The 2002-2003 Implant Yearbook on Orthopaedic Endoprostheses

Editor:Juha Nevalainen Docent, D.Med.Sc., Orthopaedic Surgeon

System Analyst:Anneli Keinonen

Register Secretary:Auni Mäkelä

Translation Secretary:Anu Pentti

The 2002-2003 Implant Yearbook on Orthopaedic Endoprostheses

Finnish Arthroplasty Register

Introduction

Annual Arthroplasty Report has been completed

In Finland, the tradition of registering endoprostheses is long. Data have been collected on a nationwide basis into one register already since 1980. In the history of registers, it is a long continuous period that has provided precious material for several purposes. In the end of 2003, follow-up data of 180446 joint pros-theses had been recorded in the Finnish Implant Register, which is maintained by the National Agency for Medicines. The number of follow-up years well exceeds one million.

The National Agency for Medicines has been responsible for the maintenance of the Implant Register since 1995. According to its task, the National Agency for Medicines is responsible for monitoring implants that are placed permanently in human beings. In addition, the National Agency for Medicines is responsible for promoting the safe use of medical devices.

Has the Implant Register had any influence in Finland? The use of implants has increased nearly tenfold in our country during the last twenty years. However, the number of operations does not yet meet the need experienced by the population. In the case of hip or knee arthroplasties, 100 operations annually in a popula-tion of 100 000 was earlier considered a sufficient number of operations, but today the wildest estimations of the need of operations are fourfold. However, there is a considerably high number of municipalities in Finland, where the number of arthroplasty operations has reached this level already, due to the distorted age structure in these municipalities. The National Agency for Medicines has not performed any studies on whether the open publication of operation numbers has influenced the municipalities’ decisions to buy arthroplasty operations for their population. It is, however, possible that open publication of operation numbers does improve democracy in the treatment of citizens in different parts of the country: people are able to compare numbers of operations to those in the neighbouring municipalities, which will put pressure on the allocation of resources in health care.

Has the outcome of arthroplasty surgery improved? In the mid 1990’s the exceptionally high number of revision hip arthroplasties arose attention in Finland. In order to improve the situation, the National Agency for Medicines increased the amount of information processed from the Implant Register. In part of the orthopaedic profession, open publication of data caused severe criticism, which, however, along with better results has subsided. But has there been any change in the use of implants? In 2003, ten most frequently used implant models covered 85 % of the total use. Most likely it is due to the publication of the outcome data, especially by the Nordic arthroplasty registers. Research results with good coverage are available for almost all most frequently used implants. In 1999, 24.6 % of all hip arthroplasty operations were revision operations. This year, the frequency of revision arthroplasties exceeds 20 % only in six hospital districts, and in some of these districts this can be explained by the modest increase in the number of primary operations.

The survival of certain implant models has been very good for both hip and knee implants throughout the country. The results of the general patient population of the country are well comparable with series published anywhere else. Training provided by manufacturers, importers and professional organizations has probably furthered this positive development.

The current trend is that arthroplasty surgery is moving into larger units and even to specialist centres founded especially for arthroplasty operations. This kind of development must be greeted with delight from the point of view of the authority monitoring device safety. In the public health care sector, the Ministry of Social Affairs and Health has even been willing to set recommendations for the minimum number of arthroplasty operations. The positive development of arthroplasty outcome has been influenced by several factors that cannot be separated from each other. However, it is most probable that the outcome is better in larger units, at least in a longer follow-up period. In addition, larger units provide better opportunities for follow-up and research activity.

New or re-introduced sliding pair materials along with the return of resurfacing implant will be among the most significant new phenomena in arthroplasty surgery during the next few years. Proportioned to the population, Finland has probably the world’s largest series of patients with hip resurfacing implants in an independent register’s follow-up (n=557). So far, it is not possible to draw any conclusions of the method’s outcome in the long run from a series including only one re-operation. We have a clear obligation to follow-up this method extremely closely and report the results to the orthopaedic community.

With the outcome of arthroplasty improving, there is a need to improve also the accuracy of the register used for the follow-up of arthroplasties. From the point of view of the authority monitoring device safety, the most significant task is to unambiguously identify all materials that are used in arthroplasty surgery. The National Agency for Medicines has almost completed a project on an implant database, where each com-ponent used will have an individual identifier. This is a step towards an electric data system. However, on the basis of experiments carried out in Finland it seems probable that, instead of the present system being replaced by the electric system, these two systems will be used side by side.

In order to maintain the high level of reliability of the register data, data must be checked manually twice by two different quarters before being entered to the register. Data are checked in the National Agency for Medicines before recording, and hospitals are offered an opportunity to check their own individualized data annually before the register report is run. Some of the hospitals have used the possibility (in 2003 app. 10 % of all hospitals used the opportunity). The majority of hospitals have found their total sums in the register data to be congruent with their own data.

Register data do not accumulate without systematic collection of data from hospitals. Data collection requires an effort, and usually filling up of forms takes place after the operation – when the next task is already wait-ing. Therefore, we want to thank everyone involved in the data collection process for the accuracy of data, which, considering the situation is good!

Juha NevalainenDocent, D.Med.Sc.Orthopaedic Surgeon

Petri PommelinHead of DepartmentMedical Devices

11

Figure G2a. Primary Total Hip Arthroplasty operations in different types of hospitals in 1993- 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

COXA

Rheumatism Foundation

Hospital Orton

Other Private Hospitals

University Hospitals

District Hospitals

Central Hospitals

1993 N=40341994 N=43721995 N=43471996 N=46951997 N=48341998 N=48341999 N=48792000 N=52302001 N=55712002 N=62572003 N=6799

Figure G2b. Primary Total Knee Arthroplasty operations in different types of hospitals in 1993 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

COXA


Hospital Orton



District Hospitals

Central Hospitals

1993 N=26481994 N=29661995 N=31581996 N=37881997 N=42761998 N=42401999 N=44522000 N=49132001 N=53172002 N=62902003 N=7203

12

Figure G3a. Total Hip Revision operations in different types of hospitals in 1993 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

COXA


Hospital Orton



District Hospitals

Central Hospitals

1993 N=9131994 N=946 1995 N=1033 1996 N=10711997 N=11151998 N=11291999 N=12002000 N=11532001 N=12262002 N=11332003 N=1211

Figure G3b. Total Knee Revision operations in different types of hospitals in 1993 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

COXARheumatism FoundationHospital OrtonOther Private HospitalsUniversity HospitalsDistrict HospitalsCentral Hospitals

1993 N=2241994 N=259 1995 N=299 1996 N=358 1997 N=3771998 N=4261999 N=4242000 N=4292001 N=4182002 N=5022003 N=511

13

Figure G4a. First, second and third revision operations in 2003 Total Hip Revisions

Other revisions 2,0%

1st revision, 75,9%

2nd revision, 17,8%

3rd revision 4,3%

Figure G4b. First, second and third revision operations in 2003 Total Knee Revisions

