Australia has been leading the world with its National Joint Replacement Registry since 2000, with every joint replacement and its long term outcome being followed.
Key issues identified this year include:
- The registry is now tracking the outcome of 1.8 million joint replacements.
- 2021 saw 52,787 hip replacements, 68,466 knee replacements, and 8,733 shoulder replacements.
- As a result of COVID, some 19,500 people have not had a joint replacement that in normal times should have occurred. This was predominantly in the public sector, with a 14.9% reduction compared with 2019.
Implants that were implanted 10 years ago, still being used, have a 4.4% ten-year failure for hips, and 4.7% for knees. Young patients under 55 having knee replacement are the biggest risk.
Various designs and surgical approaches have been advocated to improve results. Highly cross-linked polyethylene (XLPE) is a proven winner, but dual mobility, and constrained liners, have not improved outcomes for primary hip replacement.
Anterior surgical approach in the Australian Registry has a lower dislocation rate, but the overall revision rate not changed. It seems currently any dislocation improvement is offset by an increased risk in fracture & loosening.
Total hip replacement for fracture (instead of bipolar) has become more common, with a 10-year revision rate of 6.9% vs 5.3% for the bipolars. That difference is obvious for the older patients over 70, but not very different for the younger ones.
Hip resurfacing in men, with a femoral head size of 50mm or greater still has a place.
Partial knee replacement has diminished to 5.6% of knee replacements, the robotic Restoris (Mako) doesn’t seem better than the ZUK, or Persona.
Some designs have been identified as having a higher-than-expected revision rate, fortunately we have not routinely used these.