AUSTRALIA IDENTIFIES BEST AND WORST PERFORMING JOINT REPLACEMENTS (Orthopedics This Week)
Every year 8,000 Australians have to get back on the operating table because of faulty joint replacements, according to national health reporter Sue Dunlevy, writing for the Melbourne Herald Sun. A study by the National Joint Replacement Registry has identified the four devices with the lower record of problems. Even when these four devices are implanted by novice surgeons, the report claims, they have the same risk of requiring revision as when an experienced surgeon implanted them.
This is the first time the registry, which has been tracking the performance of hip and knee replacements since 1999, has reported on the question of how surgeon experience affects the outcome of joint replacement surgery. While it found that surgeons with more than eight years of experience had a lower rate of revision operations, it also found that when surgeons used certain devices their years of experience did not matter.
Dunlevy reported that the two most commonly used hip replacements in Australia—Exeter V40/Trident and Corail/Pinnacle combinations—show no difference in rates of revision regardless of the experience of the surgeon. And with knee replacements there was no difference in the revision rate when comparing surgeon experience for two commonly used LCS/MBT and Nexgen CR Flex/Nexgen combinations.
“We believe this is a very reassuring finding for the public,” Australian Orthopaedic Association President Peter Choong, M.D., told Dunlevy. More than 800,000 Australians now have a joint replacement and each year surgeons insert another 90,000 devices at a cost of around $1 billion.
But, according to the registry, hundreds of thousands of patients have been fitted with devices that loosen, get infected, erode and have to be replaced. The registry’s annual report identified more than 100 hip and knee replacement devices that have higher than average rates of revision. Of these, it reported eight hip and six knee prostheses for the first time.
The registry’s annual report found that hip replacements with a head size of 32mm had the lowest rate of revision, while those with smaller head sizes had the highest rate of revision. Using cement to fix hip replacements reduced revision rates in older age groups but cementless fixation worked better in those younger than age 75. Having a device that was constructed from cross linked polyethylene also reduced the rate of revision.
With knee replacements the report found unicompartmental knee replacements had a higher rate of revision than primary total knee replacement. The report also found that using a knee replacement constructed from cross-linked polyethylene may reduce rate revision, the report found. Choong told Dunlevy that the Australian Orthopaedic Association is making this information accessible to patients.