost exclu- surgeries, only NOAC was planned, which is similar to sively in form of auto graft. Bone grafting was performed 2022 (54.9%). A combination of injection and NOAC in less than 1% of surgeries and was more common in the was reported in 11%, a decrease from 15.2% in 2022. tibia (73%) than in the femur (32%). Computer-assisted Overall, 66% received thromboprophylaxis with NOACs surgery (CAS) was reported in 14 surgeries from four in 2023, compared to 70% in 2022. units (seven in Lindesberg, three in Hässleholm, three in SU/Mölndal, and one in Umeå). No UKR surgeries The planned duration of thromboprophylaxis has been were reported as performed with CAS. Custom made relatively consistent over the years since this variable was instruments/sawing-blocks were reported in 4 surgeries first recorded in 2009 (see previous reports), with approx- in 2023, which is one-tenth of what was reported in 2022 imately 72–82% of surgeries reporting a planned prophy- (40 surgeries). This technique was reported by 3 units. laxis duration of 8–14 days. In 2023, this proportion was 74%. The proportion of surgeries reported with a shorter prophylaxis (1–7 days) was almost the same in 2023 Robot surgery (11.2%) as in 2022 (11.4%). The proportion of surgeries In the fall 2022, the first TKR procedures utilizing robotic reported with no prophylaxis at all was also similar as the surgery were performed at Lindesberg and SU/Mölndal. previous year, 3.5% in 2023 compared to 3.9% in 2022. Both units have initiated a randomized study with the MAKO robot (Stryker) and cemented Triathlon CR MBT prostheses. In addition, Lindesberg performs UKR with Surgical technique the MAKO robot. For UKR, the Restoris prosthesis is As with thromboprophylaxis, there are no guidelines used, which can only be utilized with the robot. Since regarding the choice of anesthesia, use of a tourniquet, May 2023, Capio Ortopediska huset has been using the drains, and local infiltration anesthesia (LIA); information CORI robot (Smith & Nephew) with Genesis II MBT in the form we call “surgical variables”. Table 6.1.5a pres- and has reported over 80 surgeries (see Table 6.1.5b). ents the proportion of surgeries using general anesthesia, 1 4 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Case-mix per unit 2023 Number of Complete < 55 Unit reports reports % OA % Females % years % BMI ≥35 % ASA ≥III % Country 20,622 99.0 97.5 55.5 5.5 8.0 18.0 University units Akademiska 124 100.0 90.5 58.0 9.0 7.5 18.5 Karolinska Huddinge 142 98.6 86.5 61,0 5.0 12.0 63.5 Karolinska Solna 37 97.3 65.0 43.0 16.0 5.5 59.5 SU/Mölndal 293 99.7 92.5 61.5 7.0 10.5 30.5 SU/Sahlgrenska <15 100.0 SUS/Lund 20 95 50.0 65.0 10.0 10.5 60.0 Umeå <15 100.0 Privately run units Aleris Specialistvård Malmö Arena 292 97.3 99.0 53.5 7.0 3.5 3.5 Aleris Specialistvård Nacka 732 100.0 99.0 53.5 6.0 4.5 5.5 Aleris Specialistvård Ängelholm 466 99.8 99.0 55.0 4.0 4.0 11.5 Art Clinic Göteborg 488 99.2 99.5 53.5 5.0 3.0 4.5 Art Clinic Jönköping 329 100.0 99.5 54.5 3.5 4.5 11.0 Capio Artro Clinic 943 99.6 99.5 56.5 9.0 4.5 1.0 Capio Movement 674 99.7 99.5 56.0 5.0 6.0 21.0 Capio Ortho Center Göteborg 326 99.7 98.5 47.0 11.5 1.5 5.5 Capio Ortho Center Stockholm 854 100.0 98.5 55.0 6.3 6.5 4.5 Capio Ortho och Spine Center Skåne 348 98.3 97.5 57.0 8.0 3.0 10.0 Capio Ortopedi Motala 662 95.6 98.5 56.5 5.0 8.5 20.5 Capio Ortopediska Huset 872 99.9 99.5 59.0 5.5 3.5 0.5 Capio Spine Center Göteborg <15 100.0 Capio S:t Göran 346 97.1 96.5 56.0 1.0 7.5 64.5 Carlanderska 445 98.7 100.0 56.0 3.0 1.5 6.0 Carlanderska-SportsMed 254 98 100.0 33.0 10.0 12.5 2.5 Frölundaortopeden <15 100.0 Hermelinen 37 100.0 94.5 43.0 11.0 21.5 11.0 Ledplastikcentrum Bromma 912 99.6 99.5 62.0 6.5 7.5 1.0 Ortopedisk Center Sophiah. 242 99.2 99.0 32.5 13.5 7.0 9.0 Specialistcenter Scandinavia Eskilstuna 167 94 100.0 53.5 6.0 4.0 1.0 Specialistcenter Scandinavia Johanniskliniken 151 98 97.5 53.0 10.5 2.5 2.0 Specialistcenter Scandinavia Malmö 205 93.7 98.5 50.0 4.5 5.0 3.5 Specialistläkarhuset Sundsvall AB 26 76.9 100.0 34.5 4.0 4.5 11.5 Other units Alingsås 203 100.0 99.5 52.5 3.5 16.5 18.0 Arvika 266 97 99.0 49.5 3.0 1.5 18.5 Bollnäs 432 100.0 95.0 54.5 5.0 1.5 17.0 Borås 78 100.0 98.5 56.5 4.0 28.0 56.5 Danderyd 130 100.0 93.0 51.5 4.5 14.6 55.5 Eksjö 352 98 97.0 57.0 1.5 6.5 19.5 Enköping 535 99.8 99.5 59.0 3.5 9.0 22.5 Table continued on next page. 1 5 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Case-mix per unit 2023, cont. Number of Complete < 55 Unit reports reports % OA % Females % years % BMI ≥35 % ASA ≥III % Eskilstuna 45 93.3 91.0 60.0 9.0 9.5 29.0 Falun 194 99.5 96.0 56.5 6.0 11.5 26.5 Gällivare 45 97.8 100,0 53.5 2.0 18.0 35.5 Gävle 65 100.0 83.0 58.5 1.5 23.0 51.0 Halmstad 130 99.2 95.5 58.5 7.0 18.0 28.5 Helsingborg 255 96.5 97.0 52.0 6.5 15.0 39.0 Hudiksvall 46 100.0 95.5 50.0 0.0 4.5 24.0 Hässleholm 997 99.9 93.0 54.5 6.0 9.0 16.0 Kalmar 91 100.0 87.0 57.0 4.5 6.5 37.5 Karlshamn 304 99.7 96.5 53.0 2.5 6.5 9.0 Karlstad 22 100.0 100.0 68.0 0.0 0.0 18.0 Kullbergska sjukhuset 436 100.0 98.5 59.5 6.5 12.5 14.0 Kungälv 152 96.1 96.5 56.0 4.0 22.5 29.5 Lidköping 225 100.0 99.5 59.0 3.0 11.0 35.5 Lindesberg 449 100.0 99.0 55.0 3.0 8.0 25.5 Ljungby 115 100.0 96.5 56.5 5.0 9.5 31.5 Lycksele 196 100.0 91.5 56.5 6.0 9.5 19.0 Mora 278 98.2 100.0 50.0 3.0 13.5 28.0 Norrköping 159 99.4 98.0 54.5 6.0 10.0 24.0 Norrtälje 198 100.0 100.0 57.5 5.5 13.0 37.0 Nyköping 94 100.0 99.0 61.5 2.0 9.5 21.5 NÄL Trollhättan <15 100.0 Oskarshamn 393 99.8 98.5 56.5 1.5 8.4 12.0 Piteå 424 99.1 95.0 58.0 4.5 16.5 30.0 Skellefteå 66 95.5 98.5 63.5 4.5 7.5 26.0 Skene 233 98.3 98.5 54.0 6.0 9.0 17.0 Skövde <15 97.2 Sollefteå 190 99.5 98.0 51.5 5.0 8.5 21.0 Sundsvall 49 93.9 100.0 59.0 2.0 2.0 45.0 Södersjukhuset 105 97.1 95.0 60,0 5.5 18.5 61.0 Södertälje 137 89.1 99.0 60.0 0.5 16.5 36.5 Torsby 126 100.0 98.5 54.0 3.0 8.5 24.5 Trelleborg 422 100.0 94.0 63.0 5.0 17.0 36.0 Uddevalla 197 100.0 93.5 57.5 5.0 8.5 34.0 Varberg 110 97.3 97.5 54.5 3.5 21.5 32.0 Visby 94 93.6 95.5 50.0 6.5 4.5 26.5 Värnamo 230 100.0 97.0 58.5 4.5 6.0 32.0 Västervik 111 99.1 100.0 48.0 2.0 4.5 9.0 Västerås 290 99.3 93.5 61.5 5.0 9.0 41.5 Växjö 135 100.0 100.0 50.5 3.5 3.5 27.5 Örnsköldsvik 213 98.6 98.0 55.0 4.0 18.0 35.0 Östersund 155 98.7 93.5 57.5 2.5 12.0 33.5 Table 6.1.2. Case-mix per unit 2023. 1 5 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Prophylactic antibiotics per unit 2023 Percent having Percent having Cloxacillin, dosage 2 g × 3, Percent AB Percent AB Number of Complete Cefotaxim or 2 g x 2 or time within time within Unit reports reports % Clindamycin % 600 mg x 2 % (45–15 min) % (45–30 min) % Country 20 622 98,0 99.5 97 81.5 52 University units Akademiska 124 97.5 99 89.5 92,0 48.5 Karolinska Huddinge 142 98,0 100 96.5 81,0 55.5 Karolinska Solna 37 97,0 100 97.5 78.5 65 SU/Mölndal 293 100,0 99.5 96 70,0 57 SU/Sahlgrenska <15 100,0 SUS/Lund 20 100,0 90 85 60,0 35 Umeå <15 100,0 Privately run units Aleris Specialistvård Malmö Arena 292 99,0 99.5 98 68,0 16 Aleris Specialistvård Nacka 732 99,0 100 98 82,0 63 Aleris Specialistvård Ängelholm 466 99.5 100 98 76.5 5.5 Art Clinic Göteborg 488 100,0 100 99.5 91.5 10.5 Art Clinic Jönköping 329 99.5 100 99 90,0 15 Capio Artro Clinic 943 99,0 99.5 99 82.5 73 Capio Movement 674 98.5 99.5 98.5 62,0 54 Capio Ortho Center Göteborg 326 100,0 100 97.5 80,0 64.5 Capio Ortho Center Stockholm 854 99.5 99.5 98 94.5 89.5 Capio Ortho och Spine Center Skåne 348 97.5 99.5 98.5 64,0 43.5 Capio Ortopedi Motala 662 99.5 100 99.5 92.5 78.5 Capio Ortopediska Huset 872 99,0 99.5 99 79,0 47.5 Capio Spine Center Göteborg <15 100,0 Capio S:t Göran 346 99,0 99.5 95 59,0 50.5 Carlanderska 445 99,0 100 98 94,0 36 Carlanderska-SportsMed 254 99,0 100 99.5 90.5 38 Frölundaortopeden <15 100,0 Hermelinen 37 100,0 100 100 92,0 13.5 Ledplastikcentrum Bromma 912 99,0 99.5 99 87,0 63 Ortopedisk Center Sophiah. 242 99.5 100 99 80.5 71.5 Specialistcenter Scandinavia Eskilstuna 167 94,0 99 93 74.5 27.5 Specialistcenter Scandinavia Johanniskliniken 151 73,0 100 90.5 67,0 23 Specialistcenter Scandinavia Malmö 205 97,0 100 98 78.5 21.5 Specialistläkarhuset Sundsvall AB 26 96,0 100 100 88.5 57.5 Other units Alingsås 203 100,0 100 99.5 91,0 67 Arvika 266 55.5 100 56 75,0 58.5 Bollnäs 432 99.5 99.5 99.5 87,0 59.5 Borås 78 100,0 98.5 95 69,0 34.5 Danderyd 130 99,0 99 95.5 61,0 45.5 Eksjö 352 99.5 100 99 88.5 62 Enköping 535 100,0 99.5 98 95,0 54.5 Table continued on next page. 1 5 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Prophylactic antibiotics per unit 2023, cont. Percent having Percent having Cloxacillin, dosage 2 g × 3, Percent AB Percent AB Number of Complete Cefotaxim or 2 g x 2 or time within time within Unit reports reports % Clindamycin % 600 mg x 2 % (45–15 min) % (45–30 min) % Eskilstuna 45 100,0 100 91 84.5 55.5 Falun 194 100,0 100 98.5 85.5 51 Gällivare 45 98,0 100 98 55.5 35.5 Gävle 65 100,0 100 94 84.5 44.5 Halmstad 130 97,0 100 91.5 73,0 52.5 Helsingborg 255 88.5 97 88 75.5 30 Hudiksvall 46 100,0 100 98 82.5 63 Hässleholm 997 99.5 99.5 96 82,0 27 Kalmar 91 98,0 100 98 90,0 53 Karlshamn 304 99,0 99.5 97.5 82,0 49 Karlstad 22 95.5 100 95.5 91,0 72.5 Kullbergska sjukhuset 436 99,0 100 93.5 87,0 61 Kungälv 152 100,0 100 94 68,0 50.5 Lidköping 225 99.5 100 99.5 85.5 54.5 Lindesberg 449 100,0 100 94 80,0 48.5 Ljungby 115 100,0 100 99 94,0 84.5 Lycksele 196 99.5 100 99 79,0 60 Mora 278 96.5 99.5 95.5 87.5 75.5 Norrköping 159 97.5 100 97.5 58,0 41.5 Norrtälje 198 99.5 100 99.5 79.5 64 Nyköping 94 100,0 100 99 73.5 61.5 NÄL Trollhättan <15 100,0 Oskarshamn 393 98,0 99.5 99.5 86,0 63 Piteå 424 96.5 98 93.5 90.5 66 Skellefteå 66 94,0 100 98.5 60.5 35 Skene 233 92,0 100 98 78,0 42.5 Skövde <15 97,0 Sollefteå 190 98.5 100 99 96,0 51 Sundsvall 49 96,0 100 94 55,0 39 Södersjukhuset 105 99,0 99 88.5 55,0 17 Södertälje 137 96.5 100 98 78,0 37 Torsby 126 97.5 100 100 93.5 92 Trelleborg 422 100,0 100 97.5 82,0 42 Uddevalla 197 100,0 99.5 98.5 71.5 55 Varberg 110 93,0 100 82 81,0 70 Visby 94 98,0 100 95.5 73.5 41.5 Värnamo 230 100,0 100 100 83,0 59.5 Västervik 111 98,0 100 98 80,0 47 Västerås 290 98,0 99.5 93.5 79.5 43 Växjö 135 95.5 100 98.5 83.5 20 Örnsköldsvik 213 100,0 100 96 87.5 65 Östersund 155 97,0 99.5 99.5 73.5 42 Table 6.1.3. Prophylactic antibiotics per unit 2023. 1 5 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Thromboprophylaxis per unit 2023 Number of Complete Percent starting Percent having Percent treated Unit reports reports % postop % NOAC % for 8–14 days % Country 20,622 99.0 88.0 66.0* 74.0 University units Akademiska 124 100.0 93.5 94* 82.5 Karolinska Huddinge 142 98.5 98.0 86.0 90.0 Karolinska Solna 37 92.0 94.5 57.0* 73.0 SU/Mölndal 293 100.0 85.5 85.0* 82.0 SU/Sahlgrenska <15 100.0 SUS/Lund 20 100.0 65.0 0.0 55.0 Umeå <15 100.0 Privately run units Aleris Specialistvård Malmö Arena 292 99.5 96.0 96.0 95.0 Aleris Specialistvård Nacka 732 99.5 98.5 99.5 98.5 Aleris Specialistvård Ängelholm 466 100.0 91.5 92.0 91.0 Art Clinic Göteborg 488 99.5 96.5 96.0 93.5 Art Clinic Jönköping 329 100.0 97.5 97.5 96.5 Capio Artro Clinic 943 99.5 98.5 99.5 98.5 Capio Movement 674 99.5 90.5 11.0* 0.5 Capio Ortho Center Göteborg 326 99.5 99.5 99.5 98.5 Capio Ortho Center Stockholm 854 99.5 99.0 99.0 97.5 Capio Ortho och Spine Center Skåne 348 99,0 99.5 99.5 96.5 Capio Ortopedi Motala 662 99.5 88.5 0.5 84.5 Capio Ortopediska Huset 872 100.0 97.0 99.0* 97.0 Capio Spine Center Göteborg <15 100.0 Capio S:t Göran 346 100.0 72.5 56.5* 59.0 Carlanderska 445 99.5 93.5 93.0 94.5 Carlanderska-SportsMed 254 99.0 97.0 96.0 92.5 Frölundaortopeden <15 100.0 Hermelinen 37 100.0 100.0 100.0 0.0 Ledplastikcentrum Bromma 912 99.5 99.5 99.5* 95.5 Ortopedisk Center Sophiah. 242 99.5 98.0 84.5* Specialistcenter Scandinavia Eskilstuna 167 97.0 96.5 96.5* 86.0 Specialistcenter Scandinavia Johanniskliniken 151 99.5 95.5 97.5 88.0 Specialistcenter Scandinavia Malmö 205 100.0 96.5 97.0 95.5 Specialistläkarhuset Sundsvall AB 26 92.5 88.5 0.0 92.5 Other units Alingsås 203 100.0 99.0 0.0 99.0 Arvika 266 97.5 84.0 81.0 82.0 Bollnäs 432 98.0 90.5 91.0 88.0 Borås 78 96.0 84.5 87.0 70.5 Danderyd 130 97.0 67.5 99.5 51,0 Eksjö 352 97.0 15.5 0.5 12.0 Enköping 535 100.0 86.0 87.5* 86.5 Table continued on next page. 1 5 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Thromboprophylaxis per unit 2023, cont. Number of Complete Percent starting Percent having Percent treated Unit reports reports % postop % NOAC % for 8–14 days % Eskilstuna 45 100.0 84.5 88.5 84.5 Falun 194 100.0 96.5 0.0 22.0 Gällivare 45 98.0 91.0 91.0 86.5 Gävle 65 100.0 77.0 67.5 77.0 Halmstad 130 98.5 90,0 1.0 3.0 Helsingborg 255 99.0 86.0 86.5 80.5 Hudiksvall 46 100.0 93.5 0.0 93.5 Hässleholm 997 97.0 87.0 0.0 13.5 Kalmar 91 100.0 54.0 0.0 48.5 Karlshamn 304 100.0 94.0 94.0 94.0 Karlstad 22 100.0 91.0 91.0 86.5 Kullbergska sjukhuset 436 99.0 91.5 93.0 91.0 Kungälv 152 100.0 87.0 89.5 88.0 Lidköping 225 100.0 88.0 90.0 86.0 Lindesberg 449 0.0 91.5 78.0* 74.5 Ljungby 115 100.0 80.0 81.0 81.0 Lycksele 196 99.0 34.5 41.0 97.5 Mora 278 97.5 87.0 89.5 87.0 Norrköping 159 98.0 50.5 0.0 50.5 Norrtälje 198 99.0 89.5 0.0 88.5 Nyköping 94 100.0 89.5 91.5 88.5 NÄL Trollhättan <15 100.0 Oskarshamn 393 100.0 65.0 0.0 60.5 Piteå 424 99.0 73.0 93.0* 92.0 Skellefteå 66 100.0 100.0 100.0 100.0 Skene 233 99.5 94.0 95.0 92.0 Skövde <15 100.0 Sollefteå 190 100.0 89.5 89.5 75.5 Sundsvall 49 100.0 80.0 85.5 79.5 Södersjukhuset 105 0.0 65.5 4.0* 66.5 Södertälje 137 100.0 88.5 0.0 60.0 Torsby 126 100.0 88.0 85.0* 80.0 Trelleborg 422 100.0 97.0 0.0 7.0 Uddevalla 197 99.5 80.0 80.0 82.0 Varberg 110 98,0 94.5 0.0 73.5 Visby 94 97.0 87.0 89.5 51.0 Värnamo 230 100.0 41.5 0.0 35.0 Västervik 111 99.0 4.5 0.0 3.5 Västerås 290 100.0 87.0 2.0* 5.0 Växjö 135 98.0 84.5 85.0 86.0 Örnsköldsvik 213 100.0 87.5 81.0 85.0 Östersund 155 97.5 84.0 1.0 81.5 Table 6.1.4. Thromboprophylaxis per unit 2023. * Include a combination of injection and NOAC 1 5 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Surgical technique per unit 2023 Percent having Percent Number of Complete general Percent tourni- Percent Median Unit reports reports % anesthesia % drainage % quet % LIA % Op time Country 20 622 98.2 37.0 <0.5 25.0 97.0 63 University units Akademiska 124 97.6 83.0 0.0 1.5 92.5 77 Karolinska Huddinge 142 98.6 15.0 0.0 0.0 98.0 107 Karolinska Solna 37 100.0 11.0 2.5 2.5 92.0 103 SU/Mölndal 293 99.7 5.0 0.0 7.0 87.5 90 SU/Sahlgrenska <15 100.0 SUS/Lund 20 100.0 50.0 0.0 5,0 75.0 148 Umeå <15 50,0 Privately run units Aleris Specialistvård Malmö Arena 292 99.3 99.0 0,0 0.0 99.0 60 Aleris Specialistvård Nacka 732 99,0 99.5 <0.5 56.0 97.0 26 Aleris Specialistvård Ängelholm 466 99.4 100,0 0.0 <0.5 98.5 45 Art Clinic Göteborg 488 99.8 99.5 <0.5 4.0 100.0 58 Art Clinic Jönköping 329 99.1 99.0 0.0 6.0 96.5 62 Capio Artro Clinic 943 99.2 2.0 <0.5 1.0 99.0 49 Capio Movement 674 98.5 0.0 0.0 13.0 98.5 51 Capio Ortho Center Göteborg 326 99.7 92.0 0.0 1.0 96.5 86 Capio Ortho Center Stockholm 854 99.4 1.5 0.0 7.5 99.5 60 Capio Ortho och Spine Center Skåne 348 92.5 3.0 0.0 11.0 95.5 61 Capio Ortopedi Motala 662 99.6 4.0 0.5 16.5 99.5 60 Capio Ortopediska Huset 872 98.7 1.5 0.0 20.5 99.0 43 Capio Spine Center Göteborg <15 88.9 Capio S:t Göran 346 99.4 9.5 0.5 47.5 98.0 79 Carlanderska 445 97.3 3.5 0.0 6.0 99.5 63 Carlanderska-SportsMed 254 93.1 0.5 1.0 10.0 99.0 42 Frölundaortopeden <15 100.0 Hermelinen 37 100.0 2.5 0.0 2.5 100.0 56 Ledplastikcentrum Bromma 912 98.9 99.0 <0.5 7.0 100.0 45 Ortopedisk Center Sophiah. 242 100.0 0.5 0.0 37.5 58.5 63 Specialistcenter Scandinavia Eskilstuna 167 98.2 2.0 0.0 0.0 95.0 53 Specialistcenter Scandinavia Johanniskliniken 151 98.7 84.0 0.5 94.0 99.5 36 Specialistcenter Scandinavia Malmö 205 87.8 4.0 0.0 68.0 97.5 58 Specialistläkarhuset Sundsvall AB 26 96.2 7.5 0.0 4.0 100.0 62 Other units Alingsås 203 100.0 1.0 0.0 0.0 100.0 70 Arvika 266 90.2 2.5 0.5 2.0 97.0 71 Bollnäs 432 100.0 90.5 0.0 83.0 97.0 60 Borås 78 100.0 9.0 0.0 78.0 96.0 91 Danderyd 130 90,0 10.0 0.0 24.0 91.0 90 Eksjö 352 90.9 12.0 0.0 1.5 94.0 66 Enköping 535 98.7 85.5 0.0 31.5 99.5 67 Table continued on next page. 1 5 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Surgical technique per unit 2023, cont. Percent having Percent Number of Complete general Percent tourni- Percent Median Unit reports reports % anesthesia % drainage % quet % LIA % Op time Eskilstuna 45 97.8 9.0 0.0 0.0 100.0 95 Falun 194 99.5 34.0 1.0 95.5 99.5 62 Gällivare 45 91.1 4.5 0.0 29.0 86.5 78.5 Gävle 65 95.4 47.5 4.5 95.5 100.0 70 Halmstad 130 93.9 4.5 0.0 87.0 95.5 83 Helsingborg 255 93.7 47.5 0.0 0.5 97.0 70 Hudiksvall 46 100.0 13.0 0.0 4.5 95.5 64 Hässleholm 997 99.3 90.0 0.0 0.0 99.5 49 Kalmar 91 98.9 9.0 0.0 0.0 99.0 88 Karlshamn 304 99,0 98.5 0.0 83.0 96.5 66 Karlstad 22 100.0 23.5 0.0 0.0 86.5 96.5 Kullbergska sjukhuset 436 100.0 4.0 0.0 12.5 98.5 61 Kungälv 152 100.0 18.0 0.0 29.5 97.5 92 Lidköping 225 100.0 11.0 0.0 2.0 98.5 68 Lindesberg 449 100.0 100.0 0.0 0.0 100.0 84 Ljungby 115 100.0 81.5 0.0 29.5 93.0 59 Lycksele 196 99,0 11.5 0.0 98.0 97.5 86 Mora 278 94,0 12.0 0.0 98.0 88.0 60 Norrköping 159 98.7 13.0 0.0 10.5 78.0 92 Norrtälje 198 98,0 17.5 0.0 91.5 97.0 73 Nyköping 94 100.0 1.0 0.0 42.5 100.0 77 NÄL Trollhättan <15 0,0 Oskarshamn 393 99.5 11.5 <0.5 66.0 99.5 71 Piteå 424 98.4 1.5 0.5 75.0 95.5 62 Skellefteå 66 99.9 0.0 0.0 94.0 100.0 85.5 Skene 233 92.7 8.5 0.0 86.5 95.5 84 Skövde <15 97.2 0.0 Sollefteå 190 99.5 3.0 0.0 70.5 99,0 85 Sundsvall 49 100.0 6.0 0.0 2.0 98.0 114 Södersjukhuset 105 97.1 11.5 0.0 0.0 100.0 84 Södertälje 137 100.0 12.5 0.0 0.0 100.0 66 Torsby 126 99.2 16.0 0.0 16.5 98.5 79 Trelleborg 422 99.8 37.0 0.0 35.5 99.0 82 Uddevalla 197 99.5 8.0 0.0 0.0 99.0 105 Varberg 110 95.5 15.5 0.0 1.0 90.0 85 Visby 94 88.3 9.5 0.0 0.0 87,0 93.5 Värnamo 230 100.0 11.0 0.0 0.0 100.0 80 Västervik 111 98.2 28.0 0.0 1.0 100.0 77 Västerås 290 97.6 8.5 0.0 0.0 98.5 58 Växjö 135 97.8 86.0 0.0 5.0 98.5 49 Örnsköldsvik 213 96.2 1.0 0.5 92.5 99.0 76 Östersund 155 97.4 26.5 0.0 83.0 97.5 89.5 Table 6.1.5.a. Surgical technique per unit 2023. 1 5 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Robot assisted surgery 2022 and 2023 2022 2023 Unit Robot TKR number UKR number Robot TKR number UKR number Capio Ortopediska huset CORI 84 Lindesberg MAKO 7 MAKO 27 22 SU/Mölndal MAKO 4 MAKO 15 Total 11 126 22 Table 6.1.5b. Robot assisted surgery 2022 and 2023. Type of arthrotomy in UKR Fixation Mini incision Standard incision Unknown The use of cement remains the most common method Model number number number for fixating the components to bone. In 2010, 2.4% of Oxford 1,171 628 1 all TKR procedures were completely cementless, and by ZUK 31 135 2 2023, 6.8% were reported as completely uncemented. Persona-PK 27 49 0 Uncemented fixation has decreased over the past two years from 9% in 2021. In 2023, 1.2% of TKRs were Triathlon Uni 3 113 0 hybrids (see Figure 6.1.2). For UKR, the change has been Restoris 0 21 0 significant in recent years. Before 2010, nearly all UKRs Link 0 126 0 were cemented, but since 2013, there has been a notable change. In 2023, 70.5% of UKRs were performed with- Sigma-PKR 0 62 0 out cement, and 4.3% were hybrids (see Figure 6.1.3). Total 1,232 1,134 3 This shift is primarily due to the popularity of the Oxford Table 6.1.6. Type of arthrotomy in UKR 2023. uncemented version, used in 96.5% of Oxford cases. Fig- ure 6.1.4 shows the percentage of type of by region for TKR in 2023. Skåne reports cementless fixation in one- Arthrotomy third of TKR cases (32.9%), Västerbotten in just under a quarter (24.4%), Dalarna 13.4%, and Västernorrland Since 1999 it is registered if the minimally invasive surgery 11.4%, while most regions reported no or very low per- (MIS) was used. We define MIS as a small arthrotomy centages of cementless TKRs. (without a specific limit on the length) where the opera- tion is performed without everting the patella. While the use of MIS in TKR is rare, its popularity for UKR surged Cement rapidly in the late 1990s, peaking in 2007 when 61% of Since 2007, labels with article numbers for cements used all UKRs were performed with MIS. Certain prosthesis in nearly all surgeries where cement was used have been models, especially the Oxford, are used more frequently available, ensuring that cement types can be accurately with MIS than others. In 2023, MIS was reported in 52% identified (see Table 6.1.7). As the type of mixing system of UKR surgeries (see Table 6.1.6) but only in 0.9% of may affect the cement quality, we are also interested in TKR cases. the article numbers for these systems, i.e., whether sepa- rate mixing systems with their own article numbers were used. Practically all cement reported in 2023 for primary surgeries contained antibiotics of the gentamicin type. 1 5 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 6.1.2. Time trend for fixation method, TKR/OA. Figure 6.1.3. Time trend for fixation method, UKR/OA. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 6.1.4. The relative use of fixation type in TKR/OA. The column on the right shows the number cemented/total num- ber (%). Figure 6.1.5 Distribution of type of prosthesis in primary surgery 1975–2023. 1 5 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Type of cement TKR UKR Cement Number Proportion % Number Proportion % Optipac Refobacin (prefilled) 10,227 60 335 49 Palacos R+G Pro (prefilled) 3,516 21 107 16 Smartset GHV (gentamicin) 1,160 7 163 24 Palacos R+G (gentamicin) 1,063 6 43 6 Refobacin Bone Cement (genta) 1,048 6 38 6 Copal (genta + vanco) 23 0 0 0 Copal (genta + clinda) 13 0 1 0 Refobacin Revision Cement (genta+clinda) 12 0 0 0 CMW with Gentamicin 8 0 3 0 Optipac Refobacin Plus (prefilled) 2 0 0 0 Optipac Refobacin Revision (prefilled) 2 0 0 0 Palacos R 1 0 0 0 Total 17,075 100 690 100 Table 6.1.7. Type of cement in TKR and UKR 2023. Implants TKR was developed in the 1970s, a time when hinge be noted that the disease may progress in the parts of prostheses and UKR were already available. When the the knee that are not replaced in UKR. This can make it knee arthroplasty register started registration in 1975, tempting to offer revision from UKR to TKR for patients TKR had just been introduced in Sweden. Consequently, with unexplained pain. Nonetheless, the risk of revision hinge prostheses and UKR were used for the majority of due to infection is significantly lower for UKR compared primary operations (see Figure 6.1.5). It was also common to TKR. This also applies to the risk that revisions may to perform bilateral UKR, where two UKRs were used in be performed with stabilized implant, arthrodesis or the same knee when knee disease affected more than one amputation, which of course is in favor in UKRs (see compartment. However, as the use of TKR became more Table 6.4.2 a-b). widespread, bilateral UKR ceased to be used. Today, hinge prostheses, linked and stabilizing prostheses are primarily reserved for particularly difficult primary cases, trauma, Prosthesis model tumors, and revisions. For uncomplicated primary cases, The prosthesis model is probably the factor that gener- TKR is most commonly used, though UKR is still used ates the most interest and that is most often related to in some cases of unicompartmental disease. the outcome after knee replacement. However, it is not only the model/design that determines the risk of a later The use of UKR declined steadily from 1990 to 2014 reoperation, but also the so-called case-mix. The Swedish but has been increasing gradually since then. Using UKR Arthroplasty Register attempts to mitigate the effects of on the lateral side of the knee has been extremely rare case-mix in its analyses by considering factors such as since the mid-1990s. The decreased popularity of UKR patients’ underlying diseases, sex, age, and the time period may be attributed to its considerably higher revision rate during which the operations were performed. compared to TKR (see Figure 6.4.4). However, it should 1 6 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Another important factor that the register is not able for nearly half (45%) of the implants, while Triathlon to include in the analyses is the surgical experience of MBT from Stryker accounts for 20%, Persona from Zim- the individual surgeon. It is obvious that surgeons and mer Biomet for 11%, and Attune from DePuy for 10%. surgical teams can be more or less skilled at operating, Regarding UKR, the Oxford model dominated, being which may influence the results of individual implants, used in 75% of procedures in 2023, which is a higher especially when the use has been limited to a few surgeons proportion than in 2022. and units. Therefore, it could be discussed whether it is fair to report results for individual models when it can be argued that deviant outcomes may be influenced by Types of polyethylene the skill of the surgeon and team. To this, we can only Figure 6.1.6 shows that Swedish orthopedic surgeons say that the risk of revision for individual models is the have been relatively late in replacing the well-proven result of what the users have been able to achieve with conventional polyethylene (UHMWPE) with the newer that particular model. The final result is determined by highly cross-linked polyethylene (HXLPE). Since its the prosthesis’s design, material, durability, accompanying introduction in Sweden in 2006, the proportion of instruments, user-friendliness, safety margins (how the highly cross-linked polyethylene has increased gradually, prosthesis behaves if it is not inserted in exact position), reaching 28.3% in 2019, but has since declined in recent along with the skill of the surgeon and the surgical team, years to 16%. and the training in using the instruments/prosthesis and in selecting appropriate patients for this particular sur- The majority of implants using highly cross-linked gery. Manufacturers, together with distributors, have the polyethylene in Sweden until 2023 have been Triathlon opportunity to influence most of these factors. Therefore, (X3 polyethylene), PFC (XLK polyethylene), or Per- it cannot be considered wrong to associate the model with sona (Vivacit-E polyethylene). In last year’s report, we the results, even if the results are not solely due to design, presented an in-depth analysis comparing the conven- material, and durability. tional and highly cross-linked polyethylene showing a statistically significant disadvantage for the highly cross- Historically, the most used knee replacement models in linked polyethylene, with 34% higher risk of revision Sweden have also had the lowest revision rates. This may for all causes. Due to the possibility that the issues with be because surgeons and units have managed to choose Triathlon’s uncemented version, which we reported in the best models, but it may also be because when the same the 2022 report (chapter 9.2), influenced the outcome, implant is used frequently, surgical expertise increases. we conducted a sensitivity analysis where we excluded Models that have shown significantly worse results than uncemented prostheses. In the sensitivity analysis, the others have usually disappeared from the Swedish market. increased risk for the highly cross-linked polyethylene One exception, however, was the Oxford UKR prosthesis, was not as pronounced, at 21%, but we still found a which initially had poor results but recovered after modi- statistically significant higher risk of revision compared fications and increased surgical experience. to the conventional polyethylene. Table 6.1.8 a shows the most commonly used TKR A study from the National Joint Registry (NJR) found no (including revision models) and 6.1.8 b UKR implants advantage for highly cross-linked polyethylene compared used in primary surgery in 2023. Table 6.1.8 a does not to the conventional polyethylene in follow-up up to 12 include 78 linked prostheses reported during primary years after total knee replacement surgery (Partridge et surgery, mainly rotation models (Link Endo, MUTARS, al. 2020), while the Australian registry (AOANJRR) has NexGen, S-ROM Noiles, Smith & Nephew, and Stryker) reported lower revision rates for the highly cross-linked for the treatment of malignancy, fractures, and other polyethylene. However, the result was dependent on the special cases. Just like last year, the same three models specific prosthesis model studied (de Steiger et al. 2015). dominate. NexGen MBT from Zimmer Biomet accounts The latest meta-analyses have not been able to show that 1 6 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 highly cross-linked polyethylene improves clinical and radiological outcomes compared to the conventional polyethylene in total knee replacement (Sheridan et al. 2021, Gkiatas et al. 2022, Bistolfi et al. 2022). It is important to remember that the methods used to © 2024 The Swedish Arthroplasty Register increase the durability of the new polyethylene types through radiation and/or the addition of antioxidants vary greatly among manufacturers. Figure 6.1.6. Distribution of UHMWPE and the highly cross-linked polyethylene. Most common TKR implants 2011–2020 2021 2022 2023 Proportion Proportion Proportion Proportion Model Number % Number % Number % Number % NexGen MBT 60,967 47.2 5,845 52.5 7,285 48.5 8,207 44.9 Triathlon MBT – cemented 9,382 7.3 901 8.1 1,558 10.4 2,739 15.0 Persona TKA 1,213 0.9 536 4.8 1,156 7.7 1,999 10.9 Attune MB TKA 139 0.1 55 0.5 812 5.4 1,765 9.7 PFC Sigma TKA MBT 24,318 18.8 1,853 16.6 1,808 12.1 968 5.3 Triathlon MBT – uncemented 5,591 4.3 762 6.8 891 5.9 907 5.0 Genesis II MBT 2,416 1.9 226 2.0 211 1.4 329 1.8 NexGen Trabecular Metal 2,305 1.8 139 1.3 228 1.5 187 1.0 Persona TKA Trabicular Metal 47 0.0 138 1.2 232 1.6 186 1.0 PFC Sigma TKA APT 8,767 6.8 166 1.5 98 0.7 167 0.9 Triathlon MBT - Hybrid 34 0.0 9 0.1 14 0.1 165 0.9 NexGen Revision 589 0.5 66 0.6 111 0.7 146 0.8 Triathlon Total Stabilizer 734 0.6 114 1.0 146 1.0 140 0.8 Legion/Genesis II Pri MBT 1,880 1.5 185 1.7 180 1.2 121 0.7 PFC Sigma TC-3 (revision) 436 0.3 59 0.5 71 0.5 61 0.3 Triathlon APT 97 0.1 42 0.3 32 0.2 Journey TKA 170 0.1 18 0.2 47 0.3 26 0.1 Other 10,043 7.8 36 0.6 62 0.8 56 0.8 Total 129,128 100.0 11,142 100.0 15,009 100.0 18,285 100.0 Table 6.1.8 a. Most common TKR implants (including revision models) in primary surgery 2023. 1 6 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Most common UKR implants 2012–2021 2022 2023 Proportion Proportion Proportion Model Number Number Number % % % Oxford Phase III Uni Twin Pegged 5,399 50.7 1,482 70.1 1,688 71.2 – Cementless ZUK Uni MBT 837 8.0 132 6.2 168 7.1 Link Endo Sled UniAPT 1,370 12.7 158 7.5 126 5.3 Triathlon Uni 760 7.1 135 6.4 116 4.9 Persona PK unspec. 169 1.6 88 4.2 76 3.2 Sigma PKR 313 2.9 34 1.6 62 2.6 Oxford Phase III Uni Twin Pegged – Hybrid 154 1.4 22 1.0 61 2.6 Oxford Fixed Lateral 177 1.7 48 2.3 43 1.8 Restoris 21 0.9 Oxford Phase III Uni Twin Pegged – Cemented 1,053 9.9 11 0.5 8 0.3 Other 419 3.9 15 0.3 0 0.0 Total 10,651 100.0 2,114 100.0 2,369 100.0 Table 6.1.8 b. Most common UKR implants in primary surgery 2023. 1 6 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Patella component in TKR During the 1980s, patella components were used in over half of TKR cases. Since then, the use has decreased, but in 2021 it increased slightly from previous years (just under 3%) to 4.6% in 2021, 4% in 2022, and then decreased again to just over 3% in 2023 (Figure 6.1.7 and Table © 2024 The Swedish Arthroplasty Register 6.1.9). The use of the patella component has historically been strongly associated with the prosthesis model. In 2023, the patella component was most commonly used proportionally with the Journey, Genesis, and Triathlon Total Stabilizer models. In Sweden, females are slightly more likely than males to receive a patella component during TKR. This has been explained by the fact that femoral patellar problems are more common in females. In 2023, 2.5% of males received a patella component compared to 4.2% of females. The relative use of patella components across different age groups in 2023 shows that they are slightly more common in the youngest age Figure 6.1.7. Distribution of TKR with or without patella component. groups (Figure 6.1.8). However, the proportions have fluctuated somewhat due to the relatively small number of young patients and those aged 85 and older. How the use of a patella component affects the risk of revision is discussed in Chapter 6.4, along with CRR curves (Figures 6.4.8 and 6.4.9), which show how the impact has changed over time. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 6.1.8. Distribution of the use of patella component in the Figure 6.1.9. The relative use of CR and PS TKR respectively in the different age groups 2023 regions 2023. The column on the right shows the number of CR/ total number (%). 1 6 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Cruciate ligament retaining and cruciate PS implants have been popular in other countries such as the USA. However, they have not been used much in ligament sacrificing TKR Sweden as CR implants has been preferred, at least in There are cruciate ligament sacrificing types of TKRs that those knees that are without major malalignment and that stabilize the knee. Most common with an eminence in have an intact posterior cruciate ligament. the middle part of the tibia polyethylene that goes into a box in the femoral component between the medial and As shown in Figure 6.1.9, there are regional differences in lateral gliding surfaces without affecting the rotation too the use of PS prostheses. In 2023, this type was relatively much. The type is called “posterior stabilized” (PS) and common in two regions: Västernorrland and Örebro. In requires resection of the posterior cruciate ligament. Those 2019, 8% of primary TKR procedures were of the PS advocating the use of PS claim that it provides increased type when revision models and stemmed prostheses were flection and more normal knee movement than the min- included, but the use of PS models halved to 4% in 2021, imally stabilizing, posterior cruciate retaining (CR) type. increased to 6.3% in 2022, and then decreased again to The disadvantages of PS implants are that the increased 3.9% in 2023. At the turn of the millennium, the pro- stability stresses on the polyethylene and bone surfaces and portion of PS was just over 1% of operations. thus theoretically increase the risk of wear and loosening. Use of patella component Proportion Number TKR Proportion TKR Number TKR TKR without Model with patella with patella % without patella patella % NexGen MBT 129 1.6 8,078 98.4 Triathlon MBT 182 4.8 3,631 95.2 Persona TKA 27 1.4 1,972 98.7 Attune MB TKA 132 7.5 1,633 92.5 PFC Sigma TKA MBT 35 3.6 933 96.4 Genesis II MBT 5 1.5 324 98.5 Persona TKA Trabicular Metal 7 3.8 179 96.2 NexGen Trabecular Metal 9 4.8 178 95.2 PFC Sigma TKA APT 11 6.6 156 93.4 NexGen Revision 11 7.5 135 92.5 Triathlon Total Stabilizer 16 11.4 124 88.6 Legion/Genesis II Pri MBT 28 23.1 93 76.9 PFC Sigma TC-3 (revision) <5 6.6 57 93.4 Other 10 8.9 102 91.1 Total 616 17,669 Table 6.1.9. The use of patella component in primary TKR 2023. 1 6 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 6.2. Reoperation of knee replacements regardless of diagnosis, cause, and previous surgeries Authors: Annette W-Dahl and Ola Rolfson Reoperation includes all types of procedures related to 2014, and has remained at roughly the same level since a previously inserted knee replacement, regardless of then (Figure 6.2.2). The reason for this is likely the same whether components are inserted, any of the components as described above. Figure 6.2.3 shows the distribution of are replaced, extracted (including arthrodesis and amputa- primary operations and reoperations reported per unit in tion), or left untouched. The number of reoperations has 2023. The number and proportion of primary operations increased year by year in line with the growing number are shown in the column to the right. Units with fewer of primary operations, with a slight additional increase than 20 operations have been excluded. The proportion from 2013, except for the pandemic years 2020 and 2021 of reoperations relative to a unit’s production varies, from (Figure 6.2.1). The reason for the increase in recent years SUS/Lund, where more than half of the operations are is likely because, before 2013, procedures other than those reported as reoperations, to units that have not reported defined as revisions (where prosthesis parts are replaced, any reoperations at all. This variation may be due, for added, or removed) were not requested in the reporting of example, to primary operations being performed at one knee replacement surgery, but were registered if they were or several units in a region, while reoperations are con- submitted to the register. The year 2020 was the first year centrated in another unit within the region. in which the reoperation variable was reported. It should be noted that other procedures are not as well-defined as The mean age was just over a year older, and the propor- revisions. It is difficult to determine to what extent all tion of males was slightly higher in reoperations com- reoperations are reported, and this may affect the outcome pared to primary operations in 2023 (Table 6.2.1). The and disadvantage units that are diligent in reporting other age group 75 and older was slightly more represented in procedures. reoperations compared to primary operations. Compared to primary operations, a larger proportion had a BMI ≥35, The relative proportion of reoperations decreased since ASA ≥III, and diagnoses other than osteoarthritis (from the early 1990s, then increased again between 2012 and the primary operation). © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 6.2.1. Number of primary and reoperations Figure 6.2.2. Distribution of primary knee replacements and per year 2004–2023. reoperations (revision + other procedures) 1997–2023 divided in three-year periods. 1 6 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 6.2.3. Distribution of primary and reoperations per unit 2023. Units with fewer than 20 operations are excluded. The column on the right shows the number of primary operations/ total number of operations (% primary operations). The most common reasons for reoperation over the past reason does not necessarily reflect the risk of experiencing 10 years for TKR/osteoarthritis and UKR/osteoarthritis these complications. are shown in Figure 6.2.4. For TKR/osteoarthritis, infec- tion is the single most common reason for reoperation. As the number of primary TKR/osteoarthritis surgeries has The reoperation reason 'osteoarthritis' in the context of increased significantly over time, early reoperations, such TKR generally refers to patellofemoral osteoarthritis. The as infections and joint contractures, are overrepresented. reoperation reason 'patella' includes various patellar issues For UKR/osteoarthritis, loosening is the most common in prostheses implanted both with and without a patella reason of reoperation, closely followed by the progression component (excluding loosening or wear of the patella of osteoarthritis. The proportion of reoperations due to component). Note that the distribution of reoperation loosening is higher than in TKR/osteoarthritis, while infection is uncommon. 1 6 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Figure 6.2.5 shows the distribution of the main inter- proportion has decreased due to increased reporting of ventions: exchange/insertion, extraction, and other pro- other procedures. The most commonly reported proce- cedures where the implant is not affected, over three-year dures where the prosthesis is not affected are infection periods from 2002 to 2023. Exchange/insertion of pros- treatment/investigation and manipulation under anes- thesis components has been the dominant intervention. thesia. However, during the last four three-year periods, the Demography in reoperation Primary Reoperation operation Number 1,523 20,758 Mean age (SD) 70.4 (9.8) 69.4 (9.0) Age group, n (%) © 2024 The Swedish Arthroplasty Register < 45 years 11 (0.7) 77 (0.4) 45-54 years 82 (5.4) 1,052 (5.1) 55-64 years 328 (21.5) 5,014 (24.2) 65-74 years 518 (34.0) 7,974 (38.4) 75-84 years 499 (32.8) 6,058 (29.2) ≥85 years 85 (5.6) 583 (2.8) Females, n (%) 799 (52.5) 11,518 (55.5) BMI, n (%) < 18.5 6 (0.4) 44 (0.2) 18.5-24.9 264 (18.5) 3,970 (19.3) Figure 6.2.4. The most common reasons for reoperation in the last 10 years per type of operation. 25-29.9 596 (41.7) 9,054 (44.0) 30-34.5 406 (28.4) 5,879 (28.5) 35-39.9 129 (9.0) 1,477 (7.2) ≥ 40 29 (2.0) 171 (0.8) ASA-class, n (%) I 99 (6.7) 2,987 (14.4) II 833 (56.4) 1,3954 (67.4) © 2024 The Swedish Arthroplasty Register III-V 545 (36.9) 3,748 (18.1) Diagnosis, n (%) Artros 1,421 (94.0) 20,253 (97.7) Acute trauma 5 (0.3) 46 (0.2) Osteonecrosis 25 (1.7) 133 (0.6) Inflamatory joint disease 34 (2.2) 182 (0.9) Sequele fracture/trauma 22 (1.5) 98 (0.5) Tumor 5 (0.3) 8 (0.0) Other joint diseases 0 (0.0) 7 (0.0) Figure 6.2.5. Distribution of the main procedures exchange/ insertion, extraction and other procedures where the implant Table 6.2.1. Demography in reoperations 2023 (with diagnosis is not affected in three-year periods 2003–2023. from primary operation). Primary operations performed in 2023 for comparison. 1 6 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 6.3. Reoperation within two years for TKR/OA Authors: Annette W-Dahl and Ola Rolfson Reoperations that occur within the first two years after a the adoption of more surgically aggressive treatment for primary operation have been used as a quality indicator suspected early infections. After 2013, infection remains in hip replacement surgery for several years and have been the most common reason for reoperation within two selected by the Swedish Association of Local Authorities years, but the proportion of joint stiffness as a reason and Regions and the National Board of Health and Wel- for reoperation has increased, likely due to changes in fare as a national quality indicator. This variable is also reporting routines. included in “Vården i siffror” (vardenisiffror.se). Reop- eration within two years includes all forms of additional For TKR in OA, reoperations within two years for 2020– surgery after the primary operation. This outcome mea- 2023 are presented by unit (university hospitals, privately sure primarily reflects early and serious complications. The run units, and other units in alphabetical order) and refer indicator is considered important, quickly accessible, and to first-time occurrences (number and percentage) within easier to use for clinical improvement work compared to two years of the primary operation (Table 6.3.1). Due the ten-year revision risk. to the low number of reported reoperations within two years, only infection (suspected or verified) is presented As previously described in Chapter 6.2, we began system- as a separate group, while other causes of reoperation are atically requesting reports of other procedures, beyond combined into one group, “other causes.” The number revisions, from units starting in 2013 for knee replace- of revisions (and the percentage of reoperations) is listed ment surgery. The reason two-year reoperations have not to provide an understanding of each unit’s reporting of been reported earlier is partly due to uncertainties about procedures beyond revision. The result of the compilation the reliability of reporting other procedures, and partly is currently uncertain and does not provide a fair picture because the number of reoperations per unit per year is of the proportion of reoperations within two years at the low. Therefore, several years of reporting are needed to national and unit levels. gather a sufficient number for meaningful analysis at the unit level. It is also difficult to determine to what extent other procedures are reported, which may affect the results and disadvantage units that are diligent in reporting pro- cedures beyond prosthesis surgeries. Furthermore, an indicator requires reliable reporting, which we currently do not assess to be the case for © 2024 The Swedish Arthroplasty Register knee replacement surgery. Despite the shortcomings in reporting, we have chosen to present the indicator “Reoperation within two years for TKR/OA” for several reasons. It is naturally important to monitor the early reoperation frequency for units with good reporting. For units that have not yet reviewed their procedures for reporting reoperations that are not revisions, we want to encourage improved reporting. The presentation is also part of harmonizing the presentation of hip and knee replacement data following the merging of the registries. A corresponding analysis for hip replacements is presented in Chapter 5.3. Figure 6.3.1. Distribution of reason for reoperation within two The most common reasons for reoperation within two years after the primary operation in TKR/OA. years were infection, patella problems, and loosening in 2007, with an increasing proportion of infections in 2008–2009 (Figure 6.3.1). This increase coincides with 1 6 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Number and proportion of reoperations within two years after the primary operation per unit 2020–2023 Number Number Whereof Infection Other reason Other Unit primary reoperations revisions Number Infection % Number reason % University units Akademiska sjukhuset 324 11 5 4 1.2 7 2.2 Karolinska Huddinge 440 9 6 3 0.7 6 1.4 Karolinska Solna 76 2 1 2 2.6 0 0.0 SU/Mölndal 745 17 15 9 1.2 8 1.1 SUS/Lund 54 0 0 0 0.0 0 0.0 Umeå 161 10 9 4 2.5 6 3.7 Privately run units Aleris Malmö Arena 313 5 5 3 1.0 2 0.6 Aleris Specialistvård Nacka 755 4 3 4 0.5 0 0,0 Aleris Specialistvård Ängelholm 1,363 32 31 13 1.0 19 1.4 Art Clinic Göteborg 1,219 8 6 6 0.5 2 1.2 Art Clinic Jönköping 913 9 8 3 0.3 6 0.7 Capio Artro Clinic 2,609 106 25 22 0.8 84 3.2 Capio Movement 1,987 17 14 9 0.5 8 0.4 Capio Ortho Center Göteborg 1,118 18 15 7 0.6 11 1.0 Capio Ortho Center Stockholm 2,384 63 34 20 0.8 43 1.8 Capio Ortho och Spine Center Skåne 460 5 5 4 0.9 1 0.3 Capio Ortopedi Motala 1,579 45 37 17 1.1 28 1.8 Capio Ortopediska Huset 2,848 71 24 21 0.7 50 1.8 Capio S:t Göran 810 11 11 3 0.4 8 1.0 Carlanderska 1,380 11 6 6 0.4 5 0.4 Carlanderska-SportsMed 628 6 4 2 0.3 4 0.6 Frölundaortopeden 71 2 2 0 0.0 2 2.8 Hermelinen 121 1 1 1 0.8 0 0.0 Ledplastikcentrum Bromma 967 12 5 8 0.8 4 0.4 Ortopediskt Center - Sophiahemmet 449 11 10 8 1.8 3 0.7 Specialistcenter S:t Johanniskliniken 50 1 1 0 0.0 1 2.0 Specialistcenter Scandinavia Malmö 178 1 1 1 0.6 0 0.0 Specialistcenter Scandinavia, Eskilstuna 290 3 1 0 0.0 3 1.0 Other units Alingsås 629 6 5 3 0.5 3 0.5 Arvika 974 16 12 7 0.7 9 0.9 Bollnäs 1,153 22 15 15 1.3 7 0.6 Borås 194 7 5 2 1.0 5 2.6 Table continued on next page. 1 7 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Number and proportion of reoperations within two years after the primary operation per unit 2020–2023, cont. Number Number Whereof Infection Other reason Other Unit primary reoperations revisions Number Infection % Number reason % Danderyd 273 13 12 10 3.7 3 1.1 Eksjö 1,113 28 23 15 1.3 13 1.2 Enköping 1,700 42 33 14 0.8 28 1.6 Eskilstuna 150 10 6 3 2.0 7 4.7 Falköping 27 0 0 0 0.0 0 0.0 Falun 376 9 4 3 0.8 6 1.6 Gällivare 171 2 1 1 0.6 1 0.6 Gävle 192 8 6 4 2.1 4 2.1 Halmstad 414 4 4 4 1.0 0 0.0 Helsingborg 797 9 8 5 0.6 4 0.5 Hudiksvall 183 1 1 1 0.5 0 0.0 Hässleholm 2,905 39 38 16 0.6 23 0.8 Kalmar 224 3 3 3 1.3 0 0.0 Karlshamn 820 3 3 3 0.4 0 0.0 Karlstad 86 1 1 0 0.0 1 1.2 Kullbergska sjukhuset 1,048 18 11 6 0.6 12 1.1 Kungälv 301 20 6 7 2.3 13 4.3 Lidköping 453 6 5 4 0.9 2 0.4 Lindesberg 1 266 22 15 11 0.9 11 0.9 Ljungby 276 5 4 3 1.1 2 0.7 Lycksele 565 18 15 13 2.3 5 0.9 Mora 688 39 5 6 0.9 33 4.8 Norrköping 384 8 8 1 0.3 7 1.8 Norrtälje 564 14 12 11 2.0 3 0.5 Nyköping 224 2 2 2 0.9 0 0.0 Oskarshamn 1,158 26 12 8 0.7 18 1.6 Piteå 948 24 11 10 1.1 14 1.5 Skellefteå 246 10 10 7 2.8 3 1.2 Skene 598 6 2 2 0.3 4 0.7 Skövde 76 1 1 1 1.3 0 0.0 Sollefteå 574 18 15 16 2.8 2 0.3 Sundsvall 82 3 3 2 2.4 1 1.2 Södersjukhuset 352 14 4 9 2.6 5 1.4 Södertälje 422 5 5 2 0.5 3 0.7 Torsby 442 5 4 2 0.5 3 0.7 Table continued on next page. 1 7 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Number and proportion of reoperations within two years after the primary operation per unit 2020–2023, cont. Number Number Whereof Infection Other reason Other Unit primary reoperations revisions Number Infection % Number reason % Trelleborg 1,374 18 17 12 0.9 6 0.4 Uddevalla 606 8 7 5 0.8 3 0.5 Varberg 401 3 3 2 0.5 1 0.2 Visby 334 4 3 1 0.3 3 0.9 Värnamo 712 12 10 6 0.8 6 0.8 Västervik 407 10 8 6 1.5 4 1.0 Västerås 751 17 17 10 1.3 7 0.9 Växjö 338 6 4 3 0.9 3 0.9 Örnsköldsvik 417 5 3 5 1.2 0 0.0 Östersund 278 7 7 6 2.2 1 0.4 Country 53,008 1,070 696 469 0.9 600 1.1 Table 6.3.1. Number and proportion of first reoperations (suspected or verified infection or other reason) within two years after primary operation 2020–2023 per unit. The number of primary and revisions (and proportion of primary operations) are given for comparison. Units with fewer than 20 primary operations in the current period are excluded but are included in the national figures. It should be noted that it is difficult to determine to what extent other procedures than revision is reported and thus it can affect the outcome and disadvantage units that are good at reporting other procedures. 1 7 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 6.4. Revision knee replacement Authors: Annette W-Dahl and Ola Rolfson A revision is defined as reoperations of a knee replacement where prosthetic components are added, exchanged, or removed (including arthrodesis and amputation). This means that soft tissue interventions such as arthroscopy and “lateral release” are not registered as revisions. The current status per surgical year in knee replacement sur- © 2024 The Swedish Arthroplasty Register gery is illustrated in Figure 6.4.1 (a person can be included with both the right and left knee). As shown in Figure 6.4.1, more than 85% of the patients who were operated on in 1990 have not undergone a revision during their lifetime. Slightly over 10% of those operated on at that time have undergone a revision, and of the few who are still alive, less than half have been revised. Demographics There was a difference of just over one year in the aver- age age at the time of the first revision of TKR 2023 Figure 6.4.1. Current status per surgical year in patients having compared to primary TKR in 2023 (Table 6.4.1). The knee replacement. mean age at first revision of UKR in 2023 was two years higher compared to primary UKR in 2023. A slightly higher proportion of males underwent revision in the Reason for revision TKR group, while a slightly higher proportion of females The most common reason for revision over the past ten underwent revision in the UKR group compared to the years for TKR due to OA and UKR due to OA are shown proportion of males and females who underwent primary in Figure 6.4.3. For TKR/OA, infection has been the most TKR and UKR. In the revision of TKR, the proportion common reason for revision in recent years, compared to of individuals with BMI ≥30 was higher than at the time earlier years when loosening was the dominant reason for of the primary operation, and in the UKR group, the pro- revision. The revision reason termed “progress” for TKR portion of individuals with BMI ≥35 was higher than at mainly refers to femoropatellar OA. The revision reason the primary operation. In both TKR and UKR revisions, “patella” includes various patellar issues in patients with the proportion of individuals classified as ASA ≥III was replacement, regardless of whether a patellar component higher than at the primary surgery. was used (excluding loosening or wear of the patellar component). It should be noted that the distribution Figure 6.4.2 shows the distribution of primary operations of reasons for revision does not necessarily reflect the and revisions per unit in 2023. The number and propor- actual risk of experiencing these complications. Due to tion of primary operations are indicated in the column the significant increase in the number of primary opera- on the right. Units with fewer than 20 operations have tions for TKR/OA over time, early revisions—and thus been excluded. The proportion of revisions relative to the infections—are overrepresented. For UKR/OA, the most unit’s production varies from SUS/Lund, where 62% of common reason for revision is the progression of OA. the operations are reported as revisions, to units that have However, the proportion of revisions due to loosening is not reported any revisions at all. This variation can, for higher, and the proportion of revisions due to infection example, be due to the fact that primary operations are is lower compared to TKR/OA. performed at one or more units in a region, while revisions are concentrated at other units within the region. 1 7 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 6.4.2. Revisions per unit 2023. The column on the right shows the number of primary operations/total number (% primary). 1 7 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  RA have reduced the need for knee replacements in this group, making it increasingly difficult to identify statis- tically significant differences. Therefore, we have chosen not to present RA separately due to too few reported cases. © 2024 The Swedish Arthroplasty Register Age The effect of age at the time of the primary operation can be illustrated by dividing patients into different age groups. It is evident for both TKR and UKR that the risk of revision is higher for those who undergo surgery at a younger age (Figure 6.4.4). Possible explanations include higher physical activity levels, greater demands for pain relief and function, a different life situation, and a health condition that allows for revision more easily than in older individuals. Surgical year Figure 6.4.3. Distribution of reason for revision 2014–2023. For TKR, we saw a decrease in revision risk during the first three decades since the start of the register, which has not been as clear for UKR (Figure 6.4.5). During the period 2006–2015, the number of early revisions for Revision procedures TKR increased, a trend that has continued into the most Tables 6.4.2 a-b show the different types of first-time recent period of 2016–2023. This has mainly been due to revisions performed between 2014–2023, categorized an increase in early revisions for infection (Figure 6.4.6). by the type of primary operation (TKR and UKR). It For UKR, the improvement over the first three decades should be noted that the type of revision is exclusive (only has not been as significant as for TKR. However, even for one type is allowed for each revision), meaning that, for UKR, the early revision rate increased during the periods example, in a patellar procedure combined with a poly- 2006–2015 and 2016–2023. The explanation here is pri- ethylene exchange, only the patellar procedure is recorded. marily that since the late 1990s, the relative proportion For TKR, we see that revisions involving the exchange of of younger patients receiving UKR has increased, and polyethylene components have stagnated but are slightly they have a higher risk. However, we see a decrease in the higher than in the period reported in last year’s report. For revision rate for UKR in the latest period compared to UKR, revision to a TKR is the most common procedure. 2006–2015 (Figure 6.4.5). Since UKR began increasing in numbers again in 2013, the average age has increased by just over three years, which may be one of the expla- Factors affecting revision rates nations for the decline in the revision rate during the The impact of implants on revision rates is covered in a 2016–2023 period. separate section (Chapter 6.5: Evaluation of implants) in this year’s report as part of the harmonization of reporting for knee and hip replacement surgeries. Risk of revision due to infection When the Swedish Arthroplasty Register reports the risk of revision due to infection, this refers specifically to the Underlying disease risk of infection at the first revision, with other revision It was recognized early on that patients with different causes censored (Figure 6.4.6). This risk decreased in underlying disease, such as RA and OA, could have dif- the early decades for OA. However, during the period ferent postoperative courses with varying revision rates. 2006–2015, we observed a significant increase in the Therefore, separate curves for these diagnoses have always risk of infection for TKR, which continued 2016–2023, been presented. However, modern medical treatments for now also affecting UKR. The increase is primarily due to 1 7 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 early polyethylene insert exchanges in cases of infection with TKRs without a patella component having a signifi- or suspected infection. This rise is likely related to more cantly lower revision rate (HR 0.8, CI 0.7–0.9). For the aggressive surgical treatment for early suspected infections current period (2014–2023), the risk remains the same in recent years. and is not significant (HR 0.8, CI 0.7–1.01). The reasons for these results can only be speculated. Sex Inserting the patella component adds extra time to the The effect of sex on the risk of revision is complex, as surgery and introduces an additional prosthesis part that males and females have different revision patterns. Early must adhere to the bone implicating an increased risk for revision due to infection is more common in males, while infection, loosening, and wear. Changes in the quality and for females, loosening and patella-related problems are fixation of patella components could explain the shift in the dominant reasons for early revision. The difference revision risk over time. On the other hand, some TKRs between sex is even more pronounced when only revisions inserted without an initial patella component are later due to infection are considered (Figure 6.4.7). The rea- revised to include one. Changes in femoral component son why males are more often revised for infection than design, making them more “patella-friendly,” or shifts in females is unclear. surgeons’ enthusiasm for secondary patella resurfacing may also explain these inconsistent outcomes. Patella component in TKR The question arises whether the use of a patella com- Assessing how the use of a patella component affects the ponent should be considered when evaluating revision risk of revision is challenging. The use of patella com- risks for individual units or implants. We have chosen to ponents varies depending on the prosthesis model, and report the overall revision risk of implants (both with and their use has decreased over time. In the 2002 annual without a patella component) to provide a comprehensive report, we noted for the first time that TKRs with a overview of how certain patient groups and implants per- patella component (inserted between 1991 and 2000) had form. When comparing HRs for implants (Tables 6.5.3 a lower revision risk than those without (Figure 6.4.8). and 6.5.4), we present both combined and separate results During this period, TKRs without a patella component for TKRs with and without patella components. Addi- had a significantly higher revision rate than those with tionally, when evaluating the revision risk for different one (HR 1.3, CI 1.1–1.4). However, an analysis of the units, we account for the use of patella components in period 2001–2010 (Figure 6.4.9) showed the opposite, our regression analysis. 1 7 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 6.4.4. CRR in different age groups TKR/OA (left) and UKR/OA (right) inserted in the period 2014–2023. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 6.4.5. CRR in different periods up to 20 years in TKR/OA (left) and UKR/OA (right). 1 7 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 6.4.6. CRR due to infection in different periods up to 20 years in TKR/OA (left) and UKR/OA (right). © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 6.4.7. CRR du to infection by sex up to 20 years in TKR/OA (left) and UKR/OA (right). 1 7 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Demography in first time revisions 2023 Primary operation Primary operation TKR revision UKR revision TKR UKR Number 669 217 18,289 2,395 Mean age (SD) 71.0 (9.2) 68.6 (9.5) 69.8 (8.8) 66.6 (9.0) Age group, n (%) < 45 years <5 <5 50 ( 0.3) 12 ( 0.5) 45-54 years 28 ( 4.2) 14 ( 6.5) 820 ( 4.5) 215 ( 9.0) 55-64 years 133 (19.9) 67 (30.9) 4,228 (23.1) 771 (32.2) 65-74 years 240 (35.9) 62 (28.6) 7,071 (38.7) 884 (36.9) 75-84 years 233 (34.8) 64 (29.5) 5,571 (30.5) 479 (20.0) ≥85 years 31 ( 4.6) 8 ( 3.7) 549 ( 3.0) 34 ( 1.4) Females, n (%) 365 (54.6) 112 (51.6) 10,282 (56.2) 1,179 (49.2) BMI, n (%) 18.5-24.9 <5 0 ( 0.0) 41 ( 0.2) <5 25-29.9 112 (17.3) 38 (18.3) 3,467 (19.1) 481 (20.2) 30-34.5 269 (41.5) 96 (46.2) 7,890 (43.5) 1,131 (47.5) 35-39.9 188 (29.0) 56 (26.9) 5,241 (28.9) 625 (26.2) ≥ 40 62 ( 9.6) 15 ( 7.2) 1,342 ( 7.4) 131 ( 5.5) ASA-class, n (%) I 15 ( 2.3) 3 ( 1.4) 160 ( 0.9) 11 ( 0.5) II 43 ( 6.5) 21 ( 9.7) 2,455 (13.5) 510 (21.4) III-V 377 (56.7) 151 (69.9) 12,300 (67.5) 1,610 (67.6) III-V 245 (36.8) 44 (20.4) 3,477 (19.1) 263 (11.0) Table 6.4.1. Demography in first time revisions 2023 divided in TKR and UKR with primary operation TKR and UKR 2023 for comparison. 1 7 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Procedure in revision of primary TKR Procedure in revision of primary UKR Propor- Propor- Procedure Number Procedure Number tion % tion % Exchange of meniscal bearing/ TKR without patella 1,189 75.4 1,770 31.5 insert Exchange of meniscal bearing/ 210 13.3 TKA without patella 1,260 22.4 insert Patella addition 1,048 18.7 TKR with patella 109 6.9 Linked (rot. Hinge) without patella 436 7.8 Linked (rot. Hinge) without patella 24 1.5 TKR with patella 337 6.0 Extraction (two-staged) 17 1.1 Extraction (two-staged) 216 3.8 Exchange tibia 7 0.4 Exchange tibia 186 3.3 Patellofemoral prosthesis 4 0.3 Extraction 133 2.4 Extraction 4 0.3 Exchange femur 63 1.1 UKR medial 3 0.2 Linked (rot. Hinge) with patella 54 1.0 Linked (rot. Hinge) with patella 1 0.1 UKR lateral 1 0.1 Linked (rot. Hinge) with patella 44 0.8 Extraction + prosthesis spacer 23 0.4 Exchange femur 1 0.1 Exchange patella 17 0.3 Reposition of the same insert 1 0.1 Arthrodesis 10 0.2 Patella addition 1 0.1 Reposition of the same insert 8 0.1 Femoral amputation 1 0.1 Patella extraction 6 0.1 Unknown 5 0.3 Exchange of hinge part 3 0.1 Total 1,578 100.0 Extraction tibia 1 0.0 Table 6.4.2 b. Procedure for revision in primary UKR/OA 2014–2023. Hinged without patella 1 0.0 Extraction (empty joint) 1 0.0 Unknown 2 0.0 Total 5,619 100.0 Table 6.4.2 a. Procedure for revision in primary TKR/OA 2014–2023. 1 8 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 6.4.8. CRR in TKR/OA inserted in the ten-year period Figure 6.4.9. CRR in TKR/OA inserted in the ten-year period 1991–2000, with or without patella component respectively. 2001–2010, with or without patella component respectively. © 2024 The Swedish Arthroplasty Register Figure 6.4.10. CRR in cemented and uncemented TKR/OA inserted in the ten-year period 2013–2023. 1 8 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Use of cement Cement has been used in a vast majority of surgeries since the most recent year has been added, resulting in a period the mid-1990s, although there has been an increase in from 2013 to 2023. This change allows surgeries to be the use of uncemented implants in recent years. Previous followed for more than ten years instead of just over nine. analyses of TKRs performed between 1985 and 1994, Including revisions from the most recent year might result when uncemented implants were somewhat more com- in some revisions being missed, as revisions reported from mon, showed that these had a higher risk of revision. In the previous year are often added in the following year. the most recent decade, we continue to observe a signifi- cantly higher risk for uncemented implants compared to Table 6.4.3 shows the number of primary surgeries (TKR) cemented ones (Figure 6.4.10). Uncemented implants performed for OA at each unit during the analyzed five- have about a 2% higher risk of revision, which may be year period (2018–2023) and how many of these have influenced by issues with the Triathlon uncemented ver- been revised. Table 6.4.4 presents the corresponding num- sion reported in the 2022 annual report (Chapter 9.2). bers for a ten-year period (2013–2023). This is followed by the relative risk of revision (RR) with a 95% confidence interval. This estimates the unit effects on revision risk Revision risk per unit relative to the national average, calculated as in previous The true average outcome of a particular treatment at a years using the “shared gamma frailty model.” Finally, given unit can only be determined for defined groups of the observed rank of each unit is shown along with a already treated patients. Such outcomes, however, reflect 95% confidence interval for the rank. The calculation was only historical conditions and cannot easily be used to performed using the Monte Carlo method. compare future treatment results. The observed average outcome of a treatment at a unit is not constant. Different Only units where more than 50 primary operations have patient selections receiving the same treatment can lead been performed during the period are included in the to varying average outcomes, as can individual surgeons. analysis of all TKRs performed for OA. The results have This unit-specific variability must be considered for mean- been adjusted for differences in sex and age distribution, ingful comparisons between units. as well as for variations in the distribution of replacements with and without a patella component. Units that are The Swedish Arthroplasty Register has standardized selec- significantly better or worse than the national average are tion, methods, and presentation of results to ensure com- marked in green and red, respectively. parability for both knee and hip replacements, though inconsistencies remain. Traditionally, operations from a Figures 6.4.11 and 6.4.12 show the CRR after five and ten-year period have been included with a one-year delay ten years, respectively (including primary operations from (e.g., 2011–2020) when calculating cumulative revision 2018–2023 and 2013–2023). Units with fewer than 50 rates (CRR). In the analyses that follow, an additional year primary operations in the past five or ten years are not has been included (making it an eleven-year period) and reported. 1 8 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Relative risk of revision per unit, five years Unit Number TKR TKR revised RR RR 95 % CI Rank Rank 95 % CI Karlshamn 1,301 8 0.44 0.26; 0.74 1 1–21 Art Clinic Jönköping 1,288 9 0.47 0.28; 0.79 2 1–24 Alingsås 1,015 7 0.49 0.28; 0.86 3 1–29 Carlanderska 1,923 16 0.5 0.33; 0.77 4 1–22 Skene 872 6 0.53 0.30; 0.94 5 1–35 Aleris Specialistvård Bollnäs 601 6 0.54 0.30; 0.96 6 1–37 Capio Movement 2,849 28 0.54 0.38; 0.76 7 2–22 Halmstad 713 6 0.56 0.31; 1.00 8 1–39 Carlanderska-SportsMed 807 7 0.59 0.34; 1.02 9 1–41 Aleris Specialistvård Nacka 1,160 11 0.6 0.37; 0.97 10 2–37 Art Clinic Göteborg 1,432 14 0.63 0.40; 0.99 11 3–38 Gällivare 352 3 0.66 0.33; 1.28 12 1–55 Kalmar 408 4 0.69 0.37; 1.31 13 2–56 Capio Ortho Center Göteborg 1,530 20 0.69 0.47; 1.03 14 5–41 Varberg 696 9 0.7 0.42; 1.17 15 3–50 Capio Ortopediska Huset 4,140 57 0.72 0.56; 0.93 16 9–35 Piteå 1,505 20 0.73 0.49; 1.07 17 6–44 Hudiksvall 297 3 0.73 0.37; 1.43 18 2–60 Aleris Specialistvård Motala 502 8 0.75 0.44; 1.28 19 4–55 Nyköping 395 5 0.78 0.42; 1.42 20 3–60 Uddevalla 1,080 16 0.79 0.51; 1.20 21 7–52 Falköping 63 0.79 0.34; 1.81 22 1–68 Trelleborg 2,893 49 0.82 0.62; 1.07 23 12–44 Karolinska Solna 123 1 0.82 0.38; 1.77 24 2–68 Capio Artro Clinic 3,384 52 0.83 0.64; 1.08 25 13–45 Mora 1,066 16 0.83 0.55; 1.27 26 8–55 Karolinska Huddinge 666 10 0.84 0.51; 1.38 27 6–59 Örnsköldsvik 632 9 0.84 0.50; 1.40 28 6–60 Oskarshamn 1,911 32 0.87 0.63; 1.20 29 13–51 Hermelinen 153 2 0.87 0.43; 1.78 30 3–68 Bollnäs 1,195 18 0.87 0.58; 1.32 31 10–57 Torsby 656 11 0.89 0.55; 1.44 32 8–61 Södersjukhuset 750 14 0.91 0.59; 1.43 33 11–61 Arvika 1,427 25 0.92 0.64; 1.32 34 14–57 Falun 658 12 0.95 0.60; 1.52 35 11–63 Södertälje 712 13 0.96 0.61; 1.51 36 12–63 SU/Mölndal 1,444 28 0.97 0.69; 1.37 37 17–59 Lindesberg 2,131 42 0.99 0.74; 1.32 38 20–57 Table continued on next page. 1 8 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Relative risk of revision per unit, five years, cont. Unit Number TKR TKR revised RR RR 95 % CI Rank Rank 95 % CI Värnamo 1,099 21 0.99 0.67; 1.45 39 16–61 SUS/Lund 93 2 1.0 0.49; 2.04 40 6–70 Helsingborg 1,196 23 1.0 0.69; 1.44 41 17–61 Ljungby 482 10 1.02 0.62; 1.68 42 12–67 Lidköping 821 16 1.03 0.67; 1.57 43 16–65 Capio S:t Göran 1,520 31 1.03 0.75; 1.44 44 21–61 Gävle 369 9 1.05 0.62; 1.75 45 13–68 Capio Ortho Center Stockholm 3,503 74 1.06 0.84; 1.33 46 28–57 Karlstad 321 8 1.07 0.63; 1.82 47 13–69 Borås 387 9 1.07 0.64; 1.80 48 14–68 Frölundaortopeden 106 3 1.08 0.55; 2.12 49 9–71 Visby 550 13 1.1 0.69; 1.73 50 17–67 Skövde 122 3 1.11 0.57; 2.18 51 10–71 Kullbergska sjukhuset 1,419 31 1.16 0.84; 1.61 52 27–66 Hässleholm 4,546 108 1.16 0.96; 1.41 53 36–61 Enköping 2,503 58 1.18 0.92; 1.52 54 33–64 Östersund 615 16 1.22 0.80; 1.87 55 25–69 Aleris Specialistvård Ängelholm 1,615 38 1.24 0.92; 1.68 56 33–67 Västervik 603 16 1.25 0.82; 1.91 57 26–70 Norrtälje 904 25 1.3 0.91; 1.86 58 33–69 Akademiska sjukhuset 465 13 1.31 0.83; 2.07 59 27–71 Eksjö 1,688 46 1.34 1.02; 1.77 60 40–68 Sollefteå 938 27 1.36 0.96; 1.92 61 37–70 Skellefteå 445 15 1.4 0.91; 2.16 62 33–71 Växjö 974 28 1.44 1.03; 2.03 63 41–71 Kungälv 632 21 1.45 0.99; 2.13 64 38–71 Västerås 1 282 39 1.48 1.10; 1.99 65 45–70 Eskilstuna 279 12 1.53 0.96; 2.45 66 36–72 Sundsvall 146 7 1.56 0.90; 2.71 67 32–72 Sophiahemmet 208 12 1.58 0.99; 2.52 68 38–72 Lycksele 759 30 1.72 1.23; 2.40 69 53–72 Umeå 410 22 1.76 1.20; 2.56 70 51–72 Danderyd 445 20 1.84 1.25; 2.72 71 54–72 Norrköping 655 31 2.03 1.46; 2.81 72 62–72 Table 6.4.3. Relative risk of revision per unit, five years. Units with significantly better or worse results than the national average are shown in green and red respectively. 1 8 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Relative risk of revision per unit, ten years Klinik Antal TKA Reviderade RR RR 95% KI Rank Rank 95% KI Art Clinic Jönköping 1,422 10 0.43 0.26; 0.71 1 1–18 Aleris Specialistvård Nacka 1,877 17 0.43 0.28; 0.65 2 1–14 Alingsås 1,975 21 0.46 0.31; 0.67 3 1–15 Karlskoga 494 5 0.47 0.25; 0.86 4 1–30 Karlshamn 2,533 31 0.51 0.37; 0.71 5 1–18 Kalmar 836 10 0.57 0.34; 0.94 6 1–36 Carlanderska 2,284 26 0.57 0.40; 0.81 7 2–25 Gällivare 652 8 0.58 0.33; 0.99 8 1–40 Carlanderska–SportsMed 1,181 16 0.58 0.38; 0.89 9 2–32 Sabbatsberg 285 4 0.59 0.31; 1.14 10 1–51 Karolinska Huddinge 1,246 18 0.62 0.41; 0.93 11 3–35 Skene 1,387 20 0.65 0.44; 0.96 12 3–38 Capio Ortho Center Göteborg 2,112 34 0.66 0.48; 0.91 13 5–34 Capio Movement 4,500 76 0.68 0.55; 0.85 14 8–29 Jönköping 577 12 0.7 0.43; 1.12 15 3–51 Karolinska Solna 476 9 0.71 0.42; 1.20 16 3–56 Spenshult 431 10 0.72 0.43; 1.19 17 3–55 Halmstad 1,645 32 0.72 0.52; 1.00 18 7–41 Hudiksvall 632 11 0.72 0.44; 1.18 19 4–54 Piteå 2,693 50 0.76 0.58; 0.99 20 9–40 Falköping 63 0.76 0.32; 1.83 21 1–75 Capio Artro Clinic 3,599 55 0.78 0.60; 1.00 22 10–42 Uddevalla 2,035 39 0.78 0.58; 1.05 23 10–45 Capio Ortopediska Huset 6,667 131 0.78 0.66; 0.93 24 14–36 Trelleborg 6,685 148 0.79 0.67; 0.93 25 14–36 Varberg 1,421 31 0.82 0.59; 1.14 26 10–52 Oskarshamn 3,346 71 0.85 0.68; 1.06 27 15–46 Värnamo 1,815 37 0.85 0.63; 1.15 28 12–52 Capio Ortho Center Stockholm 5,560 121 0.87 0.72; 1.03 29 18–44 Mora 1,969 42 0.87 0.65; 1.16 30 14–53 Torsby 1,220 27 0.88 0.62; 1.24 31 12–58 Capio S:t Göran 3,378 78 0.88 0.71; 1.10 32 17–49 Frölunda Specialistsjukhus 362 11 0.92 0.56; 1.51 33 9–69 Lindesberg 3,322 74 0.92 0.74; 1.15 34 19–53 Borås 738 18 0.94 0.62; 1.42 35 12–66 Örnsköldsvik 1,230 29 0.94 0.67; 1.32 36 15–63 Nyköping 780 19 0.95 0.63; 1.41 37 13–66 Aleris Specialistvård Bollnäs 2,143 64 0.95 0.75; 1.21 38 20–56 Bollnäs 1,195 18 0.96 0.64; 1.46 39 13–68 Table continued on next page. 1 8 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Relative risk of revision per unit, ten years, cont. Klinik Antal TKA Reviderade RR RR 95% KI Rank Rank 95% KI Örebro 149 5 0.99 0.53; 1.83 40 7–75 Ängelholm 87 3 1.0 0.50; 1.99 41 6–76 Aleris Specialistvård Motala 2,376 76 1.01 0.81; 1.26 42 25–60 Arvika 2,290 55 1.01 0.78; 1.31 43 23–62 SU/Mölndal 3,149 88 1.03 0.84; 1.26 44 27–60 Västerås 2,342 62 1.04 0.82; 1.33 45 26–63 Södersjukhuset 2,032 62 1.05 0.83; 1.34 46 27–64 Lidköping 1,890 53 1.06 0.82; 1.37 47 26–65 Karlstad 1,145 37 1.06 0.78; 1.44 48 23–67 Växjö 1,782 48 1.08 0.82; 1.42 49 26–67 Elisabethsjukhuset 55 3 1.12 0.56; 2.23 50 9–77 Södertälje 1,322 39 1.14 0.85; 1.53 51 28–70 Visby 928 28 1.15 0.82; 1.62 52 26–72 Östersund 1,255 38 1.15 0.85; 1.55 53 29–71 Ljungby 991 31 1.17 0.84; 1.62 54 28–72 Helsingborg 1,618 45 1.19 0.90; 1.57 55 33–71 Aleris Specialistvård Ängelholm 2,495 69 1.19 0.95; 1.50 56 37–69 Eksjö 2,607 76 1.21 0.97; 1.51 57 39–70 Enköping 4,329 131 1.22 1.03; 1.45 58 43–68 Falun 1,982 71 1.22 0.97; 1.53 59 39–70 Skellefteå 897 31 1.23 0.89; 1.71 60 32–73 Gävle 892 33 1.25 0.91; 1.72 61 34–74 Sophiahemmet 628 29 1.25 0.89; 1.76 62 33–74 Norrtälje 1,372 42 1.26 0.95; 1.68 63 37–73 Sollefteå 1,504 47 1.27 0.97; 1.67 64 39–73 Skövde 653 26 1.28 0.90; 1.82 65 33–75 Västervik 1,062 36 1.32 0.97; 1.80 66 39–75 Akademiska sjukhuset 865 33 1.34 0.98; 1.85 67 39–75 Danderyd 1,021 37 1.35 1.00; 1.83 68 41–75 Sundsvall 388 16 1.37 0.89; 2.10 69 33–76 Kullbergska sjukhuset 2,340 78 1.39 1.12; 1.73 70 50–74 Umeå 947 45 1.48 1.12; 1.96 71 50–76 Hässleholm 8,060 317 1.53 1.37; 1.72 72 64–74 SUS/Lund 340 19 1.61 1.08; 2.41 73 48–77 Norrköping 1,350 60 1.64 1.29; 2.10 74 60–77 Lycksele 1,209 52 1.68 1.29; 2.18 75 61–77 Kungälv 1,430 75 1.85 1.49; 2.31 76 69–77 Eskilstuna 508 34 2.16 1.58; 2.96 77 71–77 Table 6.4.4. Relative risk of revision per unit, ten years. Units with significantly better or worse results than the national average are shown in green and red respectively. 1 8 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 6.4.11. CRR after five years per unit (primary operation 2018–2023). Units with fewer than 50 primary operations in the last five years are not presented. 1 8 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 6.4.12. CRR after ten years per unit (primary operation 2013–2023). Units with fewer than 50 primary operations in the last five years are not presented. 1 8 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Patellofemoral prosthesis Partial resurfacing prosthesis A patellofemoral prosthesis addresses only the femoro- The first partial resurfacing prosthesis, Episealer, was reg- patellar compartment and is a less commonly used type istered in 2011, and various numbers have been reported of prosthesis. Its use has increased over the past 15 years, over the years, with 75 implants registered in 2023. Epi- rising from 10–20 implants per year to 50–60 per year. sealer is a custom-made implant based on MRI images Figure 6.4.13 shows the cumulative revision rate (CRR) at and is used in the femoral condyles of the knee joint nine years (14 CI 9.7–18.1) for patellofemoral prostheses (both medial and lateral), the trochlear area of the knee implanted between 2013 and 2023. joint, or both, primarily for local cartilage damage. Figure 6.4.14 shows the CRR at eight years (9.4 CI 1.1–16.9) for implants inserted between 2013 and 2023. © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 6.4.13. CRR for patellofemoral replacements inserted in the Figure 6.4.14. CRR for partial knee replacements inserted in the ten-year period 2013-2023. ten-year period 2013-2023. Due to that there are relatively few replacements, the curve ends when the number “at risk” is below ten replacements (unlike other CRR figures where the curves end at 50 at risk). 1 8 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 6.5. Evaluation of implant Authors: Annette W-Dahl and Ola Rolfson In the evaluation of implants, we have chosen to present revision models used in primary surgeries. Triathlon MBT relatively modern prosthesis models with reasonably long is reported separately for cemented and uncemented ver- follow-up times, using data from the most recent ten- sions, as it is the most commonly reported uncemented year period. A model is also reported after it has ceased prosthesis in Sweden. The hazard ratio (HR) is adjusted to be used as long as there is a sufficient amount of data for sex, age, and year of surgery (Table 6.5.1). to analyze. Note that individual prosthesis models may represent different prosthesis variants due to factors such as This year, we have chosen to replace PFC-Sigma MBT as modularity and marketing. However, within each model, the reference for TKR with NexGen MBT, as it is the most there are usually a few dominant combinations. In this commonly used prosthesis in the recent ten-year period. year's report, models that have been reported in 100 or NexGen MBT is considered a well-defined prosthesis more surgeries from 2014–2023 are included, as well as despite the many combinations available, as most consist Hazard ratio with 95% confidence interval in revision TKR/OA Model Number Revised HR (95% CI) p NexGen MBT 64,742 1,349 Reference NexGen Trabecular Metal 2,113 39 0.69 (0.50; 0.96) 0.03 PFC Sigma TKA APT 5,477 99 0.73 (0.59; 0.89) < 0.01 Triathlon MBT Hybrid 204 2 0.89 (0.22; 3.55) 0.86 Genesis II MBT 2,736 54 0.96 (0.73; 1.26) 0.76 Vanguard I-Beam Modular 1,332 45 1.16 (0.86; 1.56) 0.35 Triathlon MBT Cemented 11,547 250 1.19 (1.04; 1.36) 0.01 PFC Sigma TKA MBT 21,670 624 1.27 (1.16; 1.40) < 0.01 Attune MB TKA 2,669 34 1.46 (1.03; 2.06) 0.03 Triathlon APT 170 5 1.47 (0.61; 3.54) 0.39 Vanguard Finned Stem Modular 1,690 71 1.49 (1.17; 1.90) < 0.01 Triathlon MBT uncemented 6,894 221 1.55 (1.35; 1.79) < 0.01 Persona 5,368 107 1.60 (1.31; 1.95) < 0.01 Other 538 23 1.72 (1.14; 2.61) < 0.01 NexGen Revision 559 18 1.82 (1.15; 2.90) 0.01 PFC Sigma TC-3 (revision) 380 16 2.17 (1.33; 3.56) < 0.01 Triathlon Total Stabilizer 802 34 2.35 (1.67; 3.31) < 0.01 Legion/Genesis II Pri MBT 2,271 117 2.46 (2.03; 2.97) < 0.01 Journey TKA 216 17 3.87 (2.40; 6.24) < 0.01 Sex=Female 0.89 (0.83; 0.96) < 0.01 Age 0.98 (0.98; 0.99) < 0.01 Surgical year 1.00 (0.98; 1.01) 0.56 Table 6.5.1. Hazard ratio for revision with 95% confidence interval in TKR/OA 2014–2023. Units with significantly better or worse results than the national average are shown in green and red respectively. 1 9 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 of the same type of femur, tibial plate, and polyethylene be used in 2010. In the 2018 report, the finned version insert. Among those classified as NexGen MBT, five com- had a significantly higher risk than the reference model, binations of femur, tibia, and polyethylene insert account but in recent years the difference has not been significant, for 95%, with three combinations making up 91%. although it now shows a significantly higher risk compared to NexGen MBT. Since Vanguard is no longer used in Triathlon MBT cemented, PFC Sigma TKA MBT, Attune Sweden, this is of mostly historical interest. MB TKA, Vanguard Finned Stem Modular, Triathlon MBT uncemented, Persona, Legion/Genesis II MBT, Jour- Females have a significantly lower ten-year HR for revision ney TKA, and revision models such as NexGen Revision, (all types) than males, which is mainly explained by male’s PFC Sigma TC-3 (revision), and Triathlon Total Stabilizer higher risk of infection, which is most common early post- show a significantly higher risk of revision (higher HR) operatively. As in previous years, the risk decreases with compared to the reference NexGen MBT. Journey TKA increasing age, while the year of surgery does not affect is used less frequently, Triathlon MBT uncemented is the risk. used approximately the same amount, while Persona is increasing in usage. For UKR, we have also chosen to change the reference prosthesis from Link to Oxford’s uncemented prosthe- On the other hand, NexGen TM and PFC-Sigma APT sis (Table 6.5.2). For UKR due to OA, Oxford models have lower HRs compared to the reference. account for 75% of surgeries, while Link accounts for just over 5%. Link has a significantly higher risk, while no As in previous years, we have included revision models prosthesis has a significantly lower risk of revision com- if they have been reported sufficiently. We are aware that pared to the reference prosthesis, and the risk decreases these are used on primary patients with more advanced with increasing age. OA/malalignments and sicker patients, but we still find it interesting to show how these groups perform. All revision The risk of revision is just one measure of prosthesis model models show a higher HR than the reference prosthesis. performance. The type of revision should also be consid- ered, even though it is not reported here. A deliberately There are two different variants of the Vanguard prosthesis: sparing use of patellar components, with the option to one uses a tibial plate with an I-Beam stem, while the provide patellar support secondarily if needed, raises the other uses a plate with a finned stem. The latter began to reported revision rate. We therefore report TKA/OA Hazard ratio with 95% confidence interval in revision UKR/OA Model Number Revised HR (95% CI) p Oxford uncemented 8,407 358 Reference Sigma-PKR 368 9 0.52 (0.27; 1.01) 0.05 ZUK 1,156 45 0.74 (0.54; 1.02) 0.06 Other 600 27 1.04 (0.70; 1.53) 0.86 Oxford cemented 662 51 1.10 (0.81; 1.51) 0.54 Triathlon Uni 914 49 1.10 (0.82; 1.49) 0.53 Link 1,382 92 1.29 (1.02; 1.63) 0.03 Persona-PK 323 15 1.34 (0.80; 2.25) 0.27 Sex = Female 1.01 (0.86; 1.18) 0.91 Age 0.98 (0.97; 0.99) < 0.01 Surgical year 1.03 (0.99; 1.06) 0.2 Table 6.5.2. Hazard ratio for revision with 95% confidence interval in UKR/OA 2014–2023. Units with significantly better or worse results than the national average are shown in green and red respectively. 1 9 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 separately for those with and without a patellar compo- a patellar component (Table 6.5.4). This categorization nent. In the tables, models that are used both with and results in a reduced number of implants available for without a patellar component are listed separately. All analysis, particularly for the group where a patellar com- other models, including revision models, are categorized ponent has been used. To enable the analysis of comparable as “others.” groups, we have combined certain groups compared to the classification in Table 6.5.1. We have categorized TKR/OA into two groups: those used without a patellar component (Table 6.5.3) and those with Hazard ratio with 95% confidence interval in revision TKR/OA without patella component Model Number Revised HR (95% CI) p NexGen MBT 63,764 1,321 Reference PFC Sigma TKA APT 5,160 94 0.74 (0.60; 0.91) < 0.01 Vanguard I-Beam Modular 1,303 45 1.19 (0.88; 1.61) 0.25 Triathlon MBT Cemented 11,225 243 1.19 (1.04; 1.36) 0.01 PFC Sigma TKA MBT 20,708 597 1.28 (1.16; 1.41) < 0.01 Other 16,728 400 1.37 (1.22; 1.53) < 0.01 Triathlon MBT Uncemented 6,565 214 1.57 (1.36; 1.82) < 0.01 Legion/Genesis II Pri MBT 2,081 107 2.44 (2.00; 2.97) < 0.01 Sex = Female 0.92 (0.85; 0.98) 0.02 Age 0.98 (0.98; 0.99) < 0.01 Surgical year 1.00 (0.98; 1.01) 0.69 Table 6.5.3. Hazard ratio for revision with 95% confidence interval in TKR/OA without patella component 2014–2023. Units with significantly better or worse results than the national average are shown in green and red respectively. Hazard ratio with 95% confidence interval in revision TKR/OA with patella component Model Number Revised HR (95% CI) p NexGen MBT 978 28 Reference PFC Sigma TKA APT 317 5 0.48 (0.18; 1.26) 0.13 Triathlon MBT Uncemented 329 7 0.83 (0.35; 1.96) 0.67 PFC Sigma TKA MBT 962 27 0.87 (0.52; 1.49) 0.62 Triathlon MBT Cemented 322 7 0.90 (0.39; 2.06) 0.8 Attune MB TKA 222 4 0.97 (0.32; 2.91) 0.96 Other 524 16 1.08 (0.58; 2.00) 0.81 Legion/Genesis II Pri MBT 190 10 1.92 (0.93; 3.95) 0.08 Sex = Female 0.45 (0.31; 0.67) < 0.01 Age 1.00 (0.98; 1.02) 0.68 Surgical year 1.01 (0.93; 1.10) 0.74 Table 6.5.4. Hazard ratio for revision with 95% confidence interval in TKR/OA with patella component 2014–2023. Units with significantly better or worse results than the national average are shown in green and red respectively. 1 9 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 In the analysis of TKR without a patellar component compared to the reference, except for the Legion/Genesis (Table 6.5.3), it is noted that the same models show sig- II MBT, which has a higher risk with a patellar component nificantly higher or lower HRs compared to the reference than the reference. The impact of sex, age, and increasing model, NexGen MBT, as seen in the analysis of TKR with year of surgery remains unchanged regardless of whether or without a patellar component (Table 6.5.1). all TKRs are included or only those without a patellar component. However, when only those with a patellar Since the use of a patellar component is relatively rare, it component are considered, only female patients show a becomes more challenging to demonstrate and interpret lower HR. significant differences. None of the prostheses with a patel- lar component have significantly better or worse outcomes Hazard ratio with 95 % confidence interval in revision TKR/OA. (exchange of insert, in case of infection, is not considered to be revision) Model Number Revised HR (95% CI) p NexGen MBT 64,742 951 Reference Genesis II MBT 2,736 30 0.76 (0.53; 1.10) 0.15 Triathlon MBT Hybrid 204 1 0.81 (0.11; 5.75) 0.83 NexGen Trabecular Metal 2,113 39 0.86 (0.62; 1.18) 0.35 PFC Sigma TKA APT 5,477 99 0.99 (0.81; 1.22) 0.94 Triathlon MBT Cemented 11,547 164 1.13 (0.96; 1.34) 0.14 Attune MB TKA 2,669 13 1.21 (0.70; 2.10) 0.5 Vanguard I-Beam Modular 1,332 38 1.28 (0.92; 1.78) 0.14 PFC Sigma TKA MBT 21,670 462 1.30 (1.17; 1.46) < 0.01 Other 538 16 1.55 (0.95; 2.55) 0.08 Vanguard Finned Stem Modular 1,690 57 1.58 (1.20; 2.07) < 0.01 NexGen Revision 559 11 1.65 (0.91; 2.99) 0.1 Persona 5,368 67 1.73 (1.34; 2.23) < 0.01 Triathlon MBT Uncemented 6,894 172 1.73 (1.47; 2.03) < 0.01 Triathlon Total Stabilizer 802 21 2.06 (1.34; 3.17) < 0.01 Triathlon APT 170 5 2.17 (0.90; 5.23) 0.08 Legion/Genesis II Pri MBT 2,271 94 2.83 (2.29; 3.50) < 0.01 PFC Sigma TC-3 (revision) 380 16 3.10 (1.89; 5.09) < 0.01 Journey TKA 216 16 5.12 (3.12; 8.40) < 0.01 Sex = Female 1.14 (1.05; 1.24) < 0.01 Age 0.97 (0.96; 0.97) < 0.01 Surgical year 0.99 (0.97; 1.01) 0.18 Table 6.5.5. Hazard ratio for revision with 95% confidence interval in TKR/OA 2014–2023. Exchange of insert due to infection has not been classified as revision. Units with significantly better or worse results than the national average are shown in green and red respectively. 1 9 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Hazard ratio with 95 % confidence interval in revision UKR/OA (exchange of insert, in case of infection, is not considered to be revision) Model Number Revised HR (95% cI) p Oxford uncemented 8,407 336 Referens Sigma-PKR 368 9 0.55 (0.28; 1.07) 0.08 ZUK 1,156 40 0.69 (0.50; 0.97) 0.03 Oxford cemented 662 48 1.07 (0.78; 1.48) 0.68 Triathlon Uni 914 46 1.09 (0.80; 1.49) 0.57 Other 600 27 1.10 (0.74; 1.62) 0.65 Persona-PK 323 13 1.24 (0.71; 2.16) 0.45 Link 1,382 92 1.36 (1.08; 1.72) < 0.01 Sex = Female 1.06 (0.90; 1.24) 0.48 Age 0.98 (0.97; 0.99) < 0.01 Surgical year 1.02 (0.98; 1.06) 0.4 Table 6.5.6. Hazard ratio for revision with 95% confidence interval in UKR/OA 2014–2023. Exchange of insert due to infection has not been classified as revision. Units with significantly better or worse results than the national average are shown in green and red respectively. As previously, we also present separate tables (6.5.5 and For TKR/OA without considering patellar supply (Table 6.5.6) where revisions involving a polyethylene component 6.5.5), compared to Table 6.5.1, the same prostheses show exchange due to infection are not counted as revisions. higher HRs compared to the reference, with the exception It has been argued that the register’s definitions might dis- of the cemented Triathlon MBT and Attune MB TKA. advantage certain implant types. This is because nearly half Component exchange is not possible for the PFC-Sigma of all revisions for infection involve synovectomies, which APT and the monoblock variant of NexGen TM, so they also include a polyethylene component exchange (thus cannot benefit from the exclusion of component exchange. being counted as revisions). Conversely, a synovectomy Compared to the NexGen MBT reference (with replace- on an implant where the component cannot be changed is able polyethylene), these are not significantly better than not counted as a revision. Thus, exchange of the polyeth- the reference. ylene component in cases of infection could arguably be considered a soft tissue intervention rather than a revision. The ZUK prosthesis, which had a significantly lower On the other hand, implants where the component cannot HR when all revisions were included, also maintains a be replaced typically require a total revision due to the lower HR when component exchange due to infection is impossibility of complete cleaning, potentially leading to excluded for UKR/OA (Table 6.5.6). reverse bias if component exchange is not considered a revision. Without definitively determining what is most In summary, it can be observed that the outcome is affected reasonable, we have chosen to present the risk where when component exchange due to infection is not counted component exchange due to infection is not counted as a as a true revision. HR slightly decreases for some fully revision. Note that such an exclusion reduces the number modular models, while others no longer have a signifi- of revisions, which in turn decreases the sensitivity of sta- cantly higher risk. For prostheses with non-modular tibial tistical calculations. component, HR slightly increases with this adjustment and no longer shows a significantly lower risk. 1 9 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 6.6. Knee Osteotomy Authors: Annette W-Dahl and Ola Rolfson Joint preserving surgery – knee osteotomy Tibial osteotomy was introduced in Sweden in 1969 by The outcomes of knee osteotomy are related to the ability Professor Göran Bauer in Lund as a standard procedure to achieve and maintain the predetermined correction for unicompartmental knee osteoarthritis. After the intro- of the deformity. This requires not only achieving the duction of modern knee prostheses in the mid-1970s, intended degree of correction during the operation but these quickly became the most common surgical treat- also maintaining a stable fixation of the correction until ment for knee osteoarthritis. the bone heals. Each technique has its own advantages and disadvantages, and there is ongoing development in The number of osteotomies has gradually decreased since techniques, materials, and management to achieve better then. In 1981, Björn Tjörnstrand estimated in his dis- results. sertation, “Tibial Osteotomy for Medial Gonarthrosis,” that one-third of knee reconstruction surgery consisted of The choice of method and technique in knee osteot- tibial osteotomies. By the mid-1990s, the Swedish Knee omy can influence the risk of complications both in the Arthroplasty Register reported that they accounted for short and long term, and it can also impact future knee only about 20% of knee reconstruction surgeries. replacement surgery from both technical and outcome perspectives. Using the appropriate technique for the right Among the osteotomies performed around the knee, tibial patient is crucial from both a health economic and patient osteotomy is by far the most common method. It is used perspective. primarily for medial osteoarthritis and less frequently for lateral osteoarthritis. Femoral osteotomies are rarer in Sweden and are mostly used for more severe deformi- ties, whether congenital or acquired, as well as for lateral osteoarthritis of the knee. There are several techniques for knee osteotomy, and the initial fixation of the osteotomy varies depending on the method used. Closed wedge osteotomy (“minus osteot- omy”), a bone wedge, sized according to the required degree of correction, is removed (Figure 6.6.1). The oste- otomy can be fixed with a clamp, plate with screws, or an external frame. Open wedge osteotomy (“plus osteot- omy”), a wedge is opened to achieve the desired degree of correction. Fixation can involve internal fixation, usually with a plate screwed in place (Figure 6.6.2), or external © 2024 The Swedish Arthroplasty Register fixation, which involves an external metal frame (Figure 6.6.3). Internal fixation may include a plate with screws or a clamp, and sometimes a bone graft or bone substitute (artificial bone) is used. In open wedge osteotomy with external fixation, correction can be achieved gradually by slowly separating the ends of the bone, allowing new bone to grow into the osteotomy. This is a biological proce- dure also used for lengthening or other bone corrections, such as such as improperly healed fracture, also known Figure 6.6.1. Closed wedge osteotomy fixed with as hemicallostasis. Lastly, there is the curved or “dome” a staple. The inserted picture above shows the osteotomy, which is rare in Sweden. wedge that is removed before the osteotomy is closed. 1 9 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 6.6.2. Open wedge osteotomy with internal Figure 6.6.3. Open wedge osteotomy with external fixation. fixation. Sweden was the first in the world to initiate knee osteot- injury in the knee. Information from the National Board omy registration as a complement to knee replacement of Health and Welfare in a previous analysis indicated registration (W-Dahl et al., 2014). Australia started in the that approximately 400 different diagnoses, of which 148 fall of 2016, and New Zealand plans to start a similar reg- were primary diagnoses, were listed for the procedure code istration. Both countries have harmonized their reporting NGK59 in the National Patient Register (NPR). 65% of forms with Sweden’s to facilitate future comparisons and the operations could be attributed to osteoarthritis and collaboration. The United Kingdom started its osteotomy instability diagnoses. We have extracted the number of registration in the fall of 2014, funded by the industry and NGK59 from the National Board of Health and Wel- independent from the English joint replacement register fare’s statistics for the years 2014–2022 and compared (Elson et al., 2015). these with all primary osteotomies performed for osteo- arthritis or instability in the knee osteotomy register for In 2023, a total of 107 primary osteotomies were reported the corresponding years. Assuming that the osteotomy from 19 units. As shown in Figure 6.6.1, only three units register predominantly captures osteoarthritis and insta- reported performing 10 or more osteotomies during bility diagnoses, we estimate that the completeness of the the year. The hospital that reported the highest number knee osteotomy register was 75–87% during the period was Capio Artro Clinic, with 29 procedures. There were 2014–2022. 25 more knee osteotomies reported in 2023 compared to 2022. The Centre of Registers Västra Götaland has implemented principles for anonymization, meaning that it should It is challenging to assess how many of the osteotomies not be possible to identify an individual in the annual performed in the country are also reported to the knee report. These principles are extensive and could affect the osteotomy register. The procedure codes for knee osteot- purpose of the report and, in some cases, provide incor- omy (NGK59 and NFK59) which are used for osteot- rect information. As the Swedish Arthroplasty Register omies performed on the femur and tibia, also apply to absolutely does not intend to disclose any identities, we osteotomies performed for other reasons than disease or have chosen not to show numbers in any category below 1 9 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Type of knee osteotomy per unit 2013–2023 Open wedge Open wedge osteotomy osteotomy Distal Closed Double internal ­external femur wedge osteotomy Dome Rotational Unit fixation fixation osteotomy osteotomy (F&T) osteotomy osteotomy Total Aleris Specialistvård 5 0 0 0 0 0 0 5 Eskilstuna Aleris Specialistvård <5 0 0 0 0 0 0 <5 Ängelholm Art Clinic Jönköping 7 0 0 0 0 0 0 7 Borås <5 0 0 0 0 <5 0 <5 Capio Artro Clinic 67 0 10 0 0 <5 0 79 Capio Movement 72 0 0 0 0 0 0 72 Capio OrthoCenter 0 0 <5 <5 0 0 0 <5 Stockholm Capio Ortho och Spine 8 0 0 0 0 0 0 8 Center Skåne Capio Ortopedi Motala 127 0 16 0 0 0 0 143 Capio Ortopediskahuset 0 0 0 12 0 0 0 12 Danderyd 6 0 <5 0 0 0 0 7 Eksjö 26 8 <5 0 0 0 0 35 Elisabethkliniken 11 0 0 0 0 0 0 11 Enköping 25 0 0 0 0 0 0 25 Eskilstuna 15 0 0 0 0 0 0 15 Falun <5 0 0 0 0 0 <5 <5 Gävle 113 0 8 5 10 <5 0 138 Helsingborg 52 0 8 0 0 0 0 60 Hudiksvall 51 0 <5 0 0 0 0 53 Hässleholm 0 136 <5 0 0 0 0 137 Jönköping 17 <5 <5 0 0 0 0 20 Kalmar 0 23 0 0 0 0 0 23 Karolinska Huddinge 0 0 0 5 0 0 0 5 Karolinska Solna 17 12 19 0 28 <5 <5 80 Kungsbacka 42 0 <5 <5 0 0 0 48 Kungälv 13 0 0 0 0 0 0 13 Köping <5 0 0 0 0 0 0 <5 Norrköping 5 0 0 0 0 0 <5 6 Norrtälje 11 0 0 0 0 0 0 11 Ortopediskt Center/ 37 0 <5 0 0 0 0 39 Sophiahemmet Oskarshamn 64 0 0 0 0 0 0 64 Piteå 5 0 0 0 0 0 0 5 Table continued on next page. 1 9 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Type of knee osteotomy per unit 2013-2023, cont. Open wedge Open wedge osteotomy osteotomy Distal Closed Double internal ­external femur wedge osteotomy Dome Rotational Unit fixation fixation osteotomy osteotomy (F&T) osteotomy osteotomy Total Sabbatsberg 6 0 <5 0 0 0 0 8 SU/Mölndal <5 0 0 0 0 0 0 <5 Sunderby sjukhus <5 0 0 0 0 0 0 <5 Sundsvall <5 0 0 <5 0 0 0 <5 SU/Sahlgrenska <5 0 0 0 0 0 0 <5 SUS/Lund 6 <5 <5 0 0 0 0 10 SUS/Malmö 30 <5 10 0 <5 0 0 43 Södersjukhuset 39 0 11 0 0 0 0 50 Trelleborg 76 19 9 <5 0 0 1 106 Uddevalla 157 <5 20 <5 0 0 0 179 Umeå <5 60 <5 0 0 0 <5 65 Visby 15 0 <5 0 0 0 0 17 Västervik <5 0 0 0 0 0 0 <5 Västerås 6 0 0 <5 0 0 0 7 Växjö <5 24 0 0 0 0 0 26 Ängelholm <5 0 0 0 0 0 0 <5 Örebro 6 0 <5 0 0 0 0 7 Östersund <5 0 0 0 0 0 0 <5 Total 976 261 98 29 15 5 <5 1,673 Table 6.6.1. Type of knee osteotomy per unit 2013-2023. Demography knee osteotomy 2023 All Proximal Tibia Distal Femur Number 127 99 16 Age Median (min–max) 49 (16–65) 50 (17–62) 38,5 (16–65) < 45 years, n (%) 48 (38) 31 11 45–54 years, n (%) 54 (42) 48 <5 55–6 5years, n (%) 25 (20) 20 <5 ≥ 65 years, n (%) 1 (1) 0 <5 Sex Females, n (%) 46 (36) 34 9 Table continued on next page. 1 9 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Demography knee osteotomy 2023, cont. All Proximal Tibia Distal Femur BMI Median (range) 27 (19–40) 27 (19–40) 26 (20–35) 18.5–24.9, n (%) 37 (29) 26 7 25–29.9, n (%) 58 (46) 49 <5 30–34.9, n (%) 23 (18) 18 <5 35–39.9, n (%) 7 (6) 6 0 Missing, n (%) <5 0 <5 ASA–class, n (%) I 63 (50) 49 9 II 55 (43) 44 5 III–V 8 (6) 5 <5 Missing 1 (1) 1 0 Previous surgery, n (%) None 64 (50) 50 6 Osteosynthesis 9 (7) <5 <5 Cruciate ligament repair 10 (8) 9 <5 Meniscal surgery 22 (17) 18 <5 Arthroscopy 14 (11) 13 <5 Other 6 (5) <5 <5 Missing 2 (2) 2 0 Diagnosis OA Number, (%) 94 (74) 79 12 Ahlbäck 1 26 21 5 Ahlbäck 2 17 15 <5 Ahlbäck 3–4 <5 <5 0 Missing a) 48 40 6 Varus/valgus Number (%) 127 99 16 Varus 102 (80) 90 <5 Valgus 19 (15) <5 13 Missing 6 (5) 5 0 Preop HKA–angle Number 121 94 16 Median (range) 7 (0–25) 7 (0–25) 7 (1–25) Table 6.6.2. Demography knee osteotomy 2023. 1 9 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 five but instead indicate <5 to avoid this possibility. As the patients were reported as healthy (ASA I) and had a a consequence of these principles, it is, for example, not median BMI of 27. There was a period during which the possible for us to present which units performed knee variable “Osteoarthritis Grade” was mistakenly removed osteotomies and which methods and techniques they used from the web form, resulting in missing information for for 2023. Instead, we have chosen to show the number over half of the knee osteotomies performed for osteo- of knee osteotomies and the type of osteotomy per unit arthritis. Most patients were reported to have medial from 2013 to 2023, i.e., since the start of the registration osteoarthritis, with a median deformity of 7 degrees varus (Table 6.6.1). or valgus. Patients who underwent distal femoral osteot- omy were younger, with a higher proportion of females compared to those who had proximal tibial osteotomy, Results but had similar degrees of preoperative deformity (Table The Knee Osteotomy Register records similar information 6.6.2). as the Swedish Arthroplasty Register regarding patients (BMI, ASA, previous surgeries), antibiotics, thrombo- When reporting previous surgeries on the affected knee, prophylaxis, and surgical techniques. Additionally, infor- multiple options can be selected. Half of the patients mation on deformity measured by the HKA angle and reported having had a knee surgery before the current osteoarthritis grade at the time of diagnosis according to osteotomy, with 15% having undergone more than one. Ahlbäck’s classification is collected for knee osteotomies. In comparison, for knee replacement patients, just under The results for 2023 are presented with numbers and, 15% reported having had a knee surgery before the cur- where appropriate, percentage values. rent operation, and 3% had undergone more than one. The reported information about previous surgeries does not provide a comprehensive description of the type of Demographics procedures but gives an overview of what was known at Nearly two-thirds of the patients were males, and the the time of surgery (Table 6.6.1). median age was 49 years, compared to a median age of 71 years for TKR and 67 years for UKR in 2023. Half of Type of knee osteotomy and reason for surgery Open wedge Open wedge HTO internal HTO external Distal femoral Double osteot- Rotational Diagnosis fixation fixation Closed wedge osteotomy omy osteotomy Total OA 65 14 0 12 0 0 94 Acquired deformity <5 0 0 <5 <5 0 5 Congenital deformity 6 0 <5 <5 8 <5 18 Instability <5 0 <5 <5 0 0 <5 Osteonecrosis <5 0 0 0 0 0 <5 Other <5 0 0 <5 0 0 5 Missing 0 0 0 0 0 0 0 Total 81 4 <5 16 12 <5 127 Table 6.6.3. Type of knee osteotomy and reason for surgery 2023. 2 0 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Reason and type of osteotomy which suggests administering it 2 g × 3 on the first day The majority of the procedures were performed due to of surgery or a single 2 g dose. Since Cloxacillin has a osteoarthritis. The most popular method was open wedge short half-life, it must be administered within the correct osteotomy with internal fixation, followed by distal time interval. The updated PRISS recommendations femoral osteotomy. Only two closed wedge osteotomies (April 2018 and April 2023) specify the optimal time as were reported in 2023. For open wedge osteotomies with 45–30 minutes before surgery, a narrower interval than external fixation, only Orthofix was reported in 2023 previously recommended (45–15 minutes) (Table 6.6.5). (Table 6.6.3). Other surgical variables Type of plate fixation and bone grafting General anesthesia was the most commonly reported For open wedge osteotomy with internal fixation, sev- form of anesthesia, used in 60% of surgeries. The use of eral different plates were used. The Tomofix plate was torniquet has decreased among Swedish orthopedic sur- the most frequently reported for open wedge osteotomy geons but is reported slightly more frequently for knee with internal fixation. Six different types of plate fixation osteotomies (50%) compared to knee prosthesis surgeries were used in osteotomies with this technique. In just over (25%). The use of drains has become increasingly rare, half of the open wedge osteotomies with internal fixation, with no drains used in the osteotomies and less than 0.5% no bone grafting was reported. When bone grafting was used in knee preplacement surgeries. used, synthetic bone was reported most frequently, with Innotere being the most common form. For distal femoral In one-third of surgeries, an additional simultaneous osteotomies, various types of fixation were reported, with procedure was performed alongside the knee osteotomy, Tomofix being the most common (Table 6.6.4). with arthroscopy being the most common (Table 6.6.6). The median operation time, excluding osteotomies with additional simultaneous procedures, was shorter for open Thrombosis and Antibiotic Prophylaxis wedge osteotomies with external fixation (61 minutes, Innohep and Fragmin were the most commonly reported 38–118 minutes) than with internal fixation (70.5 min- antithrombotic agents, while NOACs were reported in utes, 27–209 minutes). The median time for distal femo- only 10% of surgeries. This contrasts with 66% of knee ral osteotomy was 113 minutes (32–167 minutes) and for replacement surgeries, where NOACs or a combination double osteotomy was 172 minutes (110–271 minutes). of injections and NOACs were used for prophylaxis. Pro- Table 6.6.4 shows median times including the duration phylaxis with Fragmin, Innohep, and Klexane was more of any additional simultaneous procedures. None of the frequently started postoperatively. In four surgeries, no osteotomies were performed using computer-assisted thrombosis prophylaxis was reported. The duration of navigation (CAS). prophylaxis varied, but in nearly three-quarters of the surgeries, prophylaxis was planned to last 8–14 days (Table 6.6.5). Reoperation Since the start of the knee osteotomy register in 2013, Cloxacillin was reported as the infection prophylaxis in around one hundred reoperations have been reported. The the majority of surgeries in 2023, and Dalacin (clindamy- most common reasons for reoperation have been pain/ cin) was reported in 5% of surgeries. In contrast, only 4% irritation of the plate, pseudoarthrosis/delayed healing, of knee replacement surgeries used clindamycin. Given and over- or under-correction. that clindamycin has shown a higher risk of revision due to infection in knee prosthesis surgery (Robertsson et al. The cumulative revision rate (CRR) at ten years for open 2017), the PRISS recommendations were updated in wedge osteotomies performed from 2013 to 2023 and April 2018 and April 2023 (www.patientforsakringen. followed up to December 31, 2023, with internal and se). In nearly half of the surgeries, the preoperative dose external fixation was 25.2% (95% CI 17.8–31.9) and was administered according to PRISS recommendations, 26.1% (95% CI 21.4–30.6), respectively (Figure 6.6.4). 2 0 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Type of plate fixation and bone graft Thrombosis prophylaxis and prophylactic antibiotics Open wedge HTO Distal femoral internal fixation, osteotomy, Thrombosis prophylaxis and prophylactic antibiotics number number Thrombosis prophylaxis, number (%) Type of plate No prophylaxis <5 Tomofix 14 10 Dalteparin preop <5 PEEKPower 14 <5 Dalteparin postop 55 (44) Puddo 13 Tinzaparin preop <5 Activmotion <5 <5 Tinzaparin postop 30 (24) Other <5 Enoxaparin postop 13 (10) Missing 0 <5 Apixaban 13 (10) Total 81 16 Missing <5 Bone graft Total 127 None 49 11 Number of days, number (%) Autograft 6 <5 No prophylaxis <5 Bank bone <5 0 1-7 6 (5) Synthetic graft 24 <5 8 - 14 92 (72) Missing <5 0 >14 21 (17) Total 81 16 Missing <5 Synthetic graft Total 127 INNOTERE 13 <5 Prophylactic antibiotics, number (%) ChronOS 6 <5 No prophylaxis <5 Aktivmotion <5 <5 Cloxacillin 118 (93) Other <5 0 Cindamycin 6 (5) Missing 0 0 Cefotaxim <5 Total 24 <5 Missing <5 Table 6.6.4. Type of plate fixation and bone graft 2023. Total 127 Dosage, Cloxacillin, number (%) 2g x 1 30 (25) 2g x 2 35 (30) 2g x 3 53 (45) Missing 0 Total 118 Minutes before surgery, number No prophylaxis <5 0 - 29 31 (24) 30 - 45 57 (45) >45 35 (28) Missing <5 Total 127 Table 6.6.5. Thromboprophylaxis and prophylactic antibiotics 2023. 2 0 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Type of anesthesia and surgical variables Type of anesthesia and surgical variables Type of anesthesia, number (%) Generell 75 (59) Spinal 28 (22) Epidural 7 (5) Combination 16 (13) © 2024 The Swedish Arthroplasty Register Missing <5 Total 127 Tourniquet, number (%) Yes 64 (51) No 60 (47) Missing <5 Total 127 Drainage, number (%) Figure 6.6.4. CRR for conversion to TKR after open Yes 0 wedge osteotomy. No 124 (98) Missing <5 Total 127 Concomitant surgery, number (%) None 85 (67) Arthroscopy 18 (14) Cruciate ligament reapir 5 (4) Meniscal surgery <5 Other 9 (7) Missing 8 (6) Total 127 Surgical time minutes, median (min-max) Open wedge internal 74 (27–257) Open wedge external 61 (38–118) Closed wedge 229.5 (192–267) Distal femoral 112.5 (32–320) Double osteotomy 191.5 (110–307) Rotational osteotomy 164 (151–177) Table 6.6.6. Type of anesthesia and surgical variables 2023. 2 0 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 An adverse event is any unfavorable event in a patient that occurs during or after treatment but is not necessarily causally related to that treatment. 7. Adverse events Authors: Cecilia Rogmark, Annette W-Dahl, and Ola Rolfson 7.1. 90-day mortality The 90-day mortality rate is often used to assess the risks and Västmanland have mortality rates above the national associated with various medical treatments and is openly average for both hips and knees. reported. This year’s report presents regional data for both primary hip and knee replacement surgeries, as well as hip A joint replacement carries an increased risk of poten- fractures. The Swedish Arthroplasty Register database is tially life-threatening complications, such as infections updated nightly with any recorded patient death dates and thromboembolic events. Comprehensive informa- from the Swedish Tax Agency. The data includes the last tion is a crucial part of the decision-making process for three years (2021–2023) to account for random variation. patients considering an elective operation, and while mortality rates may appear low, there is always room for Elective orthopedic surgeries, such as joint replacement, improvement. It is also essential that other units treating are typically performed when the patient’s health is as newly operated patients with complications inform the stable as possible. In some cases, surgery may be deemed operating unit of these cases. If the orthopedic surgeon is too risky and therefore not recommended. This careful not aware of these severe incidents, they may mistakenly selection and optimization of patients undergoing joint assume such complications do not occur. replacement surgeries contribute to a low mortality rate. The 90-day mortality after a primary elective total hip For patients with a hip fracture, surgery is almost always replacement is 1.7 ‰ (see Table 7.1.1). However, mortal- performed, regardless of coexisting illnesses. Therefore, the ity varies between regions. In one region, no deaths were 90-day mortality rate after hip fracture surgery is higher reported within 90 days, while another region reported a than after elective surgeries. The national level is slightly mortality rate of 8.1‰. Mortality after knee replacement lower than in the previous year, at 12.1% (see Table 7.1.2). surgery is even lower, at 1.0‰ (Table 7.1.1). The variation A few regions, such as Jämtland and Västmanland, report between regions is smaller for knee replacement, ranging even higher rates, around 14%. These regions tend to have from 0 to 3.4‰. Gotland has a relatively high mortality a higher proportion of male patients and patients with rate following hip replacement surgery but one of the severe health conditions. In Västernorrland, patients are lowest in the country after knee preplacement surgery. more frequently ill and/or over 80 years old. A significant However, as Gotland is one of the smallest regions, even proportion of patients in Västra Götaland, Halland, and a single death can significantly impact the overall mor- Blekinge are also over 80 years old. High mortality rates tality rate. Halland, Kronoberg, Uppsala, Västerbotten, should prompt internal review and analysis. 2 0 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 90-days mortality after primary elective hip replacements and knee replacements Hip Knee Number of Number of Region operations Number of deaths Mortality, ‰ operations Number of deaths Mortality, ‰ Blekinge 804 1 1.2 729 0 0.0 Dalarna 1,181 2 1.7 1,153 1 0.9 Gotland 370 3 8.1 285 0 0.0 Gävleborg 1,558 2 1.3 1,463 0 0.0 Halland 2,175 5 2.3 2,436 4 1.6 Jämtland 474 2 4.2 297 1 3.4 Jönköping 2,555 1 0.4 2,350 1 0.4 Kalmar 1,754 0 0.0 1,493 2 1.3 Kronoberg 763 2 2.6 644 1 1.6 Norrbotten 1,435 5 3.5 1,257 1 0.8 Skåne 6,273 12 1.9 7,112 5 0.7 Stockholm 13,806 19 1.4 13,536 11 0.8 Sörmland 2,085 2 1.0 1,808 2 1.1 Uppsala 2,080 9 4.3 2,010 3 1.5 Värmland 1,462 1 0.7 1,326 1 0.8 Västerbotten 1,285 4 3.1 862 2 2.3 Västernorrland 1,629 2 1.2 1,068 3 2.8 Västmanland 1,057 3 2.8 704 1 1.4 Västra Götaland 8,098 13 1.6 6,963 9 1.3 Örebro 1,406 3 2.1 1,048 1 1.0 Östergötland 1,956 3 1.5 1,958 2 1.0 Country 54,206 94 1.7 50,502 51 1.0 Table 7.1.1. 90-day mortality after primary elective total hip and knee replacement per region 2021–2023. 2 0 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 90-days mortality after hip fracture Number of Acute Number of Region operations1 >80 years2 Males3 ASA III4 ASA IV5 fracture6 deaths Mortality7 Blekinge 437 59.3 36.8 46.0 4.6 95.9 59 13.5 Dalarna 707 57.4 39.2 52.0 7.8 96.2 86 12.2 Gotland 160 53.8 35.0 48.3 4.8 94.4 20 12.5 Gävleborg 733 53.2 39.3 44.4 7.1 96.2 70 9.5 Halland 765 60.4 38.7 45.6 8.3 96.1 104 13.6 Jämtland 310 50.6 39.7 59.0 10.4 92.9 44 14.2 Jönköping 630 55.1 37.5 55.6 9.0 95.6 62 9.8 Kalmar 571 54.3 32.7 51.5 4.2 95.8 44 7.7 Kronoberg 453 57.6 34.4 56.6 7.8 94.9 56 12.4 Norrbotten 722 58.7 40.4 54.9 10.1 94.7 92 12.7 Skåne 2,747 57.5 36.3 55.2 5.2 94.2 313 11.4 Stockholm 3,539 57.1 35.5 65.9 7.5 91.9 412 11.6 Sörmland 583 54.7 36.4 53.3 6.9 93.3 69 11.8 Uppsala 777 56.9 38.0 62.7 5.8 94.5 87 11.2 Värmland 686 56.9 38.6 52.7 4.9 96.2 87 12.7 Västerbotten 672 56.5 36.9 56.5 6.8 96.0 82 12.2 Västernorrland 596 59.1 33.4 56.1 13.0 97.0 80 13.4 Västmanland 589 54.5 40.9 62.7 9.0 97.6 80 13.6 Västra Götaland 3,511 59.1 35.6 54.1 6.9 96.2 476 13.6 Örebro 690 53.3 36.1 56.4 8.9 93.3 91 13.2 Östergötland 869 57.7 33.9 51.8 8.5 93.9 91 10.5 Country 20,747 57.1 36.5 56.1 7.2 94.7 2,505 12.1 Table 7.1.2. 90-day mortality after hip fracture per region 2021–2023. 1) Number of primary surgeries in the current period 2) Number of surgeries in the age group >80 years. 3) Proportion of males in the current period. 4) Proportion with ASA class III. 5) Proportion with ASA class IV. 6) Proportion with acute fracture. 7) 90-day mortality (proportion who have died within 90 days after surgery). 2 0 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 7.2. Adverse events Joint replacements are among the interventions that In the comparison of units, data from five years has been have the greatest cost benefits in healthcare. Although used, 2019–2023. Units with fewer than 40 operations the surgery is considered safe and have few complications are not shown. some patients experience health problems after surgery that could have arisen or become symptomatic as a result This year, the National Board of Health and Welfare has of the surgery. delivered adverse events after 30 and 90 days per unit in elective hip replacements and total knee replacements due to osteoarthritis respectively, hip replacements due to Description of the analysis fracture and those having first-time revision of primary The analysis is performed by linking the register data to hip and knee replacements. The analyses include partly the Patient Register of the National Board of Health and 2013–2023 and partly the most recent five-year period, Welfare (PAR). We have examined the diagnostic and 2019–2023. procedure codes that have been reported to the PAR during and after hip and knee replacement surgery and If both hips/knees have been operated within 90 days only have identified codes that may represent adverse events the latter is included and only one hip or knee if both have during the hospital stay or during readmission within 90 been operated the same day. The Swedish Arthroplasty days of surgery (see table 7.2.1). Register sends data on all registered operations to the National Board of Health and Welfare which performs Due to the Swedish National Board of Health and Wel- the match against the PAR and codes corresponding to the fare’s changed regulations regarding confidentiality, the definition of adverse events, during or after the hospital method for analyzing adverse events has been altered over stay, up to 90 days after the operation is sought. the past few years. It is no longer allowed to present the number of adverse events if they are three or fewer per The codes were divided into the following groups (table unit. Data from the Swedish National Board of Health 7.2.1): and Welfare’s were not available when the Swedish ver- sion of the annual report was published. However, in this • A – Surgical procedure codes that include reoperations English version we have included adverse events for 2023. of hip or knee replacement and other procedures that may represent a complication. In order not to risk revealing information on individuals, the National Board of Health and Welfare delivers the • DA – Diagnosis codes that imply surgical complica- number of adverse events as intervals of five events (min, tions. max; 0–4, 5–9, 10–14, etc.), where the actual number of events is within the interval. All proportions are calcu- • DB – Diagnosis codes that cover hip/knee-related dis- lated based on the midpoint of the interval (for example, eases that may have been used for complication after the numerator is set to 12 if the interval is 10–14). The hip/knee replacement surgery. lower bound of the confidence interval is calculated on the lowest possible number of events according to the • DC – Diagnosis codes covering cardiovascular events number interval and the upper limit is calculated based that may be related to the surgery. on that the highest possible number. So the confidence interval includes both the uncertainty from the round- • DM – Diagnosis codes considering other medical ing and from the random variation. For the country and events not related to the surgery if they occur shortly larger units, the interval will be roughly the same as before afterwards. but generally it will be wider range and fewer significant differences. 2 0 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Codes for adverse events Additional codes Used for primary Used for reoperations HIP for hip KNEE surgeries and revisions ICD-10 and NOMESCO codes fractures ICD-10 and NOMESCO codes Surgical A If the procedure oc- If the proucedure Exact code Exact code NOMESCO codes cur after the opera- occur during an NFA02, NFA11, NFA12, NFQ09, NFQ19, NFQ99, Complications and tion date OR during admission after the NFA20, NFA21, NFA22, NGB59* NGF01, NGF02, suspected an admission after operation NFQ09, NFU09, NFU19, NGF10, NGF11, NGF12, complications the operation NFU39, NFU89, NFU99, NGF91, NGF92, NGK09, QDA10, QDB00, QDB05, NGK19, NGM09, NGQ09, QDB99, QDE35, QDG30, NGT09, NGT19, QDA10, TNF05, TNF10 QDE35, TNG05, TNG10 Start with Start with NFC.., NFF.., NFG.., NFH.., NGA.., NGC.., NGE.., NGG.., NFJ.., NFK.., NFL.., NFM.., NGH.., NGJ.., NGL.., NGS.., NFS.., NFT.., NFW.. NGU.., NGW.., QDB.., QDG.. If the procedure If the procedure NFU49 NGB59 occur during an occur during an admission after the admission after the operation operation DA If they occur as main If they occur as main G978, G979, M966F, G978, G979, M966G, M968, ICD-10 codes or co-diagnosis at the diagnosis at M968, M969, T810, T812, M969, T810, T812, T813, Surgical time for surgery or as re-admission T813, T814, T815, T816, T814, T815, T816, T817, complications main code at T817, T818, T818W, T819, T818, T818W, T819, re-admission T840, T840F, T843, T843F, T840, T840G,T843, T843G, T844, T844F, T845, T845F, T844, T844G, T845, T845G, T847, T847F, T848, T848F, T847, T847G, T848, T848G, T849, T888, T889 T849, T888, T889 DB If they occur as main If they occur as main G570, G571, G572, M000, G573, G574, M000, M000G, ICD-10 codes for or co-diagnosis at the diagnosis at M000F, M002F, M008F, M002G, M008G, M009G, hip/knee related time for surgery or as re-admission M009F, M243, M244, M220, M221, M236, conditions main code at M244F, S730. M244G, M621G, M662G, re-admission Start with M663G, S74.., S75.., S76.. M843G, S342, S800, S810, S830, S831, S834L, S834M, S835R, S835S, S835X, S840, S841 If they occur as main If they occur as main M240F, M245F, M246F, M235, M240, M245, M246, diagnosis at diagnosis at M610F, M621F, M662F, M256, M659G, M860G, re-admission re-admission M663F, M843F, M860F, M861G, M866, M861F, M866, M866F, M866G, M895G M895E Table continued on next page. 2 0 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Codes for adverse events, cont. Additional codes Used for primary Used for reoperations HIP for hip KNEE surgeries and revisions ICD-10 and NOMESCO codes fractures ICD-10 and NOMESCO codes Cardiovascular DC If they occur as main If they occur as main Exact code Exact code ICD-10 codes for or co-diagnosis at the or co-diagnosis at the I260, I269, I460, I461, I260, I269, I460, I461, I469, serious cardiovas- time for surgery or as time for surgery or as I469, I490, I649, I770, I490, I649, I770, I771, I772, cular conditions main code at main code at I771, I772, I819, I978, I819, I978, I979, J809, re-admission re-admission I979, J809, J819, T811 J819,T811 Start with Start with I21.., I24.., I60.., I61..,I62.., I21.., I24.., I60.., I61.., I62.., I63.., I65.., I66.., I72.., I74.., I63.., I65.., I66.., I72.., I74.., I82.. I82.. Medical DM If they occur as main If they occur as main Exact code N300, Exact code ICD-10 codes for or co-diagnosis at the or co-diagnosis at the J952, J953, J955, J958, N308, J952, J953, J955, J958, J959, other medical time for surgery or as time for surgery or as J959, J981, N990, N998, N309, J981, N990, N998, N999, conditions main code at main code at N999, R339 N390 R339, re-admission re-admission Start with Start with I80.., J13.., J14.., J15.., I80.., J13.., J14.., J15.., J16.., J16.., J17.., J18.., J96.., J17.., J18.., K25.., K26.., K25.., K26.., L89.., N17.. K27.., L89..,N17.. If they occur as main If they occur as main Exact code Exact code diagnosis at diagnosis at K590, N991 K590, N991 re-admission re-admission Start with Start with J20.., J21.., J22.., K29.. J20.., J21.., J22.., K29.. Table 7.2.1. Codes for adverse events. * Only for readmission. 2 1 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Sources of error Results The definition of an adverse events is based on diagnostic Regarding both hip and knee replacement surgery, elective and procedure codes. There may be differences between primary procedures are distinguished. In knee surgery, units in the accuracy of the coding during hospital stay. total replacements due to osteoarthritis are reported. In Information on death after surgery is not depending hip surgery, elective total hip replacements (includes all on coding. diagnoses other than hip fracture and tumour) and first- time revisions are reported (figures 7.2.1 and 7.2.2). The Inadequate registration in the PAR of surgical date can results for patients with hip fractures treated with hip influence if an adverse event during the surgery is included replacement are reported separately, as they differ from or not. Some units performing hip and knee replacements those having an elective procedure due to osteoarthritis. do not report to the PAR and for those, adverse events Those with fracture are older, sicker and often in need occurring during the admission will not be included in the of immediate surgery. However, the fracture group also indicator. The PAR lacks certain information on laterality. include those who are re-operated with a hip replacement Therefore, a complication in the other hip/knee than the after failed internal fixation. “Fracture cases” means for current will be registered as an adverse event. However, some elective units only such planned salvage proce- we consider it unlikely that a complication or surgical dures, which may explain a lower incidence of adverse procedure is registered in the opposite hip or knee within events compared to units doing emergency surgery only. 90 days after hip or knee replacement surgery. That only The fracture group has in general the highest incidence adverse events that occur during the primary admission of adverse events, about one third are affected in the or during readmission are included is a weak-ness of the first 90 days. analysis. Outpatient care is not included. A patient with a closed reduction of a dislocation in an emergency unit and The incidence of adverse events is fairly the same after returns to home is not included. This also applies to, for both primary elective hip and knee replacement surgery. example, venous thromboses, which usually do not lead After revision of a primary hip replacement, the incidence to inpatient care. Furthermore, the coding routines differ is almost 10 percent higher than after revision of a primary between different units. In some cases, there may exist knee replacement. We have not analysed the reasons for economic incentives to register many codes to increase the this, but one possible explanation may be that a number DRG-creep. The threshold for including certain compli- of fracture patients also need revision surgery and then cation codes differs between units. bring their increased risk into the group. It is gratify- ing that the incidence of adverse events is decreasing in The unit’s result should be followed over time to stimulate both primary hip and knee replacement and hip revision local analysis. The panorama of adverse events must be 2013–2023. (figures 7.2.1 and 7.2.2). Surgical adverse better understood, thereby identifying areas of improve- events, decreased somewhat after all procedures/diagnoses ment. The aim of the quality indicator is not primarily to (figures 7.2.3 and 7.2.4). The results of each unit must be compare results between units. Finally, it is important to seen in the light of its case-mix. realize that many adverse events (especially the medical ones) do not have to have a causally related to the surgery. Therefore, the proportion of adverse events per unit is This implies that local differences in general health (case- presented for both hip replacement and for the “standard mix), the access to healthcare and preventive medicine patient” (standardised case-mix) (figures 7.2.5 and 7.2.6), partly may influence the outcome. and for the fracture patients (figure 7.2.7). The propor- tion of adverse events after total knee replacement due to osteoarthritis shows relatively large variations between the units (figure 7.2.9). Regarding the proportion of adverse events after hip and knee revision possibly case- mix and varying degrees of complicated revisions explain some of the varying outcome (figures 7.2.8 and 7.2.10). Units with a deviating result here should perform local improvement work. 2 1 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 7.2.1. Adverse events within 30 and 90 days after primary hip replacement and hip revision 2013-2023. © 2024 The Swedish Arthroplasty Register Figure 7.2.2. Adverse events within 30 and 90 days after primary total knee replacement and knee revision 2013-2023. 2 1 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 7.2.3. Adverse surgical events within 30 and 90 days after primary hip replacement and hip revision 2013-2023. © 2024 The Swedish Arthroplasty Register Figure 7.2.4. Adverse surgical events within 30 and 90 days in primary total knee replacement and knee revision 2013-2023. 2 1 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 7.2.5. Adverse events per unit 2019-2023, elective hip replacement. 2 1 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 7.2.6. Adverse events per unit 2019-2023, “standard patient”, 2 1 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 7.2.7. Adverse events per unit 2019-2023, hip replacement due to fracture, 2 1 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 7.2.8. Adverse events per unit 2019-2023, first hip revision. 2 1 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figur 7.2.9. Adverse events per unit 2019-2023, total knee replacement due to OA. 2 1 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figur 7.2.10. Adverse events per unit 2019-2023, first knee revision. 2 1 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 The goal is a life without pain, with restored function and quality of life. 8. Patient-Reported Outcome Measures Authors: Annette W-Dahl and Ola Rolfson Patient-Reported Outcome Measures (PROMs) are tools PROMs included in the project or only parts of it. With used to assess health or health-related aspects based on the merging of the hip and knee replacement registers into the patient’s own experience. The instruments or tools the Swedish Arthroplasty Register, PROM collection for used for measuring these outcomes are standardized ques- knee replacement surgeries now includes all units, just tionnaires completed by patients, with no interpretation like for hip replacement surgeries. Patients operated on in from anyone else. The primary goal of most hip and 2022 are the first cohort with both pre- and postoperative knee replacement surgeries is to reduce pain and improve responses since the merger. Six units did not report any function, thereby enhancing the patient's health-related PROMs for patients operated on in 2022, but three of quality of life. these have started collecting PROMs for patients operated on in 2023. Development of PROM collection for hip and knee replacement surgeries Outcome Measures The PROM routine for hip replacement surgeries began as All patients scheduled for elective total hip or knee a pilot project in northern Sweden and the Västra Göta- replacement surgery are asked to complete a questionnaire land region in 2002. Over time, more units joined, and before surgery, containing 25 questions for hip and 24 for since 2008, all units have participated in the follow-up knee procedures. Postoperatively, an additional question routine. on satisfaction with the operation outcome is included, using a 5-point Likert scale. The questionnaires cover For knee replacement surgeries, PROM collection started comorbidities and walking ability to determine Charnley as a pilot project in Trelleborg in 2008. Over the follow- class, questions about hip pain (right and left) or knee pain ing years, the rest of Skåne joined. Units that wished to (current knee), rated on a 5-point Likert scale, and the participate were invited, and by the end of 2012/2013, EQ-5D tool, which measures overall health status. Since Norrköping, Motala, and Oskarshamn had joined. Since 2017, the new version of the EQ-5D tool (EQ-5D-5L) then, more units have gradually been added, and by has been used instead of the previous EQ-5D-3L for elec- 2021, PROM was collected from over 50% of all pri- tive total hip replacement surgeries, and with the register mary operations. Units could choose whether to collect all merger, it is also used for knee replacement surgeries. 2 2 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 The EQ-5D-5L consists of two parts: the first includes according to these criteria one year after surgery as either five general questions, each with five response options, a responder (high or low) or not a responder. The percent- creating a health profile that can be converted into an age of responders is presented as a percentage. index. The second part is a visual analog scale (VAS) ther- mometer, where patients rate their current health on a Until the merger, the hip questionnaire included a ques- scale from 0 to 100. The EQ-5D index is calculated using tion about whether the patient had seen a physiotherapist the Swedish value set, meaning an algorithm converts the or participated in an osteoarthritis school. This question index. Values can be presented either as VAS units (rang- has now been removed from the survey. Instead, data from ing from worst to best health, 0-100) or on a scale from the Swedish Arthroplasty Register and the Swedish Osteo- death to full health, ranging from 0-1. arthritis Register (formerly the BOA register) have been linked to determine how many hip and knee replacement A question about smoking, included for hip replacements surgeries have a record in the Osteoarthritis Register. since 2013, was added for knee replacements from Sep- tember 1, 2021. New since the 2021 merger are two questions about weekly physical exercise and everyday Collection Methods activity, recommended by the National Board of Health The methods of collection differ slightly between hip and Welfare. As part of the PROM harmonization, the full and knee replacement surgeries. Knee replacements are KOOS (Knee injury and Osteoarthritis Outcome Score), tracked per operation (both right and left), meaning all consisting of 42 questions, has been replaced by KOOS- primary and reoperations are followed up after one year. 12, and the hip-specific HOOS-12 (Hip dysfunction and In contrast, the most recent hip replacement surgery Osteoarthritis Outcome Score 12) has been used since is followed up after one, six, and ten years, including September 1, 2021, for elective total hip replacements. reoperations. There are two different follow-up forms for Both KOOS-12 and HOOS-12 contain three subscales knees: one for unilateral knee replacements and one for (0-100): pain, daily living activities (ADL), and quality patients who have both knees replaced at the same time. of life (QoL). A total score can also be calculated by aver- Similarly, for hips, there are separate forms for patients aging the three subscales (0-100). with a replacement in one hip (unilateral) and for those with replacement in both hips (bilateral). The follow-up The term “responder” is a method used to evaluate the routine is managed by contact secretaries who send percentage of hip and knee replacement patients who out forms, enter the survey responses into the PROM improve from preoperative to one year postoperative, database, and send a reminder after about two months if instead of using a PROM average, which can mask both there is no response. The option to receive the follow-up poor and good results. The Osteoarthritis Research Society form via email was discontinued on May 24, 2023, and International (OARSI) working group, Outcome Mea- replaced with a notification from 1177 (the Swedish sures in Arthritis Clinical Trials (OMERACT-OARSI), national patient portal) that a follow-up form is available developed criteria for defining a responder. These crite- with a link to respond.registercentrum.se. ria have been used in previous annual reports for knee replacement patients, based on WOMAC. Since KOOS- Patients who have not activated their 1177 account will 12 has replaced the full KOOS, it is no longer possible continue to receive a paper survey, and those who do to convert to WOMAC. However, OMERACT-OARSI not respond will receive a reminder with a paper form. responder criteria can still be used for KOOS/HOOS- This new routine relieves the units of the task of entering 12 by calculating a combination of absolute and relative survey responses. It is also possible for units to collect changes in KOOS/HOOS-12 pain, ADL, and total score PROM data digitally preoperatively. However, units no one year after knee and hip replacement surgery. A high longer have direct access to these pre- and postoperative responder is a patient who has improved by 50% or more results at the patient level as before, but they can request and has an absolute improvement of 20 points or more access to them through a data extraction request for the in KOOS/HOOS-12 pain or ADL. If these criteria are unit’s PROM responses. The new routine does not affect not met, a patient can still be classified as a low responder statistical display. if they improve by 20% or more and have an absolute change of 10 points or more in two of KOOS/HOOS- In the previous PROM routine (hip until 2017 and 12 pain, ADL, or total score. Each patient is classified knee until 2021), pain and satisfaction with the surgical 2 2 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 8.1. Pareto classification EQ-5D-5L, elective total hip replacement 2022. 2 2 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 PROMs in hip replacement 2020–2023 Primary operation Revision 1 year 6 years 10 years 1 year Pre- post- post- post- Pre- post- operatively operatively operatively operatively operatively operatively Number 51,277 62,152 47,396 33,793 1,694 7,408 Hip Pain, n (%) None 379 (0.7) 32,562 (52.8) 26,595 (56.6) 18,264 (54.6) 82 (4.9) 2,442 (33.2) Very mild 446 (0.9) 14,617 (23.7) 8,630 (18.4) 5,986 (17.9) 83 (4.9) 1,645 (22.4) Mild 1,379 (2.7) 7,169 (11.6) 5,187 (11.0) 3,959 (11.8) 152 (9.1) 1,200 (16.3) Moderate 16,115 (31.7) 5,662 (9.2) 4,989 (10.6) 4,004 (12.0) 594 (35.4) 1,489 (20.2) Severe 32,568 (64.0) 1,671 (2.7) 1,553 (3.3) 1,213 (3.6) 768 (45.7) 580 (7.9) Mobility, n (%) I have no problems 1,438 (2.8) 30,838 (49.6) 22,755 (48.0) 14,867 (44.0) 143 (8.4) 2,075 (28.0) in walking about I have slight problems 5,001 (9.8) 15,390 (24.8) 10,355 (21.8) 7,479 (22.1) 236 (13.9) 1,860 (25.1) in walking about I have moderate problems 16,629 (32.4) 10,412 (16.8) 8,722 (18.4) 6,666 (19.7) 555 (32.8) 1,897 (25.6) in walking about I have severe problems 26,356 (51.4) 4,915 (7.9) 4,831 (10.2) 4,009 (11.9) 629 (37.1) 1,219 (16.5) in walking about I am unable to walk about 1,853 (3.6) 597 (1.0) 733 (1.5) 772 (2.3) 131 (7.7) 357 (4.8) Self-care, n (%) I have no problems washing 14,551 (28.4) 46,307 (74.5) 35,499 (74.9) 24,286 (71.9) 734 (43.4) 4,228 (57.2) or dressing myself I have slight problems washing 16,641 (32.5) 11,071 (17.8) 7,371 (15.6) 5,604 (16.6) 463 (27.4) 1,741 (23.5) or dressing myself I have moderate problems washing 14,819 (28.9) 3,668 (5.9) 3,220 (6.8) 2,607 (7.7) 349 (20.6) 979 (13.2) or dressing myself I have severe problems washing 5,074 (9.9) 899 (1.4) 923 (1.9) 909 (2.7) 123 (7.3) 315 (4.3) or dressing myself I am unable to wash or dress myself 192 (0.4) 207 (0.3) 383 (0.8) 387 (1.1) 22 (1.3) 133 (1.8) Usual activities, n (%) I have no problems doing 2,718 (5.3) 31,512 (50.7) 24,081 (50.8) 15,981 (47.3) 176 (10.4) 2,182 (29.5) my usual activities I have slight problems doing 8,704 (17.0) 17,418 (28.0) 11,899 (25.1) 8,568 (25.4) 361 (21.4) 2,159 (29.2) my usual activities I have moderateproblems doing 16,446 (32.1) 8,639 (13.9) 7,037 (14.8) 5,496 (16.3) 510 (30.2) 1,683 (22.8) my usual activities I have severe problems doing 18,688 (36.4) 3,595 (5.8) 3,278 (6.9) 2,655 (7.9) 454 (26.9) 939 (12.7) my usual activities I am unable to do my usual activities 4,721 (9.2) 988 (1.6) 1,101 (2.3) 1,093 (3.2) 189 (11.2) 428 (5.8) Pain/discomfort, n (%) I have no pain or discomfort 142 (0.3) 21,720 (34.9) 16,396 (34.6) 11,031 (32.6) 46 (2.7) 1,554 (21.0) I have slight pain or discomfort 1,458 (2.8) 21,833 (35.1) 14,381 (30.3) 10,026 (29.7) 195 (11.6) 2,420 (32.7) I have moderate pain or discomfort 17,887 (34.9) 13,828 (22.2) 12,107 (25.5) 9,204 (27.2) 704 (41.7) 2,359 (31.9) Table continued on next page. 2 2 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 PROMs in hip replacement 2020–2023, cont. Primary operation Revision 1 year 6 years 10 years 1 year Pre- post- post- post- Pre- post- operatively operatively operatively operatively operatively operatively I have severe pain or discomfort 28,045 (54.7) 4,406 (7.1) 4,123 (8.7) 3,178 (9.4) 648 (38.4) 945 (12.8) I have extreme pain or discomfort 3,745 (7.3) 365 (0.6) 389 (0.8) 354 (1.0) 95 (5.6) 117 (1.6) Anxiety/depression, n (%) I am not anxious or depressed 18,155 (35.4) 42,088 (67.7) 31,276 (66.0) 21,319 (63.1) 658 (38.9) 3,884 (52.5) I am slightly anxious or depressed 20,332 (39.7) 14,581 (23.5) 11,482 (24.2) 8,804 (26.1) 599 (35.4) 2,203 (29.8) I am moderately anxious or depressed 9,166 (17.9) 3,981 (6.4) 3,389 (7.2) 2,620 (7.8) 291 (17.2) 907 (12.3) I am severely anxious or depressed 3,21 (6.1) 1,278 (2.1) 1,027 (2.2) 872 (2.6) 120 (7.1) 335 (4.5) I am extremely anxious or depressed 503 (1.0) 224 (0.4) 222 (0.5) 178 (0.5) 24 (1.4) 70 (0.9) EQ VAS, mean (SD) 54.7 (22.3) 74.2 (19.2) 71.3 (20.8) 69.4 (21.5) 55.60 (22.27) 65.5 (22.3) Satisfaction with the surgery, n (%) Very dissatisfied 1,132 (1.8) 1,164 (2.5) 774 (2.3) 523 (7.1) Dissatisfied 2 ,219 (3.6) 2,021 (4.3) 1,299 (3.9) 758 (10.3) Neither satisfied nor dissatisfied 4,694 (7.7) 3,678 (7.9) 2,671 (8.0) 1,202 (16.3) Satisfied 13,484 (22.0) 10,326 (22.2) 7,766 (23.4) 2,191 (29.8) Very satisfied 39,783 (64.9) 29,411 (63.1) 20,676 (62.3) 2,681 (36.5) EQ5D-index, Swedish TTO, mean (SD) 0.64 (0.14) 0.86 (0.13) 0.85 (0.14) 0.84 (0.14) 0.68 (0.15) 0.79 (0.16) EQ5D-index, Swedish VAS, mean (SD) 46.97 (13.35) 73.06 (15.76) 71.84 (16.74) 70.28 (17.32) 51.16 (15.79) 63.99 (18.35) Tabell 8.1. PROM-svar för höftprotesoperationer 2020–2023. outcome were measured using a Visual Analog Scale at the six- and ten-year follow-ups, most seem to maintain (VAS). Now, a 5-point Likert scale is used. VAS results relatively good overall health in the long term. from previous years have been converted to the Likert scale using a transposition key that corresponds to the There have been significantly more one-year follow-ups distribution of current responses on the Likert scale. after hip revision surgeries compared to preoperative responses. The routine for collecting preoperative PROM for revisions does not appear to be as well-established as for PROM for hip replacement surgeries primary surgeries. However, the follow-up process seems 2020–2023 to be functioning satisfactorily. Part of the data loss can Table 8.1 is a summary of all PROM responses collected naturally be explained by the fact that many revision sur- between 2020 and 2023, divided into preoperative, and geries are performed semi-urgently, meaning that patients one, six, and ten years postoperative for primary surger- do not go through the elective admission process. The ies, as well as preoperative and one year postoperative for Swedish Arthroplasty Register urges units to review their revisions. Note that the summary consists of cross-sec- routines for collecting preoperative PROM for revisions, tional data for the patients who responded during the especially considering that patient-reported health one period, rather than longitudinal data. In over 95% of year after revision is significantly worse compared to after cases, patients reported moderate or severe pain in the a primary replacement. Around 17% were dissatisfied or affected hip preoperatively. For the one-year follow-up, very dissatisfied, and 28% reported moderate or severe 76% reported no or very mild pain in the operated hip. pain in the operated hip one year after revision surgery. Although the percentage of pain-free patients was lower 2 2 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 PROMs in hip replacement 2022 Primary operation Preoperatively 1 year postoperatively Number 11,575 11,575 Hip pain, n (%) None 82 (0.7) 6,304 (54.9) Very mild 88 (0.8) 2,733 (23.8) Mild 294 (2.6) 1,207 (10.5) Moderate 3,676 (32.1) 950 (8.3) Severe 7,306 (63.8) 283 (2.5) Mobility, n (%) I have no problems in walking about 368 (3.2) 5,974 (51.6) I have slight problems in walking about 1,121 (9.7) 2,830 (24.4) I have moderate problems in walking about 3,858 (33.3) 1,847 (16.0) I have severe problems in walking about 5,877 (50.8) 856 (7.4) I am unable to walk about 351 (3.0) 68 (0.6) Self-care, n (%) I have no problems washing or dressing myself 3,393 (29.3) 8,856 (76.5) I have slight problems washing or dressing myself 3,899 (33.7) 1,966 (17.0) I have moderate problems washing or dressing myself 3,169 (27.4) 593 (5.1) I have severe problems washing or dressing myself 1,075 (9.3) 142 (1.2) I am unable to wash or dress myself 39 (0.3) 18 (0.2) Usual activities, n (%) I have no problems doing my usual activities 681 (5.9) 6,162 (53.2) I have slight problems doing my usual activities 2,109 (18.2) 3,323 (28.7) I have moderateproblems doing my usual activities 3,847 (33.2) 1,384 (12.0) I have severe problems doing my usual activities 4,003 (34.6) 585 (5.1) I am unable to do my usual activities 935 (8.1) 121 (1.0) Pain/discomfort, n (%) I have no pain or discomfort 29 (0.3) 4,050 (35.0) I have slight pain or discomfort 322 (2.8) 4,161 (35.9) I have moderate pain or discomfort 4,190 (36.2) 2,524 (21.8) I have severe pain or discomfort 6,261 (54.1) 788 (6.8) I have extreme pain or discomfort 773 (6.7) 52 (0.4) Anxiety/depression, n (%) I am not anxious or depressed 4,243 (36.7) 7,978 (68.9) I am slightly anxious or depressed 4,640 (40.1) 2,672 (23.1) I am moderately anxious or depressed 1,962 (17.0) 655 (5.7) I am severely anxious or depressed 644 (5.6) 238 (2.1) I am extremely anxious or depressed 86 (0.7) 32 (0.3) Table continued on next page. 2 2 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 PROMs in hip replacement 2022, cont. Primary operation Preoperatively 1 year postoperatively EQ VAS, mean (SD) 54.16 (22.15) 73.87 (18.61) Satisfaction with the surgery, n (%) Very dissatisfied 190 (1.7) Dissatisfied 403 (3.5) Neither satisfied nor dissatisfied 755 (6.6) Satisfied 2,394 (20.9) Very satisfied 7,691 (67.3) EQ5D-index, Swedish TTO, mean (SD) 0.65 (0.14) 0.87 (0.12) EQ5D-index, Swedish VAS, mean (SD) 47.71 (13.17) 73.91 (15.18) Number 4,078 4,078 HOOS-12, mean (SD) Pain 85 (20) 30 (15) Function in daily living 82 (20) 35 (18) QoL 77 (22) 20 (14) Table 8.2. PROMs pre- and one-year postoperatively in primary total hip replacements 2022. Elective total hip replacement 2022 There was also considerable variation in the proportion Table 8.2 shows data for those who underwent hip of patients who remained the same or experienced mixed replacement surgery in 2022 and had completed pre- and changes (0–25%). one-year postoperative PROM responses. 87% reported being satisfied or very satisfied with the surgery, and just over 76% reported no or very mild pain in the hip. It Proportion of satisfied patients and was also noted that the mean change in EQ VAS was responders after primary total hip 19 units on the 100-point scale. In terms of the EQ-5D replacement by unit dimensions, pain, mobility, and daily activities showed Table 8.3 shows the response rate and the proportion the most improvement. of patients satisfied (very satisfied or satisfied) with the surgical outcome for those who underwent elective pri- Changes in the EQ-5D dimensions can be described mary total hip replacement in 2022 and answered the using the so-called Pareto classification. If there is an one-year follow-up. The table also shows the response rate improvement in one or more dimensions without a and proportion of responders for patients who underwent deterioration in any other, it is classified as “better.” If surgery in 2022 and completed the HOOS-12 survey there is deterioration in one or more dimensions without both preoperatively and one year postoperatively. Results improvement in any other, it is classified as “worse.” No for units with fewer than 20 responses are not presented change is classified as “same,” and mixed results are classi- but are included in the national totals. 88% of patients fied as “mixed.” Figure 8.1 shows how EQ-5D dimensions reported being satisfied with the surgical outcome, but change across different units after primary elective total there are significant differences between units, with the hip replacement surgery. For the nation, 85% improved, proportion of satisfied patients ranging from 75% to and only 3% worsened. However, there was significant 97%. Four units had a satisfaction rate below 80%, while variation across the country. The highest proportion 29 units had satisfaction rates of 90% or higher. Among of patients who improved was at Hermelinen (100%), the large-volume units, it was noted that Hässleholm and while 65% improved in Kungälv. At some units, none Ortho Center Stockholm continue to have a high propor- or just 1% of patients worsened, while 9% of patients tion of satisfied patients. The variation in the proportion at Linköping, Södersjukhuset, and Södertälje worsened. of responders is not as large as the variation in satisfied 2 2 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Proportion of satisfied and responders after primary total hip replacement per unit 2022 Number Response Proportion Number Response Proportion Unit response rate, % satisfied, % response rate, % responders, % Akademiska sjukhuset 153 82 84 120 64 91 Aleris Malmö Arena 21 68 90 0 Aleris Specialistvård Nacka 468 87 94 417 78 96 Aleris Specialistvård Ängelholm 400 78 92 292 57 96 Alingsås 125 66 86 117 62 92 Art Clinic Göteborg 234 85 91 190 69 99 Art Clinic Jönköping 237 89 93 229 86 98 Arvika 242 79 83 102 33 95 Bollnäs 297 85 90 283 81 95 Borås 57 83 82 33 48 91 Capio Artro Clinic 563 79 85 450 63 95 Capio Movement 419 89 88 219 46 95 Capio Ortho Center Göteborg 249 81 88 127 41 94 Capio Ortho Center Stockholm 737 86 94 620 72 96 Capio Ortho och Spine Center Skåne 125 61 95 80 39 98 Capio Ortopedi Motala 402 89 89 321 71 97 Capio Ortopediska Huset 698 87 82 0 Capio S:t Göran 196 55 83 143 40 95 Carlanderska 227 63 90 60 17 95 Carlanderska-SportsMed 23 10 96 <20 Danderyd 116 54 94 39 18 100 Eksjö 262 85 89 221 72 94 Enköping 435 82 86 278 52 95 Eskilstuna 44 75 75 33 56 91 Falun 80 47 85 73 43 90 Gällivare 35 85 89 24 59 100 Gävle 79 81 91 62 64 98 Halmstad 119 83 83 82 57 93 Helsingborg 48 86 85 32 57 91 Hermelinen 29 76 97 24 63 100 Hudiksvall 54 78 96 43 62 93 Hässleholm 535 85 92 460 73 94 Jönköping 120 80 83 88 59 91 Kalmar 66 74 91 62 70 95 Karlshamn 230 81 90 214 76 93 Karlstad 23 58 83 16 40 Karolinska Huddinge 181 60 88 113 38 97 Karolinska Solna 20 51 <20 Table continued on next page. 2 2 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Proportion of satisfied and responders after primary total hip replacement per unit 2022, cont. Number Response Proportion Number Response Proportion Unit response rate, % satisfied, % response rate, % responders, % Kullbergska sjukhuset 315 88 80 312 88 91 Kungälv 85 81 76 35 33 86 Ledplastikcentrum Bromma 141 54 89 72 28 94 Lidköping 134 62 84 106 49 94 Lindesberg 313 76 90 171 42 97 Linköping 67 79 84 34 40 97 Ljungby 87 83 91 74 70 96 Lycksele 206 90 90 187 81 93 Mora 225 89 84 176 69 94 Norrköping 122 85 80 76 53 97 Norrtälje 122 81 87 102 68 95 Nyköping 114 89 77 90 70 92 Ortopediskt Center – Sophiahemmet 232 79 91 202 69 96 Oskarshamn 385 91 90 364 86 96 Piteå 298 75 88 236 60 92 Skellefteå 78 57 90 38 28 89 Skene 141 63 87 0 Skövde 31 66 90 25 53 100 Sollefteå 337 89 89 309 82 95 Specialistcenter Scandinavia Malmö 85 70 95 55 45 91 Specialistcenter Scandinavia, Eskilstuna 74 60 85 60 48 93 SU/Mölndal 339 78 79 292 67 91 SUS/Lund 22 73 77 <20 Södersjukhuset 104 73 88 72 51 85 Södertälje 53 51 83 43 42 91 Torsby 78 62 85 64 51 92 Trelleborg 234 85 87 205 74 91 Uddevalla 281 88 88 244 76 95 Umeå 54 90 89 23 38 100 Varberg 165 87 92 115 61 97 Visby 89 81 85 76 69 92 Värnamo 137 88 83 125 80 96 Västervik 64 55 89 44 38 98 Västerås 226 65 90 171 49 97 Växjö 163 87 90 51 27 92 Ängelholm 152 82 87 129 69 89 Örnsköldsvik 138 88 88 122 78 95 Östersund 155 80 92 132 68 92 Country 14,430 78 88 10,332 56 95 Table 8.3. Response rate and proportion of satisfied and responders after primary total hip replacement per unit 2022. 2 2 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 HOOS-12 per unit 2022 and 2023 Response Pain ADL QoL rate Charnley C mean (SD) mean (SD) mean (SD) Surgical Number Preopera- Preopera- Preopera- Unit year response % % tively 1 year tively 1 year tively 1 year 2022 120 64 34 27 (15) 83 (22) 35 (19) 81 (23) 17 (13) 75 (25) Akademiska sjukhuset 2023 127 68 43 29 (15) 33 (19) 18 (14) 2022 0 Aleris Malmö Arena 2023 0 2022 417 78 36 32 (14) 90 (16) 37 (17) 87 (16) 21 (13) 81 (19) Aleris Specialistvård Nacka 2023 577 88 33 33 (15) 38 (18) 21 (14) Aleris Specialistvård 2022 ­Renmarkstorget, Umeå 2023 22 49 32 32 (14) 39 (16) 20 (14) Aleris Specialistvård 2022 292 57 38 28 (14) 87 (19) 32 (16) 84 (20) 18 (12) 81 (21) Ängelholm 2023 273 65 39 29 (15) 33 (19) 21 (14) 2022 117 62 36 33 (14) 84 (20) 37 (17) 81 (20) 21 (14) 76 (24) Alingsås 2023 156 84 44 33 (15) 37 (18) 20 (13) 2022 190 69 31 31 (14) 87 (18) 37 (17) 86 (19) 20 (14) 79 (22) Art Clinic Göteborg 2023 384 87 35 32 (14) 36 (17) 21 (14) 2022 229 86 33 28 (13) 87 (17) 33 (16) 86 (17) 20 (12) 79 (19) Art Clinic Jönköping 2023 237 92 24 29 (14) 33 (16) 20 (13) 2022 102 33 40 28 (15) 80 (21) 32 (15) 79 (19) 19 (13) 69 (25) Arvika 2023 189 66 40 32 (14) 37 (17) 22 (15) 2022 283 81 32 30 (15) 86 (19) 34 (17) 83 (19) 19 (14) 79 (21) Bollnäs 2023 375 98 32 30 (14) 33 (17) 20 (15) 2022 33 48 36 25 (18) 72 (21) 29 (17) 64 (23) 16 (15) 65 (24) Borås 2023 48 52 54 25 (13) 28 (15) 11 (10) 2022 450 63 33 32 (15) 85 (19) 38 (19) 84 (18) 21 (14) 74 (22) Capio Artro Clinic 2023 505 83 29 35 (16) 42 (18) 23 (14) 2022 219 46 34 35 (14) 90 (17) 42 (18) 88 (16) 25 (14) 82 (19) Capio Movement 2023 125 30 19 34 (14) 41 (16) 25 (13) 2022 127 41 26 31 (13) 85 (19) 41 (16) 85 (18) 21 (12) 76 (22) Capio Ortho Center Göteborg 2023 157 63 27 33 (15) 37 (16) 20 (13) 2022 620 72 31 33 (15) 89 (17) 39 (18) 87 (17) 22 (14) 80 (20) Capio Ortho Center Stockholm 2023 740 82 32 35 (15) 40 (18) 23 (14) Capio Ortho och Spine Center 2022 80 39 33 32 (17) 91 (14) 40 (19) 89 (16) 23 (16) 84 (17) Skåne 2023 128 51 32 32 (15) 39 (17) 21 (13) 2022 321 71 34 29 (13) 85 (17) 33 (15) 81 (18) 20 (12) 76 (20) Capio Ortopedi Motala 2023 343 82 33 30 (14) 32 (17) 20 (13) 2022 0 Capio Ortopediska Huset 2023 156 20 36 37 (18) 42 (19) 24 (16) 2022 143 40 40 31 (17) 84 (19) 35 (18) 80 (18) 20 (14) 75 (23) Capio S:t Göran 2023 290 80 43 33 (16) 38 (17) 22 (14) 2022 Capio Spine Center Göteborg 2023 44 66 30 29 (14) 33 (17) 19 (13) Table continued on next page. 2 3 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 HOOS-12 per unit 2022 and 2023, cont. Response Pain ADL QoL rate Charnley C mean (SD) mean (SD) mean (SD) Surgical Number Preopera- Preopera- Preopera- Unit year response % % tively 1 year tively 1 year tively 1 year 2022 60 17 25 31 (15) 86 (18) 37 (19) 84 (18) 21 (16) 78 (21) Carlanderska 2023 208 47 35 34 (13) 37 (17) 21 (14) 2022 <20 Carlanderska – SportsMed 2023 81 34 25 35 (14) 38 (18) 23 (12) 2022 39 18 36 31 (15) 86 (18) 35 (19) 83 (20) 18 (14) 80 (21) Danderyd 2023 41 28 49 32 (16) 35 (17) 23 (12) 2022 221 72 34 31 (15) 83 (20) 34 (18) 79 (21) 21 (14) 76 (20) Eksjö 2023 213 74 36 32 (15) 36 (18) 22 (13) 2022 278 52 32 29 (14) 84 (19) 33 (16) 82 (20) 20 (13) 76 (23) Enköping 2023 342 62 31 30 (15) 34 (17) 21 (13) 2022 33 56 38 25 (16) 73 (25) 28 (17) 70 (23) 17 (16) 62 (26) Eskilstuna 2023 35 69 66 24 (16) 28 (17) 17 (15) 2022 73 43 41 27 (18) 80 (23) 31 (20) 78 (22) 18 (16) 73 (27) Falun 2023 117 75 38 28 (17) 33 (19) 19 (16) 2022 24 59 38 27 (17) 90 (15) 32 (16) 84 (17) 19 (18) 79 (18) Gällivare 2023 61 79 33 29 (16) 30 (19) 19 (13) 2022 62 64 53 23 (14) 82 (20) 27 (17) 74 (23) 13 (12) 74 (21) Gävle 2023 81 64 43 26 (16) 29 (20) 16 (14) 2022 82 57 32 28 (15) 81 (21) 35 (18) 81 (20) 18 (14) 75 (22) Halmstad 2023 62 73 39 30 (17) 36 (18) 18 (14) 2022 32 57 50 29 (13) 76 (25) 31 (18) 69 (27) 18 (16) 75 (25) Helsingborg 2023 32 73 42 23 (19) 22 (19) 10 (14) 2022 24 63 25 33 (13) 93 (11) 40 (17) 89 (15) 20 (11) 81 (20) Hermelinen 2023 29 76 14 28 (13) 38 (13) 18 (11) 2022 43 62 42 27 (13) 86 (18) 29 (14) 78 (22) 15 (12) 81 (20) Hudiksvall 2023 38 72 42 23 (15) 22 (15) 13 (13) 2022 460 73 37 30 (15) 84 (20) 36 (17) 82 (20) 22 (15) 78 (21) Hässleholm 2023 662 86 40 31 (15) 36 (18) 22 (15) 2022 88 59 39 31 (13) 83 (19) 37 (19) 80 (18) 23 (15) 77 (19) Jönköping 2023 136 69 41 29 (14) 32 (17) 21 (16) 2022 62 70 37 30 (14) 87 (19) 34 (15) 84 (18) 19 (13) 82 (19) Kalmar 2023 100 96 33 32 (14) 36 (16) 21 (14) 2022 214 76 32 30 (14) 84 (21) 34 (16) 81 (21) 21 (13) 78 (23) Karlshamn 2023 268 88 31 31 (15) 34 (18) 22 (15) 2022 <20 Karlstad 2023 42 79 45 30 (15) 34 (20) 19 (15) 2022 113 38 42 29 (17) 82 (23) 32 (19) 79 (23) 17 (12) 76 (24) Karolinska Huddinge 2023 91 51 44 25 (16) 27 (19) 12 (12) 2022 <20 Karolinska Solna 2023 <20 Table continued on next page. 2 3 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 HOOS-12 per unit 2022 and 2023, cont. Response Pain ADL QoL rate Charnley C mean (SD) mean (SD) mean (SD) Surgical Number Preopera- Preopera- Preopera- Unit year response % % tively 1 year tively 1 year tively 1 year 2022 312 88 32 30 (14) 81 (22) 36 (16) 78 (22) 22 (15) 71 (24) Kullbergska sjukhuset 2023 418 97 36 30 (14) 35 (17) 22 (14) 2022 35 33 51 25 (13) 71 (25) 28 (19) 69 (24) 15 (14) 60 (26) Kungälv 2023 102 87 48 27 (16) 29 (19) 16 (13) 2022 72 28 26 32 (15) 87 (18) 39 (18) 86 (16) 21 (13) 79 (22) Ledplastikcentrum Bromma 2023 245 30 34 35 (14) 41 (18) 23 (14) 2022 106 49 43 28 (16) 83 (19) 32 (18) 77 (20) 17 (14) 74 (22) Lidköping 2023 264 81 38 30 (15) 34 (18) 19 (14) 2022 171 42 22 26 (14) 86 (18) 31 (16) 83 (18) 17 (12) 77 (21) Lindesberg 2023 312 54 37 27 (14) 30 (16) 17 (13) 2022 34 40 30 25 (13) 81 (20) 36 (17) 83 (19) 17 (13) 70 (23) Linköping 2023 66 85 33 26 (15) 32 (18) 17 (14) 2022 74 70 32 35 (14) 85 (19) 39 (18) 84 (21) 26 (15) 80 (21) Ljungby 2023 97 92 37 35 (16) 37 (16) 28 (17) 2022 187 81 45 31 (16) 83 (21) 34 (17) 80 (22) 19 (14) 76 (23) Lycksele 2023 261 90 38 29 (15) 33 (18) 19 (14) 2022 176 69 38 29 (16) 82 (22) 31 (18) 79 (21) 17 (14) 75 (24) Mora 2023 240 81 40 30 (14) 31 (15) 19 (12) 2022 76 53 46 27 (16) 80 (21) 30 (19) 76 (20) 16 (14) 69 (25) Norrköping 2023 136 69 38 27 (14) 31 (17) 16 (12) 2022 102 68 38 36 (15) 81 (19) 40 (16) 78 (19) 25 (13) 73 (22) Norrtälje 2023 122 82 38 33 (17) 38 (21) 24 (15) 2022 90 70 46 27 (14) 78 (23) 30 (15) 75 (23) 17 (11) 70 (26) Nyköping 2023 119 90 35 31 (14) 34 (19) 19 (13) Ortopediskt Center – 2022 202 69 20 34 (15) 91 (17) 41 (19) 90 (14) 23 (14) 82 (20) ­Sophiahemmet 2023 241 92 30 36 (16) 42 (18) 25 (14) 2022 364 86 36 29 (14) 86 (18) 34 (17) 83 (19) 20 (14) 77 (21) Oskarshamn 2023 359 95 39 29 (14) 33 (17) 20 (13) 2022 236 60 41 26 (15) 82 (22) 33 (18) 79 (23) 16 (13) 76 (24) Piteå 2023 322 76 43 29 (15) 32 (18) 19 (13) 2022 38 28 42 29 (12) 86 (17) 42 (14) 86 (16) 18 (13) 76 (20) Skellefteå 2023 30 25 43 48 (23) 60 (23) 32 (20) 2022 0 Skene 2023 41 16 38 30 (13) 35 (14) 20 (10) 2022 25 53 48 31 (14) 85 (16) 35 (15) 85 (16) 25 (15) 75 (20) Skövde 2023 39 95 31 33 (14) 43 (18) 25 (13) 2022 309 82 30 32 (14) 87 (19) 35 (16) 82 (20) 20 (13) 79 (22) Sollefteå 2023 404 95 35 31 (15) 35 (17) 21 (14) Specialistcenter Scandinavia 2022 55 45 24 29 (15) 87 (18) 36 (20) 86 (18) 20 (15) 78 (22) Malmö 2023 65 53 34 30 (15) 35 (21) 23 (15) Table continued on next page. 2 3 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 HOOS-12 per unit 2022 and 2023, cont. Response Pain ADL QoL rate Charnley C mean (SD) mean (SD) mean (SD) Surgical Number Preopera- Preopera- Preopera- Unit year response % % tively 1 year tively 1 year tively 1 year Specialistcenter Scandinavia, 2022 60 48 27 31 (12) 86 (18) 36 (14) 82 (20) 21 (13) 79 (20) Eskilstuna 2023 169 81 31 30 (14) 36 (15) 20 (13) 2022 292 67 42 27 (15) 78 (22) 31 (18) 75 (23) 17 (13) 69 (25) SU/Mölndal 2023 262 78 38 29 (17) 31 (18) 17 (14) 2022 Sundsvall 2023 28 78 39 32 (20) 32 (22) 19 (17) 2022 <20 SUS/Lund 2023 <20 2022 72 51 42 31 (17) 78 (23) 38 (20) 71 (24) 19 (14) 72 (23) Södersjukhuset 2023 78 58 42 30 (14) 35 (19) 18 (15) 2022 43 42 44 30 (15) 78 (23) 36 (16) 78 (24) 19 (14) 72 (25) Södertälje 2023 85 73 40 30 (17) 34 (18) 21 (15) 2022 64 51 44 28 (14) 83 (23) 36 (17) 82 (24) 20 (13) 75 (25) Torsby 2023 43 28 49 36 (15) 39 (17) 24 (17) 2022 205 74 38 29 (16) 80 (23) 36 (22) 78 (22) 20 (15) 74 (25) Trelleborg 2023 363 94 46 26 (16) 34 (21) 18 (14) 2022 244 76 38 29 (16) 83 (21) 31 (17) 79 (21) 18 (14) 73 (22) Uddevalla 2023 309 92 40 28 (15) 30 (18) 17 (14) 2022 23 38 13 36 (12) 88 (20) 46 (19) 89 (19) 27 (18) 82 (20) Umeå 2023 <20 2022 115 61 34 28 (14) 85 (20) 33 (16) 81 (22) 18 (13) 78 (22) Varberg 2023 91 73 36 33 (15) 35 (16) 21 (14) 2022 76 69 39 27 (13) 77 (22) 32 (17) 75 (21) 20 (13) 70 (23) Visby 2023 110 83 45 31 (14) 34 (17) 20 (13) 2022 125 80 37 30 (14) 80 (22) 33 (16) 79 (21) 20 (13) 74 (24) Värnamo 2023 148 94 44 29 (14) 34 (16) 21 (13) 2022 44 38 48 29 (16) 85 (21) 34 (19) 82 (20) 21 (15) 78 (23) Västervik 2023 79 53 47 28 (15) 28 (16) 20 (13) 2022 171 49 41 26 (14) 84 (20) 30 (17) 80 (21) 17 (13) 77 (21) Västerås 2023 352 80 35 28 (15) 30 (17) 18 (13) 2022 51 27 45 36 (15) 87 (17) 39 (17) 83 (19) 24 (14) 79 (20) Växjö 2023 <20 2022 129 69 39 30 (15) 81 (22) 35 (19) 78 (25) 20 (16) 74 (24) Ängelholm 2023 196 82 38 29 (13) 35 (17) 21 (12) 2022 122 78 40 27 (15) 85 (19) 31 (15) 83 (19) 17 (12) 78 (22) Örnsköldsvik 2023 145 98 39 30 (15) 32 (18) 21 (15) 2022 132 68 36 30 (16) 86 (20) 36 (17) 83 (20) 20 (15) 79 (23) Östersund 2023 177 88 43 27 (14) 30 (17) 17 (12) 2022 10,332 56 35 30 (15) 84 (20) 35 (18) 82 (20) 20 (14) 76 (22) Country 2023 14,090 69 36 31 (15) 35 (18) 20 (14) Table 8.4. HOOS-12, elective total hip replacement per unit 2022 and 2023. 2 3 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 patients, ranging from 86% to 100%. However, there are 36%, depending on the PROM and type of replacement. 18 units with a relatively high response rate (≥70%) and However, the proportion of preoperative responses from ≥70 surgeries. Among these, the proportion of responders patients operated on in 2023 has increased but is still varies from 91% at Kullbergska Hospital, Nyköping, and lower than before the merger. Transitioning from units Trelleborg to 98% at Art Clinic Jönköping. The response independently collecting PROM to a national routine rate for satisfaction is relatively high, while it is lower requires patience, and it is encouraging that 77 out of 80 for responders, which likely reflects that the collection of units are currently collecting PROM. HOOS-12 began in September 2021. Results for units with fewer than 20 responses are not pre- sented but are included in the national totals. Units that HOOS-12 – elective total hip replacement performed surgeries during the year but did not report by unit PROM are marked with zero, and for those that did not Table 8.4 shows the results for the three HOOS-12 sub- perform surgeries during the year, there is a blank space. scales and the proportion classified as Charnley C by unit. HOOS-12 is presented for patients who underwent elec- Note that results and percentages for units with few oper- tive total hip replacement surgery in 2022 and responded ations and/or a low response rate may be misleading. both preoperatively and one year postoperatively, as well as for those who responded preoperatively and were oper- Table 8.5 shows that general health (EQ VAS) reported ated on in 2023. The proportion classified as Charnley improvements from preoperative to one year postopera- Class C preoperatively at the units that reported HOOS tive, with a mean change of 12 units on the 100-point was 35% in 2022 and 37% in 2023, with variation among scale for TKR and 14 units for UKR. 93% and 94% of units with a relatively high response rate (≥70%) and TKR and UKR patients, respectively, reported moderate ≥70 surgeries in 2022, ranging from 30% in Sollefteå to or severe pain in the affected knee preoperatively. One 45% in Lycksele, and in 2023 from 24% at Art Clinic year postoperatively, 64% of TKR patients and 65% of Jönköping to 48% in Kungälv. These proportions should UKR patients reported no or very mild pain in the oper- be interpreted cautiously due to the relatively low response ated knee. Knee-related pain, ADL function, and QoL rate. There were 19 units with a relatively high response measured with KOOS-12 improved at the group level rate (≥70%) and ≥70 surgeries in 2022, and the difference from preoperative to one year postoperative. For general in the HOOS-12 subscales varied between zero to nine health, knee pain, and KOOS-12 three subscales, the points preoperatively and zero to ten points one year post- results were relatively similar for TKR and UKR, with a operatively. For other units, the variation is greater. The slightly higher proportion reporting being satisfied (very response rate for preoperative HOOS-12 is significantly satisfied or satisfied) with the surgical outcome after UKR higher for those who underwent surgery in 2023, and (84%) compared to TKR (81%). all but one unit have reported preoperative HOOS-12. Here too, the results should be interpreted cautiously Changes in the EQ-5D dimensions can be described using when comparing different units due to the relatively low the so-called Pareto classification. If there is an improve- response rate. ment in one or more dimensions without deterioration in any other, it is classified as “better.” If there is deterioration in one or more dimensions without improvement in any Patient-Reported Outcomes for primary other, it is classified as “worse.” No change is classified knee replacement surgeries 2022 as “same,” and mixed changes are classified as “mixed.” Due to the harmonization of PROM in the merger, the Figure 8.2 shows how EQ-5D dimensions change across response rates from units have been negatively affected. different units after primary knee replacement surgery. For Some units initially experienced issues with the PROM the nation, 77% improved, and 6% worsened. However, manager or misunderstandings during data entry. there was significant variation. The highest proportion of patients who improved was in Skövde (90%), while 54% Both preoperative and postoperative responses have improved in Skene. At some units, none or only a small decreased by up to 20% for patients who underwent sur- proportion worsened, while 15% of patients in Skene gery in 2022 compared to before the merger, leading to a experienced deterioration. There was also considerable decrease in the proportion of patients with both pre- and variation in the proportion of patients who had the same postoperative responses, which varies between 46% and or mixed changes (10–37%). 2 3 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 PROMs in primary knee replacements 2022 with both pre and 1-year postoperative response TKR UKR 1 year 1 year Preoperatively postoperatively Preoperatively postoperatively Knee pain in the operated knee, n (%) 5,975 5,975 791 791 None 14 (0) 2,018(34) 3 (0) 254 (32) Very mild 79 (1) 1,774 (30) 12 (2) 263 (33) Mild 330 (6) 1,083 (18) 35 (4) 143 (18) Moderate 2,944 (49) 868 (14) 397 (50) 106 (14) Severe 2,608 (44) 232 (4) 344 (44) 25 (3) Satisfaction with the surgery, n (%) 8,441 1,120 Very dissatisfied 221 (3) 24 (2) Dissatisfied 474 (5) 53 (5) Neither satisfied nor dissatisfied 928 (11) 107 (9) Satisfied 2,426 (29) 302 (27) Very satisfied 4,392 (52) 634 (57) Charnley class, n (%) 9,955 1,346 A 3,597 (36) 552 (41) B 3,116 (31) 454 (34) C 3,242 (33) 340 (25) Number 5,490 5,490 768 768 KOOS-12, mean (SD) Pain 35 (14) 78 (21) 35 (14) 77 (22) Function in daily living 43 (18) 79 (20) 38 (18) 75 (21) QoL 23 (13) 68 (23) 22 (13) 67 (23) Number 3,369 3,369 696 696 EQ VAS, mean (SD) 61 (21) 73 (19) 61 (22) 75 (18) Number 5,990 5,990 783 783 EQ5D-index, Swedish TTO, mean (SD) 0.72 (0.12) 0.86 (0.13) 0.73 (0.12) 0.88 (0.11) EQ5D-index, Swedish VAS, mean (SD) 54.40 (12.84) 72.73 (15.20) 54.92 (12.58) 74.04 (13.60) EQ-5D index, svensk VAS, medel (SD) 54,40 (12,84) 72,73 (15,20) 54,92 (12,58) 74,04 (13,60) Table 8.5. PROMs in primary knee replacements 2022 with both pre- and one-year postoperative response. 2 3 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register Figure 8.2. Pareto classification EQ-5D-5L, knee replacement 2022. 2 3 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Primary knee replacement results per unit Table 8.6 shows the proportion of patients satisfied (very similarly. The difference in KOOS various subscales var- satisfied or satisfied) with the surgical outcome. Among ies most preoperatively with ten points among the three units with a relatively high response rate (≥70%) and units, and between zero and four points postoperatively ≥70 knee replacement surgeries, satisfaction rates vary in 2022. The response rate for preoperative KOOS-12 significantly from 72% in Kungälv and Norrtälje to 86% is significantly higher for those operated in 2023, with in Uddevalla. 91% of those who reported KOOS-12, hav- all units except three reporting KOOS-12 preoperatively. ing surgery in 2022, were classified as responders. Only For 2023, only preoperative responses are available and five units (Eksjö, Ljungby, Lycksele, Oskarshamn, and vary between 22 and 23 points in KOOS-12 different Sollefteå) had a relatively high response rate (≥70%) and subscales at the units. ≥70 surgeries, with satisfaction rates ranging from 92% in Ljungby, Oskarshamn, and Sollefteå to 88% in Eksjö. For units with a low response rate and/or few surgeries, KOOS-12 – UKR the proportion of responders ranged between 74% and Table 8.9 shows the results for KOOS-12 three subscales 100%. The low response rate likely reflects changes in with both pre- and one year postoperative responses, as PROM collection following the merger. well as the proportion classified as Charnley C for UKR surgeries in 2022 at each unit, and preoperative responses for UKR surgeries in 2023. The proportion classified as General health for primary TKR and UKR Charnley class C at the units reporting KOOS varied from General health (EQ VAS) for TKR and UKR at each unit 6% at Capio Movement to 38% at Nyköping. For 2023, is shown in Table 8.7. Preoperatively, general health ranged the proportion was 25%, ranging from 15% at Orthope- from 44 to 72 units on the 100-point scale for TKR, and dic Center Sophiahemmet to 47% at Capio Movement. from 62 to 79 units postoperatively. For the few units with a relatively high response rate (≥70%) and ≥70 surgeries, No units reporting KOOS-12 for UKR had a relatively EQ VAS ranged from 58 to 72 units preoperatively and high response rate (≥70%) and ≥70 surgeries for 2022, from 68 to 73 units one year postoperatively. For UKR, and results in the different subscales of KOOS-12 varied general health ranged from 53 to 67 units preoperatively greatly both preoperatively and postoperatively. For 2023, and from 70 to 79 units postoperatively among units with there are two units (Aleris Specialistvård Nacka and Capio 20 or more responses. Ortho Center Stockholm) with a relatively high response rate (≥70%) and ≥70 surgeries that reported KOOS-12, showing a difference of one point in the three subscales. KOOS-12 – TKR Table 8.8 shows the results for KOOS-12 three subscales with both pre- and one year postoperative responses, as Variation in results between units well as the proportion classified as Charnley C for TKR Group-level results vary among comparable units, those surgeries in 2022 at each unit, and preoperative responses with a relatively high response rate (≥70%) and ≥70 sur- for TKR surgeries in 2023. The proportion classified as geries. When a unit has relatively few surgeries and/or sig- Charnley class C at the three units (Ljungby, Lycksele, and nificant dropout, it is challenging to compare their results Oskarshamn) with a relatively high response rate (≥70%) with other units. Additionally, we do not account for case and ≥70 surgeries reporting KOOS in 2022 varied among mix, which may reduce or increase differences between units from 30% in Oskarshamn to 35% in Ljungby and units, when presenting patient-reported outcomes in this 38% in Lycksele. For 2023, where significantly more year's report. units had a relatively high response rate, 19% of patients at Orthopedic Center, Sophiahemmet were classified as Charnley C, while 49% in Trelleborg were classified 2 3 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Proportion of satisfied and responders after primary knee replacement per unit 2022 Number Response Proportion Number Response Proportion Unit response rate, % satisfied, % response rate, % responders, % Akademiska 49 49 63 48 47 88 Aleris Malmö Arena 0 0 Aleris Specialistvård Nacka 283 55 86 257 50 91 Aleris Specialistvård Ängelholm 387 63 78 272 44 91 Alingsås 115 56 83 102 47 94 Art Clinic Göteborg 250 71 83 211 60 89 Art Clinic Jönköping 164 66 86 148 59 97 Arvika 141 44 87 <20 Bollnäs 252 67 83 243 64 94 Borås 32 60 72 21 40 100 Capio Artro Clinic 460 58 83 313 39 93 Capio Movement 391 73 84 229 43 92 Capio Ortho Center Göteborg 163 55 85 101 34 93 Capio Ortho Center Stockholm 462 53 88 391 45 93 Capio Ortho och Spine Center Skåne 75 41 83 39 22 90 Capio Ortopedi Motala 264 58 5 98 43 96 Capio Ortopediska Huset 484 57 80 0 Capio S:t Göran 112 39 75 90 31 88 Carlanderska 181 50 87 64 18 92 Carlanderska-SportsMed 0 0 Danderyd 60 31 75 25 13 92 Eksjö 247 79 78 226 72 88 Enköping 371 74 80 102 20 80 Eskilstuna 26 49 69 23 43 96 Falun 27 14 81 0 Frölundaortopeden <20 <20 Gällivare <20 <20 Gävle 37 58 78 30 47 93 Halmstad 62 53 81 25 21 92 Helsingborg 148 57 74 92 36 83 Hermelinen <20 <20 Hudiksvall 20 53 75 <20 Hässleholm 437 44 80 378 38 90 Kalmar 46 49 87 45 48 91 Karlshamn 132 55 77 116 48 88 Karlstad <20 <20 Karolinska Huddinge 85 50 74 39 23 74 Karolinska Solna 26 54 62 <20 Kullbergska sjukhuset 197 58 83 198 59 94 Kungälv 85 83 72 64 62 88 Table continued on next page. 2 3 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Proportion of satisfied and responders after primary knee replacement per unit 2022, cont. Number Response Proportion Number Response Proportion Unit response rate, % satisfied, % response rate, % responders, % Ledplastikcentrum Bromma 95 31 81 42 14 98 Lidköping 36 37 56 30 32 87 Lindesberg 183 56 82 33 10 91 Ljungby 87 78 82 90 80 92 Lycksele 185 83 82 164 74 90 Mora 147 65 85 92 41 93 Norrköping 105 91 77 63 55 89 Norrtälje 116 71 72 92 56 86 Nyköping 66 60 80 60 55 88 NÄL Trollhättan <20 <20 Ortopedisk Center Sophiah. 143 64 90 121 54 92 Oskarshamn 281 81 81 264 76 92 Piteå 208 62 83 171 51 93 Skellefteå 36 50 69 24 34 88 Skene 94 49 82 63 33 87 Skövde <20 <20 Sollefteå 108 75 81 103 73 92 Specialistcenter Scandinavia Eskilstuna 54 45 89 49 41 96 Specialistcenter Scandinavia 24 28 92 0 Johanniskliniken Specialistcenter Scandinavia Skåne 54 66 82 35 61 94 SU/Mölndal 163 54 69 143 47 90 SU/Sahlgrenska 0 0 Sundsvall <20 <20 SUS/Lund <20 <20 Södersjukhuset 88 59 72 60 40 83 Södertälje 61 46 75 40 30 85 Torsby 54 43 83 39 31 95 Trelleborg 173 53 75 126 38 89 Uddevalla 125 82 86 103 68 96 Umeå <20 <20 Varberg 74 69 84 42 39 95 Visby 48 63 79 39 51 85 Värnamo 106 54 78 103 53 91 Västervik 70 63 79 65 58 89 Västerås 93 38 78 75 31 93 Växjö 79 66 67 21 18 76 Örnsköldsvik 40 20 93 0 Östersund 54 53 89 50 49 98 Country 7,796 46 81 6,479 38 91 Table 8.6. Response rate and proportion of satisfied and responders after primary knee replacement per unit 2022. 2 3 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 EQ VAS in primary knee replacement 2022 Number Response Number Response response rate, % TKR mean (SD) response rate, % UKR mean (SD) Unit pre 1 year pre 1 year Akademiska 47 47 55 (17) 71 (18) 0 Aleris Malmö Arena 0 Aleris Specialistvård Nacka 92 51 60 (21) 75 (15) 156 47 60 (20) 73 (15) Aleris Specialistvård Ängelholm 213 45 62 (22) 75 (17) 52 37 55 (19) 73 (16) Alingsås 100 49 66 (20) 74 (18) 0 Art Clinic Göteborg 189 55 61 (21) 74 (18) <20 Art Clinic Jönköping 140 60 62 (21) 75 (17) <20 Arvika <20 0 Bollnäs 211 65 58 (20) 72 (19) 25 57 63 (19) 74 (19) Borås <20 0 Capio Artro Clinic 273 38 65 (20) 75 (16) 38 43 62 (19) 74 (17) Capio Movement 190 41 64 (20) 75 (18) 38 58 66 (19) 77 (15) Capio Ortho Center Göteborg 93 33 61 (18) 75 (18) <20 Capio Ortho Center Stockholm 300 45 61 (19) 74 (16) 85 43 62 (18) 78 (13) Capio Ortho och Spine Center Skåne 37 23 61 (23) 73 (23) <20 Capio Ortopedi Motala 86 22 56 (22) 72 (17) <20 Capio Ortopediska Huset 385 47 63 (20) 75 (17) <20 Capio S:t Göran 71 30 63 (20) 71 (19) <20 Carlanderska 60 18 64 (19) 73 (18) <20 Carlanderska-SportsMed 0 0 Danderyd 17 15 51 (21) 69 (22) <20 Eksjö 218 72 64 (18) 72 (16) <20 Enköping 90 19 58 (22) 66 (21) <20 Eskilstuna 20 41 52 (17) 63 (20) Falun 0 0 Frölundaortopeden <20 <20 Gällivare <20 0 Gävle 26 48 54 (21) 62 (22) <20 Halmstad <20 44 (20) 69 (20) <20 Helsingborg 81 34 63 (21) 67 (21) <20 Hermelinen <20 Hudiksvall <20 Hässleholm 363 49 63 (20) 73 (21) <20 Kalmar 45 48 64 (18) 73 (17) Karlshamn 111 49 66 (17) 73 (19) <20 Karlstad <20 Karolinska Huddinge 36 22 52 (21) 62 (20) <20 Karolinska Solna <20 Kullbergska sjukhuset 174 60 60 (19) 72 (18) 22 48 59 (17) 79 (14) Kungälv 57 68 56 (23) 69 (22) <20 Table continued on next page. 2 4 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 EQ VAS in primary knee replacement 2022, cont. Number Response Number Response response rate, % TKR mean (SD) response rate, % UKR mean (SD) Unit pre 1 year pre 1 year Ledplastikcentrum Bromma 28 13 57 (19) 76 (15) <20 Lidköping 25 27 46 (25) 66 (20) <20 Lindesberg 31 10 63 (21) 76 (17) <20 Ljungby 63 75 72 (16) 73 (16) 23 82 67 (21) 73 (21) Lycksele 133 74 61 (21) 70 (19) 27 69 59 (17) 71 (15) Mora 76 42 60 (20) 74 (17) <20 Norrköping 53 51 54 (20) 67 (20) <20 Norrtälje 87 58 60 (20) 69 (21) <20 Nyköping 37 51 61 (18) 69 (20) 22 58 54 (21) 70 (19) NÄL Trollhättan <20 Ortopedisk Center Sophiah. 76 58 66 (21) 79 (15) 45 51 66 (18) 76 (16) Oskarshamn 249 72 61 (19) 73 (17) <20 Piteå 136 51 56 (21) 69 (21) 26 43 53 (20) 70 (19) Skellefteå 22 31 63 (15) 74 (13) Skene 55 30 62 (21) 71 (20) <20 Skövde <20 Sollefteå 99 70 58 (20) 68 (17) Specialistcenter Scandinavia Eskilstuna 43 39 59 (19) 73 (17) <20 Specialistcenter Scandinavia Johannisk- 0 0 liniken Specialistcenter Scandinavia Skåne 21 41 56 (22) 74 (19) <20 Specialistläkarhuset i Sundsvall AB <20 SU/Mölndal 132 46 55 (22) 65 (23) <20 SU/Sahlgrenska 0 Sundsvall <20 SUS/Lund <20 Södersjukhuset 58 41 57 (17) 66 (19) Södertälje 37 28 51 (22) 64 (21) Torsby 31 28 63 (19) 76 (16) <20 Trelleborg 120 38 55 (21) 66 (20) <20 Uddevalla 101 67 56 (21) 72 (19) Umeå <20 Varberg 40 39 64 (20) 80 (16) <20 Visby 36 48 61 (19) 69 (18) <20 Värnamo 99 53 60 (21) 74 (16) <20 Västervik 62 55 53 (20) 70 (20) Västerås 70 29 62 (20) 70 (18) Växjö 21 18 58 (19) 66 (23) <20 Örnsköldsvik 0 0 Östersund 33 45 52 (20) 69 (20) <20 Country 5,923 40 60(20) 72 (19) 778 37 61 (20) 74 (17) Table 8.7. EQ VAS in primary knee replacement per unit 2022. 2 4 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 KOOS-12 per unit TKR 2022 and 2023 Response Proportion Pain ADL QoL Number rate Charnley C mean (SD) mean (SD) mean (SD) Unit Year response Preopera- Preopera- Preopera- % % tively 1 year tively 1 year tively 1 year 2022 47 47 43 29 (14) 68 (23) 32 (16) 67 (26) 18 (11) 59 (24) Akademiska 2023 99 81 36 32 (15) 35 (17) 19 (11) 2022 0 Aleris Malmö Arena 2023 0 2022 87 48 32 36 (14) 82 (19) 40 (16) 79 (20) 22 (12) 72 (21) Aleris Specialistvård Nacka 2023 269 85 33 34 (15) 40 (20) 22 (14) 2022 216 46 33 33 (15) 76 (22) 36 (17) 75 (21) 22 (13) 68 (24) Aleris Specialistvård Ängelholm 2023 208 55 29 34 (14) 36 (18) 22 (13) 2022 97 48 31 37 (12) 81 (19) 45 (15) 80 (19) 24 (12) 71 (22) Alingsås 2023 149 73 38 35 (16) 39 (18) 23 (14) 2022 198 58 22 34 (15) 78 (22) 40 (19) 78 (21) 22 (13) 69 (24) Art Clinic Göteborg 2023 382 85 26 36 (13) 39 (16) 23 (13) 2022 137 58 29 34 (14) 80 (20) 38 (17) 77 (19) 22 (12) 71 (22) Art Clinic Jönköping 2023 262 87 31 35 (14) 38 (17) 24 (13) 2022 <20 Arvika 2023 145 55 37 36 (13) 39 (16) 23 (12) 2022 206 63 33 36 (14) 80 (21) 38 (17) 73 (18) 23 (13) 62 (23) Bollnäs 2023 408 97 29 34 (14) 37 (18) 22 (14) 2022 <20 Borås 2023 44 62 43 30 (15) 31 (19) 18 (13) 2022 274 39 24 39 (16) 80 (20) 44 (18) 79 (19) 23 (13) 68 (22) Capio Artro Clinic 2023 679 79 27 38 (15) 44 (18) 25 814) 2022 181 39 33 38 (14) 81 (20) 45 (18) 80 (20) 27 (14) 73 (22) Capio Movement 2023 164 27 31 38 (13) 43 (17) 28 (14) 2022 94 34 27 33 (14) 78 (21) 38 (18) 77 (21) 20 (13) 66 (24) Capio Ortho Center Göteborg 2023 179 58 22 38 (15) 45 (18) 25 (14) 2022 299 44 28 37 (14) 81 (19) 41 (18) 79 (19) 23 (14) 70 (22) Capio Ortho Center Stockholm 2023 575 84 29 36 (15) 40 (18) 23 (13) Capio Ortho och Spine Center 2022 37 23 22 32 (14) 79 (18) 40 (21) 75 (18) 23 (13) 65 (22) Malmö 2023 133 43 29 35 (14) 42 (17) 25 (13) 2022 85 22 27 30 (16) 80 (20) 32 (17) 77 (20) 20 (13) 68 (22) Capio Ortopedi Motala 2023 229 42 34 35 (15) 38 (18) 22 (13) 2022 0 Capio Ortopediska Huset 2023 197 23 26 39 (16) 44 (18) 27 (13) 2022 Capio Spine Center Göteborg 2023 <20 2022 70 29 38 34 (15) 72 (23) 41 (17) 70 (21) 23 (14) 66 (25) Capio S:t Göran 2023 239 78 40 35 (17) 39 (20) 23 (15) 2022 59 18 30 35 (13) 77 (20) 40 (15) 75 (21) 23 (13) 66 (25) Carlanderska 2023 172 40 27 36 (13) 41 (16) 26 (12) Table continued on next page. 2 4 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 KOOS-12 per unit TKR 2022 and 2023, cont. Response Proportion Pain ADL QoL Number rate Charnley C mean (SD) mean (SD) mean (SD) Unit Year response Preopera- Preopera- Preopera- % % tively 1 year tively 1 year tively 1 year 2022 0 Carlanderska – SportsMed 2023 65 28 18 37 (14) 41 (18) 23 (13) 2022 <20 Danderyd 2023 26 28 37 29 (16) 31 (19) 17 (13) 2022 208 68 30 37 (13) 76 (21) 40 (15) 75 (20) 26 (13) 66 (21) Eksjö 2023 283 83 31 36 (13) 39 (16) 24 (12) 2022 87 19 31 30 (14) 71 (24) 34 (17) 69 (22) 21 (13) 63 (24) Enköping 2023 170 33 34 34 (17) 36 (18) 21 (13) 2022 <20 Eskilstuna 2023 34 81 44 32 (19) 35 (20) 22 (19) 2022 0 Falun 2023 0 2022 <20 Frölundaortopeden 2023 <20 2022 <20 Gällivare 2023 32 68 31 32 (13) 37 (18) 21 (12) 2022 26 48 40 32 (12) 78 (19) 34 (14) 64 (20) 19 (11) 62 (22) Gävle 2023 41 79 46 26 (13) 25 (14) 14 (11) 2022 <20 Halmstad 2023 46 44 39 34 (15) 34 (16) 21 (13) 2022 77 32 30 32 (14) 70 (26) 39 (17) 71 (26) 22 (14) 66 (27) Helsingborg 2023 163 67 33 30 (14) 33 (18) 21 (14) 2022 <20 Hermelinen 2023 31 78 29 34 (15) 38 (14) 20 (13) 2022 <20 Hudiksvall 2023 35 76 43 35 (13) 35 (14) 22 (11) 2022 353 47 34 36 (15) 78 (22) 40 (18) 76 (21) 25 (14) 68 (25) Hässleholm 2023 749 77 33 35 (15) 39 (18) 24 (14) 2022 45 48 37 42 (18) 82 (18) 43 (19) 80 (17) 27 (19) 72 (22) Kalmar 2023 83 97 37 33 (13) 36 (16) 22 (12) 2022 108 48 28 36 (15) 77 (22) 39 (18) 75 (20) 24 (13) 65 (23) Karlshamn 2023 255 89 24 36 (14) 39 (16) 25 (13) 2022 <20 Karlstad 2023 <20 2022 35 21 34 26 (18) 64 (27) 27 (22) 62 (25) 12 (12) 55 (30) Karolinska Huddinge 2023 42 30 51 30 (15) 30 (16) 17 (12) 2022 <20 Karolinska Solna 2023 20 56 30 32 (11) 32 (18) 18 (10) 2022 174 60 28 34 (13) 76 (21) 38 (15) 75 (20) 25 (15) 66 (24) Kullbergska sjukhuset 2023 369 97 36 33 (14) 36 (17) 22 (13) Table continued on next page. 2 4 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 KOOS-12 per unit TKR 2022 and 2023, cont. Response Proportion Pain ADL QoL Number rate Charnley C mean (SD) mean (SD) mean (SD) Unit Year response Preopera- Preopera- Preopera- % % tively 1 year tively 1 year tively 1 year 2022 54 64 41 31 (17) 66 (24) 32 (19) 67 (24) 20 (15) 60 (25) Kungälv 2023 96 89 39 33 (15) 34 (18) 20 (15) 2022 29 14 40 32 (14) 86 (17) 36 (17) 82 (18) 20 (12) 71 (17) Ledplastikcentrum Bromma 2023 177 23 33 37 (14) 43 (17) 26 (14) 2022 29 32 32 27 (17) 71 (26) 32 (19) 68 (25) 18 (14) 62 (24) Lidköping 2023 180 83 34 36 (16) 38 (17) 25 (14) 2022 32 10 34 31 (17) 78 (23) 35 (20) 76 (23) 22 (15) 62 (24) Lindesberg 2023 87 21 28 31 (14) 36 (18) 20 (13) 2022 65 77 35 38 (11) 79 (20) 46 (15) 75 (20) 30 (13) 70 (21) Ljungby 2023 76 94 44 38 (15) 37 (18) 25 (14) 2022 125 70 38 38 (11) 79 (20) 36 (16) 73 (20) 22 (12) 66 (21) Lycksele 2023 135 88 32 35 (14) 40 (17) 23 (13) 2022 74 41 35 34 (15) 82 (21) 38 (20) 79 (22) 22 (14) 72 (23) Mora 2023 173 74 30 34 (13) 37 (17) 22 (13) 2022 52 50 38 30 (14) 71 (26) 32 (19) 65 (26) 19 (13) 58 (25) Norrköping 2023 95 66 37 30 (14) 32 (17) 19 (11) 2022 86 57 36 34 (14) 72 (24) 40 (16) 72 (24) 24 (12) 61 (25) Norrtälje 2023 152 82 34 36 (14) 41 (15) 26 (14) 2022 36 50 32 36 (13) 77 (17) 38 (18) 74 (19) 23 (13) 66 (21) Nyköping 2023 42 78 52 33 (15) 36 (20) 21 (13) 2022 <20 NÄL Trollhättan 2023 0 Ortopediskt Center – 2022 75 57 20 39 (14) 85 (18) 45 (16) 83 (18) 25 (12) 76 (19) Sophiahemmet 2023 104 71 19 39 (15) 44 (16) 24 (15) 2022 251 73 30 34 (13) 79 (21) 37 (15) 76 (20) 23 (12) 69 (23) Oskarshamn 2023 365 93 29 36 (14) 38 (17) 24 814) 2022 140 52 44 32 (15) 80 (22) 35 (17) 75 (23) 19 (12) 70 (23) Piteå 2023 254 75 41 33 (14) 35 (17) 20 (12) 2022 24 34 28 43 (12) 79 (20) 42 (18) 74 (21) 30 (17) 69 (21) Skellefteå 2023 22 34 23 45 (18) 47 (23) 30 (19) 2022 58 31 38 42 (17) 77 (22) 40 (18) 75 (20) 22 (15) 67 (22) Skene 2023 127 56 26 36 (16) 37 (19) 19 (13) 2022 <20 Skövde 2023 32 89 34 39 (18) 23 (17) 2022 95 67 31 34 (14) 76 (22) 36 (15) 74 (21) 22 (12) 67 (23) Sollefteå 2023 183 96 35 35 (14) 38 (16) 23 (12) Specialistcenter Scandinavia 2022 45 41 30 33 (10) 81 (19) 41 (14) 80 (19) 20 (14) 69 (20) Eskilstuna 2023 127 76 22 34 (13) 40 (15) 23 (13) Specialistcenter Scandinavia 2022 0 Johanniskliniken 2023 0 Table continued on next page. 2 4 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 KOOS-12 per unit TKR 2022 and 2023, cont. Response Proportion Pain ADL QoL Number rate Charnley C mean (SD) mean (SD) mean (SD) Unit Year response Preopera- Preopera- Preopera- % % tively 1 year tively 1 year tively 1 year Specialistcenter Scandinavia 2022 21 41 39 35 (15) 80 (22) 41 (20) 78 (24) 22 (14) 70 (27) Skåne 2023 80 61 30 34 (15) 37 (17) 24 (13) Specialistläkarhuset 2022 Sundsvall AB 2023 0 2022 136 47 55 31 (15) 72 (25) 35 (19) 72 (25) 18 (13) 61 (26) SU/Mölndal 2023 210 80 30 32 (13) 35 (17) 19 (13) 2022 SU/Sahlgrenska 2023 2022 <20 Sundsvall 2023 41 84 27 37 (14) 38 (16) 23 (14) 2022 <20 SUS/Lund 2023 <20 2022 58 41 37 34 (15) 75 (24) 37 (20) 71 (23) 20 (14) 67 (25) Södersjukhuset 2023 67 68 49 32 (15) 36 (19) 19 (14) 2022 38 29 42 34 (14) 69 (23) 34 (17) 69 (22) 21 (12) 61 (24) Södertälje 2023 94 68 44 33 (18) 35 (21) 23 (15) 2022 31 28 36 38 (14) 83 (23) 41 (19) 84 (19) 25 (15) 78 (21) Torsby 2023 24 23 29 35 (16) 40 (16) 21 (11) 2022 116 37 48 31 (13) 69 (24) 34 (15) 69 (24) 22 (14) 60 (26) Trelleborg 2023 325 79 49 32 (16) 34 (17) 22 (15) 2022 101 67 37 32 (13) 80 (19) 34 (18) 75 (21) 20 (13) 70 (22) Uddevalla 2023 176 90 25 34 (14) 36 (18) 21 (14) 2022 <20 Umeå 2023 <20 2022 40 39 40 38 (13) 84 (18) 39 (15) 82 (20) 23 (13) 77 (19) Varberg 2023 <20 38 32 (12) 32 (17) 20 (14) 2022 37 49 28 33 (14) 77 (23) 34 (16) 72 (20) 20 (13) 66 (24) Visby 2023 76 81 43 28 (12) 34 (16) 20 (12) 2022 101 53 33 34 (16) 78 (23) 37 (17) 76 (21) 23 (14) 70 (23) Värnamo 2023 215 95 34 33 (15) 37 (18) 24 (14) 2022 63 56 34 33 (14) 77 (24) 35 (16) 73 (25) 21 (12) 69 (26) Västervik 2023 58 52 34 32 (13) 37 (16) 22 (14) 2022 73 30 39 36 (14) 77 (22) 36 (16) 73 (21) 23 (14) 66 (24) Västerås 2023 207 72 29 31 (8) 34 (16) 20 (14) 2022 <20 Växjö 2023 <20 2022 0 Örnsköldsvik 2023 142 94 46 32 (13) 34 (15) 22 (13) 2022 33 45 41 29 (13) 76 (21) 27 (16) 75 (21) 16 (10) 71 (22) Östersund 2023 96 76 41 34 (14) 34 (18) 21 (14) 2022 5,490 37 33 35 (14) 77 (22) 38 (18) 75 (21) 22 (13) 67 (23) Country 2023 11,277 62 32 35 (15) 38 (18) 23 (14) Table 8.8. KOOS-12 per unit TKR 2022 and 2023. 2 4 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 KOOS-12 per unit UKR 2022 and 2023 Response Proportion Pain ADL QoL Number rate Charnley C mean (SD) mean (SD) mean (SD) Unit Year response Preopera- Preopera- Preopera- % % tively 1 year tively 1 year tively 1 year 2022 <20 Akademiska 2023 2022 0 Aleris Malmö Arena 2023 0 2022 160 49 27 33 (13) 76 (23) 40 (16) 75 (22) 22 (12) 67 (23) Aleris Specialistvård Nacka 2023 371 91 25 36 (13) 41 (16) 24 (12) 2022 52 37 25 32 (12) 70 (22) 41 (17) 72 (19) 20 (10) 59 (22) Aleris Specialistvård Ängelholm 2023 49 53 31 37 (14) 43 (16) 28 (14) 2022 <20 Art Clinic Göteborg 2023 38 90 21 38 (14) 42 (20) 23 (13) 2022 <20 Art Clinic Jönköping 2023 25 89 16 37 (12) 42 (17) 22 (12) 2022 Arvika 2023 <20 2022 23 52 30 40 (14) 78 (18) 46 (16) 79 (17) 25 (10) 66 (24) Bollnäs 2023 <20 51 (15) 28 (13) 2022 39 44 24 38 (14) 73 (21) 45 (20) 74 (21) 25 (13) 64 (21) Capio Artro Clinic 2023 63 78 27 40 (16) 47 (18) 23 (13) 2022 39 60 6 42 (15) 82 (18) 48 (20) 85 (17) 31 (16) 72 (19) Capio Movement 2023 23 29 47 39 (12) 42 (17) 26 (13) 2022 <20 Capio Ortho Center Göteborg 2023 <20 2022 84 42 24 37 (15) 85 (16) 44 (21) 87 (12) 24 (13) 76 (18) Capio Ortho Center Stockholm 2023 144 83 24 35 (14) 41 (17) 24 (13) 2022 <20 Capio Ortho och Spine Center Malmö 2023 22 48 18 36 (13) 46 (10) 29 (16) 2022 <20 Capio Ortopedi Motala 2023 34 32 32 33 (15) 41 (22) 25 (16) 2022 0 Capio Ortopediska Huset 2023 <20 2022 <20 Capio S:t Göran 2023 26 84 42 36 (15) 46 (21) 24 (13) 2022 <20 Carlanderska 2023 <20 Table continued on next page. 2 4 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 KOOS-12 per unit UKR 2022 and 2023, cont. Response Proportion Pain ADL QoL Number rate Charnley C mean (SD) mean (SD) mean (SD) Unit Year response Preopera- Preopera- Preopera- % % tively 1 year tively 1 year tively 1 year 2022 0 Carlanderska – SportsMed 2023 <20 2022 <20 Danderyd 2023 <20 2022 <20 Eksjö 2023 <20 2022 <20 Enköping 2023 <20 2022 Eskilstuna 2023 <20 2022 0 Falun 2023 0 2022 0 Frölundaortopeden 2023 0 2022 <20 Gävle 2023 <20 2022 <20 Halmstad 2023 <20 2022 <20 Helsingborg 2023 <20 2022 <20 Hässleholm 2023 <20 2022 Kalmar 2023 <20 2022 <20 Karlshamn 2023 <20 2022 0 Karolinska Huddinge 2023 0 2022 23 50 20 35 (16) 83 (18) 42 (17) 82 (20) 26 (12) 70 (21) Kullbergska sjukhuset 2023 56 98 46 34 (16) 42 (18) 23 (12) 2022 <20 Kungälv 2023 40 91 44 31 (15) 37 (16) 21 (13) 2022 <20 Ledplastikcentrum Bromma 2023 33 22 24 38 (10) 43 (14) 23 (9) Table continued on next page. 2 4 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 KOOS-12 per unit UKR 2022 and 2023, cont. Response Proportion Pain ADL QoL Number rate Charnley C mean (SD) mean (SD) mean (SD) Unit Year response Preopera- Preopera- Preopera- % % tively 1 year tively 1 year tively 1 year 2022 0 Lidköping 2023 <20 2022 <20 Lindesberg 2023 <20 2022 22 79 22 37 (14) 80 (20) 43 (16) 76 (18) 24 (13) 68 (24) Ljungby 2023 34 100 30 39 (13) 45 (18) 29 (14) 2022 27 69 29 36 (12) 81 (18) 42 (16) 82 (17) 25 (13) 74 (21) Lycksele 2023 30 86 42 38 (14) 44 (18) 29 (15) 2022 <20 Mora 2023 33 73 21 36 (12) 44 (15) 23 (12) 2022 <20 Norrköping 2023 <20 2022 <20 Norrtälje 2023 <20 2022 23 61 38 34 (14) 80 (23) 41 (19) 73 (24) 23 (13) 65 (28) Nyköping 2023 36 88 33 33 (14) 41 (20) 23 (13) 2022 44 50 22 35 (11) 81 (19) 46 (17) 80 (20) 21 (12) 71 (22) Ortopediskt Center – Sophiahemmet 2023 60 67 15 40 (17) 45 (18) 24 (14) 2022 <20 Oskarshamn 2023 <20 2022 26 43 33 31 (11) 90 (14) 36 (17) 90 (13) 16 (10) 85 (13) Piteå 2023 66 78 29 31 (12) 36 (16) 20 (13) 2022 <20 Skene 2023 <20 Specialistcenter Scandinavia 2022 <20 Eskilstuna 2023 2022 0 Specialistcenter Scandinavia Johanniskliniken 2023 0 2022 <20 Specialistcenter Scandinavia Skåne 2023 41 55 32 33 (16) 41 (22) 24 (17) 2022 <20 SU/Mölndal 2023 <20 2022 <20 Torsby 2023 <20 Table continued on next page. 2 4 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 KOOS-12 per unit UKR 2022 and 2023, cont. Response Proportion Pain ADL QoL Number rate Charnley C mean (SD) mean (SD) mean (SD) Unit Year response Preopera- Preopera- Preopera- % % tively 1 year tively 1 year tively 1 year 2022 <20 Trelleborg 2023 <20 2022 <20 Varberg 2023 <20 2022 <20 Visby 2023 2022 <20 Värnamo 2023 <20 2022 0 Växjö 2023 0 2022 0 Örnsköldsvik 2023 62 98 21 32 (17) 36 (18) 22 (17) 2022 <20 Östersund 2023 24 83 40 37 (13) 38 (16) 27 (14) 2022 768 36 26 35 (14) 78 (21) 43 (18) 76 (20) 23 (13) 68 (23) Country 2023 1,493 62 27 36 (14) 42 (17) 24 (13) Table 8.9. KOOS-12 per unit UKR 2022 and 2023. 2 4 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Small differences in results since 2009 Hip and Knee Prosthesis Surgeries with Registration in the Swedish Osteoarthritis Since 2009, when patient-reported outcomes for TKR Register Before Surgery from Trelleborg were first presented, until this year’s report on TKR performed in 2022, the variation has been min- The purpose of the Osteoarthritis Register is to follow up imal. General health one year postoperatively has ranged and improve the basic treatment for patients with osteo- from 75 to 78. The proportion of OMERTACT-OARSI arthritis. Basic treatment includes information, exercise, responders was 85% in 2009 and has been 89% in recent and weight control, which patients can access by partici- years. For 2021, the proportion of responders was 92%, pating in an osteoarthritis school. In this year’s report, we and for 2022, it was 91% based on KOOS-12. The pro- have cross-referenced the Swedish Osteoarthritis Register portion of satisfied patients has increased since 2009 (Trel- with the Swedish Arthroplasty Register to determine the leborg patients only) from 81% to a range of 81% to 88% proportion of total hip and knee replacement surgeries in recent years. In the full-scale KOOS (42 questions), performed in 2021 and 2022 due to osteoarthritis that are the variation in the five subscales has been small over the registered in the Osteoarthritis Register. Table 8.11 shows years, between 1 and 4 points, and in KOOS-12 for 2021 that approximately 25.5% of total hip replacement surger- and 2022, the variation in the three subscales was between ies and 27% of knee replacement surgeries are registered zero and two points. These small variations between in the Osteoarthritis Register. The table also indicates years are notable considering that different patients report significant variation between different units. In Helsing- each year. borg, only 6% of total hip replacement surgeries have a registration in the Osteoarthritis Register, while 52% in Mora do. Corresponding figures for knee replacement Daily exercise and physical activity in surgeries are 5% in Gällivare and 52% in Skövde. Table elective total hip and knee replacement 8.12 shows similar information by region. Even at the Table 8.10 presents the two new questions regarding regional level, there is significant variation from just over how much time is spent on daily exercise and physical 9% and 11% in Norrbotten for hip and knee replacement activity each week. The table includes patients who were surgeries, respectively, to 48% and 46% in Dalarna. operated on in 2022 and who have pre- and one-year postoperative responses per unit. Here too, the response The relatively low proportion and large variation of rate is low, likely due to the same reasons mentioned total hip and knee replacement surgeries registered in earlier in the chapter, and for units with few operations the Osteoarthritis Register for 2022 and 2023 may be and/or a low response rate, the results and percentages due to several factors. One reason may be that the units’ may be misleading. 24% of hip replacement patients and routines for recommending or requiring osteoarthritis 29% of knee replacement patients reported engaging school before surgery vary, and regional priorities set by in daily exercise for more than 150 minutes per week politicians might differ. preoperatively, and 33% of hip replacement patients and 35% of knee replacement patients reported doing so one year postoperatively. Corresponding figures for physical activity for more than 60 minutes per week were 22% and 27% for hip and knee replacement patients preoperatively, and 33% and 37% one year postoperatively. 2 5 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Everyday exercise and physical activity in hip and knee replacement 2022 Hip Knee Number Re- Everyday Number Re- Everyday re- sponse exercise >150 Physical activity re- sponse exercise >150 Physical activity sponse rate % min/week, % >60 min/week, % sponse rate % min/week, % >60 min/week, % Enhet pre 1 year pre 1 year pre 1 year pre 1 year Akademiska 50 62 22 32 21 40 45 44 53 33 22 33 Aleris Malmö Arena 0 0 0 Aleris Specialistvård Nacka 153 88 27 39 29 45 249 47 30 37 24 40 Aleris Specialistvård 97 70 41 41 31 43 262 43 35 39 35 42 ­Ängelholm Alingsås 26 36 18 36 24 37 106 51 34 44 36 35 Art Clinic Göteborg 96 74 22 30 18 42 201 57 34 38 23 38 Art Clinic Jönköping 83 82 21 33 23 37 150 60 27 35 32 40 Arvika 67 62 27 23 20 40 <20 Bollnäs 98 82 28 34 18 38 237 63 27 35 23 38 Borås <20 22 42 14 14 18 36 Capio Artro Clinic 203 71 35 43 31 47 310 38 39 40 31 44 Capio Movement 66 42 34 39 31 42 236 44 33 42 35 44 Capio Ortho Center 50 45 39 44 30 38 95 32 39 39 31 48 ­Göteborg Capio Ortho Center 230 74 32 41 35 47 387 44 31 38 35 46 ­Stockholm Capio Ortho och Spine 41 43 48 52 45 62 38 21 34 45 39 47 ­Center Skåne Capio Ortopedi Motala 111 74 30 33 19 31 97 21 19 31 18 29 Capio Ortopediska Huset 223 73 34 41 27 41 392 46 29 39 26 40 Capio S:t Göran 52 37 21 28 16 36 88 30 24 39 31 35 Carlanderska 20 18 26 32 39 37 65 17 48 48 35 48 Carlanderska – SportsMed <20 0 Danderyd 21 19 7 25 24 29 24 12 21 33 25 25 Eksjö 92 75 18 29 19 28 227 72 27 36 37 37 Enköping 137 64 21 35 23 33 101 20 30 35 38 43 Eskilstuna 18 62 22 40 18 23 18 23 Falun 22 31 14 13 19 13 0 Frölundaortopeden <20 Gällivare <20 <20 Gävle <20 30 48 13 20 20 20 Halmstad 25 49 21 37 10 26 25 20 32 40 24 44 Helsingborg <20 89 34 27 26 25 31 Hermelinen <20 Table continued on next page. 2 5 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Everyday exercise and physical activity in hip and knee replacement 2022, cont. Hip Knee Number Re- Everyday Number Re- Everyday re- sponse exercise >150 Physical activity re- sponse exercise >150 Physical activity sponse rate % min/week, % >60 min/week, % sponse rate % min/week, % >60 min/week, % Enhet pre 1 year pre 1 year pre 1 year pre 1 year Hudiksvall <20 <20 Hässleholm 227 77 29 40 19 29 375 48 31 31 29 42 Jönköping 35 55 20 27 20 29 Kalmar 26 65 22 30 27 26 45 50 24 29 20 29 Karlshamn 57 69 26 28 22 30 115 48 26 36 28 31 Karlstad <20 Karolinska Huddinge 53 34 18 27 12 31 35 20 29 23 14 31 Karolinska Solna <20 Kullbergska sjukhuset 113 88 22 29 8 33 195 57 33 39 27 36 Kungälv 32 52 22 15 10 25 64 62 19 31 17 30 Ledplastikcentrum Bromma 65 28 27 40 25 41 42 13 38 38 41 50 Lidköping 42 45 15 31 11 27 31 33 13 26 23 19 Lindesberg 24 23 19 25 22 25 31 10 29 32 35 29 Linköping <20 Ljungby 32 70 17 31 19 31 84 74 25 25 21 33 Lycksele 78 84 15 28 19 24 165 73 21 36 18 27 Mora 95 75 16 26 16 25 92 40 22 32 21 38 Norrköping 43 61 29 28 23 30 61 52 23 38 25 26 Norrtälje 33 63 30 46 11 36 88 52 28 39 20 28 Nyköping 42 71 21 25 10 25 58 52 31 31 29 34 NÄL Trollhättan <20 Ortopediskt Center – 69 70 41 46 37 44 123 54 34 40 46 50 Sophiahemmet Oskarshamn 134 88 36 41 27 39 259 74 34 35 29 36 Piteå 104 70 13 21 13 34 171 51 17 20 14 27 Skellefteå <20 22 31 31 27 36 27 Skene 0 0 0 Skövde 25 61 24 37 30 22 <20 Sollefteå 128 81 17 26 20 29 100 69 22 28 20 25 Specialistcenter ­Scandinavia 28 64 26 34 28 45 45 37 29 38 31 38 Eskilstuna Specialistcenter ­Scandinavia 0 Johanniskliniken Table continued on next page. 2 5 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Everyday exercise and physical activity in hip and knee replacement 2022, cont. Hip Knee Number Re- Everyday Number Re- Everyday re- sponse exercise >150 Physical activity re- sponse exercise >150 Physical activity sponse rate % min/week, % >60 min/week, % sponse rate % min/week, % >60 min/week, % Enhet pre 1 year pre 1 year pre 1 year pre 1 year Specialistcenter Scandinavia 25 49 33 35 19 48 33 40 27 24 33 42 Skåne Specialistläkarhuset i 0 Sundsvall AB SU/Mölndal 114 66 25 29 21 34 143 47 31 38 32 34 SU/Sahlgrenska Sundsvall <20 SUS/Lund <20 Södersjukhuset 41 60 6 7 10 17 63 42 25 25 24 35 Södertälje <20 40 29 30 30 18 48 Torsby 21 40 25 35 19 32 38 30 29 39 34 45 Trelleborg 69 78 24 34 23 34 126 38 26 29 21 30 Uddevalla 122 80 20 23 13 30 102 65 29 35 25 38 Umeå <20 Varberg 34 55 21 15 13 22 42 39 29 33 19 40 Visby 26 72 13 23 23 37 38 49 32 35 29 42 Värnamo 54 81 17 28 14 21 100 50 24 33 20 32 Västervik <20 66 58 35 42 30 36 Västerås 72 49 19 24 16 32 66 27 20 33 24 33 Växjö <20 20 17 35 25 5 10 Ängelholm 58 64 20 30 19 26 Örnsköldsvik 46 87 12 30 27 30 0 Östersund 97 71 21 29 18 22 45 43 16 33 16 22 Country 11,240 54 24 33 22 33 6,709 39 29 35 27 37 Table 8.10. Proportion everyday exercise >150 min/week and physical activity >60 min/week preoperatively and one year postoperatively in hip and knee replacement 2022. 2 5 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Proportion of hip and knee replacements for OA with a registration in the Osteoarthritis registry before the replacement per unit Total hip Knee Number % in OA Number % in OA Unit in SAR registry in SAR registry Akademiska sjukhuset 307 19.9 211 19.0 Aleris Malmö Arena 293 21.8 323 20.1 Aleris Specialistvård Nacka 1,172 26.3 1,246 23.0 Aleris Specialistvård Renmarkstorget, Umeå 44 22.7 Aleris Specialistvård Ängelholm 918 20.4 1,063 25.3 Alingsås 354 40.4 403 45.7 Art Clinic Göteborg 721 36.5 837 34.9 Art Clinic Jönköping 525 38.9 572 40.2 Arvika 581 27.0 583 34.3 Bollnäs 685 14.5 774 17.6 Borås 133 23.3 127 36.2 Capio Artro Clinic 1,318 23.4 1,735 23.1 Capio Movement 882 26.5 1,199 28.1 Capio Ortho Center Göteborg 518 29.2 610 26.1 Capio Ortho Center Stockholm 1,744 28.9 1,706 28.6 Capio Ortho och Spine Center Skåne 431 21.3 519 17..5 Capio Ortopedi Motala 874 43.0 1,108 43.1 Capio Ortopediska Huset 1,577 30.5 1,712 27.8 Capio S:t Göran 696 22.8 616 18.5 Capio Spine Center Göteborg 69 20.3 <20 Capio Sports Medicine Umeå AB <20 Carlanderska 792 36.1 816 37.0 Carlanderska-SportsMed 454 20.0 467 17.1 Danderyd 298 12.8 296 12.2 Eksjö 621 17.7 651 20.0 Enköping 1,012 19.3 1,038 19.3 Eskilstuna 92 21.7 91 20.9 Falun 294 51.7 375 49.3 Frölundaortopeden 26 19.2 40 27.5 Gällivare 113 23.1 74 5.4 Gävle 67 16.4 112 9.8 Halmstad 200 12.0 250 13.2 Helsingborg 72 5.6 499 19.2 Table continued on next page. 2 5 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Proportion of hip and knee replacements for OA with a registration in the Osteoarthritis registry before the replacement per unit, cont. Total hip Knee Number % in OA Number % in OA Unit in SAR registry in SAR registry Hermelinen 72 13.9 70 8.6 Hudiksvall 102 11.8 82 17.1 Hässleholm 1,289 17.2 1,645 23.0 Jönköping 332 20.2 Kalmar 148 35.8 151 29.8 Karlshamn 559 22.5 525 33.7 Karlskrona <20 Karlstad 48 20.8 38 36.8 Karolinska Huddinge 383 22.2 277 19.5 Karolinska Solna 30 23.3 54 16.7 Kristianstad <20 Kullbergska sjukhuset 781 26.4 765 26.7 Kungälv 181 27.6 246 36.2 Ledplastikcentrum Bromma 1,069 31.0 1,210 31.3 Lidköping 499 36.3 318 42.8 Lindesberg 853 24.6 768 27.3 Linköping 122 42.6 Ljungby 185 21.6 222 23.4 Lycksele 487 15.8 386 22.3 Mora 562 52.1 504 41.3 Norrköping 296 44.9 268 48.9 Norrtälje 294 4.8 364 24.2 Nyköping 258 17.4 203 1.7 NÄL <20 <20 Ortopediskt Center – Sophiahemmet 553 21.2 461 15.0 Oskarshamn 793 0.3 728 34.5 Piteå 753 8.5 715 12.4 Skellefteå 247 13.4 136 8.1 Skene 428 33.4 415 30.1 Skövde 80 45.0 68 51.5 Sollefteå 782 12.8 326 16.3 Specialistcenter S:t Johanniskliniken <20 232 22.8 Specialistcenter Scandinavia Malmö 244 16.8 283 28.6 Table continued on next page. 2 5 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Proportion of hip and knee replacements for OA with a registration in the Osteoarthritis registry before the replacement per unit, cont. Total hip Knee Number % in OA Number % in OA Unit in SAR registry in SAR registry Specialistcenter Scandinavia, Eskilstuna 331 23.6 284 31.3 Specialistläkarhuset i Sundsvall AB 31 12.9 SU/Mölndal 615 35.1 552 34.6 Sundsvall 41 7.3 67 20.9 SUS/Lund <20 <20 Södersjukhuset 217 25.3 244 22.5 Södertälje 202 16.8 270 17.0 Torsby 273 22.3 252 31.7 Trelleborg 502 16.7 720 19.3 Uddevalla 590 32.0 332 38.0 Umeå 67 13.4 <20 Varberg 296 11.5 214 14.0 Visby 228 25.0 163 37.4 Värnamo 310 12.3 416 16.8 Västervik 255 18.0 224 25.9 Västerås 710 38.7 507 42.0 Växjö 354 22.9 255 25.1 Ängelholm 399 12.5 Örnsköldsvik 285 14.7 411 19.5 Östersund 353 33.7 237 40.9 Country 36,462 25.5 36,737 27.0 Table 8.11. Proportion of total hip and knee replacements due to OA with a registration in the Swedish Osteoarthritis Registry before the replacement per unit 2022 and 2023. Units with fewer than 20 operations are excluded. 2 5 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Proportion of hip and knee replacements for OA with a registration in the Osteoarthritis registry before the replacement per region Total hip Knee Number % in OA Number % in OA Region in SAR registry in SAR registry Blekinge 597 22.9 556 33.1 Dalarna 1,547 48.1 1,455 45.8 Gotland 266 25.9 223 38.6 Gävleborg 1,142 15.1 1,179 16.6 Halland 1,225 13.3 1,491 14.8 Jämtland 649 30.8 641 33.9 Jönköping 1,469 17.7 1,141 19.5 Kalmar 1,076 28.3 1,041 31.9 Kronoberg 764 24.5 772 29.7 Norrbotten 1,181 9.5 1,101 11.3 Skåne 4,220 17.7 4,974 21.6 Stockholm 6,959 23.8 7,239 21.7 Sörmland 1,249 22.3 1,204 25.0 Uppsala 1,395 19.2 1,323 19.1 Värmland 1,111 29.2 1,013 33.7 Västerbotten 1,008 16.2 698 17.5 Västernorrland 1,232 13.7 888 17.7 Västmanland 1,122 39.8 1,021 42.3 Västra Götaland 5,546 355,0 5,362 37.6 Örebro 1,010 23.9 780 26.9 Östergötland 1,495 42.5 1,612 43.6 Country 36,462 25.5 36,737 27.0 Table 8.12. Proportion of total hip and knee replacements due to OA with a registration in the Swedish Osteoarthritis Registry before the replacement per region 2022 and 2023. 2 5 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Analyses for a deeper understanding of selected areas. 9. In-Depth Analyses 9.1. Custom made cups Author: Johan Kärrholm Patients with significant pelvic defects due to previ- The literature includes a relatively large number of ous implant failures or other reasons, such as tumors mainly retrospective studies with up to 50 cases, as well or pelvic fractures, present a surgical challenge when as meta-analyses often including other types of surgical prosthetic reconstruction becomes necessary. In the last solutions. The most common indication is pelvic disso- two decades, the use of custom-made cups has become ciation, though other less pronounced bone defects and increasingly common for these cases. By utilizing electron tumor cases also occur. After a follow-up period of two beam melting (EBM), metal particles are directed in a to five years, the revision rate for the cup is reported to be vacuum to build up an implant layer by layer, reflecting around five percent, while the overall revision rate may be the three-dimensional extent of the bone defect based on significantly higher. The most common reason for revision radiological mapping with computed tomography (CT). are dislocation and infection. In the current timeframe, The result is an implant that more or less accurately fills loosening has been cited as a cause for revision only in the created defect. Additionally, screw holes are placed to a few cases, though based on small materials. For pelvic provide optimal fixation in the remaining bone. Typically, dissociation, custom-made cups have been compared with a standard cup or a dual mobility cup is cemented into several other techniques, including uncemented cups with the metal shell. In rarer cases, a liner intended for one or without augmentation, reinforcement rings, trabecular of the standard cups available on the market has been metal cups combined with modified reinforcement rings used instead. (cup-cage), or using distraction techniques or simultane- ous plate fixation of the pelvis. 2 5 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 The first custom-made cup was reported to the Swedish of posterior approaches is higher, and the proportion with Arthroplasty Register in 2012. By 2017, the number of dual mobility cups is higher. In the study group, 16 out reports had increased to 29. Since then, the number has of 17 replacements were revised either due to infection or varied between five and 17 per year. Because the Swedish dislocation, and none due to loosening. One was revised Arthroplasty Register lacks information based on radio- due to fracture (“other reasons” in Table 9.1.1), and none graphic examinations, it is not possible to define a truly due to loosening. In the comparison group, the same pri- appropriate comparison group, especially since patients mary reasons for revision dominated, totaling 25 out of 34 with the most pronounced bone defects are likely selected cases. Loosening was the main reason in five of these cases. for surgery with a custom-made cup. The cumulative risk of revision did not differ between the groups (Log Rank test, all observations: p=0.98; observa- To provide a benchmark comparison group, we identified tions from 2017 onwards: p=0.57). a group using techniques involving uncemented cups with augmentation and/or some form of reinforcement ring. In summary, we find that the risk of revision is similar The majority of these cases are first-time revisions, while in both groups, possibly with a trend towards increased custom-made cups have been used equally often for both risk of revision due to loosening and a slightly lower risk primary and second-time revisions. Since custom-made of revision due to infection and dislocation in the com- cups have also been used in primary surgery, these cases parison group. Since we do not know the indication for are included in both groups. There are many manu- the surgeries performed, the extent of bone defects, and facturers of custom-made cups, but in Sweden, almost the groups also show differences in background factors, exclusively one (Materialize) has been used. Therefore, no definitive conclusions can be drawn. However, it only these implants are included in the study group. is of interest to describe these surgeries and the results Furthermore, the use of augmentation or reinforcement achieved, especially considering that patients undergoing rings was not detailed until 2017, after the reoperation these procedures often suffer from severe disability, where database was restructured the year before. Therefore, data surgical options to maintain walking function are highly for custom-made cups between 2017 and 2023 is reported limited. separately (in parentheses) in Table 9.1.1. Between 2012 and 2023, 150 custom-made cups were reported to the register (2017–2023: n=101). The corresponding number for the comparison group from 2017 to 2023 was 331. Of these, 275 had augments, 46 had a reinforcement ring, nine had been operated with two augments, and one hip had both two augments and a reinforcement ring. As shown in the table, there are differences in background factors between the groups. In the study group, for exam- ple, the proportion of primary prostheses is lower, the proportion of “other diagnoses” is higher, the proportion 2 6 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Demographics, approach, implant choices, and outcomes related to the type of surgery in primary total prosthesis or revision using a custom-made cup between 2012 and 2023, as well as between 2017 and 2023 for an uncemented cup with augment and/or reinforcement ring Type of implant Custom made cups 1, 2 Uncemented cup + augment a/o ring Number 150 (101) 331 Primary replacements, n (%) 12 (8) 81 (24,5) Follow-up year, mean, (95% CI) 3.6 (3.2-4.1) (2.6 (2.2-3.1)) 2.3 (3 2.1-2.5) Age, mean (95% CI) 67.0 (64.8-69.6) (68.2( 65.8-70.7)) 71.3 (70.1-72.5) Females % 63.3 (65.3) 57.4 Diagnosis, n (%) OA 66 (44.0) (47 (46.5)) 208 (62.8) Fracture/Trauma3 12 (8.0) (5 (5.0)) 14 (4.2) Tumor 5 (3.3) (1 (1.0)) 2 (0.8) Other diagnosis 4 67 (44.7) (48 (47.5)) 107 (32.3) ASA-class, n (%) ASA I-II 75 (50.0) (58 (57.5)) 206 (62.2) ASA III-V 70 (46.7) (42 (41.6)) 123 (37.2) Missing 7 (3.3) (1 (1.0)) 2 (0.6) BMI Mean (95% CI) 25.6 (24.8-26.3) (25.4 (24.4-26.4)) 26.9 (26.4-27.4) Missing, n (%) 3 (2.0) (1 (1.0)) 4 (1.2) Approach, n (%) Posterior 108 (72.0) (72 (71.3)) 186 (56.2) Direct lateralt lateral- or supine position 21 (14.0) (21 (20.8)) 137 (41.4) Other 11 (7.3) (-) 3 (0.9) Missing, n (%) 10 (6.7) (4 (4.0)) 5 (1.5) Bone graft/bone substitute, n (%) 85 (56.6) (56 (55.5)) 176 (53.2) Type of cup, the five most used, n (%) Materialize 150 (100) (101 (100)) - TMT revision - 105 (31.7) Continuum - 86 (26.0) Tritanium revision - 45 (13.6) Pinnacle W/Gription - 36 (10.9) Other - 59 (17.8) Table continued on next page. 2 6 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Demographics, approach, implant choices, and outcomes related to the type of surgery in primary total prosthesis or revision using a custom-made cup between 2012 and 2023, as well as between 2017 and 2023 for an uncemented cup with augment and/or reinforcement ring, cont. Type of implant Custom made cups 1, 2 Uncemented cup + augment a/o ring Type of inlay, n (%) Cup fixed with cement 143 (95.3) (96 (95.0)) 61 (18.4) Liner fixed without or with cement 3 (2.0) (1 (1.0)) 260 (78.5) Missing 4 (2.7) (4( 4.0)) 10 (3.0) DM cup/inlay, n (%)5 54 (36.0) (39 (38.6)) 77 (23.2) Reason for revision/re-revision, n (%) All reasons 17 (11.3) (13 (12.9)) 34 (10.3) Loosening - (-) 5 (1.5) Infection 8 (5.3) (6 (5.9)) 14 (4.2) Dislocation 8 (5.3) (7 (6.9)) 11 (3.3) Other 1 (0.7) 3 (0.9) Missing - (-) 1 (0.3) Procedure in revision/re-revision, n (%) Exchange of cup/liner ± exchange of anoth- 5 (3.3) (4 (4.0)) 9 (2.7) er part Complete extraction 2 (2.3) (2 (2.0)) 3 (0.9) Other procedures 10 (6.6) (8 (8.0)) 21 (6.3) Missing - 1 (0.3) All observations 150 332 CRR revision 5 year6 (95% CI) 12.3 (6.6-18.8) 11.8 (8.8-15.8) Observations 2017-2023 101 331 CRR revision (95% CI). 7 12.6 (5.8-19.4) 11.0 (7.2-14.8) Table 9.1.1. Demographics, approach, implant choices, and results related to the type of surgery at the insertion of a primary total hip replacement or revision using a custom-made cup between 2012 and 2023, and between 2017 to 2023 for an uncemented cup with augment and/or reinforcement ring. 1) all manufactured by Materialize. 2) hips operated 2017–2023 in brackets 3) including sequele after trauma . 4) diagnosis is missing for five and nine cases respectively in the respective groups 5) All variants of dual mobility joints, 3 and 28 had missing observations in each group (all observations). 6) 70 and 81 observations respectively left at five years. 7) 50 and 137 observations respectively left at fouryears. 2 6 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 9.1.1. Annual distribution of custom-made cups Figure 9.1.2. Distribution of primary surgeries (0), first (1), and and uncemented cups combined with augment and/or multiple revisions (2-8) for custom-made cups and uncemented reinforcement ring. cups combined with augment and/or reinforcement ring. © 2024 The Swedish Arthroplasty Register Figure 9.1.3. Cumulative risk of revision for custom-made cups (yellow line) and uncemented cups with augment and/or reinforce- ment ring (blue line). Only implants inserted between 2017 and 2023 are included. 2 6 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 9.2 SPII stem 130 or 150 mm? Author: Johan Kärrholm The SPII stem with a 130 mm length was introduced stem. This in-depth analysis aims to investigate whether to the market in 1995. It has been represented in the this difference could be due to variations in patient Swedish Arthroplasty Register since 1999, the first year demographics, choice of cup, joint surface, stem size, or stem length was recorded. Until 2013, the number of surgical technique, based on data reported to the Swedish reported cases was low, ranging from 0 to 19 per year. Arthroplasty Register. Although register data can never After that, the number increased, and by 2022, 7.9% of provide definitive conclusions, in-depth analysis can shed all SPII implants were either 130 or 150 mm in length. more light on the results. The following year, the proportion dropped to 6.4% (Figure 9.2.1). According to the manufacturer, the short To ensure a fair evaluation and avoid cases with missing stem represented 23% of all SPII stems produced and sold data, 104 short stems and 3,745 standard stems have been in 2022. Most were sold in Germany, the Netherlands, excluded (Figure 9.2.2). The analysis focuses on 4,191 Sweden, and the United Kingdom. In Sweden, nine units 130 mm stems and 60,752 150 mm stems (Table 9.2.1). reported at least 50 inserted 130 mm stems from 2014 to After selection, several more or less pronounced differ- 2023, accounting for 94% of the total number. All units ences remain between the groups. The follow-up time is using the 130 mm stem also used the 150 mm stem, slightly shorter in the short stem group, the proportion of with seven out of nine using the latter more frequently. females is higher, and the proportion with trauma diagno- An additional 26 units have used the 130 mm stem more sis is lower, while the proportion with “other diagnoses” is sporadically, with numbers ranging between 1 and 47 higher. Regarding other implant choices, the short stem during the period from 2014 to 2023. is used more often with older types of polyethylene in the cup, more frequently with a 36 mm head, more often Previous annual reports have shown that the short SPII with a metal head, and the two smallest stem sizes are stem experiences more revisions compared to the 150 mm used more frequently. © 2024 The Swedish Arthroplasty Register Figure 9.2.1. Distribution between 130 mm and 150 mm SP II stems reported to the Swedish Arthro- plasty Register from 2014 to 2023. Throughout the period, the short stem accounted for 6.5% (bars on the right). 2 6 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  Primary 130 and 150 mm SPII stems inserted 1999-2023, 130/150 mm. n=4,396/151,339 Stems inserted 1999 – 2013. n=100/86,842. Primary 130 and 150 mm SPII stems inserted 2014-2023. n=4,296/64,497 Operations where information on diagnosis, ASA, BMI, approach, type of cup, head size, or head material is missing. n=95/3,500 Primary 130 and 150 mm SPII stems with complete data. n=4,201/60,997 Tumor diagnosis or other cup diameter than 28, 32 or 36 mm when using standard cup. n=9/245 Primary 130 and 150 mm SPII included in the analysis. n=4,191/60,752 Primary SPII stem 130 mm. Primary SPII stem 150 mm. n=4 191 n=60 752 Figure 9.2.2. Flow-chart showing the number of primary SPII stems included in the analysis and reason for exclusion. Loosening, infection, and dislocation, in that order, are Evaluation in a regression analysis, adjusting for factors the most common reasons for revision in both groups. listed in the footnotes of Table 9.2.1, shows that the risk The short stem is revised slightly more often than the of revision is increased by about 60% for the short stem standard stem due to loosening (0.5% of cases compared when stem revision regardless of reason is the outcome. to 0.3%). The cumulative risk of revision has been calcu- Excluding cases with dual mobility cups and including lated up to 9 years, with 67 cases remaining in the smaller only standard cups leaves the outcome largely unchanged. group (130 mm stem). Whether considering all types of For stem revision due to non-infectious reasons, the risk revision (Figure 9.2.3) or only stem revision regardless ratio increases to 2.0 (100%) before and 2.2 (120%) of reason, the risk of revision is greater with the short after adjustment. Again, only a marginal change occurs if stem (p=0.001 and 0.023, Log Rank test). If infection-re- operations with dual mobility cups are excluded. In both lated revisions are excluded from the latter outcome, the analyses, stem revisions where the reason is unspecified difference remains (p<0.001), although the number of (standard stem only) are classified as non-infectious. revisions in the short stem group is limited in this analysis (29 short, 243 standard stems revised, Figure 9.2.4). 2 6 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 9.2.3. Cumulative risk of revision with all outcomes and all Figure 9.2.4. Cumulative risk of revision with stem revision for reason for surgeries with 130 mm or 150 mm SP II stems included all reasons excluding infection for surgeries with 130 mm or in the analysis according to figure 9.2.2. After nine years, 67 stems 150 mm SP II stems included in the analysis according to figure of 130 mm and 4,098 stems of 150 mm remain. 9.2.2. After nine years, 67 stems of 130 mm and 4,098 stems of 150 mm remain. Summary Over the past decade, the short SPII stem has shown However, it remains to be evaluated whether outcomes a higher risk of revision compared to the 150 mm after stem revision differ based on which of these two stem, primarily due to an increased incidence of revi- stems was used in the primary surgery. sions related to loosening. Our data suggest that when choosing between a short and a standard stem, the latter This analysis should be interpreted with the under- should be preferred, especially if the risk of loosening is standing that the short SPII stem has been used more considered high. frequently by a relatively small number of units and less frequently by many others, and that some background Theoretically, a short stem might be preferable over a lon- factors remain unknown. ger one in the event of a potential revision due to a lower risk of perioperative and postoperative complications. 2 6 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Demographics, approach, implant choices, and results related to stem length (130 or 150 mm) in primary total hip replacement 2014–2023 Stem length 130 mm Stem length 150 mm Number 4,191 60,752 Follow-up year, mean, (95% CI) 3.8 (3.8-3.9) 4.4 (4.4-4.4) Age, mean (95% CI) 74.2 (74.0-74.5) 74.0 (74.0-74.0) Females, n (%) 2,980 (71.1) 37,864 (62.3) Diagnosis, n (%) OA 3,282 (78.3) 47,242 (77.8) Fracture/Trauma1 612 (14.6) 10,528 (17.3) Other diagnosis 297 (7.1) 2,982 (4.9) ASA-class, n (%) ASA I-II 3,102 (74.0) 43,933 (72.3) ASA III-V 1,089 (26.0) 16,819 (27.7) BMI, mean (95% CI) 26.9 (26.8-27.1) 26.7 (26.7-26.8) Approach, n (%) Posterior 2,399 (57.2) 35,451 858.4) Direct lateralt lateral- or supine position 1,699 (40.5) 24,836 (40.9) Other 93 (2.2) 465 80.8) Type of cup, n (%) Cementented 4,010 (95.7) 58,131 (95.7) Articulation, n (%) Older types of polyethylene 880 (21.0) 9,543 (15.7) Highly cross-linked polyethylene 2,932 (70.0) 46,619 (76.7) DM cup 374 (8.9) 4,523 (7.4) Other, missing 5 (0.1) 67 (0.1) Most common cup, n (%) Lubinus x-link 2,737 (65.3) 39,458 864.9) Lubinus older type of polyethylene 879 (21.0) 9,439 (15.5) Avantage 205 (4.9) 3,066 (5.0) Other 370 (8.8) 8,789 (14.5) Femoral head size, n (%) 2 28 mm 151 (4.0) 2,584 (4.6) 32 mm 3 234 (84.7) 51,128 (90.9) 36 mm 432 (11.3) 2,517 (4.2) Femoral head material, n (%) 3 Metal 3,526 (84.1) (3,259 (85.4)) 48,826 (80.4) (44,493 (79.1)) Ceramics 665 (15.9) (558 (14.6)) 11,926 (19.6) (11,736 (20.9)) Table continued on next page. 2 6 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Demographics, approach, implant choices, and results related to stem length (130 or 150 mm) in primary total hip replacement 2014-2023, cont. Stem length 130 mm Stem length 150 mm Stem size, n (%) 01 114 (2.7) 1,326 (2.2) 1 1,552 (37.0) 16,869 (27.8) Other sizes 2,525 (60.2) 42,557 (70.1) Revision, all reasons and procedures, n (%) 118 (2.8) 1,332 (2.2) Reason for stem revision, n (%) All reasons 35 (0.8) 383 (0.6) Loosening 21 (0.5) 170 (0.3) Infection 6 (0.1) 143 (0.2) Dislocation 3 (0.1) 40 (0.1) Other reasons 5 (0.1) 25 (0.0) Missing - 5 (0.0) Cumulative risk of revision at 9 years (95% CI)4 All reasons and procedures 4.4 (3.3-5.5) 3.2 (3.0-3.5) Stem revision all reasons 1.6 (1.0-2.2) 1.3 (1.1-1.5) Stem revision for non-infectious reasons only 1.2 (0.7-1.7) 0.9 (0.7-1.1) Outcome stem revision all reasons Risk ratio all observations, (95% CI) Unadjusted 1.5 (1.1 – 2.1). p=0.02 1 Adjusted 5 1.6 (1.1-2.3). p=0.007 1 Risk ratio standard cup only, (95% CI) Unadjusted 1.5 (1.03-2.1). p=0.04 1 Adjusted6 1.6 1.1-2.2). p=0.02 1 Outcome stem revision, not infection Risk ratio all observations, (95% CI) Unadjusted 2.0 (1.4-3.0). p<0.001 1 Adjusted 5 2.2 (1.5-3.2). p<0.001 Risk ratio standard cup only, (95% CI) Unadjusted 2.1 (1.4-3.0). p<0.001 1 Adjusted6 2.2 (1.5-3.3). p<0.001 1 Table 9.2.1. Demographics, approach, implant choices, and results related to stem length (130 or 150 mm) at the insertion of a primary total replacement from 2014 to 2023. Excluded observations and reasons for exclusion are indicated in figure 9.2.2. 1) Including sequele after trauma. 2) Only standard cups. 3) Data for standard cup in parentheses. 4) Number of observations at nine years: 67 in the short stem group and 4,098 in the standard stem group. 5) Adjusted for age, sex, ASA, diagnosis, type of bearing (highly cross-linked polyethylene, older polyethylene, DM cup), and stem size. Operations with missing information on the bearing surface are excluded. 6) Adjusted for age, sex, ASA, diagnosis, type of bearing (highly cross-linked polyethylene, older polyethylene), head size and material, and stem size. Operations with missing information on the bearing surface are excluded. 2 6 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 9.3 Choice of fixation related to age Author: Johan Kärrholm Despite Sweden’s higher proportion of cemented pros- pandemic years. The later introduction of highly cross- theses compared to most other countries, the use of linked polyethylene for cemented cups means that the completely uncemented fixation has gradually increased relative proportion of these implants (fully cemented and over the past two decades. In 2023, 45.5% of all reported reverse hybrid prostheses) was relatively low in the early primary cups were fixed without cement, and the cor- years (Figure 9.3.2b). responding proportion for stems was 41.2%. Previous reports have shown that cemented fixation generally The analysis is based on five age groups, with the youngest results in fewer revisions over a medium-term period for group chosen to ensure sufficient observations in each patients aged 65 and older. This also applies to the group prosthesis group. Table 9.3.2 highlights the age groups under 65, considered as a homogeneous group, provided used in the statistical analysis. For the youngest and oldest all reasons of revision, including infection, are included groups, subgroups are also shown for increased transpar- as outcome parameters. The group younger than 65 years ency. In the youngest group under 55 years, most patients includes a wide age range, with a relatively large number are between 45 and 54 years. Patients aged 44 and younger of operations for patients aged 50 to 64 and fewer for have primarily been operated with uncemented fixation those younger. Most patients under 50 are operated with (n=3,285) or reverse hybrid (n=428). In the cemented completely uncemented prostheses, which complicates or and hybrid groups, there are about 100 cases per group. prevents a fair comparison between cemented and unce- In the oldest group, aged 85 and older, the vast majority mented fixation among the youngest patients. have been operated with cemented prostheses (n=6,246), followed by hybrid prostheses (n=532). Fully uncemented This year’s in-depth analysis does not focus on individual or reverse hybrid fixation has been used in fewer than components but instead examines the choice of prosthesis 100 cases. fixation based on the prosthesis type, i.e., whether the patient receives a fully cemented, fully uncemented, The analysis of combined groups (all ages) shows that hybrid, or reverse hybrid prosthesis. Clinically, fixation uncemented prostheses are predominantly used for males, choice is made for each component, and for the patient, and these patients, as well as those receiving hybrid pros- it may be less significant, though not indifferent, which theses, are somewhat more likely to have osteoarthritis components are revised. This year’s analysis considers with known reason. There are also differences between revision regardless of intervention and reason, although groups regarding incision choice, head size, and head we know that the prognosis for further revisions varies material (Table 9.3.3). Overall, the revision rate is highest depending on the reason for the initial revision. The aim among uncemented and reverse hybrid prostheses. The is to make the evaluation as clinically relevant as possible reason for revision varies, with a higher proportion of from the patient’s perspective. revisions due to loosening in the uncemented and reverse hybrid fixation groups. Revision due to infection is most To minimize confounding factors and ensure relevance, common in the uncemented group, and periprosthetic only operations using metal–polyethylene or ceramic– fracture is most common in the reverse hybrid group. polyethylene articulations, standard cups with highly Assessing the performed intervention is more complex, as cross-linked polyethylene, heads with diameters of 28, liner exchange is only relevant for uncemented fixation. 32, or 36 mm, and patients operated with posterior or However, the proportion of cup and/or stem exchanges direct lateral incisions are included. Furthermore, only is higher in the uncemented and reverse hybrid fixation operational years with at least 20 surgeries reported for groups, with isolated cup or stem exchanges more fre- the smallest fixation group (fully cemented, uncemented, quent in the reverse hybrid fixation group. hybrid, or reverse hybrid) and implant types reported in at least 475 surgeries during the period (2006 to 2023) In the total dataset, including all ages, the cumulative risk are included. Figure 9.3.2a shows that the number of of revision is lowest in the cemented and hybrid groups replacements meeting the inclusion criteria has gradually (Figure 9.3.3). After 10 years, the risk tends to increase in increased since 2006, with a temporary decline during the all groups, and after approximately 13 years, the situation 2 6 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  Flow-chart cemented cup Primary total hip replacements inserted 1999-2023. n=391,289 Resurfacing prostheses or surgeries with dual mobility articulation. n= 12,924. Primary total hip replacements of standard type. n=378,365 Operations with a bearing surface type on the cup other than highly cross-linked polyethylene, and head with a diameter other than 28, 32, or 36 mm. n=169,351 Primary total hip replacements with ceramic or metal head 28, 32 or 36 mm diameter. n=209,014 Trauma, sequele trauma or tumor diagnosis, other approaches than posterior or direct lateral. n=20,213 Primary total hip replacements due to primary or different types of secondary OA with posterior or direct lateral approach. n=188,801 Implants used in <450 or not been used the past five years (2019-2023). n=7,431 Primary total hip replacements with at last 450 observations of the same implant type that also has been used in the past five years. n=181,370 Years with <10 of the selected implants that occurred in either a fully cemented, fully uncemented, hybrid, or reverse hybrid prosthesis (for the years 1999-2005). n=630 Primary fully cemented, fully uncemented, hybrid, or reverse hybrid prostheses inserted 2006-2023. n=180,740* Fully cemented. Fully uncemented. Hybrid prostheses. Reverse hybrid n=94,408 n=56,118 n=11,320 prostheses. n=18,894 Figure 9.3.1. The flowchart shows the selection of fully cemented, fully uncemented, hybrid, and reverse hybrid prostheses included in the analysis. See Table 9.3.1 for selected implants. 2 7 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 9.3.2 a-b. Number (a) and relative distribution (b) of cemented, uncemented, hybrid, and reverse hybrid prostheses included in the analysis. becomes difficult to assess, likely due to a decreasing num- ber of observations. Evaluation in a regression analysis shows that the risk of revision is lowest for the cemented group and increases progressively with the use of hybrid, reverse hybrid, and uncemented prostheses. In the age groups ranging from 55 to 84 years (Table 9.3.4), the risk of revision remains elevated with the use of uncemented and reverse hybrid fixation compared to fully cemented fixation. In the youngest group under 55 years, there is no statistically significant difference between the replace- © 2024 The Swedish Arthroplasty Register ment groups. In the oldest group, 85 years and older, the number of observations is too few to analyze uncemented and reverse hybrid fixation. Hybrid prostheses present a more complex picture, with a tendency towards increased or comparable risk of revi- sion in the age groups between 55 and 84 years. In the oldest group, the risk is significantly lower compared to fully cemented fixation. However, the number of hybrid prostheses inserted in patients aged 85 years and older is Figure 9.3.3. Cumulative risk of revision related to the choice of limited to 532. fixation. After 16 years, 266, 1,096, 93, and 105 remain in the respective groups of cemented, uncemented, hybrid, and reverse hybrid prostheses. 2 7 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Implants included in the analysis of fixation Type of cup Number Type of stem Number Cemented cup Cemented stem Lubinus x-link 50,236 SPII 130 or 150 mm 50,496 Exeter Rim-fit 26,627 Exeter standard 125, 150 mm# 34,495 Marathon 17,751 MS-30 polished 20,154 ZCA XLPE 13,846 CPT 130 mm 573 IP cup 2,572 Exceed ABT without flange (E-poly) 2,263 Uncemented cup Uncemented stem Pinnacle Gription, all variations 20,077 Corail (standard*, coxa vara, high offset) 38,881 Trident, all variations 11,951 CLS 11,132 Trilogy ± HA 8,546 Accolade (Straight eller typ II) 7,559 Pinnacle porocoat, all variations 8,029 Bi-Metric X por HA NC 6,569 Continuum 5,507 M/L Taper 5,345 G7 PPS 3,082 Echo Bi-Metric, FPP eller RPP 2,008 Trilogy IT 2,231 ABG II HA 1,839 Allofit 1,787 Wagner Cone 1,689 Exceed ABT (Ringlock eller Taper-Fit) 1,720 Tritanium, all variations 1,173 Trident II 1,124 TMT, modular or revision 904 Regenerex 836 Delta, TT or Delta-One TT 478 Table 9.3.1. Implants used in 180,740 primary hip replacements (94,408 fully cemented, 56,118 fully uncemented, 11,320 hybrid and 18,894 reverse hybrid prostheses) included in the fixation analysis. 2 7 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Age distribution for the hip replacements included in the fixation analysis Age Cemented, number (%) Uncemented, number (%) Hybrid, number (%) Reverse hybrid, number (%) 0–24 years 6 (3.6) 146 (86.9) 3 (1.8) 13 (7.7) 25–34 years 19 (2.8) 588 8(6.2) 19 (2.8) 56 (8.2) 35–44 years 85 (2.8) 2,551 (83.1) 74 (2.4) 359 (11.7) 45–54 years 879 (5.1) 13,001 (75.4) 524 (3.0) 2,847 (16.5) <55 years 989 (4.7) 16,286 (76.9) 620 (2.9) 3,275 (15.5) 55–64 years 10,118 (23.7) 23,597 (55.2) 2,030 84.8) 6,984 (16.3) 65–74 years 40,077 (61.7) 13,755 (21.2) 4,581 (7.1) 6,556 (10.1) 75–84 years 36,978 (82.3) 2,414 (5.4) 3,557 (7.9) 1,989 (4.4) 85– years 6,246 (90.1) 65 (0.9) 532 (7.7) 90 (1.3) 85–94 years 6,189 (90.1) 65 (0.9) 526 (7.7) 90 (1.3) ≥ 95 years 57 (90.5) 0 (0.0) 6 (9.5) 0 (0.0) Table 9.3.2. Age distribution for the hip replacement included in the fixation analysis. Bold font indicates the groups used in the statistical analysis. Additionally, a more detailed breakdown is provided for the youngest and oldest age groups. Approximately 100 operations with fully cemented or hybrid prostheses were performed during the period in patients younger than 45 years, following exclusion as per figure 9.3.1, and fewer than 100 uncemented or reverse hybrid prostheses in patients aged 85 years and older. Percentages refer to the distribution of fixation methods within the specified age group. 2 7 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Demographics, approach, reason and procedure in case of revision, and results. All age groups have been included. Cemented Uncemented Hybrid Reverse hybrid Number 94,408 56,118 11,320 18,894 Follow-up, mean (95% CI) 5.8 (5.8-5.8) 5.8 (5.8-5.8) 4.5 (4.4-4.6) 7.1 (7.1-7.2) Age mean (95% CI)1 74.2 (74.0-74.5) 74.0 (74.0-74.0) 74.2 (74.0-74.5) 74.0 (74.0-74.0) Sex, females, n (%) 61,092 (64.7) 24,039 (42.8) 7,183 (63.5) 10,179 (53.9) Diagnosis, primary OA, n (%) 89,291 (94.6) 50,223 (89.5) 9,920 (87.6) 17,695 (93.7) ASA-class, n (%) ASA I-II 73,053 (77.4) 48,717 (86.8) 8,785 (77.6) 16,506 (87.4) ASA III-V 19,599 (20.8) 5,338 (9.5) 2,193 (19.4) 2,001 (10.6) Missing 1,756 (1.9) 2,063 (3.7) 342 (3.0) 387 (2.0) BMI, mean, (95% CI) 27.0 (27.0-27.0) 28.0 (27.9-28.0) 27.0 (26.9-27.1) 27.5 (27.5-27.6) Missing, n % 2,400 (2.5) 2,417 (4.3) 386 (3.4) 505 (2.7) Approach, n (%) Posterior 49,712 (52.7) 33,648 (60.0) 8,388 (74.1) 9,103 (48.2) Direct lateral lateral 44,696 (47.3) 22,470 (40.0) 2,932 (25.9) 9,791 (51.8) or supine position Caput size, n (%)2 28 8,580 (9.1) 4,102 (7.3) 322 (2.8) 4,473 (23.7) 32 80,043 (84.8) 42,194 (75.2) 6,133 (54.2) 13,795 (73.0) 36 5,785 (6.1) 9,822 (17.5) 4,865 (43.0) 626 (3.3) Caputmaterial, n (%)3 Metal 81,638(86.5) 37,044 (66.0) 10,631 (93.9) 14,073 (74.5) Ceramic 12,770 (13.5) 19,074 (34.0) 699 (6.1) 4,821 (25.5) Revision, all reasons and 118 (2.8) 1,332 (2.2) 118 (2.8) 1,332 (2.2) procedures, n (%) Reason for stem revision, n (%)3 All reasons 2,065 (2.2) 1,952 (3.5) 249 (2.2) 625 (3.3) Loosening 367 (0.4) 322 80.6) 33 (0.3) 208 (1.1) Infection 988 (1.0) 840 (1.5) 117 (1.0) 162 (0.9) Dislocation 357 (0.4) 402 (0.7) 49 (0.4) 69 (0.4) Periprosthetic fracture 257 (0.3) 231 (0.4) 38 (0.3) 145 (0.8) Other reasons 67(0.1) 127(0.2) 4(0.0) 30(0.2) Missing 29 (0.0) 30 (0.1) 8 (0.1) 11 (0.1) Table continued on next page. 2 7 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Demographics, approach, reason and procedure in case of revision, and results, cont. All age groups have been included. Cemented Uncemented Hybrid Reverse hybrid Procedure at revision, n (%)3 Exchange caput 839 (0.9) 839 (0.9) 839 (0.9) 839 (0.9) Exchange caput a/o liner 0 (0.0) 524 (0.9) 23 (0.2) 0 (0.0) Exchange cup 424 (0.4) 288 (0.5) 32 (0.3) 187 (1.0) Exchange cup+stem 293 (0.3) 273 (0.5) 21 (0.2) 72 (0.4) Exchange stem +/-liner 332 (0.4) 512 (0.9) 59 (0.5) 211 (1.1) Partial/total extraction 161 (0.2) 198 (0.4) 28 (0.2) 40 (0.2) Missing 12 (0.09 10 (0.0) 3 (0.2) 1 (0.0) Cumulative risk of revision at 16 years (95% CI)4 All reasons and procedures 4.6 (3.8-5.4) 6.5 (6.0-7.0) 4.5 (3.4-5.6) 7.3 (5.4-9.2) Outcome all reasons Risk ratio all observations, (95% CI) Crude 1 1.6 (1.5-1.7). p<0.001 1.1 (1.0-1.3). p=0.05 1.3 (1.2-1.4). p<0.001 Adjusted5 1 1.6 (1.5-1.7). p<0.001 1.2 (1.1-1.4). p=0.005 1.4 (1.2-1.5). p<0.001 Adjusted 6 1 1.6 (1.5-1.8). p<0.001 1.2 (1.1-1.49. p=0.006 1.4 (1.2-1.5). p<0.001 Table 9.3.3. Demographics, approach, reason, and procedure of any revision, along with the outcomes. All age groups are included. 1) See table 9.3.2 for the number of observations within each age group. 2) See figure 9.3.1 for inclusion and exclusion criteria. 3) The sum of percentage values may deviate from the total percentage due to rounding effects. 4) Number of observations at 16 years: 266 cemented, 1,096 uncemented, 93 hybrid prostheses and 105 reverse hybrid prostheses. 5) Adjusted for age, sex, diagnosis, choice of incision, head size, and head material. 6) Adjusted for age, sex, diagnosis, choice of incision, head size, head material, ASA-class, and BMI (174,162 observations). Cumulative risk of revision and risk ratio for revision regardless of reason divided in five age groups Cemented Uncemented Hybrid Reverse hybrid Age group < 55 years, n 989 16,286 620 3,275 Observations at 12 years, n 133 2,312 80 508 Cumulative risk of revision 4.4 (2.8-6.0) 5.1 (4.6-5.6) 7.3 (4.8-10.8) 4.0 (3.2-4.8) at 12 years, (95% CI) Risk of revision, all reasons, (95% CI) 0–4 years1 Unadjusted 1 1.4(0.9-2.3). p<0.1 1.4 (0.8-2.7). p=0.3 1.0 (0.6-1.7). p<0.9 Adjusted2 1 1.4(0.9-2.2). p<0.1 1.5 (0.8-2.8). p=0.2 1.0 (0.6-1.7). p=1.0 > 4 years 1 Unadjusted 1 0.8 (0.5-1.5). p<0.5 1.4 (0.8-2.7). p=0.3 1.0 (0.6-1.7). p<0.9 Adjusted2 1 0.8 (0.5-1.5). p<0.5 1.6 (0.7-3.8). p=0.3 0.8 (0.4-1.5). p=0.5 Table continued on next page. 2 7 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Cumulative risk of revision and risk ratio for revision regardless of reason divided in five age groups, cont. Cemented Uncemented Hybrid Reverse hybrid Age group 55-64 years, n 10,118 23,597 2,030 6,984 Observations at 14 years, n 435 1,496 88 328 Cumulative risk of revision 4.2 (3.4-5.0) 5.8 (5.2-6.6) 3.8 (2.7-4.9) 6.2 (4.8-6.6) at 14 years, (95% CI) Risk of revision, all reasons, (95% CI)5 Unadjusted 1 1.6(1.4-1.9). p<0.001 1.4 (1.0-1.9). p=0.03 1.3 (1.1-1.6). p<0.005 Adjusted2 1 1.6(1.3-1.8). p<0.001 1.4 (1.0-1.8). p=0.05 1.3 (1.1-1.6). p=0.008 Age group 65-74 years, n 40,077 13,755 4,581 6,556 Observations at 13 years, n 1,788 667 105 497 Cumulative risk of revision 3.4 (3.1-3.7) 5.2 (4.5-5.9) 5.4 (2.8-8.0) 6.3 (5.1-7.5) at 13 years, (95% CI) Risk of revision, (95% CI) Unadjusted 1 1.6(1.4-1.9). p<0.001 0.9 (0.8-1.2). p=0.6 1.4 (1.2-1.6) p<0.001 Adjusted2 1 1.6(1.4-1.8). p<0.001 1.1 (0.9-1.4). p=0.5 1.4 (1.2-1.7). p<0.001 Age group 75-84 years, n 36,978 2,415 3,557 1,989 Observations at 11 years, n 2,622 154 82 234 Cumulative risk of revision 3.1 (2.8-3.4) 5.8 (3.8-7.8) 3.4 82.2-4.6) 4.4 (3.0-5.8) at 11 years, (95% CI) Risk of revision, (95% CI) Unadjusted 1 1.8(1.4-2.2). p<0.001 1.2 .(1.0-1.6). p=0.07 1.4 (1.1-1.8). p=0.006 Adjusted2 1 1.6(1.3-2.0). p<0.001 1.3 (1.0-1.6). p=0.05 1.4 (1.1-1.8). p<0.01 Age group ≥ 85 years, n 6,246 65 532 90 Observations at 6 years, n 1,860 23 94 39 Cumulative risk of revision 2.6 (2.1-3.1) 3 0.7 (0.0-1.9) 3 at 6 years, (95% CI) Risk of revision 0-6 years, (95% CI) Unadjusted 1 3 0.3 (0.1-0.8). p=0.02 3 Adjusted2 1 3 0.2 (0.1-0.7). p=0.01 3 Table 9.3.4: Relative risk of revision, regardless of reason or procedure, divided into five age groups. Cumulative risk of revision is calculated until at least 80 observations remain in the smallest group. Cumulative revision risk and risk ratio for revision, regardless of reason or procedure, are presented with 95% confidence intervals (CI). 1) Divided into two intervals to maintain conditions for evaluation using Cox regression. 2) Adjusted for age, sex, diagnosis, incision, head size, and head material. 3) Not calculated due to a small number of observations. 2 7 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register © 2024 The Swedish Arthroplasty Register Figure 9.3.4 a-e. Cumulative risk of revision related to the choice of fixation in the age groups younger than 55 years (a), 55-64 years (b), 65-74 years (c), 75-84 years (d), and 85 years and older (e, see next page). Observation period and the number of observations at the start and end of each period are specified in Table 9.3.4. 2 7 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  Summary Cemented fixation is an excellent choice, provided that these prostheses are used in the ways that have been standard in Sweden over the past two decades. Hybrid prostheses yield largely similar results but offer no added value, except possibly for our very oldest patients. © 2024 The Swedish Arthroplasty Register For the youngest patient group, this analysis does not provide specific guidelines, especially for patients under 45 years of age, as these patients are few in number and the vast majority are operated on with fully uncemented fixation. The relatively low cumulative risk of revision in this group, with no tendency to increase after 10 years in three of the groups, is particularly advantageous for fully uncemented and reverse hybrid fixation, given that results in these two groups are based on a large Figure 9.3.4 e. Cumulative risk of revision related to the choice of number of observations. fixation in the age group 85 years and older. The analysis has several limitations, including that it is only applicable to the implant choices and surgical environment relevant in Sweden, and that the observation period extends only 11–16 years after surgery. 2 7 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Swedish Arthroplasty Register and clinical research Author: Ola Rolfson The government, together with the Swedish Association mid-1970s. The total number of scientific publications of Local Authorities and Regions, has entered into an from the registers amounts to nearly 500, and in 2023 agreement to finance Swedish national quality registers. alone, 17 articles were published using data from the The vision is that these registers will become an integrated Swedish Arthroplasty Register. We will continue to work part of a national system for collective knowledge man- strategically to maintain the research infrastructure to agement and for monitoring Swedish healthcare. The uphold high research activity. It is particularly gratifying registers aim to contribute to learning and improvement, that the PhD candidates currently working on their theses quality development, saving lives, achieving equitable using data from the Swedish Arthroplasty Register repre- health, research, resource-efficient healthcare and social sent six Swedish universities (Uppsala University, Lund care, and improvement work among healthcare providers, University, University of Gothenburg, Umeå University, as well as serving as a source for clinical research, includ- Linköping University, Karolinska Institute, and Örebro ing collaborations with the life science sector. Apart from University). financing costs for managing the registries, the allocations from the Swedish Association of Local Authorities and Regions and the government go to the two first missions. Theses Defended in 2023 The idea is that register-based research should be financed In 2023, three theses based partly on data from the Swed- through other means. ish Arthroplasty Register were defended: • On femoral neck fractures in the elderly by Johan What is Research and What is Activity Lagergren, 2023-11-24 Evaluation? • Hip and Knee Osteoarthritis: Who Are the Patients The line between what should be considered clinical Referred to First-Line Intervention and What Happens research and activity evaluation or improvement work is to Them? by Kristin Gustafsson, 2023-09-22 unclear. All register analyses aimed at providing feedback to improve activities are based on scientific methods. • Total Knee Arthroplasty and Bariatric Surgery: Within the register, we conduct targeted in-depth analy- Patients, Outcomes and Surgeons by Perna Ighani ses, validation studies, and combine data with other health Arani, 2023-06-02 data registers, following established register research meth- ods. There is ongoing work, based on scientific principles, Why is Observational Research to improve and develop the methods used in register work. Necessary? Although central funding is not intended for research, the Register studies and randomized clinical trials (RCTs) Swedish Association of Local Authorities and Regions and complement each other. Research in joint replacement the Swedish Agency for Health and Care Services Analysis surgery requires long follow-up periods and a large num- regularly evaluate the research activity within the registers. ber of patients. Some key outcome parameters (reopera- A high level of research activity is a criterion for a register tions, prosthesis survival, and mortality) are relatively rare. to be awarded the highest certification level. This makes register studies particularly useful for research in joint replacement surgery. Register studies have several advantages that are worth highlighting: 66 Theses from the Swedish Arthroplasty Register • Register studies represent real-world outcomes. This When all the theses that are fully or partly based on data means the results are highly generalizable. A register from the Swedish Hip and Knee Arthroplasty Registers study provides an accurate picture of how a particu- are combined, it is evident that we have had an impressive lar treatment performs in routine care in the general research output since the registers were established in the population. 2 7 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 • Due to their size and long follow-up, register studies Many Researchers Contribute to the can investigate rare exposures and outcomes that occur Register’s Activity infrequently. Within the register management and steering group, there • The registration of an individual in a quality register are senior researchers who supervise PhD candidates asso- does not require written informed consent, making it ciated with the register. In addition, steering group mem- easier to collect complete data and conduct data col- bers and other researchers collaborate with register staff lection at a lower cost. to conduct research in the field. Ongoing studies involve various implants and fixation types, epidemiology, health • Continuous longitudinal data collection allows for the economics, equitable healthcare, hip fractures and joint analysis of changes in patient demographics, treatment, replacement, periprosthetic fractures, revision surgery, and outcomes over time. statistical methodology, infections, and patient-reported outcomes after joint replacement surgery. What is Required to Use Register Data for Research Purposes? International Research Collaborations All register-based research involving individual data The register has an intensive research collaboration within requires approval from the Swedish Ethical Review Author- the NARA (Nordic Arthroplasty Register Association), ity (EPM). All information in the register is considered a registry collaboration between Finland, Norway, Den- public but is protected by confidentiality according to the mark, and Sweden, which has created a common database Public Access to Information and Secrecy Act. The Västra since 2007. The group has now published around 50 sci- Götaland Region is the central data controller (CPUA), entific articles, and additional manuscripts are in progress. and the operational manager at Registercentrum Västra NARA data is also available to Swedish PhD candidates. Götaland is responsible for confidentiality and harm Through the International Society of Arthroplasty Regis- assessments in data release requests. We use specific forms tries (ISAR), research collaboration exists with about ten for data extraction requests, available for download from other arthroplasty registers worldwide. The international the Registercentrum website (registercentrum.se/research). collaboration is described in more detail in a separate Work is ongoing at Registercentrum to digitalize the data section of the annual report. request application process. Regulations regarding register research are available on the Swedish Association of Local Authorities and Regions website about Quality Registers. If you wish to discuss a research project, we recommend contacting the register management. The register man- agement is open to ideas, proposals, and discussions about collaborations in new register studies. The registry’s databases are also well-suited for scientific work during specialist training (ST), medical program theses, and master’s projects. © 2024 The Swedish Arthroplasty Register Register Research Internships Since 2012, we have held annual retreats for register research. PhD candidates, supervisors, and other research- ers working with register studies on musculoskeletal diseases and injuries have participated. Both general and specific research questions are discussed in workshop for- mat. After a brief hiatus due to the pandemic, we resumed a productive two-day meeting in January 2023. Production of scientific publications containing data from the Swedish Arthroplasty Register from its start. 2 8 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 ABOGRAFT – Bone grafts treated with antibiotics to reduce the risk of infection in hip replacement surgery Author: Jörg Schilcher, Linköping University Why the ABOGRAFT study? The ABOGRAFT study is a double-blind randomized bone graft has been used as a carrier for local antibiotic clinical drug trial, with the primary goal of determining treatment in several pilot studies and appears to be an whether antibiotic-impregnated bone graft can reduce attractive and effective treatment option for established the risk of prosthetic joint infection (PJI) after total hip infections. However, to date, no randomized clinical trial replacement (THR). PJI is the most severe complication has supported its use for prophylactic purposes. following total hip replacement. As noted in this annual report, almost two-thirds of the revisions performed within two years of primary THR in Sweden are due to Research question and objectives infection. The risk of infection is even higher in more The aim of this research is to investigate whether antibiot- complex procedures, such as revision surgeries or total ics mixed into bone graft can reduce the risk of infection hip replacement in cases of dysplasia or failed fracture after hip replacement surgery. As a secondary objective, we treatment. will assess the risk of reoperation or revision and examine the resistance patterns in patients who develop PJI. Antibiotic-loaded bone cement, along with perioperative intravenous antibiotic treatment, has been the standard in primary THR. An alternative carrier for local antibiotic Method and patient group treatment is morselized bone graft, which is used to fill This study is a Phase II, international, randomized, dou- bone defects. Antibiotic-impregnated bone graft offers ble-blind clinical trial with a total follow-up period of five better antibiotic release compared to cement, and it is years. The primary outcome measure is reoperation due both simple and cost-effective to add antibiotics to bone to infection or clinical diagnosis of PJI after two years. graft. The combination of vancomycin, which targets gram-positive bacteria, and tobramycin, which is effective All patients scheduled for total hip replacement surgery against gram-negative bacteria, is considered effective for who require bone grafting are eligible to participate, treating most bacterial infections in PJI. This regimen is except for those with an ongoing infection. associated with a low risk of osteotoxicity and systemic side effects due to minimal systemic absorption. Morselized Progress to date We have included and operated more than 55 patients in the study out of a total of 850 required. In the spring of 2024, we began including patients at additional study sites. More hospitals will join our consortium in 2024 and 2025, with funding provided by an initial grant from the Swedish Research Council. Interested in including patients? Contact us at [email protected] or visit our website for more information: www.abograft.se. 2 8 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 References 1. Cnudde, P., et al., Association between patient survival 4. Dunbar, M.J., Antibiotic bone cements: their use in following reoperation after total hip replacement and routine primary total joint arthroplasty is justified. the reason for reoperation: an analysis of 9,926 patients Orthopedics, 2009. 32(9). in the Swedish Hip Arthroplasty Register. Acta Ortho- paedica, 2019. 90(3): p. 226-230. 5. Berberich, C., J. Josse, and P.S. Ruiz, Patients at a high risk of PJI: Can we reduce the incidence of infection 2. Wildeman, P., et al., What Are the Long-term Out­ using dual antibiotic-loaded bone cement? Arthro- comes of Mortality, Quality of Life, and Hip Function plasty, 2022. 4(1): p. 41. after Prosthetic Joint Infection of the Hip? A 10-year Follow-up from Sweden. Clinical Orthopaedics and Related Research®, 2021. 479(10). 3. AlBuhairan, B., D. Hind, and A. Hutchinson, Anti- biotic prophylaxis for wound infections in total joint arthroplasty. The Journal of Bone & Joint Surgery ­British Volume, 2008. 90-B(7): p. 915-919. 2 8 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 International work Author: Ola Rolfson A key platform for our international work is the NARA among countries in Africa, Europe, North America, and collaboration (Nordic Arthroplasty Register Association). Oceania. Acta Orthop. 2023 Aug 9;94:416-425 och Leta Since 2007, we have regularly combined anonymized hip TH et al. Periprosthetic Joint Infection After Total Knee and knee replacement data from Denmark, Norway, Swe- Arthroplasty With or Without Antibiotic Bone Cement. den, and Finland for unique studies. This collaboration JAMA Netw Open. 2024 May 1;7(5):e2412898. doi: has resulted in over 50 scientific publications that have 10.1001/jamanetworkopen. 2024.12898). significantly contributed to advancing the evidence base in joint replacement surgery. It has also led to the harmo- Since 2021, we have also been part of the EU-funded nization of research methods and the way register data Horizon 2020 project CORE-MD (Coordinating are analyzed and presented. The collaboration has gained Research and Evidence for Medical Devices). The project renewed momentum post-pandemic under the leadership aims to enhance knowledge on methods for testing and of Professor Nils Hailer, who is also a member of the evaluating implants. The project has been highly relevant, Swedish Arthroplasty Register steering group. given the challenges manufacturers and regulatory author- ities face in implementing the new EU Medical Device Another important international platform is the Interna- Regulation (MDR). The three-year project has recently tional Society of Arthroplasty Registries (ISAR), where concluded, and a follow-up project is in development. we are actively involved in the organization’s management and working groups. The ISAR collaboration has led to The Swedish Arthroplasty Register has been represented several projects combining data from multiple registers, at several international meetings in 2023, organized by and we continued to participate actively in ISAR’s work- groups such as the European Federation of National ing groups throughout 2023. Associations of Orthopaedics and Traumatology, the Osteoarthritis Research Society International, Interna- We have also contributed to the OECD’s working group tional Society of Arthroplasty Registries, and the Nordic for “Patient-Reported Indicator Surveys (PaRIS) on Hip Orthopaedic Federation. At these meetings, research and Knee Replacement Surgery.” The first report was pub- findings from the Swedish Arthroplasty Register were lished in 2019, the second in 2022, and we have provided presented. data for the upcoming OECD report. In addition, that such collaboration projects lead to An additional example of our international efforts is the interesting results, they contribute to the various actors collaboration with Australia and Kaiser Permanente in the receiving information about each other’s methods for USA. In September 2022, Peter defended his PhD-work registration, selection, analyses and reporting. In turn, that studied revision rates after total knee replacement this also hopefully means that the registries are approach- using information from joint replacement registers in ing each other so that in the future it will become easier these three countries (Knee replacement revision – An to compare the individual countries’ results in scientific international comparison), lucris.lub.lu.se/ws/portalfiles/ articles and reports. portal/122386605/Knee_replacement_revision_ dissertation.pdf ). We believe that the growing international cooperation in recent years has had a positive impact both on research, Moreover, a collaboration between 14 international joint activities and not least for patients. replacement registers has resulted in two published articles on the use of bone cement with or without antibiotics in knee replacement surgery and the risk of infection-related revisions: (Leta TH et al. The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2,971,357 primary total knee arthroplasties from 2010 to 2020: an international register-based observational study 2 8 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Publications 2021–2024 Here is a list of scientific articles that have fully or partially utilized data from the Swedish Arthroplasty Register or its predecessors from January 1, 2021, to May 8, 2024. For the complete publication list, please refer to the Swedish Arthroplasty Register’s website. 2024 (until 8 May) Eneqvist T, Persson L, Kojer E, Gunnarsson L, Gerdhem Rahmanian S, Aggeryd C, Gustafson P, Heijbel S, P. Spinal surgery and the risk of reoperation after total W-Dahl A, Hedström M. Regional skillnad i inci- hip arthroplasty: a cohort study based on Swedish spine densen av skador efter ledprotesoperation [Considerable and hip arthroplasty registers. Acta Orthop. 2024 Jan regional differences in patient injuries after primary hip 18;95:25-31. and knee arthroplasty and between orthopedic depart- ments depending on surgical volume]. Lakartidningen. 2024 May 8;121:23140. Swedish. 2023 Wojtowicz R, Otten V, Henricson A, Crnalic S, Nilsson Olerud F, Garland A, Hailer NP, Wolf O. Risk of conver- KG. Uncemented trabecular metal high-flex posterior- sion to total knee arthroplasty after surgically treated tibial stabilized monoblock total knee arthroplasty in patients plateau fractures: an observational cohort study of 439 aged 60 years or younger. Epub 2023 Dec 8. patients. Acta Orthop. 2024 May 7;95:206-211. Lind D, Nåtman J, Mohaddes M, Rogmark C. Long- Heijbel S, W-Dahl A, E-Naili J, Hedström M. Patient- term risk of reoperation after modular hemiarthroplasty Reported Anxiety or Depression Increased the Risk of : Any differences between uni- or bipolar design? BMC Dissatisfaction Despite Improvement in Pain or Func- Musculoskelet Disord. 2023 Nov 24;24(1):911. tion Following Total Knee Arthroplasty: A Swedish Register-Based Observational Study of 8,745 Patients. Lagergren J, Strøm Rönnquist S, Wolf O, Mukka S, J Arthroplasty. 2024 Apr 30:S0883-5403(24)00419-4. Möller M, Nåtman J, Rogmark C. The different strategies in treating displaced femoral neck fractures: mid-term sur- Wildeman P, Rolfson O, Wretenberg P, Nåtman J, gical outcome in a register-based cohort of 1,283 patients Gordon M, Söderquist B, Lindgren V. Effect of a national aged 60-69 years. Acta Orthop. 2023 Oct 10;94:505-510. infection control programme in Sweden on prosthetic joint infection incidence following primary total hip Ferid K, Slavko M, Svemir C, Mirsad F, Sahmir S, arthroplasty: a cohort study. BMJ Open. 2024 Apr Johan K. Influence of immigrant background on the 29;14(4):e076576. outcome of total hip arthroplasty: better outcome in 280 native patients in Bosnia and Herzegovina than in Wolf O, Ghukasyan Lakic T, Ljungdahl J, Sundkvist J, 449 immigrants living in Sweden. Hip Int. 2023 Oct Möller M, Rogmark C, Mukka S, Hailer NP. Reopera- 5:11207000231182321. tion-free survival after hip screws or hip arthroplasty for undisplaced femoral neck fractures in the elderly. Bone Jt Persson A, Sköldenberg O, Mohaddes M, Eisler T, Open. 2024 Feb 2;5(2):87-93. Gordon M. Increased mortality after total hip prosthetic joint infection is mainly caused by the comorbidities Cnudde PHJ, Nåtman J, Rolfson O, Hailer NP. The rather than the infection itself. Acta Orthop. 2023 Sep True Dislocation Incidence following Elective Total Hip 26;94:484-489. Replacement in Sweden: How Does It Relate to the Revi- sion Rate? J Clin Med. 2024 Jan 20;13(2):598. 2 8 4 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Schaufelberger M, Rolfson O, Kärrholm J. Outcome of Mikkelsen RT, Overgaard S, Pedersen AB, Kärrholm J, patients with osteoarthritis aged 90 to 101 years after Rolfson O, Fenstad AM, Furnes O, Hallan G, Mäkelä K, cemented total hip arthroplasty: 1,385 patients from the Eskelinen A, Varnum C. Does choice of bearings influ- Swedish Arthroplasty Register. Acta Orthop. 2023 Sep ence the survival of cementless total hip arthroplasty in 22;94:477-483. patients aged 20-55 years? Comparison of 21,594 patients reported to the Nordic Arthroplasty Register Association Gustafsson K, Kvist J, Eriksson M, Rolfson O. What dataset 2005-2017. Acta Orthop. 2023 Jun 5;94:266-273. Factors Identified in Initial Osteoarthritis Management Are Associated With Poor Patient-reported Outcomes Jolbäck P, Bedeschi Rego De Mattos C, Rogmark C, After THA? A Register-based Study. Clin Orthop Relat Chen AF, Nauclér E, Tsikandylakis G. Patient-reported Res. 2023 Sep 1;481(9):1732-1742. Outcomes After Primary Total Hip Arthroplasty Are Not Affected by the Sex of the Surgeon: A Register-based Itayem R, Rolfson O, Mohaddes M, Kärrholm J. What is Study of 8,383 Procedures in Western Sweden. J Am Acad the Role of Stem Size and Offset in the Risk of Nonseptic Orthop Surg. 2023 Apr 28. Revision of the Exeter® 150-mm Stem? A Study From the Swedish Arthroplasty Register. Clin Orthop Relat Res. Teni FS, Burström K, Devlin N, Parkin D, Rolfson O; 2023 Sep 1;481(9):1689-1699. Swedish Quality Register (SWEQR) Study Group. Expe- rience-based health state valuation using the EQ VAS: a Sattar A, Kärrholm J, Möller M, Chatziagorou G. Fracture register-based study of the EQ-5D-3L among nine patient pattern and risk factors for reoperation after treatment of groups in Sweden. Health Qual Life Outcomes. 2023 Apr 156 periprosthetic fractures around an anatomic cemented 10;21(1):34. hip stem. Acta Orthop. 2023 Aug 16;94:438-446. Ighani Arani P, Wretenberg P, Stenberg E, Ottosson J, Leta TH, Fenstad AM, Lygre SHL, Lie SA, W-Dahl A. Total knee arthroplasty and bariatric sur- Lindberg-Larsen M, Pedersen AB, W-Dahl A, Rolfson gery: change in BMI and risk of revision depending on O, Bülow E, Ashforth JA, Van Steenbergen LN, sequence of surgery. BMC Surg. 2023 Mar 10;23(1):53. Nelissen RGHH, Harries D, De Steiger R, Lutro O, Hakulinen E, Mäkelä K, Willis J, Wyatt M, Frampton C, Lagergren J, Mukka S, Wolf O, Nauclér E, Möller M, Grimberg A, Steinbrück A, Wu Y, Armaroli C, Molinari Rogmark C. Conversion to Arthroplasty After Internal M, Picus R, Mullen K, Illgen R, Stoica IC, Vorovenci AE, Fixation of Nondisplaced Femoral Neck Fractures: Results Dragomirescu D, Dale H, Brand C, Christen B, Shapiro from a Swedish Register Cohort of 5,428 Individuals 60 J, Wilkinson JM, Armstrong R, Wooster K, Hallan G, Years of Age or Older. J Bone Joint Surg Am. 2023 Mar Gjertsen JE, Chang RN, Prentice HA, Paxton EW, Furnes 1;105(5):389-396. O. The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2,971,357 primary total Cöster MC, Bremander A, Nilsdotter A. Patient-reported knee arthroplasties from 2010 to 2020: an international outcome for 17,648 patients in 5 different Swedish ortho- register-based observational study among countries in paedic quality registers before and 1 year after surgery: an Africa, Europe, North America, and Oceania. Acta observational study. Acta Orthop. 2023 Jan 23;94:1-7. Orthop. 2023 Aug 9;94:416-425. Dale H, Fenstad AM, Hallan G, Overgaard S, Pedersen AB, Hailer NP, Kärrholm J, Rolfson O, Eskelinen A, Mäkelä KT, Furnes O. Increasing risk of revision due to infection after primary total hip arthroplasty: results from the Nordic Arthroplasty Register Association. Acta Orthop. 2023 Jun 27;94:307-315. 2 8 5 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 2022 Ighani Arani P, Wretenberg P, Ottosson J, W-Dahl A. Jolbäck P, Mukka S, Wetterling K, Mohaddes M, Garland Pain, Function, and Satisfaction After Total Knee Arthro- A. Patient-surgeon sex discordance impacts adverse events plasty, with or Without Bariatric Surgery. Obes Surg. but does not affect patient-reported satisfaction after 2022 Apr;32(4):1164-1169. primary total hip arthroplasty: a regional register-based cohort study. Acta Orthop. 2022 Dec 27;93:922–9. Qvistgaard M, Nåtman J, Lovebo J, Almerud-Österberg S, Rolfson O. Risk factors for reoperation due to peripros- Ighani Arani P, Wretenberg P, W-Dahl A. Information thetic joint infection after elective total hip arthroplasty: a and BMI limits for patients with obesity eligible for knee study of 35,056 patients using linked data of the Swedish arthroplasty: the Swedish surgeons’ perspective from a Hip Arthroplasty Registry (SHAR) and Swedish Perioper- nationwide cross-sectional study. J Orthop Surg Res. 2022 ative Registry (SPOR). BMC Musculoskelet Disord. 2022 Dec 19;17(1):550. Mar 23;23(1):275. Thompson O, W-Dahl A, Stefánsdóttir A. Increased Bülow E, Hahn U, Andersen IT, Rolfson O, Pedersen short- and long-term mortality amongst patients with AB, Hailer NP. Prediction of Early Periprosthetic Joint early periprosthetic knee joint infection. BMC Muscu- Infection After Total Hip Arthroplasty. Clin Epidemiol. loskelet Disord. 2022 Dec 6;23(1):1069. 2022; 14:239-253. Irmola T, Ponkilainen V, Mäkelä KT, Robertsson O, Mukka S, Hailer NP, Möller M, Gordon M, Lazarinis W-Dahl A, Furnes O, Fenstad AM, Pedersen AB, S, Rogmark C, Östlund O, Sköldenberg O, Wolf O; Schrøder HM, Niemeläinen MJ, Eskelinen A. Impact of DAICY study group. Study protocol: The DAICY trial- Nordic Arthroplasty Register Association (NARA) col- dual versus single-antibiotic impregnated cement in laboration on demographics, methods and revision rates primary hemiarthroplasty for femoral neck fracture – a in knee arthroplasty: a register-based study from NARA register-based cluster-randomized crossover-controlled 2000-2017. Acta Orthop. 2022 Nov 28;93:866-873. trial. Acta Orthop. 2022 Oct 5;93:794-800. Agerholm J, Teni FS, Sundbye J, Rolfson O, Burström K. Pyrhönen HS, Lagergren J, Wolf O, Bojan A, Mukka S, Patient-reported outcomes among patients undergoing Möller M, Rogmark C. No Difference in Conversion Rate total hip replacement in an integrated care system and to Hip Arthroplasty After Intramedullary Nail or Sliding in a standard care system in Region Stockholm, Sweden. Hip Screw for Extracapsular Hip Fractures: An Observa- BMC Health Serv Res. 2022 Nov 24;22(1):1414. tional Cohort Study of 19,604 Individuals. J Bone Joint Surg Am. 2022 Oct 5;104(19):1703-1711. Porter M, Rolfson O, de Steiger R. International Reg- istries: U.K. National Joint Registry, Nordic Registries, Farey JE, Masters J, Cuthbert AR, Iversen P, van Steenber- and Australian Orthopaedic Association National Joint gen LN, Prentice HA, Adie S, Sayers A, Whitehouse MR, Replacement Registry (AOANJRR). J Bone Joint Surg Paxton EW, Costa ML, Overgaard S, Rogmark C, Rolfson Am. 2022 Oct 19;104(Suppl 3):23-27. O, Harris IA. Do Dual-mobility Cups Reduce Revision Risk in Femoral Neck Fractures Compared With Con- Rilby K, Nauclér E, Mohaddes M, Kärrholm J. No ventional THA Designs? An International Meta-analysis diffe-rence in outcome or migration but greater loss of of Arthroplasty Registries. Clin Orthop Relat Res. 2022 bone mineral density with the Collum Femoris Preserving Oct 1;480(10):1912-1925. stem compared with the Corail stem: a randomized con- trolled trial with five-year follow-up. Bone Joint J. 2022 Enocson A, Wolf O. Pipkin fractures: epidemiology and May;104-B(5):581-588. outcome. Eur J Trauma Emerg Surg. 2022 Oct;48(5): 4113-4118. 2 8 6 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Jolbäck P, Rogmark C, Rego De Mattos CB, Chen AF, Hailer YD, Kärrholm J, Eriksson N, Holmberg L, Hailer Nauclér E, Tsikandylakis G. The Influence of Surgeon Sex NP. Similar risk of cancer in patients younger than 55 on Adverse Events Following Primary Total Hip Arthro- years with or without a total hip arthroplasty (THA): plasty: A Register-Based Study of 11,993 Procedures and a population-based cohort study on 18,771 exposed 200 Surgeons in Swedish Public Hospitals. J Bone Joint to THA and 87,683 controls. Acta Orthop. 2022 Feb Surg Am. 2022 Aug 3;104(15):1327-1333. 8;93:317-326. Goude F, Garellick G, Kittelsen S, Malchau H, Peltola Lewis PL, W-Dahl A, Robertsson O, Lorimer M, Prentice M, Rehnberg C. Effects of competition and bundled pay- HA, Graves SE, Paxton EW. The effect of patient and ment on the performance of hip replacement surgery in prosthesis factors on revision rates after total knee replace- Stockholm, Sweden: results from a quasi-experimental ment using a multi-registry meta-analytic approach. Acta study. BMJ Open. 2022 Jul 14;12(7):e061077. Orthop. 2022 Feb 1;93:284-293. Lewis PL, W-Dahl A, Robertsson O, Prentice HA, Graves Teni FS, Rolfson O, Devlin N, Parkin D, Nauclér E, SE. Impact of patient and prosthesis characteristics on Burström K; Swedish Quality Register (SWEQR) Study common reasons for total knee replacement revision: a Group. Longitudinal study of patients’ health-related registry study of 36,626 revision cases from Australia, quality of life using EQ-5D-3L in 11 Swedish National Sweden, and USA. Acta Orthop. 2022 Jul 5;93:623-633. Quality Registers. BMJ Open. 2022 Jan 6;12(1):e048176. Ingelsrud LH, Wilkinson JM, Overgaard S, Rolfson O, Simonsson J, Bülow E, Svensson Malchau K, Nyberg F, Hallstrom B, Navarro RA, Terner M, Karmakar-Hore Berg U, Rolfson O. Worse patient-reported outcomes and S, Webster G, Slawomirski L, Sayers A, Kendir C, higher risk of reoperation and adverse events after total de Bienassis K, Klazinga N, Dahl AW, Bohm E. How do hip replacement in patients with opioid use in the year Patient-reported Outcome Scores in International Hip before surgery: a Swedish register-based study on 80,483 and Knee Arthroplasty Registries Compare? Clin Orthop patients. Acta Orthop. 2022 Jan 3;93:190-197. Relat Res. 2022 Jul 8. Heijbel S, W-Dahl A, Nilsson KG, Hedström M. Sub- Gustafsson K, Kvist J, Zhou C, Eriksson M, Rolfson O. stantial clinical benefit and patient acceptable symptom Progression to arthroplasty surgery among patients with states of the Forgotten Joint Score 12 after primary knee hip and knee osteoarthritis : a study from the Swedish arthroplasty. Acta Orthop. 2022 Jan 3;93:158-163. BOA Register. Bone Joint J. 2022 Jul;104-B(7):792-800. Itayem R, Rolfson O, Mohaddes M, Kärrholm J. Influ- Rogmark C, Nåtman J, Jobory A, Hailer NP, Cnudde P. ence of implant variations on survival of the Lubinus The association of surgical approach and bearing size and SP II stem: evaluation of 76,530 hips in the Swedish type with dislocation in total hip arthroplasty for acute Arthroplasty Register, 2000-2018. Acta Orthop. 2022 hip fracture. Bone Joint J. 2022 Jul;104-B(7):844-851. Jan 3;93:37-42. Rönnquist SS, Lagergren J, Viberg B, Möller M, Cnudde PHJ, Nåtman J, Hailer NP, Rogmark C. Total, Rog-mark C. Rate of conversion to secondary arthroplasty hemi, or dual-mobility arthroplasty for the treatment after femoral neck fractures in 796 younger patients of femoral neck fractures in patients with neurological treated with internal fixation: a Swedish national regis- disease: analysis of 9,638 patients from the Swedish Hip ter-based study. Acta Orthop. 2022 Jun 14;93:547-553. Arthroplasty Register. Bone Joint J. 2022 Jan;104-B(1): 134-141. Wojtowicz AL, Al-Azzani W, Nåtman J, Rolfson O, Rog- mark C, Cnudde PHJ. Hip arthroplasty for acute hip fracture in patients with neurological disorders: A report Of 9,702 cases from the Swedish arthroplasty register. Injury. 2022 Mar;53(3):1202-1208. 2 8 7 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 2021 Lacny S, Faris P, Bohm E, Woodhouse L J, Robertsson Moran MM, Wessman P, Rolfson O, Bohl DD, O, Marshall D A. Competing Risks Methods Are Rec- Kärr-holm J, Keshavarzian A, Sumner DR. The risk of ommended for Estimating the Cumulative Incidence of revision following total hip arthroplasty in patients with Revision Arthroplasty for Health Care Planning Purposes. inflammatory bowel disease, a registry based study. PLoS Orthopedics. Jul-Aug 2021;44(4):e549-e555. One. 2021 Nov 4;16(11):e0257310. Bohm E R, Kirby S, Trepman E, Hallstrom B R, Rolfson Sebastian S, Sezgin EA, Stučinskas J, Tarasevičius Š, O, Wilkinson J M, Sayers A, Overgaard S, Lyman S, Liu Y, Raina DB, Tägil M, Lidgren L, W-Dahl A. Dif- Franklin P D, Dunn J, Denissen G, W-Dahl A, Holm ferent microbial and resistance patterns in primary total Ingelsrud L, Navarro R A. Collection and Reporting knee arthroplasty infections – a report on 283 patients of Patient-reported Outcome Measures in Arthroplasty from Lithuania and Sweden. BMC Musculoskelet Disord. Registries: Multinational Survey and Recommendations. 2021 Sep 17;22 Clin Orthop Relat Res. 2021 Jul 21. Thompson O, W-Dahl A, Lindgren V, Gordon M, Silman A J, Combescure C, Ferguson R J, Graves S Robertsson O, Stefánsdóttir A. Similar periprosthetic E, *Paxton E W, Frampton C, Furnes O, Fenstad A joint infection rates after and before a national infection M, Hooper G, Garland A, Spekenbrink-Spooren A, control program: a study of 45,438 primary total knee Wilkinson J M, Mäkelä K, Lübbeke A, Rolfson O. Inter- arthroplasties. Acta Orthop. 2021 Sep 17;1-7. national variation in distribution of ASA class in patients undergoing total hip arthroplasty and its influence on mor- Teni FS, Rolfson O, Berg J, Leidl R, Burström K. Con- tality: data from an international consortium of arthro- cordance among Swedish, German, Danish, and UK plasty registries. Acta Orthop. 2021 Jun;92(3):304-310. EQ-5D-3L Value Sets: Analyses of Patient-Reported Outcomes in the Swedish Hip Arthroplasty Register. Wildeman P, Rolfson O, Söderquist B, Wretenberg P, J Clin Med. 2021 Sep 17;10(18):4205. Lindgren V. What Are the Long-term Outcomes of Mor- tality, Quality of Life, and Hip Function after Prosthetic Joelson A, Wildeman P, Sigmundsson FG, Rolfson O, Joint Infection of the Hip? A 10-year Follow-up from Karlsson J. Properties of the EQ- 5D-5L when prospec- Sweden. Clin Orthop Relat Res. 2021 May 31. tive longitudinal data from 28,902 total hip arthroplasty procedures are applied to different European EQ-5D-5L Goude F, Kittelsen SAC, Malchau H, Mohaddes M, value sets. Lancet Reg Health Eur. 2021 Jul 14;8:100165. Rehnberg C. The effects of competition and bundled payment on patient reported outcome measures after hip Teni FS, Rolfson O, Devlin N, Parkin D, Nauclér E, replacement surgery. BMC Health Serv Res. 2021 Apr Burström K, Swedish Quality Register (SWEQR) Study 26;21(1):387. Group. Variations in Patients’ Overall Assessment of Their Health Across and Within Disease Groups Using Berg U, W-Dahl A, Nilsdotter A, Nauclér E, Sundberg M, the EQ-5D Questionnaire: Protocol for a Longitudinal Rolfson O. Fast-Track Programs in Total Hip and Knee Study in the Swedish National Quality Registers. JMIR Replacement at Swedish Hospitals-Influence on 2-Year Res Protoc. 2021 Aug 27;10(8):e27669. Risk of Revision and Mortality. J Clin Med. 2021 Apr 14;10(8):1680. Wadström M G, Hailer N P, Hailer Y D. No increased mortality after total hip arthroplasty in patients with a his- Jobory A, Kärrholm J, Hansson S, Åkesson K, Rogmark tory of pediatric hip disease: a matched, population-based C. Dislocation of hemiarthroplasty after hip fracture is cohort study on 4,043 patients. Acta Orthop. 2021 Aug common and the risk is increased with posterior approach: 16:1-5. result from a national cohort of 25,678 individuals in the Swedish Hip Arthroplasty Register. Acta Orthop. 2021 Apr 6:1-6. 2 8 8 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Garland A, Bülow E, Lenguerrand E, Blom A, Wilkinson Dissertations 2023 M, Sayers A, Rolfson O, Hailer NP. Prediction of 90-day mortality after total hip arthroplasty. Bone Joint J. 2021 The following theses with data from the Swedish Arthro- Mar;103-B(3):469-478. plasty Register or its predecessors were defended in 2023. Silman AJ, Combescure C, Ferguson RJ, Graves SE, For a complete list of dissertations, please refer to the Paxton EW, Frampton C, Furnes O, Fenstad AM, Hooper Register’s website. G, Garland A, Spekenbrink-Spooren A, Wilkinson JM, Mäkelä K, Lübbeke A, Rolfson O. International variation • On femoral neck fractures in the elderly. Johan in distribution of ASA class in patients undergoing total Lagergren, 2023-11-24. hip arthroplasty and its influence on mortality: data from an international consortium of arthroplasty registries. • Hip and Knee Osteoarthritis: Who Are the Patients Acta Orthop. 2021 Mar 1:1-7. Referred to First-Line Intervention and What Happens to Them? Kristin Gustafsson, 2023-09-22. Lindman I, Nåtman J, Öhlin A, Svensson Malchau K, Karlsson L, Mohaddes M, Rolfson O, Sansone M. Prior • Total knee Arthroplasty and Bariatric Surgery – hip arthroscopy does not affect 1-year patient-reported Patients, Outcome and Surgeons. Perna Ighani Arani, outcomes following total hip arthroplasty: a register-based 2023-06-02. matched case-control study of 675 patients. Acta Orthop. 2021 Feb 10:1-5. Ighani Arani P, Wretenberg P, Ottosson J, Robertsson O, W-Dahl A. Bariatric surgery prior to total knee arthro- plasty is not associated with lower risk of revision: a register-based study of 441 patients. Acta Orthop. 2021 Feb;92(1):97-10. 2 8 9 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Thank you to contact secretaries and contact surgeons We would like to take the opportunity to acknowledge and thank our contact secretaries and contact surgeons all around Sweden for your fine work and commitment during the past year. Akademiska sjukhuset Art Clinic Jönköping Capio Ortho och Spine Danderyd Andreas Brüggeman Gustav Hedbäck Center Skåne Olof Sköldenberg Caroline Sköld Marie Claar Gunnar Flivik Agata Rysinska Mari Nilsson Jenny Ernstsson Annika Wallier Stina Sundstedt Arvika Åsa Hugo Eriksson Fredrik Sundström Capio Ortopedi Motala Lena Braun Aleris Malmö Arena Ann Säterman Jonas Holmertz Eva Jansson Elina Tiderius Maleki Bengt Horn Evelina Larsson Atleva Ortopedi Center Carin Hjelm Eksjö Torsten Jonsson Anna Alsterqvist Predrag Jovanovic Aleris Specialistvård Pia Gustavsson Lotta Gustavsson Daniel Wärnsberg ­Elisabethsjukhuset Åsa Josefsson Torun Liljeholm-Baroudi Bollnäs Capio Ortopediska Anette Dolk Hampus Stigbrand ­Huset Aleris Specialistvård Josefin Haaga Martin Thorsell Enköping Nacka Lena Wallin Ingra Sandell Robert Wisniewski Mikael Bouleu Marie Bingselius Soran Strbac Jennie Henriksson-Lantto Borås Mimmi Eriksson Christan Kopp Capio Spine Center Carina Eriksson Aleris Specialistvård Karin Ståhl ­Göteborg Ann Westerberg ­Renmarkstorget Carin Egelhof Rebecca Thorén Volker Otten Jessica Scherman Eskilstuna Mari Larsson-Burström Capio Artro Clinic Nils Isaksson Jenny Saving Capio Sports Medicine Dimitrios Antonopoulos Aleris Specialistvård Karin Lundh Umeå AB Britta Båverud ­Ängelholm Elin Karlsson Per Liljeholm Emelie Eriksson Herbert Franzén Annika Rhodin Stina Andersson Capio Movement Falun Susanne Vaxby Linus Nilsson Capio S:t Göran Anders Krakau Karin Ylander Olle Wallner Dan Rösmark Alingsås Tom von Oelreich Lena Jonsson Ralf Beutinger Capio Ortho Center Anneli Engström Caroline Hed Karin Holmgren ­Göteborg Victoria Lippens Goran Puretic Carlanderska Frölundaortopeden Heléne Sahlén Reza Razaznejad Torsten Jonsson Art Clinic Göteborg Ulrika Holst Susanne Fält Michael Widmark Capio Ortho Center Ida Gustafsson Stockholm Carlanderska SportsMed Anders Persson Cecilia Larsson Marcelle Broumana Adad Baranto 2 9 0 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Gällivare Karlshamn Kungälv Norrköping Tomas Nilsson Christian Hellerfelt Johan Larsson-Wahlberg Johann Varenhorst Thomas Lerenius Cecilia Rönnfjärd Therese Bergström Oskar Korske Cecilia Jakobsson Liselott Höök Lisa Johansson Evelina Svensson Marita Eriksson Marie Olofsson Monika Båstedt Anette Altstedt Ida Österberg Anna Karlsson Pernilla Landelius Gävle Gösta Ullmark Karlskoga Ledplastikcenter Bromma Norrtälje Maria Östergård-Hansen Peter Wildeman Per Björk Mats Falk Ulla Laursen Vera Salazar Mia Lundell Halmstad Anna Sjögren Jenny Lundqvist Bo Granath Lidköping Daniel Stam Karlskrona Mats Jolesjö Nyköping Camilla Berggren Christian Hellerfelt Hussein Alkhaled Maja Notini Helsingborg Cecilia Rönnfjärd Britt-Marie Johansson Thomas Widercrantz Sadik Tözmal Madelene Karlsson Linda Broberg Alexandra Johansson Britt Berlin Charlotte Baeckström Frida Rygell Andersson NÄL Hermelinen Lindesberg Christina Chrysanthou Tomas Isaksson Karlstad Peter Wildeman Constantinou Sanna Gärdelid Karin Tholén Sanna Vähärautiou Anna Lövgren Victoria Sotterman Lisbeth Johansson Annelie Wetterberg Camilla Eriksson Anna Sjögren Hudiksvall Kristianstad Ortopedisk Center Anders Eriksson Ibrahim Abdulameer Linköping ­Sophiahemmet Magnus Thulin Annica Olofsson Jörg Schilcher Björn Skyttning Ulrica Wallin Mari Fröjd Gunilla Lindholm Christian Inngul Eszter Fodor Gunilla Persson Kalle Eriksson Ljungby Gunilla Gottfridsson Hässleholm Karolinska Huddinge Oscar Sjölin Muhanned Ali Harald Brismar Gustav Kalin Oskarshamn Samuel Dencker Lena Gustavsson Mikaela Carlén Fredrik Tydén Anneli Korneliusson Kristina Alfvén Maria Andersson Anthony Molin Gunilla Persson Ingela Johansson Mari Fröjd Karolinska Solna Lycksele Evelina Solnevik Anne Lindvall Rüdiger Weiss Maria Thorén Örnberg Ann-Christin Eriksson Helene Jonsson Piteå Jönköping Lena Gustavsson Emma Larsson Klas Stenström Robert Gustafsson Linnea Sundelin Jan Viklund Heléne Schelin Kullbergska sjukhuset Karin Berg Nils Isaksson Mora Lena Grönlund Kalmar Dimitrios Antonopoulos Alicia Avdic Sofia Strandberg Larsson Rasmus Bjerre Marie Fredberg Emelie Svensson Dziunia Malmberg Eva Karlsson Carina Olmedal Ekblom 2 9 1 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 Skellefteå SU/Sahlgrenska Trelleborg Växjö Claes Fahlman Georgios Tsikandylakis Jon Tjörnstrand Andreas Wahl David Löfgren Kamal Kadum Camilla Strid Helena Bergh André Erika Eriksson Jennifer Johansson Rose-Marie Persson Emma Steneros Marina Wågberg Denise Ersson Skene Ystad Christian Kopp Sunderby sjukhus Uddevalla Dan Bergkvist Anne Parviainen Nicole Jessen Christina Chrysanthou Marie Nilsson Gunnar Pettersson Constantinou Skövde ­Monica Larsson Michail Zacharatos Ängelholm Daniel Brandin Jeanette Paulsson Sadik Tözmal Abdol Balasem Sundsvall Britt Berlin Lena Åberg Emmanouil Bonatos Umeå Fredrik Andersson Volker Otten Örebro Sollefteå Susanne Svensk Kjell Gunnar Nilsson Peter Wildeman Elenor Andersson Majsan Pettersson Lena Jensen Gunnar Falk Anna Nordlöf David Lundström Anna Sjögren Eva Strindberg SUS/Lund Anna Garp Ulla-Karin Nordin Uldis Kesteris Varberg Emma Turesson Fredrik Nielsen Örnsköldsvik Specialistcenter Eva Larsson Andreas Kogler Torgil Boström S:t Johanniskliniken Charlott Ihlström Caroline Sjöberg Hans Rahme SUS/Malmö Helena Höök Jeanette Fredriksson Maria Påhlsson Ammar Jobory Elisabet Berthilsson Petra Sjögren Visby Lena Gustafsson Specialistcenter Anne Garland ­Scandinavia Malmö Södersjukhuset Veronica Nilsson Östersund Torgil Boström Leif Mattisson Anna-Carin Skarstedt Lars Korsnes Yaojiayin Zhang Karl Eriksson Nils Axrup Kristine Almgren Värnamo Birgitta Svanberg Specialistcenter Madeleine Tano Jorge Montana Benavides Maria Fastesson ­Scandinavia, Eskilstuna Marcin Szoltysik Aldoori Abdul Ateef Södertälje Susanne Svensson Ulrica Sandell Ferenc Schneider ­Marianne Mårtensson Västervik Specialistläkarhuset i Catharina Höög Johan Alkstedt Sundsvall AB Mats Odensten Magnus Thulin Telge Ortopedi Södertälje Ann Edström Berit Engberg Fawaz Soumi Hanna Ohlzon Ann-Christine Karlsson SU/Mölndal Västerås Georgios Tsikandylakis Torsby Thomas Ekblom Kamal Kadum Jan Claussen Sara Aldén Jennifer Johansson Sandra Bäckström Charlott Hermansson Marina Wågberg Ann-Sofie Gustafsson Kim Granström 2 9 2 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24  Steering committee Address Helene Andersson-Molina, MD, Norrköping The Swedish Arthroplasty Register Centre of Registers Västra Götaland Annika Belfrage, patient representative, Göteborg 413 45 Göteborg Anders Brüggemann, associate professor, Uppsala Telephone: see respective contact person Nils Hailer, professor, Uppsala E-mail: [email protected] Peter Johansson, Umeå Website: slr.registercentrum.se Kristin Gustafsson, PhD, Linköping Johan Kärrholm, professor, Göteborg Register Director and Editor Martin Magnéli, PhD, Stockholm Professor Ola Rolfson Berit Magnusson, patient representative, Göteborg Telephone: +46 31-343 08 52 E-mail: [email protected] Sebastian Mukka, associate professor, Umeå Kjell G Nilsson, professor, Umeå Jörg Schilcher, professor, Linköping Deputy Directors Professor Johan Kärrholm Olof Sköldenberg, professor, Stockholm Telephone: +46 31-342 82 47 Annette W-Dahl, associate professor, Lund E-mail: [email protected] Per Wretenberg, professor, Örebro Professor Cecilia Rogmark Telephone: +46 40-33 61 23 Graphic design and typesetting E-mail: [email protected] Gullers Grupp Associate professor Annette W-Dahl Telephone: +46 704-24 04 10 E-mail: [email protected] Illustrations Pontus Art Production Contact persons Register coordinator Sandra Olausson In collaboration with Telephone: +46 10 – 441 29 31 Centre of Registers Västra Götaland E-mail: [email protected] Region Västra Götaland Register coordinator Pär Werner Swedish Orthopaedic Association E-mail: [email protected] Lund University University of Gothenburg Other register co-workers Statistician Oskar Johansson E-mail: [email protected] Professor Henrik Malchau E-mail: [email protected] Associate professor, Maziar Mohaddes E-mail: [email protected] Med dr Perna Ighani Arani E-mail: [email protected] 2 9 3 | T H E S W E D I S H A R T H R O P L A S T Y R E G I S T E R 2 0 24 slr.registercentrum.se | [email protected] | 010–441 29 31 6.5. Implantaadi hindamine Autorid: Annette W-Dahl ja Ola Rolfson Implantaatide hindamisel oleme otsustanud esitada esmase operatsiooni käigus kasutatavad revisioonimudelid. suhteliselt kaasaegsed proteesimudelid, mille jälgimisaeg on Triathlon MBT-d käsitletakse tsementeeritud ja tsementeerimata piisavalt pikk, kasutades viimase kümne aasta andmeid. versioonide puhul eraldi, kuna tegemist on Rootsis kõige Mudelist antakse aru ka pärast selle kasutamise lõpetamist, sagedamini registreeritud tsementeerimata proteesiga. Riskisuhe kui analüüsimiseks on piisavalt andmeid. Tuleb märkida, et (HR) on korrigeeritud soo, vanuse ja operatsiooni aasta järgi üksikud proteesimudelid võivad esindada erinevaid (tabel 6.5.1). proteesivariante selliste tegurite tõttu nagu modulaarne ülesehitus ja turundus. Siiski on iga mudeli raames tavaliselt Sel aastal oleme otsustanud asendada PFC-Sigma MBT-d TKR- mõned domineerivad kombinatsioonid. Käesoleva aasta i võrdlusproteesina NexGen MBT-ga, kuna see on viimase aruandes on kaasatud mudelid, millest on 2014–2023. aastal kümne aasta jooksul kõige sagedamini kasutatud protees. teatatud 100 või enama operatsiooni puhul, samuti NexGen MBT-d peetakse hästi määratletud proteesiks hoolimata paljudest saadaval olevatest kombinatsioonidest, kuna enamik neist koosneb Riskisuhe 95% usaldusvahemikuga kordusoperatsioonidel TKR/OA NexGen MBT 64 742 1 349 Võrdlus NexGen Trabecular Metal 2 113 39 0,69 (0,50; 0,96) 0,03 PFC Sigma TKA APT 5 477 99 0,73 (0,59; 0,89) < 0,01 Triatlon MBT Hybrid 204 2 0,89 (0,22; 3,55) 0,86 Genesis II MBT 2 736 54 0,96 (0,73; 1,26) 0,76 Vanguard I-Beam Modular 1 332 4S 1,16 (0,86; 1,56) 0,35 Triathlon MBT tsementeeritud 11 547 250 1,19 (1,04; 1,36) 0,01 PFC Sigma TKA MBT 21 670 624 1,27 (1,16; 1,40) < 0,01 Attune MB TKA 2 669 34 1,46 (1,03; 2,06) 0,03 Triatlon APT 170 5 1,47 (0,61; 3,54) 0,39 Vanguard ribitud vars, modulaarne 1 690 71 1,49 (1,17; 1,90) < 0,01 Triatlon MBT tsementeerimata 6 894 221 1,55 (1,35; 1,79) < 0,01 Persona 5 368 107 1,60 (1,31; 1,95) < 0,01 Muud 538 23 1,72 (1,14; 2,61) < 0,01 NexGen'i versioon 559 18 1,82 (1,15; 2,90) 0,01 PFC Sigma TC-3 (muudatus) 3g0 16 2,17 (1,33; 3,56) < 0,01 Triatloni üldstabilisaator 802 34 2,35 (1,67; 3,31) < 0,01 Legion/Genesis II Pri MBT 2 271 117 2,46 (2,03; 2,97) < 0,01 Journey TKA 216 17 3,87 (2,40; 6,24) < 0,01 Sugu = naine 0,89 (0,83; 0,96) < 0,01 Vanus 0,98 (0,98; 0,99) < 0,01 Operatsiooni aasta 1,00 (0,98; 1,01) 0,56 Tabel 6.5.1. Revisioonirisk 95% usaldusvahemikuga TKR/OA 2014–2023. Ühikud, mille tulemused on riiklikust keskmisest oluliselt paremad või halvemad, on vastavalt rohelise ja punase värviga märgitud. 1 9 0 | ROOTSI ARTROPLASTIKA REGISTER 2024 sama tüüpi reieluu, sääreluu plaat ja polüetüleenist sisekate. kasutati 2010. aastal. 2018. aasta aruandes oli ribidega NexGen MBT-ks klassifitseeritud toodete hulgas moodustavad versiooni risk oluliselt suurem kui võrdlusmudelil, kuid viis reieluu, sääreluu ja polüetüleenist sisekatte kombinatsiooni viimastel aastatel ei ole see erinevus olnud märkimisväärne, 95% ning kolm kombinatsiooni 91%. kuigi praegu on selle risk oluliselt suurem võrreldes NexGen MBT-ga. Kuna Vanguardit Rootsis enam ei kasutata, on see Triathlon MBT tsementeeritud, PFC Sigma TKA MBT, Attune peamiselt ajaloolise tähtsusega. MB TKA, Vanguard Finned Stem Modular, Triathlon MBT tsementeerimata, Persona, Legion/Genesis II MBT, Journey Naiste kümneaastane HR-risk revisjoniks (kõik tüübid) on TKA ning revisioonimudelid, nagu NexGen Revision, PFC oluliselt madalam kui meestel, mis on peamiselt seletatav Sigma TC-3 (revisioon) ja Triathlon Total Stabilizer, näitavad meeste suurema infektsiooniriskiga, mis on kõige sagedasem oluliselt suuremat revisiooniriski (kõrgem HR) võrreldes varases operatsioonijärgses perioodis. Nagu eelnevatelgi võrdluseks kasutatud NexGen MBT-ga. Journey TKA-d aastatel, väheneb risk vanuse kasvades, samas kui operatsiooni kasutatakse harvem, Triathlon MBT tsementeerimata aasta riskile mõju ei avalda. kasutatakse ligikaudu sama palju, samas kui Persona kasutamine on kasvamas. UKR puhul oleme otsustanud vahetada võrdlusproteesi Linki vastu Oxfordi tsementeerimata proteesi (tabel 6.5.2). OA-st Teisalt on NexGen TM-il ja PFC-Sigma APT-l tingitud UKR-i puhul moodustavad Oxfordi mudelid 75% võrdlusmudeliga võrreldes madalamad HR-id. operatsioonidest, samas kui Link moodustab veidi üle 5%. Linkil on oluliselt kõrgem risk, samas kui ühelgi proteesil ei Nagu varasematelgi aastatel, oleme lisanud ka ole oluliselt madalamat revisjoni riski võrreldes revisioonimudelid, kui nende kohta on esitatud piisavalt võrdlusproteesiga ning risk väheneb vanuse kasvades. andmeid. Oleme teadlikud, et neid kasutatakse esmase proteesimise puhul patsientidel, kellel on edasijõudnud Revisioonirisk on vaid üks proteesimudeli toimivuse näitaja. osteoartriit või luude valest asetus ning kes on halvemas Arvestada tuleks ka revisiooni liigiga, kuigi seda siin ei ole tervislikus seisundis, kuid peame siiski huvitavaks näidata, esitatud. Põlvekapsli komponentide teadlikult säästlik kuidas need rühmad toimivad. Kõikidel revisioonimudelitel kasutamine, koos võimalusega pakkuda vajaduse korral on kõrgem riskimäär kui võrdlusproteesil. põlvekapsli tuge hiljem, suurendab esitatud revisioonimäära. Seetõttu esitame TKA/OA Vanguard-proteesil on kaks erinevat varianti: ühes kasutatakse sääreplaati koos I-Beam-varrega, teises aga plaati koos viimistletud varrega. Viimane hakkas ohu suhtarvu 95% usaldusvahemikuga revisjonide puhul UKR/OA Oxford tsementeerimata 8 407 358 Võrdlus Sigma-PKR 368 9 0,52 (0,27; 1,01) 0,05 ZUK 1 156 4S 0,74 (0,54; 1,02) 0,06 Muud 600 27 1,04 (0,70; 1,53) 0,86 Oxfordi tsementeeritud 662 51 1,10 (0,81; 1,51) 0,54 Triatlon Uni 914 49 1,10 (0,82; 1,49) 0,53 Link 1 382 92 1,29 (1,02; 1,63) 0,03 Persona-PK 323 15 1,34 (0,80; 2,25) 0,27 Sugu = naine 1,01 (0,86; 1,18) 0,91 Vanus 0,98 (0,97; 0,99) < 0,01 Operatsiooni aasta 1,03 (0,99; 1,06) 0,2 Tabel 6.5.2. Revisiiooni riskisuhe 95% usaldusvahemikuga RFP/OA 2014–2023. Üksused, mille tulemused on oluliselt paremad või halvemad kui riiklik keskmine, on näidatud vastavalt rohelise ja punase värviga. 1 9 1 | ROOTSI KARDIO-PLASTILISE KIRURGIA REGISTER 2024 eraldi patella komponendiga ja ilma selleta. Tabelites on põlvekapsli komponendiga (tabel €i.5.4). Selle liigituse mudelid, mida kasutatakse nii patella komponendiga kui ka tulemusena väheneb analüüsiks kättesaadavate implantaatide ilma selleta, loetletud eraldi. Kõik muud mudelid, sealhulgas arv, eriti rühmas, kus on kasutatud põlvekapsli komponenti. revisioonimudelid, on liigitatud kategooriasse „muud”. Võrreldavate rühmade analüüsimiseks oleme teatud rühmad ühendanud võrreldes tabelis C.5.1 esitatud klassifikatsiooniga. Oleme jaganud TKR/OA kaks rühma: need, mida kasutatakse ilma põlvekapsli komponendita (tabel 6.5.3), ja need, millel on Riskisuhe 95% usaldusvahemikuga patellakomponendita TKR/OA korduvoperatsioonidel NexGen MBT 63 764 1 321 Võrdlus PFC Sigma TKA APT 5 160 94 0,74 (0,60; 0,91) < 0,01 Vanguard I-Beam Modular 1 303 45 1,19 (0,88; 1,61) 0,25 Triathlon MBT tsementeeritud 11 225 243 1,19 (1,04; 1,36) 0,01 PFC Sigma TKA MBT 20 708 597 1,28 (1,16; 1,41) < 0,01 Muud 16 728 400 1,37 (1,22; 1,53) < 0,01 Triatlon MBT tsementeerimata 6 565 214 1,57 (1,36; 1,82) < 0,01 Legion/Genesis II Pri MBT 2 081 107 2,44 (2,00; 2,97) < 0,01 Sugu = Naine 0,92 (0,85; 0,98) 0,02 Vanus 0,98 (0,98; 0,99) < 0,01 Operatsiooni aasta 1,00 (0,98; 1,01) 0,69 Tabel 6.5.3. Riskisuhe korduvoperatsioonile koos 95% usaldusvahemikuga TKR/OA puhul ilma patella komponendita 2014–2023. Ühikud, mille tulemused on oluliselt paremad või halvemad kui teoreetiline keskmine, on vastavalt rohelise ja punase värviga märgitud. Riskisuhe koos 95% usaldusvahemikuga põlveliigese asendamise korduvoperatsioonil (TKR) ja põlveliigese artriidi (OA) korral, kui kasutatakse põlvekedra komponenti NexGen MBT 978 28 Viide PFC Sigma TKA APT 317 S 0,48 (0,18; 1,26) 0,13 Triathlon MBT tsementeerimata 329 7 0,83 (0,35; 1,96) 0,67 PFC Sigma TKA MBT 962 27 0,87 (0,52; 1,49) 0,62 Triatlon MBT tsementeeritud 322 7 0,90 (0,39; 2,06) 0,8 Attune MB TKA 222 4 0,97 (0,32; 2,91) 0,96 Muud 524 16 1,08 (0,58; 2,00) 0,81 Legion/Genesis II Pri MBT 190 10 1,92 (0,93; 3,95) 0,08 Sugu = Naine 0,45 (0,31; 0,67) < 0,01 Vanus 1,00 (0,98; 1,02) 0,68 Kirurgiline aasta 1,01 (0,93; 1,10) 0,74 Tabel 6.5.4. Revisiooni riskimudel 95% usaldusvahemikuga TKR/OA puhul, millel on patella komponent, 2014–2023. Üksused, mille tulemused on riiklikust keskmisest oluliselt paremad või halvemad, on vastavalt rohelise ja punase värviga märgitud. 1 9 2 | ROOTSI ARTROPLASTIKA REGISTER 2024 The German Arthroplasty Registry (EPRD) Annual Report 2024 2024 EPRD- Annual Report EPRD Deutsche Endoprothesenregister gGmbH Straße des 17. Juni 106–108 10623 Berlin Phone: +049-30-3406036-40 Fax: +049-30-3406036-41 Email: [email protected] www.eprd.de Annual Report 2024  The German Arthroplasty Registry An initiative of the German Society for Orthopaedics and Orthopaedic Surgery (DGOOC) Imprint with partners EPRD Deutsche Endoprothesenregister gGmbH Straße des 17. Juni 106–108 10623 Berlin Phone: +49-(0)30-3406036-40 Fax: +49-(0)30-3406036-41 Email: [email protected] Annual Report 2024 www.eprd.de Authors: Alexander Grimberg, Stephan Kirschner, Jörg Lützner, ©2024 EPRD Oliver Melsheimer, Michael Morlock, Arnd Steinbrück ISBN: 978-3-949872-05-1 Managing Director: DOI: 10.36186/reporteprd112025 Timo Stehn Bibliographic Information of the German National Library: Executive Committee of the EPRD: The German National Library lists this publication in the German Na- For the DGOOC: tional Bibliography; detailed bibliographic information is available on the Klaus-Peter Günther, Karl-Dieter Heller, Bernd Kladny, internet at http://portal.dnb.de. Carsten Perka (Spokesperson), Heiko Reichel, Dieter Wirtz Typeset and designed by: Corinna Märting, Berlin For the health insurance providers: Sascha Dold, Claus Fahlenbrach, Thomas Hopf, Dorothee Krug, Jürgen Malzahn (Deputy Spokesperson), Christian Rotering Copyrights: Images: For the manufacturers: Prof. Carsten Perka, MD: Charité/Wiebke Peitz; Achim Bagatsch, Björn Kleiner, Marc Michel, Michael Morlock, Prof. Klaus-Peter Günther MD: UKD; Michaela Münnig (Deputy Spokesperson), Matthias Spenner Prof. Arnd Steinbrück, MD: Arlett Mattescheck, Thomas Hedrich; Prof. Bernd Kladny MD: Intercongress; Dr. Carola Reimann: AOK health insurance provider, media services; Ulrike Elsner: vdek/G. Lopata; Michaela Münnig: private Illustrations on pp 16, 20, 21 and 47: © EPRD For better readability, we refrain from gender-specific wording in the text. We are very grateful to the members of the working groups for This publication is inclusive of the male, female and diverse genders. their suggestions and feedback regarding this annual report! Message from the Scientific Advisory Board of the EPRD Prof. C. Perka, MD Prof. K.-P. Günther, MD Prof. A. Steinbrück, MD Chair, Scientific Advisory Board Scientific Advisory Board Scientific Advisory Board (International Relations) (Study Coordination) As scientific directors of the EPRD, we are and patient mortality. Although, in Ger- delighted to present the most recent annual many, total hip arthroplasty (THA) has been report on the latest developments in arthro- established as a safe procedure for older pa- plasty quality. We would also like to bring to tients (> 90 years), the stem design appears your attention a number of national and in- to influence the rate of early revisions and ternational developments that are having an post-operative mortality, independently of impact on or that are directly related to the the type of fixation (cemented or unce- registry work now and in the near future. mented) used. These results are particularly relevant for the ageing demographic and With data collection spanning 12 years and have therefore been published in high impact approximately 3 million data sets docu- factor, international, journals. mented, the EPRD is not only one of the world’s largest registries, but also allows to In terms of health policy, the positive associ- draw relevant conclusions about the quality ation between the number of procedures per- of hip and knee arthroplasties performed in formed by a given hospital and arthroplasty Germany. This year’s report confirms the ef- quality, which has been analysed in the fects of implant-related and general non-im- EPRD for some time now, has increasingly plant-related factors on implant survival that featured in the current health-policy debates. began to emerge in the last few years. The A statement by the government commission, extensive scope of available data has also en- prepared as part of the health reform, re- abled analyses that, for example, help to ferred to the EPRD evidence that supports clarify the association between arthroplasty these volume effects. Beyond hospital case 5  numbers, other features of the structural and to collect additional clinical data to identify proach to be a significant step down from the process quality of arthroplasty centres also any other factors that may impact arthro- current evaluation standard. We are never- need to be included in the health policy meas- plasty outcome. From 2025, for instance, the theless working tirelessly to find solutions ures that have already been initiated, which type of surgical approach for hip arthroplas- that would allow reciprocal sharing of the is why the close co-operation between the ties and the use of computer navigation and collected data, in order to safeguard arthro- EPRD and the EndoCert© initiative, which robotics in knee arthroplasty, will also be re- plasty quality. To minimise the documenta- is also supported by the DGOOC, is of great corded. tion burden for hospitals that continue to importance. participate in the EPRD, we are also explor- Furthermore, starting next year, all EPRD ing options for interface optimisation with The international significance of our registry hospitals will be able to use the Oxford Hip the Hospital Information System (HIS) pro- work in Germany is also reflected in the fact Score (OHS) and Oxford Knee Score (OKS) viders, to enable parallel IRD and EPRD that the inaugural congress of the Interna- for their patients, free of charge. The EPRD data entry. tional Society of Arthroplasty Registries has developed a digital solution to collect pa- (ISAR) was held in Hamburg in May 2024. tient-reported outcomes from the PROM In the context of the currently initiated, The EPRD presented its latest analyses which (Patient Reported Outcome Measures) ques- health policy driven, reorganisation of the were well received at the meeting and al- tionnaires. The objective is to minimise the healthcare landscape, it is particularly im- lowed participants to agree to designate the response burden on hospitals whilst collect- portant to emphasise that a high-quality ar- EPRD’s "product database", which serves to ing reliable preoperative as well as 6 and 12 throplasty registry can serve as a central ele- characterise implant components, and has months post-operative data. Participating ment of national quality assurance. We already been harmonised with the British hospitals simply generate a QR code, via the would therefore like to take this opportunity registry, as the future mandatory standard EPRD’s PROM portal, before the surgery, to express our sincere thanks for the many for all registries worldwide. We attribute this and patients then complete the surveys them- years of data transmission and hope that the remarkable achievement to the many years selves. information contained in this year’s annual of close co-operation between the manufac- report will continue to support your daily turers, health insurance funds and the pro- Another very important development is the work and help you select the most effective fessional society in our registry! inclusion of arthroplasty in the Implant Reg- arthroplasty strategy for your patients. ister Germany (IRD), albeit that the specific The increasing international visibility also repercussions of this development on the means that the EPRD evaluation criteria EPRD and participating hospitals are as yet need to be aligned with international stand- unclear. Even though the German Federal ards. It also inevitably entails other changes. Ministry of Health (BMG) is planning to in- To name but one, as of this year, secondary troduce this reform in January 2025, there is patellar resurfacing will be evaluated as a re- currently still a lack of essential information vision operation, although many surgeons on the recording system to be used. What is do not consider the procedure to represent a evident at this stage is that the IRD’s cur- failure of the primary implant. rently planned case documentation includes fewer clinically relevant details than we strive What changes can be expected for the EPRD’s for in the EPRD. Moreover, we consider an participating hospitals? First of all, we want exclusive IRD-based data collection ap- 6 EPRD Annual Report 2024 7  Statements from the EPRD partners The German Arthroplasty Registry (EPRD) will continue its work to improve arthroplasty quality and patient safety even after the planned start of hip and knee arthroplasty data col- lection by the Implant Register Germany (IRD). The following statements from EPRD part- ners confirm that this objective is the cornerstone of a constructive co-operation. As General Secretary of the German Society From the time of its inception 12 years ago, for Orthopaedics and Orthopaedic Surgery the EPRD has processed around three mil- (DGOOC) and representative of the sole lion data sets that provide information on shareholder of EPRD gGmbH, the arthro- the quality of arthroplasty implants, the fre- plasty registry is very close to my heart. In 12 quency of operations, and, above all, on ar- years of a unique partnership between the throplasty survival. Around 730 hospitals professional association, public health funds participate by submitting data. The level of and industry, we have built up an interna- transparency provided by the hospitals is an tionally and nationally renowned registry. important contribution to improving arthro- All partners benefit, especially our patients. Prof. Bernd Kladny, MD plasty quality and patient safety. We appeal I urgently appeal for the EPRD, with its General Secretary of the to the government to use the expertise and German Society for Orthopae- wealth of data and all of its established struc- wealth of data gained in over a decade of Ulrike Elsner dics and Orthopaedic Surgery tures, to be preserved and for the govern- EPRD activity towards the development Full-time Chair of ment-run IRD arthroplasty registry to work of the German implant registry and we call the vdek Board together with the EPRD to benefit both sides. for co-operation. The goal is, after all, to It is essential that the EPRD continues to re- provide people with the best possible hip and ceive data. knee arthroplasties. The journey has been long and challenging, but it was worth it. After 12 years of work, the EPRD, which is supported on an equal The EPRD has been providing valuable data footing by doctors, manufacturers and pub- and analyses on the quality of joint replace- lic health funds, delivers results at the highest ments for over 12 years now. Clinicians, in- scientific level. The EPRD’s analyses also at- dustry and public health funds have joined tract international attention and are con- forces to record and continuously improve stantly being developed further. This report arthroplasty quality. But the EPRD is more again demonstrates how valuable data col- than just a registry – it is a roadmap for the lection and the associated results transpar- German statutory implant registry, the IRD. ency are for improving arthroplasty quality What we need now is intensive co-operation and patient safety. So far, the statutory im- Michaela Münnig between these two entities. It is all about plant registry has not utilised the EPRD’s BVMed (German Medical Technology learning from valuable experiences and capi- Dr. Carola Reimann Association) spokesperson for the data and experience in any meaningful way. talising on existing data. Our vision: A close Chair of the AOK Board manufacturers on the EPRD Executive The IRD therefore falls considerably short of Committee collaboration between the EPRD and IRD to its potential. We need to work together to safeguard arthroplasty quality over the long- find solutions that benefit all participants term. and, above all, the patients. 8 EPRD Annual Report 2024 9  Table of contents List of Abbreviations List of Abbreviations...............................................................................................................................................11 Abbreviation Definition 1 Introduction..........................................................................................................................................................12 AOK German regional health insurance provider (stands for: Allgemeine Ortskrankenkasse Bundesverband eGbR) 2 Registry development........................................................................................................................................14 ASA American Society of Anaesthesiologists physical status 3 Summary of statistical methodology and data linkage...............................................................................20 classification system 4 The 2023 operating year...................................................................................................................................30 BMG German Federal Ministry of Health (stands for: Bundesministerium für Gesundheit) 4.1 Primary hip arthroplasties������������������������������������������������������������������������������������������������������������������������ 30 BMI Body Mass Index 4.2 Hip arthroplasty revisions������������������������������������������������������������������������������������������������������������������������� 36 BVMed German Medical Technology Association 4.3 Primary knee arthroplasties��������������������������������������������������������������������������������������������������������������������� 39 (stands for: Bundesverband Medizintechnologie e. V.) 4.4 Knee arthroplasty revisions���������������������������������������������������������������������������������������������������������������������� 44 CR Cruciate-Retaining 4.5 Mismatch detection in the EPRD������������������������������������������������������������������������������������������������������������� 47 CReRR Cumulative Re-Revision Rate 5 Hip and knee arthroplasty survival.................................................................................................................52 CRR Cumulative Revision Rate 5.1 Primary hip arthroplasty survival���������������������������������������������������������������������������������������������������������� 53 CS Cruciate-Sacrificing 5.1.1 Comparison by type of primary hip arthroplasty 53 DGOOC German Society for Orthopaedics and Orthopaedic Surgery (stands for: Deutschen Gesellschaft für Orthopädie und Orthopädische 5.1.2 Non-implant-related factors in primary hip arthroplasty 59 Chirurgie e. V.) 5.1.3 Impact of implant characteristics in primary hip arthroplasty 68 HIS Hospital Information System 5.1.4 Outcomes for specific combinations of hip components 82 hXLPE Highly cross-linked polyethylene 5.2 Revision hip arthroplasty survival���������������������������������������������������������������������������������������������������������� 97 ICD-10 10th revision of the International Classification of Diseases 5.3 Primary knee arthroplasty survival�����������������������������������������������������������������������������������������������������104 ICPM International Classification of Procedures in Medicine IRD Implant Register Germany (stands for: Implantateregister Deutschland) 5.3.1 Comparison by type of primary knee arthroplasty 104 ISAR International Society of Arthoplasty Registries 5.3.2 Non-implant-related factors in primary knee arthroplasty 108 mXLPE Moderately cross-linked polyethylene 5.3.3 Impact of implant characteristics in primary knee arthroplasty 116 NJR National Joint Registry (which covers England, Wales, Northern Ireland, 5.3.4 Outcomes for specific combinations of knee components 124 the Isle of Man and Guernsey) 5.4 Revision knee arthroplasty survival����������������������������������������������������������������������������������������������������140 OHS Oxford Hip Score 5.5 Survival trends�����������������������������������������������������������������������������������������������������������������������������������������146 OKS Oxford Knee Score 6 Patient mortality...............................................................................................................................................152 PE Polyethylene 7 Summary............................................................................................................................................................158 PROM Patient Reported Outcome Measures PSI Patient-Specific Instrumentation Glossary..................................................................................................................................................................164 THA Total Hip Arthroplasty Additional results tables......................................................................................................................................172 TKA Total Knee Arthroplasty References..............................................................................................................................................................188 UHMWPE Ultra-high-molecular-weight polyethylene List of figures.........................................................................................................................................................190 vdek German statutory health insurance provider List of tables...........................................................................................................................................................192 (stands for: Verband der Ersatzkassen e. V.) Publications based on EPRD data......................................................................................................................195 yrs years 10 EPRD Annual Report 2024 11  1 Introduction The German Arthroplasty Registry (EPRD) survival analysis. The EPRD has since revised began collecting data on hip and knee im- these definitions (to reflect international con- plants 12 years ago. In that time, the EPRD ventions) and now categorises any procedure has documented, almost 3 million procedures involving the removal or exchange of im- from data provided on a strictly voluntary plant components or complementary surgery basis. The long-term evolution of 1 million of as the endpoint of the survival analysis (also these procedures is already being monitored refer to page 24). by participating public health funds. The basic structure of the 2024 annual re- However, the roll-out of the Implant Register port follows that of previous reports. There Germany (IRD) next year does not mean the is, however, a stronger visual distinction be- end of the EPRD. After all, the potential of tween the hip and knee arthroplasty sections previously collected data also needs to be ex- in this year’s report. Chapter 2 provides a ploited in the future. The EPRD therefore brief summary of the registry’s development, aims to continue to provide reliable informa- up to the end of the 2023 operating year, and tion on arthroplasty quality and to identify outlines future developments. Chapter 3 then opportunities for improvement. The German describes the unique structure of the EPRD, Society for Orthopaedics and Orthopaedic its data sources and methods. This informa- Surgery e. V. (DGOOC), together with indus- tion provides the background for analyses try partners and public health funds, have presented in the following chapters. therefore committed to continuing, and in some instances even expand, EPRD data col- Analyses are subdivided into two main sec- lection over the next few years. tions. Chapter 4 first describes the registry documentation for the calendar year 2023 Since its inception in 2012 the EPRD has and compares current arthroplasty practices added a number of new variables to its data to previous years. This is followed by two collection, including patient height and detailed analysis chapters: Chapter 5 evalu- weight, and has also refined the evaluation ates the survival rates of arthroplasties that criteria. Numerous basic definitions have are under observation and Chapter 6 analy- nevertheless remained unchanged. The EPRD ses the post-operative mortality rate of ar- previously classified an isolated insert ex- throplasty patients, though it should be change, as an endpoint of the previous ar- noted that patient mortality need not be di- throplasty, whilst a subsequent complemen- rectly associated with the arthroplasty itself. tary patellar resurfacing operation was sim- Chapter 7 then briefly summarises the most ply noted but not included in the arthroplasty significant findings of the report. 12 EPRD Annual Report 2024 2 Registry development   2 Registry development History to date It remains to be seen whether these latest in- 800 720 725 734 754 754 726 800 creases are sustained or whether they reflect Number of hospitals providing data 709 700 680 700 The EPRD was launched in November 2012 a catch-up effect from the coronavirus pan- © EPRD Annual Report 2024 600 600 as part of a trial period during which a few demic. Interestingly, the increase in proce- 544 pilot hospitals submitted their surgical docu- dure volumes from 2022 to 2023 is predomi- 500 500 mentation to the registry. In early 2014, the nantly due to increases in knee arthroplasties. 400 400 EPRD was opened up to all interested hos- The hip arthroplasty volume only increased 300 258 300 pitals. The annual number of documented by 6,634 cases, whereas 17,914 additional procedures has risen continuously since then, knee arthroplasties were documented. 200 200 with the exception of 2020 and 2021, when 100 75 100 submission volumes decreased due to the Although the number of documented pro- 17 0 0 Covid-19 pandemic. Subsequent procedure cedures has risen significantly, the number 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 volumes have recovered quickly and have of hospitals submitting data has markedly even set new records since then. In 2023, a decreased for the first time. Whilst 754 hos- Figure 2: Number of hospitals submitting data each year. A hospital is considered a “data provider”, if it submitted at total of 378,812 data sets were submitted, pitals were submitting data to the EPRD in least one surgical document to the EPRD during the calendar year. which corresponds to an increase of almost 2022, this figure dropped to 726 hospitals 7% compared to 2022. Figure 1 summarises in 2023 due to mergers and facility closures the annual procedure volume. (see Figure 2). Future developments Data collection will be extended in the com- ing years. Hospital and patient participation in the EPRD and support for the registry have The EPRD will start collecting surgical ap- 449 378,812 been consistently strong for many years. proach data for primary hip arthroplasties, 375,000 © EPRD Annual Report 2024 345 354,162 375,000 The Implant Register Germany (IRD) will which will become mandatory in the IRD. 350,000 350,000 375 348 298 be launched on the 1st of January 2025 and From next year, the EPRD will also include 325,000 Total femoral replacements 325 319,144 325,000 300,000 Knee arthroplasty 19 303,708 295,058 310,429 300,000 renders the registration of all hip and knee the option of specifying whether the primary 287,397 171,790 275,000 Hip arthroplasty 153,876 275,000 replacement treatments mandatory in Ger- knee arthroplasty was performed with pa- 1 250,000 249,678 140,783 130,984 250,000 many. It will take several years before the tient-specific instrumentation (PSI), computer- 133,871 225,000 127,372 127,062 225,000 IRD can provide any meaningful analyses. assisted navigation or robot assistance. 