OFICIÁLNÍ ORGÁN ČESKÉ SPOLEČNOSTI PRO ORTOPEDII A TRAUMATOLOGII
A SLOVENSKEJ ORTOPEDICKEJ A TRAUMATOLOGICKEJ SPOLOČNOSTI
OFFICIAL JOURNAL OF THE CZECH SOCIETY FOR ORTHOPAEDICS AND TRAUMATOLOGY
AND THE SLOVAK SOCIETY FOR ORTHOPAEDICS AND TRAUMATOLOGY
Indexed in
Science Citation Index Expanded (SciSearch®
)
Journal Citation Reports/Science Edition
Index Medicus and MEDLINE
Excerpta Medica
Scopus
April 2013
VOLUME 80
Published
since 1926
ISSN 0001-5415
www.achot.cz
SURVIVAL ANALYSIS OF TOTAL HIP
AND KNEE REPLACEMENT IN SLOVAKIA 2003–2011
L. NEČAS, S. KATINA, J. UHLÁROVÁ
C. L. COLTON
English language editor to SAR
SUPPLEMENTUM
°
ACTA CHIRURGIAE
ORTHOPAEDICAE
ET TRAUMATOLOGIAE
CECHOSLOVACA
ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE ČECHOSLOVACA ISSN 0001-5415
2013 | ROČNÍK/VOLUME 80 | ČÍSLO/NUMBER 1 | ÚNOR/FEBRUARY 2013
Indexed in: Science Citation Index Expanded (SciSearch®
), Journal Citation Reports/Science Edition, Index Medicus and MEDLINE, Excerpta
Medica, Scopus
Prof. MUDr. Martin Krbec, CSc.
Prof. MUDr. Antonín Sosna, DrSc.
Prof. MUDr. Milan Kokavec, Ph.D.
Doc. MUDr. Richard Chaloupka, CSc.
Prof. MUDr. Pavel Dungl, DrSc.
Prof. MUDr. Pavel Haninec, Ph.D.
Prof. MUDr. Petr Havránek, CSc.
Prof.. MUDr. David Jahoda, Ph.D.
Doc. MUDr. Karel Karpaš, CSc.
Prof. MUDr. Karel Koudela, CSc.
Prof. MUDr. Ivan Landor, Ph.D.
Prim. MUDr. Peter Maresch, CSc.
Doc. MUDr. Josef Masár, Ph.D.
Doc. MUDr. Ivan Müller, CSc.
Doc. MUDr.Aleš Podškubka, Ph.D.
Doc. MUDr. Stanislav Popelka, CSc.
Prof. MUDr. Jan Poul, CSc.
Prof. MUDr. Peter Šimko, CSc.
Prof. MUDr. Jan Štulík, CSc.
Prof. MUDr. Peter Wendsche, CSc.
Prof. Richard E. Buckley, M.D., Canada
Prof. Maurice Hinsenkamp, M.D., Belgium
Prof. Jesse B. Jupiter, M.D., USA
Prof. Ivan Kempf, M.D., France
Prof. Lars Lidgren, M.D., Ph.D., Sweden
Prof. René Marti, M.D., Ph.D., Netherlands
Prof.Augusto Sarmiento, M.D., USA
Prof. Erich Schemitsch, M.D., Canada
Prof. Knut Stromsoe, M.D., Norway
Prof. Vilmos Vécsei, M.D.,Austria
Prof. James P. Waddell, M.D., Canada
150 00 Praha 5
SV, spol. s r. o.
150 00 Praha 5-Smíchov
:
OMIKRON Praha, spol. s. r. o.
150 00 Praha 5
Osveta Martin
E-mail: husarova@vydosveta.sk
Prof. MUDr. Martin Krbec, CSc.
Šrobárova 50
Šrobárova 50
:
Praha
Acta Chir. orthop. Traum 80, 2013, Suppl. ISSN 0001-5415
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Slovakian Arthroplasty Register
Survival analysis of total hip and knee
replacement in Slovakia 2003–2011
1
, S. KATINA2
, J. UHLÁROVÁ1
1
Slovakian Arthroplasty Register, University Hospital Martin, Slovakia
2
Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia
Department of Applied Mathematics and Statistics, Faculty of Mathematics, Physics and Informatics,
Comenius University, Bratislava, Slovakia
C. L. COLTON
English language editor to SAR
Professor emeritus, Orthopaedic and Accident Surgery, Nottingham University, England
ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE ČECHOSLOVACA ISSN 0001-5415
2013 | ROČNÍK/VOLUME 80 | SUPPLEMENTUM 1 | DUBEN/APRIL 2013
Indexed in: Science Citation Index Expanded (SciSearch®
), Journal Citation Reports/Science Edition, Index Medicus and MEDLINE, Excerpta
Medica, Scopus
Prof. MUDr. Martin Krbec, CSc.
Prof. MUDr. Antonín Sosna, DrSc.
Prof. MUDr. Milan Kokavec, Ph.D.
Doc. MUDr. Richard Chaloupka, CSc.
Prof. MUDr. Pavel Dungl, DrSc.
Prof. MUDr. Pavel Haninec, Ph.D.
Prof. MUDr. Petr Havránek, CSc.
Prof.. MUDr. David Jahoda, Ph.D.
Doc. MUDr. Karel Karpaš, CSc.
Prof. MUDr. Karel Koudela, CSc.
Prof. MUDr. Ivan Landor, Ph.D.
Prim. MUDr. Peter Maresch, CSc.
Doc. MUDr. Josef Masár, Ph.D.
Doc. MUDr. Ivan Müller, CSc.
Doc. MUDr.Aleš Podškubka, Ph.D.
Prof. MUDr. Stanislav Popelka, CSc.
Prof. MUDr. Jan Poul, CSc.
Prof. MUDr. Peter Šimko, CSc.
Prof. MUDr. Jan Štulík, CSc.
MUDr.Andrey Švec, Ph.D.
Prof. MUDr. Peter Wendsche, CSc.
Prof. Richard E. Buckley, M.D., Canada
Prof. Maurice Hinsenkamp, M.D., Belgium
Prof. Jesse B. Jupiter, M.D., USA
Prof. Ivan Kempf, M.D., France
Prof. Lars Lidgren, M.D., Ph.D., Sweden
Prof. René Marti, M.D., Ph.D., Netherlands
Prof.Augusto Sarmiento, M.D., USA
Prof. Erich Schemitsch, M.D., Canada
Prof. Knut Stromsoe, M.D., Norway
Prof. Vilmos Vécsei, M.D.,Austria
Prof. James P. Waddell, M.D., Canada
150 00 Praha 5
SV, spol. s r. o.
150 00 Praha 5-Smíchov
:
OMIKRON Praha, spol. s. r. o.
150 00 Praha 5
Osveta Martin
E-mail: husarova@vydosveta.sk
Prof. MUDr. Martin Krbec, CSc.
Šrobárova 50
Šrobárova 50
:
Praha
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Introduction …………………………………………………………………………………………. 4
Summary ……………………………………………………………………………………………. 5
Statistical methods …..……………………………………………………………………..…..…. 6
Basic survival/failure characteristics of primary implants and their components
in the SAR database …………...…...…………………………………………………………… 7
Testing of hypotheses about differences in mean time of survival between groups
of primary implants and their components in SAR database ..……………………………... 8
Results in 2011 ……………………………………………………………………………………... 9
Total Hip Arthroplasty ……………………………………………………………………………. 9
Total Knee Arthroplasty ………………………………………………………………………….. 9
Demographic situation in Slovakia 2011 ………………………………………………………. 9
Departments ………………………………………………………………………………….…... 13
Implant Tracking System ………………………………………………………………………... 18
Primary Total Hip Arthroplasty ………..…………...……………………………………………… 19
Age groups ……………………………………………………………………………………….. 21
Diagnoses ………………………………………………………………………………………… 26
Surgical approaches …………………………..………………………………………………… 27
Types of implants used …………………………………………………………………………. 28
Types of the fixation …..…………………………………………………………………………. 28
Bone cements and cementing techniques ………………………….…………………………. 31
Antibiotic prophylaxis in primary THA ………………………………………..………………... 33
Components and their combinations ……………………………………………………….….. 34
Acetabular components …………………………………………………………………………. 36
Femoral components ……………………………………………………………………………. 38
Component combinations ………………………………………………………………………. 42
Combinations of uncemented components …………………………..……………………… 42
Combinations of cemented components ……………………………………………………… 43
Hybrid components ………………………………………………………………………………. 44
Reverse hybrid components ……………………………………………………………………. 45
Revision Total Hip Arthroplasty ..……………………………….…………………………………. 46
Types of fixation of primary THA …………….………………………………………………… 46
Age groups ……………………………………………………………………………………….. 47
Reasons for the revision ………………………………………………………………………… 52
Revised components of implants ………………………………………………………………. 53
Revision implants and components ………………………………………………………….…. 53
Revision components and their combinations ………………………………………………….. 61
Antibiotic prophylaxis in revision THA ………….………………….………………………….. 67
Primary Total Knee Arthroplasty …………………..……………………………………………... 68
Age groups …………………………………………………………………………………......... 69
Diagnoses ………………………………………………………………………………………… 73
Surgical approaches …………………………………………………………………………….. 75
Types of implants used ……………………………………………………………………….…. 75
Types of the fixation ……………………………………………………………………………... 76
Brands of implants …………………………………………………………………………….…. 77
Antibiotic prophylaxis in primary TKA ………………………………………..………………... 79
Revision Total Knee Arthroplasty ……………………..…………………………………………. 80
Types of fixation of revised TKA …………………………………………………………..…… 80
Age groups ……………………………………………………………………………………….. 81
Reasons for the revision ………………………………………………………………………… 83
Revised components of implants ………………………………………………………………. 83
Antibiotic prophylaxis in revision TKA …………………………………………….…………… 83
Glossary …………………………………………………………………………………………….. 84
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
In 1979, when the Swedish arthroplastic hip registry
was founded no one knew how important
these registers would become. The basic objective
of arthroplastic registry was and remains the
improvement of the results of these types of surgery.
In the short term it is possible to follow demographic
data particularly. Longer term monitoring
of patients after arthroplasty brings us valuable
information about the results in terms of the
method of implants fixation, the relative risk of
surgery revisions according to the implants´ type,
age group and many other important statistical
data. The Slovakian arthroplastic registry was
one of the first national registries in Europe which
at the millennium break started to systematically
collect data about arthoplastics. It is most appropriate
to hereby sincerely thank the current Head
of the dpt. of Orthopaedics and Traumatology at
University Hospital in Martin PhD,
who together, with his team launched and
maintained this registry. Of course, thanks also
needs to go to all departments´ head and physicians
of all departments who understood the
importance of the national registry and who are
continuously involved in the systematic data collection.
In 2009 we have noticed a significant
progress in the process of sending and collecting
data from individual departments by using of bar
code system (Implant Tracking System). This
enabled a speed up of data transfer, and made
the system more precise and efficient. The outcomes
from the registry over recent years show
an increasing trend in the number of arthroplastic
surgeries. Nowadays, in the time of economic
restrictions and the perspective of new cheap
implants registrations, especially from Asia, the
registry helps us to answer the question whether
the quality of the new implants is at the same
level or behind those which we are using now. At
the same time we can clarify the question whether
a few hundred Euros saved on primary surgery
doesn´t mean an overpayment of thousands Euros
due to the necessity of early revision surgery.
In conclusion, let me state, that it is a pleasure
and honour for me to provide you with the 2011
annual report of Slovak arthroplastic registry. It
seems that the quality of joint replacements
treatment in Slovakia has an increasing trend.
Registry data also enable us to compare our
own results with results abroad. Current results
show that the Slovak departments captured all
the modern trends in joint replacements and easily
can be compared with foreign workplaces.
Andrey Švec
Chief Expert for Orthopaedics, Ministry of Health
The Slovakian Arthroplasty Register reached
46,062 records by 31. December 2011. In THA
we have 35,290 and in TKA 10,772 records. The
team of the SAR dedicated majority of the time in
this year to the validization of all registry databases.
We were focused on the implementation
of Implant tracking system which has reached
improvement in 5.33% compared to the previous
year and reached 79.34% coverage. This summary
of the SAR’s annual report for 2011
demonstrates the collaboration of Slovakian orthopaedic
and traumatology society, Ministry of
health and industry. In this report we have improved
our statistical tools and this extract from
annual report seeks to present the most important
parameters. We have tried to reduced
text and present the results in the graphics and
tables. If we compare this report to previous one,
it is clear that we have improved data mining.
The team of SAR hopes that this report will help
orthopaedic surgeons and medical authorities to
improve their knowledge about arthroplasty and
could also contribute to improvement in the results
of arthroplasty in Slovakia. .
Head of the SAR
Ac 80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
This survival analysis of Slovakian Arthroplasty
Register (SAR) deals with all arthroplasty procedures
performed in Slovakia from 1 January 2003
until 31 December 2011. Forty orthopaedic and
traumatology departments performed 5,107 primary
total hip arthroplasties (THA) and 433 revision
total hip arthroplasties. In 2011, primary THA
accounted for 92.18 % and revision THA for
7.82 % of all hip arthroplasties; the revision rate
(RR) of all THAs reached 8.48 %, which represents
a decrease of 0.73 % compared to 2010.
The incidence of primary THA was 94.50 per
100,000 inhabitants and gender distribution was
59.19 % female and 40.81 % male. RR for the all
arthroplasties performed after 1 January 2003
reached 2.27 %, with a mean survival time 8.75
years. Primary coxarthrosis was the reason for
primary THA in 60.32 % of all cases. Femoral
neck fracture accounted for 17.97 % and avascular
necrosis of femoral head for 5.89 %. The most
commonly used approach was anterolateral in
52.35 % of all cases, then the lateral approach in
30.82 %, and a posterior approach in 16.48 %.
Total arthroplasty was used in 88.76 % and hemiarthroplasty
in 10.45 % of all cases. 35.26 % of
all implants were cemented, 51.16 % uncemented,
and in 13.56 % a hybrid type of fixation was
used. The four most commonly used brands of
bone cement were distributed as follows:
SmartSet HV – 33.45 %, Palacos R – 28.12 %,
Palacos R Gentamycin – 14.03 %, and SmartSet
GHV – 13.05 %. Third generation cementing
techniques for femoral components was used in
38.69 % of all cemented implantations. In 2011,
we have recorded 29 uncemented acetabular
cups (UAC) and 12 cemented acetabular cups
(CAC). The RR of UAC was 1.00 % and RR of
CAC was 1.75 %. In femoral stems we recorded
41 uncemented femoral stems (UFS) and 28
cemented femoral stems (CFS). The RR of UFS
was 0.95 % and RR of CFS was 1.75 %. In 2011
we recorded a decrease in revision THA by 25
cases compared to 2010. The revision database
of SAR contains 3,195 protocols. We do not have
detailed data about the primary THAs of 2,074
revisions. For deeper analysis we have used only
1,121 revision protocols. In 2011, 51.50 % of all
revised implants were cemented, 30.48 %
uncemented, and 18.01 % hybrids. After aseptic
loosening of femoral and/or acetabular components,
the third most commonly marked reason
for revision is luxation of THA, with 149 cases.
30.42 % of all revisions were due to aseptic loosening
of the femoral component, 24.19 % were
due aseptic loosening of the acetabular component
and 18.58 % due to luxation.
In 2011, we registered 2,679 primary total knee
arthroplasties (TKA) and 116 revision TKAs. The
incidence of primary THA was 49.57 per 100,000
inhabitants. The RR of TKAs reached 4.33 %,
which is in 0.13 % less than in 2010. The RR of
TKAs performed after 2006 was 1.80 %. The
gender ratio was 67.53 % female to 32.47 %
male. The main diagnosis for primary TKA is
primary bicondylar degenerative joint disease
(DJD) of the knee, which accounted for 89.95 %.
The second most common diagnoses, posttraumatic
DJD, reached a share of 2.87 %. A medial
parapatellar approach was used in 77.64 % of all
cases and a mid-vastus approach in 20.86 %. In
98.54 % of all TKAs bone cement was used for
fixation of both components. The revision database
contains 411 protocols, but 141 of the primary
TKAs were performed before 2006 and only
270 revision protocols were used for deeper statistical
analyses. From all revised patients,
61.2 % were females and 38.8 % males. Cemented
fixation was used in 72.01 % of all patients,
uncemented fixation in 3.65 %, and hybrid
fixation has 0.73 %. Explantation was performed
in 3.65 %, revision without complete data in
4.62 %, and conversion to a spacer in 15.33 %.
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Descriptive statistics of SAR data, implants and
their components, are derived on the basis of a
year-by-year break-down of the THA and TKA
database into the following four groups, using
nine time intervals in total, from 1 January 2003
to 31 December 2011:
1. alive and not revised,
2. alive and revised,
3. dead and not revised, and
4. dead and revised.
Tab. 1 Primary THA database break-down
Chart 1 Primary THA database break-down
Survival analysis is used to describe the time to
revision (failure), where the frequency of revisions
increases with time.
Tab. 2 Revision THA database break-down
Chart 2 Revision THA database break-down
Therefore, the break-down of the primary THA
database into four groups – alive and not revised,
alive and revised, dead and not revised, and
dead and revised, is important (table 1, chart 1).
Table 2 and chart 2 show the break-down of revision
THA database.
The same structure can also be seen for TKA
(table 3, chart 3), where the differences between
THA and TKA are due to the shorter TKA followup.
Table 4 and chart 4 show results of the revision
TKA database. We presume that both databases
will follow the same trend in the next few
years.
Considering the very low numbers of all deceased
patients, 4.50 % only, this part of the
database will not be analysed further.
Tab. 3 Primary TKA database break-down
Chart 3 Primary TKA database break-down
Year
Aliv e not
rev ised
Aliv e
rev ised
Dead not
rev ised
Dead
rev ised
1740 131 246 3
2532 118 432 4
2502 102 366 6
3107 94 390 3
3884 96 275 2
4205 88 117 1
4597 75 95 0
4846 58 66 2
5070 19 18 0
80%
85%
90%
95%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Aliv e not
rev ised
Aliv e
rev ised
Dead not
rev ised
Dead
rev ised
220 37 32 4
258 48 26 1
214 32 23 1
278 37 19 1
300 36 12 0
303 30 5 1
347 38 1 0
423 33 2 0
415 18 0 0
70%
75%
80%
85%
90%
95%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Aliv e not
rev ised
Aliv e
rev ised
Dead not
rev ised
Dead
rev ised
816 41 35 0
1306 37 20 0
1560 40 11 0
1976 40 12 0
2176 20 3 0
2665 14 0 0
90%
95%
100%
2006 2007 2008 2009 2010 2011
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
7 / 80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 4 Revision TKA database break-down
Chart 4 Revision TKA database break-down
The SAR database consists of the contributions
of 40 departments – 12 performing THA and 31
both THA and TKA. The departments are characterised
basically by the annual numbers of primary
and revision THA and TKA performed. For any
particular year (2003–2011), the frequencies of
THA and TKA are recorded and compared with
the databases of Ministry of Health of the Slovak
Republic and the databases of component/implant
distributors Since 2009, an Implant
Tracking System (ITS), based on Global Trade
Item Number (GTIN) bar-codes and the Health
Industry Business Communications Council
(HIBCC) system, has been used to identify the
implants. The database is divided into two subdatabases,
THA and TKA, respectively, each of
which is further divided into primary and revised
sub-groups. Basic characteristics are summarized
in frequency tables and bar plots as follows:
implantation frequency,
gender,
age groups at five-year intervals (16 in
total),
diagnosis
type of implant,
surgical approach,
antibiotic prophylaxis,
type of fixation,
brand of bone cement, and
type of cementing technique.
In addition, for revision operations:
type of fixation of revised implant,
reasons for revision,
revised components, and
type of revision component
are recorded.
Basic survival/failure characteristics of primary
implants and their components in the SAR
database
Statistical analyses were performed with R software,
as nine-year follow up from 1 January 2003
to 31 December 2011, with censored date equal
to 31 December 2011. The basic characteristics
of Revision Rate (RR) and of Hazard Rate (HR)
are used to describe the failure and survival of
implants/components. Of the above-mentioned
basic characteristics, only the frequencies of
failed and survived implants/components are
used, but not the time to failure or censorship,
which are necessary to describe implant/component
survival completely. Therefore,
in addition to (1) to (2),
1. mean survival time (in years),
2. 95% confidence interval (CI) of mean
survival time characterized by its lower
and upper bounds (LB and UB, respec-
tively)
were also used. For the particular implant
/component groups (primary and revision THA)
and their combinations (primary THA), curves of
cumulative risk with 95% confidence intervals
derived from Kaplan-Meier survival curves (detailes
is later) are used:
for four most frequent acetabular compo-
nents,
for four most frequent femoral compo-
nents,
for four most frequent uncemented component
combinations,
for four most frequent cemented component
combinations, and
for four most frequent hybrid component
combinations.
Year
Aliv e not
rev ised
Aliv e
rev ised
Dead not
rev ised
Dead
rev ised
2006 15 3 2 0
2007 32 10 0 0
2008 39 12 0 0
2009 60 24 0 0
2010 81 17 0 0
2011 107 9 0 0
65%
70%
75%
80%
85%
90%
95%
100%
2006 2007 2008 2009 2010 2011
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
8 / 80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Testing of hypotheses about differences in
mean time of survival between groups of primary
implants and their components in SAR
database
Testing of hypotheses about differences in mean
time of survival between stratified components of
primary and revision THA (1 to 5) and implants of
primary and revision THA (6 to 16), primary TKA
(6 to 12, 14 to 16), and revision TKA (6 to 9, 10,
11, and 16) is performed as follows:
1. component type – acetabular and femo-
ral,
2. interaction of the first order – component
type (acetabular and femoral) vs type of
fixation (uncemented and cemented),
3. interaction of the second order – gender
vs component type and type of fixation,
4. generation of cemented techniques (1
st
,
2
nd
, and 3
rd
),
5. interaction of the first order – gender vs
generation of cemented techniques
6. gender – females and males,
7. age groups – less than or equal to 55
years [min,55], from 55 to 65 years
(55,65], from 65 to 75 years (65,75], and
more than 75 years (75,max],
8. type of the implant fixation (for both primary
and revision THA, primary and revision
TKA – uncemented, cemented,
hybrids; additionally, for primary THA –
reverse hybrid, cemented and
uncemented hemiartroplasty),
9. diagnosis (7 types for THA and 5 types
for TKA),
10. interaction of the first order – gender vs
age groups,
11. interaction of the first order – gender vs
type of fixation,
12. interaction of the first order – gender vs
diagnosis,
13. interaction of the first order – age groups
vs type of fixation,
14. interaction of the first order – age groups
vs diagnosis,
15. interaction of the first order – type of fixation
vs diagnosis, and
16. reasons for revision (17 types for THA
and 18 for TKA).
The results are presented as
1) cumulative risk (CR) curves equivalent to
Kaplan-Meier survival curves (S), where
CR(t) equals to natural logarithm of S(t) multiplied
by minus one at the time point t (the
former represents component/implant failure
and the latter component/implant survival);
2) p-values (to simplify the outputs, test statistics
are omitted), using the following termi-
nology
A. significance, if p-value fails to the interval
[0,0.05),
B. marginal significance, if p-value fails to
the interval [0.05,0.1).
Since a revision procedure is defined as any
operation replacing any component, the CR
curve is used to calculate the time from primary
insertion to the first revision. A failure time is
characterized by implementing both failed and
censored implants into the calculation.
9 / 80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Results in 2011
By 31 December 2011 SAR had received in total
49,668 protocols, of which 38,485 were THA and
11,183 were TKA protocols.
Total Hip Arthroplasty
From 1 January 2011 till 31 December 2011 we
had received 5,540 THA protocols, of which
5,107 were primary and 433 were revision procedures.
The annual increase was 2.03 %. Table 5
and chart 5 show the annual increases in primary
and revision THA.
Tab. 5 Number of THA and annual growth (%)
Chart 5 Number of primary and revision THA
The increase of primary THA procedures is not
linked to revision THA and there is a slight decrease
in revision procedures from 458 in 2010 to
433 in 2011.
Total Knee Arthroplasty
From both table 6 and chart 6, it is clear that the
annual growth in TKA in 2011 was 21.68 %,
compared to 2010.
The number of revision TKAs does not follow the
trend of primary TKAs, as shown in chart 6 the
increase in revision TKA was only 18.36 %.
Tab. 6 Number of TKA and annual growth (%)
Chart 6 Number of primary and revision TKA
Demographic situation in Slovakia 2011
The number of inhabitants in Slovakia by 31 December,
2011 reached 5,404,322; according to
chart 7 the population of the country has de-
creased.
Tab.7 Number of inhabitants in Slovakia 2003–2011
Chart 7 Number of inhabitants in Slovakia 2003–2011
Year Primary THA Annual growth Rev ision THA Annual growth
2003 2120 293
2004 3086 45.57% 333 13.65%
2005 2976 -3.56% 270 -18.92%
2006 3594 20.77% 335 24.07%
2007 4257 18.45% 348 3.88%
2008 4411 3.62% 339 -2.59%
2009 4767 8.07% 386 13.86%
2010 4972 4.30% 458 18.65%
2011 5107 2.72% 433 -5.46%
Year Primary TKA Annual growth Rev ision TKA Annual growth
2006 892 20
2007 1363 52.80% 42 110.00%
2008 1611 18.20% 51 21.43%
2009 2028 25.88% 84 64.71%
2010 2199 8.43% 98 16.67%
2011 2679 21.83% 116 18.37%
Year Male Female Total
2003 2611124 2768929 5380053
2004 2613490 2771332 5384822
2005 2615872 2773308 5389180
2006 2618284 2775353 5393637
2007 2623127 2777871 5400998
2008 2629804 2782450 5412254
2009 2636938 2787987 5424925
2010 2642240 2793033 5435273
2011 2631752 2772570 5404322
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 8 Ages of patients at the time of primary THA (interaction of gender and type of fixation; sd: standard deviation, Q1: first
quartile, Q3: third quartile)
Tab. 9 Ages of patients at the time of primary THA (interaction of gender and diagnosis; sd: standard deviation, Q1: first quartile,
Q3: third quartile)
Total
number Mean 95% CI for mean SD Min Q1 Median Q3 Max
Uncemented
Cemented
Hybrids
Reverse hybrids
Hemiarthropl. uncem.
Hemiarthropl. cem.
Uncemented
Cemented
Hybrids
Reverse hybrids
Hemiarthropl. uncem.
Hemiarthropl. cem.
Uncemented
Cemented
Hybrids
Reverse hybrids
Hemiarthropl. uncem.
Hemiarthropl. cem.
Whole database
Females
Males
Whole database total
Females total
Males total
Total
number Mean 95% CI for mean SD Min Q1 Median Q3 Max
Primary coxarthrosis
Dysplastic coxarthrosis
Posttraumatic coxarthrosis
Avascular necrosis
M. Perthes
Rheumatoid arthritis
Fracture of femoral neck
Primary coxarthrosis
Dysplastic coxarthrosis
Posttraumatic coxarthrosis
Avascular necrosis
M. Perthes
Rheumatoid arthritis
Fracture of femoral neck
Primary coxarthrosis
Dysplastic coxarthrosis
Posttraumatic coxarthrosis
Avascular necrosis
M. Perthes
Rheumatoid arthritis
Fracture of femoral neck
Whole database
Females
Males
Whole database total
Females total
Males total
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Table 8 shows the mean age of patients at operation
for primary THA, according to gender and
type of fixation. From this table it is evident that
the mean age of all groups is increasing slowly
from 64.64 years in 2010 to 64.68 years in 2011.
Table 9 shows the mean age of patients at operation
according to diagnosis. For these descriptive
statistics we were not able to use 1,453 protocols
with the recorded diagnosis – “other causes”.
