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  • Author: Brian R Hallstrom x
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Colby Foster, Christopher Posada, Bryan Pack, Brian R. Hallstrom, and Richard E. Hughes

  • Optimal implant selection is a major component of high-quality arthroplasty care, and revision risk is an important parameter characterizing knee arthroplasty implant clinical performance.

  • National and regional arthroplasty registries are essential sources of revision risk data, but these data are often difficult to find because they are buried within extensive annual reports. Summarizing total knee arthroplasty (TKA) implant revision risks as presented in registry reports can maximize the usefulness of registry data for orthopaedic surgeons.

  • The findings summarize the revision risk data found in national arthroplasty reports from the Australian, Danish, Finnish, and the England, Wales, Northern Ireland and the Isle of Man registries, and in regional arthroplasty reports from the Emilia-Romagna Region (Italty), and the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) registries.

  • The six supplemental summary tables present revision risk data for TKA implants by cemented, uncemented, hybrid, and unreported fixation types. Additional summary tables are presented for revision risk of unicondylar (UKA) and patellofemoral joint (PFJ) revisions. Within TKA fixation categories, revision risks at 10 years ranged from 2.4% to 35.7% (cemented), 2.8% to 25.0% (uncemented), 2.0% to 9.2% (hybrid), and 0.0% to 39.7% (unreported). Unicondylar 10-year revision risk ranged from 4.9% to 17.2%. Patellofemoral joint 10-year revision risk ranged from 15.2% to 21.7%.

  • There is substantial variation in one, three, five, and 10-year revision risk across implants, which suggests surgeons should choose implants carefully.

Cite this article: EFORT Open Rev 2020;5:268-272. DOI: 10.1302/2058-5241.5.190053

Richard N de Steiger, Brian R Hallstrom, Anne Lübbeke, Elizabeth W Paxton, Liza N van Steenbergen, and Mark Wilkinson

  • Recent concerns surrounding joint replacements that have a higher than expected rate of revision have led to stricter controls by regulatory authorities with regards to the introduction of new devices into the marketplace.

  • Implant post-market surveillance remains important, and joint replacement registries are ideally placed to perform this role. This review examined if and how joint replacement registries identified outlier prostheses, outlined problems and suggested solutions to improve post-market surveillance.

  • A search was performed of all joint replacement registries that had electronic or published reports detailing the outcomes of joint replacement. These reports were examined for registry identification of outlier prostheses. Five registries publicly identified outlier prostheses in their reports and the methods by which this was performed, and three others had internal reports.

  • Identification of outlier prostheses is one area that may improve overall joint replacement outcomes; however, further research is needed to determine the optimum methods for identification, including the threshold, the comparator and the numbers required for notification of devices.

  • Co-operation of registries at a global level may lead to earlier identification of devices and thereby further improve the results of joint replacement.