International comparison of variation in performance between hospitals for THA and TKA: Is it even possible? A systematic review including 33 studies and 8 arthroplasty register reports

Over a decade of experience in total knee arthroplasty with a multiradius design and fixed bearing at a single centre: Data from the Catalan Arthroplasty Registry

Purpose

Arthroplasty registers can provide feedback information on the results of arthroplasties performed by a certain institution or surgeon. The use of real-world data to achieve real-world evidence can help evaluate the performance of the implants used and help counsel our patients. The main objective of our study was to determine the survivorship of the total knee implant we are currently using.

Methods

A retrospective cohort study of patients who received a total knee arthroplasty from January 2009 to December 2020 in our hospital was conducted, using data from the Catalan arthroplasty registry and the Catalan health service database. Demographic and surgical data were analysed using the Kaplan-Meier method, log-rank test and Cox proportional hazards models with the R Project software (p < 0.05).

Results

A total of 1336 total knee arthroplasties were included in the study, of which 992 were women. The causes for revision included aseptic loosening (17), infection (29), instability (13), patellar implantation (13), arthrofibrosis (5) and quadriceps tendon rupture (1).The cumulative risk for revision at 5 years using the Kaplan-Meier method was 6.0% and at 10 years 6.5%. Considering gender, this risk was 7.0% and 7.5% at 5 and 10 years, respectively, in women and 3.3% in men, both at 5 and 10 years (p = 0.009). A higher risk for revision in women was seen, which is considered statistically significant (p = 0.012).

Conclusion

Our survivorship results are comparable to those published in the literature, but with a higher revision risk in women that is only statistically significant for the whole group of reoperations and for patellar implantation, but not for the rest of the diagnoses.

Level of Evidence

Level IV.

Optimal timing of hip and knee arthroplasty after bariatric surgery: A systematic review

Background

Obesity is a risk factor for the development of osteoarthritis and contributes to the increasing demand for total joint arthroplasty (TJA). Because a lower preoperative weight decreases the risk of complications after TJA, and because bariatric surgery (BS) can reduce weight and comorbidity burden, orthopedic surgeons often recommend BS prior to TJA in patients with obesity. However, the optimal timing of TJA after BS in terms of complications, revisions and dislocations is unknown.

Methods

PubMed, Embase and Cochrane CENTRAL databases were systematically searched for any type of study reporting rates of complications, revisions and dislocations in patients who had TJA after BS. The included studies' quality was assessed using the Newcastle-Ottawa Scale.

Results

Out of the 16 studies eligible for review, eight registry-based retrospective studies of high to moderate quality compared different time periods between BS and TJA and overall their results suggest little differences in complication rates. The remaining eight retrospective studies evaluated only one time period and had moderate to poor quality. Overall, there were no clear differences in outcomes after TJA for the different time frames between BS and TJA.

Conclusion

The results of this systematic review suggest that there is limited and insufficient high-quality evidence to determine the optimal timing of TJA after BS in terms of the rates of complications, revisions and dislocations. Given this lack of evidence, timing of TJA after BS will have to be decided by weighing the individual patients' risk factors against the expected benefits of TJA.

Quality and Utility of European Cardiovascular and Orthopaedic Registries for the Regulatory Evaluation of Medical Device Safety and Performance Across the Implant Lifecycle: A Systematic Review

BACKGROUND

The European Union Medical Device Regulation (MDR) requires manufacturers to undertake post-market clinical follow-up (PMCF) to assess the safety and performance of their devices following approval and Conformité Européenne (CE) marking. The quality and reliability of device registries for this Regulation have not been reported. As part of the Coordinating Research and Evidence for Medical Devices (CORE-MD) project, we identified and reviewed European cardiovascular and orthopaedic registries to assess their structures, methods, and suitability as data sources for regulatory purposes.

METHODS

Regional, national and multi-country European cardiovascular (coronary stents and valve repair/replacement) and orthopaedic (hip/knee prostheses) registries were identified using a systematic literature search. Annual reports, peer-reviewed publications, and websites were reviewed to extract publicly available information for 33 items related to structure and methodology in six domains and also for reported outcomes.

RESULTS

Of the 20 cardiovascular and 26 orthopaedic registries fulfilling eligibility criteria, a median of 33% (IQR: 14%-71%) items for cardiovascular and 60% (IQR: 28%-100%) items for orthopaedic registries were reported, with large variation across domains. For instance, no cardiovascular and 16 (62%) orthopaedic registries reported patient/ procedure-level completeness. No cardiovascular and 5 (19%) orthopaedic registries reported outlier performances of devices, but each with a different outlier definition. There was large heterogeneity in reporting on items, outcomes, definitions of outcomes, and follow-up durations.

CONCLUSION

European cardiovascular and orthopaedic device registries could improve their potential as data sources for regulatory purposes by reaching consensus on standardised reporting of structural and methodological characteristics to judge the quality of the evidence as well as outcomes.