Are the findings in the Swedish National Total Hip Arthroplasty Register valid?: A comparison between the Swedish National Total Hip Arthroplasty Register, the National Discharge Register, and the National Death Register

doi:10.1054/arth.2000.8591

The Journal of Arthroplasty

Volume 15, Issue 7, October 2000, Pages 884-889

https://doi.org/10.1054/arth.2000.8591 Get rights and content

Abstract

The Swedish National Total Hip Arthroplasty (THA) Register was initiated in 1979, and it is one of the oldest quality registers in the world. The register covers all hospitals in Sweden, and today it contains >205,000 hip arthroplasties. The failure endpoint definition in the register is revision. There is no information about quality of life and mortality. The aim of this study was to validate the results presented by the Swedish THA register by comparison with the Discharge register (the Swedish National Board of Health and Welfare) and to study mortality after hip arthroplasties. All hip arthroplasties from the Discharge register, performed in 1986 and thereafter, were compared with the Swedish THA register. Epidemiologic parameters, including mortality, were documented from the Swedish Death register. The mortality for primary THAs for men was 1% higher and for women 6% higher when compared with an age-matched and sex-matched cohort. For revision, the numbers were 7% and 9% higher. The risk for death compared with an age-matched and sex-matched population was lower for patients with osteoarthrosis treated with hip arthroplasty. The results with revision as failure endpoint showed that the Swedish THA register is reliable. The register includes >95% of the primary and revision THAs performed in Sweden between 1986 and 1995.

Section snippets

Materials and methods

The National Hospital Discharge Register from the National Board of Health and Welfare was developed during the 1980s and named in 1993. The register contains information about the patient's identification number (unique for every citizen), gender, age, county, hospital, ICD code for diagnosis and surgical interventions, and date of admittance and discharge. Since 1986, all hospitals in Sweden must report to the register when a patient is admitted to or discharged from the hospital. The

Age and gender

The mean age for the patients treated with primary arthroplasties increased between 1986 and 1994 from 68.3 to 69.9 years and for the revisions from 68.0 to 69.9 years. There was no difference in the ratio of men to women in the 2 primary cohorts, but in the Discharge register, more women underwent reoperation than men compared with the Swedish THA register (59% women in the Discharge register and 54% women in the Swedish THA register).

Primary operations

A total of 84,884 and 83,137 primary operations were

Discussion

During the last 20 years, mortality has been used as a measure for quality of medical and surgical interventions, and there are some studies of mortality in patients with rheumatoid arthritis and hip fractures that have been treated with a THA 14, 15, 16. For patients with osteoarthrosis treated with THA, especially revisions, however, the knowledge is not well established 4, 17, 18, 19. The mortality after emergency THA is much higher than after elective operation, and, in general, patients

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Cited by (78)