200,000 109,884 200,000 The EPRD will therefore continue its activ- To reduce irrelevant prompts, options will 175,000 175,000 149,827 ities. be automatically preselected, e.g. if the same 150,000 150,000 surgical approach is consistently selected or 125,000 125,000 100,000 64,838 199,941 206,573 100,000 To help minimise the burden of dual data if computer-assisted surgical procedures are 75,000 139,793 160,006 169,512 177,986 167,648 179,147 75,000 entries for hospitals, the EPRD will offer all not available in the facility. From 2025, hos- 56,905 50,000 24,479 84,989 50,000 HIS providers a transfer interface from Jan- pitals with a strong focus on periprosthetic 25,000 18,598 32,426 25,000 uary 2025. This will allow the IRD data set infection and not deterred by the additional 695 0 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 0 to be simply transferred to EPRD-Edit along workload can access an optional infection with the patient master files. The EPRD will module for revisions listed as due to "infec- Figure 1: Annual procedure volume by operation date. The total number of documented procedures is shown in black above supply the corresponding specifications to tion". This allows to collect additional data the respective bar. the HIS providers before the end of 2024. on the diagnostics and treatment of peri- 14 EPRD Annual Report 2024 15  2 Registry development  prosthetic infections for use in future eval- their outcomes with them" when changing uations. hospitals. The second major project planned for the registry in 2026 is to start collecting In 2023, the EPRD began a trial period to shoulder arthroplasty data. collect PROM (Patient Reported Outcome Analyses for participating hospitals and manufacturers Measures) questionnaires, i.e. the subjective assessment of treatment outcome by the pa- In brief tients themselves. From 2025, this test phase will transition to regular operations. This • In 2023, a record number of more than Selected EPRD analysis results are presented in In addition, the EPRD has established an early means that, starting next year, all patients in 378,000 procedures were documented in the annual reports and published in international warning system. The outcomes of all implants hospitals that provide a PROM assessment the EPRD. journals. Participating hospitals and manufactur- and implant combinations included in the EPRD will be able to complete this survey. • From 2025, the EPRD will start collecting ers also receive individual reports: are monitored automatically and, in the event of surgical approach as well as computer- statistical outliers, discussed by a panel of ex- Two major projects are planned for 2026. assisted surgery data for primary hip and • Each spring, hospitals supplying data receive a perts. If the EPRD classifies an outlier as a poten- Firstly, the EPRD will offer a voluntary op- knee arthroplasties, respectively. descriptive comparison of the arthroplasty proce- tially medically relevant abnormality, it contacts tion for documenting the surgeons perform- dures they performed in the previous year and the the manufacturer concerned and, if necessary, • From 2025, participation in the collection ing the arthroplasty and in the future pro- total number of cases documented in the EPRD the hospital in question and asks them to respond. of arthroplasty PROM questionnaires will vide surgeons with personalised outcome during this period. This summary, for instance, in- be extended to all hospitals. reports on their procedures. These outcomes dicates whether a hospital differs from other par- These measures ensure that the EPRD can iden- • A voluntary option for documenting ar- are treated with absolute confidentiality ticipating hospitals in terms of the types of arthro- tify and address potential implant issues at an throplasty surgeons will start in 2026. and are only made available to the respec- plasties performed or the types of stems used. early stage. The close co-operation between the tive surgeon. Surgeons will be able to "take EPRD, manufacturers and hospitals, therefore Since 2018, the EPRD also provides hospitals with serves to the continuous improvement of arthro- half-yearly evaluations that provide detailed in- plasty safety and quality. formation on the arthroplasty survival rates and comparisons with other hospitals. An important component of these analyses are the funnel plots, as explained and shown on page 18. At the end of 2023, analyses were further expanded to include adjusted outcomes that take into account specific patient-related factors. • At the end of each year, participating implant manufacturers receive comprehensive evalu- ations of arthroplasties that use their products. These include both descriptive summaries and evaluations of implant survival. The analyses are so detailed that manufacturers can see exactly how the procedures carried out with their respec- Illustration 1: Extract from the online PROM questionnaire of the Oxford Hip Score. The text shown reads: Welcome tive prosthetic systems and subsystems fare – e.g. to the survey portal of the German Arthroplasty Registry!; Hip Surgery Questionnaire - Oxford Hip Score; © Oxford University Innovation Limited, 1996, All rights reserved; Questions about your left hip; During the past 4 weeks… in specific age groups or when restricted to ar- 1. How would you describe the pain you usually have from your hip? None / Very mild / Mild / Moderate / Severe; throplasties with specific characteristics. Back / Continue. 16 EPRD Annual Report 2024 17  2 Registry development Funnel plots for inter-hospital comparisons Funnel plots summarise the clinical outcomes revisions over the expected number of revisions. for the different hospitals. Each individual hos- Thus, if more revisions than expected were ob- pital is represented as a dot. The location of served for a given hospital, the dot on the y-axis is each dot on the graph indicates how many of above 1; if observation and expectation coincide, the primary arthroplasties performed by a given the dot is exactly at 1; otherwise it is below 1. The hospital actually required a revision (observed dot circled in black denotes the specific hospital number of revisions) and how many revisions being evaluated in the half-yearly review. would have been expected had the risk of revi- sion over time been the same for all hospitals. The graph also includes a horizontal dark grey ex- The number of revision arthroplasties of a given pectation line extending from 1 as well as upper hospital is expected to increase as the number of and lower 95% confidence intervals represented documented arthroplasties, and their follow-up as dashed light grey lines. Dots above the upper times, increase. The calculation is stratified for light grey line represent hospitals that performed the different types of arthroplasties. significantly more revisions. Hospitals below the lower line performed significantly fewer revi- The x-coordinate of individual dots corresponds sions. The light grey dotted lines converge into a to the number of expected revisions and the y-co- funnel from left to right, giving the funnel plot its ordinate represents the ratio of the number of name. © EPRD Annual Report 2024 Considered for your hospital: 97 Primary arthroplasties 4 Observed for your hospital: 8 Revisions Expected for your hospital: 2.65 Revisions Standardised revision ratio 3 2 Worse 1 Better 0 0 20 40 60 80 100 120 Expected number of revisions 18 EPRD Annual Report 2024   3 Summary of statistical methodology and data linkage 19   3 Summary of statistical to be grouped together for analysis purposes. The product database is continuously im- proved and corrected. As these changes may from then on independently check the system for changes to the patient’s arthroplasty and status. Any revisions and censoring events, methodology and data linkage have an impact on the results of the analysis, the annual report also retrospectively re-eval- uates data sets from previous years based on such as the death of a patient, are then auto- matically reported to the EPRD by the fed- eral health insurance association. This means the current version of the product database. that the EPRD also gets notified about revi- Health insurance provider Hospital Implant manufacturer To some extent this limits comparisons of the sions that have not been directly documented results presented in this report with previous in the registry. Although the EPRD, as a vol- Information annual reports. untary registry, cannot guarantee complete about product coverage of procedures performed in hos- • A major hallmark of the EPRD is its pitals, the collaboration with public health Case-based routine data Product identification collaboration with the German federal as- funds enables an almost 100% follow-up of sociations of health insurance providers registry cases. Routine data for current Registry documentation Product database (AOK-Bundesverband eGbR and the Ver- and follow-up cases band der Ersatzkassen e. V (vdek)). By con- Individual chapters from this annual report senting to participate in the registry, the pa- draw on a variety of data sources: The purely tients agree that their health insurance fund descriptive analysis of the current arthro- Basic and classification may provide the EPRD with additional in- plasty situation described in Chapter 4 is EPRD information formation – in accordance with data protec- based on registry documentation and data tion regulations – on both the documented from the product database. For Chapter 5, surgery and any subsequent revisions. The which analyses and evaluates arthroplasty Illustration 2: The flow of data from hospitals, health insurance providers and implant manufacturers to the EPRD German ICPM and ICD codes contained in survival rates, the routine data from the public this routine data, allow the EPRD to derive health funds is indispensable. For a voluntary details about the procedure and its accom- registry such as the EPRD, it is essential to The EPRD essentially obtains its data from submitted to the registry, but the hospitals panying circumstances. Once the health in- consider all these data sources to ensure that three sources: the registry documentation of document exactly which components were surance provider has reported the relevant none of the revisions or censored cases are the participating hospitals, the product data- implanted during the procedure – usually by patient data to the EPRD, the former will missed, and to draw meaningful conclusions base provided and maintained by the partic- simply scanning the product barcode. ipating implant manufacturers, and from the routine data of the participating health in- • Participating implant manufacturers en- surance providers. Illustration 2 and the fol- ter information about their products into the lowing description explain the data and how EPRD product database. The database not the data from the three sources is combined: only contains basic product information, e.g. part number and trade name, but also more • With the patient’s consent, participating detailed classification data including specific hospitals may document arthroplasty proce- information about material, size, condition, dures directly into the EPRD (Illustration 3). etc. The product database has been further The EPRD uses this registry documentation refined in recent years through international to extract basic information about the proce- exchange with the National Joint Registry dure and the patient. This includes the date (NJR) in the UK and currently contains data of the operation, the joint operated on, the on over 75,000 individual products. The clas- type of procedure, as well as the patient’s sification data can be linked directly to the age, sex, height and weight (since 2017), registry documentation via the documented and the patient’s general health status via part numbers. This allows the reported reg- the ASA classification (since 2020). No in- istry documentation to be categorised and Illustration 3: There are several options to enter registry documentation, including the EPRD‘s in-house solution, formation allowing patient identification is arthroplasties with the same characteristics EPRD-Edit. 20 EPRD Annual Report 2024 21  3 Summary of statistical methodology and data linkage  about implant survival rates. Since the EPRD 5.3.4 , it should therefore be noted that these a patient dies, the respective public health only receives routine data for patients insured represent the endpoint of the arthroplasty fund provides the EPRD with the month of with one of the regional health insurance pro- analysis for specific implant systems and not death but not the exact day of death. For the viders (Allgemeine Ortskrankenkasse) or one necessarily a revision of the component itself. purposes of this report, the EPRD defines the of the other statutory health insurance pro- day of death as the day in the middle of the viders (Ersatzkasse), the data sets of patients 2. The time interval between different re- month during which the patient died. For from other health insurance providers are not visions on the same joint (sections 5.2 and calculating the patient mortality rate, only included in the survival analysis. Not all pro- 5.4): Only revisions of primary arthroplas- the end of follow-up is considered to be a cedures registered in the EPRD are therefore ties already documented in the registry are censoring event. Revisions or additional ar- included in these analyses. considered as the starting point for the cal- throplasties are not considered to be censor- culation. For first revisions carried out in ing events. In order to ensure the highest possible data two stages – i.e. with components explanted quality, the EPRD thoroughly reviews in- and re-implanted at two different dates – the The following text boxes provide more de- coming data sets for plausibility and consist- second follow-up starts at the re-implanta- tailed information about the methodology ency and notifies the hospitals of any doc- tion. The registry does not have a complete and the illustrations shown in the sections umentation issues. Routine data from the medical history for most revisions since the below. health insurance providers is also included corresponding primary arthroplasties pre- in these reviews to identify any inconsisten- date EPRD data collection. In some cases, cies. The EPRD excludes all data sets with however, the complete arthroplasty history In brief conflicting or ambiguous information from is recorded in the registry, starting with the the analysis until these issues have been re- primary surgery. Any subsequent revisions in • Descriptive analyses are entirely based on solved. The current annual report is based these particular cases are therefore amenable the registry documentation. on survival data from more than 1,150,000 to further analyses. The registry also records • Arthroplasty revision and arthroplasty primary arthroplasties and 125,000 revision the reasons for revisions which allows to patient mortality analyses are restricted procedures under follow-up from November differentiate infection-related from non-in- to data sets for which participating health 2012 to September 2023. fection-related revisions. This is further insurance funds have provided data. confirmed by the code T84.5 (infection and • The 2024 EPRD report analysed 1,150,000 The survival of different types of arthroplas- inflammatory reaction due to internal joint primary arthroplasties and 125,000 revi- ties and arthroplasty systems is evaluated prosthesis) listed as a primary or secondary sions. based on the incidence of a first revision or a diagnosis in the health insurance data. repeat revision (re-revision) over time. Chap- ter 5 of this annual report therefore focuses Patient-specific censoring events include, on two different timelines: amputation of the leg, death of the patient, and the end of follow-up due to the patient 1. The time interval between the primary changing health insurance provider. For cases arthroplasty and the first revision involving that are still under observation and where changes to the prosthesis (sections 5.1 and neither the respective end point nor a censor- 5.3): If, the revision procedure subsequent ing event has been reached, the period evalu- to a primary arthroplasty, replaces, removes ated extends to the time point of the current or complements at least one component of evaluation. For censoring events it extends to the prosthesis, this is considered as the end- the time point of the event. point of the primary arthroplasty and of all implanted components. This definition does Chapter 6 addresses patient mortality after not differentiate implant components that primary arthroplasties and revisions1. When were actually replaced from those left in situ. In terms of the revision rates of specific im- 1 Similarly to the arthroplasty revision analyses, only one-stage re- visions and re-implantations as part of a two-stage revision are con- plant systems presented in sections 5.1.4 and sidered here. 22 EPRD Annual Report 2024 23  3 Summary of statistical methodology and data linkage  Major changes compared to previous years: Modified approach to secondary patellar resurfacing Presentation of descriptive results in Chapter 4 In previous annual EPRD reports, a subsequent complementary patellar resurfacing operation was not included in In Chapter 4, data sets submitted to the EPRD are categorised separately by type of arthroplasty with the following the arthroplasty survival rate analysis even if the procedure was combined with exchange of insert components. descriptive parameters determined for each category: The EPRD has now revised its position on this classification. From 2024 onwards, the EPRD will generally consider secondary patellar resurfacing to constitute an endpoint of primary arthroplasty. The rationale for this modifica- Parameter Explanation tion is based on the following: Proportion [%] Percentage of procedures in each category Median age in years of patients in this category. Thus, at least 50% of patients in this catego- • Better international comparability: The EPRD is • More consistent evaluation of revisions: For prima- Age ry are not older and at least 50% are not younger than this age. aligning itself with other international arthroplas- ry arthroplasty with patellar resurfacing, a subse- m/f [%] Percentage of male and female patients in this category. ty registries, such as the the NJR in the UK, which quent re-operation counted as the endpoint of the started classifying any subsequent patellar resur- primary procedure. In cases without primary pa- Median BMI of patients in this category. In each case, the figure refers to the subgroup of BMI facing procedures as revisions many years ago. tellar resurfacing, however, subsequent resurfac- these patients for whom valid data on weight and height has been provided. ing was considered as a complementary operation ASA Mean ASA classification of the patients in this category. • Better comparability of arthroplasties with or rather than an endpoint. In this context, arguing that without primary patellar resurfacing: Prior to an isolated insert exchange should be classified as 2024, primary arthroplasties with patellar resur- the endpoint of arthroplasty survival is inconsistent The documentation is classified into the different ar- lines in the "Age", "BMI" and "ASA" columns respectively, facing have been difficult to compare to procedures and remains challenging to convey. throplasty categories. This is based on the products spanning ranges from 50 to 90 years, 20 to 35 points, documented for the procedure and the classification and ASA I to V. The further left a line is, the younger the where patellar resurfacing was not part of the pri- information stored in the product database. As a rule, patients are or the lower the BMI or ASA classification mary arthroplasty. The reason: Reoperations to ad- • The revision rate of secondary patellar resurfacing the categories are designed so that they do not overlap. of the patients in this category. The sex ratio is repre- dress problems associated with primary patellar is not independent of the knee system used: Stud- Most stated percentages add up to 100%. They refer sented as two additional bars: A light blue bar for male resurfacing received a complete follow-up evalua- ies have shown that specific implant systems are to the total number of data sets to which the corre- patients and a pink bar for female patients. tion, whereas subsequent complementary patellar associated with a considerable increase in the rate resurfacing procedures were not given further con- of secondary patellar resurfacing. The definition Proportion [%] Age m/f [%] BMI ASA sideration. The EPRD anticipates that the amended change will ensure that implant system outcomes Category A 97.8 72 40 / 60 26.9 2.3 definition will reduce bias and allow results to be better reflect the overall risk. Category B 2.2 67 38 / 62 25.9 2.3 presented more clearly. Subcategory B1 0.4 59 48 / 52 26.6 2.1 Subcategory B2 1.7 70 37 / 63 25.7 2.4 This change significantly impacts how total knee arthroplasty (TKA) outcomes are presented. The TKA outcomes Subcategory B3 0.1 54 30 / 70 26.0 2.0 provided in the 2024 annual report are therefore not directly comparable with those of previous annual reports. In contrast to last year’s report, the 2024 report no longer includes the cumulative rate of secondary patellar resur- sponding rule could be applied. If analysis rules could There are two exceptions to the above rule where per- facing, as it is now considered the endpoint of the primary procedure. Instead, the outcomes for specific implant not be applied to data sets, for example because the centages indicated in the tables do not add up to 100%. systems now list primary arthroplasties with and without primary patellar resurfacing. classification was not known for all essential products, Firstly, indented category names that indicate subcate- these data sets were excluded from the corresponding gories of the category previously listed but not indented analysis. (also refer to tables 3, 18, 21, 23 and 36, among others). As illustrated in the example, descriptive results are Apart from rounding errors, the sum of all subcatego- presented in table format, and include numerical values ries adds up to their superordinate category. Secondly, for key parameters as well as additional graphic fea- tables 2, 17, 20 and 35, which describe the patients tures. In addition to percentages, the respective propor- treated in more detail, present the respective distribu- tions are depicted as horizontal bars, with longer bars tion by age, sex and BMI in different colours, with per- denoting larger proportions. Median age, median BMI centages for each of these three categories adding up and mean ASA, are symbolised by additional horizontal to 100%. 24 EPRD Annual Report 2024 25  3 Summary of statistical methodology and data linkage  Calculation of cumulative revision rates in Chapter 5 Cumulative revision rate tables Chapter 5 focuses on arthroplasty survival and cumu- • that censoring events such as patient death or am- Outcomes for primary arthroplasties in sections 5.1 to 5.4 are represented in tables and include the following key lative revision rates (CRRs). putation of the leg may prevent the follow-up of an parameters: arthroplasty. The EPRD defines the "arthroplasty failure" end- Parameter Explanation point as any arthroplasty subsequently requir- The results of estimates are presented as figures and ing the exchange or removal of components or tables (see the explanations below). Number of arthroplasties being followed up in the respective category. complementary surgery. Kaplan-Meier estima- The sum total from all displayed subcategories may be smaller than the total number listed tors are used to calculate the probability that no The reciprocal probabilities of the Kaplan-Meier esti- Number for the superordinate category. This may either occur because only subcategories for which such revision will be required within a certain time mators, i.e. the arthroplasty CRRs, are presented to- a minimum treatment threshold has been reached are included (see below), or because a subcategory cannot be assigned due to missing data. frame after the primary arthroplasty or first revision gether with their 95% confidence intervals. surgery, and that the arthroplasty will therefore remain Age Median age and the age quartiles of the patients who received these arthroplasties. in place. It should be noted, Most of the figure and table legends specify the corre- sponding p-value for the overall test of equal revision • that at the time of the analysis the monitoring of the rates. m/f [%] Percentage of male and female patients in this category. arthroplasty has not yet been completed in most cases and Median body mass index of arthroplasty patients. This value relates to the subgroup of BMI patients with valid BMI data. The tables on the outcomes of specific arthroplasty systems in sections 5.1.4 and 5.3.4 do not include BMI. Hosp. Number of hospitals documenting these arthroplasties. Cumulative revision rate graphs The years that specific arthroplasty systems under observation were implanted. These time Yrs implanted periods are only presented in the outcome tables for specific implant systems of sections CRRs are depicted as follows. The graphs present CRRs observation at a given time point, i.e. the total number 5.1.4 and 5.3.4. with their 95% confidence intervals. Tables below the of arthroplasties that did not require revision or where graphs indicate the number of arthroplasties under patients were not lost to follow-up for other reasons. The CRRs are given as a percentage for the respective implant system or specific implant combination. If the points in time. The number of arthroplasties under number of arthroplasties under observation is less observation at the respective time point is included than 150 at any one time, both the CRR and confidence in parentheses. For CRRs that do not approach 0, the intervals are shown in italics; if the number is less than Cumulative revision [%] 95 percent confidence interval is indicated in square 50, results are not reported. brackets. Results are only presented if at least 300 primary ar- throplasties from at least three different hospitals are available for the analysis of this type of arthroplasty, Years since primary Numbers 31,208 22,229 16,706 12,143 8,290 5,344 2,988 1,309 at risk 126,602 117,714 96,303 58,268 17,670 10,727 9,743 8,802 2,526 884 Representative example: of cumulative revision rates for two arthroplasty subgroups. 26 EPRD Annual Report 2024 27   4 The 2023 operating year 29  4.1 Primary hip arthroplasties 4 The 2023 operating year Between January 1, 2023, and December 31, ating year, i.e. procedures for which non-ap- Proportion [%] Age m/f [%] BMI ASA All primary hip arthroplasties 100.0 71 40 / 60 26.9 2.3 2023, the EPRD registered a total of 378,812 proved or unsuitable implant combinations hip and knee arthroplasty procedures. This were recorded. < 45 years 1.8 56 / 44 27.2 1.8 chapter details the documentation of these 45 to 54 years 6.3 50 / 50 28.7 1.9 procedures and describes emerging trends 55 to 64 years 21.8 48 / 52 28.1 2.0 4.1 Primary hip Hip since the EPRD’s inception. There has been 65 to 74 years 30.9 40 / 60 27.6 2.2 a recent shift in the ratio of hip to knee ar- arthroplasties 75 to 84 years 28.5 35 / 65 25.9 2.4 throplasties in the EPRD. Time will tell if this is a sustainable development or a delayed In 2023, the EPRD registered a total of ≥ 85 years 10.8 30 / 70 24.6 2.7 effect of the Covid-19 pandemic, i.e. defer- 187,640 primary hip joint surgeries. Ap- Male 40.1 69 100 / 0 27.5 2.3 ral of non-urgent procedures (also refer to proximately 40% of cases were men. The Female 59.9 73 0 / 100 26.3 2.3 page 14). proportion of men is considerably higher in Patients with BMI ≤ 25 33.8 75 31 / 69 2.3 younger age groups, and steadily decreases Patients with BMI > 25 to 30 36.0 71 47 / 53 2.2 Table 1 summarises the distribution of pri- with increasing age (Table 2). mary procedures and revisions recorded for Patients with BMI > 30 to 35 18.3 69 45 / 55 2.3 hip and knee procedures as well as total fem- A relevant previous surgery was specified for Patients with BMI > 35 to 40 6.5 66 41 / 59 2.4 oral replacements. Between 2013 and 2022 only 3.0% of primary hip procedures (Ta- Patients with BMI > 40 2.4 63 37 / 63 2.5 the proportion of primary knee arthroplast- ble 3). Osteosynthesis and osteotomy pre- Patients without (valid) BMI data 2.9 72 38 / 62 2.1 ies remained consistently below 40%. But in dominantly in the femoral region were the © EPRD Annual Report 2024 2023, it increased to 41.1%. most common previous surgeries. Table 2: Primary hip arthroplasties in 2023 by patient age, sex and BMI The following sections present the data sets Tables 4 to 16 provide detailed information registered during the 2023 calendar year, by on the types of arthroplasties and the charac- operated joint and type of procedure. The teristics of patients undergoing primary hip last section of Chapter 4 details potential arthroplasty in 2023. Importantly, the pro- mismatches identified during the 2023 oper- portions of the different types of arthroplast- Proportion [%] Age m/f [%] BMI ASA No prior surgery 97.0 71 40 / 60 26.9 2.3 Proportion [%] Age m/f [%] BMI ASA Osteosynthesis / Osteotomy 1.9 67 40 / 60 25.9 2.3 All data sets submitted 100.0 (378,812) 70 41 / 59 28.1 2.3 Pelvis 0.4 62 47 / 53 26.4 2.1 Primary hip arthroplasties 49.5 (187,640) 71 40 / 60 26.8 2.3 Femur 1.4 70 39 / 61 25.7 2.4 Hip arthroplasty revisions 5.0 (18,933) 75 41 / 59 26.9 2.5 Pelvis and femur 0.1 56 34 / 66 26.0 2.1 Primary knee arthroplasties 41.1 (155,859) 69 42 / 58 29.7 2.2 Femoral head necrosis 0.2 62 57 / 43 26.5 2.2 Knee arthroplasty revisions 4.2 (15,931) 70 43 / 57 30.1 2.4 Arthrodesis <0.1 72 49 / 51 26.9 2.3 Total femoral replacements 01 (449) 73 38 / 62 27.7 2.5 © EPRD Annual Report 2024 Other prior surgery 0.9 66 42 / 58 26.6 2.2 © EPRD Annual Report 2024 Table 1: Proportion of registered procedures by joint and type of intervention in 2023. Absolute number of data sets in brackets below the percentages. Table 3: Previous surgeries reported for primary hip arthroplasties in 2023 30 EPRD Annual Report 2024 31  4 The 2023 operating year 4.1 Primary hip arthroplasties ies performed in any individual hospital may throplasties in 2023 (compared to 60.4% in Proportion [%] Age m/f [%] BMI ASA deviate significantly from the overall figures 2015). For the first time since the inception Total arthroplasty 88.8 70 41 / 59 27.2 2.2 presented below. This may reflect hospital of the EPRD, the proportion of highly cross- Hemiarthroplasty 11.2 85 33 / 67 24.2 2.8 preferences for different types of procedures. linked PE inserts without antioxidants was © EPRD Annual Report 2024 below the previous year’s figure, whilst use Table 4: Types of primary hip replacements in 2023 In the EPRD, for example, only 35% of hos- of antioxidant stabilised variants continued pitals implant short stems in over one out to gain ground. The use of ceramic inserts Proportion [%] Age m/f [%] BMI ASA of twenty primary THAs. In contrast, more also decreased by over 5 percentage points to Uncemented implants 77.2 67 45 / 55 27.7 2.1 than 52 hospitals use short stems in over half 7.1% compared to 2015. of their THAs. The highest proportion of Hybrid implants 18.6 79 27 / 73 25.9 2.4 short stems recorded for an individual hos- • The total arthroplasty trend favouring Cemented implants 3.2 81 25 / 75 25.4 2.6 pital was 95%. larger head components continues to be Reverse hybrid implants 0.9 74 29 / 71 26.4 2.4 Hip sustained in the EPRD. For the first time in Unknown 0.1 73 33 / 67 27.3 2.2 The proportions of the different types of 2023, 36 mm heads were the most frequently © EPRD Annual Report 2024 arthroplasties registered in the EPRD have used size. Since 2014, the proportion of 36 evolved as follows: mm heads has continuously increased from Table 5: Fixations in primary total hip arthroplasties in 2023 31.6% to 50.1%. This is in contrast, to 32 • The percent of uncemented THAs remains mm heads which have dropped from 61.1% Proportion [%] Age m/f [%] BMI ASA relatively constant at around 77%. However, in 2014 to 45.3% in 2023. Cemented implants 89.6 85 32 / 68 24.2 2.8 there is a small shift from fully cemented to Uncemented implants 10.3 83 41 / 59 24.3 2.8 hybrid fixations. From 2016 to 2023, the Unknown 0.1 86.5 40 / 60 26.2 3.0 proportion of hybrid arthroplasties rose con- In brief: © EPRD Annual Report 2024 tinuously from 15.6% to 18.6%, while the proportion of cemented arthroplasties fell Table 6: Fixations in primary hip hemiarthroplasties in 2023 • The proportion of highly cross-linked PE from 6.4% to 3.2% at a similar rate. insert components continues to increase Proportion [%] Age m/f [%] BMI ASA and now stands at 83.5%. The use of an- • In the EPRD, the share of short-stem im- Femoral stem with modular head 82.8 71 40 / 60 27.2 2.2 tioxidant stabilised variants increased for plants has been increasing continuously for Short stem 15.1 64 48 / 52 27.7 2.1 the first time in the EPRD. many years. In 2015, short stems were im- Femoral neck prosthesis 1.0 61 47 / 53 27.8 2.0 • The proportion of short-stem implants planted in 6.6% of total arthroplasties, in continued to increase to 15.1%. Revision or tumour stem 0.5 76 41 / 59 25.9 2.6 2019 this increased to 10.4% and in 2023 to 15.1%. • 36 mm heads are increasingly favoured. Modular stem 0.3 76 27 / 73 26.7 2.4 Surface replacement 0.1 58 95 / 5 28.1 1.7 • The use of monobloc cups continues to Unknown 0.3 72 38 / 62 27.8 2.1 decrease and now stands at 8.7% (compared © EPRD Annual Report 2024 to 12.7% in 2015). In contrast the preva- lence of dual-mobility cups has increased Table 7: Stem types in primary total hip arthroplasties in 2023 continuously, admittedly by small incre- ments, and now stands at 2.2% (compared Proportion [%] Age m/f [%] BMI ASA Femoral stem with modular head 97.7 85 33 / 67 24.2 2.8 to 0.5% in 2015). But the classic modular cup is still by far the most commonly used Revision or tumour stem 1.0 83 31 / 69 24.8 2.9 cup type (88.1%). Short stem 0.8 85 37 / 63 24.2 3.1 Modular stem 0.4 85 39 / 61 24.6 3.0 • In the EPRD, the proportion of highly Unknown 0.1 88 41 / 59 26.1 3.0 cross-linked polyethylene insert components © EPRD Annual Report 2024 is increasing from year to year. Overall, these insert components were used in 83.5% of ar- Table 8: Stem types in primary hip hemiarthroplasties in 2023 32 EPRD Annual Report 2024 33  4 The 2023 operating year 4.1 Primary hip arthroplasties Proportion [%] Age m/f [%] BMI ASA Proportion [%] Age m/f [%] BMI ASA Modular cup 88.1 69 41 / 59 27.3 2.2 hXLPE 56.9 70 41 / 59 27.2 2.2 Monobloc cup 8.7 72 40 / 60 26.9 2.2 hXLPE + antioxidant 26.6 69 42 / 58 27.4 2.1 Dual mobility 2.2 78 34 / 66 25.8 2.6 Ceramic 7.1 63 46 / 54 27.5 2.1 Revision cup 0.9 71 35 / 65 26.5 2.3 mXLPE 5.4 73 43 / 57 27.2 2.3 Resurfacing cup <0.1 56.5 100 / 0 28.4 1.7 PE 3.8 78 29 / 71 26.4 2.5 Unknown 0.1 70 39 / 61 26.2 2.3 Metal 0.1 58 95 / 5 28.1 1.7 © EPRD Annual Report 2024 mXLPE + antioxidant <0.1 75 43 / 57 24.5 2.4 Unknown 0.1 78 28 / 72 26.1 2.4 Table 9: Acetabular components in primary total hip arthroplasties in 2023 © EPRD Annual Report 2024 Table 13: Acetabular bearing materials in primary total hip arthroplasties in 2023 Hip Proportion [%] Age m/f [%] BMI ASA Without reconstruction shell 99.8 70 41 / 59 27.3 2.2 Proportion [%] Age m/f [%] BMI ASA With reconstruction shell 0.2 78.5 33 / 67 24.9 2.6 Ceramic 90.1 69 42 / 58 27.3 2.2 © EPRD Annual Report 2024 Metal 6.7 80 35 / 65 25.9 2.5 Ceramicised metal 3.2 70 40 / 60 27.7 2.3 Table 10: Reconstruction shells in primary total hip arthroplasties in 2023 Unknown <0.1 76 0 / 100 33.7 2.4 © EPRD Annual Report 2024 Table 14: Modular head materials in primary total hip arthroplasties in 2023 Proportion [%] Age m/f [%] BMI ASA 28 mm 4.2 73 21 / 79 26.0 2.4 Proportion [%] Age m/f [%] BMI ASA 32 mm 45.3 70 28 / 72 27.0 2.2 Ceramic / hXLPE 50.0 69 41 / 59 27.3 2.2 36 mm 50.1 69 55 / 45 27.5 2.2 Ceramic / hXLPE + Antioxidant 25.5 69 42 / 58 27.4 2.1 Other diameters 0.4 71 31 / 69 26.0 2.4 Ceramic / Ceramic 7.1 63 46 / 54 27.5 2.1 Unknown <0.1 76 17 / 83 32.5 2.5 Ceramic / mXLPE 4.7 72 45 / 55 27.4 2.2 © EPRD Annual Report 2024 Ceramic / PE 2.6 76 29 / 71 26.7 2.4 Table 11: Head sizes in primary total hip arthroplasties in 2023 Ceramicised metal / hXLPE 3.0 69 40 / 60 27.8 2.3 Metal / hXLPE 3.9 80 35 / 65 26.0 2.5 Metal / hXLPE + Antioxidant 1.1 80 35 / 65 25.7 2.6 Proportion [%] Age m/f [%] BMI ASA Other or unknown 2.1 80 34 / 66 25.9 2.5 XS 0.8 70 34 / 66 26.8 2.3 © EPRD Annual Report 2024 S 41.1 70 35 / 65 26.9 2.2 Table 15: Bearing materials in primary total hip arthroplasties in 2023. Only combinations with a share of more M 36.3 70 42 / 58 27.3 2.2 than 1% are listed. L 16.1 69 51 / 49 27.7 2.2 XL 4.1 68 59 / 41 28.0 2.2 Proportion [%] Age m/f [%] BMI ASA XXL 0.3 70 63 / 37 27.8 2.2 Metal 95.1 85 33 / 67 24.2 2.8 XXXL <0.1 74 54 / 46 27.9 2.5 Ceramic 3.7 85 33 / 67 24.2 2.6 Unknown 1.4 75 43 / 57 26.7 2.4 Ceramicised metal 1.2 84 36 / 64 24.7 2.9 © EPRD Annual report 2024 © EPRD Annual Report 2024 Table 12: Head-neck lengths in primary total hip arthroplasties in 2023 Table 16: Modular head materials in primary hip hemiarthroplasties in 2023 34 EPRD Annual Report 2024 35  4 The 2023 operating year 4.2 Hip arthroplasty revisions 4.2 Hip arthroplasty Proportion [%] Age m/f [%] BMI ASA by 1.3 percentage points from 2022 to 2023 Infection 18.0 73 49 / 51 28.1 2.6 revisions alone (from 16.7% to 18.0%). Loosening 22.1 75 41 / 59 26.8 2.4 Cup 11.8 75 35 / 65 26.6 2.4 For the 2023 calendar year, 18,933 hip revi- Table 19 shows the proportions of the dif- sions were documented in the EPRD 15,788 ferent types of components exchanged in Stem 8.5 74 49 / 51 27.3 2.4 of these were one-stage procedures. For two- one-stage revisions and re-implanted as part Cup and stem 1.9 75 45 / 55 26.7 2.5 or multi-stage revisions, the EPRD considers of multi-stage revisions in 2023. Modular Osteolysis with fixed component 0.7 71 48 / 52 26.5 2.4 data from both explantation as well as re-im- heads and cup inserts were exchanged in Cup 0.4 71 37 / 63 26.5 2.4 plantation (as the next index operation). 97.1% and 73.1% of cases, respectively. In Stem 0.2 71 62 / 38 26.0 2.3 However, the EPRD contains considerably 20.5% of revisions, both a new stem and an fewer two-stage explantation (1,225) than acetabular component were re-implanted. At Cup and stem 0.2 72.5 56 / 44 27.6 2.4 re-implantation (1,920) data sets. Table 17 least one of these two bone-anchored com- Periprosthetic fracture 15.8 81 35 / 65 25.6 2.7 Hip and Table 18 present the patient age, BMI ponents was replaced in 70.3% of the pro- Dislocation 14.1 78 30 / 70 26.1 2.6 and sex distributions, as well as reasons for cedures, with an almost equal proportion of Wear 5.2 75 41 / 59 27.1 2.4 the documented revisions. Consistently with stems (44.9%) and cups (45.9%). A specific Component failure 2.0 74 42 / 58 27.8 2.5 previous years, the most common reasons revision stem or cup was used in 31.7% of for hip revisions were loosening (22.1%), revisions considered. Dual mobility cups rep- Malalignment 1.8 73 37 / 63 27.2 2.4 infection (18.0%), periprosthetic fracture resented 41.3% of re-implanted acetabular Progression of osteoarthritis 0.4 73 46 / 54 26.4 2.3 (15.8%) and dislocation (14.1%). However, components. This figure was 10% in 2014 Condition after removal 10.1 71 53 / 47 27.7 2.6 individual percentages continue to shift: and has been rising steadily year on year. Other reasons 9.7 74 41 / 59 27.1 2.4 Loosening is cited less frequently (minus 21.6 © EPRD Annual report 2024 percentage points compared to 2014), whilst The trend in septic revision is particularly the other three reasons have gained ground. noteworthy: with bone-anchored compo- Table 18: Reasons for hip revisions in 2023 The proportion of septic revisions increased nents increasingly left in situ. Whereas in Proportion [%] Age m/f [%] BMI ASA All hip revisions 100.0 75 41 / 59 26.9 2.5 Proportion [%] Age w/f [%] BMI ASA < 45 years 1.7 55 / 45 26.3 2.0 Head, cup, insert 23.8 77 33 / 67 26.4 2.5 45 to 54 years 4.4 50 / 50 29.4 2.2 Stem, head, cup, insert 20.5 73 48 / 52 27.1 2.5 55 to 64 years 14.6 51 / 49 28.8 2.3 Head, insert 19.7 73 43 / 57 27.8 2.5 65 to 74 years 26.5 44 / 56 28.3 2.5 Stem, head 17.5 79 39 / 61 26.1 2.6 75 to 84 years 35.5 39 / 61 26.2 2.6 Head 8.8 79 37 / 63 26.3 2.6 ≥ 85 years 17.3 28 / 72 24.8 2.8 Stem, head, insert 6.9 74 44 / 56 27.7 2.5 Male 41.1 73 100 / 0 27.4 2.5 Cup, insert 1.6 76 38 / 62 26.4 2.4 Female 58.9 77 0 / 100 26.4 2.5 Insert 0.7 75 40 / 60 26.7 2.5 Patients with BMI ≤ 25 35.2 79 34 / 66 2.5 Other components 0.6 72.5 49 / 51 28.7 2.3 Patients with BMI > 25 to 30 33.6 76 48 / 52 2.5 © EPRD Annual Report 2024 Patients with BMI > 30 to 35 17.9 72 44 / 56 2.5 Patients with BMI > 35 to 40 7.1 69 40 / 60 2.6 Table 19: Hip components re-implanted2 as part of one- or multi-stage revisions in 2023 Patients with BMI > 40 3.6 66 32 / 68 2.7 Patients without (valid) BMI data 2.6 78 37 / 63 2.5 © EPRD Annual Report 2024 2 Only surgical documentation from one-stage revisions and re-implantation procedures of multi-stage revisions for which all the main prothesis Table 17: Hip revisions in 2023 by patient age. sex and BMI components could be identified in the product database are considered. 36 EPRD Annual Report 2024 37  4 The 2023 operating year 4.3 Primary knee arthroplasties 2014, the stem or the cup was replaced in 4.3 Primary knee A number of additional trends are also ob- 75.5% revisions, in 2023 this decreased to arthroplasties served among the different types of primary 53.1% of revisions. knee arthroplasties. In 2023, a total of 155,859 primary knee arthroplasties were registered in the EPRD. • The majority of knee arthroplasties re- In brief: Tables 20 and 21 summarise the character- corded in the EPRD are fully cemented. How- istics and relevant previous surgeries of knee ever, as the proportion of cemented TKAs • Most common indications for revision: arthroplasty patients. Knee arthroplasty pa- continues to rise (96.0% in 2023 vs. 90.7% Loosening (22.1%), infection (18.0%), peri- tients tend to be younger and have a median in 2016), the share of cemented unicondy- prosthetic fracture (15.8%) and dislocation body mass index that is approximately three lar knee arthroplasties has decreased slightly (14.1%), with a decrease in loosenings in points higher than hip arthroplasty patients (83.4% in 2023 vs. 88.4% in 2016). Hybrid favour of the remaining indications over (refer to previous Section 4.1). Younger age fixations are being used less frequently in the past few years. groups tend to have even higher BMIs. Ta- TKAs. Uncemented fixations are becoming bles 22 to 34 show the distributions of the more common for unicondylar arthroplasties. • 70.3% of one-stage revisions and re-im- different types of primary knee arthroplasties plantation procedures included a new and implant systems registered in the EPRD • The use of mobile bearings in TKAs as well stem and/or acetabular component. in 2023. Distributions can vary greatly be- as unicondylar arthroplasties has reached its Dual mobility cups are the increasingly tween hospitals. Primary patellar resurfacing lowest level in the registry although the level preferred cup design. for example, is performed fewer than one in of decline between these two procedures Knee • In septic revisions, bone-anchored com- twenty TKAs in over 76% of hospitals, but differs. A mobile bearing was, for example, ponents are increasingly left in situ. approximately 5% of hospitals implement only implanted in 8.1% of registered TKAs the procedure in at least half of their TKAs. (compared to 19.2% in 2015), and only in Proportion [%] Age m/f [%] BMI ASA All primary knee arthroplasties 100.0 69 42 / 58 29.7 2.2 < 45 years 0.5 42 / 58 31.7 2.0 45 to 54 years 6.1 40 / 60 32.7 2.0 55 to 64 years 28.1 46 / 54 31.3 2.1 65 to 74 years 36.1 41 / 59 30.1 2.2 75 to 84 years 25.9 38 / 62 27.8 2.3 ≥ 85 years 3.2 35 / 65 26.3 2.5 Male 41.6 68 100 / 0 29.3 2.2 Female 58.4 70 0 / 100 30.1 2.2 Patients with BMI ≤ 25 15.5 74 36 / 64 2.1 Patients with BMI > 25 to 30 34.3 71 49 / 51 2.1 Patients with BMI > 30 to 35 27.4 68 42 / 58 2.2 Patients with BMI > 35 to 40 13.1 65 35 / 65 2.3 Patients with BMI > 40 6.5 62 27 / 73 2.5 Patients without (valid) BMI data 3.2 68 42 / 58 1.9 © EPRD Annual Report 2024 Table 20: Primary knee arthroplasties in 2023 by patient age, sex and BMI 38 EPRD Annual Report 2024 39  4 The 2023 operating year  53.7% of unicondylar arthroplasties (com- (from 3.5 and 8.0%, respectively in 2015 to pared to 67.9% in 2015). 14.1 and 13.4% in 2023). Similarly, in uni- condylar knee arthroplasties, the proportion • The use of cruciate-retaining (CR) sys- of antioxidant stabilised hXLPE inserts rose Proportion [%] Age m/f [%] BMI ASA tems in TKAs, registered in the EPRD, has from 0 to 15.4%, whilst the proportion of Standard systems 95.4 70 40 / 60 29.9 2.2 decreased over the years. While 52.2% of hXLPE inserts without antioxidants fell from Cruciate-retaining 42.5 70 41 / 59 29.9 2.2 TKAs still used a CR system in 2015, this 9.7% to 5.4%, over the same time period. figure dropped to only 42.5% in 2023. Posterior-stabilised 25.5 69 40 / 60 29.9 2.2 Conversely, the use of posterior-stabilised Cruciate-sacrificing 11.5 71 38 / 62 30.0 2.3 (PS) and pivot systems has increased (from In brief: Cruciate-retaining / sacrificing 10.6 69 42 / 58 29.7 2.2 15.8% to 25.5% and from 2.1% to 5.3%, Pivot 5.3 70 42 / 58 30.0 2.2 respectively). • 96% of primary TKAs were fully cemented Constrained systems 4.3 73 29 / 71 28.8 2.3 in 2023. Hinged 2.3 75 26 / 74 28.1 2.4 • A trend favouring the use of highly cross- • Mobile bearings continued to lose ground, linked PE insert components is also evident Varus-valgus-stabilised 2.0 71 33 / 67 29.6 2.3 and were only deployed in 8.1% of TKAs. in knee arthroplasties. This trend is, however, Unknown 0.3 67 54 / 46 28.1 2.2 not as pronounced as in hip arthroplasties. • The use of CR systems also decreased, © EPRD Annual Report 2024 In TKAs, the use of hXLPE inserts with or whereas the PS system share increased. without antioxidants has risen continuously Table 23: Grade of constraint in primary total knee arthroplasties in 2023 Knee Proportion [%] Age m/f [%] BMI ASA No prior surgery 92.9 69 41 / 59 29.8 2.2 Osteosynthesis / Osteotomy 1.5 64 55 / 45 28.7 2.2 Proportion [%] Age m/f [%] BMI ASA Femur 0.3 67 52 / 48 28.7 2.2 Cemented implants 96.0 70 40 / 60 29.8 2.2 Tibia 0.9 63 57 / 43 29.0 2.2 Hybrid implants 2.6 69 45 / 55 30.0 2.1 Patella 0.1 67 45 / 55 28.9 2.3 Uncemented implants 1.3 66 47 / 53 30.0 2.2 Several locations 0.2 62 57 / 43 28.4 2.2 Reverse hybrid implants <0.1 65.5 46 / 54 29.7 2.2 Capsule and ligaments 2.2 63 56 / 44 29.2 2.2 Unknown 0.1 68 40 / 60 25.9 2.6 © EPRD Annual Report 2024 Arthrodesis <0.1 65 38 / 62 30.4 2.4 Other prior surgery 3.3 65 48 / 52 29.4 2.2 Table 24: Fixations in primary total knee arthroplasties in 2023 © EPRD Annual Report 2024 Table 21: Previous surgeries reported for knee arthroplasties in 2023 Proportion [%] Age m/f [%] BMI ASA Proportion [%] Age m/f [%] BMI ASA Total knee arthroplasty 86.5 70 40 / 60 29.8 2.2 Cemented implants 83.4 64 51 / 49 29.1 2.1 Unicondylar knee arthroplasty 13.2 64 52 / 48 29.1 2.1 Uncemented implants 16.0 65 58 / 42 29.0 2.0 Patellofemoral knee arthroplasty 0.2 57 31 / 69 27.5 2.0 Hybrid implants 0.4 63 42 / 58 29.7 2.1 Other arthroplasties <0.1 60 67 / 33 28.1 2.0 Unknown 0.1 65 39 / 61 29.6 2.0 © EPRD Annual Report 2024 © EPRD Annual Report 2024 Table 22: Types of primary knee replacements in 2023 Table 25: Fixations in primary unicondylar knee arthroplasties in 2023 40 EPRD Annual Report 2024 41  4 The 2023 operating year 4.3 Primary knee arthroplasties Proportion [%] Age m/f [%] BMI ASA Proportion [%] Age m/f [%] BMI ASA Fixed bearing 91.9 70 40 / 60 29.8 2.2 Uncoated metal / PE 38.2 70 42 / 58 29.7 2.2 Mobile bearing 8.1 70 40 / 60 29.8 2.3 Uncoated metal / mXLPE 26.5 71 42 / 58 29.9 2.2 © EPRD Annual Report 2024 Uncoated metal / hXLPE + antioxidant 13.8 70 44 / 56 29.8 2.2 Uncoated metal / hXLPE 12.5 69 40 / 60 29.7 2.2 Table 26: Bearing mobility in primary total knee arthroplasties in 2023 Coated metal / mXLPE 2.7 66 16 / 84 31.0 2.2 Ceramicised metal / PE 2.7 66 24 / 76 30.9 2.2 Coated metal / PE 2.0 67 23 / 77 30.9 2.2 Proportion [%] Age m/f [%] BMI ASA Mobile bearing 53.7 64 52 / 48 29.3 2.1 Other or unknown 1.6 65 22 / 78 30.8 2.2 © EPRD Annual Report 2024 Fixed bearing 46.3 64 52 / 48 29.0 2.1 © EPRD Annual Report 2024 Table 31: Bearing materials in primary total knee arthroplasties in 2023. Only combinations with a share of more than 1% are listed. Table 27: Bearing mobility in primary unicondylar knee arthroplasties in 2023 Proportion [%] Age m/f [%] BMI ASA Uncoated metal 93.4 64 54 / 46 29.1 2.1 Ceramicised metal 3.8 63 37 / 63 28.9 2.1 Proportion [%] Age m/f [%] BMI ASA Without patellar resurfacing 90.0 70 40 / 60 29.8 2.2 Coated metal 2.8 60 21 / 79 29.8 2.0 © EPRD Annual Report 2024 Knee With patellar resurfacing 10.0 70 38 / 62 30.1 2.2 © EPRD Annual Report 2024 Table 32: Femoral bearing materials in primary unicondylar knee arthroplasties in 2023 Table 28: Patellar resurfacing in primary total knee arthroplasties in 2023 Proportion [%] Age m/f [%] BMI ASA mXLPE 56.0 64 51 / 49 29.3 2.1 Proportion [%] Age m/f [%] BMI ASA PE 22.9 63 52 / 48 29.0 2.1 Uncoated metal 91.2 70 42 / 58 29.7 2.2 hXLPE + antioxidant 15.4 64 54 / 46 29.2 2.1 Coated metal 5.1 66 19 / 81 31.0 2.2 hXLPE 5.4 63 55 / 45 28.7 2.0 Ceramicised metal 3.7 66 24 / 76 30.9 2.2 Unknown 0.3 67.5 54 / 46 29.5 2.5 Ceramic <0.1 66 10 / 90 31.0 2.2 © EPRD Annual Report 2024 Unknown <0.1 73 100 / 0 26.8 2.0 Table 33: Tibial bearing materials in primary unicondylar knee arthroplasties in 2023 © EPRD Annual Report 2024 Table 29: Femoral bearing materials in primary total knee arthroplasties in 2023 Proportion [%] Age m/f [%] BMI ASA Uncoated metal / mXLPE 52.6 65 53 / 47 29.3 2.1 Uncoated metal / PE 19.8 64 55 / 45 28.9 2.1 Proportion [%] Age m/f [%] BMI ASA Uncoated metal / hXLPE + antioxidant 15.3 64 55 / 45 29.2 2.1 PE 42.9 70 40 / 60 29.8 2.2 Uncoated metal / hXLPE 5.4 63 55 / 45 28.7 2.0 mXLPE 29.3 70 40 / 60 30.0 2.2 Ceramicised metal / PE 2.4 60 36 / 64 29.3 2.1 hXLPE + antioxidant 14.1 69 43 / 57 29.9 2.2 Coated metal / mXLPE 2.0 60 14 / 86 29.7 2.0 hXLPE 13.4 69 39 / 61 29.7 2.2 Ceramicised metal / mXLPE 1.4 67 38 / 62 28.5 2.1 mXLPE + antioxidant 0.2 69 36 / 64 30.4 2.1 Other or unknown 1.0 61 43 / 57 29.7 2.1 Unknown 0.1 69 45 / 55 29.7 2.2 © EPRD Annual Report 2024 © EPRD Annual Report 2024 Table 34: Bearing materials in primary unicondylar knee arthroplasties in 2023. Only combinations with a share Table 30: Tibial bearing materials in primary total knee arthroplasties in 2023 of more than 1% are listed. 42 EPRD Annual Report 2024 43  4 The 2023 operating year 4.4 Knee arthroplasty revisions 4.4 Knee arthroplasty Table 37 specifies the components re-im- Also in septic knee revisions the trend favours revisions planted during knee arthroplasty revisions. leaving previously implanted bone-anchored We presume that 15.3% of revision proce- components in situ. In 2014, only 24.5% For the 2023 calendar year, the EPRD regis- dures involved the subsequent complemen- of septic revisions3 did not exchange bone- tered 15,931 knee revisions. These included tary patellar resurfacing of a previous ar- anchored components, compared to 44.4% 1,013 explantations and 1,938 re-implanta- throplasty. in 2023. tions as part of multi-stage revisions. Sim- ilarly to the registry’s hip joint data, the In almost half of the revisions considered 3 This also includes two-stage re-implantations. number of knee re-implantation procedures (49.1%), new bone-anchored components surpassed the number of prothesis explanta- were implanted in the femur as well as the tions. tibia. This means that in approximately Proportion [%] Age m/f [%] BMI ASA five out of six cases with a new femur or Infection 15.0 72 54 / 46 29.8 2.6 Table 35 summarises a number of revision tibial component, the previously implanted Loosening 21.6 70 41 / 59 30.4 2.4 knee arthroplasty patient characteristics. In- prosthesis was completely replaced. In Femoral component 4.2 71 45 / 55 30.1 2.4 dications for revisions are listed in Table 36. 59% of cases, these complete exchanges in- Similarly to hip revisions, loosening (21.6%) volved switching to a hinged or varus-val- Tibial component 8.5 68 38 / 62 30.5 2.3 and infection (15.0%) were also the most gus-stabilised – and therefore a more con- Patellar component 0.6 68 40 / 60 30.3 2.2 commonly cited reasons for knee arthroplasty strained – system. But these systems were Several components 8.3 71 42 / 58 30.1 2.4 revisions, although the proportion of reported only implanted in 4.3% of primary arthro- Osteolysis with fixed component 1.2 71 52 / 48 29.9 2.4 Knee loosenings has decreased in recent years. plasties (Table 23). Femoral component 0.4 72 54 / 46 29.1 2.3 Tibial component 0.3 72 52 / 48 29.6 2.6 Patellar component 0.1 69 36 / 64 27.9 2.3 Proportion [%] Age m/f [%] BMI ASA Several components 0.5 70.5 53 / 47 30.9 2.3 All knee revisions 100.0 70 43 / 57 30.1 2.4 Periprosthetic fracture 3.8 79 20 / 80 28.4 2.6 < 45 years 1.1 51 / 49 28.7 2.0 Ligament instability 9.1 67 32 / 68 30.1 2.3 45 to 54 years 6.3 41 / 59 31.6 2.1 Wear 4.9 73 40 / 60 30.0 2.3 55 to 64 years 26.4 46 / 54 31.5 2.2 Component failure 1.9 70 43 / 57 31.0 2.4 65 to 74 years 32.7 44 / 56 30.9 2.4 Prosthetic malalignment / Malrotation 1.5 68 32 / 68 29.7 2.3 75 to 84 years 27.8 40 / 60 28.4 2.5 Restricted mobility 5.4 66 40 / 60 30.1 2.2 ≥ 85 years 5.8 35 / 65 27.2 2.7 Progression of osteoarthritis 7.6 68 34 / 66 30.1 2.3 Male 42.6 69 100 / 0 29.7 2.4 Condition after removal 12.2 70 52 / 48 29.7 2.5 Female 57.4 71 0 / 100 30.4 2.4 Other reasons 15.8 68 44 / 56 30.3 2.2 Patients with BMI ≤ 25 15.8 74 37 / 63 2.3 © EPRD Annual Report 2024 Patients with BMI > 25 to 30 32.4 72 49 / 51 2.3 Table 36: Reasons for knee revisions in 2023 Patients with BMI > 30 to 35 27.4 69 45 / 55 2.4 Patients with BMI > 35 to 40 13.8 67 38 / 62 2.5 Patients with BMI > 40 8.2 64 28 / 72 2.6 Patients without (valid) BMI data 2.4 69 43 / 57 2.3 © EPRD Annual Report 2024 Table 35: Knee revisions in 2023 by patient age, sex and BMI 44 EPRD Annual Report 2024 45  4 The 2023 operating year 4.5 Mismatch detection in the EPRD Femoral and tibial component, insert Proportion [%] 42.5 Age 70 m/f [%] BMI 41 / 59 30.0 2.4 ASA 4.5 Mismatch detection Mismatch checks are based on the EPRD’s Insert 23.9 70 48 / 52 30.1 2.4 in the EPRD product database. For the year 2023, the fol- lowing potential mismatch cases were identi- Patellar arthroplasty 7.7 69 39 / 61 30.8 2.3 The EPRD strives to help eliminate arthro- fied in otherwise plausibly documented pri- Insert, patellar arthroplasty 7.6 68 39 / 61 30.4 2.3 plasty component mismatches. These are mary arthroplasties: Femoral and tibial component, insert, patellar arthroplasty 6.6 69 44 / 56 29.6 2.4 arthroplasties where the combination of Tibial component, insert 3.6 69 39 / 61 30.9 2.4 implanted components is not authorised or • In 57 THAs, the documented sizes of the unsuitable. Such mismatches can have seri- head component and the insert or acetabu- Femoral component, insert 3.1 71 46 / 54 29.7 2.4 ous consequences for the patient and are in lar component differed. The selected head Femoral component 2.1 73 25 / 75 30.0 2.6 all likelihood due to oversight, ignorance or, was too large for the insert or cup in 19 Other components 1.7 73 39 / 61 28.7 2.6 under certain circumstances, the lack of suit- cases and too small in 38 cases (Table 38 Tibial component, insert, patellar arthroplasty 0.4 67 42 / 58 32.0 2.4 able components available in the hospital. and an example in Table 39). Heads that Femoral component, insert, patellar arthroplasty 0.4 70 43 / 57 29.4 2.2 are too large may result in malalignment, Femoral component, patellar arthroplasty 0.3 70.5 44 / 56 28.7 2.6 To prevent mismatches, the EPRD provides and heads that are too small in impinge- © EPRD Annual Report 2024 real-time compatibility checks for implant ment and insert damage. Size incompati- components selected. A mismatch warn- bilities were also observed in three hemi- Table 37: Re-implanted components4 in knee revisions in 2023 ing message is issued directly by the EPRD arthroplasty procedures. In these cases, the data acquisition software after scanning the bipolar head or its insert did not match the labels of incompatible implant components modular head used. In brief: • Main reasons for knee revisions are loos- ening (21.6%) and infection (15.0%). • All previously implanted components are exchanged in approximately half of revi- sions. 59% of revisions involved switching to a more constrained system. • There is also a distinct trend in septic Illustration 4: An EPRD-Edit software mismatch notification during data entry. The knee revisions to leave previously im- text shown reads: The online plausibility check has returned warnings. If you still planted bone-anchored components in want to continue, select OK. OP 1: There may be a head and acetabular component situ. size mismatch. (Illustration 4). The case queries provided • In 4 arthroplasties, the stem taper did not with the monthly summary reports of the match the taper of the head (see example EPRD also point out potential mismatches. in Table 40). This type of taper mismatch However, at this stage the mismatch can increases the risk of ceramic head fractures no longer be easily corrected. The earlier and the risk of metal head corrosion. a procedure is documented in the hospital, the greater the chances the mismatch can be • In 13 TKAs, components intended solely corrected without harming the patient. The for the left knee were combined with com- EPRD therefore recommends that proce- ponents approved only for the right knee dures be documented during surgery, as far (see example in Table 41). Whether this type as this can be accommodated in the hospital of mismatch has consequences for the ar- 4 Only surgical documentation from one-stage revisions and re-implantation procedures of multi-stage revisions for which all the main prothesis components could be identified in the product database are considered. workflow. throplasty depends on the specific design of 46 EPRD Annual Report 2024 47  4 The 2023 operating year 4.5 Mismatch detection in the EPRD Inner diameter of insert/acetabular component the respective knee system. However, since • In 19 unicondylar knee replacements, all side-specific components are available for components approved only for medial use 22 mm 28 mm 32 mm 36 mm both sides, this type of mismatch is unneces- were combined with components approved Head size 22 mm 8 sary and preventable. only for lateral use. 28 mm 2 8 2 • In 376 TKAs and 2 unicondylar replace- • In 11 TKAs a PS insert component was 32 mm 1 4 20 ments, the documented side of all compo- documented together with a femoral compo- nents implanted during the procedure did nent not designed for this type of stabilisa- 36 mm 12 not match the side specification stored in the tion (see example in Table 43). Depending on © EPRD Annual Report 2024 product database. the design, this may result in impingement, Table 38: Number of mismatches due to deviations between head size and inner diameter of insert or cup in 2023 extension deficit and partial dislocation upon • In 115 cases, the combination of knee leg extension. components implanted did not comply with the manufacturer’s permitted size specifica- It is important to note that not all mismatch Component type Identification Manufacturer tions, see example in Table 42. It has only re- cases listed correspond to an actual mis- Acetabular component PLASMAFIT PLUS CUP SZ.52MM G Aesculap cently become possible to automatically de- match. Mismatches may also arise from a tect size mismatches in knee arthroplasties in misclassification by the manufacturer or a Acetabular insert VITELENE INSERT G 36MM SYM. Aesculap the EPRD, as this data could not previously hospital documentation error. For example, be entered into the product database. The the majority of cases where the page refer- Knee Femoral component METHA µCAP 12/14 130°/0° SIZE 3 Aesculap number of size mismatches presented there- ence for all components does not match the Head component BIOLOX DELTA PROSTH.HEAD 12/14 32MM S Aesculap fore only relates to approximately 35,000 side operated on, can be traced back to an arthroplasties registered in 2023, for which incorrect page reference entered when the © EPRD Annual Report 2024 this data was available. procedure was registered in the EPRD. Table 39: Example of a THA head size mismatch Component type Identification Manufacturer Component type Identification Manufacturer Acetabular component Lubinus Eccentric Acetabular Cup, withsnap fit, 32.5 x 46 mm Waldemar Link PERSONA TIBIA GESCHAFTET, ZEMENTIERT, 5 GRAD, Tibial component Zimmer Biomet GRÖßE D, LINKS SPII Model Lubinus, Hip Prosthesis Stem Standard Neck, Femoral component cemented, L= 150 mm, left L1, narrow, CCD 126°, CoCrMo, Waldemar Link Insert component PERSONA UC GLEITFLÄCHE, 10MM, FEM 3-7, TIB CD, LINKS Zimmer Biomet anatomical, Taper 12/14 PERSONA CR FEMUR, ZEMENTIERT, COCR, NARROW, SPII, ProsthesisHead B, 32 mm, head-neck-l. 50 mm, Femoral component Zimmer Biomet Head component Waldemar Link GRÖßE 8, LINKS taper 14/16, CoCrMo © EPRD Annual Report 2024 © EPRD Annual Report 2024 Table 42: Example of a TKA size mismatch Table 40: Example of a THA taper mismatch Component type Identification Manufacturer Component type Identification Manufacturer Tibial component GNS II CMT TIB SIZE 3 RIGHT Smith & Nephew Tibial component ATTUNE™ Tibia S+, zementiert, RP, Gr. 6 DePuy Insert component LGN PS HIGH FLEX XLPE SZ 3-4 9MM Smith & Nephew Insert component ATTUNE™ Inlay AOX, RP, PS, Gr.7 6mm DePuy Femoral component LEGION PS NP FEM SZ 5 LT Smith & Nephew Femoral component ATTUNE Femur CR zementiert, 73 M/L, 67 A/P, links, Gr. 7 DePuy © EPRD Annual Report 2024 © EPRD Annual Report 2024 Table 41: Example of a TKA side mismatch Table 43: Example of a TKA size mismatch 48 EPRD Annual Report 2024 49  4 The 2023 operating year In brief: • A mismatch warning message is issued directly in the EPRD data acquisition software after scanning the labels of incompatible implant components. This warning is reiterated in the monthly EPRD case queries. • In 2023, a potential mismatch was de- tected in a three-digit number of proce- dures. 50 EPRD Annual Report 2024   5 Hip and knee arthroplasty survival 51  5.1 Primary hip arthroplasty survival 5 Hip and knee terms of the expected arthroplasty survival of 15 to 20 years, this time span is still rather short. The following statements therefore elective procedures, hip hemiarthroplasties are more often performed on older patients with proximal femur fractures. The CRRs arthroplasty survival only apply to the short to mid-term phase of an arthroplasty. It is particularly important to note that arthroplasties with good short- for these two types of arthroplasties differ considerably, as shown in Figure 3. term outcomes do not necessarily do as well The vast majority of EPRD analyses also ex- The term "arthroplasty survival" denotes arthroplasty survival. Since a number of ar- in the medium to long term. amine the different types of femoral fixations the period of time an arthroplasty system re- throplasty systems are only implanted in spe- in elective THAs. In Germany, most femoral mains unchanged in the patient’s body until cific hospitals and patients, it is not always fixations are not cemented (also refer to Ta- components need to be removed, replaced or feasible to unequivocally determine whether 5.1 Primary hip ble 5), whilst cemented stems, are primarily complemented. Arthroplasty survival rates a good or poor outcome is due to the implant arthroplasty survival implanted in older patients with pre-existing Hip are a key quality criterion for assessing hip itself or to the circumstances associated with medical conditions. The differences between as well as knee arthroplasties and are there- the surgery. The potential overlap of differ- The following subsections present CRRs for the CRR for uncemented and cemented fore a central focus of EPRD annual reports. ent contributing factors complicates the in- different types of primary hip arthroplasties. stems during the first few post-operative Since most cases are still being followed up, terpretation of several outcomes in Section The influences of non-implant-related risk years from the primary arthroplasty (see Fig- the sections below present the CRRs of pri- 5.1.4 and needs to be considered, particu- factors and implant characteristics are dis- ure 4) therefore reflect the considerable out- mary procedures and re-revisions over time. larly when assessing the outcomes of specific cussed in detail from page 59 and page 68 come differences observed in older patients arthroplasty systems presented in Section onwards, respectively. Tables included at the (also refer to Table 45). Section 5.1 focuses on primary hip arthro- 5.3.4. Whilst previously mentioned sections end of each subsection provide a summary plasties and Section 5.3 on primary knee ar- focus on the interval between primary ar- and all outcome details. The final section, on Figure 3 additionally shows that CRRs dif- throplasties. Subsections 5.1.1 and 5.3.1pres- throplasty and the first revision, sections 5.2 page 82, details outcomes of specific femoral fer considerably depending on whether the ent outcomes for the basic types of primary and 5.4 investigate the period after a revi- and acetabular component combinations. surgery was performed for a femoral frac- arthroplasties and investigate the influences sion and the risk of re-revision surgery. Sec- ture close to the hip joint or for other rea- of different indications on arthroplasty sur- tion 5.5 addresses whether the EPRD’s cur- 5.1.1 Comparison by type sons. But the primary diagnosis also plays vival. Subsections 5.1.2 and 5.3.2 discuss the rent data already allows to discern a trend in of primary hip arthroplasty an important role beyond this. Elective hip impact of non-implant-related factors – such arthroplasty survival. In addition to planned operations, the EPRD arthroplasties for post-traumatic hip oste- as patient and hospital variables. Subsections also documents emergency femoral fracture oarthritis carry a higher revision risk com- 5.1.3 and 5.3.3 then address the effects of The 2024 EPRD annual report presents procedures close to the hip joint. Whilst to- pared to other forms of hip osteoarthritis implant and arthroplasty characteristics on outcomes for up to 9 years of follow up. In tal hip arthroplasties are usually planned or (Figure 5). Non-elective arthroplasties have 10 © EPRD Annual Report 2024 9 5 © EPRD Annual report 2024 8 Cumulative revision [%] 7 4 Cumulative revision [%] 6 5 3 4 3 2 2 Non-elective THAs 1 Hip hemiarthroplasties 1 Elective THAs 0 Elective THAs with uncemented stems Elective THAs with cemented stems 0 0 1 2 3 4 5 6 7 8 9 Years since primary 0 1 2 3 4 5 6 7 8 9 34,964 24,594 18,634 13,636 9,688 6,362 3,846 1,949 668 Years since primary Numbers at risk 73,215 40,585 27,056 17,231 10,597 6,110 3,163 1,340 Numbers 420,224 345,502 284,035 231,728 182,117 132,732 88,080 49,430 19,866 5,443 535,840 438,492 359,038 291,578 228,311 165,843 109,986 61,680 25,006 6,845 at risk 115,036 92,529 74,629 59,684 46,133 33,074 21,880 12,240 5,139 1,402 Figure 3: Cumulative revision rates for elective and non-elective hip arthroplasties (p < 0.0001) Figure 4: Cumulative revision rates for elective total hip arthroplasties with cemented and uncemented stems (p < 0.0001) 52 EPRD Annual Report 2024 53  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival 7 © EPRD Annual Report 2024 lower CRRs when they involve femoral neck 6 fractures than other femoral fractures. Cumulative revision [%] 5 Table 44 lists CRRs for the different types of 4 hip arthroplasties by indication. 3 2 1 Elective THAs with uncemented stems in post-traumatic osteoarthritis Elective THAs with uncemented stems in other osteoarthritis In brief Elective THAs with uncemented stems in primary osteoarthritis Elective THAs with uncemented stems in dysplastic osteoarthritis 0 • The CRR is generally higher for non- 0 1 2 3 4 5 6 7 8 9 elective procedures. Years since primary • Post-traumatic osteoarthritis is Hip 4,156 3,424 2,849 2,336 1,869 1,328 863 514 Numbers 32,633 27,161 22,741 18,876 14,809 10,937 7,198 3,890 1,371 associated with a higher revision risk. at risk 330,035 271,494 222,618 181,340 142,467 103,648 68,755 38,737 15,692 4,252 39,392 32,345 26,733 21,917 17,303 12,696 8,596 4,827 1,956 563 Figure 5: Cumulative revision rates for elective total hip arthroplasties with uncemented stems by primary diagnosis (p < 0.0001) Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category Elective THAs with uncemented stems 420,224 67 (59 - 74) 41/59 27.8 762 2.8 [2.7; 2.8] 3.2 [3.1; 3.2] 3.4 [3.4; 3.5] 3.6 [3.5; 3.7] 3.8 [3.7; 3.8] 4.0 [3.9; 4.0] 4.1 [4.1; 4.2] 4.3 [4.2; 4.4] 4.5 [4.4; 4.7] (345,502) (284,035) (231,728) (182,117) (132,732) (88,080) (49,430) (19,866) (5,443) Primary diagnosis Primary osteoarthritis 330,035 68 (61 - 75) 41/59 28.0 759 2.7 [2.6; 2.7] 3.0 [3.0; 3.1] 3.3 [3.2; 3.3] 3.5 [3.4; 3.5] 3.6 [3.5; 3.7] 3.8 [3.7; 3.9] 4.0 [3.9; 4.1] 4.2 [4.1; 4.3] 4.4 [4.2; 4.5] (271,494) (222,618) (181,340) (142,467) (103,648) (68,755) (38,737) (15,692) (4,252) Diagnoses other than osteoarthritis or 3.8 [3.6; 3.9] 4.2 [4.0; 4.4] 4.5 [4.3; 4.7] 4.7 [4.5; 4.9] 5.0 [4.7; 5.2] 5.1 [4.9; 5.4] 5.4 [5.1; 5.6] 5.7 [5.4; 6.0] 6.1 [5.6; 6.7] 46,641 64 (56 - 73) 46/54 27.5 741 fracture (38,239) (31,835) (26,135) (20,478) (15,060) (9,866) (5,352) (2,002) (557) Dysplastic osteoarthritis 39,392 59 (52 - 66) 31/69 27.2 715 2.4 [2.2; 2.5] 2.8 [2.6; 3.0] 3.1 [2.9; 3.3] 3.3 [3.1; 3.5] 3.5 [3.3; 3.7] 3.7 [3.4; 3.9] 3.8 [3.5; 4.0] 3.9 [3.6; 4.1] 3.9 [3.6; 4.1] (32,345) (26,733) (21,917) (17,303) (12,696) (8,596) (4,827) (1,956) (563) Post-traumatic osteoarthritis 4,156 62 (54 - 71) 56/44 26.6 583 3.7 [3.2; 4.3] 4.4 [3.8; 5.1] 4.9 [4.2; 5.6] 5.1 [4.4; 5.8] 5.3 [4.6; 6.1] 5.7 [4.9; 6.5] 5.9 [5.0; 6.7] 6.1 [5.1; 7.0] 6.1 [5.1; 7.0] (3,424) (2,849) (2,336) (1,869) (1,328) (863) (514) (216) (71) Prior operations No relevant prior operations 405,323 67 (60 - 74) 40/60 27.9 762 2.7 [2.7; 2.8] 3.1 [3.1; 3.2] 3.4 [3.3; 3.4] 3.5 [3.5; 3.6] 3.7 [3.6; 3.8] 3.9 [3.8; 4.0] 4.1 [4.0; 4.2] 4.3 [4.2; 4.4] 4.5 [4.3; 4.6] (333,083) (273,595) (223,049) (175,036) (127,303) (84,165) (47,018) (18,892) (5,183) Osteosynthesis / Osteotomy 8,551 60 (51 - 69) 40/60 26.6 654 4.3 [3.9; 4.8] 4.9 [4.5; 5.4] 5.3 [4.8; 5.8] 5.5 [5.0; 6.0] 5.7 [5.1; 6.2] 5.8 [5.2; 6.3] 6.0 [5.4; 6.6] 6.2 [5.5; 6.8] 6.6 [5.5; 7.6] (7,032) (5,826) (4,735) (3,788) (2,824) (1,910) (1,134) (493) (151) Other prior operations 5,140 62 (52 - 71) 43/57 27.7 510 2.8 [2.3; 3.3] 3.5 [2.9; 4.0] 3.8 [3.2; 4.3] 3.9 [3.4; 4.5] 4.1 [3.5; 4.7] 4.4 [3.8; 5.0] 4.7 [4.0; 5.4] 5.3 [4.4; 6.1] 5.7 [4.5; 6.9] (4,370) (3,777) (3,259) (2,745) (2,209) (1,717) (1,097) (401) (87) Femoral head necrosis 1,158 56 (45 - 67) 59/41 27.9 339 5.4 [4.1; 6.7] 5.8 [4.4; 7.2] 6.3 [4.9; 7.8] 6.5 [5.0; 8.0] 7.3 [5.6; 8.9] 7.3 [5.6; 8.9] 7.3 [5.6; 8.9] 7.3 [5.6; 8.9] (975) (801) (655) (527) (377) (275) (175) (77) Elective THAs with cemented stems 115,036 79 (75 - 83) 25/75 26.5 735 2.4 [2.3; 2.5] 2.7 [2.6; 2.8] 2.9 [2.8; 3.0] 3.2 [3.0; 3.3] 3.4 [3.3; 3.5] 3.6 [3.5; 3.7] 3.9 [3.7; 4.0] 4.1 [3.9; 4.3] 4.3 [4.0; 4.5] (92,529) (74,629) (59,684) (46,133) (33,074) (21,880) (12,240) (5,139) (1,402) Primary diagnosis Primary osteoarthritis 92,444 79 (75 - 83) 24/76 26.6 716 2.0 [2.0; 2.1] 2.3 [2.2; 2.4] 2.5 [2.4; 2.7] 2.7 [2.6; 2.9] 2.9 [2.8; 3.1] 3.1 [3.0; 3.3] 3.4 [3.3; 3.6] 3.6 [3.4; 3.8] 3.7 [3.5; 4.0] (75,143) (60,862) (48,889) (38,061) (27,375) (18,328) (10,437) (4,407) (1,207) Diagnoses other than osteoarthritis or 4.1 [3.8; 4.4] 4.6 [4.3; 4.9] 5.0 [4.7; 5.4] 5.4 [5.0; 5.8] 5.8 [5.4; 6.2] 6.1 [5.7; 6.6] 6.3 [5.8; 6.8] 6.7 [6.1; 7.4] 7.2 [6.1; 8.4] 16,937 79 (73 - 83) 26/74 26.0 685 fracture (12,881) (10,128) (7,919) (5,882) (4,117) (2,524) (1,274) (520) (140) Table 44: Revision rates for different types of primary hip arthroplasties and diagnoses 54 EPRD Annual Report 2024 55  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category Dysplastic osteoarthritis 4,130 77 (70 - 81) 20/80 26.2 488 2.3 [1.8; 2.7] 2.6 [2.1; 3.1] 2.8 [2.2; 3.3] 3.0 [2.4; 3.6] 3.4 [2.7; 4.0] 3.8 [3.0; 4.5] 4.3 [3.3; 5.3] 5.3 [3.8; 6.7] (3,309) (2,675) (2,104) (1,608) (1,184) (778) (402) (160) Post-traumatic osteoarthritis 1,525 78 (72 - 82) 29/71 25.0 412 3.3 [2.4; 4.2] 4.1 [3.0; 5.1] 4.4 [3.3; 5.5] 5.0 [3.8; 6.2] 5.0 [3.8; 6.2] 5.3 [3.9; 6.6] 5.3 [3.9; 6.6] 5.3 [3.9; 6.6] (1,196) (964) (772) (582) (398) (250) (127) (52) Prior operations No relevant prior operations 110,402 79 (75 - 83) 24/76 26.6 732 2.3 [2.2; 2.4] 2.6 [2.5; 2.7] 2.8 [2.7; 2.9] 3.0 [2.9; 3.1] 3.3 [3.2; 3.4] 3.5 [3.4; 3.6] 3.8 [3.6; 3.9] 4.0 [3.8; 4.2] 4.1 [3.9; 4.3] (88,869) (71,664) (57,320) (44,322) (31,757) (20,981) (11,733) (4,971) (1,378) Osteosynthesis / Osteotomy 2,852 79 (72 - 83) 24/76 24.9 524 4.8 [4.0; 5.6] 5.5 [4.6; 6.3] 6.0 [5.1; 7.0] 6.5 [5.5; 7.5] 7.0 [5.9; 8.1] 7.3 [6.1; 8.5] 7.5 [6.2; 8.8] 7.5 [6.2; 8.8] (2,163) (1,691) (1,298) (956) (646) (401) (203) (69) Other prior operations 1,410 78 (73 - 82) 30/70 26.5 288 3.9 [2.9; 4.9] 4.2 [3.2; 5.3] 4.8 [3.7; 6.0] 5.2 [4.0; 6.4] 5.5 [4.2; 6.8] 5.8 [4.4; 7.2] 5.8 [4.4; 7.2] 6.2 [4.6; 7.7] (1,215) (1,056) (898) (733) (589) (443) (280) (90) Femoral head necrosis 344 78 (72 - 84) 27/73 25.7 136 4.5 [2.3; 6.7] 5.3 [2.8; 7.7] 5.3 [2.8; 7.7] 6.0 [3.2; 8.8] 6.0 [3.2; 8.8] (260) (197) (150) (107) (72) Hip Non-elective THAs 34,964 76 (68 - 82) 30/70 24.6 707 6.1 [5.8; 6.3] 6.7 [6.4; 6.9] 7.0 [6.7; 7.3] 7.4 [7.1; 7.7] 7.6 [7.3; 8.0] 7.9 [7.6; 8.3] 8.2 [7.8; 8.7] 8.5 [8.0; 8.9] 8.5 [8.0; 8.9] (24,594) (18,634) (13,636) (9,688) (6,362) (3,846) (1,949) (668) (126) Primary diagnosis Femoral neck fracture 32,500 76 (68 - 82) 31/69 24.6 699 5.9 [5.6; 6.1] 6.5 [6.2; 6.7] 6.8 [6.5; 7.1] 7.2 [6.8; 7.5] 7.5 [7.1; 7.8] 7.7 [7.4; 8.1] 8.1 [7.7; 8.5] 8.3 [7.8; 8.8] 8.3 [7.8; 8.8] (23,076) (17,512) (12,808) (9,109) (5,986) (3,608) (1,817) (613) (110) Other femoral fracture 1,685 81 (73 - 86) 24/76 24.8 459 9.7 [8.2; 11.2] 10.3 [8.8; 11.9] 10.6 [9.0; 12.2] 11.0 [9.3; 12.6] 11.0 [9.3; 12.6] 11.0 [9.3; 12.6] 11.0 [9.3; 12.6] (994) (719) (534) (368) (225) (145) (76) Pathologic fracture 779 75 (66 - 81) 25/75 25.4 341 7.6 [5.6; 9.5] 7.8 [5.8; 9.8] 8.8 [6.6; 11.0] 8.8 [6.6; 11.0] 8.8 [6.6; 11.0] 8.8 [6.6; 11.0] 8.8 [6.6; 11.0] (524) (403) (294) (211) (151) (93) (56) Prior operations No relevant prior operations 33,556 76 (68 - 82) 30/70 24.6 703 6.0 [5.7; 6.2] 6.5 [6.2; 6.8] 6.9 [6.6; 7.2] 7.2 [6.9; 7.6] 7.5 [7.2; 7.8] 7.8 [7.4; 8.1] 8.1 [7.7; 8.6] 8.4 [7.8; 8.9] 8.4 [7.8; 8.9] (23,620) (17,863) (13,027) (9,238) (6,061) (3,634) (1,834) (628) (116) Osteosynthesis / Osteotomy 937 77 (67 - 84) 28/72 25.0 387 9.3 [7.3; 11.2] 10.4 [8.3; 12.4] 10.6 [8.5; 12.7] 10.8 [8.7; 13.0] 11.3 [8.9; 13.6] 11.8 [9.2; 14.3] 11.8 [9.2; 14.3] (620) (487) (387) (268) (175) (117) (55) Other prior operations 445 76 (68 - 82) 30/70 24.5 164 8.5 [5.8; 11.1] 8.7 [6.0; 11.4] 9.2 [6.3; 11.9] 9.6 [6.6; 12.5] 9.6 [6.6; 12.5] 9.6 [6.6; 12.5] 9.6 [6.6; 12.5] (335) (275) (215) (176) (123) (93) (59) Hip hemiarthroplasties 73,215 84 (80 - 89) 29/71 24.2 624 4.6 [4.4; 4.7] 4.8 [4.6; 5.0] 5.0 [4.8; 5.2] 5.2 [5.0; 5.4] 5.3 [5.1; 5.5] 5.5 [5.3; 5.7] 5.6 [5.3; 5.8] 6.0 [5.5; 6.5] 6.0 [5.5; 6.5] (40,585) (27,056) (17,231) (10,597) (6,110) (3,163) (1,340) (375) (50) Primary diagnosis Femoral neck fracture 67,142 85 (80 - 89) 28/72 24.2 606 4.4 [4.2; 4.5] 4.6 [4.4; 4.7] 4.7 [4.5; 4.9] 4.9 [4.7; 5.1] 5.0 [4.8; 5.2] 5.1 [4.9; 5.4] 5.2 [5.0; 5.5] 5.7 [5.2; 6.2] (37,702) (25,199) (16,046) (9,864) (5,669) (2,932) (1,244) (352) Diagnoses other than osteoarthritis or 7.6 [6.6; 8.5] 8.0 [7.0; 9.0] 8.4 [7.4; 9.5] 9.0 [7.8; 10.2] 9.3 [8.0; 10.5] 10.0 [8.3; 11.7] 10.0 [8.3; 11.7] 3,912 82 (75 - 87) 37/63 24.5 530 fracture (1,719) (1,123) (717) (443) (278) (150) (61) Other femoral fracture 1,395 85 (80 - 90) 23/77 24.5 369 7.3 [5.8; 8.8] 7.8 [6.2; 9.4] 8.2 [6.4; 9.8] 8.6 [6.7; 10.5] 8.6 [6.7; 10.5] 8.6 [6.7; 10.5] (723) (427) (269) (172) (98) (50) Pathologic fracture 609 83 (76 - 88) 20/80 24.2 262 4.4 [2.6; 6.1] 4.4 [2.6; 6.1] 4.9 [2.9; 6.9] 5.9 [3.1; 8.6] (325) (222) (137) (81) Prior operations No relevant prior operations 71,275 84 (80 - 89) 29/71 24.2 621 4.5 [4.3; 4.7] 4.7 [4.6; 4.9] 4.9 [4.7; 5.1] 5.1 [4.9; 5.3] 5.3 [5.0; 5.5] 5.4 [5.2; 5.7] 5.5 [5.2; 5.8] 6.0 [5.5; 6.5] (39,428) (26,237) (16,667) (10,221) (5,864) (3,010) (1,272) (361) Osteosynthesis / Osteotomy 1,035 85 (80 - 89) 24/76 24.8 331 9.7 [7.8; 11.6] 9.9 [7.9; 11.8] 10.1 [8.1; 12.0] 10.1 [8.1; 12.0] 10.1 [8.1; 12.0] 10.1 [8.1; 12.0] (624) (434) (299) (209) (133) (76) Other prior operations 875 83 (78 - 88) 31/69 24.5 192 4.4 [3.0; 5.8] 4.8 [3.3; 6.3] 5.2 [3.5; 6.8] 5.5 [3.7; 7.3] 5.5 [3.7; 7.3] 5.5 [3.7; 7.3] (515) (372) (257) (162) (109) (76) Table 44 (continued) 56 EPRD Annual Report 2024 57  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival 7 © EPRD Annual Report 2024 5.1.2 Non-implant-related factors in ence in the risk of infection between men 6 primary hip arthroplasty and women which has also been reported in Arthroplasty outcomes are influenced by a other international registries [2]. Cumulative revision [%] 5 number of factors including the type of ar- 4 throplasty as well as patient and hospital As sex is a significant influencing factor, the 3 characteristics. Patient age is a particularly EPRD’s website presents outcomes for the 2 important factor in elective THA with unce- different types of arthroplasties, risk factors 1 Elective THAs with uncemented stems in patients ≥ 85 years mented stems, which is the most frequently and implant characteristics separately for Elective THAs with uncemented stems in patients between 75 and 84 years 0 Elective THAs with uncemented stems in patients < 75 years performed type of hip arthroplasty (Fig- male and female subpopulations, also refer ure 6). to pages 172/173. 0 1 2 3 4 5 6 7 8 9 Years since primary Older patients have a higher revision risk, Patient body type also substantially impacts Hip Numbers 8,332 6,344 4,883 3,623 2,589 1,637 919 if this type of arthroplasty is performed for arthroplasty outcome. The EPRD has been 93,726 77,962 64,910 53,311 41,646 29,670 18,865 9,883 3,525 791 at risk 318,166 261,196 214,242 174,794 137,882 101,425 68,296 39,126 16,221 4,635 periprosthetic fractures (also refer to [1]). deriving body mass index (BMI) data from Conversely, CRRs for other types of hip ar- patients’ height and weight since 2017 (also throplasties are lower in older compared to refer to page 164). Figure 6: Cumulative revision rates for elective total hip arthroplasties with uncemented stems by age group (p< 0.0001) younger age groups (see Table 45). Figure 8 shows that patients in higher BMI 6 Male patients have a higher revision risk irre- categories have a considerably increased © EPRD Annual Report 2024 spectively of the type of primary hip arthro- revision risk after elective THA with unce- 5 plasty, when compared to female patients, mented stems. This holds true despite higher Cumulative revision [%] 4 as shown in Figure 7 for elective THAs with BMI patients generally being younger at the 3 cemented stems. This may reflect a differ- time of the primary procedure. 2 1 9 © EPRD Annual Report 2024 Elective THAs with cemented stems in male patients Elective THAs with cemented stems in female patients 8 0 Cumulative revision [%] 7 0 1 2 3 4 5 6 7 8 9 6 Years since primary 5 28,282 22,519 18,160 14,431 11,076 7,869 5,135 2,812 1,169 4 Numbers at risk 86,754 70,010 56,469 45,253 35,057 25,205 16,745 9,428 3,970 1,102 3 Elective THAs with uncemented stems in patients with BMI > 40 2 Elective THAs with uncemented stems in patients with BMI > 35 to 40 Elective THAs with uncemented stems in patients with BMI > 30 to 35 Figure 7: Cumulative revision rates for elective total hip arthroplasties with uncemented stems by patient sex (p < 0.0001) 1 Elective THAs with uncemented stems in patients with BMI > 25 to 30 Elective THAs with uncemented stems in patients with BMI < 25 0 0 1 2 3 4 5 6 Years since primary 11,157 8,479 6,569 4,810 3,311 1,834 27,057 20,729 15,792 11,649 7,932 4,288 1,092 Numbers at risk 72,246 56,508 43,671 32,607 22,202 12,053 3,107 121,429 95,834 73,984 55,747 38,300 20,993 5,446 83,777 65,839 50,446 37,552 25,492 13,750 3,520 Figure 8: Cumulative revision rates for elective total hip arthroplasties with uncemented stems by patient body mass index (p < 0.0001) 58 EPRD Annual Report 2024 59  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival 6 © EPRD Annual Report 2024 5 Cumulative revision [%] 4 3 2 1 Elective THAs with uncemented stems in hospitals with up to 200 such primary procedures per year Elective THAs with uncemented stems in hospitals with 201 to 500 such primary procedures per year Elective THAs with uncemented stems in hospitals with more than 500 such primary procedures per year 0 0 1 2 3 4 5 6 7 8 9 Years since primary Hip 128,794 105,087 86,119 70,435 55,288 40,079 26,220 14,023 4,909 770 Numbers at risk 140,733 115,403 93,569 75,814 59,542 43,628 28,993 16,392 6,798 1,614 142,377 117,130 96,954 78,773 61,566 44,432 29,695 17,177 7,331 2,895 Figure 9: Cumulative revision rates for elective total hip arthroplasties by the hospital's annual volume of primary elective total hip arthroplasties (p < 0.0001) When focusing on elective hip arthroplasty in more detail, hospitals that have more experi- In brief ence with this type of procedure also achieve better outcomes5 (see Figure 9 for example). • Men and patients with high BMI are at But this trend is not absolute. The EPRD also increased risk of revision. includes hospitals that achieve good results • Only elective THAs with uncemented despite low case numbers as well as hospi- stems have higher CRRs in older com- tals with high case numbers but poorer out- pared to younger patients. comes. • Hospitals with higher elective arthroplasty volumes tend to achieve lower risks of Table 45 lists CRRs for different types of hip revision. arthroplasties by selected non-implant-re- lated factors. 5 The classifications in this report are based on the hospitals’ quality reports for 2022 and the corresponding IQTIG quality indicators listed therein. 60 EPRD Annual Report 2024 61  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty /Category Elective THAs with uncemented stems 420,224 67 (59 - 74) 41/59 27.8 762 2.8 [2.7; 2.8] 3.2 [3.1; 3.2] 3.4 [3.4; 3.5] 3.6 [3.5; 3.7] 3.8 [3.7; 3.8] 4.0 [3.9; 4.0] 4.1 [4.1; 4.2] 4.3 [4.2; 4.4] 4.5 [4.4; 4.7] (345,502) (284,035) (231,728) (182,117) (132,732) (88,080) (49,430) (19,866) (5,443) Age group ≤ 54 years 54,575 50 (46 - 53) 49/51 28.4 743 2.3 [2.2; 2.4] 2.9 [2.7; 3.0] 3.2 [3.1; 3.4] 3.5 [3.3; 3.6] 3.7 [3.5; 3.9] 3.9 [3.7; 4.1] 4.1 [3.9; 4.3] 4.3 [4.1; 4.6] 4.5 [4.2; 4.8] (45,733) (38,326) (31,585) (25,367) (18,875) (12,722) (7,437) (3,146) (948) 55 to 64 years 119,739 60 (58 - 62) 44/56 28.5 754 2.3 [2.3; 2.4] 2.8 [2.7; 2.9] 3.1 [3.0; 3.2] 3.2 [3.1; 3.4] 3.4 [3.3; 3.5] 3.6 [3.5; 3.7] 3.8 [3.6; 3.9] 3.9 [3.8; 4.1] 4.1 [3.9; 4.3] (98,032) (80,069) (65,014) (50,843) (37,266) (24,983) (14,119) (5,826) (1,650) 65 to 74 years 143,852 69 (67 - 72) 38/62 28.1 753 2.6 [2.5; 2.6] 2.9 [2.8; 3.0] 3.1 [3.1; 3.2] 3.3 [3.2; 3.4] 3.5 [3.4; 3.6] 3.6 [3.5; 3.7] 3.8 [3.7; 3.9] 4.0 [3.9; 4.2] 4.2 [4.0; 4.4] (117,431) (95,847) (78,195) (61,672) (45,284) (30,591) (17,570) (7,249) (2,037) 75 to 84 years 93,726 78 (76 - 81) 36/64 26.9 754 3.7 [3.6; 3.8] 4.0 [3.9; 4.1] 4.2 [4.1; 4.4] 4.4 [4.3; 4.5] 4.6 [4.4; 4.7] 4.8 [4.6; 4.9] 5.0 [4.8; 5.2] 5.1 [4.9; 5.3] 5.4 [5.1; 5.7] (77,962) (64,910) (53,311) (41,646) (29,670) (18,865) (9,883) (3,525) (791) ≥ 85 years 8,332 86 (85 - 88) 35/65 25.7 633 4.7 [4.2; 5.1] 4.8 [4.4; 5.3] 5.1 [4.6; 5.6] 5.2 [4.7; 5.7] 5.6 [5.0; 6.1] 5.9 [5.2; 6.5] 6.0 [5.3; 6.7] 7.4 [5.8; 9.0] (6,344) (4,883) (3,623) (2,589) (1,637) (919) (421) (120) Hip Sex Male 170,533 65 (58 - 73) 100/0 28.4 755 2.8 [2.7; 2.9] 3.3 [3.2; 3.3] 3.5 [3.5; 3.6] 3.7 [3.6; 3.8] 3.9 [3.8; 4.0] 4.1 [4.0; 4.2] 4.3 [4.2; 4.4] 4.5 [4.3; 4.6] 4.6 [4.4; 4.8] (139,548) (114,135) (92,701) (72,164) (52,167) (34,299) (18,923) (7,505) (2,073) Female 249,691 68 (60 - 75) 0/100 27.5 759 2.7 [2.6; 2.8] 3.1 [3.0; 3.2] 3.3 [3.3; 3.4] 3.5 [3.4; 3.6] 3.7 [3.6; 3.8] 3.9 [3.8; 4.0] 4.1 [4.0; 4.1] 4.2 [4.1; 4.4] 4.5 [4.3; 4.6] (205,954) (169,900) (139,027) (109,953) (80,565) (53,781) (30,507) (12,361) (3,370) Body-Mass-Index ≤ 25 83,777 68 (60 - 76) 30/70 23.2 733 2.2 [2.1; 2.3] 2.5 [2.4; 2.6] 2.8 [2.6; 2.9] 3.0 [2.8; 3.1] 3.2 [3.0; 3.3] 3.4 [3.3; 3.6] (65,839) (50,446) (37,552) (25,492) (13,750) (3,520) > 25 to 30 121,429 68 (60 - 75) 46/54 27.4 742 2.4 [2.3; 2.5] 2.7 [2.6; 2.8] 2.9 [2.8; 3.0] 3.1 [3.0; 3.2] 3.2 [3.1; 3.3] 3.4 [3.3; 3.5] (95,834) (73,984) (55,747) (38,300) (20,993) (5,446) > 30 to 35 72,246 66 (59 - 73) 45/55 32.0 732 3.1 [3.0; 3.2] 3.5 [3.4; 3.6] 3.8 [3.6; 3.9] 3.9 [3.8; 4.1] 4.1 [3.9; 4.3] 4.2 [4.1; 4.4] (56,508) (43,671) (32,607) (22,202) (12,053) (3,107) > 35 to 40 27,057 64 (57 - 70) 40/60 36.8 714 4.1 [3.9; 4.3] 4.6 [4.3; 4.9] 4.9 [4.6; 5.2] 5.1 [4.8; 5.4] 5.2 [4.9; 5.5] 5.3 [4.9; 5.6] (20,729) (15,792) (11,649) (7,932) (4,288) (1,092) above 40 11,157 62 (56 - 68) 34/66 42.5 697 6.6 [6.2; 7.1] 7.2 [6.7; 7.7] 7.6 [7.1; 8.1] 7.9 [7.3; 8.4] 8.2 [7.6; 8.7] 8.2 [7.6; 8.7] (8,479) (6,569) (4,810) (3,311) (1,834) (474) ASA status ASA 1 24,712 62 (55 - 70) 43/57 26.6 668 2.1 [1.9; 2.3] 2.4 [2.2; 2.6] 2.6 [2.4; 2.8] 2.8 [2.5; 3.2] (16,861) (9,930) (2,358) (61) ASA 2 109,022 66 (59 - 73) 38/62 27.7 702 2.5 [2.4; 2.6] 2.8 [2.7; 2.9] 3.1 [3.0; 3.2] 3.2 [3.0; 3.4] (70,787) (37,030) (9,649) (193) ASA 3 50,007 71 (64 - 78) 44/56 29.3 691 4.1 [3.9; 4.2] 4.5 [4.3; 4.7] 4.8 [4.6; 5.0] (31,695) (16,252) (4,152) ASA 4 or 5 945 73 (65 - 80) 52/48 29.1 358 5.9 [4.3; 7.4] 6.3 [4.6; 7.9] 6.7 [4.8; 8.5] (582) (306) (84) Hospital size* Hospitals with low annual case volumes 128,794 68 (61 - 76) 41/59 28.1 478 3.3 [3.2; 3.4] 3.8 [3.7; 3.9] 4.1 [4.0; 4.2] 4.3 [4.2; 4.4] 4.5 [4.4; 4.6] 4.7 [4.6; 4.8] 4.9 [4.7; 5.0] 5.1 [4.9; 5.2] 5.4 [5.1; 5.7] (105,087) (86,119) (70,435) (55,288) (40,079) (26,220) (14,023) (4,909) (770) Hospitals with average annual case volumes 140,733 67 (60 - 74) 41/59 28.0 179 2.7 [2.6; 2.8] 3.1 [3.0; 3.2] 3.4 [3.3; 3.5] 3.6 [3.5; 3.7] 3.7 [3.6; 3.9] 3.9 [3.8; 4.0] 4.2 [4.0; 4.3] 4.4 [4.3; 4.6] 4.6 [4.4; 4.8] (115,403) (93,569) (75,814) (59,542) (43,628) (28,993) (16,392) (6,798) (1,614) Hospitals with high annual case volumes 142,377 66 (58 - 73) 40/60 27.6 65 2.3 [2.2; 2.4] 2.6 [2.6; 2.7] 2.9 [2.8; 3.0] 3.0 [2.9; 3.1] 3.2 [3.1; 3.3] 3.3 [3.2; 3.5] 3.5 [3.4; 3.6] 3.7 [3.5; 3.8] 3.8 [3.6; 4.0] (117,130) (96,954) (78,773) (61,566) (44,432) (29,695) (17,177) (7,331) (2,895) Elective THAs with cemented stems 115,036 79 (75 - 83) 25/75 26.5 735 2.4 [2.3; 2.5] 2.7 [2.6; 2.8] 2.9 [2.8; 3.0] 3.2 [3.0; 3.3] 3.4 [3.3; 3.5] 3.6 [3.5; 3.7] 3.9 [3.7; 4.0] 4.1 [3.9; 4.3] 4.3 [4.0; 4.5] (92,529) (74,629) (59,684) (46,133) (33,074) (21,880) (12,240) (5,139) (1,402) Age group ≤ 54 years 1,032 51 (47 - 53) 60/40 27.7 289 3.2 [2.1; 4.3] 4.1 [2.8; 5.3] 4.8 [3.4; 6.2] 5.3 [3.8; 6.8] 6.0 [4.3; 7.7] 6.8 [4.8; 8.8] 7.7 [5.3; 10.0] (837) (724) (602) (485) (366) (222) (118) 55 to 64 years 3,798 61 (58 - 63) 37/63 27.8 542 3.1 [2.5; 3.7] 4.0 [3.3; 4.6] 4.2 [3.6; 4.9] 4.5 [3.8; 5.2] 5.0 [4.2; 5.8] 5.5 [4.6; 6.3] 6.2 [5.0; 7.3] 6.7 [5.3; 8.0] 6.7 [5.3; 8.0] (3,000) (2,432) (1,982) (1,610) (1,169) (784) (449) (182) (56) 65 to 74 years 22,082 72 (69 - 73) 23/77 27.6 678 2.3 [2.1; 2.6] 2.7 [2.5; 3.0] 3.1 [2.8; 3.3] 3.3 [3.1; 3.6] 3.6 [3.3; 3.9] 3.9 [3.6; 4.2] 4.1 [3.8; 4.5] 4.3 [3.9; 4.7] 4.5 [4.0; 5.0] (17,821) (14,547) (11,917) (9,585) (7,293) (5,174) (3,158) (1,475) (471) 75 to 84 years 71,403 80 (77 - 82) 24/76 26.4 722 2.2 [2.1; 2.4] 2.5 [2.4; 2.7] 2.8 [2.6; 2.9] 3.0 [2.8; 3.1] 3.2 [3.1; 3.4] 3.4 [3.2; 3.6] 3.7 [3.5; 3.9] 4.0 [3.7; 4.2] 4.1 [3.8; 4.4] (58,290) (47,446) (38,225) (29,564) (21,090) (13,836) (7,643) (3,169) (818) ≥85 years 16,721 87 (85 - 88) 24/76 25.5 690 2.7 [2.5; 3.0] 2.9 [2.7; 3.2] 3.1 [2.8; 3.4] 3.2 [2.9; 3.5] 3.3 [3.0; 3.6] 3.4 [3.1; 3.7] 3.4 [3.1; 3.7] 3.4 [3.1; 3.7] 3.4 [3.1; 3.7] (12,581) (9,480) (6,958) (4,889) (3,156) (1,864) (872) (275) (51) Sex Male 28,282 79 (74 - 82) 100/0 27.0 693 2.8 [2.6; 3.0] 3.2 [3.0; 3.4] 3.5 [3.2; 3.7] 3.7 [3.4; 3.9] 4.0 [3.7; 4.3] 4.2 [4.0; 4.5] 4.5 [4.2; 4.8] 4.8 [4.4; 5.1] 5.3 [4.5; 6.1] (22,519) (18,160) (14,431) (11,076) (7,869) (5,135) (2,812) (1,169) (300) Table 45: Cumulative revision rates for different types of primary hip arthroplasties by non-implant-related factors 62 EPRD Annual Report 2024 63  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty /Category Sex Female 86,754 79 (75 - 83) 0/100 26.3 732 2.2 [2.1; 2.3] 2.5 [2.4; 2.7] 2.8 [2.7; 2.9] 3.0 [2.9; 3.1] 3.2 [3.1; 3.3] 3.4 [3.3; 3.6] 3.7 [3.5; 3.9] 3.9 [3.7; 4.1] 4.0 [3.7; 4.2] (70,010) (56,469) (45,253) (35,057) (25,205) (16,745) (9,428) (3,970) (1,102) Body-Mass-Index ≤ 25 32,364 80 (76 - 83) 20/80 23.0 692 1.9 [1.8; 2.1] 2.2 [2.1; 2.4] 2.4 [2.2; 2.6] 2.6 [2.4; 2.8] 2.9 [2.7; 3.1] 3.3 [3.0; 3.7] (24,331) (18,000) (12,799) (8,347) (4,385) (1,194) > 25 to 30 33,376 80 (76 - 83) 29/71 27.3 691 2.2 [2.0; 2.3] 2.5 [2.3; 2.6] 2.7 [2.5; 2.9] 2.8 [2.6; 3.0] 3.1 [2.8; 3.3] 3.4 [3.1; 3.7] (25,850) (19,552) (14,382) (9,760) (5,290) (1,476) > 30 to 35 15,403 79 (74 - 82) 25/75 31.6 656 2.9 [2.6; 3.2] 3.3 [3.0; 3.6] 3.6 [3.2; 3.9] 3.8 [3.5; 4.1] 4.2 [3.8; 4.6] 4.4 [4.0; 4.9] (11,857) (9,019) (6,644) (4,537) (2,482) (706) > 35 to 40 4,562 76 (71 - 80) 22/78 36.7 570 4.6 [4.0; 5.2] 4.9 [4.3; 5.6] 5.2 [4.5; 5.9] 5.6 [4.9; 6.4] 5.9 [5.1; 6.7] 5.9 [5.1; 6.7] (3,426) (2,601) (1,952) (1,325) (749) (233) above 40 1,624 73 (67 - 78) 20/80 42.2 435 6.8 [5.6; 8.1] 7.2 [5.9; 8.5] 7.4 [6.1; 8.7] 7.5 [6.2; 8.9] 7.8 [6.3; 9.2] 8.4 [6.5; 10.2] (1,219) (955) (717) (481) (267) (80) Hip ASA status ASA 1 4,080 79 (73 - 82) 23/77 26.0 374 2.3 [1.8; 2.8] 2.6 [2.1; 3.1] 2.8 [2.2; 3.4] (2,763) (1,613) (353) ASA 2 23,710 79 (74 - 82) 19/81 25.9 620 1.9 [1.7; 2.1] 2.2 [2.0; 2.4] 2.4 [2.2; 2.7] (15,130) (7,829) (2,012) ASA 3 22,480 81 (76 - 84) 27/73 26.9 641 3.2 [2.9; 3.4] 3.5 [3.2; 3.7] 3.6 [3.3; 3.9] (13,796) (6,867) (1,674) ASA 4 or 5 670 81 (75 - 84) 38/62 26.4 286 6.6 [4.6; 8.6] 7.1 [4.9; 9.3] (341) (176) Hospital size* Hospitals with low annual case volumes 37,615 79 (75 - 83) 26/74 26.7 463 2.9 [2.7; 3.1] 3.2 [3.0; 3.4] 3.5 [3.3; 3.7] 3.8 [3.5; 4.0] 4.1 [3.8; 4.3] 4.3 [4.0; 4.5] 4.5 [4.3; 4.8] 4.9 [4.6; 5.3] 4.9 [4.6; 5.3] (30,025) (24,552) (19,944) (15,618) (11,267) (7,497) (4,156) (1,561) (248) Hospitals with average annual case volumes 40,376 79 (75 - 83) 25/75 26.6 175 2.2 [2.1; 2.4] 2.6 [2.5; 2.8] 2.8 [2.7; 3.0] 3.0 [2.8; 3.2] 3.2 [3.0; 3.4] 3.4 [3.2; 3.6] 3.6 [3.4; 3.8] 3.7 [3.5; 4.0] 4.1 [3.5; 4.6] (32,496) (26,203) (20,951) (16,284) (11,750) (7,618) (4,220) (1,725) (410) Hospitals with high annual case volumes 35,838 79 (75 - 82) 23/77 26.2 65 2.0 [1.8; 2.1] 2.2 [2.1; 2.4] 2.4 [2.3; 2.6] 2.7 [2.5; 2.9] 2.9 [2.7; 3.1] 3.1 [2.9; 3.3] 3.5 [3.2; 3.8] 3.7 [3.4; 4.1] 3.8 [3.4; 4.3] (28,885) (22,836) (17,815) (13,333) (9,314) (6,208) (3,511) (1,676) (677) Non-elective THAs 34,964 76 (68 - 82) 30/70 24.6 707 6.1 [5.8; 6.3] 6.7 [6.4; 6.9] 7.0 [6.7; 7.3] 7.4 [7.1; 7.7] 7.6 [7.3; 8.0] 7.9 [7.6; 8.3] 8.2 [7.8; 8.7] 8.5 [8.0; 8.9] 8.5 [8.0; 8.9] (24,594) (18,634) (13,636) (9,688) (6,362) (3,846) (1,949) (668) (126) Age group ≤ 54 years 1,020 51 (48 - 53) 52/48 24.2 437 7.6 [5.9; 9.2] 8.1 [6.4; 9.9] 8.3 [6.5; 10.1] 8.8 [6.9; 10.6] 9.0 [7.1; 10.9] 9.5 [7.3; 11.6] 9.5 [7.3; 11.6] (761) (600) (483) (374) (253) (156) (74) 55 to 64 years 4,607 61 (58 - 63) 40/60 24.2 610 7.1 [6.3; 7.8] 7.9 [7.0; 8.7] 8.3 [7.5; 9.2] 8.7 [7.8; 9.6] 9.0 [8.0; 9.9] 9.2 [8.2; 10.2] 9.4 [8.3; 10.6] 10.1 [8.4; 11.7] (3,357) (2,512) (1,843) (1,308) (854) (548) (302) (111) 65 to 74 years 9,928 70 (67 - 72) 31/69 25.0 660 5.8 [5.3; 6.3] 6.5 [6.0; 7.0] 6.9 [6.4; 7.5] 7.3 [6.8; 7.9] 7.6 [7.0; 8.2] 7.7 [7.1; 8.4] 8.2 [7.4; 8.9] 8.4 [7.5; 9.4] 8.4 [7.5; 9.4] (7,208) (5,481) (4,082) (3,017) (2,059) (1,306) (689) (249) (52) 75 to 84 years 13,890 79 (77 - 82) 27/73 24.7 656 6.0 [5.6; 6.4] 6.5 [6.0; 6.9] 6.8 [6.3; 7.2] 7.1 [6.6; 7.6] 7.4 [6.9; 7.9] 7.7 [7.2; 8.3] 8.0 [7.4; 8.6] 8.0 [7.4; 8.6] (10,042) (7,814) (5,794) (4,112) (2,713) (1,584) (781) (257) ≥85 years 5,519 88 (86 - 90) 26/74 24.2 541 5.7 [5.1; 6.4] 6.1 [5.5; 6.8] 6.4 [5.7; 7.1] 6.7 [5.9; 7.4] 6.8 [6.0; 7.6] 7.0 [6.1; 8.0] 7.8 [6.4; 9.3] (3,226) (2,227) (1,434) (877) (483) (252) (103) Sex Male 10,577 74 (66 - 81) 100/0 25.1 655 7.3 [6.8; 7.8] 8.0 [7.5; 8.6] 8.6 [8.0; 9.2] 9.0 [8.3; 9.6] 9.3 [8.6; 9.9] 9.5 [8.8; 10.2] 9.9 [9.1; 10.8] 10.8 [9.3; 12.2] (6,966) (5,055) (3,564) (2,467) (1,581) (941) (457) (159) Female 24,387 77 (69 - 82) 0/100 24.2 698 5.6 [5.3; 5.9] 6.1 [5.8; 6.4] 6.4 [6.1; 6.7] 6.7 [6.4; 7.1] 7.0 [6.6; 7.3] 7.2 [6.8; 7.6] 7.6 [7.1; 8.0] 7.6 [7.1; 8.0] 7.6 [7.1; 8.0] (17,628) (13,579) (10,072) (7,221) (4,781) (2,905) (1,492) (509) (101) Body-Mass-Index ≤ 25 14,946 76 (68 - 82) 28/72 22.5 655 5.4 [5.0; 5.8] 6.0 [5.6; 6.4] 6.2 [5.8; 6.6] 6.7 [6.2; 7.2] 6.9 [6.4; 7.4] 7.2 [6.6; 7.8] (10,041) (7,083) (4,689) (2,806) (1,341) (358) > 25 to 30 9,229 76 (69 - 82) 35/65 26.9 636 6.2 [5.7; 6.7] 6.8 [6.3; 7.4] 7.2 [6.6; 7.8] 7.4 [6.8; 8.0] 7.7 [7.0; 8.3] 7.9 [7.2; 8.7] (6,303) (4,549) (3,093) (1,997) (1,046) (285) > 30 to 35 2,543 74 (68 - 81) 32/68 31.6 519 8.1 [7.0; 9.2] 8.6 [7.4; 9.7] 9.0 [7.8; 10.2] 9.3 [8.0; 10.5] 9.5 [8.2; 10.8] 9.5 [8.2; 10.8] (1,773) (1,296) (908) (585) (277) (58) > 35 to 40 535 72 (65 - 79) 28/72 36.6 276 10.8 [8.1; 13.5] 10.8 [8.1; 13.5] 11.2 [8.4; 14.0] 11.2 [8.4; 14.0] 11.2 [8.4; 14.0] (353) (248) (170) (108) (59) ASA status ASA 1 1,084 71 (63 - 79) 31/69 24.2 332 5.4 [4.0; 6.7] 6.1 [4.5; 7.6] 6.6 [4.9; 8.3] (722) (426) (132) ASA 2 6,786 73 (66 - 79) 27/73 24.5 583 4.9 [4.3; 5.4] 5.5 [4.9; 6.1] 5.6 [5.0; 6.3] (4,183) (2,152) (524) ASA 3 8,575 78 (70 - 84) 34/66 24.7 582 7.9 [7.3; 8.5] 8.4 [7.7; 9.0] 8.7 [8.0; 9.5] (4,556) (2,228) (489) Table 45 (continued) 64 EPRD Annual Report 2024 65  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty /Category ASA status ASA 4 or 5 519 80 (71 - 87) 43/57 24.7 210 8.9 [6.1; 11.7] 8.9 [6.1; 11.7] (190) (83) Hospital size* Hospitals with low annual case volumes 6,326 76 (68 - 82) 29/71 24.8 245 6.3 [5.7; 7.0] 6.8 [6.2; 7.5] 7.2 [6.5; 7.9] 7.5 [6.8; 8.2] 8.0 [7.2; 8.8] 8.3 [7.4; 9.1] 8.6 [7.6; 9.5] 8.6 [7.6; 9.5] (4,590) (3,619) (2,667) (1,921) (1,291) (810) (415) (144) Hospitals with average annual case volumes 15,036 76 (68 - 82) 31/69 24.6 301 6.2 [5.8; 6.6] 6.8 [6.4; 7.3] 7.3 [6.8; 7.7] 7.7 [7.2; 8.1] 8.0 [7.5; 8.5] 8.1 [7.6; 8.6] 8.7 [8.0; 9.4] 8.9 [8.1; 9.8] 8.9 [8.1; 9.8] (10,389) (7,778) (5,634) (4,017) (2,599) (1,543) (790) (274) (51) Hospitals with high annual case volumes 13,353 76 (69 - 82) 30/70 24.5 134 5.8 [5.4; 6.2] 6.4 [6.0; 6.8] 6.7 [6.2; 7.1] 7.1 [6.6; 7.5] 7.1 [6.7; 7.6] 7.5 [6.9; 8.0] 7.6 [7.0; 8.2] 7.9 [7.0; 8.7] (9,408) (7,046) (5,165) (3,603) (2,357) (1,418) (708) (244) Hip hemiarthroplasties 73,215 84 (80 - 89) 29/71 24.2 624 4.6 [4.4; 4.7] 4.8 [4.6; 5.0] 5.0 [4.8; 5.2] 5.2 [5.0; 5.4] 5.3 [5.1; 5.5] 5.5 [5.3; 5.7] 5.6 [5.3; 5.8] 6.0 [5.5; 6.5] 6.0 [5.5; 6.5] (40,585) (27,056) (17,231) (10,597) (6,110) (3,163) (1,340) (375) (50) Age group ≤ 54 years 301 50 (45 - 53) 52/48 24.4 168 7.4 [4.2; 10.4] 8.4 [4.9; 11.8] 9.1 [5.4; 12.6] 10.8 [6.4; 14.9] 10.8 [6.4; 14.9] (182) (140) (113) (75) (59) Hip 55 to 64 years 1,363 61 (59 - 63) 49/51 24.2 372 7.0 [5.5; 8.4] 7.1 [5.6; 8.5] 7.5 [6.0; 9.1] 7.8 [6.1; 9.5] 7.8 [6.1; 9.5] 7.8 [6.1; 9.5] 7.8 [6.1; 9.5] (773) (524) (345) (243) (146) (88) (50) 65 to 74 years 5,622 71 (69 - 73) 43/57 24.7 527 5.4 [4.8; 6.1] 5.9 [5.2; 6.6] 6.3 [5.5; 7.0] 6.5 [5.8; 7.3] 6.5 [5.8; 7.3] 6.9 [6.0; 7.8] 6.9 [6.0; 7.8] 6.9 [6.0; 7.8] (3,283) (2,234) (1,551) (1,023) (667) (383) (195) (52) 75 to 84 years 29,761 81 (79 - 83) 30/70 24.5 603 4.7 [4.5; 5.0] 5.0 [4.7; 5.3] 5.2 [4.9; 5.5] 5.4 [5.1; 5.7] 5.7 [5.4; 6.0] 5.9 [5.5; 6.3] 6.1 [5.6; 6.5] 6.8 [5.9; 7.6] (17,985) (12,532) (8,349) (5,374) (3,150) (1,663) (708) (205) ≥ 85 years 36,168 89 (87 - 92) 25/75 24.0 594 4.2 [3.9; 4.4] 4.3 [4.1; 4.5] 4.4 [4.2; 4.6] 4.5 [4.2; 4.7] 4.5 [4.3; 4.8] 4.5 [4.3; 4.8] 4.5 [4.3; 4.8] 4.5 [4.3; 4.8] (18,362) (11,626) (6,873) (3,882) (2,088) (994) (366) (96) Sex Male 21,069 83 (78 - 88) 100/0 24.7 595 5.0 [4.7; 5.3] 5.3 [5.0; 5.7] 5.7 [5.3; 6.1] 6.1 [5.6; 6.5] 6.2 [5.7; 6.6] 6.4 [5.8; 6.9] 6.6 [5.9; 7.3] 7.1 [5.9; 8.4] (9,979) (6,094) (3,631) (2,093) (1,133) (563) (232) (62) Female 52,146 85 (81 - 89) 0/100 24.0 615 4.4 [4.2; 4.6] 4.6 [4.4; 4.8] 4.7 [4.5; 4.9] 4.9 [4.7; 5.1] 5.1 [4.8; 5.3] 5.2 [4.9; 5.5] 5.3 [5.0; 5.5] 5.7 [5.2; 6.2] (30,606) (20,962) (13,600) (8,504) (4,977) (2,600) (1,108) (313) Body-Mass-Index ≤ 25 33,901 85 (80 - 89) 28/72 22.3 593 4.3 [4.1; 4.6] 4.5 [4.3; 4.8] 4.7 [4.4; 4.9] 4.8 [4.5; 5.1] 5.0 [4.7; 5.3] 5.1 [4.7; 5.5] (17,514) (10,745) (6,084) (3,149) (1,356) (275) > 25 to 30 18,011 84 (80 - 88) 33/67 26.9 565 4.6 [4.3; 5.0] 4.8 [4.5; 5.1] 5.0 [4.6; 5.3] 5.2 [4.8; 5.6] 5.5 [5.0; 6.0] 5.5 [5.0; 6.0] (9,966) (6,449) (3,847) (2,115) (937) (199) > 30 to 35 4,564 83 (79 - 87) 26/74 31.2 525 6.3 [5.6; 7.1] 6.6 [5.8; 7.4] 6.8 [6.0; 7.6] 7.1 [6.2; 8.0] 7.4 [6.3; 8.4] 7.4 [6.3; 8.4] (2,599) (1,698) (1,071) (596) (270) (61) > 35 to 40 873 82 (77 - 86) 22/78 36.5 368 8.7 [6.7; 10.7] 9.2 [7.1; 11.2] 9.6 [7.3; 11.7] 10.7 [8.0; 13.3] (478) (305) (190) (99) ASA status ASA 1 1,302 84 (80 - 89) 28/72 24.2 189 5.2 [3.9; 6.5] 5.3 [4.0; 6.6] 5.3 [4.0; 6.6] (718) (431) (114) ASA 2 6,715 84 (80 - 88) 24/76 24.2 482 3.9 [3.4; 4.4] 4.2 [3.6; 4.7] 4.2 [3.6; 4.7] (3,577) (1,686) (408) ASA 3 26,059 85 (80 - 89) 30/70 24.2 542 4.9 [4.7; 5.2] 5.1 [4.8; 5.4] 5.4 [5.0; 5.7] (11,560) (5,017) (1,009) ASA 4 or 5 3,325 85 (80 - 90) 40/60 24.2 440 5.1 [4.2; 6.0] 5.3 [4.3; 6.2] 5.3 [4.3; 6.2] (963) (369) (64) Hospital size* Hospitals with low annual case volumes 11,628 84 (80 - 89) 28/72 24.5 196 4.3 [3.9; 4.7] 4.6 [4.2; 5.0] 4.7 [4.3; 5.2] 4.8 [4.4; 5.3] 5.1 [4.6; 5.6] 5.5 [4.8; 6.1] 5.8 [5.0; 6.7] 6.3 [5.1; 7.5] (6,691) (4,586) (3,048) (1,936) (1,164) (608) (255) (74) Hospitals with average annual case volumes 33,778 84 (80 - 89) 29/71 24.3 278 4.7 [4.5; 5.0] 5.0 [4.7; 5.2] 5.2 [4.9; 5.4] 5.4 [5.1; 5.7] 5.5 [5.2; 5.8] 5.6 [5.3; 6.0] 5.6 [5.3; 6.0] 6.1 [5.4; 6.7] (18,619) (12,326) (7,782) (4,713) (2,663) (1,366) (612) (182) Hospitals with high annual case volumes 27,199 85 (80 - 89) 29/71 24.0 129 4.5 [4.3; 4.8] 4.7 [4.4; 5.0] 4.9 [4.6; 5.2] 5.1 [4.8; 5.4] 5.3 [4.9; 5.6] 5.3 [5.0; 5.7] 5.3 [5.0; 5.7] 5.8 [5.0; 6.6] (14,892) (9,844) (6,177) (3,793) (2,175) (1,124) (455) (118) * The classifications in this report are based on the hospitals’ quality reports for 2022 and the corresponding primary hip ar- throplasty IQTIG quality indicators listed therein. For elective arthroplasties, the case number cutoffs for classification as low case volume is up to 200 cases, for medium volume 201 to 500 cases and for the high volume category greater than 500 corre- sponding procedures per year; for non-elective arthroplasties, the cutoffs are up to 50, 51 to 100 and over 100 corresponding procedures per year. Table 45 (continued) 66 EPRD Annual Report 2024 67  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival 5.1.3 Impact of implant character- In the EPRD, THAs still predominantly head-neck lengths – e.g. to compensate for ure 13). It should be noted that short stems istics in primary hip arthroplasty rely on three different head sizes: 28 mm, a shorter leg length with a more cranial cen- are predominantly favoured for younger The choice of femoral fixation impacts hip 32 mm and 36 mm. Over the entire EPRD tre of rotation – may have fundamentally and healthier patients. Nevertheless, the sig- arthroplasty outcomes differently in specific data collection period, small head compo- worse initial conditions than other arthro- nificantly lower infection rate observed for patient groups. Among younger patients, ar- nents have higher CRRs both in elective as plasties. It is also apparent that specific stem short stems cannot solely be rationalised throplasty outcomes for uncemented stems well as non-elective procedures (Figure 11 systems are frequently used in combination by differences between patient groups [3]. are no worse than for cemented stems. But and Table 46). This is probably due to the with longer head-neck lengths and do not There are major overall outcome differences this is not the case in older patients (also re- lower risk of dislocation of larger heads. necessarily achieve poorer outcomes as a re- between specific short and standard stem fer to Table 45). The CRRs, of all age groups Although CRRs decrease with increasing sult. systems. Some standard stem components, combined, are lower for cemented stems head diameters, rates increase for longer for instance, achieve the same outcomes as both in elective and non-elective hip arthro- head-neck lengths (see Figure 12). However, For the period analysed, short stems achieve the best short stems (see Table 63 in the ap- plasties (see Figure 10 for example). it should be noted that cases with longer better outcomes than standard stems (Fig- pendix). Hip 10 8 © EPRD Annual Report 2024 © EPRD Annual Report 2024 9 7 8 Cumulative revision [%] Cumulative revision [%] 6 7 6 5 5 4 4 3 3 2 2 Elective THAs with uncemented stems and head-neck lengths XL, XXL and XXXL Elective THAs with uncemented stems and head-neck length L 1 1 Elective THAs with uncemented stems and head-neck length M Hip hemiarthroplasties with uncemented stems Hip hemiarthroplasties with cemented stems Elective THAs with uncemented stems and head-neck lengths XS and S 0 0 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 Years since primary Years since primary Numbers 8,619 4,989 3,486 2,350 1,439 832 18,834 15,413 12,756 10,462 8,206 6,088 4,076 2,380 944 at risk 70,924 58,870 49,009 40,506 32,410 24,393 16,722 9,823 4,160 1,125 64,562 35,582 23,562 14,876 9,155 5,275 2,754 1,167 Numbers at risk 153,002 126,291 104,360 85,251 67,101 48,923 32,636 18,526 7,482 2,072 174,736 142,826 116,213 94,132 73,365 52,647 34,228 18,479 7,192 1,966 Figure 10: Cumulative revision rates for uncemented and cemented hip hemiarthroplasties (p < 0.0001) Figure 12: Cumulative revision rates for elective total hip arthroplasties with uncemented stems by head-neck lengths (p < 0.0001) 6 © EPRD Annual Report 2024 6 5 © EPRD Annual Report 2024 Cumulative revision [%] 5 4 Cumulative revision [%] 4 3 3 2 2 1 Elective THAs with cemented stems and head size 28 mm Elective THAs with cemented stems and head size 32 mm Elective THAs with cemented stems and head size 36 mm 1 0 Elective THAs with uncemented standard stems Elective THAs with uncemented short stems 0 1 2 3 4 5 6 7 8 9 0 Years since primary 0 1 2 3 4 5 6 7 8 9 7,804 6,107 4,864 3,806 2,972 2,207 1,533 904 Years since primary Numbers at risk 70,643 58,270 47,956 39,144 30,601 22,169 14,875 8,490 3,632 1,014 Numbers 351,329 291,156 241,337 198,266 156,325 114,196 76,074 42,924 17,498 4,797 35,228 27,053 20,885 15,966 11,936 8,246 5,196 2,709 1,074 at risk 58,995 46,222 35,853 27,717 20,951 14,624 9,111 4,661 1,832 582 Figure 11: Cumulative revision rates for elective total hip arthroplasties with cemented stems by head size (p < 0.0001) Figure 13: Cumulative revision rates for elective total hip arthroplasties with uncemented stems by stem type (p < 0.0001) 68 EPRD Annual Report 2024 69  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Table 46 illustrates the correlations between implant characteristics and CRRs for differ- ent types of hip arthroplasties. In brief • Arthroplasties with cemented femoral components have lower CRRs due to bet- ter outcomes in older patients. • Larger heads have lower revision rates during the early post-operative phase. Hip Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category Elective THAs with uncemented stems 420,224 67 (59 - 74) 41/59 27.8 762 2.8 [2.7; 2.8] 3.2 [3.1; 3.2] 3.4 [3.4; 3.5] 3.6 [3.5; 3.7] 3.8 [3.7; 3.8] 4.0 [3.9; 4.0] 4.1 [4.1; 4.2] 4.3 [4.2; 4.4] 4.5 [4.4; 4.7] (345,502) (284,035) (231,728) (182,117) (132,732) (88,080) (49,430) (19,866) (5,443) Bearing Ceramic / hXLPE 211,006 67 (59 - 74) 40/60 27.8 671 2.7 [2.7; 2.8] 3.1 [3.1; 3.2] 3.4 [3.3; 3.5] 3.6 [3.5; 3.7] 3.7 [3.7; 3.8] 3.9 [3.8; 4.0] 4.1 [4.0; 4.2] 4.2 [4.1; 4.3] 4.3 [4.2; 4.5] (172,999) (141,751) (115,181) (90,124) (65,400) (43,349) (24,261) (9,515) (2,536) Ceramic / hXLPE+antioxidant 88,165 67 (60 - 74) 41/59 28.0 478 2.7 [2.6; 2.8] 3.0 [2.9; 3.1] 3.2 [3.1; 3.3] 3.3 [3.2; 3.5] 3.5 [3.3; 3.6] 3.6 [3.4; 3.7] 3.7 [3.5; 3.8] 3.8 [3.6; 3.9] 3.9 [3.5; 4.3] (69,418) (54,338) (42,542) (31,885) (21,450) (12,540) (5,742) (1,651) (292) Ceramic / ceramic 44,050 62 (55 - 69) 43/57 27.7 407 2.1 [2.0; 2.3] 2.5 [2.4; 2.7] 2.7 [2.6; 2.9] 2.9 [2.7; 3.1] 3.0 [2.8; 3.2] 3.2 [3.0; 3.4] 3.4 [3.2; 3.6] 3.5 [3.3; 3.7] 3.6 [3.3; 3.8] (37,672) (31,789) (26,479) (21,480) (16,406) (11,654) (7,163) (3,233) (1,013) Ceramic / mXLPE 32,039 70 (63 - 77) 41/59 27.8 282 2.7 [2.5; 2.9] 3.2 [3.0; 3.4] 3.5 [3.3; 3.8] 3.8 [3.6; 4.1] 4.0 [3.7; 4.2] 4.2 [3.9; 4.4] 4.4 [4.1; 4.6] 4.8 [4.4; 5.2] 5.1 [4.6; 5.5] (27,525) (23,476) (19,779) (15,711) (11,934) (8,316) (4,748) (1,957) (582) Ceramic / PE 17,111 72 (64 - 78) 34/66 27.9 491 3.5 [3.2; 3.7] 4.1 [3.8; 4.4] 4.5 [4.2; 4.8] 4.8 [4.5; 5.1] 5.0 [4.7; 5.4] 5.3 [4.9; 5.6] 5.6 [5.2; 6.0] 6.0 [5.5; 6.4] 6.5 [5.9; 7.1] (15,207) (13,667) (12,130) (10,512) (8,587) (6,537) (4,373) (2,211) (701) Ceramicised metal / hXLPE 11,663 67 (59 - 74) 41/59 28.1 131 2.7 [2.4; 3.0] 2.9 [2.6; 3.2] 3.1 [2.8; 3.5] 3.4 [3.0; 3.7] 3.6 [3.2; 4.0] 3.8 [3.4; 4.3] 4.5 [3.8; 5.1] 5.3 [3.9; 6.7] (9,325) (7,578) (5,941) (4,478) (2,918) (1,559) (616) (117) Metal / hXLPE 8,673 74 (65 - 79) 42/58 27.7 396 4.1 [3.6; 4.5] 4.3 [3.9; 4.7] 4.6 [4.2; 5.1] 4.9 [4.4; 5.4] 5.1 [4.6; 5.6] 5.3 [4.8; 5.9] 5.6 [5.0; 6.2] 6.0 [5.3; 6.7] 6.3 [5.4; 7.2] (7,208) (6,120) (5,068) (4,068) (3,064) (2,097) (1,218) (505) (113) metal / mXLPE 2,765 75 (68 - 80) 36/64 27.5 172 4.9 [4.1; 5.7] 5.5 [4.6; 6.4] 5.7 [4.8; 6.6] 5.9 [5.0; 6.8] 6.0 [5.1; 7.0] 6.3 [5.3; 7.3] 6.4 [5.4; 7.4] 6.4 [5.4; 7.4] 6.8 [5.6; 8.0] (2,339) (2,074) (1,839) (1,566) (1,235) (908) (618) (356) (93) Metal / hXLPE+antioxidant 1,668 76 (69 - 81) 36/64 27.5 259 6.4 [5.2; 7.5] 6.9 [5.7; 8.2] 7.2 [5.9; 8.5] 7.4 [6.0; 8.7] 7.4 [6.0; 8.7] 7.6 [6.2; 9.0] 8.0 [6.4; 9.5] 8,0 [6.4; 9.5] (1,262) (1,016) (834) (656) (481) (286) (159) (71) Metal / PE 1,484 77 (71 - 82) 32/68 27.0 284 6.1 [4.8; 7.3] 6.2 [4.9; 7.4] 6.4 [5.1; 7.7] 6.8 [5.4; 8.1] 7.2 [5.8; 8.6] 7.9 [6.4; 9.5] 8.2 [6.6; 9.8] 9.5 [7.3; 11.7] (1,195) (1,062) (957) (828) (672) (458) (301) (143) Ceramicised metal / PE 1,039 73 (65 - 79) 34/66 28.0 62 3.7 [2.5; 4.8] 4.5 [3.2; 5.8] 4.8 [3.4; 6.1] 5.1 [3.7; 6.5] 5.1 [3.7; 6.5] 5.1 [3.7; 6.5] 5.6 [3.9; 7.3] (880) (754) (641) (533) (381) (204) (93) Acetabular articulating 2.8 [2.7; 2.9] 3.2 [3.1; 3.2] 3.4 [3.4; 3.5] 3.6 [3.5; 3.7] 3.8 [3.7; 3.9] 4.0 [3.9; 4.1] 4.2 [4.1; 4.3] 4.3 [4.2; 4.4] 4.4 [4.3; 4.6] hXLPE 231,348 67 (60 - 74) 40/60 27.9 680 surface (189,538) (155,453) (126,193) (98,673) (71,385) (47,008) (26,097) (10,137) (2,664) hXLPE+antioxidant 89,895 67 (60 - 75) 41/59 28.0 517 2.7 [2.6; 2.8] 3.1 [3.0; 3.2] 3.3 [3.2; 3.4] 3.4 [3.3; 3.5] 3.6 [3.4; 3.7] 3.7 [3.5; 3.8] 3.8 [3.6; 3.9] 3.8 [3.7; 4.0] 4.0 [3.6; 4.4] (70,730) (55,396) (43,414) (32,573) (21,953) (12,842) (5,906) (1,723) (308) Ceramic 44,055 62 (55 - 69) 43/57 27.7 408 2.1 [2.0; 2.3] 2.5 [2.4; 2.7] 2.7 [2.6; 2.9] 2.9 [2.7; 3.1] 3.0 [2.8; 3.2] 3.2 [3.0; 3.4] 3.4 [3.2; 3.6] 3.5 [3.3; 3.7] 3.6 [3.3; 3.8] (37,675) (31,792) (26,482) (21,483) (16,408) (11,655) (7,164) (3,233) (1,013) mXLPE 34,829 71 (63 - 77) 41/59 27.8 304 2.9 [2.7; 3.0] 3.4 [3.2; 3.5] 3.7 [3.5; 3.9] 4.0 [3.8; 4.2] 4.1 [3.9; 4.4] 4.4 [4.1; 4.6] 4.5 [4.3; 4.8] 4.9 [4.6; 5.2] 5.2 [4.7; 5.6] (29,887) (25,571) (21,634) (17,289) (13,171) (9,224) (5,366) (2,313) (675) PE 19,635 73 (64 - 78) 34/66 27.8 546 3.7 [3.4; 3.9] 4.2 [4.0; 4.5] 4.6 [4.3; 4.9] 5.0 [4.6; 5.3] 5.2 [4.9; 5.5] 5.5 [5.1; 5.8] 5.8 [5.4; 6.2] 6.2 [5.8; 6.6] 6.8 [6.2; 7.4] (17,283) (15,484) (13,729) (11,874) (9,641) (7,200) (4,768) (2,367) (740) Table 46: Cumulative revision rates for different types and characteristics of primary hip arthroplasties 70 EPRD Annual Report 2024 71  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category Head component Ceramic 392,789 67 (59 - 74) 41/59 27.8 758 2.7 [2.6; 2.7] 3.1 [3.0; 3.1] 3.3 [3.3; 3.4] 3.5 [3.5; 3.6] 3.7 [3.6; 3.8] 3.9 [3.8; 3.9] 4.1 [4.0; 4.1] 4.2 [4.1; 4.3] 4.4 [4.3; 4.5] (323,179) (265,338) (216,376) (169,930) (123,946) (82,543) (46,412) (18,660) (5,167) metal 14,631 75 (67 - 80) 39/61 27.6 593 4.7 [4.3; 5.0] 5.0 [4.7; 5.4] 5.3 [4.9; 5.7] 5.6 [5.2; 6.0] 5.8 [5.4; 6.2] 6.1 [5.6; 6.5] 6.3 [5.9; 6.8] 6.7 [6.1; 7.2] 7.1 [6.4; 7.8] (12,034) (10,295) (8,710) (7,126) (5,458) (3,753) (2,300) (1,075) (261) Ceramicised metal 12,797 67 (60 - 75) 40/60 28.1 135 2.8 [2.5; 3.1] 3.1 [2.8; 3.4] 3.3 [3.0; 3.6] 3.5 [3.2; 3.9] 3.8 [3.4; 4.1] 4.0 [3.5; 4.4] 4.5 [3.9; 5.2] 5.3 [4.1; 6.5] (10,282) (8,397) (6,638) (5,057) (3,324) (1,780) (715) (131) Head size 22 mm 332 64.5 (49 - 76) 9/91 26.0 127 9.1 [5.9; 12.2] 9.1 [5.9; 12.2] 9.1 [5.9; 12.2] 9.1 [5.9; 12.2] 9.1 [5.9; 12.2] (225) (154) (114) (81) (63) 28 mm 20,754 67 (58 - 75) 11/89 27.3 663 3.4 [3.2; 3.7] 3.8 [3.5; 4.1] 4.1 [3.8; 4.4] 4.3 [4.1; 4.6] 4.4 [4.1; 4.7] 4.6 [4.3; 4.9] 4.7 [4.4; 5.0] 5.0 [4.6; 5.4] 5.2 [4.8; 5.7] (17,728) (15,208) (12,848) (10,529) (8,090) (5,743) (3,467) (1,485) (390) 32 mm 220,657 67 (60 - 75) 31/69 27.7 760 2.8 [2.7; 2.8] 3.2 [3.1; 3.3] 3.4 [3.4; 3.5] 3.6 [3.5; 3.7] 3.8 [3.7; 3.9] 4.0 [3.9; 4.1] 4.2 [4.1; 4.3] 4.4 [4.3; 4.5] 4.6 [4.5; 4.8] (184,863) (155,239) (128,839) (102,385) (75,286) (50,134) (28,091) (11,516) (3,192) Hip 36 mm 178,040 66 (59 - 74) 56/44 28.1 692 2.6 [2.6; 2.7] 3.0 [3.0; 3.1] 3.3 [3.2; 3.4] 3.5 [3.4; 3.6] 3.6 [3.5; 3.7] 3.8 [3.7; 3.9] 4.0 [3.9; 4.1] 4.1 [4.0; 4.3] 4.3 [4.1; 4.4] (142,302) (113,104) (89,657) (68,901) (49,129) (32,042) (17,790) (6,837) (1,856) Head-neck length XS 3,258 70 (62 - 76) 31/69 27.4 88 2.8 [2.2; 3.3] 3.2 [2.6; 3.8] 3.5 [2.8; 4.1] 3.7 [3.0; 4.4] 3.7 [3.0; 4.5] 4.0 [3.2; 4.8] 4.0 [3.2; 4.8] 4.0 [3.2; 4.8] (2,633) (2,160) (1,739) (1,307) (874) (535) (325) (130) S 171,478 68 (60 - 75) 33/67 27.5 750 2.4 [2.3; 2.5] 2.8 [2.7; 2.8] 3.0 [2.9; 3.1] 3.2 [3.1; 3.3] 3.4 [3.3; 3.4] 3.5 [3.4; 3.6] 3.7 [3.6; 3.8] 3.9 [3.7; 4.0] 4.0 [3.8; 4.2] (140,193) (114,053) (92,393) (72,058) (51,773) (33,693) (18,154) (7,062) (1,945) M 153,002 67 (59 - 74) 42/58 28.0 758 2.7 [2.7; 2.8] 3.1 [3.1; 3.2] 3.4 [3.3; 3.5] 3.6 [3.5; 3.7] 3.7 [3.6; 3.8] 3.9 [3.8; 4.0] 4.1 [3.9; 4.2] 4.2 [4.1; 4.3] 4.5 [4.3; 4.7] (126,291) (104,360) (85,251) (67,101) (48,923) (32,636) (18,526) (7,482) (2,072) L 70,924 66 (59 - 74) 50/50 28.4 747 3.2 [3.1; 3.3] 3.6 [3.5; 3.8] 3.9 [3.8; 4.1] 4.1 [4.0; 4.3] 4.3 [4.1; 4.4] 4.5 [4.3; 4.7] 4.7 [4.6; 4.9] 5.1 [4.8; 5.3] 5.2 [5.0; 5.5] (58,870) (49,009) (40,506) (32,410) (24,393) (16,722) (9,823) (4,160) (1,125) XL 17,137 66 (58 - 73) 57/43 28.7 673 4.0 [3.7; 4.3] 4.4 [4.1; 4.8] 4.8 [4.5; 5.1] 5.1 [4.7; 5.4] 5.4 [5.0; 5.8] 5.7 [5.3; 6.1] 6.0 [5.5; 6.4] 6.1 [5.6; 6.6] 6.1 [5.6; 6.6] (14,006) (11,563) (9,445) (7,388) (5,456) (3,620) (2,110) (822) (235) XXL 1,652 67 (59 - 74) 62/38 28.7 262 5.2 [4.1; 6.3] 5.7 [4.6; 6.8] 5.9 [4.7; 7.0] 6.1 [4.9; 7.3] 6.6 [5.3; 7.9] 6.8 [5.4; 8.1] 7.2 [5.8; 8.7] 7.7 [6.0; 9.4] (1,367) (1,155) (981) (784) (600) (426) (247) (110) Cup type Modular cup 386,520 67 (59 - 74) 41/59 27.8 758 2.7 [2.7; 2.8] 3.1 [3.1; 3.2] 3.4 [3.3; 3.5] 3.6 [3.5; 3.7] 3.8 [3.7; 3.8] 3.9 [3.9; 4.0] 4.1 [4.1; 4.2] 4.3 [4.2; 4.4] 4.5 [4.4; 4.6] (318,743) (262,707) (214,918) (169,313) (123,700) (82,272) (46,302) (18,614) (5,084) Monobloc cup 27,805 68 (60 - 76) 40/60 27.8 528 2.3 [2.1; 2.4] 2.6 [2.4; 2.7] 2.7 [2.5; 2.9] 2.9 [2.7; 3.1] 3.1 [2.8; 3.3] 3.2 [2.9; 3.4] 3.3 [3.0; 3.6] 3.5 [3.1; 3.8] 3.9 [3.3; 4.5] (22,453) (18,043) (14,315) (10,939) (7,717) (4,972) (2,668) (1,070) (302) Revision cup 3,168 64 (55 - 73) 32/68 27.1 356 6.7 [5.8; 7.5] 7.7 [6.7; 8.6] 8.2 [7.2; 9.2] 8.4 [7.4; 9.4] 8.8 [7.7; 9.9] 9.1 [8.0; 10.3] 9.1 [8.0; 10.3] 9.1 [8.0; 10.3] (2,474) (2,043) (1,672) (1,319) (990) (653) (361) (153) Dual mobility 2,600 72 (63 - 80) 36/64 27.7 327 5.5 [4.6; 6.4] 6.2 [5.2; 7.1] 6.7 [5.6; 7.8] 6.8 [5.7; 7.9] 6.8 [5.7; 7.9] 7.7 [6.1; 9.4] 8.4 [6.3; 10.5] (1,751) (1,198) (805) (539) (325) (183) (99) Stem type Femoral stem with modular head 351,329 68 (60 - 75) 40/60 27.9 760 2.8 [2.8; 2.9] 3.2 [3.2; 3.3] 3.5 [3.5; 3.6] 3.7 [3.6; 3.8] 3.9 [3.8; 3.9] 4.1 [4.0; 4.1] 4.3 [4.2; 4.3] 4.5 [4.4; 4.6] 4.7 [4.6; 4.8] (291,156) (241,337) (198,266) (156,325) (114,196) (76,074) (42,924) (17,498) (4,797) Short stem 58,995 62 (56 - 70) 44/56 27.8 428 2.1 [1.9; 2.2] 2.4 [2.3; 2.5] 2.6 [2.4; 2.7] 2.7 [2.6; 2.8] 2.9 [2.7; 3.0] 3.0 [2.8; 3.2] 3.1 [2.9; 3.3] 3.1 [2.9; 3.3] 3.2 [2.9; 3.4] (46,222) (35,853) (27,717) (20,951) (14,624) (9,111) (4,661) (1,832) (582) Femoral neck prosthesis 6,290 60 (54 - 67) 46/54 27.6 124 2.2 [1.9; 2.6] 2.6 [2.2; 3.0] 2.8 [2.4; 3.2] 3.1 [2.6; 3.5] 3.2 [2.7; 3.7] 3.3 [2.8; 3.8] 3.6 [3.1; 4.2] 3.8 [3.1; 4.5] (5,361) (4,535) (3,796) (3,191) (2,592) (1,887) (1,239) (380) Modular stem 1,909 69 (61 - 76) 37/63 27.6 124 4.2 [3.2; 5.1] 4.8 [3.8; 5.8] 5.1 [4.1; 6.2] 5.5 [4.4; 6.5] 5.8 [4.6; 6.9] 6.2 [5.0; 7.3] 6.4 [5.2; 7.7] 6.4 [5.2; 7.7] (1,616) (1,426) (1,256) (1,112) (946) (790) (483) (109) Revision or tumour stem 1,540 74 (63 - 81) 37/63 26.4 406 11.5 [9.8; 13.1] 12.7 [11.0; 14.5] 13.0 [11.2; 14.7] 13.1 [11.3; 14.9] 14.2 [12.2; 16.2] 14.2 [12.2; 16.2] 14.2 [12.2; 16.2] (1,088) (850) (660) (505) (348) (202) (116) Reconstruction shell Without reconstruction shell 419,713 67 (59 - 74) 41/59 27.8 762 2.7 [2.7; 2.8] 3.1 [3.1; 3.2] 3.4 [3.3; 3.5] 3.6 [3.5; 3.6] 3.8 [3.7; 3.8] 3.9 [3.9; 4.0] 4.1 [4.1; 4.2] 4.3 [4.2; 4.4] 4.5 [4.4; 4.6] (345,122) (283,711) (231,462) (181,902) (132,568) (87,975) (49,372) (19,847) (5,437) With reconstruction shell 511 70 (60 - 78) 35/65 26.1 221 10.1 [7.4; 12.7] 11.6 [8.7; 14.4] 13.1 [9.9; 16.1] 14.5 [11.1; 17.8] 15.3 [11.7; 18.8] 15.9 [12.2; 19.5] 15.9 [12.2; 19.5] (380) (324) (266) (215) (164) (105) (58) Fixation Uncemented 414,462 67 (59 - 74) 41/59 27.8 762 2.7 [2.7; 2.8] 3.1 [3.1; 3.2] 3.4 [3.3; 3.4] 3.6 [3.5; 3.6] 3.7 [3.7; 3.8] 3.9 [3.8; 4.0] 4.1 [4.0; 4.2] 4.3 [4.2; 4.4] 4.5 [4.4; 4.6] (340,917) (280,292) (228,712) (179,758) (131,011) (86,949) (48,812) (19,642) (5,387) Reverse-hybrid 5,618 74 (66 - 80) 25/75 27.0 567 5.4 [4.8; 6.0] 6.0 [5.4; 6.7] 6.6 [6.0; 7.3] 6.9 [6.2; 7.6] 7.3 [6.6; 8.1] 7.6 [6.8; 8.4] 7.7 [6.9; 8.5] 8.1 [7.1; 9.1] 8.1 [7.1; 9.1] (4,479) (3,659) (2,963) (2,324) (1,697) (1,117) (611) (223) (56) Elective THAs with cemented stems 115,036 79 (75 - 83) 25/75 26.5 735 2.4 [2.3; 2.5] 2.7 [2.6; 2.8] 2.9 [2.8; 3.0] 3.2 [3.0; 3.3] 3.4 [3.3; 3.5] 3.6 [3.5; 3.7] 3.9 [3.7; 4.0] 4.1 [3.9; 4.3] 4.3 [4.0; 4.5] (92,529) (74,629) (59,684) (46,133) (33,074) (21,880) (12,240) (5,139) (1,402) Bearing Ceramic / hXLPE 55,408 78 (74 - 82) 24/76 26.6 575 2.1 [2.0; 2.2] 2.4 [2.3; 2.5] 2.6 [2.5; 2.8] 2.8 [2.7; 3.0] 3.0 [2.9; 3.2] 3.2 [3.0; 3.3] 3.4 [3.2; 3.6] 3.6 [3.4; 3.9] 3.6 [3.4; 3.9] (44,407) (34,961) (27,280) (20,524) (14,271) (9,177) (4,918) (2,051) (641) Table 46 (continued) 72 EPRD Annual Report 2024 73  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category Bearing Ceramic / PE 12,721 79 (75 - 83) 23/77 26.6 476 2.4 [2.1; 2.6] 2.8 [2.5; 3.1] 3.0 [2.7; 3.3] 3.2 [2.9; 3.5] 3.4 [3.0; 3.7] 3.7 [3.4; 4.1] 3.9 [3.5; 4.3] 4.3 [3.8; 4.8] 4.6 [3.9; 5.3] (10,963) (9,574) (8,258) (6,917) (5,473) (4,050) (2,553) (1,188) (344) Metal / hXLPE 12,253 81 (77 - 84) 27/73 26.4 400 2.8 [2.5; 3.1] 3.1 [2.8; 3.4] 3.2 [2.9; 3.6] 3.4 [3.1; 3.8] 3.6 [3.3; 4.0] 4.1 [3.6; 4.5] 4.3 [3.8; 4.8] 4.4 [3.8; 4.9] 4.4 [3.8; 4.9] (9,809) (8,052) (6,532) (5,060) (3,633) (2,275) (1,209) (496) (100) Ceramic / hXLPE+antioxidant 11,550 79 (75 - 83) 21/79 26.5 345 2.3 [2.0; 2.6] 2.6 [2.3; 2.9] 2.9 [2.6; 3.2] 3.1 [2.7; 3.5] 3.4 [3.0; 3.8] 3.6 [3.2; 4.1] 4.0 [3.4; 4.5] 4.0 [3.4; 4.5] (8,659) (6,625) (5,084) (3,740) (2,358) (1,349) (630) (222) Metal / PE 7,453 81 (78 - 84) 25/75 26.3 421 3.3 [2.9; 3.7] 3.6 [3.2; 4.0] 3.8 [3.4; 4.3] 4.1 [3.6; 4.6] 4.3 [3.8; 4.8] 4.4 [3.9; 5.0] 4.8 [4.2; 5.4] 5.4 [4.7; 6.2] 5.4 [4.7; 6.2] (6,174) (5,290) (4,474) (3,622) (2,732) (1,904) (1,141) (503) (104) Ceramic / mXLPE 6,202 79 (75 - 82) 23/77 26.3 198 2.7 [2.3; 3.1] 3.1 [2.6; 3.5] 3.4 [2.9; 3.8] 3.7 [3.2; 4.2] 4.1 [3.5; 4.7] 4.3 [3.7; 5.0] 4.5 [3.8; 5.2] 4.5 [3.8; 5.2] 4.5 [3.8; 5.2] (5,081) (4,072) (3,193) (2,393) (1,764) (1,206) (748) (321) (89) metal / mXLPE 2,417 81 (78 - 85) 24/76 26.0 177 3.6 [2.8; 4.3] 3.8 [3.0; 4.6] 4.4 [3.6; 5.3] 4.9 [4.0; 5.8] 5.5 [4.5; 6.6] 5.7 [4.6; 6.8] 6.1 [4.8; 7.3] 6.4 [5.0; 7.8] (2,018) (1,731) (1,414) (1,092) (799) (565) (325) (130) Hip Metal / hXLPE+antioxidant 2,175 81 (77 - 84) 26/74 25.9 259 3.6 [2.8; 4.4] 4.2 [3.3; 5.1] 4.4 [3.4; 5.3] 4.5 [3.5; 5.5] 4.5 [3.5; 5.5] 4.5 [3.5; 5.5] 5.8 [3.7; 7.8] (1,530) (1,127) (802) (582) (383) (223) (120) Ceramic / ceramic 1,826 76 (71 - 80) 23/77 26.9 133 1.2 [0.7; 1.7] 1.4 [0.8; 1.9] 1.5 [0.9; 2.1] 1.8 [1.2; 2.5] 2.5 [1.7; 3.4] 2.8 [1.9; 3.8] 3.2 [2.1; 4.3] 3.2 [2.1; 4.3] (1,501) (1,277) (1,134) (980) (776) (610) (368) (137) Ceramicised metal / hXLPE 1,116 79 (75 - 83) 24/76 26.6 56 2.1 [1.3; 3.0] 2.6 [1.6; 3.6] 2.6 [1.6; 3.6] 3.2 [1.9; 4.6] 3.2 [1.9; 4.6] 3.2 [1.9; 4.6] (762) (531) (352) (272) (189) (90) Metal/Metal 829 56 (51 - 61) 94/6 28.1 33 1.0 [0.3; 1.6] 1.5 [0.7; 2.4] 2.2 [1.1; 3.2] 2.5 [1.3; 3.6] 2.5 [1.3; 3.6] 2.8 [1.5; 4.2] 3.7 [1.9; 5.5] (740) (670) (595) (509) (389) (243) (127) Ceramicised metal / PE 429 81 (77 - 83) 20/80 26.3 37 3.3 [1.6; 5.0] 4.3 [2.2; 6.3] 4.3 [2.2; 6.3] 4.3 [2.2; 6.3] 4.3 [2.2; 6.3] 4.3 [2.2; 6.3] (347) (282) (224) (179) (141) (98) Acetabular articulating 2.2 [2.1; 2.3] 2.5 [2.4; 2.6] 2.7 [2.6; 2.9] 2.9 [2.8; 3.1] 3.1 [3.0; 3.3] 3.3 [3.2; 3.5] 3.6 [3.4; 3.8] 3.8 [3.5; 4.0] 3.8 [3.5; 4.0] hXLPE 68,777 79 (75 - 82) 25/75 26.6 609 surface (54,978) (43,544) (34,164) (25,856) (18,093) (11,542) (6,147) (2,554) (744) PE 20,604 80 (76 - 83) 24/76 26.5 558 2.7 [2.5; 2.9] 3.1 [2.9; 3.3] 3.3 [3.1; 3.6] 3.6 [3.3; 3.8] 3.7 [3.5; 4.0] 4.0 [3.7; 4.3] 4.3 [3.9; 4.6] 4.7 [4.3; 5.1] 4.9 [4.4; 5.5] (17,485) (15,147) (12,957) (10,719) (8,347) (6,053) (3,726) (1,696) (448) hXLPE+antioxidant 13,736 80 (75 - 83) 22/78 26.4 425 2.5 [2.3; 2.8] 2.8 [2.5; 3.1] 3.1 [2.8; 3.5] 3.3 [3.0; 3.7] 3.6 [3.2; 4.0] 3.8 [3.4; 4.2] 4.3 [3.7; 4.9] 4.3 [3.7; 4.9] 6.0 [2.5; 9.3] (10,197) (7,758) (5,889) (4,325) (2,743) (1,572) (750) (254) (51) mXLPE 8,620 80 (75 - 83) 23/77 26.3 253 2.9 [2.6; 3.3] 3.3 [2.9; 3.7] 3.7 [3.3; 4.1] 4.1 [3.6; 4.5] 4.5 [4.0; 5.0] 4.7 [4.2; 5.3] 5.0 [4.4; 5.6] 5.1 [4.4; 5.7] 5.1 [4.4; 5.7] (7,100) (5,804) (4,608) (3,485) (2,563) (1,771) (1,073) (451) (130) Ceramic 1,827 76 (71 - 80) 23/77 26.9 134 1.2 [0.7; 1.7] 1.4 [0.8; 1.9] 1.5 [0.9; 2.0] 1.8 [1.2; 2.5] 2.5 [1.7; 3.4] 2.8 [1.9; 3.8] 3.2 [2.1; 4.3] 3.2 [2.1; 4.3] (1,501) (1,277) (1,134) (980) (776) (610) (368) (137) metal 829 56 (51 - 61) 94/6 28.1 33 1.0 [0.3; 1.6] 1.5 [0.7; 2.4] 2.2 [1.1; 3.2] 2.5 [1.3; 3.6] 2.5 [1.3; 3.6] 2.8 [1.5; 4.2] 3.7 [1.9; 5.5] (740) (670) (595) (509) (389) (243) (127) Head component Ceramic 88,037 79 (74 - 82) 24/76 26.6 712 2.2 [2.1; 2.3] 2.5 [2.4; 2.6] 2.7 [2.6; 2.9] 3.0 [2.8; 3.1] 3.2 [3.1; 3.3] 3.4 [3.3; 3.6] 3.6 [3.5; 3.8] 3.9 [3.7; 4.1] 4.0 [3.7; 4.3] (70,885) (56,736) (45,128) (34,696) (24,743) (16,448) (9,250) (3,927) (1,141) metal 25,439 81 (77 - 84) 28/72 26.4 616 3.0 [2.8; 3.2] 3.3 [3.1; 3.6] 3.6 [3.4; 3.8] 3.8 [3.6; 4.1] 4.1 [3.8; 4.3] 4.3 [4.0; 4.6] 4.7 [4.3; 5.0] 5.0 [4.6; 5.4] 5.0 [4.6; 5.4] (20,525) (17,072) (13,975) (10,982) (7,998) (5,243) (2,938) (1,200) (258) Ceramicised metal 1,559 80 (76 - 83) 23/77 26.6 68 2.6 [1.8; 3.4] 3.2 [2.3; 4.2] 3.2 [2.3; 4.2] 3.6 [2.5; 4.7] 3.6 [2.5; 4.7] 3.6 [2.5; 4.7] 3.6 [2.5; 4.7] (1,118) (820) (580) (454) (332) (188) (52) Head size 22 mm 373 81 (76 - 84) 5/95 25.5 113 3.7 [1.7; 5.7] 4.7 [2.3; 7.0] 4.7 [2.3; 7.0] 4.7 [2.3; 7.0] (237) (154) (92) (59) 28 mm 7,804 79 (75 - 83) 15/85 26.0 536 3.5 [3.1; 3.9] 3.8 [3.4; 4.2] 4.0 [3.5; 4.4] 4.2 [3.7; 4.7] 4.4 [3.9; 4.9] 4.7 [4.2; 5.3] 4.9 [4.3; 5.5] 5.0 [4.4; 5.7] 5.4 [4.4; 6.4] (6,107) (4,864) (3,806) (2,972) (2,207) (1,533) (904) (391) (81) 32 mm 70,643 79 (75 - 83) 20/80 26.4 715 2.3 [2.2; 2.4] 2.7 [2.5; 2.8] 2.9 [2.7; 3.0] 3.1 [3.0; 3.2] 3.3 [3.2; 3.5] 3.5 [3.4; 3.7] 3.8 [3.6; 4.0] 4.1 [3.9; 4.3] 4.2 [3.9; 4.5] (58,270) (47,956) (39,144) (30,601) (22,169) (14,875) (8,490) (3,632) (1,014) 36 mm 35,228 79 (75 - 82) 35/65 26.7 596 2.2 [2.1; 2.4] 2.6 [2.4; 2.7] 2.8 [2.6; 3.0] 3.0 [2.8; 3.2] 3.3 [3.1; 3.5] 3.6 [3.3; 3.8] 3.8 [3.5; 4.1] 3.9 [3.6; 4.2] 4.2 [3.5; 4.9] (27,053) (20,885) (15,966) (11,936) (8,246) (5,196) (2,709) (1,074) (303) Head-neck length XS 512 80 (76 - 83) 20/80 25.9 52 1.6 [0.5; 2.7] 2.0 [0.8; 3.3] 2.0 [0.8; 3.3] 2.0 [0.8; 3.3] 2.5 [0.9; 4.1] 2.5 [0.9; 4.1] 2.5 [0.9; 4.1] (445) (377) (318) (255) (181) (102) (50) S 40,148 79 (75 - 83) 17/83 26.2 691 2.0 [1.8; 2.1] 2.3 [2.1; 2.4] 2.4 [2.3; 2.6] 2.6 [2.5; 2.8] 2.8 [2.6; 3.0] 3.1 [2.8; 3.3] 3.3 [3.1; 3.6] 3.3 [3.1; 3.6] 3.3 [3.1; 3.6] (31,840) (25,021) (19,549) (14,743) (10,209) (6,640) (3,572) (1,476) (410) M 44,536 79 (75 - 82) 24/76 26.6 709 2.2 [2.1; 2.4] 2.5 [2.4; 2.7] 2.8 [2.6; 3.0] 3.0 [2.8; 3.2] 3.2 [3.0; 3.4] 3.4 [3.2; 3.6] 3.7 [3.5; 3.9] 4.0 [3.7; 4.3] 4.3 [3.9; 4.8] (36,167) (29,287) (23,405) (18,172) (13,184) (8,855) (5,044) (2,124) (631) L 21,015 79 (75 - 82) 32/68 26.9 665 2.9 [2.7; 3.2] 3.3 [3.1; 3.6] 3.6 [3.3; 3.8] 3.8 [3.5; 4.1] 4.1 [3.8; 4.4] 4.3 [3.9; 4.6] 4.5 [4.2; 4.9] 4.9 [4.4; 5.3] 4.9 [4.4; 5.3] (17,070) (14,155) (11,627) (9,254) (6,835) (4,603) (2,614) (1,092) (272) Table 46 (continued) 74 EPRD Annual Report 2024 75  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category Head-neck length XL 4,190 79 (74 - 82) 42/58 27.2 500 3.6 [3.1; 4.2] 4.3 [3.6; 4.9] 4.6 [4.0; 5.3] 5.0 [4.3; 5.8] 5.9 [5.0; 6.7] 6.0 [5.1; 6.9] 6.3 [5.4; 7.3] 6.7 [5.5; 7.9] (3,305) (2,691) (2,206) (1,692) (1,225) (768) (420) (170) XXL 429 79 (74 - 82) 44/56 27.5 169 5.1 [2.9; 7.2] 5.4 [3.2; 7.5] 6.0 [3.6; 8.4] 6.0 [3.6; 8.4] 6.0 [3.6; 8.4] 6.0 [3.6; 8.4] 7.2 [3.9; 10.3] (346) (306) (272) (230) (179) (134) (79) Cup type Modular cup 84,992 79 (75 - 82) 24/76 26.6 715 2.2 [2.1; 2.3] 2.5 [2.4; 2.6] 2.7 [2.6; 2.9] 2.9 [2.8; 3.1] 3.2 [3.1; 3.3] 3.4 [3.2; 3.5] 3.7 [3.5; 3.8] 3.9 [3.7; 4.1] 4.0 [3.7; 4.3] (67,890) (53,984) (42,645) (32,505) (22,973) (14,994) (8,113) (3,330) (875) Monobloc cup 24,769 80 (76 - 84) 24/76 26.4 598 2.4 [2.2; 2.6] 2.8 [2.6; 3.0] 3.0 [2.8; 3.3] 3.2 [3.0; 3.5] 3.5 [3.2; 3.7] 3.8 [3.5; 4.0] 4.0 [3.7; 4.3] 4.3 [4.0; 4.7] 4.5 [4.0; 4.9] (21,036) (18,010) (15,206) (12,348) (9,267) (6,406) (3,880) (1,709) (507) Dual mobility 3,087 80 (75 - 84) 26/74 26.0 334 3.9 [3.2; 4.6] 4.1 [3.4; 4.9] 4.4 [3.6; 5.2] 4.9 [4.0; 5.9] 5.1 [4.1; 6.1] 5.4 [4.2; 6.6] 5.4 [4.2; 6.6] (2,045) (1,403) (888) (561) (327) (176) (71) Revision cup 1,735 79 (73 - 83) 30/70 25.7 330 8.1 [6.8; 9.5] 8.8 [7.4; 10.2] 9.4 [7.9; 10.8] 9.8 [8.3; 11.4] 10.3 [8.6; 11.9] 10.9 [9.0; 12.8] 10.9 [9.0; 12.8] 10.9 [9.0; 12.8] (1,179) (908) (674) (498) (341) (194) (115) (54) Hip Resurfacing cup 419 55 (51 - 59) 99/1 27.6 23 1.2 [0.2; 2.3] 1.8 [0.5; 3.2] 2.1 [0.7; 3.6] 2.1 [0.7; 3.6] 2.1 [0.7; 3.6] 2.1 [0.7; 3.6] 3.1 [0.7; 5.4] (361) (315) (268) (221) (166) (110) (61) Stem type Femoral stem with modular head 112,673 79 (75 - 83) 24/76 26.5 733 2.3 [2.3; 2.4] 2.7 [2.6; 2.8] 2.9 [2.8; 3.0] 3.1 [3.0; 3.2] 3.4 [3.2; 3.5] 3.6 [3.4; 3.7] 3.8 [3.7; 4.0] 4.1 [3.9; 4.3] 4.2 [4.0; 4.5] (90,820) (73,367) (58,652) (45,312) (32,486) (21,525) (12,065) (5,094) (1,396) Surface replacement 829 56 (51 - 61) 94/6 28.1 33 1.0 [0.3; 1.6] 1.5 [0.7; 2.4] 2.2 [1.1; 3.2] 2.5 [1.3; 3.6] 2.5 [1.3; 3.6] 2.8 [1.5; 4.2] 3.7 [1.9; 5.5] (740) (670) (595) (509) (389) (243) (127) Revision or tumour stem 578 78 (70 - 83) 30/70 25.4 203 11.7 [8.9; 14.3] 12.5 [9.6; 15.3] 12.5 [9.6; 15.3] 14.6 [11.1; 18.0] 15.4 [11.5; 19.1] 16.4 [12.1; 20.5] (347) (249) (199) (133) (87) (54) Modular stem 553 80 (77 - 83) 25/75 27.3 7 1.9 [0.7; 3.0] 2.4 [1.0; 3.7] 3.1 [1.4; 4.7] 3.1 [1.4; 4.7] 3.1 [1.4; 4.7] 3.1 [1.4; 4.7] (428) (311) (238) (179) (112) (58) Short stem 403 79 (74 - 83) 20/80 26.1 29 1.6 [0.3; 2.8] (194) Reconstruction shell Without reconstruction shell 114,287 79 (75 - 83) 24/76 26.5 735 2.3 [2.2; 2.4] 2.6 [2.6; 2.7] 2.9 [2.8; 3.0] 3.1 [3.0; 3.2] 3.3 [3.2; 3.5] 3.6 [3.4; 3.7] 3.8 [3.7; 4.0] 4.1 [3.9; 4.3] 4.2 [4.0; 4.5] (92,058) (74,274) (59,419) (45,948) (32,944) (21,804) (12,194) (5,115) (1,395) With reconstruction shell 749 79 (74 - 84) 33/67 24.8 253 10.2 [7.9; 12.5] 11.5 [9.0; 13.9] 12.3 [9.6; 14.8] 12.7 [9.9; 15.3] 12.7 [9.9; 15.3] 13.4 [10.3; 16.3] (471) (355) (265) (185) (130) (76) Fixation Hybrid 90,517 79 (74 - 82) 25/75 26.6 725 2.2 [2.1; 2.3] 2.5 [2.4; 2.7] 2.8 [2.7; 2.9] 3.0 [2.9; 3.1] 3.2 [3.1; 3.4] 3.4 [3.3; 3.6] 3.7 [3.6; 3.9] 3.9 [3.7; 4.2] 4.1 [3.8; 4.4] (72,263) (57,602) (45,584) (34,854) (24,672) (16,076) (8,731) (3,584) (921) Cemented 24,454 80 (77 - 84) 23/77 26.3 632 2.8 [2.6; 3.1] 3.3 [3.0; 3.5] 3.5 [3.3; 3.8] 3.8 [3.5; 4.0] 4.0 [3.7; 4.2] 4.2 [3.9; 4.5] 4.5 [4.1; 4.8] 4.8 [4.4; 5.2] 4.9 [4.4; 5.4] (20,226) (17,006) (14,087) (11,274) (8,400) (5,803) (3,509) (1,555) (481) Non-elective THAs 34,964 76 (68 - 82) 30/70 24.6 707 6.1 [5.8; 6.3] 6.7 [6.4; 6.9] 7.0 [6.7; 7.3] 7.4 [7.1; 7.7] 7.6 [7.3; 8.0] 7.9 [7.6; 8.3] 8.2 [7.8; 8.7] 8.5 [8.0; 8.9] 8.5 [8.0; 8.9] (24,594) (18,634) (13,636) (9,688) (6,362) (3,846) (1,949) (668) (126) Bearing Ceramic / hXLPE 13,142 74 (66 - 80) 31/69 24.7 530 6.3 [5.9; 6.7] 6.9 [6.5; 7.4] 7.3 [6.8; 7.7] 7.7 [7.2; 8.2] 7.9 [7.3; 8.4] 8.1 [7.5; 8.6] 8.3 [7.7; 8.9] 8.3 [7.7; 8.9] (9,304) (6,986) (4,996) (3,470) (2,197) (1,278) (666) (212) Ceramic / hXLPE+antioxidant 5,529 74 (67 - 80) 33/67 24.7 302 6.1 [5.5; 6.8] 6.6 [5.9; 7.3] 6.8 [6.0; 7.5] 7.0 [6.2; 7.7] 7.1 [6.3; 7.8] 7.2 [6.4; 8.1] 7.6 [6.5; 8.7] 7.6 [6.5; 8.7] (3,848) (2,757) (1,927) (1,293) (787) (424) (198) (69) Metal / hXLPE 3,846 79 (74 - 84) 27/73 24.5 310 5.3 [4.6; 6.0] 5.9 [5.1; 6.7] 6.3 [5.5; 7.2] 6.5 [5.6; 7.3] 6.7 [5.8; 7.6] 7.0 [6.0; 8.1] 7.6 [6.1; 9.0] 7.6 [6.1; 9.0] (2,604) (1,979) (1,454) (1,016) (663) (392) (170) (55) Ceramic / PE 3,200 77 (70 - 83) 26/74 24.5 357 5.6 [4.7; 6.4] 6.2 [5.3; 7.1] 6.5 [5.6; 7.4] 6.9 [5.9; 7.8] 7.3 [6.2; 8.3] 7.6 [6.5; 8.7] 8.5 [7.1; 10.0] 9.2 [7.2; 11.2] (2,339) (1,865) (1,436) (1,105) (801) (550) (295) (104) Metal / PE 2,887 81 (75 - 86) 25/75 24.4 301 6.4 [5.5; 7.4] 7.1 [6.1; 8.1] 7.7 [6.6; 8.7] 8.0 [6.9; 9.1] 8.5 [7.3; 9.6] 8.7 [7.4; 9.9] 9.0 [7.6; 10.3] 9.9 [7.6; 12.0] (1,940) (1,550) (1,204) (903) (620) (382) (195) (79) Ceramic / mXLPE 2,013 74 (66 - 79) 35/65 24.9 183 5.8 [4.8; 6.9] 6.2 [5.1; 7.3] 6.9 [5.7; 8.1] 7.6 [6.3; 8.8] 8.0 [6.6; 9.4] 8.2 [6.8; 9.6] 8.2 [6.8; 9.6] 8.2 [6.8; 9.6] (1,570) (1,258) (985) (748) (530) (328) (168) (65) Metal / hXLPE+antioxidant 1,260 81 (73 - 86) 32/68 24.5 202 5.5 [4.2; 6.8] 6.0 [4.6; 7.4] 6.2 [4.7; 7.7] 6.6 [4.9; 8.2] 6.6 [4.9; 8.2] (767) (508) (312) (172) (83) Ceramic / ceramic 1,192 69 (62 - 77) 33/67 24.8 155 5.3 [4.0; 6.6] 6.0 [4.6; 7.4] 6.4 [4.9; 7.9] 6.4 [4.9; 7.9] 7.1 [5.4; 8.8] 7.4 [5.7; 9.2] 7.4 [5.7; 9.2] 7.4 [5.7; 9.2] (927) (763) (616) (482) (345) (252) (144) (50) metal / mXLPE 1,059 80 (74 - 85) 30/70 24.8 128 8.5 [6.7; 10.2] 8.8 [7.0; 10.5] 9.4 [7.5; 11.2] 10.1 [8.0; 12.1] 10.1 [8.0; 12.1] 10.6 [8.3; 12.9] 10.6 [8.3; 12.9] (715) (564) (427) (322) (226) (148) (82) Ceramicised metal / hXLPE 470 72 (64 - 79) 35/65 24.8 49 5.5 [3.4; 7.6] 6.6 [4.1; 8.9] 6.6 [4.1; 8.9] 6.6 [4.1; 8.9] 6.6 [4.1; 8.9] (322) (214) (133) (86) (51) Acetabular articulating 6.1 [5.7; 6.4] 6.7 [6.3; 7.1] 7.0 [6.6; 7.4] 7.4 [6.9; 7.8] 7.6 [7.1; 8.0] 7.8 [7.3; 8.3] 8.1 [7.5; 8.6] 8.1 [7.5; 8.6] 8.1 [7.5; 8.6] hXLPE 17,458 75 (67 - 81) 30/70 24.6 563 surface (12,230) (9,179) (6,583) (4,572) (2,911) (1,693) (843) (268) (51) Table 46 (continued) 76 EPRD Annual Report 2024 77  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category Acetabular articulating 6.1 [5.5; 6.6] 6.5 [5.9; 7.1] 6.7 [6.0; 7.3] 6.9 [6.3; 7.6] 7.0 [6.3; 7.7] 7.2 [6.4; 7.9] 7.7 [6.6; 8.8] 7.7 [6.6; 8.8] hXLPE+antioxidant 6,794 75 (68 - 82) 32/68 24.7 372 surface (4,617) (3,266) (2,240) (1,466) (871) (468) (214) (75) PE 6,196 79 (73 - 85) 26/74 24.5 446 6.0 [5.4; 6.6] 6.6 [6.0; 7.3] 7.0 [6.3; 7.7] 7.4 [6.6; 8.1] 7.8 [7.0; 8.6] 8.1 [7.2; 8.9] 8.7 [7.7; 9.8] 9.5 [8.0; 11.0] (4,357) (3,474) (2,684) (2,032) (1,435) (939) (491) (183) mXLPE 3,073 76 (68 - 81) 33/67 24.9 216 6.7 [5.8; 7.6] 7.1 [6.2; 8.0] 7.8 [6.7; 8.8] 8.4 [7.3; 9.5] 8.7 [7.6; 9.9] 9.0 [7.8; 10.3] 9.0 [7.8; 10.3] 9.0 [7.8; 10.3] (2,286) (1,823) (1,413) (1,070) (756) (476) (250) (89) Ceramic 1,194 69 (62 - 77) 33/67 24.8 156 5.3 [4.0; 6.6] 6.0 [4.6; 7.4] 6.4 [4.9; 7.9] 6.4 [4.9; 7.9] 7.1 [5.4; 8.8] 7.4 [5.6; 9.2] 7.4 [5.6; 9.2] 7.4 [5.6; 9.2] (929) (764) (617) (482) (345) (252) (144) (50) Head component Ceramic 25,246 74 (67 - 80) 31/69 24.7 692 6.1 [5.8; 6.4] 6.6 [6.3; 7.0] 7.0 [6.7; 7.3] 7.3 [7.0; 7.7] 7.6 [7.2; 8.0] 7.9 [7.5; 8.3] 8.2 [7.7; 8.7] 8.3 [7.8; 8.9] 8.3 [7.8; 8.9] (18,110) (13,721) (10,030) (7,148) (4,697) (2,849) (1,477) (503) (95) metal 9,133 80 (74 - 85) 27/73 24.5 510 6.1 [5.6; 6.6] 6.7 [6.2; 7.2] 7.2 [6.6; 7.7] 7.5 [6.9; 8.1] 7.7 [7.1; 8.4] 8.1 [7.4; 8.8] 8.5 [7.6; 9.3] 8.9 [7.7; 10.0] (6,081) (4,638) (3,427) (2,429) (1,599) (966) (464) (164) Hip Ceramicised metal 584 72 (65 - 80) 35/65 24.7 58 5.9 [3.9; 7.9] 6.7 [4.5; 8.8] 6.7 [4.5; 8.8] 6.7 [4.5; 8.8] 6.7 [4.5; 8.8] (402) (274) (178) (110) (65) Head size 22 mm 300 81 (72 - 86) 7/93 24.0 85 6.0 [3.1; 8.8] 6.6 [3.4; 9.6] 6.6 [3.4; 9.6] (173) (100) (52) 28 mm 4,112 78 (70 - 84) 20/80 24.1 488 6.6 [5.8; 7.4] 7.2 [6.3; 8.0] 7.6 [6.7; 8.5] 8.3 [7.3; 9.2] 8.4 [7.4; 9.4] 8.5 [7.5; 9.6] 9.1 [7.8; 10.4] 9.1 [7.8; 10.4] (2,652) (1,957) (1,423) (998) (634) (399) (213) (100) 32 mm 18,638 76 (68 - 82) 24/76 24.5 673 6.0 [5.6; 6.3] 6.5 [6.2; 6.9] 6.9 [6.5; 7.2] 7.1 [6.7; 7.5] 7.4 [7.0; 7.8] 7.7 [7.2; 8.2] 8.0 [7.4; 8.5] 8.3 [7.6; 9.0] 8.3 [7.6; 9.0] (13,632) (10,743) (8,100) (5,929) (3,996) (2,482) (1,288) (418) (77) 36 mm 11,793 75 (67 - 81) 44/56 24.9 537 6.1 [5.6; 6.5] 6.7 [6.2; 7.2] 7.1 [6.6; 7.6] 7.6 [7.0; 8.1] 7.9 [7.3; 8.4] 8.1 [7.4; 8.7] 8.5 [7.7; 9.3] 8.5 [7.7; 9.3] (8,045) (5,770) (4,015) (2,709) (1,707) (954) (442) (149) Head-neck length S 9,527 76 (68 - 82) 24/76 24.3 623 5.5 [5.0; 6.0] 5.9 [5.4; 6.4] 6.2 [5.7; 6.8] 6.5 [5.9; 7.0] 6.7 [6.1; 7.3] 6.8 [6.2; 7.4] 6.9 [6.3; 7.5] 6.9 [6.3; 7.5] (6,762) (5,047) (3,658) (2,544) (1,624) (978) (498) (174) M 13,252 76 (68 - 82) 28/72 24.6 664 5.6 [5.2; 6.0] 6.2 [5.7; 6.6] 6.6 [6.1; 7.0] 7.1 [6.6; 7.6] 7.2 [6.7; 7.7] 7.4 [6.9; 8.0] 7.9 [7.2; 8.6] 7.9 [7.2; 8.6] (9,365) (7,110) (5,193) (3,649) (2,416) (1,461) (775) (253) L 7,881 76 (68 - 81) 36/64 24.9 621 6.7 [6.1; 7.3] 7.5 [6.9; 8.1] 7.8 [7.2; 8.4] 8.1 [7.4; 8.8] 8.5 [7.8; 9.2] 8.7 [8.0; 9.5] 9.0 [8.1; 9.8] 9.3 [8.2; 10.4] (5,578) (4,308) (3,217) (2,381) (1,609) (1,013) (501) (178) XL 2,352 75 (67 - 81) 46/54 25.1 479 7.5 [6.4; 8.6] 8.1 [6.9; 9.2] 8.7 [7.4; 9.9] 9.0 [7.7; 10.3] 9.3 [8.0; 10.7] 9.6 [8.1; 11.0] 10.6 [8.5; 12.6] (1,648) (1,255) (913) (663) (437) (258) (126) XXL 323 76 (68 - 82) 43/57 25.1 137 10.4 [6.9; 13.8] 11.3 [7.7; 14.9] 11.9 [8.1; 15.6] 12.9 [8.6; 16.9] 13.9 [9.2; 18.3] (216) (171) (125) (86) (56) Cup type Modular cup 25,199 74 (67 - 80) 32/68 24.7 687 6.4 [6.1; 6.7] 7.0 [6.6; 7.3] 7.3 [7.0; 7.6] 7.7 [7.3; 8.0] 8.0 [7.6; 8.4] 8.2 [7.8; 8.6] 8.5 [8.0; 8.9] 8.6 [8.1; 9.1] 8.6 [8.1; 9.1] (18,074) (13,803) (10,166) (7,258) (4,760) (2,885) (1,485) (522) (102) Monobloc cup 6,984 80 (74 - 85) 25/75 24.4 456 4.8 [4.3; 5.4] 5.5 [4.9; 6.0] 5.9 [5.3; 6.5] 6.1 [5.5; 6.8] 6.4 [5.7; 7.0] 6.7 [6.0; 7.5] 7.3 [6.3; 8.2] 7.8 [6.4; 9.2] (4,894) (3,752) (2,772) (2,000) (1,370) (853) (428) (133) Dual mobility 2,366 81 (73 - 86) 32/68 24.2 272 5.7 [4.7; 6.7] 6.2 [5.1; 7.2] 6.5 [5.3; 7.6] 7.1 [5.8; 8.5] 7.1 [5.8; 8.5] 7.1 [5.8; 8.5] (1,363) (879) (543) (321) (157) (68) Revision cup 406 79 (69 - 84) 28/72 24.7 142 9.5 [6.4; 12.5] 11.1 [7.7; 14.4] 12.1 [8.4; 15.6] 12.1 [8.4; 15.6] 12.1 [8.4; 15.6] (260) (198) (155) (109) (75) Stem type Femoral stem with modular head 33,504 76 (68 - 82) 30/70 24.6 705 6.0 [5.7; 6.2] 6.6 [6.3; 6.9] 6.9 [6.6; 7.2] 7.3 [7.0; 7.6] 7.6 [7.2; 7.9] 7.8 [7.5; 8.2] 8.2 [7.8; 8.6] 8.4 [7.9; 8.9] 8.4 [7.9; 8.9] (23,647) (17,923) (13,126) (9,334) (6,132) (3,710) (1,877) (646) (119) Revision or tumour stem 692 80 (72 - 86) 26/74 25.2 282 11.1 [8.6; 13.5] 12.3 [9.6; 14.9] 12.6 [9.9; 15.3] 13.0 [10.2; 15.8] 13.0 [10.2; 15.8] 13.0 [10.2; 15.8] (403) (291) (220) (159) (103) (60) Short stem 528 67 (61 - 77) 37/63 24.3 93 5.6 [3.6; 7.6] 5.6 [3.6; 7.6] 6.0 [3.8; 8.1] 6.0 [3.8; 8.1] 6.0 [3.8; 8.1] (371) (281) (191) (132) (85) Reconstruction shell Without reconstruction shell 34,848 76 (68 - 82) 30/70 24.6 707 6.1 [5.8; 6.3] 6.6 [6.4; 6.9] 7.0 [6.7; 7.3] 7.3 [7.0; 7.6] 7.6 [7.3; 7.9] 7.8 [7.5; 8.2] 8.2 [7.8; 8.6] 8.4 [7.9; 8.9] 8.4 [7.9; 8.9] (24,521) (18,581) (13,598) (9,662) (6,346) (3,838) (1,943) (665) (125) Fixation Uncemented 15,762 71 (64 - 78) 35/65 24.8 673 7.2 [6.7; 7.6] 7.8 [7.3; 8.2] 8.1 [7.6; 8.5] 8.4 [8.0; 8.9] 8.8 [8.3; 9.3] 9.0 [8.4; 9.5] 9.3 [8.7; 9.9] 9.3 [8.7; 9.9] 9.3 [8.7; 9.9] (11,463) (8,879) (6,649) (4,834) (3,247) (2,000) (1,037) (368) (65) Hybrid 11,702 78 (72 - 83) 27/73 24.6 607 5.2 [4.8; 5.6] 5.7 [5.3; 6.2] 6.2 [5.7; 6.7] 6.6 [6.1; 7.1] 6.8 [6.2; 7.3] 7.0 [6.4; 7.6] 7.4 [6.6; 8.1] 7.7 [6.7; 8.7] (8,110) (6,014) (4,278) (2,958) (1,880) (1,118) (557) (189) Cemented 6,575 81 (76 - 86) 24/76 24.3 474 4.6 [4.0; 5.1] 5.2 [4.6; 5.7] 5.4 [4.8; 6.0] 5.6 [5.0; 6.2] 5.8 [5.1; 6.5] 6.4 [5.5; 7.2] 6.8 [5.7; 7.9] 7.6 [5.8; 9.3] (4,427) (3,312) (2,400) (1,679) (1,087) (637) (310) (94) Reverse-hybrid 902 77 (67 - 83) 28/72 24.8 287 9.2 [7.3; 11.1] 10.0 [7.9; 12.0] 11.1 [8.7; 13.3] 11.4 [9.0; 13.7] 11.8 [9.3; 14.3] 11.8 [9.3; 14.3] (579) (419) (302) (213) (144) (88) Table 46 (continued) 78 EPRD Annual Report 2024 79  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category Hip hemiarthroplasties 73,215 84 (80 - 89) 29/71 24.2 624 4.6 [4.4; 4.7] 4.8 [4.6; 5.0] 5.0 [4.8; 5.2] 5.2 [5.0; 5.4] 5.3 [5.1; 5.5] 5.5 [5.3; 5.7] 5.6 [5.3; 5.8] 6.0 [5.5; 6.5] 6.0 [5.5; 6.5] (40,585) (27,056) (17,231) (10,597) (6,110) (3,163) (1,340) (375) (50) Head component metal 69,763 84 (80 - 89) 29/71 24.2 613 4.5 [4.4; 4.7] 4.8 [4.6; 4.9] 4.9 [4.8; 5.1] 5.1 [4.9; 5.3] 5.3 [5.1; 5.5] 5.4 [5.2; 5.7] 5.5 [5.2; 5.7] 6.0 [5.5; 6.4] (38,625) (25,725) (16,319) (10,000) (5,757) (2,964) (1,264) (371) Ceramic 2,495 84 (79 - 89) 29/71 24.5 302 5.3 [4.3; 6.2] 5.6 [4.6; 6.5] 5.9 [4.9; 7.0] 6.5 [5.2; 7.6] 6.5 [5.2; 7.6] 7.0 [5.4; 8.7] (1,431) (976) (680) (439) (251) (134) Ceramicised metal 499 84 (80 - 89) 30/70 24.3 34 4.6 [2.6; 6.5] 4.6 [2.6; 6.5] 4.6 [2.6; 6.5] (254) (134) (57) Head size 28 mm 68,962 84 (80 - 89) 28/72 24.2 619 4.6 [4.4; 4.7] 4.8 [4.6; 4.9] 4.9 [4.8; 5.1] 5.1 [4.9; 5.3] 5.2 [5.0; 5.5] 5.4 [5.2; 5.7] 5.5 [5.2; 5.8] 6.0 [5.5; 6.5] (38,149) (25,305) (16,012) (9,830) (5,660) (2,926) (1,242) (346) 32 mm 2,538 83 (79 - 88) 53/47 24.7 104 5.5 [4.6; 6.5] 6.0 [5.0; 7.0] 6.2 [5.2; 7.2] 6.7 [5.6; 7.8] 7.1 [5.8; 8.3] 7.1 [5.8; 8.3] 7.1 [5.8; 8.3] (1,522) (1,165) (876) (574) (333) (182) (78) Hip 302 87 (83 - 90) 4/96 23.5 17 3.9 [1.6; 6.2] 3.9 [1.6; 6.2] 4.8 [1.9; 7.6] (174) (121) (76) Head-neck length XS 486 84 (80 - 89) 30/70 23.8 30 3.6 [1.8; 5.3] 3.6 [1.8; 5.3] 3.6 [1.8; 5.3] 3.6 [1.8; 5.3] 3.6 [1.8; 5.3] (317) (234) (155) (105) (62) S 25,348 84 (80 - 89) 25/75 24.1 563 4.4 [4.1; 4.6] 4.6 [4.3; 4.9] 4.7 [4.4; 5.0] 4.8 [4.5; 5.1] 5.1 [4.7; 5.4] 5.2 [4.8; 5.6] 5.4 [4.9; 6.0] 5.8 [4.9; 6.6] (13,963) (9,102) (5,581) (3,288) (1,794) (904) (382) (102) M 32,215 84 (80 - 89) 30/70 24.2 583 4.3 [4.1; 4.6] 4.5 [4.3; 4.8] 4.7 [4.4; 4.9] 4.9 [4.6; 5.1] 5.0 [4.7; 5.3] 5.1 [4.8; 5.5] 5.1 [4.8; 5.5] 5.7 [5.0; 6.5] (18,004) (12,071) (7,767) (4,803) (2,830) (1,521) (648) (186) L 6,657 84 (80 - 89) 35/65 24.5 515 5.2 [4.6; 5.8] 5.5 [4.9; 6.1] 5.7 [5.1; 6.3] 5.9 [5.2; 6.6] 6.0 [5.3; 6.7] 6.2 [5.4; 7.0] 6.2 [5.4; 7.0] 6.8 [5.4; 8.2] (3,616) (2,421) (1,620) (1,090) (705) (400) (176) (54) XL 1,045 84 (79 - 88) 36/64 24.8 288 7.4 [5.7; 9.1] 8.1 [6.3; 9.9] 8.7 [6.7; 10.6] 9.9 [7.5; 12.2] 9.9 [7.5; 12.2] 9.9 [7.5; 12.2] (569) (403) (268) (172) (111) (73) Stem type Femoral stem with modular head 71,938 84 (80 - 89) 29/71 24.2 619 4.5 [4.3; 4.7] 4.7 [4.6; 4.9] 4.9 [4.7; 5.1] 5.1 [4.9; 5.3] 5.3 [5.0; 5.5] 5.4 [5.2; 5.6] 5.5 [5.2; 5.7] 6.0 [5.5; 6.4] (39,939) (26,656) (16,980) (10,445) (6,019) (3,120) (1,316) (368) Revision or tumour stem 902 83 (75 - 87) 29/71 25.3 257 10.2 [8.1; 12.4] 10.7 [8.5; 12.9] 10.7 [8.5; 12.9] 11.2 [8.8; 13.6] 11.2 [8.8; 13.6] (469) (309) (202) (127) (75) Reconstruction shell Without reconstruction shell 73,215 84 (80 - 89) 29/71 24.2 624 4.6 [4.4; 4.7] 4.8 [4.6; 5.0] 5.0 [4.8; 5.2] 5.2 [5.0; 5.4] 5.3 [5.1; 5.5] 5.5 [5.3; 5.7] 5.6 [5.3; 5.8] 6.0 [5.5; 6.5] 6.0 [5.5; 6.5] (40,585) (27,056) (17,231) (10,597) (6,110) (3,163) (1,340) (375) (50) Fixation Cemented 64,562 85 (80 - 89) 28/72 24.2 613 4.3 [4.1; 4.4] 4.5 [4.3; 4.6] 4.6 [4.4; 4.8] 4.8 [4.6; 4.9] 4.9 [4.7; 5.1] 5.0 [4.8; 5.3] 5.1 [4.8; 5.4] 5.6 [5.1; 6.2] (35,582) (23,562) (14,876) (9,155) (5,275) (2,754) (1,167) (327) Uncemented 8,619 83 (78 - 88) 34/66 24.6 424 6.9 [6.3; 7.5] 7.3 [6.7; 7.9] 7.6 [6.9; 8.2] 8.1 [7.4; 8.8] 8.4 [7.6; 9.1] 8.8 [7.9; 9.7] 8.8 [7.9; 9.7] (4,989) (3,486) (2,350) (1,439) (832) (407) (172) Table 46 (continued) 80 EPRD Annual Report 2024 81  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival 5.1.4 Outcomes for specific affect the listed stem or cup components per Hemiarthroplasties and total hip arthroplas- are also listed separately in Table 63 and Ta- combinations of hip components se (also refer to explanations on the analyses ties performed for a femoral fracture close to ble 64 of the appendix. Table 47 details CRRs for primary hip ar- in Chapter 3). the hip joint were not included. throplasties that use specific femoral and acetabular system combinations. Knee ar- The results are presented by type of compo- The outcomes for femoral and acetabular throplasty CRRs are listed by the compo- nent fixation. To ensure comparable baseline hip arthroplasty components, obtained by nent that subsequently required changes. conditions, we only considered survival data considering the individual component across However, these changes do not necessarily for elective hip arthroplasties. all the different component combinations, Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Femoral stem Cup Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Hip Hybrid fixation ABG II Stem (Stryker) Trident Cup (Stryker) 444 9 79 (76 - 82) 22/78 2014-2022 2.5 [1.0; 3.9] 2.9 [1.4; 4.5] 2.9 [1.4; 4.5] 2.9 [1.4; 4.5] 3.3 [1.6; 5.0] 3.3 [1.6; 5.0] (427) (413) (385) (322) (221) (89) Actinia cemented (Implantcast) EcoFit cpTi (Implantcast) 344 9 80 (76 - 83) 25/75 2016-2023 2.3 [0.7; 3.9] 3.0 [1.1; 4.7] 3.3 [1.4; 5.2] 3.6 [1.6; 5.6] 3.6 [1.6; 5.6] (318) (299) (285) (229) (139) Avenir (Zimmer Biomet) Allofit (Zimmer Biomet) 4,646 141 80 (76 - 83) 23/77 2014-2023 2.1 [1.7; 2.5] 2.3 [1.9; 2.8] 2.5 [2.0; 3.0] 2.6 [2.1; 3.1] 2.9 [2.2; 3.5] 2.9 [2.2; 3.5] 2.9 [2.2; 3.5] 2.9 [2.2; 3.5] (3,319) (2,236) (1,461) (886) (542) (342) (168) (63) Avenir (Zimmer Biomet) Allofit IT (Zimmer Biomet) 543 17 79 (75 - 82) 21/79 2014-2023 3.2 [1.6; 4.7] 3.4 [1.8; 5.0] 3.4 [1.8; 5.0] 4.0 [2.0; 5.9] (396) (287) (174) (95) BHR (Smith & Nephew) BHR (Smith & Nephew) 417 23 55 (51 - 59) 99/1 2014-2023 1.2 [0.2; 2.3] 1.8 [0.5; 3.2] 2.2 [0.7; 3.6] 2.2 [0.7; 3.6] 2.2 [0.7; 3.6] 2.2 [0.7; 3.6] 3.1 [0.7; 5.4] (359) (313) (266) (219) (164) (108) (60) BICONTACT (Aesculap) PLASMACUP (Aesculap) 376 22 78 (75 - 82) 29/71 2013-2023 2.1 [0.7; 3.6] 2.5 [0.9; 4.0] 2.5 [0.9; 4.0] 2.8 [1.1; 4.5] 2.8 [1.1; 4.5] 2.8 [1.1; 4.5] 2.8 [1.1; 4.5] 2.8 [1.1; 4.5] (322) (294) (267) (245) (202) (169) (109) (52) BICONTACT (Aesculap) PLASMAFIT (Aesculap) 1,987 86 79 (75 - 82) 22/78 2013-2023 2.1 [1.4; 2.7] 2.3 [1.6; 2.9] 2.8 [2.0; 3.5] 3.0 [2.1; 3.8] 3.3 [2.4; 4.2] 3.5 [2.5; 4.4] 3.5 [2.5; 4.4] 3.5 [2.5; 4.4] (1,656) (1,406) (1,171) (946) (719) (504) (299) (136) C-STEM™ AMT-Hüftschaft PINNACLE™ Press Fit-Hüftpfanne 2.1 [0.9; 3.2] 2.3 [1.0; 3.5] 2.5 [1.2; 3.8] 2.9 [1.4; 4.4] 3.3 [1.6; 5.0] 4.4 [2.1; 6.7] 4.4 [2.1; 6.7] 608 10 80 (76 - 84) 16/84 2014-2023 (DePuy) (DePuy) (496) (389) (301) (248) (206) (127) (71) CCA (Mathys) Allofit (Zimmer Biomet) 434 5 76 (73 - 80) 32/68 2013-2023 2.3 [0.9; 3.7] 3.3 [1.6; 5.0] 3.8 [2.0; 5.6] 4.3 [2.4; 6.3] 4.6 [2.6; 6.6] 5.2 [3.0; 7.4] 5.9 [3.5; 8.3] 6.8 [4.1; 9.3] 6.8 [4.1; 9.3] (410) (384) (369) (349) (327) (301) (260) (177) (117) CCA (Mathys) RM Classic (Mathys) 418 6 78 (74 - 82) 32/68 2014-2023 3.1 [1.3; 4.8] 4.1 [2.0; 6.1] 4.1 [2.0; 6.1] 4.6 [2.3; 6.8] 5.1 [2.6; 7.6] 5.8 [3.0; 8.5] 5.8 [3.0; 8.5] (329) (255) (194) (178) (154) (119) (58) CCA (Mathys) RM Pressfit vitamys (Mathys) 357 12 79 (76 - 82) 25/75 2013-2023 1.1 [0.0; 2.2] 1.1 [0.0; 2.2] 1.1 [0.0; 2.2] 1.1 [0.0; 2.2] 1.7 [0.1; 3.3] 1.7 [0.1; 3.3] 2.8 [0.1; 5.4] 2.8 [0.1; 5.4] (298) (259) (235) (193) (149) (117) (80) (56) CORAIL™ AMT-Hüftschaft PINNACLE™ Press Fit-Hüftpfanne 2.5 [2.1; 2.9] 2.8 [2.5; 3.2] 3.2 [2.8; 3.6] 3.5 [3.1; 4.0] 4.1 [3.5; 4.7] 4.3 [3.6; 5.0] 4.3 [3.6; 5.0] 4.3 [3.6; 5.0] 7,581 152 79 (75 - 83) 21/79 2012-2023 ohne Kragen (DePuy) (DePuy) (5,652) (4,114) (2,892) (1,963) (1,262) (749) (348) (120) COREHIP (Aesculap) PLASMAFIT (Aesculap) 881 63 81 (76 - 83) 17/83 2018-2023 3.1 [1.8; 4.3] 3.7 [2.2; 5.2] (432) (168) EXCEPTION (Zimmer Biomet) Allofit (Zimmer Biomet) 654 11 78.5 (74 - 82) 20/80 2016-2023 2.6 [1.4; 3.8] 2.8 [1.5; 4.0] 3.0 [1.6; 4.3] 3.2 [1.8; 4.6] 3.5 [2.0; 5.0] 3.5 [2.0; 5.0] (599) (562) (474) (317) (172) (64) EXCIA (Aesculap) PLASMAFIT (Aesculap) 3,856 104 79 (75 - 83) 22/78 2014-2023 2.1 [1.7; 2.6] 2.4 [1.9; 2.9] 2.8 [2.3; 3.4] 3.1 [2.5; 3.8] 3.2 [2.5; 3.9] 3.2 [2.5; 3.9] 3.8 [2.7; 4.8] 3.8 [2.7; 4.8] (2,851) (2,192) (1,691) (1,234) (739) (439) (238) (72) Exeter Stem (Stryker) Trident Cup (Stryker) 317 10 80 (75 - 83) 25/75 2015-2023 2.6 [0.8; 4.3] 2.6 [0.8; 4.3] 2.6 [0.8; 4.3] 3.3 [1.0; 5.5] 3.3 [1.0; 5.5] (271) (219) (165) (125) (89) ICON (IO-International Orthopaedics) ICON (IO-International Orthopaedics) 305 14 56 (51 - 62) 87/13 2013-2022 1.0 [0.0; 2.1] 1.3 [0.0; 2.6] 2.0 [0.4; 3.6] 2.7 [0.8; 4.6] 2.7 [0.8; 4.6] 3.3 [1.1; 5.5] 4.2 [1.4; 6.9] (297) (290) (278) (270) (219) (132) (66) LCU Hip System, cemented CombiCup 1.4 [0.4; 2.4] 1.4 [0.4; 2.4] 1.4 [0.4; 2.4] 561 6 79 (73 - 82) 36/64 2019-2023 (Waldemar Link) (Waldemar Link) (438) (285) (137) LCU Hip System, cemented MobileLink, Cluster Hole 4.0 [2.1; 5.9] 4.0 [2.1; 5.9] 4.0 [2.1; 5.9] 448 12 78 (74 - 82) 27/73 2019-2023 (Waldemar Link) (Waldemar Link) (297) (198) (84) M.E.M. Geradschaft (Zimmer Biomet) Allofit (Zimmer Biomet) 23,243 167 79 (75 - 82) 26/74 2012-2023 2.1 [1.9; 2.3] 2.3 [2.1; 2.5] 2.5 [2.3; 2.7] 2.7 [2.4; 2.9] 3.0 [2.7; 3.2] 3.1 [2.8; 3.4] 3.2 [2.9; 3.5] 3.5 [3.1; 3.9] 3.5 [3.1; 3.9] (18,602) (14,609) (11,367) (8,522) (5,792) (3,581) (1,798) (700) (146) Table 47: Implant outcomes for stem/cup combinations in elective total hip arthroplasties. For each type of fixation, the com- binations are listed alphabetically by the stem component. 