Other revisions, 1,0%

1st revision,77,7%

2nd revision, 19,4%

3rd revision, 2,0%

14

Figure G5a. Primary complications of primary Total Hip operations in 1993 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 TotalYears

Com

plic

atio

ns

Wound necrosisAnaesthetic complicationNerve injuryDeathHaematomaMalpositionThromboembolic complicationInfectionLuxationOther primary complication

1993 N=163 1994 N=175 1995 N=164 1996 N=2161997 N=1831998 N=1311999 N=1332000 N=131 2001 N=1172002 N=148 2003 N=150

% of prim. operations 4,04 4,00 3,774,603,792,712,732,502,10 2,372,21

Figure G5b. Primary complications of primary Total Knee operations in 1993 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 TotalYears

Com

plic

atio

ns

Wound necrosisAnaesthetic complicationNerve injuryDeathHaematomaMalpositionThromboembolic complicationInfectionLuxationOther primary complication

1993 N=891994 N=105 1995 N=79 1996 N=1081997 N=851998 N=591999 N=582000 N=60 2001 N=782002 N=822003 N=78

% of prim. operations 3,36 3,542,502,851,991,391,301,221,47 1,301,08

15

Figure G6. Number of hospitals performing primary and revision Total Joint Arthroplasties

39 3742

38 38 39 40

45

5148

59 6064

6865 65 65 65 65

69 70 69 6867

56 5652

2623

2831

35 3336 33

38 39

47 47 4954

58

53 53 52

5855 56

0

10

20

30

40

50

60

70

8019

80

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

Num

ber o

f hos

pita

ls

Primary Revision

16

Figure G7a. Hip revisions and their proportion of all primary Hip Arthroplasties

12,1

10,6

10,7

12,9

13,3

15,1

18,3

17,1

15,9

17,8

17,8

20,8

24,4

22,6

21,6

23,8

22,8

23,1

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,6

22,0

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18,1

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0

200

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1980

1981

1982

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1984

1985

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1987

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1989

1990

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2000

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2002

2003

Years

Num

ber o

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isio

ns

0

5

10

15

20

25

30

% o

f all

Prim

ary

Hip

Art

hrop

last

ies

Number of revision % of all Primary Hip Arthroplasties

Figure G7b. Knee revisions and their proportion of all primary Knee Arthroplasties

9,2

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8,1

7,3

8,5

5,7

7,3

5,4

5,1

6,5

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8,1 8,

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0

100

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Years

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0

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% o

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e A

rthr

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stie

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Number of revision % of all Primary Knee Arthroplasties

17

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33

04

33

711

1620

1010

176

114

27

Figure H5. Primary and revision Total Hip Arthroplasty operations in 1980 - 2003

1211

1133

216

195

165

1115

1129

1071

1033

946 12

00

1226

143

1153

253

313 469

482

467

508

572 72

6

903

913

1556

5571

5230

1185

3487

2074

1814

1670 19

00

2567 28

11 2938

2859 32

07

3700 40

34

4879

4834

4834

4695

4347

4372

6257

6799

0

1000

2000

3000

4000

5000

6000

7000

8000

900019

80

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

Num

ber

of o

pera

tions

PrimaryRevision

Figure H6. Primary indications for Total Hip Arthroplasties in 1980 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

% o

f ind

icat

ions

Congenital luxation of the hip

Other illnesses

Other arthritides

Rheumatoid arthritis

Secondary arthrosis

Primary arthrosis

28

Figure H7a. Fixation technique in primary Total Hip Arthroplasties in 1993 - 2003 FEMORAL COMPONENT

Cemented

Cementless

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

% o

f prim

ary

oper

atio

ns

Figure H7b. Fixation technique in primary Total Hip Arthroplasties in 1993 - 2003 ACETABULAR COMPONENT

Cemented

Cementless

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

% o

f prim

ary

oper

atio

ns

29

Figure H8a. Age distribution of Total Hip Arthroplasty operations in 1999 - 2003, FEMALE

0

5

10

15

20

25

30

35

40

45

50

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

% o

f prim

ary

oper

atio

ns

1999 2000 2001 2002 2003

Figure H8b. Age distribution of Total Hip Arthroplasty operations in 1999 - 2003, MALE

0

5

10

15

20

25

30

35

40

45

50

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

% o

f prim

ary

oper

atio

ns

1999 2000 2001 2002 2003

31

Figure H10. Number of hospitals performing Total Hip Arthroplasties in 1980-2003

3936

4238 38 39 40

43

48 48

5760

6467

64 65 64 64 6569 68 69 6867

52

43

48

2622

283034 33 35 32

36 37

46 46 4852

5553 52 51

48 49 49

0

10

20

30

40

50

60

70

8019

80

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

Num

ber o

f hos

pita

ls

Primary Revision

Figure H11. Indications for Total Hip Arthroplasty revisions in 1993 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

% o

f rev

isio

n in

dica

tions

Fracture of prosth. + other reason

Fracture of bone

Malposition of prosthesis

Luxation

Infection

Loosening of acetabular component

Loosening of femoral component

Loosening of both component

32

Figure H12a. The most common types of removed femoral components in Total Hip Arthroplasty operations in 1996 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001 2002 2003Years

% o

f pro

sthe

ses

OTHER FEMOLAR COMPONETS

AUSTIN-MOORE

LUBINUS SP I

ELITE PLUS FLANGED

MÜLLER MONOLOG

CHARNLEY

EXETER UNIVERSAL

MATHYS RM ISOELAS

THOMPSON

LUBINUS IP

LUBINUS SP II

Figure H12b. The most common types of removed acetabular components in Total Hip Arthroplasty operations in 1996 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001 2002 2003Years

% o

f pro

sthe

ses

OTHER ACETABULAR COMPONETS

PCA PEGGED

EXETER ALL POLY

BIOMET ROMANUS

MATHYS RM

HGP II

CHARNLEY LPW

BIOMET TTAP

LORD

BIOMET PFU

LUBINUS STD

33

Figure H13. Previous operation year in Total Hip Arthroplasty revisions in 2003

0,440,70

0,17 0,35

1,83

2,71

3,40

2,01

5,76

6,72

7,85

6,546,02

4,80

3,58

5,24

4,364,71

5,67

10,30

8,73

0,79

2,97

4,36

0

2

4

6

8

10

1219

80

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Operation year

% o

f rev

isio

ns (N

=114

6;-8

0-03

)

34

Figure H14a . The most common types of femoral componets used in Total Hip Arthroplasty revisions in 1996 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001 2002 2003Years

% o

f pro

sthe

ses

OTHER FEMORAL COMPONETSCONELOCK REVISIOBIOMET HEAD-NECWAGNER REVISIOABG HA REVISIOLINK REKONSTRUKBIOMET MALLORY/HEADBIOMET COLLARLESSBIOM INTEGRAL P/RLUBINUS SP IIEXETER UNIVERSALBIOMET COLLARED