The mean age for the diagnosis primary
coxarhrosis was 64.66 years, for dysplastic coxarthrosis
it was 52.65 years. We received 45
protocols with the diagnosis of Perthes’ disease
and the mean age of these patients was 47.84
years.
Tab. 10 Ages of the patients at the time of revision THA (interaction of gender and type of fixation; sd: standard deviation, Q1:
first quartile, Q3: third quartile)
Table 10 shows the same parameters for the
patients with revision THA. The mean age is
66.41 years, which is 1.73 years older than in the
patients with primary THA.
Tab. 11 Ages of patients at the time of primary TKA (interaction of gender and type of fixation; sd: standard deviation, Q1: first
quartile, Q3: third quartile)
50 59.46 58.34 to 60.58 16.21 14.00 57.00 64.00 68.00 81.00
7245 67.05 66.99 to 67.12 7.96 22.00 62.00 68.00 73.00 89.00
17 61.65 60.37 to 62.92 7.21 47.00 56.00 64.00 68.00 69.00
27 57.96 56.80 to 59.12 9.44 26.00 54.00 59.00 64.50 73.00
7339 66.95 66.89 to 67.02 8.09 14.00 62.00 68.00 73.00 89.00
50 55.48 54.47 to 56.49 13.25 18.00 51.00 57.50 60.75 80.00
3323 65.13 65.03 to 65.23 8.67 13.00 59.00 65.00 72.00 92.00
19 55.95 54.33 to 57.56 12.89 16.00 52.00 56.00 64.00 76.00
43 56.23 55.20 to 57.27 11.95 13.00 52.00 58.00 63.00 74.00
3435 64.83 64.73 to 64.93 8.97 13.00 59.00 65.00 71.00 92.00
100 57.47 56.71 to 58.23 14.87 14.00 52.00 60.00 67.00 81.00
10568 66.45 66.39 to 66.50 8.24 13.00 61.00 67.00 72.00 92.00
36 58.64 57.56 to 59.71 10.84 16.00 53.00 59.50 66.25 76.00
70 56.90 56.12 to 57.68 11.01 13.00 52.00 58.00 64.00 74.00
10774 66.28 66.22 to 66.33 8.44 13.00 61.00 67.00 72.00 92.00
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 12 Age of the patients at the time of primary TKA (interaction of gender and diagnosis; sd: standard deviation, Q1: first
quartile, Q3: third quartile)
Tab. 13 Ages of patients at the time of revision TKA (interaction of gender and type of fixation; sd: standard deviation, Q1: first
quartile, Q3: third quartile)
Tables 11 and 12 show the same parameters for
the patients with primary TKA. The mean age of
all primary TKA patients is 66.28 years and the
mean age of all revision TKA patients is 65.51
years. Compared to the primary TKA patients,
the mean age of revised TKA patients is slightly
smaller (by 0.77 years). Table 13 shows the
mean age of patients with revision TKA and interaction
of gender and type of fixation.
Total
number Mean 95% CI for mean SD Min Q1 Median Q3 Max
Primary monocondylar arthrosis 449 66.01 65.75 to 66.27 8.09 37.00 61.00 67.00 72.00 87.00
Primary bicondylar arthrosis 6463 67.33 67.26 to 67.40 7.64 23.00 62.00 68.00 73.00 89.00
Posttraumatic coxarthrosis 197 63.84 63.41 to 64.27 9.58 37.00 58.00 65.00 71.00 88.00
Aseptic necrosis 24 70.42 69.33 to 71.50 7.38 56.00 65.75 71.50 76.25 84.00
Rheumatoid arthritis 161 60.39 59.83 to 60.94 12.87 22.00 54.00 62.00 70.00 84.00
7294 67.01 66.95 to 67.08 7.97 22.00 62.00 68.00 73.00 89.00
Primary monocondylar arthrosis 196 64.34 63.93 to 64.75 8.61 36.00 58.00 63.00 70.25 87.00
Primary bicondylar arthrosis 2903 65.52 65.41 to 65.62 8.33 34.00 59.00 66.00 72.00 92.00
Posttraumatic coxarthrosis 224 60.47 60.06 to 60.88 9.69 32.00 54.00 59.00 67.25 84.00
Aseptic necrosis 11 66.82 64.82 to 68.82 11.48 39.00 66.00 72.00 73.00 78.00
Rheumatoid arthritis 45 59.62 58.61 to 60.64 12.05 30.00 55.00 62.00 65.00 83.00
3379 65.04 64.94 to 65.14 8.62 30.00 59.00 65.00 71.00 92.00
Primary monocondylar arthrosis 645 65.50 65.28 to 65.72 8.28 36.00 60.00 66.00 71.00 87.00
Primary bicondylar arthrosis 9366 66.77 66.71 to 66.83 7.91 23.00 62.00 67.00 73.00 92.00
Posttraumatic coxarthrosis 421 62.05 61.75 to 62.34 9.77 32.00 56.00 62.00 69.00 88.00
Aseptic necrosis 35 69.29 68.30 to 70.27 8.86 39.00 66.00 72.00 74.00 84.00
Rheumatoid arthritis 206 60.22 59.73 to 60.70 12.67 22.00 54.00 62.00 69.75 84.00
10673 66.39 66.33 to 66.44 8.23 22.00 61.00 67.00 72.00 92.00Whole database total
Females
Females total
Males
Males total
Whole database
Total
number Mean 95% CI for mean SD Min Q1 Median Q3 Max
Uncemented 12 59.17 56.72 to 61.62 18.73 27.00 55.00 66.50 70.50 77.00
Cemented 173 66.76 66.32 to 67.19 8.55 37.00 61.00 67.00 72.00 85.00
Hybrids 3 70.67 66.77 to 74.56 11.85 57.00 67.00 77.00 77.50 78.00
252 66.33 65.96 to 66.71 9.29 27.00 61.00 67.00 72.00 85.00
Uncemented 3 61.33 55.53 to 67.13 26.27 31.00 53.50 76.00 76.50 77.00
Cemented 123 63.76 63.21 to 64.30 9.60 14.00 59.50 64.00 70.00 82.00
Hybrids NA NA NA NA NA NA NA NA NA
159 64.21 63.73 to 64.70 9.59 14.00 60.00 65.00 70.00 83.00
Uncemented 15 59.60 57.37 to 61.83 19.37 27.00 47.00 68.00 74.00 77.00
Cemented 296 65.51 65.17 to 65.85 9.11 14.00 61.00 66.00 71.00 85.00
Hybrids 3 70.67 66.77 to 74.56 11.85 57.00 67.00 77.00 77.50 78.00
411 65.51 65.22 to 65.81 9.45 14.00 61.00 67.00 72.00 85.00Whole database total
Females
Females total
Males
Males total
Whole database
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
The following tables list the orthopaedic and
trauma departments according to the number of
Tab. 14 Departments according to the Nr. of performed THA
arthroplasties performed per annum. Table 14
shows the ranking of departments according to
the number of performed THA. Departments are
divided into four groups. Table 15 shows the
departments and number of TKAs performed.
Compared to 2010, when only 8 departments
performed more than 100 TKA, this year it was
12 departments.
Tab. 15 Departments according to the Nr. of performed TKA
Table 16 presents departments according to region,
type of hospital and speciality of the departments.
The last four columns show the percentage
participation of each department in the
total numbers of primary and revision THA and
TKA. The number of departments remained the
same as in 2010 – forty. Charts 8–9 show the
ranking of departments according to the numbers
of primary and revision THAs. This year only 13
departments performed more than 10 revisions.
Charts 10–11 show this ranking for primary and
revision TKAs. In this segment, only four departments
performed more than 10 revisions.
Department
Primary
THA
Rev ision
THA Total
Bratislav a – I.Orth.-traum. 406 77 483
454 25 479
B. By strica – Orth. 292 53 345
Martin – Orth.-traum. 258 60 318
270 32 302
Bratislav a – II.Orth.-traum. 268 21 289
214 17 231
195 9 204
185 5 190
169 20 189
175 10 185
179 2 181
147 2 149
137 10 147
117 26 143
120 17 137
130 3 133
127 3 130
111 8 119
99 11 110
103 1 104
92 3 95
89 5 94
91 1 92
Bratislav a S & E – Orth. 86 0 86
80 4 84
80 4 84
64 0 64
63 0 63
57 0 57
55 0 55
43 3 46
P. By strica – Orth. 43 0 43
33 0 33
27 1 28
27 0 27
13 0 13
5 0 5
2 0 2
Bratislav a DFNsP - Orth. 1 0 1
Department
Primary
TKA
Rev ision
TKA Total
271 21 292
256 3 259
Bratislav a – I.Orth.-traum. 215 23 238
Martin – Orth.-traum. 213 14 227
B. By strica – Orth. 180 7 187
Bratislav a – II.Orth.-traum. 169 8 177
124 4 128
126 1 127
113 10 123
114 1 115
109 2 111
106 1 107
92 7 99
88 0 88
56 6 62
57 0 57
54 3 57
54 0 54
49 1 50
42 0 42
39 2 41
35 0 35
Bratislav a S & E – Orth. 32 0 32
29 1 30
15 0 15
15 0 15
13 0 13
6 0 6
3 0 3
Bratislav a DFNsP - Orth. 2 1 3
2 0 2
33
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 16 Departments according to region, specialty and volume of joint replacements
Chart 8 Departments according the volume of primary THA
Region
Ty pe of
hospital Hospital Department
Primary THA
(%)
Rev ision THA
(%)
Primary TKA
(%)
Rev ision TKA
(%)
I.Orth.-traum. 7.95 17.78 8.03 19.83
II.Orth.-traum. 5.25 4.85 6.31 6.90
Traum. 1.94 2.54 1.46 1.72
Orth. 0.02 0.00 0.07 0.86
Orth. 1.68 0.00 1.19 0.00
Traum.-orth. 2.49 0.69 1.57 0.00
Orth. 1.25 0.00 2.02 0.00
Orth. 2.17 1.85 2.02 2.59
Traum.-orth. 2.02 0.23 0.07 0.00
Orth. 1.78 0.23 1.83 0.86
Orth. 2.29 6.00 2.09 5.17
Traum. 1.12 0.00 0.00 0.00
Orth. 0.84 0.00 0.00 0.00
Orth.-traum. 1.74 1.15 2.13 0.00
Traum. 0.04 0.00 0.00 0.00
Traum.-orth. 3.62 1.15 4.26 0.86
Orth. 3.50 0.46 3.96 0.86
Traum. 1.57 0.92 0.00 0.00
Orth. 2.55 0.69 4.70 0.86
Traum. 0.53 0.23 0.00 0.00
Orth.-traum. 5.05 13.86 7.95 12.07
Orth. 3.82 2.08 4.63 3.45
Traum. 1.08 0.00 0.22 0.00
Traum.-orth. 8.89 5.77 10.12 18.10
Orth.-traum. 1.57 0.92 1.31 0.00
Traum.-orth. 0.53 0.00 0.00 0.00
Traum. 0.25 0.00 0.00 0.00
Orth. 5.72 12.24 6.72 6.03
Traum. 1.80 0.69 0.11 0.00
Orth.-traum. 1.23 0.00 0.56 0.00
Orth. 5.29 7.39 9.56 2.59
Orth. 3.31 4.62 3.43 6.03
Orth. 2.88 0.46 3.28 0.00
Traum. 0.10 0.00 0.00 0.00
Orth.-traum. 4.19 3.93 4.22 8.62
Traum. 0.84 0.69 0.56 0.00
Orth. 2.68 2.31 1.08 0.86
Orth. 3.43 2.31 0.49 0.00
Traum. 0.65 0.00 0.00 0.00
Orth. 2.35 3.93 4.07 1.72
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Chart 9 Departments according the volume of revision THA
Chart 10 Departments according the volume of primary TKA
Chart 11 Departments according the volume of revision TKA
University and faculty departments have performed
66.43 % of all primary and 81.04 % of all
revision total hip arthroplasties, as shown in table
17 and chart 12. For total knee arthroplasties the
corresponding figures are 71.84 % of all primary
and 87.06 % of all revisions – table 18 and chart
13.
Tab. 17 Volume of primary and revision THA according to the
type of department
Ty pe of hospital Primary THA (%) Rev ision THA (%)
Univ ersity 25.22 43.65
Faculty 41.21 37.39
Regional 29.55 15.00
Priv ate 4.03 3.93
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Chart 12 Volume of primary and revision THA according to
the type of department
As it is clear from charts 14 and 15, majority of
hip and knee revision arthroplasties were performed
in university or faculty departments.
Tab. 18 Volume of primary and revision TKA according to the
type of department
Chart 13 Volume of performed primary and revision THA
according to the type of department
In 2010 we introduced a very sensitive parameter
for arthroplasty – volume of performed revisions
per department. To evaluate this figure precisely
we have to consider the provenance of patients
requiring revision. According to this, each department
has two groups of patients. The first
group comprises the revisions of a primary implantation
performed in the same department.
The second group comprises those referred revision
patients, whose primary implantations had
been performed in other departments. Among the
departments which have performed more than 10
revisions, two have more than 80 % of revisions
which have originated in other department. How
ever, these departments were created after 2003
and have no prior history of performing arthroplasties.
Only three departments have performed
more than 40 % of revisions, whose primary implantation
had been performed in other depart-
ments.
Tab. 19 Departments according the origin of THA revision
Chart 14 Departments according the origin of THA revision
Ty pe of hospital Primary TKA (%) Rev ision TKA (%)
Univ ersity 28.53 49.14
Faculty 43.31 37.92
Regional 22.92 11.20
Priv ate 5.26 1.72
Department
Own
rev ision
Foreign
rev ision Total
9 0 9
6 2 8
5 0 5
5 0 5
3 1 4
4 0 4
3 0 3
3 0 3
2 1 3
3 0 3
2 0 2
1 1 2
1 0 1
1 0 1
1 0 1
Total 296 137 433
Register 2013
3
3
Slovakian Arthroplasty Register 2013
3
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
For total knee arthroplasties the situation is different.
TKA revisions were performed in fewer
departments. Only four departments performed
more than 10 revisions in the year. Table 20 and
chart 15 show the figures for TKA.
Tab. 20 Departments according the origin of TKA revision
Chart 15 Departments according the origin of TKA revision
In 2010 we introduced another parameter for the
register follow-up based on the hypothesis that
the period of the year in which the arthroplasty
procedure was performed could influence the
survival of the implants. From the first two years
of observation it became clear that the volume of
the primary operation is not even throughout the
year, but the volume of revision procedures is
almost constant.
Chart 16 Volume of the performed THA during the year
There are two dips in primary THAs – one in December
and January and the other in July. This
corresponds to the results from 2010. The biggest
volume of revisions was performed in No-
vember.
Chart 17 Volume of the TKAs performed during the year
Chart 17 shows the distribution of primary and
revision TKAs for each month of the year. The
shape of the plot is similar to that for THAs.
Department
Own
rev ision
Foreign
rev ision Total
Bratislav a – II.Orth.-traum. 2 6 8
B. By strica – Orth. 7 0 7
Poprad – Orth. 7 0 7
6 0 6
4 0 4
Prešov – Orth. 3 0 3
Skalica – Orth. 3 0 3
Bratislav a – Traum. 1 1 2
Košice – Šaca - Orth. 2 0 2
Bratislav a DFNsP – Orth. 1 0 1
D. Streda – Orth. 1 0 1
1 0 1
1 0 1
Nitra – Traum.-orth. 1 0 1
1 0 1
Total 98 18 116
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Our Implant Tracking System (ITS) started in 1
January 2010. By December 2012, 25.99 % of all
components were recorded manually and
74.01 % with the use of bar-code scanners. The
goal of this system was to improve recording of
components. Table 21 shows this improvement,
but some departments are still not using this system.
We would like to achieve bar-code scanning
of at least 95 % of all components within next two
years. .
Tab. 21 Bar-code scanning and ITS usage by department
B. By strica – Orth. 151 28.38% 381 71.62%
B. By strica – Traum. 98 100.00% 0 0.00%
Bojnice – Orth.-traum. 8 5.30% 143 94.70%
Bratislav a DFNsP - Orth. 0 0.00% 4 100.00%
Bratislav a S & E – Orth. 1 0.85% 117 99.15%
Bratislav a – I.Orth.-traum. 22 3.06% 697 96.94%
Bratislav a – II.Orth.-traum. 213 45.61% 254 54.39%
Bratislav a – Traum. 50 32.89% 102 67.11%
D. Kubín – Orth.-traum. 91 76.47% 28 23.53%
D. Streda – Orth. 140 98.59% 2 1.41%
Galanta – Traum.-orth. 17 16.04% 89 83.96%
Humenné – Orth. 0 0.00% 237 100.00%
Košice – Orth.-traum. 151 42.66% 203 57.34%
Košice – Traum. 7 11.48% 54 88.52%
4 2.25% 174 97.75%
Košice – Šaca - Orth. 100 40.49% 147 59.51%
L. Mikuláš – Traum.-orth. 0 0.00% 27 100.00%
16 20.51% 62 79.49%
Martin – Orth.-traum. 17 3.12% 528 96.88%
Michalov ce – Orth. 4 2.02% 194 97.98%
Michalov ce – Traum. 0 0.00% 33 100.00%
65 22.57% 223 77.43%
10 11.90% 74 88.10%
Nitra – Traum.-orth. 294 96.39% 11 3.61%
P. By strica – Orth. 43 100.00% 0 0.00%
Partizánske – Traum. 0 0.00% 2 100.00%
4 3.39% 114 96.61%
Poprad – Orth. 19 6.60% 269 93.40%
Prešov – Orth. 5 0.89% 556 99.11%
75 9.72% 697 90.28%
Skalica – Orth. 1 0.57% 175 99.43%
30 11.54% 230 88.46%
3 10.71% 25 89.29%
16 7.80% 189 92.20%
12 21.05% 45 78.95%
Trnav a – Traum.-orth. 25 14.53% 147 85.47%
Trstená – Traum. 0 0.00% 13 100.00%
5 100.00% 0 0.00%
19 31.15% 42 68.85%
6 1.81% 325 98.19%
Total 8335 1722 20.66% 6613 79.34%
© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
In 2011, we received THA data from 40 departments.
These 40 departments performed 5,107
primary and 433 revision implantations.
Tab. 22 Number of primary and revision THAs
In comparison with 2010, there was a 2.72 %
increase in primary THAs. In 2011, primary THA
accounted for 92.18 % and revision arthroplasty
7.82 % of all hip arthroplasties. Table 22
and chart 18 show the year-by-year evolution of
these figures.
Chart 18 Number of primary and revision THAs
In 2011, the RR reached 8.48 %, which represents
a decrease of 0.73 % compared to the
previous year.
Chart 20 Primary THA – incidence per 100,000 inhabitants
In 2003, the incidence of primary THA was 39.40
per 100,000 inhabitants. In 2011, that value
reached 94.50 per 100 000 inhabitants. The gender
distribution in 2011 was 59.19 % female and
40.81 % male. The gender ratio is the same as in
previous year. Table 23 and chart 21 show the
numbers of primary THA according to gender.
Tab. 23 Primary THA – gender distribution
Chart 21 Primary THA – gender distribution
Chart 19 Primary THA – revision rate
Year Primary THA Annual growth Rev ision THA Annual growth
2120 293
3086 45.57% 333 13.65%
2976 -3.56% 270 -18.92%
3594 20.77% 335 24.07%
4257 18.45% 348 3.88%
4411 3.62% 339 -2.59%
4767 8.07% 386 13.86%
4972 4.30% 458 18.65%
5107 2.72% 433 -5.46%
Year Female Male
1325 795
1885 1201
1808 1168
2213 1381
2631 1626
2730 1681
2892 1875
2985 1987
3023 2084
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
Arthroplasty
20 / 80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
For the next observation, the whole database
was divided according to the gender, age (4
groups) and type of implant fixation. Comparison
of RR shows better results for the female gender.
The lowest RR was observed in the age group
over 75 years and in cemented hemiarthroplasty.
The highest RR – 9.84, which is 4.33 times more
than whole database, was observed in the group
of reverse hybrids.
Tab. 24 Characteristics of primary THA (gender, age groups and type of fixation)
For the first time in this survival analysis we have
introduced cumulative risk as a new figure. Chart
22 shows the cumulative risk by gender. After the
fourth year, the RR for females increases rapidly.
Chart 23 shows the same parameter by age
groups with lowest risk being in the group over 75
years. Chart 24 represents the cumulative risk
(CR) curves by the type of fixation. The risk of
revision for the reverse hybrids is significantly
higher than in the other groups in the entire time
range (increasing over time) and has lowest
mean survival time, which is 7.88 yrs.
Chart 22 Cumulative risk of primary THA (gender)
Chart 23 Cumulative risk of primary THA (age groups)
Chart 24 Cumulative risk of primary THA (type of fixation)
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
Females 21492 427 1.99 1.80 to 2.17 8.79
Males 13798 375 2.72 2.45 to 2.99 8.69
[min,55] yrs 8012 191 2.38 2.05 to 2.72 8.73
(55,65] yrs 9558 259 2.71 2.38 to 3.04 8.70
(65,75] yrs 10831 256 2.36 2.08 to 2.65 8.75
(75,max] yrs 6889 96 1.39 1.12 to 1.67 8.85
Uncemented 14274 250 1.75 1.54 to 1.97 8.76
Cemented 11022 302 2.74 2.44 to 3.04 8.74
Hybrids 4727 167 3.53 3.01 to 4.06 8.63
Reverse hybrids 193 19 9.84 5.64 to 14.05 7.88
Hemiarthropl. cem. 4816 61 1.27 0.95 to 1.58 8.84
Hemiarthropl. uncem. 258 3 1.16 0.00 to 2.47 8.60
35290 802 2.27 2.12 to 2.43 8.75
Gender
Age groups
Whole database total
Type of fixation
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
21 / 80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Interaction of gender and age groups is shown in
table 25 and charts 25–26. RR for females is
1.99 compared to 2.72 RR for males. The lowest
RR was in the male age group over 75 yrs.
Tab. 25 Characteristics of primary THA (interaction of gender and age groups)
Chart 25 Cumulative risk of primary THA (females, age
groups)
Chart 26 Cumulative risk of primary THA (males, age groups)
Age groups
Tab. 26 Primary THA – age groups
Table 26 shows the population divided into fiveyear
age groups. This analysis indicates the
trend of shifting THA towards younger age group
during last few years. In 2011 in the age groups
less than 25 years, only 12 implantations were
recorded. We have recorded only three decreases
among these age groups 40–44, 50–54 and
80–84. For our following analysis, we are using
the database divided into only four age groups
giving us the opportunity of their statistical comparison.
Table 27 and chart 27 show this development.
When we compare distribution of the
age groups in 2003 and 2011, there is a decrease
4.17 % in the age group less than or
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
[min,55] yrs 4376 83 1.90 1.49 to 2.30 8.79
(55,65] yrs 5126 131 2.56 2.12 to 2.99 8.72
(65,75] yrs 6910 139 2.01 1.68 to 2.34 8.79
(75,max] yrs 5080 74 1.46 1.13 to 1.79 8.85
21492 427 1.99 1.80 to 2.17 8.79
[min,55] yrs 3636 108 2.97 2.42 to 3.52 8.66
(55,65] yrs 4432 128 2.89 2.40 to 3.38 8.67
(65,75] yrs 3921 117 2.98 2.45 to 3.52 8.68
(75,max] yrs 1809 22 1.22 0.71 to 1.72 8.82
13798 375 2.72 2.45 to 2.99 8.69
35290 802 2.27 2.12 to 2.43 8.75Whole database total
Females
Males
Females total
Males total
Year <15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 >85
Not
Ident.
2003 0 0 0 4 6 13 33 50 121 232 220 278 349 356 239 219 0
2004 0 1 2 6 15 24 56 98 208 364 390 403 468 484 294 273 0
2005 0 2 1 9 18 29 45 95 192 300 353 410 492 451 313 266 0
2006 0 2 3 7 16 50 72 155 272 413 450 553 569 490 303 238 1
2007 0 1 8 11 28 57 113 164 343 508 554 655 645 602 322 246 0
2008 0 7 7 17 30 68 100 222 397 547 620 713 650 547 291 195 0
2009 0 1 8 22 41 59 105 226 475 633 673 747 688 575 317 197 0
2010 1 4 11 19 41 71 146 227 485 707 705 779 709 570 333 163 1
2011 0 4 8 19 42 84 125 238 472 711 799 814 742 594 261 194 0
© Slovakian Arthroplasty Register 2013© Slovakian Arthroplasty Register 2013
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© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
equal to 55 yrs but an increase of 5.13 % in
group 55–65 yrs. There is a decrease of 2.24 %
in the age group 65–75 and an increase of
1.87 % in the group over 75 yrs. Close inspection
of chart 27 reveals two-year cycles with the dips
in odd years for the age groups less than or
equal to 55 yrs and 55–65 yrs. By contrast, in the
age groups 65–75 and over 75 yrs, there are
even year dips.
Tab 27 Frequency of primary THA (age groups; in %)
Chart 27 Frequency of primary THA (age groups; in %)
Tab 28 Frequency of primary THA (females; age groups; in %)
Chart 28 Frequency of primary THA (females; age groups; in %)
Tab 29 Frequency of primary THA (males; age groups; in %)
2003 2004 2005 2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
2003 2004 2005 2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
2003 2004 2005 2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Chart 29 Frequency of primary THA (males; age groups; in %)
Table 28 and chart 28 show the results of this
analysis for females and table 29 and chart 29 for
males. For females in the age group less than
equal to 55 yrs, there is a decrease from 21.89 %
in 2003 to 18.00 % in 2011, and for males in the
age group less than 55 we have recorded decrease
from 30.19 % in 2003 to 24.95 % in 2011.
The next analyses are the failures of the implants
according to age groups. Table 30 and chart 30
show the distribution of failed implants in percentages,
according to the four age groups.
Tab 30 Frequency of failure of primary THA in a particular year (age groups; in %)
Chart 30 Frequency of failure of primary THA in a particular year (age groups; in %)
Table 31 and chart 31 show these results for
female patients and table 32 and chart 32 for
male patients. From this chart, there are apparent
differences in the percentages of failed THAs
according to the four age groups. Due to the
short observation period, the interpretation of
these data is still difficult. For female patients in
the age group less than or equal 55 yrs, we have
found a clear decrease in failures from 2003 to
2009. In 2011 there was no record of revision in
this age group. By contrast, the age group over
75 showed the significant increase in failures
from 2009 to 2011. In 2011 we found 57.14 % of
all revisions in this age group.
Tab 31 Frequency of failure of primary THA in a particular year (females; age groups; in %)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
2003 2004 2005 2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
2003 2004 2005 2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Chart 31 Frequency of failure of primary THA in a particular year (females; age groups; in %)
Tab 32 Frequency of failure of primary THA in a particular year (males; age groups; in %)
Chart 32 Frequency of failure of primary THA in a particular year (males; age groups; in %)
The last new analysis presents the failure rate of
primary THA according to age group, which is not
cumulative. We have recorded all failures in one
month, three months and each consecutive year.
Table 33 and chart 33 show the results in percentage
for the whole database.
Tab 33 Probability of failure of primary THA until certain time point (age groups; not cumulative; in %)
Chart 33 Probability of failure of primary THA until certain time point (age groups; not cumulative; in %)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
2003 2004 2005 2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
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© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Table 34 and chart 34 show the same results for
females and table 35 and chart 35 show results
for males. This analysis shows the increased
probability of failure of the implants in the age
group less or equal than 55 yrs and a decrease in
failures in the age group over 75 yrs. In the ninth
year we have recorded revisions in 60 % for the
age group less than or equal 55 yrs, but no revision
in the age group over 75.
