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Joint registry data highlight timing and causes of failure, opportunities for solutions
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ORLANDO, Fla. — In a presentation at the Current Concepts in Joint Replacement Winter Meeting, Daniel J. Berry, MD, highlighted observations from joint registries.
“Modern registries provide us actionable data. They allow us to ask, ‘Where are our problems?’ so we can attack them and fix them. Maybe just as importantly, they allow us to ask, ‘Where are successes?’ so that we can adopt them. Hopefully, we can celebrate them and most importantly, so we can capitalize on them.”
Berry noted most registries show 33% to 50% of failures in joint replacement occur in the first year to 2 years. Data for knee replacement show the main early problems are infection and early loosening, while hip replacement data highlight infection, periprosthetic fracture and dislocation, and loosening as early causes for failure. Berry said many of these problems are technical issues that can be helped by implant selection, and better teaching and dissemination of information for new techniques.
Registry data point to infection as a major unsolved problem, Berry said, noting data from the Swedish registry show “we’ve made zero progress in 30 years” regarding infection rates.
“We need new transformative approaches and technology to prevent infection,” he said.
One unexplained observation from registry data is a higher infection rate after knee arthroplasty in men than women. Swedish registry data show “Men have almost a two-fold higher rate of knee arthroplasty failure due to infection than women,” Berry said, noting similar findings in the Australian registry.
Findings from registries also indicate more revisions in young patients with total knee replacements (TKR) compared with older patients, and that young TKR patients have more variable patient-reported outcomes.
Information from registries show that new technology can work, Berry said, and he cited the impact of crosslinked polyethylene on revision rates after hip arthroplasty. Registries also provide real-time observations of a practice change, as Berry noted the increased use of ceramic femoral heads in North America since 2012 “perhaps because of angst about taper corrosion.” – by Gina Brockenbrough, MA
Reference:
Berry DJ. Paper #1. Presented at: the Current Concepts in Joint Replacement Winter Meeting; Dec. 9-12, 2015; Orlando, Fla.
Disclosure: Berry reports he receives royalties for selected hip and knee implants from DePuy Synthes.