Figure H14b. The most common types of acetabular componets used in Total Hip Arthroplasty revisions in 1996 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001 2002 2003Years

% o

f pro

sthe

ses

OTHER ACETABULAR COMPONETSPCA VITALOCKBIOMET SHPHGP IIELITE PLUS LPWTRILOGYABG IILUBINUS STDEXETER ALL POLYCONTEMPORARYLUBINUS ECCENTRICBIOMET PFUBIOMET VISION

35

Figure H15. The most commonly used cemented hip prostheses in primary arthrosis in 1996-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

96-03, N=12984

CI_MAX

CI_MIN

EXETER UNIVERSAL + EXETER CONTENPORARYEXETER UNIVERSAL + EXETER ALL POLYLUBINUS SP II + LUBINUS ECCENTRIC

LUBINUS SP II + LUBINUS STDSPECTRON EF + RFLECTION ALL POLYELITE PLUS FLANGED + ELITE PLUS LPW

Figure H16. The most commonly used cementless hip prostheses in primary arthrosis in 1996-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

96-03, N=6206

CI_MAX

CI_MIN

ABG HA + ABG IIBIOMET COLLARLESS + BIOMET VISIONBIOMET COLLARLESS + BIOMET PFUABG II + ABG II

36

Figure H17. The most commonly used cemented hip prostheses in rheumatoid arthritis in 1996-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

96-03, N=834

CI_MAX

CI_MIN

EXETER UNIVERSAL + EXETER CONTEMPORARYEXETER UNIVERSAL + EXETER ALL POLYLUBINUS SP II + LUBINUS ECCENTRICLUBINUS SP II + LUBINUS STD

Figure H18. The most commonly used cementless hip prostheses in rheumatoid arthritis in 1996-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

96-03, N=380

CI_MAX

CI_MIN

ABG HA + ABG IIBIOMET COLLARLESS + BIOMET PFUBIOMET COLLARLESS + BIOMET VISIONABG II + ABG II

37

Figure H19. The most commonly used cemented hip prostheses in first revision in 1996-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

% 96-03, N=609

CI_MAX

CI_MIN

LUBINUS SP II + LUBINUS ECCENTRICEXETER UNIVERSAL + EXETER ALL POLYLUBINUS SP II + LUBINUS STDEXETER UNIVERSAL + EXETER CONTEMPORARY

Figure H20. The most commonly used cementless hip prostheses in first revision in 1996-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

96-03, N=434

CI_MAX

CI_MIN

BIOMET INTEGRAL P/R + BIOMET VISIONBIOMET COLLARED + BIOMET PFUBIOMET COLLARED + BIOMET VISION

38

Figure H21a. ABG II + ABG II cup hip prosthesis in primary arthrosisin 1999-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

99 - 03, N=1092

CI_MAX

CI_MIN

Figure H21c. ABG II + ABG II cup hip prosthesis, annual use in primary arthrosis in 1999 - 2003

0

100

200

300

400

500

1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

39

Figure H21d. ABG II + ABG II cup hip prosthesis, age and gender, all indicationsin 1999-2003

0

100

200

300

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

Figure H21e. ABG II + ABG II cup hip prosthesis, indications for operations in 1999 - 2003

0

100

200

300

400

500

600

1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone

Change of prosthesis


Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

40

Figure H21f. ABG II + ABG II cup hip prosthesis in 1999 - 2003, indications for first revision

0

5

10

15

20

25

30

1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns


Fracture of bone


Luxation

Infection



Loosening of both components

Figure H21g. ABG II + ABG II cup hip prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1999 2000 2001 2002 2003Years

In follow-up, N = 1315

Dead, N = 20

Revised, N = 11

42

Figure H22a. EXETER UNIVERSAL + ABG II cup hip prosthesis in primary arthrosis in 1996-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

96-03, N=612

CI_MAX

CI_MIN

Figure H22c. EXETER UNIVERSAL + ABG II cup hip prosthesis, annual use in primary arthrosis in 1996 - 2003

0

20

40

60

80

100

120

140

160

180

200

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

43

Figure H22d. EXETER UNIVERSAL + ABG II cup hip prosthesis, age and gender, all indications in 1996-2003

0

20

40

60

80

100

120

140

160

180

200

220

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

Figure H22e. EXETER UNIVERSAL + ABG II cup hip prosthesis, indications for operations in 1996- 2003

0

20

40

60

80

100

120

140

160

180

200

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone



Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

44

Figure H22f. EXETER UNIVERSAL + ABG II cup hip prosthesis, indications for first revision in 1996 - 2003

0

2

4

6

8

10

12

14

16

18

20

1996 1997 1998 1999 2000 2001Years

Num

ber o

f ope

ratio

ns Fracture of prosth. + other reason

Fracture of bone


Luxation

Infection




Figure H22g. EXETER UNIVERSAL + ABG II cup hip prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001 2002 2003Years


Dead, N = 45

Revised, N = 12

46

Figure H23a. BIOMET COLLARLESS + BIOMET VISION cup hip prosthesis in primary arthrosis in 1998-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

98 - 03, N=1624

CI_MAX

CI_MIN

Figure H23c. BIOMET COLLARLESS + BIOMET VISION cup hip prosthesis, annual use in primary arthrosis in 1998 - 2003

0

100

200

300

400

500

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

47

Figure H23d. BIOMET COLLARLESS + BIOMET VISION cup hip prosthesis, age and gender, all indications in 1998-2003

0

100

200

300

400

500

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

Figure H23e. BIOMET COLLARLESS + BIOMET VISION cup hip prosthesis, indications for operations in 1998 - 2003

0

100

200

300

400

500

600

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone



Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

48

Figure H23f. BIOMET COLLARLESS + BIOMET VISION cup hip prosthesis in 1998 - 2003, indications for first revision

0

2

4

6

8

10

12

14

16

18

20

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns Fracture of prosth. + other reasonFracture of boneMalposition of prosthesisLuxationInfectionLoosening of acetabular componentLoosening of femoral componentLoosening of both components

Figure H23g. BIOMET COLLARLESS + BIOMET VISION cup hip prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1998 1999 2000 2001 2002 2003Years


Dead, N =49

Revised, N = 32

50

Figure H24a. EXETER UNIVERSAL + EXETER All Poly cup hip prosthesis in primary arthrosis in 1996-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

96 - 03, N=3423

CI_MAX

CI_MIN

Figure H24c. EXETER UNIVERSAL + EXETER All Poly cup hip prosthesis, annual use in primary arthrosis in 1996 - 2003

0

100

200

300

400

500

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

51

Figure H24d. EXETER UNIVERSAL + EXETER All Poly cup hip prosthesis, age and gender, all indications in 1996-2003

0

100

200

300

400

500

600

700

800

900

1000

1100

1200

1300

1400

1500

1600

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

Figure H24e. EXETER UNIVERSAL + EXETER All Poly cup hip prosthesis, indications for operations in 1996 - 2003

0

100

200

300

400

500

600

700

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone



Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

52

Figure H24f. EXETER UNIVERSAL + EXETER All Poly cup hip prosthesis in 1996 - 2003, indications for first revision

0

5

10

15

20

25

30

35

40

45

50

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio


Fracture of bone


Luxation

Infection




Figure H24g. EXETER UNIVERSAL + EXETER All Poly cup hip prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001Years


Dead, N = 550

Revised, N = 107

54

Figure H25a. EXETER UNIVERSAL + CONTEMPORARY cup hip prosthesis in primary arthrosis in 1996-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

96 - 03, N=3618

CI_MAX

CI_MIN

Figure H25c. EXETER UNIVERSAL + CONTEMPORARY cup hip prosthesis, annual use in primary arthrosis in 1996 - 2003

0

100

200

300

400

500

600

700

800

900

1000

1100

1200

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

55

Figure H25d. EXETER UNIVERSAL + CONTEMPORARY cup hip prosthesis, age and gender, all indications in 1996-2003

0

200

400

600

800

1000

1200

1400

1600

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

Figure H25e. EXETER UNIVERSAL + CONTEMPORARY cup hip prosthesis, indications for operations in 1996 - 2003

0

100

200

300

400

500

600

700

800

900

1000

1100

1200

1300

1400

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone



Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

56

Figure H25f. EXETER UNIVERSAL + CONTEMPORARY cup hip prosthesis in 1996 - 2003, indications for first revision

0

2

4

6

8

10

12

14

16

18

20

22

24

26

28

30

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio


Fracture of bone


Luxation

Infection




Figure H25g. EXETER UNIVERSAL + CONTEMPORARY cup hip prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001 2002 2003Years


Dead, N = 282

Revised, N = 65

58

Figure H26a. LUBINUS SP II + LUBINUS Std cup hip prosthesis in primary arthrosis in 1996-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

96 - 03, N=2188

CI_MAX

CI_MIN

Figure H26c. LUBINUS SP II + LUBINUS Std cup hip prosthesis, annual use in primary arthrosis in 1996 - 2003

0

100

200

300

400

500

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

59

Figure H26d. LUBINUS SP II + LUBINUS Std cup hip prosthesis, age and gender, all indications in 1996-2003

0

100

200

300

400

500

600

700

800

900

1000

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

Figure H26e. LUBINUS SP II + LUBINUS Std cup hip prosthesis, indications for operations in 1996 - 2003

0

100

200

300

400

500

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone



Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

60

Figure H26f. LUBINUS SP II + LUBINUS Std cup hip prosthesis in 1996 - 2003, indications for first revision

0

5

10

15

20

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio


Fracture of bone


Luxation

Infection




Figure H26g. LUBINUS SP II + LUBINUS Std cup hip prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001 2002 2003Years


Dead, N = 358

Revised, N = 61

62

Figure H27a. LUBINUS SP II + LUBINUS FC cup hip prosthesis in primary arthrosis in 2000-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

2000-2003, N=455

CI_MAX

CI_MIN

Figure H27c. LUBINUS SP II + LUBINUS FC cup hip prosthesis, annual use in primary arthrosis in 2000 - 2003

0

20

40

60

80

100

120

140

160

180

2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

63

Figure H27d. LUBINUS SP II + LUBINUS FC cup hip prosthesis, age and gender, all indications in 2000-2003

0

50

100

150

200

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

Figure H27e. LUBINUS SP II + LUBINUS FC cup hip prosthesis, indications for operations in 2000 - 2003

0

100

200

300

400

500

2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone



Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

64

Figure H27f. LUBINUS SP II + LUBINUS FC cup hip prosthesis, indications for first revision in 2000 - 2003

0

1

2

3

4

5

6

7

8

9

10

2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns


Fracture of bone


Luxation

Infection




Figure H27g. LUBINUS SP II + LUBINUS FC cup hip prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

2000 2001 2002 2003Years


Dead, N = 24

Revised, N = 7

66

Figure H28a. SPECTRON EF + REFLECTION All poly cup hip prosthesis in primary arthrosis in 1999-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

99 - 03, N=791

CI_MAX

CI_MIN

Figure H28c. SPECTRON EF + REFLECTION All poly cup hip prosthesis, annual use in primary arthrosis in 1999 - 2003

0

50

100

150

200

250

300

350

400

1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

67

Figure H28d. SPECTRON EF + REFLECTION All poly cup hip prosthesis, age and gender, all indications in 1999 - 2003

0

50

100

150

200

250

300

350

400

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

Figure H28e. SPECTRON EF + REFLECTION All poly cup hip prosthesis, indications for operations in 1999 - 2003

0

50

100

150

200

250

300

350

400

450

500

1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone



Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

68

Figure H28f. SPECTRON EF + REFLECTION All poly cup hip prosthesis, indications for first revision in 1999 - 2003

0

5

10

15

20

25

30

1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns


Fracture of bone


Luxation

Infection




Figure H28g. SPECTRON EF + REFLECTION All poly cup hip prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1999 2000 2001 2002 2003Years


Dead, N = 34

Revised, N = 7

70

Figure H29a. LUBINUS SP II + LUBINUS ECCENTRIC cup hip prosthesis in primary arthrosis in 1996-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

96 - 03, N=2260

CI_MAX

CI_MIN

Figure H29c. LUBINUS SP II + LUBINUS ECCENTRIC cup hip prosthesis, annual use in primary arthrosis in 1996 - 2003

0

100

200

300

400

500

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

71

Figure H29d. LUBINUS SP II + LUBINUS ECCENTRIC cup hip prosthesis, age andgender, all indications in 1996-2003

0

100

200

300

400

500

600

700

800

900

1000

1100

1200

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

Figure H29e. LUBINUS SP II + LUBINUS ECCENTRIC cup hip prosthesis, indications for operations in 1996 - 2003

0

100

200

300

400

500

600

700

800

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone



Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

72

Figure H29f. LUBINUS SP II + LUBINUS ECCENTRIC cup hip prosthesis, indications for first revision in 1996 - 2003

0

5

10

15

20

25

30

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio


Fracture of bone


Luxation

Infection




Figure H29g. LUBINUS SP II + LUBINUS ECCENTRIC cup hip prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001 2002 2003Years


Dead, N = 484

Revised, N = 76

74

Figure H30a. BIRMINGHAM + BIRMINGHAM cup hip prosthesis in primary arthrosis in 2001-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10Years

Surv

ival

%

2001-2003, N=449

CI_MAX

CI_MIN

Figure H30c. BIRMINGHAM + BIRMINGHAM cup hip prosthesis, annual use in primary arthrosis in 2001 - 2003

