Comparison of prosthesis brand ..

A comparison of 10 different prosthesis brands reported to the ..

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We found that the risk of revision was dependent on age. The failure rate was doubled in patients younger than 70 years, compared to those who were older. This has been shown previously for patients with hip and knee prostheses (Havelin et al. 1994, 2000), but not in shoulder arthroplasty.

Early revision among 12,179 hip prostheses : a comparison of 10 different brands reported to the Norwegian Arthroplasty Register, 1987-1993

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The overall 5-year failure rate for hemiprostheses (6%) in our study is acceptable; it is similar to the 4% overall 5-year failure rate for knee prostheses (Havelin et al. 2000) and 4% for hip prostheses (in patients with osteoarthritis) (Furnes et al. 2001). However, the threshold for revising a hip prosthesis may be different from that for shoulder prostheses. We have no information concerning the number of patients suffering from pain without being revised. Consequently, comparison of failure rates for different joints is difficult. Use of revision as outcome factor does, however, allow comparison of results for subgroups of patients with arthroplasties of the same joint.

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After radical debridement, removal of all components and taking at least five tissue samples for bacteriologic and histologic assessments, the acetabular component is cemented loosely and femoral fixation is achieved by means of a press-fit or late proximal cementation so that both are removed easily at the second stage without damaging bone stock. Postoperatively, the patient is allowed to mobilise partial weight-bearing with crutches and is discharged home when deemed safe. Antibiotic therapy tailored to the sensitivities of intraoperative cultures is continued for 4 to 6 weeks. The decision to proceed with insertion of a new prosthesis is determined if the culture of a hip aspirate performed 4 weeks after discontinuation of antibiotics is negative and inflammatory markers suggest resolution of infection (ESR ]. After the reimplantation procedure, patients are followed clinically and with ESR and CRP levels for any signs of recurring infection. Systemic antibiotics are discontinued. However, if at the second stage there is clinical evidence of ongoing infection, a repeat debridement procedure is performed with new culture specimens sent for microbiology and systemic antibiotics are adjusted accordingly. At this stage, either a repeat PROSTALAC insertion or a salvage procedure is considered after discussion of treatment options with the patient.

Early revision among 12,179 hip prostheses: A comparison of 10 different brands reported to the Norwegian Arthroplasty Register, 1987-1993


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The study was based on information given to NAR by orthopedic surgeons since 1987. Ideally, the quality of prostheses should be evaluated in high-powered randomized clinical trials, but for practical and economic reasons () such trials are seldom performed for long-term comparison of hip implants. In register based studies, the findings may also be considered representative for a wider range of patients and surgeons. Registration completeness of hip replacements in the NAR is high (98%), both for primary operations and for revisions (). Information on registration of selected variables has been validated based on data from one high-volume hospital, and few errors were observed in the registration of date of operation (1.1%) and in laterality (0.2%) (). However, both the Danish and the Swedish hip arthroplasty registers have expressed caution regarding the validity of the registration of primary diagnoses (, ). Comparison of prosthesis brand survivorship in observational studies may give results confounded by patient and procedure characteristics. We observed distributional differences both in patient characteristics and in the use of cement brands. In our study, we limited the study population to patients with implants fixated with brands of cement that had reported satisfactory results (). However, although shown to have comparable mechanical properties, handling curves and viscoelastic properties may not be identical for more recent cement preparations as compared to their predecessors (). Furthermore, prosthesis survival for these cement preparations is largely unknown. We thus treated cement brand as a possible confounder in the statistical analyses along with sex, age, and diagnosis. Differences in survival may also be confounded by other factors not reported to the register, possibly surgeon-related or associated with time of the study. With this in mind, analyses were performed based on data from 2 time periods. One may also criticize the use of revision as endpoint, ignoring the high proportion of clinically and radiologically loose implants (). Although the total percentage of failure would be higher, however, it is unlikely that the relative differences between prosthesis brands would be affected.

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There was an increase in the overall incidence of shoulder arthroplasty during the 12-year period. A similar trend was recently described in a review by Bohsali et al. (2006). In the Norwegian population, the increased incidence only applied to hemiprostheses while no significant change in the incidence of total shoulder replacement (TSR) was detected. Jain et al., investigating time trends for TSR in the United States, found a minor increase in the use of TSR during the period 1990–2000 (Jain et al. 2006).