Dataset Information

Early Revision Rates of Total Hip Arthroplasty Using the Intellijoint HIP Computer Navigation System: A Study From the Australian National Joint Replacement Registry of 1911 Procedures.

ABSTRACT:

Background

Total hip arthroplasty (THA) is an effective treatment for symptomatic hip osteoarthritis. The aim of this study was to determine the revision outcome of commercially available navigation technologies.

Methods

Data from the Australian Orthopaedic Association National Joint Replacement Registry from January 2016 to December 2020 included all primary THA procedures performed for osteoarthritis. Procedures using the Intellijoint HIP navigation system were identified and compared to procedures using "other" computer navigation systems and to nonnavigated procedures. The cumulative percent revision (CPR) was compared between the 3 groups using Kaplan-Meier estimates of survivorship and hazard ratios from Cox proportional hazards models, adjusted for age and gender.

Results

There were 1911 procedures that used the Intellijoint system, 4081 used "other" computer navigation systems, and 160,661 were nonnavigated procedures. The all-cause 2-year CPR rate for the Intellijoint system was 1.8% (95% confidence interval [CI], 1.2-2.6), compared to 2.2% (95% CI, 1.8-2.8) for other navigated cases and 2.2% (95% CI, 2.1-2.3) for nonnavigated cases. A prosthesis analysis identified the Paragon/Acetabular Shell THAs combined with the Intellijoint system to have a higher (3.4%) rate of revision than nonnavigated THAs (hazard ratio = 2.00 [95% CI, 1.01-4.00], P = .048). When this combination was excluded, the Intellijoint group demonstrated a 2-year CPR of 1.3%. There was no statistical difference in the CPR between the 3 groups before or after excluding the Paragon/Acetabular Shell system.

Conclusions

The preliminary data presented demonstrate no statistical difference in all-cause revision rates when comparing the Intellijoint system with "other" navigation systems and "nonnavigated" approaches for primary THAs.

Level of evidence

III (National registry analysis).

SUBMITTER: Lourens EC

PROVIDER: S-EPMC9633565 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Early Revision Rates of Total Hip Arthroplasty Using the Intellijoint HIP Computer Navigation System: A Study From the Australian National Joint Replacement Registry of 1911 Procedures.

Lourens Ernest C EC Kurmis Andrew P AP Holder Carl C de Steiger Richard N RN

Arthroplasty today 20221101

<h4>Background</h4>Total hip arthroplasty (THA) is an effective treatment for symptomatic hip osteoarthritis. The aim of this study was to determine the revision outcome of commercially available navigation technologies.<h4>Methods</h4>Data from the Australian Orthopaedic Association National Joint Replacement Registry from January 2016 to December 2020 included all primary THA procedures performed for osteoarthritis. Procedures using the Intellijoint HIP navigation system were identified and co ...[more]

PMID: 36338290

Similar Datasets

Project description:Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS) total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures.A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction.Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years.Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a standard practice in the future in various forms like navigation or robotics.

Project description:PurposeInfection is a major complication following joint replacement (JR) surgery. However, little data exist regarding antibiotic utilisation following primary JR and how use changes with subsequent revision surgery. This study aimed to examine variation in antibiotic utilisation rates before and after hip replacement surgery in those revised for infection, revised for other reasons and those without revision.MethodsThis retrospective cohort analysis used linked data from the Australian Orthopaedic Association National Joint Replacement Registry and Australian Government Pharmaceutical Benefits Scheme. Patients were included if undergoing total hip replacement (THR) for osteoarthritis in private hospitals between 2002 and 2017. Three groups were examined: primary THR with no subsequent revision (n = 102 577), primary THR with a subsequent revision for reasons other than periprosthetic joint infection (PJI) (n = 3156) and primary THR with a subsequent revision for PJI (n = 520). Monthly antibiotic utilisation rates and prevalence rate ratios (PRRs) with 95% confidence intervals (CIs) were calculated in the 2 years pre- and post-THR.ResultsPrior to primary THR antibiotic utilisation was 9%-10%. After primary THR, antibiotic utilisation rates were higher among patients revised for PJI (PRR 1.69, 95% CI 1.60-1.79) compared to non-revised patients, while the utilisation rate was lower in patients revised for reasons other than infection (PRR 0.96, 95% CI 0.93-0.98). For those revised for infection, antibiotic utilisation post-revision surgery was two times higher than those revised for other reasons (PRR 2.16, 95% CI 2.08-2.23). Utilisation of injectable antibiotics including, vancomycin, flucloxacillin and cephazolin was higher in those revised for PJI patients 0-2 weeks following surgery but not in those revised for other reasons compared to the non-revised group.ConclusionsOngoing antibiotic utilisation after primary surgery may be an early signal of problems with the THR and should be a prompt for primary care physicians to refer patients to specialists for further appropriate investigations and management.

