Centre of excellence of joint replacements

Transkript

1 REPORT 2009 Centre of excellence of joint replacements The Norwegian Arthroplasty Register The Norwegian Cruciate Ligament Register The Norwegian Hip Fracture Register Helse Bergen HF, Department of Orthopaedic Surgery Haukeland University Hospital Report in Norwegian: ISBN: ISSN:

2 Report 2009

3 Contents Preface Quality on prosthesis surgery in Norway... 1 The Norwegian Arthroplasty Register Hip prostheses Number of total hip replacements by year of operation Incidence of primary total hip replacements by gender and age (1995, 2000, 2005) Hip disease Patient age by year of operation Reason for revision Type of revision Bone transplant Operative approach Trochanteric osteotomy Systemic antibiotic prophylaxis Cement Cement and bone transplant in revisions Cement brands Common combinations of prosthesis brands (acetabulum and femur) Prosthesis brands, acetabulum Prosthesis brands, femur Monoblock and modular caput Caput diameter in modular prostheses Prosthesis brands, modular caput ASA classification Thrombosis prophylaxis Mini-invasive surgery Computernavigation Bone loss at revision Articulation, primary operations Knee prostheses Number of knee replacements by year of operation Incidence of primary knee replacements by gender and age (1995, 2000) Number of knee replacements by year of operation and type of prosthesis Knee disease Cement Prosthesis brands Reason for revision Patient age by year of operation Type of revision Elbow prostheses Number of elbow replacements by year of operation Elbow disease Cement Prosthesis brands Reason for revision... 65

4 Report 2009 Ankle prostheses Number of ankle replacements by year of operation Ankle disease Cement Prosthesis brands Reason for revision Finger joint prostheses (MCP, PIP) Number of finger joint replacements by year of operation Finger joint disease Cement Prosthesis brands Reason for revision Wrist prostheses Number of wrist replacements by year of operation Wrist disease Cement Prosthesis brands Reason for revision Carpometacarpal prostheses (CMC I) Number of CMC I replacements by year of operation CMC I disease Cement Prosthesis brands Reason for revision Lumbar disc prostheses Number of lumbar disc replacements by year of operation Lumbar disc disease Cement Prosthesis brands Shoulder prostheses (total, hemi) Number of shoulder replacements by year of operation Shoulder disease Cement Prosthesis brands Reason for revision Toe joint prostheses Number of toe joint replacements by year of operation Toe joint disease Cement Prosthesis brands Reason for revision... 93

5 The Norwegian Hip Fracture Register Introduction Number of hip fractures by year of operation Incidence of primary hip fracture Age by primary operation Time from fracture to operation primary operation Cognitive impairment primary operation Type of anaesthesia primary operation ASA classification Type of fracture reason for primary operation Reason for reoperation Reason for reoperation by reason for primary fracture Type of primary operation vs. reason for primary operation Type of primary operation all fractures Type of reoperation Type of reoperation after primary uni/bipolar hemiprosthesis Type of reoperation after primary screw fixation Hemiprosthesis primary operation Hemiprosthesis reoperation Screws primary operation Hip compression screw primary operation Nail primary operation Fixation of primary hemiprosthesis Cement with antibiotics primary operation Fixation of primary hemiprosthesis uncemented Pathological fracture primary operation Operative approach when primary hemiprosthesis Peroperative complications primary operation Systemic antibiotic prophylaxis Thrombosis prophylaxis The Norwegian Cruciate Ligament Register Introduction All operations Number of procedures by year of operation Incidence of primary reconstruction of crucate ligament The number of other procedures for all categories of surgeries Distribution of other procedures in combination with primary reconstruction of cruciate ligament Distribution of other procedures in combination with reconstruction Distribution of other procedures when this is the only procedure Per operative complications Primary reconstruction of cruciate ligament Age at primary operation Activity that lead to injury Injury ACL with additional injuries

6 Report 2009 PCL with additional injuries Choice of graft Fixation femur ACL Fixation femur PCL Fixation tibia ACL Fixation tibia PCL Fixation femur and tibia ACL Meniscal lesion Fixation Meniscal lesion Cartilage lesion: ICRS grade Cartilage lesion: probable cause Cartilage lesion: treatment Cartilage injuries Outpatient surgery Per operative complications Systemic antibiotic prophylaxis Thrombosis prophylaxis Revision reconstruction Age at primary operation Activity that lead to injury Injury ACL with additional injuries PCL with additional injuries Choice of graft Fixation femur ACL Fixation femur PCL Fixation tibia ACL Fixation tibia PCL Fixation femur and tibia ACL Meniscal lesion Fixation Meniscal lesion Cartilage lesion: ICRS grade Cartilage lesion: probable cause Cartilage lesion: treatment Cartilage injuries Outpatient surgery Per operative complications Systemic antibiotic prophylaxis Thrombosis prophylaxis Other procedures Age at primary operation Activity that lead to injury Injury ACL with additional injuries PCL with additional injuries Meniscal lesion Fixation Meniscal lesion Cartilage lesion: ICRS grade Cartilage lesion: probable cause Cartilage lesion: treatment Cartilage injuries Outpatient surgery

7 Per operative complications Systemic antibiotic prophylaxis Thrombosis prophylaxis Publications...175

8 Report 2009

9 ANNUAL REPORT 2009 The Norwegian Arthroplasty Register performs quality control and research on all joint replacements from all hospitals in Norway. From the period the register contains information on hip arthroplasties. In January 1994 the register expanded to include also replacements in other joints. From the period it is registered data on knee replacements and in other joints. From June 7 th 2004 the registering of operations on the cruciate ligament started. It is registered cruciate ligament operations from the start and until December 31 st For more information please refer to the preface for the National Cruciate Ligament Register on page 119. The Norwegian Hip Fracture Register was started January 1 st 2005 and there has been registered hip fracture operations so far. For more information please refer to the preface on page 95. We have decided to publish mainly descriptive statistics in the annual reports. Comparative studies, for instance of the quality of different types of prostheses, are presented in scientific lectures, poster or papers. We strongly feel that the results from comparing types of prostheses should include a thoroughly review on how the patients in the study were picked and the use of statistical methods. It should also include a discussion on how the results should be interpreted. This is best done in a scientific setting, and we refer to our list of references in the end of this report and on our web page ( The web page also includes an English version of the annual report for Most of our reports and papers can be read directly from this web page (some magazines will not give their permission). THE QUALITY OF THE PROSTHESIS SURGERY IN NORWAY In this year s report we choose to present results showing the development of the quality of the prosthesis surgery in the beginning of the report. We show that the quality, both for hip and knee arthroplasties, is improving. In the first ten years, 1987 to 1998, 30 % of the hospitals had more than 10 % revision operations after 10 years of follow up of hip arthroplasties. In the last decade less than 5 % of the hospitals had more than 10 % revisions after 10 years of follow up (page 3). ANNUAL REPORTS TO THE HOSPITALS The annual reports to each hospital where sent to the contact persons at the respective hospitals in October The reports include data for This year in addition to the paper version of the report, a PDF type file were sent to the contact person to make presentations to their colleagues easier. We encourage the orthopaedic divisions to use the annual report actively in their quality work. PhDs in 2008 Orthopedic surgeon Astvaldur Arthursson at the Department of Orthopedic Surgery, Stavanger University Hospital defended his medical PhD Surgical approach and muscle strength in total hip arthroplasty November 13 th at the University of Bergen (PhDs 8). All members of the Norwegian Orthopaedic Federation received a copy.

