dislocations of primary thr´s in denmark
DESCRIPTION
INTRODUCTION:Dislocation of THR is registered with a great variance in different publications. The Nordic countries has a unique possibility to register and follow patients due to their social security number and the registration in the LPR (Lands Patient Registret).MATERIAL AND METHODS:Data from DHR, in which there is registered THR performed in Denmark since 1995. From 2001 and forward LPR has registered the laterality for all operations. Because of this it is possible from 2001 and forward to do simultaneous registrations of the LPR and DHR. This has been done in the period 2001-2003.RESULTS:During the period 1.1.01 to 31.12.03 there have been registered 18.289 primary THR´s in the DHR. In the LPR there has been registered 18.007 primary THR´s. 15.722 was registered in both registries and with the same laterality for the operation. 2285 THR´s was registered in LPR but not in DHR. In DHR was 2650 but these were not present in LPR. 929 of these THR´s were performed in private hospitals and clinics and from these institutions registration was not mandatory to LPR.Out of the 15.722 primary THR´s 589 patients had experienced a dislocation from 1 to 11 times. The total number of dislocations was 1165. The dislocation rate for the first dislocation was 3.80%, and no difference was seen for male and females. As expected the dislocations rate for the lateral approach was lower (1.79%) than for the posterior (4.00%).CONCLUSION:We have registered a discrepancy for the two national Registries LPR and DHR for the registration of primary THR and also for the number of dislocations for the primary THR.The dislocation rate in this study does not differ much from the general rates known from several publications.The dislocation rate for the lateral approach was as expected lower than for the posterior approach.TRANSCRIPT
Luksation af primære hoftealloplastikker i Danmark
Peder Klement Jensen, Orthopædkirurgisk afdeling, Holbæk Sygehus
Jens-Erik Varmarken, Orthopædkirurgisk afdeling, Næstved Sygehus
Søren Paaske Johnsen, Klinisk Epidemiologisk Afdeling, Århus Universitetshospital
Ulf Lucht, Dansk Hoftealloplastik Register, Århus Universitetshospital
INTRODUKTIONJolles BM, Bogoch ER.
Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis.
Cochrane Database Syst Rev. 2006 Jul 19;3:CD003828.
van Stralen GM, Struben PJ, van Loon CJ.
The incidence of dislocation after primary total hip arthroplasty using posterior approach with posterior soft-tissue repair.
Arch Orthop Trauma Surg. 2003 Jun;123(5):219-22. Epub 2003 Apr 9.
Woolson ST, Rahimtoola ZO.
Risk factors for dislocation during the first 3 months after primary total hip replacement.
J Arthroplasty. 1999 Sep;14(6):662-8.
MATERIALE & METODE
♦ Data fra Landspatientregistret (LPR) for
perioden 1. Januar 2001 til 31. December
2003
♦ Data fra Dansk Hoftealloplastik Register
(DHRR) for perioden 1. Januar 2001 til 31.
December 2003
Nøgle værdi (Key-Value / Primary Key)
♦ CPR nummer
♦ Operations dato
♦ Sideangivelse
♦ Type af indgreb (operations kode KNF..)
Type af indgreb
♦ KNFB20 Primær indsættelse af ucementeret totalprotese i
hofteled
♦ KNFB30 Primær indsættelse af hybrid totalprotese i hofteled
♦ KNFB40 Primær indsættelse af cementeret totalprotese i hofteled
♦ KNFH20 Lukket reposition af lukseret ledprotese i hofte
♦ KNFH21 Artroskopisk reposition af lukseret ledprotese i hofte
♦ KNFH22 Åben reposition af lukseret ledprotese i hofte
♦ KNFH00 Lukket reposition af hofteled
♦ KNFH01 Artroskopisk reposition af hofteled
♦ KNFH02 Åben reposition af hofteled
Fejlkilder
♦ Sideangivelse
♦ Operationsdato
♦ Kode (KNFB.. - KNFC.. - KNGB..)