Project description:ObjectivesTo examine mortality and revision rates among patients with osteoarthritis undergoing hip arthroplasty and to compare these rates between patients undergoing cemented or uncemented procedures and to compare outcomes between men undergoing stemmed total hip replacements and Birmingham hip resurfacing.DesignCohort study.SettingNational Joint Registry.PopulationAbout 275,000 patient records.Main outcome measuresHip arthroplasty procedures were linked to the time to any subsequent mortality or revision (implant failure). Flexible parametric survival analysis methods were used to analyse time to mortality and also time to revision. Comparisons between procedure groups were adjusted for age, sex, American Society of Anesthesiologists (ASA) grade, and complexity.ResultsAs there were large baseline differences in the characteristics of patients receiving cemented, uncemented, or resurfacing procedures, unadjusted comparisons are inappropriate. Multivariable survival analyses identified a higher mortality rate for patients undergoing cemented compared with uncemented total hip replacement (adjusted hazard ratio 1.11, 95% confidence interval 1.07 to 1.16); conversely, there was a lower revision rate with cemented procedures (0.53, 0.50 to 0.57). These translate to small predicted differences in population averaged absolute survival probability at all time points. For example, compared with the uncemented group, at eight years after surgery the predicted probability of death in the cemented group was 0.013 higher (0.007 to 0.019) and the predicted probability of revision was 0.015 lower (0.012 to 0.017). In multivariable analyses restricted to men, there was a higher mortality rate in the cemented group and the uncemented group compared with the Birmingham hip resurfacing group. In terms of revision, the Birmingham hip resurfacings had a similar revision rate to uncemented total hip replacements. Both uncemented total hip replacements and Birmingham hip resurfacings had a higher revision rate than cemented total hip replacements.ConclusionsThere is a small but significant increased risk of revision with uncemented rather than cemented total hip replacement, and a small but significant increased risk of death with cemented procedures. It is not known whether these are causal relations or caused by residual confounding. Compared with uncemented and cemented total hip replacements, Birmingham hip resurfacing has a significantly lower risk of death in men of all ages. Previously, only adjusted analyses of hip implant revision rates have been used to recommend and justify use of cheaper cemented total hip implants. Our investigations additionally consider mortality rates and suggest a potentially higher mortality rate with cemented total hip replacements, which merits further investigation.

Project description:Background and purpose - Revision surgery after trapeziometacarpal arthroplasty is sometimes required. Varying revision rates and outcomes have been reported in rather small patient series. Data on risk factors for revision surgery, on the final outcome of revision, and possible factors affecting the outcome of revision are also limited. We evaluated these factors in 50 patients. Patients and methods - From 1,142 trapeziometacarpal arthroplasties performed during a 10-year period, 50 patients with 65 revision surgeries were retrospectively identified and invited to participate in a follow-up study involving subjective, objective, and radiologic evaluation. The revision rate, risk factors for revision, and factors affecting the outcome of revision were analyzed. Results - The revision rate was 5%. Scaphometacarpal impingement was the most common reason for revision surgery. Patient age ≤ 55 years was a risk factor with a revision rate of 9% in this age group, whereas an operation on both thumbs during the follow-up period was a negative risk factor for revision surgery. There was no difference in revision risk between ligament reconstruction and tendon interposition with or without a bone tunnel. 9 patients had multiple revision procedures and their final outcome did not differ significantly from patients revised only once. Most of the patients felt subjectively that they had benefited from revision surgery and the subjective outcome measures (QuickDash and pain VAS) and the Conolly score were in the same range as previously described for revision trapeziometacarpal arthroplasty. Interpretation - Age ≤ 55 years is a risk factor for revision surgery. The type of primary surgery does not affect the risk of revision surgery and multiple revision procedures do not result in worse outcomes than cases revised only once. Mechanical pain caused by contact between the metacarpal and scaphoid is the most common indication for revision surgery. In general, patients seem to benefit from revision surgery for trapeziometacarpal osteoarthritis.

Project description:BackgroundLittle is known about how often patients have revision total hip replacement in the same hospital in which they had the primary procedure.MethodsWe examined Medicare claims data to identify patients who had primary total hip replacement from July 1995 to June 1996 and subsequently had revision through December 31, 2006. We examined whether the revision was performed in the same or different hospital from the primary procedure, with different hospitals being categorized as being in a lower, a higher, or the same hospital volume stratum. Hospital strata included twenty-five or fewer cases of total hip replacement annually in the Medicare population, twenty-six to fifty cases, fifty-one to 100 cases, and >100 cases. We calculated the number of revisions generated (primary procedures eventuating in revision) by hospitals in each volume stratum and the number of revisions performed in these hospitals.ResultsOf 4448 revision procedures, 3306 (74%) were performed in hospitals in the same volume stratum as the hospital where the primary procedure was performed. Four hundred twenty-nine revisions (9.6%) were performed in a lower-volume hospital, and 713 (16%) were performed in a higher-volume hospital. Thirty-one (3%) of 960 patients who had revision within one year after the primary total hip replacement had the revision in a lower-volume center, compared with 204 (15%) of 1393 who had revision more than six years after the primary procedure (odds ratio = 4.6 ; 95% confidence interval, 3.0 to 6.8). The ratio of revisions performed to revisions generated was 1.21 for the highest-volume centers and 0.86 for the lowest-volume centers.ConclusionsOf 4448 revisions examined in this study, 429 (<10%) were performed in centers with a lower volume of total hip replacement than the center at which the initial hip replacement was performed, whereas 713 (16%) were performed in higher-volume centers. Higher-volume centers performed 21% more revisions than they generated (531 revisions performed, compared with 438 generated). These data will help to inform health-care policy with regard to the utilization of resources for revision total hip replacement.

Dataset Information

Early Revision Rates of Total Hip Arthroplasty Using the Intellijoint HIP Computer Navigation System: A Study From the Australian National Joint Replacement Registry of 1911 Procedures.

Background

Methods

Results

Conclusions

Level of evidence

Publications

Early Revision Rates of Total Hip Arthroplasty Using the Intellijoint HIP Computer Navigation System: A Study From the Australian National Joint Replacement Registry of 1911 Procedures.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets