IDES REVISION (B) THA RevisionObesity 1633 18.44 7088 80.05 Diabetes 451 5.09 7539 85.14 Other...
52
IDES REVISION (B) THA Revision ............................................................................................................................ 2 Data collection form: THA Revision ..................................................................................... 2 General ................................................................................................................................... 5 Chronological distribution of Revisions and primary THAs ............................................. 5 Distribution of............. ....................................................................................................... 6 Side ..................................................................................................................................... 6 Diagnosis N=9`258 ............................................................................................................ 7 Number of previous revisions N=10`220 ........................................................................... 7 OP elsewhere N=10`220 .................................................................................................... 8 Specification of previous revisions .................................................................................... 9 Status contralateral hip N= 10`220................................................................................... 10 Type of systemic illness (8855 illnesses in 5903 patients) .............................................. 10 Comparison distribution of type of systemic illness primary THA vs. Revision ............ 11 Clinical evaluation of affected hip ....................................................................................... 12 Walking capacity restriction N= 10220 ........................................................................... 13 …. Walking capacity restriction depending on revision side........................................... 13 Charnley Classification .................................................................................................... 14 Usual support needed N=1537 ......................................................................................... 15 Time walked with support N=6221.................................................................................. 15 Time walked without support N= 9157............................................................................ 16 Pain of the hip N=10`068 ................................................................................................. 16 Flexion range N=10`219 .................................................................................................. 17 Flexion range depending on number of previous revisions ............................................. 17 Apparent leg length discrepancy (shorter) ....................................................................... 19 Comparison of leg length discrepancy preoperative by surgery side............................. 19 Radiological Evaluation ....................................................................................................... 20 Acetabular side migration (superior) N=7`261 ................................................................ 20 Acetabular side migration (medial) N= 1`438 ................................................................. 21 Femoral side stem subsidence N=10`035......................................................................... 21 Endosteal resorption N=741 ............................................................................................. 22 Operation/ Prosthetic Components....................................................................................... 22 Cup material ..................................................................................................................... 22 ...chronological distribution of cup material .................................................................... 23 Acetabular Augmenation N= 8146 .................................................................................. 24 Acetabular augmenation depending on number of pervious revisions ............................ 25 Femoral head N=7`959..................................................................................................... 26 ...chronological distribution of femoral head material ..................................................... 27 Stem material N=6793 ..................................................................................................... 28 ...chronological distribution of stem material .................................................................. 28 Operation procedure ............................................................................................................. 30 Revision of Components N=10220 .................................................................................. 30 Revisions of components because of aseptic loosening ................................................... 31 Fixation of components N=10`220 .................................................................................. 