Transcript Prospective studies of hip and knee prostheses

Prospective studies
of hip and knee
prostheses
The Norwegian
Arthroplasty Register
1987-2004
Norway
2/66
• All the products mentioned in the
presentation have had CE approval
(European)
• Some of the products used in Norway do
not have FDA approval like HA coated hip
implants and antibiotic loaded bone
cement for primary hip and knee
arthroplasty
3/66
• No benefits in any form have been
received or will be received from
commercial party related directly or
indirectly to the subject of this
presentation
4/66
History of the Norwegian
Arthroplasty Register
References:
Havelin et al. Acta Orthop Scand 1994
Havelin et al. J Bone Joint Surg (Br) 1995
Havelin et al. J Bone Joint Surg (Am) 1995
5/66
Havelin et al. Acta Orthop Scand 1994
6/66
Havelin et al. J Bone Joint Surg (Br) 1995
7/66
Left
Right
Havelin et al. J Bone Joint Surg (Br) 1995
Years
8/66
Havelin et al. J Bone Joint Surg
(Br) 1995
9/66
Havelin et al. J Bone Joint
Surg (Br) 1995
10/66
Survival of hip prostheses
100
100
90
90
Survival of cemented
hip prostheses
80
70
Survival of uncemented
hip prostheses
80
70
RR
60
RR
1987-90
1
1991-93
1.6 p < 0.001
1994-96
1.1 p = 0.3
1997-03
0.8 p < 0.001
60
50
1987-90
1
1991-93
0.8 p < 0.001
1994-96
0.5 p < 0.001
1997-03
0.4 p < 0.001
50
0
4
8
12
16
0
4
8
12
16
The Cox-adjusted realtive risk (RR) for revision of a primary
THA was reduced by 35 percent from 1987-1990 to 19972003 (p<0.001).
11/66
Survival of knee prostheses
100
90
80
70
RR
60
1994-96
1
1997-99
1.1 p = 0.6
2000-03
1.0 p = 0.7
50
0
4
8
12
16
12/66
Incidence
Primary operations / 100.000 inhabitants
1200
HIP, Male
1000
HIP, Female
800
KNEE, Male
KNEE, Female
600
OTHER JOINTS, Male
400
OTHER JOINTS, Female
200
0
- 39
40-49
50-59
60-69
70-79
80-
Age at prim ary operation
13/66
Compliance: Hip prostheses
1999-2002
Number of operations
30000
NRL
NPR
25000
20000
15000
10000
5000
0
Primary
Revision
Total
NRL = The voluntary Norwegian Arthroplasty Register
NPR = The mandatory Norwegian Patient Registry
14/66
Cemented hip prostheses
100
100
90
90
80
80
CHARNLEY
EXETER
TITAN
REFLECTION
SPECTRON
ELITE
LUBINUS SP
ZCA
MODULAR HIP SYSTEM
KRONOS
70
60
50
0
4
8
12
16
Cup prostheses,
revision of cup or liner.
CHARNLEY
EXETER
TITAN
SPECTRON
ITH
LUBINUS SP
BIO-FIT
ELITE
CPT
MS-30
70
60
50
0
4
8
12
16
Stem prostheses,
revision of stem.
15/66
Cup/stem cemented hip prostheses
(combination), any revision.