10 Report 2009 Orthopedic surgeon Jan Erik Gjertsen at the Department of Orthopedic Surgery, Haukeland University Hospital defended his medical PhD Surgical treatment of hip fractures in Norway (PhDs 9). This is the first dissertation from the Hip Fracture Register. It will be sent on to all members of the Norwegian Orthopedic Association. PROSTHESIS SURGERY IN NORWAY 2008 There was a 2 % increase in the number of primary hip replacements from 2007 to 2008, and an 11 % increase in primary knee replacements (Table 1). It is still cemented prostheses (both components) which dominate as the fixation method both for hip and knee (Figure 5 7). The number of revisions in the hip has increased. The revisions constitute 13.6 % of all the operations in 2007 and 14 % of all the operations in 2008, in 2003 the revisions counted for 12.3 % (Table 1). This is unfortunately a development in the wrong direction, and is mainly because of the widespread use of the cemented Reflection (cup)/spectron EF (stem) (61) the last years. This prosthesis has been advertised the last 10 years on the basis of the good results of the Spectron stem from Sweden (Garellick G et al. The Charnley versus Spectron hip prosthesis: clinical evaluation of a randomized, prospective study of 2 different hip implants (J Arthroplasty 1999; 14:407 13)). It was not made clear in the marketing process that the sterilization of the cup was changed to EtO sterilization and that the stem s proximal part was rougher than on the documented Spectron prosthesis. The prosthesis was the most used prosthesis used in Norway in We hope this experience will make both the prosthesis producers and the surgeons more careful in using undocumented prostheses. We remind all orthopaedic surgeons about the recommendation from the SMM report 6/2002 that prosthesis should have documented good results for more than 10 years before they are used in a large number of patients. The paper from the Register (61) also shows that since 1995 the surgeons using the Charnley prostheses have improved their results, but others have not improved or they have a deterioration of the results. This especially affects the ones who have used the Titan prosthesis. We are studying this phenomenon in more detail which might be explained by a smaller size of the prosthesis combined with a high offset or a change in the cement technique (61). SUMMARY OF THE MOST IMPORTANT FINDINGS IN 2008 Two PhDs and 14 papers are published in scientific journals in 2008 and until June Instability of the hips at birth increases the risk for a total hip arthroplasty in young adults 2.6 times compared to the children not reported with instability of the hips. Surprisingly only 8 % of the infants receiving a total hip replacement prior to 38 years of age due to hip dysplasia had reported instability of the hips at birth and reported to the Medical Birth Registry. This study is the first connecting data from the Medical Birth Registry and the Norwegian Arthroplasty Register (NRL) (56). In a study at St. Olavs Hospital in Trondheim the Charnley hip prostheses were investigated with 13 years of follow up with clinical and radiological findings, the results were compared with results of revision and rate of reporting to NRL. It showed that 83 % of the patients were totally satisfied with their hips after 13 years, the survival of the prostheses were 85 % after 13 years with any revisions as endpoint. The clinical success rate was 76 %. Only 0.8 % of the primary hip prostheses were not reported to NRL, but all revisions were reported (57).

11 In the shoulder the 5 and 10 years survival of the hemi prostheses were 94 % and 92 % respectively. The results for reversed total prostheses in the shoulder were not as good, 90 % and 78 % respectively after 5 and 10 years. The results for the shoulder prostheses were best for rheumatoid arthritis (RA), primary osteoarthritis and patients with acute fracture. The results were not as good for sequelae after fracture when the endpoint were any revision (58). For the elbow the survival results with any revision as endpoint after 5 and 10 years were 92 % and 85 % respectively. The results were not as good as for hip or knee prostheses. Most of the patients receiving prosthesis were patients with rheumatoid arthritis (59). In a cost benefit analysis exploring the use of antibiotic in cement using data from the register we found that antibiotic in cement will reduce the costs in hip prosthesis surgery (60). In the first study based on data from the hip prosthesis registers in Sweden, Denmark and Norway, the results were better in Sweden than in Norway, and better in Norway than in Denmark. In Sweden it was mainly used cemented prostheses (89 % of the patients) in Denmark it was less (46 % of the patients), and in Norway 79 % of the patients received a cemented hip prosthesis. This study is the first in hopefully a wide range of studies from the Nordic Arthroplasty Register Association (62). There are ongoing studies on young patients, resurfacing prostheses, infections and children suffering from hip diseases on these data. Data from knee prostheses has just been published (Robertsson O et al Knee Arthroplasty in Denmark, Norway and Sweden Acta Orthop 2010). The Reflection (cup)/spectron EF (stem) prosthesis had, as mentioned earlier, a poorer result than the other cemented prostheses; this was especially evident after 5 or more years of follow up. With a follow up of 5 or more years the Reflection cup had a 14 times higher revision rate than the Charnley cup, and the Spectron stem a 6.1 times higher revision risk than the Charnley stem. This is especially worrying given that the Reflection/Spectron EF prosthesis was the most used total hip prosthesis in Norway in 2008 and in large periods of the last 10 years. Since the revisions came after 5 years of observation the patients must be followed carefully due to wear and loosening of the cup and stem (61). SYMPOSIUM AT THE AUTUMN MEETING The registers arranged a two hour symposium where the point of discussion was; should the individual hospital results be publically announced and on how to handle possible divergence.the magazine Overlegen summarized the symposium. The current theme is treated in the steering group of the register and a final proposal will be presented for the board and General Assembly of the Norwegian Orthopedic Association during this year s autumn meeting. LUMBAR DISC PROSTHESES Since 2002 we have collected data on lumbar disc prostheses, but since the Spine Register in Tromsø started collecting data many hospitals have stopped sending us reports. The Spine Register in Tromsø does not have an implant database. In collaboration with them we ask

12 Report 2009 you to report all lumbar disc prostheses to us. For the future we hope that the Spine Register will expand to also become an implant register for spine surgery. NEW WEB PAGE On our new web page (Norwegian) you will find patient information, research papers, and our annual reports, together with a summary of our recent research. It will all be written in Norwegian and some will in addition be in English ( BOARD AND STEERING GROUP OF THE NORWEGIAN ARTHROPLASTY REGISTER Information on the Board and the Steering Group will be found on our new web page. ACKNOWLEDGEMENT The Norwegian Arthroplasty Register/Centre of excellence of joint replacements would like to thank all orthopedic surgeons in the country for excellent reporting. Further we would like to thank Helse Bergen, Helse Vest, all product distributors, Locus for registry based epidemiology, University of Bergen, Oslo Sports Trauma Center at the Norwegian University of Sport and Physical Education, Norwegian Patient Register, Norwegian Knowledge Centre for the Health Services, The Norwegian Institute of Public Health, Norwegian Board of Health Supervision, and the Norwegian Health Authorities, for the good cooperation in 2008.