82 EPRD Annual Report 2024 83  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Femoral stem Cup Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Hybrid fixation M.E.M. Geradschaft (Zimmer Biomet) Allofit IT (Zimmer Biomet) 502 19 79 (75 - 82) 21/79 2013-2023 2.4 [1.1; 3.8] 2.7 [1.2; 4.2] 2.7 [1.2; 4.2] 3.6 [1.7; 5.5] 3.6 [1.7; 5.5] 3.6 [1.7; 5.5] (412) (341) (265) (193) (126) (76) M.E.M. Geradschaft (Zimmer Biomet) Trilogy (Zimmer Biomet) 1,591 12 78 (74 - 81) 27/73 2012-2023 1.4 [0.8; 2.0] 1.6 [0.9; 2.2] 1.7 [1.0; 2.3] 1.7 [1.0; 2.3] 1.8 [1.1; 2.4] 1.9 [1.2; 2.6] 2.5 [1.5; 3.5] 2.5 [1.5; 3.5] 2.5 [1.5; 3.5] (1,401) (1,229) (1,076) (942) (755) (584) (379) (203) (93) M.E.M. Geradschaft (Zimmer Biomet) Trilogy IT (Zimmer Biomet) 387 3 81 (78 - 83) 24/76 2015-2023 1.6 [0.3; 2.8] 1.6 [0.3; 2.8] 1.6 [0.3; 2.8] 1.6 [0.3; 2.8] 2.4 [0.3; 4.4] 2.4 [0.3; 4.4] (314) (248) (204) (149) (106) (62) METABLOC (Zimmer Biomet) Allofit (Zimmer Biomet) 1,508 24 78 (75 - 82) 28/72 2013-2022 2.3 [1.6; 3.1] 2.7 [1.9; 3.5] 2.9 [2.0; 3.7] 2.9 [2.0; 3.7] 3.2 [2.3; 4.1] 3.3 [2.4; 4.3] 3.6 [2.5; 4.7] 3.6 [2.5; 4.7] (1,437) (1,385) (1,271) (1,085) (824) (563) (336) (143) MS-30 (Zimmer Biomet) Allofit (Zimmer Biomet) 3,816 32 78 (74 - 81) 26/74 2014-2023 1.7 [1.2; 2.1] 1.8 [1.4; 2.2] 2.0 [1.5; 2.4] 2.2 [1.7; 2.7] 2.3 [1.8; 2.8] 2.5 [1.9; 3.0] 2.7 [2.1; 3.4] 2.9 [2.2; 3.7] (3,385) (2,968) (2,566) (2,119) (1,670) (1,217) (702) (256) Hip Müller Geradschaft 2.7 [1.8; 3.7] 3.0 [1.9; 4.0] 3.0 [1.9; 4.0] 3.1 [2.0; 4.2] 3.1 [2.0; 4.2] 3.1 [2.0; 4.2] R3 (Smith & Nephew) 1,080 15 78 (75 - 82) 30/70 2015-2023 (OHST Medizintechnik) (930) (799) (645) (486) (265) (131) Polarschaft Cemented 2.4 [1.7; 3.1] 2.5 [1.8; 3.2] 2.7 [1.9; 3.5] 3.0 [2.1; 3.9] 3.0 [2.1; 3.9] 3.0 [2.1; 3.9] 3.0 [2.1; 3.9] R3 (Smith & Nephew) 1,910 66 79 (75 - 83) 23/77 2013-2023 (Smith & Nephew) (1,306) (983) (786) (607) (404) (208) (66) QUADRA-C (Medacta) VERSAFITCUP CC TRIO (Medacta) 2,185 55 80 (77 - 83) 22/78 2015-2023 2.1 [1.5; 2.7] 2.4 [1.7; 3.1] 2.4 [1.7; 3.1] 2.7 [1.9; 3.4] 2.8 [2.0; 3.6] 3.7 [2.2; 5.1] 3.7 [2.2; 5.1] (1,680) (1,294) (981) (691) (403) (174) (58) SPECTRON (Smith & Nephew) R3 (Smith & Nephew) 402 8 79 (75 - 83) 27/73 2013-2023 1.0 [0.0; 2.0] 1.3 [0.2; 2.4] 1.3 [0.2; 2.4] 1.3 [0.2; 2.4] 1.3 [0.2; 2.4] 1.3 [0.2; 2.4] (338) (284) (214) (169) (123) (87) SPII Model Lubinus Hip Stem, standard stem, without Borehole Allofit (Zimmer Biomet) 6,361 51 78 (74 - 81) 27/73 2013-2023 2.2 [1.8; 2.6] 2.8 [2.4; 3.2] 3.1 [2.6; 3.5] 3.3 [2.8; 3.7] 3.4 [2.9; 3.9] 3.8 [3.2; 4.4] 4.6 [3.8; 5.4] 4.8 [3.9; 5.6] 4.8 [3.9; 5.6] (5,215) (4,187) (3,347) (2,514) (1,832) (1,231) (691) (347) (129) (Waldemar Link) SPII Model Lubinus Hip Stem, standard stem, without Borehole CombiCup (Waldemar Link) 1,399 32 78 (74 - 81) 29/71 2014-2023 0.9 [0.4; 1.4] 1.7 [1.0; 2.3] 1.9 [1.2; 2.7] 2.6 [1.7; 3.5] 3.2 [2.1; 4.2] 3.2 [2.1; 4.2] 3.5 [2.3; 4.7] 4.1 [2.4; 5.9] (1,284) (1,156) (1,033) (848) (628) (388) (222) (77) (Waldemar Link) SPII Model Lubinus Hip Stem, HI Lubricer Schale 0.9 [0.0; 1.8] 0.9 [0.0; 1.8] 1.3 [0.0; 2.5] 1.3 [0.0; 2.5] 1.8 [0.2; 3.3] 3.3 [0.6; 5.9] standard stem, without Borehole 349 3 77 (74 - 81) 27/73 2014-2023 (Smith & Nephew) (324) (289) (246) (196) (146) (84) (Waldemar Link) SPII Model Lubinus Hip Stem, MobileLink, Cluster Hole 2.5 [1.6; 3.3] 3.2 [2.1; 4.3] 3.2 [2.1; 4.3] standard stem, without Borehole 1,282 28 78 (72 - 82) 26/74 2017-2023 (Waldemar Link) (754) (370) (142) (Waldemar Link) SPII Model Lubinus Hip Stem, standard stem, without Borehole PLASMAFIT (Aesculap) 356 13 78 (73 - 81) 22/78 2015-2023 1.6 [0.2; 2.9] 2.0 [0.4; 3.6] 2.0 [0.4; 3.6] 2.0 [0.4; 3.6] (248) (176) (113) (71) (Waldemar Link) Standard C, cemented CombiCup 1.3 [0.2; 2.5] 2.2 [0.7; 3.6] 2.7 [1.1; 4.4] 3.3 [1.5; 5.2] 3.3 [1.5; 5.2] 3.3 [1.5; 5.2] 3.3 [1.5; 5.2] 382 5 77 (73 - 80) 31/69 2014-2022 (Waldemar Link) (Waldemar Link) (365) (341) (330) (318) (259) (186) (96) Taperloc Cemented (Zimmer Biomet) Allofit (Zimmer Biomet) 546 25 79 (75 - 83) 22/78 2015-2023 2.5 [1.1; 3.8] 2.9 [1.3; 4.3] 2.9 [1.3; 4.3] 2.9 [1.3; 4.3] (404) (260) (140) (74) Taperloc Cemented (Zimmer Biomet) G7 (Zimmer Biomet) 536 11 80 (75 - 83) 25/75 2015-2023 2.3 [1.0; 3.6] 3.0 [1.5; 4.4] 3.0 [1.5; 4.4] 3.0 [1.5; 4.4] 3.0 [1.5; 4.4] 3.0 [1.5; 4.4] (462) (377) (311) (235) (163) (100) TRENDHIP (Aesculap) PLASMAFIT (Aesculap) 652 36 80 (75 - 83) 25/75 2016-2023 2.3 [1.1; 3.4] 2.3 [1.1; 3.4] 2.3 [1.1; 3.4] 2.3 [1.1; 3.4] 2.9 [1.2; 4.5] (499) (395) (291) (208) (116) twinSys cem. (Mathys) RM Pressfit vitamys (Mathys) 1,071 25 79 (72 - 82) 23/77 2014-2023 2.6 [1.6; 3.6] 2.7 [1.7; 3.7] 2.7 [1.7; 3.7] 2.9 [1.8; 3.9] 3.3 [2.1; 4.5] 4.0 [2.2; 5.8] (889) (759) (630) (471) (313) (136) Reverse hybrid fixation Avenir (Zimmer Biomet) Flachprofil (Zimmer Biomet) 416 68 73 (65 - 79) 17/83 2013-2023 4.6 [2.6; 6.6] 5.3 [3.0; 7.5] 5.7 [3.3; 8.0] 5.7 [3.3; 8.0] 5.7 [3.3; 8.0] 5.7 [3.3; 8.0] (334) (259) (202) (158) (105) (69) BICONTACT (Aesculap) All POLY CUP (Aesculap) 415 62 76 (70 - 80) 24/76 2013-2023 3.4 [1.6; 5.2] 4.0 [2.1; 5.9] 4.3 [2.3; 6.3] 4.3 [2.3; 6.3] 4.7 [2.5; 6.8] 4.7 [2.5; 6.8] 4.7 [2.5; 6.8] (359) (310) (281) (235) (193) (132) (76) CORAIL™ AMT-Hüftschaft TRILOC® II-PE-Hüftpfanne 5.0 [2.5; 7.4] 5.0 [2.5; 7.4] 5.0 [2.5; 7.4] 5.0 [2.5; 7.4] 5.7 [2.8; 8.4] 5.7 [2.8; 8.4] 308 61 75 (66 - 80.5) 19/81 2014-2023 ohne Kragen (DePuy) (DePuy) (259) (226) (194) (153) (113) (77) Table 47 (continued) 84 EPRD Annual Report 2024 85  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Femoral stem Cup Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Uncemented fixation A2 Kurzschaft (ARTIQO) ANA.NOVA® Alpha Pfanne (ARTIQO) 5,408 56 64 (58 - 71) 43/57 2016-2023 2.1 [1.7; 2.5] 2.3 [1.9; 2.7] 2.4 [2.0; 2.9] 2.7 [2.2; 3.3] 3.0 [2.4; 3.6] 3.1 [2.5; 3.8] 3.1 [2.5; 3.8] (3,804) (2,656) (1,849) (1,261) (772) (330) (73) A2 Kurzschaft (ARTIQO) ANA.NOVA® Hybrid Pfanne (ARTIQO) 6,214 46 64 (57 - 70) 38/62 2016-2023 1.8 [1.5; 2.1] 2.0 [1.7; 2.4] 2.2 [1.8; 2.6] 2.3 [1.9; 2.7] 2.3 [1.9; 2.7] 2.4 [1.9; 2.9] 2.4 [1.9; 2.9] (4,925) (3,849) (2,950) (2,100) (1,321) (612) (124) ABG II Stem (Stryker) Trident Cup (Stryker) 414 12 66 (59 - 71) 42/58 2014-2022 3.1 [1.4; 4.8] 4.9 [2.8; 7.0] 5.4 [3.2; 7.6] 5.7 [3.4; 8.0] 6.1 [3.7; 8.5] 6.6 [4.0; 9.1] 6.6 [4.0; 9.1] 6.6 [4.0; 9.1] (400) (362) (337) (301) (228) (172) (138) (52) Accolade II Stem (Stryker) Trident Cup (Stryker) 7,974 45 67 (60 - 74) 43/57 2014-2023 2.5 [2.2; 2.9] 2.8 [2.4; 3.2] 3.0 [2.6; 3.4] 3.2 [2.7; 3.6] 3.3 [2.8; 3.7] 3.4 [2.9; 3.9] 3.4 [2.9; 3.9] 3.4 [2.9; 3.9] (6,609) (5,454) (4,156) (2,932) (1,665) (798) (379) (127) Accolade II Stem (Stryker) Trident II Tritanium Cup (Stryker) 1,054 22 69 (62 - 75) 43/57 2018-2023 3.8 [2.5; 5.1] 4.2 [2.7; 5.7] (394) (50) Hip Accolade II Stem (Stryker) Trident TC Cup (Stryker) 482 10 69 (62 - 75) 36/64 2015-2021 1.7 [0.5; 2.8] 2.1 [0.8; 3.4] 2.3 [1.0; 3.7] 2.8 [1.3; 4.2] 3.4 [1.8; 5.1] 3.7 [2.0; 5.4] 3.7 [2.0; 5.4] (463) (455) (448) (427) (410) (364) (263) Accolade II Stem (Stryker) Tritanium Cup (Stryker) 2,581 25 69 (62 - 76) 40/60 2014-2023 2.7 [2.1; 3.4] 3.3 [2.6; 4.0] 3.6 [2.9; 4.3] 4.1 [3.3; 4.9] 4.2 [3.3; 5.0] 4.3 [3.4; 5.2] 4.7 [3.7; 5.8] 5.1 [3.8; 6.4] (2,440) (2,159) (1,717) (1,254) (810) (549) (294) (107) Actinia cementless (Implantcast) EcoFit cpTi (Implantcast) 694 16 69 (62 - 76) 42/58 2015-2023 3.3 [2.0; 4.7] 4.3 [2.7; 5.8] 4.3 [2.7; 5.8] 4.8 [3.2; 6.4] 5.2 [3.5; 6.9] 5.7 [3.7; 7.7] (631) (588) (566) (503) (325) (135) Actinia cementless (Implantcast) EcoFit NH cpTi (Implantcast) 1,513 8 72 (65 - 78) 31/69 2015-2023 2.9 [2.0; 3.7] 3.0 [2.1; 3.9] 3.1 [2.2; 4.0] 3.2 [2.3; 4.1] 3.2 [2.3; 4.1] 3.2 [2.3; 4.1] (1,394) (1,288) (1,173) (893) (296) (98) ACTIS™-Hüftschaft PINNACLE™ Press Fit-Hüftpfanne 1.7 [1.2; 2.2] 2.0 [1.4; 2.6] 2.2 [1.5; 2.8] 2.5 [1.6; 3.4] 2,628 42 62 (55 - 69) 43/57 2018-2023 (DePuy) (DePuy) (1,657) (855) (458) (123) Alloclassic (Zimmer Biomet) Alloclassic (Zimmer Biomet) 398 8 67 (59 - 75) 32/68 2014-2023 3.8 [1.9; 5.7] 4.3 [2.3; 6.4] 4.9 [2.7; 7.0] 5.4 [3.1; 7.7] 5.4 [3.1; 7.7] 6.1 [3.7; 8.6] 6.1 [3.7; 8.6] 6.1 [3.7; 8.6] (368) (355) (346) (333) (296) (238) (171) (81) Alloclassic (Zimmer Biomet) Allofit (Zimmer Biomet) 9,582 71 70 (62 - 77) 36/64 2012-2023 2.9 [2.5; 3.2] 3.4 [3.0; 3.7] 3.7 [3.3; 4.1] 4.0 [3.6; 4.5] 4.3 [3.9; 4.7] 4.6 [4.2; 5.1] 4.8 [4.3; 5.3] 5.1 [4.6; 5.7] 5.1 [4.6; 5.7] (8,493) (7,531) (6,630) (5,575) (4,483) (3,291) (2,195) (1,008) (237) Alloclassic (Zimmer Biomet) Trilogy (Zimmer Biomet) 578 6 67 (63 - 70) 33/67 2015-2023 3.3 [1.8; 4.8] 3.9 [2.3; 5.5] 3.9 [2.3; 5.5] 4.5 [2.7; 6.2] 4.5 [2.7; 6.2] 4.9 [2.9; 6.8] 4.9 [2.9; 6.8] (515) (449) (391) (333) (264) (196) (108) Alpha-Fit (Corin) Trinity no Hole (Corin) 451 3 75 (69 - 78) 33/67 2014-2022 1.6 [0.4; 2.7] 1.8 [0.6; 3.0] 2.2 [0.9; 3.6] 2.2 [0.9; 3.6] 2.8 [1.2; 4.3] 3.2 [1.4; 5.0] 4.2 [2.0; 6.4] 4.2 [2.0; 6.4] (437) (427) (417) (396) (334) (227) (162) (98) AMISTEM-H (Medacta) VERSAFITCUP CC TRIO (Medacta) 964 26 67 (58 - 74) 42/58 2015-2020 3.2 [2.1; 4.3] 3.5 [2.4; 4.7] 3.8 [2.5; 5.0] 4.2 [2.9; 5.5] 4.7 [3.3; 6.1] 5.5 [3.8; 7.1] 6.1 [4.1; 8.2] (922) (893) (874) (722) (503) (310) (131) AMISTEM-H ProxCoat (Medacta) VERSAFITCUP CC TRIO (Medacta) 382 3 60 (53 - 67) 47/53 2016-2023 1.8 [0.5; 3.2] 2.2 [0.7; 3.6] 2.5 [0.9; 4.2] 3.0 [1.1; 4.9] 4.0 [1.3; 6.6] (339) (271) (217) (163) (85) AMISTEM-P (Medacta) VERSAFITCUP CC TRIO (Medacta) 1,099 24 66 (59 - 73) 40/60 2019-2023 2.5 [1.6; 3.5] 2.7 [1.7; 3.7] 3.9 [2.2; 5.6] (741) (428) (133) ANA.NOVA® Alpha Schaft (ARTIQO) ANA.NOVA® Alpha Pfanne (ARTIQO) 1,034 7 70 (63 - 76) 44/56 2015-2023 3.1 [2.0; 4.1] 3.5 [2.3; 4.6] 3.7 [2.5; 4.9] 4.3 [3.0; 5.6] 4.7 [3.3; 6.1] 4.7 [3.3; 6.1] 4.7 [3.3; 6.1] (927) (823) (738) (620) (488) (326) (210) ANA.NOVA® Alpha Schaft (ARTIQO) ANA.NOVA® Hybrid Pfanne (ARTIQO) 1,348 11 70 (63 - 76) 36/64 2015-2023 1.4 [0.7; 2.0] 1.8 [1.0; 2.5] 1.9 [1.1; 2.7] 1.9 [1.1; 2.7] 1.9 [1.1; 2.7] 2.5 [1.4; 3.6] 3.0 [1.5; 4.4] (1,121) (883) (715) (552) (381) (235) (129) ANA.NOVA® SL-complete® Schaft ANA.NOVA® Alpha Pfanne 3.4 [1.5; 5.2] 3.4 [1.5; 5.2] 3.4 [1.5; 5.2] 3.8 [1.7; 5.9] 3.8 [1.7; 5.9] 3.8 [1.7; 5.9] 367 5 72 (64 - 78) 37/63 2015-2023 (ARTIQO) (ARTIQO) (292) (245) (207) (178) (114) (50) ANA.NOVA® Solitär Schaft (ARTIQO) ANA.NOVA® Hybrid Pfanne (ARTIQO) 516 7 74 (65 - 80) 36/64 2015-2023 4.1 [2.4; 5.9] 4.3 [2.6; 6.1] 4.8 [2.9; 6.7] 5.1 [3.1; 7.1] 5.6 [3.4; 7.8] 5.6 [3.4; 7.8] (465) (423) (375) (277) (156) (77) Anato Stem (Stryker) Trident Cup (Stryker) 401 9 68 (60 - 75) 45/55 2016-2023 3.0 [1.3; 4.7] 3.8 [1.9; 5.7] 4.1 [2.1; 6.0] 4.1 [2.1; 6.0] 4.1 [2.1; 6.0] 4.8 [2.4; 7.2] (378) (336) (274) (205) (153) (77) Avenir (Zimmer Biomet) Allofit (Zimmer Biomet) 29,284 199 69 (62 - 75) 40/60 2013-2023 2.9 [2.7; 3.1] 3.1 [2.9; 3.4] 3.3 [3.1; 3.6] 3.4 [3.2; 3.6] 3.6 [3.3; 3.8] 3.6 [3.3; 3.8] 3.7 [3.5; 4.0] 3.8 [3.5; 4.1] 3.8 [3.5; 4.1] (23,092) (18,017) (13,724) (9,672) (6,004) (3,577) (1,721) (489) (54) Avenir (Zimmer Biomet) Allofit IT (Zimmer Biomet) 3,170 53 67 (59 - 75) 40/60 2014-2023 3.4 [2.7; 4.0] 3.9 [3.2; 4.6] 4.1 [3.4; 4.8] 4.1 [3.4; 4.9] 4.5 [3.7; 5.3] 4.5 [3.7; 5.3] 4.5 [3.7; 5.3] (2,708) (2,237) (1,769) (1,257) (807) (431) (165) Avenir Complete (Zimmer Biomet) Allofit (Zimmer Biomet) 2,445 51 67 (59 - 73) 40/60 2020-2023 3.2 [2.4; 3.9] 3.3 [2.5; 4.1] 3.3 [2.5; 4.1] (1,322) (542) (96) BICONTACT (Aesculap) PLASMACUP (Aesculap) 5,020 31 70 (63 - 76) 40/60 2013-2023 2.3 [1.9; 2.7] 2.6 [2.2; 3.0] 2.7 [2.2; 3.1] 2.8 [2.3; 3.3] 2.8 [2.4; 3.3] 2.8 [2.4; 3.3] 2.8 [2.4; 3.3] 2.8 [2.4; 3.3] 3.0 [2.4; 3.5] (4,700) (4,234) (3,791) (3,308) (2,801) (2,167) (1,491) (787) (228) BICONTACT (Aesculap) PLASMAFIT (Aesculap) 13,208 114 71 (64 - 77) 40/60 2013-2023 3.5 [3.2; 3.8] 3.8 [3.5; 4.1] 4.0 [3.6; 4.3] 4.0 [3.7; 4.4] 4.1 [3.8; 4.5] 4.1 [3.8; 4.5] 4.2 [3.8; 4.5] 4.2 [3.9; 4.6] 4.5 [3.9; 5.1] (11,823) (10,537) (9,301) (7,734) (5,814) (3,947) (2,308) (1,068) (302) Table 47 (continued) 86 EPRD Annual Report 2024 87  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Femoral stem Cup Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Uncemented fixation BICONTACT (Aesculap) SCREWCUP SC (Aesculap) 824 33 73 (64 - 78) 35/65 2013-2023 3.6 [2.3; 4.8] 4.7 [3.2; 6.2] 5.0 [3.5; 6.5] 5.4 [3.7; 7.0] 6.4 [4.5; 8.3] 6.8 [4.7; 8.7] 6.8 [4.7; 8.7] (726) (633) (544) (441) (327) (175) (89) BreXis (Stemcup / Zimmer Biomet) Allofit (Zimmer Biomet) 1,050 32 61 (55 - 68) 45/55 2016-2023 2.5 [1.6; 3.5] 2.8 [1.8; 3.9] 2.8 [1.8; 3.9] 2.8 [1.8; 3.9] 3.3 [1.9; 4.7] (763) (534) (389) (255) (96) CBC Evolution (Mathys) aneXys Flex (Mathys) 361 8 70 (62 - 77) 47/53 2016-2023 4.9 [2.6; 7.1] 5.6 [3.1; 8.0] 7.1 [4.1; 10.0] 7.1 [4.1; 10.0] 7.9 [4.5; 11.1] 7.9 [4.5; 11.1] (280) (213) (153) (124) (91) (72) CLS Spotorno (Zimmer Biomet) Allofit (Zimmer Biomet) 24,728 185 65 (58 - 72) 43/57 2012-2023 2.9 [2.7; 3.1] 3.3 [3.1; 3.5] 3.6 [3.4; 3.8] 3.7 [3.5; 4.0] 3.9 [3.6; 4.1] 4.1 [3.8; 4.4] 4.2 [4.0; 4.5] 4.4 [4.1; 4.7] 4.4 [4.1; 4.7] (21,510) (18,604) (16,031) (13,451) (10,760) (7,906) (4,952) (2,335) (721) CLS Spotorno (Zimmer Biomet) Allofit IT (Zimmer Biomet) 1,721 33 66 (59 - 74) 41/59 2013-2023 1.5 [0.9; 2.1] 2.3 [1.6; 3.0] 2.3 [1.6; 3.0] 2.3 [1.6; 3.1] 2.6 [1.8; 3.4] 2.9 [2.0; 3.7] 2.9 [2.0; 3.7] 2.9 [2.0; 3.7] 2.9 [2.0; 3.7] (1,597) (1,509) (1,340) (1,178) (929) (733) (567) (347) (191) Hip CLS Spotorno (Zimmer Biomet) Trilogy (Zimmer Biomet) 366 7 64.5 (57 - 71) 40/60 2014-2023 3.9 [1.9; 5.8] 4.8 [2.5; 7.0] 4.8 [2.5; 7.0] 4.8 [2.5; 7.0] 5.2 [2.8; 7.5] 5.2 [2.8; 7.5] 5.2 [2.8; 7.5] 5.2 [2.8; 7.5] (322) (292) (274) (263) (233) (201) (166) (86) CLS Spotorno (Zimmer Biomet) Trilogy IT (Zimmer Biomet) 1,172 3 68 (61 - 74) 41/59 2014-2023 3.9 [2.8; 5.1] 4.1 [3.0; 5.3] 4.6 [3.4; 5.9] 4.6 [3.4; 5.9] 4.8 [3.5; 6.0] 5.4 [3.9; 6.8] 5.9 [4.3; 7.5] 5.9 [4.3; 7.5] (998) (874) (767) (660) (522) (371) (239) (96) CORAIL™ AMT-Hüftschaft 2.4 [0.7; 4.0] 2.7 [1.0; 4.5] 2.7 [1.0; 4.5] 2.7 [1.0; 4.5] 2.7 [1.0; 4.5] 2.7 [1.0; 4.5] 3.6 [1.1; 5.9] Allofit (Zimmer Biomet) 343 8 60 (53 - 70) 18/82 2015-2023 mit Kragen (DePuy) (295) (253) (224) (187) (156) (133) (91) CORAIL™ AMT-Hüftschaft PINNACLE™ Press Fit-Hüftpfanne 1.7 [1.5; 1.9] 2.1 [1.8; 2.3] 2.4 [2.1; 2.6] 2.5 [2.2; 2.8] 2.6 [2.3; 2.9] 2.8 [2.5; 3.2] 2.9 [2.5; 3.2] 2.9 [2.5; 3.2] 2.9 [2.5; 3.2] 14,934 108 69 (61 - 76) 36/64 2012-2023 mit Kragen (DePuy) (DePuy) (11,176) (8,778) (6,922) (4,951) (3,187) (1,895) (843) (197) (58) CORAIL™ AMT-Hüftschaft 3.0 [2.2; 3.8] 3.2 [2.3; 4.0] 3.5 [2.6; 4.4] 3.6 [2.6; 4.5] 3.7 [2.7; 4.6] 3.7 [2.7; 4.6] 4.1 [2.8; 5.3] Allofit (Zimmer Biomet) 1,610 19 69 (62 - 76) 38/62 2015-2023 ohne Kragen (DePuy) (1,419) (1,249) (1,122) (996) (793) (416) (156) CORAIL™ AMT-Hüftschaft 3.1 [1.4; 4.9] 4.0 [2.0; 5.9] 4.2 [2.2; 6.3] 4.2 [2.2; 6.3] 4.5 [2.4; 6.6] 4.9 [2.6; 7.0] 4.9 [2.6; 7.0] Allofit IT (Zimmer Biomet) 383 4 72 (66 - 77) 39/61 2015-2023 ohne Kragen (DePuy) (362) (347) (337) (326) (310) (293) (220) CORAIL™ AMT-Hüftschaft DURALOC™ OPTION™ 4.0 [2.4; 5.6] 4.4 [2.7; 6.0] 4.4 [2.7; 6.0] 4.6 [2.9; 6.3] 4.6 [2.9; 6.3] 4.6 [2.9; 6.3] 4.6 [2.9; 6.3] 4.6 [2.9; 6.3] 600 8 67 (59.5 - 74) 41/59 2013-2023 ohne Kragen (DePuy) Press Fit-Hüftpfanne (DePuy) (532) (481) (434) (359) (297) (232) (158) (60) CORAIL™ AMT-Hüftschaft PINNACLE™ Press Fit-Hüftpfanne 2.9 [2.7; 3.0] 3.3 [3.1; 3.5] 3.6 [3.4; 3.8] 3.9 [3.7; 4.2] 4.1 [3.8; 4.3] 4.3 [4.1; 4.6] 4.6 [4.3; 4.8] 5.0 [4.6; 5.3] 5.3 [4.7; 5.8] 36,563 172 69 (62 - 76) 39/61 2012-2023 ohne Kragen (DePuy) (DePuy) (30,758) (25,546) (20,473) (15,797) (11,656) (7,662) (4,160) (1,620) (451) COREHIP (Aesculap) Allofit (Zimmer Biomet) 425 10 63 (57 - 72) 38/62 2017-2023 2.8 [1.1; 4.4] 3.2 [1.4; 4.9] (257) (146) COREHIP (Aesculap) PLASMACUP (Aesculap) 1,305 5 70 (65 - 75) 35/65 2017-2023 1.4 [0.7; 2.0] 1.5 [0.8; 2.2] 1.7 [0.9; 2.5] 1.7 [0.9; 2.5] (907) (584) (392) (238) COREHIP (Aesculap) PLASMAFIT (Aesculap) 7,014 102 67 (60 - 74) 39/61 2017-2023 2.6 [2.2; 2.9] 3.0 [2.6; 3.5] 3.6 [2.9; 4.4] 3.6 [2.9; 4.4] (3,758) (1,756) (581) (135) EcoFit 133° cpTi (Implantcast) EcoFit EPORE (Implantcast) 536 5 73 (67 - 79.5) 27/73 2019-2023 4.6 [2.7; 6.4] 5.1 [3.1; 7.0] 6.0 [3.7; 8.4] (395) (261) (108) EcoFit cpTi (Implantcast) EcoFit cpTi (Implantcast) 350 8 72 (64 - 76) 36/64 2014-2023 5.7 [3.3; 8.1] 6.0 [3.5; 8.5] 6.0 [3.5; 8.5] 6.4 [3.8; 9.0] 6.4 [3.8; 9.0] 6.4 [3.8; 9.0] 7.5 [4.5; 10.5] (311) (284) (258) (236) (212) (175) (146) EcoFit cpTi (Implantcast) EcoFit EPORE (Implantcast) 548 4 75 (68.5 - 79) 25/75 2016-2022 4.4 [2.7; 6.1] 5.3 [3.4; 7.2] 6.1 [4.1; 8.1] 6.7 [4.6; 8.8] 7.2 [5.0; 9.4] 7.2 [5.0; 9.4] (516) (500) (470) (439) (289) (148) EcoFit Short cpTi (Implantcast) EcoFit EPORE (Implantcast) 409 5 71 (64 - 77) 37/63 2019-2023 5.0 [2.8; 7.1] 5.0 [2.8; 7.1] 5.7 [3.1; 8.2] (293) (205) (119) EXCEPTION (Zimmer Biomet) Allofit (Zimmer Biomet) 1,490 12 69 (61 - 75) 50/50 2015-2023 4.4 [3.4; 5.5] 4.9 [3.8; 6.0] 5.4 [4.2; 6.5] 5.5 [4.3; 6.7] 6.2 [4.9; 7.5] 6.2 [4.9; 7.5] (1,374) (1,305) (1,178) (860) (549) (267) EXCIA (Aesculap) PLASMAFIT (Aesculap) 12,925 118 70 (62 - 76) 41/59 2014-2023 3.2 [2.9; 3.6] 3.6 [3.3; 4.0] 3.8 [3.4; 4.1] 3.9 [3.5; 4.2] 4.0 [3.6; 4.3] 4.0 [3.7; 4.4] 4.0 [3.7; 4.4] 4.2 [3.7; 4.7] (10,759) (8,658) (7,007) (5,286) (3,540) (2,068) (792) (140) Fitmore (Zimmer Biomet) Allofit (Zimmer Biomet) 25,219 217 63 (56 - 70) 46/54 2012-2023 2.3 [2.1; 2.5] 2.6 [2.4; 2.8] 2.9 [2.6; 3.1] 3.0 [2.8; 3.2] 3.1 [2.8; 3.3] 3.2 [2.9; 3.4] 3.3 [3.0; 3.5] 3.3 [3.0; 3.6] 3.5 [3.1; 3.9] (21,063) (17,519) (14,367) (11,286) (8,299) (5,535) (3,267) (1,380) (298) Fitmore (Zimmer Biomet) Allofit IT (Zimmer Biomet) 3,151 63 59 (52 - 65) 47/53 2012-2023 3.1 [2.5; 3.8] 3.9 [3.2; 4.5] 4.3 [3.6; 5.1] 4.4 [3.6; 5.1] 4.9 [4.0; 5.7] 5.1 [4.2; 5.9] 5.2 [4.3; 6.1] 5.5 [4.4; 6.7] 5.5 [4.4; 6.7] (2,635) (2,249) (1,763) (1,382) (1,033) (730) (416) (178) (59) Fitmore (Zimmer Biomet) Trilogy (Zimmer Biomet) 2,844 14 62 (56 - 68) 45/55 2012-2023 1.8 [1.3; 2.2] 2.2 [1.6; 2.7] 2.4 [1.8; 2.9] 2.5 [1.9; 3.1] 2.7 [2.0; 3.3] 2.8 [2.1; 3.5] 2.8 [2.1; 3.5] 2.8 [2.1; 3.5] 2.8 [2.1; 3.5] (2,458) (2,122) (1,792) (1,484) (1,143) (834) (542) (287) (150) GTS (Zimmer Biomet) Allofit (Zimmer Biomet) 901 19 65 (58 - 71) 47/53 2014-2023 3.2 [2.0; 4.3] 3.8 [2.5; 5.1] 4.4 [3.0; 5.8] 4.4 [3.0; 5.8] 4.6 [3.2; 6.1] 4.6 [3.2; 6.1] 4.6 [3.2; 6.1] (773) (675) (617) (520) (371) (182) (101) Table 47 (continued) 88 EPRD Annual Report 2024 89  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Femoral stem Cup Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Uncemented fixation GTS (Zimmer Biomet) G7 (Zimmer Biomet) 457 12 66 (59 - 75) 36/64 2014-2023 4.0 [2.2; 5.7] 4.9 [2.9; 6.9] 4.9 [2.9; 6.9] 5.5 [3.3; 7.7] 5.5 [3.3; 7.7] 5.5 [3.3; 7.7] 5.5 [3.3; 7.7] (419) (388) (320) (266) (204) (128) (88) Konusprothese (Zimmer Biomet) Allofit (Zimmer Biomet) 687 89 55 (46 - 62) 19/81 2013-2023 3.4 [2.0; 4.8] 3.8 [2.3; 5.2] 4.0 [2.5; 5.5] 4.0 [2.5; 5.5] 4.3 [2.7; 5.9] 4.8 [2.9; 6.6] 4.8 [2.9; 6.6] 4.8 [2.9; 6.6] (557) (486) (424) (342) (261) (193) (131) (61) Konusprothese (Zimmer Biomet) Allofit IT (Zimmer Biomet) 428 18 68 (57.5 - 76) 10/90 2013-2023 2.6 [1.1; 4.1] 3.1 [1.4; 4.7] 3.6 [1.8; 5.4] 3.9 [2.0; 5.8] 3.9 [2.0; 5.8] 3.9 [2.0; 5.8] 3.9 [2.0; 5.8] 3.9 [2.0; 5.8] 3.9 [2.0; 5.8] (404) (375) (340) (298) (259) (219) (161) (113) (63) LCU Hip System, uncemented Allofit 1.8 [0.9; 2.6] 1.9 [1.0; 2.8] 2.5 [1.4; 3.7] 2.5 [1.4; 3.7] 3.2 [1.7; 4.6] 3.2 [1.7; 4.6] 865 7 68 (62 - 75) 48/52 2015-2023 (Waldemar Link) (Zimmer Biomet) (720) (579) (442) (345) (241) (130) LCU Hip System, uncemented CombiCup 2.4 [1.7; 3.0] 2.7 [1.9; 3.4] 2.8 [2.0; 3.5] 2.9 [2.1; 3.6] 3.0 [2.2; 3.7] 3.5 [2.5; 4.5] 3.8 [2.6; 5.0] 1,928 23 66 (59 - 73) 44/56 2014-2023 (Waldemar Link) (Waldemar Link) (1,757) (1,596) (1,421) (1,100) (747) (439) (132) Hip LCU Hip System, uncemented MobileLink, Cluster Hole 4.3 [3.1; 5.6] 4.9 [3.6; 6.3] 5.2 [3.8; 6.6] 5.2 [3.8; 6.6] 1,109 33 69 (62 - 75) 40/60 2017-2023 (Waldemar Link) (Waldemar Link) (751) (468) (240) (72) M/L Taper (Zimmer Biomet) Allofit (Zimmer Biomet) 5,787 23 68 (61 - 74) 42/58 2013-2023 3.4 [2.9; 3.8] 3.8 [3.3; 4.3] 4.2 [3.6; 4.7] 4.4 [3.8; 4.9] 4.4 [3.9; 5.0] 4.6 [4.0; 5.2] 5.0 [4.3; 5.8] 5.2 [4.4; 6.0] 5.2 [4.4; 6.0] (5,044) (4,360) (3,642) (3,010) (2,404) (1,585) (799) (340) (87) M/L Taper (Zimmer Biomet) Trilogy (Zimmer Biomet) 560 4 69 (63 - 72) 33/67 2012-2023 2.2 [0.9; 3.4] 2.5 [1.2; 3.8] 2.5 [1.2; 3.8] 2.5 [1.2; 3.8] 2.8 [1.4; 4.2] 2.8 [1.4; 4.2] 2.8 [1.4; 4.2] 2.8 [1.4; 4.2] 2.8 [1.4; 4.2] (530) (492) (450) (415) (386) (361) (280) (184) (106) METABLOC (Zimmer Biomet) Allofit (Zimmer Biomet) 500 13 72.5 (66 - 78) 38/62 2012-2020 2.0 [0.8; 3.2] 2.4 [1.1; 3.8] 2.6 [1.2; 4.0] 3.5 [1.9; 5.2] 3.8 [2.1; 5.5] 3.8 [2.1; 5.5] 4.2 [2.3; 6.1] 4.2 [2.3; 6.1] 4.2 [2.3; 6.1] (482) (456) (438) (403) (348) (299) (209) (114) (56) Metafix (Corin) Trinity Hole (Corin) 737 13 73 (65 - 79) 36/64 2014-2023 1.9 [0.9; 2.9] 1.9 [0.9; 2.9] 2.1 [1.0; 3.2] 2.1 [1.0; 3.2] 2.1 [1.0; 3.2] 2.1 [1.0; 3.2] 2.1 [1.0; 3.2] (670) (561) (439) (359) (258) (185) (100) Metafix (Corin) Trinity no Hole (Corin) 965 10 71 (64 - 76) 47/53 2014-2023 1.8 [0.9; 2.6] 2.2 [1.3; 3.2] 2.4 [1.4; 3.3] 2.5 [1.5; 3.5] 3.0 [1.8; 4.1] 3.0 [1.8; 4.1] 3.0 [1.8; 4.1] 3.0 [1.8; 4.1] (882) (818) (758) (691) (525) (410) (263) (117) METHA (Aesculap) PLASMACUP (Aesculap) 1,363 35 58 (52 - 63) 44/56 2013-2023 1.5 [0.8; 2.1] 2.3 [1.5; 3.1] 2.4 [1.5; 3.2] 2.6 [1.7; 3.4] 2.6 [1.7; 3.4] 2.6 [1.7; 3.4] 2.6 [1.7; 3.4] 2.6 [1.7; 3.4] 2.6 [1.7; 3.4] (1,293) (1,185) (1,056) (932) (783) (593) (441) (277) (125) METHA (Aesculap) PLASMAFIT (Aesculap) 6,711 148 57 (52 - 62) 48/52 2013-2023 3.0 [2.6; 3.4] 3.6 [3.1; 4.0] 3.8 [3.3; 4.3] 3.9 [3.4; 4.4] 4.0 [3.5; 4.5] 4.2 [3.7; 4.7] 4.2 [3.7; 4.7] 4.2 [3.7; 4.7] 4.2 [3.7; 4.7] (5,858) (5,007) (4,202) (3,423) (2,551) (1,708) (1,002) (495) (124) MiniHip (Corin) Trinity Hole (Corin) 1,457 35 62 (55 - 68) 50/50 2013-2023 2.3 [1.5; 3.1] 2.5 [1.7; 3.3] 2.6 [1.8; 3.5] 2.8 [1.9; 3.6] 2.9 [2.0; 3.8] 3.3 [2.2; 4.3] 3.5 [2.4; 4.6] 3.5 [2.4; 4.6] (1,282) (1,050) (875) (746) (610) (444) (262) (107) MiniHip (Corin) Trinity no Hole (Corin) 976 25 61 (55 - 66) 45/55 2014-2023 3.2 [2.1; 4.4] 3.9 [2.7; 5.2] 4.3 [3.0; 5.6] 4.3 [3.0; 5.6] 5.1 [3.6; 6.6] 5.4 [3.8; 6.9] 5.4 [3.8; 6.9] (874) (749) (664) (573) (434) (264) (144) Nanos Schenkelhalsprothese 2.1 [1.2; 3.0] 2.6 [1.6; 3.6] 2.7 [1.7; 3.8] 2.7 [1.7; 3.8] 2.7 [1.7; 3.8] 2.7 [1.7; 3.8] 2.7 [1.7; 3.8] 2.7 [1.7; 3.8] Allofit (Zimmer Biomet) 967 20 63 (56 - 70) 48/52 2014-2023 (OHST / Smith & Nephew) (856) (761) (707) (640) (548) (436) (284) (109) Nanos Schenkelhalsprothese EP-FIT PLUS 3.1 [1.6; 4.6] 3.1 [1.6; 4.6] 3.1 [1.6; 4.6] 3.4 [1.8; 5.1] 3.4 [1.8; 5.1] 3.4 [1.8; 5.1] 3.4 [1.8; 5.1] 3.4 [1.8; 5.1] 538 28 57 (52 - 63) 53/47 2013-2023 (OHST / Smith & Nephew) (Smith & Nephew) (463) (374) (307) (278) (245) (211) (148) (65) Nanos Schenkelhalsprothese HI Lubricer Schale 1.4 [0.4; 2.4] 2.2 [0.9; 3.5] 3.7 [2.0; 5.4] 4.4 [2.6; 6.3] 5.0 [3.0; 6.9] 5.0 [3.0; 6.9] 5.5 [3.2; 7.7] 509 12 61 (54 - 68) 48/52 2013-2023 (OHST / Smith & Nephew) (Smith & Nephew) (483) (461) (421) (386) (342) (252) (167) Nanos Schenkelhalsprothese R3 2.5 [1.8; 3.1] 2.6 [1.9; 3.3] 2.7 [2.0; 3.4] 2.9 [2.1; 3.7] 3.1 [2.2; 3.9] 3.3 [2.4; 4.2] 3.3 [2.4; 4.2] 2,240 75 59 (53 - 64.5) 45/55 2013-2023 (OHST / Smith & Nephew) (Smith & Nephew) (1,723) (1,335) (982) (733) (520) (319) (158) Nanos Schenkelhalsprothese REFLECTION 1.6 [0.5; 2.7] 1.8 [0.6; 3.0] 2.1 [0.8; 3.4] 2.1 [0.8; 3.4] 2.1 [0.8; 3.4] 2.1 [0.8; 3.4] 2.1 [0.8; 3.4] 508 4 69 (60 - 76) 35/65 2013-2023 (OHST / Smith & Nephew) (Smith & Nephew) (470) (395) (314) (263) (235) (150) (115) optimys (Mathys) Allofit (Zimmer Biomet) 4,754 38 63 (57 - 69) 45/55 2013-2023 1.8 [1.4; 2.2] 1.9 [1.5; 2.3] 2.1 [1.7; 2.5] 2.1 [1.7; 2.6] 2.1 [1.7; 2.6] 2.1 [1.7; 2.6] 2.3 [1.8; 2.8] 2.3 [1.8; 2.8] (3,726) (2,920) (2,208) (1,735) (1,307) (854) (446) (148) optimys (Mathys) aneXys Cluster (Mathys) 575 30 60 (53 - 66) 36/64 2016-2023 2.6 [1.2; 4.0] 2.6 [1.2; 4.0] 2.6 [1.2; 4.0] 2.6 [1.2; 4.0] (352) (186) (100) (59) optimys (Mathys) aneXys Flex (Mathys) 4,553 68 61 (56 - 67) 47/53 2016-2023 1.7 [1.3; 2.1] 2.1 [1.6; 2.5] 2.2 [1.7; 2.7] 2.2 [1.7; 2.7] 2.5 [1.8; 3.2] 2.5 [1.8; 3.2] (3,145) (2,097) (1,382) (891) (485) (246) optimys (Mathys) aneXys Uno (Mathys) 408 15 55 (48 - 64) 42/58 2019-2023 2.5 [1.0; 4.1] 4.1 [1.9; 6.3] 4.1 [1.9; 6.3] (313) (210) (146) optimys (Mathys) RM Pressfit (Mathys) 733 9 72 (63 - 78) 44/56 2014-2023 2.4 [1.2; 3.5] 2.8 [1.6; 4.1] 2.8 [1.6; 4.1] 3.2 [1.9; 4.6] 3.5 [2.1; 4.9] 3.5 [2.1; 4.9] 4.1 [2.2; 5.9] (636) (573) (506) (433) (294) (178) (73) optimys (Mathys) RM Pressfit vitamys (Mathys) 16,866 102 65 (59 - 72) 45/55 2013-2023 1.6 [1.4; 1.8] 1.8 [1.6; 2.0] 1.8 [1.6; 2.1] 1.9 [1.7; 2.2] 2.0 [1.8; 2.3] 2.1 [1.8; 2.3] 2.1 [1.9; 2.4] 2.1 [1.9; 2.4] 2.1 [1.9; 2.4] (13,107) (10,053) (7,575) (5,481) (3,641) (2,144) (969) (265) (61) Table 47 (continued) 90 EPRD Annual Report 2024 91  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Femoral stem Cup Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Uncemented fixation Polarschaft (Smith & Nephew) EP-FIT PLUS (Smith & Nephew) 1,333 34 69 (61 - 75) 45/55 2013-2023 2.4 [1.6; 3.2] 2.8 [1.9; 3.7] 2.8 [1.9; 3.7] 2.8 [1.9; 3.7] 2.9 [2.0; 3.8] 2.9 [2.0; 3.8] 3.2 [2.1; 4.2] (1,240) (1,135) (1,002) (882) (762) (538) (257) Polarschaft HI Lubricer Schale 2.3 [1.8; 2.9] 2.6 [2.1; 3.2] 2.6 [2.1; 3.2] 2.9 [2.3; 3.5] 3.1 [2.4; 3.8] 3.5 [2.7; 4.2] 4.0 [3.0; 4.9] 4.4 [3.1; 5.6] 4.4 [3.1; 5.6] 3,007 17 70 (62 - 76) 35/65 2013-2023 (Smith & Nephew) (Smith & Nephew) (2,756) (2,409) (2,055) (1,708) (1,286) (846) (447) (172) (66) Polarschaft (Smith & Nephew) R3 (Smith & Nephew) 10,955 104 69 (61 - 75) 42/58 2013-2023 2.9 [2.6; 3.3] 3.2 [2.8; 3.5] 3.4 [3.1; 3.8] 3.6 [3.2; 4.0] 3.7 [3.3; 4.1] 3.7 [3.3; 4.1] 3.8 [3.4; 4.3] 3.8 [3.4; 4.3] (8,312) (6,615) (5,206) (4,003) (2,679) (1,556) (658) (183) Polarschaft (Smith & Nephew) REFLECTION (Smith & Nephew) 341 4 73 (64 - 79) 39/61 2013-2023 0.0 [0.0; 0.0] 0.3 [0.0; 0.9] 0.3 [0.0; 0.9] 0.3 [0.0; 0.9] 0.3 [0.0; 0.9] 0.3 [0.0; 0.9] 1.3 [0.0; 3.3] (328) (279) (265) (241) (185) (136) (85) PROFEMUR® GLADIATOR CLASSIC PROCOTYL® L BEADED 2.9 [1.1; 4.7] 3.8 [1.8; 5.8] 4.1 [2.0; 6.2] 4.1 [2.0; 6.2] 4.7 [2.3; 7.0] 4.7 [2.3; 7.0] 4.7 [2.3; 7.0] 341 12 69 (64 - 75) 39/61 2014-2021 (MicroPort) (MicroPort) (329) (323) (310) (213) (140) (88) (51) Hip PROFEMUR® GLADIATOR CLASSIC PROCOTYL® P 3.0 [1.5; 4.4] 3.0 [1.5; 4.4] 575 13 70 (63 - 76) 37/63 2020-2023 (MicroPort) (MicroPort) (391) (177) PROFEMUR®Preserve (MicroPort) PROCOTYL® P (MicroPort) 553 15 64 (57 - 71) 45/55 2020-2023 2.4 [1.1; 3.7] 2.4 [1.1; 3.7] (319) (125) Proxy PLUS Schaft EP-FIT PLUS 3.8 [1.8; 5.8] 4.7 [2.4; 7.0] 5.0 [2.7; 7.4] 5.4 [2.9; 7.8] 5.4 [2.9; 7.8] 5.4 [2.9; 7.8] 5.4 [2.9; 7.8] 5.4 [2.9; 7.8] 342 13 70 (62 - 75) 46/54 2013-2020 (Smith & Nephew) (Smith & Nephew) (324) (306) (296) (289) (264) (223) (158) (78) Pyramid (Atesos) Pyramid (Atesos) 3,215 26 71 (64 - 77) 36/64 2014-2023 2.8 [2.2; 3.4] 3.1 [2.5; 3.7] 3.5 [2.8; 4.2] 3.6 [2.9; 4.2] 3.6 [2.9; 4.3] 3.8 [3.1; 4.5] 3.8 [3.1; 4.5] 3.8 [3.1; 4.5] (2,876) (2,559) (2,198) (1,791) (1,443) (1,015) (562) (166) QUADRA-H (Medacta) VERSAFITCUP CC TRIO (Medacta) 11,494 75 68 (61 - 75) 40/60 2015-2023 2.7 [2.4; 3.0] 3.2 [2.9; 3.5] 3.5 [3.2; 3.9] 3.8 [3.4; 4.2] 4.1 [3.7; 4.5] 4.4 [3.9; 4.8] 4.6 [4.1; 5.1] 5.3 [3.8; 6.8] (8,902) (6,893) (5,424) (4,143) (2,928) (1,538) (552) (63) S-ROM™-Hüftschaft PINNACLE™ Press Fit-Hüftpfanne 4.0 [2.0; 6.0] 4.0 [2.0; 6.0] 4.6 [2.3; 6.9] 4.6 [2.3; 6.9] 392 22 59 (51 - 67) 30/70 2014-2023 (DePuy) (DePuy) (307) (231) (154) (96) SCS Stem standard (Stemcup) BSC-Cup pressfit closed (Stemcup) 306 3 67 (60 - 73) 18/82 2015-2023 1.0 [0.0; 2.1] 2.0 [0.4; 3.6] 2.4 [0.6; 4.1] 2.4 [0.6; 4.1] 2.8 [0.9; 4.7] 3.5 [1.1; 5.8] 3.5 [1.1; 5.8] (298) (281) (268) (240) (194) (132) (54) SL-PLUS Schaft (Smith & Nephew) Allofit (Zimmer Biomet) 595 13 65 (58 - 71) 36/64 2012-2023 3.5 [2.0; 5.0] 4.4 [2.7; 6.1] 4.8 [3.0; 6.5] 5.2 [3.3; 6.9] 5.7 [3.8; 7.6] 6.1 [4.1; 8.1] 6.8 [4.7; 8.9] 7.1 [4.9; 9.3] 7.4 [5.1; 9.6] (561) (539) (518) (497) (473) (442) (384) (334) (245) SL-PLUS Schaft (Smith & Nephew) BICON-PLUS (Smith & Nephew) 1,380 26 72 (65 - 78) 36/64 2013-2023 2.3 [1.5; 3.1] 3.4 [2.4; 4.3] 4.1 [3.0; 5.2] 4.9 [3.7; 6.1] 5.3 [4.0; 6.5] 5.9 [4.6; 7.3] 6.6 [5.1; 8.1] 6.8 [5.2; 8.4] 6.8 [5.2; 8.4] (1,290) (1,196) (1,054) (899) (766) (620) (444) (267) (67) SL-PLUS Schaft (Smith & Nephew) EP-FIT PLUS (Smith & Nephew) 428 13 66 (62 - 72) 44/56 2014-2023 2.1 [0.7; 3.5] 2.4 [0.9; 3.8] 2.4 [0.9; 3.8] 2.7 [1.1; 4.2] 2.7 [1.1; 4.2] 3.1 [1.3; 4.8] 3.1 [1.3; 4.8] 3.1 [1.3; 4.8] (391) (372) (334) (297) (260) (218) (160) (69) HI Lubricer Schale (Smith & Neph- 0.9 [0.0; 2.0] 0.9 [0.0; 2.0] 0.9 [0.0; 2.0] 1.3 [0.0; 2.6] 1.3 [0.0; 2.6] 1.8 [0.2; 3.5] 1.8 [0.2; 3.5] SL-PLUS Schaft (Smith & Nephew) 326 9 71 (62 - 77) 36/64 2014-2023 ew) (312) (286) (263) (228) (198) (136) (79) SL-PLUS Schaft (Smith & Nephew) R3 (Smith & Nephew) 2,323 27 70 (63 - 76) 35/65 2013-2023 3.6 [2.9; 4.4] 4.5 [3.6; 5.3] 4.8 [3.9; 5.7] 4.9 [4.0; 5.8] 5.2 [4.2; 6.2] 5.6 [4.5; 6.7] 5.8 [4.7; 7.0] 6.3 [4.8; 7.7] (2,013) (1,730) (1,478) (1,229) (928) (610) (296) (98) SL MIA HA Schaft (Smith & Nephew) Allofit (Zimmer Biomet) 2,625 16 70 (60 - 78) 32/68 2014-2023 2.6 [2.0; 3.2] 3.0 [2.3; 3.7] 3.2 [2.5; 3.9] 3.3 [2.6; 4.1] 3.3 [2.6; 4.1] 3.3 [2.6; 4.1] 3.8 [2.6; 5.0] (2,101) (1,612) (1,215) (840) (467) (275) (99) SL MIA HA Schaft (Smith & Nephew) BICON-PLUS (Smith & Nephew) 802 16 71 (64 - 77) 34/66 2013-2023 2.4 [1.3; 3.5] 3.1 [1.9; 4.3] 3.7 [2.3; 5.0] 4.4 [2.9; 5.9] 4.6 [3.1; 6.1] 5.7 [4.0; 7.5] 6.6 [4.6; 8.5] 6.6 [4.6; 8.5] 7.0 [4.9; 9.0] (738) (689) (638) (584) (532) (479) (389) (280) (134) SL MIA HA Schaft (Smith & Nephew) EP-FIT PLUS (Smith & Nephew) 705 10 72 (64 - 78) 40/60 2014-2023 2.7 [1.5; 3.9] 3.5 [2.1; 4.8] 3.7 [2.2; 5.0] 3.7 [2.2; 5.0] 3.7 [2.2; 5.0] 3.7 [2.2; 5.0] 3.7 [2.2; 5.0] 4.1 [2.4; 5.7] (643) (588) (535) (488) (447) (367) (232) (91) HI Lubricer Schale (Smith & Neph- 1.1 [0.0; 2.2] 1.4 [0.2; 2.7] 1.8 [0.4; 3.2] 1.8 [0.4; 3.2] 1.8 [0.4; 3.2] 1.8 [0.4; 3.2] SL MIA HA Schaft (Smith & Nephew) 362 7 69 (61 - 75) 34/66 2015-2023 ew) (329) (290) (239) (176) (116) (69) SL MIA HA Schaft (Smith & Nephew) R3 (Smith & Nephew) 1,974 34 69 (61 - 76) 39/61 2015-2023 3.0 [2.3; 3.8] 3.3 [2.5; 4.1] 3.4 [2.6; 4.2] 3.5 [2.7; 4.3] 3.7 [2.8; 4.6] 3.7 [2.8; 4.6] 3.7 [2.8; 4.6] (1,708) (1,475) (1,245) (979) (660) (325) (88) SP-CL Hip Stem, uncemented Allofit 2.9 [2.1; 3.6] 3.3 [2.5; 4.1] 3.8 [2.9; 4.6] 3.9 [3.0; 4.7] 4.2 [3.3; 5.2] 4.5 [3.5; 5.5] 4.5 [3.5; 5.5] 2,170 14 63 (56 - 68) 41/59 2015-2023 (Waldemar Link) (Zimmer Biomet) (1,840) (1,516) (1,286) (1,019) (756) (478) (179) SP-CL Hip Stem, uncemented CombiCup 3.6 [2.2; 4.9] 4.0 [2.6; 5.4] 4.3 [2.8; 5.8] 4.3 [2.8; 5.8] 4.3 [2.8; 5.8] 4.3 [2.8; 5.8] 4.3 [2.8; 5.8] 734 24 66 (58 - 72) 40/60 2014-2023 (Waldemar Link) (Waldemar Link) (670) (622) (582) (527) (406) (281) (130) SP-CL Hip Stem, uncemented MobileLink, Cluster Hole 4.2 [2.9; 5.5] 5.2 [3.7; 6.8] 5.5 [3.9; 7.2] 5.5 [3.9; 7.2] 906 22 65 (57 - 72) 39/61 2017-2023 (Waldemar Link) (Waldemar Link) (665) (453) (259) (100) SPS Evolution (Symbios) APRIL Poly (Symbios) 410 6 61 (56 - 67) 47/53 2015-2023 1.0 [0.0; 1.9] 1.5 [0.3; 2.7] 1.5 [0.3; 2.7] 1.9 [0.5; 3.2] 1.9 [0.5; 3.2] 1.9 [0.5; 3.2] (363) (325) (295) (235) (169) (84) Table 47 (continued) 92 EPRD Annual Report 2024 93  5 Hip and knee arthroplasty survival 5.1 Primary hip arthroplasty survival Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Femoral stem Cup Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Uncemented fixation STEMSYS Schaft (ARTIQO) ANA.NOVA® Hybrid Pfanne (ARTIQO) 362 8 74 (70 - 79) 36/64 2018-2023 6.5 [3.9; 9.0] 7.2 [4.4; 10.0] 7.2 [4.4; 10.0] (267) (193) (97) Taperloc (Zimmer Biomet) Allofit (Zimmer Biomet) 2,638 30 69 (62 - 76) 41/59 2015-2023 3.1 [2.5; 3.8] 3.5 [2.8; 4.2] 3.6 [2.8; 4.3] 3.6 [2.8; 4.3] 3.6 [2.8; 4.3] 3.6 [2.8; 4.3] (2,008) (1,348) (890) (577) (313) (154) Taperloc (Zimmer Biomet) G7 (Zimmer Biomet) 2,542 11 69 (62 - 76) 36/64 2014-2023 2.6 [2.0; 3.2] 3.2 [2.5; 3.9] 3.9 [3.1; 4.7] 4.5 [3.7; 5.4] 5.1 [4.1; 6.0] 5.7 [4.6; 6.7] 6.4 [5.2; 7.6] (2,307) (2,090) (1,805) (1,495) (1,194) (754) (287) TAPERLOC COMPLETE Allofit 2.7 [1.9; 3.5] 3.0 [2.1; 3.8] 3.2 [2.2; 4.1] 3.2 [2.2; 4.1] 3.9 [2.2; 5.6] 1,532 24 64 (58 - 71) 49/51 2017-2023 (Zimmer Biomet) (Zimmer Biomet) (981) (617) (418) (186) (63) TAPERLOC COMPLETE G7 4.0 [2.9; 5.1] 4.6 [3.4; 5.8] 5.3 [3.9; 6.6] 5.8 [4.3; 7.3] 6.8 [4.9; 8.6] 1,224 9 69 (61 - 76) 35/65 2015-2023 (Zimmer Biomet) (Zimmer Biomet) (968) (755) (590) (373) (99) Hip TAPERLOC COMPLETE PLASMAFIT 1.4 [0.9; 1.8] 1.5 [1.0; 2.0] 1.6 [1.1; 2.0] 1.6 [1.1; 2.2] 1.6 [1.1; 2.2] 1.6 [1.1; 2.2] 1.6 [1.1; 2.2] 2,453 3 66 (59 - 73) 43/57 2015-2023 (Zimmer Biomet) (Aesculap) (2,370) (2,307) (2,210) (1,783) (1,361) (882) (428) TRENDHIP (Aesculap) PLASMAFIT (Aesculap) 6,270 59 69 (61 - 76) 41/59 2014-2023 2.5 [2.1; 2.9] 2.8 [2.4; 3.2] 2.8 [2.4; 3.2] 2.9 [2.5; 3.3] 3.0 [2.5; 3.4] 3.2 [2.7; 3.7] 3.2 [2.7; 3.7] 3.2 [2.7; 3.7] (5,295) (4,403) (3,747) (3,002) (1,996) (1,047) (564) (216) TRENDHIP (Aesculap) SCREWCUP SC (Aesculap) 520 10 71 (63 - 78) 35/65 2015-2023 3.1 [1.6; 4.6] 3.6 [1.9; 5.2] 4.3 [2.5; 6.1] 4.6 [2.7; 6.5] 6.0 [3.5; 8.4] 7.0 [3.8; 10.0] (449) (404) (358) (261) (161) (81) TRILOCK™-Hüftschaft PINNACLE™ Press Fit-Hüftpfanne 1.8 [1.4; 2.2] 2.4 [1.9; 2.8] 2.7 [2.2; 3.2] 2.9 [2.4; 3.5] 3.0 [2.5; 3.5] 3.3 [2.6; 3.9] 3.5 [2.8; 4.2] 3.8 [2.9; 4.7] 3.8 [2.9; 4.7] 4,596 52 60 (55 - 67) 49/51 2013-2023 (DePuy) (DePuy) (4,029) (3,349) (2,733) (2,114) (1,434) (995) (611) (283) (73) TRJ (Aesculap) PLASMACUP (Aesculap) 452 8 72 (64.5 - 77) 31/69 2014-2023 2.5 [1.0; 3.9] 2.7 [1.2; 4.2] 2.7 [1.2; 4.2] 3.0 [1.4; 4.6] 3.0 [1.4; 4.6] 3.0 [1.4; 4.6] 3.0 [1.4; 4.6] 3.0 [1.4; 4.6] (422) (389) (361) (315) (233) (169) (126) (51) TRJ (Aesculap) PLASMAFIT (Aesculap) 622 26 70.5 (62 - 77) 32/68 2013-2023 3.6 [2.1; 5.1] 4.8 [3.0; 6.7] 5.2 [3.2; 7.1] 5.2 [3.2; 7.1] 5.2 [3.2; 7.1] 5.2 [3.2; 7.1] (471) (339) (247) (176) (112) (61) twinSys uncem. (Mathys) aneXys Flex (Mathys) 1,534 34 71 (65 - 77) 41/59 2016-2023 3.9 [2.9; 4.8] 4.4 [3.3; 5.5] 4.4 [3.3; 5.5] 4.7 [3.6; 5.9] 4.7 [3.6; 5.9] 4.7 [3.6; 5.9] (1,189) (919) (642) (433) (223) (94) twinSys uncem. (Mathys) RM Classic (Mathys) 902 11 76.5 (71 - 81) 29/71 2013-2023 1.5 [0.7; 2.3] 1.9 [0.9; 2.8] 2.2 [1.2; 3.2] 2.3 [1.3; 3.4] 2.6 [1.4; 3.7] 2.9 [1.6; 4.2] 2.9 [1.6; 4.2] 2.9 [1.6; 4.2] 3.5 [1.7; 5.3] (793) (701) (598) (465) (353) (271) (219) (174) (142) twinSys uncem. (Mathys) RM Pressfit (Mathys) 480 9 75 (69 - 79) 39/61 2013-2023 2.7 [1.2; 4.2] 3.4 [1.7; 5.0] 3.6 [1.9; 5.3] 3.8 [2.1; 5.6] 4.1 [2.3; 5.9] 4.1 [2.3; 5.9] 4.6 [2.5; 6.7] 4.6 [2.5; 6.7] (453) (429) (406) (385) (314) (268) (182) (98) twinSys uncem. (Mathys) RM Pressfit vitamys (Mathys) 2,952 39 72 (65 - 78) 36/64 2013-2023 2.5 [1.9; 3.0] 2.6 [2.1; 3.2] 2.7 [2.1; 3.3] 2.9 [2.3; 3.6] 2.9 [2.3; 3.6] 3.2 [2.5; 4.0] 3.2 [2.5; 4.0] 3.7 [2.5; 4.8] (2,517) (2,090) (1,712) (1,289) (898) (523) (244) (126) Cemented fixation AS PLUS Schaft Müller II Pfanne 3.0 [1.1; 5.0] 3.0 [1.1; 5.0] 3.5 [1.3; 5.5] 3.5 [1.3; 5.5] 4.0 [1.6; 6.2] 4.0 [1.6; 6.2] 4.0 [1.6; 6.2] 302 7 81 (78 - 84) 20/80 2013-2022 (Smith & Nephew) (OHST Medizintechnik) (277) (250) (225) (202) (164) (103) (54) Avenir (Zimmer Biomet) AVANTAGE (Zimmer Biomet) 314 28 81 (77 - 84) 30/70 2015-2023 3.8 [1.6; 6.0] 5.0 [2.2; 7.7] 5.0 [2.2; 7.7] (190) (104) (58) Avenir (Zimmer Biomet) Flachprofil (Zimmer Biomet) 1,149 88 81 (77 - 84) 22/78 2014-2023 3.3 [2.3; 4.4] 3.6 [2.5; 4.7] 3.6 [2.5; 4.7] 3.6 [2.5; 4.7] 3.6 [2.5; 4.7] 4.1 [2.6; 5.6] (899) (643) (428) (295) (186) (92) BICONTACT (Aesculap) All POLY CUP (Aesculap) 1,635 69 81 (77 - 84) 22/78 2013-2023 2.4 [1.6; 3.1] 2.4 [1.6; 3.1] 2.6 [1.8; 3.4] 2.8 [2.0; 3.7] 2.9 [2.1; 3.8] 3.1 [2.2; 4.0] 3.2 [2.3; 4.2] 3.5 [2.4; 4.6] 3.5 [2.4; 4.6] (1,453) (1,328) (1,203) (1,015) (795) (565) (355) (187) (75) CORAIL™ AMT-Hüftschaft ohne TRILOC® II-PE-Hüftpfanne 2.7 [1.7; 3.7] 3.0 [1.9; 4.0] 3.2 [2.1; 4.4] 3.6 [2.4; 4.8] 4.0 [2.7; 5.4] 4.6 [3.0; 6.1] 5.0 [3.2; 6.7] 1,014 76 80 (76 - 84) 19/81 2013-2023 Kragen (DePuy) (DePuy) (867) (752) (629) (501) (375) (266) (147) CS PLUS Schaft Müller II Pfanne 1.0 [0.1; 1.9] 1.7 [0.5; 2.9] 2.2 [0.8; 3.5] 2.2 [0.8; 3.5] 2.2 [0.8; 3.5] 2.2 [0.8; 3.5] 2.2 [0.8; 3.5] 485 21 79 (77 - 82) 26/74 2014-2019 (Smith & Nephew) (OHST Medizintechnik) (455) (433) (415) (387) (348) (269) (163) EXCIA (Aesculap) All POLY CUP (Aesculap) 1,217 73 80 (76 - 83) 23/77 2014-2023 2.4 [1.5; 3.2] 2.9 [1.9; 3.8] 3.0 [2.0; 4.0] 3.2 [2.1; 4.2] 3.3 [2.2; 4.4] 4.1 [2.7; 5.5] 4.5 [2.9; 6.1] 6.2 [3.3; 8.9] (1,033) (848) (689) (537) (416) (284) (187) (68) M.E.M. Geradschaft (Zimmer Biomet) Flachprofil (Zimmer Biomet) 5,293 142 80 (77 - 84) 24/76 2012-2023 2.5 [2.1; 2.9] 2.9 [2.4; 3.4] 3.2 [2.7; 3.7] 3.3 [2.8; 3.8] 3.4 [2.9; 3.9] 3.6 [3.0; 4.1] 3.6 [3.1; 4.2] 3.6 [3.1; 4.2] 3.6 [3.1; 4.2] (4,369) (3,665) (3,075) (2,482) (1,870) (1,276) (785) (372) (102) METABLOC (Zimmer Biomet) Flachprofil (Zimmer Biomet) 420 17 79 (76 - 83) 26/74 2013-2022 2.7 [1.1; 4.2] 2.9 [1.3; 4.5] 3.2 [1.5; 4.9] 3.8 [1.9; 5.7] 4.2 [2.1; 6.3] 5.8 [3.1; 8.5] 5.8 [3.1; 8.5] (390) (372) (336) (274) (210) (138) (64) MS-30 (Zimmer Biomet) Flachprofil (Zimmer Biomet) 503 28 79 (76 - 83) 23/77 2013-2023 2.0 [0.8; 3.3] 2.2 [0.9; 3.5] 2.5 [1.1; 3.8] 2.5 [1.1; 3.8] 2.5 [1.1; 3.8] 2.5 [1.1; 3.8] 2.5 [1.1; 3.8] 3.4 [1.1; 5.5] (465) (441) (411) (360) (272) (177) (120) (52) Table 47 (continued) 94 EPRD Annual Report 2024 95  5 Hip and knee arthroplasty survival 5.2 Revision hip arthroplasty survival Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Femoral stem Cup Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Cemented fixation Polarschaft Cemented Müller II Pfanne 3.9 [2.4; 5.3] 4.2 [2.7; 5.7] 4.2 [2.7; 5.7] 4.2 [2.7; 5.7] 4.8 [3.1; 6.5] 4.8 [3.1; 6.5] 4.8 [3.1; 6.5] 683 34 80 (77 - 84) 22/78 2014-2023 (Smith & Nephew) (OHST Medizintechnik) (579) (515) (461) (380) (268) (162) (64) SPII Model Lubinus Hip Stem, Cemented Acetabular Cup System, standard stem, without Borehole Endo-Model Cup 498 6 77 (73 - 81) 18/82 2012-2023 2.0 [0.8; 3.3] 2.7 [1.2; 4.1] 2.7 [1.2; 4.1] 2.9 [1.4; 4.4] 2.9 [1.4; 4.4] 2.9 [1.4; 4.4] 2.9 [1.4; 4.4] 3.3 [1.6; 5.0] 3.3 [1.6; 5.0] (474) (436) (403) (362) (322) (289) (250) (199) (136) (Waldemar Link) (Waldemar Link) SPII Model Lubinus Hip Stem, Cemented Acetabular Cup System, 2.2 [1.4; 3.0] 2.6 [1.7; 3.4] 2.9 [2.0; 3.9] 3.4 [2.4; 4.5] 3.5 [2.4; 4.6] 3.7 [2.6; 4.8] 3.7 [2.6; 4.8] 3.7 [2.6; 4.8] standard stem, without Borehole 1,294 30 81 (78 - 84) 25/75 2013-2023 IP Cup (Waldemar Link) (1,160) (1,056) (942) (807) (609) (434) (284) (103) (Waldemar Link) SPII Model Lubinus Hip Stem, Cemented Acetabular Cup System, standard stem, without Borehole Lubinus 1,001 22 80 (76 - 83) 23/77 2013-2023 1.3 [0.6; 2.0] 1.6 [0.8; 2.3] 2.0 [1.1; 2.9] 2.3 [1.3; 3.3] 2.5 [1.4; 3.6] 2.8 [1.6; 4.1] 2.8 [1.6; 4.1] 4.4 [1.9; 6.8] Hip (905) (785) (646) (499) (374) (278) (162) (79) (Waldemar Link) (Waldemar Link) twinSys cem. (Mathys) CCB (Mathys) 576 24 80 (76 - 84) 22/78 2014-2023 1.4 [0.4; 2.4] 2.1 [0.8; 3.3] 2.1 [0.8; 3.3] 2.4 [1.0; 3.8] 2.9 [1.2; 4.6] 2.9 [1.2; 4.6] 4.1 [1.3; 6.8] (486) (379) (305) (232) (170) (121) (68) Table 47 (continued) 5.2 Revision hip sons considered. Whilst the CReRR within Different stem components for different age groups? arthroplasty survival 2 years of an aseptic revision is 11.9%, it more than doubles to 29.7% after a septic A hip revision is considerably more likely revision (Figure 14). Tables 47 and 63 of the appendix summarise in- ful consideration. A recent publication based on to occur after a previous revision than after dividual stem system outcomes based on all age EPRD data evaluated outcomes for specific types of the primary arthroplasty. The cumulative re- The registry does not have a complete med- groups combined. However, as shown in Figure 6, stems in different patient groups [4]. revision rate (CReRR) is also highly depend- ical history for most revisions (including the CRR for hip arthroplasties with uncemented ent on the reason for surgery. When focus- re-revisions) where the corresponding pri- stems increases considerably with advancing pa- The authors concluded that, if cemented stems are ing on all re-revisions under observation in mary arthroplasty predates EPRD data col- tient age. to be avoided, specialised stem designs such as un- the registry, the risk of a re-revision due to lection. However, for revisions with a pri- cemented collared stems, which are associated with a periprosthetic infection is considerably mary arthroplasty recorded in the registry, The use of uncemented stems in older age groups a reduced risk of periprosthetic fractures, should be higher than that for any of the other rea- the exact number of subsequent revisions nevertheless requires critical evaluation and care- considered as an alternative in older patients. 40 © EPRD Annual Report 2024 35 Cumulative re-revision [%] 30 25 20 15 10 5 Septic hip revisions Aseptic hip revisions 0 0 1 2 3 4 5 6 7 8 9 Years since last revision Numbers 16,489 9,406 7,363 5,671 4,204 2,846 1,764 986 397 90 at risk 51,713 37,804 30,368 24,004 18,476 13,210 8,778 4,900 2,154 660 Figure 14: Hip arthroplasty cumulative re-revision rates over time (p < 0.0001) 96 EPRD Annual Report 2024 97  5 Hip and knee arthroplasty survival 5.2 Revision hip arthroplasty survival can be accurately determined because there The CReRR is also influenced by which com- gether and also when the analysis specifically are no gaps in the follow-up. Figure 15 illus- ponents were exchanged or re-implanted focuses on the first or the second revision. trates how the revision risk increases from during the revision. For example, the risk of That said, it should be noted that exchange one subsequent procedure to the next. This a re-revision is lower after exchanging/re-im- of an acetabulum or femoral component is is particularly apparent in the case of aseptic planting a bone-anchored component both in more stressful for the patient than revision revisions, whereby the differences in results the case of septic and aseptic revisions (Fig- of the head and/or insert alone. Exchang- between aseptic and septic revisions become ure 16). This trend persists when all revisions ing the stem or cup component may lead to smaller with each subsequent procedure. recorded in the registry are considered to- additional complications, which is perhaps why a less invasive procedure is the initially 40 favoured treatment option. Infection-related © EPRD Annual Report 2024 procedures where bone-anchored compo- 35 nents are left in situ are, nevertheless, associ- Cumulative re-revision [%] Hip 30 ated with a higher patient mortality rate (see 25 Chapter 6). 20 15 Table 48 presents the main factors that im- 10 pact the hip CReRR. It is worth noting that Subsequent septic revisions Subsequent aseptic revisions 5 2nd septic revision 2nd aseptic revision initial conditions for revisions may be much 1st septic revision 1st aseptic revision 0 more diverse than those for primary arthro- 0 1 2 3 4 5 plasty, which may confound the current eval- Years since last revision uation. Even though the reason for revisions 690 366 269 205 140 87 and the details of the replaced components 1,431 757 560 416 293 173 are recorded in the registry, the complexity Numbers at risk 4,688 2,448 1,818 1,298 889 527 of individual procedures can only be inferred 251 143 89 59 43 21 897 564 401 276 185 106 to a limited extent. 8,730 5,931 4,440 3,225 2,279 1,466 Figure 15: Hip arthroplasty cumulative re-revision rates after first, second and subsequent revisions (p < 0.0001). Confidence In brief intervals have been omitted for clarity. • For septic hip arthroplasty revisions, 40 the 2-year CReRR is 29.7% compared to © EPRD Annual Report 2024 35 11.9% for aseptic procedures. Cumulative re-revision [%] 30 • The revision risk increases with each 25 additional subsequent procedure. 20 15 10 Septic, without exchange of bone-anchored components Septic, with exchange of bone-anchored components 5 Aseptic, without exchange of bone-anchored components Aseptic, with exchange of bone-anchored components 0 0 1 2 3 4 5 6 7 8 9 Years since last revision 5,581 2,675 1,986 1,447 1,003 603 351 183 53 9 Numbers 10,175 6,395 5,110 4,019 3,049 2,141 1,348 769 328 78 at risk 8,833 6,448 5,205 4,103 3,172 2,252 1,466 782 293 70 40,065 29,186 23,387 18,496 14,196 10,133 6,742 3,808 1,694 526 Figure 16: Hip arthroplasty cumulative re-revision rates by implanted components (p < 0.0001) 98 EPRD Annual Report 2024 99  5 Hip and knee arthroplasty survival 5.2 Revision hip arthroplasty survival Re-revision rates after ... Type of revision / Category Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years Infection-related hip revision 16,489 74 (65 - 80) 45/55 28.1 700 27.6 [26.9; 28.3] 29.7 [29.0; 30.5] 30.9 [30.1; 31.6] 32.0 [31.2; 32.8] 32.8 [32.0; 33.6] 33.4 [32.6; 34.3] 34.1 [33.2; 35.0] 34.4 [33.4; 35.4] 34.6 [33.5; 35.6] (9,406) (7,363) (5,671) (4,204) (2,846) (1,764) (986) (397) (90) Number of procedures First revision 4,688 73 (63 - 81) 44/56 29.0 618 27.3 [26.0; 28.6] 28.8 [27.4; 30.1] 29.6 [28.2; 31.0] 30.3 [28.8; 31.7] 30.9 [29.4; 32.4] 30.9 [29.4; 32.4] 31.4 [29.6; 33.0] (2,448) (1,818) (1,298) (889) (527) (268) (135) Second revision 1,431 73 (64 - 80) 44/56 29.4 454 27.9 [25.5; 30.3] 29.4 [26.9; 31.8] 30.5 [27.9; 33.0] 31.5 [28.8; 34.1] 32.7 [29.7; 35.4] 32.7 [29.7; 35.4] (757) (560) (416) (293) (173) (99) Third or subsequent 32.6 [28.9; 36.1] 35.5 [31.7; 39.2] 36.6 [32.7; 40.3] 37.4 [33.4; 41.3] 38.0 [33.8; 41.9] 39.0 [34.4; 43.2] 690 72 (64 - 79) 43/57 29.4 259 revision (366) (269) (205) (140) (87) (52) Revision without known 27.3 [26.4; 28.2] 29.7 [28.8; 30.7] 31.0 [30.0; 31.9] 32.3 [31.3; 33.3] 33.1 [32.0; 34.1] 33.9 [32.8; 35.0] 34.5 [33.4; 35.7] 34.9 [33.7; 36.2] 35.1 [33.8; 36.4] 9,680 75 (65 - 81) 46/54 27.7 642 previous history (5,835) (4,716) (3,752) (2,882) (2,059) (1,345) (786) (345) (82) With exchange of bone- 23.7 [22.9; 24.6] 25.9 [25.0; 26.8] 27.0 [26.1; 27.9] 28.3 [27.3; 29.2] 29.1 [28.1; 30.0] 29.9 [28.9; 30.9] 30.6 [29.5; 31.7] 31.1 [29.9; 32.3] 31.3 [30.0; 32.6] Re-implanted components 10,175 73 (64 - 80) 47/53 28.0 650 anchored components Hip (6,395) (5,110) (4,019) (3,049) (2,141) (1,348) (769) (328) (78) Without exchange of bone- 32.9 [31.6; 34.2] 34.8 [33.5; 36.1] 35.8 [34.5; 37.2] 36.6 [35.2; 38.0] 37.4 [36.0; 38.9] 37.7 [36.2; 39.2] 38.2 [36.5; 39.8] 38.2 [36.5; 39.8] 5,581 75 (66 - 82) 42/58 28.4 634 anchored components (2,675) (1,986) (1,447) (1,003) (603) (351) (183) (53) not clearly defined 733 74 (64 - 80) 42/58 28.6 227 42.6 [38.7; 46.2] 45.2 [41.2; 48.9] 47.9 [43.8; 51.7] 49.1 [44.9; 52.9] 49.8 [45.6; 53.7] 49.8 [45.6; 53.7] (336) (267) (205) (152) (102) (65) Age group ≤ 54 years 1,272 50 (45 - 52) 58/42 29.4 362 24.1 [21.7; 26.5] 27.7 [25.1; 30.2] 29.7 [27.0; 32.4] 30.5 [27.7; 33.1] 32.4 [29.4; 35.2] 33.6 [30.4; 36.5] 34.0 [30.8; 37.1] (814) (644) (514) (396) (277) (187) (107) 55 to 64 years 2,847 60 (58 - 62) 55/45 30.8 511 25.1 [23.5; 26.7] 27.4 [25.7; 29.1] 28.6 [26.8; 30.3] 29.8 [28.0; 31.6] 30.6 [28.7; 32.4] 31.7 [29.7; 33.7] 32.9 [30.6; 35.1] 33.6 [31.0; 36.2] (1,775) (1,421) (1,102) (810) (574) (358) (191) (88) 65 to 74 years 4,370 70 (67 - 72) 48/52 29.8 584 28.5 [27.1; 29.8] 30.9 [29.5; 32.3] 32.0 [30.5; 33.4] 33.4 [31.9; 34.9] 34.1 [32.5; 35.6] 34.6 [33.0; 36.2] 35.2 [33.5; 36.9] 35.6 [33.7; 37.4] (2,573) (2,012) (1,581) (1,175) (820) (532) (322) (125) 75 to 84 years 6,189 79 (77 - 82) 40/60 27.3 630 28.8 [27.6; 29.9] 30.2 [29.0; 31.4] 31.4 [30.1; 32.6] 32.4 [31.1; 33.6] 33.0 [31.7; 34.3] 33.6 [32.2; 34.9] 33.9 [32.5; 35.3] 33.9 [32.5; 35.3] (3,464) (2,751) (2,132) (1,611) (1,046) (616) (328) (122) ≥ 85 years 1,811 87 (86 - 89) 30/70 25.4 468 27.7 [25.5; 29.9] 29.8 [27.4; 32.0] 29.9 [27.5; 32.2] 30.9 [28.4; 33.4] 30.9 [28.4; 33.4] 30.9 [28.4; 33.4] (780) (535) (342) (212) (129) (71) Sex Male 7,429 72 (62 - 79) 100/0 28.0 654 25.4 [24.4; 26.4] 27.8 [26.7; 28.8] 28.9 [27.8; 30.0] 30.0 [28.9; 31.1] 30.9 [29.7; 32.0] 31.8 [30.6; 33.1] 32.8 [31.4; 34.1] 33.2 [31.7; 34.6] (4,459) (3,511) (2,710) (2,014) (1,369) (862) (494) (195) Female 9,060 76 (67 - 82) 0/100 28.3 655 29.4 [28.4; 30.4] 31.4 [30.3; 32.3] 32.5 [31.5; 33.5] 33.7 [32.6; 34.7] 34.4 [33.3; 35.5] 34.7 [33.6; 35.9] 35.1 [33.9; 36.3] 35.4 [34.1; 36.7] (4,947) (3,852) (2,961) (2,190) (1,477) (902) (492) (202) Body-Mass-Index ≤ 25 3,443 78 (69 - 83) 41/59 23.0 550 24.3 [22.8; 25.8] 26.1 [24.6; 27.7] 27.1 [25.5; 28.7] 28.6 [26.9; 30.4] 29.1 [27.3; 30.9] 29.1 [27.3; 30.9] (1,831) (1,324) (903) (570) (279) (71) > 25 to 30 4,197 76 (67 - 82) 51/49 27.4 597 26.6 [25.2; 28.0] 28.6 [27.1; 30.0] 29.8 [28.3; 31.3] 31.1 [29.5; 32.6] 31.9 [30.2; 33.5] 32.1 [30.4; 33.8] (2,330) (1,731) (1,234) (795) (402) (95) > 30 to 35 2,744 72 (64 - 79) 46/54 32.0 516 28.3 [26.5; 30.0] 29.9 [28.1; 31.7] 30.9 [29.0; 32.7] 32.1 [30.1; 33.9] 33.5 [31.4; 35.5] 35.0 [32.2; 37.6] (1,528) (1,166) (849) (560) (294) (76) > 35 to 40 1,379 69 (61 - 77) 38/62 36.9 403 32.5 [29.9; 34.9] 34.7 [32.0; 37.2] 36.5 [33.8; 39.2] 36.7 [33.9; 39.4] 37.6 [34.7; 40.4] (728) (545) (386) (259) (140) above 40 841 65 (59 - 71) 33/67 43.1 319 33.4 [30.1; 36.6] 35.0 [31.6; 38.3] 35.8 [32.3; 39.1] 36.8 [33.1; 40.2] 37.2 [33.5; 40.8] (435) (315) (220) (148) (72) Hospitals with low 27.8 [26.9; 28.7] 29.7 [28.8; 30.7] 30.9 [29.9; 31.9] 31.9 [30.9; 32.9] 32.6 [31.6; 33.7] 33.4 [32.3; 34.5] 34.1 [32.9; 35.3] 34.3 [33.0; 35.6] Hospital size* 9,575 75 (66 - 81) 45/55 28.3 555 annual case volumes (5,343) (4,136) (3,145) (2,326) (1,562) (961) (554) (225) Hospitals with average 28.1 [26.4; 29.9] 30.5 [28.6; 32.3] 31.2 [29.4; 33.1] 32.3 [30.3; 34.1] 32.8 [30.8; 34.7] 33.2 [31.1; 35.3] 33.5 [31.4; 35.6] 33.5 [31.4; 35.6] 2,708 74 (65 - 81) 44/56 27.8 83 annual case volumes (1,496) (1,139) (864) (637) (418) (264) (137) (51) Hospitals with high 26.6 [25.2; 28.0] 28.9 [27.4; 30.3] 30.2 [28.7; 31.7] 31.6 [30.1; 33.1] 32.7 [31.1; 34.3] 33.3 [31.6; 34.9] 33.9 [32.2; 35.7] 34.7 [32.6; 36.8] 4,066 72 (62 - 79) 46/54 28.2 35 annual case volumes (2,480) (2,012) (1,596) (1,187) (823) (516) (283) (117) Non-infection-related hip revision 51,713 76 (67 - 82) 35/65 26.7 746 10.0 [9.7; 10.2] 11.9 [11.6; 12.2] 13.2 [12.8; 13.5] 14.1 [13.8; 14.4] 15.0 [14.6; 15.3] 15.8 [15.4; 16.2] 16.6 [16.2; 17.1] 17.5 [16.9; 18.0] 18.2 [17.5; 18.9] (37,804) (30,368) (24,004) (18,476) (13,210) (8,778) (4,900) (2,154) (660) Number of procedures First revision 8,730 73 (64 - 80) 35/65 27.0 682 9.9 [9.3; 10.6] 12.3 [11.6; 13.1] 13.8 [13.0; 14.6] 14.7 [13.8; 15.6] 15.7 [14.7; 16.6] 16.4 [15.4; 17.5] 16.8 [15.7; 17.9] 17.5 [16.0; 19.0] (5,931) (4,440) (3,225) (2,279) (1,466) (844) (385) (128) Second revision 897 74 (64 - 81) 37/63 27.4 356 15.2 [12.7; 17.6] 19.1 [16.2; 21.9] 20.3 [17.3; 23.2] 20.7 [17.6; 23.7] 22.3 [18.7; 25.8] 22.3 [18.7; 25.8] (564) (401) (276) (185) (106) (52) Revision without known 9.8 [9.5; 10.1] 11.6 [11.3; 11.9] 12.8 [12.5; 13.2] 13.8 [13.4; 14.1] 14.6 [14.2; 15.0] 15.4 [15.0; 15.8] 16.4 [15.9; 16.8] 17.2 [16.6; 17.7] 18.0 [17.3; 18.7] 41,835 77 (68 - 82) 35/65 26.6 742 previous history (31,166) (25,438) (20,444) (15,969) (11,617) (7,872) (4,497) (2,024) (632) Table 48: The main factors that impact the hip re-revision rate 100 EPRD Annual Report 2024 101  5 Hip and knee arthroplasty survival 5.2 Revision hip arthroplasty survival Re-revision rates after ... Type of revision / Category Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years With exchange of bone- 9.6 [9.3; 9.9] 11.3 [11.0; 11.7] 12.5 [12.2; 12.9] 13.4 [13.0; 13.8] 14.2 [13.8; 14.6] 15.0 [14.6; 15.4] 15.8 [15.3; 16.3] 16.6 [16.1; 17.2] 17.2 [16.5; 17.9] Re-implanted components 40,065 77 (67 - 82) 34/66 26.6 739 anchored components (29,186) (23,387) (18,496) (14,196) (10,133) (6,742) (3,808) (1,694) (526) Without exchange of bone- 12.1 [11.4; 12.8] 14.5 [13.7; 15.3] 16.0 [15.2; 16.8] 17.3 [16.4; 18.2] 18.3 [17.4; 19.3] 19.0 [18.0; 20.0] 20.0 [18.9; 21.1] 21.1 [19.8; 22.5] 23.6 [20.6; 26.6] 8,833 75 (65 - 80) 36/64 27.0 666 anchored components (6,448) (5,205) (4,103) (3,172) (2,252) (1,466) (782) (293) (70) not clearly defined 2,815 75 (66 - 81) 34/66 27.1 441 9.0 [7.9; 10.1] 11.2 [9.9; 12.4] 12.8 [11.4; 14.1] 13.7 [12.3; 15.1] 14.8 [13.3; 16.3] 15.9 [14.2; 17.5] 17.0 [15.1; 18.9] 17.4 [15.4; 19.3] 17.4 [15.4; 19.3] (2,170) (1,776) (1,405) (1,108) (825) (570) (310) (167) (64) Age group ≤ 54 years 3,346 50 (45 - 52) 44/56 27.7 539 7.9 [7.0; 8.9] 10.1 [9.1; 11.2] 12.0 [10.8; 13.1] 13.3 [12.1; 14.6] 14.5 [13.1; 15.8] 15.6 [14.1; 17.1] 17.4 [15.7; 19.1] 18.3 [16.3; 20.1] 18.3 [16.3; 20.1] (2,718) (2,287) (1,892) (1,517) (1,127) (827) (481) (234) (90) 55 to 64 years 7,304 60 (58 - 62) 42/58 28.1 658 8.3 [7.7; 9.0] 10.6 [9.8; 11.3] 12.3 [11.5; 13.1] 13.5 [12.6; 14.3] 14.3 [13.4; 15.2] 15.4 [14.4; 16.4] 16.0 [15.0; 17.1] 16.5 [15.4; 17.7] 16.8 [15.5; 18.1] (5,808) (4,788) (3,860) (3,069) (2,282) (1,558) (927) (435) (147) 65 to 74 years 12,343 70 (68 - 73) 38/62 27.8 702 9.6 [9.0; 10.1] 11.9 [11.3; 12.5] 13.4 [12.7; 14.0] 14.4 [13.7; 15.0] 15.3 [14.6; 16.1] 16.0 [15.2; 16.8] 16.7 [15.8; 17.5] 17.6 [16.6; 18.5] 18.6 [17.3; 19.9] (9,334) (7,573) (6,152) (4,862) (3,643) (2,515) (1,487) (701) (214) Hip 75 to 84 years 20,856 80 (77 - 82) 32/68 26.4 727 10.7 [10.3; 11.1] 12.5 [12.0; 12.9] 13.5 [13.0; 14.0] 14.4 [13.9; 15.0] 15.3 [14.7; 15.8] 16.0 [15.4; 16.6] 16.9 [16.2; 17.6] 17.9 [17.0; 18.7] 19.0 [17.7; 20.3] (15,414) (12,511) (9,882) (7,596) (5,307) (3,419) (1,823) (731) (197) ≥ 85 years 7,864 87 (86 - 90) 25/75 24.9 681 11.1 [10.3; 11.8] 11.9 [11.1; 12.7] 12.4 [11.6; 13.2] 12.8 [11.9; 13.6] 13.0 [12.1; 13.9] 13.4 [12.4; 14.4] 14.3 [13.0; 15.6] 14.3 [13.0; 15.6] (4,530) (3,209) (2,218) (1,432) (851) (459) (182) (53) Sex Male 17,916 74 (64 - 80) 100/0 27.4 724 9.7 [9.2; 10.1] 11.4 [10.9; 11.9] 12.6 [12.1; 13.1] 13.6 [13.0; 14.2] 14.4 [13.8; 15.0] 15.2 [14.6; 15.9] 15.9 [15.1; 16.6] 16.7 [15.8; 17.5] 17.3 [16.3; 18.4] (13,100) (10,520) (8,296) (6,376) (4,583) (3,014) (1,699) (775) (241) Female 33,797 77 (68 - 83) 0/100 26.2 741 10.1 [9.8; 10.5] 12.2 [11.8; 12.5] 13.5 [13.1; 13.9] 14.4 [14.0; 14.8] 15.3 [14.8; 15.7] 16.1 [15.6; 16.5] 17.0 [16.5; 17.6] 17.9 [17.2; 18.5] 18.7 [17.8; 19.5] (24,704) (19,848) (15,708) (12,100) (8,627) (5,764) (3,201) (1,379) (419) Body-Mass-Index ≤ 25 13,738 79 (70 - 84) 27/73 22.9 699 10.3 [9.7; 10.8] 11.8 [11.2; 12.4] 12.7 [12.1; 13.4] 13.7 [13.1; 14.4] 14.5 [13.7; 15.2] 15.3 [14.3; 16.2] (9,052) (6,586) (4,673) (2,950) (1,497) (402) > 25 to 30 13,903 77 (68 - 82) 40/60 27.3 704 9.9 [9.4; 10.4] 11.7 [11.1; 12.3] 13.0 [12.4; 13.6] 14.1 [13.4; 14.7] 15.0 [14.3; 15.8] 15.9 [15.0; 16.8] (9,757) (7,378) (5,347) (3,574) (1,957) (569) > 30 to 35 6,981 74 (65 - 80) 38/62 31.9 658 10.9 [10.2; 11.7] 12.8 [12.0; 13.7] 14.0 [13.1; 14.9] 14.9 [14.0; 15.9] 15.6 [14.6; 16.6] 16.3 [15.1; 17.5] (4,981) (3,847) (2,810) (1,942) (1,046) (311) > 35 to 40 2,329 70 (62 - 77) 35/65 36.8 522 10.5 [9.2; 11.8] 12.8 [11.3; 14.2] 14.0 [12.4; 15.5] 15.2 [13.5; 16.8] 16.4 [14.5; 18.2] 17.1 [15.1; 19.1] (1,684) (1,318) (962) (682) (386) (102) above 40 939 66 (58 - 74) 30/70 42.8 380 12.7 [10.5; 14.9] 14.5 [12.1; 16.9] 16.2 [13.6; 18.7] 17.6 [14.7; 20.3] 18.8 [15.6; 21.8] (651) (512) (364) (242) (138) Hospitals with low 9.9 [9.5; 10.2] 11.6 [11.3; 12.0] 12.9 [12.5; 13.3] 13.8 [13.4; 14.2] 14.5 [14.1; 15.0] 15.2 [14.7; 15.7] 16.0 [15.4; 16.5] 16.7 [16.0; 17.3] 17.6 [16.7; 18.6] Hospital size* 31,495 77 (68 - 82) 35/65 26.6 590 annual case volumes (22,791) (18,290) (14,395) (11,068) (7,897) (5,225) (2,880) (1,234) (311) Hospitals with average 9.8 [9.1; 10.4] 11.6 [10.8; 12.3] 12.6 [11.8; 13.4] 13.8 [12.9; 14.6] 14.6 [13.7; 15.6] 15.8 [14.7; 16.8] 17.1 [15.9; 18.4] 18.3 [16.7; 19.9] 18.7 [16.9; 20.4] 7,891 77 (67 - 82) 36/64 26.8 85 annual case volumes (5,611) (4,435) (3,439) (2,590) (1,796) (1,133) (601) (248) (56) Hospitals with high 10.4 [9.9; 11.0] 12.8 [12.1; 13.4] 14.1 [13.5; 14.8] 15.1 [14.4; 15.8] 16.3 [15.5; 17.1] 17.1 [16.3; 18.0] 18.0 [17.1; 18.9] 18.8 [17.7; 19.8] 19.3 [18.1; 20.6] 11,676 74 (64 - 80) 34/66 26.8 35 annual case volumes (8,843) (7,129) (5,717) (4,424) (3,206) (2,208) (1,295) (625) (282) * The classifications in this report are based on the hospitals’ quality reports for 2022 and the corresponding revision hip arthroplasty IQTIG quality indicators listed therein. For hip revision procedures, the case number cutoffs for classification as low case volume are up to 20 cases, medium volume is 21 to 50 cases and high volume is greater than 50 revisions per year. Table 48 (continued) 102 EPRD Annual Report 2024 103  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival 5.3 Primary knee cedures are much less common than TKAs theless largely unaffected by whether the pri- arthroplasty survival and unicondylar replacements. Their CRR is mary diagnosis was primary osteoarthritis or In brief: considerably higher than that of other types another type of osteoarthritis. The following sections deal with the CRRs of arthroplasties (see Table 49 at the end of • Unicondylar arthroplasties have a CRR of various primary knee arthroplasties, the this section). Table 49 lists the CRRs for various types of that is still almost twice that of TKAs. influence of non-implant-related risk factors knee arthroplasties by indication. • The risk of revision surgery is considera- (from page 108) and specific arthroplasty TKAs can be further differentiated accord- bly higher for post-traumatic osteoarthri- and implant characteristics (from page 116). ing to their degree of stabilisation. The most tis than for primary osteoarthritis. Tables included at the end of each subsection common type of system employed are stand- provide a summary and all outcome details. ard systems without additional lateral sta- The results for specific implant systems from bilisation. However, in patients with joint different manufacturers are listed in the final deformity or severe ligament instability, var- section from page 124. us-valgus stabilised or hinged systems are 10 © EPRD Annual Report 2024 9 also implanted. These more constrained sys- 8 5.3.1 Comparison by type tems guide the movement, but also restrict it. Cumulative revision [%] 7 of primary knee arthroplasty The EPRD data shows that CRRs increase 6 The EPRD documents three main types of as the degree of stabilisation increases (Fig- 5 knee arthroplasties. The most common is a ure 18). Due to the relatively low number of 4 3 TKA that replaces both the medial and late- cases, the following analyses combine hinged Knee 2 ral parts of the joint. In contrast, unicondy- and varus-valgus stabilised systems into one 1 Constrained TKAs, hinged Constrained TKAs, varus-valgus-stabilised lar arthroplasties, only replace the affected single group of constrained TKAs with no 0 Standard TKAs medial or lateral part of the joint – the ob- further details given for each individual sys- 0 1 2 3 4 5 6 7 8 9 jective is to preserve intact articulating sur- tem subgroup. Years since primary faces and ligaments wherever possible to 11,974 9,439 7,603 6,133 4,750 3,373 2,200 1,183 ensure the best possible natural kinematics For knee arthroplasties, the risk of revision Numbers 7,975 6,272 4,879 3,813 2,900 1,987 1,247 635 at risk and starting point for any revisions that may surgery also largely depends on the primary 424,357 347,965 282,624 230,682 181,309 131,870 86,617 48,209 19,542 5,149 become necessary. However, as is evident in diagnosis. The highest CRR for osteoar- Figure 17 the CRR of unicondylar arthro- thritis-related arthroplasty procedures is Figure 18: Cumulative revision rates for total knee arthroplasties by degree of constraint (p < 0.0001) plasties is almost twice that of total knee ar- observed in the case of post-traumatic oste- throplasties. Patellofemoral resurfacing pro- oarthritis (Figure 19). The outcome is never- 9 © EPRD Annual Report 2024 8 Cumulative revision [%] 10 7 © EPRD Annual Report 2024 9 6 8 Cumulative revision [%] 5 7 4 6 3 5 2 4 Standard TKAs for post-traumatic osteoarthritis 1 Standard TKAs for other types of osteoarthritis 3 Standard TKAs for primary osteoarthritis 2 0 1 Unicondylar knee arthroplasties Total knee arthroplasties 0 1 2 3 4 5 6 7 8 9 0 Years since primary 0 1 2 3 4 5 6 7 8 9 8,209 6,608 5,306 4,197 3,305 2,373 1,553 825 Numbers Years since primary at risk 43,451 36,159 29,983 24,897 19,540 14,123 9,531 5,281 1,955 369,870 302,834 245,341 199,920 157,124 114,370 74,880 41,724 17,108 4,577 Numbers 63,758 51,629 41,429 33,185 25,363 18,020 11,402 6,097 2,273 741 at risk 444,306 363,676 295,106 240,628 188,959 137,230 90,064 50,027 20,277 5,325 Figure 19: Cumulative revision rates for standard total knee arthroplasties by primary diagnosis (based on the documented Figure 17: Cumulative revision rates for total and unicondylar knee arthroplasties (p < 0.0001) ICD-10 codes) (p < 0.0001) 104 EPRD Annual Report 2024 105  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival Cumulative revision rates after ... Type of arthroplasty / Category Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years Standard TKAs 424,357 70 (62 - 77) 35/65 30.1 749 1.9 [1.9; 1.9] 3.1 [3.1; 3.2] 3.7 [3.7; 3.8] 4.2 [4.1; 4.2] 4.5 [4.4; 4.5] 4.7 [4.6; 4.8] 5.0 [4.9; 5.0] 5.2 [5.1; 5.3] 5.5 [5.4; 5.6] (347,965) (282,624) (230,682) (181,309) (131,870) (86,617) (48,209) (19,542) (5,149) Primary diagnosis Primary osteoarthritis 369,870 70 (63 - 77) 34/66 30.2 746 1.9 [1.8; 1.9] 3.1 [3.0; 3.1] 3.7 [3.6; 3.7] 4.1 [4.0; 4.2] 4.4 [4.3; 4.5] 4.6 [4.6; 4.7] 4.9 [4.8; 5.0] 5.1 [5.0; 5.3] 5.4 [5.2; 5.5] (302,834) (245,341) (199,920) (157,124) (114,370) (74,880) (41,724) (17,108) (4,577) Diagnosis other than osteoarthritis 46,278 69 (61 - 76) 35/65 29.7 698 2.0 [1.8; 2.1] 3.2 [3.1; 3.4] 3.9 [3.7; 4.1] 4.4 [4.1; 4.6] 4.6 [4.4; 4.9] 4.9 [4.6; 5.1] 5.1 [4.9; 5.4] 5.4 [5.1; 5.7] 5.8 [5.3; 6.3] (38,523) (31,977) (26,565) (20,880) (15,127) (10,184) (5,660) (2,109) (487) Post-traumatic osteoarthritis 8,209 61 (55 - 70) 56/44 28.7 645 2.9 [2.6; 3.3] 4.7 [4.2; 5.2] 5.7 [5.1; 6.3] 6.4 [5.8; 7.0] 7.1 [6.4; 7.7] 7.6 [6.8; 8.3] 7.9 [7.1; 8.7] 8.6 [7.5; 9.7] 9.7 [7.8; 11.5] (6,608) (5,306) (4,197) (3,305) (2,373) (1,553) (825) (325) (85) Prior operations No relevant prior operations 393,112 70 (63 - 77) 34/66 30.1 748 1.9 [1.8; 1.9] 3.1 [3.0; 3.1] 3.7 [3.6; 3.7] 4.1 [4.0; 4.2] 4.4 [4.3; 4.4] 4.6 [4.5; 4.7] 4.9 [4.8; 5.0] 5.2 [5.0; 5.3] 5.4 [5.3; 5.5] (321,976) (260,924) (212,682) (166,878) (120,950) (78,858) (43,579) (17,786) (4,784) Other prior operations 16,530 67 (59 - 74) 40/60 29.8 580 2.1 [1.9; 2.4] 3.6 [3.3; 3.9] 4.3 [4.0; 4.7] 4.8 [4.5; 5.2] 5.1 [4.8; 5.5] 5.4 [5.0; 5.8] 5.6 [5.2; 6.0] 5.9 [5.4; 6.4] 6.2 [5.6; 6.9] (13,967) (11,969) (10,311) (8,483) (6,595) (4,815) (2,975) (1,134) (224) Capsule / Ligaments 7,452 62 (56 - 70) 52/48 29.4 556 1.9 [1.6; 2.3] 3.5 [3.1; 4.0] 4.1 [3.6; 4.6] 4.8 [4.2; 5.4] 5.4 [4.7; 6.0] 6.0 [5.2; 6.7] 6.1 [5.4; 6.9] 6.6 [5.6; 7.6] 6.6 [5.6; 7.6] (5,918) (4,651) (3,595) (2,738) (1,938) (1,316) (726) (241) (68) Osteosynthesis / Osteotomy 7,158 64 (57 - 72) 48/52 29.4 613 2.6 [2.2; 3.0] 4.1 [3.7; 4.6] 5.1 [4.6; 5.7] 5.8 [5.2; 6.5] 6.3 [5.6; 6.9] 6.6 [5.9; 7.3] 6.7 [6.0; 7.4] 6.8 [6.1; 7.6] 7.3 [6.1; 8.5] (6,028) (5,014) (4,036) (3,159) (2,350) (1,604) (915) (375) (73) Constrained TKAs 19,949 74 (66 - 80) 24/76 28.9 690 4.2 [3.9; 4.5] 5.7 [5.3; 6.0] 6.4 [6.0; 6.8] 6.8 [6.4; 7.2] 7.2 [6.8; 7.6] 7.5 [7.1; 8.0] 7.8 [7.3; 8.3] 8.4 [7.7; 9.0] 8.9 [7.8; 10.0] (15,711) (12,482) (9,946) (7,650) (5,360) (3,447) (1,818) (735) (176) Primary diagnosis Primary osteoarthritis 14,421 75 (67 - 81) 22/78 29.4 660 3.6 [3.3; 3.9] 4.9 [4.6; 5.3] 5.7 [5.2; 6.1] 6.0 [5.6; 6.4] 6.3 [5.8; 6.8] 6.6 [6.1; 7.1] 6.8 [6.3; 7.3] 7.3 [6.6; 8.0] 7.8 [6.6; 9.1] (11,521) (9,216) (7,375) (5,711) (4,053) (2,628) (1,398) (568) (138) Diagnosis other than osteoarthritis 4,191 74 (65 - 81) 25/75 27.5 547 5.7 [5.0; 6.4] 7.6 [6.7; 8.5] 8.4 [7.5; 9.4] 9.0 [8.0; 10.0] 9.4 [8.4; 10.5] 9.5 [8.5; 10.6] 10.7 [9.2; 12.1] 11.0 [9.4; 12.6] Knee (3,124) (2,401) (1,878) (1,402) (941) (566) (295) (120) Post-traumatic osteoarthritis 1,337 66 (58 - 75) 42/58 28.0 413 5.2 [3.9; 6.4] 7.2 [5.7; 8.7] 8.1 [6.5; 9.6] 8.5 [6.8; 10.1] 9.9 [7.9; 11.8] 10.8 [8.6; 12.9] 10.8 [8.6; 12.9] (1,066) (865) (693) (537) (366) (253) (125) Prior operations No relevant prior operations 17,823 75 (67 - 81) 22/78 29.0 685 4.0 [3.7; 4.3] 5.3 [5.0; 5.7] 6.1 [5.7; 6.5] 6.4 [6.0; 6.8] 6.7 [6.3; 7.1] 7.0 [6.6; 7.5] 7.3 [6.8; 7.8] 7.8 [7.2; 8.5] 8.3 [7.2; 9.5] (14,047) (11,165) (8,894) (6,804) (4,741) (3,011) (1,590) (650) (152) Osteosynthesis / Osteotomy 1,037 69 (59 - 77) 34/66 27.8 363 5.7 [4.2; 7.1] 8.7 [6.9; 10.5] 9.2 [7.3; 11.1] 10.2 [8.1; 12.3] 11.3 [8.9; 13.5] 12.0 [9.5; 14.4] 12.5 [9.8; 15.2] (814) (642) (516) (409) (287) (199) (99) Other prior operations 714 71 (61 - 78) 36/64 28.5 258 4.8 [3.2; 6.4] 8.1 [5.9; 10.2] 8.5 [6.3; 10.7] 9.3 [6.9; 11.7] 10.9 [8.2; 13.6] 11.4 [8.5; 14.2] 11.4 [8.5; 14.2] (569) (451) (366) (303) (231) (173) (95) Capsule / Ligaments 354 64 (56 - 74) 44/56 29.0 183 5.4 [2.9; 7.8] 7.7 [4.6; 10.6] 8.6 [5.3; 11.7] 9.8 [6.1; 13.3] 9.8 [6.1; 13.3] 9.8 [6.1; 13.3] (267) (212) (162) (127) (94) (61) Unicondylar knee arthroplasties 63,758 63 (57 - 72) 45/55 29.4 674 2.9 [2.8; 3.0] 4.7 [4.5; 4.9] 5.7 [5.5; 5.9] 6.6 [6.4; 6.8] 7.2 [7.0; 7.5] 8.0 [7.7; 8.2] 8.5 [8.2; 8.9] 9.2 [8.8; 9.6] 9.6 [9.1; 10.1] (51,629) (41,429) (33,185) (25,363) (18,020) (11,402) (6,097) (2,273) (741) Primary diagnosis Primary osteoarthritis 54,204 64 (57 - 72) 45/55 29.6 657 2.9 [2.7; 3.0] 4.7 [4.5; 4.9] 5.7 [5.4; 5.9] 6.6 [6.3; 6.8] 7.2 [6.9; 7.4] 7.9 [7.6; 8.2] 8.5 [8.1; 8.8] 9.2 [8.8; 9.6] 9.6 [9.0; 10.2] (44,005) (35,394) (28,397) (21,788) (15,488) (9,765) (5,211) (1,925) (594) Diagnosis other than osteoarthritis 9,298 62 (56 - 71) 46/54 29.3 493 3.1 [2.7; 3.5] 4.9 [4.4; 5.4] 6.1 [5.6; 6.7] 6.8 [6.2; 7.4] 7.6 [6.9; 8.2] 8.4 [7.6; 9.2] 9.1 [8.2; 9.9] 9.5 [8.5; 10.5] 9.5 [8.5; 10.5] (7,415) (5,862) (4,648) (3,470) (2,448) (1,581) (864) (340) (144) Prior operations No relevant prior operations 59,482 64 (58 - 72) 45/55 29.5 670 2.9 [2.8; 3.1] 4.7 [4.5; 4.8] 5.7 [5.5; 5.9] 6.5 [6.3; 6.8] 7.1 [6.9; 7.4] 7.9 [7.6; 8.2] 8.4 [8.1; 8.8] 9.1 [8.7; 9.5] 9.5 [8.9; 10.0] (48,070) (38,588) (30,930) (23,561) (16,689) (10,453) (5,528) (2,093) (702) Other prior operations 2,946 61 (55 - 68) 46/54 29.4 325 2.7 [2.1; 3.3] 4.9 [4.1; 5.8] 6.1 [5.2; 7.1] 7.2 [6.1; 8.3] 7.9 [6.7; 9.1] 8.5 [7.2; 9.7] 9.1 [7.7; 10.5] 9.9 [8.3; 11.6] (2,476) (2,035) (1,640) (1,317) (978) (697) (431) (139) Capsule / Ligaments 897 59 (54 - 66) 52/48 29.0 177 2.3 [1.3; 3.3] 6.0 [4.2; 7.8] 7.3 [5.3; 9.3] 8.7 [6.3; 11.0] 9.8 [7.1; 12.4] 11.2 [8.1; 14.2] 11.2 [8.1; 14.2] (721) (514) (384) (293) (212) (156) (88) Osteosynthesis / Osteotomy 425 58 (52 - 65) 57/43 28.7 175 2.9 [1.3; 4.5] 4.7 [2.5; 6.7] 6.5 [3.8; 9.1] 7.8 [4.8; 10.8] 9.4 [5.9; 12.8] 11.8 [7.4; 16.0] 13.5 [8.0; 18.7] (355) (285) (226) (187) (137) (94) (50) Patellofemoral knee arthroplasty 1,026 55 (49 - 61) 26/74 28.4 224 4.7 [3.3; 6.0] 8.5 [6.6; 10.4] 10.8 [8.6; 12.9] 14.0 [11.3; 16.5] 16.2 [13.2; 19.0] 17.3 [14.0; 20.3] 18.8 [15.0; 22.4] (816) (641) (496) (371) (260) (168) (83) Primary diagnosis Primary osteoarthritis 533 56 (50 - 62) 28/72 28.6 164 3.3 [1.7; 4.9] 7.4 [4.9; 9.8] 10.4 [7.3; 13.4] 12.7 [9.2; 16.2] 16.5 [11.9; 20.9] 17.5 [12.5; 22.1] (425) (331) (252) (181) (111) (69) Diagnosis other than osteoarthritis 469 54 (48 - 60) 24/76 28.4 144 6.4 [4.0; 8.7] 10.2 [7.2; 13.2] 11.9 [8.5; 15.1] 16.1 [12.0; 20.0] 17.1 [12.8; 21.2] 18.4 [13.7; 22.7] 19.5 [14.4; 24.4] (370) (292) (228) (177) (141) (95) (50) Prior operations No relevant prior operations 836 56 (50 - 62) 26/74 28.7 207 4.5 [3.0; 6.0] 8.5 [6.4; 10.6] 10.4 [8.0; 12.7] 13.3 [10.5; 16.1] 15.4 [12.1; 18.5] 16.3 [12.8; 19.7] 18.4 [13.9; 22.6] (659) (518) (399) (295) (203) (128) (61) Table 49: Cumulative revision rates for different types of primary knee arthroplasties and diagnoses 106 EPRD Annual Report 2024 107  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival 5.3.2 Non-implant-related factors The patient’s body mass index also influences such arthroplasties is generally reflected in in primary knee arthroplasty knee arthroplasty outcomes (Figure 22). The the outcome. Particularly for unicondylar For knee arthroplasties, the risk of revision risk of revision surgery increases considerably arthroplasties, the risk of revision surgery surgery also largely depends on the patient’s with increasing BMI, though this association decreases in hospitals that perform more of age. As shown for standard TKAs in Fig- is even more pronounced for specific types of these types of procedures (Figure 23). How- ure 20, patients that are younger at the time hip arthroplasties (see Figure 8 for example). ever, this does not mean that hospitals with of the primary arthroplasty, also have higher lower case numbers inevitably achieve poorer CRRs. There is a correlation between the patient‘s outcomes and that hospitals with higher case general health status and the arthroplasty numbers always achieve better results. For most types of arthroplasties, men have a outcome. The EPRD has been recording significantly higher revision rate than women ASA classifications since 2020. These are (see Table 50). But this trend is reversed from the American Society of Anesthesiologists 12 the one-year time point after a unicondylar assessment of the patient’s physical status 11 © EPRD Annual Report 2024 knee arthroplasty (Figure 21). The underly- prior to surgery. Even though the earliest 10 Cumulative revision [%] 9 ing reasons are currently unclear, particularly ASA classification data only dates back to 8 given that men also have a higher risk of in- 3 years, after the primary arthroplasty, this 7 fection after a unicondylar knee arthroplasty variable already considerably influences uni- 6 5 compared to women. The observed differ- condylar arthroplasty outcomes, as shown 4 ence can therefore only be attributed to the in Table 50, for example. Patients with a 3 Knee 2 considerably lower risk of aseptic revisions. lower ASA classification – i.e. a better general 1 Unicondylar knee arthroplasties in male patients health status – are on average younger than 0 Unicondylar knee arthroplasties in female patients To shed light on the differences between men those with a higher classification. Yet despite 0 1 2 3 4 5 6 7 8 9 and women in terms of knee arthroplasty outcomes being worse for younger patients Years since primary outcomes, the EPRD website presents out- (see Figure 20), CRRs increase with increas- 28,682 23,005 18,262 14,455 10,907 7,632 4,785 2,524 966 Numbers comes for the different types of arthroplas- ing ASA classification. at risk 35,076 28,624 23,167 18.730 14,456 10,388 6,617 3,573 1,307 ties, other non-implant-related factors and implant characteristics for male and female Whether the hospital performing the pro- Figure 21: Cumulative revision rates for unicondylar knee arthroplasties by patient sex (p < 0.0001) subpopulations, see pages 172/173. cedure has extensive recent experience with 7 © EPRD Annual Report 2024 10 © EPRD Annual Report 2024 6 9 Cumulative revision [%] 8 5 Cumulative revision [%] 7 4 6 3 5 4 2 Standard TKAs in patients with BMI > 40 3 Standard TKAs in patients with BMI > 35 to 40 1 Standard TKAs in patients with BMI > 30 to 35 2 Standard TKAs in patients < 55 years Standard TKAs in patients with BMI > 25 to 30 Standard TKAs in patients between 55 and 64 years Standard TKAs in patients with BMI < 25 1 Standard TKAs in patients between 65 and 74 years 0 Standard TKAs in patients 75 years and older 0 0 1 2 3 4 5 6 0 1 2 3 4 5 6 7 8 9 Years since primary Years since primary 25,527 19,965 15,339 11,468 7,881 4,346 1,072 29,475 24,685 20,471 16,676 13,298 9,818 6,550 3,663 1,546 46,639 36,228 27,494 20,567 14,096 7,663 1,920 Numbers Numbers 106,799 86,893 69,943 56,158 43,708 31,772 20,963 11,790 4,936 1,382 at risk 92,762 72,490 55,111 41,458 28,409 15,567 3,889 at risk 144,973 118,181 95,636 78,336 62,073 45,825 30,579 17,506 7,333 2,014 109,651 85,762 65,445 49,095 33,743 18,247 4,645 143,110 118,206 96,574 79,512 62,230 44,455 28,525 15,250 5,727 1,277 46,304 35,779 26,759 19,931 13,510 7,393 1,833 Figure 20: Cumulative revision rates for standard total knee arthroplasties by age group (p < 0.0001) Figure 22: Cumulative revision rates for standard total knee arthroplasties by patient body mass index (p < 0.0001) 108 EPRD Annual Report 2024 109  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival 14 © EPRD Annual Report 2024 12 In brief: Cumulative revision [%] 10 8 • Being younger and having a higher BMI 6 increases the risk of revision surgery. 4 • Men are generally more likely to need 2 Primary unicondylar knee arthroplasty in hospitals with up to 30 such primary procedures per year revision than women, but this is reversed Primary unicondylar knee arthroplasty in hospitals with 31 to 100 such primary procedures per year Primary unicondylar knee arthroplasty in hospitals with more than 100 such primary procedures per year for unicondylar knee arthroplasty. 0 • Hospitals with higher annual volumes 0 1 2 3 4 5 6 7 8 9 tend to have lower revision rates, this is Years since primary particularly pronounced for unicondylar 15,489 12,576 10,359 8,463 6,564 4,757 3,059 1,614 680 Numbers arthroplasty. at risk 23,568 19,011 14,924 11,760 8,815 6,113 3,793 1,989 719 23,710 19,103 15,273 12,172 9,343 6,654 4,261 2,364 837 Figure 23: Cumulative revision rates for unicondylar knee arthroplasties6 by the hospital's annual volume of primary unicon- dylar knee arthroplasties (p< 0.0001) 6 The classifications in this report are based on the hospitals’ quality reports for 2022 and the corresponding IQTIG quality indicators listed therein. Knee Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category Standard TKAs 424,357 70 (62 - 77) 35/65 30.1 749 1.9 [1.9; 1.9] 3.1 [3.1; 3.2] 3.7 [3.7; 3.8] 4.2 [4.1; 4.2] 4.5 [4.4; 4.5] 4.7 [4.6; 4.8] 5.0 [4.9; 5.0] 5.2 [5.1; 5.3] 5.5 [5.4; 5.6] (347,965) (282,624) (230,682) (181,309) (131,870) (86,617) (48,209) (19,542) (5,149) Age group ≤ 54 years 29,475 52 (49 - 53) 36/64 33.2 719 2.7 [2.5; 2.9] 4.9 [4.6; 5.2] 6.2 [5.9; 6.5] 7.0 [6.7; 7.3] 7.6 [7.2; 7.9] 8.0 [7.6; 8.4] 8.5 [8.1; 8.9] 9.1 [8.5; 9.6] 9.5 [8.8; 10.1] (24,685) (20,471) (16,676) (13,298) (9,818) (6,550) (3,663) (1,546) (476) 55 to 64 years 106,799 60 (58 - 62) 39/61 32.0 741 2.0 [1.9; 2.1] 3.5 [3.4; 3.7] 4.4 [4.2; 4.5] 4.9 [4.7; 5.0] 5.3 [5.2; 5.5] 5.7 [5.5; 5.9] 6.0 [5.9; 6.2] 6.4 [6.2; 6.7] 6.8 [6.5; 7.1] (86,893) (69,943) (56,158) (43,708) (31,772) (20,963) (11,790) (4,936) (1,382) 65 to 74 years 144,973 70 (67 - 72) 34/66 30.6 743 1.7 [1.6; 1.7] 2.8 [2.7; 2.9] 3.4 [3.3; 3.5] 3.8 [3.6; 3.9] 4.0 [3.9; 4.1] 4.3 [4.1; 4.4] 4.5 [4.3; 4.6] 4.7 [4.6; 4.9] 5.0 [4.8; 5.2] (118,181) (95,636) (78,336) (62,073) (45,825) (30,579) (17,506) (7,333) (2,014) 75 to 84 years 130,800 78 (76 - 81) 32/68 28.3 743 1.9 [1.8; 2.0] 2.8 [2.7; 2.9] 3.2 [3.1; 3.3] 3.5 [3.4; 3.6] 3.6 [3.5; 3.8] 3.8 [3.7; 3.9] 3.9 [3.8; 4.0] 4.1 [3.9; 4.2] 4.1 [4.0; 4.3] (108,709) (89,204) (73,895) (58,105) (41,764) (26,942) (14,496) (5,476) (1,227) ≥ 85 years 12,310 86 (85 - 87) 31/69 26.7 699 2.1 [1.8; 2.3] 2.5 [2.2; 2.8] 2.8 [2.5; 3.1] 3.0 [2.6; 3.3] 3.1 [2.7; 3.4] 3.2 [2.8; 3.5] 3.3 [2.8; 3.7] 3.3 [2.8; 3.7] 3.3 [2.8; 3.7] (9,497) (7,370) (5,617) (4,125) (2,691) (1,583) (754) (251) (50) Sex Male 147,010 69 (61 - 76) 100/0 29.6 742 2.2 [2.1; 2.3] 3.3 [3.2; 3.4] 4.0 [3.9; 4.1] 4.4 [4.3; 4.5] 4.7 [4.6; 4.8] 5.0 [4.9; 5.1] 5.3 [5.1; 5.4] 5.6 [5.4; 5.8] 5.8 [5.5; 6.0] (118,866) (95,630) (77,099) (59,451) (42,422) (27,128) (14,732) (5,855) (1,568) Female 277,347 70 (63 - 77) 0/100 30.5 748 1.7 [1.7; 1.8] 3.0 [2.9; 3.0] 3.6 [3.5; 3.7] 4.0 [3.9; 4.1] 4.3 [4.2; 4.4] 4.6 [4.5; 4.7] 4.8 [4.7; 4.9] 5.1 [4.9; 5.2] 5.3 [5.2; 5.5] (229,099) (186,994) (153,583) (121,858) (89,448) (59,489) (33,477) (13,687) (3,581) Body-Mass-Index ≤ 25 46,304 75 (67 - 80) 31/69 23.6 716 1.6 [1.5; 1.7] 2.7 [2.5; 2.9] 3.3 [3.1; 3.5] 3.7 [3.5; 3.9] 4.0 [3.7; 4.2] 4.2 [3.9; 4.5] (35,779) (26,759) (19,931) (13,510) (7,393) (1,833) > 25 to 30 109,651 72 (64 - 78) 42/58 27.7 723 1.7 [1.6; 1.8] 2.7 [2.6; 2.9] 3.3 [3.2; 3.5] 3.7 [3.6; 3.9] 4.0 [3.9; 4.2] 4.2 [4.0; 4.3] (85,762) (65,445) (49,095) (33,743) (18,247) (4,645) > 30 to 35 92,762 69 (62 - 76) 36/64 32.1 717 1.8 [1.7; 1.8] 2.9 [2.8; 3.1] 3.6 [3.4; 3.7] 4.0 [3.8; 4.2] 4.3 [4.1; 4.4] 4.6 [4.4; 4.8] (72,490) (55,111) (41,458) (28,409) (15,567) (3,889) > 35 to 40 46,639 66 (60 - 72) 30/70 37.0 714 2.1 [2.0; 2.3] 3.5 [3.3; 3.6] 4.1 [3.9; 4.3] 4.6 [4.4; 4.9] 5.0 [4.7; 5.2] 5.3 [5.0; 5.6] (36,228) (27,494) (20,567) (14,096) (7,663) (1,920) above 40 25,527 62 (57 - 69) 23/77 42.9 708 2.8 [2.6; 3.1] 4.2 [3.9; 4.4] 5.0 [4.7; 5.3] 5.5 [5.1; 5.8] 5.8 [5.5; 6.2] 6.0 [5.6; 6.4] (19,965) (15,339) (11,468) (7,881) (4,346) (1,072) ASA status ASA 1 18,236 66 (59.5 - 74) 39/61 29.0 625 1.6 [1.4; 1.8] 2.8 [2.5; 3.1] 3.5 [3.2; 3.9] (12,440) (7,580) (1,794) Table 50: Cumulative revision rates for different types of primary knee arthroplasties by non-implant-related factors 110 EPRD Annual Report 2024 111  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category ASA status ASA 2 106,705 68 (61 - 75) 34/66 29.7 684 1.6 [1.5; 1.7] 2.8 [2.7; 2.9] 3.4 [3.3; 3.6] 3.9 [3.6; 4.2] (67,446) (33,962) (8,511) (190) ASA 3 61,238 72 (65 - 79) 37/63 31.2 674 2.3 [2.2; 2.5] 3.5 [3.3; 3.7] 4.4 [4.1; 4.6] 4.8 [4.4; 5.2] (38,300) (18,662) (4,605) (73) ASA 4 or 5 861 74 (67 - 80) 46/54 31.4 308 3.2 [1.9; 4.4] 3.6 [2.2; 5.0] 4.1 [2.4; 5.7] (546) (267) (64) Hospital size* Hospitals with low annual case volumes 170,025 70 (62 - 77) 35/65 30.4 523 2.2 [2.1; 2.3] 3.5 [3.4; 3.6] 4.1 [4.0; 4.2] 4.6 [4.4; 4.7] 4.9 [4.7; 5.0] 5.1 [5.0; 5.2] 5.4 [5.2; 5.5] 5.6 [5.5; 5.8] 6.0 [5.8; 6.3] (139,587) (113,349) (93,429) (73,777) (53,196) (34,282) (18,409) (6,906) (1,450) Hospitals with average annual case volumes 133,062 70 (62 - 77) 34/66 30.1 141 1.7 [1.7; 1.8] 2.9 [2.8; 3.0] 3.6 [3.5; 3.7] 4.1 [3.9; 4.2] 4.4 [4.2; 4.5] 4.7 [4.6; 4.8] 4.9 [4.8; 5.1] 5.2 [5.0; 5.4] 5.5 [5.2; 5.7] (109,006) (87,596) (71,015) (55,579) (40,622) (26,612) (14,623) (5,587) (1,130) Hospitals with high annual case volumes 111,766 69 (62 - 76) 35/65 30.0 46 1.6 [1.5; 1.7] 2.7 [2.6; 2.8] 3.3 [3.2; 3.4] 3.7 [3.6; 3.8] 3.9 [3.8; 4.1] 4.2 [4.1; 4.4] 4.4 [4.2; 4.6] 4.6 [4.4; 4.8] 4.8 [4.6; 5.0] (90,387) (73,359) (58,685) (45,418) (32,832) (22,142) (13,014) (6,076) (2,377) Constrained TKAs 19,949 74 (66 - 80) 24/76 28.9 690 4.2 [3.9; 4.5] 5.7 [5.3; 6.0] 6.4 [6.0; 6.8] 6.8 [6.4; 7.2] 7.2 [6.8; 7.6] 7.5 [7.1; 8.0] 7.8 [7.3; 8.3] 8.4 [7.7; 9.0] 8.9 [7.8; 10.0] (15,711) (12,482) (9,946) (7,650) (5,360) (3,447) (1,818) (735) (176) Age group ≤ 54 years 1,104 51 (47 - 53) 36/64 32.8 329 4.9 [3.6; 6.2] 7.3 [5.7; 9.0] 8.7 [6.9; 10.5] 9.9 [7.9; 11.9] 10.9 [8.7; 13.0] 11.7 [9.3; 14.1] 12.6 [9.9; 15.2] 12.6 [9.9; 15.2] (902) (734) (586) (472) (342) (233) (128) (55) 55 to 64 years 3,311 60 (58 - 63) 32/68 32.0 543 4.9 [4.2; 5.7] 6.9 [6.0; 7.9] 7.8 [6.8; 8.8] 8.4 [7.3; 9.5] 9.0 [7.8; 10.1] 9.1 [7.9; 10.2] 9.5 [8.2; 10.8] 9.5 [8.2; 10.8] (2,575) (2,033) (1,606) (1,263) (913) (597) (327) (135) 65 to 74 years 5,728 70 (68 - 72) 24/76 30.5 606 4.1 [3.6; 4.7] 5.7 [5.1; 6.3] 6.6 [5.9; 7.3] 7.1 [6.3; 7.8] 7.5 [6.7; 8.3] 7.8 [6.9; 8.6] 8.2 [7.2; 9.1] 9.0 [7.8; 10.2] 9.0 [7.8; 10.2] (4,524) (3,592) (2,894) (2,285) (1,635) (1,101) (612) (269) (60) 75 to 84 years 8,070 79 (77 - 82) 20/80 27.5 624 3.8 [3.3; 4.2] 5.0 [4.5; 5.5] 5.6 [5.0; 6.1] 5.7 [5.2; 6.3] 6.0 [5.4; 6.6] 6.4 [5.8; 7.1] 6.5 [5.9; 7.2] 7.2 [6.2; 8.2] 7.2 [6.2; 8.2] Knee (6,466) (5,189) (4,159) (3,144) (2,158) (1,350) (686) (256) (66) ≥ 85 years 1,736 87 (85 - 88) 17/83 25.8 493 4.2 [3.2; 5.2] 4.9 [3.8; 6.0] 5.3 [4.1; 6.4] 5.3 [4.1; 6.4] 5.3 [4.1; 6.4] 5.3 [4.1; 6.4] 5.3 [4.1; 6.4] (1,244) (934) (701) (486) (312) (166) (65) Sex Male 4,784 71 (62 - 79) 100/0 28.6 578 5.6 [4.9; 6.3] 7.5 [6.7; 8.3] 8.5 [7.7; 9.4] 8.8 [7.9; 9.7] 9.3 [8.4; 10.3] 9.6 [8.6; 10.6] 10.2 [9.0; 11.4] 10.9 [9.4; 12.5] (3,691) (2,911) (2,288) (1,748) (1,209) (795) (399) (156) Female 15,165 75 (67 - 81) 0/100 29.0 677 3.7 [3.4; 4.0] 5.1 [4.7; 5.4] 5.7 [5.3; 6.1] 6.2 [5.7; 6.6] 6.5 [6.1; 7.0] 6.9 [6.4; 7.3] 7.1 [6.5; 7.6] 7.6 [6.9; 8.2] 8.3 [7.0; 9.6] (12,020) (9,571) (7,658) (5,902) (4,151) (2,652) (1,419) (579) (140) Body-Mass-Index ≤ 25 3,598 79 (71 - 83) 20/80 23.0 567 3.4 [2.8; 4.0] 4.9 [4.1; 5.6] 5.5 [4.6; 6.3] 5.9 [5.0; 6.8] 6.1 [5.1; 7.1] 7.1 [5.7; 8.4] (2,655) (1,954) (1,390) (878) (467) (113) > 25 to 30 5,093 77 (69 - 81) 29/71 27.5 594 3.8 [3.3; 4.4] 5.3 [4.7; 6.0] 6.2 [5.4; 6.9] 6.4 [5.6; 7.1] 6.9 [6.0; 7.8] 7.2 [6.2; 8.1] (3,858) (2,862) (2,101) (1,427) (761) (222) > 30 to 35 3,586 73 (65 - 79) 25/75 32.0 523 3.8 [3.1; 4.4] 5.4 [4.6; 6.2] 6.0 [5.2; 6.9] 6.5 [5.6; 7.5] 7.0 [5.9; 8.1] 7.2 [6.1; 8.3] (2,751) (2,049) (1,519) (1,052) (547) (154) > 35 to 40 1,788 69 (61 - 75) 21/79 37.0 432 5.2 [4.2; 6.3] 7.0 [5.7; 8.3] 7.7 [6.4; 9.1] 8.2 [6.7; 9.6] 8.4 [6.9; 9.9] 8.4 [6.9; 9.9] (1,323) (1,014) (747) (519) (277) (90) above 40 1,186 64 (58 - 70) 16/84 43.8 366 5.2 [3.9; 6.5] 6.5 [5.1; 8.0] 8.0 [6.2; 9.7] 8.6 [6.7; 10.5] 8.6 [6.7; 10.5] 8.6 [6.7; 10.5] (921) (688) (514) (360) (202) (54) ASA status ASA 1 768 71 (63 - 79) 30/70 28.1 199 3.5 [2.1; 4.8] 5.2 [3.3; 7.0] 6.3 [3.9; 8.6] (498) (278) (59) ASA 2 3,953 72 (64 - 80) 24/76 28.3 507 3.3 [2.7; 3.8] 4.9 [4.1; 5.7] 5.1 [4.3; 5.9] (2,524) (1,289) (330) ASA 3 3,934 76 (68 - 82) 23/77 29.3 532 4.8 [4.0; 5.5] 5.9 [5.1; 6.8] 6.6 [5.5; 7.6] (2,354) (1,113) (268) Hospital size* Hospitals with low annual case volumes 10,621 75 (66 - 81) 24/76 29.0 474 4.3 [3.9; 4.7] 5.9 [5.4; 6.3] 6.7 [6.2; 7.2] 7.0 [6.5; 7.6] 7.5 [6.9; 8.1] 7.9 [7.3; 8.6] 8.3 [7.6; 9.0] 9.1 [8.1; 10.0] (8,336) (6,643) (5,326) (4,100) (2,855) (1,807) (951) (327) Hospitals with average annual case volumes 5,655 74 (66 - 81) 23/77 28.7 139 4.4 [3.9; 5.0] 5.9 [5.2; 6.5] 6.5 [5.8; 7.2] 7.0 [6.2; 7.7] 7.5 [6.7; 8.3] 7.6 [6.8; 8.5] 7.9 [7.0; 8.8] 8.6 [7.3; 9.9] (4,462) (3,525) (2,764) (2,084) (1,422) (885) (432) (169) Hospitals with high annual case volumes 3,406 73 (63 - 79) 27/73 28.7 45 3.3 [2.7; 3.9] 4.6 [3.8; 5.4] 5.2 [4.3; 6.0] 5.4 [4.6; 6.3] 5.6 [4.7; 6.5] 5.9 [4.9; 6.8] 6.0 [5.0; 7.0] 6.0 [5.0; 7.0] 6.0 [5.0; 7.0] (2,669) (2,090) (1,652) (1,280) (932) (650) (374) (203) (69) Unicondylar knee arthroplasties 63,758 63 (57 - 72) 45/55 29.4 674 2.9 [2.8; 3.0] 4.7 [4.5; 4.9] 5.7 [5.5; 5.9] 6.6 [6.4; 6.8] 7.2 [7.0; 7.5] 8.0 [7.7; 8.2] 8.5 [8.2; 8.9] 9.2 [8.8; 9.6] 9.6 [9.1; 10.1] (51,629) (41,429) (33,185) (25,363) (18,020) (11,402) (6,097) (2,273) (741) Age group ≤ 54 years 9,942 51 (49 - 53) 41/59 31.4 603 3.5 [3.1; 3.8] 6.1 [5.6; 6.6] 7.6 [7.1; 8.2] 9.0 [8.4; 9.7] 10.0 [9.3; 10.7] 11.1 [10.3; 11.9] 11.8 [10.9; 12.7] 12.6 [11.5; 13.6] 13.0 [11.7; 14.3] (8,252) (6,774) (5,429) (4,186) (3,027) (1,941) (1,066) (452) (166) 55 to 64 years 24,115 60 (57 - 62) 49/51 30.3 640 2.8 [2.6; 3.0] 4.9 [4.6; 5.2] 6.0 [5.7; 6.4] 7.0 [6.6; 7.4] 7.6 [7.2; 8.1] 8.6 [8.1; 9.1] 9.3 [8.8; 9.9] 10.1 [9.4; 10.8] 10.5 [9.6; 11.3] (19,329) (15,192) (11,854) (8,906) (6,318) (3,995) (2,121) (773) (251) Table 50 (continued) 112 EPRD Annual Report 2024 113  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category Age group 65 to 74 years 18,468 69 (67 - 72) 43/57 29.1 601 2.7 [2.4; 2.9] 4.1 [3.8; 4.4] 5.0 [4.6; 5.3] 5.7 [5.3; 6.1] 6.2 [5.7; 6.6] 6.6 [6.1; 7.1] 7.1 [6.6; 7.6] 7.8 [7.1; 8.4] 8.2 [7.3; 9.2] (14,843) (11,873) (9,614) (7,437) (5,310) (3,417) (1,873) (683) (224) 75 to 84 years 10,502 78 (76 - 80) 44/56 27.7 507 3.0 [2.7; 3.4] 4.0 [3.6; 4.4] 4.6 [4.2; 5.1] 5.1 [4.7; 5.6] 5.5 [5.0; 6.0] 6.1 [5.5; 6.7] 6.4 [5.8; 7.0] 6.9 [6.0; 7.8] 6.9 [6.0; 7.8] (8,634) (7,170) (5,960) (4,592) (3,208) (1,957) (983) (346) (91) ≥ 85 years 731 86 (85 - 87) 42/58 26.4 208 2.8 [1.5; 4.0] 3.4 [2.0; 4.8] 3.6 [2.1; 5.1] 4.0 [2.3; 5.6] 4.0 [2.3; 5.6] 4.7 [2.5; 6.9] 4.7 [2.5; 6.9] (571) (420) (328) (242) (157) (92) (54) Sex Male 28,682 63 (57 - 71) 100/0 29.4 646 2.8 [2.6; 3.0] 4.3 [4.1; 4.6] 5.2 [4.9; 5.5] 6.0 [5.7; 6.3] 6.4 [6.1; 6.8] 7.2 [6.8; 7.6] 7.7 [7.2; 8.1] 8.1 [7.6; 8.7] 8.7 [7.9; 9.6] (23,005) (18,262) (14,455) (10,907) (7,632) (4,785) (2,524) (966) (320) Female 35,076 64 (57 - 72) 0/100 29.7 650 3.0 [2.8; 3.1] 5.0 [4.7; 5.2] 6.1 [5.8; 6.4] 7.1 [6.8; 7.4] 7.8 [7.5; 8.1] 8.6 [8.2; 9.0] 9.2 [8.8; 9.6] 10.1 [9.5; 10.6] 10.2 [9.6; 10.9] (28,624) (23,167) (18,730) (14,456) (10,388) (6,617) (3,573) (1,307) (421) Body-Mass-Index ≤ 25 7,224 67 (59 - 75) 38/62 23.7 552 2.5 [2.2; 2.9] 4.5 [3.9; 5.0] 5.3 [4.7; 5.9] 6.4 [5.7; 7.1] 7.1 [6.3; 7.9] 8.3 [7.1; 9.4] (5,575) (4,077) (2,942) (1,916) (1,026) (291) > 25 to 30 18,086 65 (59 - 73) 52/48 27.7 605 2.4 [2.2; 2.6] 4.0 [3.7; 4.3] 5.1 [4.7; 5.5] 5.8 [5.4; 6.2] 6.3 [5.8; 6.7] 7.2 [6.5; 7.8] (13,975) (10,574) (7,736) (5,061) (2,760) (713) > 30 to 35 13,862 63 (57 - 70) 47/53 32.1 595 3.2 [2.9; 3.5] 5.0 [4.6; 5.4] 6.2 [5.7; 6.7] 7.0 [6.5; 7.5] 7.9 [7.3; 8.6] 9.0 [8.1; 9.8] (10,702) (8,059) (5,937) (3,947) (2,134) (550) > 35 to 40 6,042 60 (55 - 67) 41/59 36.9 518 3.3 [2.8; 3.7] 5.3 [4.7; 5.9] 6.3 [5.6; 7.0] 7.1 [6.3; 7.9] 7.7 [6.8; 8.6] 8.3 [7.2; 9.3] (4,644) (3,497) (2,542) (1,638) (887) (220) above 40 2,367 58 (53 - 63) 31/69 42.4 393 4.3 [3.4; 5.1] 6.4 [5.3; 7.4] 7.0 [5.8; 8.1] 8.1 [6.7; 9.4] 9.8 [8.1; 11.4] 11.1 [8.5; 13.6] (1,827) (1,372) (1,016) (684) (391) (88) ASA status ASA 1 3,800 61 (55 - 67) 49/51 28.2 443 2.3 [1.8; 2.8] 3.4 [2.8; 4.1] 4.8 [3.7; 5.8] Knee (2,588) (1,624) (352) ASA 2 19,475 63 (57 - 70) 45/55 29.4 563 2.8 [2.5; 3.0] 4.6 [4.2; 4.9] 5.7 [5.2; 6.2] (12,235) (6,031) (1,426) ASA 3 6,162 67 (60 - 75) 51/49 31.1 481 3.2 [2.7; 3.7] 5.0 [4.3; 5.7] 6.0 [5.1; 6.8] (3,972) (2,014) (515) Hospital size* Hospitals with low annual case volumes 15,489 62 (56 - 70) 46/54 29.6 453 3.7 [3.4; 4.0] 6.3 [5.9; 6.7] 7.8 [7.3; 8.2] 8.9 [8.4; 9.4] 9.9 [9.3; 10.4] 10.9 [10.2; 11.5] 11.7 [11.0; 12.4] 12.3 [11.5; 13.1] 13.1 [11.9; 14.3] (12,576) (10,359) (8,463) (6,564) (4,757) (3,059) (1,614) (680) (176) Hospitals with average annual case volumes 23,568 63 (57 - 72) 46/54 29.4 163 2.9 [2.6; 3.1] 4.8 [4.5; 5.1] 6.0 [5.6; 6.3] 6.9 [6.5; 7.3] 7.6 [7.1; 8.0] 8.4 [7.9; 8.8] 8.9 [8.3; 9.4] 9.8 [9.1; 10.6] 10.0 [9.2; 10.8] (19,011) (14,924) (11,760) (8,815) (6,113) (3,793) (1,989) (719) (178) Hospitals with high annual case volumes 23,710 65 (58 - 73) 43/57 29.4 31 2.4 [2.2; 2.6] 3.5 [3.3; 3.8] 4.1 [3.9; 4.4] 4.8 [4.5; 5.1] 5.1 [4.7; 5.4] 5.6 [5.2; 6.0] 6.1 [5.6; 6.5] 6.4 [5.9; 7.0] 6.6 [6.0; 7.3] (19,103) (15,273) (12,172) (9,343) (6,654) (4,261) (2,364) (837) (384) Patellofemoral knee arthroplasty 1,026 55 (49 - 61) 26/74 28.4 224 4.7 [3.3; 6.0] 8.5 [6.6; 10.4] 10.8 [8.6; 12.9] 14.0 [11.3; 16.5] 16.2 [13.2; 19.0] 17.3 [14.0; 20.3] 18.8 [15.0; 22.4] (816) (641) (496) (371) (260) (168) (83) Age group ≤ 54 years 498 48 (44 - 51) 24/76 28.7 165 5.2 [3.1; 7.2] 9.5 [6.7; 12.3] 11.7 [8.5; 14.8] 17.3 [13.1; 21.3] 19.5 [14.8; 23.9] 21.5 [16.4; 26.3] (410) (317) (243) (180) (131) (86) 55 to 64 years 361 59 (57 - 61) 26/74 28.7 133 4.5 [2.2; 6.8] 9.3 [5.8; 12.6] 11.5 [7.6; 15.3] 12.7 [8.5; 16.8] 15.3 [10.2; 20.2] (273) (206) (161) (120) (83) Sex Female 755 54 (48 - 61) 0/100 28.2 185 4.7 [3.1; 6.3] 8.3 [6.1; 10.4] 10.2 [7.7; 12.6] 12.9 [9.9; 15.7] 14.8 [11.5; 18.1] 15.8 [12.2; 19.3] 16.8 [12.7; 20.6] (594) (462) (365) (278) (195) (123) (61) ASA status ASA 2 326 55 (49 - 62) 26/74 28.6 121 2.2 [0.4; 3.9] 6.2 [2.5; 9.8] (205) (101) Hospital size* Hospitals with low annual case volumes 360 54 (48 - 60) 32/68 28.4 132 6.0 [3.4; 8.6] 10.5 [6.9; 13.9] 13.7 [9.5; 17.6] 15.4 [10.8; 19.7] 16.9 [11.9; 21.5] 18.0 [12.6; 23.1] (286) (213) (163) (122) (88) (50) Hospitals with high annual case volumes 361 56 (49 - 62) 25/75 28.2 29 4.1 [1.9; 6.2] 7.2 [4.2; 10.1] 9.8 [6.2; 13.2] 13.0 [8.7; 17.1] 14.3 [9.7; 18.7] 14.3 [9.7; 18.7] (290) (231) (182) (147) (108) (78) * The classifications in this report are based on the hospitals’ quality reports for 2022 and the corresponding primary knee arthroplasty IQTIG quality indicators listed therein. For TKAs, the case number cutoffs for classification as low case volume is up to 200 cases, for medium volume 201 to 500 cases and for the high volume category greater than 500 corresponding procedures per year; for unicondylar arthroplasties, the cutoffs are up to 30, 31 to 100 and greater than 100 corresponding procedures per year. Table 50 (continued) 114 EPRD Annual Report 2024 115  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival 5.3.3 Impact of implant character- outcomes with their mobile bearings com- 7 © EPRD Annual Report 2024 istics in primary knee arthroplasty pared to their analogous fixed bearing vari- 6 Among the standard TKAs there are marked ants (see Table 52). Cumulative revision [%] 5 differences between individual knee systems. 4 CR systems reach their endpoints later than The EPRD redefined the endpoint of arthro- other knee systems (Figure 24). However, plasty at the beginning of 2024. A comple- 3 it should be noted that in some hospitals, mentary patellar resurfacing surgery now 2 pure CR systems are probably only used also qualifies as a relevant revision, which 1 Standard TKA with mobile bearing in patients with good ligament conditions is included in the CRR calculations (refer to 0 Standard TKA with fixed bearing and stable joints, while other systems are explanation on page 24). This change has al- more likely to be preferred in cases with tered the risk of revision surgery for stand- 0 1 2 3 4 5 6 7 8 9 Years since primary poorer baseline conditions. When the anal- ard TKAs without or with patellar resurfac- ysis focuses on hospitals that specialise in a ing at the time of the primary arthroplasty. Numbers at risk 58,218 50,979 43,914 37,702 31,097 23,908 16,462 9,326 3,452 751 366,139 296,986 238,710 192,980 150,212 107,962 70,155 38,883 16,090 4,398 knee system that is used in at least 80% of The revision rates for TKAs without primary standard TKAs, the outcome differences are patellar resurfacing are now overall higher Figure 25: Cumulative revision rates for standard total knee arthroplasties by bearing mobility (p < 0.0001) smaller. The outcomes for CR and CS sys- compared to arthroplasties with primary pa- tems no longer differ. tellar resurfacing (Figure 26). However, this has not led the EPRD – contrary to some rec- 7 Total knee arthroplasties with fixed bear- ommendations – to extrapolate that primary © EPRD Annual Report 2024 Knee 6 ings have significantly lower revision rates arthroplasties should all include patellar re- Cumulative revision [%] than systems with mobile bearings (Fig- surfacing [5]. The EPRD 2022 annual report 5 ure 25). This observation also holds true addressed this topic in detail and noted that 4 for hospitals that specialise in one type of there are major differences between individ- 3 bearing mobility. However, the outcomes ual manufacturers and systems [6]. The cur- 2 for fixed and mobile bearings differ consid- rent EPRD report therefore presents arthro- 1 erably across the specific implant systems. plasty outcomes with and without primary Standard TKA without patellar resurfacing at primary TKA Standard TKA with patellar resurfacing at primary TKA Several specific systems achieve even better patellar resurfacing separately for specific 0 0 1 2 3 4 5 6 7 8 9 Years since primary 7 © EPRD Annual Report 2024 Numbers 378,276 309,583 251,244 205,530 161,875 118,078 77,724 43,275 17,513 4,650 6 at risk 46,081 38,382 31,380 25,152 19,434 13,792 8,893 4,934 2,029 Cumulative revision [%] 5 Figure 26: Cumulative revision rates for standard primary total knee arthroplasties with and without patellar resurfacing at 4 primary TKA (p < 0.0001) 3 2 Posterior-stabilised standard TKAs Cruciate-retaining/sacrificing standard TKAs implant systems in Section 5.3.4 and recom- ponents based on physically treated zirco- 1 Pivot-type standard TKAs Cruciate-sacrificing standard TKAs mends considering the appropriate strategy nium alloy. Both types of modified bearing 0 Cruciate-retaining standard TKAs for each individual implant system. surfaces are reported to have improved fric- 0 1 2 3 4 5 6 7 8 9 tion characteristics and release fewer metal Years since primary The choice of femoral bearing materials also ions. Although arthroplasties with coated 100,243 79,738 62,648 49,389 37,585 26,360 16,755 9,160 3,950 1,355 greatly influences arthroplasty outcomes. or ceramicised femoral bearing surfaces are 50,070 41,995 34,839 29,093 23,271 17,147 11,342 6,265 2,465 619 Most femoral components of knee systems standard in some hospitals, in others they are are made from cobalt-chromium-molyb- predominantly used for patients with a con- Numbers at risk 12,980 9,192 6,464 4,834 3,524 2,429 1,526 775 53,298 43,756 35,756 29,482 23,279 17,314 11,510 6,364 2,360 511 207,766 173,284 142,917 117,884 93,650 68,620 45,484 25,645 10,501 2,631 denum alloys. A small proportion of these firmed or suspected metal hypersensitivity. femoral knee components have a ceramic This may limit the comparability of outcomes Figure 24: Cumulative revision rates for standard total knee arthroplasties by knee system (p < 0.0001). Confidence intervals coating on the bearing surface. Furthermore, (also refer to [7]). In the EPRD, both types of have been omitted for clarity. there are so-called ceramicised femoral com- modified femoral components show higher 116 EPRD Annual Report 2024 117  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival 14 © EPRD Annual Report 2024 CRRs than components without a modified 12 bearing surface. The difference cannot be en- In brief: tirely attributed to patients with unmodified Cumulative revision [%] 10 metal knee components being older on av- • To date, CR and CS systems have the 8 erage. Table 51 correlates knee arthroplasty lowest CRRs. 6 outcomes with implant characteristics. • In the early post-operative years, standard 4 TKAs with fixed bearings generally have 2 lower CRRs. Unicondylar knee arthroplasty with coated or ceramicised metal femoral bearing surface Unicondylar knee arthroplasty with uncoated metal femoral bearing surface 0 • Whether or not primary patellar resurfac- 0 1 2 3 4 5 6 7 8 9 ing improves outcomes is highly depend- Years since primary ent on the implant system used. Numbers 6,054 5,064 4,196 3,470 2,611 1,766 1,072 540 at risk 57,704 46,565 37,233 29,715 22,752 16,254 10,330 5,557 2,061 665 Figure 27: Cumulative revision rates for unicondylar knee arthroplasties by material of the femoral bearing surface (p < 0.001) Cumulative revision rates after ... Type of Knee Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category Standard TKAs 424,357 70 (62 - 77) 35/65 30.1 749 1.9 [1.9; 1.9] 3.1 [3.1; 3.2] 3.7 [3.7; 3.8] 4.2 [4.1; 4.2] 4.5 [4.4; 4.5] 4.7 [4.6; 4.8] 5.0 [4.9; 5.0] 5.2 [5.1; 5.3] 5.5 [5.4; 5.6] (347,965) (282,624) (230,682) (181,309) (131,870) (86,617) (48,209) (19,542) (5,149) Bearing mobility Fixed bearing 366,139 70 (62 - 77) 35/65 30.1 738 1.8 [1.8; 1.9] 3.0 [3.0; 3.1] 3.7 [3.6; 3.7] 4.1 [4.0; 4.1] 4.4 [4.3; 4.4] 4.6 [4.6; 4.7] 4.9 [4.8; 5.0] 5.2 [5.1; 5.3] 5.5 [5.3; 5.6] (296,986) (238,710) (192,980) (150,212) (107,962) (70,155) (38,883) (16,090) (4,398) Mobile bearing 58,218 70 (63 - 77) 34/66 30.0 350 2.2 [2.1; 2.3] 3.6 [3.5; 3.8] 4.3 [4.1; 4.5] 4.7 [4.5; 4.9] 5.0 [4.8; 5.2] 5.2 [5.0; 5.4] 5.4 [5.2; 5.6] 5.6 [5.4; 5.9] 5.7 [5.4; 6.0] (50,979) (43,914) (37,702) (31,097) (23,908) (16,462) (9,326) (3,452) (751) Bearing Uncoated metal / PE 170,916 71 (63 - 77) 36/64 30.1 555 1.8 [1.7; 1.8] 2.8 [2.7; 2.9] 3.4 [3.3; 3.5] 3.8 [3.7; 3.9] 4.0 [3.9; 4.2] 4.3 [4.2; 4.4] 4.6 [4.5; 4.7] 4.9 [4.8; 5.1] 5.3 [5.0; 5.5] (142,147) (116,947) (96,701) (76,870) (57,080) (38,164) (21,919) (9,165) (2,570) Uncoated metal / mXLPE 141,606 71 (63 - 77) 36/64 30.0 485 1.9 [1.9; 2.0] 3.2 [3.1; 3.3] 3.8 [3.7; 3.9] 4.2 [4.1; 4.3] 4.5 [4.3; 4.6] 4.7 [4.6; 4.8] 4.9 [4.7; 5.0] 5.1 [5.0; 5.3] 5.3 [5.1; 5.5] (119,718) (100,569) (84,401) (67,503) (49,150) (32,403) (17,908) (7,116) (1,752) Uncoated metal / hXLPE 39,939 68 (61 - 76) 33/67 30.4 417 1.9 [1.8; 2.1] 3.2 [3.0; 3.3] 3.8 [3.5; 4.0] 4.2 [3.9; 4.4] 4.5 [4.2; 4.7] 4.8 [4.5; 5.1] 4.9 [4.6; 5.2] 5.0 [4.7; 5.4] 5.2 [4.8; 5.6] (31,204) (24,295) (18,646) (14,158) (9,842) (6,142) (3,323) (1,429) (324) Uncoated metal / hXLPE+antioxidant 36,471 69 (62 - 76) 38/62 30.1 305 1.8 [1.7; 2.0] 3.0 [2.8; 3.2] 3.5 [3.3; 3.7] 3.9 [3.7; 4.2] 4.2 [4.0; 4.5] 4.6 [4.3; 4.9] 4.7 [4.4; 5.1] 4.7 [4.4; 5.1] 4.7 [4.4; 5.1] (26,549) (18,561) (13,157) (9,090) (6,012) (3,785) (1,965) (705) (171) Coated metal / mXLPE 12,641 66 (59 - 73) 14/86 31.2 406 2.3 [2.0; 2.6] 4.5 [4.1; 4.8] 5.5 [5.1; 6.0] 6.1 [5.6; 6.6] 6.8 [6.2; 7.3] 7.3 [6.7; 7.9] 7.7 [7.1; 8.4] 8.0 [7.2; 8.7] 8.0 [7.2; 8.7] (10,390) (8,395) (6,931) (5,327) (3,762) (2,322) (1,126) (415) (82) Ceramicised metal / PE 10,154 65 (59 - 73) 18/82 31.2 266 2.1 [1.8; 2.4] 4.1 [3.7; 4.5] 5.1 [4.6; 5.6] 5.4 [4.9; 5.9] 5.7 [5.2; 6.3] 5.9 [5.3; 6.5] 6.5 [5.8; 7.2] 6.8 [6.0; 7.7] 6.8 [6.0; 7.7] (8,041) (6,211) (4,730) (3,597) (2,599) (1,680) (960) (464) (221) Coated metal / PE 6,192 67 (60 - 75) 19/81 30.9 250 2.6 [2.2; 3.1] 4.7 [4.1; 5.2] 5.7 [5.1; 6.4] 6.5 [5.8; 7.3] 7.0 [6.2; 7.8] 7.7 [6.8; 8.6] 7.9 [7.0; 8.9] 8.8 [7.6; 10.0] (4,790) (3,589) (2,818) (2,217) (1,639) (1,142) (653) (201) Ceramicised metal / hXLPE 4,922 65 (58 - 73) 27/73 30.8 147 2.9 [2.5; 3.4] 5.1 [4.5; 5.8] 6.3 [5.6; 7.1] 7.4 [6.6; 8.2] 7.9 [7.0; 8.8] 8.4 [7.5; 9.4] 8.4 [7.5; 9.4] (4,136) (3,410) (2,863) (2,279) (1,643) (903) (317) Coated metal / hXLPE+antioxidant 1,061 65 (59 - 72) 10/90 31.5 62 1.6 [0.8; 2.4] 3.0 [1.8; 4.2] 4.5 [2.9; 6.1] 4.9 [3.1; 6.7] 4.9 [3.1; 6.7] (782) (527) (345) (190) (83) Femoral articulating surface Uncoated metal 389,205 70 (63 - 77) 36/64 30.1 744 1.8 [1.8; 1.9] 3.0 [2.9; 3.0] 3.6 [3.5; 3.7] 4.0 [3.9; 4.1] 4.3 [4.2; 4.3] 4.5 [4.4; 4.6] 4.7 [4.7; 4.8] 5.0 [4.9; 5.1] 5.3 [5.1; 5.4] (319,689) (260,381) (212,905) (167,621) (122,084) (80,494) (45,115) (18,415) (4,817) Coated metal 19,934 66 (59 - 74) 15/85 31.1 545 2.4 [2.2; 2.6] 4.4 [4.1; 4.8] 5.5 [5.2; 5.9] 6.2 [5.8; 6.6] 6.8 [6.3; 7.2] 7.3 [6.8; 7.8] 7.7 [7.2; 8.2] 8.2 [7.5; 8.8] 8.3 [7.6; 9.0] (15,980) (12,518) (10,094) (7,734) (5,484) (3,505) (1,802) (620) (110) Ceramicised metal 15,076 65 (58 - 73) 21/79 31.2 295 2.4 [2.1; 2.6] 4.5 [4.1; 4.8] 5.5 [5.1; 5.9] 6.1 [5.7; 6.6] 6.5 [6.0; 7.0] 6.8 [6.3; 7.3] 7.2 [6.6; 7.8] 7.5 [6.8; 8.3] 7.5 [6.8; 8.3] (12,177) (9,621) (7,593) (5,876) (4,242) (2,583) (1,277) (503) (222) Tibial articulating surface PE 187,404 70 (62 - 77) 35/65 30.1 620 1.8 [1.7; 1.9] 2.9 [2.9; 3.0] 3.5 [3.4; 3.6] 3.9 [3.8; 4.0] 4.2 [4.1; 4.3] 4.5 [4.4; 4.6] 4.8 [4.7; 4.9] 5.1 [5.0; 5.3] 5.5 [5.3; 5.7] (155,097) (126,851) (104,339) (82,762) (61,378) (41,021) (23,547) (9,834) (2,819) mXLPE 154,247 71 (63 - 77) 34/66 30.1 526 2.0 [1.9; 2.0] 3.3 [3.2; 3.4] 3.9 [3.8; 4.0] 4.4 [4.2; 4.5] 4.7 [4.5; 4.8] 4.9 [4.8; 5.0] 5.1 [5.0; 5.2] 5.3 [5.2; 5.5] 5.5 [5.3; 5.7] (130,108) (108,964) (91,332) (72,830) (52,912) (34,725) (19,034) (7,531) (1,834) Table 51: Cumulative revision rates for different types and characteristics of primary knee arthroplasties 118 EPRD Annual Report 2024 119  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category Tibial articulating surface hXLPE 44,861 68 (61 - 75) 32/68 30.4 435 2.1 [1.9; 2.2] 3.4 [3.2; 3.6] 4.1 [3.9; 4.3] 4.6 [4.3; 4.8] 4.9 [4.6; 5.1] 5.2 [5.0; 5.5] 5.4 [5.1; 5.6] 5.5 [5.2; 5.8] 5.6 [5.2; 6.0] (35,340) (27,705) (21,509) (16,437) (11,485) (7,045) (3,640) (1,468) (325) hXLPE+antioxidant 37,532 69 (62 - 76) 38/62 30.2 313 1.8 [1.7; 2.0] 3.0 [2.8; 3.2] 3.5 [3.3; 3.8] 3.9 [3.7; 4.2] 4.3 [4.0; 4.5] 4.6 [4.3; 4.9] 4.8 [4.4; 5.1] 4.8 [4.4; 5.1] 4.8 [4.4; 5.1] (27,331) (19,088) (13,502) (9,280) (6,095) (3,826) (1,988) (709) (171) Knee system CR 207,766 70 (62 - 77) 36/64 30.1 675 1.7 [1.6; 1.7] 2.7 [2.6; 2.8] 3.2 [3.2; 3.3] 3.6 [3.5; 3.7] 3.9 [3.8; 4.0] 4.1 [4.0; 4.2] 4.3 [4.2; 4.4] 4.6 [4.4; 4.7] 4.8 [4.6; 5.0] (173,284) (142,917) (117,884) (93,650) (68,620) (45,484) (25,645) (10,501) (2,631) PS 100,243 70 (62 - 77) 33/67 30.1 636 2.3 [2.2; 2.4] 3.8 [3.7; 4.0] 4.6 [4.5; 4.8] 5.1 [5.0; 5.3] 5.5 [5.3; 5.6] 5.8 [5.6; 6.0] 6.1 [5.9; 6.4] 6.5 [6.3; 6.8] 6.9 [6.6; 7.3] (79,738) (62,648) (49,389) (37,585) (26,360) (16,755) (9,160) (3,950) (1,355) CS 53,298 71 (63 - 77) 31/69 30.1 415 1.8 [1.7; 1.9] 3.0 [2.8; 3.1] 3.6 [3.4; 3.8] 4.0 [3.8; 4.2] 4.3 [4.1; 4.5] 4.7 [4.5; 4.9] 5.0 [4.7; 5.2] 5.2 [4.9; 5.5] 5.6 [5.2; 6.0] (43,756) (35,756) (29,482) (23,279) (17,314) (11,510) (6,364) (2,360) (511) CR/CS 50,070 69 (62 - 76) 35/65 30.0 331 2.1 [2.0; 2.2] 3.5 [3.4; 3.7] 4.2 [4.1; 4.4] 4.7 [4.5; 4.9] 5.0 [4.8; 5.2] 5.2 [4.9; 5.4] 5.4 [5.1; 5.6] 5.6 [5.3; 5.9] 5.7 [5.4; 6.1] (41,995) (34,839) (29,093) (23,271) (17,147) (11,342) (6,265) (2,465) (619) Pivot 12,980 70 (62 - 76) 37/63 30.1 137 2.2 [1.9; 2.5] 3.4 [3.0; 3.7] 4.0 [3.5; 4.4] 4.2 [3.8; 4.7] 4.7 [4.2; 5.2] 5.1 [4.6; 5.7] 5.4 [4.8; 6.0] 5.9 [5.0; 6.8] (9,192) (6,464) (4,834) (3,524) (2,429) (1,526) (775) (266) Patella Without patellar resurfacing 378,276 70 (62 - 77) 35/65 30.1 747 1.9 [1.9; 1.9] 3.2 [3.1; 3.2] 3.8 [3.7; 3.9] 4.2 [4.2; 4.3] 4.5 [4.4; 4.6] 4.8 [4.7; 4.9] 5.0 [4.9; 5.1] 5.3 [5.2; 5.4] 5.6 [5.4; 5.7] (309,583) (251,244) (205,530) (161,875) (118,078) (77,724) (43,275) (17,513) (4,650) With patellar resurfacing 46,081 70 (62 - 77) 32/68 30.4 521 1.8 [1.7; 1.9] 2.7 [2.6; 2.9] 3.2 [3.1; 3.4] 3.6 [3.4; 3.8] 3.9 [3.7; 4.1] 4.2 [4.0; 4.4] 4.4 [4.2; 4.7] 4.6 [4.3; 4.9] 4.8 [4.4; 5.2] (38,382) (31,380) (25,152) (19,434) (13,792) (8,893) (4,934) (2,029) (499) Fixation Cemented 398,587 70 (62 - 77) 34/66 30.1 748 1.9 [1.8; 1.9] 3.1 [3.0; 3.2] 3.7 [3.7; 3.8] 4.2 [4.1; 4.2] 4.5 [4.4; 4.5] 4.7 [4.6; 4.8] 5.0 [4.9; 5.1] 5.2 [5.1; 5.3] 5.5 [5.3; 5.6] (325,317) (262,857) (213,461) (166,784) (120,416) (78,624) (43,517) (17,607) (4,602) Hybrid 20,043 70 (62 - 76) 39/61 30.2 228 2.0 [1.8; 2.2] 3.0 [2.8; 3.3] 3.6 [3.3; 3.9] 3.9 [3.7; 4.2] 4.2 [3.9; 4.5] 4.5 [4.2; 4.8] 4.7 [4.4; 5.1] 5.1 [4.7; 5.6] 5.8 [5.2; 6.4] Knee (17,836) (15,790) (13,918) (11,864) (9,430) (6,667) (3,970) (1,678) (471) Uncemented 5,405 68 (60 - 75) 34/66 30.1 221 2.2 [1.8; 2.6] 3.6 [3.0; 4.1] 4.4 [3.8; 5.0] 4.8 [4.1; 5.4] 5.0 [4.4; 5.7] 5.2 [4.5; 5.9] 5.3 [4.6; 6.0] 5.6 [4.7; 6.4] 5.6 [4.7; 6.4] (4,512) (3,701) (3,061) (2,475) (1,900) (1,273) (707) (256) (76) Constrained TKAs 19,949 74 (66 - 80) 24/76 28.9 690 4.2 [3.9; 4.5] 5.7 [5.3; 6.0] 6.4 [6.0; 6.8] 6.8 [6.4; 7.2] 7.2 [6.8; 7.6] 7.5 [7.1; 8.0] 7.8 [7.3; 8.3] 8.4 [7.7; 9.0] 8.9 [7.8; 10.0] (15,711) (12,482) (9,946) (7,650) (5,360) (3,447) (1,818) (735) (176) Bearing mobility Fixed bearing 19,949 74 (66 - 80) 24/76 28.9 690 4.2 [3.9; 4.5] 5.7 [5.3; 6.0] 6.4 [6.0; 6.8] 6.8 [6.4; 7.2] 7.2 [6.8; 7.6] 7.5 [7.1; 8.0] 7.8 [7.3; 8.3] 8.4 [7.7; 9.0] 8.9 [7.8; 10.0] (15,711) (12,482) (9,946) (7,650) (5,360) (3,447) (1,818) (735) (176) Bearing Uncoated metal / PE 13,239 75 (67 - 81) 24/76 28.6 587 4.1 [3.7; 4.4] 5.5 [5.1; 5.9] 6.2 [5.8; 6.7] 6.5 [6.1; 7.0] 7.0 [6.5; 7.5] 7.3 [6.8; 7.9] 7.6 [7.0; 8.1] 8.3 [7.5; 9.1] 8.5 [7.6; 9.4] (10,460) (8,343) (6,710) (5,238) (3,679) (2,396) (1,257) (515) (122) Uncoated metal / mXLPE 3,676 74 (66 - 80) 25/75 29.0 300 4.2 [3.5; 4.8] 5.6 [4.8; 6.3] 6.4 [5.5; 7.3] 6.8 [5.9; 7.7] 7.0 [6.1; 7.9] 7.5 [6.4; 8.5] 7.9 [6.8; 9.1] 7.9 [6.8; 9.1] (2,963) (2,433) (1,983) (1,534) (1,118) (734) (430) (167) Coated metal / PE 993 72 (63 - 80) 21/79 29.5 170 5.3 [3.9; 6.8] 7.8 [6.0; 9.6] 9.3 [7.2; 11.4] 9.8 [7.6; 12.0] 10.5 [8.1; 12.8] 10.5 [8.1; 12.8] (771) (580) (434) (314) (206) (108) Uncoated metal / hXLPE 969 72 (63 - 79) 29/71 29.7 68 3.3 [2.1; 4.4] 5.4 [3.8; 7.0] 6.0 [4.3; 7.6] 7.5 [5.5; 9.6] 7.5 [5.5; 9.6] 8.1 [5.7; 10.4] (750) (566) (424) (295) (180) (98) Ceramicised metal / PE 467 66 (59 - 74) 18/82 30.9 114 4.9 [2.8; 6.9] 5.2 [3.0; 7.3] 5.6 [3.3; 7.9] 6.2 [3.6; 8.6] 6.2 [3.6; 8.6] (329) (257) (193) (132) (86) Coated metal / mXLPE 377 69 (61 - 77) 10/90 30.7 134 5.1 [2.8; 7.4] 7.3 [4.4; 10.1] 8.3 [5.1; 11.3] 8.3 [5.1; 11.3] 8.3 [5.1; 11.3] 8.3 [5.1; 11.3] (298) (226) (167) (127) (90) (62) Femoral articulating surface Uncoated metal 18,109 75 (66 - 81) 25/75 28.7 684 4.1 [3.8; 4.4] 5.5 [5.2; 5.9] 6.2 [5.8; 6.6] 6.6 [6.2; 7.0] 7.0 [6.6; 7.4] 7.4 [6.9; 7.8] 7.7 [7.1; 8.2] 8.2 [7.6; 8.9] 8.8 [7.7; 9.9] (14,312) (11,418) (9,151) (7,076) (4,977) (3,228) (1,726) (696) (173) Coated metal 1,372 71 (63 - 79) 18/82 29.8 276 5.3 [4.1; 6.6] 7.7 [6.2; 9.3] 9.1 [7.4; 10.8] 9.5 [7.7; 11.2] 9.9 [8.0; 11.8] 9.9 [8.0; 11.8] 10.5 [8.3; 12.7] (1,069) (806) (601) (441) (296) (170) (64) Ceramicised metal 467 66 (59 - 74) 18/82 30.9 114 4.9 [2.8; 6.9] 5.2 [3.0; 7.3] 5.6 [3.3; 7.9] 6.2 [3.6; 8.6] 6.2 [3.6; 8.6] (329) (257) (193) (132) (86) Tibial articulating surface PE 14,700 75 (66 - 81) 24/76 28.7 603 4.2 [3.9; 4.5] 5.7 [5.3; 6.1] 6.4 [6.0; 6.8] 6.7 [6.3; 7.2] 7.2 [6.7; 7.7] 7.5 [7.0; 8.0] 7.8 [7.2; 8.3] 8.5 [7.7; 9.3] 8.7 [7.8; 9.5] (11,561) (9,181) (7,338) (5,685) (3,972) (2,553) (1,320) (541) (124) mXLPE 4,053 74 (66 - 80) 23/77 29.1 330 4.3 [3.6; 4.9] 5.7 [5.0; 6.5] 6.6 [5.7; 7.4] 7.0 [6.1; 7.8] 7.1 [6.2; 8.0] 7.5 [6.6; 8.5] 8.0 [6.9; 9.1] 8.0 [6.9; 9.1] (3,261) (2,659) (2,150) (1,661) (1,208) (796) (459) (180) hXLPE 969 72 (63 - 79) 29/71 29.7 68 3.3 [2.1; 4.4] 5.4 [3.8; 7.0] 6.0 [4.3; 7.6] 7.5 [5.5; 9.6] 7.5 [5.5; 9.6] 8.1 [5.7; 10.4] (750) (566) (424) (295) (180) (98) Knee system Hinged 11,974 76 (68 - 81) 22/78 28.2 642 4.7 [4.3; 5.1] 6.3 [5.8; 6.8] 7.2 [6.7; 7.7] 7.6 [7.1; 8.1] 8.1 [7.5; 8.6] 8.3 [7.7; 8.9] 8.6 [8.0; 9.2] 9.1 [8.3; 9.9] 10.1 [8.3; 11.7] (9,439) (7,603) (6,133) (4,750) (3,373) (2,200) (1,183) (491) (91) Varus-valgus stabilised 7,975 72 (63 - 79) 28/72 29.7 459 3.3 [2.9; 3.8] 4.7 [4.2; 5.2] 5.1 [4.6; 5.7] 5.5 [5.0; 6.1] 5.9 [5.2; 6.5] 6.3 [5.6; 6.9] 6.7 [5.9; 7.5] 7.2 [6.1; 8.3] 7.2 [6.1; 8.3] (6,272) (4,879) (3,813) (2,900) (1,987) (1,247) (635) (244) (85) Table 51 (continued) 120 EPRD Annual Report 2024 121  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival Cumulative revision rates after ... Type of Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years arthroplasty / Category Patella Without patellar resurfacing 17,169 74 (66 - 80) 24/76 28.7 679 4.1 [3.8; 4.4] 5.6 [5.3; 6.0] 6.4 [6.0; 6.8] 6.9 [6.4; 7.3] 7.2 [6.8; 7.7] 7.6 [7.1; 8.1] 7.9 [7.4; 8.4] 8.3 [7.7; 8.9] 9.0 [7.7; 10.2] (13,511) (10,712) (8,530) (6,556) (4,599) (2,975) (1,568) (641) (154) With patellar resurfacing 2,780 73 (65 - 80) 25/75 29.7 254 4.6 [3.8; 5.4] 5.7 [4.8; 6.6] 6.1 [5.2; 7.1] 6.4 [5.4; 7.4] 6.9 [5.8; 8.0] 6.9 [5.8; 8.0] 7.3 [6.1; 8.6] 8.8 [6.4; 11.0] (2,200) (1,770) (1,416) (1,094) (761) (472) (250) (94) Fixation Cemented 19,539 74 (66 - 80) 24/76 29.0 689 4.1 [3.8; 4.3] 5.5 [5.1; 5.8] 6.1 [5.8; 6.5] 6.5 [6.1; 6.9] 6.9 [6.5; 7.3] 7.2 [6.8; 7.7] 7.5 [7.0; 8.0] 8.1 [7.4; 8.7] 8.6 [7.5; 9.7] (15,456) (12,318) (9,840) (7,578) (5,311) (3,420) (1,805) (732) (176) Unicondylar knee arthroplasties 63,758 63 (57 - 72) 45/55 29.4 674 2.9 [2.8; 3.0] 4.7 [4.5; 4.9] 5.7 [5.5; 5.9] 6.6 [6.4; 6.8] 7.2 [7.0; 7.5] 8.0 [7.7; 8.2] 8.5 [8.2; 8.9] 9.2 [8.8; 9.6] 9.6 [9.1; 10.1] (51,629) (41,429) (33,185) (25,363) (18,020) (11,402) (6,097) (2,273) (741) Bearing mobility Mobile bearing 37,607 64 (57 - 72) 45/55 29.7 484 3.2 [3.0; 3.4] 4.9 [4.6; 5.1] 5.9 [5.6; 6.1] 6.7 [6.4; 7.0] 7.3 [7.0; 7.6] 8.1 [7.8; 8.5] 8.6 [8.2; 9.0] 9.2 [8.7; 9.7] 9.6 [9.0; 10.3] (30,757) (25,026) (20,450) (15,899) (11,504) (7,395) (4,073) (1,630) (566) Fixed bearing 26,151 63 (57 - 71) 45/55 29.4 485 2.5 [2.3; 2.7] 4.4 [4.2; 4.7] 5.5 [5.2; 5.9] 6.5 [6.2; 6.9] 7.1 [6.7; 7.5] 7.7 [7.3; 8.2] 8.4 [7.9; 9.0] 9.3 [8.6; 10.0] 9.5 [8.7; 10.3] (20,872) (16,403) (12,735) (9,464) (6,516) (4,007) (2,024) (643) (175) Bearing Uncoated metal / mXLPE 35,930 64 (58 - 73) 46/54 29.5 451 3.0 [2.8; 3.2] 4.6 [4.4; 4.8] 5.5 [5.3; 5.8] 6.3 [6.0; 6.6] 6.8 [6.5; 7.1] 7.6 [7.2; 8.0] 8.1 [7.7; 8.5] 8.8 [8.3; 9.3] 9.3 [8.6; 9.9] (29,378) (23,940) (19,625) (15,191) (10,901) (6,899) (3,723) (1,433) (485) Uncoated metal / PE 11,137 63 (57 - 71) 48/52 29.4 301 2.3 [2.0; 2.6] 4.1 [3.7; 4.5] 5.1 [4.6; 5.6] 6.0 [5.5; 6.5] 6.6 [6.1; 7.2] 7.3 [6.7; 8.0] 8.1 [7.3; 8.9] 9.3 [8.1; 10.4] 9.6 [8.3; 10.9] (8,927) (6,977) (5,417) (4,255) (3,184) (2,116) (1,139) (364) (116) Uncoated metal / hXLPE+antioxidant 5,474 63 (57 - 71) 49/51 29.4 140 2.4 [2.0; 2.9] 3.8 [3.2; 4.4] 4.6 [3.9; 5.3] 5.1 [4.3; 5.9] 5.2 [4.4; 6.1] (3,785) (2,481) (1,465) (785) (252) Uncoated metal / hXLPE 5,136 63 (57 - 71) 47/53 29.4 141 2.2 [1.8; 2.6] 4.2 [3.6; 4.7] 5.2 [4.6; 5.9] 6.1 [5.3; 6.8] 6.4 [5.6; 7.1] 7.1 [6.2; 7.9] 7.6 [6.7; 8.6] 7.8 [6.8; 8.8] 7.8 [6.8; 8.8] (4,462) (3,835) (3,208) (2,521) (1,917) (1,281) (695) (264) (64) Coated metal / mXLPE 3,982 61 (55 - 68) 23/77 30.1 343 3.7 [3.1; 4.3] 6.7 [5.9; 7.5] 8.4 [7.5; 9.4] 10.1 [9.1; 11.1] 10.9 [9.8; 12.0] 11.8 [10.6; 13.0] 12.0 [10.7; 13.2] 12.6 [11.1; 14.0] 12.6 [11.1; 14.0] Knee (3,535) (3,050) (2,619) (1,942) (1,307) (773) (404) (170) (65) Ceramicised metal / PE 1,333 60 (54 - 66) 33/67 29.7 161 4.5 [3.3; 5.6] 7.2 [5.6; 8.7] 8.6 [6.9; 10.3] 9.6 [7.7; 11.5] 11.8 [9.4; 14.0] 12.7 [10.1; 15.1] 14.2 [10.9; 17.4] (1,044) (805) (602) (476) (309) (190) (85) Coated metal / PE 534 60 (54 - 67) 26/74 30.2 89 9.7 [7.1; 12.3] 14.5 [11.2; 17.7] 16.0 [12.5; 19.3] 20.4 [16.2; 24.3] 22.3 [17.8; 26.6] 24.2 [19.3; 28.8] 24.2 [19.3; 28.8] (414) (325) (244) (193) (150) (109) (51) Femoral articulating surface Uncoated metal 57,704 64 (58 - 72) 47/53 29.4 655 2.7 [2.6; 2.9] 4.4 [4.2; 4.6] 5.3 [5.1; 5.6] 6.1 [5.9; 6.3] 6.7 [6.4; 6.9] 7.4 [7.1; 7.7] 8.0 [7.7; 8.3] 8.7 [8.3; 9.1] 9.1 [8.5; 9.6] (46,565) (37,233) (29,715) (22,752) (16,254) (10,330) (5,557) (2,061) (665) Coated metal 4,523 61 (55 - 68) 24/76 30.1 398 4.4 [3.8; 5.0] 7.6 [6.8; 8.4] 9.3 [8.4; 10.2] 11.2 [10.2; 12.2] 12.1 [11.0; 13.2] 13.2 [12.0; 14.4] 13.3 [12.1; 14.5] 13.8 [12.4; 15.2] 13.8 [12.4; 15.2] (3,950) (3,375) (2,863) (2,135) (1,457) (882) (455) (186) (70) Ceramicised metal 1,531 60 (55 - 67) 33/67 29.4 166 4.3 [3.2; 5.4] 6.9 [5.5; 8.4] 8.4 [6.7; 10.0] 9.4 [7.6; 11.2] 11.5 [9.2; 13.8] 12.4 [9.9; 14.9] 14.0 [10.7; 17.2] (1,114) (821) (607) (476) (309) (190) (85) Tibial articulating surface mXLPE 40,110 64 (57 - 72) 44/56 29.6 490 3.1 [2.9; 3.3] 4.8 [4.6; 5.1] 5.8 [5.6; 6.1] 6.7 [6.4; 7.0] 7.3 [7.0; 7.6] 8.1 [7.7; 8.4] 8.6 [8.2; 9.0] 9.2 [8.7; 9.7] 9.6 [9.0; 10.3] (32,983) (27,006) (22,249) (17,133) (12,208) (7,672) (4,127) (1,603) (550) PE 13,004 63 (57 - 71) 45/55 29.4 364 2.8 [2.5; 3.1] 4.8 [4.4; 5.2] 5.9 [5.5; 6.4] 7.0 [6.5; 7.5] 7.8 [7.2; 8.4] 8.6 [7.9; 9.2] 9.4 [8.6; 10.1] 10.5 [9.5; 11.6] 10.8 [9.6; 12.1] (10,385) (8,107) (6,263) (4,924) (3,643) (2,415) (1,275) (406) (127) hXLPE+antioxidant 5,481 63 (57 - 71) 49/51 29.4 143 2.4 [2.0; 2.9] 3.8 [3.2; 4.4] 4.6 [3.9; 5.3] 5.1 [4.3; 5.9] 5.2 [4.4; 6.1] (3,786) (2,481) (1,465) (785) (252) hXLPE 5,136 63 (57 - 71) 47/53 29.4 141 2.2 [1.8; 2.6] 4.2 [3.6; 4.7] 5.2 [4.6; 5.9] 6.1 [5.3; 6.8] 6.4 [5.6; 7.1] 7.1 [6.2; 7.9] 7.6 [6.7; 8.6] 7.8 [6.8; 8.8] 7.8 [6.8; 8.8] (4,462) (3,835) (3,208) (2,521) (1,917) (1,281) (695) (264) (64) Fixation Cemented 55,098 63 (57 - 72) 44/56 29.4 672 2.7 [2.6; 2.9] 4.6 [4.4; 4.8] 5.6 [5.4; 5.9] 6.6 [6.3; 6.8] 7.2 [7.0; 7.5] 8.0 [7.7; 8.3] 8.6 [8.3; 9.0] 9.4 [8.9; 9.8] 9.7 [9.1; 10.3] (44,850) (36,096) (28,833) (21,902) (15,496) (9,747) (5,153) (1,842) (562) Uncemented 8,044 63 (57 - 71) 55/45 29.5 116 3.8 [3.4; 4.3] 5.2 [4.7; 5.7] 6.2 [5.6; 6.7] 6.7 [6.0; 7.3] 7.0 [6.3; 7.6] 7.8 [7.0; 8.5] 8.1 [7.3; 9.0] 8.6 [7.6; 9.5] 9.0 [7.7; 10.3] (6,245) (4,866) (3,946) (3,105) (2,241) (1,453) (837) (385) (154) Hybrid 541 66 (59 - 74) 36/64 28.7 53 4.2 [2.5; 5.9] 5.5 [3.5; 7.4] 6.2 [4.0; 8.3] 6.4 [4.2; 8.6] 7.1 [4.7; 9.4] 7.1 [4.7; 9.4] 7.9 [5.1; 10.6] (477) (421) (366) (327) (264) (189) (97) Patellofemoral knee arthroplasty 1,026 55 (49 - 61) 26/74 28.4 224 4.7 [3.3; 6.0] 8.5 [6.6; 10.4] 10.8 [8.6; 12.9] 14.0 [11.3; 16.5] 16.2 [13.2; 19.0] 17.3 [14.0; 20.3] 18.8 [15.0; 22.4] (816) (641) (496) (371) (260) (168) (83) Femoral articulating surface Uncoated metal 586 55 (49 - 62) 28/72 28.7 138 3.1 [1.6; 4.6] 7.1 [4.7; 9.4] 8.7 [6.0; 11.3] 12.1 [8.8; 15.4] 15.0 [11.0; 18.8] 15.5 [11.4; 19.5] 16.8 [12.0; 21.3] (471) (366) (292) (216) (163) (110) (55) Ceramicised metal 421 54 (48 - 61) 26/74 28.4 114 7.1 [4.5; 9.6] 10.7 [7.5; 13.8] 13.7 [9.9; 17.3] 16.7 [12.3; 20.9] 18.0 [13.3; 22.5] 20.2 [14.6; 25.4] (326) (257) (189) (144) (90) (55) Patella With patellar resurfacing 839 55 (48 - 61) 26/74 28.7 191 4.1 [2.7; 5.5] 7.3 [5.3; 9.2] 9.3 [7.0; 11.5] 11.9 [9.2; 14.5] 14.2 [11.0; 17.2] 15.5 [12.1; 18.9] 16.7 [12.6; 20.6] (674) (536) (419) (318) (216) (139) (59) Fixation Cemented 1,024 55 (49 - 61.5) 26/74 28.4 224 4.7 [3.3; 6.0] 8.5 [6.6; 10.4] 10.8 [8.6; 12.9] 14.0 [11.3; 16.5] 16.2 [13.2; 19.1] 17.3 [14.1; 20.4] 18.8 [15.0; 22.4] (815) (641) (496) (371) (260) (168) (83) Table 51 (continued) 122 EPRD Annual Report 2024 123  5 Hip and knee arthroplasty survival 5.4 Revision knee arthroplasty survival 5.3.4 Outcomes for specific However, these changes do not necessarily are based on the type of arthroplasty and fix- combinations of knee components affect the listed femoral or tibial component ation used, the knee system and the degree of Table 52 details CRRs for primary knee ar- itself (refer to the explanations on the anal- constraint. The last two categories addition- throplasties with specific combinations of yses in Chapter 3). To take into account the ally include the insert component classifica- femoral and tibial components. Knee arthro- different baseline conditions for specific im- tion. Arthroplasties are further subdivided plasty CRRs are listed by the component plant systems, comparable arthroplasty sys- into those with and without primary patellar that subsequently required changes. tems were grouped together. These groups resurfacing. Knee arthroplasties Cumulative revision rates after ... Patellar Yrs im- Femoral component Tibial component resur- Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted facing Standard TKAs, cruciate-retaining, fixed bearing, hybrid balanSys BICONDYLAR uncem. balanSys BICONDYLAR fix 0.5 [0.0; 1.2] 0.8 [0.0; 1.8] 1.2 [0.0; 2.4] 1.9 [0.1; 3.7] 1.9 [0.1; 3.7] Without 411 7 71 (63 - 77) 46/54 2016-2023 (Mathys) (Mathys) (340) (267) (193) (133) (88) COLUMBUS (Aesculap) COLUMBUS (Aesculap) Without 774 7 69 (62 - 77) 37/63 2014-2023 3.3 [2.0; 4.5] 3.8 [2.5; 5.2] 4.3 [2.8; 5.7] 4.6 [3.1; 6.1] 4.6 [3.1; 6.1] 4.9 [3.3; 6.5] 5.4 [3.5; 7.3] (707) (666) (639) (543) (402) (265) (128) EFK Femur zementfrei EFK Tibia zementiert 1.4 [0.8; 2.0] 2.2 [1.4; 3.0] 2.4 [1.5; 3.2] 2.7 [1.8; 3.6] 3.1 [2.1; 4.1] 3.9 [2.8; 5.1] 4.6 [3.3; 5.9] 5.7 [4.1; 7.3] Without 1,325 15 70 (63 - 76) 42/58 2014-2023 (OHST Medizintechnik) (OHST Medizintechnik) (1,248) (1,143) (1,045) (946) (849) (744) (555) (265) GENESIS II CR COCR Genesis II 1.1 [0.1; 2.1] 1.6 [0.4; 2.8] 2.4 [0.9; 3.9] 2.4 [0.9; 3.9] 2.7 [1.1; 4.3] 2.7 [1.1; 4.3] 2.7 [1.1; 4.3] 2.7 [1.1; 4.3] 2.7 [1.1; 4.3] Without 454 6 68 (62 - 75) 44/56 2012-2023 Knee (Smith & Nephew) (Smith & Nephew) (432) (405) (360) (313) (273) (224) (159) (110) (50) LEGION CR COCR (Smith & Nephew) Genesis II (Smith & Nephew) Without 684 10 69 (62 - 76) 52/48 2017-2023 2.9 [1.6; 4.2] 4.5 [2.8; 6.2] 4.8 [3.0; 6.6] 5.2 [3.2; 7.1] 6.0 [3.4; 8.6] (522) (375) (249) (138) (76) NexGen CR-Flex (Zimmer Biomet) NexGen CR (Zimmer Biomet) Without 687 30 69 (61 - 75) 51/49 2014-2023 1.6 [0.6; 2.5] 2.8 [1.5; 4.1] 3.0 [1.6; 4.4] 3.0 [1.6; 4.4] 3.2 [1.8; 4.6] 3.2 [1.8; 4.6] 3.2 [1.8; 4.6] 3.2 [1.8; 4.6] (566) (518) (476) (441) (356) (228) (126) (73) NexGen CR (Zimmer Biomet) NexGen CR (Zimmer Biomet) Without 574 9 69 (62 - 75) 51/49 2014-2023 0.7 [0.0; 1.4] 1.1 [0.2; 2.0] 1.1 [0.2; 2.0] 1.1 [0.2; 2.0] 1.4 [0.3; 2.4] 1.6 [0.5; 2.7] 1.6 [0.5; 2.7] 1.6 [0.5; 2.7] (518) (483) (466) (431) (379) (326) (197) (76) SIGMA™ Femur (DePuy) SIGMA™ Tibia (DePuy) Without 945 22 68 (61 - 76) 41/59 2014-2023 1.3 [0.6; 2.0] 1.9 [1.0; 2.7] 2.5 [1.5; 3.6] 2.7 [1.6; 3.8] 3.4 [2.1; 4.7] 3.7 [2.3; 5.1] 3.7 [2.3; 5.1] 3.7 [2.3; 5.1] (888) (793) (692) (580) (441) (292) (170) (67) TC-PLUS CR (Smith & Nephew) TC-PLUS (Smith & Nephew) Without 630 12 70.5 (63 - 76) 40/60 2014-2023 2.3 [1.1; 3.5] 2.9 [1.5; 4.2] 2.9 [1.5; 4.2] 3.2 [1.7; 4.6] 3.2 [1.7; 4.6] 3.2 [1.7; 4.6] (537) (450) (371) (289) (232) (116) Triathlon CR (Stryker) Triathlon (Stryker) Without 553 18 70 (63 - 75) 40/60 2014-2023 0.8 [0.0; 1.6] 1.7 [0.5; 2.9] 2.1 [0.7; 3.4] 2.4 [0.9; 3.9] 2.4 [0.9; 3.9] 2.4 [0.9; 3.9] 2.4 [0.9; 3.9] (432) (348) (295) (250) (187) (143) (61) Vanguard CR Vanguard Tibia Cruciate 2.0 [1.2; 2.9] 3.3 [2.2; 4.3] 4.6 [3.3; 5.9] 5.3 [3.8; 6.8] 6.0 [4.3; 7.6] 6.0 [4.3; 7.6] 6.0 [4.3; 7.6] Without 1,167 17 68 (61 - 75) 44/56 2015-2023 (Zimmer Biomet) (Zimmer Biomet) (1,034) (815) (626) (472) (340) (212) (114) Standard TKAs, cruciate-retaining, fixed bearing, cemented ACS cemented (Implantcast) ACS FB cemented (Implantcast) Without 802 44 66.5 (59 - 74) 21/79 2014-2023 2.5 [1.4; 3.6] 4.6 [3.1; 6.0] 6.4 [4.6; 8.1] 7.4 [5.5; 9.3] 7.9 [5.9; 9.9] 8.7 [6.4; 10.9] 8.7 [6.4; 10.9] (772) (731) (582) (449) (302) (173) (70) ACS cemented ACS FB+ cemented incl. plugs 2.8 [1.0; 4.6] Without 430 30 65 (58 - 73) 23/77 2021-2023 (Implantcast) (Implantcast) (210) ACS LD cemented (Implantcast) ACS LD FB cemented (Implantcast) Without 362 10 70 (63 - 76) 48/52 2015-2021 3.1 [1.3; 4.8] 4.8 [2.5; 6.9] 4.8 [2.5; 6.9] 5.1 [2.8; 7.4] 5.1 [2.8; 7.4] 5.1 [2.8; 7.4] (346) (330) (291) (211) (139) (71) balanSys BICONDYLAR cem. balanSys BICONDYLAR fix 2.0 [1.5; 2.5] 2.7 [2.1; 3.3] 3.3 [2.6; 4.0] 3.6 [2.8; 4.3] 3.9 [3.0; 4.7] 4.0 [3.1; 4.8] 4.0 [3.1; 4.8] 4.9 [3.4; 6.4] Without 2,895 30 71 (64 - 78) 37/63 2014-2023 (Mathys) (Mathys) (2,419) (2,000) (1,599) (1,225) (850) (559) (248) (66) COLUMBUS (Aesculap) COLUMBUS (Aesculap) Without 21,316 171 70 (62 - 77) 35/65 2013-2023 1.5 [1.4; 1.7] 2.6 [2.4; 2.8] 3.0 [2.8; 3.3] 3.3 [3.1; 3.6] 3.7 [3.3; 3.9] 3.9 [3.5; 4.2] 4.1 [3.8; 4.5] 4.2 [3.8; 4.6] 4.3 [3.9; 4.8] (17,589) (14,262) (11,748) (9,148) (6,436) (4,081) (2,164) (884) (244) COLUMBUS (Aesculap) COLUMBUS (Aesculap) With 776 56 68 (61 - 76) 25/75 2014-2023 1.6 [0.7; 2.5] 4.4 [2.8; 5.9] 4.7 [3.1; 6.3] 5.7 [3.9; 7.5] 5.9 [4.1; 7.8] 6.2 [4.3; 8.1] 7.3 [4.8; 9.7] (688) (579) (515) (423) (317) (207) (99) EFK Femur zementiert EFK Tibia zementiert 1.4 [1.0; 1.8] 2.0 [1.5; 2.5] 2.3 [1.8; 2.9] 2.7 [2.1; 3.3] 3.2 [2.5; 3.8] 3.6 [2.9; 4.3] 4.5 [3.7; 5.3] 5.6 [4.5; 6.6] Without 3,159 40 72 (64 - 77) 38/62 2014-2023 (OHST Medizintechnik) (OHST Medizintechnik) (2,951) (2,762) (2,623) (2,448) (2,232) (1,978) (1,312) (458) Table 52: Implant outcomes for femoro-tibial combinations in primary knee arthroplasties with or without patellar resurfacing at primary TKA. Within the groups comprising type of arthroplasty, type of fixation, knee system, and degree of constraint, the combinations are listed alphabetically by the femoral component. 124 EPRD Annual Report 2024 125  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival Knee arthroplasties Cumulative revision rates after ... Patellar Yrs im- Femoral component Tibial component resur- Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted facing Standard TKAs, cruciate-retaining, fixed bearing, cemented EFK Femur zementiert TiNbN EFK Tibia zementiert TiNbN 2.1 [0.9; 3.3] 2.7 [1.3; 4.1] 3.9 [2.2; 5.7] 4.5 [2.6; 6.3] 5.4 [3.2; 7.5] 5.4 [3.2; 7.5] 5.7 [3.5; 7.9] 6.6 [4.0; 9.1] Without 546 44 65 (59 - 73) 7/93 2014-2023 (OHST Medizintechnik) (OHST Medizintechnik) (476) (423) (376) (346) (307) (276) (227) (83) GEMINI SL Total Knee System, GEMINI SL Total Knee System, Femoral Component, Tibial Component, 3.5 [1.7; 5.3] 4.9 [2.7; 7.0] 6.5 [3.9; 9.0] 7.3 [4.5; 10.1] 7.8 [4.8; 10.6] 8.5 [5.3; 11.7] Without 416 31 71 (61 - 77) 30/70 2014-2023 Mobile Bearing / Fixed Bearing CR, Fixed Bearing, cemented (357) (304) (261) (220) (150) (95) cemented (Waldemar Link) (Waldemar Link) GENESIS II CR COCR Genesis II 2.0 [1.8; 2.3] 3.6 [3.3; 4.0] 4.4 [4.0; 4.9] 4.9 [4.5; 5.4] 5.2 [4.7; 5.7] 5.4 [4.9; 5.9] 5.6 [5.0; 6.1] 5.7 [5.1; 6.3] 5.7 [5.1; 6.3] Without 10,567 98 69 (62 - 76) 36/64 2013-2023 (Smith & Nephew) (Smith & Nephew) (8,869) (7,321) (6,080) (4,803) (3,534) (2,490) (1,475) (632) (146) GENESIS II CR COCR Genesis II 1.9 [1.1; 2.6] 2.1 [1.2; 2.9] 2.8 [1.8; 3.9] 3.2 [2.0; 4.3] 3.4 [2.2; 4.6] 3.4 [2.2; 4.6] 3.4 [2.2; 4.6] 4.2 [2.2; 6.2] With 1,219 43 70 (62 - 76) 33/67 2013-2023 (Smith & Nephew) (Smith & Nephew) (971) (768) (565) (438) (330) (227) (156) (95) GENESIS II CR OXINIUM Genesis II 2.3 [1.8; 2.9] 4.1 [3.4; 4.9] 4.7 [3.9; 5.6] 5.1 [4.3; 6.0] 5.6 [4.7; 6.5] 5.6 [4.7; 6.5] 6.0 [5.0; 7.0] 6.3 [5.1; 7.5] 6.3 [5.1; 7.5] Without 2,966 123 65 (58 - 73) 20/80 2012-2023 (Smith & Nephew) (Smith & Nephew) (2,523) (2,152) (1,833) (1,538) (1,231) (869) (555) (285) (135) GENESIS II LDK COCR Genesis II 2.6 [1.8; 3.3] 4.1 [3.2; 5.1] 5.1 [4.0; 6.1] 5.5 [4.4; 6.6] 5.7 [4.6; 6.8] 5.8 [4.7; 7.0] 5.9 [4.8; 7.1] 5.9 [4.8; 7.1] 5.9 [4.8; 7.1] Without 1,717 16 70 (62 - 76) 38/62 2013-2023 (Smith & Nephew) (Smith & Nephew) (1,644) (1,581) (1,521) (1,464) (1,320) (970) (693) (317) (86) INNEX CR (Zimmer Biomet) Innex Fix (Zimmer Biomet) Without 1,329 28 73 (65 - 78) 42/58 2013-2023 2.1 [1.3; 2.9] 2.8 [1.9; 3.8] 3.4 [2.4; 4.4] 3.5 [2.5; 4.6] 3.7 [2.6; 4.7] 3.7 [2.6; 4.7] 3.7 [2.6; 4.7] 3.7 [2.6; 4.7] (1,220) (1,104) (974) (806) (638) (449) (251) (123) INNEX CR GSF (Zimmer Biomet) Innex Fix (Zimmer Biomet) Without 387 18 73 (65 - 78) 19/81 2013-2023 1.8 [0.5; 3.2] 3.0 [1.2; 4.7] 3.6 [1.7; 5.6] 3.6 [1.7; 5.6] 3.6 [1.7; 5.6] 4.2 [1.9; 6.3] 4.2 [1.9; 6.3] Knee (349) (319) (278) (243) (191) (135) (82) JOURNEY II CR COCR JOURNEY 1.8 [0.6; 3.1] 3.6 [1.7; 5.5] 5.4 [2.8; 7.9] 7.7 [4.3; 11.0] Without 468 16 71 (62 - 76) 38/62 2018-2023 (Smith & Nephew) (Smith & Nephew) (367) (275) (194) (89) JOURNEY II CR OXINIUM JOURNEY 3.3 [2.2; 4.4] 5.5 [4.1; 6.9] 6.8 [5.3; 8.4] 8.4 [6.6; 10.1] 8.7 [6.9; 10.5] 9.0 [7.1; 10.9] 9.0 [7.1; 10.9] Without 1,069 31 63 (58 - 71) 36/64 2015-2023 (Smith & Nephew) (Smith & Nephew) (988) (913) (833) (684) (511) (244) (86) LEGION CR COCR (Smith & Nephew) Genesis II (Smith & Nephew) Without 15,502 151 71 (63 - 77) 38/62 2014-2023 1.8 [1.6; 2.0] 2.9 [2.6; 3.2] 3.6 [3.3; 4.0] 4.0 [3.6; 4.4] 4.4 [4.0; 4.8] 4.4 [4.0; 4.9] 4.4 [4.0; 4.9] (12,164) (9,247) (6,639) (4,628) (2,632) (1,137) (413) LEGION CR COCR (Smith & Nephew) Genesis II (Smith & Nephew) With 701 58 71 (63 - 78) 29/71 2015-2023 2.0 [0.9; 3.0] 2.8 [1.5; 4.1] 2.8 [1.5; 4.1] 3.3 [1.7; 4.9] 3.3 [1.7; 4.9] 4.1 [1.8; 6.3] (550) (408) (270) (183) (141) (75) LEGION CR OXINIUM Genesis II 1.8 [1.4; 2.3] 3.9 [3.2; 4.6] 5.1 [4.3; 6.0] 5.3 [4.4; 6.1] 5.4 [4.5; 6.2] 5.8 [4.7; 6.8] 5.8 [4.7; 6.8] Without 3,950 159 64 (58 - 72) 17/83 2012-2023 (Smith & Nephew) (Smith & Nephew) (3,054) (2,156) (1,454) (975) (590) (273) (86) LEGION CR OXINIUM Genesis II 1.2 [0.1; 2.2] 2.4 [0.8; 4.0] 4.3 [2.0; 6.5] 4.3 [2.0; 6.5] 4.3 [2.0; 6.5] With 446 50 65 (59 - 72) 8/92 2016-2023 (Smith & Nephew) (Smith & Nephew) (366) (287) (204) (145) (105) LinkSymphoKnee, LinkSymphoKnee, FB, Femoral Component, CR, cemented Monoblock, CoCrMo, cemented Without 576 16 69 (61 - 75) 40/60 2021-2023 3.5 [0.9; 5.9] (99) (Waldemar Link) (Waldemar Link) NexGen CR-Flex-Gender NexGen CR 0.9 [0.7; 1.2] 1.8 [1.5; 2.2] 2.3 [1.9; 2.8] 2.6 [2.1; 3.1] 2.9 [2.4; 3.4] 3.0 [2.5; 3.5] 3.1 [2.5; 3.6] 3.1 [2.5; 3.6] 3.1 [2.5; 3.6] Without 5,659 108 70 (62 - 76) 11/89 2012-2023 (Zimmer Biomet) (Zimmer Biomet) (4,875) (4,161) (3,474) (2,888) (2,213) (1,498) (916) (430) (176) NexGen CR-Flex (Zimmer Biomet) NexGen CR (Zimmer Biomet) Without 19,539 128 71 (64 - 78) 42/58 2012-2023 1.4 [1.2; 1.6] 2.1 [1.9; 2.3] 2.4 [2.2; 2.6] 2.7 [2.4; 2.9] 2.8 [2.5; 3.0] 2.9 [2.7; 3.2] 3.1 [2.8; 3.4] 3.2 [2.9; 3.6] 3.2 [2.9; 3.6] (16,820) (14,053) (11,885) (9,592) (7,184) (4,755) (2,765) (1,280) (475) NexGen CR-Flex (Zimmer Biomet) NexGen CR (Zimmer Biomet) With 2,988 50 72 (64 - 78) 34/66 2013-2023 1.8 [1.3; 2.2] 2.2 [1.7; 2.8] 2.4 [1.8; 2.9] 2.6 [2.0; 3.2] 2.8 [2.1; 3.4] 2.9 [2.2; 3.6] 3.0 [2.3; 3.8] 3.0 [2.3; 3.8] (2,535) (2,153) (1,872) (1,529) (1,198) (853) (514) (269) NexGen CR (Zimmer Biomet) NexGen CR (Zimmer Biomet) Without 4,317 60 70 (63 - 76) 42/58 2013-2023 1.2 [0.9; 1.5] 2.1 [1.6; 2.6] 2.9 [2.3; 3.4] 3.5 [2.9; 4.1] 3.6 [2.9; 4.2] 3.9 [3.2; 4.6] 4.2 [3.4; 4.9] 4.4 [3.6; 5.3] 4.7 [3.7; 5.6] (3,522) (3,016) (2,673) (2,307) (1,933) (1,367) (920) (523) (149) Persona CR (Zimmer Biomet) Persona Tibia (Zimmer Biomet) Without 9,008 119 70 (62 - 77) 40/60 2013-2023 1.1 [0.9; 1.3] 1.6 [1.3; 1.9] 1.8 [1.5; 2.1] 2.1 [1.7; 2.5] 2.3 [1.8; 2.7] 2.5 [2.0; 3.1] 2.5 [2.0; 3.1] 2.5 [2.0; 3.1] (6,516) (4,362) (3,011) (1,938) (1,121) (638) (279) (80) Persona CR (Zimmer Biomet) Persona Tibia (Zimmer Biomet) With 319 35 67 (60 - 75) 31/69 2015-2023 2.7 [0.8; 4.5] 2.7 [0.8; 4.5] 3.3 [1.1; 5.6] 3.3 [1.1; 5.6] (241) (158) (116) (64) SIGMA™ Femur (DePuy) SIGMA™ Tibia (DePuy) Without 27,934 142 71 (63 - 77) 36/64 2012-2023 1.5 [1.3; 1.6] 2.5 [2.3; 2.7] 3.0 [2.8; 3.2] 3.4 [3.1; 3.6] 3.5 [3.3; 3.8] 3.8 [3.5; 4.1] 4.0 [3.7; 4.3] 4.2 [3.9; 4.6] 4.5 [4.0; 5.0] (23,455) (19,733) (16,647) (13,320) (9,729) (6,660) (3,640) (1,495) (442) SIGMA™ Femur (DePuy) SIGMA™ Tibia (DePuy) With 5,262 81 71 (63 - 77) 33/67 2012-2023 1.4 [1.1; 1.8] 2.0 [1.6; 2.5] 2.4 [2.0; 2.9] 2.6 [2.1; 3.1] 2.9 [2.3; 3.4] 3.3 [2.7; 3.9] 3.3 [2.7; 3.9] 3.5 [2.8; 4.2] (4,436) (3,765) (3,162) (2,452) (1,649) (1,096) (558) (233) TC-PLUS CR (Smith & Nephew) TC-PLUS (Smith & Nephew) Without 4,130 43 72 (65 - 78) 36/64 2014-2023 1.2 [0.8; 1.5] 1.6 [1.2; 2.0] 1.9 [1.5; 2.4] 2.2 [1.8; 2.7] 2.4 [1.9; 2.9] 2.6 [2.0; 3.1] 2.6 [2.0; 3.1] 2.6 [2.0; 3.1] (3,882) (3,515) (3,084) (2,529) (1,805) (900) (377) (87) Table 52 (continued) 126 EPRD Annual Report 2024 127  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival Knee arthroplasties Cumulative revision rates after ... Patellar Yrs im- Femoral component Tibial component resur- Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted facing Standard TKAs, cruciate-retaining, fixed bearing, cemented Triathlon CR (Stryker) Triathlon (Stryker) Without 11,006 91 70 (62 - 77) 37/63 2013-2023 1.7 [1.5; 2.0] 3.0 [2.7; 3.4] 3.8 [3.4; 4.2] 4.3 [3.8; 4.7] 4.5 [4.0; 4.9] 4.7 [4.2; 5.2] 4.9 [4.4; 5.5] 4.9 [4.4; 5.5] 4.9 [4.4; 5.5] (8,663) (6,936) (5,474) (4,237) (3,052) (2,053) (1,146) (507) (137) Triathlon CR (Stryker) Triathlon (Stryker) With 4,374 44 68 (62 - 75) 40/60 2013-2023 1.4 [1.0; 1.7] 1.9 [1.5; 2.4] 2.3 [1.8; 2.8] 2.6 [2.1; 3.2] 3.0 [2.3; 3.6] 3.1 [2.4; 3.8] 3.1 [2.4; 3.8] 3.1 [2.4; 3.8] (3,656) (2,924) (2,117) (1,460) (791) (403) (224) (106) Vanguard CR Vanguard Tibia Cruciate 1.9 [1.7; 2.1] 2.9 [2.6; 3.2] 3.6 [3.3; 4.0] 4.1 [3.7; 4.5] 4.5 [4.0; 4.9] 4.6 [4.2; 5.0] 4.7 [4.2; 5.1] 5.2 [4.5; 5.9] Without 13,663 86 71 (64 - 78) 38/62 2012-2023 (Zimmer Biomet) (Zimmer Biomet) (11,395) (9,391) (7,739) (6,125) (4,395) (2,827) (1,518) (502) Vanguard CR Vanguard Tibia Cruciate 2.8 [1.3; 4.3] 4.5 [2.6; 6.5] 5.1 [3.0; 7.2] 5.1 [3.0; 7.2] 5.6 [3.3; 7.8] 5.6 [3.3; 7.8] With 474 37 72 (63 - 79) 32/68 2013-2023 (Zimmer Biomet) (Zimmer Biomet) (418) (366) (303) (231) (163) (90) Vanguard CR TiNbN Vanguard Tibia TiNbN 1.6 [0.9; 2.3] 3.9 [2.8; 5.0] 5.0 [3.7; 6.3] 5.3 [3.9; 6.6] 5.7 [4.2; 7.1] 6.3 [4.6; 8.0] 7.3 [4.8; 9.7] Without 1,360 76 65 (58 - 72) 8/92 2013-2023 (Zimmer Biomet) (Zimmer Biomet) (1,148) (922) (730) (512) (323) (191) (99) Standard TKAs, cruciate-retaining, mobile bearing, hybrid TC-PLUS CR (Smith & Nephew) TC-PLUS SB (Smith & Nephew) Without 517 7 69 (62 - 77) 35/65 2015-2023 3.4 [1.8; 5.0] 5.0 [3.0; 6.9] 5.2 [3.2; 7.2] 6.1 [3.9; 8.3] 6.1 [3.9; 8.3] 6.1 [3.9; 8.3] 6.1 [3.9; 8.3] (457) (395) (341) (315) (281) (240) (134) Standard TKAs, cruciate-retaining, mobile bearing, cemented ACS cemented (Implantcast) ACS MB cemented (Implantcast) Without 1,010 23 70 (62 - 77) 30/70 2013-2023 2.0 [1.1; 2.9] 3.7 [2.4; 5.0] 4.3 [2.8; 5.7] 5.4 [3.7; 7.1] 5.7 [3.8; 7.5] 6.1 [4.1; 8.0] 6.1 [4.1; 8.0] (774) (575) (456) (376) (280) (190) (109) Knee COLUMBUS (Aesculap) COLUMBUS (Aesculap) Without 2,866 25 71 (63 - 77) 36/64 2013-2023 1.8 [1.3; 2.3] 2.5 [1.9; 3.1] 2.9 [2.2; 3.5] 3.1 [2.4; 3.7] 3.1 [2.4; 3.8] 3.1 [2.4; 3.8] 3.1 [2.4; 3.8] 3.1 [2.4; 3.8] (2,510) (2,175) (1,905) (1,551) (1,135) (733) (412) (162) INNEX CR (Zimmer Biomet) Innex Mobile (Zimmer Biomet) Without 1,380 65 70 (62 - 77) 97/3 2013-2023 2.2 [1.4; 3.0] 3.2 [2.2; 4.1] 3.7 [2.7; 4.8] 4.3 [3.1; 5.4] 4.8 [3.6; 6.1] 5.6 [4.1; 7.0] 5.6 [4.1; 7.0] 6.1 [4.3; 7.9] (1,244) (1,086) (926) (767) (598) (407) (223) (64) INNEX CR GSF (Zimmer Biomet) Innex Mobile (Zimmer Biomet) Without 403 33 70 (63 - 77) 82/18 2014-2023 2.6 [1.0; 4.2] 3.8 [1.8; 5.8] 4.2 [2.1; 6.3] 4.2 [2.1; 6.3] 4.7 [2.4; 7.1] 5.6 [2.7; 8.3] (335) (284) (233) (176) (137) (92) NexGen CR-Flex (Zimmer Biomet) NexGen CR (Zimmer Biomet) Without 596 9 71 (64 - 76) 42/58 2013-2022 0.8 [0.1; 1.6] 1.5 [0.5; 2.5] 2.4 [1.1; 3.6] 3.3 [1.7; 4.8] 3.3 [1.7; 4.8] 3.3 [1.7; 4.8] 3.3 [1.7; 4.8] 3.3 [1.7; 4.8] (587) (516) (445) (372) (315) (224) (166) (74) TC-PLUS CR (Smith & Nephew) TC-PLUS SB (Smith & Nephew) Without 405 11 71 (63 - 77) 30/70 2015-2022 3.5 [1.7; 5.3] 4.2 [2.2; 6.2] 5.3 [3.1; 7.5] 5.6 [3.3; 7.9] 5.6 [3.3; 7.9] 5.6 [3.3; 7.9] 5.6 [3.3; 7.9] (384) (370) (323) (262) (215) (174) (90) ZEN Femur STD zementiert ZEN Tibia STD zementiert 1.0 [0.4; 1.7] 1.4 [0.6; 2.2] 2.2 [1.2; 3.2] 2.8 [1.6; 4.1] 2.8 [1.6; 4.1] 3.4 [1.7; 5.1] Without 1,079 6 71 (65 - 78) 36/64 2015-2023 (OHST Medizintechnik) (OHST Medizintechnik) (872) (695) (522) (370) (203) (97) Standard TKAs, cruciate-retaining/sacrificing, fixed bearing, hybrid BPK-S INTEGRATION (Peter Brehm) BPK-S INTEGRATION (Peter Brehm) Without 423 3 69 (62 - 76) 37/63 2016-2023 1.5 [0.3; 2.7] 2.4 [0.8; 3.9] 3.7 [1.7; 5.7] 4.9 [2.5; 7.3] 5.4 [2.8; 8.0] 5.4 [2.8; 8.0] (371) (307) (259) (204) (130) (53) Standard TKAs, cruciate-retaining/sacrificing, fixed bearing, cemented ATTUNE™ Femur (DePuy) ATTUNE™ Tibia (DePuy) Without 9,695 133 67 (60 - 75) 39/61 2013-2023 1.7 [1.4; 2.0] 3.1 [2.7; 3.5] 3.7 [3.3; 4.2] 4.1 [3.7; 4.6] 4.4 [3.9; 5.0] 4.7 [4.2; 5.3] 4.7 [4.2; 5.3] 4.7 [4.2; 5.3] 4.7 [4.2; 5.3] (7,525) (5,750) (4,436) (3,377) (2,369) (1,541) (802) (362) (112) ATTUNE™ Femur (DePuy) ATTUNE™ Tibia (DePuy) With 2,204 53 68 (61 - 75) 37/63 2013-2023 1.6 [1.1; 2.2] 2.2 [1.5; 2.8] 2.5 [1.8; 3.2] 2.6 [1.9; 3.4] 2.8 [1.9; 3.5] 3.6 [2.3; 4.8] 3.6 [2.3; 4.8] 3.6 [2.3; 4.8] (1,801) (1,422) (1,080) (771) (495) (274) (161) (69) SIGMA™ Femur (DePuy) SIGMA™ Tibia (DePuy) Without 2,598 24 69 (61 - 76) 36/64 2015-2023 1.4 [0.9; 1.8] 2.4 [1.7; 3.0] 3.1 [2.3; 3.8] 3.4 [2.5; 4.2] 3.6 [2.7; 4.4] 4.3 [3.2; 5.4] 4.3 [3.2; 5.4] (2,023) (1,696) (1,461) (1,024) (661) (347) (103) SIGMA™ Femur (DePuy) SIGMA™ Tibia (DePuy) With 1,010 12 70 (62 - 76) 32/68 2015-2023 1.0 [0.4; 1.6] 1.8 [0.9; 2.7] 1.8 [0.9; 2.7] 2.1 [1.0; 3.1] 2.1 [1.0; 3.1] (803) (629) (452) (267) (101) Unity CR cmtd (Corin) Unity cmtd (Corin) Without 870 15 71 (63 - 77) 32/68 2014-2023 1.4 [0.5; 2.3] 2.9 [1.5; 4.3] 3.9 [2.2; 5.6] 4.2 [2.4; 6.0] 4.6 [2.6; 6.5] 4.6 [2.6; 6.5] 5.2 [2.9; 7.5] (574) (393) (333) (285) (233) (163) (97) Standard TKAs, cruciate-retaining/sacrificing, mobile bearing, hybrid ATTUNE™ Femur (DePuy) ATTUNE™ Tibia (DePuy) Without 376 8 73 (66 - 78.5) 33/67 2017-2023 1.7 [0.3; 3.0] 3.0 [0.7; 5.3] (198) (81) LCS™ COMPLETE™ Femur (DePuy) MBT Tibia (DePuy) Without 2,974 35 70 (62 - 77) 35/65 2012-2022 2.6 [2.0; 3.2] 3.9 [3.2; 4.5] 4.7 [3.9; 5.4] 5.0 [4.2; 5.8] 5.2 [4.3; 6.0] 5.4 [4.6; 6.3] 5.7 [4.7; 6.6] 5.7 [4.7; 6.6] 5.7 [4.7; 6.6] (2,850) (2,705) (2,501) (2,204) (1,756) (1,143) (610) (222) (86) Table 52 (continued) 128 EPRD Annual Report 2024 129  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival Knee arthroplasties Cumulative revision rates after ... Patellar Yrs im- Femoral component Tibial component resur- Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted facing Standard TKAs, cruciate-retaining/sacrificing, mobile bearing, uncemented ATTUNE™ Femur ATTUNE™ Tibia RP zementfrei 1.6 [0.7; 2.5] 2.9 [1.5; 4.3] 3.5 [1.7; 5.2] Without 914 17 67 (59 - 73) 40/60 2017-2023 (DePuy) (DePuy) (584) (275) (90) LCS™ COMPLETE™ Femur (DePuy) LCS™ COMPLETE™ Tibia (DePuy) Without 741 79 65 (58 - 73) 6/94 2014-2023 2.5 [1.4; 3.7] 4.8 [3.2; 6.4] 6.3 [4.4; 8.2] 7.2 [5.1; 9.3] 7.5 [5.3; 9.6] 7.5 [5.3; 9.6] 7.5 [5.3; 9.6] (641) (532) (453) (370) (268) (170) (74) LCS™ COMPLETE™ Femur (DePuy) MBT Tibia (DePuy) Without 1,225 24 70 (61 - 76) 36/64 2012-2023 1.9 [1.1; 2.6] 3.4 [2.4; 4.4] 4.0 [2.9; 5.1] 4.5 [3.3; 5.7] 4.7 [3.5; 6.0] 4.7 [3.5; 6.0] 4.7 [3.5; 6.0] 4.7 [3.5; 6.0] 4.7 [3.5; 6.0] (1,191) (1,147) (1,076) (920) (741) (510) (310) (126) (57) SCORE (Amplitude) SCORE (Amplitude) Without 630 5 69 (62 - 77) 34/66 2015-2023 1.2 [0.3; 2.0] 2.1 [0.9; 3.3] 2.8 [1.4; 4.3] 2.8 [1.4; 4.3] 2.8 [1.4; 4.3] 2.8 [1.4; 4.3] (548) (431) (335) (236) (153) (91) Standard TKAs, cruciate-retaining/sacrificing, mobile bearing, cemented ATTUNE™ Femur (DePuy) ATTUNE™ Tibia (DePuy) Without 2,670 38 69 (62 - 75) 37/63 2015-2023 1.8 [1.2; 2.3] 2.8 [2.1; 3.5] 3.4 [2.6; 4.2] 3.9 [2.9; 4.8] 3.9 [2.9; 4.8] 3.9 [2.9; 4.8] 4.4 [3.2; 5.5] 4.4 [3.2; 5.5] (1,991) (1,474) (1,136) (899) (669) (450) (249) (68) ATTUNE™ Femur (DePuy) ATTUNE™ Tibia (DePuy) With 347 8 73 (65 - 78) 23/77 2015-2023 0.9 [0.0; 1.9] 1.3 [0.0; 2.5] 1.6 [0.2; 3.0] 1.6 [0.2; 3.0] 2.1 [0.4; 3.8] 2.1 [0.4; 3.8] 2.1 [0.4; 3.8] (312) (276) (234) (204) (166) (127) (72) BPK-S INTEGRATION (Peter Brehm) BPK-S INTEGRATION (Peter Brehm) Without 316 21 70 (62 - 76) 37/63 2015-2023 3.0 [1.0; 4.8] 5.5 [2.7; 8.1] 6.9 [3.7; 10.0] 7.5 [4.1; 10.8] 8.9 [5.0; 12.6] 8.9 [5.0; 12.6] (263) (203) (179) (138) (114) (71) E.MOTION (Aesculap) E.MOTION (Aesculap) Without 12,396 92 70 (62 - 77) 34/66 2012-2023 2.4 [2.1; 2.7] 4.3 [4.0; 4.7] 5.2 [4.7; 5.6] 5.8 [5.3; 6.2] 6.2 [5.7; 6.7] 6.3 [5.8; 6.8] 6.5 [6.0; 7.1] 7.0 [6.3; 7.6] 7.7 [6.4; 8.9] (10,474) (8,707) (7,228) (5,729) (4,079) (2,537) (1,312) (522) (119) Knee E.MOTION (Aesculap) E.MOTION (Aesculap) With 563 40 68 (61 - 75) 17/83 2013-2023 5.2 [3.3; 7.1] 7.4 [5.1; 9.6] 7.9 [5.5; 10.2] 8.8 [6.2; 11.3] 8.8 [6.2; 11.3] 8.8 [6.2; 11.3] 8.8 [6.2; 11.3] (469) (380) (313) (254) (167) (102) (55) LCS™ COMPLETE™ Femur (DePuy) MBT Tibia (DePuy) Without 5,267 58 71 (64 - 77) 36/64 2013-2023 2.4 [2.0; 2.8] 3.9 [3.4; 4.4] 4.5 [4.0; 5.1] 4.9 [4.3; 5.5] 5.2 [4.6; 5.8] 5.3 [4.7; 6.0] 5.7 [5.0; 6.3] 5.9 [5.2; 6.7] 5.9 [5.2; 6.7] (5,073) (4,770) (4,365) (3,880) (3,234) (2,521) (1,654) (748) (132) SCORE (Amplitude) SCORE (Amplitude) Without 336 7 72 (62 - 77.5) 30/70 2014-2023 2.4 [0.7; 4.0] 4.0 [1.8; 6.1] 5.0 [2.6; 7.4] 5.9 [3.2; 8.5] 5.9 [3.2; 8.5] 6.8 [3.5; 10.0] 6.8 [3.5; 10.0] (315) (298) (260) (194) (150) (95) (59) SIGMA™ Femur (DePuy) MBT Tibia (DePuy) Without 2,121 31 72 (64 - 78) 37/63 2013-2023 2.8 [2.1; 3.4] 3.9 [3.1; 4.8] 4.8 [3.8; 5.7] 5.1 [4.1; 6.0] 5.1 [4.1; 6.0] 5.1 [4.1; 6.0] 5.1 [4.1; 6.0] 5.1 [4.1; 6.0] (2,001) (1,766) (1,537) (1,187) (796) (509) (273) (55) Standard TKAs cruciate-sacrificing, fixed bearing, hybrid balanSys BICONDYLAR uncem. 2.6 [1.7; 3.6] 4.3 [3.1; 5.5] 4.6 [3.3; 5.8] 4.8 [3.5; 6.1] 5.0 [3.6; 6.3] 5.2 [3.8; 6.6] 5.2 [3.8; 6.6] 5.2 [3.8; 6.6] balanSys BICONDYLAR fix (Mathys) Without 1,116 10 70 (63 - 77) 44/56 2013-2023 (Mathys) (1,034) (974) (881) (699) (459) (300) (147) (75) INNEX CR (Zimmer Biomet) Innex Fix (Zimmer Biomet) Without 331 4 70 (63 - 76) 49/51 2014-2023 1.8 [0.4; 3.3] 2.5 [0.8; 4.2] 3.2 [1.2; 5.2] 3.2 [1.2; 5.2] 3.7 [1.5; 5.9] 3.7 [1.5; 5.9] (306) (273) (244) (207) (163) (87) Standard TKAs, cruciate-sacrificing, fixed bearing, cemented balanSys BICONDYLAR cem. (Mathys) balanSys BICONDYLAR fix (Mathys) Without 2,831 33 70 (62 - 77) 30/70 2013-2023 2.0 [1.5; 2.6] 3.4 [2.6; 4.1] 4.4 [3.5; 5.3] 4.8 [3.8; 5.8] 5.3 [4.2; 6.4] 5.3 [4.2; 6.4] 5.3 [4.2; 6.4] 5.3 [4.2; 6.4] (2,125) (1,568) (1,142) (813) (546) (297) (151) (78) balanSys BICONDYLAR cem. (Mathys) balanSys BICONDYLAR fix (Mathys) With 467 15 70 (61 - 77) 27/73 2013-2023 2.7 [1.2; 4.2] 4.1 [2.1; 6.0] 4.1 [2.1; 6.0] 5.3 [2.9; 7.7] 6.0 [3.3; 8.7] 7.0 [3.7; 10.3] (386) (310) (248) (177) (103) (52) COLUMBUS (Aesculap) COLUMBUS (Aesculap) Without 4,661 112 70 (62 - 77) 28/72 2013-2023 2.1 [1.6; 2.5] 3.2 [2.7; 3.8] 3.9 [3.2; 4.5] 4.3 [3.6; 4.9] 4.6 [3.8; 5.3] 4.8 [4.0; 5.6] 5.4 [4.4; 6.3] 5.4 [4.4; 6.3] (3,630) (2,855) (2,304) (1,807) (1,323) (847) (432) (129) INNEX CR (Zimmer Biomet) Innex Fix (Zimmer Biomet) Without 1,358 46 72 (64 - 78) 40/60 2013-2023 1.1 [0.6; 1.7] 1.7 [1.0; 2.4] 2.4 [1.5; 3.2] 3.0 [2.0; 4.0] 3.4 [2.3; 4.4] 4.0 [2.8; 5.3] 4.0 [2.8; 5.3] 4.0 [2.8; 5.3] (1,242) (1,104) (981) (833) (634) (386) (195) (56) INNEX CR (Zimmer Biomet) Innex Fix (Zimmer Biomet) With 315 16 72 (65 - 77) 41/59 2015-2023 2.2 [0.6; 3.9] 3.3 [1.3; 5.3] 4.7 [2.3; 7.1] 5.2 [2.6; 7.7] 5.8 [2.9; 8.6] (292) (277) (229) (150) (70) INNEX CR GSF (Zimmer Biomet) Innex Fix (Zimmer Biomet) Without 764 35 72 (65 - 78) 20/80 2013-2023 2.8 [1.6; 4.0] 3.9 [2.4; 5.2] 4.0 [2.6; 5.4] 4.2 [2.7; 5.7] 4.9 [3.2; 6.5] 4.9 [3.2; 6.5] 5.3 [3.4; 7.2] 5.3 [3.4; 7.2] (694) (629) (553) (480) (375) (226) (144) (50) Natural Knee NK II (Zimmer Biomet) Natural Knee NK II (Zimmer Biomet) Without 335 8 73 (67 - 77) 28/72 2013-2017 2.4 [0.7; 4.0] 3.0 [1.2; 4.9] 3.0 [1.2; 4.9] 3.0 [1.2; 4.9] 3.7 [1.6; 5.7] 4.0 [1.9; 6.2] 4.0 [1.9; 6.2] 4.0 [1.9; 6.2] 4.0 [1.9; 6.2] (320) (312) (303) (297) (285) (274) (207) (149) (56) Persona CR (Zimmer Biomet) Persona Tibia (Zimmer Biomet) Without 7,185 112 70 (62 - 77) 37/63 2013-2023 1.4 [1.1; 1.7] 2.4 [2.0; 2.8] 2.7 [2.2; 3.2] 3.4 [2.7; 4.0] 3.5 [2.9; 4.2] 4.2 [3.2; 5.1] 4.2 [3.2; 5.1] 4.2 [3.2; 5.1] (4,713) (2,883) (1,945) (1,213) (734) (446) (207) (56) Persona CR (Zimmer Biomet) Persona Tibia (Zimmer Biomet) With 2,190 29 70 (61 - 77) 32/68 2013-2023 1.1 [0.7; 1.6] 1.7 [1.1; 2.3] 1.8 [1.2; 2.5] 2.3 [1.6; 3.1] 2.7 [1.8; 3.6] 2.9 [1.9; 3.8] 3.5 [1.9; 5.0] (1,831) (1,339) (970) (705) (584) (419) (125) Table 52 (continued) 130 EPRD Annual Report 2024 131  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival Knee arthroplasties Cumulative revision rates after ... Patellar Yrs im- Femoral component Tibial component resur- Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted facing Standard TKAs, cruciate-sacrificing, fixed bearing, cemented TC-PLUS CR (Smith & Nephew) TC-PLUS (Smith & Nephew) Without 323 20 73 (66 - 79) 25/75 2015-2023 2.3 [0.6; 3.9] 4.3 [1.9; 6.7] 4.3 [1.9; 6.7] 4.8 [2.2; 7.4] 5.5 [2.6; 8.3] 5.5 [2.6; 8.3] (268) (208) (188) (159) (122) (64) Triathlon CR (Stryker) Triathlon (Stryker) Without 2,286 33 70 (62 - 77) 37/63 2014-2023 1.7 [1.2; 2.3] 3.1 [2.3; 3.8] 4.0 [3.1; 4.9] 4.3 [3.3; 5.2] 4.5 [3.5; 5.5] 5.1 [3.9; 6.3] 5.5 [4.1; 7.0] 6.1 [4.3; 7.9] (1,889) (1,658) (1,323) (919) (560) (274) (169) (73) Triathlon CR (Stryker) Triathlon (Stryker) With 375 15 72 (65 - 78) 31/69 2014-2023 2.8 [1.1; 4.5] 3.7 [1.7; 5.7] 4.4 [2.2; 6.5] 4.4 [2.2; 6.5] 5.3 [2.8; 7.8] 5.3 [2.8; 7.8] 5.3 [2.8; 7.8] (324) (305) (270) (233) (177) (108) (74) Vanguard CR Vanguard Tibia Cruciate 1.6 [1.3; 1.9] 2.7 [2.3; 3.0] 3.4 [3.0; 3.8] 3.9 [3.4; 4.3] 4.0 [3.5; 4.5] 4.1 [3.6; 4.6] 4.2 [3.7; 4.7] 4.2 [3.7; 4.7] Without 8,944 75 72 (64 - 78) 33/67 2013-2023 (Zimmer Biomet) (Zimmer Biomet) (7,088) (5,616) (4,518) (3,468) (2,440) (1,491) (802) (286) Vanguard CR Vanguard Tibia Cruciate 1.6 [0.6; 2.6] 2.2 [1.0; 3.3] 2.4 [1.1; 3.6] 2.7 [1.3; 4.0] 2.7 [1.3; 4.0] 3.5 [1.7; 5.3] 3.5 [1.7; 5.3] With 626 32 71 (63 - 78) 21/79 2014-2023 (Zimmer Biomet) (Zimmer Biomet) (581) (512) (430) (340) (259) (170) (102) Vanguard CR TiNbN Vanguard Tibia TiNbN 1.2 [0.4; 2.1] 3.4 [1.9; 4.9] 4.1 [2.4; 5.8] 4.5 [2.6; 6.3] 4.9 [2.9; 6.9] 5.5 [3.2; 7.9] 5.5 [3.2; 7.9] Without 709 68 67 (59 - 75) 7/93 2014-2023 (Zimmer Biomet) (Zimmer Biomet) (559) (423) (326) (242) (156) (98) (50) Standard TKAs, cruciate-sacrificing, mobile bearing, hybrid balanSys BICONDYLAR uncem. balanSys BICONDYLAR RP 1.9 [0.9; 2.8] 3.5 [2.1; 4.9] 3.8 [2.4; 5.3] 4.2 [2.7; 5.7] 4.4 [2.8; 5.9] 4.7 [3.0; 6.3] 5.4 [3.5; 7.3] 5.4 [3.5; 7.3] 5.4 [3.5; 7.3] Without 789 6 70 (62 - 77) 41/59 2013-2023 (Mathys) (Mathys) (684) (610) (559) (480) (405) (307) (205) (121) (79) Standard TKAs, cruciate-sacrificing, mobile bearing, cemented Knee balanSys BICONDYLAR cem. balanSys BICONDYLAR RP 0.7 [0.0; 1.5] 0.7 [0.0; 1.5] 1.2 [0.2; 2.3] 1.2 [0.2; 2.3] 1.2 [0.2; 2.3] 1.2 [0.2; 2.3] 1.2 [0.2; 2.3] With 604 5 73 (65 - 79) 28/72 2013-2023 (Mathys) (Mathys) (503) (435) (366) (278) (209) (136) (73) COLUMBUS (Aesculap) COLUMBUS (Aesculap) Without 1,263 5 69 (62 - 76) 42/58 2014-2023 1.2 [0.6; 1.8] 2.3 [1.4; 3.2] 2.6 [1.7; 3.6] 3.0 [2.0; 4.0] 3.2 [2.2; 4.3] 3.6 [2.4; 4.7] 3.6 [2.4; 4.7] 3.6 [2.4; 4.7] (1,131) (973) (871) (773) (669) (545) (364) (177) INNEX CR (Zimmer Biomet) Innex Mobile (Zimmer Biomet) Without 5,420 68 73 (65 - 78) 32/68 2012-2023 2.4 [2.0; 2.8] 3.6 [3.1; 4.2] 4.4 [3.8; 4.9] 4.8 [4.2; 5.4] 5.2 [4.5; 5.8] 5.3 [4.6; 6.0] 5.4 [4.7; 6.1] 5.4 [4.7; 6.1] (4,837) (4,249) (3,684) (3,040) (2,345) (1,588) (843) (263) INNEX CR (Zimmer Biomet) Innex Mobile (Zimmer Biomet) With 797 28 74 (66 - 79) 22/78 2013-2023 1.9 [1.0; 2.9] 3.3 [2.0; 4.5] 3.8 [2.3; 5.1] 4.2 [2.7; 5.7] 4.2 [2.7; 5.7] 4.4 [2.8; 6.0] 4.8 [3.0; 6.4] 4.8 [3.0; 6.4] (715) (619) (520) (450) (389) (298) (204) (83) INNEX CR GSF (Zimmer Biomet) Innex Mobile (Zimmer Biomet) Without 4,401 63 72 (64 - 78) 19/81 2013-2023 1.9 [1.5; 2.3] 3.1 [2.6; 3.6] 3.7 [3.1; 4.3] 4.0 [3.3; 4.6] 4.2 [3.5; 4.8] 4.4 [3.7; 5.1] 5.0 [4.1; 5.9] 5.6 [4.4; 6.8] (3,978) (3,493) (2,973) (2,371) (1,741) (1,146) (565) (137) INNEX CR GSF (Zimmer Biomet) Innex Mobile (Zimmer Biomet) With 551 25 72 (64 - 77) 13/87 2013-2023 2.6 [1.3; 4.0] 3.9 [2.2; 5.6] 4.2 [2.4; 5.9] 4.4 [2.6; 6.2] 5.1 [3.0; 7.1] 5.5 [3.3; 7.6] 6.7 [3.9; 9.3] (486) (435) (378) (318) (271) (192) (113) Standard TKAs, pivot, fixed bearing, cemented ADVANCE® (MicroPort) ADVANCE® II (MicroPort) Without 462 8 72 (64 - 78) 51/49 2014-2023 4.1 [2.3; 5.9] 6.4 [4.1; 8.6] 6.6 [4.3; 8.9] 6.9 [4.5; 9.3] 8.1 [5.4; 10.7] 8.1 [5.4; 10.7] 8.8 [5.7; 11.8] (428) (389) (336) (278) (205) (136) (90) EVOLUTION® (MicroPort) EVOLUTION® (MicroPort) Without 2,719 28 69 (61 - 76) 38/62 2016-2023 1.4 [0.9; 1.9] 2.4 [1.7; 3.0] 2.7 [2.0; 3.5] 3.2 [2.3; 4.1] 3.2 [2.3; 4.1] 3.2 [2.3; 4.1] (1,917) (1,303) (973) (681) (378) (173) GMK SPHERE (Medacta) GMK (Medacta) Without 2,942 46 69 (61 - 76) 36/64 2014-2023 3.0 [2.3; 3.6] 4.6 [3.7; 5.5] 5.1 [4.1; 6.1] 5.5 [4.3; 6.5] 6.0 [4.6; 7.3] 7.0 [5.0; 9.0] (1,983) (1,284) (839) (450) (255) (104) Legacy 3D Knee (Mathys) Legacy 3D Knee (Mathys) Without 1,721 21 71 (64 - 77) 36/64 2014-2023 2.4 [1.7; 3.1] 3.7 [2.7; 4.6] 4.2 [3.2; 5.2] 4.6 [3.5; 5.6] 5.1 [4.0; 6.3] 5.7 [4.5; 6.9] 5.8 [4.6; 7.1] 6.2 [4.7; 7.7] (1,537) (1,377) (1,249) (1,062) (954) (706) (426) (162) MRK™ (IO-International Orthopaedics) MRK™ (IO-International Orthopaedics) Without 376 4 67 (60 - 74) 35/65 2018-2023 1.9 [0.5; 3.3] 2.4 [0.7; 4.0] 3.8 [1.2; 6.4] 3.8 [1.2; 6.4] (234) (165) (112) (72) Persona CR (Zimmer Biomet) Persona Tibia (Zimmer Biomet) Without 2,741 23 70 (62 - 77) 41/59 2016-2023 1.7 [1.1; 2.2] 2.5 [1.8; 3.3] 2.9 [2.0; 3.7] 2.9 [2.0; 3.7] 3.7 [2.2; 5.1] (1,614) (877) (490) (274) (110) PHYSICA KR FEMUR. CEMENTED PHYSICA SYSTEM TIBIA. CEMENTED 2.9 [1.0; 4.7] 3.6 [1.5; 5.6] 3.6 [1.5; 5.6] 4.5 [2.0; 6.9] 4.5 [2.0; 6.9] 4.5 [2.0; 6.9] Without 334 17 68 (61 - 76) 39/61 2015-2023 (Lima) (Lima) (293) (267) (224) (184) (144) (103) Standard TKAs, posterior-stabilised, cemented ATTUNE™ Femur (DePuy) ATTUNE™ Tibia (DePuy) Without 4,862 107 70 (62 - 77) 38/62 2013-2023 2.3 [1.9; 2.8] 3.9 [3.3; 4.6] 4.8 [4.0; 5.5] 5.6 [4.7; 6.5] 6.1 [5.1; 7.1] 6.4 [5.3; 7.5] 6.9 [5.6; 8.2] 6.9 [5.6; 8.2] (3,371) (2,234) (1,468) (972) (708) (495) (279) (119) ATTUNE™ Femur (DePuy) ATTUNE™ Tibia (DePuy) With 688 54 68.5 (59 - 76) 37/63 2014-2023 1.6 [0.6; 2.6] 1.8 [0.7; 2.8] 2.4 [1.0; 3.7] 4.5 [2.0; 6.9] 6.0 [2.8; 9.1] 7.0 [3.2; 10.7] 7.0 [3.2; 10.7] (511) (353) (231) (157) (119) (86) (50) Table 52 (continued) 132 EPRD Annual Report 2024 133  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival Knee arthroplasties Cumulative revision rates after ... Patellar Yrs im- Femoral component Tibial component resur- Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted facing Standard TKAs, posterior-stabilised, cemented balanSys BICONDYLAR cem. balanSys BICONDYLAR fix 2.4 [1.6; 3.1] 4.2 [3.1; 5.2] 5.2 [4.0; 6.4] 5.9 [4.6; 7.2] 6.5 [5.0; 8.0] 6.5 [5.0; 8.0] 6.5 [5.0; 8.0] Without 1,711 31 71 (64 - 78) 40/60 2013-2023 (Mathys) (Mathys) (1,342) (1,053) (879) (631) (394) (199) (90) balanSys BICONDYLAR cem. balanSys BICONDYLAR fix 1.6 [1.0; 2.1] 3.1 [2.2; 3.9] 3.6 [2.7; 4.5] 4.1 [3.1; 5.2] 4.3 [3.2; 5.5] 4.3 [3.2; 5.5] 4.3 [3.2; 5.5] With 1,977 10 70 (63 - 76) 39/61 2014-2023 (Mathys) (Mathys) (1,604) (1,222) (868) (532) (252) (91) (66) COLUMBUS (Aesculap) COLUMBUS (Aesculap) Without 662 48 69 (62 - 76) 36/64 2013-2023 3.5 [2.0; 4.9] 5.2 [3.4; 7.0] 5.9 [3.9; 7.8] 6.9 [4.7; 9.0] 7.5 [5.2; 9.8] 7.5 [5.2; 9.8] 8.3 [5.5; 11.1] 8.3 [5.5; 11.1] (540) (453) (399) (314) (241) (175) (106) (60) E.MOTION PS/PS Pro (Aesculap) E.MOTION PS (Aesculap) Without 2,956 41 69 (62 - 76) 36/64 2012-2023 3.0 [2.3; 3.6] 5.7 [4.8; 6.6] 7.2 [6.1; 8.2] 8.0 [6.8; 9.1] 8.3 [7.1; 9.4] 8.8 [7.6; 10.1] 9.0 [7.7; 10.3] 10.1 [8.3; 11.8] (2,500) (2,048) (1,633) (1,259) (895) (607) (355) (161) AS E.MOTION PS Pro (Aesculap) AS E.MOTION PS (Aesculap) Without 524 27 65 (58 - 72.5) 18/82 2015-2023 2.3 [1.0; 3.7] 7.0 [4.5; 9.5] 8.6 [5.7; 11.3] 9.3 [6.3; 12.2] 10.0 [6.7; 13.1] 11.5 [7.6; 15.2] (415) (325) (260) (196) (130) (69) GEMINI SL Total Knee System, GEMINI SL Total Knee System, Femoral Component, Fixed Bearing Tibial Component, Fixed Bearing, Without 768 18 72 (64 - 78) 36/64 2014-2023 2.6 [1.4; 3.8] 4.1 [2.6; 5.6] 4.9 [3.2; 6.6] 5.7 [3.8; 7.6] 7.2 [4.6; 9.6] 7.2 [4.6; 9.6] (620) (506) (410) (286) (157) (86) PS, cemented (Waldemar Link) cemented (Waldemar Link) GEMINI SL Total Knee System, GEMINI SL Total Knee System, Femoral Component, Tibial Component, 1.6 [0.7; 2.6] 3.1 [1.7; 4.5] 3.3 [1.9; 4.8] 3.7 [2.1; 5.2] 3.7 [2.1; 5.2] Without 707 20 71 (63 - 78) 35/65 2015-2023 Mobile Bearing / Fixed Bearing CR, Fixed Bearing, cemented (577) (449) (344) (194) (88) (Waldemar Link) (Waldemar Link) GENESIS II PS COCR Genesis II 2.9 [2.3; 3.5] 4.9 [4.2; 5.7] 5.7 [4.9; 6.5] 6.3 [5.4; 7.2] 6.8 [5.9; 7.7] 7.2 [6.2; 8.1] 7.5 [6.4; 8.5] 7.9 [6.7; 9.1] Without 3,495 75 71 (63 - 77) 35/65 2013-2023 Knee (Smith & Nephew) (Smith & Nephew) (3,040) (2,636) (2,318) (1,915) (1,502) (974) (462) (162) GENESIS II PS COCR Genesis II 2.6 [1.0; 4.2] 4.0 [1.9; 6.0] 4.7 [2.4; 7.0] 5.5 [3.0; 8.0] 5.5 [3.0; 8.0] 6.7 [3.7; 9.6] With 406 31 71 (64 - 77) 32/68 2013-2023 (Smith & Nephew) (Smith & Nephew) (317) (265) (246) (227) (187) (111) GENESIS II PS OXINIUM Genesis II 2.3 [1.2; 3.3] 4.0 [2.5; 5.4] 5.1 [3.4; 6.7] 5.5 [3.7; 7.2] 5.5 [3.7; 7.2] 6.1 [4.1; 8.1] 6.5 [4.4; 8.6] Without 874 61 65 (58 - 73) 23/77 2013-2023 (Smith & Nephew) (Smith & Nephew) (710) (571) (477) (407) (334) (260) (141) JOURNEY II BCS COCR JOURNEY 3.3 [2.2; 4.4] 5.7 [4.2; 7.2] 6.9 [5.2; 8.7] 8.7 [6.4; 11.0] 8.7 [6.4; 11.0] Without 1,221 39 70 (62 - 77) 42/58 2017-2023 (Smith & Nephew) (Smith & Nephew) (865) (597) (362) (223) (99) JOURNEY II BCS OXINIUM JOURNEY 4.1 [3.1; 5.1] 6.6 [5.3; 7.9] 7.6 [6.2; 9.0] 8.4 [6.9; 9.8] 9.1 [7.5; 10.6] 9.8 [8.1; 11.5] 9.8 [8.1; 11.5] Without 1,575 42 68 (60 - 75) 30/70 2014-2023 (Smith & Nephew) (Smith & Nephew) (1,383) (1,243) (1,127) (936) (679) (391) (94) LEGION PS COCR (Smith & Nephew) Genesis II (Smith & Nephew) Without 10,246 134 70 (62 - 77) 38/62 2014-2023 2.7 [2.3; 3.0] 4.7 [4.2; 5.2] 5.5 [5.0; 6.1] 6.0 [5.4; 6.6] 6.2 [5.6; 6.9] 6.7 [5.9; 7.4] 6.7 [5.9; 7.4] 6.7 [5.9; 7.4] (7,648) (5,473) (3,605) (2,415) (1,390) (605) (217) (51) LEGION PS COCR (Smith & Nephew) Genesis II (Smith & Nephew) With 1,586 65 71 (63 - 77) 34/66 2015-2023 2.3 [1.5; 3.0] 3.1 [2.1; 4.0] 3.4 [2.3; 4.4] 3.8 [2.6; 5.0] 3.8 [2.6; 5.0] (1,128) (772) (501) (308) (128) LEGION PS OXINIUM Genesis II 2.0 [1.5; 2.5] 4.3 [3.4; 5.1] 5.3 [4.3; 6.2] 5.7 [4.7; 6.8] 6.0 [4.9; 7.1] 6.6 [5.2; 7.9] 8.2 [6.1; 10.3] 8.2 [6.1; 10.3] Without 2,987 144 66 (59 - 74) 22/78 2012-2023 (Smith & Nephew) (Smith & Nephew) (2,207) (1,566) (1,090) (749) (480) (286) (166) (75) LEGION PS OXINIUM Genesis II 3.1 [1.4; 4.7] 4.2 [2.1; 6.3] 5.9 [3.1; 8.6] 8.4 [4.4; 12.3] 9.8 [5.0; 14.3] With 446 49 67 (60 - 75) 15/85 2012-2023 (Smith & Nephew) (Smith & Nephew) (304) (206) (139) (95) (53) LinkSymphoKnee, LinkSymphoKnee, Femoral Component, PS, FB, Monoblock, CoCrMo, Without 689 18 69 (62 - 76) 48/52 2021-2023 0.6 [0.0; 1.2] (215) cemented (Waldemar Link) cemented (Waldemar Link) NexGen LPS-Flex-Gender NexGen CR 1.6 [1.2; 2.0] 2.5 [2.0; 3.0] 3.2 [2.6; 3.8] 3.5 [2.9; 4.1] 3.7 [3.0; 4.4] 4.0 [3.3; 4.8] 4.1 [3.4; 4.9] 5.2 [3.9; 6.5] 5.6 [4.1; 7.0] Without 3,945 85 69 (61 - 76) 9/91 2012-2023 (Zimmer Biomet) (Zimmer Biomet) (3,456) (3,022) (2,548) (2,046) (1,412) (985) (578) (315) (140) NexGen LPS-Flex-Gender NexGen CR 2.0 [0.9; 3.1] 3.4 [2.0; 4.8] 3.8 [2.3; 5.4] 3.8 [2.3; 5.4] 4.5 [2.7; 6.2] 5.3 [3.2; 7.3] 5.8 [3.5; 8.1] 5.8 [3.5; 8.1] With 668 29 69 (61 - 76) 3/97 2012-2023 (Zimmer Biomet) (Zimmer Biomet) (588) (503) (432) (358) (288) (196) (125) (57) NexGen LPS-Flex (Zimmer Biomet) NexGen CR (Zimmer Biomet) Without 14,779 228 69 (61 - 76) 30/70 2012-2023 2.0 [1.8; 2.2] 3.3 [3.0; 3.6] 3.9 [3.5; 4.2] 4.2 [3.9; 4.6] 4.5 [4.1; 4.9] 4.8 [4.3; 5.2] 5.1 [4.6; 5.6] 5.3 [4.8; 5.9] 5.5 [4.8; 6.2] (12,271) (10,007) (8,219) (6,555) (4,659) (3,000) (1,628) (677) (227) NexGen LPS-Flex (Zimmer Biomet) NexGen CR (Zimmer Biomet) With 2,715 91 70 (62 - 76) 36/64 2012-2023 2.0 [1.5; 2.6] 3.0 [2.3; 3.7] 3.6 [2.9; 4.4] 4.1 [3.3; 4.9] 4.3 [3.4; 5.1] 4.3 [3.4; 5.1] 4.7 [3.7; 5.7] 5.0 [3.9; 6.1] 5.0 [3.9; 6.1] (2,343) (1,993) (1,699) (1,397) (1,064) (734) (454) (204) (70) NexGen LPS (Zimmer Biomet) NexGen CR (Zimmer Biomet) Without 10,754 37 69 (62 - 76) 41/59 2012-2023 1.3 [1.0; 1.5] 2.1 [1.8; 2.4] 2.6 [2.3; 3.0] 2.9 [2.6; 3.3] 3.1 [2.7; 3.4] 3.3 [2.9; 3.7] 3.6 [3.2; 4.1] 3.7 [3.2; 4.1] 4.3 [3.6; 5.1] (9,377) (7,851) (6,669) (5,325) (4,129) (2,963) (1,948) (1,036) (482) NexGen LPS (Zimmer Biomet) NexGen CR (Zimmer Biomet) With 418 14 70 (62 - 77) 30/70 2013-2023 1.2 [0.2; 2.3] 2.1 [0.6; 3.5] 2.7 [1.0; 4.4] 3.1 [1.3; 4.9] 3.6 [1.5; 5.6] 4.3 [1.8; 6.8] 4.3 [1.8; 6.8] (370) (331) (283) (238) (170) (116) (70) Table 52 (continued) 134 EPRD Annual Report 2024 135  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival Knee arthroplasties Cumulative revision rates after ... Patellar Yrs im- Femoral component Tibial component resur- Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted facing Standard TKAs, posterior-stabilised, cemented Persona PS (Zimmer Biomet) Persona Tibia (Zimmer Biomet) Without 4,492 80 71 (62 - 78) 36/64 2013-2023 2.6 [2.1; 3.1] 4.2 [3.5; 4.9] 4.9 [4.1; 5.8] 5.3 [4.4; 6.2] 5.3 [4.4; 6.2] 5.9 [4.6; 7.1] 6.4 [4.8; 7.9] (2,904) (1,720) (1,082) (643) (391) (204) (93) Persona PS (Zimmer Biomet) Persona Tibia (Zimmer Biomet) With 409 31 70 (63 - 76) 27/73 2014-2023 2.7 [0.9; 4.4] 5.5 [2.4; 8.4] 5.5 [2.4; 8.4] (232) (129) (66) SIGMA™ Femur (DePuy) MBT Tibia (DePuy) Without 683 42 73 (66 - 79) 30/70 2014-2023 2.7 [1.5; 3.9] 4.0 [2.5; 5.5] 5.1 [3.4; 6.9] 5.8 [3.9; 7.7] 6.1 [4.1; 8.0] 6.1 [4.1; 8.0] 6.1 [4.1; 8.0] (627) (539) (457) (352) (242) (154) (72) SIGMA™ Femur (DePuy) SIGMA™ Tibia (DePuy) Without 4,031 118 71 (64 - 78) 34/66 2013-2023 2.7 [2.2; 3.2] 4.5 [3.8; 5.1] 5.2 [4.4; 5.9] 5.9 [5.1; 6.8] 6.2 [5.4; 7.1] 6.6 [5.7; 7.6] 6.9 [5.9; 7.8] 7.5 [6.2; 8.7] (3,315) (2,764) (2,304) (1,857) (1,376) (963) (540) (196) SIGMA™ Femur (DePuy) SIGMA™ Tibia (DePuy) With 1,714 53 70 (62 - 77) 32/68 2012-2023 2.0 [1.4; 2.7] 3.1 [2.2; 3.9] 4.0 [3.0; 5.0] 4.6 [3.5; 5.7] 5.0 [3.9; 6.1] 5.4 [4.2; 6.6] 5.8 [4.4; 7.1] 6.2 [4.6; 7.7] (1,509) (1,362) (1,222) (1,062) (853) (603) (298) (118) Triathlon PS (Stryker) Triathlon (Stryker) Without 4,351 75 71 (64 - 78) 36/64 2013-2023 3.1 [2.5; 3.6] 4.7 [4.0; 5.4] 5.3 [4.6; 6.1] 5.8 [5.0; 6.6] 6.0 [5.2; 6.8] 6.5 [5.5; 7.4] 6.5 [5.5; 7.4] 6.5 [5.5; 7.4] (3,511) (2,774) (2,184) (1,591) (1,069) (556) (221) (70) Triathlon PS (Stryker) Triathlon (Stryker) With 1,322 30 71 (63 - 78) 36/64 2013-2023 1.6 [0.9; 2.3] 3.0 [2.0; 4.0] 3.5 [2.4; 4.6] 3.5 [2.4; 4.6] 3.5 [2.4; 4.6] 3.5 [2.4; 4.6] 3.5 [2.4; 4.6] (1,082) (826) (612) (464) (305) (107) (53) Triathlon PS (Stryker) Triathlon TS (Stryker) Without 500 43 69.5 (61.5 - 77) 35/65 2013-2023 3.1 [1.5; 4.7] 3.4 [1.7; 5.1] 3.8 [1.9; 5.6] 4.4 [2.2; 6.5] 5.6 [2.3; 8.8] (361) (280) (198) (125) (72) Vanguard PS Vanguard Tibia Cruciate 2.9 [2.3; 3.4] 4.6 [3.9; 5.4] 5.1 [4.2; 5.9] 6.0 [5.0; 6.9] 6.3 [5.2; 7.3] 6.3 [5.2; 7.3] 6.3 [5.2; 7.3] 7.5 [4.9; 10.0] Without 3,357 51 72 (64 - 78) 35/65 2014-2023 (Zimmer Biomet) (Zimmer Biomet) (2,597) (1,985) (1,434) (1,001) (644) (398) (219) (61) Knee VEGA (Aesculap) VEGA (Aesculap) Without 2,237 58 69 (61 - 77) 32/68 2013-2023 1.8 [1.2; 2.4] 3.9 [3.0; 4.8] 6.1 [4.8; 7.3] 7.3 [5.9; 8.7] 8.4 [6.8; 10.0] 10.4 [8.3; 12.5] 12.3 [9.6; 14.9] 13.0 [10.0; 16.0] (1,635) (1,219) (947) (708) (469) (285) (160) (59) Constrained TKAs, hinged, fixed bearing, cemented Endo-Model SL, Endo-Model SL, Femoral Component, cemented Tibial Component, cemented Without 577 54 76 (68 - 82) 22/78 2013-2023 7.5 [5.2; 9.6] 8.6 [6.2; 10.9] 9.4 [6.8; 11.9] 9.8 [7.1; 12.3] 10.8 [7.8; 13.7] 10.8 [7.8; 13.7] 11.8 [8.2; 15.3] (448) (360) (280) (214) (157) (109) (56) (Waldemar Link) (Waldemar Link) Endo-Model, Endo-Model, Rotating Hinge, cemented Rotational Hinge, cemented Without 1,590 182 77 (69 - 82) 18/82 2013-2023 4.3 [3.3; 5.3] 5.7 [4.5; 7.0] 6.5 [5.1; 7.8] 6.7 [5.4; 8.1] 7.1 [5.6; 8.5] 7.1 [5.6; 8.5] 7.1 [5.6; 8.5] 9.5 [6.4; 12.4] (1,240) (978) (784) (621) (428) (287) (165) (76) (Waldemar Link) (Waldemar Link) ENDURO (Aesculap) ENDURO (Aesculap) Without 1,936 179 75 (67 - 81) 21/79 2013-2023 4.0 [3.1; 4.9] 5.5 [4.4; 6.6] 6.9 [5.6; 8.1] 7.2 [5.9; 8.5] 7.2 [5.9; 8.5] 7.8 [6.3; 9.2] 8.1 [6.5; 9.6] 8.1 [6.5; 9.6] (1,534) (1,245) (994) (759) (547) (360) (202) (82) ENDURO (Aesculap) ENDURO (Aesculap) With 546 45 73 (65 - 79) 27/73 2014-2023 3.8 [2.2; 5.5] 4.8 [2.9; 6.7] 5.5 [3.4; 7.6] 6.3 [3.9; 8.7] 6.3 [3.9; 8.7] 6.3 [3.9; 8.7] 6.3 [3.9; 8.7] (436) (321) (235) (178) (126) (85) (56) MUTARS GenuX MK cemented MUTARS GenuX MK cemented 3.7 [1.8; 5.5] 6.5 [3.8; 9.1] 7.3 [4.5; 10.2] 8.0 [4.9; 11.1] 8.0 [4.9; 11.1] Without 451 88 77 (67 - 82) 25/75 2015-2023 (Implantcast) (Implantcast) (317) (229) (171) (108) (63) NexGen RHK (Zimmer Biomet) NexGen RHK (Zimmer Biomet) Without 1,177 148 76 (68 - 81) 23/77 2012-2023 3.0 [2.0; 4.0] 4.2 [3.0; 5.4] 5.1 [3.7; 6.5] 5.4 [4.0; 6.9] 5.7 [4.2; 7.2] 6.0 [4.3; 7.6] 6.4 [4.6; 8.3] 7.3 [4.8; 9.7] (988) (812) (668) (539) (377) (229) (131) (64) RT-Plus (Smith & Nephew) RT-Plus (Smith & Nephew) Without 2,325 144 77 (71 - 81) 21/79 2013-2023 4.0 [3.2; 4.8] 5.1 [4.2; 6.1] 5.8 [4.7; 6.8] 6.2 [5.1; 7.2] 6.4 [5.3; 7.4] 6.5 [5.4; 7.6] 6.5 [5.4; 7.6] 6.5 [5.4; 7.6] (1,937) (1,648) (1,399) (1,107) (802) (534) (286) (104) RT-Plus Modular (Smith & Nephew) RT-Plus Modular (Smith & Nephew) Without 619 111 75 (66 - 81) 27/73 2013-2023 4.7 [3.0; 6.3] 6.3 [4.3; 8.2] 6.7 [4.6; 8.8] 6.7 [4.6; 8.8] 7.8 [5.4; 10.2] 8.3 [5.7; 10.9] 8.3 [5.7; 10.9] (511) (426) (354) (287) (214) (147) (74) Constrained TKAs, varus-valgus stabilised, fixed bearing, cemented LCS™ COMPLETE™ Femur (DePuy) MBT Tibia (DePuy) Without 357 23 73 (67 - 80) 23/77 2013-2023 4.0 [1.9; 6.0] 5.6 [3.1; 8.1] 6.0 [3.4; 8.6] 6.0 [3.4; 8.6] 6.0 [3.4; 8.6] 6.8 [3.8; 9.7] (311) (253) (208) (165) (124) (96) LEGION PS COCR (Smith & Nephew) Genesis II (Smith & Nephew) Without 1,003 87 71 (63 - 78) 30/70 2015-2023 2.9 [1.9; 4.0] 4.3 [3.0; 5.7] 5.3 [3.6; 7.0] 5.7 [3.9; 7.5] 5.7 [3.9; 7.5] (764) (545) (343) (231) (95) LEGION Revision COCR LEGION Revision 4.6 [2.7; 6.5] 5.6 [3.4; 7.6] 5.9 [3.7; 8.0] 5.9 [3.7; 8.0] 7.3 [4.6; 10.0] 7.3 [4.6; 10.0] Without 500 72 72 (65 - 79) 28/72 2014-2023 (Smith & Nephew) (Smith & Nephew) (417) (341) (279) (237) (171) (115) NexGen LCCK (Zimmer Biomet) NexGen CR (Zimmer Biomet) Without 1,688 117 72 (64 - 79) 29/71 2012-2023 2.7 [1.9; 3.5] 3.4 [2.5; 4.3] 3.7 [2.7; 4.6] 3.9 [2.9; 4.9] 3.9 [2.9; 4.9] 4.1 [3.0; 5.2] 4.5 [3.2; 5.8] 4.5 [3.2; 5.8] (1,412) (1,118) (914) (734) (539) (379) (205) (76) NexGen LCCK (Zimmer Biomet) NexGen CR (Zimmer Biomet) With 393 25 73 (62 - 79) 28/72 2013-2023 2.8 [1.2; 4.5] 3.5 [1.6; 5.3] 3.5 [1.6; 5.3] 3.5 [1.6; 5.3] 3.5 [1.6; 5.3] 3.5 [1.6; 5.3] 3.5 [1.6; 5.3] (342) (298) (255) (200) (145) (94) (50) Table 52 (continued) 136 EPRD Annual Report 2024 137  5 Hip and knee arthroplasty survival 5.3 Primary knee arthroplasty survival Knee arthroplasties Cumulative revision rates after ... Patellar Yrs im- Femoral component Tibial component resur- Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted facing Constrained TKAs, varus-valgus stabilised, fixed bearing, cemented Triathlon PS (Stryker) Triathlon TS (Stryker) Without 496 45 73 (64 - 80) 26/74 2013-2023 1.7 [0.5; 2.9] 4.4 [2.3; 6.4] 4.8 [2.6; 7.0] 6.5 [3.5; 9.3] 6.5 [3.5; 9.3] (374) (268) (195) (123) (73) Unicondylar knee arthroplasties, fixed bearing, cemented balanSys UNI (Mathys) balanSys UNI fix (Mathys) Without 723 27 62 (56 - 71) 50/50 2013-2023 3.6 [2.2; 5.0] 5.6 [3.8; 7.4] 6.9 [4.8; 8.9] 7.1 [5.0; 9.2] 7.8 [5.5; 10.1] 8.2 [5.8; 10.6] 9.1 [6.1; 12.0] (583) (471) (372) (293) (228) (153) (83) JOURNEY UNI COCR JOURNEY UNI 2.5 [1.7; 3.3] 4.7 [3.5; 5.8] 5.8 [4.5; 7.1] 6.4 [4.9; 7.8] 8.2 [6.3; 10.1] 9.3 [7.0; 11.5] 9.9 [7.3; 12.4] Without 1,568 94 63 (57.5 - 70) 49/51 2014-2023 (Smith & Nephew) (Smith & Nephew) (1,261) (994) (733) (509) (317) (178) (79) JOURNEY UNI OXINIUM JOURNEY UNI 4.5 [3.3; 5.6] 7.2 [5.7; 8.7] 8.7 [6.9; 10.4] 9.7 [7.8; 11.6] 11.9 [9.5; 14.2] 12.8 [10.3; 15.3] 14.4 [11.0; 17.7] Without 1,309 159 60 (54 - 66) 32/68 2013-2023 (Smith & Nephew) (Smith & Nephew) (1,023) (786) (591) (466) (302) (184) (82) Link SLED, All-Poly (Waldemar 2.7 [1.5; 3.8] 6.0 [4.2; 7.7] 7.5 [5.5; 9.4] 9.3 [7.0; 11.5] 10.6 [8.1; 13.1] 11.5 [8.7; 14.2] 12.5 [9.4; 15.5] 15.6 [11.3; 19.7] LINK SLED (Waldemar Link) Without 786 33 63.5 (56 - 73) 50/50 2013-2023 Link) (703) (604) (515) (388) (284) (201) (129) (57) LINK SLED Link SLED, metal-backed 3.1 [2.0; 4.1] 6.6 [5.0; 8.2] 8.4 [6.6; 10.3] 10.4 [8.2; 12.5] 10.8 [8.6; 13.0] 12.9 [10.1; 15.6] 15.4 [11.7; 19.0] Without 1,136 68 62 (57 - 71) 42/58 2013-2023 (Waldemar Link) (Waldemar Link) (940) (742) (554) (418) (293) (199) (89) Mako MCK (Stryker) Mako MCK (Stryker) Without 1,065 19 62 (57 - 69) 55/45 2016-2023 0.8 [0.3; 1.4] 1.5 [0.6; 2.4] 2.5 [1.2; 3.8] 2.5 [1.2; 3.8] (781) (496) (293) (160) MOTO (Medacta) MOTO (Medacta) Without 513 18 63 (58 - 71) 48/52 2019-2023 1.4 [0.2; 2.7] 2.8 [0.8; 4.7] Knee (282) (126) Oxford Oxford Fixed Lateral Tibia 1.5 [0.7; 2.3] 2.7 [1.7; 3.8] 3.0 [1.9; 4.1] 4.0 [2.6; 5.3] 4.2 [2.8; 5.6] 4.2 [2.8; 5.6] 4.2 [2.8; 5.6] Without 1,050 58 71 (61 - 78) 19/81 2015-2023 (Zimmer Biomet) (Zimmer Biomet) (932) (771) (654) (465) (300) (148) (54) Persona Partial Knee Persona Partial Knee 2.3 [1.8; 2.7] 3.6 [3.0; 4.1] 4.4 [3.7; 5.1] 4.9 [4.1; 5.8] 5.1 [4.2; 5.9] Without 5,066 124 63 (58 - 71) 49/51 2017-2023 (Zimmer Biomet) (Zimmer Biomet) (3,500) (2,303) (1,376) (760) (250) SIGMA™ HP Partial-Kniesystem SIGMA™ HP Partial-Kniesystem 1.8 [1.4; 2.2] 3.7 [3.1; 4.3] 4.6 [4.0; 5.3] 5.4 [4.7; 6.2] 5.7 [4.9; 6.5] 6.3 [5.4; 7.1] 7.0 [5.9; 8.0] 7.1 [6.1; 8.2] 7.1 [6.1; 8.2] Without 4,500 109 63 (57 - 71) 47/53 2012-2023 (DePuy) (DePuy) (3,920) (3,382) (2,828) (2,202) (1,661) (1,097) (594) (214) (54) Triathlon PKR (Stryker) Triathlon PKR (Stryker) Without 636 34 62 (56 - 70) 46/54 2014-2023 4.8 [3.1; 6.4] 7.5 [5.4; 9.7] 9.3 [6.8; 11.6] 10.5 [7.9; 13.1] 11.2 [8.4; 13.9] 12.3 [9.3; 15.3] 12.3 [9.3; 15.3] 12.3 [9.3; 15.3] (542) (453) (380) (319) (256) (184) (101) (50) UNIVATION (Aesculap) UNIVATION (Aesculap) Without 1,601 73 62 (56 - 70) 44/56 2014-2020 4.8 [3.8; 5.9] 8.3 [6.9; 9.7] 10.6 [9.1; 12.1] 12.3 [10.7; 13.9] 13.3 [11.5; 15.0] 13.8 [12.0; 15.7] 14.3 [12.2; 16.2] (1,510) (1,444) (1,351) (976) (588) (266) (78) ZUK (Lima) ZUK (Lima) Without 5,463 126 64 (58 - 72) 46/54 2012-2023 2.0 [1.6; 2.4] 3.1 [2.6; 3.5] 3.7 [3.1; 4.3] 4.6 [3.9; 5.2] 4.8 [4.1; 5.5] 5.1 [4.3; 5.8] 5.5 [4.6; 6.3] 6.2 [5.0; 7.4] (4,355) (3,410) (2,696) (2,247) (1,832) (1,243) (663) (182) Unicondylar knee arthroplasties, mobile bearing, hybrid Oxford (Zimmer Biomet) Oxford Tibia (Zimmer Biomet) Without 305 38 67 (61 - 74) 36/64 2013-2023 3.0 [1.1; 5.0] 3.8 [1.6; 6.0] 4.2 [1.8; 6.6] 4.7 [2.1; 7.2] 5.2 [2.5; 7.9] 5.2 [2.5; 7.9] 6.7 [2.7; 10.5] (271) (241) (218) (194) (153) (109) (53) Unicondylar knee arthroplasties, mobile bearing, uncemented Oxford (Zimmer Biomet) Oxford Tibia (Zimmer Biomet) Without 8,003 106 63 (57 - 71) 55/45 2012-2023 3.7 [3.3; 4.2] 5.1 [4.5; 5.6] 6.0 [5.4; 6.6] 6.5 [5.8; 7.1] 6.8 [6.1; 7.4] 7.6 [6.8; 8.3] 7.9 [7.1; 8.8] 8.4 [7.4; 9.3] 8.8 [7.5; 10.1] (6,214) (4,845) (3,925) (3,086) (2,225) (1,442) (835) (385) (154) Unicondylar knee arthroplasties, mobile bearing, cemented Oxford (Zimmer Biomet) Oxford Tibia (Zimmer Biomet) Without 25,704 429 64 (58 - 73) 46/54 2012-2023 2.8 [2.6; 3.0] 4.4 [4.1; 4.7] 5.4 [5.1; 5.7] 6.2 [5.9; 6.5] 6.8 [6.4; 7.2] 7.6 [7.2; 8.0] 8.2 [7.8; 8.7] 9.0 [8.4; 9.7] 9.5 [8.7; 10.4] (21,206) (17,402) (14,221) (10,951) (7,877) (4,989) (2,657) (980) (298) Oxford TiNbN Oxford Tibia TiNbN 3.0 [2.3; 3.6] 5.7 [4.7; 6.7] 6.7 [5.6; 7.8] 7.7 [6.5; 8.9] 8.5 [7.2; 9.8] 9.0 [7.6; 10.4] 9.0 [7.6; 10.4] 9.4 [7.8; 11.0] 9.4 [7.8; 11.0] Without 2,492 304 60 (55 - 67) 12/88 2012-2023 (Zimmer Biomet) (Zimmer Biomet) (2,139) (1,726) (1,388) (1,059) (746) (488) (303) (141) (57) Patellofemoral knee arthroplasty, cemented JOURNEY PFJ OXINIUM 5.3 [2.9; 7.7] 8.2 [5.1; 11.2] 10.8 [7.1; 14.3] 12.6 [8.4; 16.6] 14.1 [9.5; 18.5] With 373 104 54 (48 - 61) 25/75 2013-2023 (Smith & Nephew) (289) (227) (165) (126) (77) Patellofemoral Joint GSF 3.0 [0.9; 5.1] 7.6 [4.1; 10.9] 7.6 [4.1; 10.9] 11.6 [6.9; 16.0] 13.6 [8.2; 18.7] With 307 78 56 (49 - 62) 27/73 2013-2023 (Zimmer Biomet) (245) (189) (155) (109) (70) Table 52 (continued) 138 EPRD Annual Report 2024 139  5 Hip and knee arthroplasty survival 5.4 Revision knee arthroplasty survival 5.4 Revision knee 2 years of an aseptic revision is 9.9%, but This applies regardless of whether only first In brief: arthroplasty survival increases to 24.2% for a septic revision. or second revisions are considered or – as in Figure 30 – all revisions are combined. Knee The knee arthroplasty CReRR is also consid- For patients with a primary arthroplasty reg- CReRRs also decrease when a new femoral • The CReRR within 2 years of a septic revi- erably higher after a revision than after a pri- istered in the EPRD, it is possible to track or tibial component is implanted instead of sion is 24.2%, compared to only 9.9% for mary procedure. The risk of re-revision sur- exactly how many procedures were per- leaving the previously implanted bone-an- aseptic revisions. gery increases even further if the revision was formed on a particular joint. The data sets chored components in situ. • The risk of re-revision surgery increases due to periprosthetic infection (Figure 28). for these patient profiles show that the risk from one subsequent procedure to the When considering all knee re-revisions re- of knee re-revision increases from one sub- This difference is particularly pronounced next. corded in the registry, the CReRR within sequent procedure to the next (Figure 29). for septic revisions. The caveat here is that, exchange of the insert alone represents the 40 initially less invasive option and in many © EPRD Annual Report 2024 35 cases does not necessarily lead to a prompt Cumulative re-revision [%] 30 re-revision. The patient’s general health sta- tus may therefore influence the decision of 25 whether or not to also exchange bone-an- 20 chored components at the same time. 15 10 Table 53 clarifies the influence of other fac- Knee 5 Septic knee revisions Aseptic knee revisions tors on the CReRRs. Since initial conditions 0 for revisions differ more extensively com- 0 1 2 3 4 5 6 7 8 9 pared to primary knee arthroplasties and the Years since last revision severity of individual revision surgeries are Numbers 11,946 7,853 6,005 4,555 3,364 2,303 1,437 773 298 77 difficult to assess, outcome results also need to be interpreted with caution. at risk 45,434 36,257 28,889 22,789 17,448 12,537 8,187 4,592 1,985 558 Figure 28: Knee arthroplasty cumulative re-revision rates over time (p < 0.0001) 40 40 © EPRD Annual Report 2024 © EPRD Annual Report 2024 35 35 Cumulative re-revision [%] Cumulative re-revision [%] 30 30 25 25 20 20 15 15 10 10 Septic, without exchange of bone-anchored components Septic, with exchange of bone-anchored components 5 Subsequent septic revisions Subsequent aseptic revisions 5 Aseptic, without exchange of bone-anchored components 2nd septic revision 2nd aseptic revision 1st septic revision 1st aseptic revision Aseptic, with exchange of bone-anchored components 0 0 0 1 2 3 4 5 0 1 2 3 4 5 6 7 8 9 Years since last revision Years since last revision 356 205 146 105 61 33 3,893 2,143 1,573 1,141 790 507 276 145 49 6 807 484 347 248 163 101 Numbers 7,078 5,173 4,037 3,115 2,361 1,651 1,077 581 230 67 at risk 2,754 1,726 1,262 917 615 364 13,182 10,306 8,210 6,468 4,981 3,530 2,239 1,226 524 143 Numbers at risk 282 181 113 65 40 25 29,783 23,914 19,089 15,108 11,535 8,294 5,466 3,068 1,311 368 1,237 860 596 384 241 140 10,275 7,557 5,583 4,036 2,777 1,699 Figure 30: Knee arthroplasty cumulative re-revision rates by implanted components (p < 0.0001) Figure 29: Knee arthroplasty cumulative re-revision rates after first, second and subsequent revisions (p < 0.0001). Confiden- ce intervals have been omitted for clarity. 140 EPRD Annual Report 2024 141  5 Hip and knee arthroplasty survival 5.4 Revision knee arthroplasty survival Re-revision rates after ... Type of revision / Category Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years Infection-related knee revision 11,946 72 (63 - 79) 47/53 30.0 669 19.5 [18.7; 20.2] 24.2 [23.4; 25.0] 27.5 [26.6; 28.4] 29.4 [28.4; 30.3] 31.2 [30.2; 32.2] 32.7 [31.7; 33.8] 33.8 [32.6; 35.0] 35.5 [34.0; 36.9] 36.8 [34.7; 38.8] (7,853) (6,005) (4,555) (3,364) (2,303) (1,437) (773) (298) (77) Number of procedures First revision 2,754 70 (61 - 77) 49/51 30.4 528 18.9 [17.4; 20.4] 22.6 [21.0; 24.3] 24.9 [23.1; 26.7] 26.9 [24.9; 28.8] 27.5 [25.4; 29.4] 28.2 [26.0; 30.4] 28.2 [26.0; 30.4] (1,726) (1,262) (917) (615) (364) (188) (80) Second revision 807 69 (61 - 77) 50/50 30.7 314 19.2 [16.3; 22.0] 25.4 [22.0; 28.6] 28.6 [24.9; 32.1] 30.7 [26.7; 34.4] 31.8 [27.6; 35.7] 33.6 [28.7; 38.2] (484) (347) (248) (163) (101) (52) Third or subsequent 21.5 [16.8; 25.9] 27.9 [22.5; 32.9] 35.9 [29.6; 41.7] 38.5 [31.7; 44.6] 356 69 (60 - 77) 54/46 31.6 167 revision (205) (146) (105) (61) Revision without known 19.6 [18.7; 20.5] 24.4 [23.4; 25.4] 27.8 [26.8; 28.9] 29.7 [28.5; 30.8] 31.8 [30.6; 33.0] 33.4 [32.1; 34.7] 34.6 [33.2; 36.0] 36.4 [34.7; 38.1] 37.6 [35.4; 39.7] 8,029 73 (64 - 79) 46/54 29.4 627 previous history (5,438) (4,250) (3,285) (2,525) (1,805) (1,180) (669) (273) (75) With exchange of 12.9 [12.1; 13.8] 18.4 [17.5; 19.4] 22.3 [21.2; 23.4] 24.5 [23.3; 25.6] 26.6 [25.4; 27.9] 28.6 [27.3; 30.0] 29.9 [28.4; 31.3] 32.0 [30.0; 33.9] 33.8 [31.1; 36.4] Re-implanted components 7,078 71 (62 - 78) 47/53 29.6 617 bone-anchored components (5,173) (4,037) (3,115) (2,361) (1,651) (1,077) (581) (230) (67) Without exchange of 28.2 [26.7; 29.6] 31.7 [30.1; 33.2] 33.9 [32.3; 35.6] 35.2 [33.4; 36.8] 36.4 [34.5; 38.1] 36.7 [34.8; 38.5] 37.4 [35.4; 39.4] 3,893 73 (64 - 79) 49/51 30.1 554 bone-anchored components (2,143) (1,573) (1,141) (790) (507) (276) (145) not clearly defined 975 72 (64 - 79) 43/57 30.1 266 33.0 [29.9; 36.0] 36.7 [33.5; 39.8] 39.4 [36.0; 42.6] 41.3 [37.7; 44.7] 42.8 [39.1; 46.4] 43.8 [39.9; 47.5] (537) (395) (299) (213) (145) (84) Age group ≤ 54 years 902 51 (48 - 53) 51/49 31.9 310 21.3 [18.6; 24.0] 29.2 [26.0; 32.2] 35.7 [32.2; 39.1] 38.1 [34.4; 41.6] 41.8 [37.8; 45.6] 45.2 [40.7; 49.4] 46.9 [42.1; 51.4] (620) (468) (339) (257) (179) (116) (60) 55 to 64 years 2,556 60 (58 - 62) 52/48 32.1 504 20.3 [18.7; 21.9] 25.7 [23.8; 27.4] 29.3 [27.3; 31.2] 31.6 [29.5; 33.6] 33.2 [31.0; 35.4] 34.7 [32.3; 37.0] 36.0 [33.4; 38.5] 39.2 [35.5; 42.6] (1,692) (1,285) (950) (718) (499) (325) (176) (65) Knee 65 to 74 years 3,652 70 (67 - 72) 48/52 31.1 548 19.1 [17.8; 20.4] 23.9 [22.5; 25.4] 27.2 [25.6; 28.8] 29.2 [27.5; 30.8] 31.2 [29.4; 33.0] 33.1 [31.1; 35.0] 34.1 [32.0; 36.1] 34.7 [32.4; 36.9] (2,435) (1,873) (1,453) (1,108) (778) (490) (278) (119) 75 to 84 years 4,120 79 (77 - 81) 44/56 28.3 590 19.1 [17.9; 20.3] 22.9 [21.5; 24.3] 25.4 [23.9; 26.8] 26.9 [25.4; 28.4] 28.3 [26.7; 29.9] 29.0 [27.3; 30.7] 29.8 [28.0; 31.6] 29.8 [28.0; 31.6] (2,693) (2,090) (1,619) (1,164) (785) (473) (243) (82) ≥ 85 years 716 87 (85 - 89) 37/63 26.7 306 17.5 [14.5; 20.4] 20.3 [16.9; 23.4] 22.2 [18.6; 25.7] 23.0 [19.3; 26.6] 23.0 [19.3; 26.6] (413) (289) (194) (117) (62) Sex Male 5,632 71 (62 - 78) 100/0 29.4 603 20.6 [19.5; 21.7] 25.7 [24.5; 26.9] 29.0 [27.7; 30.3] 30.8 [29.4; 32.2] 32.9 [31.3; 34.3] 34.8 [33.1; 36.4] 35.6 [33.8; 37.3] 37.7 [35.3; 40.0] (3,594) (2,728) (2,043) (1,502) (1,011) (625) (329) (131) Female 6,314 72 (64 - 79) 0/100 30.4 619 18.4 [17.4; 19.4] 22.9 [21.8; 24.0] 26.2 [25.0; 27.4] 28.1 [26.8; 29.4] 29.8 [28.4; 31.1] 31.0 [29.5; 32.4] 32.3 [30.7; 33.8] 33.5 [31.6; 35.4] (4,259) (3,277) (2,512) (1,862) (1,292) (812) (444) (167) Body-Mass-Index ≤ 25 1,563 77 (67 - 82) 40/60 23.4 418 15.9 [14.0; 17.8] 19.8 [17.7; 22.0] 22.2 [19.8; 24.5] 23.0 [20.5; 25.4] 24.2 [21.5; 26.9] (998) (729) (507) (318) (174) > 25 to 30 2,903 74 (65 - 80) 57/43 27.5 510 18.8 [17.3; 20.3] 23.1 [21.4; 24.7] 25.7 [23.9; 27.5] 28.0 [26.1; 30.0] 29.6 [27.4; 31.7] 31.6 [28.7; 34.3] (1,838) (1,347) (965) (633) (331) (94) > 30 to 35 2,290 70 (63 - 78) 49/51 32.3 505 17.2 [15.6; 18.8] 21.2 [19.4; 23.0] 25.1 [23.0; 27.1] 26.5 [24.3; 28.7] 28.2 [25.8; 30.6] 28.6 [26.1; 31.0] (1,463) (1,059) (738) (487) (262) (67) > 35 to 40 1,236 68 (61 - 75) 44/56 37.0 384 19.6 [17.3; 21.9] 24.6 [22.0; 27.1] 28.3 [25.3; 31.1] 31.1 [27.8; 34.2] 31.8 [28.4; 35.1] (777) (544) (376) (235) (121) above 40 893 65 (59 - 71) 34/66 43.4 328 23.0 [20.1; 25.8] 28.6 [25.3; 31.7] 31.1 [27.6; 34.4] 34.1 [30.3; 37.8] 37.1 [32.5; 41.4] (546) (385) (258) (159) (74) Hospitals with low 19.9 [18.8; 21.1] 24.0 [22.7; 25.2] 26.8 [25.4; 28.1] 28.4 [27.0; 29.8] 30.1 [28.5; 31.6] 31.5 [29.9; 33.1] 33.0 [31.2; 34.8] 33.4 [31.4; 35.3] Hospital size* 5,138 72 (64 - 79) 47/53 29.8 501 annual case volumes (3,266) (2,532) (1,905) (1,403) (962) (596) (311) (124) Hospitals with average 18.2 [16.9; 19.6] 23.2 [21.6; 24.7] 27.1 [25.4; 28.8] 29.1 [27.2; 30.9] 31.0 [29.0; 32.9] 32.2 [30.1; 34.3] 32.7 [30.5; 34.9] 35.9 [32.3; 39.3] 3,304 71 (63 - 79) 47/53 30.0 110 annual case volumes (2,213) (1,641) (1,245) (888) (570) (347) (175) (69) Hospitals with high annual 19.8 [18.4; 21.2] 25.5 [23.9; 27.0] 28.9 [27.2; 30.6] 30.9 [29.1; 32.6] 33.0 [31.1; 34.9] 35.0 [32.9; 37.0] 36.0 [33.8; 38.1] 38.2 [35.4; 40.9] 3,351 70 (62 - 77) 48/52 29.8 33 case volumes (2,265) (1,738) (1,323) (1,005) (715) (460) (269) (99) Non-infection-related knee revision 45,434 70 (61 - 77) 33/67 30.1 736 5.7 [5.4; 5.9] 9.9 [9.6; 10.1] 12.4 [12.0; 12.7] 14.2 [13.8; 14.6] 15.6 [15.2; 16.0] 16.9 [16.4; 17.3] 18.1 [17.6; 18.6] 19.1 [18.5; 19.7] 20.0 [19.2; 20.8] (36,257) (28,889) (22,789) (17,448) (12,537) (8,187) (4,592) (1,985) (558) Number of procedures First revision 10,275 66 (59 - 75) 33/67 30.5 660 6.3 [5.8; 6.8] 11.5 [10.8; 12.2] 14.3 [13.5; 15.1] 16.0 [15.1; 16.8] 17.0 [16.0; 18.0] 18.3 [17.2; 19.4] 18.8 [17.6; 20.1] 20.9 [18.5; 23.2] (7,557) (5,583) (4,036) (2,777) (1,699) (886) (369) (96) Second revision 1,237 66 (58 - 74) 37/63 30.5 381 8.0 [6.3; 9.6] 13.5 [11.3; 15.7] 17.3 [14.7; 19.9] 18.8 [15.9; 21.5] 20.3 [17.1; 23.4] 20.3 [17.1; 23.4] (860) (596) (384) (241) (140) (66) Revision without known 5.3 [5.1; 5.6] 9.2 [8.9; 9.5] 11.6 [11.2; 11.9] 13.5 [13.1; 13.9] 14.9 [14.5; 15.4] 16.2 [15.7; 16.7] 17.5 [16.9; 18.0] 18.4 [17.8; 19.1] 19.4 [18.6; 20.3] 33,640 71 (62 - 78) 33/67 30.1 732 previous history (27,659) (22,597) (18,304) (14,390) (10,673) (7,221) (4,192) (1,884) (541) Table 53: The main factors that impact the hip re-revision rate 142 EPRD Annual Report 2024 143  5 Hip and knee arthroplasty survival 5.4 Revision knee arthroplasty survival Re-revision rates after ... Type of revision / Category Type Number Age m/f BMI Hosp. 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years With exchange of 5.1 [4.8; 5.3] 9.2 [8.9; 9.6] 11.8 [11.4; 12.2] 13.7 [13.2; 14.2] 15.1 [14.6; 15.6] 16.3 [15.7; 16.8] 17.5 [16.9; 18.2] 18.4 [17.7; 19.1] 19.1 [18.2; 20.1] Re-implanted components 29,783 70 (61 - 77) 32/68 30.1 723 bone-anchored components (23,914) (19,089) (15,108) (11,535) (8,294) (5,466) (3,068) (1,311) (368) Without exchange of 6.8 [6.4; 7.3] 10.8 [10.3; 11.4] 13.1 [12.5; 13.8] 14.9 [14.2; 15.6] 16.3 [15.5; 17.1] 17.8 [16.9; 18.6] 18.8 [17.8; 19.7] 20.1 [18.9; 21.3] 21.6 [19.9; 23.2] 13,182 69 (61 - 77) 35/65 30.4 669 bone-anchored components (10,306) (8,210) (6,468) (4,981) (3,530) (2,239) (1,226) (524) (143) not clearly defined 2,469 70 (61 - 77) 32/68 30.1 386 6.6 [5.6; 7.6] 11.8 [10.4; 13.1] 14.5 [12.9; 16.0] 16.6 [14.9; 18.2] 18.2 [16.3; 20.0] 19.4 [17.4; 21.4] 20.7 [18.5; 22.9] 22.1 [19.5; 24.6] (2,037) (1,590) (1,213) (932) (713) (482) (298) (150) Age group ≤ 54 years 4,271 51 (48 - 53) 35/65 31.3 589 7.5 [6.7; 8.3] 14.4 [13.2; 15.5] 17.9 [16.6; 19.1] 20.4 [19.0; 21.8] 22.4 [20.9; 23.9] 24.8 [23.1; 26.4] 26.8 [24.9; 28.7] 27.8 [25.7; 29.8] 27.8 [25.7; 29.8] (3,465) (2,791) (2,220) (1,719) (1,274) (857) (487) (207) (58) 55 to 64 years 11,563 60 (58 - 62) 37/63 31.6 689 5.8 [5.3; 6.2] 11.0 [10.3; 11.6] 14.1 [13.4; 14.8] 16.5 [15.7; 17.3] 18.0 [17.2; 18.9] 19.8 [18.8; 20.8] 21.0 [20.0; 22.1] 22.7 [21.3; 24.0] 24.6 [22.7; 26.5] (9,247) (7,226) (5,607) (4,267) (3,056) (2,034) (1,122) (502) (134) 65 to 74 years 13,911 70 (67 - 72) 34/66 30.9 702 5.5 [5.1; 5.8] 9.4 [8.8; 9.9] 11.9 [11.3; 12.5] 13.8 [13.1; 14.5] 15.3 [14.6; 16.1] 16.5 [15.7; 17.3] 17.8 [16.9; 18.7] 18.6 [17.6; 19.6] 19.2 [18.0; 20.4] (11,175) (8,938) (7,103) (5,496) (4,027) (2,690) (1,588) (716) (212) 75 to 84 years 13,502 79 (77 - 81) 30/70 28.7 693 5.4 [5.0; 5.8] 8.5 [8.0; 9.0] 10.4 [9.8; 11.0] 11.6 [11.0; 12.2] 12.6 [12.0; 13.3] 13.3 [12.6; 14.0] 13.9 [13.1; 14.7] 14.6 [13.6; 15.5] 15.4 [14.0; 16.7] (10,819) (8,793) (7,031) (5,403) (3,820) (2,392) (1,297) (528) (150) ≥ 85 years 2,187 87 (85 - 89) 22/78 27.2 518 3.8 [2.9; 4.6] 5.5 [4.4; 6.6] 6.0 [4.9; 7.2] 6.5 [5.2; 7.7] 6.6 [5.3; 7.9] 6.9 [5.5; 8.3] 8.3 [5.9; 10.7] (1,551) (1,141) (828) (563) (360) (214) (98) Sex Male 15,038 68 (60 - 76) 100/0 29.7 703 6.8 [6.4; 7.2] 11.7 [11.1; 12.2] 14.5 [13.9; 15.1] 16.7 [16.0; 17.4] 18.1 [17.3; 18.8] 19.5 [18.7; 20.3] 20.9 [19.9; 21.8] 22.2 [21.0; 23.3] 23.7 [21.9; 25.4] (11,819) (9,240) (7,226) (5,394) (3,815) (2,471) (1,374) (569) (159) Female 30,396 70 (61 - 78) 0/100 30.5 732 5.1 [4.8; 5.3] 8.9 [8.6; 9.3] 11.3 [10.9; 11.7] 13.0 [12.5; 13.4] 14.4 [13.9; 14.9] 15.6 [15.1; 16.2] 16.7 [16.1; 17.3] 17.6 [16.9; 18.3] 18.3 [17.5; 19.1] (24,438) (19,649) (15,563) (12,054) (8,722) (5,716) (3,218) (1,416) (399) 5.1 [4.5; 5.8] 8.7 [7.8; 9.6] 11.4 [10.3; 12.4] 12.8 [11.6; 14.0] 13.6 [12.4; 14.9] 14.8 [13.2; 16.3] Knee Body-Mass-Index ≤ 25 4,999 75 (63 - 81) 27/73 23.5 612 (3,694) (2,757) (1,957) (1,329) (697) (192) > 25 to 30 11,260 72 (63 - 79) 40/60 27.7 675 5.1 [4.7; 5.5] 9.2 [8.6; 9.8] 11.7 [11.0; 12.4] 13.5 [12.8; 14.3] 15.2 [14.2; 16.1] 16.4 [15.3; 17.5] (8,669) (6,502) (4,667) (3,109) (1,681) (465) > 30 to 35 9,633 69 (61 - 77) 35/65 32.1 658 5.6 [5.1; 6.1] 9.8 [9.2; 10.5] 12.2 [11.5; 13.0] 14.4 [13.5; 15.3] 15.8 [14.8; 16.7] 17.4 [16.2; 18.6] (7,354) (5,526) (4,058) (2,679) (1,469) (373) > 35 to 40 4,903 66 (59 - 73) 28/72 37.0 604 5.6 [4.9; 6.2] 9.3 [8.4; 10.2] 11.8 [10.7; 12.8] 13.3 [12.1; 14.5] 15.4 [14.0; 16.9] 16.4 [14.7; 18.1] (3,747) (2,815) (1,982) (1,276) (707) (182) above 40 2,811 64 (58 - 70) 21/79 43.0 543 6.0 [5.1; 6.9] 9.1 [7.9; 10.3] 11.0 [9.6; 12.3] 12.8 [11.3; 14.3] 14.0 [12.3; 15.7] 14.5 [12.7; 16.3] (2,134) (1,615) (1,161) (778) (410) (98) Hospitals with low 5.6 [5.3; 6.0] 9.8 [9.3; 10.2] 12.0 [11.5; 12.5] 13.6 [13.1; 14.2] 14.8 [14.2; 15.4] 15.7 [15.0; 16.3] 16.5 [15.8; 17.2] 17.2 [16.4; 18.1] 17.9 [16.8; 19.0] Hospital size* 20,090 70 (61 - 78) 32/68 30.1 555 annual case volumes (15,858) (12,731) (10,088) (7,743) (5,499) (3,559) (1,964) (762) (162) Hospitals with average 5.6 [5.2; 6.0] 9.6 [9.0; 10.1] 12.0 [11.4; 12.7] 14.0 [13.3; 14.7] 15.4 [14.6; 16.2] 16.8 [15.9; 17.7] 18.2 [17.2; 19.2] 18.7 [17.6; 19.8] 20.1 [18.4; 21.7] 12,879 70 (61 - 77) 34/66 30.2 112 annual case volumes (10,157) (7,971) (6,146) (4,648) (3,312) (2,092) (1,134) (565) (169) Hospitals with high 5.6 [5.1; 6.0] 10.2 [9.6; 10.8] 13.2 [12.5; 13.9] 15.3 [14.5; 16.0] 17.1 [16.2; 17.9] 18.9 [18.0; 19.9] 20.5 [19.4; 21.6] 22.4 [21.1; 23.7] 23.3 [21.8; 24.8] 11,522 69 (60 - 76) 34/66 30.1 33 annual case volumes (9,392) (7,424) (5,859) (4,466) (3,259) (2,214) (1,307) (578) (205) * The classifications in this report are based on the hospitals’ quality reports for 2022 and the corresponding revision knee arthroplasty IQTIG quality indicators listed therein. For knee revision procedures, the case number cutoffs for classification as low case volume are up to 20 cases, medium volume is 21 to 50 cases and high volume is greater than 50 revisions per year. Table 53 (continued) 144 EPRD Annual Report 2024 145  5 Hip and knee arthroplasty survival 5.5 Survival trends 5.5 Survival trends the exception of a small setback during the Elective THAs with Cumulative revision rates after ... coronavirus pandemic. cemented stems The EPRD has been collecting hip and knee Operating year Number 1 year 2 years 3 years 4 years 5 years 6 years arthroplasty data for over 10 years. This pe- The reason(s) for this improvement and 2012/13 949 2.2 [1.3; 3.2] 2.5 [1.5; 3.6] 3.0 [1.9; 4.1] 3.5 [2.3; 4.7] 3.8 [2.5; 5.1] 4.0 [2.7; 5.2] riod of time is long enough to at least give whether it reflects general advances in knee (910) (843) (770) (724) (680) (648) an insight into the short- and medium-term arthroplasty remain(s) to be confirmed. 