Tab 34 Probability of failure of primary THA until certain time point (females; age groups; not cumulative; in %)
Chart 34 Probability of failure of primary THA until certain time point (females; age groups; not cumulative; in %)
Tab 35 Probability of failure of primary THA until certain time point (males; age groups; not cumulative; in %)
Chart 35 Probability of failure of primary THA until certain time point (males; age groups; not cumulative; in %)
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
26 / 80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Diagnoses
Tab. 36 Primary THA – diagnoses
Tab. 37 Characteristics of primary THA (diagnoses)
In 2011, primary coxarthrosis was still the main
indication for THA. Compared to 2010, when
primary coxarthrosis was the indication for THA
in 57.70 % off all indications, in the current year it
was 60.32 %. Between 2010 and 2011, a minor
decrease, from 11.38 % to 10.20 %, for dysplastic
coxarthrosis was recorded. For femoral neck
fracture, the decrease was similar from 19.69 %
to 17.97 %. Only one increase was recorded,
namely avascular necrosis from 4.86 % in 2010
to 5.89 % in 2011.
Tab. 38 Characteristics of primary THA (interaction of gender and diagnoses)
Year
Primary
Coxarthrosis
Dy splastic
Coxarthrosis
Posttraumatic
Coxarthrosis
Aseptic
Necrosis M.Perthes
Rheumatoid
Arthritis
Fracture of
Femoral Neck Other Causes
2003 1135 209 274 134 1 25 28 291
2004 1600 359 498 201 3 40 15 352
2005 1487 298 557 207 6 32 46 322
2006 1969 432 169 241 1 31 680 54
2007 2396 490 183 221 5 38 874 35
2008 2364 557 224 259 11 56 881 43
2009 2736 552 176 223 6 39 970 56
2010 2871 566 178 242 4 40 979 92
2011 3081 521 154 301 8 35 918 89
Total
numbers
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
Primary coxarthr. 19639 373 1.90 1.71 to 2.09 8.79 8.77 to 8.81
Dysplastic coxarthr. 3984 71 1.78 1.37 to 2.19 8.79 8.75 to 8.84
Posttraum. coxarthr. 2413 50 2.07 1.50 to 2.64 8.80 8.74 to 8.85
Avascular necrosis 2029 43 2.12 1.49 to 2.75 8.76 8.70 to 8.83
M. Perthes 45 2 4.44 0.00 to 10.47 8.26 7.73 to 8.78
Rheumatoid arthritis 336 10 2.98 1.16 to 4.79 8.70 8.52 to 8.87
Fracture of fem. 5391 91 1.69 1.34 to 2.03 8.69 8.63 to 8.75
2.27 2.12 to 2.43 8.75 8.73 to 8.77
Diagnoses
Whole database
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
Primary coxarthr. 11046 172 1.56 1.33 to 1.79 8.83 8.81 to 8.86
Dysplastic coxarthr. 3217 55 1.71 1.26 to 2.16 8.81 8.76 to 8.86
Posttraum. coxarthr. 1398 19 1.36 0.75 to 1.97 8.87 8.81 to 8.93
Avascular necrosis 817 21 2.57 1.49 to 3.66 8.68 8.57 to 8.78
M. Perthes 19 0 0.00 NA 7.68 NA
Rheumatoid arthritis 241 5 2.07 0.28 to 3.87 8.72 8.55 to 8.88
Fracture of fem. neck 3791 60 1.58 1.19 to 1.98 8.70 8.66 to 8.74
21492 427 1.99 1.80 to 2.17 8.79 8.77 to 8.81
Primary coxarthr. 8593 201 2.34 2.02 to 2.66 8.73 8.70 to 8.77
Dysplastic coxarthr. 767 16 2.09 1.07 to 3.10 8.64 8.50 to 8.77
Posttraum. coxarthr. 1015 31 3.05 2.00 to 4.11 8.69 8.59 to 8.79
Avascular necrosis 1212 22 1.82 1.06 to 2.57 8.79 8.71 to 8.87
M. Perthes 26 2 7.69 0.00 to 17.93 7.96 7.05 to 8.87
Rheumatoid arthritis 95 5 5.26 0.77 to 9.75 8.44 7.98 to 8.90
Fracture of fem. neck 1600 31 1.94 1.26 to 2.61 8.60 8.42 to 8.77
13798 375 2.72 2.45 to 2.99 8.69 8.66 to 8.72
35290 802 2.27 2.12 to 2.43 8.75 8.73 to 8.77
Females
Males
Whole database total
Females total
Males total
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27 / 80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
From the table 38 it is clear that the RR of all
diagnosis except Perthes’ disease was within
interval 1.69–2.98. There were only 45 protocols
with the diagnosis of Perthes’ disease with 2
revisions and the RR therefore reached 4.44.
Tab 39 Characteristics of primary THA (interaction of age groups and diagnoses)
Surgical approaches
Tab. 40 Primary THA – surgical approaches
Chart 36 Primary THA – surgical approaches
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
Primary coxarthr. 3284 65 1.98 1.50 to 2.46 8.75 8.70 to 8.81
Dysplastic coxarthr. 2524 41 1.62 1.13 to 2.12 8.81 8.76 to 8.86
Posttraum. coxarthr. 520 14 2.69 1.30 to 4.08 8.70 8.58 to 8.83
Avascular necrosis 892 14 1.57 0.75 to 2.39 8.82 8.74 to 8.90
M. Perthes 35 1 2.86 0.00 to 8.38 8.40 7.92 to 8.87
Rheumatoid arthritis 152 4 2.63 0.09 to 5.18 8.65 8.41 to 8.90
Fracture of fem. neck 342 11 3.22 1.35 to 5.09 7.29 7.04 to 7.53
8012 191 2.38 2.05 to 2.72 8.73 8.70 to 8.77
Primary coxarthr. 6447 130 2.02 1.67 to 2.36 8.77 8.73 to 8.81
Dysplastic coxarthr. 1005 23 2.29 1.36 to 3.21 8.71 8.62 to 8.81
Posttraum. coxarthr. 472 21 4.45 2.59 to 6.31 8.59 8.42 to 8.76
Avascular necrosis 550 10 1.82 0.70 to 2.93 8.71 8.60 to 8.82
M. Perthes 8 1 12.50 0.00 to 35.42 6.74 5.06 to 8.43
Rheumatoid arthritis 98 4 4.08 0.16 to 8.00 8.50 8.14 to 8.87
Fracture of fem. neck 724 19 2.62 1.46 to 3.79 8.22 8.10 to 8.35
9558 259 2.71 2.38 to 3.04 8.70 8.66 to 8.74
Primary coxarthr. 7682 144 1.87 1.57 to 2.18 8.80 8.77 to 8.83
Dysplastic coxarthr. 378 7 1.85 0.49 to 3.21 8.76 8.61 to 8.91
Posttraum. coxarthr. 588 10 1.70 0.66 to 2.75 8.84 8.75 to 8.94
Avascular necrosis 426 15 3.52 1.77 to 5.27 8.61 8.43 to 8.78
M. Perthes 2 0 0.00 NA 3.27 NA
Rheumatoid arthritis 72 2 2.78 0.00 to 6.57 8.74 8.42 to 9.07
Fracture of fem. neck 1296 25 1.93 1.18 to 2.68 8.47 8.39 to 8.55
10831 256 2.36 2.08 to 2.65 8.75 8.72 to 8.78
Primary coxarthr. 2226 34 1.53 1.02 to 2.04 8.83 8.77 to 8.89
Dysplastic coxarthr. 77 0 0.00 NA 7.03 NA
Posttraum. coxarthr. 833 5 0.60 0.08 to 1.12 8.91 8.85 to 8.97
Avascular necrosis 161 4 2.48 0.08 to 4.89 8.63 8.40 to 8.86
M. Perthes NA NA NA NA NA NA
Rheumatoid arthritis 14 0 0.00 NA 7.24 NA
Fracture of fem. neck 3029 36 1.19 0.80 to 1.57 8.77 8.73 to 8.82
6889 96 1.39 1.12 to 1.67 8.85 8.82 to 8.88
35290 802 2.27 2.12 to 2.43 8.75 8.73 to 8.77Whole database total
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
[min,55] yrs total
(55,65] yrs total
(65,75] yrs total
(75,max] yrs total
Year Anterior
Anterolat.
Lateral Poster. T-tomy MIS
Not
Ident.
2003 2 821 942 337 0 0 18
2004 13 1297 1173 579 0 4 20
2005 20 1381 896 635 0 24 20
2006 8 1560 1315 679 4 9 19
2007 10 1856 1545 815 4 11 16
2008 5 2120 1436 829 3 2 16
2009 6 2151 1749 850 2 1 8
2010 5 2617 1433 910 5 2 0
2011 10 2674 1574 842 3 4 0
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© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
In 2011, the most commonly used approach was
anterolateral, in 52.35 % of all cases, then the
lateral approach in 30.82 % and the posterior
approach in 16.48 %. Trochanterotomy with a
minimally invasive approach was used only in
0.35 % of all cases. Table 40 and chart 36 shows
the types of surgical approaches used.
In the THA database, there are three basic
groups of implants: total arthroplasty, bipolar
hemiarthroplasty and hemiarthroplasty. In 2011,
total arthroplasty was used in 88.76 %, which is
an increase of 1.98 % compared to 2010. The
frequency of bipolar hemiarthroplasty remained
under 1 % and in 2011 a decrease in its use from
12.44 % in 2010 to 10.45 % was recorded.
Tab. 41 Primary THA – types of implant
Chart 37 Primary THA – types of implant
For the anchoring of the implants, three types of
fixation are distinguished: cemented, uncemented
and hybrid fixations. In 2011, the distribution
of fixation was as follows: 35.26 % cemented,
51.16 % uncemented, and 13.56 % hybrid fixation.
Comparing 2011 to the previous year, only
hybrid fixation increased in 2011 from 11.66 % to
13.56 %. Back in 2003 (comparing with 2011),
the distribution was 63.99 % cemented, 23.07 %
uncemented and 12.93 % hybrid fixation. Significant
change has occurred only between cemented
and uncemented groups. Table 42 and chart
38 show the records for the types of the fixation.
Tab. 42 Primary THA – types of fixation
Chart 38 Primary THA – types of fixation
The next table shows the interaction of gender
and type of fixation. For this observation, the
hemiarthroplasty was selected to be compared to
total arthroplasty. The RR for females with cemented
hemiarthroplasty was only 0.57 %, and
the mean survival time 8.67 years. Similar results
were observed in the group of uncemented hemiarthroplasties
where RR was 1.22 % and the
mean survival time 8.85 years. The worst results
were observed in the female group with reverse
hybrids, in which the RR was 6.5 % and mean
survival time 8.26 years. In males, reverse hy-
Year
Total
arthroplasty
Bipolar
hemiarth. Hemiarth.
1786 4 330
2580 10 496
2425 14 537
3061 13 517
3641 20 596
3784 18 609
4089 22 656
4315 38 619
4533 40 534
Year Cement Uncement Hybrid
1373 472 275
1820 900 366
1625 826 525
1847 1163 584
1938 1639 680
1750 2002 659
1870 2339 558
1814 2578 580
1801 2613 693
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© Slovakian Arthroplasty Register 2013
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
brids suffered a RR of 15.71 % and survival time
was 7.19 years, which is the worst in the whole
database. In 2010, by comparison, the RR of
males with reverse hybrids was 8.20 %. Chart 39
shows the cumulative risks of implants in interaction
with type of fixation. Charts 40–41 show the
cumulative risks of implants in interaction with
gender and type of fixation. The results of reverse
hybrids are inferior to the other groups of
implants. The RR of reverse hybrids was 9.84 %,
compared to 3.53 % of standard hybrids.
Chart 39 Cumulative risk of primary THA (type of fixation)
Tab. 43 Characteristics of primary THA (interaction of gender and type of fixation)
Chart 40 Cumulative risk of primary THA (females, type of
fixation)
Chart 41 Cumulative risk of primary THA (males, type of
fixation)
Table 44 shows the interaction of type of fixation
with diagnoses. For uncemented fixations, a RR
of 3.03 % was recorded for posttraumatic coxarthrosis
and 3.56 % for fractures of the femoral
neck. The lowest RR in cemented fixations was
recorded for a diagnosis of fracture of the femoral
neck – 1.64 %. In total, reverse hybrids bore the
worst RR – 9.84 %. The RR in cemented THA for
posttraumatic coxarthrosis was 21.43 %.
7577 117 1.54 1.27 to 1.82 8.78
7283 169 2.32 1.97 to 2.67 8.78
2734 88 3.22 2.56 to 3.88 8.66
123 8 6.50 2.15 to 10.86 8.26
3600 44 1.22 0.86 to 1.58 8.85
175 1 0.57 0.00 to 1.69 8.67
21492 427 1.99 1.80 to 2.17 8.79
6697 133 1.99 1.65 to 2.32 8.72
3739 133 3.56 2.96 to 4.15 8.66
1993 79 3.96 3.11 to 4.82 8.58
70 11 15.71 7.19 to 24.24 7.19
1216 17 1.40 0.74 to 2.06 8.80
83 2 2.41 0.00 to 5.71 7.18
13798 375 2.72 2.45 to 2.99 8.69
35290 802 2.27 2.12 to 2.43 8.75
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
30 / 80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab 44 Characteristics of primary THA (interaction of type of fixation and diagnosis)
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
Primary coxarthr. 8312 105 1.26 1.02 to 1.50 8.79 8.76 to 8.83
Dysplastic coxarthr. 3145 46 1.46 1.04 to 1.88 8.80 8.75 to 8.85
Posttraum. coxarthr. 660 20 3.03 1.72 to 4.34 8.60 8.47 to 8.74
Avascular necrosis 1162 11 0.95 0.39 to 1.50 8.88 8.82 to 8.94
M. Perthes 35 1 2.86 0.00 to 8.38 7.63 7.20 to 8.06
Rheumatoid arthritis 184 4 2.17 0.07 to 4.28 8.64 8.41 to 8.88
Fracture of fem. neck 533 19 3.56 1.99 to 5.14 6.17 6.00 to 6.34
14274 250 1.75 1.54 to 1.97 8.76 8.73 to 8.79
Primary coxarthr. 8156 186 2.28 1.96 to 2.60 8.78 8.75 to 8.82
Dysplastic coxarthr. 383 10 2.61 1.01 to 4.21 8.73 8.59 to 8.88
Posttraum. coxarthr. 571 14 2.45 1.18 to 3.72 8.79 8.68 to 8.90
Avascular necrosis 557 20 3.59 2.05 to 5.14 8.65 8.52 to 8.78
M. Perthes 4 0 0.00 NA 8.64 NA
Rheumatoid arthritis 104 3 2.88 0.00 to 6.10 8.73 8.46 to 9.01
Fracture of fem. neck 855 14 1.64 0.79 to 2.49 8.51 8.42 to 8.60
11022 302 2.74 2.44 to 3.04 8.74 8.71 to 8.77
Primary coxarthr. 3047 78 2.56 2.00 to 3.12 8.71 8.65 to 8.77
Dysplastic coxarthr. 416 13 3.12 1.45 to 4.80 8.73 8.59 to 8.86
Posttraum. coxarthr. 256 9 3.52 1.26 to 5.77 8.70 8.52 to 8.89
Avascular necrosis 286 11 3.85 1.62 to 6.07 8.53 8.34 to 8.73
M. Perthes 4 0 0.00 NA 7.68 NA
Rheumatoid arthritis 44 3 6.82 0.00 to 14.27 7.73 7.11 to 8.35
Fracture of fem. neck 527 19 3.61 2.01 to 5.20 7.35 7.21 to 7.48
4727 167 3.53 3.01 to 4.06 8.63 8.58 to 8.69
Primary coxarthr. 92 4 4.35 0.18 to 8.51 8.42 7.95 to 8.89
Dysplastic coxarthr. 37 2 5.41 0.00 to 12.69 7.49 7.01 to 7.96
Posttraum. coxarthr. 14 3 21.43 0.00 to 42.92 6.20 4.70 to 7.69
Avascular necrosis 16 1 6.25 0.00 to 18.11 7.99 7.99 to 7.99
M. Perthes 2 1 50.00 0.00 to 119.30 4.25 1.18 to 7.33
Rheumatoid arthritis 1 0 0.00 NA 7.83 NA
Fracture of fem. neck 12 1 8.33 0.00 to 23.97 5.18 3.66 to 6.70
193 19 9.84 5.64 to 14.05 7.88 7.44 to 8.32
Primary coxarthr. 24 0 0.00 NA 6.82 NA
Dysplastic coxarthr. 3 0 0.00 NA 5.32 NA
Posttraum. coxarthr. 884 4 0.45 0.01 to 0.89 8.93 8.88 to 8.98
Avascular necrosis 7 0 0.00 NA 8.60 NA
M. Perthes NA NA NA NA NA NA
Rheumatoid arthritis 2 0 0.00 NA 3.61 NA
Fracture of fem. neck 3252 36 1.11 0.75 to 1.47 8.78 8.74 to 8.82
4816 61 1.27 0.95 to 1.58 8.84 8.81 to 8.88
Primary coxarthr. 8 0 0.00 0.00 to 0.00 4.80 4.80 to 4.80
Dysplastic coxarthr. NA NA NA NA NA NA
Posttraum. coxarthr. 28 0 0.00 NA 8.54 NA
Avascular necrosis 1 0 0.00 NA 0.80 NA
M. Perthes NA NA NA NA NA NA
Rheumatoid arthritis 1 0 0.00 NA 8.72 NA
Fracture of fem. neck 212 2 0.94 0.00 to 2.24 5.03 4.96 to 5.09
258 3 1.16 0.00 to 2.47 8.60 8.46 to 8.74
35290 802 2.27 2.12 to 2.43 8.75 8.73 to 8.77Whole database total
Uncemented
Hemiarthropl. uncem.
Hemiarthropl. cem.
Reverse hybrids
Hybrids
Cemented
Uncemented total
Cemented total
Hybrids total
Reverse hybrids total
Hemiarthropl. cem. total
Hemiarthropl. uncem. total
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 45 Primary THA – brands of bone cement
As table 45 shows, in the 2011, 88.67 % of the
brands used were shared as follows: SmartSet
HV 33.45 %, Palacos R 28.12 %, Palacos R
Gentamycin 14.03 %, and SmartSet GHV
13.05 %. The trend in cementing techniques remains.
Increase in the 3
rd
generation of cementing
techniques was recorded. In 2010, we recorded
2,394 protocols and the ratio of cementing
techniques used was as table 46, which shows:
21.30 % 1
st
generation, 41.93 % 2
nd
, and 35.25 %
3
rd
generation cementing techniques. In 2011, we
recorded 2,494 protocols and 3
rd
generation cementing
techniques increased to 38.69 %.
Tab. 46 Primary THA – cementing techniques
Chart 42 Cumulative risk of primary THA (cementing techniques
of femoral components)
Chart 43 Cumulative risk of primary THA (females; cementing
techniques of femoral components)
Chart 44 Cumulative risk of primary THA (males; cementing
techniques of femoral components)
Chart 42 shows the cumulative risks for revision
of the femoral component in interaction with cementing
techniques. The RR of 3
rd
generation
techniques is the lowest at 1.25 %in the whole
database The RR for uncemented femoral components
in 2011 was 0.95 %. Charts 43–44 show
this analysis for female and male patients.
Year
BiometPlus
CMW
CMW-G
Copal
Hi-FatiqueG
Osteobond
PalacosLV
genta
PalacosR
PalacosR
genta
Palamed
Palamed-G
Refobacin
Plus
Refobacin
Revision
Simplex
SimplexABC
SmartSetGHV
SmartSetHV
Synicem1
SynicemG
0 1633 162 1 0 79 1 527 44 215 10 0 0 0 0 0 11 0 0
0 1556 104 0 0 33 2 878 79 324 41 0 0 0 0 30 456 0 0
2 340 53 0 0 18 1 1112 147 95 119 0 0 0 0 198 1144 0 0
2 227 2 0 0 16 2 1619 96 115 65 0 0 0 0 289 1314 0 0
0 372 5 0 0 29 8 1587 133 144 37 0 0 0 0 239 1430 0 0
0 272 9 0 0 19 14 1326 245 128 11 5 0 0 0 411 1140 0 0
35 313 18 13 0 6 13 1127 482 0 0 112 3 0 30 428 1076 1 0
73 213 16 18 2 0 0 1042 686 0 0 41 1 2 118 324 1000 42 1
73 156 29 21 2 9 3 1056 527 0 0 48 0 12 35 490 1256 31 6
Year 1st gen. 2nd gen. 3rd gen. Not Ident.
1069 465 100 14
1114 904 146 22
820 1078 229 23
530 1360 517 24
662 1272 659 25
592 1175 625 17
594 1011 783 40
510 1004 844 36
526 982 965 21
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 47 Characteristics of primary THA (cementing techniques of femoral components)
During the period 2003–2011 we recorded
20,560 cemented femoral components (CFS) and
table 47 shows the generation of cementing
techniques related to RR. The 3
rd
generation has
the lowest RR of 1.25 %. Table 48 shows the
cumulative RR and number of failures for each
generation of cementing technique. Table 49
shows these results for females and table 50 for
males.
Tab. 48 Cumulative characteristics of primary THA (cementing techniques of femoral components)
Tab. 49 Cumulative characteristics of primary THA (females; cementing techniques of femoral components)
Tab. 50 Cumulative characteristics of primary THA (males; cementing techniques of femoral components)
Analyses were performed looking at cementing
techniques and cumulative risk of revision of this
component until certain time point. We have observed
the components at one month, three
months and every year after primary surgery.
Table 51 shows these results for the whole database,
table 52 shows these results for females
and table 53 for males.
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 51 Characteristics of failure of primary THA until certain time point (cementing technique of femoral components)
Tab. 52 Characteristics of failure of primary THA until certain time point (females; cementing technique of femoral components)
Tab. 53 Characteristics of failure of primary THA until certain time point (males; cementing technique of femoral components)
Antibiotic prophylaxis in primary THA
Tab. 54 Primary THA – antibiotic prophylaxis in 2011 (brands, numbers)
Table 54 presents antibiotic prophylaxis in 2011.
The mostly used antibiotic was Vulmizolin with
2,875 records followed by Axetine and Bitamon.
Compared to 2010, the only change is 3
rd
place
for Bitamon instead Unasyn. The antibiotic
prophylaxis was not used only in 16 cases.
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
1st generation Nr. of failures 8 7 14 22 14 11 15 12 7 8 NA
Cumulative risk (%) 0.127 0.243 0.495 0.941 1.264 1.574 2.059 2.528 2.892 3.484 NA
95% LB 0.038 0.118 0.308 0.667 0.931 1.188 1.587 1.975 2.261 2.675 NA
95% UB 0.217 0.367 0.681 1.215 1.596 1.960 2.531 3.082 3.523 4.294 NA
2nd generation Nr. of failures 11 9 22 36 23 21 16 11 9 4 1
Cumulative risk (%) 0.120 0.220 0.489 0.977 1.346 1.757 2.170 2.595 3.165 3.577 4.019
95% LB 0.048 0.122 0.336 0.745 1.063 1.408 1.747 2.074 2.461 2.742 2.816
95% UB 0.191 0.318 0.641 1.209 1.630 2.105 2.594 3.116 3.868 4.412 5.221
3rd generation Nr. of failures 4 2 11 16 11 3 6 4 3 1 NA
Cumulative risk (%) 0.082 0.125 0.389 0.845 1.292 1.446 1.925 2.616 3.593 4.532 4.532
95% LB 0.001 0.024 0.194 0.516 0.851 0.966 1.210 1.539 1.641 1.849 NA
95% UB 0.164 0.226 0.585 1.174 1.733 1.925 2.640 3.692 5.545 7.214 NA
Cementing technique
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
1st generation Nr. of failures 7 5 7 11 8 9 9 4 1 2 NA
Cumulative risk (%) 0.162 0.281 0.463 0.788 1.059 1.426 1.844 2.080 2.159 2.385 NA
95% LB 0.041 0.120 0.249 0.491 0.697 0.980 1.316 1.501 1.559 1.682 NA
95% UB 0.283 0.441 0.678 1.085 1.421 1.871 2.373 2.659 2.759 3.088 NA
2nd generation Nr. of failures 7 8 15 20 11 11 6 7 4 2 NA
Cumulative risk (%) 0.114 0.248 0.523 0.930 1.199 1.532 1.770 2.195 2.617 2.942 NA
95% LB 0.029 0.121 0.330 0.654 0.873 1.135 1.315 1.602 1.848 2.029 NA
95% UB 0.200 0.376 0.716 1.207 1.524 1.928 2.225 2.787 3.386 3.855 NA
3rd generation Nr. of failures 1 2 4 7 2 3 1 2 2 1 NA
Cumulative risk (%) 0.033 0.102 0.251 0.582 0.715 0.964 1.073 1.564 2.770 4.320 NA
95% LB 0.000 0.000 0.051 0.235 0.318 0.464 0.529 0.648 0.403 0.468 NA
95% UB 0.098 0.219 0.452 0.929 1.112 1.464 1.618 2.481 5.137 8.172 NA
Cementing technique
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
1st generation Nr. of failures 1 2 7 11 6 2 6 8 6 6 NA
Cumulative risk (%) 0.051 0.158 0.565 1.282 1.721 1.908 2.527 3.475 4.414 5.793 NA
95% LB 0.000 0.000 0.206 0.700 1.025 1.164 1.615 2.319 2.976 3.824 NA
95% UB 0.152 0.337 0.924 1.864 2.416 2.652 3.438 4.630 5.852 7.762 NA
2nd generation Nr. of failures 4 1 7 16 12 10 10 4 5 2 1
Cumulative risk (%) 0.130 0.163 0.420 1.065 1.629 2.184 2.918 3.342 4.168 4.749 5.947
95% LB 0.001 0.019 0.177 0.648 1.091 1.523 2.066 2.387 2.913 3.237 3.155
95% UB 0.259 0.308 0.664 1.482 2.167 2.845 3.771 4.297 5.424 6.261 8.739
3rd generation Nr. of failures 3 NA 7 9 9 NA 5 2 1 NA NA
Cumulative risk (%) 0.163 NA 0.614 1.276 2.233 NA 3.305 4.327 4.946 NA NA
95% LB 0.000 NA 0.219 0.644 1.288 NA 1.743 2.798 2.479 NA NA
95% UB 0.349 NA 1.009 1.908 3.177 NA 4.866 7.093 7.413 NA NA
Cementing technique
Brand
Vulmizolin
Axetine
Bitamon
Climicin
Kefzol
Xorim
Ciphin
Lendacín
Unasyn
Zinacef
Dalacin
Abactal
Cefuroxim
Amoxiklav
Augmentin
Cefazolin
Cefizox
Vankomycin
Cefotaxim
Amoxycilin
Ciprinol
Claforan
Edicin
Gentamycin
Zinat
Ampicilin
Clacid
2875 880 541 198 97 88 82 57 56 38 37 31 22 19 17 15 10 10 4 2 2 2 2 2 2 1 1
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
In comparison to 2010, there was no increase the
number of different brands of acetabular components
(AC) used. There were reductions of one
uncemented and two cemented brands. Each of
thirteen ACs accounted for less than 1 % and all
13 together represent only 3.72 % from all AC.
Table 55 shows UACs.
Tab. 55 Uncemented acetabular cups
Tab. 56 Cemented acetabular cups
Table 56 shows CACs. From all CACs, only two
brands accounted for less than 1 %.
Tab. 57 Uncemented femoral stems
In femoral components (FC), we have recorded
an increase in UFS from 37 brands in 2010 to 41
in 2011: CFS increased from 25 brands to 28.