13 QUALITY OF PROSTHESIS SURGERY IN NORWAY HIP PROSTHESIS Figure 1 shows that for all types of prostheses there were half the risk (Risk Rate (RR) 0.5) for a revision operation in the time period 2000 to 2002 compared to the time period 1987 to In a cost perspective this means a reduction of 500 revision operations per year in the period 2000 to 2002 in relation to the period 1987 to This represent yearly reduced expenses for the hospitals for 500 operations x the cost for a revision operation (NOK ) = 100 millions NOK and not least lesser suffering for the patients. Figure 2a shows the survival curve for each hospital for cemented prostheses the first 10 years from 1987 to It shows that after 10 years of follow up 30 % of the hospitals had worse results than 90 % survival of the prostheses after 10 years. 90 % survival after 10 years is an accepted standard of quality for hip prostheses (Norwegian Knowledge Centre for the Health Services SMM report 6/2002). Figure 2b shows the last 10 years period from 1998 to In this period less than 5 % of the hospitals had results worse than 90 % survival after 10 years of follow up. KNEE PROSTHESES Figure 3c and 3d show that there has been a reduction of revisions of more than 40 % with total prostheses with or without patella prosthesis (counts for 88 % of all knee prosthesis operations) in the time period 2003 to 2008 compared to 1994 to There has been no improvement for operations with unicondylar knee prostheses. OTHER JOINT PROSTHESES Figure 4a h show that the results for elbow prostheses (a) have been less satisfactory the last years, this is especially true for some hospitals. Our publication (59) deals with some of this. The same is true for Carpometacarpal prostheses (d) and wrist prostheses (c). This will be studied thoroughly. There has been no improvement for ankle (50), finger joint or toe joint prostheses. For the shoulder prostheses; the total joint prosthesis seems to improve somewhat, but there are no change in the results for the hemi prostheses (58). HIP FRACTURES Figure 5c shows that the results for displaced intracapsular fractures improve in the period 2007 to 2008 compared to 2005 to 2006 in terms fewer revisions. The life quality of these patients has also improved (Figure 6). This is due to an increase in the use of hemi prostheses for patients with a displaced intracapsular fracture (Thesis 9). This change in treatment policy for hip fractures is mainly due to the results from the Hip Fracture Register together with an excellent randomized study at Ullevål University Hospital (Frihagen F BMJ 2007). In 2005 about 50 % of all patients with a displaced intracapsular fracture was operated using hemi prosthesis, in % of the patients were operated using this method. The thesis written by Jan Erik Gjertsen (Thesis 9) shows improvement in the patients quality of life, with less pain and better function 4 and 12 months after operation with hemi prosthesis compared to two screws. 1

14 Report 2009 CRUCIATE LIGAMENT OPERATIONS Figure 7a shows that for the patients with a cruciate ligament reconstruction operated in the period 2005 to 2006 about 3 % will have a revision reconstruction after 4 years. For the patients operated in 2007 to 2008 the results are similar. Figure 7b shows that two years after operation the KOOS values (functionality and pain) are better for all sub scores, and remarkably better in terms of sporting activity and quality of life. 2

15 Figure 1: Survival of total hip prostheses a) All prostheses b) Cemented Prosthesis survival (%) RR (p value) (<0.001) 0.9 (<0.001) 0.6 (<0.001) 0.5 (<0.001) 0.8 (<0.001) RR (p value) (<0.001) 1.1 (0.03) 0.8 (<0.001) 0.7 (<0.001) 0.9 (0.1) c) Uncemented d) Hybrid cementation Cem. acetab./ uncem. femur (few obs. before 2000) Prosthesis survival (%) RR (p value) (0.004) 0.5 (<0.001) 0.3 (<0.001) 0.3 (<0.001) 0.7 (0.001) Time periods compared for hybrid cementation (cem. femur/uncem. acetabulum): RR (p value) (1.0) 0.8 (0.03) 0.7 (0.002) 0.5 (<0.001) 0.5 (<0.001) Cem. femur/ uncem. acetab Years to failure Years to failure Risk ratio (RR) adjusted for age and sex. In figure d), the percentage of unrevised prostheses was given only for times where > 20 hips remained at risk. 3

16 Report 2009 Figure 2: Survival of cemented hip prostheses 100 a) 100 b) Survival of prosthesis (%) All hospitals All hospitals Years to failure Years to failure 4

17 Figure 3: Survival of knee prostheses 100 a) All prostheses 100 b) Unicondylar Prosthesis survival (%) RR (p value) (0.3) 0.8 (0.02) 0.7 (<0.001) RR (p value) (0.4) 0.9 (0.6) 1.0 (1.0) c) with patella d) without patella Prosthesis survival (%) RR (p value) (0.8) 1.1 (0.7) 0.6 (0.03) RR (p value) (0.3) 0.7 (<0.001) 0.6 (<0.001) Years to failure Years to failure Risk ratio (RR) adjusted for age and sex. 5

18 Report a) Figure 4a: Survival of prostheses in the elbow, ankle, wrist and carpometacarpal joints Elbow 100 b) Ankle Prosthesis survival (%) c) Wrist 100 d) Carpometacarpal (CMC I) Prosthesis survival (%) Years to failure Years to failure In all figures, the percentage of unrevised prostheses was given only for times where > 20 prostheses remained at risk. 6

19 100 e) Figure 4b: Survival of prostheses in the finger, shoulder and toe joints Shoulder, total prosthesis 100 f) Shoulder, hemi prosthesis Prosthesis survival g) Finger (MCP) 100 h) Toe Prosthesis survival (%) Years to failure Years to failure In all figures, the percentage of unrevised prostheses was given only for times where > 20 prostheses remained at risk. 7

20 Report a) Figure 5a: Survival of hip fracture operations All fractures 100 b) Intracapsular fracture, undisplaced Survival (%) Two screws or sticks c) Intracapsular fracture, displaced d) Intracapsular fracture, displaced Unipolar or bipolar hemi prosthesis Survival (%) Two screws or sticks 60 Two screws or sticks, or a unipolar or bipolar hemi prosthesis Years to failure Years to failure 8

21 100 e) Figure 5b: Survival of hip fracture operations Intertrochantric fracture, two fragments 100 f) Intertrochantric fracture, multifragment Survival (%) Years to failure Years to failure 9

22 Report Figure 6: EQ-5D INDEX SCORE FOR PATIENTS WITH DISPLACED INTRACAPSULAR HIP FRACTURES Displaced intracapsular fractures treated with two screws or sticks, or a unipolar or bipolar hemi prosthesis 0.55 Mean value (95 % CI) EQ-5D = EuroQol-5D. 10

23 Figure 7: Survival of cruciate ligament operations 100 a) All operations 90 Survival (%) Years to failure 11

24 Report Figure 8: KOOS VALUES FOR CRUCIATE LIGAMENT OPERATED PATIENTS Before the primary operation Two years after the primary operation Meann value (95 % CI) SYMPTOM PAIN ADL SPORT QOL Information was included also from patients that gave information only preoperatively or two years after the primary operation. Mean values are similar to those for patients with both pre and postoperative information. KOOS = Knee Injury and Osteoarthritis Outcome Score. 12

25 Hip prostheses Table 1: Annual number of operations Year Figure 1: Annual number of operations Primary operations Revisions (85,9%) (14,1%) (86,4%) (13,6%) (86,3%) (13,7%) (86,2%) (13,8%) (86,9%) 940 (13,1%) (87,7%) 990 (12,3%) (86,6%) 956 (13,4%) (87,0%) 922 (13,0%) (85,4%) 975 (14,6%) (85,3%) 943 (14,7%) (83,5%) (16,5%) (84,0%) (16,0%) (82,8%) (17,2%) (83,8%) 985 (16,2%) (83,5%) 910 (16,5%) (85,1%) 845 (14,9%) (86,4%) 769 (13,6%) (85,2%) 783 (14,8%) (86,9%) 732 (13,1%) (87,5%) 741 (12,5%) (85,8%) 651 (14,2%) (88,0%) 179 (12,0%) Registration complete from 1989 The Norwegian Arthroplasty Register (85,7%) (14,3%) Number of operations Primary operations Revisions 55,2 % of the operations were performed on the right side. 68,6 % of the operations were performed in women. Mean age was: 69,4 years. Figure 2: Incidence of primary hip prostheses Number of operations per inhabitants Women 2000 Women 2005 Women 1995 Men 2000 Men 2005 Men 0 Age: < > 79 13