2014 2,528 1.9 [1.4; 2.4] (2,374) 2.3 [1.7; 2.8] (2,236) 2.7 [2.1; 3.3] (2,131) 3.0 [2.3; 3.7] (2,036) 3.2 [2.5; 3.9] (1,928) 3.4 [2.7; 4.2] (1,816) CRR trends. 2015 6,912 2.1 [1.8; 2.5] 2.5 [2.1; 2.9] 2.7 [2.4; 3.1] 3.1 [2.7; 3.6] 3.4 [2.9; 3.8] 3.6 [3.1; 4.0] (6,497) (6,216) (5,988) (5,693) (5,386) (5,052) Whilst previous sections presented CRRs In brief: 2016 10,389 2.2 [1.9; 2.4] 2.6 [2.3; 2.9] 2.8 [2.5; 3.1] 3.0 [2.7; 3.3] 3.2 [2.8; 3.5] 3.3 [2.9; 3.6] (9,781) (9,397) (9,019) (8,599) (8,093) (7,587) across operating years, the current section 2017 12,088 2.3 [2.0; 2.6] 2.7 [2.4; 3.0] 2.9 [2.6; 3.2] 3.0 [2.7; 3.3] 3.2 [2.9; 3.5] 3.5 [3.2; 3.9] lists CRRs by the individual operating year • Hip arthroplasty outcome trends in the (11,461) (11,047) (10,610) (10,093) (9,495) (6,777) of the primary surgery. Table 54 and Ta- EPRD have remained constant over time. 2018 12,651 2.3 [2.1; 2.6] 2.6 [2.3; 2.8] 2.8 [2.5; 3.1] 3.0 [2.7; 3.3] 3.3 [3.0; 3.6] (11,985) (11,556) (11,086) (10,530) (7,492) ble 55 present CRR trends for elective THAs • In contrast standard TKA outcomes have 2019 13,430 2.3 [2.1; 2.6] 2.7 [2.4; 2.9] 2.9 [2.6; 3.2] 3.1 [2.8; 3.4] with uncemented and cemented stems by op- significantly improved over time. (12,698) (12,220) (11,681) (8,458) erating year. The hip arthroplasty data does 2020 12,756 2.5 [2.2; 2.8] 2.8 [2.5; 3.1] 3.1 [2.8; 3.4] • The reason(s) for this improvement re- (11,986) (11,560) (8,399) not yet show a clear trend towards a reduc- main(s) to be established. 2021 13,925 2.5 [2.3; 2.8] 2.8 [2.5; 3.1] tion in the CRR. (13,104) (9,554) 2022 16,079 2.5 [2.2; 2.7] (11,733) This is in contrast to the knee arthro- © EPRD Annual Report 2024 plasty data. Tables 56 and 57 present Table 55: Cumulative revision rates for elective total hip arthroplasties with cemented stems by operating year (p = 0.7) standard TKA and unicondylar arthro- plasty data by operating year. For stand- ard TKAs, there has been a considerable Standard TKAs Cumulative revision rates after ... improvement in outcome over time, with Operating year Number 1 year 2 years 3 years 4 years 5 years 6 years Elective THAs with 2012/13 3,056 2.0 [1.5; 2.5] 3.9 [3.2; 4.6] 4.7 [4.0; 5.5] 5.1 [4.3; 5.9] 5.3 [4.5; 6.1] 5.4 [4.6; 6.3] Cumulative revision rates after ... (2,973) (2,724) (2,531) (2,414) (2,331) (2,257) uncemented stems 2014 7,521 1.9 [1.6; 2.2] 3.3 [2.9; 3.7] 4.1 [3.6; 4.6] 4.6 [4.1; 5.0] 4.9 [4.4; 5.4] 5.3 [4.8; 5.8] Operating year Number 1 year 2 years 3 years 4 years 5 years 6 years (7,204) (6,843) (6,634) (6,463) (6,258) (6,055) 2012/13 3,003 2.6 [2.0; 3.1] 3.3 [2.7; 3.9] 3.5 [2.8; 4.1] 3.8 [3.1; 4.4] 4.0 [3.3; 4.7] 4.2 [3.4; 4.9] 2015 23,138 2.2 [2.0; 2.3] 3.5 [3.3; 3.8] 4.3 [4.0; 4.5] 4.6 [4.3; 4.9] 4.9 [4.6; 5.2] 5.1 [4.9; 5.4] (22,195) (21,331) (20,708) (20,129) (19,540) (18,825) (2,896) (2,670) (2,529) (2,435) (2,377) (2,319) 2014 7,323 2.3 [2.0; 2.6] 3.0 [2.6; 3.4] 3.2 [2.8; 3.6] 3.5 [3.0; 3.9] 3.6 [3.2; 4.1] 3.8 [3.4; 4.2] 2016 37,869 1.9 [1.8; 2.1] 3.3 [3.1; 3.5] 3.9 [3.7; 4.1] 4.4 [4.2; 4.6] 4.6 [4.4; 4.9] 4.9 [4.7; 5.1] (36,378) (35,184) (34,293) (33,370) (32,270) (31,146) (7,003) (6,769) (6,622) (6,477) (6,320) (6,128) 2015 22,279 2.4 [2.2; 2.6] 2.8 [2.6; 3.0] 3.1 [2.9; 3.3] 3.3 [3.1; 3.6] 3.5 [3.3; 3.8] 3.7 [3.5; 4.0] 2017 45,586 1.9 [1.8; 2.1] 3.2 [3.1; 3.4] 3.8 [3.6; 4.0] 4.2 [4.0; 4.3] 4.5 [4.3; 4.6] 4.7 [4.5; 4.9] (44,162) (42,903) (41,835) (40,700) (39,436) (28,334) (21,364) (20,729) (20,237) (19,793) (19,316) (18,726) 2016 38,067 2.7 [2.5; 2.8] 3.2 [3.0; 3.3] 3.4 [3.3; 3.6] 3.6 [3.4; 3.8] 3.8 [3.6; 3.9] 3.9 [3.7; 4.1] 2018 48,950 1.8 [1.7; 1.9] 2.9 [2.7; 3.0] 3.5 [3.3; 3.6] 3.9 [3.7; 4.1] 4.2 [4.0; 4.4] (47,509) (46,252) (45,006) (43,704) (32,035) (36,238) (35,394) (34,668) (33,916) (33,074) (32,146) 2017 44,828 2.8 [2.6; 2.9] 3.1 [3.0; 3.3] 3.4 [3.3; 3.6] 3.6 [3.4; 3.8] 3.8 [3.6; 3.9] 3.9 [3.8; 4.1] 2019 51,216 1.8 [1.7; 1.9] 2.9 [2.8; 3.1] 3.5 [3.4; 3.7] 4.0 [3.8; 4.1] (49,783) (48,403) (47,197) (34,529) (42,971) (42,140) (41,296) (40,332) (39,314) (28,761) 2018 48,695 2.6 [2.5; 2.8] 3.1 [2.9; 3.2] 3.3 [3.1; 3.4] 3.5 [3.3; 3.6] 3.6 [3.5; 3.8] 2020 47,409 2.0 [1.9; 2.1] 3.1 [3.0; 3.3] 3.8 [3.7; 4.0] (45,896) (44,722) (32,478) (46,809) (45,872) (44,920) (43,920) (32,331) 2019 51,749 2.8 [2.6; 2.9] 3.2 [3.0; 3.3] 3.4 [3.2; 3.6] 3.6 [3.4; 3.8] 2021 49,973 1.8 [1.7; 1.9] 3.0 [2.9; 3.2] (48,536) (34,262) (49,751) (48,708) (47,785) (35,244) 2020 48,529 2.9 [2.8; 3.1] 3.3 [3.1; 3.4] 3.6 [3.4; 3.7] 2022 59,318 1.8 [1.7; 1.9] (43,329) (46,526) (45,717) (33,671) © EPRD Annual Report 2024 2021 51,563 2.8 [2.7; 3.0] 3.2 [3.0; 3.3] (49,460) (36,036) Table 56: Cumulative revisions rates for standard total knee arthroplasties by operating year (p < 0.0001) 2022 58,224 2.8 [2.7; 2.9] (42,484) © EPRD Annual Report 2024 Table 54: Cumulative revision rates for elective total hip arthroplasties with uncemented stems by operating year (p = 0.2) 146 EPRD Annual Report 2024 147  5 Hip and knee arthroplasty survival 5.5 Survival trends Unicondylar Burden of revision as an alternative measure of outcome trends Cumulative revision rates after ... knee arthroplasties Operating year Number 1 year 2 years 3 years 4 years 5 years 6 years 2012/13 409 2.9 [1.3; 4.6] 5.2 [3.0; 7.3] 6.0 [3.6; 8.3] 7.0 [4.5; 9.5] 8.4 [5.6; 11.2] 8.7 [5.9; 11.5] In the literature burden of revision refers to the impact subsequent reduction in revisions of recent years is a (396) (370) (351) (342) (329) (325) of joint replacement registries on improving the out- persistent trend or simply due to a temporary increase 2014 962 2.8 [1.8; 3.9] 4.6 [3.2; 5.9] 5.1 [3.7; 6.5] 6.4 [4.9; 8.0] 6.8 [5.2; 8.4] 7.5 [5.8; 9.2] (910) (881) (858) (828) (811) (788) comes of arthroplasty surgeries [8]. This annual "bur- in primary arthroplasty numbers arising from a "catch- 2015 2,467 3.2 [2.5; 3.9] 5.3 [4.4; 6.2] 6.5 [5.6; 7.5] 7.8 [6.8; 8.9] 8.4 [7.2; 9.5] 9.0 [7.9; 10.2] den" is a measure of the number of revisions expressed up effect". (2,351) (2,247) (2,185) (2,128) (2,076) (2,016) as a proportion of the total arthroplasty volume for any 2016 5,128 3.5 [3.0; 4.0] 5.4 [4.8; 6.0] 6.2 [5.5; 6.9] 7.1 [6.4; 7.8] 7.6 [6.9; 8.4] 8.5 [7.7; 9.3] (4,858) (4,684) (4,582) (4,471) (4,341) (4,216) given year. The cause(s) that underpin(s) such changes The burden of revision calculations also need to en- 2017 6,501 3.0 [2.6; 3.4] 5.0 [4.4; 5.5] 6.0 [5.5; 6.6] 6.7 [6.1; 7.3] 7.3 [6.6; 7.9] 8.0 [7.3; 8.6] in outcome can therefore not be assigned to a specific sure the comparability of procedures and definitions. (6,244) (6,049) (5,892) (5,761) (5,631) (4,057) year. An increase or decrease in the annual burden of The EPRD for instance only records reoperations which 2018 7,316 2.9 [2.5; 3.3] 4.6 [4.1; 5.1] 5.6 [5.1; 6.1] 6.4 [5.9; 7.0] 7.2 [6.6; 7.7] revision may also reflect a change in the number of pri- involve changes to the implant. This means that reop- (7,025) (6,833) (6,672) (6,526) (4,832) 2019 8,036 2.7 [2.3; 3.0] 4.4 [3.9; 4.8] 5.6 [5.1; 6.1] 6.3 [5.8; 6.9] mary arthroplasties performed that year. erations to remove a haematoma, for example, are not (7,755) (7,529) (7,350) (5,307) registered. 2020 7,725 2.9 [2.5; 3.3] 4.9 [4.4; 5.4] 5.9 [5.3; 6.4] In the EPRD, the burden of revision stayed relatively (7,450) (7,234) (5,295) 2021 8,047 2.6 [2.3; 3.0] 4.3 [3.8; 4.7] constant at 10.3% to 10.5%, after the 2014-2019 reg- Table 59 lists the results obtained when the burden of (7,767) (5,602) istry trial period, but rose to 10.9% in 2020 (Table 58). revision is determined based on the total annual treat- 2022 9,468 2.8 [2.4; 3.1] ment figures from the German Federal Statistical Of- (6,873) © EPRD Annual Report 2024 This increase in 2020 coincided with a pandemic-relat- fice for OPS treatment codes 5-820 ("Implantation of ed drop in the number of primary arthroplasty surger- an endoprosthesis in the hip joint”), 5-821 ("Inspection, Table 57: Cumulative revisions rates for unicondylar knee arthroplasties by operating year (p = 0.2) ies performed, as many procedures were suspended replacement and removal of a hip joint endoprosthe- or postponed. It remains to be established whether the sis"), 5-822 ("Implantation of an endoprosthesis in the Year 2012/3 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total 12.1% 10.4 % 10.5 % 10.4 % 10.4% 10.3% 10.5% 10.9% 10.5% 9.6 % 9.3 % Burden of Revision Only hip 12.5% 10.3% 10.5% 10.5% 10.6% 10.2% 10.3% 10.5% 10.2% 9.5% 9.2% arthroplasties Only knee 11.6% 10.4% 10.6% 10.2% 10.3% 10.1% 10.5% 11.1% 10.9% 9.7% 9.3% arthroplasties © EPRD Annual Report 2024 Table 58: Burden of revision based on EPRD datasets (i.e. revisions as a percentage of all procedures registered in a given year) Year 2012/3 2014 2015 2016 2017 2018 2019 2020 2021 2022 Total 14.6% 13.9% 13.0% 12.6% 12.5% 12.4% 12.4% 12.3% 12.0% 10.9% Burden of Revision Only hip 14.7% 13.9% 13.4% 13.2% 13.2% 13.0% 12.8% 12.6% 12.2% 11.4% arthroplasties Only knee 14.4% 14.0% 12.5% 11.7% 11.6% 11.6% 11.8% 11.9% 11.6% 10.4% arthroplasties © EPRD Annual Report 2024 Table 59: Burden of revision based on total case numbers from the German Federal Statistical Office 7 7 available at https://www-genesis.destatis.de, Code 23141-0102 [„Operationen und Prozeduren an vollstationären Patienten: Deutschland, Jahre, Geschlecht, Altersgruppen, Operationen und Prozeduren (1-4-Steller Hierarchie)" [Meaning "Inpatient operations and procedures: in Germany, by year, sex, age group, operations and procedures (hierarchy of 1-4 digits)"] 148 EPRD Annual Report 2024 149  5 Hip and knee arthroplasty survival knee joint") and 5-823 ("Inspection, replacement and removal of a knee joint endoprosthesis"), where the frequencies of codes 5-820 and 5-822 are considered as the total number of primary arthroplasties and codes 5-821 and 5-823 as revisions. (The English OPS code descriptions were sourced from https://gesund. bund.de/en/ops-code-search). These results deviate (in some cases considerably) from the revision burdens previously determined based on the EPRD documenta- tion, but reveal a continuous downward trend. Howev- er, it should be noted that: • reoperations that leave components in place are not classed/categorised as revisions; • individual treatment codes cannot always be clearly assigned to primary procedures; • several OPS codes can be used for a single proce- dure; • OPS codes are also subject to change that may af- fect the treatment figures based on these codes. Patellar resurfacing, for instance, can be performed at the same time as the primary arthroplasty or as a sep- arate procedure at a later date. As of 2015, the treat- ment figures no longer allow to differentiate between these two procedures, since primary patellar resurfac- ing is also assigned the code 5-822.8. These code mod- ifications have already led to the proliferation of codes starting with 5-822 and thus, by the above definition, to a reduction in the burden of revision. The burden of revision is of limited use for assess- ing arthroplasty trends. Comparing CRRs over time is perhaps a more robust alternative (see Table 54 to Ta- ble 57). 150 EPRD Annual Report 2024   6 Patient mortality 151   Mortality within ... 6 Patient mortality Type of procedure Elective THAs with Number Age m/f [%] 3 months 0.3 6 months 0.5 12 months 1.0 24 months 2.1 36 months 3.5 60 months 7.3 420,224 67 41/59 uncemented stems [0.3; 0.3] (404,776) [0.5; 0.6] (388,578) [0.9; 1.0] (355,022) [2.1; 2.2] (292,977) [3.5; 3.6] (239,527) [7.2; 7.4] (137,522) Elective THAs with 1.2 1.9 3.2 6.2 9.8 19.0 115,036 79 25/75 cemented stems [1.1; 1.2] (109,392) [1.8; 2.0] (104,111) [3.1; 3.3] (94,589) [6.1; 6.4] (76,466) [9.6; 10.0] (61,286) [18.7; 19.3] (34,071) 6.2 8.6 12.2 18.5 25.3 38.4 Non-elective THAs 34,964 76 30/70 [5.9; 6.4] [8.3; 8.9] [11.8; 12.6] [18.1; 18.9] [24.8; 25.9] [37.7; 39.1] (31,673) (29,656) (26,018) (19,817) (14,523) (6,818) Primary arthroplasties Once a year, the EPRD receives information row of each table alongside the cumulative 17.9 24.0 31.5 43.6 54.6 71.5 Hemiarthroplasties 73,215 84 29/71 directly from the participating federal health mortality rates of EPRD patients.9 [17.6; 18.2] (58,014) [23.7; 24.4] (51,485) [31.2; 31.9] (42,095) [43.2; 44.0] (28,098) [54.2; 55.0] (17,931) [71.0; 71.9] (6,377) fund associations about the vital status of participating patients. However, this is lim- Comparison of these mortality rates reveals 0.3 0.4 0.9 2.1 3.8 8.3 Standard TKAs 424,357 70 35/65 [0.2; 0.3] [0.4; 0.5] [0.8; 0.9] [2.1; 2.2] [3.7; 3.8] [8.2; 8.4] ited to information on whether the patient the following: (408,108) (390,794) (354,514) (291,598) (239,568) (138,005) is still alive or has died and in which month 1.2 2.0 3.4 6.5 10.2 19.4 Constrained TKAs 19,949 74 24/76 the death occurred. The cause of death is not • The EPRD arthroplasty patient mortal- [1.0; 1.3] (19,027) [1.8; 2.2] (18,070) [3.1; 3.6] (16,380) [6.1; 6.9] (13,205) [9.7; 10.7] (10,588) [18.6; 20.1] (5,768) included in this information. ity rates for elective THAs with uncemented Unicondylar 0.1 0.2 0.4 1.1 2.0 4.4 stems, standard TKAs and partial knee pros- knee arthroplasties 63,758 63 45/55 [0.1; 0.1] [0.2; 0.2] [0.4; 0.5] [1.0; 1.2] [1.9; 2.1] [4.2; 4.7] (61,362) (58,799) (53,170) (43,476) (35,247) (19,463) In the following patient mortality tables, the theses are considerably lower than the com- arthroplasty surgery and the death of the parable rates, for the respective age groups, Patellofemoral 0.0 0.1 0.4 0.7 0.9 2.6 1,026 55 26/74 respective patient are thus not necessarily from the German Federal Statistical Office. knee arthroplasties [0.0; 0.0] (987) [0.0; 0.3] (944) [0.0; 0.9] (857) [0.1; 1.3] (710) [0.2; 1.5] (558) [1.1; 4.0] (320) related. As stated in Chapter 5, the choice This suggests that doctors are performing Hip revisions, asep- tic, with exchange of 4.3 5.9 8.1 12.3 16.6 26.1 of treatment often hinges on the patient’s these procedures on healthier individuals. bone-anchored com- 40,065 77 34/66 [4.1; 4.5] [5.7; 6.1] [7.8; 8.4] [11.9; 12.6] [16.2; 17.0] [25.5; 26.6] physical condition. The interpretation of Data from other countries also shows that (37,067) (35,277) (32,157) (26.,278) (21,045) (11,788) ponents outcomes therefore needs to factor in some osteoarthritis patients have a lower mortality Hip revisions, aseptic, without exchange of 2.5 3.8 5.7 8.9 12.6 19.6 degree of patient selection. rate than the general population [9, 10]. bone-anchored com- 8,833 75 36/64 [2.2; 2.9] (8,320) [3.4; 4.2] (7,944) [5.2; 6.2] (7,295) [8.3; 9.5] (6,025) [11.8; 13.4] (4,827) [18.5; 20.6] (2,713) ponents Hip revisions, sep- Table 60 lists cumulative mortality rates • EPRD knee arthroplasty patients have tic, with exchange of 4.4 6.4 8.5 12.5 17.0 26.5 10,175 73 47/53 of arthroplasty patients at different time a slightly lower mortality rate than hip ar- bone-anchored com- [4.0; 4.8] (9,471) [5.9; 6.8] (8,999) [8.0; 9.1] (8,212) [11.8; 13.2] (6,786) [16.2; 17.8] (5,440) [25.4; 27.5] (2,982) ponents points8, up to five years after primary or revi- throplasty patients. The EPRD mortality Hip revisions, septic, sion arthroplasty. These summarised values rate after unicondylar arthroplasty, for pa- without exchange of 5,581 75 42/58 9.8 13.5 16.6 21.3 25.5 36.2 bone-anchored com- only lend themselves to a direct comparison tients of similar age, tended to be even lower [9.0; 10.5] [12.6; 14.4] [15.6; 17.6] [20.1; 22.4] [24.2; 26.8] [34.4; 37.8] Revisions (4,833) (4,434) (3,846) (2,960) (2,205) (989) ponents to a very limited extent, as the mean age of compared to standard TKAs. This trend is Knee revisions, aseptic, several of these patient groups already differs also confirmed in an independent systematic with exchange of 29,783 70 32/68 1.0 1.5 2.4 4.5 6.8 12.6 bone-anchored com- [0.9; 1.1] [1.4; 1.7] [2.2; 2.6] [4.2; 4.7] [6.4; 7.1] [12.1; 13.1] considerably at the current time point. review [11]. ponents (28,520) (27,364) (25,221) (21,121) (17,243) (9,938) Knee revisions, aseptic, without exchange of 0.4 0.8 1.5 3.2 5.0 9.4 For better comparability, Table 61 and Ta- • The mortality rate of EPRD patients that bone-anchored com- 13,182 69 35/65 [0.3; 0.5] [0.6; 0.9] [1.3; 1.7] [2.8; 3.5] [4.6; 5.4] [8.8; 10.1] (12,676) (12,077) (11,071) (9,228) (7,473) (4,281) ble 62 therefore provide separate 1-year underwent hip arthroplasty as part of hip ponents mortality rates for men and women of differ- trauma surgery is particularly high. Hemiar- Knee revisions, septic, with exchange of 1.8 2.7 4.5 7.8 11.7 20.6 ent age groups. The mortality rates for differ- throplasties have the highest mortality rate. 7,078 71 47/53 bone-anchored com- [1.4; 2.1] (6,750) [2.3; 3.1] (6,454) [4.0; 5.0] (5,942) [7.1; 8.4] (4,970) [10.9; 12.5] (4,052) [19.4; 21.8] (2,309) ent age groups of the general German popu- Even in younger age groups, the 1-year mor- ponents Knee revisions, septic, lation, from the German Federal Statistical tality rate is over 20%. without exchange of 5.0 6.6 9.3 13.9 18.3 27.2 3,893 73 49/51 Office, are given in the highlighted centre bone-anchored com- [4.3; 5.7] (3,544) [5.8; 7.4] (3,318) [8.4; 10.3] (2,973) [12.7; 15.1] (2,322) [16.9; 19.7] (1,754) [25.4; 29.0] (868) ponents 9 Mortality tables can be downloaded from https://www.destatis.de/ © EPRD Annual Report 2024 DE/Themen/Gesellschaft-Umwelt/Bevoelkerung/Sterbefaelle-Leb- 8 The date of death is an approximation, to within 2 weeks, of the enserwartung/Tabellen/_tabellen-innen-lebenserwartung-ster- actual date of death (refer to explanation in Chapter 3). betafel.html Table 60: Summary of patient mortality rates, 3, 6, 12, 24, 36 and 60 months after primary arthroplasty or revision 152 EPRD Annual Report 2024 153  6 Patient mortality  Male patients 1-year mortality expressed as a percent of the age group ... Female patients 1-year mortality expressed as a percent of the age group ... Type of procedure ≤ 54 55 to 59 60 to 64 65 to 69 70 to 74 75 to 79 80 to 84 ≥ 85 Type of procedure ≤ 54 55 to 59 60 to 64 65 to 69 70 to 74 75 to 79 80 to 84 ≥ 85 Elective THAs with 0,45 0,58 0,71 1,05 1,17 2,15 3,85 6,29 Elective THAs with 0.24 0.27 0.39 0.46 0.69 1.09 2.02 4.32 uncemented stems [0,36; 0,53] (23.085) [0,48; 0,68] (19.965) [0,61; 0,81] (24.454) [0,93; 1,18] (23.677) [1,03; 1,30] (21.515) [1,95; 2,35] (19.101) [3,49; 4,22] (9.449) [5,37; 7,21] (2.259) uncemented stems [0.18; 0.30] (23,705) [0.20; 0.33] (23,196) [0.33; 0.46] (32,743) [0.39; 0.52] (37,966) [0.61; 0.77] (37,269) [0.98; 1.19] (34,374) [1.83; 2.22] (17,889) [3.76; 4.88] (4,375) Elective THAs with 3,40 5,80 5,94 5,98 3,96 3,81 4,50 7,59 Elective THAs with 6.80 6.13 3.65 2.43 1.57 1.87 2.47 5.31 cemented stems [1,92; 4,86] (523) [3,86; 7,70] (493) [4,25; 7,59] (651) [4,70; 7,24] (1.165) [3,30; 4,61] (3.042) [3,38; 4,24] (6.956) [4,05; 4,94] (7.294) [6,73; 8,45] (2.972) cemented stems [4.29; 9.25] (337) [4.24; 7.98] (542) [2.72; 4.57] (1,396) [1.96; 2.90] (3,666) [1.34; 1.79] (10,351) [1.69; 2.04] (22,038) [2.28; 2.66] (23,238) [4.91; 5.72] (9,925) 6,49 7,89 10,70 10,08 10,96 15,40 20,58 35,89 5.32 4.86 5.50 5.46 5.76 7.09 12.12 25.29 Non-elective THAs [4,28; 8,64] [5,79; 9,95] [8,82; 12,53] [8,49; 11,64] [9,34; 12,54] [13,72; 17,05] [18,61; 22,50] [33,26; 38,41] Non-elective THAs [3.22; 7.38] [3.44; 6.25] [4.41; 6.59] [4.61; 6.30] [4.99; 6.52] [6.39; 7.79] [11.17; 13.06] [23.91; 26.64] Primary arthroplasties Primary arthroplasties (428) (544) (851) (1.117) (1.150) (1.408) (1.193) (768) (393) (778) (1,425) (2,322) (3,015) (4,374) (3,634) (2,618) 24,21 23,54 29,44 31,77 31,73 34,20 38,34 48,60 26.28 26.45 27.38 22.87 21.87 20.26 21.55 33.54 Hemiarthroplasties [17,09; 30,72] [17,45; 29,17] [24,93; 33,67] [28,34; 35,04] [29,32; 34,05] [32,50; 35,86] [37,02; 39,63] [47,52; 49,65] Hemiarthroplasties [18.49; 33.33] [20.19; 32.23] [23.12; 31.40] [20.05; 25.58] [20.11; 23.60] [19.25; 21.26] [20.86; 22.24] [32.96; 34.11] (108) (135) (265) (455) (896) (1.836) (2.884) (3.809) (92) (144) (284) (612) (1,498) (4,510) (9,460) (15,107) 0,37 0,44 0,55 0,83 1,18 1,76 3,02 4,80 0.14 0.21 0.35 0.40 0.54 0.87 1.35 2.31 Standard TKAs [0,25; 0,49] [0,33; 0,54] [0,45; 0,65] [0,71; 0,96] [1,04; 1,32] [1,59; 1,92] [2,74; 3,30] [4,08; 5,51] Standard TKAs [0.09; 0.20] [0.15; 0.27] [0.29; 0.41] [0.34; 0.46] [0.48; 0.61] [0.78; 0.95] [1.22; 1.47] [1.98; 2.65] (9.145) (13.675) (20.333) (19.188) (21.244) (22.365) (12.623) (2.917) (16,233) (22,498) (32,105) (37,482) (42,223) (46,974) (28,733) (6,776) 1,87 1,27 1,61 2,76 3,26 4,68 6,82 9,53 1.38 1.18 1.09 1.67 2.36 2.62 4.31 9.69 Constrained TKAs [0,49; 3,23] [0,16; 2,37] [0,56; 2,64] [1,46; 4,05] [1,91; 4,59] [3,23; 6,11] [4,91; 8,68] [6,04; 12,89] Constrained TKAs [0.48; 2.27] [0.45; 1.90] [0.52; 1.66] [1.06; 2.27] [1.73; 2.98] [2.04; 3.18] [3.59; 5.03] [8.09; 11.27] (335) (366) (490) (542) (591) (741) (598) (234) (613) (734) (1,118) (1,543) (2,044) (2,709) (2,661) (1,061) Unicondylar 0,32 0,34 0,28 0,76 0,87 0,96 1,87 3,32 Unicondylar 0.09 0.11 0.18 0.22 0.33 0.66 0.85 0.97 knee arthroplasties [0,14; 0,51] (3.492) [0,19; 0,50] (4.589) [0,14; 0,42] (5.065) [0,49; 1,04] (3.434) [0,55; 1,18] (3.023) [0,60; 1,31] (2.653) [1,14; 2,60] (1.170) [1,16; 5,44] (243) knee arthroplasties [0.01; 0.18] (5,058) [0.02; 0.20] (4,941) [0.07; 0.29] (5,298) [0.09; 0.34] (4,626) [0.16; 0.50] (4,160) [0.39; 0.92] (3,459) [0.42; 1.27] (1,616) [0.02; 1.92] (343) Patellofemoral 0,00 0,00 0,00 0,00 12,50 0,00 0,00 0,00 Patellofemoral 0.00 0.00 0.95 0.00 0.00 3.33 7.14 0.00 knee arthroplasties (107) (57) (24) (19) [0,00; 32,66] (7) (10) (3) (6) knee arthroplasties (326) (106) [0.00; 2.79] (99) (28) (20) [0.00; 9.55] (29) [0.00; 19.70] (13) (3) Corresponding Corresponding ≤0,50 0,57 – 0,87 0,98 – 1,45 1,59 – 2,23 2,39 – 3,26 3,26 – 5,01 5,74 – 9,00 >10,29 < 0.28 0.30 – 0.46 0.52 – 0.76 0.83 – 1.19 1.30 – 1.88 2.12 – 3.20 3.67 – 6.35 > 7.46 DESTATIS figures DESTATIS figures Hip revisions, aseptic, Hip revisions, aseptic, 0,75 1,47 2,40 4,68 5,72 7,40 12,17 28,42 0.77 1.13 1.68 2.80 3.25 4.69 8.00 22.06 with exchange of bone- [0,23; 1,26] [0,70; 2,24] [1,55; 3,24] [3,58; 5,76] [4,64; 6,78] [6,38; 8,40] [10,87; 13,46] [26,13; 30,64] with exchange of bone- [0.29; 1.25] [0.54; 1.72] [1.08; 2.27] [2.13; 3.45] [2.63; 3.87] [4.10; 5.28] [7.28; 8.72] [20.87; 23.23] anchored components (998) (871) (1.131) (1.278) (1.547) (2.238) (1.955) (973) anchored components (1,191) (1,124) (1,642) (2,132) (2,725) (4,488) (4,602) (3,262) Hip revisions, aseptic, Hip revisions, aseptic, without exchange of 2,27 0,77 2,14 2,70 4,80 5,42 9,15 28,70 without exchange of 1.36 1.85 2.63 2.80 2.15 2.93 7.58 19.43 bone-anchored com- [0,46; 4,04] (246) [0,00; 1,83] (232) [0,56; 3,70] (304) [1,03; 4,34] (335) [2,90; 6,65] (445) [3,66; 7,15] (569) [6,56; 11,67] (395) [22,32; 34,55] (141) bone-anchored com- [0.17; 2.53] (348) [0.37; 3.30] (298) [1.08; 4.15] (378) [1.39; 4.20] (481) [1.13; 3.16] (713) [1.95; 3.89] (1,065) [5.98; 9.16] (900) [16.26; 22.48] (445) ponents ponents Hip revisions, septic, Hip revisions, septic, 1,70 2,32 2,38 5,17 3,92 6,93 11,97 32,49 0.59 3.87 2.14 3.45 5.91 9.40 14.86 27.17 with exchange of bone- [0,53; 2,87] [0,89; 3,73] [1,09; 3,65] [3,41; 6,90] [2,43; 5,38] [5,18; 8,65] [9,53; 14,34] [26,91; 37,65] with exchange of bone- [0.00; 1.40] [1.60; 6.09] [0.82; 3.45] [1.95; 4.92] [4.25; 7.54] [7.67; 11.10] [12.62; 17.05] [23.54; 30.62] anchored components (445) (385) (502) (546) (594) (722) (569) (175) anchored components (308) (255) (409) (501) (689) (960) (754) (398) Hip revisions, septic, Hip revisions, septic, without exchange of 4,32 5,78 6,09 9,79 8,13 13,50 26,55 43,85 without exchange of 2.63 7.20 4.53 6.83 10.81 13.04 22.93 39.09 bone-anchored com- [1,13; 7,40] [2,22; 9,20] [3,15; 8,95] [6,33; 13,12] [5,01; 11,14] [10,04; 16,82] [22,04; 30,80] [36,83; 50,09] bone-anchored compo- [0.05; 5.14] [3.19; 11.05] [1.73; 7.25] [3.89; 9.68] [7.77; 13.75] [10.31; 15.69] [19.65; 26.08] [34.88; 43.03] Revisions Revisions (143) (143) (217) (237) (250) (315) (253) (107) (129) (135) (181) (239) (316) (459) (438) (284) ponents nents Knee revisions, aseptic, Knee revisions, aseptic, 0,48 0,74 0,76 1,61 1,44 2,69 4,91 15,93 0.24 0.25 0.35 0.67 1.49 2.08 4.88 15.69 with exchange of bone- [0,01; 0,94] [0,23; 1,25] [0,31; 1,20] [0,94; 2,27] [0,83; 2,05] [1,88; 3,51] [3,54; 6,26] [11,81; 19,87] with exchange of bone- [0.00; 0.47] [0.03; 0.48] [0.11; 0.58] [0.35; 0.99] [1.06; 1.92] [1.60; 2.55] [4.03; 5.73] [13.67; 17.67] anchored components (809) (994) (1.309) (1.237) (1.332) (1.404) (839) (244) anchored components (1,603) (1,828) (2,240) (2,368) (2,760) (3,171) (2,119) (964) Knee revisions, aseptic, Knee revisions, aseptic, without exchange of 0,24 1,25 0,58 2,10 2,11 2,78 3,40 5,93 without exchange of 0.75 0.35 0.39 0.42 0.98 1.44 3.24 8.64 bone-anchored com- [0,00; 0,71] (412) [0,32; 2,16] (507) [0,01; 1,15] (622) [0,96; 3,22] (556) [1,01; 3,19] (587) [1,60; 3,94] (686) [1,63; 5,13] (367) [1,57; 10,10] (101) bone-anchored compo- [0.15; 1.35] (734) [0.00; 0.74] (789) [0.01; 0.77] (980) [0.05; 0.78] (1,088) [0.45; 1.51] (1,242) [0.84; 2.04] (1,403) [2.07; 4.40] (784) [5.11; 12.04] (213) ponents nents Knee revisions, septic, Knee revisions, septic, 2,51 2,95 2,40 2,13 6,08 6,16 9,15 13,30 1.97 1.31 0.25 2.05 2.51 5.88 7.17 14.55 with exchange of bone- [0,66; 4,34] [1,13; 4,74] [0,92; 3,85] [0,81; 3,44] [3,98; 8,14] [4,21; 8,06] [6,21; 11,99] [6,98; 19,19] with exchange of bone- [0.24; 3.66] [0.03; 2.57] [0.00; 0.73] [0.84; 3.24] [1.25; 3.76] [4.09; 7.63] [4.97; 9.31] [9.82; 19.02] anchored components (260) (297) (369) (425) (440) (541) (326) (94) anchored components (238) (273) (399) (495) (534) (607) (462) (182) Knee revisions, septic, Knee revisions, septic, without exchange of 3,23 3,36 3,66 5,18 8,89 8,14 21,83 32,51 without exchange of 2.20 3.10 3.42 5.48 3.88 9.53 14.30 24.62 bone-anchored com- [0,06; 6,30] (112) [0,41; 6,23] (130) [1,28; 5,99] (211) [2,39; 7,89] (210) [5,49; 12,16] (235) [5,25; 10,94] (295) [16,72; 26,62] (183) [22,65; 41,11] (60) bone-anchored com- [0.00; 4.64] (122) [0.05; 6.06] (109) [0.90; 5.87] (168) [2.53; 8.34] (201) [1.49; 6.21] (211) [6.55; 12.40] (322) [10.75; 17.71] (304) [17.37; 31.23] (100) ponents ponents © EPRD Annual Report 2024 © EPRD Annual Report 2024 Table 61: 1-year arthroplasty mortality rates for male patients by age category and type of arthroplasty Table 62: 1-year arthroplasty mortality rates for female patients by age category and type of arthroplasty 154 EPRD Annual Report 2024 155  6 Patient mortality • The mortality rate does not uniformly in- • Interestingly, the mortality rate is higher crease with age across the different types of after septic revisions when bone-anchored arthroplasties. In the case of elective THAs components are left in situ whilst the reverse with cemented stems, for example, the is true for aseptic revisions. This may reflect 1-year mortality for patients between 75 and that patients with poorer health status tend 79 years of age is considerably lower com- to undergo less invasive procedures. pared to patients that are 20 years younger. This is presumably due to patient selection: With younger patients, cemented stems are In brief: typically only used for those in poor health; this is no longer the case for older patients. • In the EPRD, mortality rates after elective primary arthroplasties are often lower • Mortality rates after revisions are gen- than the general population figure from erally higher compared to elective pri- the German Federal Statistical Office. mary arthroplasties, but lower compared • Mortality rates after non-elective hip to non-elective hip arthroplasties. With the arthroplasties and after septic revisions notable exception of aseptic knee revisions, are considerably higher. the mortality rate for revisions is higher than the comparable rates, for the respective age groups, from the German Federal Statistical Office. • In the EPRD, the mortality rate after sep- tic revisions is higher compared to aseptic revisions. Severe infections Infection-related revision surgery not only increas- hip registry further concludes that it is mainly the es the risk of additional revisions that may become comorbidity of the patient rather than the infection necessary (see sections 5.2 and 5.4), but also – as itself that accounts for this increased mortality previously shown – the patient mortality rate. [13]. This increase in patient mortality after peripros- The data confirms that periprosthetic infection thetic infection has also been reported in other remains a particularly serious complication for countries. In a US cohort, for example, the 5-year patients. The EPRD website (also refer to pages overall survival proportions for THA and TKA pa- 172/173 of this report) therefore includes sup- tients with periprosthetic infections were found plementary tables which detail the factors that to be comparable with those of cancer patients influence the risk of infection based on the avail- [12]. An analysis based on data from the Swedish able registry data. 156 EPRD Annual Report 2024   7 Summary 157   7 Summary The German Arthroplasty Registry (EPRD) ported Outcome Measures) will transition to reasons, over the past few years. 70.3% of nents selected for implantation. When it is has been documenting the practice of hip and regular operations in 2025. This will allow all one-stage revisions and re-implantation pro- possible to document procedures during knee arthroplasty in Germany for 12 years. patients from hospitals that record PROMs cedures included a new stem and/or acetabu- surgery, the software warns of a component In 2023 alone, a record volume of almost to participate in the survey. The EPRD will lar component; with the use of dual mobility mismatch during data entry. In 2023, the 380,000 data sets were submitted to the reg- start documenting individual surgeon data, cups increasing. In septic revisions bone-an- EPRD detected approximately 600 poten- istry. This means that the EPRD currently provided on a voluntary basis, in 2026. This chored components were more frequently tial mismatch cases. Although this number encompasses around 3 million data sets, of will allow the EPRD to confidentially provide left in situ. is higher than in previous years, the system which over one million are under long-term surgeon-specific outcome analyses to the re- only started screening for knee component follow-up. The length of follow-up extends spective surgeon. In 2023, the EPRD registered a total of size mismatches in 2023. up to 9 years and reflects short to medi- 155,859 primary knee arthroplasties. Most um-term arthroplasty outcomes. The 2023 operating year knee arthroplasties continue to be fully ce- Primary hip arthroplasty survival Between January 1 and December 31, 2023, mented. The proportion of fully cemented The CRRs of primary hip arthroplasties This comprehensive database is the corner- the EPRD registered a total of 378,812 hip TKAs rose from 90.7% in 2016 to 96.0%, largely depend on the primary diagnosis. stone for a large range of different analyses and knee arthroplasty procedures. The pro- whilst the proportion of unicondylar ar- Femoral fractures close to the hip joint have and studies. The increasing number of re- portion of primary knee arthroplasties rose throplasties fell slightly to 83.4% in favour higher revision rates than elective proce- cent publications in peer-reviewed journals to 41.1% for the first time, compared to ap- of completely uncemented fixations. Mobile dures. These rates vary by type of femoral based on EPRD data, not only highlights the proximately 40% in previous years. bearings continued to lose ground in TKAs fracture: Femoral neck fractures have lower value of this fundamental resource but also as well as unicondylar arthroplasties. They CRRs than other fractures. In terms of elec- enhances the international visibility of the A total of 187,640 primary hip replace- were only deployed in 8.1% of registered tive arthroplasty, post-traumatic osteoarthri- registry and its results. The influence of the ments were registered in 2023. The propor- TKAs and 53.7% of unicondylar arthroplas- tis is associated with a higher risk of revision EPRD is further underlined by the intention tion of short-stem implants has been stead- ties. The use of cruciate-retaining systems surgery than other forms of osteoarthritis. of the International Society of Arthroplasty ily increasing for years and reached 15.1% also fell to 42.5%. hXLPE inserts with and Registries (ISAR) to establish the product in 2023. In contrast, the use of monobloc without antioxidants steadily rose to 14.1% In elective THAs, most stem components are classification system used by the EPRD as the cups further decreased to 8.7%, compared and 13.4%, respectively. uncemented, whilst cemented stems are fa- standard for all registries in the future. to 12.7% in 2015. The proportion of insert voured for older and sicker patients. How- components made of highly cross-linked pol- Loosening (21.6%) and infection (15.0%) ever, the EPRD data generally shows that The Implant Register Germany (IRD) is due yethylene rose to 83.5%, with the largest in- were also the most frequently given reasons uncemented stems deployed in older patients to start recording hip and knee arthroplasties crease recorded for antioxidant variants. The for the 15,391 knee arthroplasty revisions have a higher CRR, particularly due to peri- in 2025. As the IRD is anticipated to take sev- use of ceramic inserts shrank to 7.1%. 2023 in 2023, although, similarly to the hip, the prosthetic fracture. Being a man is also a sig- eral years to provide any meaningful analy- marks the first year that 36 mm heads were proportion of reported loosenings has also nificant risk factor since male patients have ses, the EPRD will continue its work and also the most prevalent size, rising from 31.6% in decreased in the knee. Approximately half of a higher risk of infection. CRRs of elective refine the type of data it collects. In 2025 for 2014 to 50.1%. revisions involved a complete replacement of THAs with uncemented stems also increase instance, the EPRD will start collecting data the entire implant system, with a switch to significantly as patient BMI increases. on surgical approaches in hip arthroplasty Similarly to previous years, the most com- a more constrained knee system in 59% of and on implantation aids (computer naviga- mon reasons for the 18,933 hip arthroplasty cases. In septic knee revisions, there was also Larger head components lower the risk of tion and robotics) in knee arthroplasty. An revisions, registered in 2023, were loosening a tendency to leave previously implanted dislocation whilst longer head-neck lengths optional module for recording diagnostics (22.1%), infection (18.0%), periprosthetic bone-anchored components in situ. are often associated with increased CRRs. and treatments for periprosthetic infections fracture (15.8%) and dislocation (14.1%). Short stems fare better than standard stems, in more detail will also be added. The EPRD The share of loosenings has been gradu- To improve patient safety, the EPRD offers particularly in terms of the infection rate, but test phase for registering PROMs (Patient Re- ally shifting towards the other mentioned an online compatibility check of compo- are generally used in younger and healthier 158 EPRD Annual Report 2024 159  7 Summary  patients. The outcomes for short and stand- primary patellar resurfacing. Nonetheless, a age health. Knee replacement patients have ard stems nevertheless vary considerably be- blanket recommendation for patellar resur- a lower mortality rate than hip arthroplasty tween different stem systems. facing at primary TKA cannot be derived patients and unicondylar arthroplasties are based on this observation. associated with the lowest death rate. Pa- Primary knee arthroplasty survival tients that undergo hip arthroplasty, and spe- In terms of primary knee arthroplasties, the Revision hip and knee cifically hemiarthroplasty, as part of trauma revision rate for unicondylar prostheses are arthroplasty survival surgery have the highest mortality rate in the almost twice that of TKAs. Patellofemoral The risk of further revisions increases con- EPRD. Trauma arthroplasty patients and the implants have even higher CRRs. TKAs with siderably more after a hip or knee revision majority of revision procedures, particularly a higher degree of stabilisation, such as var- than after a primary arthroplasty. The risk septic revisions are associated with higher us-valgus-stabilised or hinged systems, used of re-revision surgery also greatly depends death rates compared to the corresponding in patients with joint deformity or ligament on the cause of revision. For periprosthetic general population control groups. instability, are associated with higher revi- infections, the CReRR within two years of sion rates than unconstrained standard sys- the revision is greater than twice that for any tems. of the other reported reasons. Assessing revi- sion outcomes is complex, since differences The risk of revision surgery varies greatly de- in the initial conditions impede comparabil- pending on the primary diagnosis, with the ity. Nonetheless, the CReRR increases from highest CRR observed for post-traumatic one subsequent procedure to the next. The osteoarthritis. Younger patients and men are CReRR also tends to be slightly lower when generally at higher risk of revision surgery. bone-anchored components are exchanged Unicondylar arthroplasties are a notable ex- than when they are left in situ. ception. Men have a lower CRR compared to women approximately one year after this Survival trends type of arthroplasty. Hospitals that have Analysis of primary hip arthroplasty data by more experience and with higher annual vol- operating year does not identify a clear trend umes generally achieve better unicondylar and does not show a CRR decrease during arthroplasty outcomes, although the EPRD the early post-operative phase. In contrast, database also includes a number of excep- the corresponding outcomes for standard tions. primary total knee arthroplasties have im- proved significantly over time. The underly- During the first few years after an arthro- ing reasons are open to speculation. plasty, fixed bearings have a lower CRR than systems with mobile bearings. Coated Patient mortality or ceramicised femoral components are asso- The federal health insurance provider as- ciated with a higher risk of revision surgery sociations inform the EPRD whether a pa- than non-modified metal components. tient is alive or deceased, but do not specify the cause of death. This means that death is The EPRD redefined the endpoint of arthro- not necessarily related to the arthroplasty plasty at the beginning of 2024. A comple- per se. The patient's general health status mentary patellar resurfacing surgery now often influences the type of arthroplasty se- also qualifies as a relevant revision, which is lected. Comparison of the age and sex strat- included in the CRR calculations. This means ified mortality rates of EPRD patients and that the risk of revision surgery for standard the general German population, reveals an TKAs with patellar resurfacing at the time overall lower mortality rate in elective pri- of the primary arthroplasty are now overall mary arthroplasty patients. This points to lower compared to arthroplasties without arthroplasty patients enjoying above aver- 160 EPRD Annual Report 2024 161   Appendix 163  Glossary Glossary Term Coated metal Explanation Implant components that have been coated with titanium nitride, tita- nium niobium nitride or zirconium nitride. In the EPRD, these coated components are treated separately from components made of ceram- icised metal or all-ceramic components. The following summary explains the terms and designations used in the tables and text. Complementary surgery In previous EPRD annual reports patellar resurfacing, following pri- mary bicondylar knee arthroplasty on the same joint affected by “nor- Term Explanation mal” progression of the disease (including exchange of the insert for prophylactic reasons), was defined as a complementary operation Acetabular component Part of the hip arthroplasty that replaces the acetabulum. The acetab- and not as an endpoint. The EPRD has revised this classification in ular component can either consist of one part (monobloc) or of sev- its 2024 annual report, to reflect international conventions, and now eral parts (modular acetabular component). Typically, a modular ace- categorises any procedure involving the removal or exchange of im- tabular component consists of a metal cup and an acetabular insert. plant components or complementary surgery as the endpoint of the survival analysis. Antioxidant Additive/chemical compound, such as Vitamin E, which decreases ox- idation of the polyethylene used in arthroplasty. Confidence interval Interval that contains the true value within a specified probability range (confidence level). ASA status ASA status refers to the patient health status classification system which estimates perioperative risk. The classification system was Constraint Knee replacements are characterised by their level of constraint (sta- established over 80 years ago by the American Society of Anesthe- bilisation). In this report, we define “standard” knee systems as cruci- siologists (ASA). The anaesthesiologist assigns each patient a status ate-retaining, cruciate-retaining/sacrificing, pure cruciate-sacrificing between I (normal, without relevant concomitant diseases) and VI and also posterior-stabilised systems without varus-valgus stabilisa- (brain-dead). In the EPRD, the spectrum ranges from I to V (a mori- tion. Varus-valgus-stabilised and (rigid/rotational) hinge systems are bund patient who is not expected to survive without the operation). considered as “constrained”. Bearing Describes the materials of the two surfaces that move against each Cruciate retaining Design preserving the posterior cruciate ligament without constrain- other in a joint replacement, for example, metal/polyethylene, metal/ ing knee motion/kinematics. metal, ceramic/polyethylene, ceramic/ceramic. In this report, the first material mentioned refers to the femoral component of the articula- Cruciate retaining/sacrificing The design is suitable for both a cruciate ligament-retaining or a re- tion. placement procedure. Body Mass Index Ratio between a person’s height and weight defined as their weight Cruciate sacrificing Design replacing the posterior cruciate ligament with kinematics, (abbreviation: BMI) (in kilograms) divided by their squared height (in metres). which partially permits a limited relative motion in all three planes. Bone cement Material used to anchor prosthetic components in the bone. The ma- Cumulative Re-Revision Rate The cumulative repeat revision (re-revision) rate refers to the revision terial used is polymethyl methacrylate (PMMA). Antibiotics reduce the (abbreviation: CReRR) rate after a previous revision surgery. Also refer to Cumulative Revi- risk of infection and can be added to the bone cement either during sion Rate (CRR). production or during the surgery. Cumulative Revision Rate The EPRD defines the “arthroplasty failure” endpoint as any arthro- Cemented Component fixation with cement (abbreviation: CRR) plasty subsequently requiring the exchange or removal of compo- nents or complementary surgery. Kaplan-Meier estimators are used Cementless /Uncemented Component fixation without cement to calculate the probability that no such revision will be required within a certain time frame after the primary arthroplasty, and that Censoring events In some cases, events such as the patient’s death or loss-to-fol- the arthroplasty will therefore remain in place. The revision rate cor- low-up, may occur before the patient requires a subsequent arthro- responds to the reciprocal probabilities of the Kaplan-Meier estima- plasty revision (endpoint). Up to the occurrence of such a censoring tors and is described as cumulative since it summarises results from event arthroplasty outcomes are still included in the analyses, but the multiple event times. patient is no longer followed up thereafter. Cup See Acetabular component. Ceramicised metal Implant components that consist of a zirconium alloy substrate and a ceramic surface modification – oxidised zirconium alloy. Ceramicised metal is therefore neither all-ceramic nor a coated metal. 164 EPRD Annual Report 2024 165  Glossary Term Explanation Term Explanation Dual mobility In case of a dual mobility arthroplasty the acetabular insert is de- Hip stem See Femoral component (hip). signed (convex surface) to articulate with a dual mobility acetabular component. It is inserted into the concave surface of this bone facing hXLPE Highly cross-linked polyethylene (UHMWPE). Also refer to Polyethylene. shell. The femoral head is usually inserted into the dual mobility in- sert which is in turn inserted into the bone facing shell. Hybrid Arthroplasty in which one component is cemented whilst the other is not cemented. In hip replacement, “hybrid” refers to the combina- Elixhauser Comorbidity Score Comorbidity index which is checked for the presence and the overall tion of a cemented stem and an uncemented acetabular component, severity of certain comorbidities based on the diagnosis codes from whilst “reverse hybrid” refers to the combination of an uncemented the billing data. This is then used to calculate a measure of the pa- stem and a cemented acetabular component. In the case of knee ar- tient’s state of health. The higher the score, the worse the patient’s throplasty, “hybrid” refers to the combination of a cemented tibial tray health and the higher the mortality risk. and an uncemented femoral component whereas “reverse hybrid” re- fers to the reverse combination. Femoral component (hip) Arthroplasty component inserted into the proximal femur. It is either already inseparably connected to the femoral head (monobloc) or a ICD-10 code The International Statistical Classification of Diseases and Related modular head can be attached to obtain a complete femoral compo- Health Problems (Version 10) is an internationally accepted system nent (modular head stem), it can also include a modular structure for documenting principal diagnoses and concomitant diseases. Ger- with a modular neck or proximal section (modular stem). man hospitals use the German ICD-10 codes to document the diag- noses determined during the patient’s stay in hospital to the health Femoral component (knee) Arthroplasty component inserted onto the distal femur. It can form insurance providers. For example, S72.0 is the code for “fracture of either one single femoral condyle or both femoral condyles, and the neck of femur”. femoral trochlear. Impingement Mechanical complication due to inappropriate contact of implant com- Femoral neck prosthesis Generally refers to a hip stem component anchored in the femoral ponents and/or bone. neck but it also refers to the “mid-head resection” prosthesis. Insert Tibial inserts are part of a knee replacement and are attached to the Fixed bearing Monobloc design of the tibial tray or modular connection between superior surface of the tibial tray and provide the articulating surface the tibial tray and the tibial insert that does not permit any relative with the femoral component. Acetabular inserts are part of a hip re- movement between these components. Hinged systems with a rotat- placement and are inserted inside of a modular acetabular compo- ing hinge are also classified as fixed bearings, as opposed to a mobile nent. bearing. Kaplan-Meier estimator Statistical methodology to determine the probability that a given German ICPM code German hospitals use the German ICPM (International Classification event of interest will not occur within a specified time interval. Events of Procedures in Medicine) codes to document inpatient procedures that make it impossible to observe the occurrence of the given events tor health insurance claims. Each procedure has been assigned a nu- can be taken into account in the calculation and can be censored. merical code. For example, code 5-820.01 refers to cemented total hip arthroplasty. Mismatch Arthroplasty involving a combination of components that are either incompatible or a component that is incompatible with existing com- Head (component) See Modular head. ponents. Head-neck length Describes the distance between the centre of the head and a refer- Mobile bearing Mobile connection between the tibial tray and the tibial insert. As op- ence point on the taper in the direction of the taper axis. The size posed to a fixed bearing. Hinged systems with a rotating hinge are not specifications which range from XS to XXXL vary between manufac- classified as mobile bearings. See Fixed bearing. turers. Modular cup An acetabular component designed to accommodate a separate bear- Hemiarthroplasty In contrast to a total arthroplasty, a hemiarthroplasty (hemi = half) ing surface within its internal diameter. Also refer to Monobloc cup does not replace the entire joint but only part of it. A typical example is and Acetabular component. a dual-head arthroplasty, in which only the femoral component of the hip joint is replaced with the head, but not the acetabular component. Hinge Describes coupled knee systems with lateral joint stability and with a simple (single degree of mobility = a “rigid hinge”) or a rotating hinge joint between the femoral component and the tibial tray. 166 EPRD Annual Report 2024 167  Glossary Term Explanation Term Explanation Modular head Femoral head with an upper-convex surface which articulates with Patellofemoral arthroplasty Artificial replacement of the trochlea (groove in the distal femur) and the acetabular articular surface. At its distal aspect, there is a female usually of the patellar surface too, also applies to cases with an addi- taper which is designed to engage with the male taper of the modular tional unicondylar replacement. femoral stem or modular femoral neck. Heads are available in vary- ing sizes to match the internal diameter of the acetabular articulating Periprosthetic joint infection These infections are generally a bacterial colonisation of an im- surface. planted endoprosthesis. This is a particularly dreaded complication, which is difficult and time-consuming to treat surgically. Typically, the Modular stem A femoral stem component that is composed of several parts and infection is caused by pathogens that are part of the normal human which also requires a modular head. Also refer to Monobloc stem and skin and mucosal flora. Femoral component (hip). Pivot Describes knee systems designed to support natural rotation/trans- Monobloc A component consisting of one part, e.g. for hip replacement a stem lation kinematics. component with an integrated head or a polyethylene cup that does not require a separate insert. Polyethylene (abbreviation: PE) Polyethylene is a thermoplastic made by chain polymerisation of ethene [CH2=CH2], from which prosthetic components (e.g. inserts) Monobloc cup An acetabular component, which usually consists of one part or parts can be produced. In arthroplasty, ultra high molecular weight poly- that have been “inseparably” pre-assembled/connected. In contrast, ethylene (UHMWPE) is usually used. This can subsequently be mod- modular cups consist of at least two parts, which are usually only ified by irradiation and coupling to antioxidants. Also refer to hXLPE connected to one another during the implantation. Also refer to Mod- or mXLPE. ular cup and Femoral component (hip). Posterior stabilised Design allowing the posterior cruciate ligament to be replaced with Monobloc stem A femoral stem component that consists of one part and does not re- a mechanical element such as an articulated polyethylene extension quire a separate head component. In contrast, other stems consist of which controls and limits anterior and/or posterior movement. at least two parts. Also refer to Modular stem and Femoral component (hip). Primary surgery/arthroplasty The primary implantation of one or more arthroplasty components in a specific joint. Mortality Refers to the number of deaths in a given period as a percentage of the total number of individuals considered. p-value Lowest significance level at which a statistical test would still reject the null hypothesis. Values below 0.05 are usually referred to as be- mXLPE Moderately cross-linked polyethylene (UHMWPE). ing statistically significant. Offset The distance from the centre of rotation of the femoral head to a line Reconstruction shell A device to provide structural stability to the pelvis prior to implanting bisecting the longitudinal axis of the femoral stem. the definitive acetabular articular component. Such a device may be required in bony defect situations. This may be the case in revision Partial knee arthroplasty A partial knee prosthesis only replaces part of the joint surface. A surgery, but also in primary surgery where pelvic discontinuity arises typical example is a unicondylar prosthesis which only replaces the secondary to bone loss, e.g. tumour or post-traumatic reconstruc- medial/lateral part of the knee joint, not the entire knee joint. Also tions. refer to Total knee arthroplasty. Reverse-hybrid See Hybrid. Partially cemented Partially cemented indicates that one component is not cemented and the other is. Also refer to Hybrid. Revision (surgery/arthroplasty) Surgery referring to the removal and, if necessary, the replacement of previously implanted hip or knee arthroplasty components. Revision Patellar component Component of patellar resurfacing. While this often only consists of a surgery may or may not be followed by re-implantation of new arthro- polyethylene cap, which is cemented into the posterior surface of the plasty components during the same operation (one-stage revision) or patella, there are also designs in which a polyethylene cap is fixed to at a later date (multi-stage revision). It is interpreted as a failure of a metal base plate. Also refer to Patellar resurfacing. the index arthroplasty. Since the beginning of 2024, the reoperation of a knee replacement with patellofemoral-resurfacing as a conse- quence of progressive patellofemoral osteoarthritis is interpreted as Patellar resurfacing Use of an implant replacing the articulation surface of the kneecap. a revision. For secondary patella resurfacing following primary bicondylar knee arthroplasty also refer to Complementary surgery. 168 EPRD Annual Report 2024 169  Glossary Term Explanation Term Explanation Revision cup Monobloc or modular acetabulum component with added design Tumour stem Primarily refers to a modular stem system, implanted as a recon- characteristics for bridging acetabular bone defects or for added struction option for extensive bony defects after femoral tumour re- bony fixation (e.g. additional screw hole). section or at repeat revision (re-revision). Revision stem A hip stem component that is specifically designed for revision hip Two-stage revision surgery The EPRD defines this as a procedure in which the removal and the arthroplasties. re-implantation (replacement) of prosthetic components are per- formed separately and not during the same operation. This is usually Routine data Data stored by public health insurance companies, in particular for performed as part of infection-related revision surgery. As further administrative and billing purposes, in accordance with §301 SGB V interventions may be necessary between explantation and re-im- (German Social Code, Book V). This data, which includes ICD codes for plantation (e.g. spacer replacement, etc.), these procedures are also main and secondary diagnoses as well as OPS codes for treatments, referred to as “two-/multi-stage revisions”. See Revision arthroplasty. is delivered to the EPRD together with the vital status of the partici- pating patients twice a year. The data is used to supplement the case Uncoated metal Implant components that have not been ceramic coated. documentation submitted directly to the registry from participating hospitals. Unicondylar knee arthroplasty Replacement of only one femoral condyle and the corresponding por- tion of the tibial plateau of the knee joint. Short stem Hip stem components that are specified by the manufacturer as an- choring in the metaphyseal area. These include: Femoral neck-pre- serving systems, in which only the femoral head is removed and the femoral neck is left intact, femoral neck-preserving systems, in which parts of the femoral neck are also removed, and femoral neck-resect- ing systems, in which the femoral neck is also completely removed. Standard TKA Describes “unconstrained/minimally stabilised” knee systems such as cruciate-retaining/sacrificing, pure cruciate-sacrificing and also posterior stabilised systems without varus-valgus stabilisation. Surface replacement (hip) Surface replacement of the femoral head (resurfacing head) and/or the acetabular cup (surface replacement cup). The “resurfacing head” is used to describe a femoral component that is designed only to cover the patient’s own femoral head. There may be an anchoring de- vice for epiphyseal fixation (e.g. central pins). The head is used with a corresponding “surface replacement cup” which is made of one piece of material (monobloc). Tibial tray The component that replaces/resurfaces the upper tibia can be mod- ular (more than one piece and accept an insert, monobloc (one piece), preassembled (the insert and tibial tray are assembled by the man- ufacturer but can be separated) or prefixed (where the tibial tray and insert are assembled by the manufacturer and cannot be separated). Total hip arthroplasty Orthopaedic implant which replaces a hip joint. In contrast to a hemi- (abbreviation: THA) arthroplasty, a total hip arthroplasty replaces the entire joint. Total knee arthroplasty A knee arthroplasty replacing all three compartments of the knee joint (abbreviation: TKA) (medial and lateral compartment of the tibiofemoral joint, and the pa- tellofemoral compartment). Current practice in knee arthroplasty in Germany rarely includes patellar resurfacing. Strictly speaking, these cases should therefore not be classified as total knee arthroplasties, but rather as bicompartmental arthroplasties. However, the term “to- tal knee arthroplasty” is widely used in Germany to refer to a bicom- partmental knee arthroplasty. 170 EPRD Annual Report 2024 171  Additional results tables Additional results tables The following table lists outcomes for elec- to 46, 48 to 51 as well as 53 included in this These tables are available at www.eprd.de/ tive primary hip arthroplasties by consid- report. The website also includes additional de/downloads/tabellen or by scanning the ering stem (Table 63) and cup components results tables. These present outcomes ob- adjacent QR code. (Table 64) across all the different component tained when male and female patients are combinations registered. The EPRD website considered separately and when focussing on provides filter search functions for tables 44 specific end points of septic revision. Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Femoral stem Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Uncemented femoral component A2 Kurzschaft (ARTIQO) 12,241 91 64 (57 - 71) 40/60 2016-2023 2.0 [1.7; 2.2] 2.2 [1.9; 2.5] 2.4 [2.1; 2.7] 2.5 [2.2; 2.8] 2.6 [2.3; 3.0] 2.7 [2.4; 3.1] 2.7 [2.4; 3.1] (9,198) (6,825) (5,026) (3,519) (2,205) (1,017) (252) ABG II Stem (Stryker) 528 15 66 (60 - 71) 40/60 2014-2023 4.6 [2.8; 6.4] 6.3 [4.1; 8.4] 6.7 [4.5; 8.9] 7.2 [4.9; 9.5] 7.6 [5.2; 9.9] 7.9 [5.4; 10.3] 7.9 [5.4; 10.3] 7.9 [5.4; 10.3] (469) (422) (392) (355) (269) (203) (164) (65) Accolade II Stem (Stryker) 12,984 67 68 (60 - 75) 42/58 2014-2023 2.7 [2.4; 3.0] 3.0 [2.7; 3.3] 3.3 [3.0; 3.6] 3.5 [3.2; 3.9] 3.7 [3.3; 4.1] 3.9 [3.5; 4.3] 4.0 [3.6; 4.4] 4.1 [3.6; 4.6] (10,546) (8,612) (6,737) (4,959) (3,188) (1,929) (1,081) (336) Actinia cementless (Implantcast) 3,307 26 72 (64 - 78) 34/66 2015-2023 3.6 [3.0; 4.3] 4.0 [3.3; 4.7] 4.1 [3.4; 4.8] 4.4 [3.7; 5.2] 4.7 [3.9; 5.4] 4.9 [4.0; 5.7] 4.9 [4.0; 5.7] (2,906) (2,601) (2,302) (1,830) (875) (353) (74) ACTIS™-Hüftschaft (DePuy) 2,678 43 62 (55 - 69) 43/57 2018-2023 1.8 [1.3; 2.3] 2.2 [1.6; 2.8] 2.4 [1.7; 3.0] 2.6 [1.7; 3.5] (1,694) (879) (475) (131) Alloclassic (Zimmer Biomet) 11,706 91 69 (62 - 76) 35/65 2012-2023 3.1 [2.7; 3.4] 3.6 [3.2; 3.9] 4.0 [3.6; 4.4] 4.3 [4.0; 4.7] 4.6 [4.2; 5.0] 4.9 [4.5; 5.4] 5.1 [4.6; 5.5] 5.4 [4.9; 5.9] 5.4 [4.9; 5.9] (10,354) (9,184) (8,096) (6,813) (5,442) (3,990) (2,628) (1,188) (268) Alpha-Fit (Corin) 691 3 75 (69 - 79) 30/70 2014-2022 1.9 [0.9; 2.9] 2.0 [1.0; 3.1] 2.3 [1.2; 3.5] 2.3 [1.2; 3.5] 2.9 [1.6; 4.2] 3.2 [1.8; 4.6] 3.8 [2.2; 5.5] 4.3 [2.4; 6.1] (663) (650) (637) (601) (501) (338) (246) (143) AMISTEM-H (Medacta) 1,002 28 67 (58 - 74) 43/57 2015-2020 3.2 [2.1; 4.3] 3.5 [2.4; 4.6] 3.7 [2.5; 4.9] 4.2 [2.9; 5.4] 4.6 [3.3; 6.0] 5.6 [3.9; 7.2] 6.2 [4.2; 8.1] (959) (930) (911) (752) (530) (331) (142) 60 (53 - 1.8 [0.5; 3.2] 2.1 [0.7; 3.6] 2.5 [0.9; 4.1] 3.0 [1.1; 4.9] 4.0 [1.3; 6.6] AMISTEM-H ProxCoat (Medacta) 384 3 47/53 2016-2023 (340) (272) (218) (163) (85) 66.5) AMISTEM-P (Medacta) 1,145 26 66 (59 - 73) 40/60 2019-2023 2.6 [1.7; 3.5] 2.8 [1.8; 3.8] 3.9 [2.3; 5.6] (773) (445) (139) ANA.NOVA® Alpha Schaft (ARTIQO) 2,415 13 70 (63 - 76) 39/61 2015-2023 2.2 [1.6; 2.8] 2.7 [2.0; 3.4] 2.9 [2.2; 3.6] 3.2 [2.4; 3.9] 3.4 [2.6; 4.2] 3.6 [2.8; 4.5] 3.8 [2.9; 4.8] 3.8 [2.9; 4.8] (2,072) (1,728) (1,473) (1,190) (884) (572) (347) (66) ANA.NOVA® SL-complete® Schaft (ARTIQO) 737 10 72 (63 - 78) 38/62 2015-2023 3.8 [2.4; 5.2] 4.2 [2.7; 5.7] 4.4 [2.8; 6.0] 4.7 [3.0; 6.3] 4.7 [3.0; 6.3] 5.9 [3.5; 8.2] 5.9 [3.5; 8.2] (571) (464) (372) (309) (221) (130) (65) ANA.NOVA® Solitär Schaft (ARTIQO) 569 7 74 (66 - 80) 35/65 2015-2023 4.1 [2.5; 5.7] 4.3 [2.6; 6.0] 4.7 [2.9; 6.5] 5.0 [3.1; 6.8] 5.5 [3.4; 7.5] 5.5 [3.4; 7.5] (512) (463) (410) (306) (168) (84) Anato Stem (Stryker) 432 9 68 (60 - 75) 45/55 2016-2023 3.2 [1.6; 4.9] 4.0 [2.1; 5.8] 4.2 [2.3; 6.2] 4.2 [2.3; 6.2] 4.2 [2.3; 6.2] 4.9 [2.6; 7.2] (406) (363) (298) (227) (171) (84) Avenir (Zimmer Biomet) 33,903 217 69 (62 - 75) 40/60 2013-2023 3.0 [2.8; 3.2] 3.3 [3.1; 3.5] 3.5 [3.3; 3.7] 3.6 [3.4; 3.8] 3.7 [3.5; 3.9] 3.7 [3.5; 4.0] 3.9 [3.6; 4.2] 4.0 [3.7; 4.4] 4.0 [3.7; 4.4] (26,969) (21,121) (16,142) (11,423) (7,136) (4,193) (1,961) (551) (66) Avenir Complete (Zimmer Biomet) 3,084 60 67 (59 - 74) 40/60 2020-2023 3.3 [2.6; 4.0] 3.4 [2.7; 4.1] 3.4 [2.7; 4.1] (1,605) (588) (97) BICONTACT (Aesculap) 20,076 138 71 (63 - 77) 40/60 2013-2023 3.2 [3.0; 3.5] 3.6 [3.3; 3.8] 3.8 [3.5; 4.0] 3.8 [3.6; 4.1] 3.9 [3.7; 4.2] 4.0 [3.7; 4.2] 4.0 [3.7; 4.3] 4.0 [3.7; 4.3] 4.2 [3.8; 4.6] (18,157) (16,218) (14,374) (12,118) (9,464) (6,687) (4,134) (1,994) (560) BreXis (Stemcup / Zimmer Biomet) 1,923 42 61 (54 - 68) 46/54 2015-2023 2.3 [1.6; 3.0] 3.0 [2.1; 3.8] 3.1 [2.2; 3.9] 3.1 [2.2; 3.9] 3.6 [2.5; 4.6] 4.1 [2.6; 5.6] (1,382) (942) (654) (470) (229) (108) Table 63: Cumulative revision rates for femoral stems in elective total hip arthroplasties. For each type of fixation, the femoral stems are listed alphabetically by their designation. 172 EPRD Annual Report 2024 173  Additional results tables Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Femoral stem Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Uncemented femoral component C.F.P. Hip Prosthesis Stem, uncemented, Curvature A (Waldemar Link) 1,444 29 61 (55 - 68) 51/49 2012-2023 2.1 [1.3; 2.8] 2.7 [1.9; 3.6] 3.0 [2.1; 3.9] 3.4 [2.4; 4.3] 3.7 [2.6; 4.8] 3.9 [2.7; 5.0] 3.9 [2.7; 5.0] 3.9 [2.7; 5.0] 3.9 [2.7; 5.0] (1,259) (1,099) (963) (838) (733) (590) (383) (205) (134) CBC Evolution (Mathys) 980 14 68 (62 - 76) 44/56 2013-2023 3.6 [2.4; 4.7] 4.4 [3.1; 5.7] 4.8 [3.4; 6.2] 5.5 [3.9; 7.0] 5.6 [4.1; 7.2] 5.6 [4.1; 7.2] 5.9 [4.3; 7.6] 5.9 [4.3; 7.6] 5.9 [4.3; 7.6] (854) (737) (630) (537) (435) (348) (226) (90) (53) CBH (Mathys) 323 7 74 (69 - 78) 28/72 2013-2023 1.6 [0.2; 2.9] 2.6 [0.8; 4.4] 2.6 [0.8; 4.4] 2.6 [0.8; 4.4] 2.6 [0.8; 4.4] 2.6 [0.8; 4.4] 2.6 [0.8; 4.4] (290) (263) (234) (209) (173) (139) (92) CLS Spotorno (Zimmer Biomet) 28,969 209 65 (58 - 72) 43/57 2012-2023 2.9 [2.7; 3.1] 3.4 [3.2; 3.6] 3.6 [3.4; 3.9] 3.8 [3.5; 4.0] 3.9 [3.7; 4.2] 4.2 [3.9; 4.4] 4.3 [4.1; 4.6] 4.4 [4.2; 4.7] 4.5 [4.2; 4.8] (25,288) (22,047) (19,095) (16,161) (12,930) (9,566) (6,114) (2,957) (953) CORAIL™ AMT-Hüftschaft mit Kragen (DePuy) 15,502 114 69 (61 - 76) 36/64 2012-2023 1.8 [1.5; 2.0] 2.1 [1.9; 2.4] 2.4 [2.2; 2.7] 2.6 [2.3; 2.9] 2.7 [2.4; 3.0] 2.9 [2.6; 3.2] 3.0 [2.6; 3.4] 3.0 [2.6; 3.4] 3.0 [2.6; 3.4] (11,622) (9,156) (7,233) (5,196) (3,379) (2,059) (949) (210) (61) CORAIL™ AMT-Hüftschaft ohne Kragen (DePuy) 40,733 178 69 (62 - 76) 38/62 2012-2023 3.0 [2.8; 3.1] 3.4 [3.2; 3.5] 3.7 [3.5; 3.9] 4.0 [3.8; 4.2] 4.1 [3.9; 4.3] 4.4 [4.1; 4.6] 4.6 [4.3; 4.8] 4.9 [4.6; 5.2] 5.2 [4.8; 5.7] (34,432) (28,826) (23,451) (18,434) (13,900) (9,283) (5,190) (2,048) (612) COREHIP (Aesculap) 9,006 106 68 (60 - 74) 38/62 2017-2023 2.5 [2.1; 2.8] 2.9 [2.5; 3.2] 3.3 [2.8; 3.8] 3.3 [2.8; 3.8] 3.3 [2.8; 3.8] (5,065) (2,555) (1,026) (402) (56) EcoFit 133° cpTi (Implantcast) 648 6 73 (67 - 80) 28/72 2019-2023 4.7 [3.0; 6.4] 5.4 [3.5; 7.2] 6.7 [4.3; 9.0] (465) (302) (122) EcoFit 133° HA (Implantcast) 387 5 71 (64 - 77) 42/58 2018-2023 2.6 [1.0; 4.2] 3.0 [1.2; 4.7] 3.0 [1.2; 4.7] 3.0 [1.2; 4.7] (308) (215) (147) (82) EcoFit cpTi (Implantcast) 1,073 17 73 (66 - 78) 30/70 2014-2023 5.0 [3.7; 6.3] 5.7 [4.3; 7.1] 6.1 [4.6; 7.5] 6.6 [5.0; 8.1] 6.8 [5.3; 8.4] 6.8 [5.3; 8.4] 7.5 [5.7; 9.4] (971) (898) (835) (771) (571) (370) (187) EcoFit HA (Implantcast) 975 8 70 (64 - 78) 43/57 2014-2023 3.1 [2.0; 4.2] 3.4 [2.2; 4.5] 3.4 [2.2; 4.5] 3.4 [2.2; 4.5] 3.4 [2.2; 4.5] 3.4 [2.2; 4.5] (829) (680) (568) (427) (287) (162) EcoFit Short cpTi (Implantcast) 565 8 69 (62 - 76) 42/58 2018-2023 4.1 [2.5; 5.8] 4.1 [2.5; 5.8] 4.5 [2.7; 6.3] 4.5 [2.7; 6.3] (434) (334) (237) (120) EXCEPTION (Zimmer Biomet) 1,519 14 68 (61 - 75) 50/50 2015-2023 4.4 [3.4; 5.5] 4.8 [3.8; 5.9] 5.4 [4.2; 6.5] 5.5 [4.3; 6.6] 6.1 [4.8; 7.4] 6.1 [4.8; 7.4] 6.1 [4.8; 7.4] (1,400) (1,329) (1,200) (876) (562) (275) (50) EXCIA (Aesculap) 13,765 121 70 (62 - 76) 40/60 2013-2023 3.2 [2.9; 3.5] 3.6 [3.3; 4.0] 3.8 [3.5; 4.1] 3.9 [3.6; 4.2] 4.0 [3.6; 4.3] 4.0 [3.7; 4.4] 4.1 [3.7; 4.5] 4.2 [3.8; 4.7] (11,486) (9,238) (7,492) (5,639) (3,781) (2,218) (865) (157) Fitmore (Zimmer Biomet) 32,422 254 62 (56 - 69) 46/54 2012-2023 2.4 [2.2; 2.5] 2.8 [2.6; 2.9] 3.0 [2.8; 3.2] 3.1 [2.9; 3.3] 3.3 [3.0; 3.5] 3.4 [3.2; 3.6] 3.5 [3.2; 3.7] 3.5 [3.3; 3.8] 3.7 [3.4; 4.0] (27,189) (22,774) (18,679) (14,777) (10,975) (7,465) (4,450) (1,931) (535) GTS (Zimmer Biomet) 2,011 31 64 (57 - 71) 42/58 2013-2023 3.5 [2.7; 4.3] 4.4 [3.5; 5.3] 4.6 [3.7; 5.6] 4.9 [3.9; 5.9] 5.1 [4.1; 6.1] 5.3 [4.2; 6.3] 5.5 [4.4; 6.6] 6.1 [4.4; 7.9] (1,803) (1,636) (1,482) (1,287) (985) (604) (328) (112) Konusprothese (Zimmer Biomet) 1,625 138 57 (48 - 66) 16/84 2013-2023 3.3 [2.4; 4.1] 3.9 [3.0; 4.9] 4.3 [3.3; 5.4] 4.7 [3.6; 5.7] 4.9 [3.7; 6.0] 5.2 [4.0; 6.3] 5.2 [4.0; 6.3] 5.2 [4.0; 6.3] 5.9 [4.0; 7.8] (1,386) (1,237) (1,084) (917) (754) (594) (410) (230) (94) LCU Hip System, uncemented (Waldemar Link) 4,204 47 68 (61 - 74) 43/57 2014-2023 2.9 [2.4; 3.4] 3.2 [2.7; 3.8] 3.5 [3.0; 4.1] 3.6 [3.0; 4.2] 3.8 [3.2; 4.4] 4.2 [3.4; 5.0] 5.2 [3.8; 6.6] (3,441) (2,816) (2,240) (1,629) (1,092) (621) (188) M/L Taper (Zimmer Biomet) 6,705 26 68 (61 - 74) 42/58 2012-2023 3.2 [2.8; 3.7] 3.7 [3.2; 4.2] 4.0 [3.5; 4.5] 4.1 [3.7; 4.6] 4.3 [3.8; 4.8] 4.5 [3.9; 5.0] 4.8 [4.2; 5.4] 4.9 [4.2; 5.5] 4.9 [4.2; 5.5] (5,880) (5,109) (4,290) (3,586) (2,917) (2,038) (1,135) (549) (200) METABLOC (Zimmer Biomet) 713 14 72 (65 - 78) 39/61 2012-2020 2.4 [1.3; 3.5] 2.7 [1.5; 3.9] 2.8 [1.6; 4.1] 3.5 [2.1; 4.8] 3.6 [2.2; 5.0] 3.6 [2.2; 5.0] 3.9 [2.4; 5.5] 3.9 [2.4; 5.5] 3.9 [2.4; 5.5] (685) (655) (635) (585) (497) (389) (250) (116) (56) Metafix (Corin) 1,774 17 71 (65 - 77) 41/59 2014-2023 1.8 [1.2; 2.4] 2.0 [1.4; 2.7] 2.2 [1.5; 2.9] 2.3 [1.5; 3.0] 2.6 [1.8; 3.3] 2.6 [1.8; 3.3] 2.6 [1.8; 3.3] 2.9 [1.9; 3.8] (1,607) (1,420) (1,229) (1,077) (806) (614) (374) (158) METHA (Aesculap) 8,731 171 57 (52 - 63) 47/53 2012-2023 2.7 [2.4; 3.1] 3.4 [3.0; 3.8] 3.6 [3.2; 4.0] 3.8 [3.3; 4.2] 3.9 [3.5; 4.3] 4.0 [3.6; 4.5] 4.1 [3.7; 4.6] 4.1 [3.7; 4.6] 4.1 [3.7; 4.6] (7,751) (6,739) (5,755) (4,811) (3,734) (2,632) (1,711) (907) (305) MiniHip (Corin) 2,677 46 61 (55 - 68) 45/55 2013-2023 2.8 [2.1; 3.4] 3.2 [2.5; 3.9] 3.4 [2.7; 4.1] 3.6 [2.8; 4.3] 4.0 [3.2; 4.8] 4.3 [3.4; 5.1] 4.4 [3.5; 5.3] 4.4 [3.5; 5.3] (2,340) (1,915) (1,629) (1,395) (1,103) (749) (425) (159) MiniMIS Schaft (Falcon) 305 4 66 (59 - 75) 30/70 2016-2023 2.4 [0.6; 4.1] 2.4 [0.6; 4.1] 2.4 [0.6; 4.1] 2.4 [0.6; 4.1] (230) (174) (127) (79) MRP-TITAN (Peter Brehm) 424 145 74 (62 - 81) 36/64 2013-2023 14.0 [10.5; 17.4] 15.8 [12.1; 19.4] 15.8 [12.1; 19.4] 15.8 [12.1; 19.4] 16.6 [12.6; 20.4] (298) (235) (184) (142) (96) Nanos Schenkelhalsprothese (OHST / Smith & Nephew) 5,826 120 59 (53 - 66) 46/54 2013-2023 2.2 [1.8; 2.6] 2.5 [2.1; 3.0] 2.8 [2.4; 3.3] 3.1 [2.6; 3.6] 3.3 [2.8; 3.8] 3.4 [2.8; 3.9] 3.7 [3.1; 4.3] 3.9 [3.2; 4.5] (4,977) (4,211) (3,536) (3,023) (2,500) (1,845) (1,218) (368) optimys (Mathys) 29,393 152 64 (57 - 71) 44/56 2013-2023 1.8 [1.6; 1.9] 2.0 [1.8; 2.1] 2.1 [1.9; 2.3] 2.2 [2.0; 2.4] 2.3 [2.1; 2.5] 2.3 [2.1; 2.5] 2.5 [2.2; 2.7] 2.5 [2.2; 2.7] 2.7 [2.2; 3.1] (22,458) (17,045) (12,747) (9,283) (6,215) (3,751) (1,728) (491) (89) Table 63 (continued) 174 EPRD Annual Report 2024 175  Additional results tables Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Femoral stem Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Uncemented femoral component Peira Schaft (ARTIQO) 384 6 72 (66 - 77) 36/64 2015-2022 3.4 [1.6; 5.2] 3.4 [1.6; 5.2] 3.7 [1.8; 5.5] 3.7 [1.8; 5.5] 4.0 [2.0; 5.9] 4.0 [2.0; 5.9] (364) (358) (340) (313) (225) (129) Polarschaft (Smith & Nephew) 17,015 129 69 (62 - 76) 40/60 2013-2023 2.8 [2.5; 3.0] 3.1 [2.8; 3.4] 3.3 [3.0; 3.5] 3.4 [3.1; 3.7] 3.6 [3.3; 3.9] 3.7 [3.3; 4.0] 4.1 [3.6; 4.5] 4.3 [3.8; 4.9] 4.6 [3.8; 5.4] (13,803) (11,423) (9,357) (7,524) (5,486) (3,472) (1,668) (542) (133) PROFEMUR® GLADIATOR (MicroPort) 458 8 70 (64 - 75) 33/67 2014-2023 2.7 [1.2; 4.2] 3.6 [1.8; 5.3] 4.3 [2.2; 6.2] 4.7 [2.5; 6.9] 4.7 [2.5; 6.9] 5.5 [2.8; 8.1] (380) (307) (243) (185) (129) (90) PROFEMUR® GLADIATOR CLASSIC (MicroPort) 1,190 19 70 (63 - 76) 36/64 2014-2023 2.9 [1.9; 3.8] 3.2 [2.2; 4.2] 4.0 [2.7; 5.2] 4.0 [2.7; 5.2] 4.3 [2.9; 5.7] 4.8 [3.1; 6.5] 4.8 [3.1; 6.5] (944) (690) (485) (334) (226) (142) (81) PROFEMUR® L Classic (MicroPort) 494 10 69 (62 - 76) 40/60 2015-2023 2.3 [0.9; 3.6] 2.3 [0.9; 3.6] 2.3 [0.9; 3.6] 2.3 [0.9; 3.6] (357) (272) (126) (78) PROFEMUR®Preserve (MicroPort) 755 18 63 (56 - 70) 46/54 2015-2023 2.6 [1.4; 3.7] 3.3 [1.9; 4.7] 3.3 [1.9; 4.7] 3.3 [1.9; 4.7] 3.3 [1.9; 4.7] (511) (310) (177) (97) (66) Proxy PLUS Schaft (Smith & Nephew) 894 25 69 (63 - 75) 44/56 2013-2023 3.6 [2.4; 4.8] 4.2 [2.9; 5.5] 4.4 [3.1; 5.8] 4.6 [3.2; 5.9] 4.7 [3.3; 6.1] 5.1 [3.6; 6.5] 5.4 [3.8; 6.9] 6.2 [3.9; 8.4] (837) (791) (733) (671) (577) (446) (296) (112) Pyramid (Atesos) 3,369 27 71 (64 - 77) 36/64 2014-2023 2.8 [2.3; 3.4] 3.1 [2.5; 3.7] 3.5 [2.9; 4.1] 3.5 [2.9; 4.2] 3.6 [2.9; 4.3] 3.8 [3.1; 4.5] 3.8 [3.1; 4.5] 4.0 [3.2; 4.8] (3,007) (2,670) (2,276) (1,845) (1,489) (1,047) (576) (174) QUADRA-H (Medacta) 12,436 79 68 (61 - 75) 39/61 2015-2023 2.8 [2.5; 3.1] 3.3 [3.0; 3.7] 3.7 [3.3; 4.0] 4.0 [3.6; 4.4] 4.2 [3.8; 4.6] 4.5 [4.0; 4.9] 4.7 [4.2; 5.2] 5.4 [3.9; 6.8] (9,586) (7,362) (5,740) (4,351) (3,089) (1,646) (595) (69) S-ROM™-Hüftschaft (DePuy) 439 36 59 (48 - 67) 29/71 2013-2023 5.2 [3.0; 7.3] 5.2 [3.0; 7.3] 5.7 [3.3; 8.0] 5.7 [3.3; 8.0] 5.7 [3.3; 8.0] (345) (266) (186) (121) (62) SBG-Schaft (Smith & Nephew) 546 10 72 (64 - 78) 38/62 2013-2023 4.6 [2.8; 6.4] 5.0 [3.1; 6.8] 5.5 [3.5; 7.4] 5.7 [3.7; 7.7] 6.0 [3.9; 8.1] 6.0 [3.9; 8.1] 6.0 [3.9; 8.1] 10.0 [5.5; 14.2] (499) (445) (382) (325) (280) (213) (132) (67) SCS Stem standard (Stemcup) 382 6 68 (61 - 74) 21/79 2014-2023 1.3 [0.2; 2.5] 2.1 [0.7; 3.6] 2.4 [0.9; 4.0] 2.4 [0.9; 4.0] 2.8 [1.1; 4.5] 3.3 [1.3; 5.2] 3.3 [1.3; 5.2] 3.3 [1.3; 5.2] (367) (349) (335) (303) (254) (188) (108) (53) SL-PLUS Schaft (Smith & Nephew) 5,750 65 69 (62 - 76) 35/65 2012-2023 3.2 [2.7; 3.6] 4.0 [3.5; 4.5] 4.4 [3.9; 5.0] 4.8 [4.2; 5.4] 5.1 [4.5; 5.7] 5.6 [4.9; 6.2] 6.1 [5.3; 6.8] 6.5 [5.7; 7.3] 6.6 [5.8; 7.4] (5,178) (4,674) (4,132) (3,592) (3,014) (2,360) (1,616) (889) (364) SL MIA HA Schaft (Smith & Nephew) 7,231 58 70 (61 - 77) 35/65 2013-2023 2.8 [2.4; 3.2] 3.2 [2.8; 3.6] 3.4 [3.0; 3.9] 3.6 [3.1; 4.1] 3.7 [3.3; 4.2] 4.1 [3.5; 4.6] 4.4 [3.8; 5.0] 4.7 [4.0; 5.5] 5.0 [4.1; 5.9] (6,140) (5,182) (4,307) (3,424) (2,453) (1,644) (919) (426) (156) SP-CL Hip Stem, uncemented (Waldemar Link) 4,248 48 64 (57 - 70) 40/60 2014-2023 3.4 [2.8; 3.9] 4.0 [3.4; 4.6] 4.4 [3.8; 5.1] 4.5 [3.9; 5.2] 4.7 [4.0; 5.4] 5.0 [4.2; 5.7] 5.1 [4.3; 5.9] 7.5 [4.3; 10.6] (3,537) (2,909) (2,402) (1,841) (1,342) (835) (342) (50) SPS Evolution (Symbios) 1,213 17 64 (57 - 70) 44/56 2013-2023 2.4 [1.5; 3.2] 2.7 [1.8; 3.7] 3.1 [2.0; 4.0] 3.3 [2.2; 4.3] 3.3 [2.2; 4.3] 3.3 [2.2; 4.3] 3.3 [2.2; 4.3] (1,071) (957) (839) (672) (494) (262) (124) Stelia Stem (Stemcup) 397 3 69 (60 - 76) 32/68 2014-2023 0.8 [0.0; 1.6] 1.0 [0.0; 2.0] 1.6 [0.3; 2.9] 1.9 [0.5; 3.3] 2.2 [0.7; 3.8] 2.6 [0.9; 4.3] 3.0 [1.1; 4.8] 3.0 [1.1; 4.8] (379) (358) (339) (308) (281) (271) (268) (178) STEMSYS Schaft (ARTIQO) 447 13 73 (69 - 79) 38/62 2018-2023 6.6 [4.2; 8.9] 7.2 [4.7; 9.7] 7.2 [4.7; 9.7] (322) (231) (124) Taperloc (Zimmer Biomet) 5,835 38 70 (62 - 76) 37/63 2014-2023 3.1 [2.6; 3.5] 3.6 [3.1; 4.1] 4.0 [3.5; 4.5] 4.3 [3.8; 4.9] 4.7 [4.1; 5.3] 5.1 [4.4; 5.8] 5.6 [4.8; 6.4] 5.9 [4.9; 6.8] (4,841) (3,861) (3,049) (2,403) (1,805) (1,178) (533) (153) TAPERLOC COMPLETE (Zimmer Biomet) 5,304 32 66 (59 - 73) 43/57 2015-2023 2.5 [2.1; 2.9] 2.7 [2.3; 3.2] 2.9 [2.4; 3.4] 3.1 [2.6; 3.6] 3.3 [2.7; 3.8] 3.3 [2.7; 3.8] 3.3 [2.7; 3.8] (4,377) (3,716) (3,247) (2,358) (1,536) (936) (441) TRENDHIP (Aesculap) 7,080 62 69 (62 - 76) 40/60 2013-2023 2.6 [2.2; 2.9] 2.9 [2.5; 3.3] 3.0 [2.6; 3.4] 3.1 [2.7; 3.5] 3.3 [2.8; 3.7] 3.6 [3.0; 4.1] 3.6 [3.0; 4.1] 3.6 [3.0; 4.1] (5,995) (5,031) (4,299) (3,429) (2,285) (1,214) (651) (247) TRILOCK™-Hüftschaft (DePuy) 5,596 53 61 (55 - 67) 49/51 2013-2023 1.9 [1.5; 2.3] 2.5 [2.1; 2.9] 2.8 [2.4; 3.3] 3.1 [2.6; 3.6] 3.2 [2.7; 3.7] 3.4 [2.8; 3.9] 3.6 [3.0; 4.2] 3.8 [3.1; 4.5] 3.8 [3.1; 4.5] (4,924) (4,164) (3,490) (2,829) (2,085) (1,552) (984) (415) (89) TRJ (Aesculap) 1,201 34 71 (63 - 77) 33/67 2013-2023 2.9 [1.9; 3.9] 3.6 [2.5; 4.7] 3.8 [2.7; 5.0] 4.1 [2.9; 5.3] 4.1 [2.9; 5.3] 4.4 [3.1; 5.7] 4.4 [3.1; 5.7] 4.4 [3.1; 5.7] (1,011) (835) (709) (585) (424) (293) (198) (96) twinSys uncem. (Mathys) 6,543 66 73 (66 - 78) 36/64 2013-2023 2.8 [2.4; 3.2] 3.2 [2.7; 3.6] 3.3 [2.8; 3.7] 3.5 [3.0; 4.0] 3.6 [3.1; 4.1] 3.8 [3.3; 4.4] 3.9 [3.4; 4.5] 4.1 [3.4; 4.7] 4.4 [3.5; 5.4] (5,469) (4,572) (3,705) (2,854) (1,988) (1,307) (765) (447) (192) VEKTOR-TITAN (Peter Brehm) 317 8 66 (59 - 73) 42/58 2014-2021 2.2 [0.6; 3.8] 2.8 [1.0; 4.7] 3.5 [1.4; 5.5] 4.2 [1.9; 6.4] 4.5 [2.2; 6.8] 4.9 [2.5; 7.3] 6.3 [3.4; 9.1] 6.8 [3.8; 9.8] (308) (302) (294) (285) (259) (223) (189) (133) Cemented femoral component A2 Kurzschaft zem. (ARTIQO) 403 29 79 (74 - 83) 20/80 2020-2023 1.6 [0.3; 2.8] (194) Table 63 (continued) 176 EPRD Annual Report 2024 177  Additional results tables Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Femoral stem Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Cemented femoral component ABG II Stem (Stryker) 676 11 79 (76 - 82) 21/79 2014-2023 2.7 [1.5; 3.9] 3.1 [1.8; 4.5] 3.3 [1.9; 4.7] 3.3 [1.9; 4.7] 3.5 [2.1; 5.0] 3.5 [2.1; 5.0] 3.5 [2.1; 5.0] (637) (613) (577) (497) (381) (220) (122) Actinia cemented (Implantcast) 717 19 80 (77 - 83) 21/79 2015-2023 3.4 [2.0; 4.7] 4.0 [2.5; 5.4] 4.2 [2.7; 5.6] 4.3 [2.8; 5.8] 4.6 [3.0; 6.2] 4.6 [3.0; 6.2] (648) (602) (553) (425) (211) (65) AS PLUS Schaft (Smith & Nephew) 701 23 80 (77 - 83) 20/80 2013-2023 3.3 [2.0; 4.7] 3.6 [2.2; 5.0] 4.0 [2.5; 5.5] 4.2 [2.7; 5.7] 4.6 [3.0; 6.2] 4.6 [3.0; 6.2] 5.1 [3.2; 6.9] (641) (586) (533) (482) (401) (270) (160) Avenir (Zimmer Biomet) 7,026 159 80 (76 - 83) 23/77 2014-2023 2.5 [2.2; 2.9] 2.8 [2.4; 3.2] 2.9 [2.5; 3.4] 3.1 [2.6; 3.5] 3.3 [2.7; 3.8] 3.4 [2.8; 4.0] 3.4 [2.8; 4.0] 3.4 [2.8; 4.0] (5,024) (3,412) (2,198) (1,356) (798) (468) (222) (86) BHR (Smith & Nephew) 417 23 55 (51 - 59) 99/1 2014-2023 1.2 [0.2; 2.3] 1.8 [0.5; 3.2] 2.2 [0.7; 3.6] 2.2 [0.7; 3.6] 2.2 [0.7; 3.6] 2.2 [0.7; 3.6] 3.1 [0.7; 5.4] (359) (313) (266) (219) (164) (108) (60) Bicana (Implantcast) 446 20 79 (75 - 82) 29/71 2013-2023 2.8 [1.2; 4.3] 3.3 [1.6; 5.0] 3.6 [1.8; 5.4] 3.9 [2.0; 5.8] 3.9 [2.0; 5.8] 4.3 [2.3; 6.3] 4.3 [2.3; 6.3] 4.3 [2.3; 6.3] (364) (345) (321) (299) (263) (220) (180) (128) BICONTACT (Aesculap) 4,371 114 80 (76 - 83) 23/77 2013-2023 2.4 [2.0; 2.9] 2.6 [2.1; 3.1] 2.9 [2.4; 3.4] 3.1 [2.6; 3.7] 3.3 [2.7; 3.9] 3.4 [2.8; 4.0] 3.5 [2.9; 4.1] 3.6 [3.0; 4.3] 4.3 [2.8; 5.8] (3,751) (3,294) (2,866) (2,388) (1,858) (1,328) (809) (391) (132) C-STEM™ AMT-Hüftschaft (DePuy) 784 16 80 (76 - 84) 18/82 2013-2023 2.1 [1.1; 3.1] 2.6 [1.4; 3.8] 3.2 [1.9; 4.5] 3.7 [2.2; 5.2] 4.4 [2.6; 6.1] 5.1 [3.1; 7.1] 5.1 [3.1; 7.1] 5.1 [3.1; 7.1] (645) (509) (408) (341) (284) (194) (120) (54) CCA (Mathys) 1,791 28 78 (74 - 82) 28/72 2012-2023 3.2 [2.4; 4.0] 4.0 [3.1; 5.0] 4.3 [3.3; 5.2] 4.6 [3.5; 5.6] 5.1 [4.0; 6.2] 5.5 [4.3; 6.7] 6.1 [4.7; 7.4] 6.6 [5.0; 8.1] 6.6 [5.0; 8.1] (1,468) (1,249) (1,089) (937) (756) (623) (461) (262) (150) CORAIL™ AMT-Hüftschaft ohne Kragen (DePuy) 9,762 159 80 (75 - 83) 21/79 2012-2023 2.7 [2.4; 3.0] 3.0 [2.6; 3.3] 3.3 [2.9; 3.7] 3.7 [3.2; 4.1] 4.1 [3.6; 4.6] 4.5 [3.9; 5.1] 4.9 [4.2; 5.5] 5.1 [4.3; 5.9] (7,390) (5,530) (3,976) (2,778) (1,842) (1,164) (598) (194) COREHIP (Aesculap) 1,443 67 81 (77 - 84) 17/83 2018-2023 3.5 [2.5; 4.5] 3.8 [2.7; 4.9] 4.0 [2.9; 5.2] 4.0 [2.9; 5.2] (847) (464) (190) (62) CS PLUS Schaft (Smith & Nephew) 937 33 78 (75 - 82) 26/74 2014-2020 1.7 [0.9; 2.5] 2.4 [1.4; 3.4] 2.6 [1.6; 3.7] 2.6 [1.6; 3.7] 2.8 [1.7; 3.8] 2.9 [1.8; 4.1] 2.9 [1.8; 4.1] 2.9 [1.8; 4.1] (889) (855) (820) (773) (665) (426) (245) (87) EXCEPTION (Zimmer Biomet) 781 14 79 (75 - 83) 20/80 2016-2023 3.0 [1.8; 4.2] 3.3 [2.0; 4.5] 3.4 [2.1; 4.7] 3.6 [2.3; 4.9] 3.9 [2.4; 5.3] 3.9 [2.4; 5.3] (710) (661) (547) (360) (203) (77) EXCIA (Aesculap) 5,749 122 79 (75 - 83) 22/78 2014-2023 2.2 [1.8; 2.6] 2.6 [2.1; 3.0] 2.9 [2.4; 3.3] 3.2 [2.7; 3.7] 3.4 [2.8; 3.9] 3.7 [3.1; 4.3] 4.1 [3.3; 4.9] 5.1 [3.7; 6.4] (4,395) (3,445) (2,725) (2,066) (1,366) (877) (542) (194) Exeter Stem (Stryker) 731 26 81 (77 - 84) 24/76 2015-2023 3.2 [1.9; 4.5] 3.2 [1.9; 4.5] 3.2 [1.9; 4.5] 3.7 [2.1; 5.2] 3.7 [2.1; 5.2] 3.7 [2.1; 5.2] (542) (413) (296) (197) (100) (52) ICON (IO-International Orthopaedics) 305 14 56 (51 - 62) 87/13 2013-2022 1.0 [0.0; 2.1] 1.3 [0.0; 2.6] 2.0 [0.4; 3.6] 2.7 [0.8; 4.6] 2.7 [0.8; 4.6] 3.3 [1.1; 5.5] 4.2 [1.4; 6.9] (297) (290) (278) (270) (219) (132) (66) LCU Hip System, cemented (Waldemar Link) 1,098 22 79 (74 - 82) 32/68 2019-2023 2.7 [1.7; 3.6] 2.8 [1.8; 3.8] 2.8 [1.8; 3.8] (777) (512) (241) Lubinus Classic Plus, cemented (Waldemar Link) 741 9 81 (78 - 84) 14/86 2012-2023 2.6 [1.5; 3.8] 2.6 [1.5; 3.8] 2.8 [1.6; 4.0] 2.8 [1.6; 4.0] 3.6 [2.0; 5.1] 4.4 [2.4; 6.4] 4.4 [2.4; 6.4] (615) (521) (439) (346) (256) (161) (70) M.E.M. Geradschaft (Zimmer Biomet) 32,765 201 79 (75 - 82) 25/75 2012-2023 2.2 [2.1; 2.4] 2.5 [2.3; 2.7] 2.7 [2.5; 2.9] 2.8 [2.6; 3.0] 3.1 [2.9; 3.3] 3.2 [3.0; 3.5] 3.4 [3.1; 3.7] 3.5 [3.2; 3.8] 3.5 [3.2; 3.8] (26,433) (21,144) (16,772) (12,887) (9,087) (5,867) (3,154) (1,359) (367) METABLOC (Zimmer Biomet) 2,290 28 79 (75 - 82) 27/73 2013-2022 2.7 [2.0; 3.3] 3.0 [2.3; 3.7] 3.2 [2.5; 3.9] 3.4 [2.6; 4.1] 3.7 [2.9; 4.5] 4.1 [3.2; 4.9] 4.2 [3.3; 5.2] 4.5 [3.4; 5.5] (2,160) (2,064) (1,892) (1,614) (1,236) (842) (497) (203) MS-30 (Zimmer Biomet) 4,458 38 78 (74 - 81) 26/74 2013-2023 1.8 [1.4; 2.1] 1.9 [1.5; 2.3] 2.1 [1.7; 2.6] 2.4 [1.9; 2.8] 2.4 [1.9; 2.9] 2.6 [2.1; 3.1] 2.8 [2.2; 3.3] 3.1 [2.3; 3.8] (3,971) (3,519) (3,069) (2,557) (2,008) (1,447) (855) (318) MUELLER V40 Stem (Stryker) 325 13 79 (74 - 83) 26/74 2014-2023 2.8 [1.0; 4.6] 3.4 [1.4; 5.4] 3.8 [1.7; 5.9] 4.1 [1.9; 6.3] 4.9 [2.4; 7.3] 4.9 [2.4; 7.3] 4.9 [2.4; 7.3] (307) (288) (273) (251) (223) (172) (120) Müller Geradschaft (OHST Medizintechnik) 2,141 50 79 (75 - 82) 27/73 2014-2023 2.4 [1.7; 3.0] 2.6 [2.0; 3.3] 2.7 [2.0; 3.4] 2.9 [2.2; 3.6] 3.0 [2.2; 3.8] 3.1 [2.3; 3.9] 3.6 [2.6; 4.6] 3.9 [2.7; 5.0] (1,915) (1,721) (1,500) (1,259) (944) (660) (347) (139) MV40 Schaft (OHST Medizintechnik) 389 19 80 (76 - 83) 23/77 2015-2023 0.8 [0.0; 1.7] 0.8 [0.0; 1.7] 1.1 [0.0; 2.2] 1.1 [0.0; 2.2] 1.1 [0.0; 2.2] 1.1 [0.0; 2.2] (327) (287) (238) (191) (137) (98) Polarschaft Cemented (Smith & Nephew) 3,694 89 79 (76 - 83) 23/77 2013-2023 2.9 [2.3; 3.4] 3.2 [2.6; 3.7] 3.2 [2.6; 3.8] 3.4 [2.7; 4.0] 3.6 [2.9; 4.3] 3.8 [3.0; 4.5] 3.9 [3.1; 4.8] 4.4 [3.2; 5.7] (2,763) (2,202) (1,789) (1,402) (956) (560) (233) (92) PROFEMUR® GLADIATOR CEMENTED (MicroPort) 532 5 80 (77 - 83) 25/75 2015-2023 2.0 [0.7; 3.2] 2.5 [1.1; 3.8] 3.2 [1.5; 4.8] 3.2 [1.5; 4.8] 3.2 [1.5; 4.8] 3.2 [1.5; 4.8] (416) (303) (233) (176) (109) (58) Pyramid (Atesos) 327 15 80 (76 - 83) 22/78 2014-2023 2.8 [1.0; 4.5] 2.8 [1.0; 4.5] 2.8 [1.0; 4.5] 2.8 [1.0; 4.5] 3.9 [1.0; 6.7] (270) (197) (135) (85) (54) Table 63 (continued) 178 EPRD Annual Report 2024 179  Additional results tables Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Femoral stem Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Cemented femoral component QUADRA-C (Medacta) 2,702 59 80 (77 - 83) 22/78 2015-2023 2.3 [1.7; 2.9] 2.6 [2.0; 3.3] 2.6 [2.0; 3.3] 2.9 [2.2; 3.6] 3.2 [2.4; 4.1] 3.9 [2.6; 5.1] 3.9 [2.6; 5.1] (2,036) (1,552) (1,171) (822) (490) (234) (73) SPECTRON (Smith & Nephew) 588 15 80 (76 - 83) 25/75 2013-2023 2.3 [1.0; 3.5] 2.9 [1.5; 4.3] 2.9 [1.5; 4.3] 2.9 [1.5; 4.3] 2.9 [1.5; 4.3] 2.9 [1.5; 4.3] 2.9 [1.5; 4.3] (490) (410) (309) (240) (174) (117) (67) SPII Model Lubinus Hip Stem, standard stem, without Borehole 2.0 [1.8; 2.2] 2.5 [2.3; 2.8] 2.8 [2.5; 3.1] 3.1 [2.8; 3.4] 3.3 [3.0; 3.6] 3.6 [3.2; 4.0] 4.0 [3.6; 4.5] 4.3 [3.8; 4.8] 4.7 [4.0; 5.4] 15,349 121 78 (74 - 82) 26/74 2012-2023 (Waldemar Link) (12,620) (10,303) (8,404) (6,594) (5,037) (3,581) (2,146) (981) (347) Standard C, cemented (Waldemar Link) 443 7 77 (74 - 81) 32/68 2014-2022 1.4 [0.3; 2.5] 2.1 [0.7; 3.4] 2.6 [1.1; 4.1] 3.1 [1.4; 4.8] 3.1 [1.4; 4.8] 3.1 [1.4; 4.8] 3.1 [1.4; 4.8] (422) (390) (378) (362) (290) (198) (98) STEMSYS Schaft (ARTIQO) 345 16 81 (76 - 83) 22/78 2018-2023 3.3 [1.4; 5.2] 3.8 [1.6; 5.9] 3.8 [1.6; 5.9] (209) (130) (63) 80 (75.5 2.4 [1.7; 3.1] 2.8 [2.0; 3.6] 2.9 [2.1; 3.7] 2.9 [2.1; 3.7] 2.9 [2.1; 3.7] 2.9 [2.1; 3.7] 2.9 [2.1; 3.7] Taperloc Cemented (Zimmer Biomet) 1,864 32 21/79 2014-2023 (1,533) (1,217) (917) (646) (405) (226) (104) - 83) TRENDHIP (Aesculap) 872 40 80 (76 - 84) 24/76 2016-2023 2.0 [1.0; 2.9] 2.0 [1.0; 2.9] 2.4 [1.3; 3.5] 2.4 [1.3; 3.5] 2.8 [1.4; 4.1] 2.8 [1.4; 4.1] (667) (538) (408) (309) (177) (79) twinSys cem. (Mathys) 2,333 49 79 (74 - 83) 23/77 2013-2023 2.3 [1.7; 2.9] 2.5 [1.9; 3.2] 2.6 [1.9; 3.2] 2.8 [2.1; 3.6] 3.2 [2.4; 4.0] 3.6 [2.6; 4.6] 4.0 [2.7; 5.3] 4.0 [2.7; 5.3] (1,900) (1,573) (1,276) (962) (660) (388) (185) (85) Weber (Zimmer Biomet) 365 31 81 (76 - 84) 20/80 2014-2023 2.0 [0.5; 3.4] 2.3 [0.7; 3.9] 3.1 [1.2; 5.0] 4.1 [1.7; 6.4] 4.7 [2.1; 7.3] 4.7 [2.1; 7.3] (321) (281) (230) (181) (134) (88) Table 63 (continued) 180 EPRD Annual Report 2024 181  Additional results tables Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Cups Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Uncemented acetabular component Alloclassic (Zimmer Biomet) 538 12 68 (59 - 77) 30/70 2014-2023 3.2 [1.7; 4.7] 3.8 [2.1; 5.4] 4.2 [2.5; 5.9] 4.6 [2.8; 6.4] 4.6 [2.8; 6.4] 5.1 [3.2; 7.1] 5.1 [3.2; 7.1] 5.1 [3.2; 7.1] (505) (484) (470) (447) (394) (313) (224) (113) Alloclassic Variall (Zimmer Biomet) 560 14 70 (61 - 78) 34/66 2013-2022 0.5 [0.0; 1.1] 0.9 [0.1; 1.7] 1.3 [0.3; 2.3] 1.6 [0.5; 2.6] 1.6 [0.5; 2.6] 2.3 [0.8; 3.7] 2.3 [0.8; 3.7] 2.3 [0.8; 3.7] (551) (518) (474) (411) (312) (203) (130) (67) Allofit (Zimmer Biomet) 166,048 399 70 (61 - 77) 38/62 2012-2023 2.6 [2.5; 2.7] 3.0 [2.9; 3.0] 3.2 [3.1; 3.3] 3.3 [3.3; 3.4] 3.5 [3.4; 3.6] 3.7 [3.6; 3.8] 3.9 [3.8; 4.0] 4.1 [3.9; 4.2] 4.2 [4.0; 4.3] (136,477) (111,433) (90,308) (70,560) (51,730) (34,947) (20,088) (8,632) (2,345) Allofit IT (Zimmer Biomet) 11,462 119 65 (57 - 74) 39/61 2012-2023 3.0 [2.6; 3.3] 3.5 [3.2; 3.9] 3.8 [3.4; 4.1] 3.9 [3.5; 4.3] 4.2 [3.8; 4.7] 4.4 [4.0; 4.8] 4.5 [4.0; 4.9] 4.8 [4.2; 5.3] 4.8 [4.2; 5.3] (9,728) (8,305) (6,813) (5,413) (4,023) (2,864) (1,740) (767) (341) ANA.NOVA® Alpha Pfanne (ARTIQO) 7,605 61 66 (59 - 74) 42/58 2015-2023 2.4 [2.0; 2.7] 2.6 [2.2; 3.0] 2.8 [2.4; 3.2] 3.1 [2.7; 3.6] 3.5 [3.0; 4.0] 3.6 [3.0; 4.1] 4.0 [3.2; 4.8] 4.0 [3.2; 4.8] (5,582) (4,066) (3,063) (2,278) (1,522) (788) (321) (58) ANA.NOVA® Hybrid Pfanne (ARTIQO) 10,446 62 67 (59 - 75) 36/64 2015-2023 2.3 [2.0; 2.5] 2.6 [2.2; 2.9] 2.7 [2.4; 3.1] 2.8 [2.5; 3.2] 3.0 [2.6; 3.4] 3.2 [2.8; 3.6] 3.6 [3.1; 4.2] 4.2 [3.2; 5.3] (8,507) (6,891) (5,488) (4,149) (2,830) (1,665) (754) (120) aneXys Cluster (Mathys) 1,016 36 63 (56 - 71) 35/65 2016-2023 2.9 [1.9; 4.0] 3.3 [2.1; 4.6] 3.3 [2.1; 4.6] 3.3 [2.1; 4.6] 3.3 [2.1; 4.6] 3.3 [2.1; 4.6] (633) (359) (209) (147) (85) (58) aneXys Flex (Mathys) 6,962 75 64 (58 - 72) 44/56 2016-2023 2.5 [2.1; 2.9] 2.9 [2.5; 3.4] 3.1 [2.7; 3.6] 3.2 [2.7; 3.7] 3.5 [2.9; 4.0] 3.5 [2.9; 4.0] 3.7 [3.0; 4.5] (4,976) (3,511) (2,380) (1,580) (877) (462) (117) aneXys Uno (Mathys) 441 15 56 (49 - 65) 43/57 2019-2023 2.6 [1.1; 4.1] 4.1 [2.0; 6.3] 4.1 [2.0; 6.3] (324) (213) (147) APRIL Poly (Symbios) 673 22 64 (57 - 71) 40/60 2014-2023 1.5 [0.6; 2.5] 2.1 [0.9; 3.2] 2.1 [0.9; 3.2] 2.3 [1.1; 3.5] 2.6 [1.3; 4.0] 2.6 [1.3; 4.0] (561) (470) (398) (318) (224) (110) AVANTAGE (Zimmer Biomet) 384 59 77 (67 - 83) 33/67 2013-2023 3.5 [1.6; 5.4] 4.8 [2.4; 7.1] 4.8 [2.4; 7.1] 4.8 [2.4; 7.1] 4.8 [2.4; 7.1] (283) (196) (130) (98) (60) BHR (Smith & Nephew) 417 23 55 (51 - 59) 99/1 2014-2023 1.2 [0.2; 2.3] 1.8 [0.5; 3.2] 2.2 [0.7; 3.6] 2.2 [0.7; 3.6] 2.2 [0.7; 3.6] 2.2 [0.7; 3.6] 3.1 [0.7; 5.4] (359) (313) (266) (219) (164) (108) (60) BICON-PLUS (Smith & Nephew) 3,200 53 72 (64 - 77) 36/64 2013-2023 2.5 [2.0; 3.0] 3.2 [2.6; 3.9] 3.8 [3.1; 4.5] 4.4 [3.6; 5.1] 4.7 [3.9; 5.4] 5.3 [4.4; 6.1] 6.1 [5.2; 7.1] 6.3 [5.3; 7.2] 6.6 [5.5; 7.6] (2,974) (2,770) (2,519) (2,237) (1,968) (1,661) (1,252) (782) (221) BiMobile Dual Mobility System, uncemented (Waldemar Link) 543 38 74 (65 - 81) 35/65 2017-2023 3.5 [1.9; 5.0] 3.8 [2.1; 5.4] 5.0 [2.6; 7.4] (325) (191) (97) BSC-Cup pressfit closed (Stemcup) 814 5 68 (60 - 73) 34/66 2014-2023 0.8 [0.2; 1.4] 1.4 [0.5; 2.2] 1.6 [0.6; 2.5] 1.8 [0.8; 2.8] 2.2 [1.0; 3.3] 2.5 [1.2; 3.9] 2.5 [1.2; 3.9] 2.5 [1.2; 3.9] (718) (618) (542) (468) (361) (280) (171) (76) CombiCup (Waldemar Link) 5,560 60 72 (63 - 78) 38/62 2013-2023 2.0 [1.6; 2.4] 2.5 [2.1; 2.9] 2.7 [2.3; 3.2] 3.0 [2.5; 3.5] 3.2 [2.7; 3.7] 3.4 [2.9; 3.9] 3.6 [3.0; 4.2] 4.6 [3.3; 5.8] (5,034) (4,487) (3,966) (3,215) (2,364) (1,552) (725) (238) DURALOC™ OPTION™ Press Fit-Hüftpfanne (DePuy) 1,514 14 70 (61 - 77) 38/62 2013-2023 3.1 [2.2; 3.9] 3.6 [2.6; 4.6] 4.0 [2.9; 5.0] 4.4 [3.3; 5.5] 4.6 [3.4; 5.7] 4.6 [3.4; 5.7] 4.7 [3.6; 5.9] 4.7 [3.6; 5.9] (1,338) (1,179) (1,064) (908) (777) (674) (501) (220) EcoFit cpTi (Implantcast) 1,522 27 73 (65 - 79) 36/64 2014-2023 3.6 [2.7; 4.6] 4.3 [3.2; 5.3] 4.4 [3.4; 5.5] 4.8 [3.7; 5.9] 5.1 [4.0; 6.3] 5.3 [4.1; 6.5] 6.1 [4.5; 7.7] (1,380) (1,276) (1,199) (1,047) (738) (383) (179) EcoFit EPORE (Implantcast) 2,286 31 73 (66 - 79) 31/69 2016-2023 4.5 [3.6; 5.3] 4.9 [4.0; 5.8] 5.4 [4.4; 6.4] 6.0 [4.9; 7.0] 6.3 [5.1; 7.4] 6.3 [5.1; 7.4] (1,888) (1,520) (1,121) (809) (490) (246) EcoFit EPORE NH (Implantcast) 786 6 71 (64 - 78) 40/60 2018-2023 3.1 [1.9; 4.3] 3.3 [2.0; 4.5] 3.3 [2.0; 4.5] 3.3 [2.0; 4.5] (640) (467) (331) (184) EcoFit NH cpTi (Implantcast) 2,688 16 72 (64 - 78) 34/66 2014-2023 3.3 [2.6; 4.0] 3.4 [2.7; 4.1] 3.5 [2.8; 4.2] 3.7 [3.0; 4.4] 3.9 [3.2; 4.7] 4.4 [3.4; 5.5] 5.1 [3.7; 6.4] (2,404) (2,171) (1,948) (1,492) (630) (321) (141) EcoFit SC (Implantcast) 404 7 73 (65 - 79) 30/70 2014-2023 4.4 [2.3; 6.4] 4.7 [2.5; 6.8] 5.9 [3.4; 8.4] 7.0 [4.0; 9.8] 7.0 [4.0; 9.8] 7.0 [4.0; 9.8] (332) (269) (195) (155) (97) (50) EL PFANNE (Smith & Nephew) 350 4 71 (63 - 77) 32/68 2013-2015 4.9 [2.6; 7.1] 4.9 [2.6; 7.1] 5.2 [2.8; 7.5] 5.8 [3.3; 8.3] 5.8 [3.3; 8.3] 5.8 [3.3; 8.3] 5.8 [3.3; 8.3] 5.8 [3.3; 8.3] 6.2 [3.6; 8.8] (327) (310) (304) (284) (275) (261) (256) (239) (129) EP-FIT PLUS (Smith & Nephew) 3,888 67 69 (61 - 76) 43/57 2013-2023 2.6 [2.1; 3.1] 3.0 [2.4; 3.5] 3.1 [2.5; 3.6] 3.2 [2.6; 3.7] 3.2 [2.6; 3.8] 3.3 [2.7; 3.9] 3.3 [2.8; 3.9] 3.7 [3.0; 4.4] 4.8 [3.0; 6.6] (3,565) (3,247) (2,912) (2,627) (2,310) (1,826) (1,142) (436) (103) Exceed (Zimmer Biomet) 339 10 72 (63 - 77) 34/66 2013-2019 2.9 [1.1; 4.7] 3.6 [1.6; 5.5] 3.6 [1.6; 5.5] 3.6 [1.6; 5.5] 3.6 [1.6; 5.5] 4.3 [2.1; 6.5] 4.6 [2.3; 6.9] 5.2 [2.6; 7.7] (319) (306) (298) (293) (279) (268) (254) (148) Fitmore (Zimmer Biomet) 734 12 68 (59 - 76) 34/66 2012-2023 2.1 [1.0; 3.1] 2.5 [1.3; 3.6] 2.8 [1.6; 3.9] 2.8 [1.6; 3.9] 3.2 [1.9; 4.5] 3.2 [1.9; 4.5] 3.2 [1.9; 4.5] 3.2 [1.9; 4.5] (703) (685) (664) (645) (529) (380) (194) (65) Table 64: Cumulative revision rates for acetabular cups in elective total hip arthroplasties. For each type of fixation, the cups are listed alphabetically by their designation. 182 EPRD Annual Report 2024 183  Additional results tables Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Cups Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Uncemented acetabular component G7 (Zimmer Biomet) 5,433 31 70 (62 - 77) 35/65 2014-2023 3.2 [2.7; 3.7] 3.9 [3.3; 4.4] 4.4 [3.8; 5.0] 4.9 [4.3; 5.6] 5.4 [4.7; 6.1] 5.9 [5.1; 6.6] 6.4 [5.5; 7.2] 6.7 [5.6; 7.8] (4,508) (3,759) (3,109) (2,432) (1,702) (1,051) (453) (84) HI Lubricer Schale (Smith & Nephew) 6,274 40 70 (62 - 77) 36/64 2013-2023 2.4 [2.0; 2.8] 2.8 [2.4; 3.2] 3.1 [2.6; 3.5] 3.4 [2.9; 3.8] 3.6 [3.1; 4.1] 4.0 [3.4; 4.5] 4.6 [3.9; 5.3] 5.6 [4.5; 6.6] 5.6 [4.5; 6.6] (5,749) (5,105) (4,397) (3,661) (2,836) (1,903) (1,098) (405) (99) ICON (IO-International Orthopaedics) 305 14 56 (51 - 62) 87/13 2013-2022 1.0 [0.0; 2.1] 1.3 [0.0; 2.6] 2.0 [0.4; 3.6] 2.7 [0.8; 4.6] 2.7 [0.8; 4.6] 3.3 [1.1; 5.5] 4.2 [1.4; 6.9] (297) (290) (278) (270) (219) (132) (66) MobileLink, Cluster Hole (Waldemar Link) 4,231 63 72 (63 - 79) 36/64 2017-2023 3.6 [3.1; 4.2] 4.4 [3.7; 5.0] 4.5 [3.8; 5.2] 4.5 [3.8; 5.2] 4.5 [3.8; 5.2] (2,783) (1,701) (826) (242) (90) MPACT (Medacta) 365 11 68 (61 - 76) 35/65 2019-2023 1.4 [0.2; 2.7] 1.4 [0.2; 2.7] (207) (100) PINNACLE™ Press Fit-Hüftpfanne (DePuy) 69,017 209 70 (61 - 77) 37/63 2012-2023 2.5 [2.4; 2.6] 2.9 [2.8; 3.0] 3.2 [3.1; 3.4] 3.5 [3.3; 3.6] 3.6 [3.5; 3.8] 3.9 [3.7; 4.1] 4.1 [3.9; 4.3] 4.4 [4.1; 4.6] 4.6 [4.2; 4.9] (55,423) (44,423) (34,932) (26,133) (18,427) (11,886) (6,338) (2,353) (654) PINNACLE™ SPIROFIT™-Schraubpfanne (DePuy) 440 18 74 (65 - 79) 26/74 2013-2020 3.9 [2.1; 5.7] 4.4 [2.4; 6.3] 4.6 [2.6; 6.6] 4.6 [2.6; 6.6] 5.1 [3.0; 7.2] 5.1 [3.0; 7.2] 5.1 [3.0; 7.2] 5.1 [3.0; 7.2] (408) (396) (386) (371) (337) (274) (173) (100) PLASMACUP (Aesculap) 9,444 59 69 (61 - 76) 38/62 2013-2023 2.1 [1.9; 2.4] 2.5 [2.2; 2.8] 2.6 [2.3; 2.9] 2.8 [2.4; 3.1] 2.8 [2.5; 3.2] 2.8 [2.5; 3.2] 2.8 [2.5; 3.2] 2.9 [2.5; 3.2] 3.0 [2.6; 3.5] (8,455) (7,352) (6,423) (5,477) (4,384) (3,358) (2,335) (1,246) (417) PLASMAFIT (Aesculap) 59,293 279 69 (61 - 77) 39/61 2013-2023 2.9 [2.8; 3.0] 3.3 [3.1; 3.4] 3.5 [3.3; 3.6] 3.6 [3.4; 3.7] 3.7 [3.5; 3.8] 3.8 [3.6; 3.9] 3.8 [3.6; 4.0] 3.8 [3.7; 4.0] 4.2 [3.7; 4.6] (47,951) (39,025) (32,043) (25,145) (17,877) (11,295) (5,957) (2,245) (504) POLARCUP cementless (Smith & Nephew) 366 42 72 (63 - 80) 35/65 2014-2023 3.2 [1.3; 5.0] 3.2 [1.3; 5.0] 3.2 [1.3; 5.0] 3.2 [1.3; 5.0] (232) (172) (112) (72) PROCOTYL® L BEADED (MicroPort) 1,165 25 68 (60 - 75) 41/59 2014-2021 2.5 [1.6; 3.4] 3.2 [2.2; 4.2] 3.6 [2.5; 4.6] 3.7 [2.6; 4.8] 4.1 [2.8; 5.3] 4.8 [3.3; 6.3] 4.8 [3.3; 6.3] (1,123) (1,103) (956) (651) (418) (252) (130) PROCOTYL® P (MicroPort) 1,740 22 68 (61 - 75) 38/62 2020-2023 2.9 [2.0; 3.7] 3.0 [2.1; 3.9] (1,066) (439) Pyramid (Atesos) 3,766 28 71 (64 - 78) 36/64 2014-2023 2.7 [2.2; 3.2] 3.0 [2.5; 3.6] 3.4 [2.8; 4.0] 3.4 [2.8; 4.0] 3.5 [2.9; 4.1] 3.7 [3.0; 4.3] 3.7 [3.0; 4.3] 3.7 [3.0; 4.3] (3,263) (2,801) (2,355) (1,887) (1,504) (1,056) (583) (172) R3 (Smith & Nephew) 23,313 148 69 (61 - 77) 38/62 2013-2023 2.9 [2.7; 3.1] 3.2 [3.0; 3.5] 3.4 [3.2; 3.7] 3.6 [3.4; 3.9] 3.8 [3.5; 4.0] 3.9 [3.6; 4.2] 4.1 [3.8; 4.4] 4.2 [3.8; 4.5] 4.2 [3.8; 4.5] (18,471) (15,136) (12,177) (9,507) (6,573) (3,864) (1,702) (499) (83) REFLECTION (Smith & Nephew) 1,206 10 69 (60 - 77) 36/64 2013-2023 1.6 [0.9; 2.3] 1.9 [1.2; 2.7] 2.3 [1.4; 3.1] 2.3 [1.4; 3.1] 2.3 [1.4; 3.1] 2.4 [1.5; 3.4] 2.7 [1.6; 3.9] (1,133) (978) (846) (750) (607) (397) (263) RM Classic (Mathys) 2,616 21 76 (69 - 80) 32/68 2013-2023 2.9 [2.3; 3.6] 3.3 [2.6; 4.0] 3.5 [2.7; 4.2] 3.8 [3.0; 4.5] 4.0 [3.2; 4.8] 4.4 [3.5; 5.3] 4.5 [3.6; 5.4] 4.8 [3.8; 5.8] 5.9 [4.3; 7.5] (2,273) (1,998) (1,710) (1,449) (1,191) (961) (721) (377) (167) RM Pressfit (Mathys) 1,392 14 74 (67 - 80) 41/59 2013-2023 2.5 [1.6; 3.3] 3.0 [2.1; 3.9] 3.2 [2.3; 4.2] 3.5 [2.5; 4.5] 3.8 [2.7; 4.8] 3.8 [2.7; 4.8] 4.3 [3.0; 5.6] 4.3 [3.0; 5.6] (1,246) (1,136) (1,035) (928) (678) (497) (279) (124) RM Pressfit vitamys (Mathys) 22,215 111 67 (60 - 75) 42/58 2013-2023 1.8 [1.6; 2.0] 2.0 [1.8; 2.2] 2.1 [1.9; 2.3] 2.2 [2.0; 2.4] 2.3 [2.1; 2.5] 2.4 [2.2; 2.6] 2.5 [2.2; 2.8] 2.6 [2.3; 2.9] 2.6 [2.3; 2.9] (17,616) (13,845) (10,747) (7,931) (5,363) (3,173) (1,515) (542) (108) SCREWCUP SC (Aesculap) 2,580 62 73 (64 - 79) 33/67 2013-2023 3.2 [2.5; 3.9] 3.9 [3.1; 4.7] 4.3 [3.5; 5.1] 4.7 [3.8; 5.5] 5.3 [4.3; 6.2] 5.7 [4.7; 6.8] 6.3 [5.1; 7.5] 6.8 [5.2; 8.4] 6.8 [5.2; 8.4] (2,263) (2,004) (1,790) (1,441) (1,069) (664) (370) (168) (50) seleXys PC (Mathys) 579 7 71 (61 - 77) 38/62 2015-2023 0.9 [0.1; 1.6] 0.9 [0.1; 1.6] 0.9 [0.1; 1.6] 1.5 [0.5; 2.6] 1.5 [0.5; 2.6] 1.5 [0.5; 2.6] 1.5 [0.5; 2.6] (549) (525) (479) (412) (325) (220) (115) T.O.P. (Waldemar Link) 353 8 62 (56 - 69) 50/50 2012-2022 2.3 [0.7; 3.8] 2.8 [1.1; 4.6] 3.1 [1.3; 5.0] 3.4 [1.5; 5.3] 3.8 [1.7; 5.7] 4.4 [2.2; 6.6] 4.4 [2.2; 6.6] 4.4 [2.2; 6.6] 4.4 [2.2; 6.6] (342) (333) (324) (316) (301) (277) (241) (172) (119) TM Modular (Zimmer Biomet) 1,748 149 65 (54 - 75) 28/72 2012-2023 6.4 [5.2; 7.6] 7.3 [6.0; 8.5] 7.6 [6.3; 8.9] 8.0 [6.6; 9.3] 8.4 [6.9; 9.8] 8.9 [7.4; 10.4] 8.9 [7.4; 10.4] 8.9 [7.4; 10.4] (1,378) (1,155) (962) (782) (606) (427) (266) (126) Trident Cup (Stryker) 10,392 57 69 (61 - 76) 40/60 2014-2023 2.6 [2.3; 2.9] 3.0 [2.7; 3.3] 3.2 [2.9; 3.6] 3.4 [3.0; 3.8] 3.5 [3.1; 3.9] 3.7 [3.3; 4.1] 3.8 [3.3; 4.2] 3.8 [3.3; 4.2] (8,826) (7,389) (5,807) (4,301) (2,697) (1,416) (711) (235) Trident II Tritanium Cup (Stryker) 1,330 23 71 (63 - 78) 39/61 2018-2023 3.3 [2.2; 4.4] 3.7 [2.4; 5.0] (452) (52) Trident TC Cup (Stryker) 834 16 73 (65 - 78) 32/68 2014-2021 2.5 [1.5; 3.6] 3.0 [1.9; 4.2] 3.4 [2.2; 4.6] 3.8 [2.5; 5.1] 4.2 [2.8; 5.6] 4.5 [3.1; 5.9] 4.5 [3.1; 5.9] 4.5 [3.1; 5.9] (791) (771) (754) (723) (687) (617) (452) (108) Trilogy (Zimmer Biomet) 7,032 36 68 (60 - 75) 38/62 2012-2023 2.1 [1.8; 2.5] 2.7 [2.3; 3.0] 2.8 [2.4; 3.2] 3.0 [2.6; 3.4] 3.1 [2.7; 3.6] 3.2 [2.8; 3.7] 3.4 [3.0; 3.9] 3.4 [3.0; 3.9] 3.4 [3.0; 3.9] (6,222) (5,477) (4,783) (4,180) (3,394) (2,602) (1,705) (889) (382) Trilogy IT (Zimmer Biomet) 1,721 6 71 (63 - 77) 38/62 2013-2023 3.5 [2.6; 4.4] 3.7 [2.8; 4.6] 4.0 [3.0; 4.9] 4.2 [3.2; 5.2] 4.4 [3.4; 5.4] 5.0 [3.8; 6.2] 5.4 [4.1; 6.6] 5.4 [4.1; 6.6] (1,458) (1,248) (1,088) (917) (729) (526) (346) (145) Table 64 (continued) 184 EPRD Annual Report 2024 185  Additional results tables Elective total hip arthroplasties Cumulative revision rates after ... Yrs im- Cups Number Hosp. Age m/f 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years planted Uncemented acetabular component Trinity Hole (Corin) 2,607 45 66 (58 - 75) 42/58 2013-2023 2.3 [1.8; 2.9] 2.5 [1.9; 3.1] 2.6 [2.0; 3.2] 2.7 [2.0; 3.3] 2.8 [2.1; 3.4] 3.0 [2.3; 3.7] 3.3 [2.4; 4.1] 3.6 [2.6; 4.6] (2,300) (1,889) (1,528) (1,244) (968) (698) (398) (157) Trinity no Hole (Corin) 2,701 30 68 (61 - 75) 42/58 2014-2023 2.2 [1.7; 2.8] 2.7 [2.1; 3.3] 3.0 [2.3; 3.7] 3.1 [2.4; 3.8] 3.6 [2.9; 4.4] 3.9 [3.1; 4.7] 4.2 [3.3; 5.1] 4.2 [3.3; 5.1] (2,427) (2,199) (2,030) (1,843) (1,457) (1,047) (657) (281) Tritanium Cup (Stryker) 2,931 31 70 (62 - 78) 39/61 2014-2023 2.7 [2.1; 3.3] 3.2 [2.6; 3.9] 3.6 [2.9; 4.2] 4.0 [3.2; 4.7] 4.1 [3.3; 4.8] 4.2 [3.4; 5.0] 4.6 [3.6; 5.5] 4.9 [3.7; 6.1] (2,766) (2,463) (1,962) (1,440) (920) (604) (316) (109) VERSAFITCUP CC TRIO (Medacta) 16,861 82 69 (61 - 77) 38/62 2015-2023 2.7 [2.4; 2.9] 3.1 [2.8; 3.3] 3.4 [3.1; 3.7] 3.7 [3.4; 4.0] 4.0 [3.6; 4.4] 4.4 [3.9; 4.8] 4.6 [4.1; 5.1] 5.6 [4.1; 7.1] (13,083) (10,094) (7,879) (5,902) (4,033) (2,129) (772) (80) XentraX Screwcup (Stemcup) 375 15 70 (59 - 78) 27/73 2014-2023 3.0 [1.3; 4.8] 3.4 [1.5; 5.2] 3.8 [1.7; 5.9] 4.4 [2.0; 6.8] 5.1 [2.4; 7.8] 6.6 [3.2; 9.9] 6.6 [3.2; 9.9] 6.6 [3.2; 9.9] (312) (235) (179) (137) (132) (125) (122) (80) Cemented acetabular component All POLY CUP (Aesculap) 4,524 163 80 (76 - 84) 22/78 2013-2023 2.8 [2.3; 3.3] 3.2 [2.7; 3.7] 3.5 [2.9; 4.0] 3.7 [3.1; 4.3] 3.9 [3.3; 4.5] 4.1 [3.5; 4.8] 4.4 [3.7; 5.1] 4.9 [4.0; 5.9] 4.9 [4.0; 5.9] (3,834) (3,319) (2,835) (2,307) (1,741) (1,176) (711) (325) (106) AVANTAGE (Zimmer Biomet) 1,449 150 80 (73 - 84) 27/73 2014-2023 5.1 [4.0; 6.3] 5.4 [4.2; 6.7] 6.0 [4.6; 7.3] 6.2 [4.8; 7.7] 6.2 [4.8; 7.7] 6.8 [5.0; 8.7] (1,013) (714) (470) (305) (164) (87) BiMobile Dual Mobility System, cemented (Waldemar Link) 309 56 81 (73 - 85) 29/71 2017-2023 7.3 [4.1; 10.4] 7.3 [4.1; 10.4] (153) (78) CCB (Mathys) 1,224 48 79 (74 - 83) 22/78 2013-2023 3.0 [2.0; 3.9] 3.8 [2.7; 4.9] 3.8 [2.7; 4.9] 4.3 [3.0; 5.6] 5.0 [3.5; 6.5] 5.0 [3.5; 6.5] 5.7 [3.7; 7.6] (988) (798) (629) (451) (299) (200) (114) Cemented Acetabular Cup System, Endo-Model Cup (Waldemar Link) 608 6 77 (72 - 82) 17/83 2012-2023 2.0 [0.9; 3.1] 2.7 [1.4; 4.0] 3.1 [1.7; 4.5] 3.3 [1.8; 4.7] 3.3 [1.8; 4.7] 3.3 [1.8; 4.7] 3.3 [1.8; 4.7] 4.0 [2.2; 5.7] 4.0 [2.2; 5.7] (577) (530) (488) (441) (390) (351) (297) (231) (162) Cemented Acetabular Cup System, IP Cup (Waldemar Link) 1,468 44 80 (77 - 84) 26/74 2013-2023 2.4 [1.6; 3.2] 2.9 [2.0; 3.8] 3.2 [2.3; 4.2] 3.7 [2.6; 4.7] 3.8 [2.7; 4.8] 3.9 [2.8; 5.0] 3.9 [2.8; 5.0] 3.9 [2.8; 5.0] (1,307) (1,181) (1,048) (892) (664) (464) (295) (106) Cemented Acetabular Cup System, Lubinus (Waldemar Link) 1,256 40 79 (75 - 83) 23/77 2013-2023 2.0 [1.2; 2.7] 2.2 [1.4; 3.1] 2.8 [1.8; 3.7] 3.1 [2.0; 4.1] 3.4 [2.3; 4.6] 3.7 [2.4; 4.9] 3.7 [2.4; 4.9] 5.0 [2.8; 7.1] (1,110) (961) (787) (606) (446) (331) (189) (92) EcoFit 2M cemented (Implantcast) 422 71 78 (69 - 83) 32/68 2014-2023 7.7 [5.1; 10.3] 9.5 [6.4; 12.4] 10.5 [7.2; 13.8] 11.5 [7.7; 15.1] (285) (195) (117) (65) Flachprofil (Zimmer Biomet) 9,641 312 80 (75 - 83) 23/77 2012-2023 3.2 [2.8; 3.5] 3.5 [3.2; 3.9] 3.9 [3.5; 4.3] 4.1 [3.7; 4.5] 4.3 [3.9; 4.7] 4.6 [4.2; 5.1] 4.7 [4.2; 5.3] 5.0 [4.4; 5.6] 5.0 [4.4; 5.6] (7,952) (6,617) (5,417) (4,353) (3,241) (2,165) (1,283) (557) (151) Mueller II (Implantcast) 529 36 79 (74 - 83) 24/76 2014-2023 3.8 [2.1; 5.4] 4.8 [2.8; 6.7] 5.1 [3.1; 7.1] 6.0 [3.6; 8.3] 6.6 [3.9; 9.1] 7.7 [4.3; 10.9] (407) (319) (246) (195) (118) (80) Müller II Pfanne (OHST Medizintechnik) 2,902 118 80 (76 - 83) 23/77 2013-2023 3.1 [2.5; 3.7] 3.6 [2.9; 4.3] 3.9 [3.2; 4.6] 4.1 [3.3; 4.8] 4.2 [3.5; 5.0] 4.3 [3.5; 5.1] 4.5 [3.7; 5.3] 4.5 [3.7; 5.3] (2,543) (2,284) (2,048) (1,778) (1,437) (1,020) (562) (199) POLARCUP cemented (Smith & Nephew) 449 59 79 (70 - 84) 27/73 2013-2023 4.2 [2.3; 6.1] 5.2 [3.0; 7.4] 5.7 [3.3; 8.1] 5.7 [3.3; 8.1] 5.7 [3.3; 8.1] (318) (216) (151) (99) (63) PROCOTYL® C (MicroPort) 411 6 80 (76 - 83) 24/76 2015-2023 1.3 [0.2; 2.4] 2.2 [0.7; 3.7] 3.0 [1.1; 4.8] 3.5 [1.4; 5.5] 4.3 [1.6; 6.8] (345) (272) (209) (149) (82) TRILOC® II-PE-Hüftpfanne (DePuy) 1,478 98 80 (74 - 83) 19/81 2013-2023 3.4 [2.5; 4.3] 3.6 [2.6; 4.5] 3.9 [2.8; 4.9] 4.1 [3.0; 5.1] 4.5 [3.4; 5.7] 4.9 [3.6; 6.2] 5.6 [4.0; 7.1] 5.6 [4.0; 7.1] (1,251) (1,083) (906) (722) (541) (389) (227) (73) Table 64 (continued) 186 EPRD Annual Report 2024 187  References References [9] Soderman P, Malchau H, Herberts P, Johnell O. Are the findings in the Swedish National Total Hip Arthroplasty Register valid? A comparison between the Swedish National Total Hip Arthroplasty Register, the National Discharge Register, and the National Death Register. [1] Konow T, Baetz J, Melsheimer O, Grimberg A, Morlock M. J Arthroplasty 2000;15(7): 884-9. Factors influencing periprosthetic femoral fracture risk - A German registry https://doi.org/10.1054/arth.2000.8591 study. Bone Joint J 2021;103-B(4): 650-658. [10] Kim S, Won SJ, Lee NK, Chang CB. https://doi.org/10.1302/0301-620X.103B4.BJJ-2020-1046.R2 Life Expectancy of Patients Undergoing Total Knee Arthroplasty: Comparison With General Population. [2] Roerink AMC, Nelissen R, Holder C, Graves S, Dunbar M, Bohm ER, Grimberg J Korean Med Sci 2024;39(11): e106. A, Steinbrück A, Dale H, Fenstad AM, Blom A, Lenguerrand E, Frampton C, Wil- https://doi.org/10.3346/jkms.2024.39.e106 lems TM, Victor J, Espallargues M, Arias-De La Torre J, Ciminello E, Torre M, Pijls BG. [11] Wilson HA, Middleton R, Abram SGF, Smith S, Alvand A, Jackson WF, Sex-based differences in risk of revision for infection after hip, knee, shoulder Bottomley N, Hopewell S, Price AJ. and ankle arthroplasty in osteoarthritis patients, a multinational registry study Patient relevant outcomes of unicompartmental versus total knee replacement: of 4.800.000 implants. systematic review and meta-analysis. Acta Orthopaedica 2024 (article in press) Bmj 2019;364: l352. https://doi.org/10.1136/bmj.l352 [3] Steinbrück A, Grimberg AW, Elliott J, Melsheimer O, Jansson V. Short versus conventional stem in cementless total hip arthroplasty: [12] Kurtz SM, Lau EC, Son MS, Chang ET, Zimmerli W, Parvizi J. An evidence-based approach with registry data of mid-term survival. Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Der Orthopade 2021;50(4): 296-305. Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare https://doi.org/10.1007/s00132-021-04083-y Population. J Arthroplasty 2018;33(10): 3238-3245. [4] Morlock M, Perka C, Melsheimer O, Kirschbaum SM. https://doi.org/10.1016/j.arth.2018.05.042 Influence of the type of stem and its fixation on revision and immediate postoperative mortality in elective total hip arthroplasty. [13] Persson A, Skoldenberg O, Mohaddes M, Eisler T, Gordon M. Bone Joint J 2024;106-B(3 Supple A): 130-136. Increased mortality after total hip prosthetic joint infection is mainly caused https://doi.org/10.1302/0301-620X.106B3.BJJ-2023-0820.R2 by the comorbidities rather than the infection itself. Acta Orthop 2023;94: 484-489. [5] Hunt LP, Matharu GS, Blom AW, Howard PW, Wilkinson JM, Whitehouse MR. https://doi.org/10.2340/17453674.2023.18619 Patellar resurfacing during primary total knee replacement is associated with a lower risk of revision surgery. Bone Joint J 2021;103-B(5): 864-871. https://doi.org/10.1302/0301-620X.103B5.BJJ-2020-0598.R2 [6] EPRD Deutsche Endoprothesenregister gGmbH. Endoprothesenregister Deutschland (EPRD) - Jahresbericht 2022. Berlin, 2022. https://doi.org/10.36186/reporteprd062022 [7] Grimberg AW, Grupp TM, Elliott J, Melsheimer O, Jansson V, Steinbrück A. Ceramic Coating in Cemented Primary Total Knee Arthroplasty is Not Associated With Decreased Risk of Revision due to Early Prosthetic Joint Infection. J Arthroplasty 2021;36(3): 991-997. https://doi.org/10.1016/j.arth.2020.09.011 [8] Okafor CE, Nghiem S, Byrnes J. Are joint replacement registries associated with burden of revision changes? A real-world panel data regression analysis. BMJ Open 2023;13(1): e063472. https://doi.org/10.1136/bmjopen-2022-063472 188 EPRD Annual Report 2024 189  List of figures List of figures Figure 21: Figure 22: Cumulative revision rates for unicondylar knee arthroplasties by patient sex.............109 Cumulative revision rates for standard total knee arthroplasties by patient body mass index .......................................................................................................................109 Figure 1: Annual procedure volume by operation date.........................................................................14 Figure 23: Cumulative revision rates for unicondylar knee arthroplasties by the hospital's annual volume of primary unicondylar knee arthroplasties.............................................110 Figure 2: Number of hospitals submitting data each year...................................................................15 Figure 24: Cumulative revision rates for standard total knee arthroplasties by knee system......116 Figure 3: Cumulative revision rates of elective and non-elective hip arthroplasties .....................52 Figure 25: Cumulative revision rates for standard total knee arthroplasties by bearing Figure 4: Cumulative revision rates for elective total hip arthroplasties with cemented mobility .......................................................................................................................................117 and uncemented stems .............................................................................................................53 Figure 26: Cumulative revision rates for standard primary total knee arthroplasties with Figure 5: Cumulative revision rates for elective total hip arthroplasties with uncemented and without patellar resurfacing at primary TKA................................................................117 stems by primary diagnosis......................................................................................................54 Figure 27: Cumulative revision rates for unicondylar knee arthroplasties by material of Figure 6: Cumulative revision rates for elective total hip arthroplasties with uncemented the femoral bearing surface....................................................................................................117 stems by age group.....................................................................................................................58 Figure 28: Knee arthroplasty cumulative re-revision rates over time...............................................140 Figure 7: Cumulative revision rates for elective total hip arthroplasties with uncemented stems by primary diagnosis......................................................................................................58 Figure 29: Knee arthroplasty cumulative re-revision rates after first, second and subsequent revisions................................................................................................................140 Figure 8: Cumulative revision rates for elective total hip arthroplasties with uncemented stems by patient body mass index ..........................................................................................59 Figure 30: Knee arthroplasty cumulative re-revision rates by implanted components .................141 Figure 9: Cumulative revision rates for elective total hip arthroplasties by the hospital's annual volume of primary elective total hip arthroplasties................................................60 Figure 10: Cumulative revision rates for uncemented and cemented hip hemiarthroplasties.......68 Figure 11: Cumulative revision rates for elective total hip arthroplasties with cemented stems by head size......................................................................................................................68 Figure 12: Cumulative revision rates for elective total hip arthroplasties with uncemented stems by head-neck lengths .....................................................................................................69 Figure 13: Cumulative revision rates for elective total hip arthroplasties with uncemented stems by stem type.....................................................................................................................69 Figure 14: Hip arthroplasty cumulative re-revision rates over time.....................................................97 Figure 15: Hip arthroplasty cumulative re-revision rates after first, second and subsequent revisions........................................................................................................................................98 Figure 16: Hip arthroplasty cumulative re-revision rates by implanted components.......................98 Figure 17: Cumulative revision rates for total and unicondylar knee arthroplasties......................104 Figure 18: Cumulative revision rates for total knee arthroplasties by degree of constraint.........105 Figure 19: Cumulative revision rates for standard total knee arthroplasties by primary diagnosis (based on the documented ICD-10 codes)..........................................................105 Figure 20: Cumulative revision rates for standard total knee arthroplasties by age group..........108 190 EPRD Annual Report 2024 191  List of tables List of tables Table 27: Table 28: Bearing mobility in primary unicondylar knee arthroplasties in 2023...................................42 Patellar resurfacing in primary total knee arthroplasties in 2023..........................................42 Table 29: Femoral bearing materials in primary total knee arthroplasties in 2023.............................42 Table 1: Proportion of registered procedures by joint and type of intervention in 2023....................30 Table 30: Tibial bearing materials in primary total knee arthroplasties in 2023..................................42 Table 2: Primary hip arthroplasties in 2023 by patient age, sex and BMI.............................................31 Table 31: Bearing materials in primary total knee arthroplasties in 2023.............................................43 Table 3: Previous surgeries reported for primary hip arthroplasties in 2023.....................................31 Table 32: Femoral bearing materials in primary unicondylar knee arthroplasties in 2023................43 Table 4: Types of primary hip replacements in 2023................................................................................33 Table 33: Tibial bearing materials in primary unicondylar knee arthroplasties in 2023.....................43 Table 5: Fixations in primary total hip arthroplasties in 2023.................................................................33 Table 34: Bearing materials in primary unicondylar knee arthroplasties in 2023................................43 Table 6: Fixations in primary hip hemiarthroplasties in 2023.................................................................33 Table 35: Knee revisions in 2023 by patient age, sex and BMI...................................................................44 Table 7: Stem types in primary total hip arthroplasties in 2023.............................................................33 Table 36: Reasons for knee revisions in 2023...............................................................................................45 Table 8: Stem types in primary hip hemiarthroplasties in 2023.............................................................33 Table 37: Re-implanted components in knee revisions in 2023................................................................46 Table 9: Acetabular components in primary total hip arthroplasties in 2023......................................34 Table 38: Number of mismatches due to deviations between head size and inner diameter Table 10: Reconstruction shells in primary total hip arthroplasties in 2023..........................................34 of insert or cup in 2023....................................................................................................................48 Table 11: Head sizes in primary total hip arthroplasties in 2023.............................................................34 Table 39: Example of a THA head size mismatch.........................................................................................48 Table 12: Head-neck lengths in primary total hip arthroplasties in 2023...............................................34 Table 40: Example of a THA taper mismatch................................................................................................48 Table 13: Acetabular bearing materials in primary total hip arthroplasties in 2023............................35 Table 41: Example of a TKA side mismatch...................................................................................................48 Table 14: Modular head materials in primary total hip arthroplasties in 2023......................................35 Table 42: Example of a TKA size mismatch...................................................................................................49 Table 15: Bearing materials in primary total hip arthroplasties in 2023................................................35 Table 43: Example of a PS insert and non-PS femoral component mismatch.......................................49 Table 16: Modular head materials in primary hip hemiarthroplasties in 2023......................................35 Table 44: Cumulative revision rates for different types of primary hip arthroplasties and diagnoses....................................................................................................................................54 Table 17: Hip revisions in 2023 by patient age, sex and BMI......................................................................36 Table 45: Cumulative revision rates for different types of primary hip arthroplasties Table 18: Reasons for hip revisions in 2023..................................................................................................37 by non-implant-related factors......................................................................................................62 Table 19: Hip components re-implanted as part of one- or multi-stage revisions in 2023.................37 Table 46: Cumulative revision rates for different types and characteristics of primary hip arthroplasties..............................................................................................................................70 Table 20: Primary knee arthroplasties in 2023 by patient age, sex and BMI..........................................39 Table 47: Implant outcomes for stem/cup combinations in elective total hip arthroplasties.............82 Table 21: Previous surgeries reported for primary knee arthroplasties in 2023..................................40 Table 48: The main factors that impact the hip cumulative re-revision rate........................................100 Table 22: Types of primary knee replacements in 2023.............................................................................41 Table 49: Cumulative revision rates for different types of primary knee arthroplasties Table 23: Grade of constraint in primary total knee arthroplasties in 2023...........................................41 and diagnoses..................................................................................................................................106 Table 24: Fixations in primary total knee arthroplasties in 2023.............................................................41 Table 50: Cumulative revision rates for different types of primary knee arthroplasties by non-implant-related factors....................................................................................................110 Table 25: Fixations in primary unicondylar knee arthroplasties in 2023................................................41 Table 51: Cumulative revision rates for different types and characteristics of primary Table 26: Bearing mobility in primary total knee arthroplasties in 2023................................................42 knee arthroplasties.........................................................................................................................118 192 EPRD Annual Report 2024 193  Publications based on EPRD data Table 52: Implant outcomes for femoro-tibial combinations in primary knee arthroplasties with or without patellar resurfacing at primary TKA...............................................................124 Publications based on EPRD data Table 53: The main factors that impact the hip cumulative re-revision rate........................................142 Table 54: Cumulative revision rates for elective total hip arthroplasties with uncemented stems by operating year................................................................................................................146 The following list, in reverse chronological order, includes all publications and study collabo- Table 55: Cumulative revision rates for elective total hip arthroplasties with cemented rations, that appeared in journals since 2012, and that are based on the systematic approach stems by operating year................................................................................................................147 and objectives of the EPRD and the underlying data. Analyses based on data from the EPRD Table 56: Cumulative revision rates for standard total knee arthroplasties by operating year........147 or extracts from its collective database can be requested for scientific purposes. Details on the procedures, formalities and any potential fees are listed on the EPRD website at https://www. Table 57: Cumulative revision rates for unicondylar knee arthroplasties by operating year............148 eprd.de/de/downloads/auswertungsantraege. Table 58: Burden of revision based on EPRD data sets.............................................................................149 Table 59: Burden of revision based on total case numbers from the German Federal Straub J, Szymski D, Walter N, Wu Y, Melsheimer O, Grimberg A, Alt V, Steinbrueck A, Rupp M. What are the age-related factors linked to aseptic revisions in constrained and unconstrained TKA Statistical Office...............................................................................................................................149 as well as UKA? A register-based study from the German arthroplasty registry (EPRD). Arch Orthop Trauma Surg. 2024 Sep 11. https://doi.org/10.1007/s00402-024-05550-9 Table 60: Summary of patient mortality rates, 3, 6, 12, 24, 36 and 60 months after primary arthroplasty or revision.................................................................................................................153 Günther K, Grimberg A. Was bringt uns das Endoprothesenregister? Table 61: 1-year arthroplasty mortality rates for male patients by age category and type Mobil 2024 Vol. 4-2024. of arthroplasty.................................................................................................................................154 Resl M, Becker L, Steinbrück A, Wu Y, Perka C. Table 62: 1-year arthroplasty mortality rates for female patients by age category and type Re-revision and mortality rate following revision total hip arthroplasty for infection. of arthroplasty.................................................................................................................................155 Bone Joint J. 2024 Jun 1;106-B(6):565-572. https://doi.org/10.1302/0301-620X.106B6.BJJ-2023-1181.R1 Table 63: Cumulative revision rates for femoral stems in elective total hip arthroplasties..............172 Leta T, Lie S, Fenstad A, Lygre S, Lindberg-Larsen M, Pedersen A, W-Dahl A, Rolfson O, Bülow E, van Steenbergen L, Nelissen R, Harries D, de Steiger R, Lutro O, Mäkelä K, Venäläinen M, Willis J, Table 64: Cumulative revision rates for acetabular cups in elective total hip arthroplasties...........182 Wyatt M, Frampton C, Grimberg A, Steinbrück A, Wu Y, Armaroli C, Gentilini M, Picus R, Bonetti M, Dragosloveanu S, Vorovenci A, Dragomirescu D, Dale H, Brand C, Christen B, Shapiro J, Wilkinson J, Armstrong R, Wooster K, Hallan G, Gjertsen J, Chang R, Prentice H, Sedrakyan A, Paxton E, Furnes O. Periprosthetic Joint Infection After Total Knee Arthroplasty With or Without Antibiotic Bone Cement. JAMA Netw Open. 2024;7(5):e2412898. https://doi.org/10.1001/jamanetworkopen.2024.12898 Straub J, Szymski D, Walter N, Wu Y, Melsheimer O, Grimberg A, Alt V, Steinbrueck A, Rupp M. Unicondylar knee arthroplasty demonstrating a significant increased risk for aseptic revisions compared to unconstrained and constrained total knee arthroplasty: An analysis of aseptic revisions after unicondy- lar and primary total knee arthroplasty of the German Arthroplasty Registry. Knee Surg Sports Traumatol Arthrosc. 2024 Apr 21. https://doi.org/10.1002/ksa.12192 Maslaris, A., Grimberg, A., Melsheimer, O., Tsiridis, E., Matziolis, G. Aseptic midterm survival rates between different cemented tibial stem designs in hinged total knee arthroplasty: a 6-year evaluation from the German Arthroplasty Registry. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05273-x Szymski D, Walter N, Straub J, Wu Y, Melsheimer O, Grimberg A, Alt V, Steinbrueck A, Rupp M. Low implantation volume, comorbidities, male sex and implantation of constrained TKA identified as risk factors for septic revision in knee arthroplasty: A register-based study from the German Arthroplasty Registry. Knee Surg Sports Traumatol Arthrosc. 2024 Apr 17. https://doi.org/10.1002/ksa.12182 194 EPRD Annual Report 2024 195  Publications based on EPRD data Osmanski-Zenk K, Ellenrieder M, Melsheimer O, Mittelmeier W. Krull P, Steinbrück A, Grimberg AW, Melsheimer O, Morlock MM, Perka C. Evaluation of the Reports of the German Arthroplasty Registry (EPRD) in Consideration of EndoCert Standard- und Spezialinlays in primarer Huftendoprothetik: Aktuelle Studien- und Requirements: Guidance for Hospitals Participating in the EPRD and EndoCert experts. Umfrageergebnisse aus dem Endoprothesenregister Deutschland (EPRD). Z Orthop Unfall 2024;162:2:118-26. https://doi.org/10.1055/a-2230-8967 Die Orthopädie 2023;52(3): 222-232. https://doi.org/10.1007/s00132-022-04333-7 Morlock M, Perka C, Melsheimer O, Kirschbaum SM. Szymski D, Walter N, Krull P, Melsheimer O, Grimberg A, Alt V, Steinbrück A, Rupp M. Influence of the type of stem and its fixation on revision and immediate postoperative mortality Aseptic revisions and pulmonary embolism after surgical treatment of femoral neck fractures in elective total hip arthroplasty. Bone Joint J 2024;106-B:3 Supple A:130-6 with cemented and cementless hemiarthroplasty in Germany: an analysis from the German https://doi.org/10.1302/0301-620X.106B3.BJJ-2023-0820.R2 Arthroplasty Registry (EPRD). J Orthop Traumatol 2023;24(1): 9. https://doi.org/10.1186/s10195-023-00689-4 Leopold VJ, Krull P, Hardt S, Hipfl C, Melsheimer O, Steinbrück A, Perka C, Giebel GM. Is Elective Total Hip Arthroplasty Safe in Nonagenarians?: An Arthroplasty Registry Analysis. Krull P, Steinbrück A, Grimberg AW, Melsheimer O, Morlock M, Perka C. J Bone Joint Surg Am 2023. https://doi.org/10.2106/JBJS.23.00092 Modified acetabular component liner designs are not superior to standard liners at reducing the risk of revision: An analysis of 151,096 cementless total hip arthroplasties from the German Leta TH, Fenstad AM, Lygre SHL, Lie SA, Lindberg-Larsen M, Pedersen AB, A WD, Rolfson O, Arthroplasty Registry. Bulow E, Ashforth JA, Van Steenbergen LN, Nelissen R, Harries D, De Steiger R, Lutro O, Bone Joint J 2022;104-B(7): 801-810. Hakulinen E, Makela K, Willis J, Wyatt M, Frampton C, Grimberg A, Steinbrück A, Wu Y, https://doi.org/10.1302/0301-620X.104B7.BJJ-2021-1791.R1 Armaroli C, Molinari M, Picus R, Mullen K, Illgen R, Stoica IC, Vorovenci AE, Dragomirescu D, Dale H, Brand C, Christen B, Shapiro J, Wilkinson JM, Armstrong R, Wooster K, Hallan G, Steinbrück A, Grimberg AW, Elliott J, Melsheimer O, Jansson V. Gjertsen JE, Chang RN, Prentice HA, Paxton EW, Furnes O. Short versus conventional stem in cementless total hip arthroplasty: The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2,971,357 primary An evidence-based approach with registry data of mid-term survival. total knee arthroplasties from 2010 to 2020: an international register-based observational study among Der Orthopade 2021;50(4): 296-305. https://doi.org/10.1007/s00132-021-04083-y countries in Africa, Europe, North America, and Oceania. Acta Orthop 2023;94: 416-425. https://doi.org/10.2340/17453674.2023.17737 Steinbrück A, Jansson V. Endoprothesenregister Deutschland (EPRD) - Stellenwert in Deutschland und international – Lützner J, Melsheimer O, Steinbrück A, Postler AE. was können wir lernen, was nicht? High revision rates and mortality after distal femoral replacement for periprosthetic distal femoral Orthopädie und Unfallchirurgie up2date 2022;17(4): 1-15. fractures: analysis from the German Arthroplasty Registry (EPRD). https://doi.org/10.1055/a-1588-2644 Eur J Orthop Surg Traumatol 2023. https://doi.org/10.1007/s00590-023-03582-2 Konow T, Baetz J, Melsheimer O, Grimberg A, Morlock M. Szymski D, Walter N, Krull P, Melsheimer O, Schindler M, Grimberg A, Alt V, Steinbrück A, Rupp M. Factors influencing periprosthetic femoral fracture risk - A German registry study. Comparison of mortality rate and septic and aseptic revisions in total hip arthroplasties for osteoarthritis Bone Joint J 2021;103-B(4): 650-658. and femoral neck fracture: an analysis of the German Arthroplasty Registry. https://doi.org/10.1302/0301-620X.103B4.BJJ-2020-1046.R2 J Orthop Traumatol 2023;24(1): 29. https://doi.org/10.1186/s10195-023-00711-9 Renner L, Perka C, Melsheimer O, Grimberg A, Jansson V, Steinbrück A. Grimberg AW, Steinbrück A. Ceramic-on-Ceramic Bearing in Total Hip Arthroplasty Reduces the Risk for Revision for Periprosthetic 10 Jahre Endoprothesenregister Deutschland (EPRD): was wurde erreicht? Joint Infection Compared to Ceramic-on-Polyethylene: A Matched Analysis of118,753 Cementless THA Die Orthopädie 2023. https://doi.org/10.1007/s00132-023-04385-3 Based on the German Arthroplasty Registry. J Clin Med 2021;10(6). https://doi.org/10.3390/jcm10061193 Szymski D, Walter N, Melsheimer O, Grimberg A, Alt V, Steinbrück A, Rupp M. Mortalität nach Hemiarthroplastik bei Schenkelhalsfrakturen – Grimberg AW, Grupp TM, Elliott J, Melsheimer O, Jansson V, Steinbrück A. Auswertung des Endoprothesenregisters Deutschland (EPRD). Ceramic Coating in Cemented Primary Total Knee Arthroplasty is Not Associated With Decreased Risk Dtsch Arztebl Int 2023;120: 297-8. https://doi.org/10.3238/arztebl.m2023.0007 of Revision due to Early Prosthetic Joint Infection. Szymski D, Walter N, Krull P, Melsheimer O, Grimberg A, Alt V, Steinbrück A, Rupp M. J Arthroplasty 2021;36(3): 991-997. https://doi.org/10.1016/j.arth.2020.09.011 Infection after intracapsular femoral neck fracture - does antibiotic-loaded bone cement Bauer L, Woiczinski M, Thorwachter C, Melsheimer O, Weber P, Grupp TM, Jansson V, Steinbrück A. reduce infection risk after hemiarthroplasty and total hip arthroplasty? Secondary Patellar Resurfacing in TKA: A Combined Analysis of Registry Data and Biomechanical Testing. Bone Joint Res 2023;12(5): 331-338. https://doi.org/10.1302/2046-3758.125.BJR-2022-0314.R1 J Clin Med 2021;10(6). https://doi.org/10.3390/jcm10061227 Szymski D, Walter N, Krull P, Melsheimer O, Lang S, Grimberg A, Alt V, Steinbrück A, Rupp M. Steinbrück A, Melsheimer O, Grimberg A, Jansson V. The Prophylactic Effect of Single vs. Dual Antibiotic-Loaded Bone Cement against Periprosthetic Einfluss der institutionellen Erfahrung auf die Ergebnisse in Hüft- und Knietotalendoprothetik. Joint Infection Following Hip Arthroplasty for Femoral Neck Fracture: An Analysis of the German Der Orthopade 2020. https://doi.org/10.1007/s00132-020-03963-z Arthroplasty Registry. Antibiotics (Basel) 2023;12(4). https://doi.org/10.3390/antibiotics12040732 Steinbrück A, Melsheimer O, Grimberg A, Jansson V. Warum versagen unikondyläre Knieendoprothesen in Deutschland? Knie Journal 2020. https://doi.org/10.1007/s43205-020-00069-6 196 EPRD Annual Report 2024 197 Hey A, Grimberg A, Mühlnikel I, Kleinfeld A. Das Endoprothesenregister Deutschland (EPRD) als Prototyp für das neue staatliche Implantateregister. In: Uwe Repschläger CSuNOb, BARMER Institut für Gesundheitssystemforschung, ed. Gesundheitswesen aktuell 2020 Beiträge und Analysen. 2020 Jansson V, Grimberg A, Melsheimer O, Perka C, Steinbrück A. Orthopaedic registries: the German experience. EFORT Open Rev 2019;4(6): 401-408. https://doi.org/10.1302/2058-5241.4.180064 Jansson V, Steinbrück A, Hassenpflug J. Welcher Zusatznutzen ergibt sich in Zukunft aus den Daten des EPRD im Vergleich zu anderen Registern? Unfallchirurg 2016;119(6): 488-92. https://doi.org/10.1007/s00113-016-0171-7 Hassenpflug J, Liebs TR. Register als Werkzeug für mehr Endoprothesensicherheit. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014;57(12): 1376-83. https://doi.org/10.1007/s00103-014-2057-6 Sternkopf J, Liebs TR, Schultz C. Endoprothesenregister: Große Akzeptanz in Krankenhäusern. Dtsch Arztebl 2014;111(43): 1848-50. Liebs TR, Melsheimer O, Hassenpflug J. Frühzeitige Detektion systematischer Schadensfälle durch Endoprothesenregister. Orthopäde 2014;43(6): 549-54. https://doi.org/10.1007/s00132-014-2293-3 Hassenpflug J. The German Arthroplasty Register (EPRD). In: Structure, procedures and organisation. Paper presented at the EFORT Congress, Berlin. 2012 Saksamaa artroplastika register (EPRD) Aastaaruanne 2024 2024 EPRD – aastaaruanne EPRD Deutsche Endoprothesenregister gGmbH Straße des 17. Juni 106–108 10623 Berliin Telefon: +049-30-3406036-40 Faks: +049-30-3406036-41 E-post: [email protected] www.eprd.de Aastaaruanne 2024  Saksamaa artroplastika register Saksamaa Ortopeedia ja Ortopeedilise Kirurgia Seltsi (DGOOC) algatus Saksa Ortopeedia ja Ortopeedilise Kirurgia Seltsi (DGOOC) algatus Väljaandja koos partneritega EPRD Deutsche Endoprothesenregister gGmbH Straße des 17. Juni 106–108 10623 Berliin Telefon: +49-(0)30-3406036-40 Faks: +49-(0)30-3406036-41 E-post: [email protected] Aastaaruanne 2024 Autorid: www.eprd.de Alexander Grimberg, Stephan Kirschner, Jörg Lützner, Oliver Melsheimer, Michael Morlock, Arnd Steinbrück ©2024 EPRD Tegevdirektor: ISBN: 978-3-949872-05-1 Timo Stehn DOI: 10.36186/reporteprd112025 EPRD täitevkomitee: Saksamaa Rahvusraamatukogu bibliograafilised andmed: DGOOCi nimel: Saksamaa Rahvusraamatukogu on lisanud käesoleva väljaande Saksamaa Klaus-Peter Günther, Karl-Dieter Heller, Bernd Kladny, Carsten Perka rahvusbibliograafiasse; üksikasjalikud bibliograafilised andmed on kättesaadavad (pressiesindaja), Heiko Reichel, Dieter Wirtz veebiaadressil http://portal.dnb.de. Tervisekindlustusandjate nimel: Kujundus ja küljendus: Corinna Märting, Berliin Sascha Dold, Claus Fahlenbrach, Thomas Hopf, Dorothee Krug, Jürgen Malzahn (asetäitja), Christian Rotering Autoriõigused: Tootjate nimel: Pildid: Achim Bagatsch, Björn Kleiner, Marc Michel, Michael Morlock, Michaela Prof. Carsten Perka, MD: Charité/Wiebke Peitz; Prof. Klaus- Münnig (asetäitja), Matthias Spenner Peter Günther MD: UKD; Prof. Arnd Steinbrück, MD: Arlett Mattescheck, Thomas Hedrich; Prof. Bernd Kladny MD: Intercongress; Dr. Carola Reimann: AOK tervisekindlustus, meediateenused; Ulrike Elsner: vdek/G. Lopata; Michaela Münnig: eraviisiline Illustratsioonid lk 16, 20, 21 ja 47: © EPRD Parema loetavuse huvides hoidume tekstis soospetsiifilistest sõnastustest. Käesolev Oleme töörühmade liikmetele väga tänulikud nende ettepanekute ja tagasiside väljaanne hõlmab mehi, naisi ja mitmesuguseid soolisi identiteete. eest seoses käesoleva aastaaruandega! EPRD teadusliku nõuandekomitee sõnum Prof. C. Perka, MD Prof. K.-P. Günther, MD Prof. A. Steinbrück, MD Teadusliku nõuandekomitee esimees Teaduslik nõuandekogu Teaduslik nõuandekogu (rahvusvahelised suhted) (uuringute koordineerimine) EPRD teadusdirektoritena on meil hea meel tutvustada ja patsiendi suremuse vahelist seost. Kuigi Saksamaal viimast aastaaruannet, mis käsitleb viimaseid arenguid on puusaliigese täielik proteesimine (THA) vanematele artroplastika kvaliteedi valdkonnas. Soovime teie patsientidele (> 90 aastat) osutunud ohutuks tähelepanu juhtida ka mitmetele riiklikele ja protseduuriks, näib varre disain mõjutavat varajaste rahvusvahelistele arengutele, mis mõjutavad registri revisioonide määra ja operatsioonijärgset suremust, tööd praegu ja lähitulevikus või on sellega otseselt sõltumata kasutatud kinnitustüübist (tsementeeritud või seotud. tsementeerimata). Need tulemused on eriti olulised vananeva elanikkonna jaoks ning on seetõttu avaldatud Kuna andmete kogumine hõlmab 12 aastat ja mõjukates rahvusvahelistes ajakirjades. registreeritud on ligikaudu 3 miljonit andmekogumit, ei ole EPRD mitte ainult üks maailma suurimaid Tervishoiupoliitika kontekstis on EPRD-s juba mõnda registreid, vaid võimaldab ka teha asjakohaseid aega analüüsitud positiivne seos konkreetse haigla järeldusi Saksamaal tehtud puusa- ja põlveliigese poolt läbiviidud protseduuride arvu ja proteesimiste kvaliteedi kohta. Käesoleva aasta liigeseproteesimise kvaliteedi vahel leidnud üha enam aruanne kinnitab implantaadiga seotud ja üldiste, kajastamist praegustes tervishoiupoliitilistes aruteludes. implantaadiga mitteseotud tegurite mõju implantaadi Tervishoiureformi raames koostatud valitsuskomisjoni püsivusele, mis on hakanud ilmnema viimastel avalduses viidati EPRD andmetele, mis toetavad neid aastatel. Kättesaadavate andmete ulatuslik maht on mahuga seotud mõjusid. Haigla juhtumite arvust võimaldanud ka analüüse, mis aitavad näiteks kaugemale selgitada seost artroplastika 5  arvu kõrval tuleb juba algatatud tervishoiupoliitilistesse koguda täiendavaid kliinilisi andmeid, et tuvastada oluliseks tagasiminekuteks praegusest meetmetesse kaasata ka artroplastikakeskuste muid tegureid, mis võivad mõjutada artroplastika hindamisstandardist. Siiski töötame väsimatult selle struktuurilise ja protsessikvaliteedi muud tunnused, tulemusi. Alates 2025. aastast registreeritakse näiteks nimel, et leida lahendusi, mis võimaldaksid kogutud mistõttu on väga oluline tihe koostöö EPRD ja ka puusaliigese artroplastika kirurgilise andmete vastastikust jagamist, et tagada artroplastika EndoCert© algatuse vahel, mida toetab ka DGOOC. lähenemisviisi tüüp ning arvutinavigatsiooni ja kvaliteet. EPRD-s osalevate haiglate robootika kasutamine põlveliigese artroplastikas. dokumenteerimiskoormuse minimeerimiseks uurime Meie registritöö rahvusvahelist tähtsust Saksamaal ka võimalusi liideste optimeerimiseks haigla peegeldab ka asjaolu, et Rahvusvahelise Artroplastika Lisaks saavad alates järgmisest aastast kõik EPRD infosüsteemi (HIS) pakkujatega, et võimaldada IRD- Registrite Ühingu (ISAR) asutamiskongress toimus haiglad kasutada oma patsientide puhul tasuta Oxford ja EPRD-andmete paralleelset sisestamist. 2024. aasta mais Hamburgis. EPRD esitas oma Hip Score’i (OHS) ja Oxford Knee Score’i (OKS). viimased analüüsid, mis said kohtumisel hea vastuvõtu EPRD on välja töötanud digitaalse lahenduse, et Praegu käimasoleva, tervishoiupoliitikast lähtuva osaliseks ja võimaldasid osalejatel kokku leppida, et koguda patsientide poolt teatatud tulemusi PROM tervishoiusüsteemi ümberkorralduse kontekstis on EPRD „tootebaas”, mis teenib implantaadi (Patient Reported Outcome Measures) küsimustikest. eriti oluline rõhutada, et kvaliteetne artroplastika komponentide iseloomustamiseks ja on juba Eesmärk on vähendada haiglate vastamiskohustust, register võib olla riikliku kvaliteeditagamise keskne ühtlustatud Briti registriga, määratakse tulevikus kogudes samal ajal usaldusväärseid andmeid nii enne element. Seetõttu soovime kasutada seda võimalust, kohustuslikuks standardiks kõikidele registritele üle operatsiooni kui ka 6 ja 12 kuud pärast operatsiooni. et avaldada siirast tänu pikaajalise andmeedastuse maailma. Me omistame selle märkimisväärse saavutuse Osalevad haiglad loovad lihtsalt enne operatsiooni eest ning loodame, et käesoleva aasta aruandes meie registri tootjate, ravikindlustusfondide ja EPRD PROM-portaali kaudu QR-koodi ja patsiendid sisalduv teave toetab jätkuvalt teie igapäevatööd ja erialaseltsi vahelise pikaajalise tiheda koostööle! täidavad küsimustikud ise. aitab teil valida oma patsientidele kõige tõhusama artroplastika strateegia. Suurenev rahvusvaheline nähtavus tähendab ka seda, Teine väga oluline muudatus on artroplastika et EPRD hindamiskriteeriumid tuleb viia vastavusse lisamine Saksamaa implantaadiregistrisse (IRD), kuigi rahvusvaheliste standarditega. See toob paratamatult selle muudatuse konkreetsed tagajärjed EPRD-le ja kaasa ka muid muudatusi. Näiteks alates käesolevast osalevatele haiglatele on veel ebaselged. Kuigi aastast hinnatakse teistkordset põlveliigese pindamise Saksamaa tervishoiuministeerium (BMG) kavatseb operatsiooni kui korduvoperatsiooni, kuigi paljud selle reformi ellu viia 2025. aasta jaanuaris, puudub kirurgid ei pea seda protseduuri esmase implantaadi praegu veel oluline teave kasutatava ebaõnnestumiseks. registreerimissüsteemi kohta. Praeguses etapis on selge, et IRD-s praegu kavandatud juhtumidokumentatsioon Milliseid muudatusi võib oodata EPRD-s osalevate sisaldab vähem kliiniliselt olulisi üksikasju, kui meie haiglate puhul? Esiteks soovime EPRD-s püüame saavutada. Lisaks peame IRD-põhist andmete kogumist lähenemist 6 EPRD aastaaruanne 2024 7  EPRD partnerite avaldused Saksamaa artroplastika register (EPRD) jätkab oma tööd artroplastika kvaliteedi ja patsiendi ohutuse parandamiseks ka pärast seda, kui Saksamaa implantaadiregister (IRD) on kavandatud ajal alustanud puusa- ja põlveliigese artroplastika andmete kogumist. Järgmised EPRD partnerite avaldused kinnitavad, et see eesmärk on konstruktiivse koostöö nurgakivi. Saksamaa Ortopeedia ja Ortopeedilise Kirurgia Seltsi Alates loomisest 12 aastat tagasi on EPRD töötlenud (DGOOC) peasekretärina ning EPRD gGmbH ligikaudu kolm miljonit andmekogumit, mis annavad ainuaktsionäri esindajana on liigeseproteeside register teavet liigeseproteeside kvaliteedi, operatsioonide mulle väga südamelähedane. 12 aasta jooksul, mil on sageduse ja eelkõige proteeside püsivuse kohta. kestnud ainulaadne koostöö kutseühingu, riiklike Andmeid esitab umbes 730 haiglat. Haiglate poolt tervisekindlustusfondide ja tööstuse vahel, oleme pakutav läbipaistvus on oluline panus artroplastika loonud rahvusvaheliselt ja riiklikult tunnustatud kvaliteedi ja patsiendi ohutuse parandamisse. Me registri. Sellest saavad kasu kõik partnerid, eriti aga kutsume valitsust üles kasutama EPRD üle kümne meie patsiendid. Ma kutsun tungivalt üles säilitama aasta tegevuse käigus omandatud teadmisi ja EPRD-d koos selle rikkalike andmete ja kogu andmeid Saksamaa implantaadiregistri arendamiseks väljakujunenud struktuuriga ning soovin, et valitsuse ning kutsume üles koostööle. Lõppude lõpuks on hallatav IRD-artroplastika register teeks EPRD-ga Prof. Bernd Kladny, MD Saksamaa eesmärk pakkuda inimestele parimaid võimalikke puusa- koostööd, millest saaksid kasu mõlemad pooled. On Ortopeedia ja Ortopeedilise Kirurgia ja põlveliigese artroplastikaid. Seltsi peasekretär äärmiselt oluline, et EPRD jätkaks andmete kogumist. Ulrike Elsner vdek juhatuse täistööajaga esimees Tee on olnud pikk ja raske, kuid see oli seda väärt. Pärast 12 aastat kestnud tööd annab EPRD, mida toetavad võrdsetel alustel arstid, tootjad ja riiklikud EPRD on pakkunud väärtuslikke andmeid ja analüüse tervisekindlustusfondid, tulemusi kõrgeimal teaduslikul liigeseproteeside kvaliteedi kohta juba üle 12 aasta. tasemel. EPRD analüüsid äratavad ka rahvusvahelist Kliinikud, tööstus ja riiklikud tervisekindlustusfondid tähelepanu ja neid arendatakse pidevalt edasi. on ühendanud jõud, et registreerida ja pidevalt Käesolev aruanne näitab taas, kui väärtuslikud on parandada artroplastika kvaliteeti. Kuid EPRD on andmete kogumine ja sellega seotud tulemuste rohkem kui lihtsalt register – see on tegevuskava läbipaistvus artroplastika kvaliteedi ja patsiendi Saksamaa seadusjärgse implantaadiregistri, IRD jaoks. ohutuse parandamisel. Seni ei ole seadusjärgne Nüüd on vaja nende kahe asutuse vahelist tihedat implantaadiregister EPRD andmeid ja kogemusi koostööd. Kõik seisneb selles, et õppida väärtuslikest mõistlikul viisil ära kasutanud. Seetõttu jääb IRD oma kogemustest ja kasutada ära olemasolevaid andmeid. potentsiaalist märkimisväärselt maha. Me peame Meie visioon: tihe koostöö EPRD ja IRD vahel, et tegema koostööd, et leida lahendusi, mis toovad kasu Michaela Münnig tagada liigeseproteeside kvaliteet pikas perspektiivis kõigile osapooltele ja eelkõige patsientidele. BVMed (Saksamaa meditsiinitehnoloogia liit) tootjate esindaja EPRD täitevkomitees Dr Carola Reimann AOK juhatuse esimees ametia 8 EPRD 2024. aasta aruanne eg. 9  Sisukord Lühendite loetelu Lühendite loetelu .....................................................................................................................................................................11 Lühendid Mõiste 1 Sissejuhatus .......................................................................................................................................................................12 AOK Saksamaa piirkondlik tervisekindlustusandja (täisnimi: Allgemeine Ortskrankenkasse Bundesverband eGbR) 2 Registri arendamine............................................................................................................................................................14 ASA Ameerika Anestesioloogide Seltsi füüsilise seisundi klassifikatsioonisüsteem 3 Statistilise metoodika ja andmete seostamise kokkuvõte.....................................................................................................20 BMG Saksamaa tervishoiuministeerium 4 2023. tegevusaasta .............................................................................................................................................................30 (lühend: Bundesministerium für Gesundheit) 4.1 Esmased puusaliigese proteesimised .........................................................................................................................30 BMI kehamassiindeks BVMed Saksamaa meditsiinitehnoloogia liit 4.2 Lõualuu proteeside revisioonid....................................................................................................................................36 (tähistab: Bundesverband Medizintechnologie e. V.) 4.3 Esmane põlveliigese proteesimine ...............................................................................................................................39 CR Ristisideme säilitav 4.4 Põlveliigese proteesi vahetused ...................................................................................................................................44 CReRR Kumulatiivne re-revisiooni määr CRR Kumulatiivne revisioonimäär 4.5 EPRD-s tuvastatud mittevastavused ...........................................................................................................................47 CS Ristisideme ohverdamine 5 Puusa- ja põlveliigese proteeside eluea pikkus ...................................................................................................................52 DGOOC Saksamaa Ortopeedia ja Ortopeedilise Kirurgia Selts 5.1 Esmase puusaliigese proteesimise elulemus ............................................................................................................53 (tähistab: Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie e. V.) HIS Haigla infosüsteem 5.1.1 Võrdlus esmase puusaliigese endoproteesimise tüübi järgi 53 hXLPE Kõrgelt ristsillatud polüetüleen 5.1.2 Esmase puusaliigese endoproteesimise implantaadiga mitteseotud tegurid 59 ICD-10 Rahvusvahelise haiguste klassifikatsiooni 10.redaktsioon ICPM 5.1.3 Implantaadi omaduste mõju esmasel puusaliigese endoproteesimisel 68 Rahvusvaheline meditsiiniliste protseduuride klassifikatsioon 5.1.4 Puusaliigese komponentide konkreetsete kombinatsioonide tulemused 82 IRD Saksamaa implantaadiregister (lühend: Implantateregister Deutschland) ISAR Rahvusvaheline artroplastika registrite ühing mXLPE 5.2 Lõikuse järelhoolduse tulemused................................................................................................................................97 Mõõdukalt ristseotud polüetüleen 5.3 Esmase põlveliigese proteesimise elulemus............................................................................................................104 NJR Riiklik liigeseregister (mis hõlmab Inglismaad, Walesi, Põhja-Iirimaad, Mani saart ja 5.3.1 Võrdlus esmase põlveliigese proteesimise tüübi järgi 104 Guernseyt) OHS Oxfordi puusaliigese skoor 5.3.2 Esmase põlveliigese proteesimise puhul implantaadiga mitteseotud tegurid 108 OKS Oxfordi põlveskoor 5.3.3 Implantaadi omaduste mõju esmasel põlveliigese endoproteesimisel 116 PE Polüetüleen 5.3.4 Põlveproteesi komponentide konkreetsete kombinatsioonide tulemused 124 PROM Patsiendi poolt teatatud tulemusnäitajad 5.4 Põlveliigese revisioonilõikuse elulemus.....................................................................................................................140 PSI Patsiendispetsiifilised instrumendid THA Täielik puusaliigese endoproteesimine 5.5 Elulemuse suundumused .........................................................................................................................................146 TKA Põlveliigese täielik asendamine 6 Patsientide suremus ..........................................................................................................................................................152 UHMWPE Ülikõrge molekulmassiga polüetüleen vdek 7 Kokkuvõte .........................................................................................................................................................................158 Saksamaa kohustuslik tervisekindlustus Sõnastik.................................................................................................................................................................................164 (lühend: Verband der Ersatzkassen e. V.) Täiendavad tulemustabelid ...................................................................................................................................................172 aastat aastat Viited .....................................................................................................................................................................................188 Jooniste loetelu......................................................................................................................................................................190 Tabelite loetelu ......................................................................................................................................................................192 EPRD andmetel põhinevad väljaanded ......................................................................................................................................195 10 EPRD aastaaruanne 2024 11  1 Sissejuhatus Saksamaa artroplastika register (EPRD) alustas EPRD on vahepeal neid määratlusi (rahvusvaheliste puusa- ja põlveproteeside andmete kogumist 12 konventsioonide järgimiseks) läbi vaadanud ja liigitab aastat tagasi. Selle aja jooksul on EPRD nüüd kõik protseduurid, mis hõlmavad implantaadi dokumenteerinud ligi 3 miljonit operatsiooni, mille komponentide eemaldamist või vahetamist või andmed on esitatud rangelt vabatahtlikul alusel. Neist täiendavat operatsiooni, elulemusanalüüsi operatsioonidest 1 miljoni pikaajalist kulgu jälgivad lõpptulemusena (vt ka lk 24). juba osalevad riiklikud ravikindlustusfondid. 2024. aasta aruande põhistruktuur järgib varasemate Saksamaa implantaadiregistri (IRD) käivitamine aruannete struktuuri. Käesoleva aasta aruandes on aga järgmisel aastal ei tähenda aga EPRD lõppu. puusa- ja põlveliigese endoproteesimise osade vahel Lõppude lõpuks tuleb ka tulevikus ära kasutada varem tugevam visuaalne eristus. 2. peatükis antakse lühike kogutud andmete potentsiaali. Seetõttu on EPRD ülevaade registri arengust kuni 2023. operatsiooniaasta eesmärk jätkata usaldusväärse teabe pakkumist lõpuni ning kirjeldatakse tulevasi arengusuundi. 3. artroplastika kvaliteedi kohta ja leida võimalusi selle peatükis kirjeldatakse EPRD unikaalset struktuuri, parandamiseks. Saksamaa Ortopeedia ja Ortopeedilise andmeallikaid ja meetodeid. See teave moodustab Kirurgia Selts (DGOOC) on koos tööstuspartnerite ja taustsüsteemi järgmistes peatükkides esitatud riiklike tervisekindlustusfondidega võtnud endale analüüsidele. kohustuse jätkata ja mõnel juhul isegi laiendada EPRD andmete kogumist järgnevatel aastatel. Analüüsid on jagatud kaheks peamiseks osaks. 4. peatükis kirjeldatakse esmalt registri andmeid Alates loomisest 2012. aastal on EPRD lisanud oma kalendriaasta 2023 kohta ning võrreldakse andmekogumisse mitmeid uusi muutujaid, sealhulgas praeguseid artroplastika tavasid eelmiste aastatega. patsiendi pikkuse ja kaalu, ning täiendanud ka Sellele järgnevad kaks üksikasjalikku hindamiskriteeriume. Mitmed põhimõisted on siiski analüüsipeatükki: 5. peatükis hinnatakse jälgitavate jäänud muutumatuks. EPRD klassifitseeris varem artroplastikate elulemusnäitajaid ja 6. peatükis isoleeritud implantaadi vahetuse eelmise artroplastika analüüsitakse artroplastika patsientide lõpptulemusena, samas kui järgnev täiendav operatsioonijärgset suremust, kuigi tuleb märkida, et põlveliigese pinna uuendamise operatsioon lihtsalt patsientide suremus ei pruugi olla otseselt seotud märgiti ära, kuid ei kaasatud artroplastika artroplastikaga. 7. peatükis võetakse lühidalt kokku aruande olulisimad järeldused. 12 EPRD 2024. aasta aruanne 2 Registri arendamine  2 Registri arendamine Ajalugu Jääb veel näha, kas need viimased kasvud on 800 734 754 754 800 720 725 726 püsivad või peegeldavad need koronaviiruse 700 Andmeid esitavate haiglate arv 680 709 700 EPRD käivitati 2012. aasta novembris katseperioodi pandeemia tagajärjel tekkinud järelejõudmise efekti. © EPRD aastaaruanne 2024 600 600 raames, mille jooksul mõned piloothaiglad esitasid Huvitaval kombel on protseduuride arvu kasv aastatel 544 registrile oma kirurgilised dokumendid. 2014. aasta 2022–2023 peamiselt tingitud põlveliigese proteesimiste 500 500 alguses avati EPRD kõigile huvitatud haiglatele. arvu suurenemisest. Puusaliigese proteesimiste arv 400 400 Dokumenteeritud protseduuride arv on sellest ajast suurenes vaid 6634 juhtumi võrra, samas kui alates pidevalt kasvanud, välja arvatud 2020. ja 2021. dokumenteeriti 17 914 täiendavat põlveliigese 300 300 aastal, mil esituste maht vähenes Covid-19-pandemia proteesimist. 200 258 200 tõttu. Hilisem protseduuride maht on kiiresti taastunud 100 100 ja Kuigi dokumenteeritud protseduuride arv on märkimisväärselt kasvanud, on andmeid esitavate 0 75 0 haiglate arv märgatavalt 17 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 isegi uusi rekordeid. 2023. aastal esitati kokku 378 esmakordselt vähenenud. Kui 2022. aastal esitasid Joonis 2: Andmeid igal aastal esitavate haiglate arv. Haiglat loetakse „andmepakkujaks”, kui see esitas kalendriaasta jooksul EPRD-le vähemalt 812 andmekogumit, mis vastab peaaegu andmeid EPRD-le 754 haiglat, siis 2023. aastal langes ühe kirurgilise dokumendi. 7% võrreldes 2022. aastaga. Joonisel 1 on see arv ühinemiste ja rajatiste sulgemiste tõttu 726 kokkuvõtlikult esitatud haiglani 2023. aastal ühinemiste ja raviasutuste sulgemiste tõttu aastane protseduuride maht. (vt joonis 2). Tulevased arengud Andmete kogumist laiendatakse lähiaastatel. Haiglate ja patsientide osalus EPRD-s ning registri EPRD hakkab koguma esmase puusaliigese toetamine on olnud juba aastaid järjepidevalt tugev. 1. endoproteesimise kirurgilise lähenemisviisi andmeid, jaanuaril 2025 käivitatakse Saksamaa mis muutuvad IRD-s kohustuslikuks. Alates järgmisest 449 378 812 implantaadiregister (IRD), mis muudab Saksamaal aastast lisab EPRD ka võimaluse täpsustada, kas 375 000 345 375 000 © EPRD aastaaruanne 2024 354 162 kohustuslikuks kõikide puusa- ja põlveliigese esmane põlveliigese endoproteesimine teostati 350 000 350 000 375 348 298 asendusravi juhtude registreerimise. Kulub mitu aastat, patsiendispetsiifiliste instrumentidega (PSI), 325 000 Reieluuproteeside koguarv 325 319 144 325 000 Põlveliigese proteesimine 303 708 310 429 enne kui IRD suudab pakkuda sisukaid analüüse. arvutiabiga navigeerimise või robotabi abil. 300 000 19 295 058 300 000 275 000 Puusaliigese endoproteesimine 287 397 171 790 275 000 Seetõttu jätkab EPRD oma tegevust. Asjakohatute küsimuste vähendamiseks valitakse 153 876 250 000 1 250 000 valikud automaatselt ette, nt kui valitakse järjepidevalt 249 678 225 000 140 783 130 984 225 000 sama kirurgilist lähenemisviisi või kui asutuses ei ole 133 871 127 062 Et vähendada haiglate koormust seoses andmete 200 000 127 372 200 000 arvutiabiga kirurgilisi protseduure saadaval. Alates kahekordse sisestamisega, pakub EPRD alates 2025. 175 000 175 000 2025. aastast saavad haiglad, kes keskenduvad tugevalt 109 884 aasta jaanuarist kõigile haiglate infosüsteemide 150 000 150 000 periprotetilisele infektsioonile ja keda lisatöökoormus pakkujatele andmeedastusliidest. See võimaldab IRD 125 000 149 827 125 000 ei heiduta, kasutada valikulist infektsioonimoodulit 100 000 100 000 andmekogumi koos patsientide põhiandmetega lihtsalt revisioonide puhul, mis on loetletud kui tingitud 75 000 64 838 75 000 EPRD-Editisse üle kanda. EPRD 199 941 206 573 „infektsioonist 50 000 169 512 177 986 167 648 179 147 50 000 160 006 25 000 56 905 139 793 25 000 0 24 479 84 989 0 18 598 32 426 695 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Joonis 1: Protseduuride aastane maht operatsioonikuupäeva järgi. Dokumenteeritud protseduuride koguarv on näidatud mustana vastava tulba kohal. esitada vastavad spetsifikatsioonid HIS- „peri-“. See võimaldab koguda täiendavaid andmeid teenusepakkujatele enne 2024. aasta lõppu. peri- 14 EPRD 2024. aasta aruanne 15  2 Registri arendamine proteeside infektsioonide kohta, mida saab kasutada nende tulemused nendega kaasa", kui nad vahetavad tulevastes hindamistes. haiglat. Teine suur projekt, mis registri jaoks 2026. aastaks kavandatud on, on õlaartroplastika andmete 2023. aastal alustas EPRD katseperioodi, et koguda kogumise alustamine. PROM-küsimustikke (patsiendi poolt teatatud tulemuste mõõtmine), st patsientide enda subjektiivset Osalevate haiglate ja tootjate analüüsid hinnangut ravi tulemusele. Alates 2025. aastast Lühidalt muutuvad regulaarseks tegevuseks. See tähendab, et Valitud EPRD analüüsi tulemused esitatakse Lisaks on EPRD loonud varajase hoiatussüsteemi. Kõigi alates järgmisest aastast saavad kõik patsiendid aastaaruannetes ja avaldatakse rahvusvahelistes EPRD-sse kaasatud implantaatide ja haiglates, mis pakuvad PROM-hindamist, selle • 2023. aastal registreeriti EPRD-s rekordiline arv – ajakirjades. Osalevad haiglad ja tootjad saavad ka implantaadikombinatsioonide tulemusi jälgitakse küsitluse täita. üle 378 000 protseduuri. individuaalseid aruandeid: automaatselt ning statistiliste hälvete korral arutab neid ekspertide komisjon. Kui EPRD klassifitseerib hälbe • Alates 2025. aastast hakkab EPRD koguma potentsiaalselt meditsiiniliselt olulise kõrvalekaldena, võtab 2026. aastaks on kavandatud kaks suurt projekti. andmeid kirurgilise lähenemisviisi ning arvutiabiga • Igal kevadel saavad andmeid edastavad haiglad ülevaatliku ta ühendust asjaomase tootja ja vajaduse korral ka Esiteks pakub EPRD vabatahtlikku võimalust läbiviidud operatsioonide kohta vastavalt esmaste võrdluse eelmisel aastal läbi viidud liigeseproteesimise asjaomase haiglaga ning palub neil vastata. dokumenteerida liigeseproteesimist teostavaid kirurge puusa- ja põlveliigese endoproteesimiste puhul. protseduuride ja selle perioodi jooksul EPRD-s registreeritud ning edaspidi esitada kirurgidele nende operatsioonide juhtumite koguarvu kohta. See kokkuvõte näitab näiteks, • Alates 2025. aastast laiendatakse osalemist Need meetmed tagavad, et EPRD suudab potentsiaalseid kohta isikustatud tulemusaruandeid. Neid tulemusi kas haigla erineb teistest osalevatest haiglatest läbi viidud artroplastika PROM-küsimustike kogumises implantaadiga seotud probleeme varakult tuvastada ja käsitletakse täiesti konfidentsiaalselt ja need tehakse liigeseproteesimise tüüpide või kasutatud proteesivarte kõikidele haiglatele. lahendada. EPRD, tootjate ja haiglate tihe koostöö aitab kättesaadavaks ainult asjaomasele kirurgile. Kirurgid tüüpide poolest. saavad „võtta • 2026. aastal käivitatakse vabatahtlik võimalus seega kaasa artroplastika ohutuse ja kvaliteedi pidevale artroplastika kirurgide dokumenteerimiseks. parandamisele. Alates 2018. aastast esitab EPRD haiglatele ka poolaastaaruandeid, mis sisaldavad üksikasjalikku teavet liigeseproteeside püsivuse näitajate kohta ning võrdlusi teiste haiglatega. Nende analüüside oluline osa on lehvikdiagrammid, mida on selgitatud ja näidatud leheküljel 18. 2023. aasta lõpus laiendati analüüse veelgi, lisades neisse korrigeeritud tulemused, mis võtavad arvesse konkreetseid patsiendiga seotud tegureid. • Iga aasta lõpus saavad osalevad implantaaditootjad põhjaliku ülevaate nende tooteid kasutavatest liigeseproteesimistest. Need hõlmavad nii kirjeldavaid kokkuvõtteid kui ka implantaatide püsivuse hindamisi. Analüüsid on nii üksikasjalikud, et tootjad saavad täpselt näha, kuidas läheb nende vastavate proteesisüsteemide ja alamsüsteemidega tehtud operatsioonidel – näiteks konkreetsetes vanuserühmades või kui piirdutakse teatud omadustega liigeseproteesimistega. Joonis 1: Väljavõte Oxford Hip Score’i veebipõhisest PROM-küsimustikust. Tekst on järgmine: Tere tulemast Saksamaa artroplastika registri küsitlusportaali!; Puusakirurgia küsimustik – Oxford Hip Score; © Oxford University Innovation Limited, 1996, kõik õigused kaitstud; Küsimused teie vasaku puusa kohta; Viimase 4 nädala jooksul… 1. Kuidas kirjeldaksite oma tavapärast puusavalu? Puudub / Väga kerge / Kerge / Mõõdukas / Tugev; Tagasi / Edasi. 