32 Other operations (reduction, trochanter; others) N=2`327 .............................................. 33 Acetabular reconstruction with bone graft N=10`219...................................................... 33 Calcar defect N=2`316 ..................................................................................................... 34 Femoral Cortex N=3`085 ................................................................................................. 35 Extraction cement N=4`717 ............................................................................................. 36 Fixation of greater trochanter N=5`883 ........................................................................... 36 Anteversion of stem N=1`423 .......................................................................................... 37
Transcript of IDES REVISION (B) THA RevisionObesity 1633 18.44 7088 80.05 Diabetes 451 5.09 7539 85.14 Other...
IDES REVISION (B) THA Revision ............................................................................................................................ 2
Data collection form: THA Revision ..................................................................................... 2 General ................................................................................................................................... 5
Chronological distribution of Revisions and primary THAs ............................................. 5 Distribution of............. ....................................................................................................... 6 Side..................................................................................................................................... 6 Diagnosis N=9`258 ............................................................................................................ 7 Number of previous revisions N=10`220........................................................................... 7 OP elsewhere N=10`220 .................................................................................................... 8 Specification of previous revisions .................................................................................... 9 Status contralateral hip N= 10`220................................................................................... 10 Type of systemic illness (8855 illnesses in 5903 patients) .............................................. 10 Comparison distribution of type of systemic illness primary THA vs. Revision ............ 11
Clinical evaluation of affected hip ....................................................................................... 12 Walking capacity restriction N= 10220 ........................................................................... 13 …. Walking capacity restriction depending on revision side........................................... 13 Charnley Classification .................................................................................................... 14 Usual support needed N=1537 ......................................................................................... 15 Time walked with support N=6221.................................................................................. 15 Time walked without support N= 9157............................................................................ 16 Pain of the hip N=10`068 ................................................................................................. 16 Flexion range N=10`219 .................................................................................................. 17 Flexion range depending on number of previous revisions ............................................. 17 Apparent leg length discrepancy (shorter) ....................................................................... 19 Comparison of leg length discrepancy preoperative by surgery side............................. 19
Radiological Evaluation ....................................................................................................... 20 Acetabular side migration (superior) N=7`261 ................................................................ 20 Acetabular side migration (medial) N= 1`438 ................................................................. 21 Femoral side stem subsidence N=10`035......................................................................... 21 Endosteal resorption N=741............................................................................................. 22
Operation/ Prosthetic Components....................................................................................... 22 Cup material ..................................................................................................................... 22 ...chronological distribution of cup material .................................................................... 23 Acetabular Augmenation N= 8146 .................................................................................. 24 Acetabular augmenation depending on number of pervious revisions ............................ 25 Femoral head N=7`959..................................................................................................... 26 ...chronological distribution of femoral head material ..................................................... 27 Stem material N=6793 ..................................................................................................... 28 ...chronological distribution of stem material .................................................................. 28