26 Report 2009 Hip disease Table 2: Hip disease Year Figure 3: Age by year of operation 50 Primary osteoarthritis Rheumatoid arthritis Fract. of femoral neck Congenital dysplasia Congenital dislocation Epiphysiol./Pert hes' disease Diseases are not mutually exclusive Bechterew Acute fract. of the femoral neck Avascular necrosis Sequela acetabularfracture Other Missing information Proportion (%) of primary operations Year of operation Age: < > 79 14

27 The Norwegian Arthroplasty Register Reasons for revisions Table 3: Reasons for revisions Year of revision Acetabular loosening Femoral loosening Dislocation Deep infection Fracture of femur Revision causes are not mutually exclusive Pain Osteolysis acet., no loosening Osteolysis femur, Polyethylene wear Previous Girdlestone Other Missing information Figure 4: Reasons for revisions 100 % Mis sing Other Reasons for revision 80 % 60 % 40 % 20 % Pain Osteolysis femur, no loosening Osteolysis acet., no loosening Osteolysis acet. and femur, no loosening Dislocation Fracture Loosening 0 % Deep infection Year of revision The graph is hierarchical, i.e. if a revision is marked both "Deep infection" and "Loosening", only "Deep infection" is counted. The hierarchy follows the explanation, with "Deep infection" being the highest and "Other" the lowest level. 15

28 Report 2009 Type of revision Table 4: Type of revision Year of revision Exchange, cup Exchange, caput Exchange, caput and cup Exchange, stem Exchange, all components Exchange, PE liner only Exchange, PE liner and caput Exchange, PE liner and stem Removal of stem Girdlestone Insertion after Girdlestone Other Missing information % 7% 25% 13% 27% 0% 4% 1% 0% 7% 2% 2% 0% % 6% 27% 13% 26% 0% 4% 1% 0% 5% 1% 3% 0% % 3% 21% 14% 26% 1% 6% 1% 0% 6% 2% 1% 0% % 3% 16% 13% 30% 1% 4% 2% 0% 5% 2% 3% 1% % 4% 20% 14% 29% 1% 5% 2% 0% 7% 2% 1% 1% % 3% 13% 17% 28% 1% 5% 2% 0% 6% 2% 1% 1% % 2% 15% 19% 31% 1% 6% 2% 1% 5% 3% 2% 1% % 2% 19% 21% 31% 1% 5% 2% 5% 3% 1% 0% % 2% 20% 21% 31% 1% 7% 1% 0% 4% 3% 0% 0% % 2% 14% 21% 37% 0% 5% 1% 0% 5% 3% 1% 0% % 1% 16% 20% 37% 1% 4% 2% 0% 4% 4% 1% % 1% 11% 22% 40% 1% 3% 1% 0% 4% 4% 0% 0% % 1% 11% 23% 42% 0% 1% 0% 0% 6% 3% 1% 0% % 1% 9% 24% 42% 0% 1% 0% 0% 4% 4% 1% % 0% 2% 28% 44% 0% 1% 0% 1% 4% 2% 1% % 0% 1% 28% 45% 0% 0% 0% 4% 1% 0% 0% % 1% 1% 26% 49% 0% 0% 0% 0% 5% 1% 1% 0% % 0% 0% 25% 49% 0% 1% 5% 0% 1% 1% % 1% 25% 55% 0% 0% 3% 0% 0% 2% % 0% 0% 24% 58% 0% 2% 0% 0% 1% % 1% 20% 63% 0% 0% 2% 2% 0% 1% % 1% 21% 63% 1% 1% 1% % 2% 12% 20% 38% 0% 3% 1% 0% 5% 2% 1% 1%

29 The Norwegian Arthroplasty Register Bone transplantation Table 5: Bone transplantation acetabulum - Revisions Year of revision Yes No Bone impaction Missing (9,8 %) 661 (59,3 %) 210 (18,9 %) 134 (12 %) (12,6 %) 592 (56,4 %) 193 (18,4 %) 132 (12,6 %) (11,4 %) 554 (55 %) 201 (20 %) 137 (13,6 %) (15,2 %) 527 (49,8 %) 230 (21,7 %) 140 (13,2 %) (17,1 %) 570 (60,6 %) 162 (17,2 %) 47 (5 %) (16,4 %) 651 (65,8 %) 147 (14,8 %) 30 (3 %) (22,1 %) 621 (65 %) 86 (9 %) 38 (4 %) (19,7 %) 578 (62,7 %) 132 (14,3 %) 30 (3,3 %) (22,2 %) 601 (61,6 %) 136 (13,9 %) 22 (2,3 %) (20,3 %) 593 (62,9 %) 141 (15 %) 18 (1,9 %) (21,5 %) 642 (61,1 %) 160 (15,2 %) 22 (2,1 %) (21,6 %) 636 (62,9 %) 134 (13,3 %) 23 (2,3 %) (25,2 %) 639 (63,6 %) 82 (8,2 %) 30 (3 %) (31,8 %) 641 (65,1 %) 4 (0,4 %) 27 (2,7 %) (31,6 %) 607 (66,7 %) 0 (0 %) 15 (1,6 %) (31,4 %) 558 (66 %) 0 (0 %) 22 (2,6 %) (26,9 %) 541 (70,4 %) 0 (0 %) 21 (2,7 %) (27,2 %) 555 (70,9 %) 0 (0 %) 15 (1,9 %) (29 %) 506 (69,1 %) 0 (0 %) 14 (1,9 %) (26,7 %) 535 (72,2 %) 0 (0 %) 8 (1,1 %) (25 %) 477 (73,3 %) 0 (0 %) 11 (1,7 %) (19 %) 144 (80,4 %) 0 (0 %) 1 (0,6 %) (21,6 %) (63,4 %) (10,3 %) 937 (4,8 %) Table 6: Bone transplantation femur - Revisions Year of revision Yes No Bone impaction Missing (12,8 %) 670 (60,1 %) 70 (6,3 %) 231 (20,7 %) (11,9 %) 599 (57,1 %) 70 (6,7 %) 255 (24,3 %) (14,4 %) 598 (59,4 %) 81 (8 %) 183 (18,2 %) (17,1 %) 571 (54 %) 86 (8,1 %) 220 (20,8 %) (13,3 %) 647 (68,8 %) 119 (12,7 %) 49 (5,2 %) (13,8 %) 726 (73,3 %) 97 (9,8 %) 30 (3 %) (18,1 %) 646 (67,6 %) 99 (10,4 %) 38 (4 %) (17,1 %) 584 (63,3 %) 150 (16,3 %) 30 (3,3 %) (22,2 %) 571 (58,6 %) 166 (17 %) 22 (2,3 %) (21,7 %) 534 (56,6 %) 186 (19,7 %) 18 (1,9 %) (20,9 %) 603 (57,4 %) 206 (19,6 %) 22 (2,1 %) (21,5 %) 581 (57,5 %) 190 (18,8 %) 23 (2,3 %) (23,4 %) 615 (61,3 %) 124 (12,4 %) 30 (3 %) (37,3 %) 586 (59,5 %) 5 (0,5 %) 27 (2,7 %) (30,3 %) 619 (68 %) 0 (0 %) 15 (1,6 %) (27,6 %) 590 (69,8 %) 0 (0 %) 22 (2,6 %) (16 %) 625 (81,3 %) 0 (0 %) 21 (2,7 %) (11,5 %) 678 (86,6 %) 0 (0 %) 15 (1,9 %) (16,9 %) 594 (81,1 %) 0 (0 %) 14 (1,9 %) (18,1 %) 599 (80,8 %) 0 (0 %) 8 (1,1 %) (13,8 %) 550 (84,5 %) 0 (0 %) 11 (1,7 %) (17,9 %) 146 (81,6 %) 0 (0 %) 1 (0,6 %) (19,1 %) (65,9 %) (8,4 %) (6,6 %) Regsitration of "Bone impaction" started in