100
90
80
N
CHARNLEY/CHARNLEY 25409
EXETER/EXETER
7192
TITAN/TITAN
5144
REFLECTION/SPECTRON 3520
SPECTRON/ITH
2365
LUBINUS SP/LUBINUS SP 1061
REFLECTION/BIO-FIT
895
REFLECTION/ITH
879
KRONOS/TITAN
817
ELITE/CHARNLEY
763
70
60
50
0
4
8
12
16
16/66
Cemented hip, cup prostheses
Cup
prostheses
Charnley
Exeter
Titan
Reflection
Spectron
Elite
Lubinus SP
ZCA
Modular Hip System
Kronos
N
26394
7364
5593
5406
3543
2215
1634
958
830
825
R
647
219
147
49
98
51
25
14
16
2
Median
Follow-up
in years
5.5
6.1
6.2
2.4
8.9
3.0
5.1
2.6
9.0
2.9
Revision %
at 10 years
3.6 (3.3-4.0)
3.6 (2.8-4.4)
3.7 (3.0-4.4)
*
2.9 (2.2-3.6)
3.9 (2.7-5.2)
2.2 (1.1-3.4)
*
2.4 (1.2-3.7)
*
Revision %
at 15 years
5.5 (4.9-6.2)
7.2 (5.4-8.9)
8.9 (6.3-11.5)
*
5.4 (4.1-6.7)
*
5.4 (1.3-9.6)
*
*
*
17/66
Cemented hip, stem prostheses
Stem
prostheses
Charnley
Exeter
Titan
Spectron
ITH
Lubinus SP
Bio-Fit
CPT
Elite
MS-30
N
26221
7567
7439
3889
3533
1657
1556
875
829
816
R
976
138
118
17
64
62
10
6
24
7
Median
Follow-up
in years
5.8
5.7
5.1
1.6
7.2
5.8
6.8
2.8
3.4
2.4
Revision %
at 10 years
5.5 (5.0-5.9)
2.2 (1.7-2.7)
2.4 (1.9-3.0)
*
2.1 (1.5-2.7)
4.5 (3.1-5.9)
1.0 (0.3-1.6)
*
7.9 (3.9-12)
*
Revision %
at 15 years
7.9 (7.1-8.7)
3.0 (2.3-3.8)
6.8 (4.6-8.9)
*
4.9 (2.6-7.2)
8.3 (5.2-11.3)
*
*
*
*
18/66
100
Type of cement
and failure
of hip prostheses
Simplex
Palacos G
95
Palacos
90
CMW1 G
85
CMW1
CMW3
80
0
Cement type No. THR No. rev.
2
4
10 yr %
6
8
10
12
95% CL
RR
p
Palacos Ga
9,186
277
5.9 5.0 – 6.9
1
Palacos
2,115
101
6.6 5.1 – 8.1
1.1
0.28
Simplex
736
35
7.1
1.1
0.78
CMW1 Ga
1,394
43
___b
CMW1
3,306
279
12
10 – 14
2.0 <0.001
CMW3
586
82
17
13 - 21
3.0 <0.001
4.2 – 10
2.1 <0.001
19/66
Uncemented hip prostheses
100
100
90
90
80
80
TROPIC
ATOLL
IGLOO
TRILOGY
DURALOC
BICON-PLUS
GEMINI
REFLECTION
ENDLER
EUROPEAN CUP SYSTEM
70
60
50
0
4
8
12
16
Cup prostheses,
revision of cup or liner.
CORAIL
FILLER
PROFILE
ZWEYMЬLLER
LMT
SCP
ABG I
OMNIFIT
TI-FIT
BIO-FIT
70
60
50
0
4
8
12
16
Stem prostheses,
revision of stem.
20/66
Cup/stem uncemented hip prostheses
(combination), any revision.