The 17 most popular UFSs represent a share of
92.07 % and the remaining 24 UFSs represent
only 7.93 %. From CFS, nine brands each represent
a share of under 1 % and all 9 together
Name n %
PINNACLE 815 25.27%
DELTA - PF 455 14.11%
DURALOC 360 11.16%
SF 327 10.14%
NOVAE EVOLUTION 262 8.12%
PLASMACUP 257 7.97%
SUNFIT TH 149 4.62%
CLS SPOTORNO 147 4.56%
M-H-shell 77 2.39%
DELTA - FINS 58 1.80%
TRILOGY 51 1.58%
ZWEYMULLER-ALLOCLASSIC CSF 39 1.21%
ANA.NOVA 38 1.18%
TRIDENT HEMISPHERICAL SOLID 37 1.15%
T.O.P. 33 1.02%
BEZNOSKA (uncement) 29 0.90%
NOVAE E TH 28 0.87%
DELTA - TT 24 0.74%
TRIDENT HEMISPHERICAL CLUSTER 10 0.31%
DELTA - ONE - TT 8 0.25%
DELTA - ST - C 5 0.16%
COPTOS 3 0.09%
PLASMACUP DC 3 0.09%
RINGLOC - 10 st 3 0.09%
RINGLOC - STANDARD 3 0.09%
RINGLOC - HIGH WALL 1 0.03%
TC - rev ision 1 0.03%
TRILOGY IT 1 0.03%
DURALOC OPTION 1 0.03%
Acetabular uncemented 3225 100.00%
Name n %
O2 469 36.87%
PE-CUP 214 16.82%
BEZNOSKA (cement) 175 13.76%
ELITE PLUS 108 8.49%
TRILOC 91 7.15%
MULLER 80 6.29%
MUELLER 52 4.09%
CHARNLEY 29 2.28%
EXETER Contemporary Cup 27 2.12%
ZCA 25 1.97%
MARATHON 1 0.08%
NOVAE STICK 1 0.08%
Acetabular cemented 1272 100.00%
Name n %
CORAIL 779 29.85%
FIT 262 10.04%
SF 200 7.66%
SAGITA EVOLUTION HA 200 7.66%
BICONTACT 182 6.97%
LOGICA (uncement) 149 5.71%
CLS SPOTORNO 130 4.98%
BIMETRIC (uncement) 93 3.56%
PROXIMA 93 3.56%
LIBRA HA 70 2.68%
TRI-LOCK BPS 54 2.07%
S-ROM 37 1.42%
C.F.P. 35 1.34%
ZWEYMULLER-ALLOCLASICS SL 35 1.34%
ABGII V40 31 1.19%
TRIO modular (uncement) 27 1.03%
TRIO (necement) 26 1.00%
AUSTIN-MOORE CCEP (uncement) 25 0.96%
COLLO - MIS 24 0.92%
VERSYS FMT 24 0.92%
SAM - FIT 22 0.84%
SOLITÄR 22 0.84%
SL (uncement) 16 0.61%
METHA 12 0.46%
ANA.NOVA MII 11 0.42%
MODULUS 11 0.42%
C 2 6 0.23%
ANA.NOVA MII double stem couted 5 0.19%
BETA CONE 4 0.15%
VERSYS FMMC 4 0.15%
ZMR 4 0.15%
H - MAX S 3 0.11%
REVISION 3 0.11%
AML 2 0.08%
H - MAX M 2 0.08%
SAGITTA EVL R 2 0.08%
REEF 1 0.04%
RMD rev ision 1 0.04%
SF - rev ision 1 0.04%
SL-PLUS 1 0.04%
WM HA 1 0.04%
Femoral uncemented 2610 100.00%
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© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 58 Cemented femoral stems
represent only 3.16 %; remaining 19 brands are
over 1 %, represents all together 96.84 %.
Chart 45 Cumulative risk of primary THA (component type)
Chart 45 shows the cumulative risks of acetabular
and femoral components. Until the fourth year
from the operation, there is no difference, but
after this time point ACs with a RR of 1.28 % are
performing better than FCs with a RR of 1.42 %.
Chart 46 shows an analysis of the components
according to the type of fixation and reveals that
uncemented components are surviving better
than cemented, with a RR of 1.00 % for the
UACs and 0.95 % for the UFSs.
Chart 46 Cumulative risk of primary THA (interaction of component
type and fixation)
Charts 47–48 show the results of components
according to the type of fixation in interaction with
the gender.
Chart 47 Cumulative risk of primary THA (females; interaction
of component type and fixation)
According to chart 47, in females the type of fixation
of the components does not affect the RR as
much as in males. In males, uncemented components
performed significantly better than cemented
components.
Chart 48 Cumulative risk of primary THA (males; interaction
of component type and fixation)
Name n %
BEZNOSKA 519 21.02%
BEZNOSKA hemiarthroplasty 391 15.84%
CSC 225 9.11%
SAGITA EVOLUTION 162 6.56%
TRILLIANCE 128 5.18%
CENTRAMENT 124 5.02%
CHARNLEY 117 4.74%
CORAIL (cement) 92 3.73%
BIMETRIC (cement) 79 3.20%
LOGICA (cement) 74 3.00%
C-STEM AMT 67 2.71%
AUTOBLOQAUATE 66 2.67%
TRIO (cement) 64 2.59%
CSC hemiarthroplasty 61 2.47%
C-STEM 49 1.98%
CPT 48 1.94%
SL (cement) 46 1.86%
EXETER V40 42 1.70%
AUSTIN-MOORE hemiarthropl. (cement) 37 1.50%
AAP 20 0.81%
CL TRAUMA - hemiarthropl. 18 0.73%
CHARNLEY MODULAR 13 0.53%
LIBRA 13 0.53%
Rev ision stem (cement) 4 0.16%
MS-30 4 0.16%
ELITE PLUS 3 0.12%
BEZNOSKA - custom-made, tumor. 2 0.08%
REVISION - LR 1 0.04%
Femoral cemented 2469 100.00%
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Acetabular components
During the observed period 2003–2011, we recorded
a total number 18,999 ACs, of which only
47 were uncemented. Only 7 brands have each
reached more than 1,000 applications. These 7
brands comprise the 75.84 % share of all ACs. In
16 brands we recorded less than 10 applications
each during this observed period. Table 59 and
60 shows the results of UACs and CACs.
Tab. 59 Characteristics of primary THA (acetabular, uncemented components)
Component name
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
PINNACLE 3608 11 0.30 0.12 to 0.48 6.43 6.18 to 6.68
DURALOC 3293 28 0.85 0.54 to 1.16 8.89 8.87 to 8.92
NOVAE EVOLUTION 2796 19 0.68 0.38 to 0.98 8.92 8.88 to 8.95
SF 1266 8 0.63 0.20 to 1.07 8.76 8.70 to 8.82
PLASMACUP 1249 17 1.36 0.72 to 2.00 8.68 8.60 to 8.76
TRILOGY 1159 10 0.86 0.33 to 1.40 8.93 8.88 to 8.97
BEZNOSKA (uncem) 1039 27 2.60 1.63 to 3.57 8.69 8.61 to 8.77
DELTA - PF 791 3 0.38 0.00 to 0.81 2.79 2.77 to 2.80
CLS SPOTORNO 712 5 0.70 0.09 to 1.32 6.85 6.78 to 6.91
L-CUP 641 7 1.09 0.29 to 1.90 8.91 8.87 to 8.96
DELTA 585 3 0.51 0.00 to 1.09 3.88 3.86 to 3.89
M-H-shell 359 1 0.28 0.00 to 0.82 8.22 8.17 to 8.27
ZWEYMULLER-ALLOCLASSIC CSF 295 16 5.42 2.84 to 8.01 7.36 6.76 to 7.95
ANA.NOVA 184 0 0.00 NA 3.94 NA
SUNFIT TH 149 0 0.00 NA 0.90 NA
T.O.P. 117 1 0.85 0.00 to 2.52 6.10 5.97 to 6.22
DELTA - FINS 108 1 0.93 0.00 to 2.73 3.92 3.83 to 4.00
TRIDENT HEMISPHERICAL SOLID 74 0 0.00 NA 2.10 NA
COPTOS 51 1 1.96 0.00 to 5.77 7.57 7.05 to 8.08
RINGLOC - HIGH WALL 45 0 0.00 NA 4.65 NA
DELTA - TT 44 1 2.27 0.00 to 6.68 3.33 3.18 to 3.48
BICON-PLUS 43 1 2.33 0.00 to 6.83 8.81 9.00 to 9.04
Y-AXIS II 39 0 0.00 NA 8.94 NA
TRIDENT HEMISPHERICAL CLUSTER 34 0 0.00 NA 1.87 NA
NOVAE E TH 28 0 0.00 NA 0.65 NA
DURALOC OPTION 26 1 3.85 0.00 to 11.24 8.23 7.66 to 8.79
OCTOPUS 23 5 21.74 4.88 to 38.60 6.85 5.45 to 8.24
ASR 20 1 5.00 0.00 to 14.55 6.37 5.79 to 6.96
DELTA - ST - C 14 0 0.00 NA 1.83 NA
DELTA - ONE - TT 9 0 0.00 NA 2.60 NA
ULTIMA UTC 7 0 0.00 NA 6.24 NA
TC - rev ision 6 0 0.00 NA 2.56 NA
TRILOGY AB - ceramic 6 0 0.00 NA 5.66 NA
BS - rev ision 5 0 0.00 NA 6.95 NA
WM ov al 5 0 0.00 NA 1.72 NA
RINGLOC - 10 st 3 0 0.00 NA 0.90 NA
RINGLOC - STANDARD 3 0 0.00 NA 0.52 NA
PLASMACUP DC 3 0 0.00 NA 0.64 NA
NNC - Titan 3 0 0.00 NA 5.55 NA
ACETABULAR PLATES 2 0 0.00 NA 1.61 NA
CENTRAMENT 2 1 50.00 0.00 to 119.30 3.00 0.00 to 7.04
CERAFIT Cup 1 0 0.00 NA 0.39 NA
TRILOGY IT 1 0 0.00 NA 0.91 NA
WM conical 1 1 100.00 NA 4.02 NA
RSC - rev ision 1 0 0.00 NA 2.80 NA
Acetabular uncemented 18999 190 1.00 0.86 to 1.14 8.88 8.86 to 8.90
All acetabular 30214 386 1.28 1.15 to 1.40 8.86 8.85 to 8.88
Whole database total 65499 886 1.35 1.26 to 1.44 8.85 8.84 to 8.86
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 60 Characteristics of primary THA (acetabular, cemented components)
During the observed period, 18 brands of CAC
were recorded. Four brands have more than
1,000 applications each, comprising together a
share of 73.90 %. Regardless of the fixation type,
charts 49 to 52 show the cumulative risks of revision
of the most commonly used AC.
Chart 49 Cumulative risk of primary THA, acet. comp.
BEZNOSKA (cement)
Chart 50 Cumulative risk of primary THA, acet. comp.
PINNACLE
Chart 51 Cumulative risk of primary THA, acet. comp.
DURALOC
Chart 52 Cumulative risk of primary THA, acet. comp. NOVAE
EVOLUTION
Component name
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
BEZNOSKA (cem) 3852 104 2.70 2.19 to 3.21 8.75 8.70 to 8.79
CHARNLEY 1886 22 1.17 0.68 to 1.65 8.91 8.87 to 8.95
PE-CUP 1545 29 1.88 1.20 to 2.55 8.80 8.74 to 8.87
O2 1006 3 0.30 0.00 to 0.64 4.92 4.88 to 4.97
MULLER 837 9 1.08 0.38 to 1.77 8.91 8.85 to 8.97
ELITE PLUS 661 3 0.45 0.00 to 0.97 8.90 8.85 to 8.95
ULTIMA MK2 351 7 1.99 0.53 to 3.46 8.81 8.69 to 8.93
ZCA 288 2 0.69 0.00 to 1.65 8.89 8.80 to 8.99
MUELLER 281 0 0.00 NA 3.75 NA
EXETER Contemporary Cup 139 1 0.72 0.00 to 2.12 5.03 4.91 to 5.15
TRILOC 105 0 0.00 NA 1.97 NA
EXETER Duration Cup 85 0 0.00 NA 3.21 NA
LUBINUS CLASSIC PLUS 69 1 1.45 0.00 to 4.27 8.79 9.00 to 9.03
BURCH-SCHNEIDER CAGE 7 1 14.29 0.00 to 40.21 6.17 4.35 to 8.00
MULLER LOW PROFILE 5 2 40.00 0.00 to 82.94 6.60 9.00 to 9.05
MARATHON 4 0 0.00 NA 5.88 NA
NOVAE STICK 2 0 0.00 NA 2.95 NA
OSTEAL PE Cup 1 0 0.00 NA 0.45 NA
Acetabular Cemented 11215 196 1.75 1.51 to 1.99 8.83
All acetabular 30214 386 1.28 1.15 to 1.40 8.86
Whole database total 65499 886 1.35 1.26 to 1.44 8.85
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 61 Characteristics of primary THA (femoral, uncemented components)
Component name
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
CORAIL 3527 28 0.79 0.50 to 1.09 8.70 8.64 to 8.75
SAGITA EVOLUTION HA 2179 8 0.37 0.11 to 0.62 8.96 8.94 to 8.99
AML 1226 13 1.06 0.49 to 1.63 8.89 8.85 to 8.93
SF 1031 11 1.07 0.44 to 1.69 8.78 8.70 to 8.86
BIMETRIC (uncem) 834 6 0.72 0.15 to 1.29 8.91 8.86 to 8.97
BICONTACT 790 3 0.38 0.00 to 0.81 7.66 7.57 to 7.74
FIT 779 7 0.90 0.24 to 1.56 3.92 3.90 to 3.95
CLS SPOTORNO 572 1 0.17 0.00 to 0.52 4.60 4.58 to 4.62
LIBRA HA 513 4 0.78 0.02 to 1.54 5.84 4.79 to 6.88
VERSYS 512 4 0.78 0.02 to 1.54 8.84 8.77 to 8.91
PROXIMA 478 0 0.00 NA 5.89 NA
LOGICA (uncem) 402 2 0.50 0.00 to 1.19 5.06 5.03 to 5.10
ZWEYMULLER-ALLOCLASICS SL 281 4 1.42 0.04 to 2.81 8.82 8.67 to 8.96
VERSYS FMT 208 6 2.88 0.61 to 5.16 6.15 5.97 to 6.32
AUSTIN-MOORE hemiarthropl. (uncem) 194 1 0.52 0.00 to 1.52 8.48 8.37 to 8.59
ANA.NOVA MII 149 0 0.00 NA 3.94 NA
S-ROM 116 1 0.86 0.00 to 2.54 8.58 9.00 to 9.06
ABGII V40 77 1 1.30 0.00 to 3.83 2.07 2.02 to 2.12
TRI-LOCK BPS 72 0 0.00 NA 1.24 NA
SL (uncem) 70 2 2.86 0.00 to 6.76 3.59 3.44 to 3.73
BETA CONE 67 2 2.99 0.00 to 7.06 5.41 5.22 to 5.60
C.F.P. 56 0 0.00 NA 6.16 NA
SAM - FIT 55 0 0.00 NA 3.52 NA
SL-PLUS 44 0 0.00 NA 8.93 NA
COLLO - MIS 37 0 0.00 NA 1.53 NA
TRIO (uncem) 32 1 3.12 0.00 to 9.15 3.50 NA
METHA 32 0 0.00 NA 4.84 NA
VERSYS FMMC 32 1 3.12 0.00 to 9.15 7.61 7.17 to 8.04
TRIO modular (uncem) 31 0 0.00 NA 1.11 NA
X-AXIS 25 0 0.00 NA 8.81 NA
SOLUTION 25 2 8.00 0.00 to 18.63 8.15 9.00 to 9.04
SOLITÄR 22 0 0.00 NA 0.54 NA
MODULUS 19 0 0.00 NA 1.50 NA
ANA.NOVA MII double stem couted 15 0 0.00 NA 2.14 NA
ZMR 14 3 21.43 0.00 to 42.92 4.79 3.97 to 5.61
RMD rev ision 10 1 10.00 0.00 to 28.59 4.91 NA
ASR 10 2 20.00 0.00 to 44.79 6.47 5.25 to 7.70
REVISION 8 0 0.00 NA 2.94 NA
SF - rev ision 7 0 0.00 NA 5.81 NA
H - MAX S 6 0 0.00 NA 1.62 NA
C 2 6 0 0.00 NA 0.07 NA
MP 6 2 33.33 0.00 to 71.05 6.68 9.00 to 9.03
H - MAX M 5 0 0.00 NA 1.83 NA
SAGITTA EVL R 3 0 0.00 NA 1.12 NA
ANTEGA 3 1 33.33 0.00 to 86.68 1.89 0.41 to 3.36
WM HA 3 0 0.00 NA 5.19 NA
CERAFIT Standard 2 0 0.00 NA 0.39 NA
SL-TWIN 2 0 0.00 NA 2.56 NA
REEF 1 0 0.00 NA 0.93 NA
ANA.NOVA NANOS 1 0 0.00 NA 2.39 NA
Y-AXIS 1 0 0.00 NA 7.61 NA
Femoral Uncemented 14725 140 0.95 0.79 to 1.11 8.88
All femoral 35285 500 1.42 1.29 to 1.54 8.84
Whole database total 65499 886 1.35 1.26 to 1.44 8.85
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
During the period 2003–2011, we recorded
14,725 UFS applications. Only four brands had
each more than 1,000 applications with combined
share of 54.07 %. Fourteen brands had less than
10 applications each. Table 61 shows the results
of these components.
Tab. 62 Characteristics of primary THA (femoral, cemented components)
Table 62 shows the results for CFSs. In the observed
period, we recorded 38 brands, with total
number of 20,560 applications. Seven brands
had more than 1,000 applications each, comprising
a share of 79.71 % and only 6 brands of
CFSs had less than 10 applications each. Charts
53 to 56 show the cumulative risks of revision of
the four most commonly used femoral components,
regardless of the fixation type. In terms of
the number of applications, only one uncemented
stem is in this group of charts. Cemented hemiarthroplasty
reached a total number of 3,843 with a
RR of 1.04 %.
Component name
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
BEZNOSKA 5271 104 1.97 1.60 to 2.35 8.80 8.77 to 8.84
BEZNOSKA hemiarthropl. 3843 40 1.04 0.72 to 1.36 8.87 8.83 to 8.91
CHARNLEY 2183 47 2.15 1.54 to 2.76 8.84 8.79 to 8.88
CENTRAMENT 1700 24 1.41 0.85 to 1.97 8.74 8.69 to 8.79
CSC 1201 17 1.42 0.75 to 2.08 8.70 8.62 to 8.77
BIMETRIC (cem) 1184 23 1.94 1.16 to 2.73 8.84 8.78 to 8.91
C-STEM 1007 8 0.79 0.25 to 1.34 7.78 7.72 to 7.84
CPT 762 8 1.05 0.33 to 1.77 8.89 8.83 to 8.95
AUSTIN-MOORE hemiarthropl. 356 5 1.40 0.18 to 2.63 8.83 8.69 to 8.96
ELITE PLUS 355 33 9.30 6.28 to 12.32 8.39 8.20 to 8.59
SAGITA EVOLUTION 343 4 1.17 0.03 to 2.30 8.77 8.56 to 8.98
LOGICA (cem) 330 1 0.30 0.00 to 0.90 3.74 3.72 to 3.76
EXETER V40 273 2 0.73 0.00 to 1.74 8.58 8.36 to 8.79
CHARNLEY MODULAR 255 5 1.96 0.26 to 3.66 5.38 5.00 to 5.77
CSC hemiarthropl. 229 5 2.18 0.29 to 4.08 6.86 6.72 to 7.00
TRILLIANCE 217 1 0.46 0.00 to 1.36 3.24 3.19 to 3.29
SL (cem) 154 2 1.30 0.00 to 3.09 3.70 3.64 to 3.77
CORAIL (cem) 95 0 0.00 NA 1.23 NA
LUBINUS CLASSIC PLUS 79 2 2.53 0.00 to 6.00 8.77 8.58 to 8.96
AUTOBLOQAUATE 77 0 0.00 NA 1.37 NA
CL TRAUMA - hemiarthropl. 69 0 0.00 NA 3.56 NA
ULTIMA-HOWSE II 69 8 11.59 4.04 to 19.15 7.16 6.66 to 7.66
C-STEM AMT 67 1 1.49 0.00 to 4.40 0.89 0.87 to 0.92
AUSTIN-MOORE hemiarthropl. (cem) 67 1 1.49 0.00 to 4.40 5.13 2.27 to 8.00
TRIO (cem) 66 0 0.00 NA 1.38 NA
FJORD 56 0 0.00 NA 5.51 NA
BEZNOSKA - custom-made, tumor. 50 2 4.00 0.00 to 9.43 8.09 7.41 to 8.77
AAP 45 1 2.22 0.00 to 6.53 3.62 3.17 to 4.07
MULLER GERADSCHAFT 21 3 14.29 0.00 to 29.25 6.00 5.27 to 6.72
LIBRA 19 0 0.00 NA 2.45 NA
ASR 14 1 7.14 0.00 to 20.63 6.31 5.62 to 7.01
Z-AXIS 14 0 0.00 NA 8.94 NA
MS-30 7 0 0.00 NA 5.49 NA
REVISION STEM (cem) 6 0 0.00 NA 2.35 NA
ULTIMA-STREIGHT STEM 6 2 33.33 0.00 to 71.05 6.48 9.00 to 9.08
FRIENDLY 4 0 0.00 NA 3.35 NA
REVISION - LR 2 0 0.00 NA 1.12 NA
OSTEAL Standard 1 0 0.00 NA 0.45 NA
Femoral Cemented 20560 360 1.75 1.57 to 1.93 8.82
All femoral 35285 500 1.42 1.29 to 1.54 8.84
Whole database total 65499 886 1.35 1.26 to 1.44 8.85
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Chart 53 Cumulative risk of primary THA, fem. comp.
BEZNOSKA
Chart 54 Cumulative risk of primary THA, fem. comp.
BEZNOSKA hemiarthropl.
Chart 55 Cumulative risk of primary THA, fem. comp.
CORAIL
Chart 56 Cumulative risk of primary THA, fem. comp.
CHARNLEY
Tab. 63 Characteristics of primary THA (acetabular and femoral components)
Tab. 64 Cumulative characteristics of primary THA (acetabular and femoral components)
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
Acetabular
Uncemented
Cemented
Femoral
Uncemented
Cemented
Component type
Whole database total
2003 2004 2005 2006 2007 2008 2009 2010 2011
Acetabular
Uncemented
RR 0.14 0.15 0.46 0.66 0.86 0.93 1.00 1.07 1.00
Cemented
RR 0.29 0.63 0.86 0.91 1.12 1.45 1.51 1.67 1.75
Femoral
Uncemented
RR 0.00 0.21 0.36 0.67 0.75 0.92 0.92 1.02 0.95
Cemented
RR 0.18 0.47 0.83 0.95 1.18 1.36 1.52 1.76 1.75
Component type
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Table 63 shows an analysis of RR and mean
survival time for acetabular and femoral components
during the period 2003 to 2011, with
65,499 components. Table 64 shows the cumulative
results of components year by year. Table 65
shows the cumulative risks of revision until certain
time points for the whole database.
Tab. 65 Characteristics of failure of primary THA until certain time point (acetabular and femoral components)
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
Acetabular Nr. of failures 32 30 67 74 56 43 22 27 19 16 NA
Cumulative risk (%) 0.106 0.209 0.457 0.770 1.070 1.363 1.563 1.914 2.280 2.907 NA
95% LB 0.069 0.156 0.374 0.655 0.924 1.186 1.360 1.654 1.949 2.313 NA
95% UB 0.144 0.261 0.539 0.886 1.216 1.541 1.765 2.174 2.612 3.502 NA
Uncemented Nr. of failures 17 20 32 32 24 29 12 10 10 4 NA
Cumulative risk (%) 0.090 0.198 0.388 0.611 0.827 1.174 1.380 1.626 2.014 2.397 NA
95% LB 0.047 0.134 0.292 0.481 0.663 0.952 1.120 1.314 1.587 1.713 NA
95% UB 0.133 0.263 0.483 0.741 0.991 1.397 1.641 1.938 2.442 3.082 NA
Cemented Nr. of failures 15 10 35 42 32 14 10 17 9 12 NA
Cumulative risk (%) 0.134 0.226 0.571 1.026 1.447 1.669 1.862 2.321 2.664 3.496 NA
95% LB 0.066 0.137 0.421 0.812 1.180 1.373 1.536 1.904 2.169 2.601 NA
95% UB 0.203 0.316 0.720 1.240 1.714 1.965 2.189 2.738 3.160 4.391 NA
Femoral Nr. of failures 43 30 76 99 70 53 49 37 25 16 2
Cumulative risk (%) 0.123 0.211 0.457 0.829 1.157 1.479 1.872 2.311 2.759 3.275 3.472
95% LB 0.086 0.162 0.380 0.716 1.013 1.304 1.651 2.031 2.399 2.705 2.833
95% UB 0.160 0.260 0.534 0.942 1.300 1.654 2.093 2.592 3.118 3.844 4.110
Uncemented Nr. of failures 19 11 26 19 21 17 10 8 5 3 1
Cumulative risk (%) 0.130 0.207 0.406 0.581 0.837 1.128 1.372 1.675 1.943 2.422 2.850
95% LB 0.071 0.132 0.294 0.440 0.645 0.878 1.060 1.281 1.475 1.535 1.629
95% UB 0.189 0.282 0.518 0.723 1.028 1.379 1.683 2.070 2.411 3.309 4.071
Cemented Nr. of failures 24 19 50 80 49 36 39 29 20 13 1
Cumulative risk (%) 0.118 0.214 0.493 0.999 1.373 1.714 2.184 2.684 3.210 3.759 3.893
95% LB 0.070 0.149 0.389 0.837 1.173 1.477 1.887 2.314 2.740 3.142 3.223
95% UB 0.165 0.279 0.598 1.160 1.573 1.951 2.480 3.054 3.680 4.376 4.563
Component type
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Component combinations
Due to the standardised diameters of the articulating
heads, THA offers the possibility of combinations
either with recommended components by
the same manufacturer or with components from
other manufacturers. These combinations are,
from the legal point of view, off-label use of components
and the surgeon is thereby creating
completely new implant. The use of such a combination
is not recommended by any manufacturer.
These combinations are highlighted in blue in
the following tables.
Combinations of uncemented components
Tab. 66 Characteristics of primary components combinations (uncemented THA)
Chart 57 Cumulative risk of primary THA, acet. comp. Novae
Evolution and fem. comp. Sagita Evolution HA
Chart 58 Cumulative risk of primary THA, acet. comp. Pinnacle
and fem. comp. Corail
Acetabular Femoral
Total
number
Nr. of
failures RR
Nr. of
failures RR
Nr. of
failures RR
Nov ae Ev olution Sagita Ev olution HA 2049 18 0.88 15 0.73 8 0.39
Pinnacle Corail 1988 12 0.60 6 0.30 11 0.55
Duraloc Corail 1355 19 1.40 10 0.74 14 1.03
Plasmacup Bicontact 769 10 1.30 8 1.04 3 0.39
Duraloc AML 759 14 1.84 9 1.19 9 1.19
SF SF 732 8 1.09 7 0.96 5 0.68
CLS Spotorno CLS Spotorno 539 1 0.19 0 0.00 1 0.19
Trilogy Versy s 491 3 0.61 1 0.20 3 0.61
Nov ae Ev olution Libra HA 480 4 0.83 2 0.42 3 0.62
Pinnacle Proxima 470 2 0.43 2 0.43 0 0.00
L-Cup Bimetric (uncem) 421 6 1.43 5 1.19 4 0.95
Pinnacle AML 415 4 0.96 2 0.48 3 0.72
Delta - PF Fit 365 6 1.64 0 0.00 6 1.64
Delta Fit 317 0 0.00 0 0.00 0 0.00
M-H-shell Bimetric (uncem) 278 2 0.72 1 0.36 1 0.36
Zwey muller Alloclassic CSF Zwey muller Alloclassic SL 259 12 4.63 12 4.63 3 1.16
Beznoska (uncem) SF 248 8 3.23 4 1.61 5 2.02
Delta - PF Logica (uncem) 235 1 0.43 0 0.00 1 0.43
Trilogy Versy s FMT 190 5 2.63 3 1.58 5 2.63
Ana.Nov a Ana.Nov a MII 141 0 0.00 0 0.00 0 0.00
Delta Logica (uncem) 135 2 1.48 2 1.48 0 0.00
Pinnacle Tri-lock BPS 68 0 0.00 0 0.00 0 0.00
Pinnacle S-ROM 68 0 0.00 0 0.00 0 0.00
67 2 2.99 2 2.99 0 0.00
Delta - Fins Fit 67 1 1.49 1 1.49 1 1.49
Sunf it TH Sagita Ev olution HA 66 0 0.00 0 0.00 0 0.00
T.O.P Beta Cone 63 2 3.17 1 1.59 2 3.17
Acetabular FemoralComponent name Implants
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Chart 59 Cumulative risk of primary THA, acet. comp. Duraloc
and fem. comp. Corail
Chart 60 Cumulative risk of primary THA, acet. comp.