30 Report 2009 Operative approach Table 7: Operative approach - Primary operations Year Smith- Petersen Anterolateral Lateral Posterolateral Other Missing information (1 %) 388 (5,7 %) (63,8 %) (27,9 %) 7 (0,1 %) 99 (1,5 %) (0,2 %) 404 (6,1 %) (66,3 %) (25,7 %) 9 (0,1 %) 107 (1,6 %) (0 %) 452 (7,2 %) (67,5 %) (23,4 %) 3 (0 %) 115 (1,8 %) (0,1 %) 520 (7,9 %) (67 %) (23,3 %) 4 (0,1 %) 110 (1,7 %) (0,1 %) 463 (7,4 %) (68,9 %) (23,1 %) 5 (0,1 %) 20 (0,3 %) (0,2 %) 591 (8,4 %) (68,8 %) (22,1 %) 3 (0 %) 36 (0,5 %) (0,2 %) 414 (6,7 %) (69,6 %) (22,6 %) 17 (0,3 %) 35 (0,6 %) (0,1 %) 410 (6,6 %) (69,3 %) (23,5 %) 8 (0,1 %) 26 (0,4 %) (0,3 %) 437 (7,7 %) (67,6 %) (24,2 %) 2 (0 %) 13 (0,2 %) (0,1 %) 455 (8,3 %) (67 %) (24,2 %) 8 (0,1 %) 14 (0,3 %) (0,2 %) 395 (7,4 %) (69 %) (23,2 %) 0 (0 %) 12 (0,2 %) (0,1 %) 371 (7 %) (69,9 %) (22,5 %) 1 (0 %) 26 (0,5 %) (0,1 %) 366 (7,6 %) (65,5 %) (26,2 %) 3 (0,1 %) 26 (0,5 %) (0,1 %) 311 (6,1 %) (66,3 %) (27,2 %) 8 (0,2 %) 10 (0,2 %) (0,2 %) 188 (4,1 %) (69,1 %) (26,5 %) 2 (0 %) 6 (0,1 %) (0,9 %) 226 (4,7 %) (71,2 %) (22,5 %) 12 (0,2 %) 23 (0,5 %) (0,7 %) 283 (5,8 %) (69,3 %) (23 %) 9 (0,2 %) 52 (1,1 %) (0,1 %) 260 (5,8 %) (69,1 %) (24,1 %) 1 (0 %) 37 (0,8 %) (0,1 %) 323 (6,7 %) (66,3 %) (26 %) 0 (0 %) 49 (1 %) (0,2 %) 380 (7,3 %) (61,3 %) (30,6 %) 0 (0 %) 35 (0,7 %) (0,2 %) 262 (6,7 %) (63,1 %) (29 %) 1 (0 %) 39 (1 %) (0,1 %) 119 (9 %) 840 (63,8 %) 350 (26,6 %) 2 (0,2 %) 5 (0,4 %) 288 (0,2 %) (6,8 %) (67,4 %) (24,7 %) 105 (0,1 %) 895 (0,8 %) Table 8: Operative approach - Revisions Year Smith- Petersen Anterolateral Lateral Posterolateral Other Missing information (0,3 %) 51 (4,6 %) 785 (70,5 %) 246 (22,1 %) 10 (0,9 %) 19 (1,7 %) (0,1 %) 55 (5,2 %) 703 (67 %) 273 (26 %) 2 (0,2 %) 15 (1,4 %) (0,1 %) 61 (6,1 %) 699 (69,4 %) 231 (22,9 %) 2 (0,2 %) 13 (1,3 %) (0,3 %) 44 (4,2 %) 790 (74,7 %) 198 (18,7 %) 14 (1,3 %) 9 (0,9 %) (0,2 %) 52 (5,5 %) 732 (77,9 %) 134 (14,3 %) 1 (0,1 %) 19 (2 %) (0,1 %) 85 (8,6 %) 738 (74,5 %) 114 (11,5 %) 6 (0,6 %) 46 (4,6 %) (0,2 %) 68 (7,1 %) 722 (75,5 %) 137 (14,3 %) 8 (0,8 %) 19 (2 %) (0,5 %) 83 (9 %) 673 (73 %) 131 (14,2 %) 10 (1,1 %) 20 (2,2 %) (0,3 %) 90 (9,2 %) 737 (75,6 %) 129 (13,2 %) 11 (1,1 %) 5 (0,5 %) (0,3 %) 83 (8,8 %) 728 (77,2 %) 114 (12,1 %) 8 (0,8 %) 7 (0,7 %) (0,2 %) 73 (7 %) 827 (78,8 %) 137 (13 %) 6 (0,6 %) 5 (0,5 %) (0,2 %) 55 (5,4 %) 777 (76,9 %) 168 (16,6 %) 4 (0,4 %) 5 (0,5 %) (0 %) 73 (7,3 %) 712 (70,9 %) 202 (20,1 %) 5 (0,5 %) 12 (1,2 %) (0,1 %) 60 (6,1 %) 738 (74,9 %) 178 (18,1 %) 5 (0,5 %) 3 (0,3 %) (0,1 %) 48 (5,3 %) 685 (75,3 %) 174 (19,1 %) 1 (0,1 %) 1 (0,1 %) (0,1 %) 38 (4,5 %) 624 (73,8 %) 173 (20,5 %) 4 (0,5 %) 5 (0,6 %) (0,4 %) 40 (5,2 %) 536 (69,7 %) 179 (23,3 %) 5 (0,7 %) 6 (0,8 %) (0,1 %) 36 (4,6 %) 526 (67,2 %) 216 (27,6 %) 0 (0 %) 4 (0,5 %) (0,1 %) 43 (5,9 %) 464 (63,4 %) 220 (30,1 %) 1 (0,1 %) 3 (0,4 %) (0,4 %) 51 (6,9 %) 419 (56,5 %) 261 (35,2 %) 1 (0,1 %) 6 (0,8 %) (0,9 %) 51 (7,8 %) 347 (53,3 %) 242 (37,2 %) 0 (0 %) 5 (0,8 %) (0,6 %) 23 (12,8 %) 94 (52,5 %) 61 (34,1 %) 0 (0 %) 0 (0 %) 46 (0,2 %) (6,4 %) (71,7 %) (20 %) 104 (0,5 %) 227 (1,2 %)