100
90
80
N
2621
TROPIC/CORAIL
1229
ATOLL/CORAIL
945
IGLOO/FILLER
446
TRILOGY/CORAIL
408
GEMINI/PROFILE
332
DURALOC/PROFILE
254
REFLECTION/CORAIL
248
DURALOC/SCP
EUROP. CUP SYSTEM/LMT 245
245
ENDLER/ZWEYMЬLLER
70
60
50
0
4
8
12
16
21/66
Uncemented hip, cup prostheses
Cup
prostheses
Tropic
Atoll
Igloo
Trilogy
Duraloc
Bicon-Plus
Gemini
Reflection
Endler
European cup system
N
2772
1285
1111
873
844
418
411
404
303
246
R
299
211
10
13
25
7
77
8
102
68
Median
Follow-up
in years
7.0
9.3
2.5
2.9
5.2
1.3
11.1
5.4
15.0
13.1
Revision %
Revision %
at 10 years
at 15 years
15.5 (13.5-17.6) 27.7(23.7-31.8)
18.5 (16.0-21.0)
*
*
*
*
*
5.8 (3.0-8.6)
*
*
*
15.0 (11.5-18.5)
*
*
*
25.2 (20.2-30.2) 36.8(30.9-42.7)
28.6 (22.3-34.9) 39.1(28.7-49.6)
22/66
Uncemented hip, stem prostheses
Stem
prostheses
Corail
Filler
Profile
Zweymüller
LMT
SCP
ABG
Omnifit
Ti-Fit
Bio-Fit
N
5130
956
863
512
491
443
300
299
212
207
R
83
9
60
21
35
1
5
5
16
141
Median
Follow-up
in years
6.8
2.3
9.5
8.3
12.5
2.9
5.3
4.5
8.7
15.1
Revision %
Revision %
at 10 years
at 15 years
2.4(1.8-3.1)
4.9(2.5-7.2)
*
*
7.5(5.5-9.5) 10.3(7.0-13.5)
5.2(2.8-7.7)
7.5(4.2-10.8)
7.6(4.9-10.3) 10.8(6.8-14.7)
*
*
5.8(0.4-11.2)
*
*
*
7.2(3.3-11.0)
*
55.7(48.6-62.7) 70.9(64.2-77.6)
23/66
Hip prostheses in young patients
(< 60 years)
100
100
90
90
80
80
CHARNLEY/CHARNLEY
EXETER/EXETER
REFLECTION/SPECTRON
SPECTRON/ITH
ALLO PRO/MS-30
TITAN/TITAN
KRONOS/TITAN
ZCA/CPT
CHARNLEY/ELITE
LUBINUS SP/LUBINUS SP
70
60
50
TROPIC/CORAIL
ATOLL/CORAIL
IGLOO/FILLER
GEMINI/PROFILE
TRILOGY/CORAIL
DURALOC/PROFILE
DURALOC/SCP
ENDLER/ZWEYMЬLLER
REFLECTION/CORAIL
TI-FIT/BIO-FIT
70
60
50
0
4
8
12
16
Cemented cup/stem
(combination),
any revision.
0
4
8
12
16
Uncemented cup/stem
(combination),
any revision.
24/66
Hip prostheses in young patients
(< 60 years)
100
100
90
90
80
80
70
70
60
60
CEMENTED (Palacos or Simplex)
UNCEMENTED (Ti-fit/Bio-fit excluded)
50
CEMENTED (Palacos or Simplex)
UNCEMENTED (Ti-fit/Bio-fit excluded)
50
0
4
8
12
16
Cemented and uncemented
cup/stem (combination),
revision of cup or liner.
0
4
8
12
16
Cemented and uncemented
cup/stem (combination),
revision of stem.
25/66
1
Femoral headFigsize
is a risk factor
for total hip luxation
Adjusted survival (%)
100
99
98
Prostheses with head diameters of 28 and 32
(n=9943)
97
32 mm
28 mm
96
22 mm (Charnley)
95
0
2
4
6
8
10
12
Years
Prosthesis survival until revision due to dislocation.
Adjusted for age gender, diagnosis and surgical approach
(Bystrøm et al. Acta Orthop Scand 2003)
26/66
Prosthesis combinations, 28 and 32
mm femoral head sizes
27/66
Exeter prosthesis (n=5598) with
Fig 2
head diameters of 26, 28 and 30
Adjusted survival (%)
100
99
98
97
30 m m
28 m m
26 m m
96
22 m m (Charnley)
95
0
2
4
6
8
10
12
Years
Prosthesis survival until revision due to dislocation.
Adjusted for age gender, diagnosis and surgical approach
28/66
Operation time
Operating time of
the primary
operation (minutes)
No.
THRs*
Revision due to aseptic loosening
Revision due to infection
No.
RRAdj. 95% CI
revised
No.
RRAdj. 95% CI
revised
p
Revision due to luxation
p
No.