Plasmacup and fem. comp. Bicontact
Table 66 shows the combinations of uncemented
components with one component from a different
manufacturer. Charts 57 to 60 show the cumulative
risk of revision for the commonest UAC/UFS
combinations.
Combinations of cemented components
Tab. 67 Characteristics of primary components combinations (cemented THA)
Table 67 shows the combination of cemented
components, including two combinations not
recommended by the manufacturer, with a higher
RR in one CFS of 5.45 %. With RR of 4.94 %,
this CFS failed also in another combination recommended
by manufacturer. Charts 61 to 64
show the cumulative risks of revision of the
commonest combination of CAC/CFS used. Table
65 shows hybrid combinations of UAC/CFS.
All RRs equal to or higher than 5.00 % are in
orange and RR equal to or higher than 10.00 %
are in red. Charts 65 to 68 show cumulative risks
of revision for these component combinations.
Acetabular Femoral
Total
number
Nr. of
failures RR
Nr. of
failures RR
Nr. of
failures RR
Beznoska (cem) Beznoska 3196 111 3.47 91 2.85 74 2.32
Charnley Charnley 1857 43 2.32 18 0.97 39 2.10
Cup Centrament 1299 28 2.16 24 1.85 17 1.31
Muller Bimetric (cem) 694 15 2.16 8 1.15 11 1.59
O2 Beznoska 437 2 0.46 1 0.23 1 0.23
O2 CSC 432 3 0.69 1 0.23 3 0.69
Beznoska (cem) CSC 418 6 1.44 2 0.48 5 1.20
Elite Plus Charnley 274 1 0.36 0 0.00 1 0.36
ZCA CPT 273 2 0.73 2 0.73 1 0.37
Mueller Logica (cem) 225 0 0.00 0 0.00 0 0.00
Elite Plus Charnley Modular 198 1 0.51 1 0.51 1 0.51
Ultima MK2 C-Stem 183 4 2.19 3 1.64 2 1.09
PE-Cup Trilliance 165 3 1.82 3 1.82 1 0.61
Exeter Contemporary Cup Exeter V40 139 2 1.44 1 0.72 2 1.44
90 1 1.11 1 1.11 1 1.11
Elite Plus Elite Plus 81 4 4.94 0 0.00 4 4.94
Exeter Duration Cup Exeter V40 76 0 0.00 0 0.00 0 0.00
71 0 0.00 0 0.00 0 0.00
Triloc Autobloqauate 67 0 0.00 0 0.00 0 0.00
Lubinus Classic Plus Lubinus Classic Plus 65 0 0.00 0 0.00 0 0.00
O2 Trio (cem) 57 0 0.00 0 0.00 0 0.00
Elite Plus C-Stem 55 0 0.00 0 0.00 0 0.00
Ultima MK2 Elite Plus 55 3 5.45 2 3.64 2 3.64
Component name Implants Acetabular Femoral
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Chart 61 Cumulative risk of primary THA, acet. comp. Beznoska
(cem) and fem. comp. Beznoska
Chart 62 Cumulative risk of primary THA, acet. comp. Charnley
and fem. comp. Charnley
Chart 63 Cumulative risk of primary THA, acet. comp. PE-Cup
and fem. comp. Centrament
Chart 64 Cumulative risk of primary THA, acet. comp. Muller
and fem. comp. Bimetric (cem)
Hybrid components
Tab. 68 Characteristics of primary components combinations (hybrids)
Acetabular Femoral
Total
number
Nr. of
failures RR
Nr. of
failures RR
Nr. of
failures RR
Beznoska (uncem) Beznoska 459 18 3.92 15 3.27 6 1.31
Plasmacup Centrament 357 10 2.80 8 2.24 6 1.68
Duraloc C-Stem 353 5 1.42 1 0.28 5 1.42
Trilogy CPT 348 6 1.72 2 0.57 6 1.72
SF Beznoska 325 9 2.77 1 0.31 8 2.46
319 4 1.25 1 0.31 3 0.94
Pinnacle C-Stem 290 1 0.34 1 0.34 0 0.00
Nov ae Ev olution Sagita Ev olution 236 5 2.12 2 0.85 3 1.27
Duraloc Elite Plus 194 25 12.89 2 1.03 25 12.89
L-Cup Bimetric (cem) 177 4 2.26 1 0.56 4 2.26
Beznoska (uncem) CSC 152 6 3.95 3 1.97 5 3.29
132 3 2.27 3 2.27 1 0.76
SF CSC 120 0 0.00 0 0.00 0 0.00
M-H-shell Bimetric (cem) 74 0 0.00 0 0.00 0 0.00
66 0 0.00 0 0.00 0 0.00
Sunf it TH Sagita Ev olution 66 0 0.00 0 0.00 0 0.00
Pinnacle Corail (cem) 66 0 0.00 0 0.00 0 0.00
Duraloc Ultima-Howse II 53 8 15.09 2 3.77 8 15.09
53 0 0.00 0 0.00 0 0.00
Component name Implants Acetabular Femoral
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
During the observation period we have recorded
3,840 implants with hybrid type of fixation and
only 73 implants with reverse hybrid type of fixation.
Table 68 shows the results of UACs combined
with CFSs. Charts 65–68 show CR of four
mostly used hybrid combinations in the database.
Table 69 presents results of implants with reverse
type of fixation.
Chart 65 Cumulative risk of primary THA, acet. comp. Beznoska
(uncem) and fem. comp. Beznoska
Chart 66 Cumulative risk of primary THA, acet. comp.
Plasmacup and fem. comp. Centrament
Chart 67 Cumulative risk of primary THA, acet. comp. Duraloc
and fem. comp. C-Stem
Chart 68 Cumulative risk of primary THA, acet. comp. Trilogy
and fem. comp. CPT
Reverse hybrid components
Tab. 69 Characteristics of primary components combinations (reverse hybrids)
Acetabular Femoral
Total
number
Nr. of
failures RR
Nr. of
failures RR
Nr. of
failures RR
Beznoska (cem) SF 20 1 5.00 1 5.00 0 0.00
Muller Bimetric (uncem) 19 0 0.00 0 0.00 0 0.00
PE-Cup Bicontact 12 0 0.00 0 0.00 0 0.00
Elite Plus AML 12 0 0.00 0 0.00 0 0.00
10 1 10.00 0 0.00 1 10.00
Component name Implants Acetabular Femoral
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Revision Total Hip Arthroplasty
In 2011 we recorded a decrease in revision THA
by 25 cases. Chart 69 shows evolution of RR
during the observed period 2003–2011.
Chart 69 Revision THA – revision rate
Tab. 70 Structure of revision database
The revision database contains in total 3,195
protocols. The majority of them had the primary
THA performed before the start of the register –
prior to 1 January 2003. We do not have detailed
data about the primary THAs of 2,074 revisions.
We know only that 192 of these revisions failed.
The rest of the database is divided according to
the number of revisions performed, as table 70
shows. In this report we will analyse only first
revisions. This part of database comprises 803
protocols. The gender ratio is shown in table 71
and chart 70. We have recorded a decrease in
females from 58.73 % in 2010 to 56.35 % in
2011.
Tab. 71 Revision THA – gender distribution
Chart 70 Revision THA – gender distribution
Types of fixation of primary THA
From 2008, there was observed an increase in
the numbers of revisions of primary uncemented
implants and a decrease of the numbers of revisions
of cemented implants. Table 72 and chart
71 show the evolution of revised primary implants
according to the type of fixation.
Tab. 72 Revision THA – types of fixation of primary implants
Chart 71 Revision THA – types of primary fixation
In 2011, 51.50 % of all revised implants were
cemented, 30.48 % uncemented and 18.01 %
hybrids; in 2010, 52.95 % of all revised implants
were primarily cemented, 28.67 % uncemented,
and 18.38 % were hybrids.
Total Censored Failured
1st rev ision 803 720 83
2nd rev ision 276 241 35
3rd rev ision 35 31 4
4th rev ision 4 4 0
Missed primary operation 3 0 3
Primary THA bef ore 2003 2074 1882 192
Total 3195 2878 317
Year Female Male
2003 171 122
2004 189 144
2005 164 106
2006 198 137
2007 214 134
2008 208 131
2009 226 160
2010 269 189
2011 244 189
Year Cement Uncement Hy brid Not Ident.
2003 184 34 74 1
2004 204 47 78 4
2005 162 41 66 1
2006 196 73 66 0
2007 175 82 91 0
2008 199 63 77 0
2009 196 112 78 0
2010 243 130 85 0
2011 223 132 78 0
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Age groups
In the age group less than 55 years, an increase
of revision THAs from 12.6 % in 2010 to 15.11 %
in 2011 was observed. Also in the age group 55–
65 years, a 26.32 % increase, compared to
23.64 % in 2010, was observed. 40.21 % of patients
in the age group 65–75 years and 18.34 %
in the age group over 75 were revised. Table 73
shows the age groups according the methodology
of Statistical Office of the Slovak Republic.
Table 74 shows the four age groups and the interaction
of gender. The number of failures represents
the number of re-revisions, which means
that of 3,195 revision THAs 317 were revised
again THAs. Table 75 shows the interaction of
gender, age groups and type of fixation of revision
THA.
Tab. 73 Revision THA – age groups
Tab. 74 Characteristics of revision THA (interaction of gender and age groups)
Tab. 75 Characteristics of revision THA (interaction of gender, age groups and type of fixation)
Year 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 >85
2003 0 0 0 3 2 0 6 8 17 25 53 63 60 42 14
2004 0 1 0 1 1 2 5 14 36 36 43 55 79 40 20
2005 0 0 1 2 1 1 5 11 20 32 33 51 75 27 11
2006 0 1 0 2 2 1 9 13 33 41 55 67 79 23 9
2007 1 0 0 3 4 5 11 23 33 45 57 69 64 28 5
2008 0 0 0 0 1 4 12 12 41 52 60 83 47 18 9
2009 0 0 0 0 5 5 12 33 58 48 76 58 64 19 8
2010 0 0 2 3 1 5 17 30 46 62 87 94 65 37 9
2011 0 0 1 4 3 9 8 27 54 69 53 101 67 29 8
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
[min,55] yrs 277 37 13.36 9.35 to 17.36 7.79
(55,65] yrs 469 45 9.59 6.93 to 12.26 7.99
(65,75] yrs 756 60 7.94 6.01 to 9.86 8.21
(75,max] yrs 381 21 5.51 3.22 to 7.80 8.34
1883 163 8.66 7.39 to 9.93 8.13
[min,55] yrs 206 22 10.68 6.46 to 14.90 7.84
(55,65] yrs 372 42 11.29 8.07 to 14.51 7.81
(65,75] yrs 529 77 14.56 11.55 to 17.56 7.56
(75,max] yrs 205 13 6.34 3.01 to 9.68 8.26
1312 154 11.74 10.00 to 13.48 7.81
3195 317 9.92 8.89 to 10.96 8.00
Females
Males
Whole database total
Females total
Males total
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
Females 1883 163 8.66 7.39 to 9.93 8.13
Males 1312 154 11.74 10.00 to 13.48 7.81
[min,55] yrs 483 59 12.22 9.29 to 15.14 7.82
(55,65] yrs 841 87 10.34 8.29 to 12.40 7.93
(65,75] yrs 1285 137 10.66 8.97 to 12.35 7.96
(75,max] yrs 586 34 5.80 3.91 to 7.69 8.36
Uncemented
Cemented
Hybrids
3195 317 9.92 8.89 to 10.96 8.00
Gender
Age groups
Type of fixation
Whole database total
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Chart 72 Cumulative risk of revision THA (gender) Chart 74 Cumulative risk of revision THA (females, age
group)
Chart 73 Cumulative risk of revision THA (age groups) Chart 75 Cumulative risk of revision THA (males, age groups)
Tab. 76 Frequency of revision THA (age groups; in %)
Chart 76 Frequency of revision THA (age groups; in %)
Tab. 77 Frequency of revision THA (females; age groups; in %)
2003 2004 2005 2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
2003 2004 2005 2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Chart 77 Frequency of revision THA (females; age groups; in %)
Tab. 78 Frequency of revision THA (males; age groups; in %)
Chart 78 Frequency of revision THA (males; age groups; in %)
Charts 72–75 show the cumulative risk of rerevision
according to the age group and gender.
The higher risk of revision of revision THA is
among males (chart 72) and the age group less
than 55 years (chart 73). In females the highest
risk was in the age group less than 55 years
(chart 74) and in the male age group 65–75 years
(chart 75). Table 76 and chart 76 show the percentage
participation of age groups in the revision
THA. There is a trend for increasing numbers
of revision in the age group 65–75 years,
from 41.46 % in 2003 to 61.11 % in 2011. The
next two tables and charts show these results for
females and for males. The following analysis is
the percentage probability of failure of revision
THA according to the age groups Table 79 and
chart 79 show results for the whole database,
tables 80–81 and charts 80–81 show these results
for females and males. In 2011, the probability
of failure of revision THA was highest in the
age group 65–75 years, at 61.11 %. In males, the
probability of failure was 87.50 %. There was no
risk of failure in the age group less than 55 years.
The final analysis (tables 82–84 and charts 82–
84) shows this probability until a certain time
point with one, three month and every year.
This analysis is not cumulative.
Tab. 79 Probability of revision THA (age groups; in %)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
2003 2004 2005 2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
2003 2004 2005 2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Chart 79 Probability of revision THA (age groups; in %)
Tab. 80 Probability of revision THA (females; age groups; in %)
Chart 80 Probability of revision THA (females; age groups; in %)
Tab. 81 Probability of revision THA (males; age groups; in %)
Chart 81 Probability of revision THA (males; age groups; in %)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
2003 2004 2005 2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
20%
40%
60%
80%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
2003 2004 2005 2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
20%
40%
60%
80%
100%
2003 2004 2005 2006 2007 2008 2009 2010 2011
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 82 Probability of failure of revision THA until certain time point (age groups; not cumulative)
Chart 82 Probability of failure of revision THA until certain time point (age groups; not cumulative)
Tab. 83 Probability of failure of revision THA until certain time point (females; age groups; not cumulative)
Chart 83 Probability of failure of revision THA until certain time point (females; age groups; not cumulative)
Tab. 84 Probability of failure of revision THA until certain time point (males; age groups; not cumulative)
Chart 84 Probability of failure of revision THA until certain time point (males; age groups; not cumulative)
Age groups 1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
[min,55] yrs 12.50 3.13 20.29 14.71 11.90 32.00 35.00 31.25 50.00 20.00 NA
(55,65] yrs 12.50 15.63 28.99 33.82 28.57 36.00 20.00 31.25 25.00 60.00 NA
(65,75] yrs 59.38 56.25 39.13 42.65 52.38 28.00 35.00 31.25 25.00 20.00 NA
(75,max] yrs 15.63 25.00 11.59 8.82 7.14 4.00 10.00 6.25 0.00 0.00 NA
0%
20%
40%
60%
80%
100%
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
[min,55] yrs 16.67 7.69 18.42 22.22 12.00 42.86 50.00 36.36 50.00 0.00 NA
(55,65] yrs 5.56 7.69 36.84 33.33 24.00 35.71 25.00 27.27 0.00 100.00 NA
(65,75] yrs 55.56 46.15 26.32 37.04 56.00 14.29 25.00 36.36 50.00 0.00 NA
(75,max] yrs 22.22 38.46 18.42 7.41 8.00 7.14 0.00 0.00 0.00 0.00 NA
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
[min,55] yrs 7.14 0.00 22.58 9.76 11.76 18.18 12.50 20.00 50.00 50.00 NA
(55,65] yrs 21.43 21.05 19.35 34.15 35.29 36.36 12.50 40.00 33.33 0.00 NA
(65,75] yrs 64.29 63.16 54.84 46.34 47.06 45.45 50.00 20.00 16.67 50.00 NA
(75,max] yrs 7.14 15.79 3.23 9.76 5.88 0.00 25.00 20.00 0.00 0.00 NA
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
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52 / 80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Reasons for the revision
Tab. 85 Revision THA – reasons for revision
Table 85 shows all reasons for revision according
to the protocol. Analyses of the reasons for revisions
are complicated, with the multiple-choice in
the revision protocol, which means that each
revision THA could potentially have more than
one reason for revision. Therefore, the total number
of reasons for revision does not correspond
to the total number of performed revision THAs.
In the table are displayed all 3,195 revision
THAs. For deeper analysis we can use only
1,121 revisions from the observed period 2003–
2011. Table 86 shows the frequency of these
reasons. From this table is clear that after aseptic
loosening of femoral and acetabular components,
the third mostly marked reason for revision is
luxation. 30.42 % of all revisions were due to
aseptic loosening of the femoral component,
24.19 % were due to aseptic loosening of the
acetabular component and 18.58 % due to luxation.
Chronic infection was the reason for revision
in 11.22 % and early infection in 2.87 % of 802
cases. Table 87 shows the same characteristics
of re-revision THA. The frequency of septic loosening
of the acetabular component was 22.71 %,
aseptic loosening of femoral component was
21.77 %, chronic infection 18.30 % and luxation
17.98 %.
Tab. 86 Characteristics of revision THA (reasons for revision)
Year
Paraarticular
Osifications
Luxation
PolyethyleneWear
EarlyInfection
ChronicInfection
AcetabularyProtrusis
AsepticLoos.ofBoth
Components
AsepticLoos.ofAcet.
Component
AsepticLoos.ofFem.
Component
Osteolysisof
Acetabulum
OsteolysisofFemur
BigBoneDefectof
Acetabulum
BigBoneDefectof
Femur
Periprosthesis
Fracture
FractureofImplant
SpacertoTHA
GirdlestonetoTHA
Other
2003 5 14 8 6 16 28 6 175 136 39 45 14 5 20 39 0 1 15
2004 10 20 18 3 20 17 2 194 165 29 28 21 9 11 32 0 1 15
2005 4 19 12 1 12 17 6 124 126 31 28 14 5 13 16 0 1 22
2006 10 25 28 8 26 32 13 122 147 40 30 12 10 16 11 0 3 11
2007 12 28 14 6 34 20 40 113 105 13 22 6 6 24 18 0 1 5
2008 3 38 15 4 32 11 51 95 109 13 23 12 4 13 11 0 2 10
2009 4 38 28 3 30 22 52 108 133 13 14 13 5 12 19 0 1 13
2010 11 56 21 4 35 27 58 113 108 15 12 12 2 35 17 9 3 19
2011 10 46 29 8 47 19 51 100 108 15 14 19 7 32 15 11 5 7
Nr. of
events RR 95% CI for RR
Mean
survival 95% CI for mean
Paraarticular osifications 16 2.00 1.03 to 2.96 8.08
Luxation 149 18.58 15.89 to 21.27 6.63
Polyethylene wear 25 3.12 1.91 to 4.32 7.80
Early infection 23 2.87 1.71 to 4.02 8.12
Chronic infection 90 11.22 9.04 to 13.41 6.84
Acetabulary protrusis 24 2.99 1.81 to 4.17 7.98
Asept. loosening of acet. comp. 194 24.19 21.23 to 27.15 5.52
Asept. loosening of fem. comp. 244 30.42 27.24 to 33.61 5.00
Osteolysis of acetabulum 24 2.99 1.81 to 4.17 8.05
Osteolysis of femur 27 3.37 2.12 to 4.61 7.94
Big bone defect of acet. 6 0.75 0.15 to 1.34 8.37
Big bone defect of femur 7 0.87 0.23 to 1.52 8.35
Periprosthesis fracture 55 6.86 5.11 to 8.61 7.50
Fracture of implant 17 2.12 1.12 to 3.12 8.18
Asept. loosening of both comp. 45 5.61 4.02 to 7.20 7.48
Spacer to THA 5 0.62 0.08 to 1.17 8.39
Girdlestone to THA 1 0.12 0.00 to 0.37 8.40
2.27 2.12 to 2.43 8.75
Reason for revision
Whole database
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 87 Characteristics of re-revision THA (reasons for revision)
Revised components of implants
Tab. 88 Revision THA – revised components of implants
The revision protocol has eleven options for revised
components. Soft tissue revision was introduced
for the first time in January 2011. In comparison
to 2010, when the whole implant combination
was revised in 35.86 %, during 2011 complete
revision was performed in 32.71 %. The
acetabular component was revised in 20.50 %
and the femoral component in 23.73 %, compared
to 26.95 % in 2010. We have observed an
increased number of head revisions from 6.73 %
in 2010 to 8.98 % in 2011 (table 88).
Revision implants and components
The revision database contains 3,195 records of
revision THA implants. These are revision implants
used after 1 January 2003 and we have
complete data from the primary protocols about
these revision procedures. 32.45 % of these revision
implants were cemented, 30.98 % were
uncemented, 13.58 % were hybrids and 12.26 %
were reverse hybrids. Table 89 shows the characteristics
of the revision THAs – interaction of
gender and type of fixation of revision implants.
Nr. of
events RR 95% CI for RR
Mean
survival 95% CI for mean
Paraarticular osifications 7 2.21 0.59 to 3.83 7.34
Luxation 57 17.98 13.75 to 22.21 5.99
Polyethylene wear 9 2.84 1.01 to 4.67 7.13
Early infection 6 1.89 0.39 to 3.39 7.54
Chronic infection 58 18.30 14.04 to 22.55 5.63
Acetabulary protrusis 12 3.79 1.68 to 5.89 6.87
Asept. loosening of acet. comp. 72 22.71 18.10 to 27.33 4.99
Asept. loosening of fem. comp. 69 21.77 17.22 to 26.31 4.96
Osteolysis of acetabulum 12 3.79 1.68 to 5.89 7.17
Osteolysis of femur 13 4.10 1.92 to 6.28 7.10
Big bone defect of acet. 9 2.84 1.01 to 4.67 7.24
Big bone defect of femur 5 1.58 0.21 to 2.95 7.55
Periprosthesis fracture 15 4.73 2.39 to 7.07 7.11
Fracture of implant 11 3.47 1.46 to 5.48 6.97
Asept. loosening of both comp. 23 7.26 4.40 to 10.11 6.43
Spacer to THA 13 4.10 1.92 to 6.28 7.31
Girdlestone to THA 12 3.79 1.68 to 5.89 7.29
9.92 8.89 to 10.96 8.00
Reason for revision
Whole database
Year
SoftTissue
Revision
WholeSystem
Acetabular
Component
Femoral
Component
Head
Inlay
TotalReplacement
ofBipolar
Hemiarthropl.
Osteosynthesis
Girdlestone
Spacer
Other
2003 0 130 93 69 3 0 0 1 1 0 0
2004 0 141 93 77 8 2 1 0 12 0 0
2005 0 91 76 89 7 1 1 0 10 0 0
2006 0 135 80 92 14 7 0 0 16 0 0
2007 0 131 95 96 8 1 1 0 16 0 0
2008 0 120 86 102 7 0 1 1 21 0 1
2009 0 149 77 111 17 3 1 1 19 5 3
2010 0 165 94 124 31 4 1 1 23 17 0
2011 16 142 89 103 39 3 0 3 22 16 1
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 89 Characteristics of revision THA (interaction of gender and type of fixation)
Table 90 presents the mean age of patients at
the time of revision operation and the type of
revision implant fixation. Uncemented fixation
was used for the youngest group of patients with
a mean age 60.97 years. The cemented type of
fixation was used in patients with a mean age
70.95 years. The mean age of patients who had
hybrid or reverse hybrid fixation was 67.55 years,
and 67.22 years respectively. Chart 85 shows the
cumulative risk of revision THA for whole revision
database, according to the type of fixation. The
lowest risk represents the group of reverse hybrids
with RR 4.59 %. The next two charts show
the cumulative risk of revision in females and in
males.
Chart 85 Cumulative risk of revision THA (type of fixation)
Chart 86 Cumulative risk of revision THA (females, type of
fixation)
Chart 87 Cumulative risk of revision THA (males, type of
fixation)
1883 163 8.66 7.39 to 9.93 8.13
1312 154 11.74 10.00 to 13.48 7.81
3195 317 9.92 8.89 to 10.96 8.00
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 90 Ages of the patients at the time of revision THA (interaction of gender and type of fixation; sd: standard deviation, Q1:
first quartile, Q3: third quartile)
Tab. 91 Characteristics of revision THA (acetabular and femoral components)
Table 91 presents re-revision of components in
291 failures from 5,239 revision components.
Revision of cemented femoral components has
the highest RR at 7.03 %, in contrast to
uncemented revision femoral components with
the lowest RR – 4.40 %. Chart 88 shows the
cumulative risks of failure and compares acetabular
and femoral components. Chart 89 presents
the cumulative risks of revision according
to the component and the type of fixation. Charts
90–91 show cumulative risks of component in
interaction with gender.
Chart 88 Cumulative risk of revision THA (component type) Chart 89 Cumulative risk of revision THA (interaction of component
type and fixation)
Total
number Mean 95% CI for mean SD Min Q1 Median Q3 Max
Uncemented
Cemented
Hybrids
Reverse hybrids
Uncemented
Cemented
Hybrids
Reverse hybrids
Uncemented
Cemented
Hybrids
Reverse hybrids
Whole database total
Whole database
Females
Males
Females total
Males total
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
Acetabular total
Uncemented
Cemented
Femoral total
Uncemented
Cemented
Component type
Whole database total
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Chart 90 Cumulative risk of revision THA (females; interaction
of component type and fixation)
Chart 91 Cumulative risk of revision THA (males; interaction
of component type and fixation)
Table 91 presents the cumulative RR of revision
THA according to the component type and fixation
method. Table 92 and 93 show these characteristics
for females and males. The highest cumulative
RR was observed in the male database
for cemented femoral components – 10.15 % and
the lowest was observed in female database for
uncemented femoral stems with 3.84 %.
Tab. 92 Cumulative characteristics of revision THA (acetabular and femoral components)
Tab. 93 Cumulative characteristics of revision THA (females; acetabular and femoral components)
2003 2004 2005 2006 2007 2008 2009 2010 2011
Acetabular
Uncemented
RR 0.00 0.74 2.32 3.18 4.83 5.42 5.42 5.16 4.98
Cemented
RR 0.62 2.12 2.81 3.39 3.63 3.52 4.14 5.60 5.87
Femoral
Uncemented
RR 0.00 0.80 1.38 2.06 4.43 4.42 4.39 4.58 4.38
Cemented
RR 1.13 2.27 3.61 3.81 4.07 4.66 6.05 6.94 7.01
Component type
2003 2004 2005 2006 2007 2008 2009 2010 2011
Acetabular
Uncemented
RR 0.00 0.74 3.06 3.27 5.35 5.69 5.88 5.30 5.32
Cemented
RR 0.00 0.95 1.67 2.23 2.38 2.28 2.61 4.51 4.97
Femoral
Uncemented
RR 0.00 0.78 1.57 1.98 4.58 4.56 4.25 3.83 3.84
Cemented
RR 0.00 0.45 1.60 1.61 1.85 2.48 3.78 4.88 5.25
Component type
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 94 Cumulative characteristics of revision THA (males; acetabular and femoral components)
Table 95 show cumulative risk of re-revision THA
in one month, three month and yearly intervals
and table 96–97 present these characteristics for
females and males.