16 EPRD 2024. aasta aruanne 17  2 Registri arendamine Lehvikdiagrammid haiglatevaheliste võrdluste jaoks Lehvikdiagrammid võtavad kokku erinevate haiglate revisioone üle oodatava revisioonide arvu. Seega, kui antud kliinilised tulemused. Iga haiglat esindab üks punkt. Iga haiglas täheldati oodatust rohkem revisioone, asub punkt y- punkti asukoht graafikul näitab, kui paljudest antud haiglas teljel üle 1; kui täheldatud ja oodatud arv langevad kokku, tehtud esmasest liigeseproteesimisest vajasid tegelikult asub punkt täpselt 1 juures; muul juhul asub see alla 1. kordusoperatsiooni (vaadeldud kordusoperatsioonide arv) Mustaga ringiga märgitud punkt tähistab konkreetset ja kui palju kordusoperatsioone oleks oodata olnud, kui haiglat, mida poolaastaülevaates hinnatakse. kordusoperatsiooni risk oleks aja jooksul olnud kõigis haiglates sama. Eeldatakse, et antud haigla Graafik sisaldab ka horisontaalset tumedat halli ootuste joont, kordusartroplastikate arv suureneb koos dokumenteeritud mis algab punktist 1, ning ülemist ja alumist 95% artroplastikate arvu ja nende jälgimisaja pikenemisega. usaldusvahemikku, mida kujutavad heledad hallid Arvutus on liigitatud erinevate artroplastikate tüüpide katkendjooned. Ülemise heleda halli joone kohal asuvad kaupa. punktid tähistavad haiglaid, kus tehti oluliselt rohkem korduvoperatsioone. Haiglad, mis asuvad alumise joone all, Iga punkti x-koordinaat vastab eeldatavate muudatuste tegid oluliselt vähem korduvoperatsioone. Heledad hallid arvule ja y-koordinaat näitab katkendjooned jooksevad vasakult paremale kokku, moodustades lehterjoone, millest tuleneb ka graafiku nimetus. © EPRD aastaaruanne 2024 Teie haigla puhul kaalutud: 97 esmast artroplastikat Teie haigla puhul täheldatud: 8 4 korduvoperatsiooni Teie haiglas oodatav: 2,65 korduvoperatsiooni 3 2 kordusoperatsioonide suhe Halvem Standardiseeritud 1 Parem 0 0 20 40 60 80 100 120 Oodatav muudatuste arv 18 EPRD 2024. aasta aruanne  Statistiliste 3 andmete kokkuvõte metoodika ja andmete seostamine  3 Statistilise metoodika ja andmete analüüsi eesmärgil rühmitatakse. Tootekataloogi täiustatakse ja parandatakse pidevalt. Kuna need muudatused võivad mõjutada analüüsi tulemusi, , kes kontrollivad seejärel iseseisvalt süsteemi, et tuvastada muutusi patsiendi artroplastikas ja seisundis. Kõik muudatused ja tsenseerimissündmused, nagu ühendamise kokkuvõte hinnatakse aastaaruandes tagasiulatuvalt ka eelmiste aastate andmekogumeid tootekataloogi praeguse patsiendi surm, edastatakse seejärel föderaalse versiooni alusel. See piirab teataval määral käesolevas tervisekindlustusliidu poolt automaatselt EPRD-le. See aruandes esitatud tulemuste võrdlemist eelmiste tähendab, et EPRD-le teatatakse ka muudatustest, mida aastaaruannetega. registrisse otseselt ei ole dokumenteeritud. Kuigi EPRD Tervisekindlustusandja Haigla Implantaadi tootja kui vabatahtlik register ei saa tagada haiglate poolt Teave toote • EPRD peamine tunnusjoon on koostöö Saksamaa kohta tervisekindlustusandjate liitudega tehtud protseduuride täielikku hõlmatust, võimaldab koostöö riiklike tervisekindlustusfondidega registri Juhtumipõhised rutiinsed andmed Toote identifitseerimine juhtumite peaaegu 100% jälgimist. Rutiinsed andmed praeguste Registri dokumentatsioon Tootedatabaas (AOK-Bundesverband eGbR ja Verband der ja järelkontrolli juhtumite Ersatzkassen e. V (vdek)). Registreerimisega nõustudes Käesoleva aastaaruande üksikud peatükid tuginevad annavad patsiendid oma tervisekindlustusfondile mitmesugustele andmeallikatele: 4. peatükis nõusoleku edastada EPRD-le – kooskõlas andmekaitse- kirjeldatud praeguse artroplastika olukorra puhtalt eeskirjadega – täiendavat teavet nii dokumenteeritud kirjeldav analüüs põhineb registri dokumentatsioonil Põhi- ja klassifitseerimisteave operatsiooni kui ka hilisemate korrigeerimiste kohta. ja tootevõrgustiku andmetel. 5. peatükis, milles EPRD analüüsitakse ja hinnatakse artroplastikat Joonis 2: Andmevoog haiglatest, ravikindlustusandjatelt ja implantaaditootjatelt EPRD-sse Kõnealustes rutiinsetes andmetes sisalduvad Saksa ellujäämismäärad, on riiklike tervisekindlustusfondide ICPM- ja ICD-koodid võimaldavad EPRD-l saada rutiinsed andmed hädavajalikud. Vabatahtliku registri, üksikasju protseduuri ja sellega kaasnevate nagu EPRD, jaoks on oluline EPRD saab oma andmed peamiselt kolmest allikast: registrile esitatud andmete põhjal, kuid haiglad asjaoludega. Kui tervisekindlustusandja on edastanud võtab arvesse kõiki neid andmeallikaid, et tagada, et osalevate haiglate registridokumentidest, osalevate dokumenteerivad täpselt, millised komponendid asjakohased patsiendiandmed EPRD-le, võtab ta ükski muudatus ega tsenseeritud juhtum ei jääks implantaaditootjate poolt pakutavast ja hallatavast protseduuri käigus implanteeriti – tavaliselt lihtsalt tähelepanuta, ning teha asjakohaseid järeldusi tooteandmebaasist ning osalevate toote vöötkoodi skaneerimise teel. ravikindlustusandjate rutiinsetest andmetest. Joonisel 2 ja järgnevas kirjelduses selgitatakse • Osalevad implantaaditootjad sisestavad oma andmeid ning seda, kuidas neid kolme allikatest pärit toodete andmed EPRD tooteteki andmebaasi. andmeid ühendatakse: Andmebaas sisaldab mitte ainult toote põhiandmeid, nagu osanumber ja kaubanduslik nimetus, vaid ka • Patsiendi nõusolekul võivad osalevad haiglad üksikasjalikumaid klassifitseerimisandmeid, sealhulgas dokumenteerida liigeseproteesimise protseduure otse konkreetset teavet materjali, suuruse, seisukorra jms EPRD-sse (joonis 3). EPRD kasutab seda registri kohta. Tooteteki andmebaasi on viimastel aastatel dokumentatsiooni, et saada protseduuri ja patsiendi täiustatud rahvusvahelise koostöö kaudu kohta põhiandmeid. See hõlmab operatsiooni Ühendkuningriigi riikliku liigeseregistriga (NJR) kuupäeva, opereeritud liigest, protseduuri tüüpi, samuti ning see sisaldab praegu andmeid üle 75 000 erineva patsiendi vanust, sugu, pikkust ja kaalu (alates 2017. toote kohta. Klassifitseerimisandmed saab aastast) ning patsiendi üldist tervislikku seisundit, mis dokumenteeritud osanumbrite kaudu otse registri on dokumentatsiooniga seostada. See võimaldab registreeritud ASA klassifikatsioon (alates 2020. aastast). Ühtegi registri dokumentatsiooni liigitamiseks ja samade Joonis 3: Registri dokumentatsiooni sisestamiseks on mitmeid võimalusi, sealhulgas EPRD-i sisemine lahendus EPRD-Edit. patsiendi tuvastamist võimaldavat teavet omadustega artroplastikate 20 EPRD aastaaruanne 2024 21  3 Statistilise metoodika ja andmete seostamise kokkuvõte implantaadi säilivusnäitajate kohta. Kuna EPRD saab 5.3.4 Seetõttu tuleks märkida, et need näitavad Kui patsient sureb, edastab vastav rutiinseid andmeid ainult patsientide kohta, kes on konkreetsete implantaadisüsteemide artroplastika tervisekindlustusfond EPRD-le surma kuu, kuid kindlustatud ühe piirkondliku ravikindlustusandja analüüsi lõpptulemust ega pruugi tingimata tähendada mitte surma täpse kuupäeva. Käesoleva aruande jaoks (Allgemeine Ortskrankenkasse) või mõne muu komponendi enda vahetamist. määratleb EPRD surma kuupäevana selle kuu seadusjärgse ravikindlustusandja (Ersatzkasse) juures, keskpäeva, mil patsient suri. Patsientide ei ole säilivusanalüüsis arvestatud teiste 2. Ajavahemik sama liigese erinevate suremusmäära arvutamisel loetakse tsenseerivaks ravikindlustusandjate patsientide andmeid. Seetõttu ei korduvoperatsioonide vahel (punktid 5.2 ja 5.4): sündmuseks ainult jälgimisperioodi lõppu. ole kõiki EPRD-s registreeritud protseduure nendes Arvutuse lähtepunktiks loetakse ainult registris juba Korrektsioone või täiendavaid artroplastikaid ei loeta analüüsides arvesse võetud. dokumenteeritud esmaste liigeseproteeside tsenseerimisjuhtumiteks. korduvoperatsioone. Kahe etapina läbiviidud esimeste Andmete võimalikult kõrge kvaliteedi tagamiseks revisioonide puhul – st kui komponendid eemaldatakse Järgmistes tekstikastides on esitatud üksikasjalikum kontrollib EPRD põhjalikult saabuvate ja implanteeritakse uuesti kahel erineval kuupäeval – teave allpool esitatud jaotistes kirjeldatud metoodika andmekogumite usaldusväärsust ja järjepidevust ning algab teine jälgimisperiood uuesti implanteerimise ja illustratsioonide kohta. teavitab haiglaid võimalikest dokumentatsiooniga hetkest. Registris puudub enamiku revisioonide puhul seotud probleemidest. Nende kontrollide käigus täielik haiguslugu, kuna vastavad esmased vaadatakse läbi ka tervisekindlustusandjate rutiinsed artroplastikad on tehtud enne EPRD andmete kogumise Lühidalt andmed, et tuvastada võimalikke vastuolusid. EPRD algust. Mõnel juhul on registrisse siiski kantud täielik jätab analüüsist välja kõik andmekogumid, mis artroplastika ajalugu, alates esmasest operatsioonist. sisaldavad vastuolulist või ebaselget teavet, kuni • Kirjeldavad analüüsid põhinevad täielikult registri Seetõttu on kõnealustel juhtudel kõik järgnevad dokumentatsioonil. need probleemid on lahendatud. Käesolev revisioonid sobivad edasiseks analüüsiks. Registris on aastaaruanne põhineb elulemusandmetel, mis on kirjas ka revisioonide põhjused, mis võimaldab eristada • Artroplastika revisiooni ja artroplastika patsientide saadud enam kui 1 150 000 esmase artroplastika ja infektsiooniga seotud revisioone nendest, mis ei ole suremuse analüüsid piirduvad andmekogumitega, 125 000 korduvoperatsiooni jälgimise käigus infektsiooniga seotud. Seda kinnitab veelgi kood T84.5 mille kohta osalevad ravikindlustusfondid on ajavahemikus novembrist 2012 kuni septembrini (sisemise liigeseproteesi põhjustatud infektsioon ja andmeid esitanud. 2023. põletikuline reaktsioon), mis on tervisekindlustuse • 2024. aasta EPRD aruandes analüüsiti 1 150 000 andmetes loetletud esmase või teisese diagnoosina. esmast artroplastikat ja 125 000 Erinevate liigeseasendussüsteemide ja -meetodite korduvoperatsiooni. püsivust hinnatakse aja jooksul esinevate esimeste Patsiendispetsiifilised tsenseerimisjuhtumid kordusoperatsioonide või kordusoperatsioonide (re- hõlmavad jala amputatsiooni, patsiendi surma ja revisioon) sageduse alusel. Seetõttu keskendub jälgimisperioodi lõppu seoses patsiendi käesoleva aastaaruande 5. peatükk kahele erinevale tervisekindlustusandja vahetusega. Juhul, kui patsient on ajavahemikule: endiselt jälgimise all ja ei ole veel jõutud vastava lõpp-punkti ega tsenseerimisjuhtumini, ulatub hinnatav 1. Esmase artroplastika ja esimese revisiooni, periood käesoleva hindamise hetkeni. millega kaasnevad proteesi muudatused, vaheline Tsenseerimisjuhtumite puhul ulatub see juhtumi ajavahemik (punktid 5.1 ja 5.3): Kui esmase toimumise hetkeni. artroplastika järgneva revisiooni käigus asendatakse, eemaldatakse või täiendatakse vähemalt ühte proteesi 6. peatükis käsitletakse patsientide suremust pärast komponenti, loetakse seda esmase artroplastika ja kõigi esmaseid artroplastikaid ja revisioone1 . Kui implanteeritud komponentide lõpp-punktiks. Käesolev määratlus ei erista tegelikult asendatud implantaadi 1 Sarnaselt artroplastika revisjoni analüüsidele võetakse siin arvesse ainult üheetapilisi revisjone ja kaheetapilise revisjoni osana tehtud reimplanteerimisi. komponente nendest, mis jäid paigale. Punktides 5.1.4 ja 22 EPRD 2024. aasta aruanne 23  3 Statistilise metoodika ja andmete seostamise kokkuvõte Olulisemad muudatused võrreldes eelmiste aastatega: muudetud lähenemisviis sekundaarse põlveliigese pinna asendamisele Kirjeldavate tulemuste esitamine 4. peatükis EPRD varasemates aastaaruannetes ei arvestatud hilisemat täiendavat põlveliigese pindmise kihi asendamise operatsiooni artroplastika 4. peatükis on EPRD-le esitatud andmekogumid liigitatud eraldi artroplastika tüübi järgi, kusjuures iga kategooria jaoks on määratud järgmised kirjeldavad elulemusnäitajate analüüsis, isegi kui protseduuri teostati koos sisekomponentide vahetamisega. EPRD on nüüd oma seisukohta selle parameetrid: klassifikatsiooni suhtes muutnud. Alates 2024. aastast käsitleb EPRD teistkordset põlveliigese pinna uuendamist üldjuhul esmase artroplastika Parameeter Selgitus lõpptulemusena. Selle muudatuse põhjenduseks on järgmine: Osakaal [%] Protsent protseduuridest igas kategoorias Selle kategooria patsientide keskmine vanus aastates. Seega on vähemalt 50% selle kategooria patsientidest vanemad • Parem rahvusvaheline võrreldavus: EPRD ühtlustab oma • Revisioonide järjepidevam hindamine: esmase patella pinna Vanus ja vähemalt 50% nooremad kui see vanus. andmeid teiste rahvusvaheliste artroplastika registritega, nagu uuendamisega artroplastika puhul loeti järgnev reoperatsioon näiteks Ühendkuningriigi NJR, mis hakkas juba aastaid tagasi esmase protseduuri lõpp-punktiks. Juhtudel, kus esmast patella m/n [%] Selles kategoorias olevate meeste ja naiste protsent. klassifitseerima kõiki hilisemaid põlveliigese pindamise pinna uuendamist ei toimunud, peeti järgnevat pinna protseduure revisioonidena. uuendamist pigem täiendavaks operatsiooniks kui lõpp-punktiks. Selle kategooria patsientide keskmine KMI. Igal juhul viitab see näitaja nende patsientide alarühmale, kelle kohta KMI on esitatud kehtivad andmed kaalu ja pikkuse kohta. Selles kontekstis on väide, et isoleeritud sisendi vahetust tuleks klassifitseerida artroplastika elulemuse lõpp-punktina, • Esmase põlveliigese proteesimise ja põlveliigese esmase ASA Selle kategooria patsientide keskmine ASA-klassifikatsioon. ebajärjekindel ja seda on endiselt raske selgitada. pinnaasendamisega või ilma selleta tehtud operatsioonide parem võrreldavus: Enne 2024. aastat oli esmaseid põlveliigese proteesimisi, millega kaasnes põlveliigese • Teisese põlveliigese pindmise kihi asendamise Dokumentatsioon on liigitatud erinevatesse artroplastika jooned vastavalt veergudes „Vanus”, „KMI” ja „ASA”, mis hõlmavad pinnaasendamine, raske võrrelda protseduuridega, kus kordusoperatsioonide sagedus ei ole sõltumatu kasutatavast kategooriatesse. See põhineb protseduuri jaoks dokumenteeritud vahemikke 50–90 aastat, 20–35 punkti ning ASA I–V. Mida põlveliigese pinnaasendamine ei kuulunud esmase proteesimise põlvesüsteemist: uuringud on näidanud, et teatud toodetel ja tootebaasis salvestatud klassifitseerimisandmetel. vasakpoolsem on joon, seda nooremad on patsiendid või seda juurde. Põhjus: esmase patella pinna uuendamisega seotud implantaadisüsteemidega kaasneb teisese põlveliigese Reeglina on kategooriad kavandatud nii, et need ei kattuks. Enamik madalam on selle kategooria patsientide KMI või ASA probleemide lahendamiseks tehtud reoperatsioonid said täieliku pindmise kihi asendamise kordusoperatsioonide sageduse esitatud protsendimäärasid moodustab kokku 100%. Need viitavad klassifikatsioon. Sooline jaotus on esitatud kahe täiendava tulbana: järelhindamise, samas kui hilisemad täiendavad patella pinna märkimisväärne suurenemine. Mõiste muutmine tagab, et andmekogumite koguarvule, millele vastab... helesinine tulp tähistab meespatsiente ja roosa tulp naispatsiente. uuendamise protseduurid ei saanud edasist tähelepanu. EPRD implantaadisüsteemide tulemused peegeldavad paremini üldist eeldab, et muudetud määratlus vähendab eelarvamusi ja riski. võimaldab tulemusi selgemalt esitada. See muudatus mõjutab oluliselt põlveliigese täieliku asendamise (TKA) tulemuste esitamist. Seetõttu ei ole 2024. aasta aruandes esitatud TKA tulemusi otseselt võrreldavad varasemate aastaaruannete tulemustega. Erinevalt eelmise aasta aruandest ei sisalda 2024. aasta aruanne Osakaal [%] Vanu m/n [%] KMI ASA enam sekundaarse põlveliigese pinna uuendamise kumulatiivset määra, kuna seda peetakse nüüd esmase protseduuri lõpptulemuseks. s Selle asemel loetletakse konkreetsete implantaadisüsteemide tulemuste juures esmased artroplastikad koos esmase põlveliigese pinna võis kohaldada Kategooria A vastavat reeglit. Kui analüüsireegleid ei olnud 97,8 Eespool nimetatud72reeglile40on/ 60 kaks 2,3 mille puhul tabelites 26,9 erandit, uuendamisega ja ilma selleta. Kategooria B kohaldada, näiteks seetõttu, et võimalik andmekogumitele esitatud 2,2 protsendimäärade 67 summa ei moodusta 100%. Esiteks on 38 / 62 25,9 2,3 klassifikatsioon ei olnud teada kõigi oluliste toodete puhul, jäeti need sisselõigatud kategooriate nimetused, mis viitavad eelnevalt loetletud, Alamkategooria B1 andmekogumid vastavast analüüsist välja. kuid0,4sisselõigamata kategooria 59 52 26,6 48 /alamkategooriatele 2.1 (vt muu hulgas ka Alamkategooria Nagu näites illustreeritud, B2 esitatakse kirjeldavad tulemused tabelina tabelid 3, 18, 21, 23 ja 36). Ümardamisvigadest kõrvale jättes 70 37 / 63 25,7 ning need sisaldavad Alamkategooria võtmeparameetrite 1,7 kõigi alamkategooriate summa 2,4 B3 numbrilisi väärtusi ja moodustab nende ülemkategooria. täiendavaid graafilisi elemente. Protsentide kõrval on vastavad Teiseks 0,1 on tabelites 54 2, 17, 3020/ ja 70 35, 26,0 milles 2,0 kirjeldatakse ravitud osakaalud kujutatud horisontaalsete tulbadena, kus pikemad tulbad patsiente üksikasjalikumalt, esitatud vastav jaotus vanuse, soo ja tähistavad suuremaid osakaale. Keskmine vanus, keskmine KMI ja KMI järgi erinevates värvides, kusjuures kõigi kolme kategooria keskmine ASA on tähistatud täiendavate horisontaalsete protsendid moodustavad kokku 100%. 24 EPRD 2024. aasta aruanne 25  3 Statistilise metoodika ja andmete seostamise kokkuvõte Kumulatiivsete korrigeerimismäärade arvutamine 5. peatükis Kumulatiivse revisioonimäära tabelid 5. peatükk keskendub artroplastika elueale ja kumulatiivsetele • et sellised tsenseerivad sündmused nagu patsiendi surm või jala Esmaste artroplastikate tulemused punktides 5.1–5.4 on esitatud tabelites ja hõlmavad järgmisi põhiparameetreid: revisioonimääradele (CRR). amputatsioon võivad takistada artroplastika järelkontrolli. EPRD määratleb „artroplastika ebaõnnestumise” lõpptulemusena Parameeter Selgitus Hinnangute tulemused on esitatud joonistena ja tabelitena (vt mis tahes artroplastika, mis nõuab hiljem komponentide vahetamist allpool olevaid selgitusi). või eemaldamist või täiendavat operatsiooni. Kaplan-Meieri Vastavas kategoorias jälgitavate artroplastikate arv. hinnangute abil arvutatakse tõenäosus, et teatud aja jooksul pärast Kõigi kuvatud alamkategooriate summa võib olla väiksem kui ülemkategooria juures näidatud koguarv. See võib Kaplan-Meieri hinnangute vastastikused tõenäosused, st juhtuda kas seetõttu, et arvesse on võetud ainult need alamkategooriad, mille puhul on saavutatud minimaalne esmast artroplastikat või esimest revisioonoperatsiooni ei ole sellist Arv artroplastika kordusoperatsioonide määrad, on esitatud koos 95% ravikünnis (vt allpool), või seetõttu, et alamkategooriat ei ole võimalik määrata andmete puudumise tõttu. revisiooni vaja ja et artroplastika jääb seega paigale. Tuleb märkida, usaldusvahemikega. • et analüüsi tegemise ajal ei olnud artroplastika jälgimine Enamiku jooniste ja tabelite selgitustes on märgitud vastav p- enamikus juhtudel veel lõpetatud ja väärtus üldise võrdse revisioonimäära testi jaoks. Vanus Nende artroplastikaid saanud patsientide keskmine vanus ja vanuse kvartiilid. m/n [%] Selles kategoorias olevate meeste ja naiste protsent. Kumulatiivse revisioonimäära graafikud Artroplastika patsientide keskmine kehakaalunäitaja. See näitaja kehtib alarühma kohta KMI patsientide alarühmaga, kelle kohta on olemas kehtivad BMI andmed. Tabelid konkreetsete artroplastikasüsteemide tulemuste kohta punktides 5.1.4 ja 5.3.4 ei sisalda BMI-d. Kumulatiivsed revisioonimäärad on kujutatud järgmiselt. Graafikud näitavad kumulatiivseid revisioonimäärasid koos nende 95% usaldusvahemikega. Graafikute all olevad tabelid näitavad Haigla Haiglad artroplastikate arvu vaatlus teatud ajahetkel, st nende artroplastikate koguarv, mis ei vajanud korduvoperatsiooni või mille puhul patsiendid ei kadunud Aastad, mil implanteeriti jälgitavaid konkreetseid artroplastikasüsteeme. Need ajavahemikud Yrs implanted on jälgimisest muudel põhjustel. esitatud ainult punktides 5.1.4 ja 5.3.4. CRR-id on esitatud protsendina vastavate ajahetkede kohta. Sulgudes implantaadisüsteem või konkreetne implantaadikombinatsioon. Kui on esitatud vastaval ajahetkel jälgimisel olevate artroplastikate arv. jälgitavate artroplastikate arv on mingil hetkel väiksem kui 150, CRR-ide puhul, mis ei lähenegu 0-le, on nurksulgudes esitatud 95- esitatakse nii CRR kui ka usaldusvahemikud kaldkirjas; kui arv on protsendiline usaldusvahemik. väiksem kui 50, tulemusi ei avaldata. Kumulatiivne revisioon [%] Tulemused esitatakse ainult juhul, kui selle tüüpi artroplastika analüüsimiseks on kättesaadavad vähemalt 300 esmast artroplastikat vähemalt kolmest erinevast haiglast, Aastad alates esimesest Riskirühm 31 208 22 229 16 706 12 143 8 290 5 344 2 988 1 309 126 602 117 714 96 303 58 268 17 670 10 727 9 743 8 802 2 526 884 Tüüpiline näide: kahe artroplastika alarühma kumulatiivsed revisioonimäärad. 26 EPRD 2024. aasta aruanne 27  2023. tegevusaasta 4  4.1 Esmane puusaliigese endoproteesimine 4 2023. tegevusaasta Ajavahemikus 1. jaanuarist 2023 kuni 31. detsembrini viimasel aastal, st protseduurid, mille puhul Osakaal [%] Vanus m/n [%] KMI ASA 2023 registreeris EPRD kokku 378 812 puusa- ja registreeriti heakskiitmata või sobimatud Kõik esmased puusaliigese 100,0 71 40 / 60 26,9 2,3 endoproteesimised põlveliigese endoproteesimise protseduuri. implantaadikombinatsioonid. 1,8 56 / 44 27,2 1,8 Käesolevas peatükis kirjeldatakse üksikasjalikult < 45 aastat nende protseduuride dokumenteerimist ning EPRD 50 / 50 28,7 1,9 45–54 aastat 6,3 loomisest alates ilmnenud suundumusi. Viimasel ajal 4.1 Esmased 55–64 aastat 21,8 48 / 52 28,1 2,0 Puu on EPRD-s toimunud muutus puusa- ja põlveliigese puusaliigese 65–74 aastat 27,6 s endoproteesimise protseduuride suhtarvus. Aeg näitab, 30,9 40 / 60 2,2 kas tegemist on püsiva arenguga või Covid-19- proteesimised 75–84 aastat 28,5 35 / 65 25,9 2,4 pandemia hilinenud mõjuga, st mittekiireloomuliste ≥ 85 aastat / 70 24,6 10,8 30 2,7 protseduuride edasilükkamisega (vt ka lk 14). 2023. aastal registreeris EPRD kokku 187 640 esmast Mehed 27,5 puusaliigese operatsiooni. Umbes 40% juhtudest olid 40,1 69 100 / 0 2,3 Naised 26,3 Tabelis 1 on kokku võetud puusa- ja põlveliigese mehed. Meeste osakaal on märkimisväärselt suurem Patsiendid, kelle KMI on ≤ 25 59,9 73 0 31/ /100 2,3 operatsioonide puhul registreeritud esmaste nooremates vanuserühmades ja väheneb järk-järgult 69 vanuse kasvades (tabel 2). Patsiendid, kelle KMI on > 25 kuni 30 75 operatsioonide ja korduvoperatsioonide jaotus ning 33,8 2,3 puusa- ja põlveliigese proteeside koguarv. Aastatel Patsiendid, kelle KMI on > 30 kuni 35 71 36,0 47 / 53 2,2 2013–2022 on esmaste põlveliigese proteesimiste Ainult 3,0% esmaste puusaliigese operatsioonide puhul Patsiendid, kelle KMI on > 35 kuni 40 69 osakaal märgiti ära eelnev asjakohane operatsioon (tabel 3). Patsiendid, kelle KMI on > 40 18,3 45 / 55 2,3 66 Osteosüntees ja osteotoomia enne Patsiendid, kelle kohta puuduvad 6,5 41 / 59 2,4 (kehtivad) BMI andmed 63 37 / 63 püsis järjepidevalt alla 40%. Aastal 2023 tõusis see aga peamiselt reieluupiirkonnas olid kõige levinumad 2,4 © EPRD aastaaruanne 2024 2,5 72 38 / 62 41,1%ni. eelnevad operatsioonid. 2,9 2,1 Tabel 2: Esmased puusaliigese artroplastikad 2023. aastal patsientide vanuse, soo ja KMI Järgmistes alajaotustes esitatakse 2023. kalendriaasta Tabelites 4–16 on esitatud üksikasjalik teave järgi jooksul registreeritud andmekogumid operatsioonile artroplastika tüüpide ja 2023. aastal esmase allutatud liigese ja protseduuri tüübi kaupa. 4. puusaliigese artroplastika läbinud patsientide peatüki viimases alajaotuses kirjeldatakse omaduste kohta. Oluline on märkida, et erinevate üksikasjalikult 2023. aasta operatsioonide käigus artroplastika tüüpide osakaalud tuvastatud võimalikke mittevastavusi Osakaal [%] Vanus m/n [%] KMI ASA Eelnevaid operatsioone pole 97,0 71 40 / 60 26,9 2,3 Osakaal [%] Vanus m/n [%] KMI ASA olnud Osteosüntees / Osteotoomia Kõik esitatud andmekogumid 100,0 70 41 / 59 28,1 2,3 Vaagnal 1,9 67 40 / 60 25,9 2,3 (378 812) Esmased puusaliigese uu 0,4 62 47 / 53 26,4 2,1 49,5 71 40 / 60 26,8 2,3 proteesimised Puusaliigese (187 640) Reieluu / 61 25,7 2,4 5,0 75 41 / 59 26,9 2,5 1,4 70 39 proteeside revisioonid (18 933) Vaagna ja reieluu / 66 26,0 2,1 41,1 69 42 / 58 29,7 2,2 0,1 56 34 Esmased põlveliigese (155 859) Reieluupea nekroos 26,5 2,2 proteesimised Põlveliigese 4,2 70 43 / 57 30,1 2,4 0,2 62 57 / 43 Artrodees (15 931) 26,9 2,3 proteeside revisioonid Muud eelnevad operatsioonid <0,1 72 49 / 51 01 73 38 / 62 27,7 2,5 Reieluuproteeside koguarv (449) 26,6 2,2 66 © EPRD aastaaruanne 2024 0,9 42 / 58 © EPRD aastaaruanne 2024 Tabel 1: Registreeritud protseduuride osakaal liigeste ja sekkumise tüübi järgi 2023. aastal. Andmekogumite absoluutarvud on esitatud protsentide all sulgudes. Tabel 3: 2023. aastal esmase puusaliigese endoproteesimise puhul teatatud varasemad operatsioonid 30 EPRD 2024. aasta aruanne 31  4 2023. tegevusaasta 4.1 Esmased puusaliigese proteesimised mis on tehtud üksikutes haiglates, võivad oluliselt liigeseproteesimised 2023. aastal (võrreldes 60,4%ga Osakaal [%] 88,8 Vanus 70 m/n [%] 41 / 59 KMI 27,2 ASA 2.2 erineda allpool esitatud üldistest näitajatest. See võib 2015. aastal). Esmakordselt alates EPRD loomisest Täielik artroplastika Poolartroplastika 11,2 85 33 / 67 24.2 2.8 peegeldada haigla on täielikult ristseotud © EPRD aastaaruanne 2024 eelistused erinevate protseduuride tüüpide suhtes. Antioksüdantideta seotud PE-sisestuste osakaal oli eelmise aasta näitajast madalam, samas kui Näiteks EPRD-s kasutab vaid 35% haiglatest lühikesi antioksüdantidega stabiliseeritud variantide Tabel 4: Esmased puusaliigese proteesid 2023. aastal varreid rohkem kui ühes kahekümnest esmasest kasutamine jätkas tõusu. Keraamiliste sisestuste puusaliigese asendamisest. Seevastu üle 52 haigla kasutamine vähenes võrreldes 2015. aastaga samuti Vanus m/n [%] KMI ASA Osakaal [%] kasutab lühikesi varreid enam kui pooles oma üle 5 protsendipunkti, jäädes 7,1% juurde. Tsementeerimata implantaadid 77,2 67 45 / 55 27,7 puusaliigese asendamistest. Ühe haigla puhul Hübriidimplantaadid 18,6 79 27 / 73 25,9 2,4 registreeritud lühikeste varrete suurim osakaal oli 95%. • EPRD-s jätkub üldine artroplastika trend, mis Tsementeeritud implantaadid 25 / 75 25,4 2,6 soosib suuremaid peaosade komponente. 2023. aastal 3,2 81 Pöördhübriidimplantaadid EPRD-s registreeritud erinevate liigeseplastikate olid 36 mm pead esimest korda kõige sagedamini 0,9 74 29 / 71 26,4 2,4 Teadmata osakaalud on muutunud järgmiselt: kasutatav suurus. Alates 2014. aastast on 36 mm peade 33 / 67 27,3 2,2 osakaal pidevalt kasvanud 31,6%lt 50,1%ni. See on 0,1 73 Hip vastupidine 32 mm peadele, mille osakaal on langenud © EPRD aastaaruanne 2024 • Tsemendita puusaliigese proteeside osakaal püsib Tabel 5: Kinnitused esmaste täielike puusaliigese proteesimiste puhul 61,1%lt 2014. aastal 45,3%ni 2023. aastal. suhteliselt stabiilsena, jäädes umbes 77% juures. 2023. aastal Siiski on täheldatav väike nihe täielikult tsemenditud proteesidelt hübriidkinnituste poole. Aastatel 2016– 2023 tõusis hübriidartroplastika osakaal pidevalt Tsementeeritud implantaadid Osakaal [%] Vanus m/n [%] KMI ASA 15,6%lt 18,6%ni, samal ajal kui tsementeeritud 89,6 85 32 / 68 24,2 2.8 Lühidalt: Tsementeerimata implantaadid artroplastika osakaal langes samas tempos 6,4%lt Teadmata 10,3 83 41 / 59 24.3 2.8 3,2%ni. • Kõrgelt ristsillatud PE sisekomponentide osakaal 0,1 86,5 40 / 60 26.2 3.0 © EPRD aastaaruanne 2024 kasvab jätkuvalt ja on praegu 83,5%. Tabel 6: Kinnitused esmaste puusaliigese poolproteesimiste puhul 2023. Antioksüdantidega stabiliseeritud variantide aastal kasutamine suurenes EPRD-s esimest korda. Osakaal [%] 82,8 Vanus 71 40[%] / 60 m/n 27, 2 ASA2,2 KMI • EPRD-s on lühikese varrega implantaatide • Lühikese varrega implantaatide osakaal Reieluuvars modulaarse peaga Lühike 15,1 64 48 / 52 27. 7 2,1 osakaal juba mitu aastat pidevalt kasvanud. 2015. kasvas jätkuvalt, ulatudes 15,1%ni. vars 1,0 61 47 / 53 27. 8 2,0 aastal kasutati lühikese varrega implantaate 6,6% • 36 mm pead on üha enam eelistatud. Reieluukaela protees kõigist artroplastikast, 2019. aastal kasvas see Revisioon- või kasvajavars 0,5 76 41 / 59 25. 9 2,6 10,4%ni ja 2023. aastal Modulaarne vars 0,3 76 27 / 73 26. 7 2,4 15,1%ni. Pinna asendamine 0,1 58 95 / 5 28. 1 1,7 Teadmata • Monoblokk-põlvekapslite kasutamine jätkub 0,3 72 38 / 62 27. 8 2,1 vähenenud ja on praegu 8,7% (võrreldes 12,7%ga © EPRD aastaaruanne 2024 2015. aastal). Seevastu kahe liikumisega kausside levimus on pidevalt kasvanud, kuigi tõepoolest väikeste Tabel 7: Varraste tüübid esmaste täielike puusaliigese proteesimiste puhul sammudega, ja on praegu 2,2% (võrreldes 0,5%ga 2023. aastal 2015. aastal). Kuid klassikaline modulaarne kauss on Vanus m/n [%] KMI ASA Osakaal [%] endiselt kaugelt kõige levinum kausitüüp (88,1%). 97,7 85 33 / 67 24,2 2,8 Reieluuvars modulaarse peaga 1,0 83 31 / 69 24,8 2,9 • EPRD-s suureneb kõrge ristseotuse astmega Revisioonivars või kasvajavars polüetüleenist sisekomponentide osakaal aastast Lühike vars 0,8 85 37 / 63 24.2 3,1 aastasse. Kokku kasutati neid sisekomponente 83,5% Modulaarne vars 0,4 85 39 / 61 24,6 3,0 operatsioonidest Teadmata 0,1 88 41 / 59 26.1 3,0 © EPRD 2024. aasta aruanne Tabel 8: Varre tüübid esmaste puusaliigese poolproteeside paigaldamisel 2023. aastal 32 EPRD 2024. aasta aruanne 33  4 2023. tegevusaasta 4.1 Esmased puusaliigese proteesimised 88,1 Osakaal [%] Vanus 69 41[%] / 59 m/n 27. 3 ASA KMI 2,2 Osakaal [%] Vanus m/n [%] KMI ASA 56,9 70 41 / 59 27,2 2,2 Modulaarne kupp hXLPE 8,7 72 40 / 60 26. 9 2,2 Monoblokk-kupp 26,6 69 42 / 58 27,4 2,1 hXLPE + antioksüdant Kahepoolne 2,2 78 34 / 66 25. 8 2,6 27,5 Keraamika 7,1 63 46 / 54 2,1 liikuvus 0,9 71 35 / 65 26. 5 2,3 mXLPE PE 27,2 5,4 73 43 / 57 2,3 Revisioonikupp <0,1 56,5 100 / 0 28. 4 1,7 Metall 29 / 71 26,4 3,8 78 2,5 Pinnakattekupp 70 2,3 0,1 39 / 61 26. 2 Teadmata 0,1 58 95 / 5 28,1 1,7 © EPRD aastaaruanne 2024 mXLPE + antioksüdant <0,1 75 43 / 57 24,5 2,4 Teadmata 0,1 78 28 / 72 26,1 2,4 Tabel 9: Lõualuu komponendid esmaste täielike puusaliigese proteesimiste puhul 2023. aastal © EPRD aastaaruanne 2024 Tabel 13: Lõualuu pesa materjalid esmaste puusaliigese täielike proteesimiste puhul 2023. aastal Puu sa Osakaal [%] Vanus m/n [%] KMI ASA Ilma rekonstruktsioonikilbita 99,8 70 41 / 59 27 ,3 2.2 Osakaal [%] Vanus m/n [%] KMI ASA 0,2 78,5 33 / 67 24 ,9 2.6 Keraamika 90,1 69 42 / 58 27,3 2.2 Rekonstruktsioonikilbiga © EPRD aastaaruanne 2024 Metall 6,7 80 35 / 65 25,9 2.5 Keraamiline metall 3,2 70 40 / 60 27,7 2.3 Tabel 10: Esmase puusaliigese täieliku endoproteesimise puhul kasutatud proteesikorpused Teadmata 2023. aastal <0,1 76 0 / 100 33,7 2.4 © EPRD aastaaruanne 2024 Tabel 14: Modulaarse pea materjalid esmaste täielike puusaliigese proteesimiste puhul 2023. Osakaal [%] Vanus m/n [%] KMI ASA aastal 28 mm 4,2 73 21 / 79 26,0 2,4 Vanus m/n [%] KMI ASA 32 mm 45,3 70 28 / 72 27,0 2,2 Osakaal [%] 36 mm Keraamika / hXLPE 50,0 69 41 / 59 27, 3 2,2 50,1 69 55 / 45 27,5 2,2 Muud läbimõõdud Keraamika / hXLPE + antioksüdant 25,5 69 42 / 58 27. 4 2,1 0,4 71 31 / 69 26,0 2,4 Teadmata Keraamika / keraamika 7,1 63 46 / 54 27. 5 2,1 <0,1 76 17 / 83 32,5 2,5 Keraamika / mXLPE Keraamika © EPRD aastaaruanne 2024 / PE 4,7 72 45 / 55 27. 4 2.2 Tabel 11: Peade suurused esmaste täielike puusaliigese proteesimiste puhul Keraamiline metall / hXLPE Metall / 2,4 2,6 76 29 / 71 26. 7 2023. aastal hXLPE 3,0 69 40 / 60 27. 8 2,3 Metall / hXLPE + antioksüdant 3,9 80 35 / 65 26. 0 2,5 Osakaal [%] Vanus m/n [%] KMI ASA Muu või teadmata 1,1 80 35 /aastaaruanne 65 25.2024 7 2,6 XS 0,8 70 34 / 66 26. 8 2.3 © EPRD 80 2,5 S 2,1 34 / 66 25. 9 41,1 70 35 / 65 26. 9 2.2 Tabel 15: Põhiliste puusaliigese täielike proteeside kandematerjalid 2023. aastal. Ainult kombinatsioonid, mille osakaal on üle M 36,3 70 42 / 58 27. 3 2.2 1% on loetletud. L XL 16,1 69 51 / 49 27. 7 2.2 Osakaal [%] Vanus m/n [%] KMI ASA 95,1 85 33 / 67 24,2 2.8 XXL XXXL Metall 4,1 68 59 / 41 28. 0 2.2 3,7 85 33 / 67 24,2 2.6 Tundmatu Keraamika 0,3 70 63 / 37 27. 8 2.2 Keraamiline metall 1,2 84 36 / 64 24,7 2.9 <0,1 74 54 / aastaaruanne © EPRD 46 27.2024 9 2.5 © EPRD aastaaruanne 2024 1,4 75 43 / 57 26. 7 2.4 Tabel 12: Pea-kaela pikkused esmaste täielike puusaliigese proteesimiste puhul 2023. Tabel 16: Modulaarse pea materjalid esmaste puusaliigese hemiartroplastika operatsioonidel 2023. aastal aastal 34 EPRD 2024. aasta aruanne 35  4 2023. tegevusaasta 18,0 73 4.2 Puusaliigese proteesi 49 2. 6 vahetus / 51 28,1 22,1 75 41 / 59 26,8 2. 4 / 65 26,6 Osakaal [%] 11,8 Vanus 75 35[%] 2. 4 4.2 Puusaartroplastika m/n KMI ASA 1,3 protsendipunkti võrra aastatel 2022–2023 Infektsioon Lahtitulek 8,5 74 49 / 51 27,3 2. 4 korduvoperatsioonid üksnes (16,7%lt 18,0%ni). Kauss 1,9 75 45 / 55 26,7 2. 5 Varras 2023. kalendriaastal registreeriti EPRD-s 18 933 Tabelis 19 on esitatud erinevat tüüpi komponentide 0,7 71 48 / 52 26,5 2. 4 puusaliigese revisioonioperatsiooni, millest 15 788 osakaalud, mida vahetati üheetapiliste revisioonide Põlv ja vars / 63 26,5 0,4 71 37 2. 4 olid üheetapilised protseduurid. Kahe- või mitmeetapiliste käigus ja implanteeriti uuesti mitmeetapiliste Osteolüüs fikseeritud komponendiga 26,0 revisioonide puhul võtab EPRD arvesse nii eksplantaadi revisioonide raames 2023. aastal. Modulaarseid peade Põlvekupp 0,2 71 62 / 38 2. 3 eemaldamise kui ka uue implantaadi paigaldamise ja kausikomponente vahetati vastavalt 97,1% ja 73,1% 72,5 27,6 Vars 0,2 56 / 44 2. 4 (järgmise indeksoperatsioonina) andmeid. Siiski juhtudest. 20,5% revisioonidest implanteeriti uuesti nii / 65 25,6 sisaldab EPRD märkimisväärselt vähem uus vars kui ka puusakomponent. Vähemalt üks neist Kauss ja vars Periproteetiline 15,8 81 35 2. 7 30 / 70 26,1 kaheetapilise eksplantaadi eemaldamise (1 225) kui kahest luusse kinnitatud komponendist asendati 70,3% murd Dislokatsioon 14,1 78 2. 6 uue implantaadi paigaldamise (1 920) andmeid. protseduuridest, kusjuures varte (44,9%) ja Kulumine / 59 27,1 Tabelis 17 ja tabelis 18 on esitatud patsientide puusakomponentide (45,9%) osakaal oli peaaegu 5,2 75 41 / 58 27,8 2. 4 Komponendi rike Valesti paigaldamine vanuse, KMI ja soo jaotus ning dokumenteeritud võrdne. 31,7% vaadeldud revisioonidest kasutati 2,0 74 42 2. 5 Osteoartriidi progresseerumine / 63 27,2 revisioonide põhjused. Sarnaselt eelmiste aastatega spetsiaalset revisioonivart või -kaussi. Kahe Puu sa olid kõige levinumad puusaliigese revisioonide liikumisega kausid moodustasid 41,3% uuesti Seisund pärast eemaldamist 1,8 73 37 / 54 26,4 2. 4 põhjused lahtitulek (22,1%), infektsioon (18,0%), implanteeritud asetabulaarkomponentidest. 2014. aastal Muud põhjused 0,4 73 46 27,7 2. 3 periprostetiline luumurd (15,8%) ja nihestus oli see näitaja 10% ja on aastast aastasse pidevalt / 59 27,1 kasvanud. 10,1 71 53 / 47 2. 6 (14,1%). Siiski muutuvad üksikud protsendimäärad jätkuvalt: 9,7 74 41 2. 4 Lahtitulemist nimetatakse harvem (21,6 © EPRD Aastaaruanne 2024 protsendipunkti vähem võrreldes 2014. aastaga), samas Septilise revisiooni suundumus on eriti kui teised kolm põhjust on populaarsust võitnud. märkimisväärne: luusse kinnitatud komponente Tabel 18: Põlveliigese revisioonide põhjused 2023. Septiliste revisioonide osakaal on suurenenud jäetakse üha sagedamini paigale. Samas kui aastal 100,0 75 41 / 59 26. 9 2,5 Osakaal 1,7 [%] Vanus 55[%]/ m/n 45 26. 3 ASA KMI 2,0 Kõik puusaliigese revisioonid 4,4 50 / 50 29. 4 2,2 < 45 aastat Osakaal [%] Vanus n/n [%] KMI ASA 14,6 51 / 49 28. 8 2,3 45–54 aastat Pea, tass, sisend Varras, 23,8 77 33 / 67 26,4 2. 5 26,5 44 / 56 28. 3 2,5 pea, tass, sisend Pea, 55–64 aastat 20,5 73 48 / 52 27,1 2. 5 35,5 39 / 61 26. 2 2,6 sisend 65–74 aastat 19,7 73 43 / 57 27,8 2. 5 28 / 72 24. 8 Vars, pea Pea 75–84 aastat 17,3 2,8 17,5 79 39 / 61 26,1 2. 6 Varras, pea, sisend Kauss, ≥ 85 aastat 41,1 73 100 / 0 27. 4 2,5 sisend 8,8 79 37 / 63 26,3 2. 6 Mees Naine 77 0 / 100 26, 4 2,5 58,9 Sisend 6,9 74 44 / 56 27,7 2. 5 Patsiendid, kelle KMI on ≤ 35,2 79 34 / 66 2,5 Muud komponendid 25 1,6 76 38 / 62 26,4 2. 4 Patsiendid, kelle KMI on > 25 kuni 33,6 76 48 / 52 2,5 © EPRD aastaaruanne 2024 0,7 75 40 / 60 26,7 2. 5 30 Patsiendid, kelle KMI on > 30 17,9 72 44 / 56 2,5 0,6 72,5 49 / 51 28,7 2. 3 kuni 35 Patsiendid, kelle KMI on > 7,1 69 2,6 Tabel 19: 2023. aastal ühe- või mitmeastmeliste revisioonide raames uuesti implanteeritud 40 / 60 35 kuni 40 Patsiendid, kelle KMI puusakomponendid2 3,6 66 2,7 32 / 68 on > 40 2,6 2,5 Patsiendid, kelle kohta puuduvad 78 37 / 63 (kehtivad) BMI andmed © EPRD aastaaruanne 2024 2 Arvesse võetakse ainult üheetapiliste korrigeerimisoperatsioonide ja mitmeetapiliste korrigeerimisoperatsioonide reimplanteerimise kirurgilisi dokumente, mille puhul oli võimalik tootebaasist Tabel 17: Puusaliigese revisioonid 2023. aastal patsiendi vanuse, soo ja KMI tuvastada kõik proteesi peamised komponendid. järgi 36 EPRD 2024. aasta aruanne 37  4 2023. tegevusaasta 4.3 Esmased põlveliigese proteesimised 2014. aastal vahetati 75,5% revisioonidest välja vars 4.3 Esmased Erinevate esmaste põlveliigese proteesimise tüüpide või kauss, 2023. aastal vähenes see 53,1%ni puhul on täheldatud ka mitmeid muid suundumusi. revisioonidest. põlveliigese proteesimised • Enamik EPRD-s registreeritud põlveliigese 2023. aastal registreeriti EPRD-s kokku 155 859 proteesimisi on täielikult tsementeeritud. Kuid kuna Lühidalt: esmast põlveliigese proteesimist. Tabelites 20 ja 21 tsementeeritud TKA-de osakaal jätkab tõusu (96,0% on kokku võetud põlveliigese endoproteesimise aastal 2023 võrreldes 90,7%ga aastal 2016), on patsientide omadused ja varasemad asjakohased tsementeeritud ühe kondüüli põlveliigese • Kõige sagedasemad revisiooni näidustused: endoproteesimiste osakaal veidi vähenenud (83,4% operatsioonid. Põlveliigese endoproteesimise lahtitulek (22,1%), infektsioon (18,0%), proteesi aastal 2023 võrreldes 88,4%ga aastal 2016). patsiendid on tavaliselt nooremad ja nende keskmine ümbruse luumurd (15,8%) ja nihestus (14,1%), Hübriidfikseeringuid kasutatakse TKA-de puhul kehakaalunäitaja on umbes kolm punkti kõrgem kui kusjuures viimastel aastatel on lahtitulekute arv harvemini. Tsementeerimata fikseeringud on puusaliigese endoproteesimise patsientidel (vt vähenenud teiste näidustuste kasuks. eelmine punkt 4.1). Nooremates vanuserühmades on muutumas ühe kondüüli artroplastika puhul üha • 70,3% üheetapilistest revisioonidest ja kehakaalunäitaja tavaliselt veelgi kõrgem. Tabelites tavalisemaks. reimplanteerimistoimingutest hõlmasid uut varre 22–34 on esitatud 2023. aastal EPRD-s registreeritud ja/või asetabulaarkomponenti. Kahe liikumisega erinevate esmaste põlveliigese proteesimiste ja • Liikuvate liigendite kasutamine nii täielikes kausid on üha enam eelistatud kausi disain. implantaadisüsteemide jaotus. Jaotus võib haiglate põlveliigese proteesimistes kui ka ühe kondüüli • Septiliste operatsioonide puhul jäetakse vahel oluliselt erineda. Näiteks esmast põlveliigese proteesimistes on registri andmetel jõudnud luukinnitustega komponendid üha sagedamini pindmise kihi asendamist tehakse enam kui 76% madalaimale tasemele, kuigi languse määr on nende paigale. haiglatest vähem kui ühel juhul 20-st TKA-st, kuid kahe protseduuri puhul erinev. Näiteks implanteeriti ligikaudu 5% haiglatest teostab seda protseduuri liikuv liigend vaid 8,1% registreeritud täielikest vähemalt pooltel oma TKA-dest. põlveliigese proteesimistest (võrreldes 19,2%ga 2015. aastal) ja vaid Põlve 100,0 69 42 / 58 29,7 2,2 Osakaal [%] 0,5 Vanus 42[%] / 58 m/n 31,7 KMI 2,0 ASA Kõik esmased põlveliigese proteesimised 6,1 40 / 60 32,7 2,0 < 45 aastat 28,1 46 / 54 31,3 2,1 45–54-aastastel 36,1 41 / 59 30,1 2,2 55–64-aastastel 65–74 aastat 25,9 38 / 62 27. 8 2,3 75–84 aastat 3,2 35 / 65 26, 3 2,5 ≥ 85 aastat 41,6 68 100 / 0 29,3 2,2 Mehed 58,4 2,2 70 0 / 100 30,1 Naised 15,5 2,1 74 36 / 64 Patsiendid, kelle KMI on ≤ 25 2,1 Patsiendid, kelle KMI on > 25 kuni 30 34,3 71 49 / 51 27,4 2,2 Patsiendid, kelle KMI on > 30 kuni 35 68 42 / 58 13,1 2,3 Patsiendid, kelle KMI on > 35 kuni 40 65 35 / 65 6,5 27 / 73 2,5 Patsiendid, kelle KMI on > 40 3,2 62 1,9 Patsiendid, kelle kohta puuduvad (kehtivad) BMI andmed 68 42 / 58 © EPRD aastaaruanne 2024 Tabel 20: Esmased põlveliigese proteesimised 2023. aastal patsiendi vanuse, soo ja KMI järgi 38 EPRD aastaaruanne 2024 39  4 2023. tegevusaasta 53,7% ühe kondüüli proteesimistest (võrreldes (vastavalt 3,5 ja 8,0% 2015. aastal kuni 67,9%ga 2015. aastal). 14,1 ja 13,4%ni 2023. aastal). Samamoodi tõusis ühe kondüüliga põlveliigese proteesimisel • EPRD-s registreeritud ristisidemeid säilitavate (CR) antioksüdantidega stabiliseeritud hXLPE süsteemide kasutamine põlveliigese täieliku sisekomponentide osakaal 0-lt 15,4%ni, samal ajal Osakaal [%] Vanus m/n [%] KMI ASA asendamise operatsioonidel (TKA) on aastate jooksul kui antioksüdantideta hXLPE sisekomponentide osakaal Standardseadmed 95,4 29,9 70 40 / 60 2,2 vähenenud. Kui 2015. aastal kasutati 52,2% TKA- langes 9,7%-lt 5,4%ni. Ristisideme säilitavad 42,5 70 29,9 2,2 41 / 59 operatsioonidest veel CR-süsteemi, siis 2023. aastaks Tagakülje stabiliseeritud langes see näitaja vaid 42,5%ni. Seevastu on tagakülje 25,5 69 40 / 60 29,9 2,2 Ristisideme ohverdavad stabiliseeritud (PS) ja pöördsüsteemide kasutamine 11,5 71 30,0 2,3 Ristisideme säilitavad / ohverdavad 38 / 62 kasvanud (vastavalt 15,8%lt 25,5%ni ja 2,1%lt 5,3%ni). Lühidalt: Pivot 10,6 69 29,7 2,2 42 / 58 70 2,2 • Põlveliigese endoproteesimisel on samuti märgata Piiratud süsteemid Hingedega 5,3 42 / 58 30,0 suundumust, mis soosib tugevalt ristsillitatud • 96% esmasest TKA-st oli 2023. aastal täielikult Varus-valgus-stabiliseeritud 73 2,3 4,3 29 / 71 28,8 polüetüleeni sisekomponentide kasutamist. See tsementeeritud. 75 2,4 Teadmata suundumus on siiski • Liikuvad laagrid kaotasid jätkuvalt populaarsust ja 2,3 71 26 / 74 28,1 2,3 ei ole nii märgatav kui puusaliigese proteesimisel. neid kasutati vaid 8,1% põlveliigese 2,0 © EPRD aastaaruanne 2024 33 / 67 29,6 67 2,2 TKA-de puhul on hXLPE-sisestuste kasutamine asendamisoperatsioonidest. koos antioksüdantidega või ilma nendeta pidevalt 0,3 54 / 46 28,1 • CR-süsteemide kasutamine vähenes samuti, Tabel 23: Piirangute tase esmaste põlveliigese proteesimiste puhul 2023. aastal kasvanud samas kui PS-süsteemide osakaal suurenes. Põlve Osakaal [%] Vanus m/n [%] KMI ASA 92,9 69 41 / 59 29,8 2.2 Eelnevaid operatsioone pole olnud Osteosüntees / osteotoomia 1,5 64 55 / 45 28,7 2.2 Osakaal [%] Vanus m/n [%] KMI ASA Reieluu 0,3 67 52 / 48 28,7 2.2 Tsementeeritud implantaadid 96,0 70 40 / 60 29,8 2,2 Sääreluu 0,9 63 57 / 43 29,0 2.2 Hübriidimplantaadid 2,6 69 45 / 55 30,0 2,1 Põlvekapsli 0,1 67 45 / 55 28,9 2.3 Tsementeerimata Mitmed asukohad Kapsel ja 1,3 66 47 / 53 30,0 2,2 implantaadid sidemete 0,2 62 57 / 43 28,4 2.2 65,5 29,7 Pöördhübriidimplantaadid <0,1 46 / 54 2,2 2,2 63 56 / 44 29,2 2.2 68 25,9 Teadmata 0,1 40 / 60 2,6 © EPRD aastaaruanne 2024 Artrodees <0,1 65 38 / 62 30,4 2.4 Muud eelnevad 3,3 65 48 / 52 29,4 2.2 Tabel 24: Kinnitused esmaste põlveliigese täielike proteesimiste puhul 2023. operatsioonid © EPRD aastaaruanne 2024 aastal Tabel 21: 2023. aastal põlveliigese proteesimise puhul teatatud varasemad operatsioonid Osakaal [%] Vanus m/n [%] KMI ASA Osakaal [%] Vanus m/n [%] KMI ASA Põlveliigese täielik proteesimine Ühe 86,5 70 40 / 60 29,8 2,2 Tsementeeritud 83,4 64 51 / 49 29,1 2,1 kondüüli proteesimine implantaadid 13,2 64 52 / 48 29,1 2,1 16,0 65 58 / 42 29,0 2,0 Patellofemoraalne proteesimine Muud Tsementeerimata 0,2 57 31 / 69 27,5 2,0 0,4 63 42 / 58 29,7 2,1 proteesimised implantaadid <0,1 60 67 / 33 28,1 2,0 Hübriidimplantaadid 0,1 65 39 / 61 29,6 2,0 Teadmata © EPRD 2024. aasta aruanne © EPRD aastaaruanne 2024 Tabel 22: Esmased põlveliigese proteesimise tüübid 2023. aastal Tabel 25: Fikseerimised esmaste ühe kondüüli põlveliigese proteesimiste puhul 2023. aastal 40 EPRD aastaaruanne 2024 41  4 2023. tegevusaasta 4.3 Esmased põlveliigese proteesimised Osakaal [%] Vanus m/n [%] KMI ASA Osakaal [%] Vanus m/n [%] KMI ASA Fikseeritud 91,9 70 40 / 60 29,8 2,2 Katmata metall / PE Katmata 38,2 70 42 / 58 29,7 2,2 liigend Liikuv metall / mXLPE 29,9 2,2 8,1 70 40 / 60 29,8 2,3 26,5 71 42 / 58 liigend 29,8 2,2 13,8 70 44 / 56 © EPRD aastaaruanne 2024 Katmata metall / hXLPE + antioksüdant Katmata metall / 29,7 2,2 12,5 69 40 / 60 hXLPE Tabel 26: Liigese liikuvus esmaste põlveliigese täielike proteesimiste puhul 2023. aastal / 84 31,0 2,2 Kaetud metall / mXLPE 2,7 66 16 / 76 30,9 2,2 Keraamilise kattega metall / 2,7 66 24 / 77 30,9 2,2 PE-kattega metall / PE 2,0 67 23 / 78 30,8 2,2 Osakaal [%] Vanus m/n [%] KMI ASA Liikuv laagriosa 53,7 64 52 / 48 29,3 2,1 Muu või teadmata 1,6 65 22 Paikne laagriosa © EPRD aastaaruanne 2024 46.3 64 52 / 48 29,0 2,1 © EPRD aastaaruanne 2024 Tabel 31: Laagrimaterjalid esmaste täielike põlveliigese proteesimiste puhul 2023. aastal. Loetletud on ainult kombinatsioonid, mille osakaal on üle 1%. Tabel 27: Liigese liikuvus esmaste ühe kondüüli põlveliigese proteesimiste puhul 2023. aastal Osakaal [%] Vanus m/n [%] KMI ASA Katmata metall 93,4 64 54 / 46 29,1 2,1 Keraamiline metall 3,8 63 37 / 63 28,9 2,1 Osakaal [%] Vanus m/n [%] KMI ASA Kattega metall Ilma põlveliigese pinna 90,0 2,8 60 21 / 79 29,8 2,0 70 40 / 60 29,8 2,2 uuendamiseta 10,0 70 38 / 62 30,1 2,2 © EPRD aastaaruanne 2024 Põlvekapsli pinna Põlve taastamisega © EPRD aastaaruanne 2024 Tabel 32: Reieluupinna materjalid esmaste ühe kondüüli põlveliigese proteesimiste puhul 2023. aastal Tabel 28: Põlveliigese esmase täieliku proteesimise käigus tehtud põlveliigese pindmise kihi asendamine 2023. aastal Osakaal [%] Vanus m/n [%] KMI ASA mXLPE PE 56,0 64 51 / 49 29,3 2,1 hXLPE + antioksüdant 22,9 63 52 / 48 29,0 2,1 Osakaal [%] Vanus m/n [%] KMI ASA hXLPE Katmata metall 91,2 70 42 / 58 29,7 15,4 64 54 / 46 29,2 2,1 Kattega metall Teadmata 5,1 66 19 / 81 31,0 2,2 5,4 63 55 / 45 28,7 2,0 Keraamiline metall 24 / 76 30,9 2,2 3,7 66 0,3 67,5 54 / 46 29,5 2,5 Keraamika © EPRD aastaaruanne 2024 10 / 90 31,0 2,2 <0,1 66 Teadmata 73 26,8 2,0 Tabel 33: Sääreluu kandepinnamaterjalid esmaste ühe kondüüli põlveliigese proteesimiste puhul 2023. <0,1 100 / 0 © EPRD aastaaruanne 2024 aastal Tabel 29: Reieluupõhja materjalid esmaste täielike põlveliigese proteesimiste puhul 2023. aastal Osakaal [%] Vanus m/n [%] KMI ASA Katmata metall / mXLPE 52,6 65 53 / 47 29,3 2,1 Katmata metall / PE 19,8 64 55 / 45 28,9 2,1 Osakaal [%] Katmata metall / hXLPE + antioksüdant Vanus m/n [%] KMI ASA 15,3 64 55 / 45 29,2 2,1 PE mXLPE 42,9 70 40 / 60 29,8 2,2 Katmata metall / hXLPE hXLPE + antioksüdant hXLPE 5,4 63 55 / 45 28,7 2,0 Keraamiline metall / PE Kaetud metall 29,3 70 40 / 60 30,0 2,2 mXLPE + antioksüdant Teadmata / mXLPE Keraamiline metall / mXLPE 2,4 60 36 / 64 29,3 2,1 14,1 69 43 / 57 29,9 2,2 Muu või teadmata 2,0 60 14 / 86 29,7 2,0 13,4 69 39 / 61 29,7 2,2 1,4 67 38 / 62 28,5 2,1 0,2 69 36 / 64 30,4 2,1 1,0 61 43 / 57 29,7 2,1 0,1 69 45 / 55 29,7 2,2 © EPRD 2024. aasta aruanne © EPRD aastaaruanne 2024 Tabel 34: Põlveliigese ühe kondüüli esmase endoproteesimise puhul kasutatud kandematerjalid 2023. aastal. Loetelus on esitatud ainult Tabel 30: Sääreluu kandev materjal esmaste täielike põlveliigese proteesimiste puhul 2023. aastal need kombinatsioonid, mille osakaal on üle 1%. 42 EPRD aastaaruanne 2024 43  4 2023. tegevusaasta 4.4 Põlveliigese proteesi vahetused 4.4 Põlveliigese proteesi Tabelis 37 on täpsustatud põlveliigese proteesi Ka septiliste põlveliigese revisioonide puhul on trend jätta korduvoperatsiooni käigus uuesti implanteeritud varem implanteeritud luukinnitusega komponendid vahetused komponendid. Eeldame, et 15,3% paigale. 2014. aastal jäeti septiliste revisioonide 2023. kalendriaastal registreeris EPRD 15 931 korduvoperatsioonidest hõlmasid eelmise proteesimise puhul3 luukinnitusega komponendid vahetamata põlveproteesi revisiooni. Nende hulgas oli 1013 järel tehtud täiendavat põlveliigese pindmise kihi vaid 24,5% juhtudest, võrreldes 44,4%ga 2023. proteesi eemaldamist ja 1938 reimplanteerimist asendamist. aastal. mitmeastmeliste revisioonide raames. Sarnaselt registri puusaliigese andmetega ületas põlve Peaaegu pooltel uuritud korduvoperatsioonidest 3 See hõlmab ka kaheastmelisi reimplanteerimisi. reimplanteerimiste arv proteeside eemaldamiste arvu. (49,1%) implanteeriti nii reieluusse kui ka sääreluusse uued luukinnitusega komponendid. See Tabelis 35 on kokku võetud mitmed põlveliigese tähendab, et ligikaudu viiel juhul kuuest, kus kasutati proteesi korduvoperatsiooni läbinud patsientide uut reie- või säärekomponenti, asendati varem iseloomulikud tunnused. Korduvoperatsioonide implanteeritud protees täielikult. 59% juhtudest Infektsioon Lahtitulek Osakaal [%] Vanus m/n [%] KMI ASA näidustused on loetletud tabelis 36. Sarnaselt hõlmasid need täielikud asendused üleminekut Reieluukomponent 15,0 72 54 / 46 2. 6 29,8 puusaliigese korduvoperatsioonidega olid ka liigend- või varus-valgus-stabiliseeritud – ja seega Sääreluukomponent piiratumale – süsteemile. Neid süsteeme 21,6 70 41 / 59 30,4 2. 4 põlveliigese proteesi korduvoperatsioonide kõige Põlvekapsli komponent sagedasemateks põhjusteks proteesi lahtitulek (21,6%) implanteeriti aga vaid 4,3% esmaste artroplastikate 4,2 71 45 / 55 30,1 2. 4 Mitmed komponendid ja infektsioon (15,0%), kuigi teatatud lahtitulekute puhul (tabel 23). Osteolüüs koos fikseeritud 8,5 68 38 / 62 30,5 2. 3 osakaal on viimastel aastatel vähenenud. komponendiga Reieluukomponent 0,6 68 40 / 60 30,3 2. 2 Säärekomponent 8,3 71 42 / 58 30,1 2. 4 100,0 70 43 / 57 30,1 2,4 Põlvekomponent 29,9 1,2 71 52 / 48 2. 4 Osakaal [%] 1,1 Vanus 51[%] / 49 m/n 28,7 KMI 2,0 ASA Mitmed komponendid Põlve 29,1 Kõik põlveliigese korduvoperatsioonid 2,1 Periproteetiline luumurd 0,4 72 54 / 46 2. 3 6.3 41 / 59 31,6 29,6 < 45 aastat 2,2 Sidemete ebastabiilsus 0,3 72 52 / 48 2. 6 26,4 46 / 54 31,5 45–54 aastat Kulumine / 64 27,9 2,4 0,1 69 36 2. 3 32,7 44 / 56 30,9 70,5 30,9 55–64 aastat Komponendi rike 2,5 0,5 53 / 47 2. 3 65–74 aastat 27,8 40 / 60 28,4 20 / 80 28,4 Proteesi valesti paigaldamine / valesti 3,8 79 2. 6 75–84 aastat 5,8 35 / 65 27,2 2,7 pööramine Piiratud liikuvus / 68 30,1 ≥ 85 aastat 42,6 69 100 / 0 29,7 2,4 Osteoartriidi progresseerumine 9,1 67 32 / 60 30,0 2. 3 Mehed Seisund pärast eemaldamist Muud 4,9 73 40 31,0 2. 3 57,4 71 0 / 100 30,4 2,4 Naised põhjused 15,8 74 2,3 1,9 70 43 / 57/ 68 29,7 2. 4 37 / 63 Patsiendid, kelle KMI on ≤ 25 2,3 5,4 / 60 30,1 32,4 72 49 / 51 Tabel 36: Põlveliigese revisioonide põhjused 2023. aastal 1,5 68 32 2. 3 Patsiendid, kelle KMI on > 25–30 2,4 7,6 / 66 30,1 Patsiendid, kelle KMI on > 30–35 27,4 69 66 40 aastaaruanne 2024 © EPRD 2. 2 45 / 55 13,8 2,5 29,7 Patsiendid, kelle KMI on > 35–40 68 34 2. 3 67 38 / 62 8,2 28 / 72 2,6 30,3 Patsiendid, kelle KMI on > 40 64 12,2 70 52 / 48 2. 5 Patsiendid, kellel puuduvad (kehtivad) 2,3 2,4 69 15,8 68 44 / 56 2. 2 BMI andmed 43 / 57 © EPRD aastaaruanne 2024 Tabel 35: Põlveproteesi vahetused 2023. aastal patsiendi vanuse, soo ja KMI järgi 44 EPRD aastaaruanne 2024 45  4 2023. tegevusaasta 4.5 EPRD-s esinevate lahknevuste tuvastamine 4.5 EPRD-s esinevate Osakaal [%] Vanus m/n [%] KMI ASA Reie- ja sääreosa, sisestus Sisestus 42,5 70 41 / 59 30,0 2. 4 Sobimatuse kontrollimine põhineb EPRD tootebaasil. 2023. aastal tuvastati järgmised potentsiaalsed Põlvekapsli artroplastika 23,9 70 48 / 52 30,1 2. 4 ebakõlade tuvastamine sobimatuse juhtumid muidu usaldusväärselt Sisestus, põlvekapsli 7,7 69 39 / 61 30,8 2. 3 EPRD püüab aidata kaotada proteesikomponentide dokumenteeritud esmaste artroplastikate puhul: artroplastika 7,6 68 39 / 61 30,4 2. 3 sobimatuse juhtumeid. Tegemist on Reie- ja säärekomponent, sisestus, põlveliigese proteesimine • 57 puusaliigese asendamisel erinesid 29,6 proteesimisoperatsioonidega, kus implanteeritud Säärekomponent, sisestus 6,6 69 44 / 56 2. 4 komponentide kombinatsioon ei ole lubatud või dokumenteeritud peaosa ja sisestuse või puusaliigese 30,9 Reieluukomponent, sisestus 3,6 69 39 / 61 2. 4 sobimatu. Sellisel sobimatusel võivad olla patsiendile osa suurused. Valitud pea oli 19 juhul sisestuse või Reieluukomponent 29,7 tõsised tagajärjed ning see on tõenäoliselt tingitud puusaliigese jaoks liiga suur ja 38 juhul liiga väike 3,1 71 46 / 54 2. 4 (tabel 38 ja näide tabelis 39). Liiga suured pead võivad 30,0 tähelepanematusest, teadmatusest või teatavatel Muud komponendid 2,1 73 25 / 75 2. 6 juhtudel sobivate komponentide puudumisest haiglas. põhjustada valest paigutust ja liiga väikesed pead 28,7 Säärekomponent, sisestus, põlveliigese endoproteesimine kokkupõrkeid 1,7 73 39 / 61 32,0 2. 6 Reiekomponent, sisestus, põlveliigese endoproteesimine Sobimatuste vältimiseks pakub EPRD 0,4 67 42 / 58 29,4 2. 4 Reiekomponent, põlveliigese endoproteesimine 28,7 0,4 70 43 /aastaaruanne © EPRD 57 2024 2. 2 implantaadi komponentide ühilduvuse kontrollimine ja sisendi kahjustused. Suuruse sobimatust reaalajas täheldati ka kolmes hemiartroplastika protseduuris. 0,3 70. 5 44 / 56 2. 6 Tabel 37: 2023. aastal põlveliigese korduvoperatsioonidel uuesti paigaldatud komponentide reaalajas ühilduvuse kontroll. EPRD Nendel juhtudel ei sobinud bipolaarne pea või selle komponendid4 andmekogumistarkvara väljastab ühilduvuse sisestus kasutatud modulaarse peaga. puudumise hoiatuse vahetult pärast ühilduvate implantaadi komponentide siltide skaneerimist Lühidalt: • Põlveliigese revisioonide peamised põhjused on lahtitulek (21,6%) ja infektsioon (15,0%). • Umbes pooltel korduvoperatsioonidel vahetatakse välja kõik varem implanteeritud komponendid. 59% korduvoperatsioonidest hõlmas üleminekut rangemale süsteemile. • Samuti on septiliste põlveliigese revisioonide puhul märgatav tendents jätta varem implanteeritud luukinnitusega komponendid Joonis 4: EPRD-Edit tarkvara sobimatuse teade andmete sisestamise ajal. Tekst on järgmine: paigale. Veebipõhine usaldusväärsuse kontroll on andnud hoiatusi. Kui soovite siiski jätkata, valige OK. OP 1: Võib esineda pea ja asetabulaarkomponendi suuruse sobimatus. (Joonis 4). EPRD igakuiste kokkuvõtete juures • Neljal artroplastikaoperatsioonil ei vastanud esitatud juhtumipäringud osutavad samuti varre koonus pea koonusele (vt näidet tabelis 40). võimalikele mittevastavustele. Selles etapis ei ole Selline koonuste mittevastavus suurendab mittevastavust aga enam lihtne parandada. Mida keraamilise pea murdumise ja metallpea korrosiooni varem protseduur haiglas dokumenteeritakse, seda riski. suurem on võimalus, et mittevastavust saab parandada patsiendile kahju tekitamata. Seetõttu soovitab EPRD protseduure dokumenteerida • 13 TKA-l kombineeriti komponente, mis olid mõeldud ainult vasakule põlvele, komponentidega, mis operatsiooni ajal, niivõrd kui see on haigla olid heaks kiidetud ainult paremale põlvele (vt näide töövooguga kooskõlas. tabelis 41). Kas sellisel mittevastavusel on tagajärgi artroplastikale, sõltub konkreetse disaini 4 Arvesse võetakse ainult üheetapiliste korrigeerimisoperatsioonide ja mitmeetapiliste korrigeerimisoperatsioonide reimplanteerimise kirurgilist dokumentatsiooni, mille puhul oli võimalik tootebaasist tuvastada kõik proteesi peamised komponendid. 46 EPRD aastaaruanne 2024 47  4 2023. tegevusaasta 4.5 EPRD-s esinevate lahknevuste tuvastamine Sisendosa/acetabulaarkomponendi siseläbimõõt vastav põlvesüsteem. Kuna aga kõik külgspetsiifilised • 19 ühe kondüüli põlveliigese asendamisel komponendid on saadaval mõlemale küljele, on selline kombineeriti komponente, mis olid heaks kiidetud 22 mm 28 mm 32 mm 36 mm mittevastavus tarbetu ja vältimatu. ainult mediaalseks kasutamiseks, komponentidega, mis olid heaks kiidetud ainult lateraalseks kasutamiseks. 22 mm 8 • 376 täieliku põlveliigese asendamise ja 2 ühe kondüüli asendamise puhul ei vastanud protseduuri • 11 täieliku põlveliigese asendamise operatsioonis 28 mm 2 8 2 Pea suurus käigus implanteeritud komponentide dokumenteeriti PS-sisestuskomponent koos 32 mm 1 4 20 dokumenteeritud pool tootebaasis salvestatud poole reieluukomponendiga, mis ei olnud selliseks spetsifikatsioonile. stabiliseerimiseks mõeldud (vt näide tabelis 43). 36 mm 12 Sõltuvalt konstruktsioonist võib see põhjustada • 115 juhul ei vastanud implanteeritud kokkupõrget, sirutamisdefitsiiti ja osalist nihestust jala © EPRD aastaaruanne 2024 põlvekomponentide kombinatsioon tootja poolt lubatud sirutamisel. Tabel 38: Pea suuruse ning sisekõrguse või kausi siseläbimõõdu erinevustest tingitud sobimatuste arv 2023. aastal suurusnõuetele, vt näide tabelis 42. Alles hiljuti sai EPRD-s võimalikuks põlveliigese proteesimisel Tuleb märkida, et mitte kõik loetletud mittevastavuse suurusvahede automaatne tuvastamine, kuna varem ei juhtumid ei tähenda tegelikku mittevastavust. olnud neid andmeid võimalik tootebaasi sisestada. Mittevastavused võivad tuleneda ka tootja poolt Komponendi tüüp Tunnus Tootja Seetõttu on seal esitatud suurusvahede arv seotud vaid tehtud valest klassifitseerimisest või haigla umbes 35 000-ga 2023. aastal registreeritud dokumentatsiooni veast. Näiteks enamik juhtumeid, Lõualuu komponent PLASMAFIT PLUS CUP SZ.52MM G Aesculap artroplastikaga, mille kohta need andmed olid kus kõikide komponentide leheküljenumber ei vasta kättesaadavad. opereeritud küljele, on seotud valesti sisestatud Lõualuu sisekomponent VITELENE INSERT G 36MM SYM. Aesculap leheküljenumbriga, kui protseduuri registreeriti EPRD-s. Reieluukomponent METHA µCAP 12/14 130°/0° SUURUS 3 Aesculap Põlve Peakomponent BIOLOX DELTA proteesipea 12/14 32 mm S Aesculap © EPRD aastaaruanne 2024 Tabel 39: Näide puusaliigese proteesi pea suuruse mittevastavusest Komponendi tüüp Identifikatsioon Tootja Komponendi tüüp Identifikatsioon Tootja Lõualuu komponent Lubinus eksentriline asetabulaarne kauss, klõpsuga kinnitamisega, 32,5 x 46 mm Waldemar Link PERSONA TIBIA GESCHAFTET, ZEMENTIERT, 5 GRAD, Säärekomponent ZimmerBiomet SUURUS D, VASAK SPII mudel Lubinus, puusaproteesi vars, standardkael, tsementeeritud, pikkus 150 mm, Reieluukomponent vasak L1, kitsas, CCD 126°, CoCrMo, anatoomiline, koonus 12/14 Waldemar Link Sisestuskomponent PERSONA UC LIBISTUSPINNA, 10 MM, FEM 3-7, TIB CD, VASAK Zimmer Biomet PERSONA CR FEMUR, tsementeeritud, COCR, kitsas, Reieluukomponent ZimmerBiomet SPII, proteesipea B, 32 mm, pea-kael-pikkus 50 mm, SUURUS 8, VASAK Peakomponent WaldemarLink koonus 14/16, CoCrMo © EPRD aastaaruanne 2024 © EPRD aastaaruanne 2024 Tabel 42: Näide TKA suuruse mittevastavusest Tabel 40: Näide puusaliigese proteesi koonuse mittevastavusest Komponendi tüüp Tunnus Tootja Komponendi tüüp Identifitseerimine Tootja Säärekomponent GNS II CMT TIB SUURUS 3 PAREM Smith & Nephew Säärekomponent ATTUNE™ Tibia S+, tsementeeritud, RP, suurus 6 DePuy Sisestuskomponent LGN PS HIGH FLEX XLPE suurus 3–4 9 mm Smith & Nephew Sisekomponent ATTUNE™ sisekomponent AOX, RP, PS, suurus 7, 6 mm DePuy Reieluukomponent LEGION PS NP naiste suurus 5 LT Smith & Nephew Reieluukomponent ATTUNE reieluu CR tsementeeritud, 73 M/L, 67 A/P, vasak, suurus 7 DePuy © EPRD aastaaruanne 2024 © EPRD aastaaruanne 2024 Tabel 41: Näide TKA külgmise sobimatuse kohta Tabel 43: Näide TKA suuruse mittevastavusest 48 EPRD aastaaruanne 2024 49  4 2023. tegevusaasta Lühidalt: • Pärast ühilduvate implantaadikomponentide etikettide skaneerimist kuvatakse EPRD andmekogumistarkvaras otse hoiatus sobimatuse kohta. Seda hoiatust korratakse igakuistes EPRD juhtumipäringutes. • 2023. aastal tuvastati potentsiaalne mittevastavus kolmekohalises arvus protseduurides. 50 EPRD 2024. aasta aruanne  Puusa- ja 5 põlveliigese endoproteeside püsivus  5.1 Esmane puusaliigese endoproteesimise elulemus 5 Puusa- ja põlveliigese Arvestades, et proteesi eeldatav eluiga on 15–20 aastat, on see ajavahemik siiski üsna lühike. Seetõttu kehtivad järgmised väited vaid proteesimise lühi- ja valikuliste protseduuridena, tehakse puusaliigese hemiartroplastikaid patsientidele, kellel sagedamini on vanematele proksimaalne proteesimise elulemus keskpika perioodi kohta. Eriti oluline on märkida, et reieluukaelamurd. Nende kahe liiki artroplastika proteesid, mille lühiajalised tulemused on head, ei CRR-id erinevad märkimisväärselt, nagu on näidatud pruugi sama hästi toimida joonisel 3. Enamik EPRD analüüse käsitleb ka Mõiste „artroplastika eluea” tähistab ajavahemikku, artroplastika püsivusele. Kuna mitmeid keskpikas ja pikas perspektiivis. Uurida erinevaid reieluukinnituste tüüpe plaaniliste mille jooksul artroplastikasüsteem püsib patsiendi artroplastikasüsteeme implanteeritakse ainult teatud puusaliigese endoproteesimiste puhul. Saksamaal on Puu sa kehas muutumatuna, kuni komponendid tuleb haiglates ja teatud patsientidele, ei ole alati võimalik enamik reieluukinnitusi tsementeerimata (vt ka tabel 5), eemaldada, asendada või täiendada. Artroplastika elulemusmäärad on puusa- ja põlveliigese artroplastika üheselt kindlaks teha, kas hea või halb tulemus on tingitud implantaadist endast või operatsiooniga seotud 5.1 Esmase samas kui tsementeeritud varred implanteeritakse peamiselt vanematele patsientidele, kellel on eelnevad hindamise peamine kvaliteedikriteerium ning seetõttu asjaoludest. Erinevate mõjutavate tegurite võimalik puusaliigese terviseprobleemid. Erinevused tsementeerimata ja on need EPRD aastaaruannete keskmes. Kuna kattumine raskendab mitmete tulemuste tõlgendamist endoproteesimise tsementeeritud varte CRR-i vahel esimesel paaril aastal enamikku juhtumeid jälgitakse endiselt, esitatakse allpool esmase protseduuri ja kordusoperatsioonide jaotises 5.1.4 ja seda tuleb arvesse võtta, eriti kui hinnatakse elulemus pärast esmast artroplastikat (vt joonis 4) peegeldavad seega märkimisväärseid tulemuste erinevusi, mida on CRR-id aja jooksul. punktis Järgmistes alajaotustes esitatakse CRR-id erinevat täheldatud vanematel patsientidel (vt ka tabel 45). 5.3.4. Kui eespool mainitud jaotised keskenduvad tüüpi esmaste puusaliigese proteesimiste puhul. Punktis 5.1 keskendutakse esmasele puusaliigese esmase artroplastika ja esimese revisiooni vahelisele Implantaadiga mitteseotud riskitegurite ja implantaadi Joonis 3 näitab lisaks, et CRR-id erinevad endoproteesimisele ja punktis 5.3 esmasele ajavahemikule, siis jaotistes 5.2 ja 5.4 uuritakse omaduste mõju on üksikasjalikult arutatud vastavalt märkimisväärselt sõltuvalt sellest, kas operatsioon põlveliigese endoproteesimisele. Alajaotustes 5.1.1 ja revisiooni järgset perioodi ja kordusrevisiooni riski. alates leheküljest 59 ja leheküljest 68. Iga alajaotuse tehti reieluukaare murru tõttu puusaliigese lähedal 5.3.1 esitatakse tulemused esmase endoproteesimise Jaotises 5.5 käsitletakse seda, kas EPRD praegused lõpus esitatud tabelites on esitatud kokkuvõte ja kõik või muudel põhjustel. Kuid peale selle mängib olulist põhitüüpide kohta ning uuritakse erinevate andmed võimaldavad juba eristada suundumust tulemuste üksikasjad. Viimases jaotuses, leheküljel 82, rolli ka esmane diagnoos. Posttraumaatilise näidustuste mõju endoproteesi püsivusele. Alajaotustes artroplastika püsivuses. on üksikasjalikult kirjeldatud konkreetsete puusaliigese osteoartriidi puhul tehtud plaanilised 5.1.2 ja 5.3.2 arutatakse implantaadiga mitteseotud reieluukomponendi ja puusaluu komponendi puusaliigese proteesimised kaasnevad suurema tegurite – nagu patsiendi ja haigla muutujad – mõju. EPRD 2024. aasta aruandes esitatakse tulemused kombinatsioonide tulemusi. revisiooniriskiga võrreldes teiste puusaliigese Alajaotustes kuni 9-aastase jälgimisperioodi kohta. osteoartriidi vormidega (joonis 5). Mitteplaanilised 5.1.3 ja 5.3.3 käsitlevad seejärel implantaadi ja proteesimised on artroplastika omaduste mõju 5.1.1 Võrdlus esmase puusaliigese endoproteesimise tüübi järgi Lisaks planeeritud operatsioonidele dokumenteerib EPRD ka puusaliigese lähedal asuvate reieluukaare murdude erakorralisi operatsioone. Kuigi täielikud puusaliigese proteesimised on tavaliselt planeeritud või 10 © EPRD aastaaruanne 2024 9 5 8 © EPRD 2024. aasta aruanne 7 4 6 Kumulatiivne muutus [%] 5 Kumulatiivne revisjon [%] 4 3 3 2 2 1 0 Mitteelektiveeritud 1 puusaliigese endoproteesimine Puusa poolproteesid Planeeritud puusaliigese asendamine Valikulised puusaliigese 0 tsementeerimata varrega Planeeritud asendused puusaliigese asendamine tsementeeritud 0 1 2 3 4 5 6 7 8 9 varrega 34 964 24 594 18 634 13 636 9 688 Aastad alates algkoolist 6 362 3 846 1 949 668 Ohustatud 0 1 2 3 4 5 6 7 8 9 arvud 73 215 40 585 27 056 17 231 10 597 6 110 3 163 1 340 Aastad alates algkoolist 535 840 438 492 359 038 291 578 228 311 165 843 109 986 61 680 25 006 6 845 420 224 345 502 284 035 231 728 182 117 132 732 88 080 49 430 19 866 5 443 Ohustatud arv 115 036 92 529 74 629 59 684 46 133 33 074 21 880 12 240 5 139 1 402 Joonis 3: Planeeritud ja mitteplaneeritud puusaliigese endoproteesimiste kumulatiivsed revisioonimäärad (p < 0,0001) Joonis 4: Kumulatiivsed revisioonimäärad plaaniliste täielike puusaliigese proteesimiste puhul tsementeeritud ja tsementeerimata vartega (p < 0,0001) 52 EPRD 2024. aasta aruanne 53  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus 7 madalamad kumulatiivsed revisjonimäärad, kui need hõlmavad reieluukaela © EPRD aastaaruanne 2024 6 murdude puhul kui teiste reieluukaare murdude puhul. 5 Kumulatiivne revisioon [%] Tabelis 44 on loetletud CRR-id erinevate tüüpide puhul 4 puusaartroplastika tüüpide kumulatiivsed korrigeerimismäärad näidustuse järgi. 3 2 1 Lühidalt Planeeritud puusaliigese asendamine tsementeerimata varrega posttraumaatilise osteoartriidi korral Planeeritud puusaliigese asendamine tsementeerimata varrega 0 muude osteoartriitide korral Planeeritud puusaliigese asendamine tsementeerimata varrega esmase 0 1 2 3 4 5 osteoartriidi korral Planeeritud puusaliigese asendamine tsementeerimata varrega düsplastilise osteoartriidi korral 6 7 8 9 • CRR on üldiselt kõrgem mitte-elektiveeritud Aastad alates algkoolist protseduuride puhul. • Posttraumaatiline osteoartriit on seotud Puu 4 156 3 424 2 849 2 336 1 869 1 328 863 514 sa Riskirühm 32 633 27 161 22 741 18 876 14 809 10 937 7 198 3 890 1 371 suurema revisiooniriskiga. 330 035 271 494 222 618 181 340 142 467 103 648 68 755 38 737 15 692 4 252 39 392 32 345 26 733 21 917 17 303 12 696 8 596 4 827 1 956 563 Joonis 5: Tsementeerimata varrega plaaniliste puusaliigese täielike proteesimiste kumulatiivsed revisioonimäärad esmase diagnoosi järgi (p < 0,0001) Kumulatiivsed revisioonimäärad pärast ... Artroplastika Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat / Kategooria Valikulised THA-d tsementeerimata vartega 420 224 67 (59–74) 41/59 27,8 762 2,8 [2,7; 2,8] 3,2 [3,1; 3,2] 3,4 [3,4; 3,5] 3,6 [3,5; 3,7] 3,8 [3,7; 3,8] 4,0 [3,9; 4,0] 4,1 [4,1; 4,2] 4,3 [4,2; 4,4] 4,5 [4,4; 4,7] (345 502) (284 035) (231 728) (182 117) (132 732) (88 080) (49 430) (19 866) (5 443) Esmane diagnoos Esmane osteoartriit 330 035 68 (61–75) 41/59 28,0 759 2,7 [2,6; 2,7] 3,0 [3,0; 3,1] 3,3 [3,2; 3,3] 3,5 [3,4; 3,5] 3,6 [3,5; 3,7] 3,8 [3,7; 3,9] 4,0 [3,9; 4,1] 4,2 [4,1; 4,3] 4,4 [4,2; 4,5] (271 494) (222 618) (181 340) (142 467) (103 648) (68 755) (38 737) (15 692) (4 252) Muud diagnoosid peale osteoartriidi või luumurru 46 641 64 46/54 27,5 741 3,8 [3,6; 3,9] 4,2 [4,0; 4,4] 4,5 [4,3; 4,7] 4,7 [4,5; 4,9] 5,0 [4,7; 5,2] 5,1 [4,9; 5,4] 5,4 [5,1; 5,6] 5,7 [5,4; 6,0] 6,1 [5,6; 6,7] (56–73) (38 239) (31 835) (26 135) (20 478) (15 060) (9 866) (5 352) (2 002) (557) Düsplastiline osteoartriit 39 392 59 (52–66) 31/69 27,2 715 2,4 [2,2; 2,5] 2,8 [2,6; 3,0] 3,1 [2,9; 3,3] 3,3 [3,1; 3,5] 3,5 [3,3; 3,7] 3,7 [3,4; 3,9] 3,8 [3,5; 4,0] 3,9 [3,6; 4,1] 3,9 [3,6; 4,1] (32 345) (26 733) (21 917) (17 303) (12 696) (8 596) (4 827) (1 956) (563) Posttraumaatiline osteoartriit 4 156 62 56/44 26,6 583 3,7 [3,2; 4,3] 4,4 [3,8; 5,1] 4,9 [4,2; 5,6] 5,1 [4,4; 5,8] 5,3 [4,6; 6,1] 5,7 [4,9; 6,5] 5,9 [5,0; 6,7] 6,1 [5,1; 7,0] 6,1 [5,1; 7,0] (54–71) (3 424) (2 849) (2 336) (1 869) (1 328) (863) (514) (216) (71) Eelnevad toimingud Puuduvad asjakohased eelnevad operatsioonid 405 323 67 (60–74) 40/60 27,9 762 2,7 [2,7; 2,8] 3,1 [3,1; 3,2] 3,4 [3,3; 3,4] 3,5 [3,5; 3,6] 3,7 [3,6; 3,8] 3,9 [3,8; 4,0] 4,1 [4,0; 4,2] 4,3 [4,2; 4,4] 4,5 [4,3; 4,6] (333 083) (273 595) (223 049) (175 036) (127 303) (84 165) (47 018) (18 892) (5 183) Osteosüntees / osteotoomia 8 551 60 40/60 26,6 654 4,3 [3,9; 4,8] 4,9 [4,5; 5,4] 5,3 [4,8; 5,8] 5,5 [5,0; 6,0] 5,7 [5,1; 6,2] 5,8 [5,2; 6,3] 6,0 [5,4; 6,6] 6,2 [5,5; 6,8] 6,6 [5,5; 7,6] (51–69) (7 032) (5 826) (4 735) (3 788) (2 824) (1 910) (1 134) (493) (151) Muud varasemad operatsioonid 5 140 6 2 43/57 27,7 510 2,8 [2,3; 3,3] 3,5 [2,9; 4,0] 3,8 [3,2; 4,3] 3,9 [3,4; 4,5] 4,1 [3,5; 4,7] 4,4 [3,8; 5,0] 4,7 [4,0; 5,4] 5,3 [4,4; 6,1] 5,7 [4,5; 6,9] (4 370) (3 777) (3 259) (2 745) (2 209) (1 717) (1 097) (401) (87) Reieluupea nekroos 1 158 56 59/41 27,9 339 5,4 [4,1; 6,7] 5,8 [4,4; 7,2] 6,3 [4,9; 7,8] 6,5 [5,0; 8,0] 7,3 [5,6; 8,9] 7,3 [5,6; 8,9] 7,3 [5,6; 8,9] 7,3 [5,6; 8,9] (45–67) (975) (801) (655) (527) (377) (275) (175) (77) Valikulised tsementeeritud varrega puusaliigese proteesid 115 036 79 (75–83) 25/75 26,5 735 2,4 [2,3; 2,5] 2,7 [2,6; 2,8] 2,9 [2,8; 3,0] 3,2 [3,0; 3,3] 3,4 [3,3; 3,5] 3,6 [3,5; 3,7] 3,9 [3,7; 4,0] 4,1 [3,9; 4,3] 4,3 [4,0; 4,5] (92 529) (74 629) (59 684) (46 133) (33 074) (21 880) (12 240) (5 139) (1 402) Esmane diagnoos Esmane osteoartriit 92 444 79 (75–83) 24/76 26,6 716 2,0 [2,0; 2,1] 2,3 [2,2; 2,4] 2,5 [2,4; 2,7] 2,7 [2,6; 2,9] 2,9 [2,8; 3,1] 3,1 [3,0; 3,3] 3,4 [3,3; 3,6] 3,6 [3,4; 3,8] 3,7 [3,5; 4,0] (75 143) (60 862) (48 889) (38 061) (27 375) (18 328) (10 437) (4 407) (1 207) Muud diagnoosid peale osteoartriidi või luumurru 16 937 79 26/74 26,0 685 4,1 [3,8; 4,4] 4,6 [4,3; 4,9] 5,0 [4,7; 5,4] 5,4 [5,0; 5,8] 5,8 [5,4; 6,2] 6,1 [5,7; 6,6] 6,3 [5,8; 6,8] 6,7 [6,1; 7,4] 7,2 [6,1; 8,4] (73–83) (12 881) (10 128) (7 919) (5 882) (4 117) (2 524) (1 274) (520) (140) Tabel 44: Erinevate esmaste puusaliigese proteesimiste ja diagnooside korduvoperatsioonide määrad 54 EPRD aastaaruanne 2024 55  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Kumulatiivsed revisioonimäärad pärast ... Artroplastika Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat / Kategooria Düsplastiline osteoartriit 4 130 77 (70–81) 20/80 26,2 488 2,3 [1,8; 2,7] 2,6 [2,1; 3,1] 2,8 [2,2; 3,3] 3,0 [2,4; 3,6] 3,4 [2,7; 4,0] 3,8 [3,0; 4,5] 4,3 [3,3; 5,3] 5,3 [3,8; 6,7] (3 309) (2 675) (2 104) (1 608) (1 184) (778) (402) (160) Posttraumaatiline osteoartriit 1 525 78 29/71 25,0 412 3,3 [2,4; 4,2] 4,1 [3,0; 5,1] 4,4 [3,3; 5,5] 5,0 [3,8; 6,2] 5,0 [3,8; 6,2] 5,3 [3,9; 6,6] 5,3 [3,9; 6,6] 5,3 [3,9; 6,6] (72–82) (1 196) (964) (772) (582) (398) (250) (127) (52) Eelnevad operatsioonid Puuduvad asjakohased eelnevad operatsioonid 110 402 79 (75–83) 24/76 26,6 732 2,3 [2,2; 2,4] 2,6 [2,5; 2,7] 2,8 [2,7; 2,9] 3,0 [2,9; 3,1] 3,3 [3,2; 3,4] 3,5 [3,4; 3,6] 3,8 [3,6; 3,9] 4,0 [3,8; 4,2] 4,1 [3,9; 4,3] (88 869) (71 664) (57 320) (44 322) (31 757) (20 981) (11 733) (4 971) (1 378) Osteosüntees / osteotoomia 2 852 79 24/76 24,9 524 4,8 [4,0; 5,6] 5,5 [4,6; 6,3] 6,0 [5,1; 7,0] 6,5 [5,5; 7,5] 7,0 [5,9; 8,1] 7,3 [6,1; 8,5] 7,5 [6,2; 8,8] 7,5 [6,2; 8,8] (72–83) (2 163) (1 691) (1 298) (956) (646) (401) (203) (69) Muud eelnevad operatsioonid 1 410 78 (73–82) 30/70 26,5 288 3,9 [2,9; 4,9] 4,2 [3,2; 5,3] 4,8 [3,7; 6,0] 5,2 [4,0; 6,4] 5,5 [4,2; 6,8] 5,8 [4,4; 7,2] 5,8 [4,4; 7,2] 6,2 [4,6; 7,7] (1 215) (1 056) (898) (733) (589) (443) (280) (90) Reieluupea nekroos 344 78 27/73 25,7 136 4,5 [2,3; 6,7] 5,3 [2,8; 7,7] 5,3 [2,8; 7,7] 6,0 [3,2; 8,8] 6,0 [3,2; 8,8] (72–84) (260) (197) (150) (107) (72) Puu Planeerimata puusaliigese asendamine 34 964 76 (68–82) 30/70 24,6 707 6,1 [5,8; 6,3] 6,7 [6,4; 6,9] 7,0 [6,7; 7,3] 7,4 [7,1; 7,7] 7,6 [7,3; 8,0] 7,9 [7,6; 8,3] 8,2 [7,8; 8,7] 8,5 [8,0; 8,9] 8,5 [8,0; 8,9] s (24 594) (18 634) (13 636) (9 688) (6 362) (3 846) (1 949) (668) (126) Esmane diagnoos Reieluukaela murd 32 500 76 (68–82) 31/69 24,6 699 5,9 [5,6; 6,1] 6,5 [6,2; 6,7] 6,8 [6,5; 7,1] 7,2 [6,8; 7,5] 7,5 [7,1; 7,8] 7,7 [7,4; 8,1] 8,1 [7,7; 8,5] 8,3 [7,8; 8,8] 8,3 [7,8; 8,8] (23 076) (17 512) (12 808) (9 109) (5 986) (3 608) (1 817) (613) (110) Muud reieluukaare murrud 1 685 81 24/76 24,8 459 9,7 [8,2; 11,2] 10,3 [8,8; 11,9] 10,6 [9,0; 12,2] 11,0 [9,3; 12,6] 11,0 [9,3; 12,6] 11,0 [9,3; 12,6] 11,0 [9,3; 12,6] (73–86) (994) (719) (534) (368) (225) (145) (76) Patoloogiline luumurd 779 75 (66–81) 25/75 25,4 341 7,6 [5,6; 9,5] 7,8 [5,8; 9,8] 8,8 [6,6; 11,0] 8,8 [6,6; 11,0] 8,8 [6,6; 11,0] 8,8 [6,6; 11,0] 8,8 [6,6; 11,0] (524) (403) (294) (211) (151) (93) (56) Eelnevad operatsioonid Puuduvad asjakohased eelnevad operatsioonid 33 556 76 30/70 24,6 703 6,0 [5,7; 6,2] 6,5 [6,2; 6,8] 6,9 [6,6; 7,2] 7,2 [6,9; 7,6] 7,5 [7,2; 7,8] 7,8 [7,4; 8,1] 8,1 [7,7; 8,6] 8,4 [7,8; 8,9] 8,4 [7,8; 8,9] (68–82) (23 620) (17 863) (13 027) (9 238) (6 061) (3 634) (1 834) (628) (116) Osteosüntees / osteotoomia 937 77 (67–84) 28/72 25,0 387 9,3 [7,3; 11,2] 10,4 [8,3; 12,4] 10,6 [8,5; 12,7] 10,8 [8,7; 13,0] 11,3 [8,9; 13,6] 11,8 [9,2; 14,3] 11,8 [9,2; 14,3] (620) (487) (387) (268) (175) (117) (55) Muud eelnevad operatsioonid 445 76 30/70 24,5 164 8,5 [5,8; 11,1] 8,7 [6,0; 11,4] 9,2 [6,3; 11,9] 9,6 [6,6; 12,5] 9,6 [6,6; 12,5] 9,6 [6,6; 12,5] 9,6 [6,6; 12,5] (68–82) (335) (275) (215) (176) (123) (93) (59) Puusa poolproteesid 73 215 84 (80–89) 29/71 24,2 624 4,6 [4,4; 4,7] 4,8 [4,6; 5,0] 5,0 [4,8; 5,2] 5,2 [5,0; 5,4] 5,3 [5,1; 5,5] 5,5 [5,3; 5,7] 5,6 [5,3; 5,8] 6,0 [5,5; 6,5] 6,0 [5,5; 6,5] (40 585) (27 056) (17 231) (10 597) (6 110) (3 163) (1 340) (375) (50) Esmane diagnoos Reieluukaela murd 67 142 85 (80–89) 28/72 24,2 606 4,4 [4,2; 4,5] 4,6 [4,4; 4,7] 4,7 [4,5; 4,9] 4,9 [4,7; 5,1] 5,0 [4,8; 5,2] 5,1 [4,9; 5,4] 5,2 [5,0; 5,5] 5,7 [5,2; 6,2] (37 702) (25 199) (16 046) (9 864) (5 669) (2 932) (1 244) (352) Muud diagnoosid peale osteoartriidi või 3 912 82 37/63 24,5 530 7,6 [6,6; 8,5] 8,0 [7,0; 9,0] 8,4 [7,4; 9,5] 9,0 [7,8; 10,2] 9,3 [8,0; 10,5] 10,0 [8,3; 11,7] 10,0 [8,3; 11,7] (75–87) murd (1 719) (1 123) (717) (443) (278) (150) (61) Muud reieluukaare murrud 1 395 85 (80–90) 23/77 24,5 369 7,3 [5,8; 8,8] 7,8 [6,2; 9,4] 8,2 [6,4; 9,8] 8,6 [6,7; 10,5] 8,6 [6,7; 10,5] 8,6 [6,7; 10,5] (723) (427) (269) (172) (98) (50) Patoloogiline luumurd 609 83 20/80 24,2 262 4,4 [2,6; 6,1] 4,4 [2,6; 6,1] 4,9 [2,9; 6,9] 5,9 [3,1; 8,6] (76–88) (325) (222) (137) (81) Eelnevad operatsioonid Puuduvad asjakohased eelnevad toimingud 71 275 84 (80–89) 29/71 24,2 621 4,5 [4,3; 4,7] 4,7 [4,6; 4,9] 4,9 [4,7; 5,1] 5,1 [4,9; 5,3] 5,3 [5,0; 5,5] 5,4 [5,2; 5,7] 5,5 [5,2; 5,8] 6,0 [5,5; 6,5] (39 428) (26 237) (16 667) (10 221) (5 864) (3 010) (1 272) (361) Osteosüntees / osteotoomia 1 035 85 24/76 24,8 331 9,7 [7,8; 11,6] 9,9 [7,9; 11,8] 10,1 [8,1; 12,0] 10,1 [8,1; 12,0] 10,1 [8,1; 12,0] 10,1 [8,1; 12,0] (80–89) (624) (434) (299) (209) (133) (76) Muud varasemad operatsioonid 875 83 (78–88) 31/69 24,5 192 4,4 [3,0; 5,8] 4,8 [3,3; 6,3] 5,2 [3,5; 6,8] 5,5 [3,7; 7,3] 5,5 [3,7; 7,3] 5,5 [3,7; 7,3] (515) (372) (257) (162) (109) (76) Tabel 44 (jätkub) 56 EPRD 2024. aasta aruanne 57  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus 7 © EPRD aastaaruanne 2024 5.1.2 Esmase puusaliigese meeste ja naiste vahel infektsiooniriski erinevust, 6 endoproteesimise puhul implantaadiga millest on teatatud ka teistes rahvusvahelistes registrites mitteseotud tegurid [2]. 5 Kumulatiivne revisioon [%] Artroplastika tulemusi mõjutavad mitmed tegurid, 4 sealhulgas artroplastika tüüp ning patsiendi ja haigla Kuna sugu on oluline mõjutav tegur, esitab EPRD 3 omadused. Patsiendi vanus on eriti oluline tegur veebileht erinevate liigeseasenduste tulemused, 2 plaanilise tsementeerimata varrega puusaliigese riskitegurid ja implantaadi omadused eraldi meeste ja endoproteesimise puhul, mis on kõige sagedamini naiste alarühmade kohta, vt ka lk 172/173. 1 teostatav puusaliigese artroplastika tüüp (joonis 6). Valikulised THA-d tsementeerimata varrega ≥ 85-aastastel patsientidel 0 Planeeritud puusaliigese asendamine tsementeerimata varrega 75–84-aastastel patsientidel Planeeritud puusaliigese asendamine tsementeerimata varrega alla 75-aastastel Ka patsiendi kehatüüp mõjutab oluliselt artroplastika Puu patsientidel Vanematel patsientidel on suurem revisioonirisk, kui tulemust. EPRD on alates 2017. aastast arvutanud sa 0 1 2 3 4 5 6 7 8 9 seda tüüpi artroplastikat tehakse periprostetiliste kehakaaluindeksi (BMI) andmeid patsientide pikkuse ja Aastad esmase operatsiooni järel luumurdude puhul (vt ka [1]). Seevastu on teiste kaalu põhjal (vt ka lk 164). 8 332 6 344 4 883 3 623 2 589 1 637 919 Ohustatud arvud 93 726 77 962 64 910 53 311 41 646 29 670 18 865 9 883 3 525 791 puusaliigese artroplastika tüüpide 318 166 261 196 214 242 174 794 137 882 101 425 68 296 39 126 16 221 4 635 kordusoperatsioonide sagedus vanematel patsientidel madalam võrreldes Joonis 6: Kumulatiivsed revisioonimäärad valikuliste tsementimata varrega puusaliigese endoproteesimiste puhul vanuserühmade kaupa (p < 0,0001) nooremad vanuserühmad (vt tabel 45). Joonis 8 näitab, et kõrgemate KMI kategooriate Meessoost patsientidel on esmase puusaliigese patsientidel on märkimisväärselt suurem revisioonirisk 6 © EPRD aastaaruanne 2024 endoproteesimise tüübist sõltumata suurem pärast valikulist puusaliigese endoproteesimist 5 revisioonirisk võrreldes naissoost patsientidega, nagu tsementeerimata varrega. See kehtib hoolimata sellest, on näidatud joonisel 7 tsementeeritud varrega plaanilise et kõrgemate KMI-ga patsiendid on esmase protseduuri Kumulatiivne revisioon [%] 4 puusaliigese endoproteesimise puhul. See võib ajal üldiselt nooremad. 3 peegeldada erinevust 2 1 9 © EPRD aastaaruanne 2024 8 0 Meessoost patsientidel tehtud plaanilised tsementitud varrega puusaliigese täielikud asendused Naissoost patsientidel tehtud 7 plaanilised tsementitud varrega puusaliigese täielikud asendused Kumulatiivne revisioon [%] 0 1 2 3 4 5 6 7 8 9 6 Aastad alates algkoolist 5 4 28 282 22 519 18 160 14 431 11 076 7 869 5 135 2 812 1 169 Riskirühma kuuluvate 3 patsientide 86 754 70 010 56 469 45 253 35 057 25 205 16 745 9 428 3 970 1 102 arv 2 Planeeritud puusaliigese asendamine tsementeerimata varrega patsientidel, kelle Joonis 7: Tsementeerimata varrega plaaniliste puusaliigese täielike proteeside kumulatiivsed revisioonimäärad patsientide soo järgi (p < 0,0001) 1 KMI on > 40 Planeeritud puusaliigese asendamine tsementeerimata varrega patsientidel, kelle KMI on > 35 kuni 40 Planeeritud puusaliigese asendamine 0 tsementeerimata varrega patsientidel, kelle KMI on > 30 kuni 35 Planeeritud puusaliigese asendamine tsementeerimata varrega patsientidel, kelle KMI on > 25 kuni 30 Planeeritud puusaliigese asendamine tsementeerimata varrega 0 1 2 3 patsientidel, kelle 4 KMI on < 25 5 6 Aastad alates algkoolist 11 157 8 479 6 569 4 810 3 311 1 834 27 057 20 729 15 792 11 649 7 932 4 288 1 092 Riskirühm 72 246 56 508 43 671 32 607 22 202 12 053 3 107 121 429 95 834 73 984 55 747 38 300 20 993 5 446 83 777 65 839 50 446 37 552 25 492 13 750 3 520 Joonis 8: Tsementeerimata varrega plaaniliste puusaliigese täielike proteeside kumulatiivsed revisioonimäärad patsiendi kehakaaluindeksi järgi (p < 0,0001) 58 EPRD aastaaruanne 2024 59  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus 6 © EPRD aastaaruanne 2024 5 4 Kumulatiivne muutus [%] 3 2 1 Planeeritud puusaliigese asendamisoperatsioonid tsementeerimata varrega haiglates, kus tehakse kuni 200 sellist esmast 0 operatsiooni aastas Planeeritud puusaliigese asendamisoperatsioonid tsementeerimata varrega haiglates, kus tehakse 201– 500 sellist esmast operatsiooni aastas Planeeritud puusaliigese asendamisoperatsioonid tsementeerimata varrega haiglates, kus tehakse üle 500 sellist esmast operatsiooni aastas 0 1 2 3 4 5 6 7 8 9 Aastad alates algkoolist Puu 128 794 105 087 86 119 70 435 55 288 40 079 26 220 14 023 4 909 770 sa Riskirühma kuuluvate 140 733 115 403 93 569 75 814 59 542 43 628 28 993 16 392 6 798 1 614 patsientide arv 142 377 117 130 96 954 78 773 61 566 44 432 29 695 17 177 7 331 2 895 Joonis 9: Valikuliste puusaliigese täielike proteesimiste kumulatiivsed revisioonimäärad haigla esmaste valikuliste puusaliigese täielike proteesimiste aastase mahu järgi (p < 0,0001) Kui vaadelda valikulist puusaliigese endoproteesimist lähemalt, saavutavad sellist tüüpi protseduuridega Lühidalt rohkem kogemusi omavad haiglad ka paremaid tulemusi5 (vt näiteks joonis 9). Kuid see suundumus ei ole absoluutne. EPRD hõlmab ka haiglaid, mis • Meestel ja kõrge kehakaaluga patsientidel on saavutavad häid tulemusi hoolimata väikesest suurem risk operatsiooni kordamiseks. juhtumite arvust, samuti haiglaid, kus juhtumite arv • Ainult valikulistel puusaliigese asendamisel on suur, kuid tulemused halvemad. tsementeerimata varrega on vanematel patsientidel kõrgem korduvoperatsiooni risk Tabelis 45 on loetletud erinevate puusaliigese võrreldes nooremate patsientidega. endoproteesimise tüüpide korduvoperatsioonide määrad • Haiglad, kus tehakse rohkem plaanilisi valitud implantaadiga mitteseotud tegurite kaupa. artroplastikaid, saavutavad tavaliselt madalama revisiooniriski. 5 Käesoleva aruande klassifikatsioonid põhinevad haiglate 2022. aasta kvaliteediaruannetel ja neis loetletud vastavatel IQTIGi kvaliteedinäitajatel. 60 EPRD 2024. aasta aruanne 61  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Kumulatiivsed revisioonimäärad pärast ... Artroplastika tüüp Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat /Kategooria Valikulised tsementimata varrega puusaliigese proteesid 420 224 67 (59–74) 41/59 27,8 762 2,8 [2,7; 2,8] 3,2 [3,1; 3,2] 3,4 [3,4; 3,5] 3,6 [3,5; 3,7] 3,8 [3,7; 3,8] 4,0 [3,9; 4,0] 4,1 [4,1; 4,2] 4,3 [4,2; 4,4] 4,5 [4,4; 4,7] (345 502) (284 035) (231 728) (182 117) (132 732) (88 080) (49 430) (19 866) (5 443) Vanuserühm ≤ 54 aastat 54 575 50 (46–53) 49/51 28,4 743 2,3 [2,2; 2,4] 2,9 [2,7; 3,0] 3,2 [3,1; 3,4] 3,5 [3,3; 3,6] 3,7 [3,5; 3,9] 3,9 [3,7; 4,1] 4,1 [3,9; 4,3] 4,3 [4,1; 4,6] 4,5 [4,2; 4,8] (45 733) (38 326) (31 585) (25 367) (18 875) (12 722) (7 437) (3 146) (948) 55–64 aastat 119 739 60 44/56 28,5 754 2,3 [2,3; 2,4] 2,8 [2,7; 2,9] 3,1 [3,0; 3,2] 3,2 [3,1; 3,4] 3,4 [3,3; 3,5] 3,6 [3,5; 3,7] 3,8 [3,6; 3,9] 3,9 [3,8; 4,1] 4,1 [3,9; 4,3] (58–62) (98 032) (80 069) (65 014) (50 843) (37 266) (24 983) (14 119) (5 826) (1 650) 65–74 aastat 143 852 69 (67–72) 38/62 28,1 753 2,6 [2,5; 2,6] 2,9 [2,8; 3,0] 3,1 [3,1; 3,2] 3,3 [3,2; 3,4] 3,5 [3,4; 3,6] 3,6 [3,5; 3,7] 3,8 [3,7; 3,9] 4,0 [3,9; 4,2] 4,2 [4,0; 4,4] (117 431) (95 847) (78 195) (61 672) (45 284) (30 591) (17 570) (7 249) (2 037) 75–84 aastat 93 726 78 36/64 26,9 754 3,7 [3,6; 3,8] 4,0 [3,9; 4,1] 4,2 [4,1; 4,4] 4,4 [4,3; 4,5] 4,6 [4,4; 4,7] 4,8 [4,6; 4,9] 5,0 [4,8; 5,2] 5,1 [4,9; 5,3] 5,4 [5,1; 5,7] (76–81) (77 962) (64 910) (53 311) (41 646) (29 670) (18 865) (9 883) (3 525) (791) ≥ 85 aastat 8 332 86 (85–88) 35/65 25,7 633 4,7 [4,2; 5,1] 4,8 [4,4; 5,3] 5,1 [4,6; 5,6] 5,2 [4,7; 5,7] 5,6 [5,0; 6,1] 5,9 [5,2; 6,5] 6,0 [5,3; 6,7] 7,4 [5,8; 9,0] (6 344) (4 883) (3 623) (2 589) (1 637) (919) (421) (120) Puu Sugu Mehed 170 533 65 2,8 [2,7; 2,9] 3,3 [3,2; 3,3] 3,5 [3,5; 3,6] 3,7 [3,6; 3,8] 3,9 [3,8; 4,0] 4,1 [4,0; 4,2] 4,3 [4,2; 4,4] 4,5 [4,3; 4,6] 4,6 [4,4; 4,8] s (58–73) 100/0 28,4 755 (139 548) (114 135) (92 701) (72 164) (52 167) (34 299) (18 923) (7 505) (2 073) Naised 249 691 68 (60–75) 0/100 27,5 759 2,7 [2,6; 2,8] 3,1 [3,0; 3,2] 3,3 [3,3; 3,4] 3,5 [3,4; 3,6] 3,7 [3,6; 3,8] 3,9 [3,8; 4,0] 4,1 [4,0; 4,1] 4,2 [4,1; 4,4] 4,5 [4,3; 4,6] (205 954) (169 900) (139 027) (109 953) (80 565) (53 781) (30 507) (12 361) (3 370) Kehamassiindeks ≤ 25 83 777 68 30/70 23,2 733 2,2 [2,1; 2,3] 2,5 [2,4; 2,6] 2,8 [2,6; 2,9] 3,0 [2,8; 3,1] 3,2 [3,0; 3,3] 3,4 [3,3; 3,6] (60–76) (65 839) (50 446) (37 552) (25 492) (13 750) (3 520) > 25–30 121 429 68 (60–75) 46/54 27,4 742 2,4 [2,3; 2,5] 2,7 [2,6; 2,8] 2,9 [2,8; 3,0] 3,1 [3,0; 3,2] 3,2 [3,1; 3,3] 3,4 [3,3; 3,5] (95 834) (73 984) (55 747) (38 300) (20 993) (5 446) > 30–35 72 246 66 45/55 32,0 732 3,1 [3,0; 3,2] 3,5 [3,4; 3,6] 3,8 [3,6; 3,9] 3,9 [3,8; 4,1] 4,1 [3,9; 4,3] 4,2 [4,1; 4,4] (59–73) (56 508) (43 671) (32 607) (22 202) (12 053) (3 107) > 35–40 27 057 64 (57–70) 40/60 36,8 714 4,1 [3,9; 4,3] 4,6 [4,3; 4,9] 4,9 [4,6; 5,2] 5,1 [4,8; 5,4] 5,2 [4,9; 5,5] 5,3 [4,9; 5,6] (20 729) (15 792) (11 649) (7 932) (4 288) (1 092) üle 40 11 157 62 34/66 42,5 697 6,6 [6,2; 7,1] 7,2 [6,7; 7,7] 7,6 [7,1; 8,1] 7,9 [7,3; 8,4] 8,2 [7,6; 8,7] 8,2 [7,6; 8,7] (56–68) (8 479) (6 569) (4 810) (3 311) (1 834) (474) ASA staatus ASA 1 24 712 62 (55–70) 43/57 26,6 668 2,1 [1,9; 2,3] 2,4 [2,2; 2,6] 2,6 [2,4; 2,8] 2,8 [2,5; 3,2] (16 861) (9 930) (2 358) (61) ASA 2 109 022 66 38/62 27,7 702 2,5 [2,4; 2,6] 2,8 [2,7; 2,9] 3,1 [3,0; 3,2] 3,2 [3,0; 3,4] (59–73) (70 787) (37 030) (9 649) (193) ASA 3 50 007 71 (64–78) 44/56 29,3 691 4,1 [3,9; 4,2] 4,5 [4,3; 4,7] 4,8 [4,6; 5,0] (31 695) (16 252) (4 152) ASA 4 või 5 945 73 52/48 29,1 358 5,9 [4,3; 7,4] 6,3 [4,6; 7,9] 6,7 [4,8; 8,5] (65–80) (582) (306) (84) Haigla suurus* Haiglad, kus on väike aastane patsientide arv 128 794 68 (61–76) 41/59 28,1 478 3,3 [3,2; 3,4] 3,8 [3,7; 3,9] 4,1 [4,0; 4,2] 4,3 [4,2; 4,4] 4,5 [4,4; 4,6] 4,7 [4,6; 4,8] 4,9 [4,7; 5,0] 5,1 [4,9; 5,2] 5,4 [5,1; 5,7] (105 087) (86 119) (70 435) (55 288) (40 079) (26 220) (14 023) (4 909) (770) Haiglad, kus on keskmine aastane patsientide arv 140 733 67 41/59 28,0 179 2,7 [2,6; 2,8] 3,1 [3,0; 3,2] 3,4 [3,3; 3,5] 3,6 [3,5; 3,7] 3,7 [3,6; 3,9] 3,9 [3,8; 4,0] 4,2 [4,0; 4,3] 4,4 [4,3; 4,6] 4,6 [4,4; 4,8] (60–74) (115 403) (93 569) (75 814) (59 542) (43 628) (28 993) (16 392) (6 798) (1 614) Haiglad, kus on suur aastane patsientide arv 142 377 66 (58–73) 40/60 27,6 65 2,3 [2,2; 2,4] 2,6 [2,6; 2,7] 2,9 [2,8; 3,0] 3,0 [2,9; 3,1] 3,2 [3,1; 3,3] 3,3 [3,2; 3,5] 3,5 [3,4; 3,6] 3,7 [3,5; 3,8] 3,8 [3,6; 4,0] (117 130) (96 954) (78 773) (61 566) (44 432) (29 695) (17 177) (7 331) (2 895) Valikulised tsementeeritud varrega puusaliigese proteesid 115 036 79 (75–83) 25/75 26,5 735 2,4 [2,3; 2,5] 2,7 [2,6; 2,8] 2,9 [2,8; 3,0] 3,2 [3,0; 3,3] 3,4 [3,3; 3,5] 3,6 [3,5; 3,7] 3,9 [3,7; 4,0] 4,1 [3,9; 4,3] 4,3 [4,0; 4,5] (92 529) (74 629) (59 684) (46 133) (33 074) (21 880) (12 240) (5 139) (1 402) Vanuserühm ≤ 54 aastat 1 032 51 60/40 27,7 289 3,2 [2,1; 4,3] 4,1 [2,8; 5,3] 4,8 [3,4; 6,2] 5,3 [3,8; 6,8] 6,0 [4,3; 7,7] 6,8 [4,8; 8,8] 7,7 [5,3; 10,0] (47–53) (837) (724) (602) (485) (366) (222) (118) 55–64 aastat 3 798 61 (58–63) 37/63 27,8 542 3,1 [2,5; 3,7] 4,0 [3,3; 4,6] 4,2 [3,6; 4,9] 4,5 [3,8; 5,2] 5,0 [4,2; 5,8] 5,5 [4,6; 6,3] 6,2 [5,0; 7,3] 6,7 [5,3; 8,0] 6,7 [5,3; 8,0] (3 000) (2 432) (1 982) (1 610) (1 169) (784) (449) (182) (56) 65–74 aastat 22 082 72 23/77 27,6 678 2,3 [2,1; 2,6] 2,7 [2,5; 3,0] 3,1 [2,8; 3,3] 3,3 [3,1; 3,6] 3,6 [3,3; 3,9] 3,9 [3,6; 4,2] 4,1 [3,8; 4,5] 4,3 [3,9; 4,7] 4,5 [4,0; 5,0] (69–73) (17 821) (14 547) (11 917) (9 585) (7 293) (5 174) (3 158) (1 475) (471) 75–84 aastat 71 403 80 (77–82) 24/76 26,4 722 2,2 [2,1; 2,4] 2,5 [2,4; 2,7] 2,8 [2,6; 2,9] 3,0 [2,8; 3,1] 3,2 [3,1; 3,4] 3,4 [3,2; 3,6] 3,7 [3,5; 3,9] 4,0 [3,7; 4,2] 4,1 [3,8; 4,4] (58 290) (47 446) (38 225) (29 564) (21 090) (13 836) (7 643) (3 169) (818) ≥85 aastat 16 721 87 24/76 25,5 690 2,7 [2,5; 3,0] 2,9 [2,7; 3,2] 3,1 [2,8; 3,4] 3,2 [2,9; 3,5] 3,3 [3,0; 3,6] 3,4 [3,1; 3,7] 3,4 [3,1; 3,7] 3,4 [3,1; 3,7] 3,4 [3,1; 3,7] (85–88) (12 581) (9 480) (6 958) (4 889) (3 156) (1 864) (872) (275) (51) Sugu Mees 28 282 79 (74–82) 100/0 27,0 693 2,8 [2,6; 3,0] 3,2 [3,0; 3,4] 3,5 [3,2; 3,7] 3,7 [3,4; 3,9] 4,0 [3,7; 4,3] 4,2 [4,0; 4,5] 4,5 [4,2; 4,8] 4,8 [4,4; 5,1] 5,3 [4,5; 6,1] (22 519) (18 160) (14 431) (11 076) (7 869) (5 135) (2 812) (1 169) (300) Tabel 45: Esmase puusaliigese proteesimise erinevate tüüpide kumulatiivsed korduvoperatsioonide määrad implantaadiga mitteseotud tegurite lõikes 62 EPRD aastaaruanne 2024 63  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Kumulatiivsed revisioonimäärad pärast ... Artroplastika Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat /Kategooria Sugu Naised 86 754 79 0/100 26,3 732 2,2 [2,1; 2,3] 2,5 [2,4; 2,7] 2,8 [2,7; 2,9] 3,0 [2,9; 3,1] 3,2 [3,1; 3,3] 3,4 [3,3; 3,6] 3,7 [3,5; 3,9] 3,9 [3,7; 4,1] 4,0 [3,7; 4,2] (75–83) (70 010) (56 469) (45 253) (35 057) (25 205) (16 745) (9 428) (3 970) (1 102) Kehamassiindeks ≤ 25 32 364 80 (76–83) 20/80 23,0 692 1,9 [1,8; 2,1] 2,2 [2,1; 2,4] 2,4 [2,2; 2,6] 2,6 [2,4; 2,8] 2,9 [2,7; 3,1] 3,3 [3,0; 3,7] (24 331) (18 000) (12 799) (8 347) (4 385) (1 194) > 25–30 33 376 80 29/71 27,3 691 2,2 [2,0; 2,3] 2,5 [2,3; 2,6] 2,7 [2,5; 2,9] 2,8 [2,6; 3,0] 3,1 [2,8; 3,3] 3,4 [3,1; 3,7] (76–83) (25 850) (19 552) (14 382) (9 760) (5 290) (1 476) > 30–35 15 403 79 (74–82) 25/75 31,6 656 2,9 [2,6; 3,2] 3,3 [3,0; 3,6] 3,6 [3,2; 3,9] 3,8 [3,5; 4,1] 4,2 [3,8; 4,6] 4,4 [4,0; 4,9] (11 857) (9 019) (6 644) (4 537) (2 482) (706) > 35–40 4 562 76 22/78 36,7 570 4,6 [4,0; 5,2] 4,9 [4,3; 5,6] 5,2 [4,5; 5,9] 5,6 [4,9; 6,4] 5,9 [5,1; 6,7] 5,9 [5,1; 6,7] (71–80) (3 426) (2 601) (1 952) (1 325) (749) (233) üle 40 1 624 73 (67–78) 20/80 42,2 435 6,8 [5,6; 8,1] 7,2 [5,9; 8,5] 7,4 [6,1; 8,7] 7,5 [6,2; 8,9] 7,8 [6,3; 9,2] 8,4 [6,5; 10,2] (1 219) (955) (717) (481) (267) (80) Puu ASA staatus ASA 1 4 080 79 2,3 [1,8; 2,8] 2,6 [2,1; 3,1] 2,8 [2,2; 3,4] s (73–82) 23/77 26,0 374 (2 763) (1 613) (353) ASA 2 23 710 79 (74–82) 19/81 25,9 620 1,9 [1,7; 2,1] 2,2 [2,0; 2,4] 2,4 [2,2; 2,7] (15 130) (7 829) (2 012) ASA 3 22 480 81 27/73 26,9 641 3,2 [2,9; 3,4] 3,5 [3,2; 3,7] 3,6 [3,3; 3,9] (76–84) (13 796) (6 867) (1 674) ASA 4 või 5 670 1 8 38/62 26,4 286 6,6 [4,6; 8,6] 7,1 [4,9; 9,3] (341) (176) Haigla suurus* Haiglad, kus on väike aastane patsientide arv 37 615 79 26/74 26,7 463 2,9 [2,7; 3,1] 3,2 [3,0; 3,4] 3,5 [3,3; 3,7] 3,8 [3,5; 4,0] 4,1 [3,8; 4,3] 4,3 [4,0; 4,5] 4,5 [4,3; 4,8] 4,9 [4,6; 5,3] 4,9 [4,6; 5,3] (75–83) (30 025) (24 552) (19 944) (15 618) (11 267) (7 497) (4 156) (1 561) (248) Haiglad, kus on keskmine aastane patsientide arv 40 376 79 (75–83) 25/75 26,6 175 2,2 [2,1; 2,4] 2,6 [2,5; 2,8] 2,8 [2,7; 3,0] 3,0 [2,8; 3,2] 3,2 [3,0; 3,4] 3,4 [3,2; 3,6] 3,6 [3,4; 3,8] 3,7 [3,5; 4,0] 4,1 [3,5; 4,6] (32 496) (26 203) (20 951) (16 284) (11 750) (7 618) (4 220) (1 725) (410) Haiglad, kus on suur aastane patsientide arv 35 838 79 23/77 26,2 65 2,0 [1,8; 2,1] 2,2 [2,1; 2,4] 2,4 [2,3; 2,6] 2,7 [2,5; 2,9] 2,9 [2,7; 3,1] 3,1 [2,9; 3,3] 3,5 [3,2; 3,8] 3,7 [3,4; 4,1] 3,8 [3,4; 4,3] (75–82) (28 885) (22 836) (17 815) (13 333) (9 314) (6 208) (3 511) (1 676) (677) Mittevalikulised puusaliigese asendused 34 964 76 (68–82) 30/70 24,6 707 6,1 [5,8; 6,3] 6,7 [6,4; 6,9] 7,0 [6,7; 7,3] 7,4 [7,1; 7,7] 7,6 [7,3; 8,0] 7,9 [7,6; 8,3] 8,2 [7,8; 8,7] 8,5 [8,0; 8,9] 8,5 [8,0; 8,9] (24 594) (18 634) (13 636) (9 688) (6 362) (3 846) (1 949) (668) (126) Vanuserühm ≤ 54 aastat 1 020 51 (48–53) 52/48 24,2 437 7,6 [5,9; 9,2] 8,1 [6,4; 9,9] 8,3 [6,5; 10,1] 8,8 [6,9; 10,6] 9,0 [7,1; 10,9] 9,5 [7,3; 11,6] 9,5 [7,3; 11,6] (761) (600) (483) (374) (253) (156) (74) 55–64 aastat 4 607 61 40/60 24,2 610 7,1 [6,3; 7,8] 7,9 [7,0; 8,7] 8,3 [7,5; 9,2] 8,7 [7,8; 9,6] 9,0 [8,0; 9,9] 9,2 [8,2; 10,2] 9,4 [8,3; 10,6] 10,1 [8,4; 11,7] (58–63) (3 357) (2 512) (1 843) (1 308) (854) (548) (302) (111) 65–74 aastat 9 928 70 (67–72) 31/69 25,0 660 5,8 [5,3; 6,3] 6,5 [6,0; 7,0] 6,9 [6,4; 7,5] 7,3 [6,8; 7,9] 7,6 [7,0; 8,2] 7,7 [7,1; 8,4] 8,2 [7,4; 8,9] 8,4 [7,5; 9,4] 8,4 [7,5; 9,4] (7 208) (5 481) (4 082) (3 017) (2 059) (1 306) (689) (249) (52) 75–84 aastat 13 890 79 27/73 24,7 656 6,0 [5,6; 6,4] 6,5 [6,0; 6,9] 6,8 [6,3; 7,2] 7,1 [6,6; 7,6] 7,4 [6,9; 7,9] 7,7 [7,2; 8,3] 8,0 [7,4; 8,6] 8,0 [7,4; 8,6] (77–82) (10 042) (7 814) (5 794) (4 112) (2 713) (1 584) (781) (257) ≥85 aastat 5 519 88 (86–90) 26/74 24,2 541 5,7 [5,1; 6,4] 6,1 [5,5; 6,8] 6,4 [5,7; 7,1] 6,7 [5,9; 7,4] 6,8 [6,0; 7,6] 7,0 [6,1; 8,0] 7,8 [6,4; 9,3] (3 226) (2 227) (1 434) (877) (483) (252) (103) Sugu Mehed 10 577 74 100/0 25,1 655 7,3 [6,8; 7,8] 8,0 [7,5; 8,6] 8,6 [8,0; 9,2] 9,0 [8,3; 9,6] 9,3 [8,6; 9,9] 9,5 [8,8; 10,2] 9,9 [9,1; 10,8] 10,8 [9,3; 12,2] (66–81) (6 966) (5 055) (3 564) (2 467) (1 581) (941) (457) (159) Naised 24 387 77 (69–82) 0/100 24,2 698 5,6 [5,3; 5,9] 6,1 [5,8; 6,4] 6,4 [6,1; 6,7] 6,7 [6,4; 7,1] 7,0 [6,6; 7,3] 7,2 [6,8; 7,6] 7,6 [7,1; 8,0] 7,6 [7,1; 8,0] 7,6 [7,1; 8,0] (17 628) (13 579) (10 072) (7 221) (4 781) (2 905) (1 492) (509) (101) Kehamassiindeks ≤ 25 14 946 76 28/72 22,5 655 5,4 [5,0; 5,8] 6,0 [5,6; 6,4] 6,2 [5,8; 6,6] 6,7 [6,2; 7,2] 6,9 [6,4; 7,4] 7,2 [6,6; 7,8] (68–82) (10 041) (7 083) (4 689) (2 806) (1 341) (358) > 25–30 9 229 76 (69–82) 35/65 26,9 636 6,2 [5,7; 6,7] 6,8 [6,3; 7,4] 7,2 [6,6; 7,8] 7,4 [6,8; 8,0] 7,7 [7,0; 8,3] 7,9 [7,2; 8,7] (6 303) (4 549) (3 093) (1 997) (1 046) (285) > 30–35 2 543 74 (68–81) 32/68 31,6 519 8,1 [7,0; 9,2] 8,6 [7,4; 9,7] 9,0 [7,8; 10,2] 9,3 [8,0; 10,5] 9,5 [8,2; 10,8] 9,5 [8,2; 10,8] (1 773) (1 296) (908) (585) (277) (58) > 35–40 535 72 (65–79) 28/72 36,6 276 10,8 [8,1; 13,5] 10,8 [8,1; 13,5] 11,2 [8,4; 14,0] 11,2 [8,4; 14,0] 11,2 [8,4; 14,0] (353) (248) (170) (108) (59) ASA staatus ASA 1 1 084 71 (63–79) 31/69 24,2 332 5,4 [4,0; 6,7] 6,1 [4,5; 7,6] 6,6 [4,9; 8,3] (722) (426) (132) ASA 2 6 786 73 (66–79) 27/73 24,5 583 4,9 [4,3; 5,4] 5,5 [4,9; 6,1] 5,6 [5,0; 6,3] (4 183) (2 152) (524) ASA 3 8 575 78 (70–84) 34/66 24,7 582 7,9 [7,3; 8,5] 8,4 [7,7; 9,0] 8,7 [8,0; 9,5] (4 556) (2 228) (489) Tabel 45 (jätkub) 64 EPRD 2024. aasta aruanne 65  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Kumulatiivsed korrigeerimismäärad pärast ... Artroplastika tüüp Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat /Kategooria ASA staatus ASA 4 või 5 519 80 (71–87) 43/57 24,7 210 8,9 [6,1; 11,7] 8,9 [6,1; 11,7] (190) (83) Haigla suurus* Haiglad, kus on väike aastane patsientide arv 6 326 76 29/71 24,8 245 6,3 [5,7; 7,0] 6,8 [6,2; 7,5] 7,2 [6,5; 7,9] 7,5 [6,8; 8,2] 8,0 [7,2; 8,8] 8,3 [7,4; 9,1] 8,6 [7,6; 9,5] 8,6 [7,6; 9,5] (68–82) (4 590) (3 619) (2 667) (1 921) (1 291) (810) (415) (144) Haiglad, kus on keskmine aastane patsientide arv 15 036 76 (68–82) 31/69 24,6 301 6,2 [5,8; 6,6] 6,8 [6,4; 7,3] 7,3 [6,8; 7,7] 7,7 [7,2; 8,1] 8,0 [7,5; 8,5] 8,1 [7,6; 8,6] 8,7 [8,0; 9,4] 8,9 [8,1; 9,8] 8,9 [8,1; 9,8] (10 389) (7 778) (5 634) (4 017) (2 599) (1 543) (790) (274) (51) Haiglad, kus on suur aastane patsientide arv 13 353 76 30/70 24,5 134 5,8 [5,4; 6,2] 6,4 [6,0; 6,8] 6,7 [6,2; 7,1] 7,1 [6,6; 7,5] 7,1 [6,7; 7,6] 7,5 [6,9; 8,0] 7,6 [7,0; 8,2] 7,9 [7,0; 8,7] (69–82) (9 408) (7 046) (5 165) (3 603) (2 357) (1 418) (708) (244) Puusa poolproteesid 73 215 84 (80–89) 29/71 24,2 624 4,6 [4,4; 4,7] 4,8 [4,6; 5,0] 5,0 [4,8; 5,2] 5,2 [5,0; 5,4] 5,3 [5,1; 5,5] 5,5 [5,3; 5,7] 5,6 [5,3; 5,8] 6,0 [5,5; 6,5] 6,0 [5,5; 6,5] (40 585) (27 056) (17 231) (10 597) (6 110) (3 163) (1 340) (375) (50) Vanuserühm ≤ 54 aastat 301 50 (45–53) 52/48 24,4 168 7,4 [4,2; 10,4] 8,4 [4,9; 11,8] 9,1 [5,4; 12,6] 10,8 [6,4; 14,9] 10,8 [6,4; 14,9] (182) (140) (113) (75) (59) Puu 55–64 aastat 1 363 61 7,0 [5,5; 8,4] 7,1 [5,6; 8,5] 7,5 [6,0; 9,1] 7,8 [6,1; 9,5] 7,8 [6,1; 9,5] 7,8 [6,1; 9,5] 7,8 [6,1; 9,5] s (59–63) 49/51 24,2 372 (773) (524) (345) (243) (146) (88) (50) 65–74 aastat 5 622 71 (69–73) 43/57 24,7 527 5,4 [4,8; 6,1] 5,9 [5,2; 6,6] 6,3 [5,5; 7,0] 6,5 [5,8; 7,3] 6,5 [5,8; 7,3] 6,9 [6,0; 7,8] 6,9 [6,0; 7,8] 6,9 [6,0; 7,8] (3 283) (2 234) (1 551) (1 023) (667) (383) (195) (52) 75–84 aastat 29 761 81 30/70 24,5 603 4,7 [4,5; 5,0] 5,0 [4,7; 5,3] 5,2 [4,9; 5,5] 5,4 [5,1; 5,7] 5,7 [5,4; 6,0] 5,9 [5,5; 6,3] 6,1 [5,6; 6,5] 6,8 [5,9; 7,6] (79–83) (17 985) (12 532) (8 349) (5 374) (3 150) (1 663) (708) (205) ≥ 85 aastat 36 168 89 (87–92) 25/75 24,0 594 4,2 [3,9; 4,4] 4,3 [4,1; 4,5] 4,4 [4,2; 4,6] 4,5 [4,2; 4,7] 4,5 [4,3; 4,8] 4,5 [4,3; 4,8] 4,5 [4,3; 4,8] 4,5 [4,3; 4,8] (18 362) (11 626) (6 873) (3 882) (2 088) (994) (366) (96) Sugu Mehed 21 069 83 100/0 24,7 595 5,0 [4,7; 5,3] 5,3 [5,0; 5,7] 5,7 [5,3; 6,1] 6,1 [5,6; 6,5] 6,2 [5,7; 6,6] 6,4 [5,8; 6,9] 6,6 [5,9; 7,3] 7,1 [5,9; 8,4] (78–88) (9 979) (6 094) (3 631) (2 093) (1 133) (563) (232) (62) Naised 52 146 85 (81–89) 0/100 24,0 615 4,4 [4,2; 4,6] 4,6 [4,4; 4,8] 4,7 [4,5; 4,9] 4,9 [4,7; 5,1] 5,1 [4,8; 5,3] 5,2 [4,9; 5,5] 5,3 [5,0; 5,5] 5,7 [5,2; 6,2] (30 606) (20 962) (13 600) (8 504) (4 977) (2 600) (1 108) (313) Kehamassiindeks ≤ 25 33 901 85 28/72 22,3 593 4,3 [4,1; 4,6] 4,5 [4,3; 4,8] 4,7 [4,4; 4,9] 4,8 [4,5; 5,1] 5,0 [4,7; 5,3] 5,1 [4,7; 5,5] (80–89) (17 514) (10 745) (6 084) (3 149) (1 356) (275) > 25–30 18 011 84 (80–88) 33/67 26,9 565 4,6 [4,3; 5,0] 4,8 [4,5; 5,1] 5,0 [4,6; 5,3] 5,2 [4,8; 5,6] 5,5 [5,0; 6,0] 5,5 [5,0; 6,0] (9 966) (6 449) (3 847) (2 115) (937) (199) > 30–35 4 564 83 26/74 31,2 525 6,3 [5,6; 7,1] 6,6 [5,8; 7,4] 6,8 [6,0; 7,6] 7,1 [6,2; 8,0] 7,4 [6,3; 8,4] 7,4 [6,3; 8,4] (79–87) (2 599) (1 698) (1 071) (596) (270) (61) > 35–40 873 82 (77–86) 22/78 36,5 368 8,7 [6,7; 10,7] 9,2 [7,1; 11,2] 9,6 [7,3; 11,7] 10,7 [8,0; 13,3] (478) (305) (190) (99) ASA staatus ASA 1 1 302 84 28/72 24,2 189 5,2 [3,9; 6,5] 5,3 [4,0; 6,6] 5,3 [4,0; 6,6] (80–89) (718) (431) (114) ASA 2 6 715 84 (80–88) 24/76 24,2 482 3,9 [3,4; 4,4] 4,2 [3,6; 4,7] 4,2 [3,6; 4,7] (3 577) (1 686) (408) ASA 3 26 059 85 30/70 24,2 542 4,9 [4,7; 5,2] 5,1 [4,8; 5,4] 5,4 [5,0; 5,7] (80–89) (11 560) (5 017) (1 009) ASA 4 või 5 3 325 85 (80–90) 40/60 24,2 440 5,1 [4,2; 6,0] 5,3 [4,3; 6,2] 5,3 [4,3; 6,2] (963) (369) (64) Haigla suurus* Haiglad, kus on väike aastane patsientide arv 11 628 84 28/72 24,5 196 4,3 [3,9; 4,7] 4,6 [4,2; 5,0] 4,7 [4,3; 5,2] 4,8 [4,4; 5,3] 5,1 [4,6; 5,6] 5,5 [4,8; 6,1] 5,8 [5,0; 6,7] 6,3 [5,1; 7,5] (80–89) (6 691) (4 586) (3 048) (1 936) (1 164) (608) (255) (74) Haiglad, kus on keskmine aastane patsientide arv 33 778 84 (80–89) 29/71 24,3 278 4,7 [4,5; 5,0] 5,0 [4,7; 5,2] 5,2 [4,9; 5,4] 5,4 [5,1; 5,7] 5,5 [5,2; 5,8] 5,6 [5,3; 6,0] 5,6 [5,3; 6,0] 6,1 [5,4; 6,7] (18 619) (12 326) (7 782) (4 713) (2 663) (1 366) (612) (182) Haiglad, kus on suur aastane patsientide arv 27 199 85 29/71 24,0 129 4,5 [4,3; 4,8] 4,7 [4,4; 5,0] 4,9 [4,6; 5,2] 5,1 [4,8; 5,4] 5,3 [4,9; 5,6] 5,3 [5,0; 5,7] 5,3 [5,0; 5,7] 5,8 [5,0; 6,6] (80–89) (14 892) (9 844) (6 177) (3 793) (2 175) (1 124) (455) (118) * Käesoleva aruande klassifikatsioonid põhinevad haiglate 2022. aasta kvaliteediaruannetel ja neis loetletud vastavatel esmase puusaliigese endoproteesimise IQTIG kvaliteedinäitajatel. Planeeritud artroplastika puhul on madala juhtumite arvu kategooria piirmäär kuni 200 juhtumit, keskmise kategooria piirmäär 201–500 juhtumit ja kõrge kategooria piirmäär üle 500 vastava protseduuri aastas; mitteelektiveeritud artroplastika puhul on piirmäärad kuni 50, 51–100 ja üle 100 vastava protseduuri aastas. Tabel 45 (jätkub) 66 EPRD 2024. aasta aruanne 67  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus 5.1.3 Implantaadi omaduste mõju EPRD-andmetes kasutatakse puusaliigese asendamisel Pea-kaela pikkusega proteesid – näiteks lühemate joonis 13). Tuleb märkida, et lühikesi varreid esmasel puusaliigese endoproteesimisel endiselt peamiselt kolme erinevat pea suurust: 28 mm, jalgade kompenseerimiseks, mille puhul pöördepunkt eelistatakse peamiselt noorematel ja tervematel Reieluukinnituse valik mõjutab puusaliigese 32 mm ja 36 mm. Kogu EPRD andmete kogumise asub rohkem pea poole – võivad olla algtingimustelt patsientidel. Siiski ei saa lühikeste varte puhul endoproteesimise tulemusi erinevalt konkreetsetes perioodi jooksul on väikeste peade komponentidel oluliselt ebasoodsamad kui muud artroplastikad. täheldatud oluliselt madalamat infektsioonimäära patsientide rühmades. Nooremate patsientide puhul ei kõrgem CRR nii plaaniliste kui ka mitteplaaniliste Samuti on ilmne, et teatud tüvesüsteeme kasutatakse põhjendada ainult patsientide rühmade vaheliste ole tsementeerimata varrega endoproteesimise protseduuride puhul (joonis 11 ja tabel 46). See on sageli koos pikema pea-kaela pikkusega ning see ei too erinevustega [3]. Konkreetsete lühikeste ja tulemused halvemad kui tsementeeritud varrega. tõenäoliselt tingitud suuremate peade väiksemast tingimata kaasa halvemate tulemuste saavutamist. standardvarte süsteemide vahel on suuri üldisi Vanemate patsientide puhul see aga nii ei ole (vt ka nihestumisriskist. Kuigi CRR väheneb pea läbimõõdu tulemuste erinevusi. Mõned standardvarte tabel 45). Kõigi vanuserühmade puhul kokku on suurenemisel, suureneb see pea-kaela pikkuse Analüüsitud perioodi jooksul saavutavad lühikesed komponendid saavutavad näiteks samad tulemused tsementeeritud varte puhul CRR-id madalamad nii suurenemisel (vt joonis 12). Siiski tuleb märkida, et varred paremaid tulemusi kui standardvarred (joonis kui parimad lühikesed varred (vt lisa tabel 63). plaaniliste kui ka mitteplaaniliste puusaliigese juhtudel, kus on pikem proteesimiste korral (vt näiteks joonis 10). 8 © EPRD aastaaruanne 2024 7 Puu 10 6 © EPRD aastaaruanne 2024 s 9 Kumulatiivne revisioon [%] 5 8 7 4 Kumulatiivne revisioon [%] 6 3 5 2 4 3 1 Planeeritud puusaliigese asendused tsementeerimata vartega ja pea-kaela pikkustega XL, XXL ja XXXL Planeeritud puusaliigese asendused tsementeerimata vartega ja pea-kaela pikkusega L 2 0 Planeeritud puusaliigese asendused tsementeerimata varre ja pea-kaela pikkusega M Planeeritud puusaliigese asendused tsementeerimata varre ja pea-kaela pikkusega XS ja 1 S 0 Lõualuu poolartroplastika tsementeerimata vartega Lõualuu poolartroplastika tsementeeritud vartega 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 Aastad alates algkoolist Aastad esmase operatsiooni järel 8 619 4 989 3 486 2 350 1 439 832 18 834 15 413 12 756 10 462 8 206 6 088 4 076 2 380 944 Riskirühm 64 562 35 582 23 562 14 876 9 155 5 275 2 754 1 167 70 924 58 870 49 009 40 506 32 410 24 393 16 722 9 823 4 160 1 125 Ohustatud arvud 153 002 126 291 104 360 85 251 67 101 48 923 32 636 18 526 7 482 2 072 174 736 142 826 116 213 94 132 73 365 52 647 34 228 18 479 7 192 1 966 Joonis 10: Kumulatiivsed revisioonimäärad tsementeerimata ja tsementeeritud puusaliigese hemiartroplastika puhul (p < 0,0001) Joonis 12: Kumulatiivsed revisioonimäärad valikuliste tsementimata varrega puusaliigese täielike proteeside puhul pea-kaela pikkuse järgi (p < 0,0001) 6 © EPRD aastaaruanne 2024 6 5 © EPRD aastaaruanne 2024 5 Kumulatiivne revisioon [%] 4 4 Kumulatiivne revisjon [%] 3 3 2 2 1 Valikulised THA-d tsementeeritud varre ja 28 mm pea suurusega 1 0 Valikulised THA-d tsementeeritud varre ja 32 mm pea suurusega Valikulised THA-d tsementeeritud varre ja 36 mm pea suurusega 0 Planeeritud puusaliigese täielikud endoproteesimised tsementeerimata standardvartega Planeeritud puusaliigese täielikud endoproteesimised 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 tsementeerimata7 lühikeste vartega 8 9 Aastad pärast esmast operatsiooni Aastad alates algkoolist 7 804 6 107 4 864 3 806 2 972 2 207 1 533 904 Ohustatud 351 329 291 156 241 337 198 266 156 325 114 196 76 074 42 924 17 498 4 797 arvud 70 643 58 270 47 956 39 144 30 601 22 169 14 875 8 490 3 632 1 014 Ohustatud arv 58 995 46 222 35 853 27 717 20 951 14 624 9 111 4 661 1 832 582 35 228 27 053 20 885 15 966 11 936 8 246 5 196 2 709 1 074 Joonis 11: Tsementeeritud varrega plaaniliste puusaliigese täielike proteesimiste kumulatiivsed revisioonimäärad pea suuruse järgi (p < 0,0001) Joonis 13: Tsementeerimata varrega valikuliste täielike puusaliigese proteesimiste kumulatiivsed revisioonimäärad varre tüübi järgi (p < 0,0001) 68 EPRD aastaaruanne 2024 69  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Tabel 46 illustreerib seoseid implantaadi omaduste ja kumulatiivse revisioonimäära vahel erinevat tüüpi puusaliigese endoproteesimiste puhul. Lühidalt • Tsementeeritud reieluukomponentidega artroplastikatel on madalamad CRR-id tänu vanemate patsientide parematele tulemustele. • Suuremate proteesipeade puhul on operatsioonijärgse varase perioodi jooksul vähem korduvoperatsioone. Puu s Kumulatiivsed revisioonimäärad pärast ... Artroplastika tüüp Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat artroplastika / Kategooria Valikulised THA-d tsementeerimata vartega 420 224 67 (59–74) 41/59 27,8 762 2,8 [2,7; 2,8] 3,2 [3,1; 3,2] 3,4 [3,4; 3,5] 3,6 [3,5; 3,7] 3,8 [3,7; 3,8] 4,0 [3,9; 4,0] 4,1 [4,1; 4,2] 4,3 [4,2; 4,4] 4,5 [4,4; 4,7] (345 502) (284 035) (231 728) (182 117) (132 732) (88 080) (49 430) (19 866) (5 443) Laager Keraamiline / hXLPE 211 006 67 (59–74) 40/60 27,8 671 2,7 [2,7; 2,8] 3,1 [3,1; 3,2] 3,4 [3,3; 3,5] 3,6 [3,5; 3,7] 3,7 [3,7; 3,8] 3,9 [3,8; 4,0] 4,1 [4,0; 4,2] 4,2 [4,1; 4,3] 4,3 [4,2; 4,5] (172 999) (141 751) (115 181) (90 124) (65 400) (43 349) (24 261) (9 515) (2 536) Keraamiline / hXLPE+antioksüdant 88 165 67 41/59 28,0 478 2,7 [2,6; 2,8] 3,0 [2,9; 3,1] 3,2 [3,1; 3,3] 3,3 [3,2; 3,5] 3,5 [3,3; 3,6] 3,6 [3,4; 3,7] 3,7 [3,5; 3,8] 3,8 [3,6; 3,9] 3,9 [3,5; 4,3] (60–74) (69 418) (54 338) (42 542) (31 885) (21 450) (12 540) (5 742) (1 651) (292) Keraamika / keraamika 44 050 62 (55–69) 43/57 27,7 407 2,1 [2,0; 2,3] 2,5 [2,4; 2,7] 2,7 [2,6; 2,9] 2,9 [2,7; 3,1] 3,0 [2,8; 3,2] 3,2 [3,0; 3,4] 3,4 [3,2; 3,6] 3,5 [3,3; 3,7] 3,6 [3,3; 3,8] (37 672) (31 789) (26 479) (21 480) (16 406) (11 654) (7 163) (3 233) (1 013) Keraamiline / mXLPE 32 039 70 41/59 27,8 282 2,7 [2,5; 2,9] 3,2 [3,0; 3,4] 3,5 [3,3; 3,8] 3,8 [3,6; 4,1] 4,0 [3,7; 4,2] 4,2 [3,9; 4,4] 4,4 [4,1; 4,6] 4,8 [4,4; 5,2] 5,1 [4,6; 5,5] (63–77) (27 525) (23 476) (19 779) (15 711) (11 934) (8 316) (4 748) (1 957) (582) Keraamika / PE 17 111 72 (64–78) 34/66 27,9 491 3,5 [3,2; 3,7] 4,1 [3,8; 4,4] 4,5 [4,2; 4,8] 4,8 [4,5; 5,1] 5,0 [4,7; 5,4] 5,3 [4,9; 5,6] 5,6 [5,2; 6,0] 6,0 [5,5; 6,4] 6,5 [5,9; 7,1] (15 207) (13 667) (12 130) (10 512) (8 587) (6 537) (4 373) (2 211) (701) Keraamiline metall / hXLPE 11 663 67 41/59 28,1 131 2,7 [2,4; 3,0] 2,9 [2,6; 3,2] 3,1 [2,8; 3,5] 3,4 [3,0; 3,7] 3,6 [3,2; 4,0] 3,8 [3,4; 4,3] 4,5 [3,8; 5,1] 5,3 [3,9; 6,7] (59–74) (9 325) (7 578) (5 941) (4 478) (2 918) (1 559) (616) (117) Metall / hXLPE 8 673 74 (65–79) 42/58 27,7 396 4,1 [3,6; 4,5] 4,3 [3,9; 4,7] 4,6 [4,2; 5,1] 4,9 [4,4; 5,4] 5,1 [4,6; 5,6] 5,3 [4,8; 5,9] 5,6 [5,0; 6,2] 6,0 [5,3; 6,7] 6,3 [5,4; 7,2] (7 208) (6 120) (5 068) (4 068) (3 064) (2 097) (1 218) (505) (113) metall / mXLPE 2 765 75 36/64 27,5 172 4,9 [4,1; 5,7] 5,5 [4,6; 6,4] 5,7 [4,8; 6,6] 5,9 [5,0; 6,8] 6,0 [5,1; 7,0] 6,3 [5,3; 7,3] 6,4 [5,4; 7,4] 6,4 [5,4; 7,4] 6,8 [5,6; 8,0] (68–80) (2 339) (2 074) (1 839) (1 566) (1 235) (908) (618) (356) (93) Metall / hXLPE+antioksüdant 1 668 76 (69–81) 36/64 27,5 259 6,4 [5,2; 7,5] 6,9 [5,7; 8,2] 7,2 [5,9; 8,5] 7,4 [6,0; 8,7] 7,4 [6,0; 8,7] 7,6 [6,2; 9,0] 8,0 [6,4; 9,5] 8,0 [6,4; 9,5] (1 262) (1 016) (834) (656) (481) (286) (159) (71) Metall / PE 1 484 77 32/68 27,0 284 6,1 [4,8; 7,3] 6,2 [4,9; 7,4] 6,4 [5,1; 7,7] 6,8 [5,4; 8,1] 7,2 [5,8; 8,6] 7,9 [6,4; 9,5] 8,2 [6,6; 9,8] 9,5 [7,3; 11,7] (71–82) (1 195) (1 062) (957) (828) (672) (458) (301) (143) Keraamilise kattega metall / PE 1 039 73 (65–79) 34/66 28,0 62 3,7 [2,5; 4,8] 4,5 [3,2; 5,8] 4,8 [3,4; 6,1] 5,1 [3,7; 6,5] 5,1 [3,7; 6,5] 5,1 [3,7; 6,5] 5,6 [3,9; 7,3] (880) (754) (641) (533) (381) (204) (93) Lülisamba liigespind hXLPE 231 348 67 40/60 27,9 680 2,8 [2,7; 2,9] 3,2 [3,1; 3,2] 3,4 [3,4; 3,5] 3,6 [3,5; 3,7] 3,8 [3,7; 3,9] 4,0 [3,9; 4,1] 4,2 [4,1; 4,3] 4,3 [4,2; 4,4] 4,4 [4,3; 4,6] (60–74) (189 538) (155 453) (126 193) (98 673) (71 385) (47 008) (26 097) (10 137) (2 664) hXLPE + antioksüdant 89 895 67 (60–75) 41/59 28,0 517 2,7 [2,6; 2,8] 3,1 [3,0; 3,2] 3,3 [3,2; 3,4] 3,4 [3,3; 3,5] 3,6 [3,4; 3,7] 3,7 [3,5; 3,8] 3,8 [3,6; 3,9] 3,8 [3,7; 4,0] 4,0 [3,6; 4,4] (70 730) (55 396) (43 414) (32 573) (21 953) (12 842) (5 906) (1 723) (308) Keraamika 44 055 62 43/57 27,7 408 2,1 [2,0; 2,3] 2,5 [2,4; 2,7] 2,7 [2,6; 2,9] 2,9 [2,7; 3,1] 3,0 [2,8; 3,2] 3,2 [3,0; 3,4] 3,4 [3,2; 3,6] 3,5 [3,3; 3,7] 3,6 [3,3; 3,8] (55–69) (37 675) (31 792) (26 482) (21 483) (16 408) (11 655) (7 164) (3 233) (1 013) mXLPE 34 829 71 (63–77) 41/59 27,8 304 2,9 [2,7; 3,0] 3,4 [3,2; 3,5] 3,7 [3,5; 3,9] 4,0 [3,8; 4,2] 4,1 [3,9; 4,4] 4,4 [4,1; 4,6] 4,5 [4,3; 4,8] 4,9 [4,6; 5,2] 5,2 [4,7; 5,6] (29 887) (25 571) (21 634) (17 289) (13 171) (9 224) (5 366) (2 313) (675) PE 19 635 73 34/66 27,8 546 3,7 [3,4; 3,9] 4,2 [4,0; 4,5] 4,6 [4,3; 4,9] 5,0 [4,6; 5,3] 5,2 [4,9; 5,5] 5,5 [5,1; 5,8] 5,8 [5,4; 6,2] 6,2 [5,8; 6,6] 6,8 [6,2; 7,4] (64–78) (17 283) (15 484) (13 729) (11 874) (9 641) (7 200) (4 768) (2 367) (740) Tabel 46: Esmase puusaliigese endoproteesimise erinevate tüüpide ja omaduste kumulatiivsed revisioonimäärad 70 EPRD aastaaruanne 2024 71  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Kumulatiivsed revisioonimäärad pärast ... Artroplastika tüüp Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat / Kategooria Peakomponent Keraamika 392 789 67 (59–74) 41/59 27,8 758 2,7 [2,6; 2,7] 3,1 [3,0; 3,1] 3,3 [3,3; 3,4] 3,5 [3,5; 3,6] 3,7 [3,6; 3,8] 3,9 [3,8; 3,9] 4,1 [4,0; 4,1] 4,2 [4,1; 4,3] 4,4 [4,3; 4,5] (323 179) (265 338) (216 376) (169 930) (123 946) (82 543) (46 412) (18 660) (5 167) metall 14 631 75 39/61 27,6 593 4,7 [4,3; 5,0] 5,0 [4,7; 5,4] 5,3 [4,9; 5,7] 5,6 [5,2; 6,0] 5,8 [5,4; 6,2] 6,1 [5,6; 6,5] 6,3 [5,9; 6,8] 6,7 [6,1; 7,2] 7,1 [6,4; 7,8] (67–80) (12 034) (10 295) (8 710) (7 126) (5 458) (3 753) (2 300) (1 075) (261) Keraamiline metall 12 797 67 (60–75) 40/60 28,1 135 2,8 [2,5; 3,1] 3,1 [2,8; 3,4] 3,3 [3,0; 3,6] 3,5 [3,2; 3,9] 3,8 [3,4; 4,1] 4,0 [3,5; 4,4] 4,5 [3,9; 5,2] 5,3 [4,1; 6,5] (10 282) (8 397) (6 638) (5 057) (3 324) (1 780) (715) (131) Pea suurus 22 mm 332 64,5 9/91 26,0 127 9,1 [5,9; 12,2] 9,1 [5,9; 12,2] 9,1 [5,9; 12,2] 9,1 [5,9; 12,2] 9,1 [5,9; 12,2] (49–76) (225) (154) (114) (81) (63) 28 mm 20 754 67 (58–75) 11/89 27,3 663 3,4 [3,2; 3,7] 3,8 [3,5; 4,1] 4,1 [3,8; 4,4] 4,3 [4,1; 4,6] 4,4 [4,1; 4,7] 4,6 [4,3; 4,9] 4,7 [4,4; 5,0] 5,0 [4,6; 5,4] 5,2 [4,8; 5,7] (17 728) (15 208) (12 848) (10 529) (8 090) (5 743) (3 467) (1 485) (390) 32 mm 220 657 67 31/69 27,7 760 2,8 [2,7; 2,8] 3,2 [3,1; 3,3] 3,4 [3,4; 3,5] 3,6 [3,5; 3,7] 3,8 [3,7; 3,9] 4,0 [3,9; 4,1] 4,2 [4,1; 4,3] 4,4 [4,3; 4,5] 4,6 [4,5; 4,8] (60–75) (184 863) (155 239) (128 839) (102 385) (75 286) (50 134) (28 091) (11 516) (3 192) Puu 36 mm 178 040 66 (59–74) 56/44 28,1 692 2,6 [2,6; 2,7] 3,0 [3,0; 3,1] 3,3 [3,2; 3,4] 3,5 [3,4; 3,6] 3,6 [3,5; 3,7] 3,8 [3,7; 3,9] 4,0 [3,9; 4,1] 4,1 [4,0; 4,3] 4,3 [4,1; 4,4] s (142 302) (113 104) (89 657) (68 901) (49 129) (32 042) (17 790) (6 837) (1 856) Pea-kaela pikkus XS 3 258 70 31/69 27,4 88 2,8 [2,2; 3,3] 3,2 [2,6; 3,8] 3,5 [2,8; 4,1] 3,7 [3,0; 4,4] 3,7 [3,0; 4,5] 4,0 [3,2; 4,8] 4,0 [3,2; 4,8] 4,0 [3,2; 4,8] (62–76) (2 633) (2 160) (1 739) (1 307) (874) (535) (325) (130) S 171 478 68 (60–75) 33/67 27,5 750 2,4 [2,3; 2,5] 2,8 [2,7; 2,8] 3,0 [2,9; 3,1] 3,2 [3,1; 3,3] 3,4 [3,3; 3,4] 3,5 [3,4; 3,6] 3,7 [3,6; 3,8] 3,9 [3,7; 4,0] 4,0 [3,8; 4,2] (140 193) (114 053) (92 393) (72 058) (51 773) (33 693) (18 154) (7 062) (1 945) M 153 002 67 42/58 28,0 758 2,7 [2,7; 2,8] 3,1 [3,1; 3,2] 3,4 [3,3; 3,5] 3,6 [3,5; 3,7] 3,7 [3,6; 3,8] 3,9 [3,8; 4,0] 4,1 [3,9; 4,2] 4,2 [4,1; 4,3] 4,5 [4,3; 4,7] (59–74) (126 291) (104 360) (85 251) (67 101) (48 923) (32 636) (18 526) (7 482) (2 072) L 70 924 66 (59–74) 50/50 28,4 747 3,2 [3,1; 3,3] 3,6 [3,5; 3,8] 3,9 [3,8; 4,1] 4,1 [4,0; 4,3] 4,3 [4,1; 4,4] 4,5 [4,3; 4,7] 4,7 [4,6; 4,9] 5,1 [4,8; 5,3] 5,2 [5,0; 5,5] (58 870) (49 009) (40 506) (32 410) (24 393) (16 722) (9 823) (4 160) (1 125) XL 17 137 66 57/43 28,7 673 4,0 [3,7; 4,3] 4,4 [4,1; 4,8] 4,8 [4,5; 5,1] 5,1 [4,7; 5,4] 5,4 [5,0; 5,8] 5,7 [5,3; 6,1] 6,0 [5,5; 6,4] 6,1 [5,6; 6,6] 6,1 [5,6; 6,6] (58–73) (14 006) (11 563) (9 445) (7 388) (5 456) (3 620) (2 110) (822) (235) XXL 1 652 67 (59–74) 62/38 28,7 262 5,2 [4,1; 6,3] 5,7 [4,6; 6,8] 5,9 [4,7; 7,0] 6,1 [4,9; 7,3] 6,6 [5,3; 7,9] 6,8 [5,4; 8,1] 7,2 [5,8; 8,7] 7,7 [6,0; 9,4] (1 367) (1 155) (981) (784) (600) (426) (247) (110) Kupitüüp Modulaarne tass 386 520 67 41/59 27,8 758 2,7 [2,7; 2,8] 3,1 [3,1; 3,2] 3,4 [3,3; 3,5] 3,6 [3,5; 3,7] 3,8 [3,7; 3,8] 3,9 [3,9; 4,0] 4,1 [4,1; 4,2] 4,3 [4,2; 4,4] 4,5 [4,4; 4,6] (59–74) (318 743) (262 707) (214 918) (169 313) (123 700) (82 272) (46 302) (18 614) (5 084) Monoblokk-kauss 27 805 68 (60–76) 40/60 27,8 528 2,3 [2,1; 2,4] 2,6 [2,4; 2,7] 2,7 [2,5; 2,9] 2,9 [2,7; 3,1] 3,1 [2,8; 3,3] 3,2 [2,9; 3,4] 3,3 [3,0; 3,6] 3,5 [3,1; 3,8] 3,9 [3,3; 4,5] (22 453) (18 043) (14 315) (10 939) (7 717) (4 972) (2 668) (1 070) (302) Revisioonikauss 3 168 64 32/68 27,1 356 6,7 [5,8; 7,5] 7,7 [6,7; 8,6] 8,2 [7,2; 9,2] 8,4 [7,4; 9,4] 8,8 [7,7; 9,9] 9,1 [8,0; 10,3] 9,1 [8,0; 10,3] 9,1 [8,0; 10,3] (55–73) (2 474) (2 043) (1 672) (1 319) (990) (653) (361) (153) Kahepoolne liikuvus 2 600 72 (63–80) 36/64 27,7 327 5,5 [4,6; 6,4] 6,2 [5,2; 7,1] 6,7 [5,6; 7,8] 6,8 [5,7; 7,9] 6,8 [5,7; 7,9] 7,7 [6,1; 9,4] 8,4 [6,3; 10,5] (1 751) (1 198) (805) (539) (325) (183) (99) Varre tüüp Reieluuvars modulaarse peaga 351 329 68 40/60 27,9 760 2,8 [2,8; 2,9] 3,2 [3,2; 3,3] 3,5 [3,5; 3,6] 3,7 [3,6; 3,8] 3,9 [3,8; 3,9] 4,1 [4,0; 4,1] 4,3 [4,2; 4,3] 4,5 [4,4; 4,6] 4,7 [4,6; 4,8] (60–75) (291 156) (241 337) (198 266) (156 325) (114 196) (76 074) (42 924) (17 498) (4 797) Lühike vars 58 995 62 (56–70) 44/56 27,8 428 2,1 [1,9; 2,2] 2,4 [2,3; 2,5] 2,6 [2,4; 2,7] 2,7 [2,6; 2,8] 2,9 [2,7; 3,0] 3,0 [2,8; 3,2] 3,1 [2,9; 3,3] 3,1 [2,9; 3,3] 3,2 [2,9; 3,4] (46 222) (35 853) (27 717) (20 951) (14 624) (9 111) (4 661) (1 832) (582) Reieluukaela protees 6 290 60 46/54 27,6 124 2,2 [1,9; 2,6] 2,6 [2,2; 3,0] 2,8 [2,4; 3,2] 3,1 [2,6; 3,5] 3,2 [2,7; 3,7] 3,3 [2,8; 3,8] 3,6 [3,1; 4,2] 3,8 [3,1; 4,5] (54–67) (5 361) (4 535) (3 796) (3 191) (2 592) (1 887) (1 239) (380) Modulaarne vars 1 909 69 (61–76) 37/63 27,6 124 4,2 [3,2; 5,1] 4,8 [3,8; 5,8] 5,1 [4,1; 6,2] 5,5 [4,4; 6,5] 5,8 [4,6; 6,9] 6,2 [5,0; 7,3] 6,4 [5,2; 7,7] 6,4 [5,2; 7,7] (1 616) (1 426) (1 256) (1 112) (946) (790) (483) (109) Revisioon või kasvaja eemaldamine 1 540 74 37/63 26,4 406 11,5 [9,8; 13,1] 12,7 [11,0; 14,5] 13,0 [11,2; 14,7] 13,1 [11,3; 14,9] 14,2 [12,2; 16,2] 14,2 [12,2; 16,2] 14,2 [12,2; 16,2] (63–81) (1 088) (850) (660) (505) (348) (202) (116) Rekonstruktsioonikest Ilma rekonstruktsioonikestata 419 713 67 (59–74) 41/59 27,8 762 2,7 [2,7; 2,8] 3,1 [3,1; 3,2] 3,4 [3,3; 3,5] 3,6 [3,5; 3,6] 3,8 [3,7; 3,8] 3,9 [3,9; 4,0] 4,1 [4,1; 4,2] 4,3 [4,2; 4,4] 4,5 [4,4; 4,6] (345 122) (283 711) (231 462) (181 902) (132 568) (87 975) (49 372) (19 847) (5 437) Rekonstruktsioonikestaga 511 70 35/65 26,1 221 10,1 [7,4; 12,7] 11,6 [8,7; 14,4] 13,1 [9,9; 16,1] 14,5 [11,1; 17,8] 15,3 [11,7; 18,8] 15,9 [12,2; 19,5] 15,9 [12,2; 19,5] (60–78) (380) (324) (266) (215) (164) (105) (58) Kinnitus Tsementeerimata 414 462 67 (59–74) 41/59 27,8 762 2,7 [2,7; 2,8] 3,1 [3,1; 3,2] 3,4 [3,3; 3,4] 3,6 [3,5; 3,6] 3,7 [3,7; 3,8] 3,9 [3,8; 4,0] 4,1 [4,0; 4,2] 4,3 [4,2; 4,4] 4,5 [4,4; 4,6] (340 917) (280 292) (228 712) (179 758) (131 011) (86 949) (48 812) (19 642) (5 387) Pöördhübriid 5 618 74 25/75 27,0 567 5,4 [4,8; 6,0] 6,0 [5,4; 6,7] 6,6 [6,0; 7,3] 6,9 [6,2; 7,6] 7,3 [6,6; 8,1] 7,6 [6,8; 8,4] 7,7 [6,9; 8,5] 8,1 [7,1; 9,1] 8,1 [7,1; 9,1] (66–80) (4 479) (3 659) (2 963) (2 324) (1 697) (1 117) (611) (223) (56) Valikulised tsementeeritud varrega puusaliigesed 115 036 79 (75–83) 25/75 26,5 735 2,4 [2,3; 2,5] 2,7 [2,6; 2,8] 2,9 [2,8; 3,0] 3,2 [3,0; 3,3] 3,4 [3,3; 3,5] 3,6 [3,5; 3,7] 3,9 [3,7; 4,0] 4,1 [3,9; 4,3] 4,3 [4,0; 4,5] (92 529) (74 629) (59 684) (46 133) (33 074) (21 880) (12 240) (5 139) (1 402) Laager Keraamiline / hXLPE 55 408 78 (74–82) 24/76 26,6 575 2,1 [2,0; 2,2] 2,4 [2,3; 2,5] 2,6 [2,5; 2,8] 2,8 [2,7; 3,0] 3,0 [2,9; 3,2] 3,2 [3,0; 3,3] 3,4 [3,2; 3,6] 3,6 [3,4; 3,9] 3,6 [3,4; 3,9] (44 407) (34 961) (27 280) (20 524) (14 271) (9 177) (4 918) (2 051) (641) Tabel 46 (jätkub) 72 EPRD 2024. aasta aruanne 73  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Kumulatiivsed korrigeerimismäärad pärast ... Artroplastika tüüp Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat / Kategooria Laager Keraamiline / PE 12 721 79 23/77 26,6 476 2,4 [2,1; 2,6] 2,8 [2,5; 3,1] 3,0 [2,7; 3,3] 3,2 [2,9; 3,5] 3,4 [3,0; 3,7] 3,7 [3,4; 4,1] 3,9 [3,5; 4,3] 4,3 [3,8; 4,8] 4,6 [3,9; 5,3] (75–83) (10 963) (9 574) (8 258) (6 917) (5 473) (4 050) (2 553) (1 188) (344) Metall / hXLPE 12 253 81 (77–84) 27/73 26,4 400 2,8 [2,5; 3,1] 3,1 [2,8; 3,4] 3,2 [2,9; 3,6] 3,4 [3,1; 3,8] 3,6 [3,3; 4,0] 4,1 [3,6; 4,5] 4,3 [3,8; 4,8] 4,4 [3,8; 4,9] 4,4 [3,8; 4,9] (9 809) (8 052) (6 532) (5 060) (3 633) (2 275) (1 209) (496) (100) Keraamiline / hXLPE+antioksüdant 11 550 79 21/79 26,5 345 2,3 [2,0; 2,6] 2,6 [2,3; 2,9] 2,9 [2,6; 3,2] 3,1 [2,7; 3,5] 3,4 [3,0; 3,8] 3,6 [3,2; 4,1] 4,0 [3,4; 4,5] 4,0 [3,4; 4,5] (75–83) (8 659) (6 625) (5 084) (3 740) (2 358) (1 349) (630) (222) Metall / PE 7 453 81 (78–84) 25/75 26,3 421 3,3 [2,9; 3,7] 3,6 [3,2; 4,0] 3,8 [3,4; 4,3] 4,1 [3,6; 4,6] 4,3 [3,8; 4,8] 4,4 [3,9; 5,0] 4,8 [4,2; 5,4] 5,4 [4,7; 6,2] 5,4 [4,7; 6,2] (6 174) (5 290) (4 474) (3 622) (2 732) (1 904) (1 141) (503) (104) Keraamiline / mXLPE 6 202 79 23/77 26,3 198 2,7 [2,3; 3,1] 3,1 [2,6; 3,5] 3,4 [2,9; 3,8] 3,7 [3,2; 4,2] 4,1 [3,5; 4,7] 4,3 [3,7; 5,0] 4,5 [3,8; 5,2] 4,5 [3,8; 5,2] 4,5 [3,8; 5,2] (75–82) (5 081) (4 072) (3 193) (2 393) (1 764) (1 206) (748) (321) (89) metall / mXLPE 2 417 81 (78–85) 24/76 26,0 177 3,6 [2,8; 4,3] 3,8 [3,0; 4,6] 4,4 [3,6; 5,3] 4,9 [4,0; 5,8] 5,5 [4,5; 6,6] 5,7 [4,6; 6,8] 6,1 [4,8; 7,3] 6,4 [5,0; 7,8] (2 018) (1 731) (1 414) (1 092) (799) (565) (325) (130) Puu Metall / hXLPE+antioksüdant 2 175 81 3,6 [2,8; 4,4] 4,2 [3,3; 5,1] 4,4 [3,4; 5,3] 4,5 [3,5; 5,5] 4,5 [3,5; 5,5] 4,5 [3,5; 5,5] 5,8 [3,7; 7,8] s (77–84) 26/74 25,9 259 (1 530) (1 127) (802) (582) (383) (223) (120) Keraamika / keraamika 1 826 76 (71–80) 23/77 26,9 133 1,2 [0,7; 1,7] 1,4 [0,8; 1,9] 1,5 [0,9; 2,1] 1,8 [1,2; 2,5] 2,5 [1,7; 3,4] 2,8 [1,9; 3,8] 3,2 [2,1; 4,3] 3,2 [2,1; 4,3] (1 501) (1 277) (1 134) (980) (776) (610) (368) (137) Keraamiline metall / hXLPE 1 116 79 24/76 26,6 56 2,1 [1,3; 3,0] 2,6 [1,6; 3,6] 2,6 [1,6; 3,6] 3,2 [1,9; 4,6] 3,2 [1,9; 4,6] 3,2 [1,9; 4,6] (75–83) (762) (531) (352) (272) (189) (90) Metall/metall 829 56 (51–61) 94/6 28,1 33 1,0 [0,3; 1,6] 1,5 [0,7; 2,4] 2,2 [1,1; 3,2] 2,5 [1,3; 3,6] 2,5 [1,3; 3,6] 2,8 [1,5; 4,2] 3,7 [1,9; 5,5] (740) (670) (595) (509) (389) (243) (127) Keraamiline metall / PE 429 81 20/80 26,3 37 3,3 [1,6; 5,0] 4,3 [2,2; 6,3] 4,3 [2,2; 6,3] 4,3 [2,2; 6,3] 4,3 [2,2; 6,3] 4,3 [2,2; 6,3] (77–83) (347) (282) (224) (179) (141) (98) Lülisamba liigespind hXLPE 68 777 79 (75–82) 25/75 26,6 609 2,2 [2,1; 2,3] 2,5 [2,4; 2,6] 2,7 [2,6; 2,9] 2,9 [2,8; 3,1] 3,1 [3,0; 3,3] 3,3 [3,2; 3,5] 3,6 [3,4; 3,8] 3,8 [3,5; 4,0] 3,8 [3,5; 4,0] (54 978) (43 544) (34 164) (25 856) (18 093) (11 542) (6 147) (2 554) (744) PE 20 604 80 24/76 26,5 558 2,7 [2,5; 2,9] 3,1 [2,9; 3,3] 3,3 [3,1; 3,6] 3,6 [3,3; 3,8] 3,7 [3,5; 4,0] 4,0 [3,7; 4,3] 4,3 [3,9; 4,6] 4,7 [4,3; 5,1] 4,9 [4,4; 5,5] (76–83) (17 485) (15 147) (12 957) (10 719) (8 347) (6 053) (3 726) (1 696) (448) hXLPE + antioksüdant 13 736 80 (75–83) 22/78 26,4 425 2,5 [2,3; 2,8] 2,8 [2,5; 3,1] 3,1 [2,8; 3,5] 3,3 [3,0; 3,7] 3,6 [3,2; 4,0] 3,8 [3,4; 4,2] 4,3 [3,7; 4,9] 4,3 [3,7; 4,9] 6,0 [2,5; 9,3] (10 197) (7 758) (5 889) (4 325) (2 743) (1 572) (750) (254) (51) mXLPE 8 620 80 23/77 26,3 253 2,9 [2,6; 3,3] 3,3 [2,9; 3,7] 3,7 [3,3; 4,1] 4,1 [3,6; 4,5] 4,5 [4,0; 5,0] 4,7 [4,2; 5,3] 5,0 [4,4; 5,6] 5,1 [4,4; 5,7] 5,1 [4,4; 5,7] (75–83) (7 100) (5 804) (4 608) (3 485) (2 563) (1 771) (1 073) (451) (130) Keraamika 1 827 76 (71–80) 23/77 26,9 134 1,2 [0,7; 1,7] 1,4 [0,8; 1,9] 1,5 [0,9; 2,0] 1,8 [1,2; 2,5] 2,5 [1,7; 3,4] 2,8 [1,9; 3,8] 3,2 [2,1; 4,3] 3,2 [2,1; 4,3] (1 501) (1 277) (1 134) (980) (776) (610) (368) (137) metall 829 56 94/6 28,1 33 1,0 [0,3; 1,6] 1,5 [0,7; 2,4] 2,2 [1,1; 3,2] 2,5 [1,3; 3,6] 2,5 [1,3; 3,6] 2,8 [1,5; 4,2] 3,7 [1,9; 5,5] (51–61) (740) (670) (595) (509) (389) (243) (127) Peakomponent Keraamika 88 037 79 (74–82) 24/76 26,6 712 2,2 [2,1; 2,3] 2,5 [2,4; 2,6] 2,7 [2,6; 2,9] 3,0 [2,8; 3,1] 3,2 [3,1; 3,3] 3,4 [3,3; 3,6] 3,6 [3,5; 3,8] 3,9 [3,7; 4,1] 4,0 [3,7; 4,3] (70 885) (56 736) (45 128) (34 696) (24 743) (16 448) (9 250) (3 927) (1 141) metall 25 439 81 28/72 26,4 616 3,0 [2,8; 3,2] 3,3 [3,1; 3,6] 3,6 [3,4; 3,8] 3,8 [3,6; 4,1] 4,1 [3,8; 4,3] 4,3 [4,0; 4,6] 4,7 [4,3; 5,0] 5,0 [4,6; 5,4] 5,0 [4,6; 5,4] (77–84) (20 525) (17 072) (13 975) (10 982) (7 998) (5 243) (2 938) (1 200) (258) Keraamiline metall 1 559 80 (76–83) 23/77 26,6 68 2,6 [1,8; 3,4] 3,2 [2,3; 4,2] 3,2 [2,3; 4,2] 3,6 [2,5; 4,7] 3,6 [2,5; 4,7] 3,6 [2,5; 4,7] 3,6 [2,5; 4,7] (1 118) (820) (580) (454) (332) (188) (52) Pea suurus 22 mm 373 81 5/95 25,5 113 3,7 [1,7; 5,7] 4,7 [2,3; 7,0] 4,7 [2,3; 7,0] 4,7 [2,3; 7,0] (76–84) (237) (154) (92) (59) 28 mm 7 804 79 (75–83) 15/85 26,0 536 3,5 [3,1; 3,9] 3,8 [3,4; 4,2] 4,0 [3,5; 4,4] 4,2 [3,7; 4,7] 4,4 [3,9; 4,9] 4,7 [4,2; 5,3] 4,9 [4,3; 5,5] 5,0 [4,4; 5,7] 5,4 [4,4; 6,4] (6 107) (4 864) (3 806) (2 972) (2 207) (1 533) (904) (391) (81) 32 mm 70 643 79 20/80 26,4 715 2,3 [2,2; 2,4] 2,7 [2,5; 2,8] 2,9 [2,7; 3,0] 3,1 [3,0; 3,2] 3,3 [3,2; 3,5] 3,5 [3,4; 3,7] 3,8 [3,6; 4,0] 4,1 [3,9; 4,3] 4,2 [3,9; 4,5] (75–83) (58 270) (47 956) (39 144) (30 601) (22 169) (14 875) (8 490) (3 632) (1 014) 36 mm 35 228 79 (75–82) 35/65 26,7 596 2,2 [2,1; 2,4] 2,6 [2,4; 2,7] 2,8 [2,6; 3,0] 3,0 [2,8; 3,2] 3,3 [3,1; 3,5] 3,6 [3,3; 3,8] 3,8 [3,5; 4,1] 3,9 [3,6; 4,2] 4,2 [3,5; 4,9] (27 053) (20 885) (15 966) (11 936) (8 246) (5 196) (2 709) (1 074) (303) Pea-kaela pikkus XS 512 80 20/80 25,9 52 1,6 [0,5; 2,7] 2,0 [0,8; 3,3] 2,0 [0,8; 3,3] 2,0 [0,8; 3,3] 2,5 [0,9; 4,1] 2,5 [0,9; 4,1] 2,5 [0,9; 4,1] (76–83) (445) (377) (318) (255) (181) (102) (50) S 40 148 79 (75–83) 17/83 26,2 691 2,0 [1,8; 2,1] 2,3 [2,1; 2,4] 2,4 [2,3; 2,6] 2,6 [2,5; 2,8] 2,8 [2,6; 3,0] 3,1 [2,8; 3,3] 3,3 [3,1; 3,6] 3,3 [3,1; 3,6] 3,3 [3,1; 3,6] (31 840) (25 021) (19 549) (14 743) (10 209) (6 640) (3 572) (1 476) (410) M 44 536 79 24/76 26,6 709 2,2 [2,1; 2,4] 2,5 [2,4; 2,7] 2,8 [2,6; 3,0] 3,0 [2,8; 3,2] 3,2 [3,0; 3,4] 3,4 [3,2; 3,6] 3,7 [3,5; 3,9] 4,0 [3,7; 4,3] 4,3 [3,9; 4,8] (75–82) (36 167) (29 287) (23 405) (18 172) (13 184) (8 855) (5 044) (2 124) (631) L 21 015 79 (75–82) 32/68 26,9 665 2,9 [2,7; 3,2] 3,3 [3,1; 3,6] 3,6 [3,3; 3,8] 3,8 [3,5; 4,1] 4,1 [3,8; 4,4] 4,3 [3,9; 4,6] 4,5 [4,2; 4,9] 4,9 [4,4; 5,3] 4,9 [4,4; 5,3] (17 070) (14 155) (11 627) (9 254) (6 835) (4 603) (2 614) (1 092) (272) Tabel 46 (jätkub) 74 EPRD 2024. aasta aruanne 75  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Kumulatiivsed korrigeerimismäärad pärast ... Artroplastika tüüp Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat / Kategooria Pea-kaela pikkus XL 4190 79 42/58 27,2 500 3,6 [3,1; 4,2] 4,3 [3,6; 4,9] 4,6 [4,0; 5,3] 5,0 [4,3; 5,8] 5,9 [5,0; 6,7] 6,0 [5,1; 6,9] 6,3 [5,4; 7,3] 6,7 [5,5; 7,9] (74–82) (3 305) (2 691) (2 206) (1 692) (1 225) (768) (420) (170) XXL 429 79 (74–82) 44/56 27,5 169 5,1 [2,9; 7,2] 5,4 [3,2; 7,5] 6,0 [3,6; 8,4] 6,0 [3,6; 8,4] 6,0 [3,6; 8,4] 6,0 [3,6; 8,4] 7,2 [3,9; 10,3] (346) (306) (272) (230) (179) (134) (79) Kupitüüp Modulaarne tass 84 992 79 24/76 26,6 715 2,2 [2,1; 2,3] 2,5 [2,4; 2,6] 2,7 [2,6; 2,9] 2,9 [2,8; 3,1] 3,2 [3,1; 3,3] 3,4 [3,2; 3,5] 3,7 [3,5; 3,8] 3,9 [3,7; 4,1] 4,0 [3,7; 4,3] (75–82) (67 890) (53 984) (42 645) (32 505) (22 973) (14 994) (8 113) (3 330) (875) Monoblokk-kauss 24 769 80 (76–84) 24/76 26,4 598 2,4 [2,2; 2,6] 2,8 [2,6; 3,0] 3,0 [2,8; 3,3] 3,2 [3,0; 3,5] 3,5 [3,2; 3,7] 3,8 [3,5; 4,0] 4,0 [3,7; 4,3] 4,3 [4,0; 4,7] 4,5 [4,0; 4,9] (21 036) (18 010) (15 206) (12 348) (9 267) (6 406) (3 880) (1 709) (507) Kahepoolne liikuvus 3 087 80 26/74 26,0 334 3,9 [3,2; 4,6] 4,1 [3,4; 4,9] 4,4 [3,6; 5,2] 4,9 [4,0; 5,9] 5.1 [4.1; 6.1] 5,4 [4,2; 6,6] 5,4 [4,2; 6,6] (75–84) (2 045) (1 403) (888) (561) (327) (176) (71) Revisioonikauss 1 735 79 (73–83) 30/70 25,7 330 8,1 [6,8; 9,5] 8,8 [7,4; 10,2] 9,4 [7,9; 10,8] 9,8 [8,3; 11,4] 10,3 [8,6; 11,9] 10,9 [9,0; 12,8] 10,9 [9,0; 12,8] 10,9 [9,0; 12,8] (1 179) (908) (674) (498) (341) (194) (115) (54) Puu Pinnakatte vahetus 419 55 1,2 [0,2; 2,3] 1,8 [0,5; 3,2] 2,1 [0,7; 3,6] 2,1 [0,7; 3,6] 2,1 [0,7; 3,6] 2,1 [0,7; 3,6] 3,1 [0,7; 5,4] s (51–59) 99/1 27,6 23 (361) (315) (268) (221) (166) (110) (61) Varre tüüp Reieluuvars modulaarse peaga 112 673 79 (75–83) 24/76 26,5 733 2,3 [2,3; 2,4] 2,7 [2,6; 2,8] 2,9 [2,8; 3,0] 3,1 [3,0; 3,2] 3,4 [3,2; 3,5] 3,6 [3,4; 3,7] 3,8 [3,7; 4,0] 4,1 [3,9; 4,3] 4,2 [4,0; 4,5] (90 820) (73 367) (58 652) (45 312) (32 486) (21 525) (12 065) (5 094) (1 396) Pinna asendamine 829 56 94/6 28,1 33 1,0 [0,3; 1,6] 1,5 [0,7; 2,4] 2,2 [1,1; 3,2] 2,5 [1,3; 3,6] 2,5 [1,3; 3,6] 2,8 [1,5; 4,2] 3,7 [1,9; 5,5] (51–61) (740) (670) (595) (509) (389) (243) (127) Revisioon või kasvaja eemaldamine 578 78 (70–83) 30/70 25,4 203 11,7 [8,9; 14,3] 12,5 [9,6; 15,3] 12,5 [9,6; 15,3] 14,6 [11,1; 18,0] 15,4 [11,5; 19,1] 16,4 [12,1; 20,5] (347) (249) (199) (133) (87) (54) Modulaarne vars 553 80 25/75 27,3 7 1,9 [0,7; 3,0] 2,4 [1,0; 3,7] 3,1 [1,4; 4,7] 3,1 [1,4; 4,7] 3,1 [1,4; 4,7] 3,1 [1,4; 4,7] (77–83) (428) (311) (238) (179) (112) (58) Lühike vars 403 79 (74–83) 20/80 26,1 29 1,6 [0,3; 2,8] (194) Rekonstruktsioonikest Ilma rekonstruktsioonikestata 114 287 79 24/76 26,5 735 2,3 [2,2; 2,4] 2,6 [2,6; 2,7] 2,9 [2,8; 3,0] 3,1 [3,0; 3,2] 3,3 [3,2; 3,5] 3,6 [3,4; 3,7] 3,8 [3,7; 4,0] 4,1 [3,9; 4,3] 4,2 [4,0; 4,5] (75–83) (92 058) (74 274) (59 419) (45 948) (32 944) (21 804) (12 194) (5 115) (1 395) Rekonstruktsioonikestaga 749 79 (74–84) 33/67 24,8 253 10,2 [7,9; 12,5] 11,5 [9,0; 13,9] 12,3 [9,6; 14,8] 12,7 [9,9; 15,3] 12,7 [9,9; 15,3] 13,4 [10,3; 16,3] (471) (355) (265) (185) (130) (76) Fikseerimine Hübriid 90 517 79 25/75 26,6 725 2,2 [2,1; 2,3] 2,5 [2,4; 2,7] 2,8 [2,7; 2,9] 3,0 [2,9; 3,1] 3,2 [3,1; 3,4] 3,4 [3,3; 3,6] 3,7 [3,6; 3,9] 3,9 [3,7; 4,2] 4,1 [3,8; 4,4] (74–82) (72 263) (57 602) (45 584) (34 854) (24 672) (16 076) (8 731) (3 584) (921) Tsementeeritud 24 454 80 (77–84) 23/77 26,3 632 2,8 [2,6; 3,1] 3,3 [3,0; 3,5] 3,5 [3,3; 3,8] 3,8 [3,5; 4,0] 4,0 [3,7; 4,2] 4,2 [3,9; 4,5] 4,5 [4,1; 4,8] 4,8 [4,4; 5,2] 4,9 [4,4; 5,4] (20 226) (17 006) (14 087) (11 274) (8 400) (5 803) (3 509) (1 555) (481) Mittevalikulised puusaliigese asendused 34 964 76 (68–82) 30/70 24,6 707 6,1 [5,8; 6,3] 6,7 [6,4; 6,9] 7,0 [6,7; 7,3] 7,4 [7,1; 7,7] 7,6 [7,3; 8,0] 7,9 [7,6; 8,3] 8,2 [7,8; 8,7] 8,5 [8,0; 8,9] 8,5 [8,0; 8,9] (24 594) (18 634) (13 636) (9 688) (6 362) (3 846) (1 949) (668) (126) Laager Keraamiline / hXLPE 13 142 74 31/69 24,7 530 6,3 [5,9; 6,7] 6,9 [6,5; 7,4] 7,3 [6,8; 7,7] 7,7 [7,2; 8,2] 7,9 [7,3; 8,4] 8,1 [7,5; 8,6] 8,3 [7,7; 8,9] 8,3 [7,7; 8,9] (66–80) (9 304) (6 986) (4 996) (3 470) (2 197) (1 278) (666) (212) Keraamiline / hXLPE+antioksüdant 5 529 74 (67–80) 33/67 24,7 302 6,1 [5,5; 6,8] 6,6 [5,9; 7,3] 6,8 [6,0; 7,5] 7,0 [6,2; 7,7] 7,1 [6,3; 7,8] 7,2 [6,4; 8,1] 7,6 [6,5; 8,7] 7,6 [6,5; 8,7] (3 848) (2 757) (1 927) (1 293) (787) (424) (198) (69) Metall / hXLPE 3 846 79 27/73 24,5 310 5,3 [4,6; 6,0] 5,9 [5,1; 6,7] 6,3 [5,5; 7,2] 6,5 [5,6; 7,3] 6,7 [5,8; 7,6] 7,0 [6,0; 8,1] 7,6 [6,1; 9,0] 7,6 [6,1; 9,0] (74–84) (2 604) (1 979) (1 454) (1 016) (663) (392) (170) (55) Keraamika / PE 3 200 77 (70–83) 26/74 24,5 357 5,6 [4,7; 6,4] 6,2 [5,3; 7,1] 6,5 [5,6; 7,4] 6,9 [5,9; 7,8] 7,3 [6,2; 8,3] 7,6 [6,5; 8,7] 8,5 [7,1; 10,0] 9,2 [7,2; 11,2] (2 339) (1 865) (1 436) (1 105) (801) (550) (295) (104) Metall / PE 2 887 81 25/75 24,4 301 6,4 [5,5; 7,4] 7,1 [6,1; 8,1] 7,7 [6,6; 8,7] 8,0 [6,9; 9,1] 8,5 [7,3; 9,6] 8,7 [7,4; 9,9] 9,0 [7,6; 10,3] 9,9 [7,6; 12,0] (75–86) (1 940) (1 550) (1 204) (903) (620) (382) (195) (79) Keraamiline / mXLPE 2 013 74 (66–79) 35/65 24,9 183 5,8 [4,8; 6,9] 6,2 [5,1; 7,3] 6,9 [5,7; 8,1] 7,6 [6,3; 8,8] 8,0 [6,6; 9,4] 8,2 [6,8; 9,6] 8,2 [6,8; 9,6] 8,2 [6,8; 9,6] (1 570) (1 258) (985) (748) (530) (328) (168) (65) Metall / hXLPE+antioksüdant 1 260 81 32/68 24,5 202 5,5 [4,2; 6,8] 6,0 [4,6; 7,4] 6,2 [4,7; 7,7] 6,6 [4,9; 8,2] 6,6 [4,9; 8,2] (73–86) (767) (508) (312) (172) (83) Keraamika / keraamika 1 192 69 (62–77) 33/67 24,8 155 5,3 [4,0; 6,6] 6,0 [4,6; 7,4] 6,4 [4,9; 7,9] 6,4 [4,9; 7,9] 7,1 [5,4; 8,8] 7,4 [5,7; 9,2] 7,4 [5,7; 9,2] 7,4 [5,7; 9,2] (927) (763) (616) (482) (345) (252) (144) (50) metall / mXLPE 1 059 80 30/70 24,8 128 8,5 [6,7; 10,2] 8,8 [7,0; 10,5] 9,4 [7,5; 11,2] 10,1 [8,0; 12,1] 10,1 [8,0; 12,1] 10,6 [8,3; 12,9] 10,6 [8,3; 12,9] (74–85) (715) (564) (427) (322) (226) (148) (82) Keraamiline metall / hXLPE 470 72 (64–79) 35/65 24,8 49 5,5 [3,4; 7,6] 6,6 [4,1; 8,9] 6,6 [4,1; 8,9] 6,6 [4,1; 8,9] 6,6 [4,1; 8,9] (322) (214) (133) (86) (51) Lülisamba liigespind hXLPE 17 458 75 30/70 24,6 563 6,1 [5,7; 6,4] 6,7 [6,3; 7,1] 7,0 [6,6; 7,4] 7,4 [6,9; 7,8] 7,6 [7,1; 8,0] 7,8 [7,3; 8,3] 8,1 [7,5; 8,6] 8,1 [7,5; 8,6] 8,1 [7,5; 8,6] (67–81) (12 230) (9 179) (6 583) (4 572) (2 911) (1 693) (843) (268) (51) Tabel 46 (jätkub) 76 EPRD 2024. aasta aruanne 77  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Kumulatiivsed korrigeerimismäärad pärast ... Artroplastika tüüp Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat / Kategooria Lõualuu liigespind hXLPE + antioksüdant 6 794 75 (68–82) 32/68 24,7 372 6,1 [5,5; 6,6] 6,5 [5,9; 7,1] 6,7 [6,0; 7,3] 6,9 [6,3; 7,6] 7,0 [6,3; 7,7] 7,2 [6,4; 7,9] 7,7 [6,6; 8,8] 7,7 [6,6; 8,8] (4 617) (3 266) (2 240) (1 466) (871) (468) (214) (75) PE 6 196 79 26/74 24,5 446 6,0 [5,4; 6,6] 6,6 [6,0; 7,3] 7,0 [6,3; 7,7] 7,4 [6,6; 8,1] 7,8 [7,0; 8,6] 8,1 [7,2; 8,9] 8,7 [7,7; 9,8] 9,5 [8,0; 11,0] (73–85) (4 357) (3 474) (2 684) (2 032) (1 435) (939) (491) (183) mXLPE 3 073 76 (68–81) 33/67 24,9 216 6,7 [5,8; 7,6] 7,1 [6,2; 8,0] 7,8 [6,7; 8,8] 8,4 [7,3; 9,5] 8,7 [7,6; 9,9] 9,0 [7,8; 10,3] 9,0 [7,8; 10,3] 9,0 [7,8; 10,3] (2 286) (1 823) (1 413) (1 070) (756) (476) (250) (89) Keraamika 1 194 69 33/67 24,8 156 5,3 [4,0; 6,6] 6,0 [4,6; 7,4] 6,4 [4,9; 7,9] 6,4 [4,9; 7,9] 7,1 [5,4; 8,8] 7,4 [5,6; 9,2] 7,4 [5,6; 9,2] 7,4 [5,6; 9,2] (62–77) (929) (764) (617) (482) (345) (252) (144) (50) Peakomponent Keraamika 25 246 74 (67–80) 31/69 24,7 692 6,1 [5,8; 6,4] 6,6 [6,3; 7,0] 7,0 [6,7; 7,3] 7,3 [7,0; 7,7] 7,6 [7,2; 8,0] 7,9 [7,5; 8,3] 8,2 [7,7; 8,7] 8,3 [7,8; 8,9] 8,3 [7,8; 8,9] (18 110) (13 721) (10 030) (7 148) (4 697) (2 849) (1 477) (503) (95) metall 9 133 80 27/73 24,5 510 6,1 [5,6; 6,6] 6,7 [6,2; 7,2] 7,2 [6,6; 7,7] 7,5 [6,9; 8,1] 7,7 [7,1; 8,4] 8,1 [7,4; 8,8] 8,5 [7,6; 9,3] 8,9 [7,7; 10,0] (74–85) (6 081) (4 638) (3 427) (2 429) (1 599) (966) (464) (164) Puu Keraamiline metall 584 72 (65–80) 35/65 24,7 58 5,9 [3,9; 7,9] 6,7 [4,5; 8,8] 6,7 [4,5; 8,8] 6,7 [4,5; 8,8] 6,7 [4,5; 8,8] s (402) (274) (178) (110) (65) Pea suurus 22 mm 300 81 7/93 24,0 85 6,0 [3,1; 8,8] 6,6 [3,4; 9,6] 6,6 [3,4; 9,6] (72–86) (173) (100) (52) 28 mm 4 112 78 (70–84) 20/80 24,1 488 6,6 [5,8; 7,4] 7,2 [6,3; 8,0] 7,6 [6,7; 8,5] 8,3 [7,3; 9,2] 8,4 [7,4; 9,4] 8,5 [7,5; 9,6] 9,1 [7,8; 10,4] 9,1 [7,8; 10,4] (2 652) (1 957) (1 423) (998) (634) (399) (213) (100) 32 mm 18 638 76 24/76 24,5 673 6,0 [5,6; 6,3] 6,5 [6,2; 6,9] 6,9 [6,5; 7,2] 7,1 [6,7; 7,5] 7,4 [7,0; 7,8] 7,7 [7,2; 8,2] 8,0 [7,4; 8,5] 8,3 [7,6; 9,0] 8,3 [7,6; 9,0] (68–82) (13 632) (10 743) (8 100) (5 929) (3 996) (2 482) (1 288) (418) (77) 36 mm 11 793 75 (67–81) 44/56 24,9 537 6,1 [5,6; 6,5] 6,7 [6,2; 7,2] 7,1 [6,6; 7,6] 7,6 [7,0; 8,1] 7,9 [7,3; 8,4] 8,1 [7,4; 8,7] 8,5 [7,7; 9,3] 8,5 [7,7; 9,3] (8 045) (5 770) (4 015) (2 709) (1 707) (954) (442) (149) Pea-kaela pikkus S 9 527 76 24/76 24,3 623 5,5 [5,0; 6,0] 5,9 [5,4; 6,4] 6,2 [5,7; 6,8] 6,5 [5,9; 7,0] 6,7 [6,1; 7,3] 6,8 [6,2; 7,4] 6,9 [6,3; 7,5] 6,9 [6,3; 7,5] (68–82) (6 762) (5 047) (3 658) (2 544) (1 624) (978) (498) (174) M 13 252 76 (68–82) 28/72 24,6 664 5,6 [5,2; 6,0] 6,2 [5,7; 6,6] 6,6 [6,1; 7,0] 7,1 [6,6; 7,6] 7,2 [6,7; 7,7] 7,4 [6,9; 8,0] 7,9 [7,2; 8,6] 7,9 [7,2; 8,6] (9 365) (7 110) (5 193) (3 649) (2 416) (1 461) (775) (253) L 7 881 76 36/64 24,9 621 6,7 [6,1; 7,3] 7,5 [6,9; 8,1] 7,8 [7,2; 8,4] 8,1 [7,4; 8,8] 8,5 [7,8; 9,2] 8,7 [8,0; 9,5] 9,0 [8,1; 9,8] 9,3 [8,2; 10,4] (68–81) (5 578) (4 308) (3 217) (2 381) (1 609) (1 013) (501) (178) XL 2 352 75 (67–81) 46/54 25,1 479 7,5 [6,4; 8,6] 8,1 [6,9; 9,2] 8,7 [7,4; 9,9] 9,0 [7,7; 10,3] 9,3 [8,0; 10,7] 9,6 [8,1; 11,0] 10,6 [8,5; 12,6] (1 648) (1 255) (913) (663) (437) (258) (126) XXL 323 76 43/57 25,1 137 10,4 [6,9; 13,8] 11,3 [7,7; 14,9] 11,9 [8,1; 15,6] 12,9 [8,6; 16,9] 13,9 [9,2; 18,3] (68–82) (216) (171) (125) (86) (56) Klaasi tüüp Modulaarne tass 25 199 74 (67–80) 32/68 24,7 687 6,4 [6,1; 6,7] 7,0 [6,6; 7,3] 7,3 [7,0; 7,6] 7,7 [7,3; 8,0] 8,0 [7,6; 8,4] 8,2 [7,8; 8,6] 8,5 [8,0; 8,9] 8,6 [8,1; 9,1] 8,6 [8,1; 9,1] (18 074) (13 803) (10 166) (7 258) (4 760) (2 885) (1 485) (522) (102) Monoblokk-kauss 6 984 80 25/75 24,4 456 4,8 [4,3; 5,4] 5,5 [4,9; 6,0] 5,9 [5,3; 6,5] 6,1 [5,5; 6,8] 6,4 [5,7; 7,0] 6,7 [6,0; 7,5] 7,3 [6,3; 8,2] 7,8 [6,4; 9,2] (74–85) (4 894) (3 752) (2 772) (2 000) (1 370) (853) (428) (133) Kahepoolne liikuvus 2 366 81 (73–86) 32/68 24,2 272 5,7 [4,7; 6,7] 6,2 [5,1; 7,2] 6,5 [5,3; 7,6] 7,1 [5,8; 8,5] 7,1 [5,8; 8,5] 7,1 [5,8; 8,5] (1 363) (879) (543) (321) (157) (68) Revisioonikauss 406 79 28/72 24,7 142 9,5 [6,4; 12,5] 11,1 [7,7; 14,4] 12,1 [8,4; 15,6] 12,1 [8,4; 15,6] 12,1 [8,4; 15,6] (69–84) (260) (198) (155) (109) (75) Varre tüüp Reieluuvars modulaarse peaga 33 504 76 (68–82) 30/70 24,6 705 6,0 [5,7; 6,2] 6,6 [6,3; 6,9] 6,9 [6,6; 7,2] 7,3 [7,0; 7,6] 7,6 [7,2; 7,9] 7,8 [7,5; 8,2] 8,2 [7,8; 8,6] 8,4 [7,9; 8,9] 8,4 [7,9; 8,9] (23 647) (17 923) (13 126) (9 334) (6 132) (3 710) (1 877) (646) (119) Revisioon või kasvajatüvi 692 80 26/74 25,2 282 11,1 [8,6; 13,5] 12,3 [9,6; 14,9] 12,6 [9,9; 15,3] 13,0 [10,2; 15,8] 13,0 [10,2; 15,8] 13,0 [10,2; 15,8] (72–86) (403) (291) (220) (159) (103) (60) Lühike vars 528 67 (61–77) 37/63 24,3 93 5,6 [3,6; 7,6] 5,6 [3,6; 7,6] 6,0 [3,8; 8,1] 6,0 [3,8; 8,1] 6,0 [3,8; 8,1] (371) (281) (191) (132) (85) Rekonstruktsioonikest Ilma rekonstruktsioonikestata 34 848 76 30/70 24,6 707 6,1 [5,8; 6,3] 6,6 [6,4; 6,9] 7,0 [6,7; 7,3] 7,3 [7,0; 7,6] 7,6 [7,3; 7,9] 7,8 [7,5; 8,2] 8,2 [7,8; 8,6] 8,4 [7,9; 8,9] 8,4 [7,9; 8,9] (68–82) (24 521) (18 581) (13 598) (9 662) (6 346) (3 838) (1 943) (665) (125) Fikseerimine Tsementeerimata 15 762 71 (64–78) 35/65 24,8 673 7,2 [6,7; 7,6] 7,8 [7,3; 8,2] 8,1 [7,6; 8,5] 8,4 [8,0; 8,9] 8,8 [8,3; 9,3] 9,0 [8,4; 9,5] 9,3 [8,7; 9,9] 9,3 [8,7; 9,9] 9,3 [8,7; 9,9] (11 463) (8 879) (6 649) (4 834) (3 247) (2 000) (1 037) (368) (65) Hübriid 11 702 78 27/73 24,6 607 5,2 [4,8; 5,6] 5,7 [5,3; 6,2] 6,2 [5,7; 6,7] 6,6 [6,1; 7,1] 6,8 [6,2; 7,3] 7,0 [6,4; 7,6] 7,4 [6,6; 8,1] 7,7 [6,7; 8,7] (72–83) (8 110) (6 014) (4 278) (2 958) (1 880) (1 118) (557) (189) Tsementeeritud 6 575 81 (76–86) 24/76 24,3 474 4,6 [4,0; 5,1] 5,2 [4,6; 5,7] 5,4 [4,8; 6,0] 5,6 [5,0; 6,2] 5,8 [5,1; 6,5] 6,4 [5,5; 7,2] 6,8 [5,7; 7,9] 7,6 [5,8; 9,3] (4 427) (3 312) (2 400) (1 679) (1 087) (637) (310) (94) Pöördhübriid 902 77 28/72 24,8 287 9,2 [7,3; 11,1] 10,0 [7,9; 12,0] 11,1 [8,7; 13,3] 11,4 [9,0; 13,7] 11,8 [9,3; 14,3] 11,8 [9,3; 14,3] (67–83) (579) (419) (302) (213) (144) (88) Tabel 46 (jätkub) 78 EPRD 2024. aasta aruanne 79  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Kumulatiivsed korrigeerimismäärad pärast ... Artroplastika tüüp Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat / Kategooria Puusa poolproteesid 73 215 84 (80–89) 29/71 24,2 624 4,6 [4,4; 4,7] 4,8 [4,6; 5,0] 5,0 [4,8; 5,2] 5,2 [5,0; 5,4] 5,3 [5,1; 5,5] 5,5 [5,3; 5,7] 5,6 [5,3; 5,8] 6,0 [5,5; 6,5] 6,0 [5,5; 6,5] (40 585) (27 056) (17 231) (10 597) (6 110) (3 163) (1 340) (375) (50) Peakomponent metall 69 763 84 (80–89) 29/71 24,2 613 4,5 [4,4; 4,7] 4,8 [4,6; 4,9] 4,9 [4,8; 5,1] 5,1 [4,9; 5,3] 5,3 [5,1; 5,5] 5,4 [5,2; 5,7] 5,5 [5,2; 5,7] 6,0 [5,5; 6,4] (38 625) (25 725) (16 319) (10 000) (5 757) (2 964) (1 264) (371) Keraamika 2 495 84 29/71 24,5 302 5,3 [4,3; 6,2] 5,6 [4,6; 6,5] 5,9 [4,9; 7,0] 6,5 [5,2; 7,6] 6,5 [5,2; 7,6] 7,0 [5,4; 8,7] (79–89) (1 431) (976) (680) (439) (251) (134) Keraamiline metall 499 84 (80–89) 30/70 24,3 34 4,6 [2,6; 6,5] 4,6 [2,6; 6,5] 4,6 [2,6; 6,5] (254) (134) (57) Pea suurus 28 mm 68 962 84 28/72 24,2 619 4,6 [4,4; 4,7] 4,8 [4,6; 4,9] 4,9 [4,8; 5,1] 5,1 [4,9; 5,3] 5,2 [5,0; 5,5] 5,4 [5,2; 5,7] 5,5 [5,2; 5,8] 6,0 [5,5; 6,5] (80–89) (38 149) (25 305) (16 012) (9 830) (5 660) (2 926) (1 242) (346) 32 mm 2 538 83 (79–88) 53/47 24,7 104 5,5 [4,6; 6,5] 6,0 [5,0; 7,0] 6,2 [5,2; 7,2] 6,7 [5,6; 7,8] 7,1 [5,8; 8,3] 7,1 [5,8; 8,3] 7,1 [5,8; 8,3] (1 522) (1 165) (876) (574) (333) (182) (78) Puu s 302 87 (83–90) 4/96 23,5 17 3,9 [1,6; 6,2] 3,9 [1,6; 6,2] 4,8 [1,9; 7,6] (174) (121) (76) Pea-kaela pikkus XS 486 84 (80–89) 30/70 23,8 30 3,6 [1,8; 5,3] 3,6 [1,8; 5,3] 3,6 [1,8; 5,3] 3,6 [1,8; 5,3] 3,6 [1,8; 5,3] (317) (234) (155) (105) (62) S 25 348 84 (80–89) 25/75 24,1 563 4,4 [4,1; 4,6] 4,6 [4,3; 4,9] 4,7 [4,4; 5,0] 4,8 [4,5; 5,1] 5,1 [4,7; 5,4] 5,2 [4,8; 5,6] 5,4 [4,9; 6,0] 5,8 [4,9; 6,6] (13 963) (9 102) (5 581) (3 288) (1 794) (904) (382) (102) M 32 215 84 (80–89) 30/70 24,2 583 4,3 [4,1; 4,6] 4,5 [4,3; 4,8] 4,7 [4,4; 4,9] 4,9 [4,6; 5,1] 5,0 [4,7; 5,3] 5,1 [4,8; 5,5] 5,1 [4,8; 5,5] 5,7 [5,0; 6,5] (18 004) (12 071) (7 767) (4 803) (2 830) (1 521) (648) (186) L 6 657 84 (80–89) 35/65 24,5 515 5,2 [4,6; 5,8] 5,5 [4,9; 6,1] 5,7 [5,1; 6,3] 5,9 [5,2; 6,6] 6,0 [5,3; 6,7] 6,2 [5,4; 7,0] 6,2 [5,4; 7,0] 6,8 [5,4; 8,2] (3 616) (2 421) (1 620) (1 090) (705) (400) (176) (54) XL 1 045 84 (79–88) 36/64 24,8 288 7,4 [5,7; 9,1] 8,1 [6,3; 9,9] 8,7 [6,7; 10,6] 9,9 [7,5; 12,2] 9,9 [7,5; 12,2] 9,9 [7,5; 12,2] (569) (403) (268) (172) (111) (73) Varre tüüp Reieluuvars modulaarse peaga 71 938 84 (80–89) 29/71 24,2 619 4,5 [4,3; 4,7] 4,7 [4,6; 4,9] 4,9 [4,7; 5,1] 5,1 [4,9; 5,3] 5,3 [5,0; 5,5] 5,4 [5,2; 5,6] 5,5 [5,2; 5,7] 6,0 [5,5; 6,4] (39 939) (26 656) (16 980) (10 445) (6 019) (3 120) (1 316) (368) Revisioon või kasvaja tüvi 902 83 (75–87) 29/71 25,3 257 10,2 [8,1; 12,4] 10,7 [8,5; 12,9] 10,7 [8,5; 12,9] 11,2 [8,8; 13,6] 11,2 [8,8; 13,6] (469) (309) (202) (127) (75) Rekonstruktsioonikest Ilma rekonstruktsioonikestata 73 215 84 (80–89) 29/71 24,2 624 4,6 [4,4; 4,7] 4,8 [4,6; 5,0] 5,0 [4,8; 5,2] 5,2 [5,0; 5,4] 5,3 [5,1; 5,5] 5,5 [5,3; 5,7] 5,6 [5,3; 5,8] 6,0 [5,5; 6,5] 6,0 [5,5; 6,5] (40 585) (27 056) (17 231) (10 597) (6 110) (3 163) (1 340) (375) (50) Kinnitus Tsementeeritud 64 562 85 (80–89) 28/72 24,2 613 4,3 [4,1; 4,4] 4,5 [4,3; 4,6] 4,6 [4,4; 4,8] 4,8 [4,6; 4,9] 4,9 [4,7; 5,1] 5,0 [4,8; 5,3] 5,1 [4,8; 5,4] 5,6 [5,1; 6,2] (35 582) (23 562) (14 876) (9 155) (5 275) (2 754) (1 167) (327) (78–88) Tsementeerimata 8 619 83 34/66 24,6 424 6,9 [6,3; 7,5] 7,3 [6,7; 7,9] 7,6 [6,9; 8,2] 8,1 [7,4; 8,8] 8,4 [7,6; 9,1] 8,8 [7,9; 9,7] 8,8 [7,9; 9,7] (4 989) (3 486) (2 350) (1 439) (832) (407) (172) Tabel 46 (jätkub) 80 EPRD 2024. aasta aruanne 81  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus 5.1.4 Tulemused konkreetsete mõjutavad loetletud varre- või kausikomponente Puusa liigese lähedal asuva reieluuka murru tõttu on samuti eraldi loetletud lisas tabelites 63 ja 64. puusakomponentide kombinatsioonide iseenesest (vt ka analüüside selgitusi 3. peatükis). tehtud pool- ja täielikud puusaliigese puhul endoproteesimised ei olnud kaasatud. Tabelis 47 on esitatud CRR-id esmaste puusaliigese Tulemused on esitatud komponentide kinnitustüübi endoproteesimiste puhul, kus kasutatakse kaupa. Võrreldavate algtingimuste tagamiseks võtsime Reieluude ja puusaliigese kopsu komponentide konkreetseid reieluude ja puusaliigese süsteemide arvesse ainult plaaniliste puusaliigese tulemused, mis saadi, võttes arvesse iga komponenti kombinatsioone. Põlveliigese endoproteesimiste endoproteesimiste elulemusandmeid. kõigi erinevate komponentide kombinatsioonide CRR-id on loetletud komponendi järgi, mis hiljem puhul, vajas vahetamist. Need vahetused ei pruugi aga tingimata Planeeritud täielikud puusaliigese proteesimised Kumulatiivsed revisioonimäärad pärast ... Implanta Reieluuvars Põlvekupp Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat paigalda mise aastad Puu sa Hübriidfikseerimine ABG II vars (Stryker) Trident Cup (Stryker) 444 9 79 (76–82) 22/78 2014–2022 2,5 [1,0; 3,9] 2,9 [1,4; 4,5] 2,9 [1,4; 4,5] 2,9 [1,4; 4,5] 3,3 [1,6; 5,0] 3,3 [1,6; 5,0] (427) (413) (385) (322) (221) (89) Actinia tsementeeritud (Implantcast) EcoFit cpTi (Implantcast) 344 9 80 25/75 2016–2023 2,3 [0,7; 3,9] 3,0 [1,1; 4,7] 3,3 [1,4; 5,2] 3,6 [1,6; 5,6] 3,6 [1,6; 5,6] (76–83) (318) (299) (285) (229) (139) Avenir (Zimmer Biomet) Allofit (Zimmer Biomet) 4 646 141 80 (76–83) 23/77 2014–2023 2,1 [1,7; 2,5] 2,3 [1,9; 2,8] 2,5 [2,0; 3,0] 2,6 [2,1; 3,1] 2,9 [2,2; 3,5] 2,9 [2,2; 3,5] 2,9 [2,2; 3,5] 2,9 [2,2; 3,5] (3 319) (2 236) (1 461) (886) (542) (342) (168) (63) Avenir (Zimmer Biomet) Allofit IT (Zimmer Biomet) 543 17 79 21/79 2014–2023 3,2 [1,6; 4,7] 3,4 [1,8; 5,0] 3,4 [1,8; 5,0] 4,0 [2,0; 5,9] (75–82) (396) (287) (174) (95) BHR (Smith & Nephew) BHR (Smith & Nephew) 417 23 55 (51–59) 99/1 2014–2023 1,2 [0,2; 2,3] 1,8 [0,5; 3,2] 2,2 [0,7; 3,6] 2,2 [0,7; 3,6] 2,2 [0,7; 3,6] 2,2 [0,7; 3,6] 3,1 [0,7; 5,4] (359) (313) (266) (219) (164) (108) (60) BICONTACT (Aesculap) PLASMACUP (Aesculap) 376 22 78 29/71 2013–2023 2,1 [0,7; 3,6] 2,5 [0,9; 4,0] 2,5 [0,9; 4,0] 2,8 [1,1; 4,5] 2,8 [1,1; 4,5] 2,8 [1,1; 4,5] 2,8 [1,1; 4,5] 2,8 [1,1; 4,5] (75–82) (322) (294) (267) (245) (202) (169) (109) (52) BICONTACT (Aesculap) PLASMAFIT (Aesculap) 1 987 86 79 (75–82) 22/78 2013–2023 2,1 [1,4; 2,7] 2,3 [1,6; 2,9] 2,8 [2,0; 3,5] 3,0 [2,1; 3,8] 3,3 [2,4; 4,2] 3,5 [2,5; 4,4] 3,5 [2,5; 4,4] 3,5 [2,5; 4,4] (1 656) (1 406) (1 171) (946) (719) (504) (299) (136) C-STEM™ AMT-puusavars PINNACLE™ Press Fit-Hüftpfanne (DePuy) 2,1 [0,9; 3,2] (DePuy) 608 10 80 16/84 2014–2023 2,3 [1,0; 3,5] 2,5 [1,2; 3,8] 2,9 [1,4; 4,4] 3,3 [1,6; 5,0] 4,4 [2,1; 6,7] 4,4 [2,1; 6,7] (76–84) (496) (389) (301) (248) (206) (127) (71) CCA (Mathys) Allofit (Zimmer Biomet) 434 5 76 (73–80) 32/68 2013–2023 2,3 [0,9; 3,7] 3,3 [1,6; 5,0] 3,8 [2,0; 5,6] 4,3 [2,4; 6,3] 4,6 [2,6; 6,6] 5,2 [3,0; 7,4] 5,9 [3,5; 8,3] 6,8 [4,1; 9,3] 6,8 [4,1; 9,3] (410) (384) (369) (349) (327) (301) (260) (177) (117) CCA (Mathys) RM Classic (Mathys) 418 6 78 32/68 2014–2023 3,1 [1,3; 4,8] 4,1 [2,0; 6,1] 4,1 [2,0; 6,1] 4,6 [2,3; 6,8] 5,1 [2,6; 7,6] 5,8 [3,0; 8,5] 5,8 [3,0; 8,5] (74–82) (329) (255) (194) (178) (154) (119) (58) CCA (Mathys) RM Pressfit vitamys (Mathys) 357 12 79 (76–82) 25/75 2013–2023 1,1 [0,0; 2,2] 1,1 [0,0; 2,2] 1,1 [0,0; 2,2] 1,1 [0,0; 2,2] 1,7 [0,1; 3,3] 1,7 [0,1; 3,3] 2,8 [0,1; 5,4] 2,8 [0,1; 5,4] (298) (259) (235) (193) (149) (117) (80) (56) CORAIL™ AMT-puusavars ilma PINNACLE™ Press Fit-Hüftpfanne (DePuy) 2,5 [2,1; 2,9] kraeta (DePuy) 7 581 152 79 21/79 2012–2023 2,8 [2,5; 3,2] 3,2 [2,8; 3,6] 3,5 [3,1; 4,0] 4,1 [3,5; 4,7] 4,3 [3,6; 5,0] 4,3 [3,6; 5,0] 4,3 [3,6; 5,0] (75–83) (5 652) (4 114) (2 892) (1 963) (1 262) (749) (348) (120) COREHIP (Aesculap) PLASMAFIT (Aesculap) 881 63 81 (76–83) 17/83 2018–2023 3,1 [1,8; 4,3] 3,7 [2,2; 5,2] (432) (168) EXCEPTION (Zimmer Biomet) Allofit (Zimmer Biomet) 654 11 78,5 20/80 2016–2023 2,6 [1,4; 3,8] 2,8 [1,5; 4,0] 3,0 [1,6; 4,3] 3,2 [1,8; 4,6] 3,5 [2,0; 5,0] 3,5 [2,0; 5,0] (74–82) (599) (562) (474) (317) (172) (64) EXCIA (Aesculap) PLASMAFIT (Aesculap) 3 856 104 79 (75–83) 22/78 2014–2023 2,1 [1,7; 2,6] 2,4 [1,9; 2,9] 2,8 [2,3; 3,4] 3,1 [2,5; 3,8] 3,2 [2,5; 3,9] 3,2 [2,5; 3,9] 3,8 [2,7; 4,8] 3,8 [2,7; 4,8] (2 851) (2 192) (1 691) (1 234) (739) (439) (238) (72) Exeter Stem (Stryker) Trident Cup (Stryker) 317 10 80 25/75 2015–2023 2,6 [0,8; 4,3] 2,6 [0,8; 4,3] 2,6 [0,8; 4,3] 3,3 [1,0; 5,5] 3,3 [1,0; 5,5] (75–83) (271) (219) (165) (125) (89) ICON (IO-International Orthopaedics) ICON (IO-International Orthopaedics) 305 14 56 (51–62) 87/13 2013–2022 1,0 [0,0; 2,1] 1,3 [0,0; 2,6] 2,0 [0,4; 3,6] 2,7 [0,8; 4,6] 2,7 [0,8; 4,6] 3,3 [1,1; 5,5] 4,2 [1,4; 6,9] (297) (290) (278) (270) (219) (132) (66) LCU puusasüsteem, tsementeeritud CombiCup (Waldemar 1,4 [0,4; 2,4] (Waldemar Link) Link) 561 6 79 36/64 2019–2023 1,4 [0,4; 2,4] 1,4 [0,4; 2,4] (73–82) (438) (285) (137) LCU puusasüsteem, tsementeeritud MobileLink, klastriga (Waldemar Link) (Waldemar Link) 448 12 78 (74–82) 27/73 2019–2023 4,0 [2,1; 5,9] 4,0 [2,1; 5,9] 4,0 [2,1; 5,9] (297) (198) (84) M.E.M. Geradschaft (Zimmer Biomet) Allofit (Zimmer Biomet) 23 243 167 79 26/74 2012–2023 2,1 [1,9; 2,3] 2,3 [2,1; 2,5] 2,5 [2,3; 2,7] 2,7 [2,4; 2,9] 3,0 [2,7; 3,2] 3,1 [2,8; 3,4] 3,2 [2,9; 3,5] 3,5 [3,1; 3,9] 3,5 [3,1; 3,9] (75–82) (18 602) (14 609) (11 367) (8 522) (5 792) (3 581) (1 798) (700) (146) Tabel 47: Implantaadi tulemused varre/kausikombinatsioonide puhul valikulistes puusaliigese täielikes endoproteesimistes. Iga kinnitustüübi puhul on kombinatsioonid loetletud tähestikulises järjekorras varre komponendi järgi. 