RRAdj.
revised
95% CI
p
Cemented implants
< 51
453
26
1.6
1.0-2.4
0.03
1
0.5
0.1-4.0
0.6
2
0.9
0.2-3.6
0.9
51 - 70
4548
147
1.1
0.9-1.3
0.5
17
1.0
0.6-1.9
0.9
26
0.8
0.5-1.3
0.5
71 – 90
9844
285
1
33
1
60
1
91 - 110
6461
242
1.3
1.1-1.5
32
1.5
0.9-2.5
0.09
33
0.9
0.6-1.4
0.6
111 - 130
4180
201
1.5
1.2-1.8 <0.001
16
1.2
0.6-2.2
0.6
31
1.3
0.9-2.1
0.2
131 - 150
1584
82
1.5
1.2-1.9
0.002
7
1.4
0.6-3.1
0.5
7
0.7
0.3-1.7
0.5
> 150
950
62
2.0
1.5-2.6 <0.001
11
3.5
1.7-7.4
0.001
12
1.7
0.8-3.4
0.1
< 51
245
38
0.8
0.5-1.3
0.3
0
----
----
----
2
1.5
0.2-8.8
0.7
51 - 70
746
52
0.8
0.6-1.2
0.4
2
1.2
0.2-8.7
0.9
7
1.4
0.5-4.0
0.6
71 – 90
929
75
1
2
1
7
1
91 - 110
406
29
0.8
0.5-1.2
0.3
4
5.3
0.9-30
0.06
9
2.5
0.9-6.8
0.08
111 - 130
272
30
0.9
0.6-1.3
0.5
0
----
----
----
0
----
----
----
131 - 150
99
15
1.2
0.7-2.1
0.6
1
7.2
0.6-95
0.1
0
----
----
----
> 150
76
18
1.3
0.7-2.2
0.4
0
----
----
----
4
2.8
0.6-12
0.2
0.01
Uncemented implants
Småbrekke et al. Acta Orthop Scand 2004
29/66
Hip disease and the prognosis of total hip
arthroplasty (Furnes et al. 2001)
Total material
Unadjusted
1
0
Adjusted
1 0 0
U nadj
us ted
A dj us t
(K apl an-Mei er)
0
9
5
9
0
9
0
Survial(%)
5
Survial(%)
9
P ri m
Rh
e
F ra
8
8
a
u
c
ry
m
t u
o
s
a
t o
re
o
P
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o
m
a a
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h
yr i o
t i s
s
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a
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t h
m
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t i t
s
o
fF
tr
h
a
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c
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fu
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m
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o
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rf
a t
l h
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n
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d
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c
6
Y e
g
l o
e
c
n
a
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ta
i o
l
d
y
e
a
h
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d
o
i n
s
t e
u
l a
rs
8
1
rs
8
0
1
s
r
A
n v
e a
c
0Ot h
20
i n
2
c
4
s
ro
cs
u
i l
s
a
e
6
h
/ P
ye
sr i
to
h l
e
ys
s
r
n
e
rs
8
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Y
e e
p
a
rr
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m
0
1
2
s
a i
rn
y
co
e
p
30/66
Hip disease and the prognosis of total hip
arthroplasty (Furnes et al. 2001)
< 60 years
Total material
1
0
Charnley
1 0 0
U nadj
us ted
U nadj us t
<= 60 y ear
<=
s60 y ears
0
9
0
8
0
8
0
Survial(%)
0
Survial(%)
9
P ri m
Rh
e
F ra
7
6
a
u
c
ry
m
t u
o
s
a
t o
re
o
P
t e
ri
o
m
a a
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h
yr i o
t i s
s
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A n
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g
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d
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s
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s
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s
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A n
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k
p y
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n
o
d
sy
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l i g
t i s
s
s
c
6
Y e
a
y
e
a
h
o
o
o
rf
a t
l h
n
e
0C o
l C
d
o
i n
s
t e
u
l a
rs
8
1
rs
6
r
A
n v
e a
c
0Ot h
0
1
20
s
i n
2
c
4
s
ro
cs
u
i l
s
a
e
6
h
/ P
ye
sr i
to
h l
e
ys
sґi
r
n
e
p
c
rs
8
1
Y
e e
p
a
rr
i s
m
0
1
2
s
a i
rn
y
co
e
p p
e
31/66
Relative risk for revision with
Charnley-prosthesis
Hip disease
Dislocation
Fracture near the
prosthesis
1
Osteoarthritis
1
Fracture
2.8 p<0.0001 5.0 p=0.002
Dysplasia with
dislocation
5.6 p=0.02
32/66
Antibiotic Prophylaxis and Survival of
Primary Total Hip Prostheses
100
%
Antibiotics administered:
Systemically and
in cement
98
Systemically
only
96
No antibiotics
In cement only
94
p=0.001
Cox-regression-adjusted
survival curves calculated
with revision due to any
cause as the endpoint
(Espehaug et al. J Bone Joint
Surg (Br) 1997).
