Total hip arthroplasties in the Dutch Arthroplasty Register (LROI) and the Nordic Arthroplasty Register Association (NARA): comparison of patient and procedure characteristics in 475,685 cases (original) (raw)

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Interpretation -Patient and THA procedure characteristics as well as revision rates evinced some differences between the Netherlands and the Nordic countries. The Netherlands compared best with Denmark in terms of patient and procedure characteristics, but resembled Sweden more in terms of short-term revision risk. Combining data from registries like LROI and the NARA collaboration is feasible and might possibly enable tracking of potential outlier implants. Arthroplasty registries are used to evaluate patient, procedure, prosthesis, and hospital characteristics associated with revision surgery as well as to improve quality of care Malchau 2000, Graves 2010). Comparison of national arthroplasty registries is important to improve our understanding of national differences and similarities. Furthermore, combining data from arthroplasty registries from several countries is needed in order to increase numbers to create the possibility of detecting inferior implants as early as possible. Malchau 2000, Graves 2010. The Nordic Arthroplasty Register Association (NARA) was established in 2007 by representatives from arthroplasty registries in Sweden, Norway, and Denmark to improve the quality of total hip and total knee arthroplasty through a registries-based research collaboration. Finland joined the association in 2010. To date, NARA is the most developed multinational arthroplasty database worldwide (Mäkelä et al. 2019). The comparison of national demographics and results was one of the main initial aims of the NARA collaboration. (Mäkelä et al. 2019) Background and purpose -Collaborations between arthroplasty registries are important in order to create the possibility of detecting inferior implants early and improve our understanding of differences between nations in terms of indications and outcomes. In this registry study we compared patient and procedure characteristics, and revision rates in the Nordic Arthroplasty Register Association (NARA) database and the Dutch Arthroplasty Register (LROI). Patients and methods -All total hip arthroplasties (THAs) performed in 2010-2016 were included from the LROI (n = 184,862) and the NARA database (n = 290,823), which contains data from Denmark, Norway, Sweden, and Finland. Descriptive statistics and Kaplan-Meier survival analyses based on all reasons for revision and stratified by fixation were performed and compared between countries. Results -In the Netherlands, the proportion of patients aged < 55 years (9%) and male patients (34%) was lower than in Nordic countries (< 55 years 11-13%; males 35-43%); the proportion of osteoarthritis (OA) (87%) was higher compared with Sweden (81%), Norway (77%), and Denmark (81%) but comparable to Finland (86%). Uncemented fixation was used in 62% of patients in the Netherlands, in 70% of patients in Denmark and Finland, and in 28% and 19% in Norway and Sweden, respectively. The 5-year revision rate for THAs for OA was lower in Sweden (2.3%, 95% CI 2.1-2.5) than in the Netherlands (3.0%, CI 2.9-3.1), Norway (3.8%, CI 3.6-4.0), Denmark (4.6%, CI 4.4-4.8), and Finland (4.4%, CI 4.3-4.5). Revision rates in Denmark, Norway, and Finland were higher for all fixation groups. Therefore, the NARA database contains only parameters that are included in all the individual registries (Havelin et al. 2011). Denmark and Finland, and in 28% and 19% (Havelin et al. 2011) The first NARA publication in 2009 described the results of 280,201 total hip arthroplasties (THAs) performed in 1995-2006 in Sweden, Norway, and Denmark (Havelin et al. 2009). This research was updated in 2014 by Mäkelä et al. using NARA data from 1995 including Finland (Mäkelä et al. 2014). Substantial differences were found in the patient populations receiving a THA in the Nordic countries and in the procedure characteristics such as surgical approach and fixation (Mäkelä et al. 2014). Furthermore, substantial differences in 10-year survival rates were found between the Nordic countries (Havelin et al. 2009). The Dutch Arthroplasty Register (LROI) contains data on THAs since 2007. We initiated this study to compare patient and treatment characteristics as well as survival rates between THAs in the Netherlands and Nordic countries.