The Swedish Hip Arthroplasty Register Annual Report 2015 FOR YEAR 2015 The Swedish Hip Arthroplasty Register Annual Report 2015 Johan Kärrholm Hans Lindahl Henrik Malchau Maziar Mohaddes Cecilia Rogmark Ola Rolfson Subject to printing errors, faulty information and/or data files. Publisher: Ola Rolfson ISBN 978-91-980507-9-0 ISSN 1654-5982 Contents Introduction ..................................................................................................................... 4 Data quality and the Register’s validation process .............................................................. 7 PROM programme’s data quality ................................................................................................... 7 Degree of coverage including the missing variables and response rate ................................................. 8 Monitoring – a validation process .................................................................................................. 12 Validation of data in the local operation programme ....................................................................... 14 Equality and gender equality within prosthetic surgery field ............................................... 15 Total hip replacement in Sweden .................................................................................................. 15 Country production and geographic inequality ................................................................................ 16 Gender – osteoarthritis patients ..................................................................................................... 19 Gender – fracture patients ............................................................................................................. 23 Register development 2015–2016 ...................................................................................... 25 Popular scientific report ................................................................................................................. 26 Individual surgery results ............................................................................................................... 27 Structured care process for elective hip replacement surgery – what is it like in Sweden? ..................... 29 International perspective on the work of the Register ......................................................... 30 Difference in cup/liner and caput diameter ........................................................................ 31 Primary total hip replacement ........................................................................................... 32 Primary total hip replacement – in-depth analyses ............................................................. 53 ”New” primary prosthesis ............................................................................................................. 53 Highly cross-linked polyethylene ..................................................................................................... 59 Caput size and risk of dislocation ................................................................................................... 62 Reoperation ...................................................................................................................... 65 Infection ...................................................................................................................................... 71 Short-term complications – reoperation within two years ................................................... 74 ”Adverse events” within 30 days and 90 days .................................................................... 84 Revision ............................................................................................................................ 93 Implant survival within ten years ......................................................................................113 Patient-reported outcomes .................................................................................................115 EQ-5D with the Swedish value set ................................................................................................. 116 Physiotherapy, Artrosskola and smoking .......................................................................................... 135 The standard patient ........................................................................................................138 Mortality after total hip replacement .................................................................................143 Fracture treatment with total or hemiarthroplasty .............................................................148 The Swedish Hip Arthroplasty Register and clinical research ..............................................162 References ........................................................................................................................164 Footnote. A number of descriptive tables have been removed from our printed annual report and are published only on our website. Refer to ”Tables” at www.shpr.se/sv/Publications/DocumentsReports.aspx 4 SWEDISH HIP ARTHROPLASTY REGISTER 2015 Introduction The Swedish Hip Arthroplasty Register is a national quality Primary total hip replacement in Sweden register with the highest level of certification. The Register 18,000 includes hip replacement surgeries performed in Sweden, either at a public or private unit, and regardless of the condition that led to the surgery. This is the 37th year of 16,000 operation for the Swedish Hip Arthroplasty Register. This year’s cover art illustrates the importance of equality and 14,000 gender equality during treatment. Regardless of who or where one is, everyone must have the possibility to receive high- 12,000 quality hip replacement surgery. We have emphasised this meaningful question in this year’s report and presented all 10,000 aspects on pages 13–22. 8,000 Another new feature in this year’s report is that the clinics’ r results for patient-reported outcomes are presented graphically 6,000 on pages 117–135. This way, it is possible to compare the achieved results with the expected result, which is based on the 4,000 composition of specific patient groups. The national results are also presented graphically. The Register hopes that this may help produce input for better quality in this important issue. 2,000 This year’s in-depth analyses concern, among others, 0 Copyright© 2016 Swedish Hip Arthroplasty Registe new prostheses, highly cross-linked polyethylene and 67 71 75 79 83 87 91 95 99 03 07 11 15 dislocation risk in relation to head size. In-depth analyses Number of primary total hip replacement operations, which have aim at supporting clinical improvement work, initiation been carried out in Sweden from 1967 (6 operations) till 2015 and subsequent publication of scientific reports. The road to (16 609 operations). scientific publication takes usually many years and may not reach everyone. We hope to make a well-balanced compromise between both reporting systems in order to disseminate the Register’s results. from the National Board of Health and Welfare is delivered to the Register in November 2016, which explains the delay of the definitive annual report. In turn, the delayed delivery is This year’s production dependent upon some counties/regions failing to report to the During 2015, the annual production of total hip replacements PAR on time. This is the second time it has happened during was identical to 2014. 16,531 operations were carried out, the last 5 years. A significant part of our report is based on the which is 168 per 100,000 inhabitants. The production annual linkage with the PAR, namely the completeness analysis of hemiarthroplasties remained unchanged as well with and the mapping of adverse events. Due to technical issues, the approximately 4,200 operations. The number of reported value compasses are not included in this year’s report. reoperations in 2015, which were carried out after total replacement surgeries, was 2,339. The Register’s analyses of its own database for 2015 were finished in June 2016, after the annual validation, and the first Elective prosthetic surgery is going through a period of change version of the annual report was published on our website. in Sweden. The annual production of total arthroplasties was carried out at about 80 clinics. Almost a quarter of them are private establishments. A number of larger elective clinics have Coverage been created. Now, more than 1/3 of the annual production is All units, public and private, that carry out hip replacements, carried out at 10 hospitals. The Register follows this structural are included in the Register. The Swedish Hip Arthroplasty change in regards to country results and patient-reported Register, thus, has a 100% degree of coverage for hospitals. outcomes, which is going to be a process lasting several years. Coverage for primary hip replacement on an individual basis (completeness), which has been controlled by linking our data with the National Patient Register, was 98.3% for total hip Validation process and publishing replacement and 97.5% for hemiarthroplasty in 2015. Details Every year, the Register carries out a comprehensive external regarding coverage are elaborated in a separate chapter. and internal validation of data with the aim of continuously improve the data quality of the Register, which takes about Patient-reported outcome measures were reported from all Swedish four months. Additionally, an annual completeness