Objectives To investigate the incidence and demographic features of anterior cruciate ligament (ACL) reconstructions in Australia by age and sex, and to determine whether the incidence has changed during the past 15 years. Design and setting Descriptive epidemiological analysis of longitudinal data on ACL reconstructions (July 2000 - June 2015) in the National Hospital Morbidity Database. Main outcome measures Population ACL reconstruction rates, by age group and sex. Results 197 557 primary ACL reconstructions were performed during the study period; the annual incidence increased by 43% (from 54.0 to 77.4 per 100 000 population), and by 74% among those under 25 years of age (from 52.6 to 91.4 per 100 000 population). In males, the peak incidence in 2014-15 was for 20-24-year-olds (283 per 100 000 population); for females, it was for 15-19-year-olds (164 per 100 000 population). Annual growth in incidence was greatest in the 5-14-year-old age group (boys, 7.7%; girls, 8.8%). Direct hospital costs of ACL reconstruction surgery in 2014-15 were estimated to be $142 million. The annual incidence of revision ACL reconstructions increased from 2.49 (2000-01) to 5.65 per 100 000 population (2014-15), or by 5.6% per year; revisions as a proportion of all ACL reconstruction increased from 4.4% to 6.8%. Conclusions The increasing incidence of ACL reconstructions in young Australians over 15 years is worrying. The individuals at greatest risk are men aged 20-24 years and women aged 15-19 years; the rate of reconstruction is increasing most rapidly among those aged 5-14 years. Revision rates are increasing more rapidly than those of primary reconstructions.

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Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000-2015.

Purpose - We performed a systematic review and meta-analyses to evaluate the early and long-term migration patterns of tibial components of TKR of all known RSA studies. Methods - Migration pattern was defined as at least 2 postoperative RSA follow-up moments. Maximal total point motion (MTPM) at 6 weeks, 3 months, 6 months, 1 year, 2 years, 5 years, and 10 years were considered. Results - The literature search yielded 1,167 hits of which 53 studies were included, comprising 111 study groups and 2,470 knees. The majority of the early migration occurred in the first 6 months postoperatively followed by a period of stability, i.e., no or very little migration. Cemented and uncemented tibial components had different migration patterns. For cemented tibial components there was no difference in migration between all-poly and metal-backed components, between mobile bearing and fixed bearing, between cruciate retaining and posterior stabilized. Furthermore, no difference existed between TKR measured with model-based RSA or marker-based RSA methods. For uncemented TKR there was some variation in migration with the highest migration for uncoated TKR. Interpretation - The results from this meta-analysis on RSA migration of TKR are in line with both the survival analyses results from joint registries of these TKRs as well as revision rates results from meta-analyses, thus providing further proof for the association between early migration and late revision for loosening. The pooled migration patterns can be used both as benchmarks and for defining migration thresholds for future evaluation of new TKR.

https://www.tandfonline.com/doi/pdf/10.1080/17453674.2018.1443635

RSA migration of total knee replacements

The use of larger femoral head size in total hip arthroplasty (THA) has increased during the past decade; 32 mm and 36 mm are the most commonly used femoral head sizes, as reported by several arthroplasty registries.The use of large femoral heads seems to be a trade-off between increased stability and decreased THA survivorship.We reviewed the literature, mainly focussing on the past 5 years, identifying benefits and complications associated with the trend of using larger femoral heads in THA.We found that there is no benefit in hip range of movement or hip function when head sizes > 36 mm are used.The risk of revision due to dislocation is lower for 36 mm or larger bearings compared with 28 mm or smaller and probably even with 32 mm.Volumetric wear and frictional torque are increased in bearings bigger than 32 mm compared with 32 mm or smaller in metal-on-cross-linked polyethylene (MoXLPE) THA, but not in ceramic-on-XLPE (CoXLPE).Long-term THA survivorship is improved for 32 mm MoXLPE bearings compared with both larger and smaller ones.We recommend a 32 mm femoral head if MoXLPE bearings are used. In hips operated on with larger bearings the use of ceramic heads on XLPE appears to be safer. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170061.

Head size in primary total hip arthroplasty.