Operation procedure............................................................................................................. 30 Revision of Components N=10220 .................................................................................. 30 Revisions of components because of aseptic loosening................................................... 31 Fixation of components N=10`220 .................................................................................. 32 Other operations (reduction, trochanter; others) N=2`327.............................................. 33 Acetabular reconstruction with bone graft N=10`219...................................................... 33 Calcar defect N=2`316 ..................................................................................................... 34 Femoral Cortex N=3`085 ................................................................................................. 35 Extraction cement N=4`717 ............................................................................................. 36 Fixation of greater trochanter N=5`883 ........................................................................... 36 Anteversion of stem N=1`423.......................................................................................... 37
Perioperative Complications N=10`221........................................................................... 37 Treatment of Complications N=10`249 ........................................................................... 38 Duration of procedure (time) N=10`220 .......................................................................... 39 Anesthesia N=10`220....................................................................................................... 40 ... chronological distribution of Anesthesia...................................................................... 40
Hospital Course .................................................................................................................... 41 Postoperative treatment/ after Operation N=9`976 .......................................................... 41 Intensive care N=10`220 .................................................................................................. 42 Prophylaxis N= 9`824 (Hips) ........................................................................................... 42 ...chronological distribution of prophylaxis ..................................................................... 43 Systemic complications N=1`494 .................................................................................... 44 Local complication N=10`310 ......................................................................................... 45 Revision N=10`220 .......................................................................................................... 46
Discharge Status................................................................................................................... 46 Distribution of ….. ........................................................................................................... 46 Hip pain N=10`219........................................................................................................... 46 Other pain N=10`220 ....................................................................................................... 47 Flexion at discharge N=10`219 ........................................................................................ 47 Comparison flexion range preoperativ and flexion range at discharge............................ 48 Apparent leg length discrepancy (shorter) N=10`216...................................................... 48 Comparison leg length discrepancy preoperative – postoperative................................... 49
X-Ray acetabular component at discharge........................................................................... 50 Inclination (abduction) N=9`025...................................................................................... 50 Anteversion N=9`010....................................................................................................... 50
X-Ray femoral component at discharge............................................................................... 51 Position of the stem N=8`307........................................................................................... 51 Cement in femur N=5`592 ............................................................................................... 51 Greater trochanter N=8`910 ............................................................................................. 52
THA Revision Based on the IDES-B forms for Revision THA (fig. 3) we can present 10220 total hip arthroplasty -revisions performed between 1968 and 2003.