92
90
0
2
4
6
8
10
Years
33/66
Antibiotics – systemically
daysdoses
100
%
13 3
14
Percent not revised
2
95
12
11
90
85
Years postoperatively
Engesaeter et al. Acta Orthop Scand 2003; 74:644-651
34/66
Antibiotic prophylaxis systemically
and in bone cement
Number of THAs performed annually
Number of THAs
SC
C
None
S
Year of operation
35/66
Antibiotic prophylaxis systemically
and in bone cement
Survival aseptic loosening
100%
Survival infection
SC
100%
SC
C
95%
None
S
None
C
95%
S
90%
90%
85%
85%
0
2
4
6
8
10
12
14
Years postoperatively
16
0
2
4
6
8
10
12
14
16
Years postoperatively
Cox-adjusted survival curves with aseptic loosening, and
infection as endpoint for THAs receiving antibiotic prohylaxis
systemically and in cement (SC), only systemically (S), only in
cements (C) or no antibiotic prohylaxis (None).
36/66
Antibiotic prophylaxis systemically
and in bone cement
Number of THAs performed annually
13
Number of THAs
14
11
12
2
3
Year of operation
37/66
Antibiotic prophylaxis systemically
and in bone cement
Survival aseptic loosening
14
100%
Survival infection
13
100%
3
14
12
2
13
12 2
95%
11
90%
3
11
95%
90%
85%
85%
0
2
4
6
8
10
12
14
Years postoperatively
16
0
2
4
6
8
10
12
14
16
Years postoperatively
Cox-adjusted survival curves with aseptic loosening and infection
as endpoint for THAs receiving antibiotic in the cement and
antibiotic prophylaxis systemically for 1 day (with number of
doses as subscript), 2 days and 3 days.
38/66
Revision - Aseptic loosening
1 day 1 dose
1 day 2 doses
1 day 3 doses
1 day 4 doses
2 days
3 days
Total
THA
Revision*
RR**
p-value
1424
2680
5522
2194
1928
717
14 465
37 (5.9%)
3.1
<0.001
53 (4.0%)
2.3
0.007
59 (2.4%)
1.5
0.18
14 (1.5%)
1
-
40 (3.0%)
1.9
0.05
16 (1.7%)
1.0
0.90
219
* Cox adjusted 10 years revision %
** RR (Failure Risk Ratio) Adjusted for sex, age, systemic
antibiotic, operating theatre, duration of operation, prosthesis.
39/66
Revision - Infection
1 day 1 dose
1 day 2 doses
1 day 3 doses
1 day 4 doses
2 days
3 days
Total
THA Revision*
1424 5 (0.3%)
2680 18 (0.6%)
5522 15 (0.2%)
2194 2 (0.2%)
1928 6 (0.2%)
717
0
14 465
46
RR**
4.2
6.8
2.7
1
2.6
-
p-value
0.09
0.01
0.19
0.25
-
* Cox adjusted 10 years revision %
** RR (Failure Risk Ratio) Adjusted for sex, age, systemic
antibiotic, operating theatre, duration of operation, prosthesis.