Background and purpose — According to previous Nordic Arthroplasty Register Association (NARA) data, the 10-year implant survival of cemented total hip arthroplasties (THAs) is 94% in patients aged 65–74 and 96% in patients aged 75 or more. Here we report a brand-level comparison of cemented THA based on the NARA database, which has not been done previously.Patients and methods — We determined the rate of implant survival of the 9 most common cemented THAs in the NARA database. We used Kaplan-Meier analysis with 95% CI to study implant survival at 10 and 15 years, and Cox multiple regression to assess survival and hazard ratios (HRs), with revision for any reason as endpoint and with adjustment for age, sex, diagnosis, and femoral head material.Results — Spectron EF THA (89.9% (CI: 89.3–90.5)) and Elite THA (89.8% (CI: 89.0–90.6)) had the lowest 10-year survivorship. Lubinus (95.7% survival, CI: 95.5–95.9), MS 30 (96.6%, CI: 95.8–97.4), and C-stem THA (95.8%, CI: 94.8–96.8) had a 10-year survivorship of a...

Implant survival of the most common cemented total hip devices from the Nordic Arthroplasty Register Association database.

Background Comparisons of satisfaction rates following total knee arthroplasty (TKA) among large, age-differentiated, rigorously matched cohorts are lacking. Therefore, we compared satisfaction rates following TKA in large, age-differentiated, propensity score-matched cohorts. Methods We identified primary TKAs performed for non-inflammatory arthritis in patients of ages 18-55 or 65-75, yielding 529 younger and 2001 older patients. Patient-reported outcomes were recorded pre-operatively and 2 years post-operatively. 1:1 propensity score matching between groups yielded 529 patient pairs. Matching was based on gender, body mass index, American Society of Anesthesiologists grade, Charlson Comorbidity Index, and Short Form 12 Mental Health Component score. Outcomes were compared between matched groups using t-test and Wilcoxon rank-sum test. Results Satisfaction with knee surgery was 86% among younger patients and 91% among older patients. Distribution of satisfaction responses was shifted toward greater satisfaction in older patients (P Conclusion Satisfaction with knee surgery was over 85% regardless of age. Younger patients perceived more knee-related dysfunction and dissatisfaction after surgery despite higher levels of self-reported activity pre-operatively and post-operatively.

Satisfaction Rates and Quality of Life Changes Following Total Knee Arthroplasty in Age-Differentiated Cohorts.

Rupture of the anterior cruciate ligament (ACL) is a common and debilitating injury that impacts significantly on knee function and risks the development of degenerative arthritis. The outcome of ACL surgery is not monitored in Australia. The optimal treatment is unknown. Consequently, the identification of best practice in treating ACL is crucial to the development of improved outcomes. The Australian Knee Society (AKS) asked the Australian Orthopaedic Association (AOA) to consider establishing a national ACL registry. As a first step, a pilot study was undertaken by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to test the hypothesis that collecting the required information in the Australian setting was possible. Surgeons completed an operative form which provided comprehensive information on the surgery undertaken. Patients provided pre- and post-operative questionnaires including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Marx Activity Scale (MA Scale). The number of ACL procedures undertaken at each hospital during the recruitment period was compared against State Government Health Department separation data. A total of 802 patients were recruited from October 2011 to January 2013. The overall capture rate for surgeon-derived data was 99%, and the capture rate for the pre-operative patient questionnaire was 97.9%. At 6 months, patient-reported outcomes were obtained from 55% of patients, and 58.5% of patients at 12 months. When checked against State Government Health Department separation data, 31.3% of procedures undertaken at each study hospital were captured in the study. It is possible to collect surgeon-derived and pre-operative patient-reported data, following ACL reconstruction in Australia. The need to gain patient consent was a limiting factor to participation. When patients did consent to participate in the study, we were able to capture nearly 100% of surgical procedures. Patient consent would not be an issue in for a national registry where inclusion is automatic unless the patient wishes to opt out. The collection of post-operative patient-reported outcome measures (PROMs) is more problematic, due to an insufficient proportion of individuals providing patient-reported outcomes. Alternative outcome measures are required for an ACL registry in Australia to be successfully implemented. Diagnostic, Level III.

Feasibility of establishing an Australian ACL registry: a pilot study by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR)

Roger Paterson

Papers

Feasibility of establishing an Australian ACL registry: a pilot study by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR)