Studies Based on the Danish Hip Arthroplasty Registry
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Studies based on the Danish Hip Arthroplasty Registry PhD thesis Alma Bečić Pedersen Faculty of Health Sciences University of Aarhus, Denmark, 2006 Department of Clinical Epidemiology, Aarhus University Hospital Report no. 20 Studies based on the Danish Hip Arthroplasty Registry PhD thesis Alma Bečić Pedersen Department of Orthopedics, Aarhus University Hospital Department of Clinical Epidemiology, Aarhus University Hospital Department of Orthopedics, Odense University Hospital Faculty of Health Sciences University of Aarhus, Denmark, 2006 Department of Clinical Epidemiology, Aarhus University Hospital Report no. 20 Supervisors Ulf Lucht, MD, DMSc Department of Orthopaedics Aarhus University Hospital, Denmark Søren Paaske Johnsen MD, PhD Department of Clinical Epidemiology Aarhus University Hospital, Denmark Kjeld Søballe, Professor, MD, DMSc Department of Orthopaedics Aarhus University Hospital, Denmark; Søren Overgaard, Professor, MD, DMSc Department of Orthopaedics Odense University Hospital, Denmark Evaluation committee Anders Odgaard, Lecturer, MD, DMSc Department of Orthopaedics Aarhus University Hospital, Denmark Torben Jørgensen, Lecturer, Chief of the Center, MD, DMSc Research Center for Prevention and Health Glostrup Hospital, Denmark Ove Furnes, MD, PhD Department of Orthopaedics Haukeland Universitetssygehus, Bergen, Norwey Preface This PhD thesis is based on studies carried out during my employment at the Department of Clinical Epidemiology and the Department of Orthopedics, Aarhus University Hospital, University of Aarhus, in the period 2002-2005. I am deeply indebted to a number of persons who have made this work possible. First of all, I wish to express my sincere gratitude to my supervisors Ulf Lucht, Søren Overgaard, and Kjeld Søballe for their valuable and skilful guidance, discussion, and support in the field of orthopedic surgery. I am especially grateful to my supervisor Søren Paaske Johnsen for his great engagement in my daily work, enthusiasm, and patience, and wonderful way of advising me throughout the research period. I wish to thank Henrik Toft Sørensen for believing in me, continuously providing constructive ideas and support to my research, and for bringing clinical epidemiology to my attention. I am also grateful to Michael Væth for being available with useful advice for data analyses. In addition, my gratitude goes to Otto Sneppen, Anne Hjelm, and orthopedic surgeons all over Denmark for their contribution to the Danish Hip Arthroplasty Registry. I also wish to thank all my colleagues and friends at the Department of Clinical Epidemiology, Aarhus University Hospital for help, fruitful discussions, and advice at any time throughout this PhD study. It has been a pleasure to work with all of you. Special thanks to my friend and colleague Ellen Mikkelsen, for both professional and personal discussions, and for many good laughs. I am sincerely indebted to my sisters, Azra and Alijana, and parents Husein Becic and Alije Becic (1945-2002) for their whole-hearted support at all times. Finally, my most sincere and deepest gratitude to my husband Sean H. Pedersen, and our daughter Sara for their encouragement, love, patience, and for reminding me what is the most important in life, namely family. The study was supported by The Danish Rheumatism Association (J.nr. 233-1082-08.10.01), Oldermand slagtermester Peter Ryholts grant, Orthopedic Research Foundation in Aarhus, Aarhus University Hospitals Research Initiative from Aarhus County, Lægekredsforeningen for Aarhus County Research Foundation, and University of Aarhus. This PhD thesis is based on the following four papers: I. Alma B. Pedersen, Søren P. Johnsen, Søren Overgaard, Kjeld Søballe, Henrik T. Sørensen, Ulf Lucht. Registration in the Danish Hip Arthroplasty Registry. Completeness of total hip arthroplasties and positive predictive value of registered diagnosis and postoperative complications. Acta Orthop Scand 2004; 75 (4):434-441. II. Alma B. Pedersen, Søren P. Johnsen, Søren Overgaard, Kjeld Søballe, Henrik T. Sørensen, Ulf Lucht. Total hip arthroplasty in Denmark. Incidence of primary operations and revisions during 1996-2002 and estimated future demands. Acta Orthopaedica 2005; 76 (2): 182-189. III. Alma B. Pedersen, Søren P. Johnsen, Søren Overgaard, Kjeld Søballe, Henrik T. Sørensen, Ulf Lucht. Regional variation in incidence of primary total hip arthroplasties and revisions in Denmark, 1996-2002. Acta Orthopaedica 2005; 76 (6): 815-822. IV. Alma B. Pedersen, Søren P. Johnsen, Søren Overgaard, Kjeld Søballe, Henrik T. Sørensen, Ulf Lucht. Patient-related predictors of short and long term implant failure after primary total hip arthroplasty. A nationwide Danish follow-up study with 36 984 patients. Submitted. Abbreviations DHR Danish Hip Arthroplasty Registry THA Total hip arthroplasty ICD International Classification of Diseases CI Confidence Interval IR Incidence rate IRR Incidence rate ratio OA Osteoarthritis CONTENTS 1. INTRODUCTION ........................................................................................................................................................ 1 1.1. Clinical background................................................................................................................1 1.2. Use of clinical databases in THA research..........................................................................10 1.3. THA clinical databases .........................................................................................................11 1.4. Conclusions............................................................................................................................14 2. AIMS OF THESIS...................................................................................................................................................... 15 3. MATERIALS AND METHODS ............................................................................................................................... 17 3.1. Data sources...........................................................................................................................17 3.2. Outcomes................................................................................................................................20 3.3. Study population ...................................................................................................................22 3.4. Data analyses .........................................................................................................................22 4. MAIN RESULTS........................................................................................................................................................ 27 4.1. Aim I: The data validity in the DHR...................................................................................27 4.2. Aim II: IRs of primary THAs and revision, and future demands....................................29 4.3. Aim III: Regional variation in the IRs of primary THAs and revisions..........................32 4.4. Aim IV: Predictors of short and long term implant failure after primary THA............36 5. METHODOLOGICAL CONSIDERATIONS......................................................................................................... 39 5.1. Aim I: The data validity in the DHR...................................................................................39 5.2. Aim II and III: IRs of primary THAs and revision, future demands, and regional variation ........................................................................................................................................40 5.3. Aim IV: Predictors of short and long term implant failure after primary THA............43 6. OVERALL DISCUSSION ......................................................................................................................................... 45 6.1. Aim I: The data validity in the DHR...................................................................................45 6.2. Aim II: IRs of primary THAs and revision and future demands.....................................46 6.3. Aim III: Regional variation in the IRs of primary THAs and revisions..........................47 6.4. Aim IV: Predictors of short and long term implant failure after primary THA............48 7. MAIN CONCUSSIONS ............................................................................................................................................. 51 8. PERSPECTIVES ........................................................................................................................................................ 53 9. ENGLISH SUMMARY.............................................................................................................................................. 55 10. DANISH SUMMARY .............................................................................................................................................. 57 11. REFERENCE LIST.................................................................................................................................................. 59 APPENDIX 12.1: Review of the medical records ....................................................................................................... 68 APPENDIX 12.2: Review of the radiographs............................................................................................................... 70 APPENDIX 12.3: Charlson Comorbidity Index .........................................................................................................