82 EPRD aastaaruanne 2024 83  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Planeeritud täielikud puusaliigese proteesimised Kumulatiivsed revisioonimäärad pärast ... Implanta Reieluuvars Põlvekupp Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat paigalda mise aastad Hübriidkinnitus M.E.M. Geradschaft (Zimmer Biomet) Allofit IT (Zimmer Biomet) 502 19 79 (75–82) 21/79 2013–2023 2,4 [1,1; 3,8] 2,7 [1,2; 4,2] 2,7 [1,2; 4,2] 3,6 [1,7; 5,5] 3,6 [1,7; 5,5] 3,6 [1,7; 5,5] (412) (341) (265) (193) (126) (76) M.E.M. Geradschaft (Zimmer Biomet) Trilogy (Zimmer Biomet) 1 591 12 78 27/73 2012–2023 1,4 [0,8; 2,0] 1,6 [0,9; 2,2] 1,7 [1,0; 2,3] 1,7 [1,0; 2,3] 1,8 [1,1; 2,4] 1,9 [1,2; 2,6] 2,5 [1,5; 3,5] 2,5 [1,5; 3,5] 2,5 [1,5; 3,5] (74–81) (1 401) (1 229) (1 076) (942) (755) (584) (379) (203) (93) M.E.M. Geradschaft (Zimmer Biomet) Trilogy IT (Zimmer Biomet) 387 3 81 (78–83) 24/76 2015–2023 1,6 [0,3; 2,8] 1,6 [0,3; 2,8] 1,6 [0,3; 2,8] 1,6 [0,3; 2,8] 2,4 [0,3; 4,4] 2,4 [0,3; 4,4] (314) (248) (204) (149) (106) (62) METABLOC (Zimmer Biomet) Allofit (Zimmer Biomet) 1 508 24 78 28/72 2013–2022 2,3 [1,6; 3,1] 2,7 [1,9; 3,5] 2,9 [2,0; 3,7] 2,9 [2,0; 3,7] 3,2 [2,3; 4,1] 3,3 [2,4; 4,3] 3,6 [2,5; 4,7] 3,6 [2,5; 4,7] (75–82) (1 437) (1 385) (1 271) (1 085) (824) (563) (336) (143) MS-30 (Zimmer Biomet) Allofit (Zimmer Biomet) 3 816 32 78 (74–81) 26/74 2014–2023 1,7 [1,2; 2,1] 1,8 [1,4; 2,2] 2,0 [1,5; 2,4] 2,2 [1,7; 2,7] 2,3 [1,8; 2,8] 2,5 [1,9; 3,0] 2,7 [2,1; 3,4] 2,9 [2,2; 3,7] (3 385) (2 968) (2 566) (2 119) (1 670) (1 217) (702) (256) Puu Müller Geradschaft (OHST s R3 (Smith & Nephew) 1 080 15 78 30/70 2015–2023 2,7 [1,8; 3,7] 3,0 [1,9; 4,0] 3,0 [1,9; 4,0] 3,1 [2,0; 4,2] 3,1 [2,0; 4,2] 3,1 [2,0; 4,2] Medizintechnik) (75–82) (930) (799) (645) (486) (265) (131) Polarschaft Cemented (Smith & Nephew) R3 (Smith & Nephew) 1 910 66 79 (75–83) 23/77 2013–2023 2,4 [1,7; 3,1] 2,5 [1,8; 3,2] 2,7 [1,9; 3,5] 3,0 [2,1; 3,9] 3,0 [2,1; 3,9] 3,0 [2,1; 3,9] 3,0 [2,1; 3,9] (1 306) (983) (786) (607) (404) (208) (66) QUADRA-C (Medacta) VERSAFITCUP CC TRIO (Medacta) 2 185 55 80 22/78 2015–2023 2,1 [1,5; 2,7] 2,4 [1,7; 3,1] 2,4 [1,7; 3,1] 2,7 [1,9; 3,4] 2,8 [2,0; 3,6] 3,7 [2,2; 5,1] 3,7 [2,2; 5,1] (77–83) (1 680) (1 294) (981) (691) (403) (174) (58) SPECTRON (Smith & Nephew) R3 (Smith & Nephew) 402 8 79 (75–83) 27/73 2013–2023 1,0 [0,0; 2,0] 1,3 [0,2; 2,4] 1,3 [0,2; 2,4] 1,3 [0,2; 2,4] 1,3 [0,2; 2,4] 1,3 [0,2; 2,4] (338) (284) (214) (169) (123) (87) SPII mudel Lubinus puusavars, standardvars, ilma puurauguta (Waldemar Allofit (Zimmer Biomet) 6 361 51 78 27/73 2013–2023 2,2 [1,8; 2,6] 2,8 [2,4; 3,2] 3,1 [2,6; 3,5] 3,3 [2,8; 3,7] 3,4 [2,9; 3,9] 3,8 [3,2; 4,4] 4,6 [3,8; 5,4] 4,8 [3,9; 5,6] 4,8 [3,9; 5,6] Link) (74–81) (5 215) (4 187) (3 347) (2 514) (1 832) (1 231) (691) (347) (129) SPII mudel Lubinus puusavars, standardvars, ilma puurauguta (Waldemar Link) CombiCup (Waldemar Link) 1 399 32 78 (74–81) 29/71 2014–2023 0,9 [0,4; 1,4] 1,7 [1,0; 2,3] 1,9 [1,2; 2,7] 2,6 [1,7; 3,5] 3,2 [2,1; 4,2] 3,2 [2,1; 4,2] 3,5 [2,3; 4,7] 4,1 [2,4; 5,9] (1 284) (1 156) (1 033) (848) (628) (388) (222) (77) SPII mudel Lubinus puusavars, standardvars, ilma puurauguta (Waldemar HI Lubricer Schale 0,9 [0,0; 1,8] 0,9 [0,0; 1,8] 1,3 [0,0; 2,5] 1,3 [0,0; 2,5] 1,8 [0,2; 3,3] 3,3 [0,6; 5,9] Link) 349 3 77 (74–81) 27/73 2014–2023 (Smith & Nephew) (324) (289) (246) (196) (146) (84) SPII mudel Lubinus puusavars, standardvars, ilma puurauguta (Waldemar Link) MobileLink, Cluster Hole (Waldemar Link) 1 282 28 78 (72–82) 26/74 2017–2023 2,5 [1,6; 3,3] 3,2 [2,1; 4,3] 3,2 [2,1; 4,3] (754) (370) (142) SPII mudel Lubinus puusavars, standardvars, ilma puurauguta (Waldemar PLASMAFIT (Aesculap) 356 13 78 22/78 2015–2023 1,6 [0,2; 2,9] 2,0 [0,4; 3,6] 2,0 [0,4; 3,6] 2,0 [0,4; 3,6] Link) (73–81) (248) (176) (113) (71) Standard C, tsementeeritud CombiCup (Waldemar (Waldemar Link) Link) 382 5 77 (73–80) 31/69 2014–2022 1,3 [0,2; 2,5] 2,2 [0,7; 3,6] 2,7 [1,1; 4,4] 3,3 [1,5; 5,2] 3,3 [1,5; 5,2] 3,3 [1,5; 5,2] 3,3 [1,5; 5,2] (365) (341) (330) (318) (259) (186) (96) Taperloc tsementeeritud (Zimmer Biomet) Allofit (Zimmer Biomet) 546 25 79 22/78 2015–2023 2,5 [1,1; 3,8] 2,9 [1,3; 4,3] 2,9 [1,3; 4,3] 2,9 [1,3; 4,3] (75–83) (404) (260) (140) (74) Taperloc tsementeeritud (Zimmer Biomet) G7 (Zimmer Biomet) 536 11 80 (75–83) 25/75 2015–2023 2,3 [1,0; 3,6] 3,0 [1,5; 4,4] 3,0 [1,5; 4,4] 3,0 [1,5; 4,4] 3,0 [1,5; 4,4] 3,0 [1,5; 4,4] (462) (377) (311) (235) (163) (100) TRENDHIP (Aesculap) PLASMAFIT (Aesculap) 652 36 80 25/75 2016–2023 2,3 [1,1; 3,4] 2,3 [1,1; 3,4] 2,3 [1,1; 3,4] 2,3 [1,1; 3,4] 2,9 [1,2; 4,5] (75–83) (499) (395) (291) (208) (116) twinSys cem. (Mathys) RM Pressfit vitamys (Mathys) 1 071 25 79 (72–82) 23/77 2014–2023 2,6 [1,6; 3,6] 2,7 [1,7; 3,7] 2,7 [1,7; 3,7] 2,9 [1,8; 3,9] 3,3 [2,1; 4,5] 4,0 [2,2; 5,8] (889) (759) (630) (471) (313) (136) Pöördhübriidkinnitus Avenir (Zimmer Biomet) Flachprofil (Zimmer Biomet) 416 68 73 17/83 2013–2023 4,6 [2,6; 6,6] 5,3 [3,0; 7,5] 5,7 [3,3; 8,0] 5,7 [3,3; 8,0] 5,7 [3,3; 8,0] 5,7 [3,3; 8,0] (65–79) (334) (259) (202) (158) (105) (69) BICONTACT (Aesculap) Kõik POLY CUP (Aesculap) 415 62 76 (70–80) 24/76 2013–2023 3,4 [1,6; 5,2] 4,0 [2,1; 5,9] 4,3 [2,3; 6,3] 4,3 [2,3; 6,3] 4,7 [2,5; 6,8] 4,7 [2,5; 6,8] 4,7 [2,5; 6,8] (359) (310) (281) (235) (193) (132) (76) CORAIL™ AMT-puusavars ilma TRILOC® II-PE-puusapann 5,0 [2,5; 7,4] kraeta (DePuy) (DePuy) 308 61 75 19/81 2014–2023 5,0 [2,5; 7,4] 5,0 [2,5; 7,4] 5,0 [2,5; 7,4] 5,7 [2,8; 8,4] 5,7 [2,8; 8,4] (66–80,5) (259) (226) (194) (153) (113) (77) Tabel 47 (jätkub) 84 EPRD 2024. aasta aruanne 85  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Valikulised puusaliigese täielikud proteesimised Kumulatiivsed revisioonimäärad pärast ... Implanta Reieluuvars Põlvekupp Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat paigalda mise aastad Tsementeerimata fikseerimine A2 lühike vars (ARTIQO) ANA.NOVA® Alpha Pfanne (ARTIQO) 5 408 56 64 (58–71) 43/57 2016–2023 2,1 [1,7; 2,5] 2,3 [1,9; 2,7] 2,4 [2,0; 2,9] 2,7 [2,2; 3,3] 3,0 [2,4; 3,6] 3,1 [2,5; 3,8] 3,1 [2,5; 3,8] (3 804) (2 656) (1 849) (1 261) (772) (330) (73) A2 lühike vars (ARTIQO) ANA.NOVA® hübriidpann (ARTIQO) 6 214 46 64 38/62 2016–2023 1,8 [1,5; 2,1] 2,0 [1,7; 2,4] 2,2 [1,8; 2,6] 2,3 [1,9; 2,7] 2,3 [1,9; 2,7] 2,4 [1,9; 2,9] 2,4 [1,9; 2,9] (57–70) (4 925) (3 849) (2 950) (2 100) (1 321) (612) (124) ABG II vars (Stryker) Trident Cup (Stryker) 414 12 66 (59–71) 42/58 2014–2022 3,1 [1,4; 4,8] 4,9 [2,8; 7,0] 5,4 [3,2; 7,6] 5,7 [3,4; 8,0] 6,1 [3,7; 8,5] 6,6 [4,0; 9,1] 6,6 [4,0; 9,1] 6,6 [4,0; 9,1] (400) (362) (337) (301) (228) (172) (138) (52) Accolade II varreosa (Stryker) Trident Cup (Stryker) 7 974 45 67 43/57 2014–2023 2,5 [2,2; 2,9] 2,8 [2,4; 3,2] 3,0 [2,6; 3,4] 3,2 [2,7; 3,6] 3,3 [2,8; 3,7] 3,4 [2,9; 3,9] 3,4 [2,9; 3,9] 3,4 [2,9; 3,9] (60–74) (6 609) (5 454) (4 156) (2 932) (1 665) (798) (379) (127) Accolade II vars (Stryker) Trident II Tritanium Cup (Stryker) 1 054 22 69 (62–75) 43/57 2018–2023 3,8 [2,5; 5,1] 4,2 [2,7; 5,7] (394) (50) Puu 1,7 [0,5; 2,8] s Accolade II vars (Stryker) Trident TC Cup (Stryker) 482 10 69 36/64 2015–2021 2,1 [0,8; 3,4] 2,3 [1,0; 3,7] 2,8 [1,3; 4,2] 3,4 [1,8; 5,1] 3,7 [2,0; 5,4] 3,7 [2,0; 5,4] (62–75) (463) (455) (448) (427) (410) (364) (263) Accolade II vars (Stryker) Tritanium Cup (Stryker) 2 581 25 69 (62–76) 40/60 2014–2023 2,7 [2,1; 3,4] 3,3 [2,6; 4,0] 3,6 [2,9; 4,3] 4,1 [3,3; 4,9] 4,2 [3,3; 5,0] 4,3 [3,4; 5,2] 4,7 [3,7; 5,8] 5,1 [3,8; 6,4] (2 440) (2 159) (1 717) (1 254) (810) (549) (294) (107) Actinia tsementivaba (Implantcast) EcoFit cpTi (Implantcast) 694 16 69 42/58 2015–2023 3,3 [2,0; 4,7] 4,3 [2,7; 5,8] 4,3 [2,7; 5,8] 4,8 [3,2; 6,4] 5,2 [3,5; 6,9] 5,7 [3,7; 7,7] (62–76) (631) (588) (566) (503) (325) (135) Actinia tsementivaba (Implantcast) EcoFit NH cpTi (Implantcast) 1 513 8 72 (65–78) 31/69 2015–2023 2,9 [2,0; 3,7] 3,0 [2,1; 3,9] 3,1 [2,2; 4,0] 3,2 [2,3; 4,1] 3,2 [2,3; 4,1] 3,2 [2,3; 4,1] (1 394) (1 288) (1 173) (893) (296) (98) ACTIS™-puusavars PINNACLE™ Press Fit-Hüftpfanne (DePuy) 1,7 [1,2; 2,2] (DePuy) 2 628 42 62 43/57 2018–2023 2,0 [1,4; 2,6] 2,2 [1,5; 2,8] 2,5 [1,6; 3,4] (55–69) (1 657) (855) (458) (123) Alloclassic (Zimmer Biomet) Alloclassic (Zimmer Biomet) 398 8 67 (59–75) 32/68 2014–2023 3,8 [1,9; 5,7] 4,3 [2,3; 6,4] 4,9 [2,7; 7,0] 5,4 [3,1; 7,7] 5,4 [3,1; 7,7] 6,1 [3,7; 8,6] 6,1 [3,7; 8,6] 6,1 [3,7; 8,6] (368) (355) (346) (333) (296) (238) (171) (81) Alloclassic (Zimmer Biomet) Allofit (Zimmer Biomet) 9 582 71 70 36/64 2012–2023 2,9 [2,5; 3,2] 3,4 [3,0; 3,7] 3,7 [3,3; 4,1] 4,0 [3,6; 4,5] 4,3 [3,9; 4,7] 4,6 [4,2; 5,1] 4,8 [4,3; 5,3] 5,1 [4,6; 5,7] 5,1 [4,6; 5,7] (62–77) (8 493) (7 531) (6 630) (5 575) (4 483) (3 291) (2 195) (1 008) (237) Alloclassic (Zimmer Biomet) Trilogy (Zimmer Biomet) 578 6 67 (63–70) 33/67 2015–2023 3,3 [1,8; 4,8] 3,9 [2,3; 5,5] 3,9 [2,3; 5,5] 4,5 [2,7; 6,2] 4,5 [2,7; 6,2] 4,9 [2,9; 6,8] 4,9 [2,9; 6,8] (515) (449) (391) (333) (264) (196) (108) Alpha-Fit (Corin) Trinity no Hole (Corin) 451 3 75 33/67 2014–2022 1,6 [0,4; 2,7] 1,8 [0,6; 3,0] 2,2 [0,9; 3,6] 2,2 [0,9; 3,6] 2,8 [1,2; 4,3] 3,2 [1,4; 5,0] 4,2 [2,0; 6,4] 4,2 [2,0; 6,4] (69–78) (437) (427) (417) (396) (334) (227) (162) (98) AMISTEM-H (Medacta) VERSAFITCUP CC TRIO (Medacta) 964 26 67 (58–74) 42/58 2015–2020 3,2 [2,1; 4,3] 3,5 [2,4; 4,7] 3,8 [2,5; 5,0] 4,2 [2,9; 5,5] 4,7 [3,3; 6,1] 5,5 [3,8; 7,1] 6,1 [4,1; 8,2] (922) (893) (874) (722) (503) (310) (131) AMISTEM-H ProxCoat (Medacta) VERSAFITCUP CC TRIO (Medacta) 382 3 60 47/53 2016–2023 1,8 [0,5; 3,2] 2,2 [0,7; 3,6] 2,5 [0,9; 4,2] 3,0 [1,1; 4,9] 4,0 [1,3; 6,6] (53–67) (339) (271) (217) (163) (85) AMISTEM-P (Medacta) VERSAFITCUP CC TRIO (Medacta) 1 099 24 66 (59–73) 40/60 2019–2023 2,5 [1,6; 3,5] 2,7 [1,7; 3,7] 3,9 [2,2; 5,6] (741) (428) (133) ANA.NOVA® Alpha Schaft (ARTIQO) ANA.NOVA® Alpha Pfanne (ARTIQO) 1 034 7 70 44/56 2015–2023 3,1 [2,0; 4,1] 3,5 [2,3; 4,6] 3,7 [2,5; 4,9] 4,3 [3,0; 5,6] 4,7 [3,3; 6,1] 4,7 [3,3; 6,1] 4,7 [3,3; 6,1] (63–76) (927) (823) (738) (620) (488) (326) (210) ANA.NOVA® Alpha vars (ARTIQO) ANA.NOVA® Hybrid-pann (ARTIQO) 1 348 11 70 (63–76) 36/64 2015–2023 1,4 [0,7; 2,0] 1,8 [1,0; 2,5] 1,9 [1,1; 2,7] 1,9 [1,1; 2,7] 1,9 [1,1; 2,7] 2,5 [1,4; 3,6] 3,0 [1,5; 4,4] (1 121) (883) (715) (552) (381) (235) (129) ANA.NOVA® SL-complete® vars (ARTIQO) ANA.NOVA® Alpha Pfanne 3,4 [1,5; 5,2] (ARTIQO) 367 5 72 37/63 2015–2023 3,4 [1,5; 5,2] 3,4 [1,5; 5,2] 3,8 [1,7; 5,9] 3,8 [1,7; 5,9] 3,8 [1,7; 5,9] (64–78) (292) (245) (207) (178) (114) (50) ANA.NOVA® Solitär Schaft (ARTIQO) ANA.NOVA® hübriidpann (ARTIQO) 516 7 74 (65–80) 36/64 2015–2023 4,1 [2,4; 5,9] 4,3 [2,6; 6,1] 4,8 [2,9; 6,7] 5,1 [3,1; 7,1] 5,6 [3,4; 7,8] 5,6 [3,4; 7,8] (465) (423) (375) (277) (156) (77) Anato Stem (Stryker) Trident Cup (Stryker) 401 9 68 45/55 2016–2023 3,0 [1,3; 4,7] 3,8 [1,9; 5,7] 4,1 [2,1; 6,0] 4,1 [2,1; 6,0] 4,1 [2,1; 6,0] 4,8 [2,4; 7,2] (60–75) (378) (336) (274) (205) (153) (77) Avenir (Zimmer Biomet) Allofit (Zimmer Biomet) 29 284 199 69 (62–75) 40/60 2013–2023 2,9 [2,7; 3,1] 3,1 [2,9; 3,4] 3,3 [3,1; 3,6] 3,4 [3,2; 3,6] 3,6 [3,3; 3,8] 3,6 [3,3; 3,8] 3,7 [3,5; 4,0] 3,8 [3,5; 4,1] 3,8 [3,5; 4,1] (23 092) (18 017) (13 724) (9 672) (6 004) (3 577) (1 721) (489) (54) Avenir (Zimmer Biomet) Allofit IT (Zimmer Biomet) 3 170 53 67 40/60 2014–2023 3,4 [2,7; 4,0] 3,9 [3,2; 4,6] 4,1 [3,4; 4,8] 4,1 [3,4; 4,9] 4,5 [3,7; 5,3] 4,5 [3,7; 5,3] 4,5 [3,7; 5,3] (59–75) (2 708) (2 237) (1 769) (1 257) (807) (431) (165) Avenir Complete (Zimmer Biomet) Allofit (Zimmer Biomet) 2 445 51 67 (59–73) 40/60 2020–2023 3,2 [2,4; 3,9] 3,3 [2,5; 4,1] 3,3 [2,5; 4,1] (1 322) (542) (96) BICONTACT (Aesculap) PLASMACUP (Aesculap) 5 020 31 70 40/60 2013–2023 2,3 [1,9; 2,7] 2,6 [2,2; 3,0] 2,7 [2,2; 3,1] 2,8 [2,3; 3,3] 2,8 [2,4; 3,3] 2,8 [2,4; 3,3] 2,8 [2,4; 3,3] 2,8 [2,4; 3,3] 3,0 [2,4; 3,5] (63–76) (4 700) (4 234) (3 791) (3 308) (2 801) (2 167) (1 491) (787) (228) BICONTACT (Aesculap) PLASMAFIT (Aesculap) 13 208 114 71 (64–77) 40/60 2013–2023 3,5 [3,2; 3,8] 3,8 [3,5; 4,1] 4,0 [3,6; 4,3] 4,0 [3,7; 4,4] 4,1 [3,8; 4,5] 4,1 [3,8; 4,5] 4,2 [3,8; 4,5] 4,2 [3,9; 4,6] 4,5 [3,9; 5,1] (11 823) (10 537) (9 301) (7 734) (5 814) (3 947) (2 308) (1 068) (302) Tabel 47 (jätkub) 86 EPRD 2024. aasta aruanne 87  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Planeeritud puusaliigese täielikud proteesimised Kumulatiivsed revisioonimäärad pärast ... Implanta Reieluuvars Põlvekupp Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat paigalda mise aastad Tsementeerimata fikseerimine BICONTACT (Aesculap) SCREWCUP SC (Aesculap) 824 33 73 35/65 2013–2023 3,6 [2,3; 4,8] 4,7 [3,2; 6,2] 5,0 [3,5; 6,5] 5,4 [3,7; 7,0] 6,4 [4,5; 8,3] 6,8 [4,7; 8,7] 6,8 [4,7; 8,7] (64–78) (726) (633) (544) (441) (327) (175) (89) BreXis (Stemcup / Zimmer Biomet) Allofit (Zimmer Biomet) 1 050 32 61 (55–68) 45/55 2016–2023 2,5 [1,6; 3,5] 2,8 [1,8; 3,9] 2,8 [1,8; 3,9] 2,8 [1,8; 3,9] 3,3 [1,9; 4,7] (763) (534) (389) (255) (96) CBC Evolution (Mathys) aneXys Flex (Mathys) 361 8 70 47/53 2016–2023 4,9 [2,6; 7,1] 5,6 [3,1; 8,0] 7,1 [4,1; 10,0] 7,1 [4,1; 10,0] 7,9 [4,5; 11,1] 7,9 [4,5; 11,1] (62–77) (280) (213) (153) (124) (91) (72) CLS Spotorno (Zimmer Biomet) Allofit (Zimmer Biomet) 24 728 185 65 (58–72) 43/57 2012–2023 2,9 [2,7; 3,1] 3,3 [3,1; 3,5] 3,6 [3,4; 3,8] 3,7 [3,5; 4,0] 3,9 [3,6; 4,1] 4,1 [3,8; 4,4] 4,2 [4,0; 4,5] 4,4 [4,1; 4,7] 4,4 [4,1; 4,7] (21 510) (18 604) (16 031) (13 451) (10 760) (7 906) (4 952) (2 335) (721) CLS Spotorno (Zimmer Biomet) Allofit IT (Zimmer Biomet) 1 721 33 66 41/59 2013–2023 1,5 [0,9; 2,1] 2,3 [1,6; 3,0] 2,3 [1,6; 3,0] 2,3 [1,6; 3,1] 2,6 [1,8; 3,4] 2,9 [2,0; 3,7] 2,9 [2,0; 3,7] 2,9 [2,0; 3,7] 2,9 [2,0; 3,7] (59–74) (1 597) (1 509) (1 340) (1 178) (929) (733) (567) (347) (191) Puu 64,5 (57–71) s CLS Spotorno (Zimmer Biomet) Trilogy (Zimmer Biomet) 366 7 40/60 2014–2023 3,9 [1,9; 5,8] 4,8 [2,5; 7,0] 4,8 [2,5; 7,0] 4,8 [2,5; 7,0] 5,2 [2,8; 7,5] 5,2 [2,8; 7,5] 5,2 [2,8; 7,5] 5,2 [2,8; 7,5] (322) (292) (274) (263) (233) (201) (166) (86) CLS Spotorno (Zimmer Biomet) Trilogy IT (Zimmer Biomet) 1 172 3 68 41/59 2014–2023 3,9 [2,8; 5,1] 4,1 [3,0; 5,3] 4,6 [3,4; 5,9] 4,6 [3,4; 5,9] 4,8 [3,5; 6,0] 5,4 [3,9; 6,8] 5,9 [4,3; 7,5] 5,9 [4,3; 7,5] (61–74) (998) (874) (767) (660) (522) (371) (239) (96) CORAIL™ AMT-puusavars kraega (DePuy) Allofit (Zimmer Biomet) 343 8 60 (53–70) 18/82 2015–2023 2,4 [0,7; 4,0] 2,7 [1,0; 4,5] 2,7 [1,0; 4,5] 2,7 [1,0; 4,5] 2,7 [1,0; 4,5] 2,7 [1,0; 4,5] 3,6 [1,1; 5,9] (295) (253) (224) (187) (156) (133) (91) CORAIL™ AMT-puusavars kraega PINNACLE™ Press Fit-Hüftpfanne (DePuy) 1,7 [1,5; 1,9] (DePuy) 14 934 108 69 36/64 2012–2023 2,1 [1,8; 2,3] 2,4 [2,1; 2,6] 2,5 [2,2; 2,8] 2,6 [2,3; 2,9] 2,8 [2,5; 3,2] 2,9 [2,5; 3,2] 2,9 [2,5; 3,2] 2,9 [2,5; 3,2] (61–76) (11 176) (8 778) (6 922) (4 951) (3 187) (1 895) (843) (197) (58) CORAIL™ AMT-puusavars ilma kraeta (DePuy) Allofit (Zimmer Biomet) 1 610 19 69 (62–76) 38/62 2015–2023 3,0 [2,2; 3,8] 3,2 [2,3; 4,0] 3,5 [2,6; 4,4] 3,6 [2,6; 4,5] 3,7 [2,7; 4,6] 3,7 [2,7; 4,6] 4,1 [2,8; 5,3] (1 419) (1 249) (1 122) (996) (793) (416) (156) CORAIL™ AMT-puusavars ilma 3,1 [1,4; 4,9] kraeta (DePuy) Allofit IT (Zimmer Biomet) 383 4 72 39/61 2015–2023 4,0 [2,0; 5,9] 4,2 [2,2; 6,3] 4,2 [2,2; 6,3] 4,5 [2,4; 6,6] 4,9 [2,6; 7,0] 4,9 [2,6; 7,0] (66–77) (362) (347) (337) (326) (310) (293) (220) CORAIL™ AMT-puusavars ilma DURALOC™ OPTION™ kraeta (DePuy) 600 8 67 (59,5–74) 41/59 2013–2023 4,0 [2,4; 5,6] 4,4 [2,7; 6,0] 4,4 [2,7; 6,0] 4,6 [2,9; 6,3] 4,6 [2,9; 6,3] 4,6 [2,9; 6,3] 4,6 [2,9; 6,3] 4,6 [2,9; 6,3] Press Fit-puusapann (DePuy) (532) (481) (434) (359) (297) (232) (158) (60) CORAIL™ AMT-puusavars ilma PINNACLE™ Press Fit-Hüftpfanne (DePuy) 2,9 [2,7; 3,0] kraeta (DePuy) 36 563 172 69 39/61 2012–2023 3,3 [3,1; 3,5] 3,6 [3,4; 3,8] 3,9 [3,7; 4,2] 4,1 [3,8; 4,3] 4,3 [4,1; 4,6] 4,6 [4,3; 4,8] 5,0 [4,6; 5,3] 5,3 [4,7; 5,8] (62–76) (30 758) (25 546) (20 473) (15 797) (11 656) (7 662) (4 160) (1 620) (451) COREHIP (Aesculap) Allofit (Zimmer Biomet) 425 10 63 (57–72) 38/62 2017–2023 2,8 [1,1; 4,4] 3,2 [1,4; 4,9] (257) (146) COREHIP (Aesculap) PLASMACUP (Aesculap) 1 305 5 70 35/65 2017–2023 1,4 [0,7; 2,0] 1,5 [0,8; 2,2] 1,7 [0,9; 2,5] 1,7 [0,9; 2,5] (65–75) (907) (584) (392) (238) COREHIP (Aesculap) PLASMAFIT (Aesculap) 7 014 102 67 (60–74) 39/61 2017–2023 2,6 [2,2; 2,9] 3,0 [2,6; 3,5] 3,6 [2,9; 4,4] 3,6 [2,9; 4,4] (3 758) (1 756) (581) (135) EcoFit 133° cpTi (Implantcast) EcoFit EPORE (Implantcast) 536 5 73 27/73 2019–2023 4,6 [2,7; 6,4] 5,1 [3,1; 7,0] 6,0 [3,7; 8,4] (67–79,5) (395) (261) (108) EcoFit cpTi (Implantcast) EcoFit cpTi (Implantcast) 350 8 72 (64–76) 36/64 2014–2023 5,7 [3,3; 8,1] 6,0 [3,5; 8,5] 6,0 [3,5; 8,5] 6,4 [3,8; 9,0] 6,4 [3,8; 9,0] 6,4 [3,8; 9,0] 7,5 [4,5; 10,5] (311) (284) (258) (236) (212) (175) (146) EcoFit cpTi (Implantcast) EcoFit EPORE (Implantcast) 548 4 75 25/75 2016–2022 4,4 [2,7; 6,1] 5,3 [3,4; 7,2] 6.1 [4.1; 8.1] 6,7 [4,6; 8,8] 7,2 [5,0; 9,4] 7,2 [5,0; 9,4] (68,5–79) (516) (500) (470) (439) (289) (148) EcoFit Short cpTi (Implantcast) EcoFit EPORE (Implantcast) 409 5 71 (64–77) 37/63 2019–2023 5,0 [2,8; 7,1] 5,0 [2,8; 7,1] 5,7 [3,1; 8,2] (293) (205) (119) EXCEPTION (Zimmer Biomet) Allofit (Zimmer Biomet) 1 490 12 69 50/50 2015–2023 4,4 [3,4; 5,5] 4,9 [3,8; 6,0] 5,4 [4,2; 6,5] 5,5 [4,3; 6,7] 6,2 [4,9; 7,5] 6,2 [4,9; 7,5] (61–75) (1 374) (1 305) (1 178) (860) (549) (267) EXCIA (Aesculap) PLASMAFIT (Aesculap) 12 925 118 70 (62–76) 41/59 2014–2023 3,2 [2,9; 3,6] 3,6 [3,3; 4,0] 3,8 [3,4; 4,1] 3,9 [3,5; 4,2] 4,0 [3,6; 4,3] 4,0 [3,7; 4,4] 4,0 [3,7; 4,4] 4,2 [3,7; 4,7] (10 759) (8 658) (7 007) (5 286) (3 540) (2 068) (792) (140) Fitmore (Zimmer Biomet) Allofit (Zimmer Biomet) 25 219 217 63 46/54 2012–2023 2,3 [2,1; 2,5] 2,6 [2,4; 2,8] 2,9 [2,6; 3,1] 3,0 [2,8; 3,2] 3,1 [2,8; 3,3] 3,2 [2,9; 3,4] 3,3 [3,0; 3,5] 3,3 [3,0; 3,6] 3,5 [3,1; 3,9] (56–70) (21 063) (17 519) (14 367) (11 286) (8 299) (5 535) (3 267) (1 380) (298) Fitmore (Zimmer Biomet) Allofit IT (Zimmer Biomet) 3 151 63 59 (52–65) 47/53 2012–2023 3,1 [2,5; 3,8] 3,9 [3,2; 4,5] 4,3 [3,6; 5,1] 4,4 [3,6; 5,1] 4,9 [4,0; 5,7] 5,1 [4,2; 5,9] 5,2 [4,3; 6,1] 5,5 [4,4; 6,7] 5,5 [4,4; 6,7] (2 635) (2 249) (1 763) (1 382) (1 033) (730) (416) (178) (59) Fitmore (Zimmer Biomet) Trilogy (Zimmer Biomet) 2 844 14 62 45/55 2012–2023 1,8 [1,3; 2,2] 2,2 [1,6; 2,7] 2,4 [1,8; 2,9] 2,5 [1,9; 3,1] 2,7 [2,0; 3,3] 2,8 [2,1; 3,5] 2,8 [2,1; 3,5] 2,8 [2,1; 3,5] 2,8 [2,1; 3,5] (56–68) (2 458) (2 122) (1 792) (1 484) (1 143) (834) (542) (287) (150) GTS (Zimmer Biomet) Allofit (Zimmer Biomet) 901 19 65 (58–71) 47/53 2014–2023 3,2 [2,0; 4,3] 3,8 [2,5; 5,1] 4,4 [3,0; 5,8] 4,4 [3,0; 5,8] 4,6 [3,2; 6,1] 4,6 [3,2; 6,1] 4,6 [3,2; 6,1] (773) (675) (617) (520) (371) (182) (101) Tabel 47 (jätkub) 88 EPRD 2024. aasta aruanne 89  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Valikulised puusaliigese täielikud proteesimised Kumulatiivsed revisioonimäärad pärast ... Implanta Reieluuvars Põlvekupp Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat paigalda mise aastad Tsementeerimata fikseerimine GTS (Zimmer Biomet) G7 (Zimmer Biomet) 457 12 66 36/64 2014–2023 4,0 [2,2; 5,7] 4,9 [2,9; 6,9] 4,9 [2,9; 6,9] 5,5 [3,3; 7,7] 5,5 [3,3; 7,7] 5,5 [3,3; 7,7] 5,5 [3,3; 7,7] (59–75) (419) (388) (320) (266) (204) (128) (88) Konusprotees (Zimmer Biomet) Allofit (Zimmer Biomet) 687 89 55 (46–62) 19/81 2013–2023 3,4 [2,0; 4,8] 3,8 [2,3; 5,2] 4,0 [2,5; 5,5] 4,0 [2,5; 5,5] 4,3 [2,7; 5,9] 4,8 [2,9; 6,6] 4,8 [2,9; 6,6] 4,8 [2,9; 6,6] (557) (486) (424) (342) (261) (193) (131) (61) Konusprotees (Zimmer Biomet) Allofit IT (Zimmer Biomet) 428 18 68 10/90 2013–2023 2,6 [1,1; 4,1] 3,1 [1,4; 4,7] 3,6 [1,8; 5,4] 3,9 [2,0; 5,8] 3,9 [2,0; 5,8] 3,9 [2,0; 5,8] 3,9 [2,0; 5,8] 3,9 [2,0; 5,8] 3,9 [2,0; 5,8] (57,5–76) (404) (375) (340) (298) (259) (219) (161) (113) (63) LCU puusasüsteem, tsementeerimata (Waldemar Allofit Link) 865 7 68 (62–75) 48/52 2015–2023 1,8 [0,9; 2,6] 1,9 [1,0; 2,8] 2,5 [1,4; 3,7] 2,5 [1,4; 3,7] 3,2 [1,7; 4,6] 3,2 [1,7; 4,6] (Zimmer Biomet) (720) (579) (442) (345) (241) (130) LCU puusasüsteem, tsementeerimata CombiCup (Waldemar 2,4 [1,7; 3,0] (Waldemar Link) Link) 1 928 23 66 44/56 2014–2023 2,7 [1,9; 3,4] 2,8 [2,0; 3,5] 2,9 [2,1; 3,6] 3,0 [2,2; 3,7] 3,5 [2,5; 4,5] 3,8 [2,6; 5,0] (59–73) (1 757) (1 596) (1 421) (1 100) (747) (439) (132) Puu s LCU puusasüsteem, tsementeerimata (Waldemar MobileLink, klastriava (Waldemar Link) Link) 1 109 33 69 (62–75) 40/60 2017–2023 4,3 [3,1; 5,6] 4,9 [3,6; 6,3] 5,2 [3,8; 6,6] 5,2 [3,8; 6,6] (751) (468) (240) (72) M/L Taper (Zimmer Biomet) Allofit (Zimmer Biomet) 5 787 23 68 3,4 [2,9; 3,8] 3,8 [3,3; 4,3] 4,2 [3,6; 4,7] 4,4 [3,8; 4,9] 4,4 [3,9; 5,0] 4,6 [4,0; 5,2] 5,0 [4,3; 5,8] 5,2 [4,4; 6,0] 5,2 [4,4; 6,0] (61–74) 42/58 2013–2023 (5 044) (4 360) (3 642) (3 010) (2 404) (1 585) (799) (340) (87) M/L Taper (Zimmer Biomet) Trilogy (Zimmer Biomet) 560 4 69 (63–72) 33/67 2012–2023 2,2 [0,9; 3,4] 2,5 [1,2; 3,8] 2,5 [1,2; 3,8] 2,5 [1,2; 3,8] 2,8 [1,4; 4,2] 2,8 [1,4; 4,2] 2,8 [1,4; 4,2] 2,8 [1,4; 4,2] 2,8 [1,4; 4,2] (530) (492) (450) (415) (386) (361) (280) (184) (106) METABLOC (Zimmer Biomet) Allofit (Zimmer Biomet) 500 13 72,5 38/62 2012–2020 2,0 [0,8; 3,2] 2,4 [1,1; 3,8] 2,6 [1,2; 4,0] 3,5 [1,9; 5,2] 3,8 [2,1; 5,5] 3,8 [2,1; 5,5] 4,2 [2,3; 6,1] 4,2 [2,3; 6,1] 4,2 [2,3; 6,1] (66–78) (482) (456) (438) (403) (348) (299) (209) (114) (56) Metafix (Corin) Trinity Hole (Corin) 737 13 73 (65–79) 36/64 2014–2023 1,9 [0,9; 2,9] 1,9 [0,9; 2,9] 2,1 [1,0; 3,2] 2,1 [1,0; 3,2] 2,1 [1,0; 3,2] 2,1 [1,0; 3,2] 2,1 [1,0; 3,2] (670) (561) (439) (359) (258) (185) (100) Metafix (Corin) Trinity no Hole (Corin) 965 10 71 47/53 2014–2023 1,8 [0,9; 2,6] 2,2 [1,3; 3,2] 2,4 [1,4; 3,3] 2,5 [1,5; 3,5] 3,0 [1,8; 4,1] 3,0 [1,8; 4,1] 3,0 [1,8; 4,1] 3,0 [1,8; 4,1] (64–76) (882) (818) (758) (691) (525) (410) (263) (117) METHA (Aesculap) PLASMACUP (Aesculap) 1 363 35 58 (52–63) 44/56 2013–2023 1,5 [0,8; 2,1] 2,3 [1,5; 3,1] 2,4 [1,5; 3,2] 2,6 [1,7; 3,4] 2,6 [1,7; 3,4] 2,6 [1,7; 3,4] 2,6 [1,7; 3,4] 2,6 [1,7; 3,4] 2,6 [1,7; 3,4] (1 293) (1 185) (1 056) (932) (783) (593) (441) (277) (125) METHA (Aesculap) PLASMAFIT (Aesculap) 6 711 148 57 48/52 2013–2023 3,0 [2,6; 3,4] 3,6 [3,1; 4,0] 3,8 [3,3; 4,3] 3,9 [3,4; 4,4] 4,0 [3,5; 4,5] 4,2 [3,7; 4,7] 4,2 [3,7; 4,7] 4,2 [3,7; 4,7] 4,2 [3,7; 4,7] (52–62) (5 858) (5 007) (4 202) (3 423) (2 551) (1 708) (1 002) (495) (124) MiniHip (Corin) Trinity Hole (Corin) 1 457 35 62 (55–68) 50/50 2013–2023 2,3 [1,5; 3,1] 2,5 [1,7; 3,3] 2,6 [1,8; 3,5] 2,8 [1,9; 3,6] 2,9 [2,0; 3,8] 3,3 [2,2; 4,3] 3,5 [2,4; 4,6] 3,5 [2,4; 4,6] (1 282) (1 050) (875) (746) (610) (444) (262) (107) MiniHip (Corin) Trinity ilma avata (Corin) 976 25 61 45/55 2014–2023 3,2 [2,1; 4,4] 3,9 [2,7; 5,2] 4,3 [3,0; 5,6] 4,3 [3,0; 5,6] 5,1 [3,6; 6,6] 5,4 [3,8; 6,9] 5,4 [3,8; 6,9] (55–66) (874) (749) (664) (573) (434) (264) (144) Nanos reieluukaelaprotees (OHST / Smith & Nephew) Allofit (Zimmer Biomet) 967 20 63 (56–70) 48/52 2014–2023 2,1 [1,2; 3,0] 2,6 [1,6; 3,6] 2,7 [1,7; 3,8] 2,7 [1,7; 3,8] 2,7 [1,7; 3,8] 2,7 [1,7; 3,8] 2,7 [1,7; 3,8] 2,7 [1,7; 3,8] (856) (761) (707) (640) (548) (436) (284) (109) Nanos reieluukaelaprotees (OHST / EP-FIT PLUS 3,1 [1,6; 4,6] Smith & Nephew) 538 28 57 53/47 2013–2023 3,1 [1,6; 4,6] 3,1 [1,6; 4,6] 3,4 [1,8; 5,1] 3,4 [1,8; 5,1] 3,4 [1,8; 5,1] 3,4 [1,8; 5,1] 3,4 [1,8; 5,1] (52–63) (Smith & Nephew) (463) (374) (307) (278) (245) (211) (148) (65) Nanos reieluuprotees (OHST / Smith & HI Lubricer kauss (Smith Nephew) & Nephew) 509 12 61 (54–68) 48/52 2013–2023 1,4 [0,4; 2,4] 2,2 [0,9; 3,5] 3,7 [2,0; 5,4] 4,4 [2,6; 6,3] 5,0 [3,0; 6,9] 5,0 [3,0; 6,9] 5,5 [3,2; 7,7] (483) (461) (421) (386) (342) (252) (167) Nanos reieluukaelaprotees (OHST / R3 2,5 [1,8; 3,1] Smith & Nephew) 2 240 75 59 45/55 2013–2023 2,6 [1,9; 3,3] 2,7 [2,0; 3,4] 2,9 [2,1; 3,7] 3,1 [2,2; 3,9] 3,3 [2,4; 4,2] 3,3 [2,4; 4,2] (53–64,5) (Smith & Nephew) (1 723) (1 335) (982) (733) (520) (319) (158) Nanos reieluukaelaprotees (OHST / REFLEKTSIOON Smith & Nephew) 508 4 69 (60–76) 35/65 2013–2023 1,6 [0,5; 2,7] 1,8 [0,6; 3,0] 2,1 [0,8; 3,4] 2,1 [0,8; 3,4] 2,1 [0,8; 3,4] 2,1 [0,8; 3,4] 2,1 [0,8; 3,4] (Smith & Nephew) (470) (395) (314) (263) (235) (150) (115) optimys (Mathys) Allofit (Zimmer Biomet) 4 754 38 63 45/55 2013–2023 1,8 [1,4; 2,2] 1,9 [1,5; 2,3] 2,1 [1,7; 2,5] 2,1 [1,7; 2,6] 2,1 [1,7; 2,6] 2,1 [1,7; 2,6] 2,3 [1,8; 2,8] 2,3 [1,8; 2,8] (57–69) (3 726) (2 920) (2 208) (1 735) (1 307) (854) (446) (148) optimys (Mathys) aneXys Cluster (Mathys) 575 30 60 (53–66) 36/64 2016–2023 2,6 [1,2; 4,0] 2,6 [1,2; 4,0] 2,6 [1,2; 4,0] 2,6 [1,2; 4,0] (352) (186) (100) (59) optimys (Mathys) aneXys Flex (Mathys) 4 553 68 61 47/53 2016–2023 1,7 [1,3; 2,1] 2,1 [1,6; 2,5] 2,2 [1,7; 2,7] 2,2 [1,7; 2,7] 2,5 [1,8; 3,2] 2,5 [1,8; 3,2] (56–67) (3 145) (2 097) (1 382) (891) (485) (246) optimys (Mathys) aneXys Uno (Mathys) 408 15 55 (48–64) 42/58 2019–2023 2,5 [1,0; 4,1] 4,1 [1,9; 6,3] 4,1 [1,9; 6,3] (313) (210) (146) optimys (Mathys) RM Pressfit (Mathys) 733 9 72 44/56 2014–2023 2,4 [1,2; 3,5] 2,8 [1,6; 4,1] 2,8 [1,6; 4,1] 3,2 [1,9; 4,6] 3,5 [2,1; 4,9] 3,5 [2,1; 4,9] 4,1 [2,2; 5,9] (63–78) (636) (573) (506) (433) (294) (178) (73) optimys (Mathys) RM Pressfit vitamys (Mathys) 16 866 102 65 (59–72) 45/55 2013–2023 1,6 [1,4; 1,8] 1,8 [1,6; 2,0] 1,8 [1,6; 2,1] 1,9 [1,7; 2,2] 2,0 [1,8; 2,3] 2,1 [1,8; 2,3] 2,1 [1,9; 2,4] 2,1 [1,9; 2,4] 2,1 [1,9; 2,4] (13 107) (10 053) (7 575) (5 481) (3 641) (2 144) (969) (265) (61) Tabel 47 (jätkub) 90 EPRD 2024. aasta aruanne 91  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Valikulised puusaliigese täielikud proteesimised Kumulatiivsed revisioonimäärad pärast ... Implanta Reieluuvars Põlvekupp Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat paigalda mise aastad Tsementeerimata fikseerimine Polarschaft (Smith & Nephew) EP-FIT PLUS (Smith & Nephew) 1 333 34 69 45/55 2013–2023 2,4 [1,6; 3,2] 2,8 [1,9; 3,7] 2,8 [1,9; 3,7] 2,8 [1,9; 3,7] 2,9 [2,0; 3,8] 2,9 [2,0; 3,8] 3,2 [2,1; 4,2] (61–75) (1 240) (1 135) (1 002) (882) (762) (538) (257) Polarschaft (Smith & HI määrdeainekauss Nephew) (Smith & Nephew) 3 007 17 70 (62–76) 35/65 2013–2023 2,3 [1,8; 2,9] 2,6 [2,1; 3,2] 2,6 [2,1; 3,2] 2,9 [2,3; 3,5] 3,1 [2,4; 3,8] 3,5 [2,7; 4,2] 4,0 [3,0; 4,9] 4,4 [3,1; 5,6] 4,4 [3,1; 5,6] (2 756) (2 409) (2 055) (1 708) (1 286) (846) (447) (172) (66) Polarschaft (Smith & Nephew) R3 (Smith & Nephew) 10 955 104 69 42/58 2013–2023 2,9 [2,6; 3,3] 3,2 [2,8; 3,5] 3,4 [3,1; 3,8] 3,6 [3,2; 4,0] 3,7 [3,3; 4,1] 3,7 [3,3; 4,1] 3,8 [3,4; 4,3] 3,8 [3,4; 4,3] (61–75) (8 312) (6 615) (5 206) (4 003) (2 679) (1 556) (658) (183) Polarschaft (Smith & Nephew) REFLECTION (Smith & Nephew) 341 4 73 (64–79) 39/61 2013–2023 0,0 [0,0; 0,0] 0,3 [0,0; 0,9] 0,3 [0,0; 0,9] 0,3 [0,0; 0,9] 0,3 [0,0; 0,9] 0,3 [0,0; 0,9] 1,3 [0,0; 3,3] (328) (279) (265) (241) (185) (136) (85) PROFEMUR® GLADIATOR CLASSIC PROCOTYL® L BEADED 341 12 69 2,9 [1,1; 4,7] 3,8 [1,8; 5,8] 4,1 [2,0; 6,2] 4,1 [2,0; 6,2] 4,7 [2,3; 7,0] 4,7 [2,3; 7,0] 4,7 [2,3; 7,0] (64–75) 39/61 2014–2021 (MicroPort) (MicroPort) (329) (323) (310) (213) (140) (88) (51) Puu s PROFEMUR® GLADIATOR CLASSIC PROCOTYL® P 575 13 70 (63–76) 37/63 2020–2023 3,0 [1,5; 4,4] 3,0 [1,5; 4,4] (MicroPort) (MicroPort) (391) (177) PROFEMUR®Preserve (MicroPort) PROCOTYL® P (MicroPort) 553 15 64 45/55 2020–2023 2,4 [1,1; 3,7] 2,4 [1,1; 3,7] (57–71) (319) (125) Proxy PLUS varre (Smith EP-FIT PLUS & Nephew) 342 13 70 (62–75) 46/54 2013–2020 3,8 [1,8; 5,8] 4,7 [2,4; 7,0] 5,0 [2,7; 7,4] 5,4 [2,9; 7,8] 5,4 [2,9; 7,8] 5,4 [2,9; 7,8] 5,4 [2,9; 7,8] 5,4 [2,9; 7,8] (Smith & Nephew) (324) (306) (296) (289) (264) (223) (158) (78) Pyramid (Atesos) Püramiid (Atesos) 3 215 26 71 36/64 2014–2023 2,8 [2,2; 3,4] 3,1 [2,5; 3,7] 3,5 [2,8; 4,2] 3,6 [2,9; 4,2] 3,6 [2,9; 4,3] 3,8 [3,1; 4,5] 3,8 [3,1; 4,5] 3,8 [3,1; 4,5] (64–77) (2 876) (2 559) (2 198) (1 791) (1 443) (1 015) (562) (166) QUADRA-H (Medacta) VERSAFITCUP CC TRIO (Medacta) 11 494 75 68 (61–75) 40/60 2015–2023 2,7 [2,4; 3,0] 3,2 [2,9; 3,5] 3,5 [3,2; 3,9] 3,8 [3,4; 4,2] 4,1 [3,7; 4,5] 4,4 [3,9; 4,8] 4,6 [4,1; 5,1] 5,3 [3,8; 6,8] (8 902) (6 893) (5 424) (4 143) (2 928) (1 538) (552) (63) S-ROM™-puusavars PINNACLE™ Press Fit-Hüftpfanne (DePuy) 4,0 [2,0; 6,0] (DePuy) 392 22 59 30/70 2014–2023 4,0 [2,0; 6,0] 4,6 [2,3; 6,9] 4,6 [2,3; 6,9] (51–67) (307) (231) (154) (96) SCS-varras standard (Stemcup) BSC-Cup pressfit suletud (Stemcup) 306 3 67 (60–73) 18/82 2015–2023 1,0 [0,0; 2,1] 2,0 [0,4; 3,6] 2,4 [0,6; 4,1] 2,4 [0,6; 4,1] 2,8 [0,9; 4,7] 3,5 [1,1; 5,8] 3,5 [1,1; 5,8] (298) (281) (268) (240) (194) (132) (54) SL-PLUS varre (Smith & Nephew) Allofit (Zimmer Biomet) 595 13 65 36/64 2012–2023 3,5 [2,0; 5,0] 4,4 [2,7; 6,1] 4,8 [3,0; 6,5] 5,2 [3,3; 6,9] 5,7 [3,8; 7,6] 6,1 [4,1; 8,1] 6,8 [4,7; 8,9] 7,1 [4,9; 9,3] 7,4 [5,1; 9,6] (58–71) (561) (539) (518) (497) (473) (442) (384) (334) (245) SL-PLUS varre (Smith & Nephew) BICON-PLUS (Smith & Nephew) 1 380 26 72 (65–78) 36/64 2013–2023 2,3 [1,5; 3,1] 3,4 [2,4; 4,3] 4,1 [3,0; 5,2] 4,9 [3,7; 6,1] 5,3 [4,0; 6,5] 5,9 [4,6; 7,3] 6,6 [5,1; 8,1] 6,8 [5,2; 8,4] 6,8 [5,2; 8,4] (1 290) (1 196) (1 054) (899) (766) (620) (444) (267) (67) SL-PLUS varre (Smith & Nephew) EP-FIT PLUS (Smith & Nephew) 428 13 66 44/56 2014–2023 2,1 [0,7; 3,5] 2,4 [0,9; 3,8] 2,4 [0,9; 3,8] 2,7 [1,1; 4,2] 2,7 [1,1; 4,2] 3,1 [1,3; 4,8] 3,1 [1,3; 4,8] 3,1 [1,3; 4,8] (62–72) (391) (372) (334) (297) (260) (218) (160) (69) HI Lubricer kauss (Smith & Nephew) SL-PLUS vars (Smith & Nephew) 326 9 71 (62–77) 36/64 2014–2023 0,9 [0,0; 2,0] 0,9 [0,0; 2,0] 0,9 [0,0; 2,0] 1,3 [0,0; 2,6] 1,3 [0,0; 2,6] 1,8 [0,2; 3,5] 1,8 [0,2; 3,5] (312) (286) (263) (228) (198) (136) (79) SL-PLUS varre (Smith & Nephew) R3 (Smith & Nephew) 2 323 27 70 35/65 2013–2023 3,6 [2,9; 4,4] 4,5 [3,6; 5,3] 4,8 [3,9; 5,7] 4,9 [4,0; 5,8] 5,2 [4,2; 6,2] 5,6 [4,5; 6,7] 5,8 [4,7; 7,0] 6,3 [4,8; 7,7] (63–76) (2 013) (1 730) (1 478) (1 229) (928) (610) (296) (98) SL MIA HA varre (Smith & Nephew) Allofit (Zimmer Biomet) 2 625 16 70 (60–78) 32/68 2014–2023 2,6 [2,0; 3,2] 3,0 [2,3; 3,7] 3,2 [2,5; 3,9] 3,3 [2,6; 4,1] 3,3 [2,6; 4,1] 3,3 [2,6; 4,1] 3,8 [2,6; 5,0] (2 101) (1 612) (1 215) (840) (467) (275) (99) SL MIA HA Schaft (Smith & Nephew) BICON-PLUS (Smith & Nephew) 802 16 71 34/66 2013–2023 2,4 [1,3; 3,5] 3,1 [1,9; 4,3] 3,7 [2,3; 5,0] 4,4 [2,9; 5,9] 4,6 [3,1; 6,1] 5,7 [4,0; 7,5] 6,6 [4,6; 8,5] 6,6 [4,6; 8,5] 7,0 [4,9; 9,0] (64–77) (738) (689) (638) (584) (532) (479) (389) (280) (134) SL MIA HA Schaft (Smith & Nephew) EP-FIT PLUS (Smith & Nephew) 705 10 72 (64–78) 40/60 2014–2023 2,7 [1,5; 3,9] 3,5 [2,1; 4,8] 3,7 [2,2; 5,0] 3,7 [2,2; 5,0] 3,7 [2,2; 5,0] 3,7 [2,2; 5,0] 3,7 [2,2; 5,0] 4,1 [2,4; 5,7] (643) (588) (535) (488) (447) (367) (232) (91) HI Lubricer Schale (Smith & Neph- SLMIAHASchaft(Smith&Nephew) 362 7 69 34/66 2015–2023 1,1 [0,0; 2,2] 1,4 [0,2; 2,7] 1,8 [0,4; 3,2] 1,8 [0,4; 3,2] 1,8 [0,4; 3,2] 1,8 [0,4; 3,2] (61–75) ew) (329) (290) (239) (176) (116) (69) SL MIA HA varre (Smith & Nephew) R3 (Smith & Nephew) 1 974 34 69 (61–76) 39/61 2015–2023 3,0 [2,3; 3,8] 3,3 [2,5; 4,1] 3,4 [2,6; 4,2] 3,5 [2,7; 4,3] 3,7 [2,8; 4,6] 3,7 [2,8; 4,6] 3,7 [2,8; 4,6] (1 708) (1 475) (1 245) (979) (660) (325) (88) SP-CL puusavars, tsementeerimata Allofit 2,9 [2,1; 3,6] (Waldemar Link) 2 170 14 63 41/59 2015–2023 3,3 [2,5; 4,1] 3,8 [2,9; 4,6] 3,9 [3,0; 4,7] 4,2 [3,3; 5,2] 4,5 [3,5; 5,5] 4,5 [3,5; 5,5] (56–68) (Zimmer Biomet) (1 840) (1 516) (1 286) (1 019) (756) (478) (179) SP-CL puusavars, tsementeerimata (Waldemar CombiCup (Waldemar Link) Link) 734 24 66 (58–72) 40/60 2014–2023 3,6 [2,2; 4,9] 4,0 [2,6; 5,4] 4,3 [2,8; 5,8] 4,3 [2,8; 5,8] 4,3 [2,8; 5,8] 4,3 [2,8; 5,8] 4,3 [2,8; 5,8] (670) (622) (582) (527) (406) (281) (130) SP-CL puusavars, tsementeerimata MobileLink, klastri auk 4,2 [2,9; 5,5] (Waldemar Link) (Waldemar Link) 906 22 65 39/61 2017–2023 5,2 [3,7; 6,8] 5,5 [3,9; 7,2] 5,5 [3,9; 7,2] (57–72) (665) (453) (259) (100) SPS Evolution (Symbios) APRIL Poly (Symbios) 410 6 61 (56–67) 47/53 2015–2023 1,0 [0,0; 1,9] 1,5 [0,3; 2,7] 1,5 [0,3; 2,7] 1,9 [0,5; 3,2] 1,9 [0,5; 3,2] 1,9 [0,5; 3,2] (363) (325) (295) (235) (169) (84) Tabel 47 (jätkub) 92 EPRD 2024. aasta aruanne 93  5 Puusa- ja põlveliigese proteesimise 5.1 Esmase puusaliigese endoproteesimise püsivus elulemus Valikulised puusaliigese täielikud proteesimised Kumulatiivsed revisioonimäärad pärast ... Implanta Reieluuvars Põlvekupp Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat paigalda mise aastad Tsementeerimata fikseerimine STEMSYS varre (ARTIQO) ANA.NOVA® hübriidpann (ARTIQO) 362 8 74 36/64 2018–2023 6,5 [3,9; 9,0] 7,2 [4,4; 10,0] 7,2 [4,4; 10,0] (70–79) (267) (193) (97) Taperloc (Zimmer Biomet) Allofit (Zimmer Biomet) 2 638 30 69 (62–76) 41/59 2015–2023 3,1 [2,5; 3,8] 3,5 [2,8; 4,2] 3,6 [2,8; 4,3] 3,6 [2,8; 4,3] 3,6 [2,8; 4,3] 3,6 [2,8; 4,3] (2 008) (1 348) (890) (577) (313) (154) Taperloc (Zimmer Biomet) G7 (Zimmer Biomet) 2 542 11 69 36/64 2014–2023 2,6 [2,0; 3,2] 3,2 [2,5; 3,9] 3,9 [3,1; 4,7] 4,5 [3,7; 5,4] 5,1 [4,1; 6,0] 5,7 [4,6; 6,7] 6,4 [5,2; 7,6] (62–76) (2 307) (2 090) (1 805) (1 495) (1 194) (754) (287) TAPERLOC COMPLETE Allofit 1 532 24 64 (58–71) 49/51 2017–2023 2,7 [1,9; 3,5] 3,0 [2,1; 3,8] 3,2 [2,2; 4,1] 3,2 [2,2; 4,1] 3,9 [2,2; 5,6] (Zimmer Biomet) (Zimmer Biomet) (981) (617) (418) (186) (63) TAPERLOC COMPLETE G7 1 224 9 69 4,0 [2,9; 5,1] 4,6 [3,4; 5,8] 5,3 [3,9; 6,6] 5,8 [4,3; 7,3] 6,8 [4,9; 8,6] (61–76) 35/65 2015–2023 (Zimmer Biomet) (Zimmer Biomet) (968) (755) (590) (373) (99) Puu s TAPERLOC COMPLETE PLASMAFIT 2 453 3 66 (59–73) 43/57 2015–2023 1,4 [0,9; 1,8] 1,5 [1,0; 2,0] 1,6 [1,1; 2,0] 1,6 [1,1; 2,2] 1,6 [1,1; 2,2] 1,6 [1,1; 2,2] 1,6 [1,1; 2,2] (Zimmer Biomet) (Aesculap) (2 370) (2 307) (2 210) (1 783) (1 361) (882) (428) TRENDHIP (Aesculap) PLASMAFIT (Aesculap) 6 270 59 69 41/59 2014–2023 2,5 [2,1; 2,9] 2,8 [2,4; 3,2] 2,8 [2,4; 3,2] 2,9 [2,5; 3,3] 3,0 [2,5; 3,4] 3,2 [2,7; 3,7] 3,2 [2,7; 3,7] 3,2 [2,7; 3,7] (61–76) (5 295) (4 403) (3 747) (3 002) (1 996) (1 047) (564) (216) TRENDHIP (Aesculap) SCREWCUP SC (Aesculap) 520 10 71 (63–78) 35/65 2015–2023 3,1 [1,6; 4,6] 3,6 [1,9; 5,2] 4,3 [2,5; 6,1] 4,6 [2,7; 6,5] 6,0 [3,5; 8,4] 7,0 [3,8; 10,0] (449) (404) (358) (261) (161) (81) TRILOCK™-puusavars PINNACLE™ Press Fit-puusaliiges (DePuy) 1,8 [1,4; 2,2] (DePuy) 4 596 52 60 49/51 2013–2023 2,4 [1,9; 2,8] 2,7 [2,2; 3,2] 2,9 [2,4; 3,5] 3,0 [2,5; 3,5] 3,3 [2,6; 3,9] 3,5 [2,8; 4,2] 3,8 [2,9; 4,7] 3,8 [2,9; 4,7] (55–67) (4 029) (3 349) (2 733) (2 114) (1 434) (995) (611) (283) (73) TRJ (Aesculap) PLASMACUP (Aesculap) 452 8 72 (64,5–77) 31/69 2014–2023 2,5 [1,0; 3,9] 2,7 [1,2; 4,2] 2,7 [1,2; 4,2] 3,0 [1,4; 4,6] 3,0 [1,4; 4,6] 3,0 [1,4; 4,6] 3,0 [1,4; 4,6] 3,0 [1,4; 4,6] (422) (389) (361) (315) (233) (169) (126) (51) TRJ (Aesculap) PLASMAFIT (Aesculap) 622 26 70,5 32/68 2013–2023 3,6 [2,1; 5,1] 4,8 [3,0; 6,7] 5,2 [3,2; 7,1] 5,2 [3,2; 7,1] 5,2 [3,2; 7,1] 5,2 [3,2; 7,1] (62–77) (471) (339) (247) (176) (112) (61) twinSys uncem. (Mathys) aneXys Flex (Mathys) 1 534 34 71 (65–77) 41/59 2016–2023 3,9 [2,9; 4,8] 4,4 [3,3; 5,5] 4,4 [3,3; 5,5] 4,7 [3,6; 5,9] 4,7 [3,6; 5,9] 4,7 [3,6; 5,9] (1 189) (919) (642) (433) (223) (94) twinSys uncem. (Mathys) RM Classic (Mathys) 902 11 76,5 29/71 2013–2023 1,5 [0,7; 2,3] 1,9 [0,9; 2,8] 2,2 [1,2; 3,2] 2,3 [1,3; 3,4] 2,6 [1,4; 3,7] 2,9 [1,6; 4,2] 2,9 [1,6; 4,2] 2,9 [1,6; 4,2] 3,5 [1,7; 5,3] (71–81) (793) (701) (598) (465) (353) (271) (219) (174) (142) twinSys uncem. (Mathys) RM Pressfit (Mathys) 480 9 75 (69–79) 39/61 2013–2023 2,7 [1,2; 4,2] 3,4 [1,7; 5,0] 3,6 [1,9; 5,3] 3,8 [2,1; 5,6] 4,1 [2,3; 5,9] 4,1 [2,3; 5,9] 4,6 [2,5; 6,7] 4,6 [2,5; 6,7] (453) (429) (406) (385) (314) (268) (182) (98) twinSys uncem. (Mathys) RM Pressfit vitamys (Mathys) 2 952 39 72 36/64 2013–2023 2,5 [1,9; 3,0] 2,6 [2,1; 3,2] 2,7 [2,1; 3,3] 2,9 [2,3; 3,6] 2,9 [2,3; 3,6] 3,2 [2,5; 4,0] 3,2 [2,5; 4,0] 3,7 [2,5; 4,8] (65–78) (2 517) (2 090) (1 712) (1 289) (898) (523) (244) (126) Tsementeeritud kinnitus AS PLUS varre (Smith & Müller II Pfanne (OHST Nephew) Medizintechnik) 302 7 81 (78–84) 20/80 2013–2022 3,0 [1,1; 5,0] 3,0 [1,1; 5,0] 3,5 [1,3; 5,5] 3,5 [1,3; 5,5] 4,0 [1,6; 6,2] 4,0 [1,6; 6,2] 4,0 [1,6; 6,2] (277) (250) (225) (202) (164) (103) (54) Avenir (Zimmer Biomet) AVANTAGE (Zimmer Biomet) 314 28 81 30/70 2015–2023 3,8 [1,6; 6,0] 5,0 [2,2; 7,7] 5,0 [2,2; 7,7] (77–84) (190) (104) (58) Avenir (Zimmer Biomet) Flachprofil (Zimmer Biomet) 1 149 88 81 (77–84) 22/78 2014–2023 3,3 [2,3; 4,4] 3,6 [2,5; 4,7] 3,6 [2,5; 4,7] 3,6 [2,5; 4,7] 3,6 [2,5; 4,7] 4,1 [2,6; 5,6] (899) (643) (428) (295) (186) (92) BICONTACT (Aesculap) Kõik POLY CUP (Aesculap) 1 635 69 81 22/78 2013–2023 2,4 [1,6; 3,1] 2,4 [1,6; 3,1] 2,6 [1,8; 3,4] 2,8 [2,0; 3,7] 2,9 [2,1; 3,8] 3,1 [2,2; 4,0] 3,2 [2,3; 4,2] 3,5 [2,4; 4,6] 3,5 [2,4; 4,6] (77–84) (1 453) (1 328) (1 203) (1 015) (795) (565) (355) (187) (75) CORAIL™ AMT-puusavars ilma kraeta (DePuy) TRILOC® II-PE-puusapann (DePuy) 1 014 76 80 (76–84) 19/81 2013–2023 2,7 [1,7; 3,7] 3,0 [1,9; 4,0] 3,2 [2,1; 4,4] 3,6 [2,4; 4,8] 4,0 [2,7; 5,4] 4,6 [3,0; 6,1] 5,0 [3,2; 6,7] (867) (752) (629) (501) (375) (266) (147) CS PLUS varre (Smith Müller II Pfanne (OHST 1,0 [0,1; 1,9] & Nephew) Medizintechnik) 485 21 79 26/74 2014–2019 1,7 [0,5; 2,9] 2,2 [0,8; 3,5] 2,2 [0,8; 3,5] 2,2 [0,8; 3,5] 2,2 [0,8; 3,5] 2,2 [0,8; 3,5] (77–82) (455) (433) (415) (387) (348) (269) (163) EXCIA (Aesculap) Kõik POLY CUP (Aesculap) 1 217 73 80 (76–83) 23/77 2014–2023 2,4 [1,5; 3,2] 2,9 [1,9; 3,8] 3,0 [2,0; 4,0] 3,2 [2,1; 4,2] 3,3 [2,2; 4,4] 4,1 [2,7; 5,5] 4,5 [2,9; 6,1] 6,2 [3,3; 8,9] (1 033) (848) (689) (537) (416) (284) (187) (68) M.E.M. sirge vars (Zimmer Biomet) Lame profiil (Zimmer Biomet) 5 293 142 80 24/76 2012–2023 2,5 [2,1; 2,9] 2,9 [2,4; 3,4] 3,2 [2,7; 3,7] 3,3 [2,8; 3,8] 3,4 [2,9; 3,9] 3,6 [3,0; 4,1] 3,6 [3,1; 4,2] 3,6 [3,1; 4,2] 3,6 [3,1; 4,2] (77–84) (4 369) (3 665) (3 075) (2 482) (1 870) (1 276) (785) (372) (102) METABLOC (Zimmer Biomet) Lame profiil (Zimmer Biomet) 420 17 79 (76–83) 26/74 2013–2022 2,7 [1,1; 4,2] 2,9 [1,3; 4,5] 3,2 [1,5; 4,9] 3,8 [1,9; 5,7] 4,2 [2,1; 6,3] 5,8 [3,1; 8,5] 5,8 [3,1; 8,5] (390) (372) (336) (274) (210) (138) (64) MS-30 (Zimmer Biomet) Lame profiil (Zimmer Biomet) 503 28 79 23/77 2013–2023 2,0 [0,8; 3,3] 2,2 [0,9; 3,5] 2,5 [1,1; 3,8] 2,5 [1,1; 3,8] 2,5 [1,1; 3,8] 2,5 [1,1; 3,8] 2,5 [1,1; 3,8] 3,4 [1,1; 5,5] (76–83) (465) (441) (411) (360) (272) (177) (120) (52) Tabel 47 (jätkub) 94 EPRD 2024. aasta aruanne 95  5 Puusa- ja põlveliigese proteesimise 5.2 Lõikuse järelhoolduse puusaliigese püsivus proteesimise elulemus Valikulised puusaliigese täielikud proteesimised Kumulatiivsed revisioonimäärad pärast ... Implanta Reieluuvars Põlvekupp Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat paigalda mise aastad Tsementeeritud fikseerimine Polarschaft Cemented (Smith & Müller II Pfanne (OHST Nephew) Medizintechnik) 683 34 80 (77–84) 22/78 2014–2023 3,9 [2,4; 5,3] 4,2 [2,7; 5,7] 4,2 [2,7; 5,7] 4,2 [2,7; 5,7] 4,8 [3,1; 6,5] 4,8 [3,1; 6,5] 4,8 [3,1; 6,5] (579) (515) (461) (380) (268) (162) (64) SPII mudel Lubinus puusavars, Tsementeeritud asetabulaarne kaussisüsteem, standardvars, ilma puurauguta (Waldemar Endo-mudeli kauss 498 6 77 18/82 2012–2023 2,0 [0,8; 3,3] 2,7 [1,2; 4,1] 2,7 [1,2; 4,1] 2,9 [1,4; 4,4] 2,9 [1,4; 4,4] 2,9 [1,4; 4,4] 2,9 [1,4; 4,4] 3,3 [1,6; 5,0] 3,3 [1,6; 5,0] Link) (Waldemar Link) (73–81) (474) (436) (403) (362) (322) (289) (250) (199) (136) SPII mudel Lubinus puusavars, standardvars, ilma puurauguta (Waldemar Link) Tsementeeritud asetabulaarne kauss, IP-kauss (Waldemar Link) 1 294 30 81 (78–84) 25/75 2013–2023 2,2 [1,4; 3,0] 2,6 [1,7; 3,4] 2,9 [2,0; 3,9] 3,4 [2,4; 4,5] 3,5 [2,4; 4,6] 3,7 [2,6; 4,8] 3,7 [2,6; 4,8] 3,7 [2,6; 4,8] (1 160) (1 056) (942) (807) (609) (434) (284) (103) SPII mudel Lubinus puusavars, Tsementeeritud asetabulaarne kaussisüsteem, standardvars, ilma puurauguta (Waldemar Lubinus (Waldemar 1 001 22 80 23/77 2013–2023 1,3 [0,6; 2,0] 1,6 [0,8; 2,3] 2,0 [1,1; 2,9] 2,3 [1,3; 3,3] 2,5 [1,4; 3,6] 2,8 [1,6; 4,1] 2,8 [1,6; 4,1] 4,4 [1,9; 6,8] Puu Link) Link) (76–83) (905) (785) (646) (499) (374) (278) (162) (79) s twinSys cem. (Mathys) CCB (Mathys) 576 24 80 (76–84) 22/78 2014–2023 1,4 [0,4; 2,4] 2,1 [0,8; 3,3] 2,1 [0,8; 3,3] 2,4 [1,0; 3,8] 2,9 [1,2; 4,6] 2,9 [1,2; 4,6] 4,1 [1,3; 6,8] (486) (379) (305) (232) (170) (121) (68) Tabel 47 (jätkub) 5.2 Lõikuse järel . Kui CReRR on 2 aasta jooksul pärast aseptilist revisiooni 11,9%, siis septilise revisiooni järel on see Erinevad varrekomponendid erinevatele vanuserühmadele? püsivus puusaliigese enam kui kahekordistunud, ulatudes 29,7%ni (joonis endoproteesimisel 14). Lisas esitatud tabelites 47 ja 63 on kokku võetud üksikute varre süsteemide tulemused kõigi vanuserühmade kohta kokku. Puusa liigese korduvoperatsioon on märkimisväärselt tõenäolisem pärast eelmist Registris puudub täielik haiguslugu enamiku Hiljutises EPRD andmetel põhinevas publikatsioonis hinnati konkreetsete tüüpi varrete tulemusi erinevates patsientide rühmades [4]. korduvoperatsiooni kui pärast esmast artroplastikat. revisioonide (sh kordusrevisioonide) puhul, kus vastav tsementeerimata varrega puusaliigese endoproteeside CRR Kumulatiivne korduvoperatsioonide määr (CReRR) esmane artroplastika on tehtud enne EPRD andmete suureneb märkimisväärselt patsiendi vanuse kasvades sõltub samuti suuresti operatsiooni põhjusest. Kui kogumise algust. Siiski on registrisse kantud esmase patsiendi vanuse kasvades. vaadelda registris jälgitavaid kõiki artroplastikaga revisioonide puhul täpne järgnevate Autorid jõudsid järeldusele, et kui soovitakse vältida korduvoperatsioone, on periprostetilise infektsiooni revisioonide arv tsementeeritud varre kasutamist, tuleks vanematel patsientidel kaaluda alternatiivina spetsiaalseid varre konstruktsioone, nagu tõttu tehtava korduvoperatsiooni risk näiteks tsementeerimata kaelaga varred, mis on seotud väiksema märkimisväärselt kõrgem kui mis tahes muu põhjuse Tsementeerimata varte kasutamine vanemates periprostetiliste luumurdude riskiga puhul vanuserühmades vanematel patsientidel alternatiivina kaaluda. nõuab siiski kriitilist hindamist ja ettevaatlikkust 40 © EPRD 2024. aasta aruanne 35 30 Kumulatiivne re-revisioon [%] 25 20 15 10 5 0 Septilised puusaliigese revisioonid Aseptilised puusaliigese revisioonid 0 1 2 3 4 5 6 7 8 9 Aastad viimasest muudatusest 16 489 9 406 7 363 5 671 4 204 2 846 1 764 986 397 90 Ohustatud arvud 51 713 37 804 30 368 24 004 18 476 13 210 8 778 4 900 2 154 660 Joonis 14: Puusaliigese endoproteesimise kumulatiivsed kordusoperatsioonide määrad aja jooksul (p < 0,0001) 96 EPRD 2024. aasta aruanne 97  5 Puusa- ja põlveliigese proteesimise 5.2 Lõikuse järelhoolduse puusaliigese püsivus proteesimise elulemus on võimalik täpselt kindlaks määrata, kuna jälgimises CReRR-i mõjutab ka see, millised komponendid nii üheskoos kui ka juhul, kui analüüs keskendub ei ole lünki. Joonisel 15 on näidatud, kuidas revisiooni vahetati või implanteeriti uuesti revisiooni käigus. konkreetselt esimesele või teisele revisioonile. risk suureneb ühe järgneva protseduuri j ä rel. See on Näiteks on re-revisiooni risk madalam pärast Sellegipoolest tuleb märkida, et puusaliigese või eriti ilmne aseptiliste revisioonide puhul, kus tulemuste luukinnituse komponendi vahetamist/uuesti reieluukomponendi vahetamine on patsiendile erinevused aseptiliste ja septiliste revisioonide vahel implanteerimist nii septiliste kui ka aseptiliste koormavam kui ainult pea ja/või sisekomponendi vähenevad iga järgneva protseduuri järel. revisioonide puhul (joonis 16). See suundumus püsib, revisioon. Varre või kausikomponendi vahetamine kui arvestada kõiki registrisse kantud revisioone... võib kaasa tuua täiendavaid tüsistusi, mis on ehk põhjuseks, miks esialgu eelistatakse vähem invasiivset 40 © EPRD aastaaruanne 2024 protseduuri. Infektsiooniga seotud protseduurid, mille 35 puhul luusse kinnitatud komponendid jäetakse paigale, Puu sa Kumulatiivne ümbervaatamine [%] 30 on siiski seotud kõrgemate patsientide 25 suremusnäitajatega (vt 6. peatükk). 20 15 Tabelis 48 on esitatud peamised tegurid, mis mõjutavad puusaliigese CReRR-i. Tuleb märkida, et 10 revisioonide algtingimused võivad olla palju 5 Järgnevad septilised revisioonid Järgnevad aseptilised revisioonid 2. mitmekesisemad kui esmase artroplastika puhul. 0 2 . septiline revisioon aseptiline revisioon 0 1 2 1. septiline revisioon 3 4 1. aseptiline revisjon 5 plastika, mis võib praegust hindamist segada. Kuigi Aastad viimasest muudatusest registrisse on kantud revisioonide põhjused ja asendatud komponentide üksikasjad, saab üksikute 690 366 269 205 140 87 protseduuride keerukust järeldada vaid piiratud 1 431 757 560 416 293 173 4 688 2 448 1 818 1 298 889 527 ulatuses. Riskirühm 251 143 89 59 43 21 897 564 401 276 185 106 8 730 5 931 4 440 3 225 2 279 1 466 Joonis 15: Puusaliigese endoproteesimise kumulatiivsed re-revisioonimäärad pärast esimest, teist ja järgnevaid revisioone (p < 0,0001). Selguse huvides on Lühidalt usaldusvahemikud välja jäetud. • Septilise puusaliigese endoproteesimise 40 korduvoperatsioonide puhul on 2-aastane © EPRD aastaaruanne 2024 35 CReRR 29,7%, võrreldes 11,9%ga aseptiliste 30 protseduuride puhul. Kumulatiivne kordusrevisioon [%] 25 • Revisioonirisk suureneb iga järgneva 20 protseduuriga. 15 10 5 Septiline, ilma luukinnitustega komponentide vahetamiseta Septiline, luukinnitustega komponentide vahetamisega Aseptiline, ilma 0 luukinnitustega komponentide vahetamiseta Aseptiline, luukinnitustega komponentide vahetamisega 0 1 2 3 4 5 6 7 8 9 Aastad viimasest muudatusest 5 581 2 675 1 986 1 447 1 003 603 351 183 53 9 10 175 6 395 5 110 4 019 3 049 2 141 1 348 769 328 78 Ohustatud arvud 8 833 6 448 5 205 4 103 3 172 2 252 1 466 782 293 70 40 065 29 186 23 387 18 496 14 196 10 133 6 742 3 808 1 694 526 Joonis 16: Puusaliigese endoproteesimise kumulatiivsed kordusoperatsioonide määrad implanteeritud komponentide kaupa (p < 0,0001) 98 EPRD 2024. aasta aruanne 99  5 Puusa- ja põlveliigese proteesimise 5.2 Lõikuse järelhoolduse puusaliigese püsivus proteesimise elulemus Kordusrevisioonide määr pärast ... Revisjoni tüüp / Kategooria Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat Infektsiooniga seotud puusaliigese revisioon 16 489 74 (65–80) 45/55 28,1 700 27,6 [26,9; 28,3] 29,7 [29,0; 30,5] 30,9 [30,1; 31,6] 32,0 [31,2; 32,8] 32,8 [32,0; 33,6] 33,4 [32,6; 34,3] 34,1 [33,2; 35,0] 34,4 [33,4; 35,4] 34,6 [33,5; 35,6] (9 406) (7 363) (5 671) (4 204) (2 846) (1 764) (986) (397) (90) Protseduuride arv Esimene korrigeerimine 4 688 73 (63–81) 44/56 29,0 618 27,3 [26,0; 28,6] 28,8 [27,4; 30,1] 29,6 [28,2; 31,0] 30,3 [28,8; 31,7] 30,9 [29,4; 32,4] 30,9 [29,4; 32,4] 31,4 [29,6; 33,0] (2 448) (1 818) (1 298) (889) (527) (268) (135) Teine läbivaatamine 1 431 73 44/56 29,4 454 27,9 [25,5; 30,3] 29,4 [26,9; 31,8] 30,5 [27,9; 33,0] 31,5 [28,8; 34,1] 32,7 [29,7; 35,4] 32,7 [29,7; 35,4] (64–80) (757) (560) (416) (293) (173) (99) Kolmas või järgnev 32,6 [28,9; 36,1] 35,5 [31,7; 39,2] 36,6 [32,7; 40,3] 37,4 [33,4; 41,3] 38,0 [33,8; 41,9] 39,0 [34,4; 43,2] muudatus 690 72 (64–79) 43/57 29,4 259 (366) (269) (205) (140) (87) (52) Läbivaatamine ilma teadaoleva 9 680 75 46/54 27,7 642 27,3 [26,4; 28,2] 29,7 [28,8; 30,7] 31,0 [30,0; 31,9] 32,3 [31,3; 33,3] 33,1 [32,0; 34,1] 33,9 [32,8; 35,0] 34,5 [33,4; 35,7] 34,9 [33,7; 36,2] 35,1 [33,8; 36,4] (65–81) varasem ajalugu (5 835) (4 716) (3 752) (2 882) (2 059) (1 345) (786) (345) (82) Koos luukinnitustega 23,7 [22,9; 24,6] 25,9 [25,0; 26,8] 27,0 [26,1; 27,9] 28,3 [27,3; 29,2] 29,1 [28,1; 30,0] 29,9 [28,9; 30,9] 30,6 [29,5; 31,7] 31,1 [29,9; 32,3] 31,3 [30,0; 32,6] Uuesti implanteeritud komponendid komponentide vahetamisega 10 175 73 (64–80) 47/53 28,0 650 (6 395) (5 110) (4 019) (3 049) (2 141) (1 348) (769) (328) (78) Puu s Ilma luu vahetamiseta 5 581 75 42/58 28,4 634 32,9 [31,6; 34,2] 34,8 [33,5; 36,1] 35,8 [34,5; 37,2] 36,6 [35,2; 38,0] 37,4 [36,0; 38,9] 37,7 [36,2; 39,2] 38,2 [36,5; 39,8] 38,2 [36,5; 39,8] (66–82) kinnitatud komponendid (2 675) (1 986) (1 447) (1 003) (603) (351) (183) (53) ei ole selgelt määratletud 733 74 (64–80) 42/58 28,6 227 42,6 [38,7; 46,2] 45,2 [41,2; 48,9] 47,9 [43,8; 51,7] 49,1 [44,9; 52,9] 49,8 [45,6; 53,7] 49,8 [45,6; 53,7] (336) (267) (205) (152) (102) (65) Vanuserühm ≤ 54 aastat 1 272 50 58/42 29,4 362 24,1 [21,7; 26,5] 27,7 [25,1; 30,2] 29,7 [27,0; 32,4] 30,5 [27,7; 33,1] 32,4 [29,4; 35,2] 33,6 [30,4; 36,5] 34,0 [30,8; 37,1] (45–52) (814) (644) (514) (396) (277) (187) (107) 55–64 aastat 2 847 60 (58–62) 55/45 30,8 511 25,1 [23,5; 26,7] 27,4 [25,7; 29,1] 28,6 [26,8; 30,3] 29,8 [28,0; 31,6] 30,6 [28,7; 32,4] 31,7 [29,7; 33,7] 32,9 [30,6; 35,1] 33,6 [31,0; 36,2] (1 775) (1 421) (1 102) (810) (574) (358) (191) (88) 65–74 aastat 4 370 70 48/52 29,8 584 28,5 [27,1; 29,8] 30,9 [29,5; 32,3] 32,0 [30,5; 33,4] 33,4 [31,9; 34,9] 34,1 [32,5; 35,6] 34,6 [33,0; 36,2] 35,2 [33,5; 36,9] 35,6 [33,7; 37,4] (67–72) (2 573) (2 012) (1 581) (1 175) (820) (532) (322) (125) 75–84 aastat 6 189 79 (77–82) 40/60 27,3 630 28,8 [27,6; 29,9] 30,2 [29,0; 31,4] 31,4 [30,1; 32,6] 32,4 [31,1; 33,6] 33,0 [31,7; 34,3] 33,6 [32,2; 34,9] 33,9 [32,5; 35,3] 33,9 [32,5; 35,3] (3 464) (2 751) (2 132) (1 611) (1 046) (616) (328) (122) ≥ 85 aastat 1 811 87 30/70 25,4 468 27,7 [25,5; 29,9] 29,8 [27,4; 32,0] 29,9 [27,5; 32,2] 30,9 [28,4; 33,4] 30,9 [28,4; 33,4] 30,9 [28,4; 33,4] (86–89) (780) (535) (342) (212) (129) (71) Sugu Mehed 7 429 72 (62–79) 100/0 28,0 654 25,4 [24,4; 26,4] 27,8 [26,7; 28,8] 28,9 [27,8; 30,0] 30,0 [28,9; 31,1] 30,9 [29,7; 32,0] 31,8 [30,6; 33,1] 32,8 [31,4; 34,1] 33,2 [31,7; 34,6] (4 459) (3 511) (2 710) (2 014) (1 369) (862) (494) (195) Naised 9 060 76 0/100 28,3 655 29,4 [28,4; 30,4] 31,4 [30,3; 32,3] 32,5 [31,5; 33,5] 33,7 [32,6; 34,7] 34,4 [33,3; 35,5] 34,7 [33,6; 35,9] 35,1 [33,9; 36,3] 35,4 [34,1; 36,7] (67–82) (4 947) (3 852) (2 961) (2 190) (1 477) (902) (492) (202) Kehamassiindeks ≤ 25 3 443 78 (69–83) 41/59 23,0 550 24,3 [22,8; 25,8] 26,1 [24,6; 27,7] 27,1 [25,5; 28,7] 28,6 [26,9; 30,4] 29,1 [27,3; 30,9] 29,1 [27,3; 30,9] (1 831) (1 324) (903) (570) (279) (71) > 25–30 4 197 76 51/49 27,4 597 26,6 [25,2; 28,0] 28,6 [27,1; 30,0] 29,8 [28,3; 31,3] 31,1 [29,5; 32,6] 31,9 [30,2; 33,5] 32,1 [30,4; 33,8] (67–82) (2 330) (1 731) (1 234) (795) (402) (95) > 30–35 2 744 72 (64–79) 46/54 32,0 516 28,3 [26,5; 30,0] 29,9 [28,1; 31,7] 30,9 [29,0; 32,7] 32,1 [30,1; 33,9] 33,5 [31,4; 35,5] 35,0 [32,2; 37,6] (1 528) (1 166) (849) (560) (294) (76) > 35–40 1 379 69 38/62 36,9 403 32,5 [29,9; 34,9] 34,7 [32,0; 37,2] 36,5 [33,8; 39,2] 36,7 [33,9; 39,4] 37,6 [34,7; 40,4] (61–77) (728) (545) (386) (259) (140) üle 40 841 65 (59–71) 33/67 43,1 319 33,4 [30,1; 36,6] 35,0 [31,6; 38,3] 35,8 [32,3; 39,1] 36,8 [33,1; 40,2] 37,2 [33,5; 40,8] (435) (315) (220) (148) (72) Haiglad, kus on vähe 9 575 75 45/55 28,3 555 27,8 [26,9; 28,7] 29,7 [28,8; 30,7] 30,9 [29,9; 31,9] 31,9 [30,9; 32,9] 32,6 [31,6; 33,7] 33,4 [32,3; 34,5] 34,1 [32,9; 35,3] 34,3 [33,0; 35,6] Haiglasuurus* (66–81) aastane juhtumite arv (5 343) (4 136) (3 145) (2 326) (1 562) (961) (554) (225) Haiglad keskmise aastase 28,1 [26,4; 29,9] 30,5 [28,6; 32,3] 31,2 [29,4; 33,1] 32,3 [30,3; 34,1] 32,8 [30,8; 34,7] 33,2 [31,1; 35,3] 33,5 [31,4; 35,6] 33,5 [31,4; 35,6] patsientide arvuga 2 708 74 (65–81) 44/56 27,8 83 (1 496) (1 139) (864) (637) (418) (264) (137) (51) Haiglad, kus on kõrge 4 066 72 46/54 28,2 35 26,6 [25,2; 28,0] 28,9 [27,4; 30,3] 30,2 [28,7; 31,7] 31,6 [30,1; 33,1] 32,7 [31,1; 34,3] 33,3 [31,6; 34,9] 33,9 [32,2; 35,7] 34,7 [32,6; 36,8] (62–79) aastane juhtumite arv (2 480) (2 012) (1 596) (1 187) (823) (516) (283) (117) Infektsiooniga mitteseotud puusaliigese revisioon 51 713 76 (67–82) 35/65 26,7 746 10,0 [9,7; 10,2] 11,9 [11,6; 12,2] 13,2 [12,8; 13,5] 14,1 [13,8; 14,4] 15,0 [14,6; 15,3] 15,8 [15,4; 16,2] 16,6 [16,2; 17,1] 17,5 [16,9; 18,0] 18,2 [17,5; 18,9] (37 804) (30 368) (24 004) (18 476) (13 210) (8 778) (4 900) (2 154) (660) Protseduuride arv Esimene korrigeerimine 8 730 73 (64–80) 35/65 27,0 682 9,9 [9,3; 10,6] 12,3 [11,6; 13,1] 13,8 [13,0; 14,6] 14,7 [13,8; 15,6] 15,7 [14,7; 16,6] 16,4 [15,4; 17,5] 16,8 [15,7; 17,9] 17,5 [16,0; 19,0] (5 931) (4 440) (3 225) (2 279) (1 466) (844) (385) (128) Teine läbivaatamine 897 74 37/63 27,4 356 15,2 [12,7; 17,6] 19,1 [16,2; 21,9] 20,3 [17,3; 23,2] 20,7 [17,6; 23,7] 22,3 [18,7; 25,8] 22,3 [18,7; 25,8] (64–81) (564) (401) (276) (185) (106) (52) Kordusoperatsioon ilma 9,8 [9,5; 10,1] 11,6 [11,3; 11,9] 12,8 [12,5; 13,2] 13,8 [13,4; 14,1] 14,6 [14,2; 15,0] 15,4 [15,0; 15,8] 16,4 [15,9; 16,8] 17,2 [16,6; 17,7] 18,0 [17,3; 18,7] teadaoleva eelneva haigusloota 41 835 77 (68–82) 35/65 26,6 742 (31 166) (25 438) (20 444) (15 969) (11 617) (7 872) (4 497) (2 024) (632) Tabel 48: Peamised tegurid, mis mõjutavad puusaliigese kordusoperatsioonide sagedust 100 EPRD 2024. aasta aruanne 101  5 Puusa- ja põlveliigese proteesimise 5.2 Lõikuse järelhoolduse puusaliigese püsivus proteesimise elulemus Re-revisiooni määr pärast ... Revisjoni tüüp / Kategooria Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat koosvahetus(luu-) Uuesti implanteeritud komponendid 40 065 77 34/66 26,6 739 9,6 [9,3; 9,9] 11,3 [11,0; 11,7] 12,5 [12,2; 12,9] 13,4 [13,0; 13,8] 14,2 [13,8; 14,6] 15,0 [14,6; 15,4] 15,8 [15,3; 16,3] 16,6 [16,1; 17,2] 17,2 [16,5; 17,9] (67–82) kinnitatud komponendid (29 186) (23 387) (18 496) (14 196) (10 133) (6 742) (3 808) (1 694) (526) Ilma luukinnituskomponentide 12,1 [11,4; 12,8] 14,5 [13,7; 15,3] 16,0 [15,2; 16,8] 17,3 [16,4; 18,2] 18,3 [17,4; 19,3] 19,0 [18,0; 20,0] 20,0 [18,9; 21,1] 21,1 [19,8; 22,5] 23,6 [20,6; 26,6] vahetamiseta 8 833 75 (65–80) 36/64 27,0 666 (6 448) (5 205) (4 103) (3 172) (2 252) (1 466) (782) (293) (70) ei ole selgelt määratletud 2 815 75 34/66 27,1 441 9,0 [7,9; 10,1] 11,2 [9,9; 12,4] 12,8 [11,4; 14,1] 13,7 [12,3; 15,1] 14,8 [13,3; 16,3] 15,9 [14,2; 17,5] 17,0 [15,1; 18,9] 17,4 [15,4; 19,3] 17,4 [15,4; 19,3] (66–81) (2 170) (1 776) (1 405) (1 108) (825) (570) (310) (167) (64) Vanuserühm ≤ 54 aastat 3 346 50 (45–52) 44/56 27,7 539 7,9 [7,0; 8,9] 10,1 [9,1; 11,2] 12,0 [10,8; 13,1] 13,3 [12,1; 14,6] 14,5 [13,1; 15,8] 15,6 [14,1; 17,1] 17,4 [15,7; 19,1] 18,3 [16,3; 20,1] 18,3 [16,3; 20,1] (2 718) (2 287) (1 892) (1 517) (1 127) (827) (481) (234) (90) 55–64 aastat 7 304 60 42/58 28,1 658 8,3 [7,7; 9,0] 10,6 [9,8; 11,3] 12,3 [11,5; 13,1] 13,5 [12,6; 14,3] 14,3 [13,4; 15,2] 15,4 [14,4; 16,4] 16,0 [15,0; 17,1] 16,5 [15,4; 17,7] 16,8 [15,5; 18,1] (58–62) (5 808) (4 788) (3 860) (3 069) (2 282) (1 558) (927) (435) (147) 65–74 aastat 12 343 70 (68–73) 38/62 27,8 702 9,6 [9,0; 10,1] 11,9 [11,3; 12,5] 13,4 [12,7; 14,0] 14,4 [13,7; 15,0] 15,3 [14,6; 16,1] 16,0 [15,2; 16,8] 16,7 [15,8; 17,5] 17,6 [16,6; 18,5] 18,6 [17,3; 19,9] (9 334) (7 573) (6 152) (4 862) (3 643) (2 515) (1 487) (701) (214) Puu s 75–84 aastat 20 856 80 32/68 26,4 727 10,7 [10,3; 11,1] 12,5 [12,0; 12,9] 13,5 [13,0; 14,0] 14,4 [13,9; 15,0] 15,3 [14,7; 15,8] 16,0 [15,4; 16,6] 16,9 [16,2; 17,6] 17,9 [17,0; 18,7] 19,0 [17,7; 20,3] (77–82) (15 414) (12 511) (9 882) (7 596) (5 307) (3 419) (1 823) (731) (197) ≥ 85 aastat 7 864 87 (86–90) 25/75 24,9 681 11,1 [10,3; 11,8] 11,9 [11,1; 12,7] 12,4 [11,6; 13,2] 12,8 [11,9; 13,6] 13,0 [12,1; 13,9] 13,4 [12,4; 14,4] 14,3 [13,0; 15,6] 14,3 [13,0; 15,6] (4 530) (3 209) (2 218) (1 432) (851) (459) (182) (53) Sugu Mees 17 916 74 100/0 27,4 724 9,7 [9,2; 10,1] 11,4 [10,9; 11,9] 12,6 [12,1; 13,1] 13,6 [13,0; 14,2] 14,4 [13,8; 15,0] 15,2 [14,6; 15,9] 15,9 [15,1; 16,6] 16,7 [15,8; 17,5] 17,3 [16,3; 18,4] (64–80) (13 100) (10 520) (8 296) (6 376) (4 583) (3 014) (1 699) (775) (241) Naised 33 797 77 (68–83) 0/100 26,2 741 10,1 [9,8; 10,5] 12,2 [11,8; 12,5] 13,5 [13,1; 13,9] 14,4 [14,0; 14,8] 15,3 [14,8; 15,7] 16,1 [15,6; 16,5] 17,0 [16,5; 17,6] 17,9 [17,2; 18,5] 18,7 [17,8; 19,5] (24 704) (19 848) (15 708) (12 100) (8 627) (5 764) (3 201) (1 379) (419) Kehamassiindeks ≤ 25 13 738 79 27/73 22,9 699 10,3 [9,7; 10,8] 11,8 [11,2; 12,4] 12,7 [12,1; 13,4] 13,7 [13,1; 14,4] 14,5 [13,7; 15,2] 15,3 [14,3; 16,2] (70–84) (9 052) (6 586) (4 673) (2 950) (1 497) (402) > 25–30 13 903 77 (68–82) 40/60 27,3 704 9,9 [9,4; 10,4] 11,7 [11,1; 12,3] 13,0 [12,4; 13,6] 14,1 [13,4; 14,7] 15,0 [14,3; 15,8] 15,9 [15,0; 16,8] (9 757) (7 378) (5 347) (3 574) (1 957) (569) > 30–35 6 981 74 38/62 31,9 658 10,9 [10,2; 11,7] 12,8 [12,0; 13,7] 14,0 [13,1; 14,9] 14,9 [14,0; 15,9] 15,6 [14,6; 16,6] 16,3 [15,1; 17,5] (65–80) (4 981) (3 847) (2 810) (1 942) (1 046) (311) > 35–40 2 329 70 (62–77) 35/65 36,8 522 10,5 [9,2; 11,8] 12,8 [11,3; 14,2] 14,0 [12,4; 15,5] 15,2 [13,5; 16,8] 16,4 [14,5; 18,2] 17,1 [15,1; 19,1] (1 684) (1 318) (962) (682) (386) (102) üle 40 939 66 30/70 42,8 380 12,7 [10,5; 14,9] 14,5 [12,1; 16,9] 16,2 [13,6; 18,7] 17,6 [14,7; 20,3] 18,8 [15,6; 21,8] (58–74) (651) (512) (364) (242) (138) Haiglad, kus on väike 9,9 [9,5; 10,2] 11,6 [11,3; 12,0] 12,9 [12,5; 13,3] 13,8 [13,4; 14,2] 14,5 [14,1; 15,0] 15,2 [14,7; 15,7] 16,0 [15,4; 16,5] 16,7 [16,0; 17,3] 17,6 [16,7; 18,6] Haigla suurus* aastane patsientide arv 31 495 77 (68–82) 35/65 26,6 590 (22 791) (18 290) (14 395) (11 068) (7 897) (5 225) (2 880) (1 234) (311) Haiglad, kus keskmine 7 891 77 36/64 26,8 85 9,8 [9,1; 10,4] 11,6 [10,8; 12,3] 12,6 [11,8; 13,4] 13,8 [12,9; 14,6] 14,6 [13,7; 15,6] 15,8 [14,7; 16,8] 17,1 [15,9; 18,4] 18,3 [16,7; 19,9] 18,7 [16,9; 20,4] (67–82) aastane juhtumite arv (5 611) (4 435) (3 439) (2 590) (1 796) (1 133) (601) (248) (56) Haiglad, kus on suur 10,4 [9,9; 11,0] 12,8 [12,1; 13,4] 14,1 [13,5; 14,8] 15,1 [14,4; 15,8] 16,3 [15,5; 17,1] 17,1 [16,3; 18,0] 18,0 [17,1; 18,9] 18,8 [17,7; 19,8] 19,3 [18,1; 20,6] aastane patsientide arv 11 676 74 (64–80) 34/66 26,8 35 (8 843) (7 129) (5 717) (4 424) (3 206) (2 208) (1 295) (625) (282) * Käesoleva aruande klassifikatsioonid põhinevad haiglate 2022. aasta kvaliteediaruannetel ja neis loetletud vastavatel puusaliigese revisioonilise artroplastika IQTIG kvaliteedinäitajatel. Puusaliigese revisiooniliste protseduuride puhul on madala juhtumite arvu klassifikatsiooni künnis kuni 20 juhtumit, keskmise juhtumite arvu klassifikatsiooni künnis on 21–50 juhtumit ja kõrge juhtumite arvu klassifikatsiooni künnis on üle 50 revisiooni aastas. Tabel 48 (jätkub) 102 EPRD 2024. aasta aruanne 103  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus 5.3 Esmase protseduurid on palju harvemad kui TKA-d ja ühe sõltub tulemus suures osas sellest, kas esmane diagnoos Lühidalt: kondüüli asendused. Nende CRR on märkimisväärselt oli primaarne osteoartriit või mõni muu osteoartriidi põlveliigese kõrgem kui teistel artroplastika tüüpidel (vt tabel 49 tüüp. endoproteesimise käesoleva jaotise lõpus). • Ühe kondüüli artroplastika CRR on endiselt püsivus Tabelis 49 on loetletud erinevate põlveliigese peaaegu kaks korda suurem kui TKA-l. TKA-d võib täiendavalt eristada vastavalt nende endoproteesimise tüüpide kordusoperatsioonide määrad • Revisioonoperatsiooni risk on posttraumaatilise Järgmistes alajaotustes käsitletakse erinevate esmaste stabiliseerimise astmele. Kõige levinumad on näidustuste kaupa. põlveliigese proteeside CRR-väärtusi, implantaadiga osteoartriidi puhul märkimisväärselt suurem kui standardsed süsteemid ilma täiendava lateraalse esmase osteoartriidi puhul. mitteseotud riskitegurite mõju (alates leheküljest 108) stabiliseerimiseta. Siiski implanteeritakse liigese ning proteeside ja implantaatide spetsiifilisi omadusi deformatsiooni või tõsise sidemete ebastabiilsusega (alates leheküljest 116). Iga alajaotuse lõpus esitatud patsientidele ka varus-valgus-stabiliseeritud või tabelites on toodud kokkuvõte ja kõik tulemuste hingedega süsteeme. Need piiratumad süsteemid üksikasjad. Erinevate tootjate spetsiifiliste juhivad liikumist, kuid piiravad seda ka. EPRD andmed implantaadisüsteemide tulemused on loetletud viimases näitavad, et CRR-id suurenevad stabiliseerimise astme alajaotuses alates leheküljest 124. suurenemisel (joonis 18). Kuna juhtude arv on 10 © EPRD aastaaruanne 2024 suhteliselt väike, ühendatakse järgmistes analüüsides 9 5.3.1 Võrdlus esmase põlveliigese liigend- ja varus-valgus-stabiliseeritud süsteemid üheks 8 7 endoproteesimise tüübi järgi piiratud TKA rühmaks, ilma et iga üksiku süsteemi Kumulatiivne revisioon [%] 6 alarühma kohta antaks täiendavaid üksikasju. esmase põlveliigese endoproteesimise tüübi 5 järgi Põlveliigese proteesimise puhul sõltub 4 3 EPRD-s on dokumenteeritud kolm peamist korduvoperatsiooni risk suures osas esmasest 2 Põlve põlveliigese endoproteesimise tüüpi. Kõige levinum diagnoosist. Osteoartriidiga seotud 1 on TKA, mille puhul asendatakse nii liigese proteesimisprotseduuride puhul on kõrgeim 0 Piiratud TKA-d, hingedega Piiratud TKA-d, varus-valgus-stabiliseeritud mediaalne kui ka lateraalne osa. Seevastu ühe korduvoperatsiooni määr täheldatud Standard-TKA-d 0 1 2 3 4 5 6 7 8 9 kondüüli proteesimisel asendatakse ainult liigese posttraumaatilise osteoartriidi korral (joonis 19). Aastad alates algkoolist kahjustatud mediaalne või lateraalne osa – eesmärk Tulemus ei sõltu on säilitada võimaluse korral terved liigespinnad ja Riskirühm 11 974 9 439 7 603 6 133 4 750 3 373 2 200 1 183 sidemete, et tagada parim võimalik loomulik 7 975 6 272 4 879 3 813 2 900 1 987 1 247 635 kinemaatika ja lähtepunkt võimalikele hilisematele 424 357 347 965 282 624 230 682 181 309 131 870 86 617 48 209 19 542 5 149 korrigeerimistele. Siiski, nagu on näha joonisel 17, on Joonis 18: Kogu põlveliigese endoproteesimise kumulatiivsed revisioonimäärad piirangute astme järgi (p < 0,0001) ühe kondüüli proteesimise CRR peaaegu kaks korda suurem kui täieliku põlveliigese proteesimise puhul. Patellofemoraalse pinna asendamine pro- 9 © EPRD aastaaruanne 2024 8 7 10 6 Kumulatiivne muutus [%] © EPRD aastaaruanne 2024 9 5 8 7 4 Kumulatiivne revisioon [%] 6 3 5 2 4 1 3 0 Standardne põlveliigese endoproteesimine posttraumaatilise osteoartriidi korral Standardne 2 põlveliigese endoproteesimine muude osteoartriidi vormide korral Standardne põlveliigese 1 0 1 2 3 4 5 6 7 endoproteesimine esmase osteoartriidi8 korral 9 0 Aastad alates algkoolist Ühepoolne põlveliigese proteesimine 0 1 2 3 4 5 6 7 Täielik põlveliigese 8 proteesimine 9 8 209 6 608 5 306 4 197 3 305 2 373 1 553 825 Ohustatud Aastad alates algkoolist arvud 43 451 36 159 29 983 24 897 19 540 14 123 9 531 5 281 1 955 369 870 302 834 245 341 199 920 157 124 114 370 74 880 41 724 17 108 4 577 63 758 51 629 41 429 33 185 25 363 18 020 11 402 6 097 2 273 741 Riskirühma kuuluvate 444 306 363 676 295 106 240 628 188 959 137 230 90 064 50 027 20 277 5 325 inimeste arv Joonis 19: Standardse täieliku põlveliigese endoproteesimise kumulatiivsed revisioonimäärad esmase diagnoosi järgi (põhineb dokumenteeritud Joonis 17: Kumulatiivsed revisioonimäärad täielike ja ühe kondüüliga põlveliigese proteeside puhul (p < 0,0001) ICD-10 koodide) (p < 0,0001) 104 EPRD aastaaruanne 2024 105  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus Kumulatiivsed revisioonimäärad pärast ... Artroplastika tüüp / Kategooria Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat Standardne põlveliigese asendus 424 357 70 (62–77) 35/65 30,1 749 1,9 [1,9; 1,9] 3,1 [3,1; 3,2] 3,7 [3,7; 3,8] 4,2 [4,1; 4,2] 4,5 [4,4; 4,5] 4,7 [4,6; 4,8] 5,0 [4,9; 5,0] 5,2 [5,1; 5,3] 5,5 [5,4; 5,6] (347 965) (282 624) (230 682) (181 309) (131 870) (86 617) (48 209) (19 542) (5 149) Esmane diagnoos Esmane osteoartriit 369 870 70 (63–77) 34/66 30,2 746 1,9 [1,8; 1,9] 3,1 [3,0; 3,1] 3,7 [3,6; 3,7] 4,1 [4,0; 4,2] 4,4 [4,3; 4,5] 4,6 [4,6; 4,7] 4,9 [4,8; 5,0] 5,1 [5,0; 5,3] 5,4 [5,2; 5,5] (302 834) (245 341) (199 920) (157 124) (114 370) (74 880) (41 724) (17 108) (4 577) Muud diagnoosid peale osteoartriidi 46 278 69 35/65 29,7 698 2,0 [1,8; 2,1] 3,2 [3,1; 3,4] 3,9 [3,7; 4,1] 4,4 [4,1; 4,6] 4,6 [4,4; 4,9] 4,9 [4,6; 5,1] 5,1 [4,9; 5,4] 5,4 [5,1; 5,7] 5,8 [5,3; 6,3] (61–76) (38 523) (31 977) (26 565) (20 880) (15 127) (10 184) (5 660) (2 109) (487) Posttraumaatiline osteoartriit 8 209 61 (55–70) 56/44 28,7 645 2,9 [2,6; 3,3] 4,7 [4,2; 5,2] 5,7 [5,1; 6,3] 6,4 [5,8; 7,0] 7,1 [6,4; 7,7] 7,6 [6,8; 8,3] 7,9 [7,1; 8,7] 8,6 [7,5; 9,7] 9,7 [7,8; 11,5] (6 608) (5 306) (4 197) (3 305) (2 373) (1 553) (825) (325) (85) Eelnevad operatsioonid Puuduvad asjakohased eelnevad operatsioonid 393 112 70 34/66 30,1 748 1,9 [1,8; 1,9] 3,1 [3,0; 3,1] 3,7 [3,6; 3,7] 4,1 [4,0; 4,2] 4,4 [4,3; 4,4] 4,6 [4,5; 4,7] 4,9 [4,8; 5,0] 5,2 [5,0; 5,3] 5,4 [5,3; 5,5] (63–77) (321 976) (260 924) (212 682) (166 878) (120 950) (78 858) (43 579) (17 786) (4 784) Muud varasemad operatsioonid 16 530 7 6 40/60 29,8 580 2,1 [1,9; 2,4] 3,6 [3,3; 3,9] 4,3 [4,0; 4,7] 4,8 [4,5; 5,2] 5,1 [4,8; 5,5] 5,4 [5,0; 5,8] 5,6 [5,2; 6,0] 5,9 [5,4; 6,4] 6,2 [5,6; 6,9] (13 967) (11 969) (10 311) (8 483) (6 595) (4 815) (2 975) (1 134) (224) Kapsel / sidemete 7 452 62 52/48 29,4 556 1,9 [1,6; 2,3] 3,5 [3,1; 4,0] 4,1 [3,6; 4,6] 4,8 [4,2; 5,4] 5,4 [4,7; 6,0] 6,0 [5,2; 6,7] 6,1 [5,4; 6,9] 6,6 [5,6; 7,6] 6,6 [5,6; 7,6] (56–70) (5 918) (4 651) (3 595) (2 738) (1 938) (1 316) (726) (241) (68) Osteosüntees / Osteotoomia 7 158 64 (57–72) 48/52 29,4 613 2,6 [2,2; 3,0] 4,1 [3,7; 4,6] 5,1 [4,6; 5,7] 5,8 [5,2; 6,5] 6,3 [5,6; 6,9] 6,6 [5,9; 7,3] 6,7 [6,0; 7,4] 6,8 [6,1; 7,6] 7,3 [6,1; 8,5] (6 028) (5 014) (4 036) (3 159) (2 350) (1 604) (915) (375) (73) Piiratud TKA-d 19 949 74 (66–80) 24/76 28,9 690 4,2 [3,9; 4,5] 5,7 [5,3; 6,0] 6,4 [6,0; 6,8] 6,8 [6,4; 7,2] 7,2 [6,8; 7,6] 7,5 [7,1; 8,0] 7,8 [7,3; 8,3] 8,4 [7,7; 9,0] 8,9 [7,8; 10,0] (15 711) (12 482) (9 946) (7 650) (5 360) (3 447) (1 818) (735) (176) Esmane diagnoos Esmane osteoartriit 14 421 75 (67–81) 22/78 29,4 660 3,6 [3,3; 3,9] 4,9 [4,6; 5,3] 5,7 [5,2; 6,1] 6,0 [5,6; 6,4] 6,3 [5,8; 6,8] 6,6 [6,1; 7,1] 6,8 [6,3; 7,3] 7,3 [6,6; 8,0] 7,8 [6,6; 9,1] (11 521) (9 216) (7 375) (5 711) (4 053) (2 628) (1 398) (568) (138) Muud diagnoosid peale osteoartriidi 4 191 74 25/75 27,5 547 5,7 [5,0; 6,4] 7,6 [6,7; 8,5] 8,4 [7,5; 9,4] 9,0 [8,0; 10,0] 9,4 [8,4; 10,5] 9,5 [8,5; 10,6] 10,7 [9,2; 12,1] 11,0 [9,4; 12,6] Põlve (65–81) (3 124) (2 401) (1 878) (1 402) (941) (566) (295) (120) Posttraumaatiline osteoartriit 1 337 66 (58–75) 42/58 28,0 413 5,2 [3,9; 6,4] 7,2 [5,7; 8,7] 8,1 [6,5; 9,6] 8,5 [6,8; 10,1] 9,9 [7,9; 11,8] 10,8 [8,6; 12,9] 10,8 [8,6; 12,9] (1 066) (865) (693) (537) (366) (253) (125) Eelnevad operatsioonid Asjakohaseid varasemaid operatsioone pole 17 823 75 22/78 29,0 685 4,0 [3,7; 4,3] 5,3 [5,0; 5,7] 6,1 [5,7; 6,5] 6,4 [6,0; 6,8] 6,7 [6,3; 7,1] 7,0 [6,6; 7,5] 7,3 [6,8; 7,8] 7,8 [7,2; 8,5] 8,3 [7,2; 9,5] (67–81) (14 047) (11 165) (8 894) (6 804) (4 741) (3 011) (1 590) (650) (152) Osteosüntees / osteotoomia 1 037 69 (59–77) 34/66 27,8 363 5,7 [4,2; 7,1] 8,7 [6,9; 10,5] 9,2 [7,3; 11,1] 10,2 [8,1; 12,3] 11,3 [8,9; 13,5] 12,0 [9,5; 14,4] 12,5 [9,8; 15,2] (814) (642) (516) (409) (287) (199) (99) Muud eelnevad operatsioonid 714 71 36/64 28,5 258 4,8 [3,2; 6,4] 8,1 [5,9; 10,2] 8,5 [6,3; 10,7] 9,3 [6,9; 11,7] 10,9 [8,2; 13,6] 11,4 [8,5; 14,2] 11,4 [8,5; 14,2] (61–78) (569) (451) (366) (303) (231) (173) (95) Kapsel / sidemete 354 64 (56–74) 44/56 29,0 183 5,4 [2,9; 7,8] 7,7 [4,6; 10,6] 8,6 [5,3; 11,7] 9,8 [6,1; 13,3] 9,8 [6,1; 13,3] 9,8 [6,1; 13,3] (267) (212) (162) (127) (94) (61) Ühe põlveliigese proteesimine 63 758 63 (57–72) 45/55 29,4 674 2,9 [2,8; 3,0] 4,7 [4,5; 4,9] 5,7 [5,5; 5,9] 6,6 [6,4; 6,8] 7,2 [7,0; 7,5] 8,0 [7,7; 8,2] 8,5 [8,2; 8,9] 9,2 [8,8; 9,6] 9,6 [9,1; 10,1] (51 629) (41 429) (33 185) (25 363) (18 020) (11 402) (6 097) (2 273) (741) Esmane diagnoos Esmane osteoartriit 54 204 64 45/55 29,6 657 2,9 [2,7; 3,0] 4,7 [4,5; 4,9] 5,7 [5,4; 5,9] 6,6 [6,3; 6,8] 7,2 [6,9; 7,4] 7,9 [7,6; 8,2] 8,5 [8,1; 8,8] 9,2 [8,8; 9,6] 9,6 [9,0; 10,2] (57–72) (44 005) (35 394) (28 397) (21 788) (15 488) (9 765) (5 211) (1 925) (594) Muud diagnoosid peale osteoartriidi 9 298 62 (56–71) 46/54 29,3 493 3,1 [2,7; 3,5] 4,9 [4,4; 5,4] 6,1 [5,6; 6,7] 6,8 [6,2; 7,4] 7,6 [6,9; 8,2] 8,4 [7,6; 9,2] 9,1 [8,2; 9,9] 9,5 [8,5; 10,5] 9,5 [8,5; 10,5] (7 415) (5 862) (4 648) (3 470) (2 448) (1 581) (864) (340) (144) Eelnevad operatsioonid Puuduvad asjakohased eelnevad operatsioonid 59 482 64 45/55 29,5 670 2,9 [2,8; 3,1] 4,7 [4,5; 4,8] 5,7 [5,5; 5,9] 6,5 [6,3; 6,8] 7,1 [6,9; 7,4] 7,9 [7,6; 8,2] 8,4 [8,1; 8,8] 9,1 [8,7; 9,5] 9,5 [8,9; 10,0] (58–72) (48 070) (38 588) (30 930) (23 561) (16 689) (10 453) (5 528) (2 093) (702) Muud varasemad operatsioonid 2 946 61 (55–68) 46/54 29,4 325 2,7 [2,1; 3,3] 4,9 [4,1; 5,8] 6,1 [5,2; 7,1] 7,2 [6,1; 8,3] 7,9 [6,7; 9,1] 8,5 [7,2; 9,7] 9,1 [7,7; 10,5] 9,9 [8,3; 11,6] (2 476) (2 035) (1 640) (1 317) (978) (697) (431) (139) Kapsel / sidemete 897 59 52/48 29,0 177 2,3 [1,3; 3,3] 6,0 [4,2; 7,8] 7,3 [5,3; 9,3] 8,7 [6,3; 11,0] 9,8 [7,1; 12,4] 11,2 [8,1; 14,2] 11,2 [8,1; 14,2] (54–66) (721) (514) (384) (293) (212) (156) (88) Osteosüntees / Osteotoomia 425 58 (52–65) 57/43 28,7 175 2,9 [1,3; 4,5] 4,7 [2,5; 6,7] 6,5 [3,8; 9,1] 7,8 [4,8; 10,8] 9,4 [5,9; 12,8] 11,8 [7,4; 16,0] 13,5 [8,0; 18,7] (355) (285) (226) (187) (137) (94) (50) Põlveliigese proteesimine 1 026 55 (49–61) 26/74 28,4 224 4,7 [3,3; 6,0] 8,5 [6,6; 10,4] 10,8 [8,6; 12,9] 14,0 [11,3; 16,5] 16,2 [13,2; 19,0] 17,3 [14,0; 20,3] 18,8 [15,0; 22,4] (816) (641) (496) (371) (260) (168) (83) Esmane diagnoos Esmane osteoartriit 533 56 28/72 28,6 164 3,3 [1,7; 4,9] 7,4 [4,9; 9,8] 10,4 [7,3; 13,4] 12,7 [9,2; 16,2] 16,5 [11,9; 20,9] 17,5 [12,5; 22,1] (50–62) (425) (331) (252) (181) (111) (69) Muud diagnoosid peale osteoartriidi 469 54 (48–60) 24/76 28,4 144 6,4 [4,0; 8,7] 10,2 [7,2; 13,2] 11,9 [8,5; 15,1] 16,1 [12,0; 20,0] 17,1 [12,8; 21,2] 18,4 [13,7; 22,7] 19,5 [14,4; 24,4] (370) (292) (228) (177) (141) (95) (50) Eelnevad operatsioonid Puuduvad asjakohased eelnevad operatsioonid 836 56 26/74 28,7 207 4,5 [3,0; 6,0] 8,5 [6,4; 10,6] 10,4 [8,0; 12,7] 13,3 [10,5; 16,1] 15,4 [12,1; 18,5] 16,3 [12,8; 19,7] 18,4 [13,9; 22,6] (50–62) (659) (518) (399) (295) (203) (128) (61) Tabel 49: Erinevate põlveliigese esmase endoproteesimise tüüpide ja diagnooside kumulatiivsed revisioonimäärad 106 EPRD aastaaruanne 2024 107  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus 5.3.2 Esmase põlveliigese Patsiendi kehakaalunäitaja mõjutab samuti põlveliigese Selliste artroplastikate puhul kajastub see üldiselt proteesimise puhul implantaadiga proteesimise tulemusi (joonis 22). Kordusoperatsiooni tulemustes. Eriti ühe kondüüli artroplastikate puhul mitteseotud tegurid risk suureneb märkimisväärselt kehamassiindeksi väheneb korduvoperatsiooni risk haiglates, kus Põlveliigese endoproteesimise puhul sõltub tõusuga, kuigi see seos on veelgi selgem teatud tüüpi tehakse rohkem selliseid protseduure (joonis 23). See korduvoperatsiooni risk suures osas ka patsiendi puusaliigese proteesimise puhul (vt näiteks joonis 8). ei tähenda aga, et haiglates, kus tehakse vähem vanusest. Nagu joonisel 20 on näidatud standardse operatsioone, oleksid tulemused paratamatult halvemad, põlveliigese täieliku asendamise puhul, on esmase Patsiendi üldise tervisliku seisundi ja liigeseproteesi ja et haiglates, kus tehakse rohkem operatsioone, endoproteesimise ajal noorematel patsientidel ka operatsiooni tulemuse vahel on seos. EPRD on alates oleksid tulemused alati paremad. kõrgem korduvoperatsioonide määr. 2020. aastast registreerinud ASA klassifikatsioone. Need on Ameerika Anestesioloogide Seltsi hinnangud Enamiku liigeseendoproteesimise liikide puhul on patsiendi füüsilisele seisundile enne operatsiooni. Kuigi meestel oluliselt kõrgem korduvoperatsioonide määr kui varaseimad ASA klassifikatsiooni andmed ulatuvad 12 © EPRD aastaaruanne 2024 11 naistel (vt tabel 50). Kuid see suundumus pöördub ümber tagasi vaid 3 aastat pärast esmast artroplastikat, 10 alates ühe aasta möödumisest ühe kondüüli mõjutab see muutuja juba märkimisväärselt ühe 9 Kumulatiivne revisioon [%] 8 põlveliigese endoproteesimise järel (joonis 21). Selle kondüüli artroplastika tulemusi, nagu on näidatud 7 põhjused on praegu ebaselged, eriti arvestades, et näiteks tabelis 50. Madalama ASA klassifikatsiooniga 6 meestel on naistega võrreldes ka suurem patsiendid – st parem üldine tervislik seisund – on 5 4 infektsioonirisk pärast ühe kondüüliga põlveliigese keskmiselt nooremad kui kõrgemate 3 proteesimist. Seega võib täheldatud erinevust klassifikatsioonidega patsiendid. Kuid hoolimata 2 Põlve 1 seletada ainult aseptiliste korduvoperatsioonide sellest, et nooremate patsientide tulemused on 0 märkimisväärselt madalama riskiga. halvemad (vt joonis 20), suureneb CRR ASA Ühe kondüüliga põlveliigese proteesimine meestel Ühe klassifikatsiooni tõusuga. 0 1 2 3 4 5 6 kondüüliga põlveliigese 7 proteesimine naistel 8 9 Aastad alates algkoolist Et selgitada meeste ja naiste vahelisi erinevusi põlveliigese proteesimise tulemuste osas, esitab Kas protseduuri läbiviival haiglal on ulatuslik hiljutine Ohustatud 28 682 23 005 18 262 14 455 10 907 7 632 4 785 2 524 966 arv EPRD veebileht tulemused erinevate kogemus 35 076 28 624 23 167 18 730 14 456 10 388 6 617 3 573 1 307 proteesitüüpide, muude implantaadiga mitteseotud tegurite ja implantaadi omaduste kohta meeste ja Joonis 21: Ühe kondüüli põlveliigese proteesimise kumulatiivsed revisioonimäärad patsientide soo järgi (p < 0,0001) naiste alarühmade puhul, vt lk 172/173. 7 © EPRD aastaaruanne 2024 10 6 © EPRD aastaaruanne 2024 9 8 5 Kumulatiivne revisioon [%] 7 4 Kumulatiivne revisioon [%] 6 5 3 4 2 3 Tavalised põlveliigese endoproteesid patsientidel, 2 1 kelle KMI on > 40 Tavalised põlveliigese endoproteesid patsientidel, kelle KMI on > 35 kuni 40 Tavalised 1 põlveliigese endoproteesid patsientidel, kelle KMI on > Standardne põlveliigese asendusoperatsioon patsientidel 0 30 kuni 35 Tavalised põlveliigese endoproteesid 0 vanuses < 55 aastat patsientidel, kelle KMI on > 25 kuni 30 Tavalised Standardne põlveliigese asendusoperatsioon 55–64-aastastel põlveliigese endoproteesid patsientidel, kelle KMI on patsientidel Standardne põlveliigese asendusoperatsioon 65– 0 1 2 3 4 < 25 5 6 74-aastastel patsientidel Standardne põlveliigese 0 1 2 3 4 5 6 asendusoperatsioon 7 8 patsientidel 75-aastastel ja vanematel 9 Aastad alates algkoolist Aastad alates algkoolist 25 527 19 965 15 339 11 468 7 881 4 346 1 072 29 475 24 685 20 471 16 676 13 298 9 818 6 550 3 663 1 546 46 639 36 228 27 494 20 567 14 096 7 663 1 920 Riskirühma Ohustatud 106 799 86 893 69 943 56 158 43 708 31 772 20 963 11 790 4 936 1 382 kuuluvad 92 762 72 490 55 111 41 458 28 409 15 567 3 889 isikud arvud 144 973 118 181 95 636 78 336 62 073 45 825 30 579 17 506 7 333 2 014 109 651 85 762 65 445 49 095 33 743 18 247 4 645 143 110 118 206 96 574 79 512 62 230 44 455 28 525 15 250 5 727 1 277 46 304 35 779 26 759 19 931 13 510 7 393 1 833 Joonis 20: Standardse täieliku põlveliigese proteesimise kumulatiivsed revisioonimäärad vanuserühmade kaupa (p < 0,0001) Joonis 22: Standardse täieliku põlveliigese endoproteesimise kumulatiivsed revisioonimäärad patsiendi kehakaaluindeksi järgi (p < 0,0001) 108 EPRD aastaaruanne 2024 109  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus 14 © EPRD 2024. aasta aruanne 12 Lühidalt: 10 kordusoperatsioonide määr 8 • Noorem vanus ja kõrgem kehamassiindeks 6 suurendavad korduvoperatsiooni riski. Kumulatiivne 4 • Meestel on üldiselt suurem tõenäosus vajada korduvoperatsiooni kui naistel, kuid ühe kondüüli [%] 2 Esmane ühe kondüüli põlveliigese endoproteesimine haiglates, kus tehakse kuni 30 sellist esmast protseduuri aastas põlveliigese endoproteesimise puhul on see 0 Esmane ühe kondüüli põlveliigese endoproteesimine haiglates, kus tehakse 31–100 sellist esmast protseduuri aastas Esmane ühe kondüüli põlveliigese endoproteesimine haiglates, kus tehakse üle 100 sellist esmast protseduuri aastas vastupidi. 0 1 2 3 4 5 6 7 8 9 • Haiglad, kus tehakse aastas rohkem Aastad alates algkoolist operatsioone, on kordusoperatsioonide määr 15 489 12 576 10 359 8 463 6 564 4 757 3 059 1 614 680 tavaliselt madalam, see kehtib eriti ühe kondüüli Riskirühma kuuluvate 23 568 19 011 14 924 11 760 8 815 6 113 3 793 1 989 719 põlveliigese proteesimise puhul. patsientide arv 23 710 19 103 15 273 12 172 9 343 6 654 4 261 2 364 837 Joonis 23: Ühe kondüüliga põlveliigese proteeside kumulatiivsed revisioonimäärad6 vastavalt haigla esmaste ühe kondüüliga põlveliigese proteeside aastasele mahule (p< 0,0001) 6 Käesoleva aruande klassifikatsioonid põhinevad haiglate 2022. aasta kvaliteediaruannetel ja neis loetletud vastavatel IQTIG kvaliteedinäitajatel. Põlve Kumulatiivsed revisioonimäärad pärast ... Artroplastika Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat artroplastika / Kategooria Standardne põlveliigese asendus 424 357 70 (62–77) 35/65 30,1 749 1,9 [1,9; 1,9] 3,1 [3,1; 3,2] 3,7 [3,7; 3,8] 4,2 [4,1; 4,2] 4,5 [4,4; 4,5] 4,7 [4,6; 4,8] 5,0 [4,9; 5,0] 5,2 [5,1; 5,3] 5,5 [5,4; 5,6] (347 965) (282 624) (230 682) (181 309) (131 870) (86 617) (48 209) (19 542) (5 149) Vanuserühm ≤ 54 aastat 29 475 52 (49–53) 36/64 33,2 719 2,7 [2,5; 2,9] 4,9 [4,6; 5,2] 6,2 [5,9; 6,5] 7,0 [6,7; 7,3] 7,6 [7,2; 7,9] 8,0 [7,6; 8,4] 8,5 [8,1; 8,9] 9,1 [8,5; 9,6] 9,5 [8,8; 10,1] (24 685) (20 471) (16 676) (13 298) (9 818) (6 550) (3 663) (1 546) (476) 55–64 aastat 106 799 60 39/61 32,0 741 2,0 [1,9; 2,1] 3,5 [3,4; 3,7] 4,4 [4,2; 4,5] 4,9 [4,7; 5,0] 5,3 [5,2; 5,5] 5,7 [5,5; 5,9] 6,0 [5,9; 6,2] 6,4 [6,2; 6,7] 6,8 [6,5; 7,1] (58–62) (86 893) (69 943) (56 158) (43 708) (31 772) (20 963) (11 790) (4 936) (1 382) 65–74 aastat 144 973 70 (67–72) 34/66 30,6 743 1,7 [1,6; 1,7] 2,8 [2,7; 2,9] 3,4 [3,3; 3,5] 3,8 [3,6; 3,9] 4,0 [3,9; 4,1] 4,3 [4,1; 4,4] 4,5 [4,3; 4,6] 4,7 [4,6; 4,9] 5,0 [4,8; 5,2] (118 181) (95 636) (78 336) (62 073) (45 825) (30 579) (17 506) (7 333) (2 014) 75–84 aastat 130 800 78 32/68 28,3 743 1,9 [1,8; 2,0] 2,8 [2,7; 2,9] 3,2 [3,1; 3,3] 3,5 [3,4; 3,6] 3,6 [3,5; 3,8] 3,8 [3,7; 3,9] 3,9 [3,8; 4,0] 4,1 [3,9; 4,2] 4,1 [4,0; 4,3] (76–81) (108 709) (89 204) (73 895) (58 105) (41 764) (26 942) (14 496) (5 476) (1 227) ≥ 85 aastat 12 310 86 (85–87) 31/69 26,7 699 2,1 [1,8; 2,3] 2,5 [2,2; 2,8] 2,8 [2,5; 3,1] 3,0 [2,6; 3,3] 3,1 [2,7; 3,4] 3,2 [2,8; 3,5] 3,3 [2,8; 3,7] 3,3 [2,8; 3,7] 3,3 [2,8; 3,7] (9 497) (7 370) (5 617) (4 125) (2 691) (1 583) (754) (251) (50) Sugu Mees 147 010 69 100/0 29,6 742 2,2 [2,1; 2,3] 3,3 [3,2; 3,4] 4,0 [3,9; 4,1] 4,4 [4,3; 4,5] 4,7 [4,6; 4,8] 5,0 [4,9; 5,1] 5,3 [5,1; 5,4] 5,6 [5,4; 5,8] 5,8 [5,5; 6,0] (61–76) (118 866) (95 630) (77 099) (59 451) (42 422) (27 128) (14 732) (5 855) (1 568) Naised 277 347 70 (63–77) 0/100 30,5 748 1,7 [1,7; 1,8] 3,0 [2,9; 3,0] 3,6 [3,5; 3,7] 4,0 [3,9; 4,1] 4,3 [4,2; 4,4] 4,6 [4,5; 4,7] 4,8 [4,7; 4,9] 5,1 [4,9; 5,2] 5,3 [5,2; 5,5] (229 099) (186 994) (153 583) (121 858) (89 448) (59 489) (33 477) (13 687) (3 581) Kehamassiindeks ≤ 25 46 304 75 31/69 23,6 716 1,6 [1,5; 1,7] 2,7 [2,5; 2,9] 3,3 [3,1; 3,5] 3,7 [3,5; 3,9] 4,0 [3,7; 4,2] 4,2 [3,9; 4,5] (67–80) (35 779) (26 759) (19 931) (13 510) (7 393) (1 833) > 25–30 109 651 72 (64–78) 42/58 27,7 723 1,7 [1,6; 1,8] 2,7 [2,6; 2,9] 3,3 [3,2; 3,5] 3,7 [3,6; 3,9] 4,0 [3,9; 4,2] 4,2 [4,0; 4,3] (85 762) (65 445) (49 095) (33 743) (18 247) (4 645) > 30–35 92 762 69 36/64 32,1 717 1,8 [1,7; 1,8] 2,9 [2,8; 3,1] 3,6 [3,4; 3,7] 4,0 [3,8; 4,2] 4,3 [4,1; 4,4] 4,6 [4,4; 4,8] (62–76) (72 490) (55 111) (41 458) (28 409) (15 567) (3 889) > 35–40 46 639 66 (60–72) 30/70 37,0 714 2,1 [2,0; 2,3] 3,5 [3,3; 3,6] 4,1 [3,9; 4,3] 4,6 [4,4; 4,9] 5,0 [4,7; 5,2] 5,3 [5,0; 5,6] (36 228) (27 494) (20 567) (14 096) (7 663) (1 920) üle 40 25 527 62 23/77 42,9 708 2,8 [2,6; 3,1] 4,2 [3,9; 4,4] 5,0 [4,7; 5,3] 5,5 [5,1; 5,8] 5,8 [5,5; 6,2] 6,0 [5,6; 6,4] (57–69) (19 965) (15 339) (11 468) (7 881) (4 346) (1 072) ASA staatus ASA 1 18 236 66 (59,5–74) 39/61 29,0 625 1,6 [1,4; 1,8] 2,8 [2,5; 3,1] 3,5 [3,2; 3,9] (12 440) (7 580) (1 794) Tabel 50: Erinevate põlveliigese esmase proteesimise tüüpide kumulatiivsed korduvoperatsioonide määrad implantaadiga mitteseotud tegurite lõikes 110 EPRD aastaaruanne 2024 111  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus Kumulatiivsed revisioonimäärad pärast ... Artroplastika Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat / Kategooria ASA staatus ASA 2 106 705 68 34/66 29,7 684 1,6 [1,5; 1,7] 2,8 [2,7; 2,9] 3,4 [3,3; 3,6] 3,9 [3,6; 4,2] (61–75) (67 446) (33 962) (8 511) (190) ASA 3 61 238 72 (65–79) 37/63 31,2 674 2,3 [2,2; 2,5] 3,5 [3,3; 3,7] 4,4 [4,1; 4,6] 4,8 [4,4; 5,2] (38 300) (18 662) (4 605) (73) ASA 4 või 5 861 74 46/54 31,4 308 3,2 [1,9; 4,4] 3,6 [2,2; 5,0] 4,1 [2,4; 5,7] (67–80) (546) (267) (64) Haigla suurus* Haiglad, kus on väike aastane patsientide arv 170 025 70 (62–77) 35/65 30,4 523 2,2 [2,1; 2,3] 3,5 [3,4; 3,6] 4,1 [4,0; 4,2] 4,6 [4,4; 4,7] 4,9 [4,7; 5,0] 5,1 [5,0; 5,2] 5,4 [5,2; 5,5] 5,6 [5,5; 5,8] 6,0 [5,8; 6,3] (139 587) (113 349) (93 429) (73 777) (53 196) (34 282) (18 409) (6 906) (1 450) Haiglad, kus on keskmine aastane patsientide arv 133 062 70 34/66 30,1 141 1,7 [1,7; 1,8] 2,9 [2,8; 3,0] 3,6 [3,5; 3,7] 4,1 [3,9; 4,2] 4,4 [4,2; 4,5] 4,7 [4,6; 4,8] 4,9 [4,8; 5,1] 5,2 [5,0; 5,4] 5,5 [5,2; 5,7] (62–77) (109 006) (87 596) (71 015) (55 579) (40 622) (26 612) (14 623) (5 587) (1 130) Haiglad, kus on suur aastane patsientide arv 111 766 69 (62–76) 35/65 30,0 46 1,6 [1,5; 1,7] 2,7 [2,6; 2,8] 3,3 [3,2; 3,4] 3,7 [3,6; 3,8] 3,9 [3,8; 4,1] 4,2 [4,1; 4,4] 4,4 [4,2; 4,6] 4,6 [4,4; 4,8] 4,8 [4,6; 5,0] (90 387) (73 359) (58 685) (45 418) (32 832) (22 142) (13 014) (6 076) (2 377) Piiratud TKA-d 19 949 74 (66–80) 24/76 28,9 690 4,2 [3,9; 4,5] 5,7 [5,3; 6,0] 6,4 [6,0; 6,8] 6,8 [6,4; 7,2] 7,2 [6,8; 7,6] 7,5 [7,1; 8,0] 7,8 [7,3; 8,3] 8,4 [7,7; 9,0] 8,9 [7,8; 10,0] (15 711) (12 482) (9 946) (7 650) (5 360) (3 447) (1 818) (735) (176) Vanuserühm ≤ 54 aastat 1 104 51 36/64 32,8 329 4,9 [3,6; 6,2] 7,3 [5,7; 9,0] 8,7 [6,9; 10,5] 9,9 [7,9; 11,9] 10,9 [8,7; 13,0] 11,7 [9,3; 14,1] 12,6 [9,9; 15,2] 12,6 [9,9; 15,2] (47–53) (902) (734) (586) (472) (342) (233) (128) (55) 55–64 aastat 3 311 60 (58–63) 32/68 32,0 543 4,9 [4,2; 5,7] 6,9 [6,0; 7,9] 7,8 [6,8; 8,8] 8,4 [7,3; 9,5] 9,0 [7,8; 10,1] 9,1 [7,9; 10,2] 9,5 [8,2; 10,8] 9,5 [8,2; 10,8] (2 575) (2 033) (1 606) (1 263) (913) (597) (327) (135) 65–74 aastat 5 728 70 24/76 30,5 606 4,1 [3,6; 4,7] 5,7 [5,1; 6,3] 6,6 [5,9; 7,3] 7,1 [6,3; 7,8] 7,5 [6,7; 8,3] 7,8 [6,9; 8,6] 8,2 [7,2; 9,1] 9,0 [7,8; 10,2] 9,0 [7,8; 10,2] (68–72) (4 524) (3 592) (2 894) (2 285) (1 635) (1 101) (612) (269) (60) 75–84 aastat 8 070 79 (77–82) 20/80 27,5 624 3,8 [3,3; 4,2] 5,0 [4,5; 5,5] 5,6 [5,0; 6,1] 5,7 [5,2; 6,3] 6,0 [5,4; 6,6] 6,4 [5,8; 7,1] 6,5 [5,9; 7,2] 7,2 [6,2; 8,2] 7,2 [6,2; 8,2] Põlve (6 466) (5 189) (4 159) (3 144) (2 158) (1 350) (686) (256) (66) ≥ 85 aastat 1 736 87 17/83 25,8 493 4,2 [3,2; 5,2] 4,9 [3,8; 6,0] 5,3 [4,1; 6,4] 5,3 [4,1; 6,4] 5,3 [4,1; 6,4] 5,3 [4,1; 6,4] 5,3 [4,1; 6,4] (85–88) (1 244) (934) (701) (486) (312) (166) (65) Sugu Mees 4 784 71 (62–79) 100/0 28,6 578 5,6 [4,9; 6,3] 7,5 [6,7; 8,3] 8,5 [7,7; 9,4] 8,8 [7,9; 9,7] 9,3 [8,4; 10,3] 9,6 [8,6; 10,6] 10,2 [9,0; 11,4] 10,9 [9,4; 12,5] (3 691) (2 911) (2 288) (1 748) (1 209) (795) (399) (156) Naised 15 165 75 0/100 29,0 677 3,7 [3,4; 4,0] 5,1 [4,7; 5,4] 5,7 [5,3; 6,1] 6,2 [5,7; 6,6] 6,5 [6,1; 7,0] 6,9 [6,4; 7,3] 7,1 [6,5; 7,6] 7,6 [6,9; 8,2] 8,3 [7,0; 9,6] (67–81) (12 020) (9 571) (7 658) (5 902) (4 151) (2 652) (1 419) (579) (140) Kehamassiindeks ≤ 25 3 598 79 (71–83) 20/80 23,0 567 3,4 [2,8; 4,0] 4,9 [4,1; 5,6] 5,5 [4,6; 6,3] 5,9 [5,0; 6,8] 6,1 [5,1; 7,1] 7,1 [5,7; 8,4] (2 655) (1 954) (1 390) (878) (467) (113) > 25–30 5 093 77 29/71 27,5 594 3,8 [3,3; 4,4] 5,3 [4,7; 6,0] 6,2 [5,4; 6,9] 6,4 [5,6; 7,1] 6,9 [6,0; 7,8] 7,2 [6,2; 8,1] (69–81) (3 858) (2 862) (2 101) (1 427) (761) (222) > 30–35 3 586 73 (65–79) 25/75 32,0 523 3,8 [3,1; 4,4] 5,4 [4,6; 6,2] 6,0 [5,2; 6,9] 6,5 [5,6; 7,5] 7,0 [5,9; 8,1] 7,2 [6,1; 8,3] (2 751) (2 049) (1 519) (1 052) (547) (154) > 35–40 1 788 69 21/79 37,0 432 5,2 [4,2; 6,3] 7,0 [5,7; 8,3] 7,7 [6,4; 9,1] 8,2 [6,7; 9,6] 8,4 [6,9; 9,9] 8,4 [6,9; 9,9] (61–75) (1 323) (1 014) (747) (519) (277) (90) üle 40 1 186 64 (58–70) 16/84 43,8 366 5,2 [3,9; 6,5] 6,5 [5,1; 8,0] 8,0 [6,2; 9,7] 8,6 [6,7; 10,5] 8,6 [6,7; 10,5] 8,6 [6,7; 10,5] (921) (688) (514) (360) (202) (54) ASA staatus ASA 1 768 71 30/70 28,1 199 3,5 [2,1; 4,8] 5,2 [3,3; 7,0] 6,3 [3,9; 8,6] (63–79) (498) (278) (59) ASA 2 3 953 72 (64–80) 24/76 28,3 507 3,3 [2,7; 3,8] 4,9 [4,1; 5,7] 5,1 [4,3; 5,9] (2 524) (1 289) (330) ASA 3 3 934 76 23/77 29,3 532 4,8 [4,0; 5,5] 5,9 [5,1; 6,8] 6,6 [5,5; 7,6] (68–82) (2 354) (1 113) (268) Haigla suurus* Haiglad, kus on väike aastane patsientide arv 10 621 75 (66–81) 24/76 29,0 474 4,3 [3,9; 4,7] 5,9 [5,4; 6,3] 6,7 [6,2; 7,2] 7,0 [6,5; 7,6] 7,5 [6,9; 8,1] 7,9 [7,3; 8,6] 8,3 [7,6; 9,0] 9,1 [8,1; 10,0] (8 336) (6 643) (5 326) (4 100) (2 855) (1 807) (951) (327) Haiglad, kus on keskmine aastane patsientide arv 5 655 74 23/77 28,7 139 4,4 [3,9; 5,0] 5,9 [5,2; 6,5] 6,5 [5,8; 7,2] 7,0 [6,2; 7,7] 7,5 [6,7; 8,3] 7,6 [6,8; 8,5] 7,9 [7,0; 8,8] 8,6 [7,3; 9,9] (66–81) (4 462) (3 525) (2 764) (2 084) (1 422) (885) (432) (169) Haiglad, kus on suur aastane patsientide arv 3 406 73 (63–79) 27/73 28,7 45 3,3 [2,7; 3,9] 4,6 [3,8; 5,4] 5,2 [4,3; 6,0] 5,4 [4,6; 6,3] 5,6 [4,7; 6,5] 5,9 [4,9; 6,8] 6,0 [5,0; 7,0] 6,0 [5,0; 7,0] 6,0 [5,0; 7,0] (2 669) (2 090) (1 652) (1 280) (932) (650) (374) (203) (69) Ühe põlveliigese proteesimine 63 758 63 (57–72) 45/55 29,4 674 2,9 [2,8; 3,0] 4,7 [4,5; 4,9] 5,7 [5,5; 5,9] 6,6 [6,4; 6,8] 7,2 [7,0; 7,5] 8,0 [7,7; 8,2] 8,5 [8,2; 8,9] 9,2 [8,8; 9,6] 9,6 [9,1; 10,1] (51 629) (41 429) (33 185) (25 363) (18 020) (11 402) (6 097) (2 273) (741) Vanuserühm ≤ 54 aastat 9 942 51 41/59 31,4 603 3,5 [3,1; 3,8] 6,1 [5,6; 6,6] 7,6 [7,1; 8,2] 9,0 [8,4; 9,7] 10,0 [9,3; 10,7] 11,1 [10,3; 11,9] 11,8 [10,9; 12,7] 12,6 [11,5; 13,6] 13,0 [11,7; 14,3] (49–53) (8 252) (6 774) (5 429) (4 186) (3 027) (1 941) (1 066) (452) (166) 55–64 aastat 24 115 60 (57–62) 49/51 30,3 640 2,8 [2,6; 3,0] 4,9 [4,6; 5,2] 6,0 [5,7; 6,4] 7,0 [6,6; 7,4] 7,6 [7,2; 8,1] 8,6 [8,1; 9,1] 9,3 [8,8; 9,9] 10,1 [9,4; 10,8] 10,5 [9,6; 11,3] (19 329) (15 192) (11 854) (8 906) (6 318) (3 995) (2 121) (773) (251) Tabel 50 (jätkub) 112 EPRD 2024. aasta aruanne 113  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus Kumulatiivsed korrigeerimismäärad pärast ... Artroplastika tüüp Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat / Kategooria Vanuserühm 65–74 aastat 18 468 69 43/57 29,1 601 2,7 [2,4; 2,9] 4,1 [3,8; 4,4] 5,0 [4,6; 5,3] 5,7 [5,3; 6,1] 6,2 [5,7; 6,6] 6,6 [6,1; 7,1] 7,1 [6,6; 7,6] 7,8 [7,1; 8,4] 8,2 [7,3; 9,2] (67–72) (14 843) (11 873) (9 614) (7 437) (5 310) (3 417) (1 873) (683) (224) 75–84 aastat 10 502 78 (76–80) 44/56 27,7 507 3,0 [2,7; 3,4] 4,0 [3,6; 4,4] 4,6 [4,2; 5,1] 5,1 [4,7; 5,6] 5,5 [5,0; 6,0] 6,1 [5,5; 6,7] 6,4 [5,8; 7,0] 6,9 [6,0; 7,8] 6,9 [6,0; 7,8] (8 634) (7 170) (5 960) (4 592) (3 208) (1 957) (983) (346) (91) ≥ 85 aastat 731 86 42/58 26,4 208 2,8 [1,5; 4,0] 3,4 [2,0; 4,8] 3,6 [2,1; 5,1] 4,0 [2,3; 5,6] 4,0 [2,3; 5,6] 4,7 [2,5; 6,9] 4,7 [2,5; 6,9] (85–87) (571) (420) (328) (242) (157) (92) (54) Sugu Mees 28 682 63 (57–71) 100/0 29,4 646 2,8 [2,6; 3,0] 4,3 [4,1; 4,6] 5,2 [4,9; 5,5] 6,0 [5,7; 6,3] 6,4 [6,1; 6,8] 7,2 [6,8; 7,6] 7,7 [7,2; 8,1] 8,1 [7,6; 8,7] 8,7 [7,9; 9,6] (23 005) (18 262) (14 455) (10 907) (7 632) (4 785) (2 524) (966) (320) Naised 35 076 64 0/100 29,7 650 3,0 [2,8; 3,1] 5,0 [4,7; 5,2] 6,1 [5,8; 6,4] 7,1 [6,8; 7,4] 7,8 [7,5; 8,1] 8,6 [8,2; 9,0] 9,2 [8,8; 9,6] 10,1 [9,5; 10,6] 10,2 [9,6; 10,9] (57–72) (28 624) (23 167) (18 730) (14 456) (10 388) (6 617) (3 573) (1 307) (421) Kehamassiindeks ≤ 25 7 224 67 (59–75) 38/62 23,7 552 2,5 [2,2; 2,9] 4,5 [3,9; 5,0] 5,3 [4,7; 5,9] 6,4 [5,7; 7,1] 7,1 [6,3; 7,9] 8,3 [7,1; 9,4] (5 575) (4 077) (2 942) (1 916) (1 026) (291) > 25–30 18 086 65 52/48 27,7 605 2,4 [2,2; 2,6] 4,0 [3,7; 4,3] 5,1 [4,7; 5,5] 5,8 [5,4; 6,2] 6,3 [5,8; 6,7] 7,2 [6,5; 7,8] (59–73) (13 975) (10 574) (7 736) (5 061) (2 760) (713) > 30–35 13 862 63 (57–70) 47/53 32,1 595 3,2 [2,9; 3,5] 5,0 [4,6; 5,4] 6,2 [5,7; 6,7] 7,0 [6,5; 7,5] 7,9 [7,3; 8,6] 9,0 [8,1; 9,8] (10 702) (8 059) (5 937) (3 947) (2 134) (550) > 35–40 6 042 60 41/59 36,9 518 3,3 [2,8; 3,7] 5,3 [4,7; 5,9] 6,3 [5,6; 7,0] 7,1 [6,3; 7,9] 7,7 [6,8; 8,6] 8,3 [7,2; 9,3] (55–67) (4 644) (3 497) (2 542) (1 638) (887) (220) üle 40 2 367 58 (53–63) 31/69 42,4 393 4,3 [3,4; 5,1] 6,4 [5,3; 7,4] 7,0 [5,8; 8,1] 8,1 [6,7; 9,4] 9,8 [8,1; 11,4] 11,1 [8,5; 13,6] (1 827) (1 372) (1 016) (684) (391) (88) ASA staatus ASA 1 3 800 61 49/51 28,2 443 2,3 [1,8; 2,8] 3,4 [2,8; 4,1] 4,8 [3,7; 5,8] Põlve (55–67) (2 588) (1 624) (352) ASA 2 19 475 63 (57–70) 45/55 29,4 563 2,8 [2,5; 3,0] 4,6 [4,2; 4,9] 5,7 [5,2; 6,2] (12 235) (6 031) (1 426) ASA 3 6 162 67 51/49 31,1 481 3,2 [2,7; 3,7] 5,0 [4,3; 5,7] 6,0 [5,1; 6,8] (60–75) (3 972) (2 014) (515) Haigla suurus* Haiglad, kus on väike aastane patsientide arv 15 489 62 (56–70) 46/54 29,6 453 3,7 [3,4; 4,0] 6,3 [5,9; 6,7] 7,8 [7,3; 8,2] 8,9 [8,4; 9,4] 9,9 [9,3; 10,4] 10,9 [10,2; 11,5] 11,7 [11,0; 12,4] 12,3 [11,5; 13,1] 13,1 [11,9; 14,3] (12 576) (10 359) (8 463) (6 564) (4 757) (3 059) (1 614) (680) (176) Haiglad keskmise aastase patsientide arvuga 23 568 63 46/54 29,4 163 2,9 [2,6; 3,1] 4,8 [4,5; 5,1] 6,0 [5,6; 6,3] 6,9 [6,5; 7,3] 7,6 [7,1; 8,0] 8,4 [7,9; 8,8] 8,9 [8,3; 9,4] 9,8 [9,1; 10,6] 10,0 [9,2; 10,8] (57–72) (19 011) (14 924) (11 760) (8 815) (6 113) (3 793) (1 989) (719) (178) Haiglad, kus on suur aastane patsientide arv 23 710 65 (58–73) 43/57 29,4 31 2,4 [2,2; 2,6] 3,5 [3,3; 3,8] 4,1 [3,9; 4,4] 4,8 [4,5; 5,1] 5,1 [4,7; 5,4] 5,6 [5,2; 6,0] 6,1 [5,6; 6,5] 6,4 [5,9; 7,0] 6,6 [6,0; 7,3] (19 103) (15 273) (12 172) (9 343) (6 654) (4 261) (2 364) (837) (384) Põlveliigese proteesimine 1 026 55 (49–61) 26/74 28,4 224 4,7 [3,3; 6,0] 8,5 [6,6; 10,4] 10,8 [8,6; 12,9] 14,0 [11,3; 16,5] 16,2 [13,2; 19,0] 17,3 [14,0; 20,3] 18,8 [15,0; 22,4] (816) (641) (496) (371) (260) (168) (83) Vanuserühm ≤ 54 aastat 498 48 24/76 28,7 165 5,2 [3,1; 7,2] 9,5 [6,7; 12,3] 11,7 [8,5; 14,8] 17,3 [13,1; 21,3] 19,5 [14,8; 23,9] 21,5 [16,4; 26,3] (44–51) (410) (317) (243) (180) (131) (86) 55–64 aastat 361 59 (57–61) 26/74 28,7 133 4,5 [2,2; 6,8] 9,3 [5,8; 12,6] 11,5 [7,6; 15,3] 12,7 [8,5; 16,8] 15,3 [10,2; 20,2] (273) (206) (161) (120) (83) Sugu Naised 755 54 0/100 28,2 185 4,7 [3,1; 6,3] 8,3 [6,1; 10,4] 10,2 [7,7; 12,6] 12,9 [9,9; 15,7] 14,8 [11,5; 18,1] 15,8 [12,2; 19,3] 16,8 [12,7; 20,6] (48–61) (594) (462) (365) (278) (195) (123) (61) ASA staatus ASA 2 326 55 (49–62) 26/74 28,6 121 2,2 [0,4; 3,9] 6,2 [2,5; 9,8] (205) (101) Haigla suurus* Haiglad, kus on väike aastane patsientide arv 360 54 32/68 28,4 132 6,0 [3,4; 8,6] 10,5 [6,9; 13,9] 13,7 [9,5; 17,6] 15,4 [10,8; 19,7] 16,9 [11,9; 21,5] 18,0 [12,6; 23,1] (48–60) (286) (213) (163) (122) (88) (50) Haiglad, kus on suur aastane patsientide arv 361 56 (49–62) 25/75 28,2 29 4,1 [1,9; 6,2] 7,2 [4,2; 10,1] 9,8 [6,2; 13,2] 13,0 [8,7; 17,1] 14,3 [9,7; 18,7] 14,3 [9,7; 18,7] (290) (231) (182) (147) (108) (78) * Käesoleva aruande klassifikatsioonid põhinevad haiglate 2022. aasta kvaliteediaruannetel ja neis loetletud vastavatel esmase põlveliigese endoproteesimise IQTIG kvaliteedinäitajatel. TKA puhul on madala juhtumite arvu kategooria piirmäär kuni 200 juhtumit, keskmise juhtumite arvu kategooria piirmäär 201–500 juhtumit ja kõrge juhtumite arvu kategooria piirmäär üle 500 vastava protseduuri aastas; ühe kondüüli artroplastika puhul on piirmäärad kuni 30, 31–100 ja üle 100 vastava protseduuri aastas. Tabel 50 (jätkub) 114 EPRD 2024. aasta aruanne 115  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus 5.3.3 Implantaadi omaduste mõju tulemused nende liikuvate laagrite puhul võrreldes 7 © EPRD aastaaruanne 2024 esmasel põlveliigese endoproteesimisel analoogsete fikseeritud laagritega (vt tabel 52). 6 Standardse põlveliigese endoproteeside hulgas esineb Kumulatiivne korrigeerimine 5 EPRD määratles 2024. aasta alguses uuesti märkimisväärseid erinevusi eri süsteemide vahel. CR- artroplastika lõpptulemuse. Täiendav põlveliigese 4 süsteemid jõuavad oma lõpptulemuseni hiljem kui pinna uuendamise operatsioon kvalifitseerub nüüd 3 teised põlvesüsteemid (joonis 24). Siiski tuleb samuti asjakohaseks revisiooniks, mis on kaasatud 2 märkida, et mõnes haiglas kasutatakse puhtalt CR- CRR-arvutustesse (vt selgitust leheküljel 24). See [%] muudatus on muutnud revisioonikirurgia riski 1 süsteeme tõenäoliselt ainult patsientidel, kellel on head standardse TKA puhul, kus esmase artroplastika ajal ei 0 Standardne TKA liikuvate liigenditega sidemete seisundid ja stabiilsed liigesed, samas kui teisi ole tehtud või on tehtud põlveliigese pinna Standardne TKA fikseeritud liigenditega süsteeme eelistatakse tõenäolisemalt juhtudel, kus uuendamine. Revisioonimäärad TKA-de puhul, kus algseisund on halvem. Kui analüüs keskendub esmase 0 1 2 3 4 5 6 7 8 9 50 979 43 914 37 702 Aastad pärast 31 097 esmast 23 908 16 462 9 326 3 452 751 58 218 haiglatele, mis on spetsialiseerunud põlvesüsteemile, Ohustatud numbrid 366 139 296 986 238 710 192 980 150 212 107 962 70 155 38 883 16 090 4 398 mida kasutatakse vähemalt 80% juhtudest standardse TKA-ga on tulemuste erinevused Põlveliigese pindmise kihi asendamise tulemused on Joonis 25: Standardse põlveliigese täieliku proteesimise kumulatiivsed korduvoperatsioonide määrad kandepinna liikuvuse järgi (p < 0,0001) väiksemad. CR- ja CS-süsteemide tulemused ei erine praegu üldiselt paremad võrreldes esmase enam. põlveliigese pindmise kihi asendamisega (joonis 26). See ei ole aga pannud EPRD-d – vastupidiselt Fikseeritud laagritega põlveliigese täielikel mõningatele soovitustele – järeldama, et esmased 7 © EPRD aastaaruanne 2024 proteesimistel on korduvoperatsioonide määr artroplastikad peaksid kõik hõlmama põlveliigese 6 Põlve märkimisväärselt madalam kui liikuvate laagritega pindmise kihi asendamist [5]. EPRD 2022. aasta 5 aruandes käsitleti seda teemat üksikasjalikult ja Kumulatiivne revisioon [%] süsteemidel (joonis 25). See tähelepanek kehtib ka haiglate puhul, mis on spetsialiseerunud ühele märgiti, et üksikute tootjate ja süsteemide vahel on 4 laagrite liikuvuse tüübile. Siiski erinevad fikseeritud suuri erinevusi [6]. Seetõttu esitatakse praeguses 3 ja liikuvate laagrite tulemused konkreetsete EPRD aruandes artroplastika tulemused esmase 2 implantaadisüsteemide lõikes märkimisväärselt. patella pinna uuendamisega ja ilma selleta eraldi Mitmed konkreetsed süsteemid saavutavad isegi paremaid konkreetsete 1 0 Standardne põlveliigese täielik asendus ilma põlvekapsli pinna uuendamiseta esmasel operatsioonil Standardne põlveliigese täielik 0 1 2 3 4 5 6asendus koos põlvekapsli 7 pinna uuendamisega 8 esmasel 9 operatsioonil Aastad alates algkoolist 7 © EPRD 2024. aasta aruanne 378 276 309 583 251 244 205 530 161 875 118 078 77 724 43 275 17 513 4 650 Arvud 6 riskirühmas 46 081 38 382 31 380 25 152 19 434 13 792 8 893 4 934 2 029 5 Kumulatiivne revisioon [%] Joonis 26: Kumulatiivsed revisioonimäärad standardse esmase täieliku põlveliigese endoproteesimise puhul koos põlveliigese pinna uuendamisega ja ilma selleta 4 esmase TKA puhul (p < 0,0001) 3 2 implantaadisüsteemidest ja soovitab kaaluda iga üksiku komponendid, mis põhinevad füüsiliselt töödeldud Tagantstabiliseeritud standard-TKA-d 1 Ristisidemeid säilitavad/ohverdavad standard-TKA-d implantaadisüsteemi jaoks sobivat strateegiat. tsirkooniumisulamil. Mõlema tüüpi modifitseeritud Pivot-tüüpi standard-TKA-d 0 Ristisidemeid ohverdavad standard-TKA-d kandepindade puhul on täheldatud paremaid Ristisidemeid säilitavad standard-TKA-d Reieluukõhre materjalide valik mõjutab samuti hõõrdumisomadusi ja väiksemat metallioonide 0 1 2 3 4 5 6 7 8 9 oluliselt artroplastika tulemusi. Enamik eraldumist. Kuigi proteesid, millel on kaetud või Aastad alates esmasest põlvesüsteemide reieluukomponente on valmistatud keraamilised reieluupinnad, on mõnes haiglas 100 243 79 738 62 648 49 389 37 585 26 360 16 755 9 160 3 950 1 355 koobalt-kroom-molübdeen-sulamitest. Väike osa standardiks, kasutatakse neid teistes peamiselt 50 070 41 995 34 839 29 093 23 271 17 147 11 342 6 265 2 465 619 neist reieluukomponentidest on keraamilised patsientidel, kellel on kinnitatud või kahtlustatav Ohustatud arvud 12 980 9 192 6 464 4 834 3 524 2 429 1 526 775 metallitundlikkus. See võib piirata tulemuste 53 298 43 756 35 756 29 482 23 279 17 314 11 510 6 364 2 360 511 võrreldavust 207 766 173 284 142 917 117 884 93 650 68 620 45 484 25 645 10 501 2 631 kattega kandepinnal. Lisaks on olemas nn keraamilised (vt ka [7]). EPRD-s näitavad mõlemad modifitseeritud Joonis 24: Standardse täieliku põlveliigese proteesimise kumulatiivsed revisioonimäärad põlvesüsteemi järgi (p < 0,0001). Selguse huvides on usaldusvahemikud välja jäetud. reieluukomponendid reieluukomponentide tüübid kõrgemat 116 EPRD aastaaruanne 2024 117  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus 14 CRR-id võrreldes komponentidega, millel puudub Lühidalt: © EPRD aastaaruanne 2024 12 modifitseeritud kandepind. Erinevust ei saa täielikult omistada asjaolule, et patsiendid, kellel on • Tänaseks on CR- ja CS-süsteemidel 10 modifitseerimata metallist põlvekomponendid, on madalaimad kumulatiivsed revisioonimäärad. Kumulatiivne revisioon [%] 8 keskmiselt vanemad. Tabelis 51 on esitatud põlveliigese endoproteesimise tulemuste ja implantaadi • Varajastes postoperatiivsetes aastates on 6 omaduste vaheline seos. standardseil fikseeritud kandepinnaga TKA-del 4 üldiselt madalamad kumulatiivsed 2 revisioonimäärad. 0 Ühe kondüüliga põlveliigese proteesimine kaetud või keraamilise metallist reieluupinnaga Ühe kondüüliga • Kas esmane põlveliigese pinna asendamine põlveliigese proteesimine katmata metallist reieluupinnaga parandab tulemusi või mitte, sõltub suuresti kasutatavast implantaadisüsteemist. 0 1 2 3 4 5 6 7 8 9 Aastad esmase 6 054 5 064 4 196 3 470 2 611 1 766 1 072 540 Ohustatud arvud 57 704 46 565 37 233 29 715 22 752 16 254 10 330 5 557 2 061 665 Joonis 27: Ühe kondüüliga põlveliigese proteeside kumulatiivsed revisioonimäärad reieluupinna materjali järgi (p < 0,001) Kumulatiivsed revisioonimäärad pärast ... Liik Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat Põlve / Kategooria Standardne põlveliigese asendus 424 357 70 (62–77) 35/65 30,1 749 1,9 [1,9; 1,9] 3,1 [3,1; 3,2] 3,7 [3,7; 3,8] 4,2 [4,1; 4,2] 4,5 [4,4; 4,5] 4,7 [4,6; 4,8] 5,0 [4,9; 5,0] 5,2 [5,1; 5,3] 5,5 [5,4; 5,6] (347 965) (282 624) (230 682) (181 309) (131 870) (86 617) (48 209) (19 542) (5 149) Laagri liikuvus Fikseeritud laagri 366 139 70 (62–77) 35/65 30,1 738 1,8 [1,8; 1,9] 3,0 [3,0; 3,1] 3,7 [3,6; 3,7] 4,1 [4,0; 4,1] 4,4 [4,3; 4,4] 4,6 [4,6; 4,7] 4,9 [4,8; 5,0] 5,2 [5,1; 5,3] 5,5 [5,3; 5,6] (296 986) (238 710) (192 980) (150 212) (107 962) (70 155) (38 883) (16 090) (4 398) Liikuv laagripesa 58 218 70 34/66 30,0 350 2,2 [2,1; 2,3] 3,6 [3,5; 3,8] 4,3 [4,1; 4,5] 4,7 [4,5; 4,9] 5,0 [4,8; 5,2] 5,2 [5,0; 5,4] 5,4 [5,2; 5,6] 5,6 [5,4; 5,9] 5,7 [5,4; 6,0] (63–77) (50 979) (43 914) (37 702) (31 097) (23 908) (16 462) (9 326) (3 452) (751) Laager Katmata metall / PE 170 916 71 (63–77) 36/64 30,1 555 1,8 [1,7; 1,8] 2,8 [2,7; 2,9] 3,4 [3,3; 3,5] 3,8 [3,7; 3,9] 4,0 [3,9; 4,2] 4,3 [4,2; 4,4] 4,6 [4,5; 4,7] 4,9 [4,8; 5,1] 5,3 [5,0; 5,5] (142,147) (116 947) (96 701) (76 870) (57 080) (38 164) (21 919) (9 165) (2 570) Katmata metall / mXLPE 141 606 71 36/64 30,0 485 1,9 [1,9; 2,0] 3,2 [3,1; 3,3] 3,8 [3,7; 3,9] 4,2 [4,1; 4,3] 4,5 [4,3; 4,6] 4,7 [4,6; 4,8] 4,9 [4,7; 5,0] 5,1 [5,0; 5,3] 5,3 [5,1; 5,5] (63–77) (119 718) (100 569) (84 401) (67 503) (49 150) (32 403) (17 908) (7 116) (1 752) Katmata metall / hXLPE 39 939 6 8 33/67 30,4 417 1,9 [1,8; 2,1] 3,2 [3,0; 3,3] 3,8 [3,5; 4,0] 4,2 [3,9; 4,4] 4,5 [4,2; 4,7] 4,8 [4,5; 5,1] 4,9 [4,6; 5,2] 5,0 [4,7; 5,4] 5,2 [4,8; 5,6] (31 204) (24 295) (18 646) (14 158) (9 842) (6 142) (3 323) (1 429) (324) Katmata metall / hXLPE+antioksüdant 36 471 69 38/62 30,1 305 1,8 [1,7; 2,0] 3,0 [2,8; 3,2] 3,5 [3,3; 3,7] 3,9 [3,7; 4,2] 4,2 [4,0; 4,5] 4,6 [4,3; 4,9] 4,7 [4,4; 5,1] 4,7 [4,4; 5,1] 4,7 [4,4; 5,1] (62–76) (26 549) (18 561) (13 157) (9 090) (6 012) (3 785) (1 965) (705) (171) Kaetud metall / mXLPE 12 641 66 (59–73) 14/86 31,2 406 2,3 [2,0; 2,6] 4,5 [4,1; 4,8] 5,5 [5,1; 6,0] 6,1 [5,6; 6,6] 6,8 [6,2; 7,3] 7,3 [6,7; 7,9] 7,7 [7,1; 8,4] 8,0 [7,2; 8,7] 8,0 [7,2; 8,7] (10 390) (8 395) (6 931) (5 327) (3 762) (2 322) (1 126) (415) (82) Keraamiline metall / PE 10 154 65 18/82 31,2 266 2,1 [1,8; 2,4] 4,1 [3,7; 4,5] 5,1 [4,6; 5,6] 5,4 [4,9; 5,9] 5,7 [5,2; 6,3] 5,9 [5,3; 6,5] 6,5 [5,8; 7,2] 6,8 [6,0; 7,7] 6,8 [6,0; 7,7] (59–73) (8 041) (6 211) (4 730) (3 597) (2 599) (1 680) (960) (464) (221) Kaetud metall / PE 6 192 67 (60–75) 19/81 30,9 250 2,6 [2,2; 3,1] 4,7 [4,1; 5,2] 5,7 [5,1; 6,4] 6,5 [5,8; 7,3] 7,0 [6,2; 7,8] 7,7 [6,8; 8,6] 7,9 [7,0; 8,9] 8,8 [7,6; 10,0] (4 790) (3 589) (2 818) (2 217) (1 639) (1 142) (653) (201) Keraamiline metall / hXLPE 4 922 65 27/73 30,8 147 2,9 [2,5; 3,4] 5,1 [4,5; 5,8] 6,3 [5,6; 7,1] 7,4 [6,6; 8,2] 7,9 [7,0; 8,8] 8,4 [7,5; 9,4] 8,4 [7,5; 9,4] (58–73) (4 136) (3 410) (2 863) (2 279) (1 643) (903) (317) Kaetud metall / hXLPE+antioksüdant 1 061 65 (59–72) 10/90 31,5 62 1,6 [0,8; 2,4] 3,0 [1,8; 4,2] 4,5 [2,9; 6,1] 4,9 [3,1; 6,7] 4,9 [3,1; 6,7] (782) (527) (345) (190) (83) Reieluupinna liigendpind Katmata metall 389 205 70 36/64 30,1 744 1,8 [1,8; 1,9] 3,0 [2,9; 3,0] 3,6 [3,5; 3,7] 4,0 [3,9; 4,1] 4,3 [4,2; 4,3] 4,5 [4,4; 4,6] 4,7 [4,7; 4,8] 5,0 [4,9; 5,1] 5,3 [5,1; 5,4] (63–77) (319 689) (260 381) (212 905) (167 621) (122 084) (80 494) (45 115) (18 415) (4 817) Kaetud metall 19 934 66 (59–74) 15/85 31,1 545 2,4 [2,2; 2,6] 4,4 [4,1; 4,8] 5,5 [5,2; 5,9] 6,2 [5,8; 6,6] 6,8 [6,3; 7,2] 7,3 [6,8; 7,8] 7,7 [7,2; 8,2] 8,2 [7,5; 8,8] 8,3 [7,6; 9,0] (15 980) (12 518) (10 094) (7 734) (5 484) (3 505) (1 802) (620) (110) Keraamiline metall 15 076 65 21/79 31,2 295 2,4 [2,1; 2,6] 4,5 [4,1; 4,8] 5,5 [5,1; 5,9] 6,1 [5,7; 6,6] 6,5 [6,0; 7,0] 6,8 [6,3; 7,3] 7,2 [6,6; 7,8] 7,5 [6,8; 8,3] 7,5 [6,8; 8,3] (58–73) (12 177) (9 621) (7 593) (5 876) (4 242) (2 583) (1 277) (503) (222) Sääreluu liigespind PE 187 404 70 (62–77) 35/65 30,1 620 1,8 [1,7; 1,9] 2,9 [2,9; 3,0] 3,5 [3,4; 3,6] 3,9 [3,8; 4,0] 4,2 [4,1; 4,3] 4,5 [4,4; 4,6] 4,8 [4,7; 4,9] 5,1 [5,0; 5,3] 5,5 [5,3; 5,7] (155 097) (126 851) (104 339) (82 762) (61 378) (41 021) (23 547) (9 834) (2 819) mXLPE 154 247 71 34/66 30,1 526 2,0 [1,9; 2,0] 3,3 [3,2; 3,4] 3,9 [3,8; 4,0] 4,4 [4,2; 4,5] 4,7 [4,5; 4,8] 4,9 [4,8; 5,0] 5,1 [5,0; 5,2] 5,3 [5,2; 5,5] 5,5 [5,3; 5,7] (63–77) (130 108) (108 964) (91 332) (72 830) (52 912) (34 725) (19 034) (7 531) (1 834) Tabel 51: Esmase põlveliigese proteesimise erinevate tüüpide ja omaduste kumulatiivsed revisioonimäärad 118 EPRD aastaaruanne 2024 119  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus Kumulatiivsed revisioonimäärad pärast ... Artroplastika Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat / Kategooria Sääreluu liigespind hXLPE 44 861 68 (61–75) 32/68 30,4 435 2,1 [1,9; 2,2] 3,4 [3,2; 3,6] 4,1 [3,9; 4,3] 4,6 [4,3; 4,8] 4,9 [4,6; 5,1] 5,2 [5,0; 5,5] 5,4 [5,1; 5,6] 5,5 [5,2; 5,8] 5,6 [5,2; 6,0] (35 340) (27 705) (21 509) (16 437) (11 485) (7 045) (3 640) (1 468) (325) hXLPE + antioksüdant 37 532 69 38/62 30,2 313 1,8 [1,7; 2,0] 3,0 [2,8; 3,2] 3,5 [3,3; 3,8] 3,9 [3,7; 4,2] 4,3 [4,0; 4,5] 4,6 [4,3; 4,9] 4,8 [4,4; 5,1] 4,8 [4,4; 5,1] 4,8 [4,4; 5,1] (62–76) (27 331) (19 088) (13 502) (9 280) (6 095) (3 826) (1 988) (709) (171) Põlvesüsteem CR 207 766 70 (62–77) 36/64 30,1 675 1,7 [1,6; 1,7] 2,7 [2,6; 2,8] 3,2 [3,2; 3,3] 3,6 [3,5; 3,7] 3,9 [3,8; 4,0] 4,1 [4,0; 4,2] 4,3 [4,2; 4,4] 4,6 [4,4; 4,7] 4,8 [4,6; 5,0] (173 284) (142 917) (117 884) (93 650) (68 620) (45 484) (25 645) (10 501) (2 631) PS 100 243 70 33/67 30,1 636 2,3 [2,2; 2,4] 3,8 [3,7; 4,0] 4,6 [4,5; 4,8] 5,1 [5,0; 5,3] 5,5 [5,3; 5,6] 5,8 [5,6; 6,0] 6,1 [5,9; 6,4] 6,5 [6,3; 6,8] 6,9 [6,6; 7,3] (62–77) (79 738) (62 648) (49 389) (37 585) (26 360) (16 755) (9 160) (3 950) (1 355) CS 53 298 71 (63–77) 31/69 30,1 415 1,8 [1,7; 1,9] 3,0 [2,8; 3,1] 3,6 [3,4; 3,8] 4,0 [3,8; 4,2] 4,3 [4,1; 4,5] 4,7 [4,5; 4,9] 5,0 [4,7; 5,2] 5,2 [4,9; 5,5] 5,6 [5,2; 6,0] (43 756) (35 756) (29 482) (23 279) (17 314) (11 510) (6 364) (2 360) (511) CR/CS 50 070 69 35/65 30,0 331 2,1 [2,0; 2,2] 3,5 [3,4; 3,7] 4,2 [4,1; 4,4] 4,7 [4,5; 4,9] 5,0 [4,8; 5,2] 5,2 [4,9; 5,4] 5,4 [5,1; 5,6] 5,6 [5,3; 5,9] 5,7 [5,4; 6,1] (62–76) (41 995) (34 839) (29 093) (23 271) (17 147) (11 342) (6 265) (2 465) (619) Pivot 12 980 70 (62–76) 37/63 30,1 137 2,2 [1,9; 2,5] 3,4 [3,0; 3,7] 4,0 [3,5; 4,4] 4,2 [3,8; 4,7] 4,7 [4,2; 5,2] 5,1 [4,6; 5,7] 5,4 [4,8; 6,0] 5,9 [5,0; 6,8] (9 192) (6 464) (4 834) (3 524) (2 429) (1 526) (775) (266) Põlvekapsli Ilma põlvekedra pinna taastamiseta 378 276 70 35/65 30,1 747 1,9 [1,9; 1,9] 3,2 [3,1; 3,2] 3,8 [3,7; 3,9] 4,2 [4,2; 4,3] 4,5 [4,4; 4,6] 4,8 [4,7; 4,9] 5,0 [4,9; 5,1] 5,3 [5,2; 5,4] 5,6 [5,4; 5,7] (62–77) (309 583) (251 244) (205 530) (161 875) (118 078) (77 724) (43 275) (17 513) (4 650) Põlvekapsli pinna taastamisega 46 081 70 (62–77) 32/68 30,4 521 1,8 [1,7; 1,9] 2,7 [2,6; 2,9] 3,2 [3,1; 3,4] 3,6 [3,4; 3,8] 3,9 [3,7; 4,1] 4,2 [4,0; 4,4] 4,4 [4,2; 4,7] 4,6 [4,3; 4,9] 4,8 [4,4; 5,2] (38 382) (31 380) (25 152) (19 434) (13 792) (8 893) (4 934) (2 029) (499) Kinnitus Tsementeeritud 398 587 70 34/66 30,1 748 1,9 [1,8; 1,9] 3,1 [3,0; 3,2] 3,7 [3,7; 3,8] 4,2 [4,1; 4,2] 4,5 [4,4; 4,5] 4,7 [4,6; 4,8] 5,0 [4,9; 5,1] 5,2 [5,1; 5,3] 5,5 [5,3; 5,6] (62–77) (325 317) (262 857) (213 461) (166 784) (120 416) (78 624) (43 517) (17 607) (4 602) Hübriid 20 043 70 (62–76) 39/61 30,2 228 2,0 [1,8; 2,2] 3,0 [2,8; 3,3] 3,6 [3,3; 3,9] 3,9 [3,7; 4,2] 4,2 [3,9; 4,5] 4,5 [4,2; 4,8] 4,7 [4,4; 5,1] 5,1 [4,7; 5,6] 5,8 [5,2; 6,4] Põlve (17 836) (15 790) (13 918) (11 864) (9 430) (6 667) (3 970) (1 678) (471) Tsementeerimata 5 405 68 34/66 30,1 221 2,2 [1,8; 2,6] 3,6 [3,0; 4,1] 4,4 [3,8; 5,0] 4,8 [4,1; 5,4] 5,0 [4,4; 5,7] 5,2 [4,5; 5,9] 5,3 [4,6; 6,0] 5,6 [4,7; 6,4] 5,6 [4,7; 6,4] (60–75) (4 512) (3 701) (3 061) (2 475) (1 900) (1 273) (707) (256) (76) Piiratud TKA-d 19 949 74 (66–80) 24/76 28,9 690 4,2 [3,9; 4,5] 5,7 [5,3; 6,0] 6,4 [6,0; 6,8] 6,8 [6,4; 7,2] 7,2 [6,8; 7,6] 7,5 [7,1; 8,0] 7,8 [7,3; 8,3] 8,4 [7,7; 9,0] 8,9 [7,8; 10,0] (15 711) (12 482) (9 946) (7 650) (5 360) (3 447) (1 818) (735) (176) Laagri liikuvus Fikseeritud laagri 19 949 74 (66–80) 24/76 28,9 690 4,2 [3,9; 4,5] 5,7 [5,3; 6,0] 6,4 [6,0; 6,8] 6,8 [6,4; 7,2] 7,2 [6,8; 7,6] 7,5 [7,1; 8,0] 7,8 [7,3; 8,3] 8,4 [7,7; 9,0] 8,9 [7,8; 10,0] (15 711) (12 482) (9 946) (7 650) (5 360) (3 447) (1 818) (735) (176) Laager Katmata metall / PE 13 239 75 24/76 28,6 587 4,1 [3,7; 4,4] 5,5 [5,1; 5,9] 6,2 [5,8; 6,7] 6,5 [6,1; 7,0] 7,0 [6,5; 7,5] 7,3 [6,8; 7,9] 7,6 [7,0; 8,1] 8,3 [7,5; 9,1] 8,5 [7,6; 9,4] (67–81) (10 460) (8 343) (6 710) (5 238) (3 679) (2 396) (1 257) (515) (122) Katmata metall / mXLPE 3 676 74 (66–80) 25/75 29,0 300 4,2 [3,5; 4,8] 5,6 [4,8; 6,3] 6,4 [5,5; 7,3] 6,8 [5,9; 7,7] 7,0 [6,1; 7,9] 7,5 [6,4; 8,5] 7,9 [6,8; 9,1] 7,9 [6,8; 9,1] (2 963) (2 433) (1 983) (1 534) (1 118) (734) (430) (167) Kaetud metall / PE 993 72 21/79 29,5 170 5,3 [3,9; 6,8] 7,8 [6,0; 9,6] 9,3 [7,2; 11,4] 9,8 [7,6; 12,0] 10,5 [8,1; 12,8] 10,5 [8,1; 12,8] (63–80) (771) (580) (434) (314) (206) (108) Katmata metall / hXLPE 969 72 (63–79) 29/71 29,7 68 3,3 [2,1; 4,4] 5,4 [3,8; 7,0] 6,0 [4,3; 7,6] 7,5 [5,5; 9,6] 7,5 [5,5; 9,6] 8,1 [5,7; 10,4] (750) (566) (424) (295) (180) (98) Keraamiline metall / PE 467 66 18/82 30,9 114 4,9 [2,8; 6,9] 5,2 [3,0; 7,3] 5,6 [3,3; 7,9] 6,2 [3,6; 8,6] 6,2 [3,6; 8,6] (59–74) (329) (257) (193) (132) (86) Kaetud metall / mXLPE 377 69 (61–77) 10/90 30,7 134 5,1 [2,8; 7,4] 7,3 [4,4; 10,1] 8,3 [5,1; 11,3] 8,3 [5,1; 11,3] 8,3 [5,1; 11,3] 8,3 [5,1; 11,3] (298) (226) (167) (127) (90) (62) Reieluupinna liigendpind Katmata metall 18 109 75 25/75 28,7 684 4,1 [3,8; 4,4] 5,5 [5,2; 5,9] 6,2 [5,8; 6,6] 6,6 [6,2; 7,0] 7,0 [6,6; 7,4] 7,4 [6,9; 7,8] 7,7 [7,1; 8,2] 8,2 [7,6; 8,9] 8,8 [7,7; 9,9] (66–81) (14 312) (11 418) (9 151) (7 076) (4 977) (3 228) (1 726) (696) (173) Kaetud metall 1 372 71 (63–79) 18/82 29,8 276 5,3 [4,1; 6,6] 7,7 [6,2; 9,3] 9,1 [7,4; 10,8] 9,5 [7,7; 11,2] 9,9 [8,0; 11,8] 9,9 [8,0; 11,8] 10,5 [8,3; 12,7] (1 069) (806) (601) (441) (296) (170) (64) Keraamiline metall 467 66 18/82 30,9 114 4,9 [2,8; 6,9] 5,2 [3,0; 7,3] 5,6 [3,3; 7,9] 6,2 [3,6; 8,6] 6,2 [3,6; 8,6] (59–74) (329) (257) (193) (132) (86) Sääreluu liigespind PE 14 700 75 (66–81) 24/76 28,7 603 4,2 [3,9; 4,5] 5,7 [5,3; 6,1] 6,4 [6,0; 6,8] 6,7 [6,3; 7,2] 7,2 [6,7; 7,7] 7,5 [7,0; 8,0] 7,8 [7,2; 8,3] 8,5 [7,7; 9,3] 8,7 [7,8; 9,5] (11 561) (9 181) (7 338) (5 685) (3 972) (2 553) (1 320) (541) (124) mXLPE 4 053 74 23/77 29,1 330 4,3 [3,6; 4,9] 5,7 [5,0; 6,5] 6,6 [5,7; 7,4] 7,0 [6,1; 7,8] 7,1 [6,2; 8,0] 7,5 [6,6; 8,5] 8,0 [6,9; 9,1] 8,0 [6,9; 9,1] (66–80) (3 261) (2 659) (2 150) (1 661) (1 208) (796) (459) (180) hXLPE 969 72 (63–79) 29/71 29,7 68 3,3 [2,1; 4,4] 5,4 [3,8; 7,0] 6,0 [4,3; 7,6] 7,5 [5,5; 9,6] 7,5 [5,5; 9,6] 8,1 [5,7; 10,4] (750) (566) (424) (295) (180) (98) Põlvesüsteem Liigendiga 11 974 76 22/78 28,2 642 4,7 [4,3; 5,1] 6,3 [5,8; 6,8] 7,2 [6,7; 7,7] 7,6 [7,1; 8,1] 8,1 [7,5; 8,6] 8,3 [7,7; 8,9] 8,6 [8,0; 9,2] 9,1 [8,3; 9,9] 10,1 [8,3; 11,7] (68–81) (9 439) (7 603) (6 133) (4 750) (3 373) (2 200) (1 183) (491) (91) Varus-valgus stabiliseeritud 7 975 72 (63–79) 28/72 29,7 459 3,3 [2,9; 3,8] 4,7 [4,2; 5,2] 5,1 [4,6; 5,7] 5,5 [5,0; 6,1] 5,9 [5,2; 6,5] 6,3 [5,6; 6,9] 6,7 [5,9; 7,5] 7,2 [6,1; 8,3] 7,2 [6,1; 8,3] (6 272) (4 879) (3 813) (2 900) (1 987) (1 247) (635) (244) (85) Tabel 51 (jätkub) 120 EPRD 2024. aasta aruanne 121  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus Kumulatiivsed korrigeerimismäärad pärast ... Artroplastika tüüp Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat / Kategooria Põlvekapsli Ilma põlvekapsli pinna uuendamiseta 17 169 74 24/76 28,7 679 4,1 [3,8; 4,4] 5,6 [5,3; 6,0] 6,4 [6,0; 6,8] 6,9 [6,4; 7,3] 7,2 [6,8; 7,7] 7,6 [7,1; 8,1] 7,9 [7,4; 8,4] 8,3 [7,7; 8,9] 9,0 [7,7; 10,2] (66–80) (13 511) (10 712) (8 530) (6 556) (4 599) (2 975) (1 568) (641) (154) Põlvekapsli pinna uuendamisega 2 780 73 (65–80) 25/75 29,7 254 4,6 [3,8; 5,4] 5,7 [4,8; 6,6] 6,1 [5,2; 7,1] 6,4 [5,4; 7,4] 6,9 [5,8; 8,0] 6,9 [5,8; 8,0] 7,3 [6,1; 8,6] 8,8 [6,4; 11,0] (2 200) (1 770) (1 416) (1 094) (761) (472) (250) (94) Kinnitamine Tsementeeritud 19 539 74 24/76 29,0 689 4,1 [3,8; 4,3] 5,5 [5,1; 5,8] 6,1 [5,8; 6,5] 6,5 [6,1; 6,9] 6,9 [6,5; 7,3] 7,2 [6,8; 7,7] 7,5 [7,0; 8,0] 8,1 [7,4; 8,7] 8,6 [7,5; 9,7] (66–80) (15 456) (12 318) (9 840) (7 578) (5 311) (3 420) (1 805) (732) (176) Ühe põlveliigese proteesimine 63 758 6 3 45/55 29,4 674 2,9 [2,8; 3,0] 4,7 [4,5; 4,9] 5,7 [5,5; 5,9] 6,6 [6,4; 6,8] 7,2 [7,0; 7,5] 8,0 [7,7; 8,2] 8,5 [8,2; 8,9] 9,2 [8,8; 9,6] 9,6 [9,1; 10,1] (51 629) (41 429) (33 185) (25 363) (18 020) (11 402) (6 097) (2 273) (741) Laagri liikuvus Liikuv laagrikorpus 37 607 64 (57–72) 45/55 29,7 484 3,2 [3,0; 3,4] 4,9 [4,6; 5,1] 5,9 [5,6; 6,1] 6,7 [6,4; 7,0] 7,3 [7,0; 7,6] 8,1 [7,8; 8,5] 8,6 [8,2; 9,0] 9,2 [8,7; 9,7] 9,6 [9,0; 10,3] (30 757) (25 026) (20 450) (15 899) (11 504) (7 395) (4 073) (1 630) (566) Fikseeritud laagrid 26 151 63 45/55 29,4 485 2,5 [2,3; 2,7] 4,4 [4,2; 4,7] 5,5 [5,2; 5,9] 6,5 [6,2; 6,9] 7,1 [6,7; 7,5] 7,7 [7,3; 8,2] 8,4 [7,9; 9,0] 9,3 [8,6; 10,0] 9,5 [8,7; 10,3] (57–71) (20 872) (16 403) (12 735) (9 464) (6 516) (4 007) (2 024) (643) (175) Laager Katmata metall / mXLPE 35 930 64 (58–73) 46/54 29,5 451 3,0 [2,8; 3,2] 4,6 [4,4; 4,8] 5,5 [5,3; 5,8] 6,3 [6,0; 6,6] 6,8 [6,5; 7,1] 7,6 [7,2; 8,0] 8,1 [7,7; 8,5] 8,8 [8,3; 9,3] 9,3 [8,6; 9,9] (29 378) (23 940) (19 625) (15 191) (10 901) (6 899) (3 723) (1 433) (485) Katmata metall / PE 11 137 63 48/52 29,4 301 2,3 [2,0; 2,6] 4,1 [3,7; 4,5] 5,1 [4,6; 5,6] 6,0 [5,5; 6,5] 6,6 [6,1; 7,2] 7,3 [6,7; 8,0] 8,1 [7,3; 8,9] 9,3 [8,1; 10,4] 9,6 [8,3; 10,9] (57–71) (8 927) (6 977) (5 417) (4 255) (3 184) (2 116) (1 139) (364) (116) Katmata metall / hXLPE+antioksüdant 5 474 63 (57–71) 49/51 29,4 140 2,4 [2,0; 2,9] 3,8 [3,2; 4,4] 4,6 [3,9; 5,3] 5,1 [4,3; 5,9] 5,2 [4,4; 6,1] (3 785) (2 481) (1 465) (785) (252) Katmata metall / hXLPE 5 136 63 47/53 29,4 141 2,2 [1,8; 2,6] 4,2 [3,6; 4,7] 5,2 [4,6; 5,9] 6,1 [5,3; 6,8] 6,4 [5,6; 7,1] 7,1 [6,2; 7,9] 7,6 [6,7; 8,6] 7,8 [6,8; 8,8] 7,8 [6,8; 8,8] (57–71) (4 462) (3 835) (3 208) (2 521) (1 917) (1 281) (695) (264) (64) Kaetud metall / mXLPE 3 982 61 (55–68) 23/77 30,1 343 3,7 [3,1; 4,3] 6,7 [5,9; 7,5] 8,4 [7,5; 9,4] 10,1 [9,1; 11,1] 10,9 [9,8; 12,0] 11,8 [10,6; 13,0] 12,0 [10,7; 13,2] 12,6 [11,1; 14,0] 12,6 [11,1; 14,0] Põlve (3 535) (3 050) (2 619) (1 942) (1 307) (773) (404) (170) (65) Keraamiline metall / PE 1 333 60 33/67 29,7 161 4,5 [3,3; 5,6] 7,2 [5,6; 8,7] 8,6 [6,9; 10,3] 9,6 [7,7; 11,5] 11,8 [9,4; 14,0] 12,7 [10,1; 15,1] 14,2 [10,9; 17,4] (54–66) (1 044) (805) (602) (476) (309) (190) (85) Kaetud metall / PE 534 60 (54–67) 26/74 30,2 89 9,7 [7,1; 12,3] 14,5 [11,2; 17,7] 16,0 [12,5; 19,3] 20,4 [16,2; 24,3] 22,3 [17,8; 26,6] 24,2 [19,3; 28,8] 24,2 [19,3; 28,8] (414) (325) (244) (193) (150) (109) (51) Reieluupinna liigendpind Katmata metall 57 704 64 47/53 29,4 655 2,7 [2,6; 2,9] 4,4 [4,2; 4,6] 5,3 [5,1; 5,6] 6,1 [5,9; 6,3] 6,7 [6,4; 6,9] 7,4 [7,1; 7,7] 8,0 [7,7; 8,3] 8,7 [8,3; 9,1] 9,1 [8,5; 9,6] (58–72) (46 565) (37 233) (29 715) (22 752) (16 254) (10 330) (5 557) (2 061) (665) Kaetud metall 4 523 61 (55–68) 24/76 30,1 398 4,4 [3,8; 5,0] 7,6 [6,8; 8,4] 9,3 [8,4; 10,2] 11,2 [10,2; 12,2] 12,1 [11,0; 13,2] 13,2 [12,0; 14,4] 13,3 [12,1; 14,5] 13,8 [12,4; 15,2] 13,8 [12,4; 15,2] (3 950) (3 375) (2 863) (2 135) (1 457) (882) (455) (186) (70) Keraamiline metall 1 531 60 33/67 29,4 166 4,3 [3,2; 5,4] 6,9 [5,5; 8,4] 8,4 [6,7; 10,0] 9,4 [7,6; 11,2] 11,5 [9,2; 13,8] 12,4 [9,9; 14,9] 14,0 [10,7; 17,2] (55–67) (1 114) (821) (607) (476) (309) (190) (85) Sääreluu liigespind mXLPE 40 110 64 (57–72) 44/56 29,6 490 3,1 [2,9; 3,3] 4,8 [4,6; 5,1] 5,8 [5,6; 6,1] 6,7 [6,4; 7,0] 7,3 [7,0; 7,6] 8,1 [7,7; 8,4] 8,6 [8,2; 9,0] 9,2 [8,7; 9,7] 9,6 [9,0; 10,3] (32 983) (27 006) (22 249) (17 133) (12 208) (7 672) (4 127) (1 603) (550) PE 13 004 63 45/55 29,4 364 2,8 [2,5; 3,1] 4,8 [4,4; 5,2] 5,9 [5,5; 6,4] 7,0 [6,5; 7,5] 7,8 [7,2; 8,4] 8,6 [7,9; 9,2] 9,4 [8,6; 10,1] 10,5 [9,5; 11,6] 10,8 [9,6; 12,1] (57–71) (10 385) (8 107) (6 263) (4 924) (3 643) (2 415) (1 275) (406) (127) hXLPE + antioksüdant 5 481 63 (57–71) 49/51 29,4 143 2,4 [2,0; 2,9] 3,8 [3,2; 4,4] 4,6 [3,9; 5,3] 5,1 [4,3; 5,9] 5,2 [4,4; 6,1] (3 786) (2 481) (1 465) (785) (252) hXLPE 5 136 63 47/53 29,4 141 2,2 [1,8; 2,6] 4,2 [3,6; 4,7] 5,2 [4,6; 5,9] 6,1 [5,3; 6,8] 6,4 [5,6; 7,1] 7,1 [6,2; 7,9] 7,6 [6,7; 8,6] 7,8 [6,8; 8,8] 7,8 [6,8; 8,8] (57–71) (4 462) (3 835) (3 208) (2 521) (1 917) (1 281) (695) (264) (64) Kinnitus Tsementeeritud 55 098 63 (57–72) 44/56 29,4 672 2,7 [2,6; 2,9] 4,6 [4,4; 4,8] 5,6 [5,4; 5,9] 6,6 [6,3; 6,8] 7,2 [7,0; 7,5] 8,0 [7,7; 8,3] 8,6 [8,3; 9,0] 9,4 [8,9; 9,8] 9,7 [9,1; 10,3] (44 850) (36 096) (28 833) (21 902) (15 496) (9 747) (5 153) (1 842) (562) Tsementeerimata 8 044 63 55/45 29,5 116 3,8 [3,4; 4,3] 5,2 [4,7; 5,7] 6,2 [5,6; 6,7] 6,7 [6,0; 7,3] 7,0 [6,3; 7,6] 7,8 [7,0; 8,5] 8,1 [7,3; 9,0] 8,6 [7,6; 9,5] 9,0 [7,7; 10,3] (57–71) (6 245) (4 866) (3 946) (3 105) (2 241) (1 453) (837) (385) (154) Hübriid 541 66 (59–74) 36/64 28,7 53 4,2 [2,5; 5,9] 5,5 [3,5; 7,4] 6,2 [4,0; 8,3] 6,4 [4,2; 8,6] 7,1 [4,7; 9,4] 7,1 [4,7; 9,4] 7,9 [5,1; 10,6] (477) (421) (366) (327) (264) (189) (97) Põlveliigese proteesimine 1 026 55 (49–61) 26/74 28,4 224 4,7 [3,3; 6,0] 8,5 [6,6; 10,4] 10,8 [8,6; 12,9] 14,0 [11,3; 16,5] 16,2 [13,2; 19,0] 17,3 [14,0; 20,3] 18,8 [15,0; 22,4] (816) (641) (496) (371) (260) (168) (83) Reieluupinna liigendpind Katmata metall 586 55 28/72 28,7 138 3,1 [1,6; 4,6] 7,1 [4,7; 9,4] 8,7 [6,0; 11,3] 12,1 [8,8; 15,4] 15,0 [11,0; 18,8] 15,5 [11,4; 19,5] 16,8 [12,0; 21,3] (49–62) (471) (366) (292) (216) (163) (110) (55) Keraamiline metall 421 54 (48–61) 26/74 28,4 114 7,1 [4,5; 9,6] 10,7 [7,5; 13,8] 13,7 [9,9; 17,3] 16,7 [12,3; 20,9] 18,0 [13,3; 22,5] 20,2 [14,6; 25,4] (326) (257) (189) (144) (90) (55) Põlvekapsli Põlvekapsli pinna taastamisega 839 55 26/74 28,7 191 4,1 [2,7; 5,5] 7,3 [5,3; 9,2] 9,3 [7,0; 11,5] 11,9 [9,2; 14,5] 14,2 [11,0; 17,2] 15,5 [12,1; 18,9] 16,7 [12,6; 20,6] (48–61) (674) (536) (419) (318) (216) (139) (59) Kinnitus Tsementeeritud 1 024 55 (49–61,5) 26/74 28,4 224 4,7 [3,3; 6,0] 8,5 [6,6; 10,4] 10,8 [8,6; 12,9] 14,0 [11,3; 16,5] 16,2 [13,2; 19,1] 17,3 [14,1; 20,4] 18,8 [15,0; 22,4] (815) (641) (496) (371) (260) (168) (83) Tabel 51 (jätkub) 122 EPRD 2024. aasta aruanne 123  5 Puusa- ja põlveliigese proteesimise 5.4 Põlveliigese revisiooniproteesi elulemus püsivus 5.3.4 Tulemused konkreetsete Kuid need muudatused ei pruugi tingimata mõjutada põhinevad kasutatud artroplastika ja fikseerimise põlvekomponentide kombinatsioonide puhul loetletud reie- või säärekomponenti ennast (vt tüübil, põlvesüsteemil ja piirangu astmel. Viimased analüüside selgitusi 3. peatükis). Et võtta arvesse kaks kategooriat hõlmavad lisaks sisekomponendi Tabelis 52 on esitatud CRR-id esmaste põlveliigese konkreetsete implantaadisüsteemide erinevaid klassifikatsiooni. Artroplastikad on omakorda jagatud proteesimiste puhul, kus on kasutatud konkreetseid algtingimusi, rühmitati võrreldavad esmaste patella pinnaasendustega ja ilma nendeta. reie- ja säärekomponentide kombinatsioone. artroplastikasüsteemid kokku. Need rühmad Põlveliigese proteesimise CRR-id on loetletud komponendi järgi, mis hiljem vajas muutmist. Põlveartroplastikad Kumulatiivsed revisioonimäärad pärast ... Põlvekap sli Implanta Reieluukomponent Säärekomponent Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat taastami ne paigalda misest möödunu d aastad Standardne põlveliigese asendus, ristisideme säilitav, fikseeritud laagriga, hübriid balanSys BICONDYLAR uncem. (Mathys) balanSys BICONDYLAR fix (Mathys) Ilma 411 7 71 (63–77) 46/54 2016–2023 0,5 [0,0; 1,2] 0,8 [0,0; 1,8] 1,2 [0,0; 2,4] 1,9 [0,1; 3,7] 1,9 [0,1; 3,7] (340) (267) (193) (133) (88) COLUMBUS (Aesculap) COLUMBUS (Aesculap) Ilma 774 7 69 37/63 2014–2023 3,3 [2,0; 4,5] 3,8 [2,5; 5,2] 4,3 [2,8; 5,7] 4,6 [3,1; 6,1] 4,6 [3,1; 6,1] 4,9 [3,3; 6,5] 5,4 [3,5; 7,3] (62–77) (707) (666) (639) (543) (402) (265) (128) EFK reieluu tsementivaba (OHST EFK sääreluu Medizintechnik) tsementeeritud (OHST Ilma 1 325 15 70 (63–76) 42/58 2014–2023 1,4 [0,8; 2,0] 2,2 [1,4; 3,0] 2,4 [1,5; 3,2] 2,7 [1,8; 3,6] 3,1 [2,1; 4,1] 3,9 [2,8; 5,1] 4,6 [3,3; 5,9] 5,7 [4,1; 7,3] (1 248) (1 143) (1 045) (946) (849) (744) (555) (265) Medizintechnik) GENESIS II CR COCR Genesis II Ilma 454 6 68 1,1 [0,1; 2,1] 1,6 [0,4; 2,8] 2,4 [0,9; 3,9] 2,4 [0,9; 3,9] 2,7 [1,1; 4,3] 2,7 [1,1; 4,3] 2,7 [1,1; 4,3] 2,7 [1,1; 4,3] 2,7 [1,1; 4,3] (62–75) 44/56 2012–2023 (Smith & Nephew) (Smith & Nephew) Põlve (432) (405) (360) (313) (273) (224) (159) (110) (50) LEGION CR COCR (Smith & Nephew) Genesis II (Smith & Nephew) Ilma 684 10 69 (62–76) 52/48 2017–2023 2,9 [1,6; 4,2] 4,5 [2,8; 6,2] 4,8 [3,0; 6,6] 5,2 [3,2; 7,1] 6,0 [3,4; 8,6] (522) (375) (249) (138) (76) NexGen CR-Flex (Zimmer Biomet) NexGen CR (Zimmer Biomet) Ilma 687 30 69 51/49 2014–2023 1,6 [0,6; 2,5] 2,8 [1,5; 4,1] 3,0 [1,6; 4,4] 3,0 [1,6; 4,4] 3,2 [1,8; 4,6] 3,2 [1,8; 4,6] 3,2 [1,8; 4,6] 3,2 [1,8; 4,6] (61–75) (566) (518) (476) (441) (356) (228) (126) (73) NexGen CR (Zimmer Biomet) NexGen CR (Zimmer Biomet) Ilma 574 9 69 (62–75) 51/49 2014–2023 0,7 [0,0; 1,4] 1,1 [0,2; 2,0] 1,1 [0,2; 2,0] 1,1 [0,2; 2,0] 1,4 [0,3; 2,4] 1,6 [0,5; 2,7] 1,6 [0,5; 2,7] 1,6 [0,5; 2,7] (518) (483) (466) (431) (379) (326) (197) (76) SIGMA™ reieluu (DePuy) SIGMA™ sääreluu (DePuy) Ilma 945 22 68 41/59 2014–2023 1,3 [0,6; 2,0] 1,9 [1,0; 2,7] 2,5 [1,5; 3,6] 2,7 [1,6; 3,8] 3,4 [2,1; 4,7] 3,7 [2,3; 5,1] 3,7 [2,3; 5,1] 3,7 [2,3; 5,1] (61–76) (888) (793) (692) (580) (441) (292) (170) (67) TC-PLUS CR (Smith & Nephew) TC-PLUS (Smith & Nephew) Ilma 630 12 70,5 (63–76) 40/60 2014–2023 2,3 [1,1; 3,5] 2,9 [1,5; 4,2] 2,9 [1,5; 4,2] 3,2 [1,7; 4,6] 3,2 [1,7; 4,6] 3,2 [1,7; 4,6] (537) (450) (371) (289) (232) (116) Triatlon CR (Stryker) Triatlon (Stryker) Ilma 553 18 70 40/60 2014–2023 0,8 [0,0; 1,6] 1,7 [0,5; 2,9] 2,1 [0,7; 3,4] 2,4 [0,9; 3,9] 2,4 [0,9; 3,9] 2,4 [0,9; 3,9] 2,4 [0,9; 3,9] (63–75) (432) (348) (295) (250) (187) (143) (61) Vanguard CR (Zimmer Vanguard sääre ristiside Biomet) (Zimmer Biomet) Ilma 1 167 17 68 (61–75) 44/56 2015–2023 2,0 [1,2; 2,9] 3,3 [2,2; 4,3] 4,6 [3,3; 5,9] 5,3 [3,8; 6,8] 6,0 [4,3; 7,6] 6,0 [4,3; 7,6] 6,0 [4,3; 7,6] (1 034) (815) (626) (472) (340) (212) (114) Standardne põlveliigese asendus, ristisideme säilitav, fikseeritud laagriga, tsementeeritud ACS tsementeeritud (Implantcast) ACS FB tsementeeritud (Implantcast) Ilma 802 44 66,5 21/79 2014–2023 2,5 [1,4; 3,6] 4,6 [3,1; 6,0] 6,4 [4,6; 8,1] 7,4 [5,5; 9,3] 7,9 [5,9; 9,9] 8,7 [6,4; 10,9] 8,7 [6,4; 10,9] (59–74) (772) (731) (582) (449) (302) (173) (70) ACS tsementeeritud ACS FB+ tsementeeritud, sh pistikud (Implantcast) (Implantcast) Ilma 430 30 65 (58–73) 23/77 2021–2023 2,8 [1,0; 4,6] (210) ACS LD tsementeeritud (Implantcast) ACS LD FB tsementeeritud (Implantcast) Ilma 362 10 70 48/52 2015–2021 3,1 [1,3; 4,8] 4,8 [2,5; 6,9] 4,8 [2,5; 6,9] 5,1 [2,8; 7,4] 5,1 [2,8; 7,4] 5,1 [2,8; 7,4] (63–76) (346) (330) (291) (211) (139) (71) balanSys BICONDYLAR cem. (Mathys) balanSys BICONDYLAR fix (Mathys) Ilma 2 895 30 71 (64–78) 37/63 2014–2023 2,0 [1,5; 2,5] 2,7 [2,1; 3,3] 3,3 [2,6; 4,0] 3,6 [2,8; 4,3] 3,9 [3,0; 4,7] 4,0 [3,1; 4,8] 4,0 [3,1; 4,8] 4,9 [3,4; 6,4] (2 419) (2 000) (1 599) (1 225) (850) (559) (248) (66) COLUMBUS (Aesculap) COLUMBUS (Aesculap) Ilma 21 316 171 70 35/65 2013–2023 1,5 [1,4; 1,7] 2,6 [2,4; 2,8] 3,0 [2,8; 3,3] 3,3 [3,1; 3,6] 3,7 [3,3; 3,9] 3,9 [3,5; 4,2] 4,1 [3,8; 4,5] 4,2 [3,8; 4,6] 4,3 [3,9; 4,8] (62–77) (17 589) (14 262) (11 748) (9 148) (6 436) (4 081) (2 164) (884) (244) COLUMBUS (Aesculap) COLUMBUS (Aesculap) Koos 776 56 68 (61–76) 25/75 2014–2023 1,6 [0,7; 2,5] 4,4 [2,8; 5,9] 4,7 [3,1; 6,3] 5,7 [3,9; 7,5] 5,9 [4,1; 7,8] 6,2 [4,3; 8,1] 7,3 [4,8; 9,7] (688) (579) (515) (423) (317) (207) (99) EFK reieluu tsementeeritud EFK sääreluu 1,4 [1,0; 1,8] (OHST Medizintechnik) tsementeeritud (OHST Ilma 3 159 40 72 38/62 2014–2023 2,0 [1,5; 2,5] 2,3 [1,8; 2,9] 2,7 [2,1; 3,3] 3,2 [2,5; 3,8] 3,6 [2,9; 4,3] 4,5 [3,7; 5,3] 5,6 [4,5; 6,6] (64–77) (2 951) (2 762) (2 623) (2 448) (2 232) (1 978) (1 312) (458) Medizintechnik) Tabel 52: Reie-sääre kombinatsioonide implantaaditulemused esmaste põlveliigese proteesimiste puhul, kus esmase TKA käigus on või ei ole tehtud põlveliigese pindmise kihi asendamist. Proteesimise tüübi, kinnitustüübi, põlvesüsteemi ja liikumispiirangu astme alusel moodustatud rühmade piires on kombinatsioonid loetletud reiekomponendi tähestikulises järjekorras. 124 EPRD aastaaruanne 2024 125  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus Põlveliigese proteesimine Kumulatiivsed revisioonimäärad pärast ... Põlvekap sli pinna Implanta Reieluukomponent Säärekomponent Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat taastami ne paigalda misest möödunu d aastad Standardne põlveliigese protees, ristisideme säilitav, fikseeritud laagriga, tsementeeritud EFK reieluu tsementeeritud TiNbN (OHST EFK sääreluu tsementeeritud TiNbN Medizintechnik) (OHST Medizintechnik) Ilma 546 44 65 (59–73) 7/93 2014–2023 2,1 [0,9; 3,3] 2,7 [1,3; 4,1] 3,9 [2,2; 5,7] 4,5 [2,6; 6,3] 5,4 [3,2; 7,5] 5,4 [3,2; 7,5] 5,7 [3,5; 7,9] 6,6 [4,0; 9,1] (476) (423) (376) (346) (307) (276) (227) (83) GEMINI SL täielik põlvesüsteem, GEMINI SL täielik põlvesüsteem, reieluukomponent, säärekomponent, liikuv laagriga / fikseeritud laagriga CR, fikseeritud laagri, tsementeeritud Ilma 416 31 71 30/70 2014–2023 3,5 [1,7; 5,3] 4,9 [2,7; 7,0] 6,5 [3,9; 9,0] 7,3 [4,5; 10,1] 7,8 [4,8; 10,6] 8,5 [5,3; 11,7] (61–77) tsementeeritud (Waldemar Link) (Waldemar Link) (357) (304) (261) (220) (150) (95) GENESIS II CR COCR Genesis II Ilma 10 567 98 69 (62–76) 36/64 2013–2023 2,0 [1,8; 2,3] 3,6 [3,3; 4,0] 4,4 [4,0; 4,9] 4,9 [4,5; 5,4] 5,2 [4,7; 5,7] 5,4 [4,9; 5,9] 5,6 [5,0; 6,1] 5,7 [5,1; 6,3] 5,7 [5,1; 6,3] (Smith & Nephew) (Smith & Nephew) (8 869) (7 321) (6 080) (4 803) (3 534) (2 490) (1 475) (632) (146) GENESIS II CR COCR Genesis II Koos 1 219 43 70 1,9 [1,1; 2,6] 2,1 [1,2; 2,9] 2,8 [1,8; 3,9] 3,2 [2,0; 4,3] 3,4 [2,2; 4,6] 3,4 [2,2; 4,6] 3,4 [2,2; 4,6] 4,2 [2,2; 6,2] (62–76) 33/67 2013–2023 (Smith & Nephew) (Smith & Nephew) (971) (768) (565) (438) (330) (227) (156) (95) GENESIS II CR OXINIUM Genesis II Ilma 2 966 123 65 (58–73) 20/80 2012–2023 2,3 [1,8; 2,9] 4,1 [3,4; 4,9] 4,7 [3,9; 5,6] 5,1 [4,3; 6,0] 5,6 [4,7; 6,5] 5,6 [4,7; 6,5] 6,0 [5,0; 7,0] 6,3 [5,1; 7,5] 6,3 [5,1; 7,5] (Smith & Nephew) (Smith & Nephew) (2 523) (2 152) (1 833) (1 538) (1 231) (869) (555) (285) (135) GENESIS II LDK COCR Genesis II Ilma 1 717 16 70 2,6 [1,8; 3,3] 4,1 [3,2; 5,1] 5,1 [4,0; 6,1] 5,5 [4,4; 6,6] 5,7 [4,6; 6,8] 5,8 [4,7; 7,0] 5,9 [4,8; 7,1] 5,9 [4,8; 7,1] 5,9 [4,8; 7,1] (62–76) 38/62 2013–2023 (Smith & Nephew) (Smith & Nephew) (1 644) (1 581) (1 521) (1 464) (1 320) (970) (693) (317) (86) INNEX CR (Zimmer Biomet) Innex Fix (Zimmer Biomet) Ilma 1 329 28 73 (65–78) 42/58 2013–2023 2,1 [1,3; 2,9] 2,8 [1,9; 3,8] 3,4 [2,4; 4,4] 3,5 [2,5; 4,6] 3,7 [2,6; 4,7] 3,7 [2,6; 4,7] 3,7 [2,6; 4,7] 3,7 [2,6; 4,7] (1 220) (1 104) (974) (806) (638) (449) (251) (123) INNEX CR GSF (Zimmer Biomet) Innex Fix (Zimmer Biomet) Ilma 387 18 73 19/81 2013–2023 1,8 [0,5; 3,2] 3,0 [1,2; 4,7] 3,6 [1,7; 5,6] 3,6 [1,7; 5,6] 3,6 [1,7; 5,6] 4,2 [1,9; 6,3] 4,2 [1,9; 6,3] (65–78) (349) (319) (278) (243) (191) (135) (82) Põlve JOURNEY II CR COCR JOURNEY Ilma 468 16 71 (62–76) 38/62 2018–2023 1,8 [0,6; 3,1] 3,6 [1,7; 5,5] 5,4 [2,8; 7,9] 7,7 [4,3; 11,0] (Smith & Nephew) (Smith & Nephew) (367) (275) (194) (89) JOURNEY II CR OXINIUM JOURNEY Ilma 1 069 31 63 3,3 [2,2; 4,4] 5,5 [4,1; 6,9] 6,8 [5,3; 8,4] 8,4 [6,6; 10,1] 8,7 [6,9; 10,5] 9,0 [7,1; 10,9] 9,0 [7,1; 10,9] (58–71) 36/64 2015–2023 (Smith & Nephew) (Smith & Nephew) (988) (913) (833) (684) (511) (244) (86) LEGION CR COCR (Smith & Nephew) Genesis II (Smith & Nephew) Ilma 15 502 151 71 (63–77) 38/62 2014–2023 1,8 [1,6; 2,0] 2,9 [2,6; 3,2] 3,6 [3,3; 4,0] 4,0 [3,6; 4,4] 4,4 [4,0; 4,8] 4,4 [4,0; 4,9] 4,4 [4,0; 4,9] (12 164) (9 247) (6 639) (4 628) (2 632) (1 137) (413) LEGION CR COCR (Smith & Nephew) Genesis II (Smith & Nephew) Koos 701 58 71 29/71 2015–2023 2,0 [0,9; 3,0] 2,8 [1,5; 4,1] 2,8 [1,5; 4,1] 3,3 [1,7; 4,9] 3,3 [1,7; 4,9] 4,1 [1,8; 6,3] (63–78) (550) (408) (270) (183) (141) (75) LEGION CR OXINIUM Genesis II Ilma 3 950 159 64 (58–72) 17/83 2012–2023 1,8 [1,4; 2,3] 3,9 [3,2; 4,6] 5,1 [4,3; 6,0] 5,3 [4,4; 6,1] 5,4 [4,5; 6,2] 5,8 [4,7; 6,8] 5,8 [4,7; 6,8] (Smith & Nephew) (Smith & Nephew) (3 054) (2 156) (1 454) (975) (590) (273) (86) LEGION CR OXINIUM Genesis II Koos 446 50 65 1,2 [0,1; 2,2] 2,4 [0,8; 4,0] 4,3 [2,0; 6,5] 4,3 [2,0; 6,5] 4,3 [2,0; 6,5] (59–72) 8/92 2016–2023 (Smith & Nephew) (Smith & Nephew) (366) (287) (204) (145) (105) LinkSymphoKnee, LinkSymphoKnee, FB, monoblokk, reieluukomponent, CR, tsementeeritud (Waldemar CoCrMo, tsementeeritud (Waldemar Ilma 576 16 69 (61–75) 40/60 2021–2023 3,5 [0,9; 5,9] Link) Link) (99) NexGen CR-Flex-Gender NexGen CR (Zimmer 0,9 [0,7; 1,2] (Zimmer Biomet) Biomet) Ilma 5 659 108 70 11/89 2012–2023 1,8 [1,5; 2,2] 2,3 [1,9; 2,8] 2,6 [2,1; 3,1] 2,9 [2,4; 3,4] 3,0 [2,5; 3,5] 3,1 [2,5; 3,6] 3,1 [2,5; 3,6] 3,1 [2,5; 3,6] (62–76) (4 875) (4 161) (3 474) (2 888) (2 213) (1 498) (916) (430) (176) NexGen CR-Flex (Zimmer Biomet) NexGen CR (Zimmer Biomet) Ilma 19 539 128 71 (64–78) 42/58 2012–2023 1,4 [1,2; 1,6] 2,1 [1,9; 2,3] 2,4 [2,2; 2,6] 2,7 [2,4; 2,9] 2,8 [2,5; 3,0] 2,9 [2,7; 3,2] 3,1 [2,8; 3,4] 3,2 [2,9; 3,6] 3,2 [2,9; 3,6] (16 820) (14 053) (11 885) (9 592) (7 184) (4 755) (2 765) (1 280) (475) NexGen CR-Flex (Zimmer Biomet) NexGen CR (Zimmer Biomet) Koos 2 988 50 72 34/66 2013–2023 1,8 [1,3; 2,2] 2,2 [1,7; 2,8] 2,4 [1,8; 2,9] 2,6 [2,0; 3,2] 2,8 [2,1; 3,4] 2,9 [2,2; 3,6] 3,0 [2,3; 3,8] 3,0 [2,3; 3,8] (64–78) (2 535) (2 153) (1 872) (1 529) (1 198) (853) (514) (269) NexGen CR (Zimmer Biomet) NexGen CR (Zimmer Biomet) Ilma 4 317 60 70 (63–76) 42/58 2013–2023 1,2 [0,9; 1,5] 2,1 [1,6; 2,6] 2,9 [2,3; 3,4] 3,5 [2,9; 4,1] 3,6 [2,9; 4,2] 3,9 [3,2; 4,6] 4,2 [3,4; 4,9] 4,4 [3,6; 5,3] 4,7 [3,7; 5,6] (3 522) (3 016) (2 673) (2 307) (1 933) (1 367) (920) (523) (149) Persona CR (Zimmer Biomet) Persona Tibia (Zimmer Biomet) Ilma 9 008 119 70 40/60 2013–2023 1,1 [0,9; 1,3] 1,6 [1,3; 1,9] 1,8 [1,5; 2,1] 2,1 [1,7; 2,5] 2,3 [1,8; 2,7] 2,5 [2,0; 3,1] 2,5 [2,0; 3,1] 2,5 [2,0; 3,1] (62–77) (6 516) (4 362) (3 011) (1 938) (1 121) (638) (279) (80) Persona CR (Zimmer Biomet) Persona Tibia (Zimmer Biomet) Koos 319 35 67 (60–75) 31/69 2015–2023 2,7 [0,8; 4,5] 2,7 [0,8; 4,5] 3,3 [1,1; 5,6] 3,3 [1,1; 5,6] (241) (158) (116) (64) SIGMA™ reieluu (DePuy) SIGMA™ sääreluu (DePuy) Ilma 27 934 142 71 36/64 2012–2023 1,5 [1,3; 1,6] 2,5 [2,3; 2,7] 3,0 [2,8; 3,2] 3,4 [3,1; 3,6] 3,5 [3,3; 3,8] 3,8 [3,5; 4,1] 4,0 [3,7; 4,3] 4,2 [3,9; 4,6] 4,5 [4,0; 5,0] (63–77) (23 455) (19 733) (16 647) (13 320) (9 729) (6 660) (3 640) (1 495) (442) SIGMA™ reieluu (DePuy) SIGMA™ sääreluu (DePuy) Koos 5 262 81 71 (63–77) 33/67 2012–2023 1,4 [1,1; 1,8] 2,0 [1,6; 2,5] 2,4 [2,0; 2,9] 2,6 [2,1; 3,1] 2,9 [2,3; 3,4] 3,3 [2,7; 3,9] 3,3 [2,7; 3,9] 3,5 [2,8; 4,2] (4 436) (3 765) (3 162) (2 452) (1 649) (1 096) (558) (233) TC-PLUS CR (Smith & Nephew) TC-PLUS (Smith & Nephew) Ilma 4 130 43 72 36/64 2014–2023 1,2 [0,8; 1,5] 1,6 [1,2; 2,0] 1,9 [1,5; 2,4] 2,2 [1,8; 2,7] 2,4 [1,9; 2,9] 2,6 [2,0; 3,1] 2,6 [2,0; 3,1] 2,6 [2,0; 3,1] (65–78) (3 882) (3 515) (3 084) (2 529) (1 805) (900) (377) (87) Tabel 52 (jätkub) 126 EPRD 2024. aasta aruanne 127  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus Põlveliigese proteesimine Kumulatiivsed revisioonimäärad pärast ... Põlvekap sli pinna Implanta Reieluukomponent Säärekomponent Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat taastami ne paigalda misest möödunu d aastad Standardne TKA, ristisideme säilitav, fikseeritud laagri, tsementeeritud Triathlon CR (Stryker) Triathlon (Stryker) Ilma 11 006 91 70 (62–77) 37/63 2013–2023 1,7 [1,5; 2,0] 3,0 [2,7; 3,4] 3,8 [3,4; 4,2] 4,3 [3,8; 4,7] 4,5 [4,0; 4,9] 4,7 [4,2; 5,2] 4,9 [4,4; 5,5] 4,9 [4,4; 5,5] 4,9 [4,4; 5,5] (8 663) (6 936) (5 474) (4 237) (3 052) (2 053) (1 146) (507) (137) Triatlon CR (Stryker) Triatlon (Stryker) Koos 4 374 44 68 40/60 2013–2023 1,4 [1,0; 1,7] 1,9 [1,5; 2,4] 2,3 [1,8; 2,8] 2,6 [2,1; 3,2] 3,0 [2,3; 3,6] 3,1 [2,4; 3,8] 3,1 [2,4; 3,8] 3,1 [2,4; 3,8] (62–75) (3 656) (2 924) (2 117) (1 460) (791) (403) (224) (106) Vanguard CR (Zimmer Vanguard põlveliigese ristiside Biomet) (Zimmer Biomet) Ilma 13 663 86 71 (64–78) 38/62 2012–2023 1,9 [1,7; 2,1] 2,9 [2,6; 3,2] 3,6 [3,3; 4,0] 4,1 [3,7; 4,5] 4,5 [4,0; 4,9] 4,6 [4,2; 5,0] 4,7 [4,2; 5,1] 5,2 [4,5; 5,9] (11 395) (9 391) (7 739) (6 125) (4 395) (2 827) (1 518) (502) Vanguard CR Vanguard sääre ristiside 2,8 [1,3; 4,3] (Zimmer Biomet) (Zimmer Biomet) Koos 474 37 72 32/68 2013–2023 4,5 [2,6; 6,5] 5,1 [3,0; 7,2] 5,1 [3,0; 7,2] 5,6 [3,3; 7,8] 5,6 [3,3; 7,8] (63–79) (418) (366) (303) (231) (163) (90) Vanguard CR TiNbN (Zimmer Vanguard Tibia TiNbN Biomet) (Zimmer Biomet) Ilma 1 360 76 65 (58–72) 8/92 2013–2023 1,6 [0,9; 2,3] 3,9 [2,8; 5,0] 5,0 [3,7; 6,3] 5,3 [3,9; 6,6] 5,7 [4,2; 7,1] 6,3 [4,6; 8,0] 7,3 [4,8; 9,7] (1 148) (922) (730) (512) (323) (191) (99) Standardne TKA, ristisideme säilitav, liikuv laagriga, hübriid TC-PLUS CR (Smith & Nephew) TC-PLUS SB (Smith & Nephew) Ilma 517 7 69 35/65 2015–2023 3,4 [1,8; 5,0] 5,0 [3,0; 6,9] 5,2 [3,2; 7,2] 6,1 [3,9; 8,3] 6,1 [3,9; 8,3] 6,1 [3,9; 8,3] 6,1 [3,9; 8,3] (62–77) (457) (395) (341) (315) (281) (240) (134) Standardne TKA, ristisideme säilitav, liikuv laagriga, tsementeeritud ACS tsementeeritud (Implantcast) ACS MB tsementeeritud (Implantcast) Ilma 1 010 23 70 (62–77) 30/70 2013–2023 2,0 [1,1; 2,9] 3,7 [2,4; 5,0] 4,3 [2,8; 5,7] 5,4 [3,7; 7,1] 5,7 [3,8; 7,5] 6,1 [4,1; 8,0] 6,1 [4,1; 8,0] (774) (575) (456) (376) (280) (190) (109) Põlve COLUMBUS (Aesculap) COLUMBUS (Aesculap) Ilma 2 866 25 71 36/64 2013–2023 1,8 [1,3; 2,3] 2,5 [1,9; 3,1] 2,9 [2,2; 3,5] 3,1 [2,4; 3,7] 3,1 [2,4; 3,8] 3,1 [2,4; 3,8] 3,1 [2,4; 3,8] 3,1 [2,4; 3,8] (63–77) (2 510) (2 175) (1 905) (1 551) (1 135) (733) (412) (162) INNEX CR (Zimmer Biomet) Innex Mobile (Zimmer Biomet) Ilma 1 380 65 70 (62–77) 97/3 2013–2023 2,2 [1,4; 3,0] 3,2 [2,2; 4,1] 3,7 [2,7; 4,8] 4,3 [3,1; 5,4] 4,8 [3,6; 6,1] 5,6 [4,1; 7,0] 5,6 [4,1; 7,0] 6,1 [4,3; 7,9] (1 244) (1 086) (926) (767) (598) (407) (223) (64) INNEX CR GSF (Zimmer Biomet) Innex Mobile (Zimmer Biomet) Ilma 403 33 70 82/18 2014–2023 2,6 [1,0; 4,2] 3,8 [1,8; 5,8] 4,2 [2,1; 6,3] 4,2 [2,1; 6,3] 4,7 [2,4; 7,1] 5,6 [2,7; 8,3] (63–77) (335) (284) (233) (176) (137) (92) NexGen CR-Flex (Zimmer Biomet) NexGen CR (Zimmer Biomet) Ilma 596 9 71 (64–76) 42/58 2013–2022 0,8 [0,1; 1,6] 1,5 [0,5; 2,5] 2,4 [1,1; 3,6] 3,3 [1,7; 4,8] 3,3 [1,7; 4,8] 3,3 [1,7; 4,8] 3,3 [1,7; 4,8] 3,3 [1,7; 4,8] (587) (516) (445) (372) (315) (224) (166) (74) TC-PLUS CR (Smith & Nephew) TC-PLUS SB (Smith & Nephew) Ilma 405 11 71 30/70 2015–2022 3,5 [1,7; 5,3] 4,2 [2,2; 6,2] 5,3 [3,1; 7,5] 5,6 [3,3; 7,9] 5,6 [3,3; 7,9] 5,6 [3,3; 7,9] 5,6 [3,3; 7,9] (63–77) (384) (370) (323) (262) (215) (174) (90) ZEN reieluu STD tsementeeritud (OHST ZEN sääreluu STD tsementeeritud Medizintechnik) (OHST Medizintechnik) Ilma 1 079 6 71 (65–78) 36/64 2015–2023 1,0 [0,4; 1,7] 1,4 [0,6; 2,2] 2,2 [1,2; 3,2] 2,8 [1,6; 4,1] 2,8 [1,6; 4,1] 3,4 [1,7; 5,1] (872) (695) (522) (370) (203) (97) Standardne TKA, ristisideme säilitav/eemaldav, fikseeritud laagriga, hübriid BPK-S INTEGRATION (Peter Brehm) BPK-S INTEGRATION (Peter Brehm) Ilma 423 3 69 37/63 2016–2023 1,5 [0,3; 2,7] 2,4 [0,8; 3,9] 3,7 [1,7; 5,7] 4,9 [2,5; 7,3] 5,4 [2,8; 8,0] 5,4 [2,8; 8,0] (62–76) (371) (307) (259) (204) (130) (53) Standardne põlveliigese asendus, ristisideme säilitav/eemaldav, fikseeritud laagriga, tsementeeritud ATTUNE™ reieluu (DePuy) ATTUNE™ sääreluu (DePuy) Ilma 9 695 133 67 (60–75) 39/61 2013–2023 1,7 [1,4; 2,0] 3,1 [2,7; 3,5] 3,7 [3,3; 4,2] 4,1 [3,7; 4,6] 4,4 [3,9; 5,0] 4,7 [4,2; 5,3] 4,7 [4,2; 5,3] 4,7 [4,2; 5,3] 4,7 [4,2; 5,3] (7 525) (5 750) (4 436) (3 377) (2 369) (1 541) (802) (362) (112) ATTUNE™ reieluu (DePuy) ATTUNE™ sääreluu (DePuy) Koos 2 204 53 68 37/63 2013–2023 1,6 [1,1; 2,2] 2,2 [1,5; 2,8] 2,5 [1,8; 3,2] 2,6 [1,9; 3,4] 2,8 [1,9; 3,5] 3,6 [2,3; 4,8] 3,6 [2,3; 4,8] 3,6 [2,3; 4,8] (61–75) (1 801) (1 422) (1 080) (771) (495) (274) (161) (69) SIGMA™ reieluu (DePuy) SIGMA™ sääreluu (DePuy) Ilma 2 598 24 69 (61–76) 36/64 2015–2023 1,4 [0,9; 1,8] 2,4 [1,7; 3,0] 3,1 [2,3; 3,8] 3,4 [2,5; 4,2] 3,6 [2,7; 4,4] 4,3 [3,2; 5,4] 4,3 [3,2; 5,4] (2 023) (1 696) (1 461) (1 024) (661) (347) (103) SIGMA™ reieluu (DePuy) SIGMA™ sääreluu (DePuy) Koos 1 010 12 70 32/68 2015–2023 1,0 [0,4; 1,6] 1,8 [0,9; 2,7] 1,8 [0,9; 2,7] 2,1 [1,0; 3,1] 2,1 [1,0; 3,1] (62–76) (803) (629) (452) (267) (101) Unity CR cmtd (Corin) Unity cmtd (Corin) Ilma 870 15 71 (63–77) 32/68 2014–2023 1,4 [0,5; 2,3] 2,9 [1,5; 4,3] 3,9 [2,2; 5,6] 4,2 [2,4; 6,0] 4,6 [2,6; 6,5] 4,6 [2,6; 6,5] 5,2 [2,9; 7,5] (574) (393) (333) (285) (233) (163) (97) Standardne põlveliigese asendus, ristisideme säilitamine/eemaldamine, liikuv laagriga, hübriid ATTUNE™ reieluu (DePuy) ATTUNE™ sääreluu (DePuy) Ilma 376 8 73 33/67 2017–2023 1,7 [0,3; 3,0] 3,0 [0,7; 5,3] (66–78,5) (198) (81) LCS™ COMPLETE™ reieluu (DePuy) MBT sääreluu (DePuy) Ilma 2 974 35 70 (62–77) 35/65 2012–2022 2,6 [2,0; 3,2] 3,9 [3,2; 4,5] 4,7 [3,9; 5,4] 5,0 [4,2; 5,8] 5,2 [4,3; 6,0] 5,4 [4,6; 6,3] 5,7 [4,7; 6,6] 5,7 [4,7; 6,6] 5,7 [4,7; 6,6] (2 850) (2 705) (2 501) (2 204) (1 756) (1 143) (610) (222) (86) Tabel 52 (jätkub) 128 EPRD 2024. aasta aruanne 129  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus Põlveliigese proteesimine Kumulatiivsed revisioonimäärad pärast ... Põlvekap sli pinna Implanta Reieluukomponent Säärekomponent Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat taastami ne paigalda misest möödunu d aastad Standardne põlveliigese asendus, ristisideme säilitav/eemaldav, liikuv laagriga, tsementeerimata ATTUNE™ reieluu ATTUNE™ sääreluu RP tsementimata 1,6 [0,7; 2,5] (DePuy) (DePuy) Ilma 914 17 67 40/60 2017–2023 2,9 [1,5; 4,3] 3,5 [1,7; 5,2] (59–73) (584) (275) (90) LCS™ COMPLETE™ reieluu (DePuy) LCS™ COMPLETE™ sääreluu (DePuy) Ilma 741 79 65 (58–73) 6/94 2014–2023 2,5 [1,4; 3,7] 4,8 [3,2; 6,4] 6,3 [4,4; 8,2] 7,2 [5,1; 9,3] 7,5 [5,3; 9,6] 7,5 [5,3; 9,6] 7,5 [5,3; 9,6] (641) (532) (453) (370) (268) (170) (74) LCS™ COMPLETE™ reieluu (DePuy) MBT sääreluu (DePuy) Ilma 1 225 24 70 36/64 2012–2023 1,9 [1,1; 2,6] 3,4 [2,4; 4,4] 4,0 [2,9; 5,1] 4,5 [3,3; 5,7] 4,7 [3,5; 6,0] 4,7 [3,5; 6,0] 4,7 [3,5; 6,0] 4,7 [3,5; 6,0] 4,7 [3,5; 6,0] (61–76) (1 191) (1 147) (1 076) (920) (741) (510) (310) (126) (57) SKOOR (amplituud) SKOOR (amplituud) Ilma 630 5 69 (62–77) 34/66 2015–2023 1,2 [0,3; 2,0] 2,1 [0,9; 3,3] 2,8 [1,4; 4,3] 2,8 [1,4; 4,3] 2,8 [1,4; 4,3] 2,8 [1,4; 4,3] (548) (431) (335) (236) (153) (91) Standardne põlveliigese asendus, ristisideme säilitav/eemaldav, liikuv laagriga, tsementeeritud ATTUNE™ reieluu (DePuy) ATTUNE™ sääreluu (DePuy) Ilma 2 670 38 69 37/63 2015–2023 1,8 [1,2; 2,3] 2,8 [2,1; 3,5] 3,4 [2,6; 4,2] 3,9 [2,9; 4,8] 3,9 [2,9; 4,8] 3,9 [2,9; 4,8] 4,4 [3,2; 5,5] 4,4 [3,2; 5,5] (62–75) (1 991) (1 474) (1 136) (899) (669) (450) (249) (68) ATTUNE™ reieluu (DePuy) ATTUNE™ sääreluu (DePuy) Koos 347 8 73 (65–78) 23/77 2015–2023 0,9 [0,0; 1,9] 1,3 [0,0; 2,5] 1,6 [0,2; 3,0] 1,6 [0,2; 3,0] 2,1 [0,4; 3,8] 2,1 [0,4; 3,8] 2,1 [0,4; 3,8] (312) (276) (234) (204) (166) (127) (72) BPK-S INTEGRATSIOON (Peter Brehm) BPK-S INTEGRATSIOON (Peter Brehm) Ilma 316 21 70 37/63 2015–2023 3,0 [1,0; 4,8] 5,5 [2,7; 8,1] 6,9 [3,7; 10,0] 7,5 [4,1; 10,8] 8,9 [5,0; 12,6] 8,9 [5,0; 12,6] (62–76) (263) (203) (179) (138) (114) (71) E.MOTION (Aesculap) E.MOTION (Aesculap) Ilma 12 396 92 70 (62–77) 34/66 2012–2023 2,4 [2,1; 2,7] 4,3 [4,0; 4,7] 5,2 [4,7; 5,6] 5,8 [5,3; 6,2] 6,2 [5,7; 6,7] 6,3 [5,8; 6,8] 6,5 [6,0; 7,1] 7,0 [6,3; 7,6] 7,7 [6,4; 8,9] (10 474) (8 707) (7 228) (5 729) (4 079) (2 537) (1 312) (522) (119) Põlve E.MOTION (Aesculap) E.MOTION (Aesculap) Koos 563 40 68 17/83 2013–2023 5,2 [3,3; 7,1] 7,4 [5,1; 9,6] 7,9 [5,5; 10,2] 8,8 [6,2; 11,3] 8,8 [6,2; 11,3] 8,8 [6,2; 11,3] 8,8 [6,2; 11,3] (61–75) (469) (380) (313) (254) (167) (102) (55) LCS™ COMPLETE™ reieluu (DePuy) MBT sääreluu (DePuy) Ilma 5 267 58 71 (64–77) 36/64 2013–2023 2,4 [2,0; 2,8] 3,9 [3,4; 4,4] 4,5 [4,0; 5,1] 4,9 [4,3; 5,5] 5,2 [4,6; 5,8] 5,3 [4,7; 6,0] 5,7 [5,0; 6,3] 5,9 [5,2; 6,7] 5,9 [5,2; 6,7] (5 073) (4 770) (4 365) (3 880) (3 234) (2 521) (1 654) (748) (132) SKOOR (amplituud) SKOOR (amplituud) Ilma 336 7 72 30/70 2014–2023 2,4 [0,7; 4,0] 4,0 [1,8; 6,1] 5,0 [2,6; 7,4] 5,9 [3,2; 8,5] 5,9 [3,2; 8,5] 6,8 [3,5; 10,0] 6,8 [3,5; 10,0] (62–77,5) (315) (298) (260) (194) (150) (95) (59) SIGMA™ reieluu (DePuy) MBT sääreluu (DePuy) Ilma 2 121 31 72 (64–78) 37/63 2013–2023 2,8 [2,1; 3,4] 3,9 [3,1; 4,8] 4,8 [3,8; 5,7] 5,1 [4,1; 6,0] 5,1 [4,1; 6,0] 5,1 [4,1; 6,0] 5,1 [4,1; 6,0] 5,1 [4,1; 6,0] (2 001) (1 766) (1 537) (1 187) (796) (509) (273) (55) Standardne TKA ristisideme ohverdamisega, fikseeritud laagriga, hübriid balanSys BICONDYLAR uncem. (Mathys) 2,6 [1,7; 3,6] balanSys BICONDYLAR fix (Mathys) Ilma 1 116 10 70 44/56 2013–2023 4,3 [3,1; 5,5] 4,6 [3,3; 5,8] 4,8 [3,5; 6,1] 5,0 [3,6; 6,3] 5,2 [3,8; 6,6] 5,2 [3,8; 6,6] 5,2 [3,8; 6,6] (63–77) (1 034) (974) (881) (699) (459) (300) (147) (75) INNEX CR (Zimmer Biomet) Innex Fix (Zimmer Biomet) Ilma 331 4 70 (63–76) 49/51 2014–2023 1,8 [0,4; 3,3] 2,5 [0,8; 4,2] 3,2 [1,2; 5,2] 3,2 [1,2; 5,2] 3,7 [1,5; 5,9] 3,7 [1,5; 5,9] (306) (273) (244) (207) (163) (87) Standardne põlveliigese asendus, ristisideme säilitamine, fikseeritud laagriga, tsementeeritud balanSys BICONDYLAR tsementeeritud (Mathys) balanSys BICONDYLAR fikseeritud (Mathys) Ilma 2 831 33 70 30/70 2013–2023 2,0 [1,5; 2,6] 3,4 [2,6; 4,1] 4,4 [3,5; 5,3] 4,8 [3,8; 5,8] 5,3 [4,2; 6,4] 5,3 [4,2; 6,4] 5,3 [4,2; 6,4] 5,3 [4,2; 6,4] (62–77) (2 125) (1 568) (1 142) (813) (546) (297) (151) (78) balanSys BICONDYLAR cem. (Mathys) balanSys BICONDYLAR fix (Mathys) Koos 467 15 70 (61–77) 27/73 2013–2023 2,7 [1,2; 4,2] 4,1 [2,1; 6,0] 4,1 [2,1; 6,0] 5,3 [2,9; 7,7] 6,0 [3,3; 8,7] 7,0 [3,7; 10,3] (386) (310) (248) (177) (103) (52) COLUMBUS (Aesculap) COLUMBUS (Aesculap) Ilma 4 661 112 70 28/72 2013–2023 2,1 [1,6; 2,5] 3,2 [2,7; 3,8] 3,9 [3,2; 4,5] 4,3 [3,6; 4,9] 4,6 [3,8; 5,3] 4,8 [4,0; 5,6] 5,4 [4,4; 6,3] 5,4 [4,4; 6,3] (62–77) (3 630) (2 855) (2 304) (1 807) (1 323) (847) (432) (129) INNEX CR (Zimmer Biomet) Innex Fix (Zimmer Biomet) Ilma 1 358 46 72 (64–78) 40/60 2013–2023 1,1 [0,6; 1,7] 1,7 [1,0; 2,4] 2,4 [1,5; 3,2] 3,0 [2,0; 4,0] 3,4 [2,3; 4,4] 4,0 [2,8; 5,3] 4,0 [2,8; 5,3] 4,0 [2,8; 5,3] (1 242) (1 104) (981) (833) (634) (386) (195) (56) INNEX CR (Zimmer Biomet) Innex Fix (Zimmer Biomet) Koos 315 16 72 41/59 2015–2023 2,2 [0,6; 3,9] 3,3 [1,3; 5,3] 4,7 [2,3; 7,1] 5,2 [2,6; 7,7] 5,8 [2,9; 8,6] (65–77) (292) (277) (229) (150) (70) INNEX CR GSF (Zimmer Biomet) Innex Fix (Zimmer Biomet) Ilma 764 35 72 (65–78) 20/80 2013–2023 2,8 [1,6; 4,0] 3,9 [2,4; 5,2] 4,0 [2,6; 5,4] 4,2 [2,7; 5,7] 4,9 [3,2; 6,5] 4,9 [3,2; 6,5] 5,3 [3,4; 7,2] 5,3 [3,4; 7,2] (694) (629) (553) (480) (375) (226) (144) (50) Natural Knee NK II (Zimmer Biomet) Natural Knee NK II (Zimmer Biomet) ilma 335 8 73 28/72 2013–2017 2,4 [0,7; 4,0] 3,0 [1,2; 4,9] 3,0 [1,2; 4,9] 3,0 [1,2; 4,9] 3,7 [1,6; 5,7] 4,0 [1,9; 6,2] 4,0 [1,9; 6,2] 4,0 [1,9; 6,2] 4,0 [1,9; 6,2] (67–77) (320) (312) (303) (297) (285) (274) (207) (149) (56) Persona CR (Zimmer Biomet) Persona Tibia (Zimmer Biomet) Ilma 7 185 112 70 (62–77) 37/63 2013–2023 1,4 [1,1; 1,7] 2,4 [2,0; 2,8] 2,7 [2,2; 3,2] 3,4 [2,7; 4,0] 3,5 [2,9; 4,2] 4,2 [3,2; 5,1] 4,2 [3,2; 5,1] 4,2 [3,2; 5,1] (4 713) (2 883) (1 945) (1 213) (734) (446) (207) (56) Persona CR (Zimmer Biomet) Persona Tibia (Zimmer Biomet) Koos 2 190 29 70 32/68 2013–2023 1,1 [0,7; 1,6] 1,7 [1,1; 2,3] 1,8 [1,2; 2,5] 2,3 [1,6; 3,1] 2,7 [1,8; 3,6] 2,9 [1,9; 3,8] 3,5 [1,9; 5,0] (61–77) (1 831) (1 339) (970) (705) (584) (419) (125) Tabel 52 (jätkub) 130 EPRD 2024. aasta aruanne 131  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus Põlveliigese proteesimine Kumulatiivsed revisioonimäärad pärast ... Põlvekap sli pinna Implanta Reieluukomponent Sääreluu komponent Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat taastami ne paigalda misest möödunu d aastad Standardne TKA, ristisideme eemaldamisega, fikseeritud laagriga, tsementeeritud TC-PLUS CR (Smith & Nephew) TC-PLUS (Smith & Nephew) Ilma 323 20 73 (66–79) 25/75 2015–2023 2,3 [0,6; 3,9] 4,3 [1,9; 6,7] 4,3 [1,9; 6,7] 4,8 [2,2; 7,4] 5,5 [2,6; 8,3] 5,5 [2,6; 8,3] (268) (208) (188) (159) (122) (64) Triatlon CR (Stryker) Triatlon (Stryker) Ilma 2 286 33 70 37/63 2014–2023 1,7 [1,2; 2,3] 3,1 [2,3; 3,8] 4,0 [3,1; 4,9] 4,3 [3,3; 5,2] 4,5 [3,5; 5,5] 5,1 [3,9; 6,3] 5,5 [4,1; 7,0] 6,1 [4,3; 7,9] (62–77) (1 889) (1 658) (1 323) (919) (560) (274) (169) (73) Triatlon CR (Stryker) Triatlon (Stryker) Koos 375 15 72 (65–78) 31/69 2014–2023 2,8 [1,1; 4,5] 3,7 [1,7; 5,7] 4,4 [2,2; 6,5] 4,4 [2,2; 6,5] 5,3 [2,8; 7,8] 5,3 [2,8; 7,8] 5,3 [2,8; 7,8] (324) (305) (270) (233) (177) (108) (74) Vanguard CR Vanguard sääre ristiside 1,6 [1,3; 1,9] (Zimmer Biomet) (Zimmer Biomet) Ilma 8 944 75 72 33/67 2013–2023 2,7 [2,3; 3,0] 3,4 [3,0; 3,8] 3,9 [3,4; 4,3] 4,0 [3,5; 4,5] 4,1 [3,6; 4,6] 4,2 [3,7; 4,7] 4,2 [3,7; 4,7] (64–78) (7 088) (5 616) (4 518) (3 468) (2 440) (1 491) (802) (286) Vanguard CR (Zimmer Vanguard sääre ristiside Biomet) (Zimmer Biomet) Koos 626 32 71 (63–78) 21/79 2014–2023 1,6 [0,6; 2,6] 2,2 [1,0; 3,3] 2,4 [1,1; 3,6] 2,7 [1,3; 4,0] 2,7 [1,3; 4,0] 3,5 [1,7; 5,3] 3,5 [1,7; 5,3] (581) (512) (430) (340) (259) (170) (102) Vanguard CR TiNbN Vanguard Tibia TiNbN 1,2 [0,4; 2,1] (Zimmer Biomet) (Zimmer Biomet) Ilma 709 68 67 7/93 2014–2023 3,4 [1,9; 4,9] 4,1 [2,4; 5,8] 4,5 [2,6; 6,3] 4,9 [2,9; 6,9] 5,5 [3,2; 7,9] 5,5 [3,2; 7,9] (59–75) (559) (423) (326) (242) (156) (98) (50) Tavalised põlveliigese proteesid, ristisideme säilitamisega, liikuvate liigenditega, hübriid balanSys BICONDYLAR uncem. (Mathys) balanSys BICONDYLAR RP (Mathys) Ilma 789 6 70 (62–77) 41/59 2013–2023 1,9 [0,9; 2,8] 3,5 [2,1; 4,9] 3,8 [2,4; 5,3] 4,2 [2,7; 5,7] 4,4 [2,8; 5,9] 4,7 [3,0; 6,3] 5,4 [3,5; 7,3] 5,4 [3,5; 7,3] 5,4 [3,5; 7,3] (684) (610) (559) (480) (405) (307) (205) (121) (79) Standardne põlveliigese asendus, ristisideme säilitamine, liikuv laagriga, tsementeeritud Põlve balanSys BICONDYLAR tsementeeritud balanSys BICONDYLAR RP 0,7 [0,0; 1,5] (Mathys) (Mathys) Koos 604 5 73 28/72 2013–2023 0,7 [0,0; 1,5] 1,2 [0,2; 2,3] 1,2 [0,2; 2,3] 1,2 [0,2; 2,3] 1,2 [0,2; 2,3] 1,2 [0,2; 2,3] (65–79) (503) (435) (366) (278) (209) (136) (73) COLUMBUS (Aesculap) COLUMBUS (Aesculap) Ilma 1 263 5 69 (62–76) 42/58 2014–2023 1,2 [0,6; 1,8] 2,3 [1,4; 3,2] 2,6 [1,7; 3,6] 3,0 [2,0; 4,0] 3,2 [2,2; 4,3] 3,6 [2,4; 4,7] 3,6 [2,4; 4,7] 3,6 [2,4; 4,7] (1 131) (973) (871) (773) (669) (545) (364) (177) INNEX CR (Zimmer Biomet) Innex Mobile (Zimmer Biomet) Ilma 5 420 68 73 32/68 2012–2023 2,4 [2,0; 2,8] 3,6 [3,1; 4,2] 4,4 [3,8; 4,9] 4,8 [4,2; 5,4] 5,2 [4,5; 5,8] 5,3 [4,6; 6,0] 5,4 [4,7; 6,1] 5,4 [4,7; 6,1] (65–78) (4 837) (4 249) (3 684) (3 040) (2 345) (1 588) (843) (263) INNEX CR (Zimmer Biomet) Innex Mobile (Zimmer Biomet) Koos 797 28 74 (66–79) 22/78 2013–2023 1,9 [1,0; 2,9] 3,3 [2,0; 4,5] 3,8 [2,3; 5,1] 4,2 [2,7; 5,7] 4,2 [2,7; 5,7] 4,4 [2,8; 6,0] 4,8 [3,0; 6,4] 4,8 [3,0; 6,4] (715) (619) (520) (450) (389) (298) (204) (83) INNEX CR GSF (Zimmer Biomet) Innex Mobile (Zimmer Biomet) Ilma 4 401 63 72 19/81 2013–2023 1,9 [1,5; 2,3] 3,1 [2,6; 3,6] 3,7 [3,1; 4,3] 4,0 [3,3; 4,6] 4,2 [3,5; 4,8] 4,4 [3,7; 5,1] 5,0 [4,1; 5,9] 5,6 [4,4; 6,8] (64–78) (3 978) (3 493) (2 973) (2 371) (1 741) (1 146) (565) (137) INNEX CR GSF (Zimmer Biomet) Innex Mobile (Zimmer Biomet) Koos 551 25 72 (64–77) 13/87 2013–2023 2,6 [1,3; 4,0] 3,9 [2,2; 5,6] 4,2 [2,4; 5,9] 4,4 [2,6; 6,2] 5,1 [3,0; 7,1] 5,5 [3,3; 7,6] 6,7 [3,9; 9,3] (486) (435) (378) (318) (271) (192) (113) Standardne põlveliigese asendus, pöördeline, fikseeritud laagri, tsementeeritud ADVANCE® (MicroPort) ADVANCE® II (MicroPort) Ilma 462 8 72 51/49 2014–2023 4,1 [2,3; 5,9] 6,4 [4,1; 8,6] 6,6 [4,3; 8,9] 6,9 [4,5; 9,3] 8,1 [5,4; 10,7] 8,1 [5,4; 10,7] 8,8 [5,7; 11,8] (64–78) (428) (389) (336) (278) (205) (136) (90) EVOLUTION® (MicroPort) EVOLUTION® (MicroPort) Ilma 2 719 28 69 (61–76) 38/62 2016–2023 1,4 [0,9; 1,9] 2,4 [1,7; 3,0] 2,7 [2,0; 3,5] 3,2 [2,3; 4,1] 3,2 [2,3; 4,1] 3,2 [2,3; 4,1] (1 917) (1 303) (973) (681) (378) (173) GMK SPHERE (Medacta) GMK (Medacta) Ilma 2 942 46 69 36/64 2014–2023 3,0 [2,3; 3,6] 4,6 [3,7; 5,5] 5,1 [4,1; 6,1] 5,5 [4,3; 6,5] 6,0 [4,6; 7,3] 7,0 [5,0; 9,0] (61–76) (1 983) (1 284) (839) (450) (255) (104) Legacy 3D põlveliiges (Mathys) Legacy 3D põlveliiges (Mathys) Ilma 1 721 21 71 (64–77) 36/64 2014–2023 2,4 [1,7; 3,1] 3,7 [2,7; 4,6] 4,2 [3,2; 5,2] 4,6 [3,5; 5,6] 5,1 [4,0; 6,3] 5,7 [4,5; 6,9] 5,8 [4,6; 7,1] 6,2 [4,7; 7,7] (1 537) (1 377) (1 249) (1 062) (954) (706) (426) (162) MRK™ (IO-International Orthopaedics) MRK™ (IO-International Orthopaedics) ilma 376 4 67 35/65 2018–2023 1,9 [0,5; 3,3] 2,4 [0,7; 4,0] 3,8 [1,2; 6,4] 3,8 [1,2; 6,4] (60–74) (234) (165) (112) (72) Persona CR (Zimmer Biomet) Persona Tibia (Zimmer Biomet) Ilma 2 741 23 70 (62–77) 41/59 2016–2023 1,7 [1,1; 2,2] 2,5 [1,8; 3,3] 2,9 [2,0; 3,7] 2,9 [2,0; 3,7] 3,7 [2,2; 5,1] (1 614) (877) (490) (274) (110) PHYSICA KR REIEKOND. TSEMENTEERITUD PHYSICA SÜSTEEM TIBIA. TSEMENTEERITUD Ilma 334 17 68 2,9 [1,0; 4,7] 3,6 [1,5; 5,6] 3,6 [1,5; 5,6] 4,5 [2,0; 6,9] 4,5 [2,0; 6,9] 4,5 [2,0; 6,9] (61–76) 39/61 2015–2023 (Lima) (Lima) (293) (267) (224) (184) (144) (103) Standardne põlveliigese asendus, tagantstabiliseeritud, tsementeeritud ATTUNE™ reieluu (DePuy) ATTUNE™ sääreluu (DePuy) Ilma 4 862 107 70 (62–77) 38/62 2013–2023 2,3 [1,9; 2,8] 3,9 [3,3; 4,6] 4,8 [4,0; 5,5] 5,6 [4,7; 6,5] 6,1 [5,1; 7,1] 6,4 [5,3; 7,5] 6,9 [5,6; 8,2] 6,9 [5,6; 8,2] (3 371) (2 234) (1 468) (972) (708) (495) (279) (119) ATTUNE™ reieluu (DePuy) ATTUNE™ sääreluu (DePuy) Koos 688 54 68,5 37/63 2014–2023 1,6 [0,6; 2,6] 1,8 [0,7; 2,8] 2,4 [1,0; 3,7] 4,5 [2,0; 6,9] 6,0 [2,8; 9,1] 7,0 [3,2; 10,7] 7,0 [3,2; 10,7] (59–76) (511) (353) (231) (157) (119) (86) (50) Tabel 52 (jätkub) 132 EPRD 2024. aasta aruanne 133  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus Põlveliigese proteesimine Kumulatiivsed revisioonimäärad pärast ... Põlvekap sli pinna Implanta Reieluukomponent Säärekomponent Number Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat taastami ne paigalda misest möödunu d aastad Standardne põlveliigese asendus, tagantstabiliseeritud, tsementeeritud balanSys BICONDYLAR tsementeeritud balanSys BICONDYLAR fix (Mathys) (Mathys) Ilma 1 711 31 71 (64–78) 40/60 2013–2023 2,4 [1,6; 3,1] 4,2 [3,1; 5,2] 5,2 [4,0; 6,4] 5,9 [4,6; 7,2] 6,5 [5,0; 8,0] 6,5 [5,0; 8,0] 6,5 [5,0; 8,0] (1 342) (1 053) (879) (631) (394) (199) (90) balanSys BICONDYLAR cem. (Mathys) balanSys BICONDYLAR fix 1,6 [1,0; 2,1] (Mathys) Koos 1 977 10 70 39/61 2014–2023 3,1 [2,2; 3,9] 3,6 [2,7; 4,5] 4,1 [3,1; 5,2] 4,3 [3,2; 5,5] 4,3 [3,2; 5,5] 4,3 [3,2; 5,5] (63–76) (1 604) (1 222) (868) (532) (252) (91) (66) COLUMBUS (Aesculap) COLUMBUS (Aesculap) Ilma 662 48 69 (62–76) 36/64 2013–2023 3,5 [2,0; 4,9] 5,2 [3,4; 7,0] 5,9 [3,9; 7,8] 6,9 [4,7; 9,0] 7,5 [5,2; 9,8] 7,5 [5,2; 9,8] 8,3 [5,5; 11,1] 8,3 [5,5; 11,1] (540) (453) (399) (314) (241) (175) (106) (60) E.MOTION PS/PS Pro (Aesculap) E.MOTION PS (Aesculap) Ilma 2 956 41 69 36/64 2012–2023 3,0 [2,3; 3,6] 5,7 [4,8; 6,6] 7,2 [6,1; 8,2] 8,0 [6,8; 9,1] 8,3 [7,1; 9,4] 8,8 [7,6; 10,1] 9,0 [7,7; 10,3] 10,1 [8,3; 11,8] (62–76) (2 500) (2 048) (1 633) (1 259) (895) (607) (355) (161) AS E.MOTION PS Pro (Aesculap) AS E.MOTION PS (Aesculap) Ilma 524 27 65 (58–72,5) 18/82 2015–2023 2,3 [1,0; 3,7] 7,0 [4,5; 9,5] 8,6 [5,7; 11,3] 9,3 [6,3; 12,2] 10,0 [6,7; 13,1] 11,5 [7,6; 15,2] (415) (325) (260) (196) (130) (69) GEMINI SL täielik põlvesüsteem, GEMINI SL täielik põlvesüsteem, reieluukomponent, fikseeritud laagriga PS, säärekomponent, fikseeritud laagri, Ilma 768 18 72 36/64 2014–2023 2,6 [1,4; 3,8] 4,1 [2,6; 5,6] 4,9 [3,2; 6,6] 5,7 [3,8; 7,6] 7,2 [4,6; 9,6] 7,2 [4,6; 9,6] tsementeeritud (Waldemar Link) tsementeeritud (Waldemar Link) (64–78) (620) (506) (410) (286) (157) (86) GEMINI SL täielik põlvesüsteem, GEMINI SL täielik põlvesüsteem, reieluukomponent, säärekomponent, Liikuv laagriosa / fikseeritud laagriosa CR, fikseeritud laagri, tsementeeritud (Waldemar Ilma 707 20 71 (63–78) 35/65 2015–2023 1,6 [0,7; 2,6] 3,1 [1,7; 4,5] 3,3 [1,9; 4,8] 3,7 [2,1; 5,2] 3,7 [2,1; 5,2] (Waldemar Link) Link) (577) (449) (344) (194) (88) GENESIS II PS COCR Genesis II Ilma 3 495 75 71 2,9 [2,3; 3,5] 4,9 [4,2; 5,7] 5,7 [4,9; 6,5] 6,3 [5,4; 7,2] 6,8 [5,9; 7,7] 7,2 [6,2; 8,1] 7,5 [6,4; 8,5] 7,9 [6,7; 9,1] 35/65 2013–2023 Põlve (63–77) (Smith & Nephew) (Smith & Nephew) (3 040) (2 636) (2 318) (1 915) (1 502) (974) (462) (162) GENESIS II PS COCR Genesis II Koos 406 31 71 (64–77) 32/68 2013–2023 2,6 [1,0; 4,2] 4,0 [1,9; 6,0] 4,7 [2,4; 7,0] 5,5 [3,0; 8,0] 5,5 [3,0; 8,0] 6,7 [3,7; 9,6] (Smith & Nephew) (Smith & Nephew) (317) (265) (246) (227) (187) (111) GENESIS II PS OXINIUM Genesis II Ilma 874 61 65 2,3 [1,2; 3,3] 4,0 [2,5; 5,4] 5,1 [3,4; 6,7] 5,5 [3,7; 7,2] 5,5 [3,7; 7,2] 6,1 [4,1; 8,1] 6,5 [4,4; 8,6] (58–73) 23/77 2013–2023 (Smith & Nephew) (Smith & Nephew) (710) (571) (477) (407) (334) (260) (141) JOURNEY II BCS COCR JOURNEY Ilma 1 221 39 70 (62–77) 42/58 2017–2023 3,3 [2,2; 4,4] 5,7 [4,2; 7,2] 6,9 [5,2; 8,7] 8,7 [6,4; 11,0] 8,7 [6,4; 11,0] (Smith & Nephew) (Smith & Nephew) (865) (597) (362) (223) (99) JOURNEY II BCS OXINIUM JOURNEY Ilma 1 575 42 68 4,1 [3,1; 5,1] 6,6 [5,3; 7,9] 7,6 [6,2; 9,0] 8,4 [6,9; 9,8] 9,1 [7,5; 10,6] 9,8 [8,1; 11,5] 9,8 [8,1; 11,5] (60–75) 30/70 2014–2023 (Smith & Nephew) (Smith & Nephew) (1 383) (1 243) (1 127) (936) (679) (391) (94) LEGION PS COCR (Smith & Nephew) Genesis II (Smith & Nephew) Ilma 10 246 134 70 (62–77) 38/62 2014–2023 2,7 [2,3; 3,0] 4,7 [4,2; 5,2] 5,5 [5,0; 6,1] 6,0 [5,4; 6,6] 6,2 [5,6; 6,9] 6,7 [5,9; 7,4] 6,7 [5,9; 7,4] 6,7 [5,9; 7,4] (7 648) (5 473) (3 605) (2 415) (1 390) (605) (217) (51) LEGION PS COCR (Smith & Nephew) Genesis II (Smith & Nephew) Koos 1 586 65 71 34/66 2015–2023 2,3 [1,5; 3,0] 3,1 [2,1; 4,0] 3,4 [2,3; 4,4] 3,8 [2,6; 5,0] 3,8 [2,6; 5,0] (63–77) (1 128) (772) (501) (308) (128) LEGION PS OXINIUM Genesis II Ilma 2 987 144 66 (59–74) 22/78 2012–2023 2,0 [1,5; 2,5] 4,3 [3,4; 5,1] 5,3 [4,3; 6,2] 5,7 [4,7; 6,8] 6,0 [4,9; 7,1] 6,6 [5,2; 7,9] 8,2 [6,1; 10,3] 8,2 [6,1; 10,3] (Smith & Nephew) (Smith & Nephew) (2 207) (1 566) (1 090) (749) (480) (286) (166) (75) LEGION PS OXINIUM Genesis II Koos 446 49 67 3,1 [1,4; 4,7] 4,2 [2,1; 6,3] 5,9 [3,1; 8,6] 8,4 [4,4; 12,3] 9,8 [5,0; 14,3] (60–75) 15/85 2012–2023 (Smith & Nephew) (Smith & Nephew) (304) (206) (139) (95) (53) LinkSymphoKnee, LinkSymphoKnee, reieluukomponent, PS, FB, monoblokk, CoCrMo, tsementeeritud Ilma 689 18 69 (62–76) 48/52 2021–2023 0,6 [0,0; 1,2] tsementeeritud (Waldemar Link) (Waldemar Link) (215) NexGen LPS-Flex-Gender (Zimmer NexGen CR (Zimmer 1,6 [1,2; 2,0] Biomet) Biomet) Ilma 3 945 85 69 9/91 2012–2023 2,5 [2,0; 3,0] 3,2 [2,6; 3,8] 3,5 [2,9; 4,1] 3,7 [3,0; 4,4] 4,0 [3,3; 4,8] 4,1 [3,4; 4,9] 5,2 [3,9; 6,5] 5,6 [4,1; 7,0] (61–76) (3 456) (3 022) (2 548) (2 046) (1 412) (985) (578) (315) (140) NexGen LPS-Flex-Gender (Zimmer NexGen CR (Zimmer Biomet) Biomet) Koos 668 29 69 (61–76) 3/97 2012–2023 2,0 [0,9; 3,1] 3,4 [2,0; 4,8] 3,8 [2,3; 5,4] 3,8 [2,3; 5,4] 4,5 [2,7; 6,2] 5,3 [3,2; 7,3] 5,8 [3,5; 8,1] 5,8 [3,5; 8,1] (588) (503) (432) (358) (288) (196) (125) (57) NexGen LPS-Flex (Zimmer Biomet) NexGen CR (Zimmer Biomet) Ilma 14 779 228 69 30/70 2012–2023 2,0 [1,8; 2,2] 3,3 [3,0; 3,6] 3,9 [3,5; 4,2] 4,2 [3,9; 4,6] 4,5 [4,1; 4,9] 4,8 [4,3; 5,2] 5,1 [4,6; 5,6] 5,3 [4,8; 5,9] 5,5 [4,8; 6,2] (61–76) (12 271) (10 007) (8 219) (6 555) (4 659) (3 000) (1 628) (677) (227) NexGen LPS-Flex (Zimmer Biomet) NexGen CR (Zimmer Biomet) Koos 2 715 91 70 (62–76) 36/64 2012–2023 2,0 [1,5; 2,6] 3,0 [2,3; 3,7] 3,6 [2,9; 4,4] 4,1 [3,3; 4,9] 4,3 [3,4; 5,1] 4,3 [3,4; 5,1] 4,7 [3,7; 5,7] 5,0 [3,9; 6,1] 5,0 [3,9; 6,1] (2 343) (1 993) (1 699) (1 397) (1 064) (734) (454) (204) (70) NexGen LPS (Zimmer Biomet) NexGen CR (Zimmer Biomet) Ilma 10 754 37 69 41/59 2012–2023 1,3 [1,0; 1,5] 2,1 [1,8; 2,4] 2,6 [2,3; 3,0] 2,9 [2,6; 3,3] 3,1 [2,7; 3,4] 3,3 [2,9; 3,7] 3,6 [3,2; 4,1] 3,7 [3,2; 4,1] 4,3 [3,6; 5,1] (62–76) (9 377) (7 851) (6 669) (5 325) (4 129) (2 963) (1 948) (1 036) (482) NexGen LPS (Zimmer Biomet) NexGen CR (Zimmer Biomet) Koos 418 14 70 (62–77) 30/70 2013–2023 1,2 [0,2; 2,3] 2,1 [0,6; 3,5] 2,7 [1,0; 4,4] 3,1 [1,3; 4,9] 3,6 [1,5; 5,6] 4,3 [1,8; 6,8] 4,3 [1,8; 6,8] (370) (331) (283) (238) (170) (116) (70) Tabel 52 (jätkub) 134 EPRD 2024. aasta aruanne 135  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus Põlveliigese proteesimine Kumulatiivsed revisioonimäärad pärast ... Põlvekap sli pinna Implanta Reieluukomponent Säärekomponent Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat taastami ne paigalda mise aastad Standardne TKA, tagantstabiliseeritud, tsementeeritud Persona PS (Zimmer Biomet) Persona Tibia (Zimmer Biomet) Ilma 4 492 80 71 36/64 2013–2023 2,6 [2,1; 3,1] 4,2 [3,5; 4,9] 4,9 [4,1; 5,8] 5,3 [4,4; 6,2] 5,3 [4,4; 6,2] 5,9 [4,6; 7,1] 6,4 [4,8; 7,9] (62–78) (2 904) (1 720) (1 082) (643) (391) (204) (93) Persona PS (Zimmer Biomet) Persona Tibia (Zimmer Biomet) Koos 409 31 70 (63–76) 27/73 2014–2023 2,7 [0,9; 4,4] 5,5 [2,4; 8,4] 5,5 [2,4; 8,4] (232) (129) (66) SIGMA™ reieluu (DePuy) MBT sääreluu (DePuy) Ilma 683 42 73 30/70 2014–2023 2,7 [1,5; 3,9] 4,0 [2,5; 5,5] 5,1 [3,4; 6,9] 5,8 [3,9; 7,7] 6,1 [4,1; 8,0] 6,1 [4,1; 8,0] 6,1 [4,1; 8,0] (66–79) (627) (539) (457) (352) (242) (154) (72) SIGMA™ reieluu (DePuy) SIGMA™ sääreluu (DePuy) Ilma 4 031 118 71 (64–78) 34/66 2013–2023 2,7 [2,2; 3,2] 4,5 [3,8; 5,1] 5,2 [4,4; 5,9] 5,9 [5,1; 6,8] 6,2 [5,4; 7,1] 6,6 [5,7; 7,6] 6,9 [5,9; 7,8] 7,5 [6,2; 8,7] (3 315) (2 764) (2 304) (1 857) (1 376) (963) (540) (196) SIGMA™ reieluu (DePuy) SIGMA™ sääreluu (DePuy) Koos 1 714 53 70 32/68 2012–2023 2,0 [1,4; 2,7] 3,1 [2,2; 3,9] 4,0 [3,0; 5,0] 4,6 [3,5; 5,7] 5,0 [3,9; 6,1] 5,4 [4,2; 6,6] 5,8 [4,4; 7,1] 6,2 [4,6; 7,7] (62–77) (1 509) (1 362) (1 222) (1 062) (853) (603) (298) (118) Triatlon PS (Stryker) Triathlon (Stryker) Ilma 4 351 75 71 (64–78) 36/64 2013–2023 3,1 [2,5; 3,6] 4,7 [4,0; 5,4] 5,3 [4,6; 6,1] 5,8 [5,0; 6,6] 6,0 [5,2; 6,8] 6,5 [5,5; 7,4] 6,5 [5,5; 7,4] 6,5 [5,5; 7,4] (3 511) (2 774) (2 184) (1 591) (1 069) (556) (221) (70) Triatlon PS (Stryker) Triathlon (Stryker) Koos 1 322 30 71 36/64 2013–2023 1,6 [0,9; 2,3] 3,0 [2,0; 4,0] 3,5 [2,4; 4,6] 3,5 [2,4; 4,6] 3,5 [2,4; 4,6] 3,5 [2,4; 4,6] 3,5 [2,4; 4,6] (63–78) (1 082) (826) (612) (464) (305) (107) (53) Triathlon PS (Stryker) Triathlon TS (Stryker) Ilma 500 43 69,5 (61,5–77) 35/65 2013–2023 3,1 [1,5; 4,7] 3,4 [1,7; 5,1] 3,8 [1,9; 5,6] 4,4 [2,2; 6,5] 5,6 [2,3; 8,8] (361) (280) (198) (125) (72) Vanguard PS (Zimmer Vanguard sääre ristiside 2,9 [2,3; 3,4] Biomet) (Zimmer Biomet) Ilma 3 357 51 72 35/65 2014–2023 4,6 [3,9; 5,4] 5,1 [4,2; 5,9] 6,0 [5,0; 6,9] 6,3 [5,2; 7,3] 6,3 [5,2; 7,3] 6,3 [5,2; 7,3] 7,5 [4,9; 10,0] (64–78) (2 597) (1 985) (1 434) (1 001) (644) (398) (219) (61) Põlve VEGA (Aesculap) VEGA (Aesculap) Ilma 2 237 58 69 (61–77) 32/68 2013–2023 1,8 [1,2; 2,4] 3,9 [3,0; 4,8] 6,1 [4,8; 7,3] 7,3 [5,9; 8,7] 8,4 [6,8; 10,0] 10,4 [8,3; 12,5] 12,3 [9,6; 14,9] 13,0 [10,0; 16,0] (1 635) (1 219) (947) (708) (469) (285) (160) (59) Piiratud liikuvusega põlveliigese proteesid, liigendiga, fikseeritud laagriga, tsementeeritud Endo-Model SL, Endo-Model SL, reieluukomponent, tsementeeritud säärekomponent, tsementeeritud Ilma 577 54 76 22/78 2013–2023 7,5 [5,2; 9,6] 8,6 [6,2; 10,9] 9,4 [6,8; 11,9] 9,8 [7,1; 12,3] 10,8 [7,8; 13,7] 10,8 [7,8; 13,7] 11,8 [8,2; 15,3] (68–82) (448) (360) (280) (214) (157) (109) (56) (Waldemar Link) (Waldemar Link) Endo-mudel, Endo-mudel, pöörlev liigend, tsementeeritud Pöörlev liigend, tsementeeritud (Waldemar Link) Ilma 1 590 182 77 (69–82) 18/82 2013–2023 4,3 [3,3; 5,3] 5,7 [4,5; 7,0] 6,5 [5,1; 7,8] 6,7 [5,4; 8,1] 7,1 [5,6; 8,5] 7,1 [5,6; 8,5] 7,1 [5,6; 8,5] 9,5 [6,4; 12,4] (Waldemar Link) (1 240) (978) (784) (621) (428) (287) (165) (76) ENDURO (Aesculap) ENDURO (Aesculap) Ilma 1 936 179 75 21/79 2013–2023 4,0 [3,1; 4,9] 5,5 [4,4; 6,6] 6,9 [5,6; 8,1] 7,2 [5,9; 8,5] 7,2 [5,9; 8,5] 7,8 [6,3; 9,2] 8,1 [6,5; 9,6] 8,1 [6,5; 9,6] (67–81) (1 534) (1 245) (994) (759) (547) (360) (202) (82) ENDURO (Aesculap) ENDURO (Aesculap) Koos 546 45 73 (65–79) 27/73 2014–2023 3,8 [2,2; 5,5] 4,8 [2,9; 6,7] 5,5 [3,4; 7,6] 6,3 [3,9; 8,7] 6,3 [3,9; 8,7] 6,3 [3,9; 8,7] 6,3 [3,9; 8,7] (436) (321) (235) (178) (126) (85) (56) MUTARS GenuX MK tsementeeritud MUTARS GenuX MK tsementeeritud 3,7 [1,8; 5,5] (Implantcast) (Implantcast) Ilma 451 88 77 25/75 2015–2023 6,5 [3,8; 9,1] 7,3 [4,5; 10,2] 8,0 [4,9; 11,1] 8,0 [4,9; 11,1] (67–82) (317) (229) (171) (108) (63) NexGen RHK (Zimmer Biomet) NexGen RHK (Zimmer Biomet) Ilma 1 177 148 76 (68–81) 23/77 2012–2023 3,0 [2,0; 4,0] 4,2 [3,0; 5,4] 5,1 [3,7; 6,5] 5,4 [4,0; 6,9] 5,7 [4,2; 7,2] 6,0 [4,3; 7,6] 6,4 [4,6; 8,3] 7,3 [4,8; 9,7] (988) (812) (668) (539) (377) (229) (131) (64) RT-Plus (Smith & Nephew) RT-Plus (Smith & Nephew) Ilma 2 325 144 77 21/79 2013–2023 4,0 [3,2; 4,8] 5,1 [4,2; 6,1] 5,8 [4,7; 6,8] 6,2 [5,1; 7,2] 6,4 [5,3; 7,4] 6,5 [5,4; 7,6] 6,5 [5,4; 7,6] 6,5 [5,4; 7,6] (71–81) (1 937) (1 648) (1 399) (1 107) (802) (534) (286) (104) RT-Plus Modular (Smith & Nephew) RT-Plus Modular (Smith & Nephew) Ilma 619 111 75 (66–81) 27/73 2013–2023 4,7 [3,0; 6,3] 6,3 [4,3; 8,2] 6,7 [4,6; 8,8] 6,7 [4,6; 8,8] 7,8 [5,4; 10,2] 8,3 [5,7; 10,9] 8,3 [5,7; 10,9] (511) (426) (354) (287) (214) (147) (74) Piiratud TKA-d, varus-valgus stabiliseeritud, fikseeritud laagriga, tsementeeritud LCS™ COMPLETE™ reieluu (DePuy) MBT sääreluu (DePuy) Ilma 357 23 73 23/77 2013–2023 4,0 [1,9; 6,0] 5,6 [3,1; 8,1] 6,0 [3,4; 8,6] 6,0 [3,4; 8,6] 6,0 [3,4; 8,6] 6,8 [3,8; 9,7] (67–80) (311) (253) (208) (165) (124) (96) LEGION PS COCR (Smith & Nephew) Genesis II (Smith & Nephew) Ilma 1 003 87 71 (63–78) 30/70 2015–2023 2,9 [1,9; 4,0] 4,3 [3,0; 5,7] 5,3 [3,6; 7,0] 5,7 [3,9; 7,5] 5,7 [3,9; 7,5] (764) (545) (343) (231) (95) LEGION Revision COCR (Smith LEGION Revision 4,6 [2,7; 6,5] & Nephew) (Smith & Nephew) Ilma 500 72 72 28/72 2014–2023 5,6 [3,4; 7,6] 5,9 [3,7; 8,0] 5,9 [3,7; 8,0] 7,3 [4,6; 10,0] 7,3 [4,6; 10,0] (65–79) (417) (341) (279) (237) (171) (115) NexGen LCCK (Zimmer Biomet) NexGen CR (Zimmer Biomet) Ilma 1 688 117 72 (64–79) 29/71 2012–2023 2,7 [1,9; 3,5] 3,4 [2,5; 4,3] 3,7 [2,7; 4,6] 3,9 [2,9; 4,9] 3,9 [2,9; 4,9] 4,1 [3,0; 5,2] 4,5 [3,2; 5,8] 4,5 [3,2; 5,8] (1 412) (1 118) (914) (734) (539) (379) (205) (76) NexGen LCCK (Zimmer Biomet) NexGen CR (Zimmer Biomet) Koos 393 25 73 28/72 2013–2023 2,8 [1,2; 4,5] 3,5 [1,6; 5,3] 3,5 [1,6; 5,3] 3,5 [1,6; 5,3] 3,5 [1,6; 5,3] 3,5 [1,6; 5,3] 3,5 [1,6; 5,3] (62–79) (342) (298) (255) (200) (145) (94) (50) Tabel 52 (jätkub) 136 EPRD 2024. aasta aruanne 137  5 Puusa- ja põlveliigese proteesimise 5.3 Esmase põlveliigese proteesimise püsivus elulemus Põlveliigese proteesimine Kumulatiivsed revisioonimäärad pärast ... Põlvekap sli pinna Implanta Reieluukomponent Säärekomponent Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat taastami ne paigalda misest möödunu d aastad Piiratud liikuvusega põlveliigese proteesid, varus-valgus stabiliseeritud, fikseeritud laagriga, tsementeeritud Triathlon PS (Stryker) Triathlon TS (Stryker) Ilma 496 45 73 (64–80) 26/74 2013–2023 1,7 [0,5; 2,9] 4,4 [2,3; 6,4] 4,8 [2,6; 7,0] 6,5 [3,5; 9,3] 6,5 [3,5; 9,3] (374) (268) (195) (123) (73) Ühepoolne põlveliigese protees, fikseeritud laagriga, tsementeeritud balanSys UNI (Mathys) balanSys UNI fix (Mathys) Ilma 723 27 62 50/50 2013–2023 3,6 [2,2; 5,0] 5,6 [3,8; 7,4] 6,9 [4,8; 8,9] 7,1 [5,0; 9,2] 7,8 [5,5; 10,1] 8,2 [5,8; 10,6] 9,1 [6,1; 12,0] (56–71) (583) (471) (372) (293) (228) (153) (83) REIS UNI COCR JOURNEY UNI Ilma 1 568 94 63 (57,5–70) 49/51 2014–2023 2,5 [1,7; 3,3] 4,7 [3,5; 5,8] 5,8 [4,5; 7,1] 6,4 [4,9; 7,8] 8,2 [6,3; 10,1] 9,3 [7,0; 11,5] 9,9 [7,3; 12,4] (Smith & Nephew) (Smith & Nephew) (1 261) (994) (733) (509) (317) (178) (79) JOURNEY UNI OXINIUM JOURNEY UNI Ilma 1 309 159 60 32/68 2013–2023 4,5 [3,3; 5,6] 7,2 [5,7; 8,7] 8,7 [6,9; 10,4] 9,7 [7,8; 11,6] 11,9 [9,5; 14,2] 12,8 [10,3; 15,3] 14,4 [11,0; 17,7] (54–66) (Smith & Nephew) (Smith & Nephew) (1 023) (786) (591) (466) (302) (184) (82) Link SLED, täispolümeerist (Waldemar LINK SLED (Waldemar Link) Link) Ilma 786 33 63,5 (56–73) 50/50 2013–2023 2,7 [1,5; 3,8] 6,0 [4,2; 7,7] 7,5 [5,5; 9,4] 9,3 [7,0; 11,5] 10,6 [8,1; 13,1] 11,5 [8,7; 14,2] 12,5 [9,4; 15,5] 15,6 [11,3; 19,7] (703) (604) (515) (388) (284) (201) (129) (57) LINK SLED Link SLED, metallist tagaküljega Ilma 1 136 68 62 42/58 2013–2023 3,1 [2,0; 4,1] 6,6 [5,0; 8,2] 8,4 [6,6; 10,3] 10,4 [8,2; 12,5] 10,8 [8,6; 13,0] 12,9 [10,1; 15,6] 15,4 [11,7; 19,0] (57–71) (Waldemar Link) (Waldemar Link) (940) (742) (554) (418) (293) (199) (89) Mako MCK (Stryker) Mako MCK (Stryker) Ilma 1 065 19 62 (57–69) 55/45 2016–2023 0,8 [0,3; 1,4] 1,5 [0,6; 2,4] 2,5 [1,2; 3,8] 2,5 [1,2; 3,8] (781) (496) (293) (160) MOTO (Medacta) MOTO (Medacta) Ilma 513 18 63 48/52 2019–2023 1,4 [0,2; 2,7] 2,8 [0,8; 4,7] (58–71) (282) (126) Põlve Oxford Oxfordi fikseeritud lateraalne sääreluu (Zimmer Biomet) Ilma 1 050 58 71 (61–78) 19/81 2015–2023 1,5 [0,7; 2,3] 2,7 [1,7; 3,8] 3,0 [1,9; 4,1] 4,0 [2,6; 5,3] 4,2 [2,8; 5,6] 4,2 [2,8; 5,6] 4,2 [2,8; 5,6] (Zimmer Biomet) (932) (771) (654) (465) (300) (148) (54) Persona osaline põlveliiges Persona osaline põlveliiges 2,3 [1,8; 2,7] (Zimmer Biomet) (Zimmer Biomet) Ilma 5 066 124 63 49/51 2017–2023 3,6 [3,0; 4,1] 4,4 [3,7; 5,1] 4,9 [4,1; 5,8] 5,1 [4,2; 5,9] (58–71) (3 500) (2 303) (1 376) (760) (250) SIGMA™ HP osaline põlvesüsteem SIGMA™ HP osaline põlvesüsteem (DePuy) (DePuy) Ilma 4 500 109 63 (57–71) 47/53 2012–2023 1,8 [1,4; 2,2] 3,7 [3,1; 4,3] 4,6 [4,0; 5,3] 5,4 [4,7; 6,2] 5,7 [4,9; 6,5] 6,3 [5,4; 7,1] 7,0 [5,9; 8,0] 7,1 [6,1; 8,2] 7,1 [6,1; 8,2] (3 920) (3 382) (2 828) (2 202) (1 661) (1 097) (594) (214) (54) Triathlon PKR (Stryker) Triathlon PKR (Stryker) Ilma 636 34 62 46/54 2014–2023 4,8 [3,1; 6,4] 7,5 [5,4; 9,7] 9,3 [6,8; 11,6] 10,5 [7,9; 13,1] 11,2 [8,4; 13,9] 12,3 [9,3; 15,3] 12,3 [9,3; 15,3] 12,3 [9,3; 15,3] (56–70) (542) (453) (380) (319) (256) (184) (101) (50) UNIVATION (Aesculap) UNIVATION (Aesculap) Ilma 1 601 73 62 (56–70) 44/56 2014–2020 4,8 [3,8; 5,9] 8,3 [6,9; 9,7] 10,6 [9,1; 12,1] 12,3 [10,7; 13,9] 13,3 [11,5; 15,0] 13,8 [12,0; 15,7] 14,3 [12,2; 16,2] (1 510) (1 444) (1 351) (976) (588) (266) (78) ZUK (Lima) ZUK (Lima) Ilma 5 463 126 64 46/54 2012–2023 2,0 [1,6; 2,4] 3,1 [2,6; 3,5] 3,7 [3,1; 4,3] 4,6 [3,9; 5,2] 4,8 [4,1; 5,5] 5,1 [4,3; 5,8] 5,5 [4,6; 6,3] 6,2 [5,0; 7,4] (58–72) (4 355) (3 410) (2 696) (2 247) (1 832) (1 243) (663) (182) Ühe kondüüli põlveliigese proteesid, liikuv kandur, hübriid Oxford (Zimmer Biomet) Oxford Tibia (Zimmer Biomet) Ilma 305 38 67 (61–74) 36/64 2013–2023 3,0 [1,1; 5,0] 3,8 [1,6; 6,0] 4,2 [1,8; 6,6] 4,7 [2,1; 7,2] 5,2 [2,5; 7,9] 5,2 [2,5; 7,9] 6,7 [2,7; 10,5] (271) (241) (218) (194) (153) (109) (53) Ühe kondüüli põlveliigese proteesid, liikuv kandur, tsementeerimata Oxford (Zimmer Biomet) Oxford Tibia (Zimmer Biomet) Ilma 8 003 106 63 55/45 2012–2023 3,7 [3,3; 4,2] 5,1 [4,5; 5,6] 6,0 [5,4; 6,6] 6,5 [5,8; 7,1] 6,8 [6,1; 7,4] 7,6 [6,8; 8,3] 7,9 [7,1; 8,8] 8,4 [7,4; 9,3] 8,8 [7,5; 10,1] (57–71) (6 214) (4 845) (3 925) (3 086) (2 225) (1 442) (835) (385) (154) Ühe kondüüli põlveliigese proteesid, liikuv kandur, tsementeeritud Oxford (Zimmer Biomet) Oxford Tibia (Zimmer Biomet) Ilma 25 704 429 64 (58–73) 46/54 2012–2023 2,8 [2,6; 3,0] 4,4 [4,1; 4,7] 5,4 [5,1; 5,7] 6,2 [5,9; 6,5] 6,8 [6,4; 7,2] 7,6 [7,2; 8,0] 8,2 [7,8; 8,7] 9,0 [8,4; 9,7] 9,5 [8,7; 10,4] (21 206) (17 402) (14 221) (10 951) (7 877) (4 989) (2 657) (980) (298) Oxford TiNbN Oxford Tibia TiNbN 3,0 [2,3; 3,6] (Zimmer Biomet) (Zimmer Biomet) Ilma 2 492 304 60 12/88 2012–2023 5,7 [4,7; 6,7] 6,7 [5,6; 7,8] 7,7 [6,5; 8,9] 8,5 [7,2; 9,8] 9,0 [7,6; 10,4] 9,0 [7,6; 10,4] 9,4 [7,8; 11,0] 9,4 [7,8; 11,0] (55–67) (2 139) (1 726) (1 388) (1 059) (746) (488) (303) (141) (57) Põlveliigese artroplastika, tsementeeritud JOURNEY PFJ OXINIUM Koos 373 104 54 (48–61) 25/75 2013–2023 5,3 [2,9; 7,7] 8,2 [5,1; 11,2] 10,8 [7,1; 14,3] 12,6 [8,4; 16,6] 14,1 [9,5; 18,5] (Smith & Nephew) (289) (227) (165) (126) (77) Põlveliigese GSF Koos 307 78 56 27/73 2013–2023 3,0 [0,9; 5,1] 7,6 [4,1; 10,9] 7,6 [4,1; 10,9] 11,6 [6,9; 16,0] 13,6 [8,2; 18,7] (49–62) (Zimmer Biomet) (245) (189) (155) (109) (70) Tabel 52 (jätkub) 138 EPRD 2024. aasta aruanne 139  5 Puusa- ja põlveliigese proteesimise 5.4 Põlveliigese revisiooniproteesi elulemus püsivus Lühidalt: 5.4 Põlveliigese Aseptilise reoperatsiooni 2-aastane risk on 9,9%, kuid See kehtib sõltumata sellest, kas arvestatakse ainult • CReRR septilise revisiooni järel 2 aasta jooksul on septilise reoperatsiooni puhul tõuseb see 24,2%ni. esimest või teist revisiooni või – nagu joonisel 30 – revisioonilõikuse kõiki revisioone kokku. Põlve CReRR-id vähenevad ka 24,2%, võrreldes vaid 9,9% aseptiliste elulemus EPRD-s registreeritud esmase artroplastika siis, kui implanteeritakse uus reieluu- või revisioonide puhul. patsientide puhul on võimalik täpselt jälgida, kui sääreluukomponent, selle asemel et jätta varem • Kordusoperatsiooni risk suureneb iga järgmise Põlveliigese endoproteesi CReRR on palju protseduure tehti konkreetsel liigesel. Nende implanteeritud luukinnitusega komponendid paigale. protseduuriga. korduvoperatsiooni järel märkimisväärselt kõrgem kui esmase protseduuri järel. Korduvoperatsiooni risk patsientide profiilide andmekogumid näitavad, et suureneb veelgi, kui korduvoperatsioon oli tingitud põlve re-revisiooni risk suureneb ühe järgneva See erinevus on eriti märgatav septiliste periproteetilisest infektsioonist (joonis 28). Kui protseduuri järel järgmise suunas (joonis 29). reoperatsioonide puhul. Siinkohal tuleb arvestada, et vaadelda kõiki registris registreeritud põlveliigese ainult sisendi vahetamine on esialgu vähem korduvoperatsioone, on CReRR invasiivne valik ning ei too paljudel juhtudel tingimata kaasa kiiret kordusoperatsiooni. Seetõttu võib patsiendi üldine tervislik seisund mõjutada 40 otsust, kas vahetada samal ajal ka luukinnitusega © EPRD aastaaruanne 2024 35 komponente. Kumulatiivne kordusoperatsioon 30 25 Tabel 53 selgitab teiste tegurite mõju CReRR-idele. Kuna revisioonide algtingimused erinevad Põlve 20 ulatuslikumalt... 15 10 5 [%] 0 Septilised põlve 0 1 2 3 4 5 6 7 korduvoperatsioonid 8 põlve Aseptilised 9 Kuna esmaseid põlveliigese proteesimisi ja üksikute Aastad viimasest muudatusest korduvoperatsioonid korduvoperatsioonide raskusastet on raske hinnata, 11 946 7 853 6 005 4 555 3 364 2 303 1 437 773 298 77 tuleb tulemusi tõlgendada ettevaatusega. Riskirühm 45 434 36 257 28 889 22 789 17 448 12 537 8 187 4 592 1 985 558 Joonis 28: Põlveliigese endoproteesimise kumulatiivsed re-revisioonimäärad aja jooksul (p < 0,0001) 40 40 © EPRD aastaaruanne 2024 © EPRD aastaaruanne 2024 35 35 Kumulatiivne kordusoperatsioon 30 Kumulatiivne kordusrevisioon [%] 30 25 25 20 20 15 15 10 10 5 5 Septiline, ilma luukinnituste vahetamiseta Septiline, luukinnituste [%] vahetamisega Aseptiline, ilma luukinnituste vahetamiseta Aseptiline, Järgnevad septilised revisioonid Järgnevad aseptilised revisioonid 2. 0 luukinnituste vahetamisega 0 2 . septiline revisioon aseptiline revisioon 1. septiline revisioon 1. aseptiline revisjon 0 1 2 3 4 5 0 1 2 3 4 5 6 7 8 9 Aastad viimasest muudatusest Aastad viimasest muudatusest 356 205 146 105 61 33 3 893 2 143 1 573 1 141 790 507 276 145 49 6 807 484 347 248 163 101 Riskirühm 7 078 5 173 4 037 3 115 2 361 1 651 1 077 581 230 67 2 754 1 726 1 262 917 615 364 13 182 10 306 8 210 6 468 4 981 3 530 2 239 1 226 524 143 Ohustatud arvud 282 181 113 65 40 25 29 783 23 914 19 089 15 108 11 535 8 294 5 466 3 068 1 311 368 1 237 860 596 384 241 140 10 275 7 557 5 583 4 036 2 777 1 699 Joonis 30: Põlveliigese endoproteesimise kumulatiivsed re-revisiooni määrad implanteeritud komponentide kaupa (p < 0,0001) Joonis 29: Põlveliigese endoproteesimise kumulatiivsed re-revisiooni määrad pärast esimest, teist ja järgnevaid revisioone (p < 0,0001). Selguse huvides on usaldusvahemikud välja jäetud. 140 EPRD aastaaruanne 2024 141  5 Puusa- ja põlveliigese proteesimise 5.4 Põlveliigese revisiooniproteesi elulemus püsivus Kordusoperatsioonide määr pärast ... Muudatuse liik / Kategooria Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat Infektsiooniga seotud põlveliigese revisioon 11 946 72 (63–79) 47/53 30,0 669 19,5 [18,7; 20,2] 24,2 [23,4; 25,0] 27,5 [26,6; 28,4] 29,4 [28,4; 30,3] 31,2 [30,2; 32,2] 32,7 [31,7; 33,8] 33,8 [32,6; 35,0] 35,5 [34,0; 36,9] 36,8 [34,7; 38,8] (7 853) (6 005) (4 555) (3 364) (2 303) (1 437) (773) (298) (77) Protseduuride arv Esimene korrigeerimine 2 754 70 (61–77) 49/51 30,4 528 18,9 [17,4; 20,4] 22,6 [21,0; 24,3] 24,9 [23,1; 26,7] 26,9 [24,9; 28,8] 27,5 [25,4; 29,4] 28,2 [26,0; 30,4] 28,2 [26,0; 30,4] (1 726) (1 262) (917) (615) (364) (188) (80) Teine läbivaatamine 807 69 50/50 30,7 314 19,2 [16,3; 22,0] 25,4 [22,0; 28,6] 28,6 [24,9; 32,1] 30,7 [26,7; 34,4] 31,8 [27,6; 35,7] 33,6 [28,7; 38,2] (61–77) (484) (347) (248) (163) (101) (52) Kolmas või järgnev läbivaatamine 356 69 (60–77) 54/46 31,6 167 21,5 [16,8; 25,9] 27,9 [22,5; 32,9] 35,9 [29,6; 41,7] 38,5 [31,7; 44,6] (205) (146) (105) (61) Korrigeerimine ilma teadaoleva 8 029 73 46/54 29,4 627 19,6 [18,7; 20,5] 24,4 [23,4; 25,4] 27,8 [26,8; 28,9] 29,7 [28,5; 30,8] 31,8 [30,6; 33,0] 33,4 [32,1; 34,7] 34,6 [33,2; 36,0] 36,4 [34,7; 38,1] 37,6 [35,4; 39,7] (64–79) varasem ajalugu (5 438) (4 250) (3 285) (2 525) (1 805) (1 180) (669) (273) (75) Uuesti implanteeritud komponendid Koos vahetamisega 7 078 71 (62–78) 47/53 29,6 617 12,9 [12,1; 13,8] 18,4 [17,5; 19,4] 22,3 [21,2; 23,4] 24,5 [23,3; 25,6] 26,6 [25,4; 27,9] 28,6 [27,3; 30,0] 29,9 [28,4; 31,3] 32,0 [30,0; 33,9] 33,8 [31,1; 36,4] luukinnitustega komponentide (5 173) (4 037) (3 115) (2 361) (1 651) (1 077) (581) (230) (67) Ilma vahetuseta 3 893 73 49/51 30,1 554 28,2 [26,7; 29,6] 31,7 [30,1; 33,2] 33,9 [32,3; 35,6] 35,2 [33,4; 36,8] 36,4 [34,5; 38,1] 36,7 [34,8; 38,5] 37,4 [35,4; 39,4] (64–79) luukinnitusega komponendid (2 143) (1 573) (1 141) (790) (507) (276) (145) ei ole selgelt määratletud 975 72 (64–79) 43/57 30,1 266 33,0 [29,9; 36,0] 36,7 [33,5; 39,8] 39,4 [36,0; 42,6] 41,3 [37,7; 44,7] 42,8 [39,1; 46,4] 43,8 [39,9; 47,5] (537) (395) (299) (213) (145) (84) Vanuserühm ≤ 54 aastat 902 51 51/49 31,9 310 21,3 [18,6; 24,0] 29,2 [26,0; 32,2] 35,7 [32,2; 39,1] 38,1 [34,4; 41,6] 41,8 [37,8; 45,6] 45,2 [40,7; 49,4] 46,9 [42,1; 51,4] (48–53) (620) (468) (339) (257) (179) (116) (60) 55–64 aastat 2556 60 (58–62) 52/48 32,1 504 20,3 [18,7; 21,9] 25,7 [23,8; 27,4] 29,3 [27,3; 31,2] 31,6 [29,5; 33,6] 33,2 [31,0; 35,4] 34,7 [32,3; 37,0] 36,0 [33,4; 38,5] 39,2 [35,5; 42,6] (1 692) (1 285) (950) (718) (499) (325) (176) (65) Põlve 65–74 aastat 3 652 70 48/52 31,1 548 19,1 [17,8; 20,4] 23,9 [22,5; 25,4] 27,2 [25,6; 28,8] 29,2 [27,5; 30,8] 31,2 [29,4; 33,0] 33,1 [31,1; 35,0] 34,1 [32,0; 36,1] 34,7 [32,4; 36,9] (67–72) (2 435) (1 873) (1 453) (1 108) (778) (490) (278) (119) 75–84 aastat 4 120 79 (77–81) 44/56 28,3 590 19,1 [17,9; 20,3] 22,9 [21,5; 24,3] 25,4 [23,9; 26,8] 26,9 [25,4; 28,4] 28,3 [26,7; 29,9] 29,0 [27,3; 30,7] 29,8 [28,0; 31,6] 29,8 [28,0; 31,6] (2 693) (2 090) (1 619) (1 164) (785) (473) (243) (82) ≥ 85 aastat 716 87 37/63 26,7 306 17,5 [14,5; 20,4] 20,3 [16,9; 23,4] 22,2 [18,6; 25,7] 23,0 [19,3; 26,6] 23,0 [19,3; 26,6] (85–89) (413) (289) (194) (117) (62) Sugu Mehed 5 632 71 (62–78) 100/0 29,4 603 20,6 [19,5; 21,7] 25,7 [24,5; 26,9] 29,0 [27,7; 30,3] 30,8 [29,4; 32,2] 32,9 [31,3; 34,3] 34,8 [33,1; 36,4] 35,6 [33,8; 37,3] 37,7 [35,3; 40,0] (3 594) (2 728) (2 043) (1 502) (1 011) (625) (329) (131) Naised 6 314 72 0/100 30,4 619 18,4 [17,4; 19,4] 22,9 [21,8; 24,0] 26,2 [25,0; 27,4] 28,1 [26,8; 29,4] 29,8 [28,4; 31,1] 31,0 [29,5; 32,4] 32,3 [30,7; 33,8] 33,5 [31,6; 35,4] (64–79) (4 259) (3 277) (2 512) (1 862) (1 292) (812) (444) (167) Kehamassiindeks ≤ 25 1 563 77 (67–82) 40/60 23,4 418 15,9 [14,0; 17,8] 19,8 [17,7; 22,0] 22,2 [19,8; 24,5] 23,0 [20,5; 25,4] 24,2 [21,5; 26,9] (998) (729) (507) (318) (174) > 25–30 2 903 74 57/43 27,5 510 18,8 [17,3; 20,3] 23,1 [21,4; 24,7] 25,7 [23,9; 27,5] 28,0 [26,1; 30,0] 29,6 [27,4; 31,7] 31,6 [28,7; 34,3] (65–80) (1 838) (1 347) (965) (633) (331) (94) > 30–35 2 290 70 (63–78) 49/51 32,3 505 17,2 [15,6; 18,8] 21,2 [19,4; 23,0] 25,1 [23,0; 27,1] 26,5 [24,3; 28,7] 28,2 [25,8; 30,6] 28,6 [26,1; 31,0] (1 463) (1 059) (738) (487) (262) (67) > 35–40 1 236 68 44/56 37,0 384 19,6 [17,3; 21,9] 24,6 [22,0; 27,1] 28,3 [25,3; 31,1] 31,1 [27,8; 34,2] 31,8 [28,4; 35,1] (61–75) (777) (544) (376) (235) (121) üle 40 893 65 (59–71) 34/66 43,4 328 23,0 [20,1; 25,8] 28,6 [25,3; 31,7] 31,1 [27,6; 34,4] 34,1 [30,3; 37,8] 37,1 [32,5; 41,4] (546) (385) (258) (159) (74) Haiglad, kus on vähe 5 138 72 47/53 29,8 501 19,9 [18,8; 21,1] 24,0 [22,7; 25,2] 26,8 [25,4; 28,1] 28,4 [27,0; 29,8] 30,1 [28,5; 31,6] 31,5 [29,9; 33,1] 33,0 [31,2; 34,8] 33,4 [31,4; 35,3] Haiglasuurus* (64–79) aastane juhtumite arv (3 266) (2 532) (1 905) (1 403) (962) (596) (311) (124) Haiglad keskmise aastase patsientide arvuga 3 304 71 (63–79) 47/53 30,0 110 18,2 [16,9; 19,6] 23,2 [21,6; 24,7] 27,1 [25,4; 28,8] 29,1 [27,2; 30,9] 31,0 [29,0; 32,9] 32,2 [30,1; 34,3] 32,7 [30,5; 34,9] 35,9 [32,3; 39,3] (2 213) (1 641) (1 245) (888) (570) (347) (175) (69) Haiglad, kus aastane 3 351 70 48/52 29,8 33 19,8 [18,4; 21,2] 25,5 [23,9; 27,0] 28,9 [27,2; 30,6] 30,9 [29,1; 32,6] 33,0 [31,1; 34,9] 35,0 [32,9; 37,0] 36,0 [33,8; 38,1] 38,2 [35,4; 40,9] (62–77) juhtumite arv (2 265) (1 738) (1 323) (1 005) (715) (460) (269) (99) Infektsiooniga mitteseotud põlveliigese revisioon 45 434 70 (61–77) 33/67 30,1 736 5,7 [5,4; 5,9] 9,9 [9,6; 10,1] 12,4 [12,0; 12,7] 14,2 [13,8; 14,6] 15,6 [15,2; 16,0] 16,9 [16,4; 17,3] 18,1 [17,6; 18,6] 19,1 [18,5; 19,7] 20,0 [19,2; 20,8] (36 257) (28 889) (22 789) (17 448) (12 537) (8 187) (4 592) (1 985) (558) Protseduuride arv Esimene korrigeerimine 10 275 66 (59–75) 33/67 30,5 660 6,3 [5,8; 6,8] 11,5 [10,8; 12,2] 14,3 [13,5; 15,1] 16,0 [15,1; 16,8] 17,0 [16,0; 18,0] 18,3 [17,2; 19,4] 18,8 [17,6; 20,1] 20,9 [18,5; 23,2] (7 557) (5 583) (4 036) (2 777) (1 699) (886) (369) (96) Teine muudatus 1 237 66 37/63 30,5 381 8,0 [6,3; 9,6] 13,5 [11,3; 15,7] 17,3 [14,7; 19,9] 18,8 [15,9; 21,5] 20,3 [17,1; 23,4] 20,3 [17,1; 23,4] (58–74) (860) (596) (384) (241) (140) (66) Kordusoperatsioon ilma teadaoleva eelneva haigusloota 33 640 71 (62–78) 33/67 30,1 732 5,3 [5,1; 5,6] 9,2 [8,9; 9,5] 11,6 [11,2; 11,9] 13,5 [13,1; 13,9] 14,9 [14,5; 15,4] 16,2 [15,7; 16,7] 17,5 [16,9; 18,0] 18,4 [17,8; 19,1] 19,4 [18,6; 20,3] (27 659) (22 597) (18 304) (14 390) (10 673) (7 221) (4 192) (1 884) (541) Tabel 53: Peamised tegurid, mis mõjutavad puusaliigese kordusoperatsioonide sagedust 142 EPRD 2024. aasta aruanne 143  5 Puusa- ja põlveliigese proteesimise 5.4 Põlveliigese revisiooniproteesi elulemus püsivus Re-revisiooni määr pärast ... Revisjoni tüüp / Kategooria Tüüp Arv Vanus m/n KMI Haigla 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat Uuesti implanteeritud komponendid 29 783 70 32/68 30,1 723 5,1 [4,8; 5,3] 9,2 [8,9; 9,6] 11,8 [11,4; 12,2] 13,7 [13,2; 14,2] 15,1 [14,6; 15,6] 16,3 [15,7; 16,8] 17,5 [16,9; 18,2] 18,4 [17,7; 19,1] 19,1 [18,2; 20,1] koosvahetuskomponenti de (61–77) luukinnitusega komponendid (23 914) (19 089) (15 108) (11 535) (8 294) (5 466) (3 068) (1 311) (368) Ilma 13 182 69 (61–77) 35/65 30,4 669 6,8 [6,4; 7,3] 10,8 [10,3; 11,4] 13,1 [12,5; 13,8] 14,9 [14,2; 15,6] 16,3 [15,5; 17,1] 17,8 [16,9; 18,6] 18,8 [17,8; 19,7] 20,1 [18,9; 21,3] 21,6 [19,9; 23,2] luukinnituskomponentideta (10 306) (8 210) (6 468) (4 981) (3 530) (2 239) (1 226) (524) (143) ei ole selgelt määratletud 2 469 70 32/68 30,1 386 6,6 [5,6; 7,6] 11,8 [10,4; 13,1] 14,5 [12,9; 16,0] 16,6 [14,9; 18,2] 18,2 [16,3; 20,0] 19,4 [17,4; 21,4] 20,7 [18,5; 22,9] 22,1 [19,5; 24,6] (61–77) (2 037) (1 590) (1 213) (932) (713) (482) (298) (150) Vanuserühm ≤ 54 aastat 4 271 51 (48–53) 35/65 31,3 589 7,5 [6,7; 8,3] 14,4 [13,2; 15,5] 17,9 [16,6; 19,1] 20,4 [19,0; 21,8] 22,4 [20,9; 23,9] 24,8 [23,1; 26,4] 26,8 [24,9; 28,7] 27,8 [25,7; 29,8] 27,8 [25,7; 29,8] (3 465) (2 791) (2 220) (1 719) (1 274) (857) (487) (207) (58) 55–64 aastat 11 563 60 37/63 31,6 689 5,8 [5,3; 6,2] 11,0 [10,3; 11,6] 14,1 [13,4; 14,8] 16,5 [15,7; 17,3] 18,0 [17,2; 18,9] 19,8 [18,8; 20,8] 21,0 [20,0; 22,1] 22,7 [21,3; 24,0] 24,6 [22,7; 26,5] (58–62) (9 247) (7 226) (5 607) (4 267) (3 056) (2 034) (1 122) (502) (134) 65–74 aastat 13 911 70 (67–72) 34/66 30,9 702 5,5 [5,1; 5,8] 9,4 [8,8; 9,9] 11,9 [11,3; 12,5] 13,8 [13,1; 14,5] 15,3 [14,6; 16,1] 16,5 [15,7; 17,3] 17,8 [16,9; 18,7] 18,6 [17,6; 19,6] 19,2 [18,0; 20,4] (11 175) (8 938) (7 103) (5 496) (4 027) (2 690) (1 588) (716) (212) 75–84 aastat 13 502 79 30/70 28,7 693 5,4 [5,0; 5,8] 8,5 [8,0; 9,0] 10,4 [9,8; 11,0] 11,6 [11,0; 12,2] 12,6 [12,0; 13,3] 13,3 [12,6; 14,0] 13,9 [13,1; 14,7] 14,6 [13,6; 15,5] 15,4 [14,0; 16,7] (77–81) (10 819) (8 793) (7 031) (5 403) (3 820) (2 392) (1 297) (528) (150) ≥ 85 aastat 2 187 87 (85–89) 22/78 27,2 518 3,8 [2,9; 4,6] 5,5 [4,4; 6,6] 6,0 [4,9; 7,2] 6,5 [5,2; 7,7] 6,6 [5,3; 7,9] 6,9 [5,5; 8,3] 8,3 [5,9; 10,7] (1 551) (1 141) (828) (563) (360) (214) (98) Sugu Mehed 15 038 68 100/0 29,7 703 6,8 [6,4; 7,2] 11,7 [11,1; 12,2] 14,5 [13,9; 15,1] 16,7 [16,0; 17,4] 18,1 [17,3; 18,8] 19,5 [18,7; 20,3] 20,9 [19,9; 21,8] 22,2 [21,0; 23,3] 23,7 [21,9; 25,4] (60–76) (11 819) (9 240) (7 226) (5 394) (3 815) (2 471) (1 374) (569) (159) Naised 30 396 70 (61–78) 0/100 30,5 732 5,1 [4,8; 5,3] 8,9 [8,6; 9,3] 11,3 [10,9; 11,7] 13,0 [12,5; 13,4] 14,4 [13,9; 14,9] 15,6 [15,1; 16,2] 16,7 [16,1; 17,3] 17,6 [16,9; 18,3] 18,3 [17,5; 19,1] (24 438) (19 649) (15 563) (12 054) (8 722) (5 716) (3 218) (1 416) (399) Kehamassiindeks ≤ 25 4 999 75 27/73 23,5 612 5,1 [4,5; 5,8] 8,7 [7,8; 9,6] 11,4 [10,3; 12,4] 12,8 [11,6; 14,0] 13,6 [12,4; 14,9] 14,8 [13,2; 16,3] Põlve (63–81) (3 694) (2 757) (1 957) (1 329) (697) (192) > 25–30 11 260 72 (63–79) 40/60 27,7 675 5,1 [4,7; 5,5] 9,2 [8,6; 9,8] 11,7 [11,0; 12,4] 13,5 [12,8; 14,3] 15,2 [14,2; 16,1] 16,4 [15,3; 17,5] (8 669) (6 502) (4 667) (3 109) (1 681) (465) > 30–35 9 633 69 35/65 32,1 658 5,6 [5,1; 6,1] 9,8 [9,2; 10,5] 12,2 [11,5; 13,0] 14,4 [13,5; 15,3] 15,8 [14,8; 16,7] 17,4 [16,2; 18,6] (61–77) (7 354) (5 526) (4 058) (2 679) (1 469) (373) > 35–40 4 903 66 (59–73) 28/72 37,0 604 5,6 [4,9; 6,2] 9,3 [8,4; 10,2] 11,8 [10,7; 12,8] 13,3 [12,1; 14,5] 15,4 [14,0; 16,9] 16,4 [14,7; 18,1] (3 747) (2 815) (1 982) (1 276) (707) (182) üle 40 2 811 64 21/79 43,0 543 6,0 [5,1; 6,9] 9,1 [7,9; 10,3] 11,0 [9,6; 12,3] 12,8 [11,3; 14,3] 14,0 [12,3; 15,7] 14,5 [12,7; 16,3] (58–70) (2 134) (1 615) (1 161) (778) (410) (98) Haiglad, kus on väike Haigla suurus* aastane patsientide arv 20 090 70 (61–78) 32/68 30,1 555 5,6 [5,3; 6,0] 9,8 [9,3; 10,2] 12,0 [11,5; 12,5] 13,6 [13,1; 14,2] 14,8 [14,2; 15,4] 15,7 [15,0; 16,3] 16,5 [15,8; 17,2] 17,2 [16,4; 18,1] 17,9 [16,8; 19,0] (15 858) (12 731) (10 088) (7 743) (5 499) (3 559) (1 964) (762) (162) Haiglad, kus keskmine 12 879 70 34/66 30,2 112 5,6 [5,2; 6,0] 9,6 [9,0; 10,1] 12,0 [11,4; 12,7] 14,0 [13,3; 14,7] 15,4 [14,6; 16,2] 16,8 [15,9; 17,7] 18,2 [17,2; 19,2] 18,7 [17,6; 19,8] 20,1 [18,4; 21,7] (61–77) aastane juhtumite arv (10 157) (7 971) (6 146) (4 648) (3 312) (2 092) (1 134) (565) (169) Haiglad, kus on suur aastane patsientide arv 11 522 69 (60–76) 34/66 30,1 33 5,6 [5,1; 6,0] 10,2 [9,6; 10,8] 13,2 [12,5; 13,9] 15,3 [14,5; 16,0] 17,1 [16,2; 17,9] 18,9 [18,0; 19,9] 20,5 [19,4; 21,6] 22,4 [21,1; 23,7] 23,3 [21,8; 24,8] (9 392) (7 424) (5 859) (4 466) (3 259) (2 214) (1 307) (578) (205) * Käesoleva aruande klassifikatsioonid põhinevad haiglate 2022. aasta kvaliteediaruannetel ja neis loetletud vastavatel põlveliigese revisioonilise artroplastika IQTIG kvaliteedinäitajatel. Põlveliigese revisiooniliste protseduuride puhul on madala juhtumite arvu klassifikatsiooni künnis kuni 20 juhtumit, keskmise juhtumite arvu klassifikatsiooni künnis on 21–50 juhtumit ja kõrge juhtumite arvu klassifikatsiooni künnis on üle 50 revisiooni aastas. Tabel 53 (jätkub) 144 EPRD 2024. aasta aruanne 145  5 Puusa- ja põlveliigese proteesimise 5.5 Elulemuse püsivus suundumused 5.5 Elulemuse suundumused välja arvatud väike tagasilöök koronaviiruse Planeeritud puusaliigese asendamine tsementeeritud Kumulatiivsed revisioonimäärad pärast ... pandeemia ajal. varrega EPRD on kogunud puusa- ja põlveliigese Tegevusaasta Arv 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat proteesimise andmeid üle 10 aasta. See ajavahemik Selle paranemise põhjused ja see, kas see peegeldab on piisavalt pikk, et anda vähemalt ülevaade lühi- ja põlveliigese endoproteesimise üldist arengut, vajavad 2012/13 949 2,2 [1,3; 3,2] (910) 2,5 [1,5; 3,6] (843) 3,0 [1,9; 4,1] (770) 3,5 [2,3; 4,7] (724) 3,8 [2,5; 5,1] (680) 4,0 [2,7; 5,2] (648) keskpikaajalistest CRR-trendidest. veel kinnitust. 