Data collection form: THA Revision Fig. 1b IDES-B form for THA Revision (Version 1999)
General
Chronological distribution of Revisions and primary THAs
Frequency Row Pct
Table of INTERVAL by THA TYP (primary – revision)
TYP INTERVAL
PRIM REVISION
Total
1968 (1966-1970) 415 93.26
30 6.74
445
1973 (1971-1975) 838 89.72
96 10.28
934
1978 (1976-1980) 1779 84.80
319 15.20
2098
1983 (1981-1985) 8065 83.57
1586 16.43
9651
1988 (1986-1990) 16838 83.26
3385 16.74
20223
1993 (1991-1995) 11953 80.57
2882 19.43
14835
1998 (1996-2000) 8087 82.66
1697 17.34
9784
2003 (2001-2003) 1870 89.43
221 10.57
2091
Total 49845 82.99
10216 17.01
60061 100.00
Frequency Missing = 24
Distribution of.............
Side
OPERATED SIDE
Frequency Percent CumulativeFrequency
Cumulative Percent
right hip 5346 52.31 5346 52.31
left hip 4874 47.69 10220 100.00
Diagnosis N=9`258
DIAGNOSIS
DIAGNOSIS Frequency Percent CumulativeFrequency
Cumulative Percent
Loosening aseptic 7641 82.53 7641 82.53
Loosening infected 341 3.68 7982 86.22
Loosening eventually infected
71 0.77 8053 86.98
Girdlestone 238 2.57 8291 89.55
malposition 228 2.46 8519 92.02
dislocation 318 3.43 8837 95.45
trochanter pathology 122 1.32 8959 96.77
ectopic ossification 27 0.29 8986 97.06
fractured femur 232 2.51 9218 99.57
broken implant 40 0.43 9258 100.00
Number of previous revisions N=10`220
PREVIOUS REVISION
PREVIOUS REVISION Frequency Percent CumulativeFrequency
Cumulative Percent
no answer 352 3.44 352 3.44
none 7592 74.29 7944 77.73
1 1831 17.92 9775 95.65
2 394 3.86 10169 99.50
3 30 0.29 10199 99.79
4 13 0.13 10212 99.92
5 3 0.03 10215 99.95
OP elsewhere N=10`220
OP ELSEWHERE
OP ELSEWHERE Frequency Percent CumulativeFrequency
Cumulative Percent
no answer 9520 93.15 9520 93.15
primary THA 531 5.20 10051 98.35
1 revision 45 0.44 10096 98.79
>1 revision 60 0.59 10156 99.37
primary THA & 1 revision 57 0.56 10213 99.93
1 revision & >1 revision 7 0.07 10220 100.00
Specification of previous revisions
SPECIFICATION OF PREVIOUS REVISIONS
Frequency Percent CumulativeFrequency
Cumulative Percent
Socket only 1 544 22.33 544 22.33
Socket only 2 27 1.11 571 23.44
Socket only >2 5 0.21 576 23.65
Stem only 1 392 16.09 968 39.74
Stem only >1 21 0.86 989 40.60
Socket and Stem 1 1095 44.95 2084 85.55
Socket and Stem 2 337 13.83 2421 99.38
Socket and Stem >2 15 0.62 2436 100.00
Status contralateral hip N= 10`220
DIAGNOSIS OPPOSITE SIDE
DIAGNOSIS OPPOSITE SIDE
Frequency Percent CumulativeFrequency
Cumulative Percent
no answer 900 8.81 900 8.81
normal 4152 40.63 5052 49.43
abnormal, no OP 1116 10.92 6168 60.35
internal fixation 29 0.28 6197 60.64
osteotomy 75 0.73 6272 61.37
arthrodesis 35 0.34 6307 61.71
primary THR 2786 27.26 9093 88.97
double cup/ bipolar 6 0.06 9099 89.03
hemi-arthroplasty 49 0.48 9148 89.51
THA revision 1039 10.17 10187 99.68
Girdlestone 33 0.32 10220 100
Type of systemic illness (8855 illnesses in 5903 patients)
SYSTEMIC ILLNESS Frequency Percent CumulativeFrequency
Cumulative Percent
Illness of nervous system 475 5.36 475 5.36
Illness of respiratory system 636 7.18 1111 12.55
Illness of venous system 475 5.36 1586 17.91
Illness of cardiovascular 2891 32.65 4477 50.56
Illness of gastro-intestinal system
815 9.20 5292 59.76
Illness of urological system 163 1.84 5455 61.60
Obesity 1633 18.44 7088 80.05
Diabetes 451 5.09 7539 85.14
Other systemic illness 1316 14.86 8855 100.00
Comparison distribution of type of systemic illness primary THA vs. Revision
Frequency Col Pct
Table of SYSTEMIC ILLNESS by OPERATION TYPE
OPERATION TYPE SYSTEMIC ILLNESS
Primary THA Revision
Total
Illness of nervous system 2709 5.99
475 5.36
3184
Illness of respiratory system 2928 6.47
636 7.18
3564
Illness of venous system 2709 5.99
475 5.36
3184
Illness of cardiovascular 14158 31.30
2891 32.65
17049
Illness of gastro-intestinal system 4252 9.40
815 9.20
5067
Illness of urological system 596 1.32
163 1.84
759
Obesity 8327 18.41
1633 18.44
9960
Diabetes 2495 5.52
451 5.09
2946
Other systemic illness 7057 15.60
1316 14.86
8373
Total 45231 8855 54086
Clinical evaluation of affected hip
Walking capacity restriction N= 10220
WALK CAPACITY
WALK CAPACITY Frequency Percent CumulativeFrequency
Cumulative Percent
no answer 21 0.21 21 0.21
none 299 2.93 320 3.13
right hip 4049 39.62 4369 42.75
left hip 3604 35.26 7973 78.01
both hips 1946 19.04 9919 97.05
other 301 2.95 10220 100.00
…. Walking capacity restriction depending on revision side
Frequency Col Pct
Table of WALK CAPACITY by OP SIDE
OP SIDE WALK CAPACITY
Left Right
Total
none 151 3.11
148 2.77
299
right hip 18 0.37
4031 75.52
4049
left hip 3589 73.83
15 0.28
3604
both hips 949 19.52
997 18.68
1946
other 154 3.17
147 2.75
301
Total 4861 5338 10199
Walking capacity restriction
SIDE L R
WALKCAPSIDE
R
L
other
both hips
left hip
right hip
none
other
both hips
left hip
right hip
none
Percent of Total Frequency
0 10 20 30 40 50 60 70 80
Charnley Classification (4 levels, Röder et al. JOR 2006)
CHARNLEY Frequency Percent CumulativeFrequency
Cumulative Percent
A 4835 52.41 4835 52.41
BB 3749 40.64 8584 93.05
B 382 4.14 8966 97.19
C 259 2.81 9225 100.00
Usual support needed N=1537
SUPPORT
SUPPORT Frequency Percent CumulativeFrequency
Cumulative Percent
one cane/stick 624 40.60 624 40.60
one crutch 207 13.47 831 54.07