0

50

100

150

200

250

300

350

400

2001 2002 2003Years

Num

ber o

f ope

ratio

ns

75

Figure H30d. BIRMINGHAM + BIRMINGHAM cup hip prosthesis, age and gender, all indications in 2001-2003

0

50

100

150

200

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

Figure H30e. BIRMINGHAM + BIRMINGHAM cup hip prosthesis, indications for operations in 2001 - 2003

0

50

100

150

200

250

300

350

400

2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone



Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

76

Figure H30f. BIRMINGHAM + BIRMINGHAM cup hip prosthesis, indications for first revision in 2001 - 2003

0

1

2

3

4

5

6

7

8

9

10

2001 2002 2003Years

Num

ber o

f ope

ratio

ns


Fracture of bone


Luxation

Infection




Figure H30g. BIRMINGHAM + BIRMINGHAM cup hip prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

2001 2002 2003Years


Dead, N = 2

Revised, N = 1

78

Figure H31a. LUBINUS SP II hip prosthesis in primary arthrosis in 1989-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

89-93, N=351094-98, N=389999-03, N=3131CI_MAXCI_MIN

Figure H31b. EXETER UNIVERSAL hip prosthesis in primary arthrosis in 1989-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

89-93, N=64894-98, N=312599-03, N=6986CI_MAXCI_MIN

79

Figure H31c. BIOMET COLLARLESS hip prosthesis in primary arthrosis in1989-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

89-93, N=159594-98, N=308999-03, N=3432CI_MAXCI_MIN

Figure H31d. BIOMET COLLARED hip prosthesis in primary arthrosis in 1989-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

89-93, N=17494-98, N=46899-03, N=441CI_MAXCI_MIN

80

Figure H31e. ABG HA hip prosthesis in primary arthrosis in 1994-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

94-98, N=1366

99-03, N=1450

CI_MAX

CI_MIN

Figure H31f. ABG II hip prosthesis in primary arthrosis in 1999-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=1141

CI_MAX

CI_MIN

81

Figure H31g. ELITE PLUS FLANGED hip prosthesis in primary arthrosis in1994-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

94-98, N=1137

99-03, N=700

CI_MAX

CI_MIN

Figure H31h. SPECTRON EF hip prosthesis in primary arthrosis in 1999-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=955

CI_MAX

CI_MIN

82

Figure H32. The most common bone cements used in Hip Arthroplasties in 1996-2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001 2002 2003Operation years

Prop

ortio

n of

cem

ents

use

d OTHER CEMENTSSIMPLEX TOBRAMYPALACOS RCMW 3GSULCEM 3PALACOSSIMPLEXSIMPLEX PSIMPLEX ANTIBPALACOS C

Figure H33. The most common antibiotic prophylaxis used in Hip Primary operations in 1996-2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001 2002 2003Operation years

Prop

ortio

n of

ant

ibio

tics

used OTHER ANTIBIOTICS

DALACIN

DICLOCIL

ROCEPHALIN

STAFLOCIL

EKVACILLIN

LIFUROX

KEFURION

ZINACEF

83

Figure H34. Allograft, Autograft and Xenograft in Hip Revisions in 1996-2003

0

100

200

300

400

500

600

1996 1997 1998 1999 2000 2001 2002 2003

Num

ber o

f ope

ratio

ns

Allograft Autograft Autograft+allograft Xenograft

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1981

1982

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1984

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1986

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1992

1993

1994

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512

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2920

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125

512

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1316

810

73

118

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312

69

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89

Figure K5. Primary and revision Total Knee Arthroplasty operations in 1980 - 2003

511

502

224

181

126

113

846254553443

429

27

418

424

259

299

358 42

6

377

29 36 31

7203

6290

4452

4240

4276

3788

3158

2966

2648

2230

1525

1284

1223

1001

749

594

503

422

444

1819

295

4913

5317

432

0

1000

2000

3000

4000

5000

6000

7000

800019

80

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

Num

ber o

f ope

ratio

ns

PrimaryRevision

Figure K6. Primary indications for Total Knee Arthroplasties in 1980 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

% o

f ind

icat

ions

Other illnesses

Other arthritides


Secondary arthrosis

Primary arthrosis

90

Figure K7a. Fixation technique in primary Total Knee Arthroplasties in 1993 - 2003 FEMORAL COMPONENT

Cemented

Cementless

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

% o

f prim

ary

oper

atio

ns

Figure K7b. Fixation technique in primary Total Knee Arthroplasties in 1993 - 2003 TIBIAL COMPONENT

Cemented

Cementless

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

% o

f prim

ary

oper

atio

ns

91

Figure K8a. Age distribution of Total Knee Arthroplasty operations in 1999-2003, FEMALE

0

5

10

15

20

25

30

35

40

45

50

55

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

% o

f prim

ary

oper

atio

ns

1999 2000 2001 2002 2003

Figure K8b. Age distribution of Total Knee Arthroplasty operations in 1999-2003, MALE

0

5

10

15

20

25

30

35

40

45

50

55

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

% o

f prim

ary

oper

atio

ns

1999 2000 2001 2002 2003

93

Figure K10. Number of hospitals performing Total Knee Arthroplasties in 1980-2003

21 2119

23 22 23

29

35

4043

51

5659

64 63 64 63 63 6466

70 69

6463

46 4751

8 81211 12 12 13

16

2218

26 2832

4143

41

46 45 46 47 48

0

10

20

30

40

50

60

70

8019

80

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

Num

ber o

f hos

pita

ls

Primary Revision

Figure K11. Indications for Total Knee Arthroplasty revisions in 1993 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

% o

f rev

isio

n in

dica

tions

Patella complicationFracture of prosth. + other reasonFracture of boneMalposition of prosthesisLuxationInfectionLoosening of tibial componentLoosening of femoral componentLoosening of both component

94

Figure K12. The most common types of removed knee prostheses in 1993 - 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

% o

f pro

sthe

ses

OTHER TYPESP.F.C PRESS FITTTOWNLEYPCA/MODULARSYNATOMIC TOWNLEYMILLER-G IPCADURACONAGC V2

Figure K13. Previous operation year in Total Knee Arthroplasty revisions in 2003

0,00 0,00 0,21 0,42 0,42

1,48 1,482,11

4,22 4,434,85

4,01

5,70

7,38

3,594,43

2,53

6,33

10,97

16,67

12,24

0,42

3,59

2,53

0

2

4

6

8

10

12

14

16

18

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Operation year

% o

f rev

isio

ns (N

=474

;-80-

03)

95

Figure K14. The most common types of knee revision prostheses used in 1993- 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

% o

f pro

sthe

ses

OTHER TYPES

P.F.C SIGMA

AGC V2

NEXGEN (CR)

ENDO MODELL-LINK

DURACON/MODULAR STA

DURACON

AGC DUAL ARTICULAR

Figure K15. Three most commonly used cemented knee prostheses in primary arthrosis 1994-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