2014 2 528 1,9 [1,4; 2,4] 2,3 [1,7; 2,8] 2,7 [2,1; 3,3] 3,0 [2,3; 3,7] 3,2 [2,5; 3,9] 3,4 [2,7; 4,2] (2 374) (2 236) (2 131) (2 036) (1 928) (1 816) Kui eelmistes jaotistes esitati CRR-id 2015 6 912 2,1 [1,8; 2,5] 2,5 [2,1; 2,9] 2,7 [2,4; 3,1] 3,1 [2,7; 3,6] 3,4 [2,9; 3,8] 3,6 [3,1; 4,0] operatsiooniaastate kaupa, siis käesolevas jaotises on Lühidalt: (6 497) (6 216) (5 988) (5 693) (5 386) (5 052) CRR-id loetletud esmase operatsiooni konkreetse 2016 10 389 2,2 [1,9; 2,4] 2,6 [2,3; 2,9] 2,8 [2,5; 3,1] 3,0 [2,7; 3,3] 3,2 [2,8; 3,5] 3,3 [2,9; 3,6] (9 781) (9 397) (9 019) (8 599) (8 093) (7 587) operatsiooniaasta järgi. Tabelis 54 ja tabelis 55 on • EPRD-s on puusaliigese endoproteesimise 2017 12 088 2,3 [2,0; 2,6] 2,7 [2,4; 3,0] 2,9 [2,6; 3,2] 3,0 [2,7; 3,3] 3,2 [2,9; 3,5] 3,5 [3,2; 3,9] esitatud CRR-i suundumused valikuliste puusaliigese tulemuste suundumused aja jooksul püsinud (11 461) (11 047) (10 610) (10 093) (9 495) (6 777) endoproteesimiste puhul, kus on kasutatud muutumatuna. 2018 12 651 2,3 [2,1; 2,6] 2,6 [2,3; 2,8] 2,8 [2,5; 3,1] 3,0 [2,7; 3,3] 3,3 [3,0; 3,6] tsementeerimata ja tsementeeritud varreid, (11 985) (11 556) (11 086) (10 530) (7 492) operatsiooniaasta kaupa. Puusaliigese • Seevastu standardse põlveliigese asendamise 2019 13 430 2,3 [2,1; 2,6] 2,7 [2,4; 2,9] 2,9 [2,6; 3,2] 3,1 [2,8; 3,4] endoproteesimise andmed ei näita veel selget tulemused on aja jooksul oluliselt paranenud. (12 698) (12 220) (11 681) (8 458) suundumust CRR-i vähenemise suunas. • Selle paranemise põhjused tuleb veel kindlaks 2020 12 756 2,5 [2,2; 2,8] 2,8 [2,5; 3,1] 3,1 [2,8; 3,4] (11 986) (11 560) (8 399) teha. 2021 13 925 2,5 [2,3; 2,8] 2,8 [2,5; 3,1] See on vastupidine põlveliigese (13 104) (9 554) 2022 16 079 2,5 [2,2; 2,7] (11 733) © EPRD aastaaruanne 2024 plastika andmed. Tabelites 56 ja 57 on esitatud Tabel 55: Kumulatiivsed revisioonimäärad valikuliste tsementeeritud varrega puusaliigese täielike proteesimiste puhul operatsiooni aasta järgi (p = 0,7) standardse TKA ja ühe kondüüli artroplastika andmed operatsiooni aasta järgi. Standardse TKA puhul on tulemused aja jooksul märkimisväärselt paranenud, Standardne TKA Kumulatiivsed revisioonimäärad pärast ... kusjuures Operatsiooni aasta Arv 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat Valikulised puusaliigese 2012/13 3 056 2,0 [1,5; 2,5] 3,9 [3,2; 4,6] 4,7 [4,0; 5,5] 5,1 [4,3; 5,9] 5,3 [4,5; 6,1] 5,4 [4,6; 6,3] asendused tsementeerimata Kumulatiivsed revisioonimäärad pärast ... (2 973) (2 724) (2 531) (2 414) (2 331) (2 257) vartega 2014 7 521 1,9 [1,6; 2,2] 3,3 [2,9; 3,7] 4,1 [3,6; 4,6] 4,6 [4,1; 5,0] 4,9 [4,4; 5,4] 5,3 [4,8; 5,8] Operatsiooniaasta Arv 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat (7 204) (6 843) (6 634) (6 463) (6 258) (6 055) 2015 23 138 2,2 [2,0; 2,3] 3,5 [3,3; 3,8] 4,3 [4,0; 4,5] 4,6 [4,3; 4,9] 4,9 [4,6; 5,2] 5,1 [4,9; 5,4] 2012/13 3 003 2,6 [2,0; 3,1] 3,3 [2,7; 3,9] 3,5 [2,8; 4,1] 3,8 [3,1; 4,4] 4,0 [3,3; 4,7] 4,2 [3,4; 4,9] (22 195) (21 331) (20 708) (20 129) (19 540) (18 825) (2 896) (2 670) (2 529) (2 435) (2 377) (2 319) 2016 37 869 1,9 [1,8; 2,1] 3,3 [3,1; 3,5] 3,9 [3,7; 4,1] 4,4 [4,2; 4,6] 4,6 [4,4; 4,9] 4,9 [4,7; 5,1] 2014 7 323 2,3 [2,0; 2,6] 3,0 [2,6; 3,4] 3,2 [2,8; 3,6] 3,5 [3,0; 3,9] 3,6 [3,2; 4,1] 3,8 [3,4; 4,2] (36 378) (35 184) (34 293) (33 370) (32 270) (31 146) (7 003) (6 769) (6 622) (6 477) (6 320) (6 128) 2017 45 586 1,9 [1,8; 2,1] 3,2 [3,1; 3,4] 3,8 [3,6; 4,0] 4,2 [4,0; 4,3] 4,5 [4,3; 4,6] 4,7 [4,5; 4,9] 2015 22 279 2,4 [2,2; 2,6] 2,8 [2,6; 3,0] 3,1 [2,9; 3,3] 3,3 [3,1; 3,6] 3,5 [3,3; 3,8] 3,7 [3,5; 4,0] (44 162) (42 903) (41 835) (40 700) (39 436) (28 334) (21 364) (20 729) (20 237) (19 793) (19 316) (18 726) 2018 48 950 1,8 [1,7; 1,9] 2,9 [2,7; 3,0] 3,5 [3,3; 3,6] 3,9 [3,7; 4,1] 4,2 [4,0; 4,4] 2016 38 067 2,7 [2,5; 2,8] 3,2 [3,0; 3,3] 3,4 [3,3; 3,6] 3,6 [3,4; 3,8] 3,8 [3,6; 3,9] 3,9 [3,7; 4,1] (47 509) (46 252) (45 006) (43 704) (32 035) (36 238) (35 394) (34 668) (33 916) (33 074) (32 146) 2019 51 216 1,8 [1,7; 1,9] 2,9 [2,8; 3,1] 3,5 [3,4; 3,7] 4,0 [3,8; 4,1] 2017 44 828 2,8 [2,6; 2,9] 3,1 [3,0; 3,3] 3,4 [3,3; 3,6] 3,6 [3,4; 3,8] 3,8 [3,6; 3,9] 3,9 [3,8; 4,1] (49 783) (48 403) (47 197) (34 529) (42 971) (42 140) (41 296) (40 332) (39 314) (28 761) 2020 47 409 2,0 [1,9; 2,1] 3,1 [3,0; 3,3] 3,8 [3,7; 4,0] 2018 48 695 2,6 [2,5; 2,8] 3,1 [2,9; 3,2] 3,3 [3,1; 3,4] 3,5 [3,3; 3,6] 3,6 [3,5; 3,8] (46 809) (45 872) (44 920) (43 920) (32 331) (45 896) (44 722) (32 478) 2019 51 749 2,8 [2,6; 2,9] 3,2 [3,0; 3,3] 3,4 [3,2; 3,6] 3,6 [3,4; 3,8] 2021 49 973 1,8 [1,7; 1,9] 3,0 [2,9; 3,2] (49 751) (48 708) (47 785) (35 244) (48 536) (34 262) 2020 48 529 2,9 [2,8; 3,1] 3,3 [3,1; 3,4] 3,6 [3,4; 3,7] 2022 59 318 1,8 [1,7; 1,9] (46 526) (45 717) (33 671) (43 329) © EPRD aastaaruanne 2024 2021 51 563 2,8 [2,7; 3,0] 3,2 [3,0; 3,3] (49 460) (36 036) Tabel 56: Standardse põlveliigese täieliku proteesimise kumulatiivsed korduvoperatsioonide määrad operatsiooni aasta järgi (p < 0,0001) 2022 58 224 2,8 [2,7; 2,9] (42 484) © EPRD aastaaruanne 2024 Tabel 54: Tsementeerimata varrega valikuliste puusaliigese täielike proteeside kumulatiivsed revisioonimäärad operatsiooni aasta järgi (p = 0,2) 146 EPRD aastaaruanne 2024 147  5 Puusa- ja põlveliigese proteeside püsivus 5,5 Elulemuse suundumused Ühe kondüüliga Kumulatiivsed revisioonimäärad pärast ... Revisioonide koormus kui alternatiivne tulemuste suundumuste mõõdik põlveliigese proteesid Operatsiooni aasta Arv 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 2012/13 409 2,9 [1,3; 4,6] 5,2 [3,0; 7,3] 6,0 [3,6; 8,3] 7,0 [4,5; 9,5] 8,4 [5,6; 11,2] 8,7 [5,9; 11,5] Kirjanduses viitab korduvoperatsioonide koormus liigeseproteesiregistrite mõjule artroplastikaoperatsioonide tulemuste (396) (370) (351) (342) (329) (325) parandamisel [8]. Kas viimaste aastate korduvoperatsioonide arvu vähenemine on püsiv trend või tuleneb see lihtsalt ajutisest esmaste 2014 962 2,8 [1,8; 3,9] 4,6 [3,2; 5,9] 5,1 [3,7; 6,5] 6,4 [4,9; 8,0] 6,8 [5,2; 8,4] 7,5 [5,8; 9,2] (910) (881) (858) (828) (811) (788) artroplastikaoperatsioonide arvu suurenemisest, mida nimetatakse „järelejõudmise efektiks“ [8]. See iga-aastane korduvoperatsioonide koormus, mis väljendatakse korduvoperatsioonide arvu osakaaluna kõigist artroplastikaoperatsioonidest [8]. 2015 2 467 3,2 [2,5; 3,9] 5.3 [4,4; 6,2] 6,5 [5,6; 7,5] 7,8 [6,8; 8,9] 8,4 [7,2; 9,5] 9,0 [7,9; 10,2] (2 351) (2 247) (2 185) (2 128) (2 076) (2 016) kogu artroplastika mahust mis tahes 2016 5 128 3,5 [3,0; 4,0] 5,4 [4,8; 6,0] 6,2 [5,5; 6,9] 7,1 [6,4; 7,8] 7,6 [6,9; 8,4] 8,5 [7,7; 9,3] kõnealusel aastal. Selliste muutuste põhjus(ed) Revisjonikalkulatsioonide koormus peab samuti hõlmama (4 858) (4 684) (4 582) (4 471) (4 341) (4 216) 2017 6501 3,0 [2,6; 3,4] 5,0 [4,4; 5,5] 6,0 [5,5; 6,6] 6,7 [6,1; 7,3] 7,3 [6,6; 7,9] 8,0 [7,3; 8,6] Tulemuste erinevusi ei saa seetõttu seostada konkreetse menetluste ja määratluste võrreldavust. (6 244) (6 049) (5 892) (5 761) (5 631) (4 057) 2018 7 316 2,9 [2,5; 3,3] 4,6 [4,1; 5,1] 5,6 [5,1; 6,1] 6,4 [5,9; 7,0] 7,2 [6,6; 7,7] aastas. Aastase koormuse suurenemine või vähenemine Näiteks EPRD registreerib ainult neid reoperatsioone, mille käigus vahetatakse (7 025) (6 833) (6 672) (6 526) (4 832) implantaati. See tähendab, et reoperatsioonid võivad kajastada ka sel aastal tehtud esmaste artroplastikate arvu muutust. Näiteks 2019 8 036 2,7 [2,3; 3,0] 4,4 [3,9; 4,8] 5,6 [5,1; 6,1] 6,3 [5,8; 6,9] hematoomi eemaldamiseks tehtud reoperatsioone ei (7 755) (7 529) (7 350) (5 307) registreeritud. 2020 7 725 2,9 [2,5; 3,3] 4,9 [4,4; 5,4] 5,9 [5,3; 6,4] EPRD-s jäi revisioonide koormus suhteliselt (7 450) (7 234) (5 295) püsis 10,3–10,5% vahemikus pärast 2014–2019. aasta katseperioodi, Tabelis 59 on loetletud tulemused, mis saadi, kui koormus 2021 8 047 2,6 [2,3; 3,0] 4,3 [3,8; 4,7] muudatuse suurus määratakse kindlaks Saksamaa Liitvabariigi (7 767) (5 602) Statistikaameti 2022 9 468 2,8 [2,4; 3,1] (6 873) Saksamaa Liitvabariigi Statistikaameti andmetel OPS-ravi koodide 5–820 („Endoproteesi implanteerimine puusaliigesesse”) 5-821 („Lõualuu endoproteesi kontroll, asendamine ja eemaldamine”) © EPRD aastaaruanne 2024 või edasi lükatud. Veel tuleb kindlaks teha, kas sis"), 5-822 ("Endoproteesi paigaldamine Tabel 57: Ühe kondüüli põlveliigese proteesimise kumulatiivsed korrigeerimismäärad operatsiooni aasta järgi (p = 0,2) Aasta 2012/3 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Kokku 12,1 % 10,4 % 10,5 % 10,4 % 10,4 % 10,3 % 10,5 % 10,9 % 10,5 % 9,6 % 9,3 % Muudatuste koormus Ainult puusaliigese proteesimine 12,5 10,3 10,5 10,5 10,6 10,2% 10,3% 10,5% 10,2% 9,5% 9,2 Ainult põlveliigese proteesimine 11,6 10,4 10,6 10,2 10,3 10,1% 10,5% 11,1% 10,9% 9,7% 9,3% © EPRD aastaaruanne 2024 Tabel 58: Revisjonide koormus EPRD andmestike põhjal (st revisjonid protsendina kõigist antud aastal registreeritud protseduuridest) Aasta 2012/3 2014 2015 2016 2017 2018 2019 2020 2021 2022 Kokku 14,6% 13,9% 13,0% 12,6% 12,5% 12,4% 12,4% 12,3% 12,0% 10,9 Muudatuste Ainult puus koormus 14,7 13,9 13,4% 13,2% 13,2% 13,0% 12,8% 12,6% 12,2% 11,4% artroplastikad Ainult põlve 14,4 14,0 12,5 11,7% 11,6% 11,6% 11,8% 11,9% 11,6% 10,4% artroplastikad © EPRD aastaaruanne 2024 7 Tabel 59: Revisjonide koormus Saksamaa Liitvabariigi Statistikaameti koguarvude põhjal 7 kättesaadav aadressil https://www-genesis.destatis.de, kood 23141-0102 [„Staatsionaarsetele patsientidele tehtud operatsioonid ja protseduurid: Saksamaa, aastad, sugu, vanuserühmad, operatsioonid ja protseduurid (1–4-kohaline hierarhia)” [Tähendab „Staatsionaarsete patsientide operatsioonid ja protseduurid: Saksamaal, aasta, sugu, vanuserühm, operatsioonid ja protseduurid (1–4-kohaline hierarhia)”] 148 EPRD aastaaruanne 2024 149  5 Puusa- ja põlveliigese proteesimise elulemus põlveliiges") ja 5-823 ("Põlveliigese endoproteesi kontroll, asendamine ja eemaldamine"), kus koodide 5-820 ja 5-822 esinemissagedust käsitletakse esmaste artroplastikate koguarvuna ning koodide 5-821 ja 5-823 esinemissagedust kordusoperatsioonidena. (Ingliskeelsed OPS-koodide kirjeldused pärinevad veebilehelt https://gesund.bund.de/en/ops-code-search). Need tulemused erinevad (mõnel juhul märkimisväärselt) varem EPRD dokumentatsiooni alusel kindlaks määratud revisioonide koormusest, kuid näitavad pidevat langustrendi. Siiski tuleks märkida, et: • reoperatsioone, mille käigus komponendid jäävad paigale, ei klassifitseerita/kategooriseerita revisioonideks; • üksikuid ravikoode ei ole alati võimalik selgelt seostada esmaste protseduuridega; • ühe protseduuri jaoks võib kasutada mitut OPS-koodi; • OPS-koodid võivad samuti muutuda, mis võib mõjutada nende koodide alusel arvutatud raviarveid. Näiteks põlveliigese pindmise kihi asendamine võib toimuda samaaegselt esmase artroplastikaga või hiljem eraldi protseduurina. Alates 2015. aastast ei võimalda raviarvud enam neid kahte protseduuri eristada, kuna esmasele patella pinna taastamisele on samuti omistatud kood 5-822.8. Need koodimuudatused on juba toonud kaasa 5-822-ga algavate koodide arvu suurenemise ja seega, eespool esitatud määratluse kohaselt, revisioonide koormuse vähenemise. Revisioonide arv on liigeseasendamise suundumuste hindamisel piiratud kasulikkusega. CRR-näitajate võrdlemine aja jooksul on ehk usaldusväärsem alternatiiv (vt tabelid 54–57). 150 EPRD aastaaruanne 2024 6 Patsientide suremus  Suremus ... 6 Patsientide suremus Protseduuri liik Planeeritud puusaliigese Arv Vanus m/n [%] 3 kuud 0,3 6 kuud 0,5 12 kuud 1,0 24 kuud 2,1 36 kuud 3,5 60 kuud 7,3 asendamine tsementeerimata 420 224 67 41/59 [0,3; 0,3] [0,5; 0,6] [0,9; 1,0] [2,1; 2,2] [3,5; 3,6] [7,2; 7,4] varrega (404 776) (388 578) (355 022) (292 977) (239 527) (137 522) Valikulised tsementeeritud 1,2 1,9 3,2 6,2 9,8 19,0 varrega puusaliigese proteesid 115 036 79 25/75 [1,1; 1,2] [1,8; 2,0] [3,1; 3,3] [6,1; 6,4] [9,6; 10,0] [18,7; 19,3] (109 392) (104 111) (94 589) (76 466) (61 286) (34 071) 6,2 8,6 12,2 18,5 25,3 38,4 Mittevalikulised puusaliigese 34 964 76 30/70 [5,9; 6,4] [8,3; 8,9] [11,8; 12,6] [18,1; 18,9] [24,8; 25,9] [37,7; 39,1] asendused (31 673) (29 656) (26 018) (19 817) (14 523) (6 818) Kord aastas saab EPRD osalevatelt föderaalse iga tabeli rida koos EPRD-patsientide kumulatiivse Esmased artroplastikad 17,9 24,0 31,5 43,6 54,6 71,5 tervisekindlustusfondide liitudelt otse teavet suremusmääraga.9 Poolartroplastikad 73 215 84 29/71 [17,6; 18,2] [23,7; 24,4] [31,2; 31,9] [43,2; 44,0] [54,2; 55,0] [71,0; 71,9] (58 014) (51 485) (42 095) (28 098) (17 931) (6 377) osalevate patsientide elusoleku kohta. See piirdub aga teabega selle kohta, kas patsient on veel elus või Nende suremusnäitajate võrdlus näitab järgmist: 0,3 0,4 0,9 2,1 3,8 8,3 surnud ning millisel kuul surm aset leidis. Surma Standardne põlveliigese 424 357 70 35/65 [0,2; 0,3] [0,4; 0,5] [0,8; 0,9] [2,1; 2,2] [3,7; 3,8] [8,2; 8,4] asendus (408 108) (390 794) (354 514) (291 598) (239 568) (138 005) põhjus ei kuulu selle teabe hulka. • EPRD andmetel on plaaniliste tsementimata varrega puusaliigese endoproteesimise, standardse Piiratud TKA-d 19 949 74 24/76 1,2 2,0 3,4 6,5 10,2 19,4 Järgnevates patsientide suremustabelites ei pruugi [1,0; 1,3] [1,8; 2,2] [3,1; 3,6] [6,1; 6,9] [9,7; 10,7] [18,6; 20,1] põlveliigese endoproteesimise ja osalise põlveliigese (19 027) (18 070) (16 380) (13 205) (10 588) (5 768) seega liigeseproteesi operatsioon ja vastava patsiendi proteesimise puhul patsientide suremusmärgid surm olla omavahel seotud. Nagu on märgitud 5. 0,1 0,2 0,4 1,1 2,0 4,4 märkimisväärselt madalamad kui Saksamaa Ühe kondüüliga 63 758 63 45/55 peatükis, sõltub ravi valik sageli patsiendi füüsilisest põlveliigese proteesid [0,1; 0,1] [0,2; 0,2] [0,4; 0,5] [1,0; 1,2] [1,9; 2,1] [4,2; 4,7] Liitvabariigi Statistikaameti vastavate (61 362) (58 799) (53 170) (43 476) (35 247) (19 463) seisundist. Seetõttu tuleb tulemuste tõlgendamisel vanuserühmade võrreldavad näitajad. See viitab arvestada teataval määral patsientide valikuga. 0,0 0,1 0,4 0,7 0,9 2,6 sellele, et arstid teostavad neid protseduure Põlveliigese proteesimine 1 026 55 26/74 [0,0; 0,0] [0,0; 0,3] [0,0; 0,9] [0,1; 1,3] [0,2; 1,5] [1,1; 4,0] tervemate patsientide puhul. Teiste riikide andmed (987) (944) (857) (710) (558) (320) Tabelis 60 on esitatud liigeseproteesiga patsientide näitavad samuti, et osteoartriidiga patsientidel on Puusa liigese kumulatiivsed suremusnäitajad erinevatel ajahetkedel8 suremus madalam kui elanikkonnal üldiselt [9, 10]. asendamine, aseptiline, 4,3 5,9 8,1 12,3 16,6 26,1 40 065 77 34/66 kuni viie aasta jooksul pärast esmast või koos luukinnitustega [4,1; 4,5] (37 067) [5,7; 6,1] (35 277) [7,8; 8,4] (32 157) [11,9; 12,6] (26 278) [16,2; 17,0] (21 045) [25,5; 26,6] (11 788) kordusoperatsiooni. Neid kokkuvõtlikke väärtusi saab komponentide otseselt võrrelda vaid väga piiratud ulatuses, kuna • EPRD-põlveliigese proteesimise patsientidel on vahetamisega suremusmäär veidi madalam kui puusaliigese Puusa liigese revisioonid, mitme patsientide rühma keskmine vanus erineb juba 2,5 3,8 5,7 8,9 12,6 19,6 proteesimise patsientidel. EPRD-suremusmäär ühe aseptilised, ilma 8 833 75 36/64 praegusel ajahetkel märkimisväärselt. luukinnitustega [2,2; 2,9] [3,4; 4,2] [5,2; 6,2] [8,3; 9,5] [11,8; 13,4] [18,5; 20,6] kondüüli proteesimise järel oli sarnase vanusega (8 320) (7 944) (7 295) (6 025) (4 827) (2 713) komponentide patsientidel tavapäraste täispõlveliigese vahetamiseta Parema võrreldavuse tagamiseks on tabelis 61 ja proteesimistega võrreldes isegi madalam. Seda Puusaliigese tabelis 62 esitatud eraldi 1-aastased suremusnäitajad suundumust kinnitab ka sõltumatu süstemaatiline korduvoperatsioonid, 4,4 6,4 8,5 12,5 17,0 26,5 10 175 73 47/53 erinevate vanuserühmade meeste ja naiste kohta. ülevaade [11]. septilised, koos [4,0; 4,8] (9 471) [5,9; 6,8] (8 999) [8,0; 9,1] (8 212) [11,8; 13,2] (6 786) [16,2; 17,8] (5 440) [25,4; 27,5] (2 982) Saksamaa elanikkonna erinevate vanuserühmade luukinnitustega komponentide suremusnäitajad, mis pärinevad Saksamaa Liitvabariigi Statistikaametilt, on esitatud esile • EPRD-patsientide suremus, kellel tehti vahetamisega puusaliigese artroplastika puusatrauma operatsiooni Puusa liigese revisioonid, tõstetud keskel septilised, ilma 9,8 13,5 16,6 21,3 25,5 36,2 Revisioonid raames, on eriti kõrge. Hemiarthroplastika puhul on 5 581 75 42/58 [9,0; 10,5] [12,6; 14,4] [15,6; 17,6] [20,1; 22,4] [24,2; 26,8] [34,4; 37,8] luukinnitustega (4 833) (4 434) (3 846) (2 960) (2 205) (989) suremus kõige kõrgem. Isegi nooremates komponentide vahetamiseta 8 Surma kuupäev on tegeliku surma kuupäeva ligikaudne väärtus, mille täpsus on vanuserühmades on 1-aastane suremus üle 20%. Põlve korduvoperatsioonid, kuni 2 nädalat (vt selgitust 3. peatükis). aseptilised, koos 1,0 1,5 2,4 4,5 6,8 12,6 luukinnitusega 29 783 70 32/68 [0,9; 1,1] [1,4; 1,7] [2,2; 2,6] [4,2; 4,7] [6,4; 7,1] [12,1; 13,1] (28 520) (27 364) (25 221) (21 121) (17 243) (9 938) komponentidega 9 Suremustabelid saab alla laadida aadressilt https://www.destatis.de/ DE/Themen/Gesellschaft-Umwelt/Bevoelkerung/Sterbefaelle-Leb- Põlveliigese enserwartung/Tabellen/_tabellen-innen-lebenserwartung-ster-betafel.html korduvoperatsioonid, 0,4 0,8 1,5 3,2 5,0 9,4 13 182 69 35/65 [0,3; 0,5] [0,6; 0,9] [1,3; 1,7] [2,8; 3,5] [4,6; 5,4] [8,8; 10,1] aseptilised, ilma (12 676) (12 077) (11 071) (9 228) (7 473) (4 281) luukinnitustega komponentide vahetamiseta Põlveliigese revisioonid, septilised, koos 1,8 2,7 4,5 7,8 11,7 20,6 7 078 71 47/53 [1,4; 2,1] [2,3; 3,1] [4,0; 5,0] [7,1; 8,4] [10,9; 12,5] [19,4; 21,8] luukinnitustega (6 750) (6 454) (5 942) (4 970) (4 052) (2 309) komponentide vahetamisega © EPRD aastaaruanne 2024 Põlveliigese revisioonid, septilised, Tabel 60: ilma suremuse näitajate Patsientide kokkuvõte 73 3, 6, 12,49/51 24, 36 ja 60 kuud 6,6 liigeseproteesimist 5,0 pärast esmast 9,3 13,9 või korduvoperatsiooni 18,3 27,2 3 893 [4,3; 5,7] [5,8; 7,4] [8,4; 10,3] [12,7; 15,1] [16,9; 19,7] [25,4; 29,0] luukinnitustega (3 544) (3 318) (2 973) (2 322) (1 754) (868) komponentide vahetamiseta 152 EPRD aastaaruanne 2024 153  6 Patsientide suremus Meessoost patsiendid 1-aastane suremus väljendatuna protsendina vanuserühmast ... Naispatsiendid 1-aastane suremus väljendatuna protsendina vanuserühmast ... Protseduuri liik ≤ 54 55–59 60–64 65–69 70–74 75–79 80–84 ≥ 85 Protseduuri liik ≤ 54 55–59 60–64 65–69 70–74 75–79 80–84 ≥ 85 Planeeritud puusaliigese 0,45 0,58 0,71 1,05 1,17 2,15 3,85 6,29 Planeeritud puusaliigese 0,24 0,27 0,39 0,46 0,69 1,09 2,02 4,32 asendamine tsementeerimata [0,36; 0,53] [0,48; 0,68] [0,61; 0,81] [0,93; 1,18] [1,03; 1,30] [1,95; 2,35] [3,49; 4,22] [5,37; 7,21] asendamine tsementeerimata [0,18; 0,30] [0,20; 0,33] [0,33; 0,46] [0,39; 0,52] [0,61; 0,77] [0,98; 1,19] [1,83; 2,22] [3,76; 4,88] (23 085) (19,965) (24,454) (23,677) (21,515) (19,101) (9,449) (2,259) (23 705) (23 196) (32 743) (37 966) (37 269) (34 374) (17 889) (4 375) varrega varrega Valikulised tsementeeritud varrega 3,40 5,80 5,94 5,98 3,96 3,81 4,50 7,59 Valikulised tsementeeritud varrega 6,80 6,13 3,65 2,43 1,57 1,87 2,47 5,31 puusaliigese proteesid [1,92; 4,86] [3,86; 7,70] [4,25; 7,59] [4,70; 7,24] [3,30; 4,61] [3,38; 4,24] [4,05; 4,94] [6,73; 8,45] puusaliigese proteesid [4,29; 9,25] [4,24; 7,98] [2,72; 4,57] [1,96; 2,90] [1,34; 1,79] [1,69; 2,04] [2,28; 2,66] [4,91; 5,72] (523) (493) (651) (1,165) (3,042) (6,956) (7,294) (2,972) (337) (542) (1 396) (3 666) (10 351) (22 038) (23 238) (9 925) 6,49 7,89 10,70 10,08 10,96 15,40 20,58 35,89 5,32 4,86 5,50 5,46 5,76 7,09 12,12 25,29 Mittevalikulised puusaliigese [4,28; 8,64] [5,79; 9,95] [8,82; 12,53] [8,49; 11,64] [9,34; 12,54] [13,72; 17,05] [18,61; 22,50] [33,26; 38,41] Mittevalikulised puusaliigese [3,22; 7,38] [3,44; 6,25] [4,41; 6,59] [4,61; 6,30] [4,99; 6,52] [6,39; 7,79] [11,17; 13,06] [23,91; 26,64] asendused (428) (544) (851) (1,117) (1,150) (1,408) (1,193) (768) asendused (393) (778) (1 425) (2 322) (3 015) (4 374) (3 634) (2 618) 24,21 23,54 29,44 31,77 31,73 34,20 38,34 48,60 26,28 26,45 27,38 22,87 21,87 20,26 21,55 33,54 Esmased artroplastikad Esmased artroplastikad Poolartroplastikad [17,09; 30,72] [17,45; 29,17] [24,93; 33,67] [28,34; 35,04] [29,32; 34,05] [32,50; 35,86] [37,02; 39,63] [47,52; 49,65] Poolartroplastikad [18,49; 33,33] [20,19; 32,23] [23,12; 31,40] [20,05; 25,58] [20,11; 23,60] [19,25; 21,26] [20,86; 22,24] [32,96; 34,11] (108) (135) (265) (455) (896) (1,836) (2,884) (3,809) (92) (144) (284) (612) (1 498) (4 510) (9 460) (15 107) 0,37 0,44 0,55 0,83 1,18 1,76 3,02 4,80 0,14 0,21 0,35 0,40 0,54 0,87 1,35 2,31 Standardne TKA [0,25; 0,49] [0,33; 0,54] [0,45; 0,65] [0,71; 0,96] [1,04; 1,32] [1,59; 1,92] [2,74; 3,30] [4,08; 5,51] Standardne põlveliigese asendus [0,09; 0,20] [0,15; 0,27] [0,29; 0,41] [0,34; 0,46] [0,48; 0,61] [0,78; 0,95] [1,22; 1,47] [1,98; 2,65] (9,145) (13,675) (20,333) (19,188) (21,244) (22,365) (12,623) (2,917) (16 233) (22 498) (32 105) (37 482) (42 223) (46 974) (28 733) (6 776) 1,87 1,27 1,61 2,76 3,26 4,68 6,82 9,53 1,38 1,18 1,09 1,67 2,36 2,62 4,31 9,69 Piiratud TKA-d [0,49; 3,23] [0,16; 2,37] [0,56; 2,64] [1,46; 4,05] [1,91; 4,59] [3,23; 6,11] [4,91; 8,68] [6,04; 12,89] Piiratud TKA-d [0,48; 2,27] [0,45; 1,90] [0,52; 1,66] [1,06; 2,27] [1,73; 2,98] [2,04; 3,18] [3,59; 5,03] [8,09; 11,27] (335) (366) (490) (542) (591) (741) (598) (234) (613) (734) (1 118) (1 543) (2 044) (2 709) (2 661) (1 061) Ühe kondüüli 0,32 0,34 0,28 0,76 0,87 0,96 1,87 3,32 Ühe kondüüliga 0,09 0,11 0,18 0,22 0,33 0,66 0,85 0,97 põlveliigese proteesid [0,14; 0,51] [0,19; 0,50] [0,14; 0,42] [0,49; 1,04] [0,55; 1,18] [0,60; 1,31] [1,14; 2,60] [1,16; 5,44] põlveliigese proteesid [0,01; 0,18] [0,02; 0,20] [0,07; 0,29] [0,09; 0,34] [0,16; 0,50] [0,39; 0,92] [0,42; 1,27] [0,02; 1,92] (3,492) (4,589) (5,065) (3,434) (3,023) (2,653) (1,170) (243) (5 058) (4 941) (5 298) (4 626) (4 160) (3 459) (1 616) (343) Põlveliigese proteesimine 0,00 0,00 0,00 0,00 12,50 0,00 0,00 0,00 Põlveliigese proteesimine 0,00 0,00 0,95 0,00 0,00 3,33 7,14 0,00 (107) (57) (24) (19) [0,00; 32,66] (10) (3) (6) (326) (106) [0,00; 2,79] (28) (20) [0,00; 9,55] [0,00; 19,70] (3) (7) (99) (29) (13) Vastavad DESTATISi näitajad Vastavad DESTATISi arvud ≤0,50 0,57 – 0,87 0,98 – 1,45 1,59 – 2,23 2,39 – 3,26 3,26 – 5,01 5,74 – 9,00 >10,29 < 0,28 0,30 – 0,46 0,52 – 0,76 0,83 – 1,19 1,30 – 1,88 2,12 – 3,20 3,67 – 6,35 > 7,46 Puusa liigese asendamine, 0,75 1,47 2,40 4,68 5,72 7,40 12,17 28,42 Puusa liigese 0,77 1,13 1,68 2,80 3,25 4,69 8,00 22,06 aseptiline, koos [0,23; 1,26] [0,70; 2,24] [1,55; 3,24] [3,58; 5,76] [4,64; 6,78] [6,38; 8,40] [10,87; 13,46] [26,13; 30,64] korduvoperatsioonid, [0,29; 1,25] [0,54; 1,72] [1,08; 2,27] [2,13; 3,45] [2,63; 3,87] [4,10; 5,28] [7,28; 8,72] [20,87; 23,23] (998) (871) (1,131) (1,278) (1,547) (2,238) (1,955) (973) (1 191) (1 124) (1 642) (2 132) (2 725) (4 488) (4 602) (3 262) luukinnitustega komponentide aseptilised, koos vahetamisega luukinnitustega komponentide Puusa liigese revisioonid, vahetamisega aseptilised, ilma 2,27 0,77 2,14 2,70 4,80 5,42 9,15 28,70 Puusa liigese revisioonid, [0,46; 4,04] [0,00; 1,83] [0,56; 3,70] [1,03; 4,34] [2,90; 6,65] [3,66; 7,15] [6,56; 11,67] [22,32; 34,55] luukinnitustega (246) (232) (304) (335) (445) (569) (395) (141) aseptilised, ilma 1,36 1,85 2,63 2,80 2,15 2,93 7,58 19,43 [0,17; 2,53] [0,37; 3,30] [1,08; 4,15] [1,39; 4,20] [1,13; 3,16] [1,95; 3,89] [5,98; 9,16] [16,26; 22,48] komponentide luukinnitustega (348) (298) (378) (481) (713) (1 065) (900) (445) vahetamiseta komponentide Puusa liigese revisioonid, vahetamiseta 1,70 2,32 2,38 5,17 3,92 6,93 11,97 32,49 septilised, koos [0,53; 2,87] [0,89; 3,73] [1,09; 3,65] [3,41; 6,90] [2,43; 5,38] [5,18; 8,65] [9,53; 14,34] [26,91; 37,65] Puusa liigese revisioonid, 0,59 3,87 2,14 3,45 5,91 9,40 14,86 27,17 (445) (385) (502) (546) (594) (722) (569) (175) luukinnitustega komponentide septilised, koos [0,00; 1,40] [1,60; 6,09] [0,82; 3,45] [1,95; 4,92] [4,25; 7,54] [7,67; 11,10] [12,62; 17,05] [23,54; 30,62] (308) (255) (409) (501) (689) (960) (754) (398) vahetamisega luukinnitustega komponentide Puusa liigese revisioonid, vahetamisega septilised, ilma 4,32 5,78 6,09 9,79 8,13 13,50 26,55 43,85 Puusa liigese revisioonid, [1,13; 7,40] [2,22; 9,20] [3,15; 8,95] [6,33; 13,12] [5,01; 11,14] [10,04; 16,82] [22,04; 30,80] [36,83; 50,09] luukinnitustega (143) (143) (217) (237) (250) (315) (253) (107) septilised, ilma luukinnitustega 2,63 7,20 4,53 6,83 10,81 13,04 22,93 39,09 Revisioonid [0,05; 5,14] [3,19; 11,05] [1,73; 7,25] [3,89; 9,68] [7,77; 13,75] [10,31; 15,69] [19,65; 26,08] [34,88; 43,03] komponentide vahetamiseta komponentide vahetamiseta Revisioonid (129) (135) (181) (239) (316) (459) (438) (284) Põlveliigese revisioonid, 0,48 0,74 0,76 1,61 1,44 2,69 4,91 15,93 aseptilised, koos [0,01; 0,94] [0,23; 1,25] [0,31; 1,20] [0,94; 2,27] [0,83; 2,05] [1,88; 3,51] [3,54; 6,26] [11,81; 19,87] Põlveliigese asendamine, 0,24 0,25 0,35 0,67 1,49 2,08 4,88 15,69 (809) (994) (1,309) (1,237) (1,332) (1,404) (839) (244) luukinnitustega aseptiline, koos [0,00; 0,47] [0,03; 0,48] [0,11; 0,58] [0,35; 0,99] [1,06; 1,92] [1,60; 2,55] [4,03; 5,73] [13,67; 17,67] (1 603) (1 828) (2 240) (2 368) (2 760) (3 171) (2 119) (964) komponentide vahetamisega luukinnitustega Põlveliigese komponentide vahetamisega korduvoperatsioonid, 0,24 1,25 0,58 2,10 2,11 2,78 3,40 5,93 Põlveliigese [0,00; 0,71] [0,32; 2,16] [0,01; 1,15] [0,96; 3,22] [1,01; 3,19] [1,60; 3,94] [1,63; 5,13] [1,57; 10,10] aseptilised, ilma (412) (507) (622) (556) (587) (686) (367) (101) korduvoperatsioonid, 0,75 0,35 0,39 0,42 0,98 1,44 3,24 8,64 [0,15; 1,35] [0,00; 0,74] [0,01; 0,77] [0,05; 0,78] [0,45; 1,51] [0,84; 2,04] [2,07; 4,40] [5,11; 12,04] luukinnitustega aseptilised, ilma (734) (789) (980) (1 088) (1 242) (1 403) (784) (213) komponentide vahetamiseta luukinnitustega komponentide Põlveliigese revisioonid, vahetamiseta 2,51 2,95 2,40 2,13 6,08 6,16 9,15 13,30 septilised, koos [0,66; 4,34] [1,13; 4,74] [0,92; 3,85] [0,81; 3,44] [3,98; 8,14] [4,21; 8,06] [6,21; 11,99] [6,98; 19,19] Põlveliigese revisioonid, 1,97 1,31 0,25 2,05 2,51 5,88 7,17 14,55 (260) (297) (369) (425) (440) (541) (326) (94) luukinnitustega komponentide septilised, koos [0,24; 3,66] [0,03; 2,57] [0,00; 0,73] [0,84; 3,24] [1,25; 3,76] [4,09; 7,63] [4,97; 9,31] [9,82; 19,02] (238) (273) (399) (495) (534) (607) (462) (182) vahetamisega luukinnitustega komponentide Põlveliigese revisioonid, vahetamisega septilised, ilma 3,23 3,36 3,66 5,18 8,89 8,14 21,83 32,51 Põlveliigese revisioonid, [0,06; 6,30] [0,41; 6,23] [1,28; 5,99] [2,39; 7,89] [5,49; 12,16] [5,25; 10,94] [16,72; 26,62] [22,65; 41,11] luukinnitustega (112) (130) (211) (210) (235) (295) (183) (60) septilised, ilma 2,20 3,10 3,42 5,48 3,88 9,53 14,30 24,62 [0,00; 4,64] [0,05; 6,06] [0,90; 5,87] [2,53; 8,34] [1,49; 6,21] [6,55; 12,40] [10,75; 17,71] [17,37; 31,23] komponentide luukinnitustega (122) (109) (168) (201) (211) (322) (304) (100) vahetamiseta komponentide vahetamiseta © EPRD 2024. aasta aruanne © EPRD aastaaruanne 2024  6 Patsientide suremus Tabel 61: Meespatsientide 1-aastane suremusprotsent liigeseproteesimise järel vanuserühmade ja proteesimise tüübi kaupa Tabel 62: Naispatsientide 1-aastane artroplastika suremus vanuserühmade ja artroplastika tüübi järgi 154 EPRD 2024. aasta aruanne 155  6 Patsientide suremus • Suremus ei suurene vanusega ühtmoodi erinevate • Huvitaval kombel on suremus kõrgem septiliste liigeseendoproteeside puhul. Näiteks tsementeeritud reoperatsioonide puhul, kui luusse kinnitatud varrega plaaniliste puusaliigese endoproteesimiste komponendid jäetakse paigale, samas kui aseptiliste puhul on 75–79-aastaste patsientide 1-aastane reoperatsioonide puhul on olukord vastupidine. See suremus märkimisväärselt madalam võrreldes 20 võib viidata sellele, et tervislikult halvemas seisundis aastat nooremate patsientidega. See on arvatavasti olevatel patsientidel tehakse pigem vähem invasiivseid tingitud patsientide valikust: nooremate patsientide protseduure. puhul kasutatakse tsementeeritud varreid tavaliselt ainult halva tervisliku seisundiga patsientidel; vanemate patsientide puhul see enam nii ei ole. Lühidalt: • Suremusnäitajad revisioonide järel on üldiselt • EPRD-s on suremusmäärad pärast plaanilisi kõrgemad võrreldes plaaniliste esmaste esmaseid artroplastikaid sageli madalamad kui artroplastikatega, kuid madalamad võrreldes Saksamaa Liitvabariigi Statistikaameti andmetel mitteplaaniliste puusaliigese artroplastikatega. üldpopulatsiooni kohta. Märkimisväärse erandina aseptilistest põlveliigese revisioonidest on revisioonide suremusnäitaja • Suremusmäärad mitteplaaniliste puusaliigese kõrgem kui Saksamaa Liitvabariigi Statistikaameti proteesimiste ja septiliste reoperatsioonide järel vastavate vanuserühmade võrreldavad näitajad. on märkimisväärselt kõrgemad. • EPRD-s on suremusmäär septiliste revisioonide järel kõrgem võrreldes aseptiliste revisioonidega. Raske infektsioon Infektsiooniga seotud korduvoperatsioon suurendab mitte ainult Puusaliigese registri andmetel on selle suurenenud vajalikuks osutuvate täiendavate korduvoperatsioonide riski (vt suremuse põhjuseks pigem patsiendi kaasuvad haigused kui punktid 5.2 ja 5.4), vaid ka – nagu infektsioon ise varem näidatud – ka patsientide suremust. [13]. Sellist patsientide suremuse suurenemist pärast Andmed kinnitavad, et periproteesne infektsioon on periproteetilist infektsiooni on täheldatud ka teistes riikides. patsientide jaoks endiselt eriti tõsine tüsistus. Seetõttu Näiteks ühes Ameerika Ühendriikide uuringus leiti, et sisaldab EPRD veebileht (vt ka käesoleva aruande lehekülgi periproteetilise infektsiooniga puusaliigese- ja põlveliigese 172/173) täiendavaid tabeleid, milles on üksikasjalikult proteesiga patsientide 5-aastane üldine elulemus oli esitatud infektsiooniriski mõjutavad tegurid kättesaadavate võrreldav vähihaigete omaga registriandmetel. [12]. Rootsi andmetel põhinev analüüs 156 EPRD aastaaruanne 2024 7 Kokkuvõte  7 Kokkuvõte Saksamaa artroplastika register (EPRD) on 12 aastat Patsientide poolt teatatud tulemusnäitajad (PROMs) põhjustel viimaste aastate jooksul. 70,3% implanteerimiseks valitud komponendid. Kui dokumenteerinud puusa- ja põlveliigese artroplastika võetakse 2025. aastal kasutusele tavapärases töös. See üheetapilistest revisioonidest ja operatsiooni käigus on võimalik protseduure praktikat Saksamaal. Ainuüksi 2023. aastal esitati võimaldab kõigil patsientidel, kes on pärit PROM- reimplanteerimistoimingutest hõlmasid uut varre dokumenteerida, hoiatab tarkvara andmete registrile rekordiline hulk andmeid – ligi 380 000 andmeid koguvatest haiglatest, uuringus osaleda. ja/või puusaliigese komponenti; kahepoolse sisestamise ajal komponentide sobimatuse eest. andmekogumit. See tähendab, et EPRD hõlmab EPRD hakkab 2026. aastal dokumenteerima kirurgide liikuvusega puusaliigese kausside kasutamine on 2023. aastal tuvastas EPRD ligikaudu 600 praegu umbes 3 miljonit andmekogumit, millest üle individuaalseid andmeid, mida esitatakse kasvanud. Septiliste revisioonide puhul jäeti potentsiaalset sobimatuse juhtumit. Kuigi see arv on miljoni on pikaajalise jälgimise all. Jälgimise kestus vabatahtlikkuse alusel. See võimaldab EPRD-l luukinnitusega komponendid sagedamini paigale. suurem kui eelmistel aastatel, hakkas süsteem ulatub kuni 9 aastani ja kajastab lühi- kuni keskmise edastada vastavale kirurgile konfidentsiaalselt põlveproteeside komponentide suuruse sobimatuse pikkusega artroplastika tulemusi. kirurgipõhiseid tulemusanalüüse. 2023. aastal registreeris EPRD kokku 155 859 kontrollimist alles 2023. aastal. esmast põlveliigese endoproteesimist. Enamik See ulatuslik andmebaas on aluseks paljudele 2023. tegevusaasta põlveliigese proteese on endiselt täielikult Esmane puusaliigese endoproteesimise elulemus erinevatele analüüsidele ja uuringutele. EPRD Ajavahemikus 1. jaanuarist kuni 31. detsembrini tsementeeritud. Täielikult tsementeeritud TKA-de Esmase puusaliigese endoproteesimise andmetel põhinevate artiklite kasvav arv 2023 registreeris EPRD kokku 378 812 puusa- ja osakaal tõusis 2016. aasta 90,7%lt 96,0%ni, samal kordusoperatsioonide määr sõltub suures osas eelretsenseeritud ajakirjades ei rõhuta mitte ainult selle põlveliigese endoproteesimise protseduuri. Esmase ajal kui ühe kondüüli proteeside osakaal langes esmasest diagnoosist. Lõualuu murdudel, mis asuvad olulise allika väärtust, vaid suurendab ka registri ja põlveliigese endoproteesimise osakaal tõusis veidi, 83,4%ni, täielikult tsementeerimata lähedal puusaliigesele, on kõrgem selle tulemuste rahvusvahelist nähtavust. EPRD mõju esmakordselt 41,1%ni, võrreldes eelmiste aastate fikseeringute kasuks. Liikuvad laagrid kaotasid kordusoperatsioonide määr kui plaanilistel rõhutab veelgi Rahvusvahelise Artroplastika Registrite ligikaudu 40%ga. jätkuvalt positsioone nii TKA-des kui ka ühe protseduuridel. Need määrad varieeruvad lõualuu Ühingu (ISAR) kavatsus kehtestada EPRD poolt kondüüli proteesides. Neid kasutati vaid 8,1% murru tüübi järgi: reieluukaela murdudel on kasutatav tooteliigitussüsteem tulevikus standardiks 2023. aastal registreeriti kokku 187 640 esmast registreeritud TKA-dest ja 53,7% ühe kondüüli madalam kordusoperatsioonide määr kui teistel kõikidele registritele. puusaliigese asendamist. Lühivarrega implantaatide artroplastikatest. Ristisidemeid säilitavate murdudel. Plaanilise artroplastika puhul on osakaal on aastaid järjekindlalt kasvanud ja jõudis süsteemide kasutamine langes samuti 42,5%ni. posttraumaatiline osteoartriit seotud kõrgemate Saksamaa implantaadiregister (IRD) hakkab 2025. 2023. aastal 15,1%ni. Seevastu monoblokk- hXLPE-sisestused antioksüdantidega ja ilma tõusid kordusoperatsioonide riskidega kui teised aastal registreerima puusa- ja põlveliigese proteese. põlvekapslite kasutamine vähenes veelgi, langedes järjekindlalt vastavalt 14,1%ni ja 13,4%ni. osteoartriidi vormid. Kuna IRD-l kulub eeldatavasti mitu aastat, enne kui see 8,7%ni võrreldes 2015. aasta 12,7%ga. Kõrgelt suudab pakkuda sisukaid analüüse, jätkab EPRD oma ristsillatud polüetüleenist sisekomponentide osakaal Lahtitulek (21,6%) ja infektsioon (15,0%) olid ka 2023. Planeeritud puusaliigese endoproteesimisel on enamik tööd ja täiustab ka kogutavate andmete liike. Näiteks tõusis 83,5%ni, kusjuures suurim kasv registreeriti aastal läbi viidud 15 391 põlveliigese proteesi varrekomponente tsementeerimata, samas kui 2025. aastal hakkab EPRD koguma andmeid antioksüdantide variantide puhul. Keraamiliste revisiooni puhul kõige sagedasemad põhjused, kuigi vanematel ja haigemate patsientidel eelistatakse puusaliigese endoproteesimise kirurgiliste sisekomponentide kasutamine vähenes 7,1%ni. sarnaselt puusaliigesega on ka põlveliigese puhul tsementeeritud varreid. Siiski näitavad EPRD andmed lähenemisviiside ja põlveliigese endoproteesimise 2023. aasta oli esimene aasta, mil 36 mm pead olid teatatud lahtitulekute osakaal vähenenud. Umbes üldiselt, et vanematel patsientidel kasutatavatel implanteerimisabivahendite (arvutinaavigatsioon ja kõige levinum suurus, tõustes 2014. aasta 31,6%lt pooltel korduvoperatsioonidel asendati kogu tsementeerimata varretel on kõrgem robootika) kohta. Lisatakse ka valikuline moodul, 50,1%ni. implantaadisüsteem täielikult, 59% juhtudest vahetati korduvoperatsioonide määr, eriti proteesi ümbruse mis võimaldab üksikasjalikumalt registreerida see piiratuma liikuvusega põlvesüsteemi vastu. luumurdude tõttu. Meessoost olemine on samuti oluline periproteetiliste infektsioonide diagnoose ja ravi. Sarnaselt eelmiste aastatega olid 2023. aastal Septiliste põlve korduvoperatsioonide puhul oli samuti riskitegur, kuna meestel on suurem infektsioonirisk. EPRD testfaas PROM-ide (patsiendi- registreeritud 18 933 puusaliigese proteesi revisiooni tendents jätta varem implanteeritud luukinnitusega Tsementeerimata varrega plaaniliste puusaliigese kõige levinumad põhjused lahtitulek (22,1%), komponendid paigale. asenduste korduvoperatsioonide määr suureneb infektsioon (18,0%), periproteetiline märkimisväärselt ka patsiendi kehamassiindeksi (BMI) luumurd (15,8%) ja nihestus (14,1%). Lahtitulemiste Patsiendi ohutuse parandamiseks pakub EPRD suurenemisel. osakaal on järk-järgult nihkunud teiste nimetatud komponentide ühilduvuse veebipõhist kontrolli Suuremad peaosad vähendavad nihestumise riski, samas kui pikem pea-kaela pikkus on sageli seotud suurema CRR-iga. Lühikesed varred on paremad kui standardvarred, eriti infektsioonide esinemissageduse osas, kuid neid kasutatakse üldiselt noorematel ja tervematel 158 EPRD aastaaruanne 2024 159  7 Kokkuvõte patsientidel. Lühikeste ja standardvarte tulemused esmase põlveliigese pinna uuendamiseta. Siiski ei vanus ja tervis. Põlveliigese proteesimise patsientidel varieeruvad siiski märkimisväärselt erinevate saa selle tähelepaneku põhjal järeldada üldist on suremus madalam kui puusaliigese proteesimise varresüsteemide vahel. soovitust põlveliigese pinna uuendamiseks esmase patsientidel ning ühe kondüüli proteesimise puhul on põlveliigese asendamise korral. suremus kõige madalam. Patsientidel, kellele tehakse Esmase põlveliigese endoproteesimise puusaliigese proteesimine, eriti hemiartroplastika, elulemus Revisioonilise puusa- ja põlveliigese traumakirurgia raames, on EPRD-s kõrgeim suremus. Esmase põlveliigese endoproteesimise puhul on ühe proteesimise elulemus Traumaproteesimise patsientidel ja enamikul kondüüli proteeside revisioonimäär peaaegu kaks korda Edasiste revisioonide risk suureneb märkimisväärselt korduvoperatsioonidel, eriti septilistel suurem kui TKA-de puhul. Patellofemoraalsetel rohkem pärast puusa- või põlveliigese revisiooni kui korduvoperatsioonidel, on kõrgem suremus võrreldes implantaatidel on veelgi kõrgemad pärast esmast artroplastikat. Kordusrevisiooni vastavate üldpopulatsiooni kontrollrühmadega. korduvoperatsioonide määrad. Suurema operatsiooni risk sõltub suuresti ka revisiooni stabiliseerimisastmega TKA-d, nagu varus-valgus- põhjusest. Periproteesiliste infektsioonide puhul on stabiliseeritud või hingedega süsteemid, mida CReRR kahe aasta jooksul pärast revisiooni üle kahe kasutatakse liigese deformatsiooni või sidemete korra suurem kui mis tahes muude teatatud põhjuste ebastabiilsusega patsientidel, on seotud kõrgemate puhul. Revisjoni tulemuste hindamine on keeruline, korduvoperatsioonide määradega kui piiranguteta kuna algse seisundi erinevused takistavad standardsüsteemid. võrreldavust. Siiski suureneb CReRR ühe järgneva protseduuri järel järgmise suhtes. CReRR on ka Revisioonoperatsiooni risk varieerub oluliselt sõltuvalt tavaliselt veidi madalam, kui luukinnitatud esmasest diagnoosist, kusjuures kõrgeim komponendid vahetatakse välja, võrreldes kordusoperatsiooni määr on täheldatud olukorraga, kus need jäetakse paigale. posttraumaatilise osteoartriidi puhul. Noorematel patsientidel ja meestel on üldiselt suurem risk Elulemuse suundumused revisioonoperatsiooni vajaduse tekkeks. Esmase puusaliigese endoproteesimise andmete Märkimisväärseks erandiks on ühe kondüüli analüüs operatsiooni aasta järgi ei näita selget proteesimine. Meestel on umbes aasta pärast seda suundumust ega viita CRR-i langusele varases tüüpi artroplastikat madalam CRR võrreldes operatsioonijärgses faasis. Seevastu on tavapäraste naistega. Haiglad, millel on rohkem kogemusi ja esmaste põlveliigese endoproteesimiste vastavad suurem aastane operatsioonide arv, saavutavad tulemused aja jooksul märkimisväärselt paranenud. üldiselt paremaid ühe kondüüli artroplastika Selle põhjuste üle võib vaid spekuleerida. tulemusi, kuigi EPRD andmebaas sisaldab ka mitmeid erandeid. Patsientide suremus Liidumaade ravikindlustusandjate liidud teavitavad Esimeste aastate jooksul pärast artroplastikat on EPRD-d sellest, kas patsient on elus või surnud, kuid fikseeritud laagritega süsteemidel madalam CRR kui ei täpsusta surma põhjust. See tähendab, et surm ei liikuvate laagritega süsteemidel. Kaetud või pruugi olla otseselt seotud liigeseproteesiga. keraamilised reieluukomponendid on seotud suurema Patsiendi üldine tervislik seisund mõjutab sageli korduvoperatsiooni riskiga kui modifitseerimata valitud liigeseproteesi tüüpi. EPRD-patsientide ja metallkomponendid. Saksamaa üldelanikkonna vanuse ja soo järgi liigitatud suremusnäitajate võrdlus näitab, et EPRD määratles 2024. aasta alguses uuesti plaanilise esmase artroplastika patsientidel on artroplastika lõpptulemuse. Nüüd loetakse suremus üldiselt madalam. See viitab sellele, et asjakohaseks revisiooniks ka täiendav põlveliigese artroplastika patsientidel on keskmisest kõrgem pinna uuendamise operatsioon, mis on kaasatud CRR- arvutustesse. See tähendab, et esmase artroplastika ajal põlveliigese pinna uuendamisega tehtud standardse põlveliigese asendamise puhul on revisioonoperatsiooni risk nüüd üldiselt madalam võrreldes artroplastikaga, mille puhul põlveliigese pinna uuendamist esmase operatsiooni ajal ei tehta 160 EPRD aastaaruanne 2024 161 Lisa  Sõnastik Sõnastik Termin Pinnakattega metall Selgitus Implantaadi komponendid, mis on kaetud titaannitriidi, titaannioobiumnitriidi või tsirkooniumnitriidiga. EPRD-s käsitletakse neid kaetud komponente eraldi keraamilisest metallist või täiskeraamilistest komponentidest. Järgnev kokkuvõte selgitab tabelites ja tekstis kasutatud termineid ja tähistusi. Täiendav operatsioon EPRD varasemates aastaaruannetes määratleti põlveliigese esmase bikondülaarse artroplastika järel tehtud põlveliigese pinna uuendamine samas liigeses, mida mõjutas haiguse „normaalne” progresseerumine (sh sisendi vahetamine profülaktilistel Mõiste Selgitus põhjustel), täiendava operatsioonina, mitte lõpptulemusena. EPRD on oma 2024. aasta aruandes seda klassifikatsiooni rahvusvaheliste konventsioonide järgimiseks läbi vaadanud ja liigitab nüüd kõik protseduurid, mis hõlmavad implantaadi komponentide Lõualuu komponent Lõualuu proteesi osa, mis asendab lõualuu. Lõualuu eemaldamist või vahetamist, või täiendava operatsiooni elulemusanalüüsi lõpp- komponent võib koosneda kas ühest osast (monoblokk) või mitmest osast (modulaarne punktiks. acetabulaarkomponent). Tavaliselt koosneb modulaarne acetabulaarkomponent metallkausist ja acetabulaarsest sisestusest. Antioksüdant Lisand/keemiline ühend, näiteks E-vitamiin, mis vähendab artroplastikas kasutatava polüetüleeni oksüdatsiooni. Usaldusvahemik Intervall, mis sisaldab tõelist väärtust kindlaksmääratud tõenäosusvahemikus (usaldusvahemik). ASA staatus ASA staatus viitab patsiendi terviseseisundi klassifitseerimissüsteemile, mis hindab perioperatiivset riski. Klassifitseerimissüsteemi kehtestas üle 80 aasta tagasi Ameerika Piirang Põlveliigese proteese iseloomustab nende stabiliseerimise tase. Käesolevas aruandes Anestesioloogide Selts (ASA). Anestesioloog määrab igale patsiendile staatuse määratleme „standardseid“ põlvesüsteeme kui ristisidemeid säilitavaid, ristisidemeid vahemikus I (normaalne, ilma oluliste kaasuvate haigusteta) kuni VI (ajusurma). EPRD- säilitavaid/ohverdavaid, puhtalt ristisidemeid ohverdavaid ning ka tagantstabiliseeritud s ulatub spekter I-st V-ni (moribundne patsient, kes ilma operatsioonita tõenäoliselt ei süsteeme ilma varus-valgus-stabiliseerimiseta. Varus-valgus-stabiliseeritud ja jää ellu). (jäigad/pöörlevad) hingedega süsteeme peetakse „piirangutega“ süsteemideks. Laager Kirjeldab liigeseasenduse puhul üksteise vastu liikuvate kahe pinna materjale, näiteks Ristisidemeid säilitavad Disain, mis säilitab tagumise ristisideme ilma põlveliigese liikumist/kinemaatikat piiramata metall/polüetüleen, metall/metall, keraamika/polüetüleen, keraamika/keraamika. põlve liikumist/kinemaatikat. Käesolevas aruandes viitab esimene nimetatud materjal liigese reieluukomponendile. Ristisideme säilitav/ohverdav Konstruktsioon sobib nii ristisideme säilitamise kui ka asendamise protseduuriks. Kehamassiindeks Inimese pikkuse ja kaalu suhe, mis on määratletud kui kaal (kilogrammides) jagatud Ristisideme eemaldamine Disain, mis asendab tagumise ristisideme kinemaatikaga, (lühend: BMI) pikkuse ruuduga (meetrites). mis võimaldab osaliselt piiratud suhtelist liikumist kõigis kolmes tasapinnas. Luutsement Materjal, mida kasutatakse proteesikomponentide kinnitamiseks luusse. Kasutatav Kumulatiivne re-revisiooni määr (lühend: Kumulatiivne kordusrevisiooni määr viitab revisioonimäärale pärast eelmist materjal on polümetüülmetakrülaat (PMMA). Antibiootikumid vähendavad CReRR) revisioonoperatsiooni. Vt ka kumulatiivne revisioonimäär (CRR). infektsiooniriski ja neid võib lisada luutsemendile kas tootmise käigus või operatsiooni ajal. Kumulatiivne revisioonimäär EPRD määratleb lõpptulemusena „artroplastika ebaõnnestumise“ kui mis tahes Tsementeeritud Komponendi kinnitamine tsementiga (lühend: CRR) artroplastika, mis nõuab hiljem komponentide vahetamist või eemaldamist või täiendavat operatsiooni. Kaplan-Meieri hinnangute abil arvutatakse tõenäosus, et Tsementimata / tsementimata Komponendi kinnitamine ilma tsementita esmase artroplastika järel ei ole teatud ajavahemiku jooksul vaja sellist revisiooni teha ning et artroplastika jääb seega paigale. Revisioonimäär vastab Kaplan-Meieri hinnangute vastastikustele tõenäosustele ja seda kirjeldatakse kui kumulatiivset, kuna Sündmuste tsenseerimine Mõnel juhul võivad sündmused, nagu patsiendi surm või jälgitavuse kaotus see võtab kokku tulemused mitmest sündmusajast. võivad esineda enne, kui patsient vajab järgnevat artroplastika revisiooni (lõpp-punkt). Kuni sellise tsenseeriva sündmuse toimumiseni on artroplastika tulemused endiselt analüüsidesse kaasatud, kuid patsienti ei jälgita enam pärast seda. Kauss Vaata puusaliigese komponenti. Keraamiline metall Implantaadi komponendid, mis koosnevad tsirkooniumisulamist alusest ja keraamilisest pinnakattest – oksüdeeritud tsirkooniumisulamist. Seega ei ole keraamilise pinnakattega metall ei täiskeraamiline ega ka pinnakattega metall. 164 EPRD aastaaruanne 2024 165  Sõnastik Termin Selgitus Termin Selgitus Kahepoolne liikuvus Kahe liikumisega artroplastika puhul on asetabulaarne sisestus (kumer pind) Puusaliigese vars Vaata reieluukomponent (puusaliiges). konstrueeritud nii, et see liiguks koos kahe liikumisega asetabulaarse komponendiga. See sisestatakse selle luu poole suunatud kestale kumerale pinnale. Reieluupea sisestatakse tavaliselt kahe liikumisega sisestusse, mis omakorda sisestatakse luu hXLPE Kõrgelt ristsillatud polüetüleen (UHMWPE). Vaata ka Polüetüleen. poole suunatud kestale. Hübriid Artroplastika, mille puhul üks komponent on tsementeeritud, teine aga mitte. Elixhauseri komorbiditeedi skoor Komorbiditeedi indeks, millega kontrollitakse teatavate komorbiditeetide esinemist ja Puusaliigese asendamisel tähendab „hübriid” tsementeeritud varre ja tsementeerimata üldist raskusastet arveldusandmete diagnoosikoodide alusel. Seda kasutatakse seejärel asetabulaarkomponendi kombinatsiooni, samas kui „pöördhübriid” tähendab patsiendi tervisliku seisundi hindamiseks. Mida kõrgem on skoor, seda halvem on tsementeerimata varre ja tsementeeritud asetabulaarkomponendi kombinatsiooni. patsiendi tervis ja seda suurem on suremusrisk. Põlveliigese endoproteesimise puhul tähendab „hübriid” tsementeeritud sääreosa ja tsementeerimata reiekomponendi kombinatsiooni, samas kui „pöördhübriid” tähendab vastupidist kombinatsiooni. Reieluukomponent (puusaliiges) Artroplastika komponent, mis paigaldatakse proksimaalsesse reieluusse. See on kas juba lahutamatult ühendatud reieluupeaga (monoblokk) või saab sellele kinnitada modulaarse pea, et saada terviklik reieluukomponent (modulaarne peavars), see võib hõlmata ka modulaarset struktuuri koos modulaarse kaela või proksimaalse osaga ICD-10-kood Rahvusvaheline haiguste ja terviseprobleemide statistiline klassifikatsioon (versioon 10) (modulaarne vars). on rahvusvaheliselt tunnustatud süsteem peamiste diagnooside ja kaasuvate haiguste dokumenteerimiseks. Saksa haiglad kasutavad Saksa ICD-10 koode, et dokumenteerida patsiendi haiglas viibimise ajal tehtud diagnoose Reieluukomponent (põlve) Artroplastika komponent, mis paigaldatakse distaalsesse reieluusse. See võib tervisekindlustusandjatele. Näiteks S72.0 on kood „reieluukaela murd“. moodustada kas ühe reieluukondüüli või mõlemad reieluukondüülid ning reieluukondüüli trohleaari. Impingement Mehaaniline tüsistus, mis on tingitud implantaadi komponentide ja/või luu ebaõigest kokkupuutest. Reieluukaela protees Viitab üldiselt reieluuvarre komponendile, mis on kinnitatud reieluukaela , kuid viitab ka „pealõikeproteesile”. Sisestus Sääre sisestused on osa põlveliigese proteesist ja need kinnitatakse sääreplaadi ülemisele pinnale ning moodustavad liigespinna reieluukomponendiga. Lõualuu Fikseeritud laagri Sääreplaadi monoblokk-konstruktsioon või sääreplaadi ja sääre sisendi vaheline sisestused on osa puusaliigese proteesist ja need paigaldatakse modulaarse modulaarne ühendus, mis ei luba nende komponentide vahel mingit suhtelist liikumist. lõualuukomponendi sisse. Pöördeliste liigenditega süsteeme klassifitseeritakse samuti fikseeritud laagriteks, vastandina liikuvatele laagritele. Kaplan-Meieri hinnang Statistiline meetod, millega määratakse kindlaks tõenäosus, et teatav huvipakkuv sündmus ei toimu kindlaksmääratud ajavahemiku jooksul. Sündmusi, mis muudavad teatavate sündmuste toimumise jälgimise võimatuks, võib arvutamisel arvesse võtta ja need võib tsenseerida. Saksa ICPM-kood Saksamaa haiglad kasutavad Saksamaa ICPM (International Classification of Procedures in Medicine) koode, et dokumenteerida haiglas viibivate patsientide protseduure tervisekindlustuse hüvitiste taotlemiseks. Iga protseduurile on omistatud Sobimatus Artroplastika, mis hõlmab ühildumatute komponentide kombinatsiooni või komponenti, numbriline kood. Näiteks kood 5-820.01 viitab tsementeeritud täielikule puusaliigese mis ei sobi kokku olemasolevate komponentidega. endoproteesimisele. Liikuv laagri Liikuv ühendus sääreplaadi ja sääre sisekomponendi vahel. Erinevalt fikseeritud Pea (komponent) Vaata moodulpead. liigendist. Pöördelüliga süsteeme ei liigitata liikuvate liigendite hulka. Vt Fikseeritud liigend. Pea-kaela pikkus Kirjeldab vahemaad pea keskpunkti ja koonuse võrdluspunkti vahel koonuse koonuse telje suunas. Suurusklassid, mis ulatuvad XS-st XXXL-ni, erinevad Modulaarne kauss Lõualuu komponent, mis on konstrueeritud nii, et selle sisemisse läbimõõtu mahub eraldi tootjate lõikes. laagripind. Vt ka monoblokk-põlvekupp ja lõualuu komponent. Poolartroplastika Erinevalt täielikust liigeseproteesist ei asendata poolproteesiga (hemi = pool) kogu liigest, vaid ainult osa sellest. Tüüpiline näide on kahepealine protees, mille puhul asendatakse puusaliigese reieluukomponent peaga, kuid mitte vaagnaosa. Hinge Kirjeldab ühendatud põlvesüsteeme, millel on külgmine liigese stabiilsus ja lihtne (ühe liikumisastmega = „jäik hing”) või pöörlev hingliiges reieluukomponendi ja sääreplaadi vahel. 166 EPRD aastaaruanne 2024 167  Sõnastik Termin Selgitus Termin Selgitus Modulaarne pea Reieluupea, mille ülemine pind on kumer ja mis liigub kokku puusaliigese liigespinnaga. Patellofemoraalne artroplastika Trohlea (distaalse reieluupoolse soone) ja tavaliselt ka patella pinna kunstlik Selle distaalses osas on emane koonus, mis on mõeldud haakuma modulaarse asendamine, kehtib ka juhtudel, kus tehakse täiendav ühe kondüüli asendamine. reieluuvarre või modulaarse reieluukaela isase koonusega. Pead on saadaval erinevates suurustes, et sobida puusaliigese liigespinna siseläbimõõduga. Proteesipiirkonna infektsioon Need infektsioonid on üldjuhul paigaldatud endoprotee s i bakteriaalne koloniseerumine. See on eriti kardetav tüsistus, mille kirurgiline ravi on keeruline ja aeganõudev. Tavaliselt põhjustavad infektsiooni patogeenid, mis kuuluvad inimese naha ja limaskestade normaalsesse mikrofloorasse. Modulaarne vars Reieluukomponent, mis koosneb mitmest osast ja mis nõuab ka modulaarse pea kasutamist. Vaata ka Monoblokkvars ja Reieluukomponent (puusaliiges). Pivot Kirjeldab põlvesüsteeme, mis on kavandatud toetama loomulikku pöörde- /nihekinemaatikat. Monoblokk Ühest osast koosnev komponent, nt puusaliigese asendamiseks varreosa integreeritud peaga või polüetüleenist kauss, mis ei vaja eraldi sisestust. Polüetüleen (lühend: PE) Polüetüleen on termoplast, mis on valmistatud etüleeni [CH2=CH2] ahelpolümerisatsiooni teel etüleeni [CH2=CH2] ahelpolümerisatsiooni teel, millest saab toota proteesikomponente (nt sisestusi). Artroplastikas kasutatakse tavaliselt ülisuure molekulmassiga polüetüleeni Monoblokk-põlv Lülisamba komponent, mis koosneb tavaliselt ühest osast või osadest, mis on eelnevalt (UHMWPE). Seda saab hiljem modifitseerida kiiritamise ja antioksüdantidega sidumise „lahutamatult” kokku pandud/ühendatud. Seevastu moodulkuppid koosnevad vähemalt teel. Vt ka hXLPE või mXLPE. kahest osast, mis ühendatakse tavaliselt omavahel alles implanteerimise ajal. Vaata ka moodulkupp ja reieluukomponent (puus). Tagumine stabiliseeritud Konstruktsioon, mis võimaldab asendada tagumise ristisideme mehaanilise elemendiga, näiteks liigendiga polüetüleenpikendusega, mis kontrollib ja piirab eesmist Monoblokk-varras Üheosaline reieluukomponent, mis ei vaja eraldi peakomponenti. Seevastu teised ja/või tagumist liikumist. luukomponendid koosnevad vähemalt kahest osast. Vt ka „Modulaarne luukomponent” ja „Reieluukomponent (puusaliiges)”. Esmane operatsioon/artroplastika Ühe või mitme artroplastika komponendi esmane implanteerimine konkreetsesse liigesesse. Suremus Viitab surmajuhtumite arvule teatavas ajavahemikus protsendina vaatlusaluste isikute p-väärtus Madalaim olulisuse tase, mille juures statistiline test ikkagi lükkaks tagasi nullhüpoteesi. koguarvust. Väärtusi alla 0,05 peetakse tavaliselt statistiliselt oluliseks. mXLPE Mõõdukalt ristsillitatud polüetüleen (UHMWPE). Rekonstruktsioonikest Seade, mis tagab vaagna struktuurilise stabiilsuse enne Ottset Vahemaa reieluupea pöörlemiskeskmest kuni jooneni, mis poolitab reieluuvarre lõplikku liigesepesakomponenti. Sellist seadet võib vaja olla luudefektide korral. See pikitelje. võib olla nii korduvkirurgia puhul, aga ka esmase operatsiooni korral, kus vaagna katkemine tekib luukadu tagajärjel, nt kasvaja või traumajärgse rekonstruktsiooni puhul. Osaline põlveliigese protees Osaline põlveliigese protees asendab ainult osa liigese pinnast. Tüüpiline näide on ühe kondüüli protees, mis asendab ainult põlveliigese mediaalse/lateraalse osa, mitte kogu Pöördhübriid Vaata hübriid. põlveliigest. Vaata ka täielik põlveliigese endoproteesimine. Revisioon (operatsioon/artroplastika) Operatsioon, mis tähendab eemaldamist ja vajaduse korral asendamist varem implanteeritud puusa- või põlveliigese proteesikomponendid. Revisioonoperatsioonile võib järgneda uute proteesikomponentide uuesti Osaliselt tsementeeritud Osaliselt tsementeeritud tähendab, et üks komponent ei ole tsementeeritud ja teine on. implanteerimine kas sama operatsiooni käigus (üheetapiline revisioon) või hiljem Vaata ka hübriid. (mitmeetapiline revisioon). Seda tõlgendatakse esialgse artroplastika ebaõnnestumisena. Alates 2024. aasta algusest tõlgendatakse progresseeruva Põlvekapsli komponent Põlvekapsli pinna uuendamise komponent. Kuigi see koosneb sageli ainult patellofemoraalse osteoartriidi tagajärjel tehtavat põlveliigese asendamise polüetüleenist kattedest, mis tsementeeritakse põlvekapsli tagaküljele, on olemas ka reoperatsiooni koos patellofemoraalse pinna taastamisega revisioonina. konstruktsioone, kus polüetüleenist katted on kinnitatud metallalusplaadile. Vaata ka „Põlvekapsli pinna uuendamine”. Põlvekapsli pinna uuendamine Implantaadi kasutamine põlvekapsli liigespinna asendamiseks. Esmase kahe kondüüliga põlveliigese endoproteesimise järel tehtava sekundaarse patella pinna uuendamise kohta vt ka täiendav operatsioon. 168 EPRD 2024. aasta aruanne 169  Sõnastik Termin Selgitus Mõiste Selgitus Revisioonikauss Monoblokk- või modulaarne asetabulaarkomponent, millel on lisatud Tuumorivars Viitab peamiselt modulaarse varre süsteemile, mida implanteeritakse konstruktsioonilised omadused asetabulaarse luudefekti ületamiseks või luu rekonstruktsioonivõimalusena ulatuslike luudefektide korral pärast reieluuvähi fikseerimise parandamiseks (nt täiendav kruviauk). resektsiooni või korduva revisiooni (re-revisiooni) korral. Kaheastmeline revisioonikirurgia EPRD määratleb seda kui protseduuri, mille käigus proteesikomponentide eemaldamine Revisioonivars Puusaliigese proteesi revisiooniks spetsiaalselt kavandatud puusaliigese proteesi vars. ja uuesti paigaldamine (asendamine) toimuvad eraldi, mitte sama operatsiooni käigus. Seda tehakse tavaliselt infektsiooniga seotud revisioonoperatsiooni raames. Kuna eksplantatsiooni ja reimplanteerimise vahel võivad olla vajalikud täiendavad sekkumised Rutiinsed andmed Andmed, mida riiklikud ravikindlustusettevõtted säilitavad eelkõige haldus- ja (nt vaheosa asendamine jne), nimetatakse neid protseduure ka „kahe- või arvelduseesmärkidel vastavalt SGB V (Saksamaa sotsiaalkoodeksi V raamat) §-le 301. mitmeastmelisteks revisioonideks”. Vt Revisioonartroplastika. Need andmed, mis hõlmavad peamiste ja sekundaarse diagnooside ICD-koode ning ravi OPS-koode, edastatakse EPRD-le koos osalevate patsientide elustatuse andmetega kaks korda aastas. Andmeid kasutatakse osalevate haiglate poolt registrile otse esitatud haiguslugude täiendamiseks. Katmata metall Implantaadi komponendid, mis ei ole kaetud keraamilise kattega. Ühe kondüüliga põlveliigese artroplastika Ainult ühe reieluukondüüli ja vastava põlveliigese sääreluu platoo osa asendamine. Lühike vars Puusaliigese varre komponendid, mis on tootja poolt määratletud kui metafüüsilises piirkonnas kinnituvad. Nende hulka kuuluvad: reieluukaela säilitavad süsteemid, milles eemaldatakse ainult reieluupea ja reieluukael jääb puutumata, reieluukaela säilitavad süsteemid, milles eemaldatakse ka osa reieluukaelast, ning reieluukaela resektsioonisüsteemid, milles reieluukael eemaldatakse täielikult. Standardne TKA Kirjeldab „piiranguteta/minimaalselt stabiliseeritud” põlvesüsteeme, nagu ristisideme säilitavad/ohverdavad, puhtalt ristisideme ohverdavad ning ka tagant stabiliseeritud süsteemid ilma varus-valgus stabiliseerimiseta. Pinnaprotees (puusaliiges) Reieluupea (peapinna asendamine) ja/või puusaliigese kausi (kausi pinna asendamine). „Pinnakattega reieluupea” on reieluukomponent, mis on mõeldud ainult patsiendi enda reieluupead katma. Epifüüsi kinnitamiseks võib olla kinnitusseade (nt keskmised tihvtid). Reieluupead kasutatakse koos vastava „pinnakattega reieluukausiga”, mis on valmistatud ühest tükist (monoblokk). Sääreplaadi Sääreluu ülaosa asendav või selle pinda uuendav komponent võib olla modulaarne (koosneb rohkem kui ühest osast ja võimaldab sisestuse paigaldamist), monoblokk (üheosaline), eelmonteeritud (sisestus ja sääreluu alus on tootja poolt kokku pandud, kuid neid on võimalik lahti võtta) või eelpaigaldatud (kus sääreluu alus ja sisestus on tootja poolt kokku pandud ja neid ei ole võimalik lahti võtta). Täielik puusaliigese Ortopeediline implantaat, mis asendab puusaliigese. Erinevalt poolartroplastikast endoproteesimine (lühend: asendab täielik puusaliigese endoproteesimine kogu liigese. THA) Täielik põlveliigese endoproteesimine (lühend: Põlveliigese endoproteesimine, mille käigus asendatakse kõik kolm põlveliigese TKA) kompartimenti (tibiofemaalse liigese mediaalne ja lateraalne kompartiment ning patellofemaalne kompartiment). Praeguses põlveliigese endoproteesimise praktikas Saksamaal hõlmab protseduur harva patella pinna asendamist. Rangelt võttes ei tohiks neid juhtumeid seetõttu klassifitseerida täielike põlveliigese proteesimistena, vaid pigem kahekompartmentaalsete proteesimistena. Siiski kasutatakse Saksamaal laialdaselt terminit „täielik põlveliigese proteesimine” kahekompartmentaalsele põlveliigese proteesimisele viitamiseks. 170 EPRD aastaaruanne 2024 171  Täiendavad tulemustabelid Täiendavad tulemustabelid Järgmises tabelis on loetletud valikuliste esmaste kuni 46, 48 kuni 51 ning 53, mis on käesolevas Need tabelid on kättesaadavad aadressil puusaliigese endoproteesimiste tulemused, võttes aruandes esitatud. Veebisaidil on ka täiendavad www.eprd.de/de/downloads/tabellen või skannides arvesse varre (tabel 63) ja kausikomponente (tabel tulemustabelid. Need kajastavad tulemusi, mis on kõrvalolevat QR-koodi. 64) kõigi registreeritud komponentide saadud meeste ja naiste patsientide eraldi käsitlemisel kombinatsioonide puhul. EPRD veebilehel on tabelite ning keskendudes septilise reoperatsiooni jaoks olemas otsingufiltrid. 44 konkreetsetele tulemusnäitajatele. Planeeritud puusaliigese täielikud proteesimised Kumulatiivsed revisioonimäärad pärast ... Aastad Reieluuvars Arv Haigla Vanus m/n pärast 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat implantee rimist Tsementeerimata reieluukomponent A2 lühike vars (ARTIQO) 12 241 91 64 (57–71) 40/60 2016–2023 2,0 [1,7; 2,2] 2,2 [1,9; 2,5] 2,4 [2,1; 2,7] 2,5 [2,2; 2,8] 2,6 [2,3; 3,0] 2,7 [2,4; 3,1] 2,7 [2,4; 3,1] (9 198) (6 825) (5 026) (3 519) (2 205) (1 017) (252) ABG II vars (Stryker) 528 15 66 40/60 2014–2023 4,6 [2,8; 6,4] 6,3 [4,1; 8,4] 6,7 [4,5; 8,9] 7,2 [4,9; 9,5] 7,6 [5,2; 9,9] 7,9 [5,4; 10,3] 7,9 [5,4; 10,3] 7,9 [5,4; 10,3] (60–71) (469) (422) (392) (355) (269) (203) (164) (65) Accolade II vars (Stryker) 12 984 67 68 (60–75) 42/58 2014–2023 2,7 [2,4; 3,0] 3,0 [2,7; 3,3] 3,3 [3,0; 3,6] 3,5 [3,2; 3,9] 3,7 [3,3; 4,1] 3,9 [3,5; 4,3] 4,0 [3,6; 4,4] 4,1 [3,6; 4,6] (10 546) (8 612) (6 737) (4 959) (3 188) (1 929) (1 081) (336) Actinia tsementivaba (Implantcast) 3 307 26 72 34/66 2015–2023 3,6 [3,0; 4,3] 4,0 [3,3; 4,7] 4,1 [3,4; 4,8] 4,4 [3,7; 5,2] 4,7 [3,9; 5,4] 4,9 [4,0; 5,7] 4,9 [4,0; 5,7] (64–78) (2 906) (2 601) (2 302) (1 830) (875) (353) (74) ACTIS™-puusavars (DePuy) 2 678 43 62 (55–69) 43/57 2018–2023 1,8 [1,3; 2,3] 2,2 [1,6; 2,8] 2,4 [1,7; 3,0] 2,6 [1,7; 3,5] (1 694) (879) (475) (131) Alloclassic (Zimmer Biomet) 11 706 91 69 35/65 2012–2023 3,1 [2,7; 3,4] 3,6 [3,2; 3,9] 4,0 [3,6; 4,4] 4,3 [4,0; 4,7] 4,6 [4,2; 5,0] 4,9 [4,5; 5,4] 5,1 [4,6; 5,5] 5,4 [4,9; 5,9] 5,4 [4,9; 5,9] (62–76) (10 354) (9 184) (8 096) (6 813) (5 442) (3 990) (2 628) (1 188) (268) Alpha-Fit (Corin) 691 3 75 (69–79) 30/70 2014–2022 1,9 [0,9; 2,9] 2,0 [1,0; 3,1] 2,3 [1,2; 3,5] 2,3 [1,2; 3,5] 2,9 [1,6; 4,2] 3,2 [1,8; 4,6] 3,8 [2,2; 5,5] 4,3 [2,4; 6,1] (663) (650) (637) (601) (501) (338) (246) (143) AMISTEM-H (Medacta) 1 002 28 67 43/57 2015–2020 3,2 [2,1; 4,3] 3,5 [2,4; 4,6] 3,7 [2,5; 4,9] 4,2 [2,9; 5,4] 4,6 [3,3; 6,0] 5,6 [3,9; 7,2] 6,2 [4,2; 8,1] (58–74) (959) (930) (911) (752) (530) (331) (142) 60 (53– AMISTEM-H ProxCoat (Medacta) 384 3 47/53 2016–2023 1,8 [0,5; 3,2] 2,1 [0,7; 3,6] 2,5 [0,9; 4,1] 3,0 [1,1; 4,9] 4,0 [1,3; 6,6] 66,5) (340) (272) (218) (163) (85) AMISTEM-P (Medacta) 1 145 26 66 40/60 2019–2023 2,6 [1,7; 3,5] 2,8 [1,8; 3,8] 3,9 [2,3; 5,6] (59–73) (773) (445) (139) ANA.NOVA® Alpha varre (ARTIQO) 2 415 13 70 (63–76) 39/61 2015–2023 2,2 [1,6; 2,8] 2,7 [2,0; 3,4] 2,9 [2,2; 3,6] 3,2 [2,4; 3,9] 3,4 [2,6; 4,2] 3,6 [2,8; 4,5] 3,8 [2,9; 4,8] 3,8 [2,9; 4,8] (2 072) (1 728) (1 473) (1 190) (884) (572) (347) (66) ANA.NOVA® SL-complete® vars (ARTIQO) 737 10 72 38/62 2015–2023 3,8 [2,4; 5,2] 4,2 [2,7; 5,7] 4,4 [2,8; 6,0] 4,7 [3,0; 6,3] 4,7 [3,0; 6,3] 5,9 [3,5; 8,2] 5,9 [3,5; 8,2] (63–78) (571) (464) (372) (309) (221) (130) (65) ANA.NOVA® Solitär varre (ARTIQO) 569 7 74 (66–80) 35/65 2015–2023 4,1 [2,5; 5,7] 4,3 [2,6; 6,0] 4,7 [2,9; 6,5] 5,0 [3,1; 6,8] 5,5 [3,4; 7,5] 5,5 [3,4; 7,5] (512) (463) (410) (306) (168) (84) Anato Stem (Stryker) 432 9 68 45/55 2016–2023 3,2 [1,6; 4,9] 4,0 [2,1; 5,8] 4,2 [2,3; 6,2] 4,2 [2,3; 6,2] 4,2 [2,3; 6,2] 4,9 [2,6; 7,2] (60–75) (406) (363) (298) (227) (171) (84) Avenir (Zimmer Biomet) 33 903 217 69 (62–75) 40/60 2013–2023 3,0 [2,8; 3,2] 3,3 [3,1; 3,5] 3,5 [3,3; 3,7] 3,6 [3,4; 3,8] 3,7 [3,5; 3,9] 3,7 [3,5; 4,0] 3,9 [3,6; 4,2] 4,0 [3,7; 4,4] 4,0 [3,7; 4,4] (26 969) (21 121) (16 142) (11 423) (7 136) (4 193) (1 961) (551) (66) Avenir Complete (Zimmer Biomet) 3 084 60 67 40/60 2020–2023 3,3 [2,6; 4,0] 3,4 [2,7; 4,1] 3,4 [2,7; 4,1] (59–74) (1 605) (588) (97) BICONTACT (Aesculap) 20 076 138 71 (63–77) 40/60 2013–2023 3,2 [3,0; 3,5] 3,6 [3,3; 3,8] 3,8 [3,5; 4,0] 3,8 [3,6; 4,1] 3,9 [3,7; 4,2] 4,0 [3,7; 4,2] 4,0 [3,7; 4,3] 4,0 [3,7; 4,3] 4,2 [3,8; 4,6] (18 157) (16 218) (14 374) (12 118) (9 464) (6 687) (4 134) (1 994) (560) BreXis (Stemcup / Zimmer Biomet) 1 923 42 61 46/54 2015–2023 2,3 [1,6; 3,0] 3,0 [2,1; 3,8] 3,1 [2,2; 3,9] 3,1 [2,2; 3,9] 3,6 [2,5; 4,6] 4,1 [2,6; 5,6] (54–68) (1 382) (942) (654) (470) (229) (108) Tabel 63: Reieluuvarraste kumulatiivsed revisioonimäärad plaaniliste puusaliigese täielike proteesimiste puhul. Iga fikseerimistüübi puhul on reieluuvarred loetletud tähistuse järgi tähestikulises järjekorras. 172 EPRD 2024. aasta aruanne 173  Täiendavad tulemustabelid Valikulised puusaliigese täielikud proteesimised Kumulatiivsed revisioonimäärad pärast ... Aastad Reieluuvars Arv Haigla Vanus m/n pärast 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat implantee rimist Tsementeerimata reieluukomponent C.F.P. puusaproteesi vars, tsementeerimata, kõverus A (Waldemar Link) 1 444 29 61 (55–68) 51/49 2012–2023 2,1 [1,3; 2,8] 2,7 [1,9; 3,6] 3,0 [2,1; 3,9] 3,4 [2,4; 4,3] 3,7 [2,6; 4,8] 3,9 [2,7; 5,0] 3,9 [2,7; 5,0] 3,9 [2,7; 5,0] 3,9 [2,7; 5,0] (1 259) (1 099) (963) (838) (733) (590) (383) (205) (134) CBC Evolution (Mathys) 980 14 68 44/56 2013–2023 3,6 [2,4; 4,7] 4,4 [3,1; 5,7] 4,8 [3,4; 6,2] 5,5 [3,9; 7,0] 5,6 [4,1; 7,2] 5,6 [4,1; 7,2] 5,9 [4,3; 7,6] 5,9 [4,3; 7,6] 5,9 [4,3; 7,6] (62–76) (854) (737) (630) (537) (435) (348) (226) (90) (53) CBH (Mathys) 323 7 74 (69–78) 28/72 2013–2023 1,6 [0,2; 2,9] 2,6 [0,8; 4,4] 2,6 [0,8; 4,4] 2,6 [0,8; 4,4] 2,6 [0,8; 4,4] 2,6 [0,8; 4,4] 2,6 [0,8; 4,4] (290) (263) (234) (209) (173) (139) (92) CLS Spotorno (Zimmer Biomet) 28 969 209 65 43/57 2012–2023 2,9 [2,7; 3,1] 3,4 [3,2; 3,6] 3,6 [3,4; 3,9] 3,8 [3,5; 4,0] 3,9 [3,7; 4,2] 4,2 [3,9; 4,4] 4,3 [4,1; 4,6] 4,4 [4,2; 4,7] 4,5 [4,2; 4,8] (58–72) (25 288) (22 047) (19 095) (16 161) (12 930) (9 566) (6 114) (2 957) (953) CORAIL™ AMT-puusavars kraega (DePuy) 15 502 114 69 (61–76) 36/64 2012–2023 1,8 [1,5; 2,0] 2,1 [1,9; 2,4] 2,4 [2,2; 2,7] 2,6 [2,3; 2,9] 2,7 [2,4; 3,0] 2,9 [2,6; 3,2] 3,0 [2,6; 3,4] 3,0 [2,6; 3,4] 3,0 [2,6; 3,4] (11 622) (9 156) (7 233) (5 196) (3 379) (2 059) (949) (210) (61) CORAIL™ AMT-puusavars ilma kraeta (DePuy) 40 733 178 69 38/62 2012–2023 3,0 [2,8; 3,1] 3,4 [3,2; 3,5] 3,7 [3,5; 3,9] 4,0 [3,8; 4,2] 4,1 [3,9; 4,3] 4,4 [4,1; 4,6] 4,6 [4,3; 4,8] 4,9 [4,6; 5,2] 5,2 [4,8; 5,7] (62–76) (34 432) (28 826) (23 451) (18 434) (13 900) (9 283) (5 190) (2 048) (612) COREHIP (Aesculap) 9 006 106 68 (60–74) 38/62 2017–2023 2,5 [2,1; 2,8] 2,9 [2,5; 3,2] 3,3 [2,8; 3,8] 3,3 [2,8; 3,8] 3,3 [2,8; 3,8] (5 065) (2 555) (1 026) (402) (56) EcoFit 133° cpTi (Implantcast) 648 6 73 28/72 2019–2023 4,7 [3,0; 6,4] 5,4 [3,5; 7,2] 6,7 [4,3; 9,0] (67–80) (465) (302) (122) EcoFit 133° HA (Implantcast) 387 5 71 (64–77) 42/58 2018–2023 2,6 [1,0; 4,2] 3,0 [1,2; 4,7] 3,0 [1,2; 4,7] 3,0 [1,2; 4,7] (308) (215) (147) (82) EcoFit cpTi (Implantcast) 1 073 17 73 30/70 2014–2023 5,0 [3,7; 6,3] 5,7 [4,3; 7,1] 6,1 [4,6; 7,5] 6,6 [5,0; 8,1] 6,8 [5,3; 8,4] 6,8 [5,3; 8,4] 7,5 [5,7; 9,4] (66–78) (971) (898) (835) (771) (571) (370) (187) EcoFit HA (Implantcast) 975 8 70 (64–78) 43/57 2014–2023 3,1 [2,0; 4,2] 3,4 [2,2; 4,5] 3,4 [2,2; 4,5] 3,4 [2,2; 4,5] 3,4 [2,2; 4,5] 3,4 [2,2; 4,5] (829) (680) (568) (427) (287) (162) EcoFit Short cpTi (Implantcast) 565 8 69 42/58 2018–2023 4,1 [2,5; 5,8] 4,1 [2,5; 5,8] 4,5 [2,7; 6,3] 4,5 [2,7; 6,3] (62–76) (434) (334) (237) (120) EXCEPTION (Zimmer Biomet) 1 519 14 68 (61–75) 50/50 2015–2023 4,4 [3,4; 5,5] 4,8 [3,8; 5,9] 5,4 [4,2; 6,5] 5,5 [4,3; 6,6] 6,1 [4,8; 7,4] 6,1 [4,8; 7,4] 6,1 [4,8; 7,4] (1 400) (1 329) (1 200) (876) (562) (275) (50) EXCIA (Aesculap) 13 765 121 70 40/60 2013–2023 3,2 [2,9; 3,5] 3,6 [3,3; 4,0] 3,8 [3,5; 4,1] 3,9 [3,6; 4,2] 4,0 [3,6; 4,3] 4,0 [3,7; 4,4] 4,1 [3,7; 4,5] 4,2 [3,8; 4,7] (62–76) (11 486) (9 238) (7 492) (5 639) (3 781) (2 218) (865) (157) Fitmore (Zimmer Biomet) 32 422 254 62 (56–69) 46/54 2012–2023 2,4 [2,2; 2,5] 2,8 [2,6; 2,9] 3,0 [2,8; 3,2] 3,1 [2,9; 3,3] 3,3 [3,0; 3,5] 3,4 [3,2; 3,6] 3,5 [3,2; 3,7] 3,5 [3,3; 3,8] 3,7 [3,4; 4,0] (27 189) (22 774) (18 679) (14 777) (10 975) (7 465) (4 450) (1 931) (535) GTS (Zimmer Biomet) 2 011 31 64 42/58 2013–2023 3,5 [2,7; 4,3] 4,4 [3,5; 5,3] 4,6 [3,7; 5,6] 4,9 [3,9; 5,9] 5,1 [4,1; 6,1] 5,3 [4,2; 6,3] 5,5 [4,4; 6,6] 6,1 [4,4; 7,9] (57–71) (1 803) (1 636) (1 482) (1 287) (985) (604) (328) (112) Konusprotees (Zimmer Biomet) 1 625 138 57 (48–66) 16/84 2013–2023 3,3 [2,4; 4,1] 3,9 [3,0; 4,9] 4,3 [3,3; 5,4] 4,7 [3,6; 5,7] 4,9 [3,7; 6,0] 5,2 [4,0; 6,3] 5,2 [4,0; 6,3] 5,2 [4,0; 6,3] 5,9 [4,0; 7,8] (1 386) (1 237) (1 084) (917) (754) (594) (410) (230) (94) LCU puusasüsteem, tsementeerimata (Waldemar Link) 4 204 47 68 43/57 2014–2023 2,9 [2,4; 3,4] 3,2 [2,7; 3,8] 3,5 [3,0; 4,1] 3,6 [3,0; 4,2] 3,8 [3,2; 4,4] 4,2 [3,4; 5,0] 5,2 [3,8; 6,6] (61–74) (3 441) (2 816) (2 240) (1 629) (1 092) (621) (188) M/L Taper (Zimmer Biomet) 6 705 26 68 (61–74) 42/58 2012–2023 3,2 [2,8; 3,7] 3,7 [3,2; 4,2] 4,0 [3,5; 4,5] 4,1 [3,7; 4,6] 4,3 [3,8; 4,8] 4,5 [3,9; 5,0] 4,8 [4,2; 5,4] 4,9 [4,2; 5,5] 4,9 [4,2; 5,5] (5 880) (5 109) (4 290) (3 586) (2 917) (2 038) (1 135) (549) (200) METABLOC (Zimmer Biomet) 713 14 72 39/61 2012–2020 2,4 [1,3; 3,5] 2,7 [1,5; 3,9] 2,8 [1,6; 4,1] 3,5 [2,1; 4,8] 3,6 [2,2; 5,0] 3,6 [2,2; 5,0] 3,9 [2,4; 5,5] 3,9 [2,4; 5,5] 3,9 [2,4; 5,5] (65–78) (685) (655) (635) (585) (497) (389) (250) (116) (56) Metafix (Corin) 1 774 17 71 (65–77) 41/59 2014–2023 1,8 [1,2; 2,4] 2,0 [1,4; 2,7] 2,2 [1,5; 2,9] 2,3 [1,5; 3,0] 2,6 [1,8; 3,3] 2,6 [1,8; 3,3] 2,6 [1,8; 3,3] 2,9 [1,9; 3,8] (1 607) (1 420) (1 229) (1 077) (806) (614) (374) (158) METHA (Aesculap) 8 731 171 57 47/53 2012–2023 2,7 [2,4; 3,1] 3,4 [3,0; 3,8] 3,6 [3,2; 4,0] 3,8 [3,3; 4,2] 3,9 [3,5; 4,3] 4,0 [3,6; 4,5] 4,1 [3,7; 4,6] 4,1 [3,7; 4,6] 4,1 [3,7; 4,6] (52–63) (7 751) (6 739) (5 755) (4 811) (3 734) (2 632) (1 711) (907) (305) MiniHip (Corin) 2 677 46 61 (55–68) 45/55 2013–2023 2,8 [2,1; 3,4] 3,2 [2,5; 3,9] 3,4 [2,7; 4,1] 3,6 [2,8; 4,3] 4,0 [3,2; 4,8] 4,3 [3,4; 5,1] 4,4 [3,5; 5,3] 4,4 [3,5; 5,3] (2 340) (1 915) (1 629) (1 395) (1 103) (749) (425) (159) MiniMIS varre (Falcon) 305 4 66 30/70 2016–2023 2,4 [0,6; 4,1] 2,4 [0,6; 4,1] 2,4 [0,6; 4,1] 2,4 [0,6; 4,1] (59–75) (230) (174) (127) (79) MRP-TITAN (Peter Brehm) 424 145 74 (62–81) 36/64 2013–2023 14.107[.140] .5; 15.189[.142] .1; 15.189[.142] .1; 15.189[.142] .1; 16.260[.142].6; (298) (235) (184) (142) (96) Nanos kaelaprotees (OHST / Smith & Nephew) 5 826 120 59 46/54 2013–2023 2,2 [1,8; 2,6] 2,5 [2,1; 3,0] 2,8 [2,4; 3,3] 3,1 [2,6; 3,6] 3,3 [2,8; 3,8] 3,4 [2,8; 3,9] 3,7 [3,1; 4,3] 3,9 [3,2; 4,5] (53 - 66) (4 977) (4 211) (3 536) (3 023) (2 500) (1 845) (1 218) (368) optimys (Mathys) 29 393 152 64 (57–71) 44/56 2013–2023 1,8 [1,6; 1,9] 2,0 [1,8; 2,1] 2,1 [1,9; 2,3] 2,2 [2,0; 2,4] 2,3 [2,1; 2,5] 2,3 [2,1; 2,5] 2,5 [2,2; 2,7] 2,5 [2,2; 2,7] 2,7 [2,2; 3,1] (22 458) (17 045) (12 747) (9 283) (6 215) (3 751) (1 728) (491) (89) Tabel 63 (jätkub) 174 EPRD 2024. aasta aruanne 175  Täiendavad tulemustabelid Valikulised puusaliigese täielikud proteesimised Kumulatiivsed revisioonimäärad pärast ... Aastad Reieluuvars Arv Haigla Vanus m/n pärast 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat implantee rimist Tsementeerimata reieluukomponent Peira varre (ARTIQO) 384 6 72 36/64 2015–2022 3,4 [1,6; 5,2] 3,4 [1,6; 5,2] 3,7 [1,8; 5,5] 3,7 [1,8; 5,5] 4,0 [2,0; 5,9] 4,0 [2,0; 5,9] (66–77) (364) (358) (340) (313) (225) (129) Polarschaft (Smith & Nephew) 17 015 129 69 (62–76) 40/60 2013–2023 2,8 [2,5; 3,0] 3,1 [2,8; 3,4] 3,3 [3,0; 3,5] 3,4 [3,1; 3,7] 3,6 [3,3; 3,9] 3,7 [3,3; 4,0] 4,1 [3,6; 4,5] 4,3 [3,8; 4,9] 4,6 [3,8; 5,4] (13 803) (11 423) (9 357) (7 524) (5 486) (3 472) (1 668) (542) (133) PROFEMUR® GLADIATOR (MicroPort) 458 8 70 33/67 2014–2023 2,7 [1,2; 4,2] 3,6 [1,8; 5,3] 4,3 [2,2; 6,2] 4,7 [2,5; 6,9] 4,7 [2,5; 6,9] 5,5 [2,8; 8,1] (64–75) (380) (307) (243) (185) (129) (90) PROFEMUR® GLADIATOR CLASSIC (MicroPort) 1 190 19 70 (63–76) 36/64 2014–2023 2,9 [1,9; 3,8] 3,2 [2,2; 4,2] 4,0 [2,7; 5,2] 4,0 [2,7; 5,2] 4,3 [2,9; 5,7] 4,8 [3,1; 6,5] 4,8 [3,1; 6,5] (944) (690) (485) (334) (226) (142) (81) PROFEMUR® L Classic (MicroPort) 494 10 69 40/60 2015–2023 2,3 [0,9; 3,6] 2,3 [0,9; 3,6] 2,3 [0,9; 3,6] 2,3 [0,9; 3,6] (62–76) (357) (272) (126) (78) PROFEMUR®Preserve (MicroPort) 755 18 63 (56–70) 46/54 2015–2023 2,6 [1,4; 3,7] 3,3 [1,9; 4,7] 3,3 [1,9; 4,7] 3,3 [1,9; 4,7] 3,3 [1,9; 4,7] (511) (310) (177) (97) (66) Proxy PLUS Schaft (Smith & Nephew) 894 25 69 44/56 2013–2023 3,6 [2,4; 4,8] 4,2 [2,9; 5,5] 4,4 [3,1; 5,8] 4,6 [3,2; 5,9] 4,7 [3,3; 6,1] 5,1 [3,6; 6,5] 5,4 [3,8; 6,9] 6,2 [3,9; 8,4] (63–75) (837) (791) (733) (671) (577) (446) (296) (112) Pyramid (Atesos) 3 369 27 71 (64–77) 36/64 2014–2023 2,8 [2,3; 3,4] 3,1 [2,5; 3,7] 3,5 [2,9; 4,1] 3,5 [2,9; 4,2] 3,6 [2,9; 4,3] 3,8 [3,1; 4,5] 3,8 [3,1; 4,5] 4,0 [3,2; 4,8] (3 007) (2 670) (2 276) (1 845) (1 489) (1 047) (576) (174) QUADRA-H (Medacta) 12 436 79 68 39/61 2015–2023 2,8 [2,5; 3,1] 3,3 [3,0; 3,7] 3,7 [3,3; 4,0] 4,0 [3,6; 4,4] 4,2 [3,8; 4,6] 4,5 [4,0; 4,9] 4,7 [4,2; 5,2] 5,4 [3,9; 6,8] (61–75) (9 586) (7 362) (5 740) (4 351) (3 089) (1 646) (595) (69) S-ROM™-puusavars (DePuy) 439 36 59 (48–67) 29/71 2013–2023 5,2 [3,0; 7,3] 5,2 [3,0; 7,3] 5,7 [3,3; 8,0] 5,7 [3,3; 8,0] 5,7 [3,3; 8,0] (345) (266) (186) (121) (62) SBG-Schaft (Smith & Nephew) 546 10 72 38/62 2013–2023 4,6 [2,8; 6,4] 5,0 [3,1; 6,8] 5,5 [3,5; 7,4] 5,7 [3,7; 7,7] 6,0 [3,9; 8,1] 6,0 [3,9; 8,1] 6,0 [3,9; 8,1] 10,0 [5,5; 14,2] (64–78) (499) (445) (382) (325) (280) (213) (132) (67) SCS-varras standard (Stemcup) 382 6 68 (61–74) 21/79 2014–2023 1,3 [0,2; 2,5] 2,1 [0,7; 3,6] 2,4 [0,9; 4,0] 2,4 [0,9; 4,0] 2,8 [1,1; 4,5] 3,3 [1,3; 5,2] 3,3 [1,3; 5,2] 3,3 [1,3; 5,2] (367) (349) (335) (303) (254) (188) (108) (53) SL-PLUS varre (Smith & Nephew) 5 750 65 69 35/65 2012–2023 3,2 [2,7; 3,6] 4,0 [3,5; 4,5] 4,4 [3,9; 5,0] 4,8 [4,2; 5,4] 5,1 [4,5; 5,7] 5,6 [4,9; 6,2] 6,1 [5,3; 6,8] 6,5 [5,7; 7,3] 6,6 [5,8; 7,4] (62–76) (5 178) (4 674) (4 132) (3 592) (3 014) (2 360) (1 616) (889) (364) SL MIA HA varre (Smith & Nephew) 7 231 58 70 (61–77) 35/65 2013–2023 2,8 [2,4; 3,2] 3,2 [2,8; 3,6] 3,4 [3,0; 3,9] 3,6 [3,1; 4,1] 3,7 [3,3; 4,2] 4,1 [3,5; 4,6] 4,4 [3,8; 5,0] 4,7 [4,0; 5,5] 5,0 [4,1; 5,9] (6 140) (5 182) (4 307) (3 424) (2 453) (1 644) (919) (426) (156) SP-CL puusavars, tsementeerimata (Waldemar Link) 4 248 48 64 40/60 2014–2023 3,4 [2,8; 3,9] 4,0 [3,4; 4,6] 4,4 [3,8; 5,1] 4,5 [3,9; 5,2] 4,7 [4,0; 5,4] 5,0 [4,2; 5,7] 5,1 [4,3; 5,9] 7,5 [4,3; 10,6] (57–70) (3 537) (2 909) (2 402) (1 841) (1 342) (835) (342) (50) SPS Evolution (Symbios) 1 213 17 64 (57–70) 44/56 2013–2023 2,4 [1,5; 3,2] 2,7 [1,8; 3,7] 3,1 [2,0; 4,0] 3,3 [2,2; 4,3] 3,3 [2,2; 4,3] 3,3 [2,2; 4,3] 3,3 [2,2; 4,3] (1 071) (957) (839) (672) (494) (262) (124) Stelia Stem (Stemcup) 397 3 69 32/68 2014–2023 0,8 [0,0; 1,6] 1,0 [0,0; 2,0] 1,6 [0,3; 2,9] 1,9 [0,5; 3,3] 2,2 [0,7; 3,8] 2,6 [0,9; 4,3] 3,0 [1,1; 4,8] 3,0 [1,1; 4,8] (60–76) (379) (358) (339) (308) (281) (271) (268) (178) STEMSYS varre (ARTIQO) 447 13 73 (69–79) 38/62 2018–2023 6,6 [4,2; 8,9] 7,2 [4,7; 9,7] 7,2 [4,7; 9,7] (322) (231) (124) Taperloc (Zimmer Biomet) 5 835 38 70 37/63 2014–2023 3,1 [2,6; 3,5] 3,6 [3,1; 4,1] 4,0 [3,5; 4,5] 4,3 [3,8; 4,9] 4,7 [4,1; 5,3] 5,1 [4,4; 5,8] 5,6 [4,8; 6,4] 5,9 [4,9; 6,8] (62–76) (4 841) (3 861) (3 049) (2 403) (1 805) (1 178) (533) (153) TAPERLOC COMPLETE (Zimmer Biomet) 5 304 32 66 (59–73) 43/57 2015–2023 2,5 [2,1; 2,9] 2,7 [2,3; 3,2] 2,9 [2,4; 3,4] 3,1 [2,6; 3,6] 3,3 [2,7; 3,8] 3,3 [2,7; 3,8] 3,3 [2,7; 3,8] (4 377) (3 716) (3 247) (2 358) (1 536) (936) (441) TRENDHIP (Aesculap) 7 080 62 69 40/60 2013–2023 2,6 [2,2; 2,9] 2,9 [2,5; 3,3] 3,0 [2,6; 3,4] 3,1 [2,7; 3,5] 3,3 [2,8; 3,7] 3,6 [3,0; 4,1] 3,6 [3,0; 4,1] 3,6 [3,0; 4,1] (62–76) (5 995) (5 031) (4 299) (3 429) (2 285) (1 214) (651) (247) TRILOCK™-puusavars (DePuy) 5 596 53 61 (55–67) 49/51 2013–2023 1,9 [1,5; 2,3] 2,5 [2,1; 2,9] 2,8 [2,4; 3,3] 3,1 [2,6; 3,6] 3,2 [2,7; 3,7] 3,4 [2,8; 3,9] 3,6 [3,0; 4,2] 3,8 [3,1; 4,5] 3,8 [3,1; 4,5] (4 924) (4 164) (3 490) (2 829) (2 085) (1 552) (984) (415) (89) TRJ (Aesculap) 1 201 34 71 33/67 2013–2023 2,9 [1,9; 3,9] 3,6 [2,5; 4,7] 3,8 [2,7; 5,0] 4,1 [2,9; 5,3] 4,1 [2,9; 5,3] 4,4 [3,1; 5,7] 4,4 [3,1; 5,7] 4,4 [3,1; 5,7] (63–77) (1 011) (835) (709) (585) (424) (293) (198) (96) twinSys uncem. (Mathys) 6 543 66 73 (66–78) 36/64 2013–2023 2,8 [2,4; 3,2] 3,2 [2,7; 3,6] 3,3 [2,8; 3,7] 3,5 [3,0; 4,0] 3,6 [3,1; 4,1] 3,8 [3,3; 4,4] 3,9 [3,4; 4,5] 4,1 [3,4; 4,7] 4,4 [3,5; 5,4] (5 469) (4 572) (3 705) (2 854) (1 988) (1 307) (765) (447) (192) VEKTOR-TITAN (Peter Brehm) 317 8 66 42/58 2014–2021 2,2 [0,6; 3,8] 2,8 [1,0; 4,7] 3,5 [1,4; 5,5] 4,2 [1,9; 6,4] 4,5 [2,2; 6,8] 4,9 [2,5; 7,3] 6,3 [3,4; 9,1] 6,8 [3,8; 9,8] (59–73) (308) (302) (294) (285) (259) (223) (189) (133) Tsementeeritud reieluukomponent A2 lühike tsementeeritud (ARTIQO) 403 29 79 (74–83) 20/80 2020–2023 1,6 [0,3; 2,8] (194) Tabel 63 (jätkub) 176 EPRD 2024. aasta aruanne 177  Täiendavad tulemustabelid Valikulised puusaliigese täielikud proteesimised Kumulatiivsed revisioonimäärad pärast ... Aastad Reieluuvars Arv Haigla Vanus m/n pärast 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat implantee rimist Tsementeeritud reieluukomponent ABG II vars (Stryker) 676 11 79 21/79 2014–2023 2,7 [1,5; 3,9] 3,1 [1,8; 4,5] 3,3 [1,9; 4,7] 3,3 [1,9; 4,7] 3,5 [2,1; 5,0] 3,5 [2,1; 5,0] 3,5 [2,1; 5,0] (76–82) (637) (613) (577) (497) (381) (220) (122) Actinia tsementeeritud (Implantcast) 717 19 80 (77–83) 21/79 2015–2023 3,4 [2,0; 4,7] 4,0 [2,5; 5,4] 4,2 [2,7; 5,6] 4,3 [2,8; 5,8] 4,6 [3,0; 6,2] 4,6 [3,0; 6,2] (648) (602) (553) (425) (211) (65) AS PLUS Schaft (Smith & Nephew) 701 23 80 20/80 2013–2023 3,3 [2,0; 4,7] 3,6 [2,2; 5,0] 4,0 [2,5; 5,5] 4,2 [2,7; 5,7] 4,6 [3,0; 6,2] 4,6 [3,0; 6,2] 5,1 [3,2; 6,9] (77–83) (641) (586) (533) (482) (401) (270) (160) Avenir (Zimmer Biomet) 7 026 159 80 (76–83) 23/77 2014–2023 2,5 [2,2; 2,9] 2,8 [2,4; 3,2] 2,9 [2,5; 3,4] 3,1 [2,6; 3,5] 3,3 [2,7; 3,8] 3,4 [2,8; 4,0] 3,4 [2,8; 4,0] 3,4 [2,8; 4,0] (5 024) (3 412) (2 198) (1 356) (798) (468) (222) (86) BHR (Smith & Nephew) 417 23 55 99/1 2014–2023 1,2 [0,2; 2,3] 1,8 [0,5; 3,2] 2,2 [0,7; 3,6] 2,2 [0,7; 3,6] 2,2 [0,7; 3,6] 2,2 [0,7; 3,6] 3,1 [0,7; 5,4] (51–59) (359) (313) (266) (219) (164) (108) (60) Bicana (Implantcast) 446 20 79 (75–82) 29/71 2013–2023 2,8 [1,2; 4,3] 3,3 [1,6; 5,0] 3,6 [1,8; 5,4] 3,9 [2,0; 5,8] 3,9 [2,0; 5,8] 4,3 [2,3; 6,3] 4,3 [2,3; 6,3] 4,3 [2,3; 6,3] (364) (345) (321) (299) (263) (220) (180) (128) BICONTACT (Aesculap) 4 371 114 80 23/77 2013–2023 2,4 [2,0; 2,9] 2,6 [2,1; 3,1] 2,9 [2,4; 3,4] 3,1 [2,6; 3,7] 3,3 [2,7; 3,9] 3,4 [2,8; 4,0] 3,5 [2,9; 4,1] 3,6 [3,0; 4,3] 4,3 [2,8; 5,8] (76–83) (3 751) (3 294) (2 866) (2 388) (1 858) (1 328) (809) (391) (132) C-STEM™ AMT-puusavars (DePuy) 784 16 80 (76–84) 18/82 2013–2023 2,1 [1,1; 3,1] 2,6 [1,4; 3,8] 3,2 [1,9; 4,5] 3,7 [2,2; 5,2] 4,4 [2,6; 6,1] 5,1 [3,1; 7,1] 5,1 [3,1; 7,1] 5,1 [3,1; 7,1] (645) (509) (408) (341) (284) (194) (120) (54) CCA (Mathys) 1 791 28 78 28/72 2012–2023 3,2 [2,4; 4,0] 4,0 [3,1; 5,0] 4,3 [3,3; 5,2] 4,6 [3,5; 5,6] 5,1 [4,0; 6,2] 5,5 [4,3; 6,7] 6,1 [4,7; 7,4] 6,6 [5,0; 8,1] 6,6 [5,0; 8,1] (74–82) (1 468) (1 249) (1 089) (937) (756) (623) (461) (262) (150) CORAIL™ AMT-puusavars ilma kraeta (DePuy) 9 762 159 80 (75–83) 21/79 2012–2023 2,7 [2,4; 3,0] 3,0 [2,6; 3,3] 3,3 [2,9; 3,7] 3,7 [3,2; 4,1] 4,1 [3,6; 4,6] 4,5 [3,9; 5,1] 4,9 [4,2; 5,5] 5,1 [4,3; 5,9] (7 390) (5 530) (3 976) (2 778) (1 842) (1 164) (598) (194) COREHIP (Aesculap) 1 443 67 81 17/83 2018–2023 3,5 [2,5; 4,5] 3,8 [2,7; 4,9] 4,0 [2,9; 5,2] 4,0 [2,9; 5,2] (77–84) (847) (464) (190) (62) CS PLUS varre (Smith & Nephew) 937 33 78 (75–82) 26/74 2014–2020 1,7 [0,9; 2,5] 2,4 [1,4; 3,4] 2,6 [1,6; 3,7] 2,6 [1,6; 3,7] 2,8 [1,7; 3,8] 2,9 [1,8; 4,1] 2,9 [1,8; 4,1] 2,9 [1,8; 4,1] (889) (855) (820) (773) (665) (426) (245) (87) ERAND (Zimmer Biomet) 781 14 79 20/80 2016–2023 3,0 [1,8; 4,2] 3,3 [2,0; 4,5] 3,4 [2,1; 4,7] 3,6 [2,3; 4,9] 3,9 [2,4; 5,3] 3,9 [2,4; 5,3] (75–83) (710) (661) (547) (360) (203) (77) EXCIA (Aesculap) 5 749 122 79 (75–83) 22/78 2014–2023 2,2 [1,8; 2,6] 2,6 [2,1; 3,0] 2,9 [2,4; 3,3] 3,2 [2,7; 3,7] 3,4 [2,8; 3,9] 3,7 [3,1; 4,3] 4,1 [3,3; 4,9] 5,1 [3,7; 6,4] (4 395) (3 445) (2 725) (2 066) (1 366) (877) (542) (194) Exeter Stem (Stryker) 731 26 81 24/76 2015–2023 3,2 [1,9; 4,5] 3,2 [1,9; 4,5] 3,2 [1,9; 4,5] 3,7 [2,1; 5,2] 3,7 [2,1; 5,2] 3,7 [2,1; 5,2] (77–84) (542) (413) (296) (197) (100) (52) ICON (IO-International Orthopaedics) 305 14 56 (51–62) 87/13 2013–2022 1,0 [0,0; 2,1] 1,3 [0,0; 2,6] 2,0 [0,4; 3,6] 2,7 [0,8; 4,6] 2,7 [0,8; 4,6] 3,3 [1,1; 5,5] 4,2 [1,4; 6,9] (297) (290) (278) (270) (219) (132) (66) LCU puusasendussüsteem, tsementeeritud (Waldemar Link) 1 098 22 79 32/68 2019–2023 2,7 [1,7; 3,6] 2,8 [1,8; 3,8] 2,8 [1,8; 3,8] (74–82) (777) (512) (241) Lubinus Classic Plus, tsementeeritud (Waldemar Link) 741 9 81 (78–84) 14/86 2012–2023 2,6 [1,5; 3,8] 2,6 [1,5; 3,8] 2,8 [1,6; 4,0] 2,8 [1,6; 4,0] 3,6 [2,0; 5,1] 4,4 [2,4; 6,4] 4,4 [2,4; 6,4] (615) (521) (439) (346) (256) (161) (70) M.E.M. Geradschaft (Zimmer Biomet) 32 765 201 79 25/75 2012–2023 2,2 [2,1; 2,4] 2,5 [2,3; 2,7] 2,7 [2,5; 2,9] 2,8 [2,6; 3,0] 3,1 [2,9; 3,3] 3,2 [3,0; 3,5] 3,4 [3,1; 3,7] 3,5 [3,2; 3,8] 3,5 [3,2; 3,8] (75–82) (26 433) (21 144) (16 772) (12 887) (9 087) (5 867) (3 154) (1 359) (367) METABLOC (Zimmer Biomet) 2 290 28 79 (75–82) 27/73 2013–2022 2,7 [2,0; 3,3] 3,0 [2,3; 3,7] 3,2 [2,5; 3,9] 3,4 [2,6; 4,1] 3,7 [2,9; 4,5] 4,1 [3,2; 4,9] 4,2 [3,3; 5,2] 4,5 [3,4; 5,5] (2 160) (2 064) (1 892) (1 614) (1 236) (842) (497) (203) MS-30 (Zimmer Biomet) 4 458 38 78 26/74 2013–2023 1,8 [1,4; 2,1] 1,9 [1,5; 2,3] 2,1 [1,7; 2,6] 2,4 [1,9; 2,8] 2,4 [1,9; 2,9] 2,6 [2,1; 3,1] 2,8 [2,2; 3,3] 3,1 [2,3; 3,8] (74–81) (3 971) (3 519) (3 069) (2 557) (2 008) (1 447) (855) (318) MUELLER V40 vars (Stryker) 325 13 79 (74–83) 26/74 2014–2023 2,8 [1,0; 4,6] 3,4 [1,4; 5,4] 3,8 [1,7; 5,9] 4,1 [1,9; 6,3] 4,9 [2,4; 7,3] 4,9 [2,4; 7,3] 4,9 [2,4; 7,3] (307) (288) (273) (251) (223) (172) (120) Müller Geradschaft (OHST Medizintechnik) 2 141 50 79 27/73 2014–2023 2,4 [1,7; 3,0] 2,6 [2,0; 3,3] 2,7 [2,0; 3,4] 2,9 [2,2; 3,6] 3,0 [2,2; 3,8] 3,1 [2,3; 3,9] 3,6 [2,6; 4,6] 3,9 [2,7; 5,0] (75–82) (1 915) (1 721) (1 500) (1 259) (944) (660) (347) (139) MV40 vars (OHST Medizintechnik) 389 19 80 (76–83) 23/77 2015–2023 0,8 [0,0; 1,7] 0,8 [0,0; 1,7] 1,1 [0,0; 2,2] 1,1 [0,0; 2,2] 1,1 [0,0; 2,2] 1,1 [0,0; 2,2] (327) (287) (238) (191) (137) (98) Polarschaft Cemented (Smith & Nephew) 3 694 89 79 23/77 2013–2023 2,9 [2,3; 3,4] 3,2 [2,6; 3,7] 3,2 [2,6; 3,8] 3,4 [2,7; 4,0] 3,6 [2,9; 4,3] 3,8 [3,0; 4,5] 3,9 [3,1; 4,8] 4,4 [3,2; 5,7] (76–83) (2 763) (2 202) (1 789) (1 402) (956) (560) (233) (92) PROFEMUR® GLADIATOR CEMENTED (MicroPort) 532 5 80 (77–83) 25/75 2015–2023 2,0 [0,7; 3,2] 2,5 [1,1; 3,8] 3,2 [1,5; 4,8] 3,2 [1,5; 4,8] 3,2 [1,5; 4,8] 3,2 [1,5; 4,8] (416) (303) (233) (176) (109) (58) Pyramid (Atesos) 327 15 80 22/78 2014–2023 2,8 [1,0; 4,5] 2,8 [1,0; 4,5] 2,8 [1,0; 4,5] 2,8 [1,0; 4,5] 3,9 [1,0; 6,7] (76–83) (270) (197) (135) (85) (54) Tabel 63 (jätkub) 178 EPRD 2024. aasta aruanne 179  Täiendavad tulemustabelid Valikulised puusaliigese täielikud proteesimised Kumulatiivsed revisioonimäärad pärast ... Aastad Reieluuvars Arv Haigla Vanus m/n pärast 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat implantee rimist Tsementeeritud reieluukomponent QUADRA-C (Medacta) 2 702 59 80 (77–83) 22/78 2015–2023 2,3 [1,7; 2,9] 2,6 [2,0; 3,3] 2,6 [2,0; 3,3] 2,9 [2,2; 3,6] 3,2 [2,4; 4,1] 3,9 [2,6; 5,1] 3,9 [2,6; 5,1] (2 036) (1 552) (1 171) (822) (490) (234) (73) SPECTRON (Smith & Nephew) 588 15 80 25/75 2013–2023 2,3 [1,0; 3,5] 2,9 [1,5; 4,3] 2,9 [1,5; 4,3] 2,9 [1,5; 4,3] 2,9 [1,5; 4,3] 2,9 [1,5; 4,3] 2,9 [1,5; 4,3] (76–83) (490) (410) (309) (240) (174) (117) (67) SPII mudel Lubinus puusavars, standardvars, ilma puurauguta (Waldemar Link) 15 349 121 78 (74–82) 26/74 2012–2023 2,0 [1,8; 2,2] 2,5 [2,3; 2,8] 2,8 [2,5; 3,1] 3,1 [2,8; 3,4] 3,3 [3,0; 3,6] 3,6 [3,2; 4,0] 4,0 [3,6; 4,5] 4,3 [3,8; 4,8] 4,7 [4,0; 5,4] (12 620) (10 303) (8 404) (6 594) (5 037) (3 581) (2 146) (981) (347) Standard C, tsementeeritud (Waldemar Link) 443 7 77 32/68 2014–2022 1,4 [0,3; 2,5] 2,1 [0,7; 3,4] 2,6 [1,1; 4,1] 3,1 [1,4; 4,8] 3,1 [1,4; 4,8] 3,1 [1,4; 4,8] 3,1 [1,4; 4,8] (74–81) (422) (390) (378) (362) (290) (198) (98) STEMSYS Schaft (ARTIQO) 345 16 81 (76–83) 22/78 2018–2023 3,3 [1,4; 5,2] 3,8 [1,6; 5,9] 3,8 [1,6; 5,9] (209) (130) (63) 80 (75,5 Taperloc tsementeeritud (Zimmer Biomet) 1 864 32 21/79 2014–2023 2,4 [1,7; 3,1] 2,8 [2,0; 3,6] 2,9 [2,1; 3,7] 2,9 [2,1; 3,7] 2,9 [2,1; 3,7] 2,9 [2,1; 3,7] 2,9 [2,1; 3,7] - 83) (1 533) (1 217) (917) (646) (405) (226) (104) TRENDHIP (Aesculap) 872 40 80 (76–84) 24/76 2016–2023 2,0 [1,0; 2,9] 2,0 [1,0; 2,9] 2,4 [1,3; 3,5] 2,4 [1,3; 3,5] 2,8 [1,4; 4,1] 2,8 [1,4; 4,1] (667) (538) (408) (309) (177) (79) twinSys cem. (Mathys) 2 333 49 79 23/77 2013–2023 2,3 [1,7; 2,9] 2,5 [1,9; 3,2] 2,6 [1,9; 3,2] 2,8 [2,1; 3,6] 3,2 [2,4; 4,0] 3,6 [2,6; 4,6] 4,0 [2,7; 5,3] 4,0 [2,7; 5,3] (74–83) (1 900) (1 573) (1 276) (962) (660) (388) (185) (85) Weber (Zimmer Biomet) 365 31 81 (76–84) 20/80 2014–2023 2,0 [0,5; 3,4] 2,3 [0,7; 3,9] 3,1 [1,2; 5,0] 4,1 [1,7; 6,4] 4,7 [2,1; 7,3] 4,7 [2,1; 7,3] (321) (281) (230) (181) (134) (88) Tabel 63 (jätkub) 180 EPRD 2024. aasta aruanne 181  Täiendavad tulemustabelid Valikulised puusaliigese täielikud proteesimised Kumulatiivsed revisioonimäärad pärast ... Implanta Kupud Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat paigalda mise aastad Tsementeerimata puusaliigese komponent Alloclassic (Zimmer Biomet) 538 12 68 (59–77) 30/70 2014–2023 3,2 [1,7; 4,7] 3,8 [2,1; 5,4] 4,2 [2,5; 5,9] 4,6 [2,8; 6,4] 4,6 [2,8; 6,4] 5,1 [3,2; 7,1] 5,1 [3,2; 7,1] 5,1 [3,2; 7,1] (505) (484) (470) (447) (394) (313) (224) (113) Alloclassic Variall (Zimmer Biomet) 560 14 70 34/66 2013–2022 0,5 [0,0; 1,1] 0,9 [0,1; 1,7] 1,3 [0,3; 2,3] 1,6 [0,5; 2,6] 1,6 [0,5; 2,6] 2,3 [0,8; 3,7] 2,3 [0,8; 3,7] 2,3 [0,8; 3,7] (61–78) (551) (518) (474) (411) (312) (203) (130) (67) Allofit (Zimmer Biomet) 166 048 399 70 (61–77) 38/62 2012–2023 2,6 [2,5; 2,7] 3,0 [2,9; 3,0] 3,2 [3,1; 3,3] 3,3 [3,3; 3,4] 3,5 [3,4; 3,6] 3,7 [3,6; 3,8] 3,9 [3,8; 4,0] 4,1 [3,9; 4,2] 4,2 [4,0; 4,3] (136 477) (111 433) (90 308) (70 560) (51 730) (34 947) (20 088) (8 632) (2 345) Allofit IT (Zimmer Biomet) 11 462 119 65 39/61 2012–2023 3,0 [2,6; 3,3] 3,5 [3,2; 3,9] 3,8 [3,4; 4,1] 3,9 [3,5; 4,3] 4,2 [3,8; 4,7] 4,4 [4,0; 4,8] 4,5 [4,0; 4,9] 4,8 [4,2; 5,3] 4,8 [4,2; 5,3] (57–74) (9 728) (8 305) (6 813) (5 413) (4 023) (2 864) (1 740) (767) (341) ANA.NOVA® Alpha pann (ARTIQO) 7 605 61 66 (59–74) 42/58 2015–2023 2,4 [2,0; 2,7] 2,6 [2,2; 3,0] 2,8 [2,4; 3,2] 3,1 [2,7; 3,6] 3,5 [3,0; 4,0] 3,6 [3,0; 4,1] 4,0 [3,2; 4,8] 4,0 [3,2; 4,8] (5 582) (4 066) (3 063) (2 278) (1 522) (788) (321) (58) ANA.NOVA® hübriidpann (ARTIQO) 10 446 62 67 36/64 2015–2023 2,3 [2,0; 2,5] 2,6 [2,2; 2,9] 2,7 [2,4; 3,1] 2,8 [2,5; 3,2] 3,0 [2,6; 3,4] 3,2 [2,8; 3,6] 3,6 [3,1; 4,2] 4,2 [3,2; 5,3] (59–75) (8 507) (6 891) (5 488) (4 149) (2 830) (1 665) (754) (120) aneXys Cluster (Mathys) 1 016 36 63 (56–71) 35/65 2016–2023 2,9 [1,9; 4,0] 3,3 [2,1; 4,6] 3,3 [2,1; 4,6] 3,3 [2,1; 4,6] 3,3 [2,1; 4,6] 3,3 [2,1; 4,6] (633) (359) (209) (147) (85) (58) aneXys Flex (Mathys) 6 962 75 64 44/56 2016–2023 2,5 [2,1; 2,9] 2,9 [2,5; 3,4] 3,1 [2,7; 3,6] 3,2 [2,7; 3,7] 3,5 [2,9; 4,0] 3,5 [2,9; 4,0] 3,7 [3,0; 4,5] (58–72) (4 976) (3 511) (2 380) (1 580) (877) (462) (117) aneXys Uno (Mathys) 441 15 56 (49–65) 43/57 2019–2023 2,6 [1,1; 4,1] 4,1 [2,0; 6,3] 4,1 [2,0; 6,3] (324) (213) (147) APRILL Poly (Symbios) 673 22 64 40/60 2014–2023 1,5 [0,6; 2,5] 2,1 [0,9; 3,2] 2,1 [0,9; 3,2] 2,3 [1,1; 3,5] 2,6 [1,3; 4,0] 2,6 [1,3; 4,0] (57–71) (561) (470) (398) (318) (224) (110) AVANTAGE (Zimmer Biomet) 384 59 77 (67–83) 33/67 2013–2023 3,5 [1,6; 5,4] 4,8 [2,4; 7,1] 4,8 [2,4; 7,1] 4,8 [2,4; 7,1] 4,8 [2,4; 7,1] (283) (196) (130) (98) (60) BHR (Smith & Nephew) 417 23 55 99/1 2014–2023 1,2 [0,2; 2,3] 1,8 [0,5; 3,2] 2,2 [0,7; 3,6] 2,2 [0,7; 3,6] 2,2 [0,7; 3,6] 2,2 [0,7; 3,6] 3,1 [0,7; 5,4] (51–59) (359) (313) (266) (219) (164) (108) (60) BICON-PLUS (Smith & Nephew) 3 200 53 72 (64–77) 36/64 2013–2023 2,5 [2,0; 3,0] 3,2 [2,6; 3,9] 3,8 [3,1; 4,5] 4,4 [3,6; 5,1] 4,7 [3,9; 5,4] 5,3 [4,4; 6,1] 6,1 [5,2; 7,1] 6,3 [5,3; 7,2] 6,6 [5,5; 7,6] (2 974) (2 770) (2 519) (2 237) (1 968) (1 661) (1 252) (782) (221) BiMobile kahepoolne liikuvussüsteem, tsementeerimata (Waldemar Link) 543 38 74 35/65 2017–2023 3,5 [1,9; 5,0] 3,8 [2,1; 5,4] 5,0 [2,6; 7,4] (65–81) (325) (191) (97) BSC-Cup pressfit suletud (Stemcup) 814 5 68 (60–73) 34/66 2014–2023 0,8 [0,2; 1,4] 1,4 [0,5; 2,2] 1,6 [0,6; 2,5] 1,8 [0,8; 2,8] 2,2 [1,0; 3,3] 2,5 [1,2; 3,9] 2,5 [1,2; 3,9] 2,5 [1,2; 3,9] (718) (618) (542) (468) (361) (280) (171) (76) CombiCup (Waldemar Link) 5 560 60 72 38/62 2013–2023 2,0 [1,6; 2,4] 2,5 [2,1; 2,9] 2,7 [2,3; 3,2] 3,0 [2,5; 3,5] 3,2 [2,7; 3,7] 3,4 [2,9; 3,9] 3,6 [3,0; 4,2] 4,6 [3,3; 5,8] (63–78) (5 034) (4 487) (3 966) (3 215) (2 364) (1 552) (725) (238) DURALOC™ OPTION™ Press Fit-Hüftpfanne (DePuy) 1 514 14 70 (61–77) 38/62 2013–2023 3,1 [2,2; 3,9] 3,6 [2,6; 4,6] 4,0 [2,9; 5,0] 4,4 [3,3; 5,5] 4,6 [3,4; 5,7] 4,6 [3,4; 5,7] 4,7 [3,6; 5,9] 4,7 [3,6; 5,9] (1 338) (1 179) (1 064) (908) (777) (674) (501) (220) EcoFit cpTi (Implantcast) 1 522 27 73 36/64 2014–2023 3,6 [2,7; 4,6] 4,3 [3,2; 5,3] 4,4 [3,4; 5,5] 4,8 [3,7; 5,9] 5,1 [4,0; 6,3] 5,3 [4,1; 6,5] 6,1 [4,5; 7,7] (65–79) (1 380) (1 276) (1 199) (1 047) (738) (383) (179) EcoFit EPORE (Implantcast) 2 286 31 73 (66–79) 31/69 2016–2023 4,5 [3,6; 5,3] 4,9 [4,0; 5,8] 5,4 [4,4; 6,4] 6,0 [4,9; 7,0] 6,3 [5,1; 7,4] 6,3 [5,1; 7,4] (1 888) (1 520) (1 121) (809) (490) (246) EcoFit EPORE NH (Implantcast) 786 6 71 40/60 2018–2023 3,1 [1,9; 4,3] 3,3 [2,0; 4,5] 3,3 [2,0; 4,5] 3,3 [2,0; 4,5] (64–78) (640) (467) (331) (184) EcoFit NH cpTi (Implantcast) 2 688 16 72 (64–78) 34/66 2014–2023 3,3 [2,6; 4,0] 3,4 [2,7; 4,1] 3,5 [2,8; 4,2] 3,7 [3,0; 4,4] 3,9 [3,2; 4,7] 4,4 [3,4; 5,5] 5,1 [3,7; 6,4] (2 404) (2 171) (1 948) (1 492) (630) (321) (141) EcoFit SC (Implantcast) 404 7 73 30/70 2014–2023 4,4 [2,3; 6,4] 4,7 [2,5; 6,8] 5,9 [3,4; 8,4] 7,0 [4,0; 9,8] 7,0 [4,0; 9,8] 7,0 [4,0; 9,8] (65–79) (332) (269) (195) (155) (97) (50) EL PFANNE (Smith & Nephew) 350 4 71 (63–77) 32/68 2013–2015 4,9 [2,6; 7,1] 4,9 [2,6; 7,1] 5,2 [2,8; 7,5] 5,8 [3,3; 8,3] 5,8 [3,3; 8,3] 5,8 [3,3; 8,3] 5,8 [3,3; 8,3] 5,8 [3,3; 8,3] 6,2 [3,6; 8,8] (327) (310) (304) (284) (275) (261) (256) (239) (129) EP-FIT PLUS (Smith & Nephew) 3 888 67 69 43/57 2013–2023 2,6 [2,1; 3,1] 3,0 [2,4; 3,5] 3,1 [2,5; 3,6] 3,2 [2,6; 3,7] 3,2 [2,6; 3,8] 3,3 [2,7; 3,9] 3,3 [2,8; 3,9] 3,7 [3,0; 4,4] 4,8 [3,0; 6,6] (61–76) (3 565) (3 247) (2 912) (2 627) (2 310) (1 826) (1 142) (436) (103) Exceed (Zimmer Biomet) 339 10 72 (63–77) 34/66 2013–2019 2,9 [1,1; 4,7] 3,6 [1,6; 5,5] 3,6 [1,6; 5,5] 3,6 [1,6; 5,5] 3,6 [1,6; 5,5] 4,3 [2,1; 6,5] 4,6 [2,3; 6,9] 5,2 [2,6; 7,7] (319) (306) (298) (293) (279) (268) (254) (148) Fitmore (Zimmer Biomet) 734 12 68 34/66 2012–2023 2,1 [1,0; 3,1] 2,5 [1,3; 3,6] 2,8 [1,6; 3,9] 2,8 [1,6; 3,9] 3,2 [1,9; 4,5] 3,2 [1,9; 4,5] 3,2 [1,9; 4,5] 3,2 [1,9; 4,5] (59–76) (703) (685) (664) (645) (529) (380) (194) (65) Tabel 64: Kumulatiivsed revisioonimäärad puusaliigese kumerate kausside puhul plaaniliste puusaliigese täielike proteesimiste korral. Iga kinnitustüübi puhul on kausid loetletud tähistuse järgi tähestikulises järjekorras. 182 EPRD aastaaruanne 2024 183  Täiendavad tulemustabelid Planeeritud puusaliigese täielikud proteesimised Kumulatiivsed parandamismäärad pärast ... Implanta Karikad Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat paigalda mise aastad Tsementeerimata asetabulaarkomponent G7 (Zimmer Biomet) 5 433 31 70 (62–77) 35/65 2014–2023 3,2 [2,7; 3,7] 3,9 [3,3; 4,4] 4,4 [3,8; 5,0] 4,9 [4,3; 5,6] 5,4 [4,7; 6,1] 5,9 [5,1; 6,6] 6,4 [5,5; 7,2] 6,7 [5,6; 7,8] (4 508) (3 759) (3 109) (2 432) (1 702) (1 051) (453) (84) HI Lubricer Schale (Smith & Nephew) 6 274 40 70 36/64 2013–2023 2,4 [2,0; 2,8] 2,8 [2,4; 3,2] 3,1 [2,6; 3,5] 3,4 [2,9; 3,8] 3,6 [3,1; 4,1] 4,0 [3,4; 4,5] 4,6 [3,9; 5,3] 5,6 [4,5; 6,6] 5,6 [4,5; 6,6] (62–77) (5 749) (5 105) (4 397) (3 661) (2 836) (1 903) (1 098) (405) (99) ICON (IO-International Orthopaedics) 305 14 56 (51–62) 87/13 2013–2022 1,0 [0,0; 2,1] 1,3 [0,0; 2,6] 2,0 [0,4; 3,6] 2,7 [0,8; 4,6] 2,7 [0,8; 4,6] 3,3 [1,1; 5,5] 4,2 [1,4; 6,9] (297) (290) (278) (270) (219) (132) (66) MobileLink, klastri auk (Waldemar Link) 4 231 63 72 36/64 2017–2023 3,6 [3,1; 4,2] 4,4 [3,7; 5,0] 4,5 [3,8; 5,2] 4,5 [3,8; 5,2] 4,5 [3,8; 5,2] (63–79) (2 783) (1 701) (826) (242) (90) MPACT (Medacta) 365 11 68 (61–76) 35/65 2019–2023 1,4 [0,2; 2,7] 1,4 [0,2; 2,7] (207) (100) PINNACLE™ Press Fit-Hüftpfanne (DePuy) 69 017 209 70 37/63 2012–2023 2,5 [2,4; 2,6] 2,9 [2,8; 3,0] 3,2 [3,1; 3,4] 3,5 [3,3; 3,6] 3,6 [3,5; 3,8] 3,9 [3,7; 4,1] 4,1 [3,9; 4,3] 4,4 [4,1; 4,6] 4,6 [4,2; 4,9] (61–77) (55 423) (44 423) (34 932) (26 133) (18 427) (11 886) (6 338) (2 353) (654) PINNACLE™ SPIROFIT™-kruviga liigesepann (DePuy) 440 18 74 (65–79) 26/74 2013–2020 3,9 [2,1; 5,7] 4,4 [2,4; 6,3] 4,6 [2,6; 6,6] 4,6 [2,6; 6,6] 5,1 [3,0; 7,2] 5,1 [3,0; 7,2] 5,1 [3,0; 7,2] 5,1 [3,0; 7,2] (408) (396) (386) (371) (337) (274) (173) (100) PLASMACUP (Aesculap) 9 444 59 69 38/62 2013–2023 2,1 [1,9; 2,4] 2,5 [2,2; 2,8] 2,6 [2,3; 2,9] 2,8 [2,4; 3,1] 2,8 [2,5; 3,2] 2,8 [2,5; 3,2] 2,8 [2,5; 3,2] 2,9 [2,5; 3,2] 3,0 [2,6; 3,5] (61–76) (8 455) (7 352) (6 423) (5 477) (4 384) (3 358) (2 335) (1 246) (417) PLASMAFIT (Aesculap) 59 293 279 69 (61–77) 39/61 2013–2023 2,9 [2,8; 3,0] 3,3 [3,1; 3,4] 3,5 [3,3; 3,6] 3,6 [3,4; 3,7] 3,7 [3,5; 3,8] 3,8 [3,6; 3,9] 3,8 [3,6; 4,0] 3,8 [3,7; 4,0] 4,2 [3,7; 4,6] (47 951) (39 025) (32 043) (25 145) (17 877) (11 295) (5 957) (2 245) (504) POLARCUP tsementivaba (Smith & Nephew) 366 42 72 35/65 2014–2023 3,2 [1,3; 5,0] 3,2 [1,3; 5,0] 3,2 [1,3; 5,0] 3,2 [1,3; 5,0] (63–80) (232) (172) (112) (72) PROCOTYL® L BEADED (MicroPort) 1 165 25 68 (60–75) 41/59 2014–2021 2,5 [1,6; 3,4] 3,2 [2,2; 4,2] 3,6 [2,5; 4,6] 3,7 [2,6; 4,8] 4,1 [2,8; 5,3] 4,8 [3,3; 6,3] 4,8 [3,3; 6,3] (1 123) (1 103) (956) (651) (418) (252) (130) PROCOTYL® P (MicroPort) 1 740 22 68 38/62 2020–2023 2,9 [2,0; 3,7] 3,0 [2,1; 3,9] (61–75) (1 066) (439) Pyramid (Atesos) 3 766 28 71 (64–78) 36/64 2014–2023 2,7 [2,2; 3,2] 3,0 [2,5; 3,6] 3,4 [2,8; 4,0] 3,4 [2,8; 4,0] 3,5 [2,9; 4,1] 3,7 [3,0; 4,3] 3,7 [3,0; 4,3] 3,7 [3,0; 4,3] (3 263) (2 801) (2 355) (1 887) (1 504) (1 056) (583) (172) R3 (Smith & Nephew) 23 313 148 69 38/62 2013–2023 2,9 [2,7; 3,1] 3,2 [3,0; 3,5] 3,4 [3,2; 3,7] 3,6 [3,4; 3,9] 3,8 [3,5; 4,0] 3,9 [3,6; 4,2] 4,1 [3,8; 4,4] 4,2 [3,8; 4,5] 4,2 [3,8; 4,5] (61–77) (18 471) (15 136) (12 177) (9 507) (6 573) (3 864) (1 702) (499) (83) REFLECTION (Smith & Nephew) 1 206 10 69 (60–77) 36/64 2013–2023 1,6 [0,9; 2,3] 1,9 [1,2; 2,7] 2,3 [1,4; 3,1] 2,3 [1,4; 3,1] 2,3 [1,4; 3,1] 2,4 [1,5; 3,4] 2,7 [1,6; 3,9] (1 133) (978) (846) (750) (607) (397) (263) RM Classic (Mathys) 2 616 21 76 32/68 2013–2023 2,9 [2,3; 3,6] 3,3 [2,6; 4,0] 3,5 [2,7; 4,2] 3,8 [3,0; 4,5] 4,0 [3,2; 4,8] 4,4 [3,5; 5,3] 4,5 [3,6; 5,4] 4,8 [3,8; 5,8] 5,9 [4,3; 7,5] (69–80) (2 273) (1 998) (1 710) (1 449) (1 191) (961) (721) (377) (167) RM Pressfit (Mathys) 1 392 14 74 (67–80) 41/59 2013–2023 2,5 [1,6; 3,3] 3,0 [2,1; 3,9] 3,2 [2,3; 4,2] 3,5 [2,5; 4,5] 3,8 [2,7; 4,8] 3,8 [2,7; 4,8] 4,3 [3,0; 5,6] 4,3 [3,0; 5,6] (1 246) (1 136) (1 035) (928) (678) (497) (279) (124) RM Pressfit vitamys (Mathys) 22 215 111 67 42/58 2013–2023 1,8 [1,6; 2,0] 2,0 [1,8; 2,2] 2,1 [1,9; 2,3] 2,2 [2,0; 2,4] 2,3 [2,1; 2,5] 2,4 [2,2; 2,6] 2,5 [2,2; 2,8] 2,6 [2,3; 2,9] 2,6 [2,3; 2,9] (60–75) (17 616) (13 845) (10 747) (7 931) (5 363) (3 173) (1 515) (542) (108) SCREWCUP SC (Aesculap) 2 580 62 73 (64–79) 33/67 2013–2023 3,2 [2,5; 3,9] 3,9 [3,1; 4,7] 4,3 [3,5; 5,1] 4,7 [3,8; 5,5] 5,3 [4,3; 6,2] 5,7 [4,7; 6,8] 6,3 [5,1; 7,5] 6,8 [5,2; 8,4] 6,8 [5,2; 8,4] (2 263) (2 004) (1 790) (1 441) (1 069) (664) (370) (168) (50) seleXys PC (Mathys) 579 7 71 38/62 2015–2023 0,9 [0,1; 1,6] 0,9 [0,1; 1,6] 0,9 [0,1; 1,6] 1,5 [0,5; 2,6] 1,5 [0,5; 2,6] 1,5 [0,5; 2,6] 1,5 [0,5; 2,6] (61–77) (549) (525) (479) (412) (325) (220) (115) T.O.P. (Waldemar Link) 353 8 62 (56–69) 50/50 2012–2022 2,3 [0,7; 3,8] 2,8 [1,1; 4,6] 3,1 [1,3; 5,0] 3,4 [1,5; 5,3] 3,8 [1,7; 5,7] 4,4 [2,2; 6,6] 4,4 [2,2; 6,6] 4,4 [2,2; 6,6] 4,4 [2,2; 6,6] (342) (333) (324) (316) (301) (277) (241) (172) (119) TM Modular (Zimmer Biomet) 1 748 149 65 28/72 2012–2023 6,4 [5,2; 7,6] 7,3 [6,0; 8,5] 7,6 [6,3; 8,9] 8,0 [6,6; 9,3] 8,4 [6,9; 9,8] 8,9 [7,4; 10,4] 8,9 [7,4; 10,4] 8,9 [7,4; 10,4] (54–75) (1 378) (1 155) (962) (782) (606) (427) (266) (126) Trident Cup (Stryker) 10 392 57 69 (61–76) 40/60 2014–2023 2,6 [2,3; 2,9] 3,0 [2,7; 3,3] 3,2 [2,9; 3,6] 3,4 [3,0; 3,8] 3,5 [3,1; 3,9] 3,7 [3,3; 4,1] 3,8 [3,3; 4,2] 3,8 [3,3; 4,2] (8 826) (7 389) (5 807) (4 301) (2 697) (1 416) (711) (235) Trident II Tritanium Cup (Stryker) 1 330 23 71 39/61 2018–2023 3,3 [2,2; 4,4] 3,7 [2,4; 5,0] (63–78) (452) (52) Trident TC Cup (Stryker) 834 16 73 (65–78) 32/68 2014–2021 2,5 [1,5; 3,6] 3,0 [1,9; 4,2] 3,4 [2,2; 4,6] 3,8 [2,5; 5,1] 4,2 [2,8; 5,6] 4,5 [3,1; 5,9] 4,5 [3,1; 5,9] 4,5 [3,1; 5,9] (791) (771) (754) (723) (687) (617) (452) (108) Trilogy (Zimmer Biomet) 7 032 36 68 38/62 2012–2023 2,1 [1,8; 2,5] 2,7 [2,3; 3,0] 2,8 [2,4; 3,2] 3,0 [2,6; 3,4] 3,1 [2,7; 3,6] 3,2 [2,8; 3,7] 3,4 [3,0; 3,9] 3,4 [3,0; 3,9] 3,4 [3,0; 3,9] (60–75) (6 222) (5 477) (4 783) (4 180) (3 394) (2 602) (1 705) (889) (382) Trilogy IT (Zimmer Biomet) 1 721 6 71 (63–77) 38/62 2013–2023 3,5 [2,6; 4,4] 3,7 [2,8; 4,6] 4,0 [3,0; 4,9] 4,2 [3,2; 5,2] 4,4 [3,4; 5,4] 5,0 [3,8; 6,2] 5,4 [4,1; 6,6] 5,4 [4,1; 6,6] (1 458) (1 248) (1 088) (917) (729) (526) (346) (145) Tabel 64 (jätkub) 184 EPRD 2024. aasta aruanne 185  Täiendavad tulemustabelid Valikulised puusaliigese täielikud proteesimised Kumulatiivsed revisioonimäärad pärast ... Implanta Kupud Arv Haigla Vanus m/n adi 1 aasta 2 aastat 3 aastat 4 aastat 5 aastat 6 aastat 7 aastat 8 aastat 9 aastat paigalda mise aastad Tsementeerimata asetabulaarkomponent Trinity Hole (Corin) 2 607 45 66 42/58 2013–2023 2,3 [1,8; 2,9] 2,5 [1,9; 3,1] 2,6 [2,0; 3,2] 2,7 [2,0; 3,3] 2,8 [2,1; 3,4] 3,0 [2,3; 3,7] 3,3 [2,4; 4,1] 3,6 [2,6; 4,6] (58–75) (2 300) (1 889) (1 528) (1 244) (968) (698) (398) (157) Trinity ilma avata (Corin) 2 701 30 68 (61–75) 42/58 2014–2023 2,2 [1,7; 2,8] 2,7 [2,1; 3,3] 3,0 [2,3; 3,7] 3,1 [2,4; 3,8] 3,6 [2,9; 4,4] 3,9 [3,1; 4,7] 4,2 [3,3; 5,1] 4,2 [3,3; 5,1] (2 427) (2 199) (2 030) (1 843) (1 457) (1 047) (657) (281) Tritanium Cup (Stryker) 2 931 31 70 39/61 2014–2023 2,7 [2,1; 3,3] 3,2 [2,6; 3,9] 3,6 [2,9; 4,2] 4,0 [3,2; 4,7] 4,1 [3,3; 4,8] 4,2 [3,4; 5,0] 4,6 [3,6; 5,5] 4,9 [3,7; 6,1] (62–78) (2 766) (2 463) (1 962) (1 440) (920) (604) (316) (109) VERSAFITCUP CC TRIO (Medacta) 16 861 82 69 (61–77) 38/62 2015–2023 2,7 [2,4; 2,9] 3,1 [2,8; 3,3] 3,4 [3,1; 3,7] 3,7 [3,4; 4,0] 4,0 [3,6; 4,4] 4,4 [3,9; 4,8] 4,6 [4,1; 5,1] 5,6 [4,1; 7,1] (13 083) (10 094) (7 879) (5 902) (4 033) (2 129) (772) (80) XentraX Screwcup (Stemcup) 375 15 70 27/73 2014–2023 3,0 [1,3; 4,8] 3,4 [1,5; 5,2] 3,8 [1,7; 5,9] 4,4 [2,0; 6,8] 5,1 [2,4; 7,8] 6,6 [3,2; 9,9] 6,6 [3,2; 9,9] 6,6 [3,2; 9,9] (59–78) (312) (235) (179) (137) (132) (125) (122) (80) Tsementeeritud asetabulaarkomponent All POLY CUP (Aesculap) 4 524 163 80 (76–84) 22/78 2013–2023 2,8 [2,3; 3,3] 3,2 [2,7; 3,7] 3,5 [2,9; 4,0] 3,7 [3,1; 4,3] 3,9 [3,3; 4,5] 4,1 [3,5; 4,8] 4,4 [3,7; 5,1] 4,9 [4,0; 5,9] 4,9 [4,0; 5,9] (3 834) (3 319) (2 835) (2 307) (1 741) (1 176) (711) (325) (106) AVANTAGE (Zimmer Biomet) 1 449 150 80 27/73 2014–2023 5,1 [4,0; 6,3] 5,4 [4,2; 6,7] 6,0 [4,6; 7,3] 6,2 [4,8; 7,7] 6,2 [4,8; 7,7] 6,8 [5,0; 8,7] (73–84) (1 013) (714) (470) (305) (164) (87) BiMobile kahekomponendiline liimimissüsteem (Waldemar Link) 309 56 81 (73–85) 29/71 2017–2023 7,3 [4,1; 10,4] 7,3 [4,1; 10,4] (153) (78) CCB (Mathys) 1 224 48 79 22/78 2013–2023 3,0 [2,0; 3,9] 3,8 [2,7; 4,9] 3,8 [2,7; 4,9] 4,3 [3,0; 5,6] 5,0 [3,5; 6,5] 5,0 [3,5; 6,5] 5,7 [3,7; 7,6] (74–83) (988) (798) (629) (451) (299) (200) (114) Tsementeeritav puusaliigese kausisüsteem, Endo-Model Cup (Waldemar Link) 608 6 77 (72–82) 17/83 2012–2023 2,0 [0,9; 3,1] 2,7 [1,4; 4,0] 3,1 [1,7; 4,5] 3,3 [1,8; 4,7] 3,3 [1,8; 4,7] 3,3 [1,8; 4,7] 3,3 [1,8; 4,7] 4,0 [2,2; 5,7] 4,0 [2,2; 5,7] (577) (530) (488) (441) (390) (351) (297) (231) (162) Tsementeeritud asetabulaarne kauss, IP Cup (Waldemar Link) 1 468 44 80 26/74 2013–2023 2,4 [1,6; 3,2] 2,9 [2,0; 3,8] 3,2 [2,3; 4,2] 3,7 [2,6; 4,7] 3,8 [2,7; 4,8] 3,9 [2,8; 5,0] 3,9 [2,8; 5,0] 3,9 [2,8; 5,0] (77–84) (1 307) (1 181) (1 048) (892) (664) (464) (295) (106) Tsementeeritud puusaliigese kausisüsteem, Lubinus (Waldemar Link) 1 256 40 79 (75–83) 23/77 2013–2023 2,0 [1,2; 2,7] 2,2 [1,4; 3,1] 2,8 [1,8; 3,7] 3,1 [2,0; 4,1] 3,4 [2,3; 4,6] 3,7 [2,4; 4,9] 3,7 [2,4; 4,9] 5,0 [2,8; 7,1] (1 110) (961) (787) (606) (446) (331) (189) (92) EcoFit 2M tsementeeritud (Implantcast) 422 71 78 32/68 2014–2023 7,7 [5,1; 10,3] 9,5 [6,4; 12,4] 10,5 [7,2; 13,8] 11,5 [7,7; 15,1] (69–83) (285) (195) (117) (65) Lame profiil (Zimmer Biomet) 9 641 312 80 (75–83) 23/77 2012–2023 3,2 [2,8; 3,5] 3,5 [3,2; 3,9] 3,9 [3,5; 4,3] 4,1 [3,7; 4,5] 4,3 [3,9; 4,7] 4,6 [4,2; 5,1] 4,7 [4,2; 5,3] 5,0 [4,4; 5,6] 5,0 [4,4; 5,6] (7 952) (6 617) (5 417) (4 353) (3 241) (2 165) (1 283) (557) (151) Mueller II (Implantcast) 529 36 79 24/76 2014–2023 3,8 [2,1; 5,4] 4,8 [2,8; 6,7] 5,1 [3,1; 7,1] 6,0 [3,6; 8,3] 6,6 [3,9; 9,1] 7,7 [4,3; 10,9] (74–83) (407) (319) (246) (195) (118) (80) Müller II Pfanne (OHST Medizintechnik) 2 902 118 80 (76–83) 23/77 2013–2023 3,1 [2,5; 3,7] 3,6 [2,9; 4,3] 3,9 [3,2; 4,6] 4,1 [3,3; 4,8] 4,2 [3,5; 5,0] 4,3 [3,5; 5,1] 4,5 [3,7; 5,3] 4,5 [3,7; 5,3] (2 543) (2 284) (2 048) (1 778) (1 437) (1 020) (562) (199) POLARCUP tsementeeritud (Smith & Nephew) 449 59 79 27/73 2013–2023 4,2 [2,3; 6,1] 5,2 [3,0; 7,4] 5,7 [3,3; 8,1] 5,7 [3,3; 8,1] 5,7 [3,3; 8,1] (70–84) (318) (216) (151) (99) (63) PROCOTYL® C (MicroPort) 411 6 80 (76–83) 24/76 2015–2023 1,3 [0,2; 2,4] 2,2 [0,7; 3,7] 3,0 [1,1; 4,8] 3,5 [1,4; 5,5] 4,3 [1,6; 6,8] (345) (272) (209) (149) (82) TRILOC® II-PE-Hüftpfanne (DePuy) 1 478 98 80 19/81 2013–2023 3,4 [2,5; 4,3] 3,6 [2,6; 4,5] 3,9 [2,8; 4,9] 4,1 [3,0; 5,1] 4,5 [3,4; 5,7] 4,9 [3,6; 6,2] 5,6 [4,0; 7,1] 5,6 [4,0; 7,1] (74–83) (1 251) (1 083) (906) (722) (541) (389) (227) (73) Tabel 64 (jätkub) 186 EPRD 2024. aasta aruanne 187  Viited Viited [9] Soderman P, Malchau H, Herberts P, Johnell O. Kas Rootsi riikliku puusaliigese endoproteesimise registri andmed on usaldusväärsed? Võrdlus Rootsi riikliku puusaliigese endoproteesimise registri, riikliku haiglast väljakirjutamise registri ja riikliku surma registri vahel. J Arthroplasty 2000;15(7): 884-9. https://doi.org/10.1054/arth.2000.8591 [1] K onow T, Baetz J, Melsheimer O, Grimberg A, Morlock M. Periprosteetilise reieluukaare murru riski mõjutavad tegurid – Saksa registri uuring. Bone Joint J 2021;103-B(4): 650-658. https://doi.org/10.1302/0301- [10] Kim S, Won SJ, Lee NK, Chang CB. 620X.103B4.BJJ-2020-1046.R2 Põlveliigese täieliku asendamise operatsiooni läbinud patsientide eluiga: võrdlus üldpopulatsiooniga. J Korean Med Sci 2024;39(11): e106. https://doi.org/10.3346/jkms.2024.39.e106 [2] R öerink AMC, Nelissen R, Holder C, Graves S, Dunbar M, Bohm ER, Grimberg A, Steinbrück A, Dale H, Fenstad AM, Blom A, Lenguerrand E, Frampton C, Willems TM, Victor J, Espallargues M, Arias-De La Torre J, Ciminello E, Torre M, Pijls BG. [11] Wilson HA, Middleton R, Abram SGF, Smith S, Alvand A, Jackson WF, Bottomley N, Soolised erinevused infektsiooni tõttu vajaliku korduvoperatsiooni riski osas pärast puusa-, põlve- Hopewell S, Price AJ. , õla- ja pahkluuartroplastikat osteoartriidiga patsientidel, rahvusvaheline registriuuring, mis Patsiendile olulised tulemused ühekompartmentaalse ja täieliku põlveliigese asendamise võrdluses: hõlmab 4 800 000 implantaati. süstemaatiline ülevaade ja metaanalüüs. Acta Orthopaedica 2024 (artikkel trükis) Bmj 2019;364: l352. https://doi.org/10.1136/bmj.l352 [3] Steinbrück A, Grimberg AW, Elliott J, Melsheimer O, Jansson V. Lühike versus tavapärane vars tsementivabas puusaliigese täielikus endoproteesimises: [12] Kurtz SM, Lau EC, Son MS, Chang ET, Zimmerli W, Parvizi J. tõenduspõhine lähenemine, tuginedes registriandmetele keskmise pikkusega Kas me võidame või kaotame võitluse periprostetilise liigesepõletikuga: periprostetilise jälgimisperioodi kohta. Der Orthopade 2021;50(4): 296–305. liigesepõletiku ja suremusriski suundumused Medicare'i rahvastiku hulgas. https://doi.org/10.1007/s00132-021-04083-y J Arthroplasty 2018;33(10): 3238–3245. https://doi.org/10.1016/j.arth.2018.05.042 [4] Morlock M, Perka C, Melsheimer O, Kirschbaum SM. [13] Per sson A, Skoldenberg O, Mohaddes M, Eisler T, Gordon M. Varre tüübi ja selle kinnituse mõju revisioonile ja vahetule postoperatiivsele suremusele plaanilise Suurenenud suremus pärast puusaliigese proteesi infektsiooni on peamiselt tingitud kaasuvate täieliku puusaliigese endoproteesimise puhul. haigustest, mitte infektsioonist endast. Bone Joint J 2024;106-B(3 Supple A): 130-136. https://doi.org/10.1302/0301- Acta Orthop 2023;94: 484–489. https://doi.org/10.2340/17453674.2023.18619 620X.106B3.BJJ-2023-0820.R2 [5] Hunt LP, Matharu GS, Blom AW, Howard PW, Wilkinson JM, Whitehouse MR. Patella pinna asendamine esmase täieliku põlveliigese asendamise käigus on seotud väiksema korduvoperatsiooni riskiga. Bone Joint J 2021;103-B(5): 864-871. https://doi.org/10.1302/0301- 620X.103B5.BJJ-2020-0598.R2 [6] EPRD Deutsche Endoprothesenregister gGmbH. Endoprothesenregister Deutschland (EPRD) – aastaaruanne 2022. Berliin, 2022. https://doi.org/10.36186/reporteprd062022 [7] Grimberg AW, Grupp TM, Elliott J, Melsheimer O, Jansson V, Steinbrück A. Keraamiline kate tsementeeritud esmase täieliku põlveliigese endoproteesimise puhul ei ole seotud varase proteesliigese infektsiooni tõttu tekkiva revisiooni riski vähenemisega. J Arthroplasty 2021;36(3): 991-997. https://doi.org/10.1016/j.arth.2020.09.011 [8] Okaf või CE, Nghiem S, Byrnes J. Kas liigeseproteeside registrid on seotud revisioonide koormuse muutustega? Regressioonianalüüs reaalse maailma paneelandmete põhjal. BMJ Open 2023;13(1): e063472. https://doi.org/10.1136/bmjopen-2022-063472 188 EPRD aastaaruanne 2024 189  Jooniste loetelu Jooniste loetelu Joonis 21: Joonis 22: Ühe kondüüli põlveliigese proteesimise kumulatiivsed revisioonimäärad patsiendi soo järgi......................109 Standardse täieliku põlveliigese proteesimise kumulatiivsed revisioonimäärad patsiendi kehamassiindeksi järgi...............................................................................................................................109 Joonis 1: Aastane protseduuride arv operatsiooni kuupäeva järgi. ..............................................................................14 Joonis 23: Ühe kondüüli põlveliigese proteesimise kumulatiivsed revisioonimäärad haigla esmaste ühe kondüüliga põlveliigese proteesimiste aastase mahu järgi ...................................................110 Joonis 2: Andmeid igal aastal esitavate haiglate arv..................................................................................................15 Joonis 24: Standardse täieliku põlveliigese proteesimise kumulatiivsed revisioonimäärad põlvesüsteemi järgi ..........116 Joonis 3: Planeeritud ja mitteplaneeritud puusaliigese proteesimiste kumulatiivsed revisioonimäärad.......................52 Joonis 25: Standardse täieliku põlveliigese endoproteesimise kumulatiivsed revisioonimäärad kandva osa järgi Joonis 4 Planeeritud täielike puusaliigese proteesimiste kumulatiivsed revisioonimäärad tsementeeritud liikuvuse....................................................................................................................................................117 ja tsementeerimata varrega .........................................................................................................................53 Joonis 26: Kumulatiivsed revisioonimäärad standardse esmase täieliku põlveliigese endoproteesimise puhul Joonis 5: Kumulatiivsed revisioonimäärad plaaniliste puusaliigese täielike endoproteesimiste puhul ja ilma põlveliigese pinna uuendamiseta esmase põlveliigese täieliku asendamise puhul .........................117 tsementeerimata varrega esmase diagnoosi järgi ................................................................................................................54 Joonis 27: Kumulatiivsed revisioonimäärad ühe kondüüliga põlveliigese proteesimisel vastavalt reieluupinna materjali järgi........................................................................................................................117 Joonis 6: Kumulatiivsed revisioonimäärad valikuliste täielike puusaliigese proteesimiste puhul tsementeerimata varrega valikuliste puusaliigese täielike proteesimiste kumulatiivsed revisjonimäärad vanuserühmade kaupa 58 Joonis 28: Põlveliigese proteesimise kumulatiivsed re-revisioonimäärad aja jooksul ..................................................140 Joonis 7: Kumulatiivsed revisioonimäärad valikuliste täielike puusaliigese endoproteesimiste puhul, kus Joonis 29: Põlveliigese endoproteesimise kumulatiivsed re-revisioonimäärad pärast esimest, teist ja kasutatakse tsementeerimata järgnevate revisioonide järel ......................................................................................................................140 varrega esmase diagnoosi järgi ................................................................................................................58 Joonis 30: Põlveliigese endoproteesimise kumulatiivsed re-revisiooni määrad implanteeritud komponentide kaupa ..141 Joonis 8: Kumulatiivsed revisioonimäärad valikuliste täielike puusaliigese endoproteesimiste puhul, kus kasutatakse tsementeerimata varrastega valikuliste puusaliigese täielike endoproteesimiste kumulatiivsed revisioonimäärad patsiendi kehakaaluindeksi järgi ...............................................................................................................................59 Joonis 9: Kumulatiivsed revisioonimäärad valikuliste täielike puusaliigese proteesimiste puhul haigla esmaste plaaniliste puusaliigese täielike proteesimiste aastane arv ........................................................60 Joonis 10: Kumuleeritud revisioonimäärad tsementeerimata ja tsementeeritud puusaliigese hemiartroplastika puhul .68 Joonis 11: Kumulatiivsed revisioonimäärad plaaniliste täielike puusaliigese proteesimiste puhul tsementeeritud varre puhul pea suuruse järgi......................................................................................................................68 Joonis 12: Kumulatiivsed revisioonimäärad valikuliste täielike puusaliigese proteesimiste puhul tsementeerimata varrastega valikuliste puusaliigese täielike endoproteesimiste puhul pea-kaela pikkuse järgi .........................69 Joonis 13: Kumulatiivsed revisioonimäärad valikuliste täielike puusaliigese endoproteesimiste puhul tsementeerimata varre tüübi järgi ..........................................................................................................................................69 Joonis 14: Puusaartroplastika kumulatiivsed re-revisiooni määrad aja jooksul..........................................................97 Joonis 15: Lõualuuartroplastika kumulatiivsed re-revisiooni määrad pärast esimest, teist ja järgnevaid revisioone .98 Joonis 16: Lõualuuartroplastika kumulatiivsed re-revisiooni määrad implanteeritud komponentide kaupa ...............98 Joonis 17: Kogu- ja ühekondülaarse põlveliigese endoproteesimise kumulatiivsed revisioonimäärad.......................104 Joonis 18: Kogu-põlveliigese proteeside kumulatiivsed revisioonimäärad piirangute astme järgi ..............................105 Joonis 19: Tavaliste põlveliigese täielike proteesimiste kumulatiivsed revisioonimäärad esmase (dokumenteeritud ICD-10 koodide alusel)...................................................................................................105 Joonis 20: Standardse põlveliigese täieliku endoproteesimise kumulatiivsed korrigeerimismäärad vanuserühmade kaupa 108 190 EPRD 2024. aasta aruanne 191  Tabelite loetelu Tabelite loetelu Tabel 27: Tabel 28: Põlveliigese ühe kondüüli esmase endoproteesimise puhul 2023. aastal .......................................................42 Põlveliigese pinna asendamine esmaste täielike põlveliigese proteesimiste puhul 2023. aastal ....................42 Tabel 29: Reieluupinnamaterjalid esmases täielikus põlveliigese endoproteesimises 2023. aastal................................42 Tabel 1: Registreeritud protseduuride osakaal liigeste ja sekkumise tüübi järgi 2023. aastal..........................................30 Tabel 30: Sääreluu kandevate osade materjalid esmaste täielike põlveliigese proteesimiste puhul 2023. aastal ..........42 Tabel 2: Esmased puusaliigese endoproteesimised 2023. aastal patsiendi vanuse, soo ja KMI järgi .............................31 Tabel 31: Põlveliigese esmase täieliku endoproteesimise puhul kasutatavad kandematerjalid 2023. aastal..................43 Tabel 3 2023. aastal esmaste puusaliigese endoproteesimiste puhul teatatud varasemad operatsioonid .................31 Tabel 32: Reieluupõhimaterjalid esmaste ühe kondüüli põlveliigese proteesimiste puhul 2023. aastal ..........................43 Tabel 4: Esmase puusaliigese asendamise tüübid 2023. aastal ....................................................................................33 Tabel 33: Sääreluu kandepinnamaterjalid esmases ühe kondüüli põlveliigese endoproteesimisel 2023. aastal ............43 Tabel 5: Fikseerimised esmaste täielike puusaliigese proteesimiste puhul 2023. aastal .............................................33 Tabel 34: Põlveliigese esmase ühe kondüüli proteesimise puhul kasutatavad kandematerjalid 2023. aastal ................43 Tabel 6: Fikseerimised esmaste puusaliigese hemiartroplastikate puhul 2023. aastal.................................................33 Tabel 35: Põlveliigese revisioonid 2023. aastal patsiendi vanuse, soo ja KMI järgi ..............................................................44 Tabel 7: Varre tüübid esmaste puusaliigese täielike proteesimiste puhul 2023. aastal ................................................33 Tabel 36: Põlveliigese revisioonide põhjused 2023. aastal .................................................................................................45 Tabel 8: Varre tüübid esmaste puusaliigese poolproteesimiste puhul 2023. aastal .....................................................33 Tabel 37: 2023. aastal põlveliigese revisioonide käigus uuesti implanteeritud komponendid.............................................46 Tabel 9: Lõualuu komponendid esmaste puusaliigese täielike proteesimiste puhul 2023. aastal ................................34 Tabel 38: Pea suuruse ja siseläbimõõdu Tabel 10: Rekonstruktsioonikestad esmaste täielike puusaliigese endoproteesimiste puhul 2023. aastal ....................34 2023. aastal......................................................................................................................................................48 Tabel 11: Peade suurused esmaste täielike puusaliigese proteesimiste puhul 2023. aastal .........................................34 Tabel 39: Näide puusaliigese proteesi pea suuruse mittevastavusest......................................................................................48 Tabel 12: Pea-kaela pikkused esmaste täielike puusaliigese proteesimiste puhul 2023. aastal ....................................34 Tabel 40: Näide THA koonuse sobimatuse kohta................................................................................................................48 Tabel 13: Lõualuu kandematerjalid esmaste täielike puusaliigese proteesimiste puhul 2023. aastal ............................35 Tabel 41: Näide TKA külgmise mittevastavuse kohta...........................................................................................................48 Tabel 14: Modulaarsete peade materjalid esmases puusaliigese täielikus endoproteesimises 2023. aastal.................35 Tabel 42: Näide TKA suuruse mittevastavusest ..................................................................................................................49 Tabel 15: Esmase täieliku puusaliigese endoproteesimise puhul kasutatavad laagrimaterjalid 2023. aastal ................35 Tabel 43: Näide PS-sisendi ja mitte-PS reieluukomponendi sobimatuse kohta....................................................................49 Tabel 16: Modulaarsete peade materjalid esmaste puusaliigese hemiartroplastika operatsioonidel 2023. aastal.........35 Tabel 44: Erinevate esmaste puusaliigese proteeside kumulatiivsed revisioonimäärad ja diagnooside ..................................................................................................................................................54 Tabel 17: Lõualuu revisioonid 2023. aastal patsiendi vanuse, soo ja KMI järgi ...................................................................36 Tabel 45: Erinevate esmaste puusaliigese endoproteesimiste kumulatiivsed revisioonimäärad Tabel 18: Põlveliigese korduvoperatsioonide põhjused 2023. aastal................................................................................37 implantaadiga mitteseotud tegurite kaupa .......................................................................................................62 Tabel 19: 2023. aastal ühe- või mitmeastmelise revisiooni käigus uuesti implanteeritud puusaliigese komponendid ...37 Tabel 46: Esmase puusaliigese endoproteesimise erinevate tüüpide ja omaduste kumulatiivsed revisioonimäärad puusaliigese proteesimine................................................................................................................................70 Tabel 20: Esmased põlveliigese proteesimised 2023. aastal patsiendi vanuse, soo ja KMI järgi ......................................39 Tabel 47: Implantaadi tulemused varre/põhja kombinatsioonide puhul plaanilistes puusaliigese täielikes endoproteesimistes 82 Tabel 21: 2023. aastal esmaste põlveliigese proteesimiste puhul teatatud varasemad operatsioonid ..........................40 Tabel 48: Peamised tegurid, mis mõjutavad puusa kumulatiivset re-revisiooni määra..................................................100 Tabel 22: Esmase põlveliigese asendamise tüübid 2023. aastal......................................................................................41 Tabel 49: Erinevate esmaste põlveliigese proteeside kumulatiivsed revisioonimäärad ja diagnooside.................................................................................................................................................106 Tabel 23: Esmase täieliku põlveliigese proteesimise piirangute tase 2023. aastal.........................................................41 Tabel 50: Erinevate esmaste põlveliigese proteesimise tüüpide kumulatiivsed revisioonimäärad Tabel 24: Fikseerimised esmaste täielike põlveliigese proteesimiste puhul 2023. aastal...............................................41 implantaadiga mitteseotud tegurite kaupa .....................................................................................................110 Tabel 25: Fikseerimised esmaste ühe kondüüli põlveliigese proteesimiste puhul 2023. aastal .....................................41 Tabel 51: Esmase põlveliigese proteesimise erinevate tüüpide ja omaduste põlveliigese endoproteesimise .........................................................................................................................118 Tabel 26: Liigese liikuvus esmaste täielike põlveliigese proteesimiste puhul 2023. aastal.............................................42 192 EPRD 2024. aasta aruanne 193  EPRD andmetel põhinevad väljaanded Tabel 52: Implantaadi tulemused femoro-tibiaalse kombinatsiooni puhul esmases põlveliigese endoproteesimises koos või ilma põlveliigese pinna uuendamiseta esmasel põlveliigese endoproteesimisel ..............................124 EPRD andmetel Tabel 53: Tabel 54: Peamised tegurid, mis mõjutavad puusaliigese kumulatiivset re-revisiooni määra......................................142 Kumulatiivsed revisioonimäärad plaaniliste puusaliigese täielike endoproteesimiste puhul tsementeerimata põhinevad publikatsioonid varrega operatsiooni aasta järgi ....................................................................................................................146 Järgnev loetelu, mis on esitatud kronoloogilises järjestuses, sisaldab kõiki alates 2012. aastast ajakirjades ilmunud Tabel 55: Kumulatiivsed revisioonimäärad valikuliste täielike puusaliigese endoproteesimiste puhul tsementeeritud publikatsioone ja uurimisprojekte, mis põhinevad EPRD süstemaatilisel lähenemisviisil ja eesmärkidel ning selle varrastega operatsiooni aasta järgi................................................................................................................147 alusandmetel. EPRD andmetel või selle kollektiivse andmebaasi väljavõtetel põhinevaid analüüse võib taotleda teaduslikel eesmärkidel. Menetluste, formaalsuste ja võimalike tasude kohta leiate üksikasjalikku teavet EPRD Tabel 56: Standardse põlveliigese täieliku endoproteesimise kumulatiivsed korrigeerimismäärad operatsiooni aasta järgi veebilehelt aadressil https://www.eprd.de/de/downloads/auswertungsantraege. 147 Tabel 57: Ühe kondüüli põlveliigese proteesimise kumulatiivsed revisioonimäärad operatsiooni aasta järgi ..................148 Straub J, Szymski D, Walter N, Wu Y, Melsheimer O, Grimberg A, Alt V, Steinbrueck A, Rupp M. Millised on vanusega Tabel 58: Revisioonide koormus EPRD andmekogude põhjal ..........................................................................................149 seotud tegurid, mis mõjutavad aseptilisi reoperatsioone nii piiratud kui ka piiramata liikuvusega põlveliigese proteesimisel (TKA) ning ülemise jala proteesimisel (UKA)? Registripõhine uuring Saksamaa artroplastika registri (EPRD) andmete põhjal. Tabel 59: Muudatuste koormus Saksamaa Liitvabariigi Arch Orthop Trauma Surg. 11. september 2024. https://doi.org/10.1007/s00402-024-05550-9 Statistikaameti ..............................................................................................................................................149 Günther K, Grimberg A. Tabel 60: Patsientide suremuse kokkuvõte 3, 6, 12, 24, 36 ja 60 kuud pärast esmast artroplastikat või revisiooni....153 Mida annab meile endoproteeside register? Mobil 2024, kd 4-2024. Tabel 61: Meessoost patsientide 1-aastane artroplastika suremus vanuserühmade ja artroplastika tüübi Resl M, Becker L, Steinbrück A, Wu Y, Perka C. artroplastika tüübi järgi..................................................................................................................................154 Infektsiooni tõttu tehtud puusaliigese täieliku proteesimise kordusoperatsioon ja suremus. Bone Joint J. 1. juuni 2024; 106-B(6):565-572. https://doi.org/10.1302/0301- Tabel 62: Naispatsientide 1-aastane artroplastika suremus vanuserühmade ja 620X.106B6.BJJ-2023-1181.R1 155 ...............................................................................................................................................................155 Leta T, Lie S, Fenstad A, Lygre S, Lindberg-Larsen M, Pedersen A, W-Dahl A, Rolfson O, Bülow E, van Steenbergen L, Tabel 63: Reieluuvarre kumulatiivsed revisioonimäärad plaaniliste täielike puusaliigese artroplastikate puhul...........172 Nelissen R, Harries D, de Steiger R, Lutro O, Mäkelä K, Venäläinen M, Willis J, Wyatt M, Frampton C, Grimberg A, Steinbrück A, Wu Y, Armaroli C, Gentilini M, Picus R, Bonetti M, Dragosloveanu S, Vorovenci A, Dragomirescu D, Dale H, Brand C, Christen B, Shapiro J, Wilkinson J, Tabel 64: Kumulatiivsed revisioonimäärad puusaliigese kumerate osade puhul plaaniliste täielike puusaliigese Armstrong R, Wooster K, Hallan G, Gjertsen J, Chang R, Prentice H, Sedrakyan A, Paxton E, Furnes O. proteesimiste korral ..............................................................................................................................................................182 Lõikekoha ümbruse liigesepõletik pärast põlveliigese täielikku endoproteesimist antibiootikumiga või ilma antibiootikumita luutsemendiga. JAMA Netw Open. 2024;7(5):e2412898. https://doi.org/10.1001/jamanetworkopen.2024.12898 Straub J, Szymski D, Walter N, Wu Y, Melsheimer O, Grimberg A, Alt V, Steinbrueck A, Rupp M. Ühe kondüüliga põlveliigese proteesimine, mis näitab oluliselt suuremat aseptiliste reoperatsioonide riski võrreldes piiramatu ja piiratud täieliku põlveliigese proteesimisega: analüüs aseptiliste reoperatsioonide kohta pärast ühe kondüüliga ja esmast täielikku põlveliigese proteesimist Saksa proteesiregistris. Knee Surg Sports Traumatol Arthrosc. 21. aprill 2024. https://doi.org/10.1002/ksa.12192 Maslaris, A., Grimberg, A., Melsheimer, O., Tsiridis, E., Matziolis, G. Erinevate tsementeeritud sääreluu varre konstruktsioonide aseptiline keskmise tähtaja elulemus liigendiga täieliku põlveliigese endoproteesimisel: 6-aastane hindamine Saksa endoproteesiregistri andmete põhjal. 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Lühike versus tavapärane varre pikkus tsementivabas puusaliigese täielikus endoproteesimises: Antibiootikumidega rikastatud luutsemendi kasutamine ja süsteemsete antibiootikumide profülaktiline manustamine 2 971 357 Tõenduspõhine lähenemine keskmise pikkusega elulemuse registriandmetega. esmase põlveliigese täieliku endoproteesimise operatsiooni puhul aastatel 2010–2020: rahvusvaheline registripõhine vaatlusuuring Der Orthopade 2021;50(4): 296-305. https://doi.org/10.1007/s00132-021-04083-y Aafrika, Euroopa, Põhja-Ameerika ja Okeaania riikides. Acta Orthop 2023;94: 416–425. https://doi.org/10.2340/17453674.2023.17737 Steinbrück A, Jansson V. Endoprothesenregister Deutschland (EPRD) – tähtsus Saksamaal ja rahvusvaheliselt – mida saame õppida, mida Lützner J, Melsheimer O, Steinbrück A, Postler AE. mitte? Kõrged reoperatsioonide määrad ja suremus pärast distaalse reieluuproteesi paigaldamist periproteetiliste distaalsete Orthopädie und Unfallchirurgie up2date 2022;17(4): 1-15. reieluumurdude puhul: analüüs Saksamaa artroplastika registrist (EPRD). https://doi.org/10.1055/a-1588-2644 Eur J Orthop Surg Traumatol 2023. https://doi.org/10.1007/s00590-023-03582-2 Konow T, Baetz J, Melsheimer O, Grimberg A, Morlock M. Szymski D, Walter N, Krull P, Melsheimer O, Schindler M, Grimberg A, Alt V, Steinbrück A, Rupp M. Surmamäära ning Periproteetilise reieluukaare murru riski mõjutavad tegurid – Saksamaa registri uuring. septiliste ja aseptiliste reoperatsioonide võrdlus puusaliigese täieliku endoproteesimise puhul osteoartriidi ja reieluukaela murru Bone Joint J 2021;103-B(4): 650-658. https://doi.org/10.1302/0301- korral: Saksamaa endoproteesiregistri analüüs. 620X.103B4.BJJ-2020-1046.R2 J Orthop Traumatol 2023;24(1): 29. https://doi.org/10.1186/s10195-023-00711-9 Renner L, Perka C, Melsheimer O, Grimberg A, Jansson V, Steinbrück A. Grimberg AW, Steinbrück A. Keraamiline-keraamiline liigend puusaliigese täieliku endoproteesimise puhul vähendab periproteetilise liigesepõletiku tõttu vajaliku 10 aastat Saksamaa endoproteesiregistrit (EPRD): mida on saavutatud? korduvoperatsiooni riski võrreldes keraamilise-polüetüleeniga: Saksamaa endoproteesiregistri andmetel põhinev 118 753 Die Orthopädie 2023. https://doi.org/10.1007/s00132-023-04385-3 tsementivaba puusaliigese täieliku endoproteesimise juhtumi võrdlev analüüs. J Clin Med 2021;10(6). https://doi.org/10.3390/jcm10061193 Szymski D, Walter N, Melsheimer O, Grimberg A, Alt V, Steinbrück A, Rupp M. Reieluukaela murdude puhul tehtud poolproteesimise järel suremus – Grimberg AW, Grupp TM, Elliott J, Melsheimer O, Jansson V, Steinbrück A. Saksamaa endoproteesiregistri (EPRD) analüüs. Keraamiline kattekiht tsementeeritud esmase täieliku põlveliigese endoproteesimise puhul ei ole seotud varase proteesiliigese Dtsch Arztebl Int 2023;120: 297-8. https://doi.org/10.3238/arztebl.m2023.0007 infektsiooni tõttu tehtava revisiooni riski vähenemisega. J Arthroplasty 2021;36(3): 991-997. https://doi.org/10.1016/j.arth.2020.09.011 Szymski D, Walter N, Krull P, Melsheimer O, Grimberg A, Alt V, Steinbrück A, Rupp M. Infektsioon pärast reieluukaela intrakapsulaarset murdu – kas antibiootikumidega rikastatud luutsement vähendab infektsiooniriski Bauer L, Woiczinski M, Thorwachter C, Melsheimer O, Weber P, Grupp TM, Jansson V, Steinbrück A. Sekundaarne põlveliigese pärast hemiartroplastikat ja täielikku puusaliigese endoproteesimist? pinna taastamine täieliku põlveliigese endoproteesimise puhul: registriandmete ja biomehaaniliste katsete kombineeritud analüüs. J Bone Joint Res 2023;12(5): 331–338. https://doi.org/10.1302/2046-3758.125.BJR-2022-0314.R1 Clin Med 2021;10(6). https://doi.org/10.3390/jcm10061227 Szymski D, Walter N, Krull P, Melsheimer O, Lang S, Grimberg A, Alt V, Steinbrück A, Rupp M. Ühe või kahe Steinbrück A, Melsheimer O, Grimberg A, Jansson V. antibiootikumiga rikastatud luutsemendi profülaktiline toime periproteetilise liigesepõletiku vastu pärast reieluukaela murru Institutsioonilise kogemuse mõju puusa- ja põlveliigese täieliku endoproteesimise tulemustele. tõttu tehtud puusaliigese endoproteesimist: Saksamaa endoproteesiregistri analüüs. Der Orthopade 2020. https://doi.org/10.1007/s00132-020-03963-z Antibiotics (Basel) 2023;12(4). https://doi.org/10.3390/antibiotics12040732 Steinbrück A, Melsheimer O, Grimberg A, Jansson V. Miks ebaõnnestuvad ühe kondüüliga põlveliigese proteesid Saksamaal? Knie Journal 2020. https://doi.org/10.1007/s43205-020-00069-6 196 EPRD aastaaruanne 2024 197 Hey A, Grimberg A, Mühlnikel I, Kleinfeld A. Saksamaa endoproteesiregister (EPRD) kui uue riikliku implantaadiregistri prototüüp. In: Uwe Repschläger CSuNOb, BARMER Institut für Gesundheitssystemforschung, toim. Gesundheitswesen aktuell 2020 Beiträge und Analysen. 2020 Jansson V, Grimberg A, Melsheimer O, Perka C, Steinbrück A. Ortopeedilised registrid: Saksamaa kogemus. EFORT Open Rev 2019;4(6): 401–408. https://doi.org/10.1302/2058-5241.4.180064 Jansson V, Steinbrück A, Hassenpflug J. Millist lisakasu annavad EPRD andmed tulevikus võrreldes teiste registritega? Unfallchirurg 2016;119(6): 488-92. https://doi.org/10.1007/s00113-016-0171-7 Hassenpflug J, Liebs TR. Register kui vahend endoproteeside ohutuse suurendamiseks. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014;57(12): 1376-83. https://doi.org/10.1007/s00103-014-2057-6 Sternkopf J, Liebs TR, Schultz C. Endoproteesiregister: suur heakskiit haiglate seas. Dtsch Arztebl 2014;111(43): 1848-50. Liebs TR, Melsheimer O, Hassenpflug J. Endoproteesiregistri abil süstemaatiliste kahjujuhtumite varajane avastamine. Orthopäde 2014;43(6): 549–54. https://doi.org/10.1007/s00132-014-2293-3 Hassenpflug J. Saksamaa artroplastika register (EPRD). In: Struktuur, protseduurid ja organisatsioon. Ettekanne EFORTi kongressil, Berliin. 2012 Open Access Original Article Evaluation of a Single Knee System: All- Polyethylene Tibia (APT) vs. Metal-Backed Tibia Review began 09/11/2025 (MBT) in Primary Total Knee Arthroplasty Review ended 10/06/2025 Published 10/08/2025 Benjamin Huang 1, Joshua Vanhoozier 1 , Charlotte Huang 2 , Russell T. Nevins 3 © Copyright 2025 Huang et al. This is an open access article 1. College of Osteopathic Medicine, Touro University Nevada, Henderson, USA 2. Statistics, University of California distributed under the terms of the Creative Santa Barbara, Santa Barbara, USA 3. Orthopaedics, Valley Health System, Las Vegas, USA Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, Corresponding author: Benjamin Huang, [email protected] and reproduction in any medium, provided the original author and source are credited. DOI: 10.7759/cureus.94155 Abstract Background The all-polyethylene tibia (APT) in total knee arthroplasty (TKA) previously demonstrated similar survival and function compared to metal-backed tibia (MBT), without the associated risk of backside wear and at a lower cost. The LinkSymphoKnee (LSK) (Waldemar Link GmbH & Co. KG, Hamburg, Germany) and its corresponding APT received FDA 510(k) approval in 2021; however, clinical outcome data remain limited. The purpose of this study was to determine whether the LSK APT would have non-inferior pain outcomes compared to the LSK MBT within two years postoperatively and compile descriptive statistics on revision, repeat surgery, manipulation under anesthesia, and range of motion. Methods This retrospective cohort study analyzed data from patients who underwent primary TKA performed by a single surgeon at a single center between January 2021 and October 2024. Patient chart data were categorized based on tibial implant design(APT vs MBT). After applying exclusion criteria, propensity score matching incompletely but significantly reduced baseline differences between groups. A linear mixed- effects model was employed to analyze differences in pain with non-inferiority of APT for pain reduction, tested against a 10% delta. The study also compiled statistics on implant survival and adverse events. Results After best-case propensity score matching, 229 patients were included in each group (APT and MBT). The APT group was significantly older (mean 77.0 years vs. 71.0 years, p < 0.001), had a lower BMI (mean 28.9 vs. 30.9, p < 0.001), and contained more females (65 vs 92, p<0.008) compared to the MBT group. Numerical Rating Scale (NRS) pain scores decreased over time in both groups. The 95% confidence interval in NRS pain scores was (-0.51, 0.19), indicating no statistically significant difference in scores. Flexion range of motion was similar between groups, reaching approximately 120 degrees. The extension range of motion was also comparable, near zero degrees. Three patients with APT and one patient with MBT required manipulation under anesthesia within eight weeks. One revision of the femur occurred in the APT group, while two full revisions occurred in the MBT group. Additional adverse events included synovectomy, patella fracture, and polyethylene insert exchange. Conclusion This study suggests that APT in TKA demonstrates non-inferior pain outcomes compared to MBT when performed by a fellowship-trained surgeon using the LSK system. While descriptive analysis showed some differences in other outcomes like revision and manipulation under anesthesia, further research with larger, randomized controlled trials is needed to confirm these findings and assess long-term functional outcomes and patient satisfaction. Categories: Orthopedics Keywords: all polyethylene tibial component, nrs pain score, propensity score matching (psm), retrospective cohort, tka Introduction Total knee arthroplasty (TKA) is a definitive treatment for advanced osteoarthritis, providing substantial pain relief and functional improvement. The demand for TKA is expected to rise significantly, with projections reaching 3.05 million procedures by 2060, driven by an aging population and increasing rates of obesity [1]. Implant selection is a critical aspect of TKA, influenced by patient-specific factors, surgeon preferences, and cost considerations [2]. How to cite this article Huang B, Vanhoozier J, Huang C, et al. (October 08, 2025) Evaluation of a Single Knee System: All-Polyethylene Tibia (APT) vs. Metal-Backed Tibia (MBT) in Primary Total Knee Arthroplasty. Cureus 17(10): e94155. DOI 10.7759/cureus.94155  The all-polyethylene tibia (APT) represents a cost-effective alternative to the modular metal-backed tibia (MBT), especially in developing countries [3-5]. The APT utilizes a monoblock design that eliminates the potential for backside wear, a known complication in modular implants [6]. Historical studies on APT showed limited indications due to poor survivorship in young, more active patients [7,8]. Developments such as cross-linking, additives, and improved geometry with coronal stability have markedly improved clinical outcomes [9,10]. Recent studies have shown comparable clinical outcomes between APT and MBT in TKA [11]. Notably, a recent analysis of the American Joint Replacement Registry reported a lower risk of revision TKA with APT [12]. The LinkSymphoKnee (LSK) system from Waldemar Link GmbH & Co. KG (Hamburg, Germany) received FDA approval in 2021, and specific data on the APT component’s clinical outcomes remain limited. Therefore, a foundational study is essential to document the clinical outcomes of this specific implant, particularly in direct comparison to the LSK MBT, which shares an identical geometry. Pain reduction, survival, and incidence of adverse events are considered useful preliminary data to capture for patient safety and to justify the cost savings associated with the APT design. This study aimed to investigate the non-inferiority of the APT compared to MBT components in the LSK system through a retrospective chart analysis. The primary objective was to assess differences in pain reduction between the two groups. Secondary objectives included the evaluation of implant survival, the rate of manipulation under anesthesia, and other adverse events. Using a predefined delta of 10%, APT has non- inferior pain outcomes if the upper bound of the confidence interval for the difference in numerical rating scale (NRS) pain scores is no more than one point worse than the MBT group. This delta was chosen through the clinical expertise of the surgeon in this study (RN). Materials And Methods This retrospective cohort study examined patient charts from a single surgeon between January 2021 and October 2024. The Institutional Review Board (IRB) waived the requirement for approval, as this research was not considered human subjects research and the data collected was part of routine medical care (approval number TUNIRB000323). Data collection was performed using a unique identifying number, and no identifiable information was collected. The study design was finalized before any statistical analysis was performed. The surgery was performed through a median parapatellar incision, and mechanical alignment was used with traditional posterior referencing. Patient charts were filtered using the International Classification of Diseases (ICD)-10 code Z95.65. Exclusion criteria included revision TKA, constrained implants (stems, constrained condylar knee (CCK), hinge), crucial-retaining designs, use of alternative bearing surfaces (ultra-congruent (UC) polyethylene inserts), or concomitant procedures (e.g., TKA with open reduction and internal fixation (ORIF)). Indications for APT included patients aged over 70 years and those with a BMI less than 38. Before data collection, a power analysis was performed using a sample size calculator. Previously published data taken from a similar patient population in the early postoperative period (0-3 months) [13] were used to calculate the required sample size that could detect a 10% difference in outcomes: at a .95 significance level and a power of 0.8, 175 patients per group was needed. Data were extracted from the electronic medical record (EMR) and recorded in a password-protected spreadsheet on secure computers, accessible only to the principal investigator (PI) and designated data abstractors. To ensure data accuracy, a randomly selected subset of 10% of charts was reviewed by two abstractors, and inter-rater reliability was assessed using Cohen's kappa. Adjustments were made to the data abstraction form to improve workflow and reduce error rates. Data collected included: date of birth, date of surgery, preoperative pain, follow-up dates, pain scores at each follow-up, range of motion (ROM) at each follow-up, body mass index (BMI), gender, smoking status, and tibial implant design. Patient names were not recorded; medical record numbers (MRNs) were used for internal tracking. The de-identified dataset was accessible to the data abstractors, PI, and data analyst. Pain scores were assessed using the Numerical Rating Scale (NRS) from 0 to 10. Range of motion was measured in degrees of flexion and extension. Implant survival was defined as the absence of any revision surgery for any reason. Adverse events, such as the need for manipulation under anesthesia, other surgery, or falls, were also documented. Statistical analysis was performed using R software, version 4.4.2 (R Foundation for Statistical Computing, Vienna, Austria). To minimize confounding due to baseline differences between the groups (APT vs MBT), propensity score matching was employed. A logistic regression model was used to calculate propensity scores based on BMI, age, gender, and smoking status. A 1:1 matching algorithm was then used, and any demographic differences were determined. A linear mixed-effects model was used to analyze differences in NRS pain scores over time, accounting for within-patient correlations. Descriptive statistics were compiled for flexion and extension, manipulation under anesthesia, and other adverse events. 2025 Huang et al. Cureus 17(10): e94155. DOI 10.7759/cureus.94155 2 of 7  Non-inferiority was assessed by defining a delta of 10% worse reduction in pain for the APT group compared to the MBT group. On the NRS pain scale, this translated to a one-point difference in average score. The confidence intervals of the difference in pain reduction between the two groups were then examined to determine if the lower bound of the confidence interval was greater than this one-point non-inferiority margin. Results Demographic data A total of 653 patient records satisfied the implant type requirement. After 1:1 propensity score matching, 229 patients were included in each group (APT and MBT), yielding a total matched cohort of 458 patients. At the most recent visit, the average follow-up period for the APT group was 201±196 days (range: 11-1116). For the MBT group, the average follow-up period was 192±186 days (range: 10-999). The APT group had a lower proportion of males (65 patients, 28%) compared to the MBT group (92 patients, 40%, p=0.008). The mean age in the APT group was 77.0±5.6 years, and in the MBT group, it was 71.0±5.2 years. The mean BMI in the APT group was 28.9±4.7lb/in 2, and in the MBT group, it was 30.9±5.4lb/in 2. Laterality and smoking status showed no significant differences using Chi-square analysis. After data collection was completed, the data underwent a verification process. At each follow-up, the number of days since surgery was calculated, and any negative or anomalous values were verified. This process was performed for a total of 12 charts. Cohen’s kappa score was 0.92. Demographic data are shown in Table 1. Characteristic APT Group (n=229) MBT Group (n=229) Statistical Test (Value, df) p-value Age, mean (SD), years 77.0 (± 5.6) 71.0 (± 5.2) Independent t-test <0.001* BMI, mean (SD), kg/m^2 28.9 (± 4.7) 30.9 (± 5.4) Independent t-test <0.001* Males, n (%) 65 (28%) 92 (40%) χ2 (7.06, 1) 0.008* Left knee, n (%) 115 (50.2%) 112 (49.1%) χ2 (0.08, 1) 0.78 Smoking status, n (%) - - χ2 (1.26, 3) 0.74 Current smoker, n (%) 13 (5.7%) 18 (7.9%) - - Previous smoker, n (%) 68 (29.7%) 61 (26.6%) - - Never smoker, n (%) 136 (59.4%) 139 (60.7%) - - Smoking status not specified, n (%) 12 (5.2%) 11 (4.8%) - - TABLE 1: Demographic Data APT: All-polyethylene tibia, MBT: Metal-backed tibia. p<.05 was considered significant, marked with a * Numerical rating scale (NRS) pain scores decreased over time in both groups following TKA, as shown in Figure 1. Mean NRS pain scores for the MBT group were: 4.2 (± 2.7) at 0-2 weeks, 4.1 (± 2.9) at 2-6 weeks, 3.1 (± 2.4) at 6-12 weeks, 2.5 (± 2.7) at 3-6 months, 2.1 (± 2.4) at 6-12 months, and 2.2 (± 2.2) at 1-2 years. For the APT group, mean scores were: 4.9 (± 2.7), 4.3 (± 2.3), 3.0 (± 2.4), 2.5 (± 2.5), 2.8 (± 2.8), and 2.2 (± 3.0) for the respective time bins. Preoperatively, the mean NRS pain score for the APT group was 6.3 (± 2.5), and for the MBT group, it was 6.1 (± 2.5). The linear mixed-effects model estimated the difference between NRS pain scores (APT minus MBT), resulting in a 95% confidence interval of (-0.51, 0.19). As the upper bound of the confidence interval is less than 1.0, APT demonstrated non-inferior outcomes compared to MBT. NRS pain scores decreased over time in both groups following TKA, as shown in Figure 1. Mean NRS pain scores for the MBT group were: 4.2 (± 2.7) at 0-2 weeks, 4.1 (± 2.9) at 2-6 weeks, 3.1 (± 2.4) at 6-12 weeks, 2.5 (± 2.7) at 3-6 months, 2.1 (± 2.4) at 6- 12 months, and 2.2 (± 2.2) at 1-2 years. For the APT group, mean scores were: 4.9 (± 2.7), 4.3 (± 2.3), 3.0 (± 2.4), 2.5 (± 2.5), 2.8 (± 2.8), and 2.2 (± 3.0) for the respective time bins. Preoperatively, the mean NRS pain score for the APT group was 6.3 (± 2.5), and for the MBT group, it was 6.1 (± 2.5). The linear mixed-effects model estimated the difference between NRS pain scores (APT minus MBT), resulting in a 95% confidence interval of (-0.51,0.19). As the upper bound of the confidence interval is less than 1.0, APT demonstrated non-inferior outcomes compared to MBT. Pain scores are shown in Figure 1. 2025 Huang et al. Cureus 17(10): e94155. DOI 10.7759/cureus.94155 3 of 7  FIGURE 1: APT vs MBT postoperative pain APT: All-polyethylene tibia, MBT: Metal-backed tibia. Flexion and extension range of motion (ROM) were evaluated for both groups across the follow-up period. Mean flexion ROM for the APT group was: 89.5 (± 15.7), 108.1 (± 13.7), 116.0 (± 10.2), 119.7 (± 4.31), 119.9 (± 3.3), and 120.3 (± 1.6), respectively. For the MBT group, mean flexion ROM was: 94.7 (± 13.7), 108.9 (± 18.4), 114.2 (± 12.9), 118.7 (± 7.2), 119.5 (± 5.1), and 119.0 (± 7.2), respectively. Flexion range of motion in the APT and MBT groups is shown in Figure 2. FIGURE 2: APT vs MBT flexion APT: All-polyethylene tibia, MBT: Metal-backed tibia. Mean extension ROM for the APT group was: 0.3 (± 2.8), 1.0 (± 2.9), 1.0 (± 2.9), 0.5 (± 3.2), 0.1 (± 2.1), and 0.8 (± 5.9), respectively. For the MBT group, mean extension ROM was: 0.3 (± [SD]), 0.3 (± 2.2), 0.1 (± 2.6), 0.2 (± 2.8), 0.1 (± 2.8), and 0.1 (± 1.3), respectively. No clinically meaningful differences were observed in either flexion or extension ROM between the two implant groups. The extension range of motion in the APT and MBT groups is shown in Figure 3. 2025 Huang et al. Cureus 17(10): e94155. DOI 10.7759/cureus.94155 4 of 7  FIGURE 3: APT vs MBT extension APT: All-polyethylene tibia, MBT: Metal-backed tibia. The indication for manipulation under anesthesia is the inability to achieve less than ninety degrees of flexion at six weeks post-surgery. Three patients in the APT group and one in the MBT group required manipulation under anesthesia. Implant survival in the APT group included one revision of the femoral component at 364 days post-surgery. In the MBT group, two patients required revision at 67 and 1052 days post-surgery. Other adverse events were also documented. A left knee anterior arthrotomy and synovectomy was performed at 620 days following APT TKA due to synovitis. An MBT TKA patient underwent synovectomy and polyethylene insert exchange at 498 days status post-TKA due to patellar clunk syndrome. Discussion This retrospective chart review analysis aimed to compare early pain outcomes between APT and MBT components in TKA. Our primary finding indicates that the APT is non-inferior to MBT within two years postoperatively. This finding aligns with other studies reporting comparable functional outcomes, pain scores, and patient satisfaction with APT [11,12]. By focusing on early pain trajectories and complications, this study supports existing literature, particularly given that early pain and complications are predictive of long-term functional outcomes [14,15]. For surgeons operating in high-volume inpatient settings, this study supports the use of APT using the indications of age over 70 years and BMI less than 38. The LSK system has identical geometry for both APT and MBT components, and these good outcomes are likely due to material differences. The ideal direction for future research would be a blinded randomized controlled trial comparing the LSK MBT TKA with the respective APT. This would include validated knee function scores, such as the Knee injury and Osteoarthritis Outcome Score (KOOS) or the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). This study was not adequately powered to detect differences in implant survival or the incidence of manipulation under anesthesia over extended periods. Descriptively, neither group showed obvious differences that suggest early failure of the APT. The APT group experienced one revision (of the femoral component due to severe flexion contracture), while two patients in the MBT group required revision, with no revisions in either group attributed to septic or aseptic loosening of the tibial component. Secondary outcome measures, such as range of motion, showed no clinically meaningful differences. While the APT group had 0.4 fewer degrees of extension, this difference is not clinically relevant. This study has several limitations that warrant consideration. First, as a retrospective chart review, it is susceptible to inherent biases, and data collection relies on the completeness and accuracy of medical record documentation. Propensity score matching was utilized in a 1:1 ratio, aiming to achieve caliper- matched cohorts from the MBT group. While baseline differences were minimized, residual differences persisted in age (77 vs. 71 years), BMI (28.9 vs. 30.9), and gender (28% vs. 40% male) between the APT and MBT groups. These baseline imbalances, which have been associated with worse outcomes in TKA [7,8,16], could potentially confound the results. However, this analysis demonstrated non-inferiority for pain outcomes, suggesting that the baseline imbalances did not negate the comparable pain trajectories observed. Second, the relatively short average follow-up time, at 201 days for the APT group and 192 days for the MBT 2025 Huang et al. Cureus 17(10): e94155. DOI 10.7759/cureus.94155 5 of 7  group, limits the applicability of these results to the short term. While the linear mixed-effects model accounted for patients with less data, the robustness of these findings is limited in the longer follow-up periods. Third, the study's data were collected from a single surgeon at a single center within a large private practice, which introduces a risk of clustering at the provider and institutional levels. This may limit the external validity and generalizability of the findings to other surgical practices or patient populations. The substantial proportion of APT TKAs (33% of the original dataset) performed by this surgeon suggests a potential "learning effect" related to the unique surgical technique required for APT due to its lack of modularity. This could have refined the surgeon's technique over time, potentially leading to improved outcomes that might not be replicated by surgeons who do not routinely use APT TKA [17]. Conclusions This analysis suggests that the LSK APT has non-inferior pain outcomes compared to MBT in an inpatient setting, done by a joint replacement surgeon. The risk of other events, such as revision and manipulation under anesthesia, shows differences, although no statistical analysis was performed. Future studies could be done in a large sample randomized controlled trial in long-term clinical outcomes, with outcomes focused on validated function scores and patient satisfaction. Additional Information Author Contributions All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the work. Concept and design: Benjamin Huang, Russell T. Nevins, Joshua Vanhoozier, Charlotte Huang Acquisition, analysis, or interpretation of data: Benjamin Huang, Russell T. Nevins, Joshua Vanhoozier, Charlotte Huang Drafting of the manuscript: Benjamin Huang, Russell T. Nevins, Joshua Vanhoozier, Charlotte Huang Critical review of the manuscript for important intellectual content: Benjamin Huang, Russell T. Nevins, Joshua Vanhoozier, Charlotte Huang Supervision: Benjamin Huang, Russell T. Nevins Disclosures Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Touro University Nevada Institutional Review Board (IRB) issued approval TUNIRB000323. The protocol TUNIRB000323, Non-inferiority analysis of all-polyethylene tibia vs metal- backed modular tibia in total knee arthroplasty, has been reviewed by the Institutional Review Board (IRB) chair and determined to be a retrospective chart review and not human subjects research. This protocol does not require review or oversight by the IRB. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Russell T. Nevins MD declare(s) personal fees, a patent, royalties and support for attending meetings/travel from Waldemar Link. Russell T. Nevins MD declare(s) royalties and support for attending meetings/travel from DePuy. Russell T. Nevins MD declare(s) a patent, royalties and support for attending meetings/travel from Microport. Russell T. Nevins MD declare(s) support for attending meetings/travel from Synvasive (Zimmer). Russell T. Nevins MD declare(s) a patent and stock/stock options from Arthrolense. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. References 1. Shichman I, Roof M, Askew N, Nherera L, Rozell JC, Seyler TM, Schwarzkopf R: Projections and epidemiology of primary hip and knee arthroplasty in Medicare patients to 2040-2060. JB JS Open Access. 2023, 8:10.2106/JBJS.OA.22.00112 2. Porteous A, Curtis A: Total knee arthroplasty: implant selection and surgical considerations . Orthopaedics and Trauma. 2021, 35:22-9. 10.1016/j.mporth.2020.12.003 3. Gioe TJ, Maheshwari AV: The all-polyethylene tibial component in primary total knee arthroplasty . J Bone Joint Surg Am. 2010, 92:478-87. 4. Kumar V, Hasan O, Umer M, Baloch N: Cemented all-poly tibia in resource constrained country, affordable and cost-effective care. Is it applicable at this era? Review article. Ann Med Surg (Lond). 2019, 47:36-40. 10.1016/j.amsu.2019.09.010 2025 Huang et al. Cureus 17(10): e94155. 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Levaillant M, Marcilly R, Levaillant L, Michel P, Hamel-Broza JF, Vallet B, Lamer A: Assessing the hospital volume-outcome relationship in surgery: a scoping review. BMC Med Res Methodol. 2021, 21:204. 10.1186/s12874-021-01396-6 2025 Huang et al. Cureus 17(10): e94155. DOI 10.7759/cureus.94155 7 of 7 Avatud juurdepääsuga originaalartikkel Ühe põlvesüsteemi hindamine: täispolüetüleenist sääreosa (APT) vs. metalliga tugevdatud sääreosa Läbivaatamine algas (MBT) esmases täielikus põlveliigese 09.11.2025 lõppes Läbivaatamine 10.06.2025 endoproteesimises Avaldatud 10.08.2025 Benjamin Huang 1, Joshua Vanhoozier 1, Charlotte Huang 2, Russell T. Nevins 3 © Autoriõigus 2025 Huang jt. See on avatud juurdepääsuga artikkel, mida levitatakse Creative Commons 1. Osteopaatilise meditsiini kolledž, Touro Ülikool, Nevada, Henderson, USA 2. Statistika, California Ülikool, Santa Barbara, Attribution License CC-BY 4.0 tingimuste Santa Barbara, USA 3. Ortopeedia, Valley Health System, Las Vegas, USA alusel, mis lubab piiramatut kasutamist, levitamist ja reprodutseerimist mis tahes meedias, tingimusel et originaali autor ja Vastutav autor: Benjamin Huang, [email protected] allikas on märgitud. DOI: 10.7759/cureus.94155 Kokkuvõte Taust Täielikult polüetüleenist sääreosa (APT) on põlveliigese täieliku asendamise operatsioonis (TKA) varem näidanud sarnast vastupidavust ja funktsionaalsust võrreldes metalltagapõhjaga sääreosaga (MBT), ilma tagakülje kulumisega seotud riskita ja madalamate kuludega. LinkSymphoKnee (LSK) (Waldemar Link GmbH & Co. KG, Hamburg, Saksamaa) ja selle vastav APT said 2021. aastal FDA 510(k) heakskiidu; kliinilised tulemused on siiski piiratud. Käesoleva uuringu eesmärk oli kindlaks teha, kas LSK APT-l oleksid võrreldes LSK MBT-ga mittehalvemad tulemused valu osas kahe aasta jooksul pärast operatsiooni, ning koostada kirjeldavad statistilised andmed revisioonide, korduvoperatsioonide, anesteesia all tehtavate manipuleerimiste ja liigese liikuvuse kohta. Meetodid Selles retrospektiivses kohortuuringus analüüsiti andmeid patsientide kohta, kellele tehti esmane põlveliigese asendusoperatsioon ühe kirurgi poolt ühes raviasutuses ajavahemikus jaanuarist 2021 kuni oktoobrini 2024. Patsientide haiguslugude andmed liigitati vastavalt sääreimplantaadi disainile (APT vs MBT). Pärast välistamiskriteeriumide kohaldamist vähendas kalduvusskooride sobitamine ebatäielikult, kuid märkimisväärselt rühmadevahelisi algseid erinevusi. Valuküsimuste analüüsimiseks kasutati lineaarset segamõjude mudelit, kus APT-implantaadi valuküsimuste leevendamise osas testiti mitte-halvemust 10% delta suhtes. Uuringus koondati ka statistika implantaadi püsivuse ja kõrvaltoimete kohta. Tulemused Pärast parima võimaliku kalduvusskooriga sobitamist kuulus mõlemasse rühma (APT ja MBT) 229 patsienti. APT- rühm oli MBT-rühmaga võrreldes oluliselt vanem (keskmine vanus 77,0 aastat vs 71,0 aastat, p < 0,001), neil oli madalam kehamassiindeks (keskmine 28,9 vs 30,9, p < 0,001) ja rühmas oli rohkem naisi (65 vs 92, p < 0,008). Numbriline hindamisskaala (NRS) valu skoorid vähenesid aja jooksul mõlemas rühmas. NRS valu skooride 95% usaldusvahemik oli (-0,51, 0,19), mis näitab, et skoorides ei olnud statistiliselt olulist erinevust. Liigese paindumise ulatus oli rühmade vahel sarnane, ulatudes ligikaudu 120 kraadini. Liigese sirutamise ulatus oli samuti võrreldav, ligikaudu null kraadi. Kolm APT-rühma patsienti ja üks MBT-rühma patsient vajasid kaheksa nädala jooksul manipuleerimist anesteesia all. APT-rühmas toimus üks reieluukirurgia kordusoperatsioon, samas kui MBT-rühmas toimus kaks täielikku kordusoperatsiooni. Lisaks esinesid sellised kõrvaltoimed nagu sünovektomia, põlveliigese luumurd ja polüetüleenist sisendi vahetus. Järeldus Käesolev uuring viitab sellele, et TKA-l APT-d kasutades on valu tulemused võrreldes MBT-ga mitte halvemad, kui operatsiooni teostab LSK-süsteemi kasutav spetsialiseeritud kirurg. Kuigi kirjeldav analüüs näitas mõningaid erinevusi muudes tulemustes, nagu revisioon ja manipuleerimine anesteesia all, on vaja täiendavaid uuringuid suuremate randomiseeritud kontrollitud uuringutega, et kinnitada neid tulemusi ning hinnata pikaajalisi funktsionaalseid tulemusi ja patsientide rahulolu. Kategooriad: Ortopeedia Märksõnad: täielikult polüetüleenist säärekomponent, NRS-valuindeks, kalduvusskooride sobitamine (PSM), retrospektiivne kohort, TKA Sissejuhatus Põlveliigese täielik asendusoperatsioon (TKA) on kaugelearenenud osteoartriidi lõplik ravi, mis pakub märkimisväärset valu leevendust ja funktsionaalset paranemist. Eeldatakse, et nõudlus TKA järele kasvab märkimisväärselt, ulatudes prognooside kohaselt 2060. aastaks 3,05 miljoni operatsioonini, mida mõjutavad elanikkonna vananemine ja rasvumise suurenemine [1]. Implantaadi valik on TKA puhul otsustava tähtsusega aspekt, mida mõjutavad patsiendispetsiifilised tegurid, kirurgi eelistused ja kulutustega seotud kaalutlused [2]. Kuidas viidata sellele artiklile Huang B, Vanhoozier J, Huang C jt. (8. oktoober 2025) Ühe põlvesüsteemi hindamine: täispolüetüleenist sääreosa (APT) vs metallist sääreosa (MBT) esmases täielikus põlveliigese endoproteesimises. Cureus 17(10): e94155. DOI 10.7759/cureus.94155  Täispolüetüleenist sääreluu (APT) on kulutõhus alternatiiv modulaarse metalltagapõhjaga sääreluule (MBT), eriti arengumaades [3–5]. APT-l on üheosaline konstruktsioon, mis välistab tagakülje kulumise võimaluse – tuntuim tüsistus modulaarsete implantaatide puhul [6]. APT-d käsitlevad varasemad uuringud näitasid piiratud näidustusi, kuna implantaadi eluea pikkus oli noorte, aktiivsemate patsientide puhul lühike [7,8]. Sellised arengud nagu r