31 The Norwegian Arthroplasty Register Trochanteric osteotomy Table 9: Trochanteric osteotomy Primary operations Revisions Year No Yes Missing No Yes Missing (91,3 %) 59 (0,9 %) 539 (7,9 %) 952 (84,9 %) 107 (9,5 %) 62 (5,5 %) (91,7 %) 75 (1,1 %) 481 (7,2 %) 866 (82,4 %) 112 (10,7 %) 73 (6,9 %) (90,5 %) 87 (1,4 %) 514 (8,1 %) 836 (83 %) 104 (10,3 %) 67 (6,7 %) (90,7 %) 112 (1,7 %) 500 (7,6 %) 865 (81,8 %) 102 (9,6 %) 91 (8,6 %) (96,5 %) 130 (2,1 %) 90 (1,4 %) 808 (86 %) 99 (10,5 %) 33 (3,5 %) (95,3 %) 213 (3 %) 121 (1,7 %) 862 (87,1 %) 97 (9,8 %) 31 (3,1 %) (95,4 %) 194 (3,1 %) 89 (1,4 %) 824 (86,2 %) 104 (10,9 %) 28 (2,9 %) (96,3 %) 157 (2,5 %) 74 (1,2 %) 776 (84,2 %) 120 (13 %) 26 (2,8 %) (96,8 %) 121 (2,1 %) 59 (1 %) 842 (86,4 %) 118 (12,1 %) 15 (1,5 %) (96,2 %) 176 (3,2 %) 30 (0,5 %) 811 (86 %) 121 (12,8 %) 11 (1,2 %) (94,1 %) 282 (5,3 %) 31 (0,6 %) 904 (86,1 %) 131 (12,5 %) 15 (1,4 %) (93,5 %) 302 (5,7 %) 46 (0,9 %) 881 (87,1 %) 115 (11,4 %) 15 (1,5 %) (92,4 %) 311 (6,4 %) 54 (1,1 %) 882 (87,8 %) 98 (9,8 %) 24 (2,4 %) (90 %) 491 (9,6 %) 17 (0,3 %) 827 (84 %) 154 (15,6 %) 4 (0,4 %) (89 %) 495 (10,7 %) 11 (0,2 %) 781 (85,8 %) 120 (13,2 %) 9 (1 %) (86,8 %) 593 (12,3 %) 44 (0,9 %) 723 (85,6 %) 113 (13,4 %) 9 (1,1 %) (85,6 %) 630 (12,9 %) 73 (1,5 %) 656 (85,3 %) 103 (13,4 %) 10 (1,3 %) (81,2 %) 790 (17,6 %) 54 (1,2 %) 626 (79,9 %) 146 (18,6 %) 11 (1,4 %) (76,9 %) (21,9 %) 54 (1,1 %) 553 (75,5 %) 169 (23,1 %) 10 (1,4 %) (76,1 %) (22,4 %) 76 (1,5 %) 539 (72,7 %) 197 (26,6 %) 5 (0,7 %) (73,2 %) 997 (25,4 %) 54 (1,4 %) 434 (66,7 %) 206 (31,6 %) 11 (1,7 %) (72,9 %) 338 (25,7 %) 19 (1,4 %) 126 (70,4 %) 52 (29,1 %) 1 (0,6 %) (90 %) (7,5 %) (2,6 %) (83,4 %) (13,7 %) 561 (2,9 %) Systemic antibiotic prophylaxis Table 10: Systemic antibiotic prophylaxis Primary operations Year No Yes Missing No Revisions Yes Missing (0,6 %) (99,4 %) 5 (0,1 %) 38 (3,4 %) (96 %) 7 (0,6 %) (0,4 %) (99,5 %) 7 (0,1 %) 30 (2,9 %) (96,5 %) 7 (0,7 %) (0,6 %) (99,4 %) 0 (0 %) 28 (2,8 %) 979 (97,2 %) 0 (0 %) (0,4 %) (99,6 %) 0 (0 %) 18 (1,7 %) (98,3 %) 0 (0 %) (0 %) (100 %) 0 (0 %) 6 (0,6 %) 929 (98,8 %) 5 (0,5 %) (0 %) (100 %) 1 (0 %) 8 (0,8 %) 975 (98,5 %) 7 (0,7 %) (0,1 %) (99,9 %) 2 (0 %) 10 (1 %) 943 (98,6 %) 3 (0,3 %) (0,2 %) (99,8 %) 2 (0 %) 3 (0,3 %) 918 (99,6 %) 1 (0,1 %) (0,2 %) (99,8 %) 1 (0 %) 6 (0,6 %) 969 (99,4 %) 0 (0 %) (0,1 %) (99,9 %) 1 (0 %) 5 (0,5 %) 935 (99,2 %) 3 (0,3 %) (0,2 %) (99,8 %) 1 (0 %) 6 (0,6 %) (99,4 %) 0 (0 %) (0,1 %) (99,9 %) 0 (0 %) 5 (0,5 %) (99,3 %) 2 (0,2 %) (0,1 %) (99,9 %) 0 (0 %) 10 (1 %) 993 (98,9 %) 1 (0,1 %) (0,2 %) (99,7 %) 1 (0 %) 3 (0,3 %) 982 (99,7 %) 0 (0 %) (0,6 %) (99,4 %) 1 (0 %) 12 (1,3 %) 898 (98,7 %) 0 (0 %) (1,2 %) (98,8 %) 3 (0,1 %) 12 (1,4 %) 832 (98,5 %) 1 (0,1 %) (2,2 %) (97,7 %) 5 (0,1 %) 16 (2,1 %) 746 (97 %) 7 (0,9 %) (3,1 %) (96,7 %) 13 (0,3 %) 24 (3,1 %) 755 (96,4 %) 4 (0,5 %) (4,8 %) (95,2 %) 4 (0,1 %) 18 (2,5 %) 711 (97,1 %) 3 (0,4 %) (8,8 %) (91,1 %) 6 (0,1 %) 36 (4,9 %) 703 (94,9 %) 2 (0,3 %) (14 %) (85,8 %) 9 (0,2 %) 45 (6,9 %) 602 (92,5 %) 4 (0,6 %) (16,9 %) (82,8 %) 5 (0,4 %) 13 (7,3 %) 164 (91,6 %) 2 (1,1 %) (1,7 %) (98,3 %) 67 (0,1 %) 352 (1,8 %) (97,9 %) 59 (0,3 %)

32 Report 2009 Use of cement in primary operations Figure 5: Use of cement in primary operations - All patients Proportion of primary operations 100 % 80 % 60 % 40 % 20 % 0 % Figure 6: Use of cement in primary operations - Patients < 60 years Proportion of primary operations 100 % 80 % 60 % 40 % 20 % 0 % Figure 7: Use of cement in primary operations - Patients >= 60 years Proportion of primary operations 100 % 80 % 60 % 40 % 20 % 0 % Cemented (containing antibiotic) Cemented (plain) Uncemented Hybrid, cemented acetabulum Hybrid, cemented femur Other / Missing information 20