94-98, N=7306

99-03, N=15789

CI_MAX

CI_MIN

DURACONAGC V2P.F.C SIGMA

96

Figure K17. Three most commonly used cemented knee prostheses in rheumatoid arthritis 1994-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

94-98, N=1176

99-03, N=1317

CI_MAX

CI_MIN

DURACONAGC V2NEXGEN (LPS)

Figure K19. Four most commonly used cemented knee prostheses in first revisions 1994-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

94-98, N=335

99-03, N=468

CI_MAX

CI_MIN

AGC DUAL ARTICENDO MODELL-LINKDURACON/MODULAR STADURACON

97

Figure K20a. AGC V2 knee prosthesis in primary arthrosis in 1989-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

89-93, N=110694-98, N=401799-03, N=5314CI_MAXCI_MIN

Figure K20b. AGC V2 knee prosthesis in primary arthrosis in 1989-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

89-93, N=110694-98, N=401799-03, N=5314CI_MAXCI_MIN

98

Figure K20c. AGC V2 knee prosthesis, annual use in primary arthrosis in 1986 - 2003

0

200

400

600

800

1000

1200

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

Num

ber o

f ope

ratio

ns

Figure K20d. AGC V2 knee prosthesis, age and gender, all indications in 1986-2003

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

5500

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

99

Figure K20e. AGC V2 knee prosthesis, indications for operations in 1986- 2003

0

200

400

600

800

1000

1200

1400

160019

86

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

Num

ber o

f ope

ratio

ns Other revision

Girdlestone


Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

Figure K20f. AGC V2 knee prosthesis, indications for first revisionin 1986 - 2003

0

10

20

30

40

50

60

70

80

90

100

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

Num

ber o

f ope

ratio

ns Patellar complicationFracture of prosth. + other reasonFracture of boneMalposition of prosthesisLuxationInfectionLoosening of tibial componentLoosening of femoral componentLoosening of both components

100

Figure K20g. AGC V2 knee prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years


Dead, N = 2507

Revised, N = 408

101

Figure K21a. ARGE knee prosthesis in primary arthrosisin 1999-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=1208

CI_MAX

CI_MIN

Figure K21b. ARGE knee prosthesis in primary arthrosisin 1999-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=1208

CI_MAX

CI_MIN

102

Figure K21c. ARGE knee prosthesis, annual use in primary arthrosis in 1998 - 2003

0

50

100

150

200

250

300

350

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Figure K21d. ARGE knee prosthesis, age and gender, all indications in 1998-2003

0

50

100

150

200

250

300

350

400

450

500

550

600

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

103

Figure K21e. ARGE knee prosthesis, indications for operations in 1998 - 2003

0

100

200

300

400

500

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns Other revision


Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

Figure K21f. ARGE knee prosthesis, indications for first revisionin 1998 - 2003

0

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns Patellar complication



Luxation

Infection

104

Figure K21g. ARGE knee prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1998 1999 2000 2001 2002 2003Years


Dead, N = 91

Revised, N = 25

105

Figure K22a. DURACON knee prosthesis in primary arthrosisin 1994-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

94-98, N=5751

99-03, N=8792

CI_MAX

CI_MIN

Figure K22b. DURACON knee prosthesis in primary arthrosisin 1994-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

94-98, N=5751

99-03, N=8792

CI_MAX

CI_MIN

106

Figure K22c. DURACON knee prosthesis, annual use in primary arthrosis in 1992 - 2003

0

200

400

600

800

1000

1200

1400

1600

1800

2000

2200

2400

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Figure K22d. DURACON knee prosthesis, age and gender, all indications in 1992-2003

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

5500

6000

6500

7000

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

107

Figure K22e. DURACON knee prosthesis, indications for operationsin 1992 - 2003

0

200

400

600

800

1000

1200

1400

1600

1800

2000

2200

2400

2600

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone


Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

Figure K22f. DURACON knee prosthesis, indications for first revisionin 1992 - 2003

0

10

20

30

40

50

60

70

80

90

100

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns Patellar complicationFracture of prosth. + other reasonFracture of boneMalposition of prosthesisLuxationInfectionLoosening of tibial componentLoosening of femoral componentLoosening of both components

108

Figure K22g. DURACON knee prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Years


Dead, N = 2257

Revised, N = 516

109

Figure K23a. MAXIM PRIMARY knee prosthesis in primary arthrosisin 1999-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=722

CI_MAX

CI_MIN

Figure K23b. MAXIM PRIMARY knee prosthesis in primary arthrosisin 1999-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=722

CI_MAX

CI_MIN

110

Figure K23c. MAXIM PRIMARY knee prosthesis, annual use in primary arthrosis in 1998 - 2003

0

50

100

150

200

250

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Figure K23d. MAXIM PRIMARY knee prosthesis, age and gender, all indications in 1998-2003

0

50

100

150

200

250

300

350

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

111

Figure K23e. MAXIM PRIMARY knee prosthesis, indications for operationsin 1998 - 2003

0

50

100

150

200

250

300

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone


Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

Figure K23f. MAXIM PRIMARY knee prosthesis, indications for first revisionin 1998 - 2003

0

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Patellar complication



Infection

112

Figure K23g. MAXIM PRIMARY knee prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1998 1999 2000 2001 2002 2003Years

In follow-up, N =752

Dead, N = 56

Revised, N = 14

113

Figure K24a. NEXGEN (CR) knee prosthesis in primary arthrosisin 1999-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=1617

CI_MAX

CI_MIN

Figure K24b. NEXGEN (CR) knee prosthesis in primary arthrosisin 1999-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=1617

CI_MAX

CI_MIN

114

Figure K24c. NEXGEN (CR) knee prosthesis, annual use in primary arthrosis in 1996 - 2003

0

50

100

150

200

250

300

350

400

450

500

550

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Figure K24d. NEXGEN (CR) knee prosthesis, age and gender, all indications in 1996-2003

0

100

200

300

400

500

600

700

800

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

115

Figure K24e. NEXGEN (CR) knee prosthesis, indications for operations in 1996 - 2003

0

50

100

150

200

250

300

350

400

450

500

550

600

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision



Other arthritides

Other illness

Secondary arthrosis

Primary arthrosis

Figure K24f. NEXGEN (CR) knee prosthesis, indications for first revisionin 1996 - 2003

0

5

10

15

20

25

30

35

40

45

50

1996 1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Patellar complicationFracture of prosth. + other reasonFracture of boneMalposition of prosthesisLuxationInfectionLoosening of tibial componentLoosening of femoral componentLoosening of both components

116

Figure K24g. NEXGEN (CR) knee prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001 200 2003Years


Dead, N = 118

Revised, N = 18

117

Figure K25a. NEXGEN (LPS) knee prosthesis in primary arthrosisin 1999-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=1149

CI_MAX

CI_MIN

Figure K25b. NEXGEN (LPS) knee prosthesis in primary arthrosisin 1999-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=1149