two canes/sticks 348 22.64 1179 76.71
two crutches 300 19.52 1479 96.23
walker 58 3.77 1537 100.00
Time walked with support N=6221
WALK WITH SUPPORT
WALK WITH SUPPORT Frequency Percent CumulativeFrequency
Cumulative Percent
none needed 2417 38.85 2417 38.85
> 60 min. 277 4.45 2694 43.30
31-60 min. 1176 18.90 3870 62.21
10-30 min. 2351 37.79 6221 100.00
Time walked without support N= 9157
WALK W/O SUPPORT
WALK W/O SUPPORT Frequency Percent CumulativeFrequency
Cumulative Percent
> 60 min. 750 8.19 750 8.19
31-60 min. 835 9.12 1585 17.31
10-30 min. 926 10.11 2511 27.42
< 10 min. 982 10.72 3493 38.15
not possible 5664 61.85 9157 100.00
Pain of the hip N=10`068
HIP PAIN
HIP PAIN Frequency Percent CumulativeFrequency
Cumulative Percent
none 389 3.86 389 3.86
mild 1017 10.10 1406 13.97
moderate 3545 35.21 4951 49.18
severe 5014 49.80 9965 98.98
intolerable 103 1.02 10068 100.00
Flexion range N=10`219
FLEXION RANGE
FLEXION RANGE Frequency Percent CumulativeFrequency
Cumulative Percent
no answer 229 2.24 229 2.24
> 90° 2948 28.85 3177 31.09
71-90° 4655 45.55 7832 76.64
30-70° 1821 17.82 9653 94.46
< 30° 399 3.90 10052 98.37
stiff 167 1.63 10219 100.00
Flexion range depending on number of previous revisions
Frequency Col Pct
Table of FLEXION RANGE by PREVIOUS REVISION
PREVIOUS REVISION FLEXION RANGE
none 1 2 3 4 5 >5
Total
> 90° 2373 31.97
446 24.90
71 18.35
4 13.33
1 7.69
0 0.00
1 20.00
2896
71-90° 3477 46.85
846 47.24
186 48.06
12 40.00
5 38.46
0 0.00
1 20.00
4527
30-70° 1222 16.46
382 21.33
89 23.00
9 30.00
5 38.46
3 100.00
2 40.00
1712
< 30° 242 3.26
80 4.47
29 7.49
4 13.33
2 15.38
0 0.00
0 0.00
357
stiff 108 1.46
37 2.07
12 3.10
1 3.33
0 0.00
0 0.00
1 20.00
159
Total 7422 1791 387 30 13 3 5 9651
Frequency Missing = 1
Apparent leg length discrepancy (shorter)
LEG LENGTH DISCREPANCY
Frequency Percent CumulativeFrequency
Cumulative Percent
equal length 3635 35.57 3635 35.57
right 3407 33.34 7042 68.92
left 3176 31.08 10218 100.00
Comparison of leg length discrepancy preoperative by surgery side
Table of LEG LENGTH DISCREPANCY by OP SIDE
OP SIDE LEG LENGTH DISCREPANCY
Left Right
Total
equal length 1734 47.70
1901 52.30
3635
right shorter 436 12.80
2971 87.20
3407
left shorter 2704 85.14
472 14.86
3176
Total 4874 47.70
5344 52.30
10218 100.00
Frequency Missing = 2
Radiological Evaluation
Acetabular side migration (superior) N=7`261
AC MIGRATION SUPERIOR
AC MIGRATION SUPERIOR Frequency Percent Cumulative Frequency
CumulativePercent
0-4 mm 4417 60.83 4417 60.83
5-10 mm 2485 34.22 6902 95.06
>10 mm 170 2.34 7072 97.40
tilt of socket 189 2.60 7261 100.00
Acetabular side migration (medial) N= 1`438
AC MIGRATION MEDIAL
AC MIGRATION MEDIAL Frequency Percent Cumulative Frequency
CumulativePercent
protrusio 1120 77.89 1120 77.89
socket in pelvis 318 22.11 1438 100.00
Femoral side stem subsidence N=10`035
FEMORAL STEM SUB-SIDENCE
Frequency Percent Cumulative Frequency
CumulativePercent
none 7585 75.59 7585 75.59
1-3 mm 392 3.91 7977 79.49
4-9 mm 1893 18.86 9870 98.36
>9 mm 165 1.64 10035 100.00
Endosteal resorption N=741
RESORPTION
RESORPTION Frequency Percent CumulativeFrequency
Cumulative Percent
Cavities <1 cm 312 42.11 312 42.11
Cavities >1 cm 233 31.44 545 73.55
extensive defect 196 26.45 741 100.00
Operation/ Prosthetic Components
Cup material
CUP MATERIAL
CUP MATERIAL
Frequency Percent CumulativeFrequency
Cumulative Percent
all PE 6431 76.40 6431 76.40
all CoCr 287 3.41 6718 79.81
metal backed 3 0.04 6721 79.85
PE+Sulmesh 480 5.70 7201 85.55
PE+CoCr surface
68 0.81 7269 86.36
Ceramic 17 0.20 7286 86.56
PE 923 10.97 8209 97.53
CoCr surface 125 1.49 8334 99.01
other 83 0.99 8417 100.00
...chronological distribution of cup material
Frequency Row Pct Col Pct
Table of CUP MATERIAL by INTERVAL
INTERVAL CUP MATERIAL
1968 (1966-1970)
1973 (1971-1975)
1978 (1976-1980)
1983 (1981-1985)
1988 (1986-1990)
1993 (1991-1995)
1998 (1996-2000)
2003 (2001-2003)
Total
all PE 21 0.33 100.0
72 1.12 100.0
267 4.15 99.63
1319 20.51 96.70
2410 37.47 82.03
1681 26.14 73.99
575 8.94 49.36
86 1.34 60.56
6431
all CoCr 0 0.00 0.00
0 0.00 0.00
0 0.00 0.00
29 10.10 2.13
169 58.89 5.75
82 28.57 3.61
6 2.09 0.52
1 0.35 0.70
287
PE+Sulmesh 0 0.00 0.00
0 0.00 0.00
0 0.00 0.00
2 0.42 0.15
139 28.96 4.73
147 30.63 6.47
168 35.00 14.42
24 5.00 16.90
480
PE 0 0.00 0.00
0 0.00 0.00
1 0.11 0.37
14 1.52 1.03
220 23.94 7.49
336 36.56 14.79
325 35.36 27.90
23 2.50 16.20
919
CoCr 0 0 0 0 0 26 91 8 125
surface 0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
20.80 1.14
72.80 7.81
6.40 5.63
Total 21 0.25
72 0.87
268 3.25
1364 16.55
2938 35.65
2272 27.57
1165 14.13
142 1.72
8242 100.00
Frequency Missing = 4
Acetabular Augmenation N= 8146
CUP AUGMENTATION
CUP AUGMEN-TATION
Frequency Percent CumulativeFrequency
Cumulative Percent
none 3148 38.64 3148 38.64
screws 132 1.62 3280 40.27
ARR 2501 30.70 5781 70.97
APC 739 9.07 6520 80.04
ARR with hook 487 5.98 7007 86.02
Titan 597 7.33 7604 93.35
alloys 5 0.06 7609 93.41
solid 21 0.26 7630 93.67
central hole 214 2.63 7844 96.29
other 302 3.71 8146 100.00
Acetabular augmenation depending on number of pervious revisions
Frequency Col Pct
Table of CUP AUGMENTATION by PREVIOUS REVISION
PREVIOUS REVISION CUP AUGMENTATION
none 1 2 3 4 5 >5
Total
none 2415 38.75
512 38.61
95 34.55
2 9.52