33 The Norwegian Arthroplasty Register Use of cement in revisions Table 11: Use of cement in revisions - Acetabulum With antibiotic Without antibiotic Uncemented Missing information >=60 yrs <60 yrs All >=60 yrs <60 yrs All >=60 yrs <60 yrs All >=60 yrs <60 yrs All >=60 yrs <60 yrs All % 55% 47% 0% 0% 0% 52% 45% 53% 0% 0% 0% % 50% 59% 0% 0% 0% 42% 50% 41% 0% 0% 0% % 54% 61% 0% 0% 0% 40% 46% 39% 0% 0% 0% % 60% 64% 0% 0% 0% 37% 40% 36% 0% 0% 0% % 58% 68% 0% 0% 0% 33% 42% 32% 0% 0% 0% % 66% 68% 0% 0% 1% 32% 34% 31% 0% 0% 0% % 68% 63% 1% 1% 1% 35% 31% 36% 0% 0% 0% % 53% 61% 3% 5% 2% 38% 42% 37% 0% 0% 0% % 52% 63% 0% 1% 0% 39% 47% 37% 0% 1% 0% % 51% 65% 0% 1% 0% 37% 48% 34% 0% 0% 0% % 55% 66% 1% 0% 1% 35% 45% 33% 0% 0% 0% % 44% 58% 0% 1% 0% 45% 56% 42% 0% 0% 0% % 35% 56% 1% 0% 1% 46% 65% 42% 0% 0% 1% % 34% 58% 0% 0% 1% 46% 66% 41% 1% 0% 1% % 30% 53% 1% 0% 1% 49% 70% 45% 0% 0% 0% % 19% 52% 1% 2% 1% 53% 79% 46% 0% 0% 0% % 32% 65% 3% 0% 3% 37% 64% 31% 1% 3% 1% % 34% 63% 3% 1% 4% 36% 62% 31% 3% 2% 3% % 32% 68% 2% 0% 2% 34% 65% 27% 3% 3% 3% % 36% 73% 3% 0% 4% 29% 61% 22% 1% 3% 1% % 46% 74% 4% 0% 5% 24% 51% 18% 2% 4% 2% % 50% 76% 3% 0% 3% 23% 50% 19% 1% 0% 2% % 46% 62% 1% 1% 1% 39% 52% 36% 1% 1% 1% Table 12: Use of cement in revisions - Femur With antibiotic Without antibiotic Uncemented Missing information >=60 yrs <60 yrs All >=60 yrs <60 yrs All >=60 yrs <60 yrs All >=60 yrs <60 yrs All >=60 yrs <60 yrs All % 17% 27% 0% 0% 0% 74% 83% 73% 0% 0% 0% % 24% 35% 0% 0% 0% 66% 76% 65% 0% 0% 0% % 20% 39% 0% 0% 0% 63% 80% 61% 0% 0% 0% % 35% 41% 0% 0% 0% 60% 65% 59% 0% 0% 0% % 31% 57% 0% 0% 0% 47% 69% 43% 0% 0% 0% % 52% 61% 0% 0% 0% 39% 48% 38% 0% 0% 0% % 67% 60% 1% 2% 1% 38% 31% 39% 0% 0% 0% % 42% 62% 1% 0% 1% 39% 58% 37% 0% 0% 0% % 59% 64% 0% 0% 0% 36% 41% 35% 1% 0% 1% % 48% 69% 0% 0% 0% 34% 52% 31% 0% 0% 0% % 52% 68% 0% 0% 0% 33% 47% 31% 1% 1% 1% % 53% 65% 0% 0% 1% 36% 47% 34% 0% 0% 0% % 43% 67% 2% 1% 2% 34% 56% 30% 1% 0% 1% % 40% 65% 3% 3% 3% 35% 57% 31% 1% 0% 1% % 31% 61% 5% 2% 5% 38% 67% 33% 1% 0% 1% % 28% 61% 3% 3% 4% 41% 69% 36% 0% 0% 0% % 52% 75% 4% 3% 5% 23% 43% 19% 2% 1% 2% % 50% 74% 5% 2% 6% 21% 45% 16% 4% 3% 4% % 40% 75% 3% 2% 4% 23% 54% 16% 5% 5% 6% % 44% 80% 4% 1% 4% 21% 52% 13% 2% 3% 2% % 46% 80% 4% 0% 4% 19% 46% 13% 4% 9% 3% % 42% 80% 5% 0% 5% 17% 47% 13% 3% 11% 2% % 42% 63% 2% 1% 2% 37% 56% 34% 1% 1% 1%

34 Report 2009 Use of cement and bone transplantation in revisions Table 13: Use of cement and bone transplantation in revisions - Acetabulum Cemented acetabulum Uncemented acetabulum Bone impaction Bone transplant No bone transplant Missing % 7% 40% 6% % 20% 63% 5% % 8% 43% 7% 413 5% 30% 61% 4% % 10% 38% 7% 405 5% 23% 63% 9% % 11% 41% 5% 474 8% 34% 50% 9% % 17% 46% 1% 423 5% 37% 55% 3% % 18% 51% 1% 446 3% 35% 60% 1% % 28% 52% 0% 402 3% 39% 56% 2% % 20% 47% 1% 366 7% 45% 47% 1% % 24% 45% 0% 375 7% 48% 43% 1% % 20% 49% 0% % 45% 44% 1% % 20% 51% 0% % 48% 40% 1% % 20% 52% 1% 374 9% 45% 45% 1% % 20% 63% 1% 359 8% 57% 35% 1% % 36% 60% 3% 361 0% 59% 39% 2% % 34% 65% 1% 300 0% 62% 36% 2% % 29% 69% 2% 265 0% 62% 35% 3% % 28% 71% 1% 326 0% 58% 38% 4% % 20% 80% 0% 335 0% 74% 26% 1% % 27% 72% 1% 334 0% 63% 35% 2% % 23% 76% 2% 374 0% 67% 33% 0% % 20% 78% 1% 372 0% 67% 30% 3% % 13% 87% 0% 107 0% 59% 41% 0% 32 22% 20% 56% 2% % 47% 46% 3% Bone impaction Bone transplant No bone transplant Missing Table 14: Use of cement and bone transplantation in revisions - Femur Cemented femur Uncemented femur Bone impaction Bone transplant No bone transplant Missing % 3% 48% 8% 126 4% 29% 59% 8% % 10% 48% 14% 147 4% 29% 58% 9% % 10% 48% 6% 157 4% 37% 54% 4% % 9% 54% 2% 202 4% 40% 50% 6% % 6% 48% 1% 245 4% 37% 56% 3% % 11% 62% 1% 299 6% 42% 50% 2% % 12% 61% 1% 314 6% 51% 42% 1% % 10% 53% 1% % 46% 37% 2% % 17% 41% 0% 347 9% 62% 28% 1% % 18% 46% 0% % 49% 28% 2% % 17% 45% 1% % 54% 29% 0% % 16% 54% 0% % 52% 22% 2% % 18% 60% 1% % 61% 27% 1% % 41% 55% 4% 452 1% 71% 26% 2% % 28% 72% 0% 409 0% 62% 37% 1% % 16% 82% 2% 370 0% 66% 33% 1% % 8% 91% 1% 445 0% 62% 35% 3% % 3% 95% 2% 452 0% 55% 44% 1% % 6% 92% 3% 435 0% 66% 34% 0% % 8% 91% 2% 476 0% 71% 29% 0% % 5% 94% 1% 438 0% 64% 34% 2% % 7% 93% 0% 123 0% 81% 19% 0% 26 17% 14% 67% 2% % 51% 40% 3% Bone impaction Bone transplant No bone transplant Missing Registration of "Bone impaction" started in