Tab. 95 Characteristics of failure of revision THA until certain time point (acetabular and femoral components)
2003 2004 2005 2006 2007 2008 2009 2010 2011
Acetabular
Uncemented Total number 64 134 192 259 330 391 471 560 656
Nr. of f ailures 0 1 3 8 14 20 23 28 30
RR 0.00 0.75 1.56 3.09 4.24 5.12 4.88 5.00 4.57
Cemented Total number 56 119 163 216 267 323 383 443 505
Nr. of f ailures 1 5 8 12 16 19 27 34 38
RR 1.79 4.20 4.91 5.56 5.99 5.88 7.05 7.67 7.52
Femoral
Uncemented Total number 59 122 172 233 306 375 462 547 638
Nr. of f ailures 0 1 2 5 13 16 21 30 32
RR 0.00 0.82 1.16 2.15 4.25 4.27 4.55 5.48 5.02
Cemented Total number 62 133 186 247 296 344 399 465 532
Nr. of f ailures 2 7 13 19 24 30 41 50 54
RR 3.23 5.26 6.99 7.69 8.11 8.72 10.28 10.75 10.15
Component type
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
Acetabular Nr. of failures 9 5 23 36 26 14 7 9 6 4 NA
Cumulative risk (%) 0.346 0.543 1.515 3.231 4.772 5.783 6.432 7.563 8.544 9.683 NA
95% LB 0.118 0.255 1.004 2.412 3.720 4.572 5.114 5.990 6.731 7.416 NA
95% UB 0.574 0.831 2.025 4.050 5.825 6.995 7.750 9.136 10.357 11.949 NA
Uncemented Nr. of failures 6 3 10 17 12 7 3 3 3 1 NA
Cumulative risk (%) 0.464 0.704 1.572 3.229 4.745 5.829 6.416 7.227 8.281 9.008 NA
95% LB 0.089 0.238 0.835 2.087 3.266 4.106 4.551 5.086 5.752 6.105 NA
95% UB 0.839 1.170 2.308 4.371 6.224 7.552 8.281 9.369 10.809 11.911 NA
Cemented Nr. of failures 3 2 13 19 14 7 4 6 3 3 NA
Cumulative risk (%) 0.229 0.384 1.457 3.224 4.790 5.733 6.440 7.859 8.769 10.268 NA
95% LB 0.000 0.046 0.753 2.087 3.355 4.100 4.646 5.638 6.254 7.088 NA
95% UB 0.489 0.723 2.160 4.361 6.224 7.365 8.234 10.079 11.284 13.447 NA
Femoral Nr. of failures 11 5 19 42 22 21 15 9 5 3 NA
Cumulative risk (%) 0.420 0.615 1.416 3.416 4.705 6.209 7.591 8.720 9.536 10.441 NA
95% LB 0.170 0.310 0.929 2.574 3.671 4.942 6.093 7.000 7.629 8.195 NA
95% UB 0.670 0.920 1.902 4.258 5.738 7.475 9.088 10.441 11.443 12.686 NA
Uncemented Nr. of failures 2 2 9 16 7 8 5 3 2 1 NA
Cumulative risk (%) 0.160 0.324 1.129 2.751 3.651 4.973 6.029 6.912 7.682 8.472 NA
95% LB 0.000 0.006 0.490 1.645 2.319 3.296 4.057 4.655 5.142 5.497 NA
95% UB 0.383 0.642 1.767 3.857 4.984 6.651 8.002 9.169 10.221 11.447 NA
Cemented Nr. of failures 9 3 10 26 15 13 10 6 3 2 NA
Cumulative risk (%) 0.655 0.879 1.676 4.007 5.627 7.291 8.911 10.225 11.074 12.067 NA
95% LB 0.223 0.376 0.953 2.769 4.094 5.455 6.755 7.754 8.365 8.971 NA
95% UB 1.087 1.382 2.400 5.246 7.161 9.128 11.067 12.695 13.783 15.162 NA
Component type
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 96 Characteristics of failure of revision THA until certain time point (females; acetabular and femoral components)
Tab. 97 Characteristics of failure of revision THA until certain time point (males; acetabular and femoral components)
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
Acetabular Nr. of failures 5 4 11 19 17 9 4 7 2 3 NA
Cumulative risk (%) 0.321 0.583 1.351 2.829 4.485 5.532 6.140 7.580 8.125 9.445 NA
95% LB 0.038 0.198 0.737 1.878 3.200 4.045 4.524 5.536 5.913 6.653 NA
95% UB 0.604 0.969 1.966 3.780 5.770 7.019 7.757 9.624 10.338 12.236 NA
Uncemented Nr. of failures 5 2 3 12 7 4 2 2 NA NA NA
Cumulative risk (%) 0.715 1.011 1.485 3.619 5.279 6.433 7.173 8.267 NA NA NA
95% LB 0.080 0.251 0.540 1.990 3.190 4.024 4.531 5.135 NA NA NA
95% UB 1.349 1.770 2.431 5.248 7.367 8.841 9.816 11.398 NA NA NA
Cemented Nr. of failures 0 2 8 7 10 5 2 5 2 3 NA
Cumulative risk (%) 0.000 0.236 1.234 2.203 3.856 4.828 5.347 7.030 7.927 NA NA
95% LB 0.000 0.000 0.437 1.098 2.313 3.016 3.384 4.414 4.966 6.003 NA
95% UB 0.000 0.566 2.030 3.307 5.400 6.640 7.311 9.646 10.887 14.242 NA
Femoral Nr. of failures 6 2 8 17 14 11 10 4 2 1 NA
Cumulative risk (%) 0.382 0.513 1.066 2.375 3.703 4.964 6.438 7.273 7.811 8.300 NA
95% LB 0.074 0.154 0.527 1.509 2.547 3.549 4.672 5.287 5.656 5.941 NA
95% UB 0.690 0.871 1.605 3.241 4.859 6.379 8.205 9.258 9.966 10.659 NA
Uncemented Nr. of failures 2 1 2 9 6 5 3 NA NA NA NA
Cumulative risk (%) 0.291 0.439 0.767 2.399 3.789 5.296 6.415 NA NA NA NA
95% LB 0.000 0.000 0.085 1.066 1.966 2.996 3.701 NA NA NA NA
95% UB 0.695 0.935 1.448 3.731 5.611 7.596 9.129 NA NA NA NA
Cemented Nr. of failures 4 1 6 8 8 6 7 4 2 1 NA
Cumulative risk (%) 0.453 0.570 1.295 2.365 3.652 4.764 6.436 7.762 8.628 9.419 NA
95% LB 0.006 0.068 0.515 1.247 2.173 2.998 4.182 5.075 5.624 6.038 NA
95% UB 0.900 1.073 2.075 3.483 5.130 6.530 8.689 10.448 11.633 12.800 NA
Component type
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
Acetabular Nr. of failures 4 1 12 17 9 5 3 2 4 1 NA
Cumulative risk (%) 0.384 0.482 1.765 3.858 5.213 6.167 6.883 7.530 9.175 10.072 NA
95% LB 0.005 0.057 0.877 2.413 3.449 4.172 4.722 5.163 6.166 6.587 NA
95% UB 0.762 0.907 2.653 5.304 6.977 8.162 9.044 9.897 12.185 13.557 NA
Uncemented Nr. of failures 1 1 7 5 5 3 1 1 3 1 NA
Cumulative risk (%) 0.168 0.342 1.674 2.762 4.101 5.111 5.522 6.050 8.203 9.730 NA
95% LB 0.000 0.000 0.520 1.212 2.059 2.714 2.993 3.317 4.312 4.821 NA
95% UB 0.499 0.816 2.829 4.313 6.144 7.509 8.051 8.782 12.095 14.640 NA
Cemented Nr. of failures 3 3 5 12 4 2 2 1 1 NA NA
Cumulative risk (%) 0.666 0.666 1.881 5.281 6.656 7.544 8.671 9.501 10.431 NA NA
95% LB 0.000 0.000 0.317 2.554 3.559 4.183 4.951 5.441 5.981 NA NA
95% UB 1.423 1.736 3.445 8.007 9.753 10.906 12.391 13.561 14.882 NA NA
Femoral Nr. of failures 5 3 11 25 8 10 5 5 3 2 NA
Cumulative risk (%) 0.476 0.768 1.952 5.050 6.276 8.185 9.421 11.029 12.287 13.881 NA
95% LB 0.057 0.234 1.038 3.385 4.355 5.847 6.807 7.965 8.828 9.545 NA
95% UB 0.895 1.302 2.866 6.714 8.197 10.523 12.036 14.092 15.745 18.217 NA
Uncemented Nr. of failures 0 1 7 7 1 3 2 3 2 1 NA
Cumulative risk (%) 0.000 0.183 1.578 3.191 3.482 4.580 5.556 7.490 9.198 10.938 NA
95% LB 0.000 0.000 0.419 1.423 1.624 2.264 2.835 3.851 4.731 5.319 NA
95% UB 0.000 0.541 2.737 4.958 5.339 6.896 8.277 11.129 13.665 16.557 NA
Cemented Nr. of failures 5 2 4 18 7 7 3 2 1 1 NA
Cumulative risk (%) 1.019 1.436 2.381 7.214 9.524 12.355 13.872 15.165 15.962 17.380 NA
95% LB 0.119 0.364 0.941 4.236 5.974 8.108 9.274 10.135 10.695 11.425 NA
95% UB 1.920 2.508 3.820 10.193 13.074 16.602 18.471 20.195 21.229 23.336 NA
Component type
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 98 Characteristics of revision THA (cementing techniques of femoral components)
Table 98 presents the results of 1,380 cemented
revision femoral components in interaction with
type of cementing techniques used. The best
results with RR of 3.94 % were achieved with 3
rd
generation cementing techniques. RR of 1
st
and
2
nd
generation techniques are similar – 8.67 %
and 7.68 % respectively. Charts 92–94 show the
results of cemented revision femoral components
in total, for females and males.
Chart 92 Cumulative risk of revision THA (cementing techniques
of femoral components)
Chart 93 Cumulative risk of revision THA (females; cementing
techniques of femoral components)
Chart 94 Cumulative risk of revision THA (males; cementing
techniques of femoral components)
Tab. 99 Cumulative characteristics of revision THA (cementing techniques of femoral components)
Cumulative RR of cemented revision stems are
shown in table 99. The third generation cementing
techniques compare favourably with 2
nd
and
1
st
generations. Tables 100–101 present these
characteristics for females and males. Tables
102–104 show the cumulative risks of re-revision
THA until certain time points.
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 100 Cumulative characteristics of revision THA (females; cementing techniques of femoral components)
Tab. 101 Cumulative characteristics of revision THA (males; cementing techniques of femoral components)
Tab. 102 Characteristics of failure of revision THA until certain time point (cementing technique of femoral components)
Tab. 103 Characteristics of failure of revision THA until certain time point (females; cementing technique of femoral compo-
nents)
2003 2004 2005 2006 2007 2008 2009 2010 2011
1st generation Total number 46 84 97 125 150 172 195 214 226
Nr. of f ailures 0 1 2 2 2 4 7 11 12
RR 0.00 1.19 2.06 1.60 1.33 2.33 3.59 5.14 5.31
2nd generation Total number 11 32 68 124 172 229 258 307 341
Nr. of f ailures 0 0 2 3 5 8 11 17 21
RR 0.00 0.00 2.94 2.42 2.91 3.49 4.26 5.54 6.16
3rd generation Total number 1 5 15 33 44 57 82 110 126
Nr. of f ailures 0 0 0 1 2 2 5 5 6
RR 0.00 0.00 0.00 3.03 4.55 3.51 6.10 4.55 4.76
Cementing technique
2003 2004 2005 2006 2007 2008 2009 2010 2011
1st generation Total number 33 51 63 70 80 84 97 107 116
Nr. of f ailures 1 2 3 6 8 10 12 15 17
RR 3.03 3.92 4.76 8.57 10.00 11.90 12.37 14.02 14.66
2nd generation Total number 11 34 53 87 108 127 145 173 199
Nr. of f ailures 0 3 5 7 9 11 15 20 21
RR 0.00 8.82 9.43 8.05 8.33 8.66 10.34 11.56 10.55
3rd generation Total number 0 4 13 30 40 51 67 86 100
Nr. of f ailures 0 0 0 0 1 2 3 3 3
RR NA 0.00 0.00 0.00 2.50 3.92 4.48 3.49 3.00
Cementing technique
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
1st generation Nr. of failures 1 1 3 7 5 7 1 3 1 NA NA
Cumulative risk (%) 0.310 0.310 1.290 3.772 5.829 9.121 9.694 11.906 12.736 NA NA
95% LB 0.000 0.000 0.000 1.323 2.691 5.020 5.442 6.855 7.430 NA NA
95% UB 0.918 1.170 2.707 6.222 8.967 13.221 13.945 16.957 18.042 NA NA
2nd generation Nr. of failures 7 2 4 9 6 4 5 5 1 NA NA
Cumulative risk (%) 1.388 1.799 2.687 4.921 6.770 8.351 10.847 10.847 11.952 NA NA
95% LB 0.346 0.609 1.194 2.703 4.041 5.156 6.801 6.100 6.734 NA NA
95% UB 2.430 2.990 4.180 7.139 9.499 11.545 14.894 15.595 17.171 NA NA
3rd generation Nr. of failures 1 1 2 2 2 2 1 NA NA NA NA
Cumulative risk (%) 0.494 0.494 1.548 2.881 4.488 4.488 6.323 NA NA NA NA
95% LB 0.000 0.000 0.000 0.000 0.805 0.150 0.688 NA NA NA NA
95% UB 1.462 1.863 3.589 5.766 8.172 8.826 11.958 NA NA NA NA
Cementing technique
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
1st generation Nr. of failures 0 0 3 3 2 3 3 1 NA NA NA
Cumulative risk (%) 0.000 0.000 1.446 2.986 4.170 6.184 6.184 7.367 NA NA NA
95% LB 0.000 0.000 0.000 0.538 1.212 2.375 1.682 2.303 NA NA NA
95% UB 0.000 0.000 3.114 5.434 7.127 9.992 10.685 12.431 NA NA NA
2nd generation Nr. of failures 3 1 2 3 5 1 4 4 1 NA NA
Cumulative risk (%) 0.931 1.253 1.913 3.018 5.329 5.930 8.919 8.919 10.788 NA NA
95% LB 0.000 0.017 0.374 0.981 2.357 2.733 4.245 3.134 3.941 NA NA
95% UB 1.994 2.489 3.453 5.055 8.301 9.127 13.592 14.704 17.635 NA NA
3rd generation Nr. of failures 1 1 1 1 1 NA NA NA NA NA NA
Cumulative risk (%) 0.897 0.897 1.902 2.995 4.434 NA NA NA NA NA NA
95% LB 0.000 0.000 0.000 0.000 0.000 NA NA NA NA NA NA
95% UB 2.655 3.383 5.074 6.822 9.188 NA NA NA NA NA NA
Cementing technique
© Slovakian Arthroplasty Register 2013
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 104 Characteristics of failure of revision THA until certain time point (males; cementing technique of femoral components)
Tab. 105 Characteristics of revision THA (acetabular, uncemented components)
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr 7 yr 8 yr 9 yr
1st generation Nr. of failures 1 1 1 4 3 4 1 2 1 NA NA
Cumulative risk (%) 0.957 0.957 0.957 5.474 9.505 15.712 17.581 22.096 24.565 NA NA
95% LB 0.000 0.000 0.000 0.000 1.755 5.573 6.800 9.370 10.950 NA NA
95% UB 2.833 3.609 4.206 11.303 17.254 25.850 28.361 34.822 38.180 NA NA
2nd generation Nr. of failures 4 1 2 6 1 3 1 NA NA NA NA
Cumulative risk (%) 2.198 2.771 4.109 8.661 9.550 13.037 14.541 NA NA NA NA
95% LB 0.008 0.310 1.016 3.405 4.013 6.076 6.982 NA NA NA NA
95% UB 4.388 5.232 7.202 13.918 15.088 19.998 22.100 NA NA NA NA
3nd generation Nr. of failures 0 0 1 1 1 NA NA NA NA NA NA
Cumulative risk (%) 0.000 0.000 1.130 2.756 4.591 NA NA NA NA NA NA
95% LB 0.000 0.000 0.000 0.000 0.000 NA NA NA NA NA NA
95% UB 0.000 0.000 3.345 6.637 9.882 NA NA NA NA NA NA
Cementing technique
Component name
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
DURALOC 289 15 5.19 2.63 to 7.75 8.54 8.32 to 8.75
OCTOPUS 104 7 6.73 1.92 to 11.55 8.43 8.07 to 8.80
PINNACLE 92 2 2.17 0.00 to 5.15 5.20 5.03 to 5.37
CLS SPOTORNO 83 3 3.61 0.00 to 7.63 5.34 5.09 to 5.59
NOVAE EVOLUTION 72 3 4.17 0.00 to 8.78 7.80 7.44 to 8.17
TRILOGY 63 4 6.35 0.33 to 12.37 8.36 7.90 to 8.82
DELTA - TT 52 0 0.00 NA 1.91 NA
ZWEYMULLER-ALLOCLASSIC CSF 51 4 7.84 0.46 to 15.22 5.90 5.48 to 6.32
COPTOS 48 0 0.00 NA 6.88 NA
BEZNOSKA (uncem) 46 5 10.87 1.87 to 19.86 7.39 6.40 to 8.39
SF 37 0 0.00 NA 5.59 NA
L-CUP 29 0 0.00 NA 8.93 NA
PLASMACUP 28 0 0.00 NA 7.68 NA
WM ov al 26 0 0.00 NA 4.61 NA
DELTA - PF 14 1 7.14 0.00 to 20.63 1.58 1.46 to 1.71
M-H-shell 14 0 0.00 NA 5.69 NA
TC - rev ision 13 0 0.00 NA 4.35 NA
DELTA 10 0 0.00 NA 3.16 NA
DELTA - FINS 7 0 0.00 NA 2.76 NA
BS - rev ision 7 0 0.00 NA 6.95 NA
WM conical 6 2 33.33 0.00 to 71.05 5.85 9.00 to 9.20
BICON-PLUS 6 1 16.67 0.00 to 46.49 8.02 9.00 to 9.61
RSC - rev ision 5 0 0.00 NA 3.75 NA
ULTIMA UTC 5 0 0.00 NA 5.28 NA
RINGLOC - HIGH WALL 3 0 0.00 NA 4.71 NA
T.O.P. 3 0 0.00 NA 2.13 NA
ASR 3 0 0.00 NA 5.68 NA
ACETABULAR PLATES 2 0 0.00 NA 1.10 NA
ANA.NOVA 2 0 0.00 NA 2.04 NA
COPTOS TH 1 0 0.00 NA 0.16 NA
TRIDENT HEMISPHERICAL SOLID 1 0 0.00 NA 0.08 NA
WM sf erical 1 0 0.00 NA 1.90 NA
BEZNOSKA rev ision 1 0 0.00 NA 4.82 NA
CENTRAMENT 1 0 0.00 NA 7.47 NA
Y-AXIS II 1 0 0.00 NA 8.54 NA
DURALOC OPTION 1 0 0.00 NA 5.64 NA
Uncemented 1298 65 5.01 3.82 to 6.19 8.48
All acetabular 2610 139 5.33 4.46 to 6.19 8.46
Whole database total 5239 291 5.55 4.93 to 6.17 8.44
© Slovakian Arthroplasty Register 2013
© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
During the observed period 2003–2011 we have
registered 1,298 UACs used in revision.
DURALOC acetabular component was used in
22.26 % of all uncemented revision cases, with
RR of 5.19 % and mean survival time 8.54 years.
Table 105 shows the results of UACs. .
Tab. 106 Characteristics of revision THA (acetabular, cemented components)
Chart 95 Cumulative risk of revision THA, acetabular component
BEZNOSKA (cem)
Chart 96 Cumulative risk of revision THA, acetabular component
DURALOC
Chart 97 Cumulative risk of revision THA, acetabular component
O2
Chart 98 Cumulative risk of revision THA, acetabular component
CHARNLEY
Component name
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
BEZNOSKA (cem) 714 60 8.40 6.37 to 10.44 8.20 8.02 to 8.38
O2 123 3 2.44 0.00 to 5.17 3.98 3.81 to 4.14
CHARNLEY 110 8 7.27 2.42 to 12.13 8.14 7.72 to 8.56
MULLER 110 1 0.91 0.00 to 2.68 8.86 9.00 to 9.01
ULTIMA MK2 90 0 0.00 NA 8.97 NA
PE-CUP 68 0 0.00 NA 8.56 NA
ELITE PLUS 58 3 5.17 0.00 to 10.87 8.40 7.89 to 8.92
LUBINUS CLASSIC PLUS 39 4 10.26 0.73 to 19.78 8.08 7.33 to 8.84
BURCH-SCHNEIDER CAGE 16 0 0.00 NA 5.69 NA
EXETER Contemporary Cup 13 0 0.00 NA 3.88 NA
MUELLER 12 0 0.00 NA 2.70 NA
MULLER LOW PROFILE 9 0 0.00 NA 6.60 NA
ZCA 6 0 0.00 NA 8.53 NA
ZWEYM LLER-ALLOCLASSIC 5 0 0.00 NA 7.30 NA
TRILOC 1 0 0.00 NA 0.08 NA
EXETER Duration Cup 1 0 0.00 NA 1.26 NA
SF/A 1 0 0.00 NA 5.53 NA
Cemented 1312 74 5.64 4.39 to 6.89 8.45
All acetabular 2610 139 5.33 4.46 to 6.19 8.46
Whole database total 5239 291 5.55 4.93 to 6.17 8.44
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Table 106 shows 17 CACs used in revisions. The
most-used cemented cup was BEZNOSKA (cem)
with 54.42 % of all applications and with RR of
8.40 %. Charts 95–98 show cumulative risks of
revision of the four most-used ACs in revision
surgery, regardless of the type of fixation.
Tab. 107 Characteristics of revision THA (femoral, uncemented components)
Table 107 show 33 UFSs used in revision surgery.
We have records of 1,249 such stems. Five
of them have reached more than 100 applications,
with a 56.36 % share. Seventeen of them
have less than ten implantations during the observed
period. Table 108 shows results of 27
CFSs Only the BEZNOSKA cemented stem has
reached more than 100 implantations and has
60.50 % share, with a RR of 7.90 %. Fourteen
stems were implanted less than ten each, with a
total 3.55 % share. The RR of this whole database
reached 5.55 %. Charts 99–102 show cumulative
risks of revision of the four most-used
stems, regardless of the type of fixation.
SOLUTION 230 9 3.91 1.41 to 6.42 8.59 8.36 to 8.81
ZMR 135 4 2.96 0.10 to 5.82 8.52 8.23 to 8.82
S-ROM 132 1 0.76 0.00 to 2.24 8.78 8.65 to 8.91
MP 106 7 6.60 1.88 to 11.33 8.47 8.11 to 8.83
REVISION 101 1 0.99 0.00 to 2.92 3.45 3.37 to 3.53
AML 92 4 4.35 0.18 to 8.51 8.58 8.23 to 8.93
RMD rev ision 87 1 1.15 0.00 to 3.39 5.46 5.31 to 5.62
SAGITA EVOLUTION HA 58 2 3.45 0.00 to 8.14 7.57 7.13 to 8.01
SF 49 1 2.04 0.00 to 6.00 8.7 9.00 to 9.04
ZWEYMULLER-ALLOCLASICS SL 43 2 4.65 0.00 to 10.95 6.48 6.00 to 6.96
BICONTACT 38 0 0.00 NA 6.61 NA
CORAIL 33 2 6.06 0.00 to 14.20 5.95 5.44 to 6.47
BIMETRIC (uncem) 28 1 3.57 0.00 to 10.45 8.53 9.00 to 9.07
WM HA 22 1 4.55 0.00 to 13.25 8.26 7.54 to 8.98
SF - rev izny 20 0 0.00 NA 5.32 NA
VERSYS 15 1 6.67 0.00 to 19.29 7.37 6.50 to 8.24
CLS SPOTORNO 9 0 0.00 NA 4.34 NA
VERSYS FMMC 9 1 11.11 0.00 to 31.64 4.04 3.70 to 4.37
SL-PLUS 9 1 11.11 0.00 to 31.64 7.87 9.00 to 9.61
LIBRA HA 7 1 14.29 0.00 to 40.21 2.55 1.68 to 3.42
LOGICA (uncem) 6 0 0.00 NA 2.85 NA
VERSYS FMT 5 1 20.00 0.00 to 55.06 3.97 3.76 to 4.17
REEF 3 0 0.00 NA 0.66 NA
SAM - FIT 3 0 0.00 NA 1.03 NA
PROXIMA 3 0 0.00 NA 2.14 NA
ASR 2 0 0.00 NA 5.64 NA
SAGITTA EVL R 1 0 0.00 NA 5.08 NA
TRI-LOCK BPS 1 0 0.00 NA 0.51 NA
TRIO modular (uncem) 1 0 0.00 NA 0.55 NA
TRIO (uncem) 1 0 0.00 NA 0.18 NA
MODULUS 1 0 0.00 NA 1.32 NA
SL (uncem) 1 0 0.00 NA 2.14 NA
C.F.P. 1 0 0.00 NA 6.93 NA
Uncemented 1249 55 4.40 3.27 to 5.54 8.53 8.42 to 8.64
All femoral 2629 152 5.78 4.89 to 6.67 8.42 8.34 to 8.50
Whole database total 5239 291 5.55 4.93 to 6.17 8.44 8.38 to 8.50
© Slovakian Arthroplasty Register 2013
80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 108 Characteristics of revision THA (femoral, cemented components)
Chart 99 Cumulative risk of revision THA, femoral component
BEZNOSKA
Chart 100 Cumulative risk of revision THA, femoral component
SOLUTION
Chart 101 Cumulative risk of revision THA, femoral component
ZMR
Chart 102 Cumulative risk of revision THA, femoral component
MP
Component name
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
BEZNOSKA 835 66 7.90 6.07 to 9.73 8.27 8.11 to 8.43
CHARNLEY 80 7 8.75 2.56 to 14.94 8.07 7.58 to 8.55
ELITE PLUS 78 6 7.69 1.78 to 13.61 8.22 7.71 to 8.73
BIMETRIC (cem) 72 2 2.78 0.00 to 6.57 8.41 8.08 to 8.75
CSC 59 2 3.39 0.00 to 8.01 6.41 6.06 to 6.76
CENTRAMENT 52 1 1.92 0.00 to 5.66 7.26 7.01 to 7.51
SAGITA EVOLUTION 52 0 0.00 NA 8.14 NA
EXETER V40 24 0 0.00 NA 7.98 NA
BEZNOSKA - custom-made, tumor. 24 2 8.33 0.00 to 19.39 6.86 5.96 to 7.76
C-STEM 20 1 5.00 0.00 to 14.55 5.67 5.16 to 6.18
LUBINUS CLASSIC PLUS 17 6 35.29 12.58 to 58.01 6.89 5.50 to 8.29
CPT 14 0 0.00 NA 6.95 NA
BEZNOSKA hemiarthropl. 13 0 0.00 NA 6.97 NA
LOGICA (cem) 8 0 0.00 NA 2.85 NA
TRILLIANCE 7 0 0.00 NA 1.99 NA
MULLER GERADSCHAFT 5 2 40.00 0.00 to 82.94 5.15 4.10 to 6.20
CHARNLEY MODULAR 5 1 20.00 0.00 to 55.06 2.73 0.88 to 4.57
ULTIMA-STREIGHT STEM 5 0 0.00 NA 8.46 NA
SL (cem) 4 0 0.00 NA 2.17 NA
C-STEM AMT 3 0 0.00 NA 0.62 NA
ULTIMA-HOWSE II 3 1 33.33 0.00 to 86.68 6.50 4.79 to 8.21
CORAIL (cem) 2 0 0.00 NA 0.81 NA
FJORD 2 0 0.00 NA 1.88 NA
CSC hemiarthropl. 2 0 0.00 NA 3.70 NA
LIBRA 1 0 0.00 NA 0.63 NA
ENDO-MODELL saddle 1 0 0.00 NA 5.07 NA
AUSTIN-MOORE hemiarthropl. 1 0 0.00 NA 6.85 NA
Cemented 1380 97 7.03 5.68 to 8.38 8.32
All femoral 2629 152 5.78 4.89 to 6.67 8.42
Whole database total 5239 291 5.55 4.93 to 6.17 8.44
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© Slovakian Arthroplasty Register 2013
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tables 109–112 show the results of component
combinations. Table 109 shows 38 combinations
of uncemented components. Only the combination
DURALOC/SOLUTION reached more than
50 implantations during observed time period,
with a 13.43 % share. Table 110 shows 20 combinations
of cemented components. BEZNOSKA
(cem)/BEZNOSKA reached 467 implantations,
with a 53.0 % share. Table 111 shows 15 hybrid
combinations and table 112 shows 20 reverse
hybrid combinations. .
Tab. 109 Characteristics of revision THA – component combinations (uncemented)
Acetabular Femoral
Total
number
Nr. of
failures RR
Nr. of
failures RR
Nr. of
failures RR
Duraloc Solution 68 2 2.94 0 0.00 2 2.94
Octopus Solution 34 2 5.88 2 5.88 2 5.88
Duraloc MP 31 5 16.13 1 3.23 4 12.90
Duraloc AML 29 2 6.90 0 0.00 2 6.90
Coptos Sagita Ev olution HA 25 0 0.00 0 0.00 0 0.00
Nov ae Ev olution Sagita Ev olution HA 23 1 4.35 1 4.35 1 4.35
Delta - TT Rev ision 20 0 0.00 0 0.00 0 0.00
Trilogy ZMR 19 1 5.26 1 5.26 1 5.26
Pinnacle Solution 17 0 0.00 0 0.00 0 0.00
Duraloc S-ROM 16 0 0.00 0 0.00 0 0.00
Pinnacle S-ROM 16 1 6.25 1 6.25 0 0.00
Zwey muller Alloclassic CSF Zwey muller Alloclassic SL 15 1 6.67 1 6.67 1 6.67
Duraloc ZMR 14 1 7.14 1 7.14 1 7.14
SF SF 11 0 0.00 0 0.00 0 0.00
Pinnacle RMD revision 10 0 0.00 0 0.00 0 0.00
Pinnacle AML 10 0 0.00 0 0.00 0 0.00
Zwey muller Alloclassic CSF ZMR 9 1 11.11 1 11.11 0 0.00
Duraloc Corail 9 1 11.11 0 0.00 1 11.11
SF RMD rev ision 8 0 0.00 0 0.00 0 0.00
WM oval RMD revision 8 0 0.00 0 0.00 0 0.00
Pinnacle Corail 8 1 12.50 1 12.50 1 12.50
CLS Spotorno CLS Spotorno 8 0 0.00 0 0.00 0 0.00
Zweymuller Alloclassic CSF Solution 8 1 12.50 1 12.50 0 0.00
Duraloc Revision 8 1 12.50 1 12.50 1 12.50
CLS Spotorno ZMR 7 1 14.29 1 14.29 1 14.29
Octopus S-ROM 7 2 28.57 2 28.57 1 14.29
Octopus AML 7 0 0.00 0 0.00 0 0.00
Nov ae Ev olution Libra HA 7 1 14.29 1 14.29 1 14.29
Plasmacup Bicontact 6 0 0.00 0 0.00 0 0.00
L-Cup S-ROM 6 0 0.00 0 0.00 0 0.00
Duraloc RMD revision 6 0 0.00 0 0.00 0 0.00
Delta Rev ision 6 0 0.00 0 0.00 0 0.00
CLS Spotorno AML 5 1 20.00 1 20.00 0 0.00
CLS Spotorno Solution 5 0 0.00 0 0.00 0 0.00
WM oval Solution 5 1 20.00 0 0.00 1 20.00
Beznoska (uncem) SF 5 1 20.00 1 20.00 0 0.00
Trilogy Versy s 5 1 20.00 0 0.00 1 20.00
PF Rev ision 5 0 0.00 0 0.00 0 0.00
Component name Implants Acetabular Femoral
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 110 Characteristics of revision THA – components combinations (cemented)
Tab. 111 Characteristics of revision THA – components combinations (hybrids)
Acetabular Femoral
Total
number
Nr. of
failures RR
Nr. of
failures RR
Nr. of
failures RR
Beznoska (cem) Beznoska 467 70 14.99 52 11.13 50 10.71
Charnley Charnley 57 5 8.77 3 5.26 4 7.02
Ultima MK2 Beznoska 55 0 0.00 0 0.00 0 0.00
O2 Beznoska 39 2 5.13 2 5.13 1 2.56
Muller Bimetric (cem) 39 0 0.00 0 0.00 0 0.00
Muller Beznoska 34 1 2.94 1 2.94 1 2.94
Beznoska (cem) Rev ision stem (cem) 22 0 0.00 0 0.00 0 0.00
Beznoska (cem) CSC 21 1 4.76 1 4.76 1 4.76
O2 CSC 21 0 0.00 0 0.00 0 0.00
PE-Cup Beznoska 21 1 4.76 0 0.00 1 4.76
PE-Cup Centrament 20 0 0.00 0 0.00 0 0.00
Elite Plus Elite Plus 17 2 11.76 0 0.00 2 11.76
Beznoska (cem) Beznoska - custom-made, tumor. 13 2 15.38 2 15.38 0 0.00
Lubinus Classic Plus Lubinus Classic Plus 11 3 27.27 2 18.18 3 27.27
Exeter Contemporary Cup Exeter V40 11 0 0.00 0 0.00 0 0.00
Elite Plus Beznoska 9 3 33.33 3 33.33 3 33.33
Beznoska (cem) Bimetric (cem) 8 1 12.50 1 12.50 1 12.50
Beznoska (cem) Centrament 6 1 16.67 1 16.67 0 0.00
Ultima MK2 C-Stem 5 1 20.00 0 0.00 1 20.00
Elite Plus Charnley 5 0 0.00 0 0.00 0 0.00
Component name Implants Acetabular Femoral
Acetabular Femoral
Total
number
Nr. of
failures RR
Nr. of
failures RR
Nr. of
failures RR
Nov ae Ev olution Sagita Ev olution 31 0 0.00 0 0.00 0 0.00
Duraloc Beznoska 27 6 22.22 5 18.52 3 11.11
CLS Spotorno Beznoska 25 0 0.00 0 0.00 0 0.00
Octopus Beznoska 23 1 4.35 1 4.35 1 4.35
Beznoska (uncem) Beznoska 20 5 25.00 4 20.00 3 15.00
Zweymuller Alloclassic CSF Beznoska 14 1 7.14 1 7.14 1 7.14
Coptos Sagita Ev olution 13 0 0.00 0 0.00 0 0.00
Duraloc Charnley 12 3 25.00 1 8.33 3 25.00
SF Beznoska 10 0 0.00 0 0.00 0 0.00
WM oval Beznoska 8 0 0.00 0 0.00 0 0.00
Pinnacle Beznoska 8 0 0.00 0 0.00 0 0.00
Plasmacup Centrament 7 1 14.29 0 0.00 1 14.29
Duraloc Elite Plus 7 2 28.57 1 14.29 2 28.57
Trilogy Beznoska 6 0 0.00 0 0.00 0 0.00
Plasmacup Beznoska 5 0 0.00 0 0.00 0 0.00
Component name Implants Acetabular Femoral
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 112 Characteristics of revision THA – components combinations (reverse hybrids)
Antibiotic prophylaxis in revision THA
Tab. 113 Revision THA – antibiotic prophylaxis in 2011 (brands, numbers)
In 2011, antibiotic prophylaxis was used in
98.61 % of all revision THAs. Table 113 shows
the brands and the number of cases when antibiotic
prophylaxis was used. Vulmizolin was the
most-used brand, administered in 51.75 % of all
revision THAs.
. .
Acetabular Femoral
Total
number
Nr. of
failures RR
Nr. of
failures RR
Nr. of
failures RR
Lubinus Classic Plus MP 23 1 4.35 1 4.35 0 0.00
Beznoska (cem) ZMR 21 0 0.00 0 0.00 0 0.00
Beznoska (cem) Solution 20 1 5.00 1 5.00 1 5.00
Muller MP 13 0 0.00 0 0.00 0 0.00
Beznoska (cem) S-ROM 11 0 0.00 0 0.00 0 0.00
Beznoska (cem) SF 10 0 0.00 0 0.00 0 0.00
Beznoska (cem) RMD rev ision 10 1 10.00 1 10.00 0 0.00
Charnley S-ROM 10 2 20.00 2 20.00 0 0.00
Beznoska (cem) AML 9 1 11.11 1 11.11 0 0.00
Charnley Solution 9 0 0.00 0 0.00 0 0.00
Beznoska (cem) Zweymuller Alloclassic SL 9 0 0.00 0 0.00 0 0.00
Charnley RMD revision 9 1 11.11 1 11.11 1 11.11
PE-Cup Bicontact 7 0 0.00 0 0.00 0 0.00
O2 RMD rev ision 7 0 0.00 0 0.00 0 0.00
Muller Bimetric (uncem) 7 0 0.00 0 0.00 0 0.00
Charnley Revision 7 0 0.00 0 0.00 0 0.00
Beznoska (cem) WM HA 6 0 0.00 0 0.00 0 0.00
O2 Bicontact 6 0 0.00 0 0.00 0 0.00
Beznoska (cem) SF rev ision 5 0 0.00 0 0.00 0 0.00
O2 Revision 5 0 0.00 0 0.00 0 0.00
Component name Implants Acetabular Femoral
Brand
Vulmizolin
Edicin
Axetine
Bitamon
Climicin
Ciphin
Unasyn
Cefotaxim
Dalacin
Abactal
Fortun
Oxacilín
Vankomycin
Amoxiklav
Cefobid
Ciprinol
Gentamycin
Kefzol
Xorim
Zinacef
221 56 54 28 21 16 7 4 4 3 2 2 2 1 1 1 1 1 1 1
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Primary Total Knee Arthroplasty
The TKA register was officially launched on the 1
January 2006. In 2011 we received TKA data
from 31 departments. These 31 departments
performed 2,679 primary TKAs and 116 revision
TKAs. During the observation period 2006–2011
we have received a total of 10,772 primary and
411 revision TKA protocols.
Tab. 114 Number of primary and revision TKAs
We are using the same statistical methods as for
the THA. Table 114 and chart 103 show development
of the data for primary and revision
TKAs. In 2011 three times more primary TKAs
were performed than in 2006 and 5.8 times more
revisions than in 2006.
Chart 103 Number of primary and revision TKAs
In 2011 the RR reached 4.33 %, which is 0.13 %
less than in 2010, but the tendency for RR is
growing.
Chart 104 Primary TKA – revision rate
For this analysis, all failed TKAs were used, but
our statistical methodology does not permit the
inclusion of revisions before the start of TKA registry
and therefore the RR in the chapter on revision
TKA, which uses the whole database for
deeper statistical analysis, is 1.80 %. Chart 105
shows the evolution of TKA incidence from 2006
to 2011. For primary TKA the growth of incidence
reached 49.57 per 100.000 inhabitants in 2011,
which is almost three times that in 2006, when it
was 16.54. Table 115 and chart 106 show gender
distribution of patients with primary TKA. There is
no significant alteration in the gender ratio and in
2011 it was 67.53 % females to 32.47 % males
for primary TKA. In 2006 the gender ratio was
70.29 % females to 29.70 % males.
Chart 105 Primary TKA – incidence per 100,000 inhabitants
Tab. 115 Primary TKA – gender distribution
Chart 106 Primary TKA – gender distribution
Year Primary Rev ision
2006 892 20
2007 1363 42
2008 1611 51
2009 2028 84
2010 2199 98
2011 2679 116
Year Female Male
2006 627 265
2007 921 442
2008 1107 504
2009 1393 635
2010 1481 718
2011 1809 870
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Age groups
Table 116 show the interaction of gender and
age groups. In females only 8.20 % of patients
were in the age group less than 55 years, in
males it was 13.82 %. The age group 65–75
years represents 46.69 % in females and
36.71 % in males. The highest RR was recorded
in males in the age group less than 55 years and
reached 2.74 %. In females in the same age
group the RR was 2.66 %.
Tab.116 Characteristics of primary TKA (interaction of gender and age groups)
Chart 107 Cumulative risk of prim. TKA (gender)
Chart 108 Cumulative risk of prim. TKA (age groups)
Chart 109 Cumulative risk of prim. TKA (females, age groups)
Chart 110 Cumulative risk of prim. TKA (males, age groups)
Table 117 shows the age groups of patients with
primary TKA according to the methodology of the
national Statistical Office. In this year, for the first
time in the history of the SAR we have recorded
at least one TKA in every age group. For the age
group less than 55 years we have recorded a
decrease from 9.11 % in 2010 to 7.87 % in 2011.
For the age group 55–65 years the share only
decreased from 32.66 % in 2010 to 32.58 % in
2011.
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Females
Females total
Males
Males total
Whole database total
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 117 Primary TKA – age groups
The age group 65–75 years rose from 42.58 % in
2010 to 44.60 % in 2011. The most significant
decrease compared to 2006 was observed in the
age group more than 75 years, from 24.66 % to
14.93 %. Table 118 and chart 111 show probabilities
of primary TKA in the different age groups.
Tab. 118 Frequency of primary TKA (age groups; in %)
Chart 111 Frequency of primary TKA (age groups; in %)
Table 119 and chart 112 show these analyses for
females. The probability of primary TKA in the
age group less than 55 years has a tendency to
decrease. Table 120 and chart 113 show this
analysis for males.
Tab. 119 Frequency of primary TKA (females; age groups; in %)
Chart 112 Frequency of primary TKA (females; age groups; in %)
Year <15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 >85
0 0 0 0 0 2 1 11 24 93 152 207 184 167 46 7
0 1 0 0 2 7 10 8 65 128 212 305 333 211 70 11
1 1 1 2 5 5 7 23 74 179 297 391 339 228 52 6
0 0 3 1 2 4 11 29 124 272 357 539 359 273 43 11
1 2 0 5 0 9 7 38 139 281 437 511 426 282 55 6
1 1 1 3 3 4 10 41 147 344 529 624 571 334 59 7
2006 2007 2008 2009 2010 2011
[min,55] yrs 10.99 11.59 9.99 9.62 10.14 9.03
(55,65] yrs 34.75 30.37 33.19 32.69 33.79 33.45
(65,75] yrs 43.61 46.00 44.79 42.95 41.84 43.75
(75,max] yrs 10.65 12.03 12.03 14.74 14.23 13.77
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006 2007 2008 2009 2010 2011
2006 2007 2008 2009 2010 2011
[min,55] yrs 8.93 9.23 8.03 8.33 8.37 7.30
(55,65] yrs 33.49 29.64 31.59 30.94 30.86 30.24
(65,75] yrs 46.89 48.43 48.38 46.09 44.97 47.37
(75,max] yrs 10.69 12.70 12.00 14.64 15.80 15.09
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006 2007 2008 2009 2010 2011
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 120 Frequency of primary TKA (males; age groups; in %)
Chart 113 Frequency of primary TKA (males; age groups; in %)
The next analysis reported is the probability of
failure of primary TKA for the whole database –
table 121 and chart 114, for females – table 122
and chart 115 and for males – table 123 and
chart 116.
Tab. 121 Frequency of failure of primary TKA in a particular year (age groups; in %)
Chart 114 Frequency of failure of primary TKA in a particular year (age groups; in %)
Tab. 122 Frequency of failure of primary TKA in a particular year (females; age groups; in %)
2006 2007 2008 2009 2010 2011
[min,55] yrs 15.85 16.52 14.29 12.44 13.79 12.64
(55,65] yrs 37.74 31.90 36.71 36.54 39.83 40.11
(65,75] yrs 35.85 40.95 36.90 36.06 35.38 36.21
(75,max] yrs 10.57 10.63 12.10 14.96 11.00 11.03
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006 2007 2008 2009 2010 2011
2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006 2007 2008 2009 2010 2011
2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Chart 115 Frequency of failure of primary TKA in a particular year (females; age groups; in %)
Tab. 123 Frequency of failure of primary TKA in a particular year (males; age groups; in %)
Chart 116 Frequency of failure of primary TKA in a particular year (males; age groups; in %)
The last new analysis is the failure rate in primary
TKA according to the age groups, which is not
cumulative. We have recorded all failures at one
month, three month and twelve months for each
year. Table 124 and chart 117 shows the results
in percentages for the whole database, table 125
and chart 118 for females and table 126 and
chart 119 for males.
Tab. 124 Probability of failure of primary TKA until certain time point (age groups; not cumulative; in %)
Chart 117 Probability of failure of primary TKA until certain time point (age groups; not cumulative; in %)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006 2007 2008 2009 2010 2011
2006 2007 2008 2009 2010 2011
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006 2007 2008 2009 2010 2011
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr
[min,55] yrs
(55,65] yrs
(65,75] yrs
(75,max] yrs
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr
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80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 125 Probability of failure of primary TKA until certain time point (females; age groups; not cumulative; in %)
Chart 118 Probability of failure of primary TKA until certain time point (females; age groups; not cumulative; in %)
Tab. 126 Probability of failure of primary TKA until certain time point (males; age groups; not cumulative; in %)
Chart 119 Probability of failure of primary TKA until certain time point (males; age groups; not cumulative; in %)
Tab. 127 Primary TKA – indicative diagnoses
Chart. 120 Primary TKA – indicative diagnoses
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr
[min,55] yrs 0.00 10.98 9.60 12.06 7.76 8.88 11.11 8.43
(55,65] yrs 18.75 26.83 34.34 29.96 28.77 33.73 30.07 38.55
(65,75] yrs 75.00 51.22 39.39 40.08 50.23 44.38 46.41 39.76
(75,max] yrs 6.25 10.98 16.67 17.90 13.24 13.02 12.42 13.25
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr
[min,55] yrs 5.88 8.62 7.20 3.05 9.40 11.21 15.46 7.58
(55,65] yrs 23.53 24.14 36.80 43.29 32.21 34.48 20.62 31.82
(65,75] yrs 58.82 58.62 36.80 43.90 42.28 45.69 51.55 48.48
(75,max] yrs 11.76 8.62 19.20 9.76 16.11 8.62 12.37 12.12
Age groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 m 3 m 1 yr 2 yr 3 yr 4 yr 5 yr 6 yr
Year
Primary
Monocondylar
Arthrosis
Primary
Bicondylar
Arthrosis
Posttraumatic
Arthrosis
Aseptic
Necrosis
Rheumatoid
Arthritis
Other
52 762 29 5 26 3
76 1 152 80 7 30 12
77 1 374 91 8 49 9
116 1 788 71 7 33 8
190 1 880 73 4 31 20
133 2410 77 4 37 18
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
The main diagnosis recorded as the reason for
primary TKA in 2011 was still primary bicondylar
DJD of the knee. The primary bicondylar DJD
accounted for a share of 89.95 % in 2011. In
comparison to the 2010, there was a significant
shift, this diagnosis accounting for 93.62 % in
2010. The second most common diagnosis, posttraumatic
DJD, reached a share of 2.87 %. Table
128 shows the distribution of diagnoses in the
whole database. .
Tab. 128 Characteristics of primary TKA (diagnoses)
Table 129 shows the interaction between age
groups and diagnoses. The highest RR was recorded
in the age group less than 55 years –
2.69 %. The RR is decreasing with the age of the
patients. The lowest RR of 0.56 % was recorded
in the age group over 75 years. The RR of whole
database is 1.80 %.
Tab. 129 Characteristics of primary TKA (interaction of age groups and diagnosis)
Table 130 shows these data for females and for
males. The RR for primary monocondylar arthrosis
in females is 4.23 %, which is 2.3 times more
than the mean RR of whole database!
Primary monocond. arthrosis 645 20 3.10 1.76 to 4.44 5.74 5.65 to 5.83
Primary bicondylar arthrosis 9366 127 1.36 1.12 to 1.59 5.88 5.87 to 5.90
Posttraumatic coxarthrosis 421 12 2.85 1.26 to 4.44 5.66 5.57 to 5.76
Aseptic necrosis 35 0 0.00 NA 5.89 NA
Rheumatoid arthritis 206 3 1.46 0.00 to 3.09 5.80 5.69 to 5.90
1.80 1.55 to 2.05 5.85 5.84 to 5.87
Primary monocond. arthrosis 73 2 2.74 0.00 to 6.48 5.53 5.30 to 5.77
Primary bicondylar arthrosis 800 17 2.12 1.13 to 3.12 5.80 5.73 to 5.86
Posttraumatic coxarthrosis 102 5 4.90 0.71 to 9.09 5.44 5.20 to 5.68
Aseptic necrosis 2 0 0.00 NA 5.89 NA
Rheumatoid arthritis 61 0 0.00 NA 5.78 NA
1077 29 2.69 1.73 to 3.66 5.76 5.70 to 5.83
Primary monocond. arthrosis 243 10 4.12 1.62 to 6.61 5.67 5.50 to 5.84
Primary bicondylar arthrosis 3054 47 1.54 1.10 to 1.98 5.87 5.84 to 5.90
Posttraumatic coxarthrosis 156 4 2.56 0.08 to 5.04 5.68 5.53 to 5.83
Aseptic necrosis 6 0 0.00 NA 5.57 NA
Rheumatoid arthritis 70 1 1.43 0.00 to 4.21 5.74 5.46 to 6.02
3561 77 2.16 1.68 to 2.64 5.82 5.79 to 5.86
Primary monocond. arthrosis 242 7 2.89 0.78 to 5.00 5.67 5.52 to 5.81
Primary bicondylar arthrosis 4226 56 1.33 0.98 to 1.67 5.88 5.86 to 5.91
Posttraumatic coxarthrosis 131 3 2.29 0.00 to 4.85 5.30 5.17 to 5.43
Aseptic necrosis 19 0 0.00 NA 5.88 NA
Rheumatoid arthritis 56 2 3.57 0.00 to 8.43 5.69 5.42 to 5.95
4702 80 1.70 1.33 to 2.07 5.86 5.83 to 5.88
Primary monocond. arthrosis 87 1 1.15 0.00 to 3.39 5.88 5.74 to 6.03
Primary bicondylar arthrosis 1286 7 0.54 0.14 to 0.95 5.94 5.91 to 5.97
Posttraumatic coxarthrosis 32 0 0.00 NA 5.63 NA
Aseptic necrosis 8 0 0.00 NA 4.17 NA
Rheumatoid arthritis 19 0 0.00 NA 5.78 NA
1434 8 0.56 0.17 to 0.94 5.94 5.91 to 5.96
10774 194 1.80 1.55 to 2.05 5.85 5.84 to 5.87
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 130 Characteristics of primary TKA (interaction of gender and diagnoses)
Tab. 131 Primary TKA – surgical approaches
Chart 121 Primary TKA – surgical approaches
Two approaches, medial parapatellar and midvastus,
were predominant in 2011. Medial
parapatellar increased from 74.26 % in 2010 to
77.64 % in 2011, in contrast to the mid-vastus
approach, which decreased from 23.69 % to
20.86 %. The lateral parapatellar approach was
used in only 22 cases (0.82 %). The two mostly
used approaches reached a combined share of
98.5 %. Table 131 and chart 121 present all approaches
used for primary TKA.
Tab. 132 Primary TKA – types of implants used
Table 132 and chart 122 shows the types of implants
used. The commonest were bicondylar
implants, used in 2011 in 98.91 % of cases,
compared to 97.27 % of cases in 2010. Hemiarthroplasty
was used in 29 cases – 1.08 %.
Chart 122 Primary TKA – types of implants used
Primary monocond. arthrosis 449 19 4.23 2.37 to 6.09 5.67 5.54 to 5.79
Primary bicondylar arthrosis 6463 78 1.21 0.94 to 1.47 5.90 5.88 to 5.91
Posttraumatic coxarthrosis 197 6 3.05 0.65 to 5.45 5.66 5.52 to 5.80
Aseptic necrosis 24 0 0.00 NA 5.57 NA
Rheumatoid arthritis 161 3 1.86 0.00 to 3.95 5.77 5.64 to 5.91
7339 124 1.69 1.39 to 1.98 5.86 5.84 to 5.88
Primary monocond. arthrosis 196 1 0.51 0.00 to 1.51 5.83 5.77 to 5.89
Primary bicondylar arthrosis 2903 49 1.69 1.22 to 2.16 5.85 5.82 to 5.89
Posttraumatic coxarthrosis 224 6 2.68 0.56 to 4.79 5.45 5.33 to 5.58
Aseptic necrosis 11 0 0.00 NA 5.89 NA
Rheumatoid arthritis 45 0 0.00 NA 5.70 NA
3435 70 2.04 1.57 to 2.51 5.83 5.80 to 5.86
10774 194 1.80 1.55 to 2.05 5.85 5.84 to 5.87
Year
Mid-vastus
Medial
Parapatellar
Lateral
Parapatellar
Subvastus
Tubercle
Osteotomy
Other
Not.Ident.
195 668 4 9 1 0 15
364 964 18 7 3 1 6
444 1105 30 25 0 4 3
492 1489 19 12 0 11 5
521 1633 28 14 1 1 1
559 2080 22 14 2 2 0
Year Unicondy lar Bicondy lar
29 863
59 1304
41 1570
35 1993
60 2139
29 2650
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Types of the fixation
Tab. 133 Primary TKA – types of the fixation
In 98.54 % of all TKAs, bone cement was used
for fixation of both components. This represents a
slight increase compared with 2010 when cement
fixation was used in 97.04 %.
Chart 123 Primary TKA – types of the fixation
There has been a small decrease in uncemented
fixations from 1.36 % in 2010 to 1.19 % in 2011.
There was a significant decrease in hybrid fixations
from 1.59 % to 0.26 %.
Tab. 134 Characteristics of primary TKA (interaction of gender and type of fixation)
Table 134 shows the interaction between gender
and type of fixation. In females uncemented
TKAs have a significantly higher RR than all other
types of fixation. With a RR of 6.0 %, this
group is 3.3 times higher than the whole database.
Table 135 shows the interaction between
gender, age groups and types of fixation. The
highest RR of 4.0 % was in uncemented TKAs.
Tab. 135 Characteristics of primary TKA(gender, age groups and type of fixation)
Year Cement Uncement Hy brid
2006 888 4 0
2007 1351 10 2
2008 1573 6 32
2009 1980 18 30
2010 2134 30 35
2011 2640 32 7
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
Uncemented 50 3 6.00 0.00 to 12.58 5.25 4.68 to 5.83
Cemented 7245 121 1.67 1.38 to 1.97 5.86 5.84 to 5.88
Hybrids 17 0 0.00 NA 3.84 NA
Reverse hybrids 27 0 0.00 NA 4.60 NA
7339 124 1.69 1.39 to 1.98 5.86 5.84 to 5.88
Uncemented 50 1 2.00 0.00 to 5.88 5.66 5.39 to 5.93
Cemented 3323 68 2.05 1.56 to 2.53 5.83 5.80 to 5.86
Hybrids 19 0 0.00 NA 3.85 NA
Reverse hybrids 43 1 2.33 0.00 to 6.83 4.13 3.96 to 4.30
3435 70 2.04 1.57 to 2.51 5.83 5.80 to 5.86
10774 194 1.80 1.55 to 2.05 5.85 5.84 to 5.87
Females
Females total
Males
Males total
Whole database total
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
Females 7339 124 1.69 1.39 to 1.98 5.86 5.84 to 5.88
Males 3435 70 2.04 1.57 to 2.51 5.83 5.80 to 5.86
[min,55] yrs 1077 29 2.69 1.73 to 3.66 5.76 5.70 to 5.83
(55,65] yrs 3561 77 2.16 1.68 to 2.64 5.82 5.79 to 5.86
(65,75] yrs 4702 80 1.70 1.33 to 2.07 5.86 5.83 to 5.88
(75,max] yrs 1434 8 0.56 0.17 to 0.94 5.94 5.91 to 5.96
Uncemented 100 4 4.00 0.16 to 7.84 5.46 5.14 to 5.78
Cemented 10568 189 1.79 1.54 to 2.04 5.85 5.84 to 5.87
Hybrids 36 0 0.00 NA 3.85 NA
Reverse hybrids 70 1 1.43 0.00 to 4.21 4.54 4.43 to 4.65
10774 194 1.80 1.55 to 2.05 5.85 5.84 to 5.87
Gender
Age groups
Type of fixation
Whole database total
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 136 Characteristics of primary TKA (interaction of type of fixation and diagnosis)
In the primary TKA database the major problem
of implant identification is the name of implant.