Lower reoperation rate with locking plates compared with conventional plates in Vancouver type C periprosthetic femoral fractures: A register study of 639 cases in Sweden
2019, Injury
To investigate demographics and outcomes of Vancouver type C periprosthetic femoral fractures (PPFF) treated with open reduction and internal fixation.
Patient data were obtained from medical charts of cases reported to the Swedish Hip Arthroplasty Register and/or from the National Patient Register. Vancouver type C fractures undergoing surgery between 2001 and 2011, in patients who had received their primary THR between 1979 and 2011, were included. Any further reoperation performed between 2001 and 2013 and related to the PPFF constituted the primary outcome.
A total of 632 patients with 639 Vancouver type C fractures were identified. The majority of the patients were women (84%) and they had a fracture distal to a cemented stem (95%). The mean age at the time of fracture was 72 years. Treatment was performed with a locking plate (363 cases), a conventional plate (184 cases), an intramedullary nail (62 cases), or with double plating (30 cases). The overall reoperation rate was 17%, and mortality within one year of the operation was 16%. Locking plates had a significantly lower reoperation rate than conventional plates (p<0.001) and intramedullary nailing (p = 0.005). Interprosthetic femoral fractures did not have a statistically different outcome compared with non-IPFFs.
The lowest reoperation rate was observed using locking plates in Vancouver type C fractures when compared with conventional plates or intramedullary nailing. The presence of an ipsilateral knee prosthesis did not influence the outcome of the surgical treatment.
Does hydroxyapatite coating of uncemented cups improve long-term survival? An analysis of 28,605 primary total hip arthroplasty procedures from the Nordic Arthroplasty Register Association (NARA)
2017, Osteoarthritis and Cartilage
Citation Excerpt :
Although this—at least to our knowledge—is the largest comparison of long-term survival in uncoated and HA-coated cups, we found only small and statistically insignificant differences in terms of the risk of revision due to aseptic loosening. The NARA dataset is based on the combined Danish, Norwegian, Swedish and Finnish hip arthroplasty registers that have all been repeatedly validated, and the completeness of data in the four countries ranges from 86% to 99%47–52. However, when we had applied all exclusion criteria mentioned in the methods section no cases from Finland were included in our analyses.
It is unclear whether hydroxyapatite (HA) coating of uncemented cups used in primary total hip arthroplasty (THA) improves bone ingrowth and reduces the risk of aseptic loosening. We therefore investigated survival of different uncemented cups that were available with or without HA coating.
We investigated three different cup types used with or without HA coating registered in the Nordic Arthroplasty Register Association (NARA) database that were inserted due to osteoarthritis (n = 28,605). Cumulative survival rates and adjusted hazard ratios (HRs) for the risk of revision were calculated.
Unadjusted 13-year survival for cup revision due to aseptic loosening was 97.9% (CI: 96.5–99.4) for uncoated and 97.8% (CI: 96.3–99.4) for HA-coated cups. Adjusted HRs were 0.66 (CI 0.42–1.04) for the presence of HA coating during the first 10 years and 0.87 (CI 0.14–5.38) from year 10–13, compared with uncoated cups. When considering the endpoint cup revision for any reason, unadjusted 13-year survival was similar for uncoated (92.5% [CI: 90.1–94.9]) and HA-coated (94.7% [CI: 93.2–96.3]) cups. The risk of revision of any component due to infection was higher in THA with HA-coated cups than in THA with uncoated cups (adjusted HR 1.4 [CI 1.1–1.9]).
HA-coated cups have a similar risk of aseptic loosening as uncoated cups, thus the use of HA coating seems to not confer any added value in terms of implant stability. The risk of infection seemed higher in THA with use of HA-coated cups, an observation that must be investigated further.
Data Quality in Institutional Arthroplasty Registries: Description of a Model of Validation and Report of Preliminary Results
2017, Journal of Arthroplasty
Citation Excerpt :
This in turn limits the comparative assessment of our results [5]. While the ideal rate of validity in the 3 domains is 100%, it has been described in the literature that adherence rates between 90% and 95% are acceptable [6,10,12,14]. However, these values have not been objectively assessed and vary significantly between authors.
Arthroplasty registries are a relevant source of information for research and quality improvement in patient care and its value depends on the quality of the recorded data. The purpose of this study is to describe a model of validation and present the findings of validation of an Institutional Arthroplasty Registry (IAR).
Information from 209 primary arthroplasties and revision surgeries of the hip, knee, and shoulder recorded in the IAR between March and September 2015 were analyzed in the following domains. Adherence is defined as the proportion of patients included in the registry, completeness is defined as the proportion of data effectively recorded, and accuracy is defined as the proportion of data consistent with medical records. A random sample of 53 patients (25.4%) was selected to assess the latest 2 domains. A direct comparison between the registry's database and medical records was performed.
In total, 324 variables containing information on demographic data, surgical procedure, clinical outcomes, and key performance indicators were analyzed. Two hundred nine of 212 patients who underwent surgery during the study period were included in the registry, accounting for an adherence of 98.6%. Completeness was 91.7% and accuracy was 85.8%. Most errors were found in the preoperative range of motion and timely administration of prophylactic antibiotics and thromboprophylaxis.
This model provides useful information regarding the quality of the recorded data since it identified deficient areas within the IAR. We recommend that institutional arthroplasty registries be constantly monitored for data quality before using their information for research or quality improvement purposes.
Spanish arthroplasty register
2014, Revista Espanola de Cirugia Ortopedica y Traumatologia
No generally increased risk of cancer after total hip arthroplasty performed due to osteoarthritis
2020, International Journal of Cancer
Are the First or the Second Hips of Staged Bilateral THAs More Similar to Unilateral Procedures? A Study from the Swedish Hip Arthroplasty Register
2020, Clinical Orthopaedics and Related Research

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^*: Benefits or funds were received in partial or total support of the research material described in this article from the Volvo Research Foundation, the Swedish National Board of Health and Welfare, the Gothenburg Medical Association, the Dr. Felix Neuberg Foundation, the Greta and Einar Asker Foundation, and the Hjalmar Svensson Foundation.

^**: Reprint requests: Peter Söderman, MD, Department of Orthopaedics, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.

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Original ArticlesAre the findings in the Swedish National Total Hip Arthroplasty Register valid?: A comparison between the Swedish National Total Hip Arthroplasty Register, the National Discharge Register, and the National Death Register*,**

Abstract

Section snippets

Materials and methods

Age and gender

Primary operations

Discussion

J Arthroplasty

J Arthroplasty

Injury

Prevalence of coxarthrosis in an urban population during four decades

Clin Orthop

Hip arthroplasty in Jutland, Denmark: age and sex-specific incidences of primary operations

Acta Orthop Scand

Total hip arthroplasties in the elderly: morbidity, mortality and cost effectiveness

Clin Orthop

A comparison of total hip arthroplasty and hemiarthroplasty for treatment of acute fracture of the femoral neck

Clin Orthop

Changes in mortality after total hip and knee arthroplasty over a ten-year period

Anesth Analg

Assessment of HCFAs 1992 Medicare hospital information report of morality following admission for hip arthroplasty

Health Serv Rep

Determinants of reduced survival following hip fractures in men

Clin Orthop

Measures of early postoperative mortality: beyond hospital fatality rates

BMJ

Prognosis of total hip replacement in Sweden: follow-up of 92,675 operations performed 1978-1990

Acta Orthop Scand

Prognosis of total hip replacement: surgical and cementing technique in THR—a revision-risk study of 134,056 primary operations

Original Articles
Are the findings in the Swedish National Total Hip Arthroplasty Register valid?: A comparison between the Swedish National Total Hip Arthroplasty Register, the National Discharge Register, and the National Death Register*,**