1 11.11
1 50.00
2 66.67
3028
screws 92 1.48
31 2.34
3 1.09
0 0.00
0 0.00
0 0.00
0 0.00
126
Acetabular Reinforcement Ring
(ARR)
1955 31.37
367 27.68
74 26.91
5 23.81
3 33.33
0 0.00
0 0.00
2404
Antiprotusion Cage (APC)
502 8.05
151 11.39
57 20.73
7 33.33
2 22.22
0 0.00
0 0.00
719
ARR with hook 382 6.13
78 5.88
17 6.18
5 23.81
1 11.11
0 0.00
1 33.33
484
Titan 479 7.68
86 6.49
16 5.82
2 9.52
2 22.22
1 50.00
0 0.00
586
alloys 3 0.05
1 0.08
1 0.36
0 0.00
0 0.00
0 0.00
0 0.00
5
solid 16 0.26
4 0.30
1 0.36
0 0.00
0 0.00
0 0.00
0 0.00
21
central hole 163 2.62
41 3.09
3 1.09
0 0.00
0 0.00
0 0.00
0 0.00
207
other 226 3.63
55 4.15
8 2.91
0 0.00
0 0.00
0 0.00
0 0.00
289
Total 6233 1326 275 21 9 2 3 7869
Femoral head N=7`959
HEAD
HEAD Frequency Percent CumulativeFrequency
Cumulative Percent
stainless 1237 15.54 1237 15.54
Cr/Co 3303 41.50 4540 57.04
Titanium 16 0.20 4556 57.24
Titanium coated
11 0.14 4567 57.38
Ceramic 3392 42.62 7959 100.00
...chronological distribution of femoral head material
Frequency Col Pct
Table of HEAD MATERIAL by INTERVAL
INTERVAL HEAD MATERIAL
1968 (1966-1970)
1973 (1971-1975)
1978 (1976-1980)
1983 (1981-1985)
1988 (1986-1990)
1993 (1991-1995)
1998 (1996-2000)
2003 (2001-2003)
Total
stainless 2 8.00
19 23.17
35 14.23
182 13.90
519 19.22
338 15.35
132 10.65
10 8.13
1237
Cr/Co 23 92.00
63 76.83
207 84.15
932 71.20
1078 39.91
591 26.84
376 30.32
33 26.83
3303
Ceramic 0 0.00
0 0.00
4 1.63
195 14.90
1104 40.87
1273 57.81
732 59.03
80 65.04
3388
Total 25
82
246 1309 2701 2202 1240 123 7928
Frequency Missing = 4
Stem material N=6793
STEM MATERIAL
STEM MATERIAL
Frequency Percent CumulativeFrequency
Cumulative Percent
stainless 805 11.85 805 11.85
casted CoCr 55 0.81 860 12.66
forged CoCr 3184 46.87 4044 59.53
Titanium alloy 2749 40.47 6793 100.00
...chronological distribution of stem material
Frequency Col Pct
Table of STEM MATERIAL by INTERVAL
INTERVAL STEM MATERIAL
1968 (1966-1970)
1973 (1971-1975)
1978 (1976-1980)
1983 (1981-1985)
1988 (1986-1990)
1993 (1991-1995)
1998 (1996-2000)
2003 (2001-2003)
Total
no answer 30 100.00
87 90.63
283 88.71
665 41.93
784 23.16
871 30.22
610 35.95
97 43.89
3427
stainless 0 0.00
2 2.08
0 0.00
139 8.76
391 11.55
188 6.52
71 4.18
14 6.33
805
casted CoCr 0 0.00
0 0.00
1 0.31
0 0.00
0 0.00
20 0.69
30 1.77
4 1.81
55
forged CoCr 0 0.00
7 7.29
35 10.97
668 42.12
1383 40.86
758 26.30
301 17.74
28 12.67
3180
Titanium alloy
0 0.00
0 0.00
0 0.00
114 7.19
827 24.43
1045 36.26
685 40.37
78 35.29
2749
Total 30 96 319 1586 3385 2882 1697 221 10216
Frequency Missing = 4
Operation procedure
Revision of Components N=10220
COMPONENT REVISION
COMPONENT REVISION
Frequency Percent CumulativeFrequency
Cumulative Percent
none 299 2.93 299 2.93
both components 5320 52.05 5619 54.98
only socket 2743 26.84 8362 81.82
only stem 1607 15.72 9969 97.54
Girdlestone 251 2.46 10220 100.00
Revisions of components because of aseptic loosening
Table of OP REVISION by DIAGNOSIS ASEPTIC LOOSENING
DIAGNOSIS OP REVISION
ASEPTIC LOOSENING
OTHER DIAGNOSIS
Total
none 42 15.56
228 84.44
270
both components
3941 84.41
728 15.59
4669
only socket 2293 88.40
301 11.60
2594
only stem 1304 85.51
221 14.49
1525
implant removal
61 30.50
139 69.50
200
Total 7641 82.53
1617 17.47
9258 100.00
Fixation of components N=10`220
COMPONENT FIXATION
COMPONENT FIXATION
Frequency Percent CumulativeFrequency
Cumulative Percent
no answer 230 2.25 230 2.25
all cemented 5087 49.77 5317 52.03
all uncemented 2251 22.03 7568 74.05
hybrid 942 9.22 8510 83.27
reverse hybrid 1177 11.52 9687 94.78
no implant 533 5.22 10220 100.00
Other operations (reduction, trochanter; others) N=2`327
OTHER OP Frequency Percent CumulativeFrequency
Cumulative Percent
Closed Reduction 5 0.21 5 0.21
Open Reduction 49 2.11 54 2.32
Trochanter Refixation
178 7.65 232 9.97
Trochanter Relocation
13 0.56 245 10.53
excision ossification
1676 72.02 1921 82.55
internal fixation 50 2.15 1971 84.70
femoral osteotomy 48 2.06 2019 86.76
wound drainage 27 1.16 2046 87.92
other 281 12.08 2327 100.00
Acetabular reconstruction with bone graft N=10`219
BONE GRAFT
BONE GRAFT Frequency Percent Cumulative Frequency
CumulativePercent
no answer 2102 20.57 2102 20.57
none 3232 31.63 5334 52.20
fresh autologous 1030 10.08 6364 62.28
frozen allograft 3371 32.99 9735 95.26
freezedried bone 134 1.31 9869 96.58
fresh autologous & frozen allograft
331 3.24 10200 99.81
fresh autologous & freezedried bone
15 0.15 10215 99.96
frozen allograft & freezedried bone
3 0.03 10218 99.99
fresh autologous & frozen allograft & freezedried bone
1 0.01 10219 100.00
Calcar defect N=2`316
CALCAR DEFECT
CALCAR DEFECT
Frequency Percent CumulativeFrequency
Cumulative Percent
>5 mm 1636 70.64 1636 70.64
to lesser trochanter
509 21.98 2145 92.62
including lesser trochanter
171 7.38 2316 100.00
Femoral Cortex N=3`085
FEMORAL CORTEX
FEMORAL CORTEX
Frequency Percent CumulativeFrequency
Cumulative Percent
normal 590 19.12 590 19.12
thin 2239 72.58 2829 91.70
defects 113 3.66 2942 95.36
atrophic 33 1.07 2975 96.43
thin & defects 53 1.72 3028 98.15
thin & atrophic 26 0.84 3054 99.00
defects & atrophic 10 0.32 3064 99.32
thin & defects & atrophic
21 0.68 3085 100.00
Extraction cement N=4`717
EXTRACTION CEMENT
EXTRACTION CEMENT
Frequency Percent CumulativeFrequency
