Orthopaedics from Down under

I wanted to share this press release the I foudn while surfing the net. I’ve already closed the window from which I pasted it in and I can’t remember the source site. For me the moral of this press release is that those of us who aren’t convinced or totally confident with mono-compartmental knees or hip resurfacing should leave them alone as we’re only putting our patients at risk.

British researchers collecting and reviewing nationwide data on hip and knee replacements reported that one in 75 patients requires a revision of their joint replacement after 3 years.

Although this compares favorably with the rest of the world, the study reinforces concerns about the new surgical techniques of hip resurfacing and unicondylar knee replacement, according to a press release.

Hip and knee replacements are among the most frequent surgical operations conducted in the United Kingdom, with about 160,000 procedures performed in England and Wales in 2006. However, there is little evidence to compare the patient outcomes of hip and knee replacement with the many types of surgical techniques and prostheses used to replace the joint, Jan van der Meulen, PhD, said in the press release.

He and his colleagues from the Royal College of Surgeons used records from the National Joint Registry (NJR) for England and Wales to address the lack of evidence comparing patient outcomes. Since April 2003, the NJR has collected data available immediately following surgery, including patient characteristics, the type of prostheses and the surgical technique used to replace the joint.

In order to identify the revision rates, the researchers linked the NJR records with another database — the Hospital Episodes Statistics — which contains information on all admissions to National Health Service hospitals in England. They considered revisions for any reason in the 3 years following a hip or knee replacement.

They also paid particular attention to hip resurfacing and unicondylar knee replacement, two techniques that are increasingly used but about which there is “little evidence” of their performance, van der Meulen said in the press release.

Of the 167,076 procedures that could be linked between the two databases between April 2003 and September 2006, one in 75 patients required a revision of their joint replacement, van der Meulen said. As expected, the patients who had cemented prostheses had the lowest revision rates.

For hip replacements, the highest revision rates were experienced by women who had undergone hip resurfacing rather than total joint replacement, according to the press release. Of patients who had undergone knee replacement operations, those who had unicondylar prostheses had the highest revision rates.

Van der Meulen said there appears to be no connection between a patient’s age and his or her revision rate for a hip replacement, whereas revision rates after knee replacement decreased strongly with age.

“This first national study on joint replacement does provide benchmark data for the further research that is needed to evaluate the performance of different procedures and types of implant,” he said in the press release.

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