OBS! Ryggbredden (10 mm) är för 176 sidor För 192 sidor blir ryggbredden 11 mm The Swedish Hip Arthroplasty Register Annual Report 2016 FOR YEAR 2016 ANY HEALTH PROBLEMS YOU WISH TO DECLARE? The Swedish Hip Arthroplasty Register Annual Report 2016 Johan Kärrholm Hans Lindahl Henrik Malchau Maziar Mohaddes Szilárd Nemes Cecilia Rogmark Ola Rolfson Subject to printing errors, faulty information and/or data files. Publisher: Ola Rolfson ISBN 978-91-984239-1-4 ISSN 1654-5982 Contents 1 Introduction ............................................................................................................... 4 2 Data quality and the Register’s validation process ........................................................ 6 2.1 PROM programme’s data quality ......................................................................................... 6 2.2 Completeness ....................................................................................................................... 7 2.3 Monitoring – a validation process ........................................................................................ 10 3 Equality and gender equality in hip replacement .......................................................... 11 3.1 Total hip replacement in Sweden ........................................................................................ 11 3.2 Geographical inequality ....................................................................................................... 12 3.3 Gender – osteoarthritis patients ............................................................................................ 15 3.4 Gender – fracture patients ................................................................................................... 19 4 Register development, improvement work and research ................................................. 20 4.1 The new platform Stratum ................................................................................................... 20 4.2 Does the surgeon‘s experience play any role in patient-reported outcomes? ................................ 21 4.3 Register-based improvement work and research ...................................................................... 23 5 International Register work ......................................................................................... 29 6 Primary prosthesis ....................................................................................................... 30 6.1 Demographics .................................................................................................................... 30 6.2 Diagnosis ........................................................................................................................... 30 6.3 BMI and ASA classification ................................................................................................ 31 6.4 Prosthesis selection .............................................................................................................. 31 6.5 Typical prostheses ................................................................................................................ 31 6.6 Articulation ....................................................................................................................... 36 6.7 Implant combinations ........................................................................................................ 36 6.8 Incision ............................................................................................................................. 36 7 Primary prosthesis – in-depth analyses ......................................................................... 48 7.1 “New” primary prosthesis .................................................................................................... 48 8 Reoperation ................................................................................................................ 55 8.1 Reoperation without replacing or extracting the implant ....................................................... 56 9 Reoperation within two years ...................................................................................... 59 10 Revision ...................................................................................................................... 70 10.1 Revision ........................................................................................................................... 70 10.2 Implant survival within five and ten years ......................................................................... 85 11 Patient-reported outcomes ........................................................................................... 88 12 90-day mortality after hip arthroplasty ........................................................................110 13 Adverse events within 30 days and 90 days ..................................................................114 14 Fracture treatment with total or hemiarthroplasty .......................................................123 15 Register development – value compasses .......................................................................135 15.1 Follow-up after total arthroplasty ..................................................................................... 135 15.2 Follow-up after hip arthroplasty as fracture treatment ........................................................ 143 16 Swedish Hip Arthroplasty Register and clinical research ...............................................148 17 References ...................................................................................................................151 Footnote. A number of descriptive tables have been removed from our printed annual report and are published only on our website. Refer to ”Tables”, www.shpr.se/sv/Publications/DocumentsReports.aspx 4 SWEDISH HIP ARTHROPLASTY REGISTER 2016 1 Introduction Welcome to the Annual Report 2016 of the Swedish Hip Primary total hip replacement in Arthroplasty Register. Although the report looks similar to Sweden reports from recent years, the whole process of assembling the 18000 annual report has been revised. This is due to the fact that in January 2017 we launched a new version of the Register, which 16000 included, among other things, modernising the content to better describe the hip arthroplasties performed today. We moved the 14000 Register to a new IT platform which gives us several advantages, for example, better validation of entered data and simpler and 12000 faster way of presenting the register data. The move to the new IT platform meant that all the programming was carried out 10000 from scratch to obtain all the tables and graphs for the report. 8000 The Swedish Hip Arthroplasty Register is a national 6000 quality register with the aim of improving care for patients who undergo hip replacement procedure in Sweden. The 4000 intention is to register all hip arthroplasty operations regardless whether the operation takes place in a public 2000 or private establishment and regardless of the condition which leads to the operation. The Register became active in 0 Copyright © 2017 Swedish Hip Arthroplasty Register 1979 and the report presents operations that were carried 1970 1980 1990 2000 2010 out by 31st of December 2016, which concluded the 38th operational year for the Register. Number of primary total hip replacement operations, which have been carried out in Sweden from 1967 (6 operations) to 2016 (17 261 operations). 1.1 This year’s production the PROM programme (patient-reported outcome measures), During 2016, the production increased and for the first the response rate for patients with osteoarthritis that were time, more than 17 000 primary total arthroplasties were operated on during 2015 was 85% both preoperatively and performed. To be more accurate, 17 261 total arthroplasties during one-year follow-up. were performed, which corresponds to 173 procedures per 100 000 inhabitants. 4 130 primary hemiarthroplasties were performed, which was slightly less than in the previous year, 1.3 Cover image however, in total, 6158 hip arthroplasties were carried out This year’s cover image illustrates our ongoing work with trying due to acute hip fracture or sequelae after fracture, which to understand how comorbidity influences patient-reported together with the year 2013 is the highest level of registration outcomes and the risk of being affected by complications. In in the Register’s history. In total, over 2 500 reoperations were April 2017, Anne Garland defended the Register-based thesis registered. ”Early mortality after total hip replacement in Sweden” which studies in detail how different comorbidities and comorbidity index may predict mortality. A summary of the thesis is 1.2 Validation process and presented in this report. Also, a ST project by Johan Larsson in Kungälv is presented, which focuses on the relationsship publishing between anaemia and patient-reported outcomes. Successful The Register data is continuously validated and controlled for hip replacement requires a thourough evaluation of risks and quality. We use several methods to ensure and maintain high expected benefits and the identification and elimation of risk level of data quality and to facilitate improvement work in factors before the operation. Make sure the patients declare areas with shortcomings. An important part in validation work any health problems preoperatively. is the annual completeness analysis which is carried out via an linkage to the Patient Register