♦ Reposition på skadestue / sengeafsnit
♦ (Private sygehuse 929)
RESULTATER
I DHRR er der i perioden 2001 til og med
2003 registreret 18.289 primære
alloplastikker.
I LPR er der registret 18,007 primære THR.
15,722 var registreret i begge registre med
samme sideangivelse og operationsdato.
RESULTATER
I LPR var der registreret 2285 som ikke kunne
genfindes i DHRR.
I DHRR fandtes 2650 som ikke var registreret
i LPR. Af dem var 929 opereret på
privatsygehuse, som ikke registreres i LPR.
RESULTATER
Af de 15.722 primære THR som var i begge registre
var der i alt 598 patienter med luksation, som
havde fra en til 11 luksationer i perioden.
Totalt var der 1165 luksationer.
Den totale luksations raten for førstegangs
luksationer var 3.80 %
Førstegangs luxationer (598)
0
50
100
150
200
250
300
350
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29
Måneder
Patienter med luxation
Kun 1 luxation (314 af 598)
020406080
100120140160
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29
Måneder
Patienter med kun 1 luxation
Adgang
adgang Antal Antal luxationer Antal luxationer i %Bagre 14313 573 4,00Forreste 34 1 2,94Lateral 1341 24 1,79
Kønsfordeling
Køn Antal Antal luxationer Antal luxationer i %Mænd 6572 250 3,80Kvinder 9150 348 3,80
Alders fordeling
0,00
1,00
2,00
3,00
4,00
5,00
6,00
7,00
8,00
9,00
10,00
25 - 30
30 - 35
35 - 40
40 - 45
45 - 50
50 - 55
55 - 60
60 - 65
65 -70
70 - 75
75 - 80
80 - 85
85 - 90
90 - 95
95 +
DiagnoseDiagnose Antal Antal luxationer Antal luxationer i %
Acetabulumdysplasi 215 10 4,65Acetabulumfraktur 88 3 3,41Anden artrit 73 2 2,74Andet 153 12 7,84Atraumatisk 425 22 5,18Epifysiolyse 56 1 1,79Frisk proks. 292 23 7,88Kongenit 125 0 0,00Mb. Bekhterew 32 0 0,00Mb. Calve-Legg- 109 1 0,92Primær (idiopatisk) 12520 433 3,46Reumatoid artrit 303 13 4,29Senflg. e. proks. 1292 76 5,88Traumatisk 39 2 5,13
Alloplastik type
opr Antal Antal luxationer Antal luxationer i %KNFB20 4442 133 2,99KNFB30 4836 233 4,82KNFB40 6444 232 3,60
Hyppigste protese kombinationer
Ucementerede KNFB20 (n=3286) førstegangs luksationer
Acetabulum Femur Total %
Trilogy Bi-metric 1882 3,13Mallory-Head Bi-metric 724 2,76Plasmacup SC Bicontact 435 2,30Ranawat-Burstein Bi-metric 198 4,04Universal Bi-metric 47 2,13
Hybrid KNFB30 (n=3100)førstegangs luksationer
Acetabulum Femur Total %
Trilogy Bi-metric 1111 4,86Universal Bi-metric 559 6,80Mallory-Head Exeter 476 3,36Trilogy CPT 495 3,64Duraloc Exeter 459 4,58
Cementerede KNFB40 (n=4595)førstegangs luksationer
Acetabulum Femur Total %
Lubinus Lubinus SP II 1680 2,44Exeter Exeter 1175 5,11ZCA CPT 978 3,07Müller Bi-metric 290 4,48Charnley Charnley 472 2,75
Saturne Cup – (Bipolær cup)
1 luxation ud af 266
(0,38 %)
KONKLUSION
Det er muligt at anvende offenlige databaser som Landspatientregisteret og Dansk Hoftealloplastik Register til at beregne luksationer af primære hoftealloplastikker i Danmark.
Det er dog påkrævet med yderligere validering af registrene for at kunne drage sikre konklusioner.