40/66
Cement Type and Survival of Primary
Total Hip Prostheses
700
600
500
400
300
200
100
0
Boneloc cement
Low viscosity cement
1987 1988 1989 1990 1991 1992 1993 1994 1995
Boneloc cement
Low viscosity cement
Havelin et al. J Bone Joint Surg (Am) 1995
41/66
Kaplan-Meier survival curves of Charnley femoral
prostheses with high viscosity, low viscosity, and
Boneloc cement.
(%)
100
High viscosity
98
96
Low viscosity
94
Boneloc
92
p<0.0001
90
0
1
2
3
4
5
6
7
YEARS
42/66
Survival of Uncemented
Primary Total Hip Prostheses
Charnley cups vs two uncemented HA-coated cups
100
95
90
85
All cup revisions
All cup 80
revisions
%
Charnley
Tropic
Tropic
Atoll
Years
Adj. survival
Charnley
4
Atoll
Years
6
8
410 6 128
10
12
43/66
Survival of Uncemented
Primary Total Hip Prostheses
Charnley cups vs two uncemented HA-coated cups, patients
< 60 years
100
95
90
85
< 60 yr
All cup revisions
All cup 80
revisions
%
Charnley
Tropic
Tropic
Atoll
Years
Adj. survival
Charnley
4
Atoll
Years
6
8
410 6 128
10
12
44/66
Cemented vs uncemented in
young patients (<60)
100
100
95
95
90
90
yr
85
< 60 yr
85
< 60 yr
80
All cup revisions
em
80
All stem
si
s
%on
revisions
Adj. survival
Adj. survival
%
c oated
HA-coated
ed
ou
s
c
oated
Porous
coated
m
en
ted
Cemented
oated
Uncoated
s
8
4
Years
4
6
8
10
10 6
12
All stem revisions
HA-coated
Porous coated
Cemented
Uncoated
12
8
Years
4
6
8
10
10
12
All cup revisions
45/66
Hospital Category and
Operating Volume
100
Central hospitals
95
Local hospitals
90
University hospitals
85
p<0.001
80
0
2
4
6
8
10
Kaplan-Meier survival curves calculated with any
revision as endpoint (Espehaug et al. Acta Orthop
Scand 1999)
46/66
Patient satisfaction
Unrevised hip implant
Revised hip implant
%
%
100
80
60
Very poor
Poor
Neither
Good
Very good
40
20
0
< 56 56- 66- 71- > 75
65 70 75
< 56 56- 66- 71- > 75
65 70 75
Age at primary operation Age at primary operation
47/66
Self-reported pain
Unrevised hip implant
Revised hip implant
6
MEAN CHARNLEY SCORE
5 At follow-up
At follow-up
4
3
2
Before primary operation
1
< 56 56 66 71 > 75
-65 -70 -75
Age at primary operation
Before revision
Before primary operation
< 56 56 66 71 > 75
-65 -70 -75
Age at primary operation
48/66
Self-reported walking ability
Unrevised hip implant
Revised hip implant
6
MEAN CHARNLEY SCORE
At follow-up
5
At follow-up
4
Before primary operation
Before primary operation
3
Before revision
2
1
< 56
56
66
71 > 75 < 56 56
66
71 > 75
-65 -70 -75
-65 -70 -75
Age at primary operation Age at primary operation
49/66
Total survival for patients with
hip prostheses
39543 patients; 6201 deaths; 323 within 60 days
Percent patients alive
100
100
90
99.5
80
99
70
98.5
60
50
0
2
4
6
8
10
Years after primary operation
98
0
30
60
90
120
150
180
Days after primary operation
Lie et al. Acta Orthopaedica Scand. 2000; 71(1): 19-27
50/66
Early postoperative mortality
Days postoperatively
Days postoperatively
51/66
Population fraction without THR
Risk factors for total hip replacement
Intensive physical activity at work and a high BMI each
contribute significantly to the overall risk of undergoing THA
due to primary osteoarthritis.
