Prognosis of total hip replacement in Sweden: Follow-up of 92,675 operations performed 1978–1990

TLDR

The vast majority of total hip replacements worldwide are performed by non‑experts. The study aims to continuously analyze outcomes of total hip replacements to support quality assurance. The Swedish Orthopedic Association conducted a prospective, national multi‑center study starting in 1979 that included all THR performed in Sweden (over 10,000 annually, 130 per 100,000 inhabitants) and used the Charnley prosthesis as the gold standard to evaluate other prostheses. Revision rates were mainly due to aseptic loosening (79 %), infection (10 %), technical error (6 %) and dislocation (2 %); deep‑infection revisions fell from 0.9 % to <0.5 % between 1979 and 1983, and improved cementation and anti‑infection measures have continuously reduced revision risk, showing that average surgeons cannot match expert outcomes.

Abstract

A prospective, national multi-center study of all reoperations after total hip replacement (THR) was started by the Swedish Orthopedic Association in 1979. The material comprises all THR performed in Sweden, presently more than 10,000 yearly or 130 THR per 100,000 inhabitants; uncemented implants have been used in less than 2 percent. The main reasons for revision have been aseptic loosening 79 percent, infection 10 percent, technical error 6 percent, and dislocation 2 percent. The cumulative rate of revision for deep infection has dropped from 0.9 percent to < 0.5 percent for implants inserted 1979 and 1983, respectively. With the Charnley prosthesis as the gold, standard the performance of other prostheses was analyzed. Improved cementation techniques and anti-infection measures have continuously reduced the revision risk.The register demonstrates that the average ortopedic surgeon cannot match the results achieved by experts. However, the vast majority of THR, worldwide, are not performed by experts. Quality-assurance in this sector of orthopedics demands a continuous analysis of the outcome of these operations.