Cumulative Percent
without window 3688 78.19 3688 78.19
with window 525 11.13 4213 89.32
with femoral osteotomy
504 10.68 4717 100.00
Fixation of greater trochanter N=5`883
FIXATION GREAT
TROCHANTER
Frequency Percent CumulativeFrequency
Cumulative Percent
one wire 1305 22.18 1305 22.18
several wires 640 10.88 1945 33.06
screws 318 5.41 2263 38.47
screws & wire 26 0.44 2289 38.91
muscle reinsertion 3594 61.09 5883 100.00
Anteversion of stem N=1`423
ANTEVERSION
ANTEVERSION Frequency Percent CumulativeFrequency
Cumulative Percent
retroversion 3 0.21 3 0.21
<10° 446 31.34 449 31.55
10-15° 959 67.39 1408 98.95
>15° 15 1.05 1423 100.00
Perioperative Complications N=10`221
PEROP COMPLICATION
Frequency Percent CumulativeFrequency
Cumulative Percent
none 8614 84.28 8614 84.28
perforation 369 3.61 8983 87.89
proximal Fx 643 6.29 9626 94.18
distal Fx 24 0.23 9650 94.41
Fx of trochanter 231 2.26 9881 96.67
tendency to dislocate
154 1.51 10035 98.18
vascular 44 0.43 10079 98.61
pelvic perforation 81 0.79 10160 99.40
other 61 0.60 10221 100.00
Treatment of Complications N=10`249
TREATMENT OF COMPLICATIONS
Frequency Percent CumulativeFrequency
Cumulative Percent
None 9231 90.07 9231 90.07
Wiring 573 5.59 9804 95.66
Screw 70 0.68 9874 96.34
Plate 89 0.87 9963 97.21
Femoral osteotomy 158 1.54 10121 98.75
Vascular repair 51 0.50 10172 99.25
Change acetabular component
1 0.01 10173 99.26
Change femoral component
8 0.08 10181 99.34
Change both components
2 0.02 10183 99.36
Other 66 0.64 10249 100.00
Duration of procedure (time) N=10`220
OP TIME
OP TIME Frequency Percent CumulativeFrequency
Cumulative Percent
no answer 294 2.88 294 2.88
<1 1/2h 1446 14.15 1740 17.03
1 1/2 - 2 1/4h 3723 36.43 5463 53.45
2 1/4 - 3h 3279 32.08 8742 85.54
3 - 4h 1245 12.18 9987 97.72
>4h 233 2.28 10220 100.00
Anesthesia N=10`220
ANAESTHESIA
ANAESTHESIA Frequency Percent CumulativeFrequency
Cumulative Percent
no answer 343 3.36 343 3.36
general 4247 41.56 4590 44.91
hypotensive 466 4.56 5056 49.47
spinal 3653 35.74 8709 85.22
epidural 1505 14.73 10214 99.94
other 6 0.06 10220 100.00
... chronological distribution of Anesthesia
Frequency Col Pct
Table of ANESTHESIA by INTERVAL
INTERVAL Total ANES-THESI
A 1968 (1966
-1970)
1973 (1971
-1975)
1978 (1976
-1980)
1983 (1981
-1985)
1988 (1986
-1990)
1993 (1991
-1995)
1998 (1996
-2000)
2003 (2001
-2003)
no answer
14 46.67
4 4.17
6 1.88
94 5.93
179 5.29
42 1.46
4 0.24
0 0.00
343
general 16 68 113 613 1552 1067 703 111 4243
53.33 70.83 35.42 38.65 45.85 37.02 41.43 50.23
Hypo-tensive
0 0.00
22 22.92
144 45.14
159 10.03
57 1.68
56 1.94
26 1.53
2 0.90
466
spinal 0 0.00
2 2.08
32 10.03
524 33.04
1054 31.14
1217 42.23
738 43.49
86 38.91
3653
Epi-dural
0 0.00
0 0.00
24 7.52
196 12.36
543 16.04
499 17.31
221 13.02
22 9.95
1505
other 0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
1 0.03
5 0.29
0 0.00
6
Total 30
96
319
1586
3385
2882
1697
221
10216
Frequency Missing = 4
Hospital Course
Postoperative treatment/ after Operation N=9`976
POSTOP TREATMENT
Frequency Percent CumulativeFrequency
Cumulative Percent
Simple bedrest 9159 91.81 9159 91.81
Traction 786 7.88 9945 99.69
cast 31 0.31 9976 100.00
Intensive care N=10`220
INTENSIVE CARE
INTENSIVE CARE Frequency Percent CumulativeFrequency
Cumulative Percent
no answer 9791 95.80 9791 95.80
1-2 days 410 4.01 10201 99.81
>2 days 19 0.19 10220 100.00
Prophylaxis N= 9`824 (Hips)
PROPHYLAXIS Frequency Percent CumulativeFrequency
Cumulative Percent
Prophylaxis of heterotopic ossification
678 3.72 678 3.72
Prophylaxis of deep vein thrombosis
9586 52.64 10264 56.36
Prophylaxis of infection
7948 43.64 18212 100.00
...chronological distribution of prophylaxis
Frequency Col Pct
Table of PROPHYLAXIS by INTERVAL
INTERVAL PROPHY-LAXIS
1968 (1966
-1970)
1973 (1971
-1975)
1978 (1976
-1980)
1983 (1981
-1985)
1988 (1986
-1990)
1993 (1991
-1995)
1998 (1996
-2000)
2003 (2001
-2003)
Total
Prophy-laxis of
heterotopic
ossification
0 0.00
0 0.00
0 0.00
0 0.00
1 0.02
148 2.76
381 11.63
144 27.12
674
Prophy-laxis of
deep vein thrombosi
s
4 80.00
88 73.95
235 68.12
1478 59.67
3315 54.41
2750 51.36
1507 46.00
205 38.61
9582
Prophy-laxis of
infection
1 20.00
31 26.05
110 31.88
999 40.33
2777 45.58
2456 45.87
1388 42.37
182 34.27
7944
Total 5
119
345
2477 6093
5354
3276
531
18200
Frequency Missing = 12
Systemic complications N=1`494
SYSTEMIC COMPLICATIONS
Frequency Percent CumulativeFrequency
Cumulative Percent
none 92 6.16 92 6.16
deep thrombosis 84 5.62 176 11.78
pulmonary emboly 301 20.15 477 31.93
cardiovascular 162 10.84 639 42.77
respiratpry 210 14.06 849 56.83
gastrointestinal 320 21.42 1169 78.25
urological 129 8.63 1298 86.88
CNS 196 13.12 1494 100.00
Local complication N=10`310
LOCAL COMPLICATION
Frequency Percent CumulativeFrequency
Cumulative Percent
none 8634 83.74 8634 83.74
haematoma 908 8.81 9542 92.55
dislocation 299 2.90 9841 95.45
neuropraxia 124 1.20 9965 96.65
wound dehiscence 94 0.91 10059 97.57
superficial infection 80 0.78 10139 98.34
deep infection 90 0.87 10229 99.21
sinus infection 33 0.32 10262 99.53
other 48 0.47 10310 100.00
Revision N=10`220
REVISION
REVISION Frequency Percent CumulativeFrequency
Cumulative Percent
no 10128 99.10 10128 99.10
yes 92 0.90 10220 100.00
Discharge Status
Distribution of …..
