Article
German results on hip replacement – A five-year survival analysis of 336,759 hips based on routine data from the AOK and comparison with the Joint Registry databases of England/Wales and Australia
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Authors
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Wolfram Mittelmeier
- Universitätsklinikum Rostock (AöR), Orthopädische Klinik und Poliklinik, Rostock, Germany
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Katrin Osmanski-Zenk
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
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Susanne Finze
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
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Jürgen Malzahn
- AOK Bundesverband, Bonn, Germany
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Peter C. Kreuz
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
| Published: | October 5, 2015 |
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Outline
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Objectives: At present the German Arthroplasty Register, established in 2010, has not published any results yet. The present study aims to evaluate for the first time the current available implant survival times of total hip replacements based on routine data from the Federation of Local Health Insurance Funds (AOK), and to compare nationwide survival rates with other nations.
Methods: For an international comparison of the estimated revision rates within the first five postoperative years, 336,759 hip replacements of AOK members, which were treated with a primary hip arthroplasty between 2005 and 2011, and the national joint registries from England/Wales (UK) and Australia (AUS) were evaluated. Kaplan-Meier survival analysis was used to calculate survival probabilities with 95% confidence intervals (CI).
Significant differences between the subgroups were analyzed with the help of the log-rank test and were considered to be significant if p-values were < 0.05.
From the National Joint Registry for England and Wales we analysed 458,568 hip replacement operations (Porter et al. 2012). According to the Australian Orthopedic Association we evaluated 332,351 hip replacements and revisions (Davidson et al. 2012).
Results and Conclusion: As 11,271 endoprostheses were revised within the first five years, the Kaplan-Meier 5-year survival for all cases was 96.11% (CI: 96.04-96.18) based on AOK routine data. The Kaplan-Meier 5-year survival for all cases from England and Wales was 97.39% (CI: 97.46-97.33)
Table 1 gives an overview of the Kaplan-Meier 1-, 3- and 5-year survival by type of fixation.
A transnational comparison of the estimated revision rates of resurfacing showed better results in England/ Wales and Australia than in Germany. While the AOK data represent a 5-year revision rate of 8.08% (CI: 6.89-9.27), UK has 5.52% (CI: 5.22-5.83) and AUS 5.20% (CI: 4.9-5.6).
The present study showed significant differences between the survival rates of a huge representative dataset of hip replacements in Germany and the data from other national joint registries. The data underline the importance of a German Arthroplasty Register for better evaluation and improvement of clinical outcome and implant survival time.