CI_MAX

CI_MIN

118

Figure K25c. NEXGEN (LPS) knee prosthesis, annual use in primary arthrosis in 1997 - 2003

0

50

100

150

200

250

300

350

1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Figure K25d. NEXGEN (LPS) knee prosthesis, age and gender, all indications in 1997-2003

0

50

100

150

200

250

300

350

400

450

500

550

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

119

Figure K25e. NEXGEN (LPS) knee prosthesis, indications for operationsin 1997 - 2003

0

50

100

150

200

250

300

350

400

450

500

1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision


Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

Figure K25f. NEXGEN (LPS) knee prosthesis, indications for first revisionin 1997 - 2003

0

5

10

15

20

25

30

35

40

45

50

1997 1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns



Luxation

Infection

120

Figure K25g. NEXGEN (LPS) knee prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1997 1998 1999 2000 2001 2002 2003Years


Dead, N = 79

Revised, N = 12

121

Figure K26a. P.F.C SIGMA knee prosthesis in primary arthrosisin 1999-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=3077

CI_MAX

CI_MIN

Figure K26b. P.F.C SIGMA knee prosthesis in primary arthrosisin 1999-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=3077

CI_MAX

CI_MIN

122

Figure K26c. P.F.C SIGMA knee prosthesis, annual use in primary arthrosis in 1998 - 2003

0

200

400

600

800

1000

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Figure K26d. P.F.C SIGMA knee prosthesis, age and gender, all indications in 1998-2003

0

200

400

600

800

1000

1200

1400

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

123

Figure K26e. P.F.C SIGMA knee prosthesis, indications for operations in 1998- 2003

0

100

200

300

400

500

600

700

800

900

1000

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone


Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

Figure K26f. P.F.C SIGMA knee prosthesis, indications for first revisionin 1998 - 2003

0

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns




Luxation

Infection

Loosening of tibial component



124

Figure K26g. P.F.C SIGMA knee prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1998 1999 2000 2001 2002 2003Years


Dead, N = 227

Revised, N = 58

125

Figure K27a. P.F.C SIGMA STAB. knee prosthesis in primary arthrosisin 1999-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=574

CI_MAX

CI_MIN

Figure K27b. P.F.C SIGMA STAB. knee prosthesis in primary arthrosisin 1999-2003, 90-100% scale

90 %

91 %

92 %

93 %

94 %

95 %

96 %

97 %

98 %

99 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

99-03, N=574

CI_MAX

CI_MIN

126

Figure K27c. P.F.C SIGMA STAB. knee prosthesis, annual use in primary arthrosis in 1998 - 2003

0

100

200

300

400

500

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Figure K27d. P.F.C SIGMA STAB. knee prosthesis, age and gender, all indications in 1998-2003

0

50

100

150

200

250

300

0-29 30-39 40-49 50-59 60-69 70-79 80-Age

Num

ber o

f ope

ratio

ns

MALEFEMALE

127

Figure K27e. P.F.C SIGMA STAB. knee prosthesis, indications for operations in 1998- 2003

0

100

200

300

400

500

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns

Other revision

Girdlestone


Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

Figure K27f. P.F.C SIGMA STAB. knee prosthesis, indications for first revisionin 1998 - 2003

0

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003Years

Num

ber o

f ope

ratio

ns




Luxation

Infection

Loosening of tibial component



128

Figure K27g. P.F.C SIGMA STAB. knee prosthesis, survival of annually installed prostheses at the end of 2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1998 1999 2000 2001 2002 2003Years


Dead, N =30

Revised, N =12

129

Figure K31. The most common bone cements used in Knee Arthroplasties in 1996-2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001 2002 2003Operation years

Prop

ortio

n of

cem

ents

use

d OTHER CEMENTS

CMW 2

PALACOS R

CMW 3G

PALACOS

SIMPLEX P

SIMPLEX

SIMPLEX ANTIB

PALACOS C

Figure K32. The most common antibiotic prophylaxis used in Knee Primary operations in 1996-2003

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

1996 1997 1998 1999 2000 2001 2002 2003Operation years

Prop

ortio

n of

ant

ibio

tics

used OTHER ANTIBIOTICS

CLAFORANROCEPHALINDICLOCILDALACINSTAFLOCILEKVACILLINKEFURIONLIFUROXZINACEF

130

Figure K33. Allograft, Autograft and Xenograft in Knee Revisions in 1996-2003

0

5

10

15

20

25

30

35

40

45

50

1996 1997 1998 1999 2000 2001 2002 2003

Num

ber o

f ope

ratio

ns

Allograft Autograft Autograft+allograft

131

Figure O1a. Primary and revision arthroplasties of other joints, upper extremity in 1980 - 2003

0

20

40

60

80

100

120

140

160

180

200

220

240

260

280

30019

80

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Num

ber o

f ope

ratio

ns

Shoulder Mcp Elbow Other

Figure O1b. Primary and revision arthroplasties of other joints, lower extremity in 1980-2003

0

10

20

30

40

50

60

70

80

90

100

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Num

ber o

f ope

ratio

ns

Femoropatellar joint only Ankle Mtp

132

Figure O2. Primary indications for arthroplasties of other joints in 1980-2003

0

100

200

300

400

500

600

70019

80

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

Num

ber o

f ope

ratio

ns

Other illness

Other arthritides


Secondary arthrosis

Primary arthrosis

133

Figure O3a. Indications for revision of other joints in 1993-2003

0

20

40

60

80

100

12019

93

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

Num

ber o

f ope

ratio


Fracture of bone


Luxation

Infection

Loosening of distal component

Loosening of proximal component


Figure O3b. Revision operations of other joints in 1980-2003

0

20

40

60

80

100

120

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

Num

ber o

f ope

ratio

ns


Remove of prosthesis

Other revision

Girdlestone

134

Figure O4. Previous operation year of first revision in other joints in 2003

0,93 0,93 0,93

4,635,56

2,783,70

4,63 4,63

9,2610,19

4,63

7,41

20,37

5,56

0,93

6,486,48

0

5

10

15

20

2519

86

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Operation year

% o

f rev

isio

ns (N

=108

;-86-

03)

Figure O5. Number of hospitals performing Elbow and Shoulder Arthroplasties in 1980-2003

1

3

1 12

1

43

5 56

56

89

23

27

25

11

14

11 1110 10

15

11

6

0

2

4

2 2

57

8 8

1011

8

10

13

17

19

21

25

22 22

20

0

5

10

15

20

25

30

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

Num

ber o

f hos

pita

ls

Elbow Shoulder

135

Figure O6. Shoulder prosthesis in primary operations in 1989-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

89-93, N=28794-99, N=84099-03, N=1126CI_MAXCI_MIN

Figure O7. Elbow prosthesis in primary operations in 1989-2003, 50-100% scale

50 %

60 %

70 %

80 %

90 %

100 %

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years

Surv

ival

%

89-93, N=33394-98, N=53199-03, N=452CI_MAXCI_MIN

139

Indentity number of patientDate of operationObject of operation

Reason for operation

Type of implanted prosthesis(femoral and acetabularcomponent)