Hip pain N=10`219
DISCHARGE HIP PAIN
DISCHARGE HIP PAIN Frequency Percent CumulativeFrequency
Cumulative Percent
no answer 134 1.31 134 1.31
none 5588 54.68 5722 55.99
mild 3970 38.85 9692 94.84
severe 30 0.29 10219 100.00
Other pain N=10`220
OTHER PAIN
OTHER PAIN Frequency Percent CumulativeFrequency
Cumulative Percent
no 9980 97.65 9980 97.65
yes 240 2.35 10220 100.00
Flexion at discharge N=10`219
DISCHARGE FLEXION
DISCHARGE FLEXION Frequency Percent CumulativeFrequency
Cumulative Percent
no answer 155 1.52 155 1.52
>90° 1884 18.44 2039 19.95
71-90° 6296 61.61 8335 81.56
30-70 1765 17.27 10100 98.84
<30° 119 1.16 10219 100.00
Comparison flexion range preoperativ and flexion range at discharge
Frequency Row pct
Table of PREOP FLEXION by DISCHARGE FLEXION
DISCHARGE FLEXION PREOP FLEXION(MFLEXION)
>90° 71-90° 30-70 <30°
Total
> 90° 865 29.48
1770 60.33
281 9.58
18 0.61
2934
71-90° 760 16.48
3113 67.50
712 15.44
27 0.59
4612
30-70° 188 10.47
1057 58.89
517 28.80
33 1.84
1795
< 30° 29 7.44
186 47.69
153 39.23
22 5.64
390
stiff 10 6.13
82 50.31
62 38.04
9 5.52
163
Total 1852 6208 1725 109 9894
Frequency Missing = 2
Apparent leg length discrepancy (shorter) N=10`216
LEG LENGTH DIS-CREPANCY
Frequency Percent CumulativeFrequency
Cumulative Percent
equal length 9825 96.17 9825 96.17
right 194 1.90 10019 98.07
left 197 1.93 10216 100.00
Comparison leg length discrepancy preoperative – postoperative
Frequency Row pct
Table of LEG LENGHT DISCREPANCY PREOP by LEG LENGHT DISCREPANCY _POSTOP
LEG LENGHT DISCREPANCY POSTOP
LEG LENGHT DISCREPANCY PREOP
equal length
right shorter
left shorter
Total
equal length 3544 97.58
43 1.18
45 1.24
3632
right shorter 3273 96.07
111 3.26
23 0.68
3407
left shorter 3007 94.71
39 1.23
129 4.06
3175
Total 9824 193 197 10214
Frequency Missing = 6
X-Ray acetabular component at discharge
Inclination (abduction) N=9`025
DISCHARGE INCLINATION
DISCHARGE INCLINATION
Frequency Percent CumulativeFrequency
CumulativePercent
<35° 32 0.35 32 0.35
35° 988 10.95 1020 11.30
40° 3288 36.43 4308 47.73
45° 4111 45.55 8419 93.29
50° 592 6.56 9011 99.84
>50° 14 0.16 9025 100.00
Anteversion N=9`010
DISCHARGE ANTEVERSION
DISCHARGE ANTEVERSION
Frequency Percent CumulativeFrequency
CumulativePercent
retroversion 47 0.52 47 0.52
<10° 2991 33.20 3038 33.72
10°-15° 5736 63.66 8774 97.38
>15° 236 2.62 9010 100.00
X-Ray femoral component at discharge
Position of the stem N=8`307
STEM POSITION
STEM POSITION Frequency Percent CumulativeFrequency
Cumulative Percent
neutral 7545 90.83 7545 90.83
valgus 313 3.77 7858 94.59
varus 449 5.41 8307 100.00
Cement in femur N=5`592
FEMUR CEMENT
FEMUR CEMENT Frequency Percent CumulativeFrequency
Cumulative Percent
above tip 303 5.42 303 5.42
below tip <2cm 4103 73.37 4406 78.79
below tip >2cm 1186 21.21 5592 100.00
Greater trochanter N=8`910
GREAT TROCHANTER
GREAT TROCHANTER Frequency Percent CumulativeFrequency
Cumulative Percent
in situ 8532 95.76 8532 95.76
displaced 201 2.26 8733 98.01
broken 177 1.99 8910 100.00