52/66
Risk factors for total hip replacement
53/66
90 100
70
80
90 100
50
60
70
80
90 100
Percent with no re-revisions
15
80
10
70
5
60
Years after primary operation
0
50
60
89 %
Percent with no third revisions
50
Percent with no revisions
Revision prostheses
74 %
0
0
5
Year after revision
Year after re-revision
5
10
10
15
62 %
15
54/66
Femoral revision prostheses
5
10
15
0
D; n=282, r=8
5
10
5
10
15
Bone grafting/
uncemented
50 60 70 80 90
No bone grafting/
uncemented
0
B; n=326, r=20
15
Years after revision
5
5
10
15
Impaction bone grafting/
uncemented
E; n=478, r=6
0
C; n=442, r=12
0
50 60 70 80 90
0
Impaction bone grafting/
cemented
50 60 70 80 90
50 60 70 80 90
50 60 70 80 90
Bone grafting/
cemented
A; n=1243, r=144
50 60 70 80 90
Percent with no re-revision
No bone grafting/
cemented
10
15
Years after revision
F; n=89, r=4
0
5
10
15
Years after revision
55/66
Femoral revision prostheses
RR 95 % CI
1 ref
& No bone grafting
0.53 0.33, 0.84
Cemented & Bone grafting
& Impaction bone grafting
0.34 0.19, 0.62
& No bone grafting
0.22 0.11, 0.46
0.27 0.16, 0.46
Uncemented & Bone grafting
& Impaction bone grafting
0.51 0.19, 1.38
Cox-regression, adjusted for age and gender
56/66
Acetabular revision prostheses
10
15
0
D: n=542, r=20
5
10
Years after revision
5
10
15
Bone grafting/
uncemented
50 60 70 80 90
No bone grafting/
uncemented
0
B: n=301, r=14
15
5
5
10
15
Impaction bone grafting/
uncemented
E: n=487, r=33
0
C: n=256, r=12
0
50 60 70 80 90
5
Impaction bone grafting/
cemented
50 60 70 80 90
50 60 70 80 90
50 60 70 80 90
Bone grafting/
cemented
A: n=1108, r=82
0
50 60 70 80 90
Percent with no re-revision
No bone grafting/
cemented
10
15
Years after revision
F: n=54, r=4
0
5
10
15
Years after revision
57/66
Acetabular revision prostheses
RR 95 % CI
1 ref
& No bone grafting
0.60 0.34, 1.06
Cemented & Bone grafting
& Impaction bone grafting
0.70 0.38, 1.30
& No bone grafting
0.37 0.22, 0.61
0.66 0.43, 0.99
Uncemented & Bone grafting
& Impaction bone grafting
1.03 0.38, 2.83
Cox-regression, adjusted for age and gender
58/66
Failures in primary total knee arthroplasties
100
100
90
90
80
80
N
70
AGC
DURACON
GENESIS I
KINEMAX
LCS
NEX GEN
PROFIX
TRICON
60
50
0
2
4
1562
279
2174
65
2193
100
1872
561
6
8 year revision
% (95% CI)
5.4
4.7
9.5
10.7
5.5
*
*
9.4
8
(3.9-7.0)
(1.8-7.6)
(7.8-11.2)
(1.3-20.1)
(3.2-8.0)
(6.8-12.1)
10
Cemented bicompartmental
primary knee arthroplasties
(patella non resurfaced),
any revision.
N
70
AGC
DURACON
GENESIS I
KINEMAX
LCS
NEX GEN
PROFIX
TRICON
60
50
0
2
4
404
97
691
244
533
228
94
441
6
8 year revision
% (95% CI)
3.0
*
8.0
6.8
*
*
*
5.6
8
(1.2-4.9)
(5.6-10.4)
(2.9-10.8)
(3.4-7.8)
10
Cemented tricompartmental
primary knee arthroplasties
(patella resurfaced),
any revision.
59/66
Failures in primary total knee arthroplasties
100
Fixation of bicompartmental
and
tricompartmental primary knee
arthroplasties, any revision.