-

1 Rheumatoid arthritis2 Other arthritis3 Primary arthrosis4 Congenital luxation

of the hip

5 Other illness**6 Change of prosthesis7 Removal of prosthesis8 Secondary arthrosis

9 Removal of previousprosthesis (Girdlestone)

0 Other revision(e.g. liner change)

1 Hip2 Knee3 Femoropatellar joint only4 Ankle5 Mtp

6 Shoulder7 Elbow8 Lunatum9 Scaphoideum10 Other construction **

11 Cmc12 Mcp13 Ip14 Jaw joint15 Other **

Joint 1 Right 2 Left

femur acetabulum*Brandname:

*

Type (Chrome, Titanium, Ceram. etc.)Cap 1 Fixed

2 ModularDiameter of cap ______ mm

National Agency for MedicinesImplant Register/EndoprosthesesP.O. Box 5500301 HELSINKI

NOTIFICATION TO THE IMPLANT REGISTERORTOPAEDIC ENDOPROSTHESES

Hospital

Type of prosthesis to be changedor removed, and date of previousoperation

Revision operation

Date

*

Fixation of the prosthesis

Name and telephone number ofperson in chargeComments **

Primary complications

Bone graft

Prophylactic antimicrobialdrug therapy

Brand of cement used

0 Anaesthetic complication1 Infection2 Haematoma3 Tromboembolism4 Dissatisfactory position of prosthesis

malposition

5 Luxation6 Nerve injury7 Other primary complication **8 Death9 Wound necrosis

CementedCementless

Hip prosthesis

femur12

acetabulum34

Knee prosthesis

femur56

tibia78

Patellarcomponentimplanted

910

Otherprosthesis

1112

Method of cementation1 Ordinary 2 Pressurized

Method of mixing cement2 Centrifuge1 Ordinary 3 Vacuum

BrandnameAntimicrobial 2 No1 Yes

femur acetabulum*

2 allograft1 autograft 3 xenograft

Brandname:

Reason for revision:1 Loosening (prox.comp.)2 Loosening (dist. comp.)3 Infection4 Luxation5 Malposition of prosthesis

6 Fracture of bone7 Fracture of prosthesis9 Patellar complication8 Other reason,

please specify **

Brandname

Pleace attach the prosthesis stickers on the reverse side !

140

HOW TO COMPLETE THE NOTIFICATION

Please fill in the notification legibly by hand in print.

Hospital is indicated by giving the numerical code of the hospital

The identity number of the patient must be given in full.

Enter the date of operation in day, month, year order.

Object of operation. Please tick the box indicating the side and joint in question, for example the right hip.Provide additional information on items 10 and 15 under Comments.

Please choose one alternative only in the section Reason for operation.

In the section Type of prosthesis, please use the general brand name of the implanted prosthesis forboth the femoral and acetabular components. In the event that a combination of components from two typesof prosthesis has been used for the hip prosthesis, enter the femoral component before the acetabularcomponent. The easiest way to indicate the type of prosthesis used is to attach the surplus stickers from the prosthesis package, if not needed for the case record on the reverse side of the form.(This also enables the use of the bar code.)

Revision operationWhen a revision operation is performed on a previously implanted endoprosthesis, indicate the main complication necessitating the operation with a tick in the appropriate box.

Enter the brandname of the femoral or acetabular components of the prosthesis to be changed or removedin the section Type of prosthesis to be changed or removed. Enter the date of the previousoperation, if known.

Indicate the manner of fixation, cemented or cementless in the section Fixation of the prosthesis.Indicate the method of cementation and the mixing technique with a tick in the appropriate box. If a patellar component has been implanted with the knee prosthesis, please indicated the method of fixation.The brand name of the cement used should be given in full (e.g. Palacos C. Centamycin).

If a bone graft has been used, please indicate its type, i.e. autograft, allograft or xenograft, etc.

Enter the brand name of the microbial drug used in the section Prophylactic microbial medication.

For the purposes of this notification, a primary complication refers to a post-operative complicationdiagnosed in the patient before his discharge from hospital. Please report complications diagnosedin a patient after his discharge on a separate form entitled NOTIFICATION TO THE IMPLANTREGISTER; LONG-TERM COMPLICATIONS.

Enter a tick in box 8, if the patient died while in hospital.

Enter the name and telephone number of the person filling the form in the section Person in charge, in case further details are needed.

CommentsIf the alternatives given in the notification are not applicable to the case in question, or additionalinformation is required, supply such information under this heading or on a separate sheet.

141

National Agency for MedicinesImplant Register/EndoprosthesesP.O. Box 5500301 HELSINKI

NOTIFICATION TO THE IMPLANT REGISTERLONG-TERM COMPLICATIONS

Joint 1 Right 2 Left

-Indentity number of patient

Date of operation

Object of operation

Type of implanted prosthesis(femoral and acetabularcomponent) femur acetabulum

Brandname:

1 Hip2 Knee3 Femoropatellar joint only4 Ankle5 Mtp

6 Shoulder7 Elbow8 Lunatum9 Scaphoideum10 Other construction **

11 Cmc12 Mcp13 Ip14 Jaw joint15 Other **

Notifying unit andtelephone

Comments *

Long-term complications Date of diagnosis of long-term complication

Signature

1 Infection2 Luxation3 Wear of articulated parts4 Breakage of prosthesis5 Other, please specify

142

HOW TO COMPLETE THE NOTIFICATION

Please fill in the notification legibly by hand in print.

Hospital is indicated by giving the numerical code of the hospital.

The identity number of the patient must be given in full.

Enter the date of operation in day, month, year order.

Object of operation. Please tick the box indicating the side and joint in question, for example the right hip.Provide additional information on items 10 and 15 under Comments.

In the section Type of prosthesis, please use the general brand name of the implanted prosthesis for both thefemoral and acetabular components. In the event that a combination of components from two types of prosthesishas been used for the hip prosthesis, mentioned the femoral component before the acetabular component.

Long-term complication:Please report complications arising in a patient after his discharge from hospital as follows:Infection when confirmed.Luxation when ascertained for the first time. Repeated luxations need not be notified.Wear of the articulating parts (e.g. polyethylene, ceramics, metal).Fracture of prosthesis (i.e. endurance failure of metal, breakage of ceramic parts, rupture of silicone.)

Do not report aseptic loosening as a complication.

Enter the name of the unit diagnosing the long-term complication in section Notifying unit. Sign the notificationand enter a telephone number for further enquiries.

CommentsUse this section, if the alternatives given in the notification are not applicable to a particular case, or additionaldetails are required.

The 2002-2003 Implant Yearbook on Orthopaedic Endoprostheses

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Transcript of The 2002-2003 Implant Yearbook on Orthopaedic Endoprostheses