Knee implants cannot be in mixed combinations
as can hip joint implants. Under the same implant
name you can find cruciate retaining (CR),
posterior stabilised (PS) and sometimes even
condylar constrained (CCK) variants of the same
implant. To increase the complexity, the tibial
component could be fixed or mobile. With the
SAR inventory of the knee implants, which was
completed during 2010, we have tried to sort all
TKAs brands with possible different designs and
types of tibial components. In table 137 we present
all knee implants sorted according to manufacturer,
brand, design and type of fixation. In the
table 138 all implants are ranked according to the
number of components used in 2011. Some
manufacturers introduced implant systems with
many different design variants, but almost identical
brand names. Therefore, table 139 shows
these systems and shares of these systems.
From 2006, the PFC Sigma (DePuy) dominated
the Slovakian market and in 2011 this implant
accounted for 33.33 % of all TKAs used. As table
139 shows, the share of the PFC Sigma system
was 34.9 %. From these figures, it is clear that
the SAR inventory does not solve the problem of
precise implant identification. The problem of
PFC Sigma was poor identification of CR and PS
design. By contrast, Nex-Gen and Multigen Plus
systems have good design identification. The
only solution is bar-code identification and ITS. In
2011 nineteen brands each have more than ten
implantations accounting for 96.94 % of all implants
used and sixteen brands with a total of
only 82 applications accounted for only 3.06 %.
Knee systems represented 67 % of all used
TKAs. Due to short observation period and poor
implant identification before the introduction of
ITS, we must wait at least four more years to
perform deeper statistical analyses of TKAs.
Primary monocond. arthrosis 3 0 0.00 NA 2.77 NA
Primary bicondylar arthrosis 66 3 4.55 0.00 to 9.57 5.45 5.08 to 5.83
Posttraumatic coxarthrosis 16 0 0.00 NA 3.76 NA
Aseptic necrosis 1 0 0.00 NA 2.60 NA
Rheumatoid arthritis 1 0 0.00 NA 1.35 NA
100 4 4.00 0.16 to 7.84 5.46 5.14 to 5.78
Primary monocond. arthrosis 639 20 3.13 1.78 to 4.48 5.74 5.65 to 5.83
Primary bicondylar arthrosis 9218 123 1.33 1.10 to 1.57 5.89 5.87 to 5.90
Posttraumatic coxarthrosis 392 12 3.06 1.36 to 4.77 5.66 5.56 to 5.76
Aseptic necrosis 34 0 0.00 NA 5.89 NA
Rheumatoid arthritis 202 3 1.49 0.00 to 3.15 5.80 5.69 to 5.90
10568 189 1.79 1.54 to 2.04 5.85 5.84 to 5.87
Primary monocond. arthrosis 2 0 0.00 NA 1.89 NA
Primary bicondylar arthrosis 30 0 0.00 NA 3.85 NA
Posttraumatic coxarthrosis 2 0 0.00 NA 2.06 NA
Aseptic necrosis NA NA NA NA NA NA
Rheumatoid arthritis 1 0 0.00 NA 1.91 NA
36 0 0.00 0.00 to 0.00 3.85 3.85 to 3.85
Primary monocond. arthrosis 1 0 0.00 NA 1.26 NA
Primary bicondylar arthrosis 52 1 1.92 0.00 to 5.66 4.52 4.37 to 4.67
Posttraumatic coxarthrosis 11 0 0.00 NA 3.60 NA
Aseptic necrosis NA NA NA NA NA NA
Rheumatoid arthritis 2 0 0.00 NA 3.29 NA
70 1 1.43 0.00 to 4.21 4.54 4.43 to 4.65
10774 194 1.80 1.55 to 2.05 5.85 5.84 to 5.87
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 137 Primary TKA – implants according to the manufacturers, brand, design and type of fixation
Implantat Cemented Hy brid Uncemented Rev ision Other
Lima Multigen Plus Biolox Delta
Multigen Plus - CR-Fix
Multigen Plus - CR-Rot
Multigen Plus - PS-Fix
Multigen Plus - PS-Rot
Multigen Plus - CCK
Multigen Plus - H
CR
PS
CR-ROT
PS-ROT
CR
PS
CR-ROT
PS-ROT
CR
PS
CR-ROT
PS-ROT
CCK
Hinged
Ceramic-CR, ALL-Poly
Zimmer Nex-Gen CR
Nex-Gen PS
Nex-Gen LCCK
Nex Gen RHK
Nex Gen Segmental
CR
PS
PS-ROT
CR
PS
PS-ROT
CCK
Hinged
Segmental
Gender CR
Gender PS
High Flex CR
High Flex PS
DePuy AMK
PFC Sigma
PFC Sigma RP
PFC Sigma ALL Poly
PFC Sigma Rev ision MBT/C3
Sigma Rev ision Stab. Plus
Preserv ation-Uni
LCS
S-ROM Noil Hinged Knee
CR
PS
PS-ROT
PS-High Flex
CR
PS
PS-ROT
PS-High Flex
CR
PS
PS-ROT
PS-High Flex
CCK
Hinged
All-poly tibia
High Flex
Biomet AGC
TMK - rot.
Uni Oxf ord
ROCC
Vanguard - min. inv asiv e surgery
Dual articular 2000 - rev ision
CR
PS
ROT
CR
Serf Rotasurf
C2F Implants
Lexa - rekonstruction
MC3 - rev ision
CR-ROT CR-ROT CR-ROT Hinged
Beznoska SVL
SVL/RP
SVS
SVR - rev ision
CMS
UKR
CR
PS
CR-ROT
PS-ROT
CCK
Hinged
Indiv idual-R
Indiv idual-Tumor
Aesculap Search Ev olution
Columbus
E-Motion
EnDuro
Mebio
CR
PS
CR-ROT
PS-ROT
CR
PS
CR-ROT
PS-ROT
CR
PS
CR-ROT
PS-ROT
CCK
Hinged
W-Link Endo-Modell
Sled Prosthesis
Gemini
CR
PS
CR-ROT
CR
PS
CR-ROT
CR
PS
CR-ROT
CCK
Hinged
Indiv idual-R
Indiv idual-Tumor
W-M - Medin WM Univ ersal
WM modular
Medin Ortopaedic
CR,PS
Stryker Scorpio NRG
Scorpio TS
Endoplant EPP Piv ot
Solution EPP
CR
PS
CR-ROT
PS-ROT
Ceraver PS
PS-ROT
Mathys Balansy s CR
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 138 Primary TKA – ranking of the implants Tab. 139 Primary TKA – implant systems
Antibiotic prophylaxis in primary TKA
Table 140 shows antibiotic prophylaxis. In 2011,
antibiotic prophylaxis was used in 99.85 % of
primary TKAs. Vulmizolin was the most-used
brand of antibiotic and was used in 57.86 % of all
cases.
Tab. 140 Primary TKA - antibiotic prophylaxis in 2011 (brands, numbers)
Name n %
PFC SIGMA 893 33.33%
COLUMBUS 381 14.22%
NEX-GEN CR 215 8.03%
NEX-GEN LPS 194 7.24%
MULTIGEN PLUS - CR - f ix. 178 6.64%
MC2 155 5.79%
AGC - univ ersal knee 135 5.04%
SVL 105 3.92%
SCORPIO NRG 53 1.98%
SVL/RP 50 1.87%
NEX-GEN LPS FLEX 43 1.61%
E-MOTION 37 1.38%
MULTIGEN PLUS - PS - f ix. 34 1.27%
LSC 32 1.19%
SOLUTION EPP 27 1.01%
PFC SIGMA RP 21 0.78%
UNI Oxf ord-hemiarthroplasty 17 0.63%
NEX-GEN LCCK 16 0.60%
SLED PROSTHESIS 11 0.41%
PFC SIGMA ALL POLY 9 0.34%
PFC SIGMA REVISION STAB PLUS 8 0.30%
MULTIGEN PLUS - CR - rot. 7 0.26%
GEMINI 5 0.19%
MULTIGEN PLUS BIOLOX DELTA 5 0.19%
ENDO-MODELL 6 0.22%
PFC SIGMA REVISION MBT/TC3 4 0.15%
CMS - hinge 3 0.11%
ROCC 3 0.11%
AMK 2 0.07%
SVS 2 0.07%
S-ROM NOIL HINGE KNEE 2 0.07%
MULTIGEN PLUS - CCK 1 0.04%
SVR - rev ision 1 0.04%
ROTASURF 1 0.04%
Others 23 0.86%
Total 2679 100.00%
System n %
PFC Sigma System
PFC SIGMA 893 33.33%
PFC SIGMA RP 21 0.78%
PFC SIGMA ALL POLY 9 0.34%
PFC SIGMA REVISION STAB PLUS 8 0.30%
PFC SIGMA REVISION MBT/TC3 4 0.15%
PFC Sigma System total 935 34.90%
Nex-Gen System
NEX-GEN CR 215 8.03%
NEX-GEN LPS 194 7.24%
NEX-GEN LPS FLEX 43 1.61%
NEX-GEN LCCK 16 0.60%
Nex-Gen System total 468 17.47%
Multigen Plus System
MULTIGEN PLUS - CR - f ix. 178 6.64%
MULTIGEN PLUS - PS - f ix. 34 1.27%
MULTIGEN PLUS - CR - rot. 7 0.26%
MULTIGEN PLUS BIOLOX DELTA 5 0.19%
MULTIGEN PLUS - CCK 1 0.04%
Multigen Plus System total 225 8.40%
SVL System
SVL 105 3.92%
SVL/RP 50 1.87%
SVS 2 0.07%
SVR - rev ision 1 0.04%
SVL System total 158 5.90%
Others 892 33.30%
Total 2679 100.00%
Brand
Vulmizolin
Axetine
Bitamon
Climicin
Xorim
Unasyn
Zinacef
Dalacin
Abactal
Ciphin
Lendacín
Amoxiklav
Cefuroxim
Augmentin
Cefazolin
Edicin
Kefzol
Vankomycin
Amoxycilin
Cefotaxim
Ciprinol
Oxacilín
1548 522 325 93 47 22 21 18 17 15 12 10 9 4 2 2 2 2 1 1 1 1
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Revision Total Knee Arthroplasty
In 2011, of the 31 Slovakian units performing
primary TKA, only 20 units performed at least
one revision TKA, and only four units performed
more than 10 revision TKAs. These four units
performed 57.75 % of all TKA revisions. The RR
of all primary TKAs (all TKAs before and after
2006 included) reached a 2011 value 4.33 %.
Chart 124 shows the evolution of the RR.
Chart 124 Revision TKA – revision rate
Tab. 141 Structure of revision database
Table 141 shows the structure of the TKA revision
database, with the numbers of revisions and
of failures.
In this chapter we shall deal only with first revisions.
RR of revision TKAs in the observed period,
from 1 January 2006 until 31 December
2011, reached 18.25 %. The gender distribution
of revised TKA patients is different from that for
THA. In 2011, females accounted for 61.2 % of
all revised TKA patients. Males accounted
38.8 %. Table 142 and chart 125 show the gender
distribution. During the whole period of observation
61.31 % of all revised patients were
female and 38.60 % were male.
Tab. 142 Revision TKA – gender distribution
Chart 125 Revision TKA – gender distribution
Types of fixation of revised TKA
Tab. 143 Revision TKA – structure of the database according
to gender and type of fixation
Revision database contained 411 records. Table
143 shows the structure of this database according
to gender and type of fixation. Explantation of
implants, conversion to spacer and revisions
without complete data are excluded from deeper
analyses.
Explantation accounted for 3.65 %, a spacer
15.33 % and revision without complete data
4.62 %. Cemented fixation for revision TKAs was
used in 72.01 % of all patients, uncemented fixation
was used in 3.65 %, and hybrid type of fixation
in 0.73 %.
Tab. 144 Revision TKA – types of fixation of primary TKAs
Total Censored Failured
1st rev ision 195 138 57
2nd rev ision 68 61 7
3rd rev ision 7 7 0
Primary TKA bef ore 2006 141 130 11
Total 411 336 75
Year Female Male
2006 14 6
2007 18 24
2008 29 22
2009 51 33
2010 69 29
2011 71 45
Total Female Male
Uncemented 15 12 3
Cemented 296 173 123
Hy brids 3 3 0
Explantation 15 10 5
Spacer 63 46 17
No data 19 8 11
Total 411 252 159
Year Cement Uncement Hy brid
2006 20 0 0
2007 39 2 1
2008 49 2 0
2009 82 2 0
2010 90 6 2
2011 110 6 0
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Chart 126 Revision TKA – types of fixation of primary TKAs
94.83 % of all revisions were performed on cemented
primary TKAs and 5.17 % on uncemented
TKAs in 2011. No hybrid type of fixation was
revised during this year. Table 144 and chart
126 show types of fixation of revised primary
TKAs. Table 145 shows interaction of gender and
type of fixation of revision implants.
Tab. 145 Characteristics of revision TKA (interaction of gender and type of fixation)
Age groups
In 2011, the age group less than 55 years constituted
11.2 % of all revised TKA patients. The age
group 55–64 years represented 29.31 %, the age
group 65–75 years 43.96 %, and over 75 years
accounted for 15.51 % of all revised patients. The
situation for the whole database is as follows: the
age group less than 55 years – 9.97 %, the age
group 55–65 years accounted for 36.73 %, the
age group 65–75 years for 39.9 %, and the age
group over 75 years accounted for 13.38 %. Table
147 presents the age group distribution.
Tab. 146 Characteristics of revision TKA (interaction of gender and age groups)
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
Uncemented 12 0 0.00 NA 0.98 NA
Cemented 173 13 7.51 3.59 to 11.44 5.41 5.13 to 5.69
Hybrids 3 0 0.00 NA 1.78 NA
Explantation 10 NA NA NA NA NA
Spacer 46 NA NA NA NA NA
No data 8 NA NA NA NA NA
252 45 17.86 13.13 to 22.59 4.69 4.37 to 5.02
Uncemented 3 0 0.00 NA 0.86 NA
Cemented 123 16 13.01 7.06 to 18.95 5.06 4.65 to 5.47
Hybrids 0 0 NA NA NA NA
Explantation 5 NA NA NA NA NA
Spacer 17 NA NA NA NA NA
No data 11 NA NA NA NA NA
159 30 18.87 12.79 to 24.95 4.65 4.23 to 5.06
411 75 18.25 14.51 to 21.98 4.68 4.42 to 4.94
Females
Females total
Males
Males total
Whole database total
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
[min,55] yrs 22 4 18.18 2.06 to 34.30 4.29 3.20 to 5.38
(55,65] yrs 81 14 17.28 9.05 to 25.52 4.71 4.17 to 5.26
(65,75] yrs 113 24 21.24 13.70 to 28.78 4.46 3.95 to 4.97
(75,max] yrs 36 3 8.33 0.00 to 17.36 5.13 4.55 to 5.71
252 45 17.86 13.13 to 22.59 4.69 4.37 to 5.02
[min,55] yrs 19 3 15.79 0.00 to 32.19 4.95 3.98 to 5.92
(55,65] yrs 70 14 20.00 10.63 to 29.37 4.65 4.08 to 5.22
(65,75] yrs 51 11 21.57 10.28 to 32.86 3.74 3.12 to 4.37
(75,max] yrs 19 2 10.53 0.00 to 24.33 4.24 3.41 to 5.08
159 30 18.87 12.79 to 24.95 4.65 4.23 to 5.06
411 75 18.25 14.51 to 21.98 4.68 4.42 to 4.94
Females
Females total
Males
Males total
Whole database total
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Tab. 147 Revision TKA – age groups
Table 148 shows the interaction of gender, age
groups and type of fixation of revision TKA implants.
The highest RR of 21.34 %.was recorded
in the age group 65–75 years.
Tab. 148 Characteristics of revision TKA (gender, age groups and type of fixation)
Chart 127 Cumulative risk of rev. TKA (gender)
Chart 128 Cumulative risk of rev. TKA (age groups)
Chart 129 Cumulative risk of rev. TKA (females, age groups)
Chart 130 Cumulative risk of rev. TKA (males, age groups)
Year <15 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
2006 0 0 0 0 1 0 1 3 9 2 1 3 0
2007 0 0 0 0 0 1 1 4 14 10 8 4 0
2008 0 0 0 0 1 1 0 9 5 12 12 9 2
2009 0 0 0 1 0 3 4 10 20 18 16 11 1
2010 0 0 1 0 0 3 2 12 24 28 11 13 4
2011 1 3 1 0 1 1 6 7 27 29 22 12 6
Total
number
Nr. of
failures RR 95% CI for RR
Mean
survival 95% CI for mean
Females 252 45 17.86 13.13 to 22.59 4.69 4.37 to 5.02
Males 159 30 18.87 12.79 to 24.95 4.65 4.23 to 5.06
[min,55] yrs 41 7 17.07 5.56 to 28.59 4.71 3.91 to 5.51
(55,65] yrs 151 28 18.54 12.34 to 24.74 4.68 4.28 to 5.07
(65,75] yrs 164 35 21.34 15.07 to 27.61 4.44 4.01 to 4.87
(75,max] yrs 55 5 9.09 1.49 to 16.69 5.05 4.55 to 5.56
Uncemented 15 0 0.00 NA 0.96 NA
Cemented 296 29 9.80 6.41 to 13.18 5.26 5.02 to 5.51
Hybrids 3 0 0.00 NA 1.78 NA
Explantation 15 NA NA NA NA NA
Spacer 63 NA NA NA NA NA
No data 19 NA NA NA NA NA
411 75 18.25 14.51 to 21.98 4.68 4.42 to 4.94
Gender
Age groups
Type of fixation
Whole database total
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Males reached a RR of 18.87 %, females
17.86 %, and the mean RR for both genders was
18.25 % with mean survival of 4.68 %. Chart 127
shows the cumulative risk of revision according to
the gender, with no difference between genders
until the first year of survival. Chart 128 presents
cumulative risk of revision according to age
groups: charts 129–130 present this analysis for
gender and age groups. The highest RR of
21.34 % was recorded in the age group 65–75
years and the lowest one of 9.09 % in the age
group over 75 years. .
Reasons for the revision
The most common reason for revision in 2011
was chronic infection, constituting 22.22 % of all
diagnoses. Acute infection was the reason for
revision in 7.63 % and knee pain without loosening
was the reason for revision in 6.94 % of all
cases. Aseptic tibial loosening at 14.58 % and
aseptic femoral loosening at 12.50 % are the
second and third most common reasons for revision.
Table 149 shows all the reasons for revision
and comparison with previous years. .
Tab. 149 Revision TKA – reasons for revision
Revised components of implants
Tab. 150 Revision TKA – revised components of implants
In 2011, the revision protocol had nine options.
The whole system was revised in 48.27 % of all
revisions. In 12.06 % of all cases only the soft
tissues were revised, spacer was used in
17.24 % and the inlay was revised in 8.62 % of
all cases. Table 150 compares revised components
year by year. In 2011 we observed an increased
number of revisions due to soft-tissue
problems. During the time period 2006–2010, we
recorded only eight revisions, in 2011 it was 14
revisions. . .
Antibiotic prophylaxis in revision TKA
Tab. 151 Revision TKA – antibiotic prophylaxis in 2011
(brands, numbers)
In 2011, antibiotic prophylaxis was used in
96.55 % of revision TKAs. Vulmizolin was the
most-commonly used brand of antibiotic and was
administered in 33.62 % of all revision TKAs.
Table 151 shows antibiotic prophylaxis in 2011
according to the brands and the numbers of cases
in which they were used.
Year
EarlyInfection
ChronicInfection
AsepticLooseningof
FemoralComponent
AsepticLooseningof
TibialComponent
AsepticLooseningof
PatellarComponent
PatellarLuxation
PatellarPain
Periprosthesis
Fracture
ColateralLigaments
Instability
InstabilityofPCL
Luxation
PolyethyleneWear
FractureofImplant
Stifness
Malposition
KneePainWithout
Loosening
SpacertoTKA
Other
2006 4 3 3 10 1 0 0 1 2 0 0 1 1 0 1 1 0 0
2007 4 12 10 12 1 0 2 1 7 1 1 2 0 2 1 3 1 3
2008 6 17 11 19 0 0 0 1 1 1 1 3 1 3 1 1 1 5
2009 7 28 22 30 1 0 0 0 3 2 1 3 4 1 1 2 2 4
2010 3 34 20 26 0 0 4 1 2 1 0 3 5 1 1 3 21 4
2011 11 32 18 21 0 2 3 3 5 1 3 4 1 6 5 10 15 4
Year
SoftTissue
Revision
WholeSystem
Femoral
Component
Tibial
Component
Patella
Inlay
Explantation
Spacer
Other
2006 1 14 0 1 0 1 2 1 0
2007 2 24 1 2 0 5 4 2 2
2008 3 33 0 4 1 1 5 4 0
2009 0 51 1 5 0 4 2 19 0
2010 2 65 2 4 1 6 0 17 1
2011 14 56 6 4 3 10 2 20 1
Brand
Vulmizolin
Edicin
Bitamon
Climicin
Axetine
Cefotaxim
Ciphin
Augmentin
Ciprinol
Lendacín
Vankomycin
Xorim
Zinacef
Zinat
39 19 18 15 10 2 2 1 1 1 1 1 1 1
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Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Glossary
AC – acetabular component
Arthroplasty – surgical exchange of all, or part,
of any joint of the human body with an artificial
joint replacement
Bipolar hemiarthroplasty – partial hip joint replacement,
with head-neck articulation
CAC – cemented acetabular cup
CCK (condylar constrained knee) – total knee
joint replacement with range of motion con-
strained
Censoring time – time point when the follow-up
is terminated (here 31 December 2011); implant/component
would be censored if it did not
fail by this time point
CFS – cemented femoral stem
CI – confidence interval with lower bound (LB)
and upper bound (UB)
Cohort – group having one, or more, similar attributes,
and monitored during the study period
Component – part of a multipart implant
CR – cumulative risk
CR implant (cruciate-retaining) – total knee
joint replacement allowing retention of the posterior
cruciate ligament
Crude (specific) incidence (implant-time, or
component-time incidence) – the ratio of the
number of new revisions divided by total time-atrisk
(sum of all component-years/implant-years)
throughout the follow-up period
Cumulative revision rate (CRR) – rate of revised
implants/components divided by total number
of implants/components × 100
Demographic analysis – methods of observing
and interpreting the state and movement of a
population
Demographic characteristics – numerical characteristics
of the state and movement of a popu-
lation
DJD – degenerative joint disease
Empirical survival function – rate of surviving
implants/components and total number of implants/components,
where censored observations
are calculated as failures
Expected value (mean) – weighted arithmetic
average of all possible values of a random variable;
its estimate is called the arithmetic average
and is calculated from a random sample
F – female
FC – femoral component
Hazard Rate (HR) – of the revision rate (RR) of
any component, component combination, or
group of components and RR of a reference
group, where the reference group is always the
group hierarchically superior to it, e.g. for acetabular
and femoral components, the whole data-
base
Hemiartroplasty – partial joint replacement
Hinge implant – total knee joint replacement
with a constrained hinge articulation
Implant – any surgically implanted device
Implant-year, or component-year – time interval
when implant/component had been at risk (of
revision); it is the number of days from primary
operation to the first revision, death, or termination
of the study, divided by 365.25
Incidence THA/TKA – the frequency of primary
THA/TKA per 100,000 inhabitants, in which new
revisions appear within a particular time period
Kaplan-Meier survival curve – non-increasing
step function of probability of survival, with jumps
in observed event times; its length is positively
correlated with the length of time-intervals to
failure, or censorship
M – male
Median survival – the time at which half of the
implants/components fail
Mean age – weighted arithmetic average of
number of years that a random sample survived
up to a time point
85 / 80, 2013 Supplementum
Survival analysis of total hip and knee replacement in Slovakia 2003–2011
Mean survival – generalised mean for censored
data; the volume under the K-M survival curve
(q.v.) calculated using survived, censored and
failed observations
Monocondylar knee replacement – hemiarthroplasty
of the knee joint.
Null hypothesis – the statement in the form of a
hypothesis about the equality of an unknown
parameter and some constant, the validity of
which is tested statistically; in this study, the parameter
is the difference between the expected
(mean) survival times of two groups, and the
constant is zero; we are testing if the difference
of expected survival times is equal to zero
P-value – minimal significance level at which the
null hypothesis can be rejected; if p-value is
smaller than the significance level, then the null
hypothesis is rejected; a smaller p-value refers to
a greater evidence about null hypothesis rejec-
tion
Population – is a set of organisms in which any
pair of members can breed together. This implies
that all members belong to the same species.
Population prognosis – a scientific calculation
of how many people, in which age and gender
structure, will be living in a country, or in a town,
at some point in the future
Probability of survival – empirical probability of
survival at time t, adjusted for censoring; ratio of
survived implants/components at time t and the
number of implants/components at risk in an
infinitely small time period before time t, where
the number of survived implants/components at
time t is equal to the difference between the
number of implants/components at risk within an
infinitely small time period before time t and the
number of failed implants/components in an infinitely
small time period before time t
Prevalence – see Revision Rate
Primary implantation – first surgical procedure
when a total or partial artroplasty is implanted
PS implant (posterior stabilised) – total knee
joint replacement with sacrifice of the posterior
cruciate ligament PCL
Q1 – first quartile
Q3 – third quartile
Rate – is a ratio that compares two quantities of
different units within a time period.
Revision Rate (RR) – rate of revision surgery
within a defined follow-up period – number of
revisions divided by total number of primary arthroplasties
included in the evaluation sample ×
100
Revision surgery of soft tissue – any surgery
after the primary implantation where only soft
tissues are revised
SD – standard deviation
SAR – Slovakian Arthroplasty Register
Significance level – the probability, fixed ahead
of testing of statistical hypotheses; upper
boundary of null hypothesis rejection (e.g., equal
to 0.05, or 0.1)
SOTS – Slovakian Orthopaedic and Traumatology
Society
Standardisation – technique of adjustment for
confounding variables, e.g., age, gender, etc.
Testing of statistical hypotheses – testing of
the validity of a null hypothesis, whether this hypothesis
is rejected, or not. If the null hypothesis
is not rejected, there is not enough statistical
evidence in the data for rejection
THA – total hip arthroplasty
TKA – total knee arthroplasty
Total implant-time, or component-time – sum
of all implant-times, or component-times (implantyears,
or component-years) characterising total
follow-up time; the number of implants
/components with a follow-up time equal to one
year (the unit of implant-years, or component-
years)
UAC – uncemented acetabular cup
UFS – uncemented femoral stem
95% CI for mean survival time – expected value
of mean survival time of implant/component
group falling within this interval with 95% confi-
dence
95% CI for K-M survival curve – expected K-M
curve of implant/component group fails to this
interval with 95% confidence
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