90
80
70
N
Cem. TRI. 2732
Cem. BI.
8805
Hybrid TRI. 261
Hybrid BI. 1168
Uncem. TRI. 66
Uncem. BI. 161
60
50
0
2
4
6
8 year revision
% (95% CI)
5.8
6.6
2.0
7.4
7.2
7.9
8
(4.6-7.0)
(5.6-7.5)
(0.2-3.7)
(4.5-10.3)
(2.0-12.5)
(2.3-13.4)
10
60/66
Reasons for revision in cemented
primary total knee arthroplasties
Type of prosthesis
Loose
femur
Loose
tibia
Number of revisions for each cause of revision.
Loose
Infection
Dislocation Instability Peri
patella
of patella
prosthetic
fracture
Pain
alone
Defect
tibial
insert
Other
causes
TKA (n=2165)
BKA (n=3968)
RR (BKAs versus
TKAs)
3
4
0.70
12
11
0.55
5
16
0
11
No value 0.41
95 % CI
0.15-3.2
0.7
0.23-1.3
0.2
P-value
0.18-0.93
0.03
4
8
1.0
11
17
0.59
4
3
0.44
9
68
5.7
4
3
0.50
10
14
1.2
0.29-3.3
1
0.26-1.3
0.2
0.10-2.0
0.3
2.7-12
<0.001
0.10-2.6
0.4
0.43-3.2
0.8
61/66
Unicompartmental and tricompartmental
cemented primary knee arthroplasties
Cemented TKA
100
90
Cemented UKA
80
100
≥70 years
100
90
60 to 69 years
90
80
<60 years
80
70
70
70
60
60
60
50
50
50
0
2
4
6
8
10
0
2
4
6
8
Cemented TKAs
10
≥70
60 to 69 years
<60 years
0
2
4
6
8
10
Cemented UKAs
62/66
Unicompartmental and tricompartmental
cemented primary knee arthroplasties
100
100
Genesis Uni (n=259)
Oxford III (n=680)
90
90
Oxford II (n=45)
Mod III (n=200)
80
70
70
60
60
Duracon Uni (n=48)
50
0
2
4
6
8
10
Miller Galante (n=166)
80
50
0
2
4
6
8
10
63/66
Unicompartmental and tricompartmental
cemented primary knee arthroplasties
100
90
Survival curves for primary
cemented Miller Galante UKAs
(all polyethylene tibia) at 13
hospitals in Norway, indicating
large variations, p=0.01.
80
70
60
50
0
2
4
6
8
10
64/66
Reasons for revision in
cemented UKAs compared
with cemented TKAs
Type of prosthesis
Loose
femur
Loose
tibia
Number of revisions for each cause of revision.
Loose
Infection
Instability/
Peri
patella
dislocation
prosthetic
fracture
Pain
alone
Wear of
tibial insert
Other causes
TKA (n=2818)
UKA (n=1410)
RR (UKAs versus
TKAs)
10
17
4.1
39
29
2.1
10
0
No value
95 % CI
1.5-11.1
0.005
1.2-3.8
0.009
P-value
35
3
0.24
46
13
0.77
8
9
3.7
30
42
4.2
17
11
1.3
19
9
1.3
0.07-0.82
0.02
0.37-1.6
0.5
1.2-11.8
0.03
2.4-7.3
<0.001
0.56-3.1
0.5
0.49-3.6
0.6
65/66
UKAs used in Norway
Prosthesis
n
Caracteristica
200
Number of
hospitals
11
MOD III
Miniarthrotomy
Poly fastened to the No
tibia
Ended 1999
Genesis uni
259
15
Whole period
No
Duracon uni
48
5
All poly tibia
Ended 1999
No
Oxford II
45
2
Ended 2000
No
Oxford III
680
27
Yes
Miller Galante
166
14
Meniscal bearing
From 1999
All poly tibia
From 1998
Link uni
9
2
Yes
Poly fastened to the No
tibia
66/66