35 Cements used in primary operations and in revisions - Acetabulum Table 15: Cements used in primary operations and in revisions - Acetabulum Year Boneloc Cemex System Genta Cemex System Genta FAST CMW I CMW I w/gentamicin CMW III Optipac Palacos Palacos w/gentamicin Palacos R + G Refobacin Bone Cement R Refobacin-Palacos Simplex Simplex w/erythr. + colistin The Norwegian Arthroplasty Register % 4% 3% 54% 24% 0% 12% 2% 0% 0% % 2% 0% 56% 26% 0% 10% 4% 0% 0% % 0% 56% 29% 2% 1% 0% 10% 0% 0% % 46% 11% 5% 26% 3% 0% 8% 0% % 82% 9% 5% 0% 4% 0% % 0% 92% 0% 1% 0% 7% 0% % 2% 91% 0% 2% 0% 5% 0% 0% % 1% 90% 0% 2% 6% 0% 0% % 2% 84% 0% 2% 8% 0% 0% % 11% 3% 76% 0% 2% 7% 0% 0% % 15% 4% 73% 0% 2% 6% 0% % 17% 6% 67% 0% 4% 4% 0% 0% % 10% 0% 10% 65% 0% 9% 1% 0% 0% % 9% 2% 0% 11% 64% 0% 13% 0% 0% 0% % 12% 2% 1% 18% 52% 14% 1% 0% % 14% 2% 3% 13% 42% 2% 16% 1% 1% 0% % 10% 1% 5% 12% 41% 16% 0% 1% 0% % 12% 1% 5% 14% 42% 16% 1% 0% 0% % 1% 3% 14% 49% 16% 2% 0% 0% % 3% 15% 45% 18% 4% 0% 0% % 0% 2% 15% 44% 20% 1% 0% 0% % 4% 12% 49% 19% 0% 0% % 0% 0% 5% 3% 1% 0% 6% 55% 10% 5% 2% 7% 2% 3% 0% 0% 0% Simplex w/tobramycin SmartSet GHV Other Missing ingformation Figure 8: Cements used in primary operations and in revisions - Acetabulum Year of operation Other/Missing information SmartSet GHV Simplex w/tobramycin Simplex w/erythr.+colistin Simplex Refobacin-Palacos Refobacin Bone Cement R Palacos R + G Palacos w/gentamicin Palacos Optipac CMW III CMW I w/gentamicin CMW I Cemex System Genta FAST Cemex System Genta Boneloc 23

36 Report 2009 Cements used in primary operations and in revisions - Femur Table 16: Cements used in primary operations and in revisions - Femur Year Boneloc Cemex System Genta Cemex System Genta FAST CMW I CMW I w/gentamicin CMW III Optipac Palacos Palacos w/gentamicin % 4% 0% 3% 54% 24% 0% 13% 2% 0% 0% % 2% 0% 0% 56% 25% 11% 4% 0% 0% % 0% 0% 0% 56% 29% 2% 1% 11% 0% 0% % 43% 11% 5% 28% 3% 0% 9% 0% % 81% 9% 5% 0% 4% 0% % 0% 91% 0% 1% 0% 7% 0% % 2% 90% 0% 2% 0% 5% 0% % 1% 89% 0% 3% 7% 0% 0% % 1% 84% 0% 2% 8% 0% % 0% 12% 2% 75% 0% 2% 8% 0% 0% % 14% 3% 73% 0% 3% 7% 0% 0% % 16% 6% 68% 0% 4% 5% 0% 0% % 9% 0% 10% 66% 0% 9% 2% 0% % 8% 2% 0% 11% 63% 0% 13% 2% 0% 0% % 10% 2% 1% 17% 53% 15% 1% 0% 0% % 12% 2% 4% 13% 42% 2% 16% 1% 1% 0% % 7% 1% 7% 11% 41% 16% 1% 3% 0% % 10% 1% 9% 11% 42% 16% 1% 1% 0% % 1% 8% 11% 50% 16% 1% 0% 0% % 6% 12% 46% 17% 3% 0% 0% % 0% 6% 14% 45% 18% 1% 0% 1% % 0% 8% 12% 49% 18% 0% 0% 0% % 0% 0% 4% 3% 2% 0% 6% 56% 8% 4% 2% 7% 2% 3% 0% 0% 0% Palacos R + G Refobacin Bone Cement R Refobacin-Palacos Simplex Simplex w/erythr. + colistin Simplex w/tobramycin SmartSet GHV Other Missing information Figure 9: Cements used in primary operations and in revisions - Femur 7000 Other/Missing information 6000 SmartSet GHV Simplex w/tobramycin Simplex w/erythr.+colistin 5000 Simplex Refobacin-Palacos 4000 Refobacin Bone Cement R Palacos R + G 3000 Palacos w/gentamicin Palacos 2000 Optipac CMW III 1000 CMW I w/gentamicin CMW I Cemex System Genta FAST Cemex System Genta Boneloc 24 Year of operation

37 The Norwegian Arthroplasty Register Cemented primary prostheses Table 17: Cemented primary prostheses (The 45 most common) Aceetabulum Femur CHARNLEY CHARNLEY EXETER EXETER REFLECTION CEMENTED A SPECTRON-EF TITAN TITAN SPECTRON ITH IP SP II CONTEMPORARY EXETER KRONOS TITAN ELITE TITAN ELITE CHARNLEY REFLECTION CEMENTED A ITH REFLECTION CEMENTED A BIO-FIT WEBER ALLO PRO MS ZCA CPT ELITE EXETER IP IP LUBINUS ELITE ELITE CHARNLEY EXETER CHARNLEY CHARNLEY MODULAR TITAN FJORD SPECTRON IP MODULAR HIP SYSTEM BIO-FIT SPECTRON TITAN CHARNLEY C-STEM CHARNLEY ELITE OPERA SPECTRON-EF ELITE MS PEARL TITAN MODULAR HIP SYSTEM ITH SPECTRON BIO-FIT IP IP ELITE CHARNLEY MODULAR LMT LMT ZCA CPS-PLUS MÜLLER TYPE MÜLLER TYPE PE-PLUS CPS-PLUS ELITE CPT ELITE C-STEM MODULAR HIP SYSTEM SP II ELITE SPECTRON-EF WATSON FARRAR LMT REFLECTION CEMENTED A TITAN ZCA TITAN EUROPEAN CUP SYSTEM LMT MÜLLER MÜLLER TYPE V

38 Report 2009 Uncemented primary prostheses Table 18: Uncemented primary prostheses (The 45 most common) Aceetabulum Femur TROPIC CORAIL IGLOO FILLER ATOLL CORAIL TRILOGY CORAIL BICON-PLUS ZWEYMÜLLER TRILOGY SCP/UNIQUE REFLECTION UNCEMENTE CORAIL DURALOC CORAIL UTGÅTT PROFILE BICON-PLUS HACTIV DURALOC PROFILE TRILOGY HACTIV DURALOC SCP/UNIQUE ENDLER ZWEYMÜLLER EUROPEAN CUP SYSTEM TAPERLOC PINNACLE SPIROFIT CORAIL PLASMACUP BICONTACT LMT TAPERLOC TI-FIT BIO-FIT SECURFIT OMNIFIT ABG I ABG I HARRIS/GALANTE HARRIS/GALANTE ABG II ABG II COXA FEMORA PARHOFER PARHOFER REFLECTION UNCEMENTE OMNIFIT BICON-PLUS CORAIL REFLECTION UNCEMENTE SCP/UNIQUE TITAN CORAIL TRILOGY OMNIFIT REFLECTION UNCEMENTE BICONTACT OMNIFIT OMNIFIT IGLOO CORAIL TRILOGY BICONTACT TRILOGY FILLER TRI-LOCK PLUS PROFILE MORSCHER OMNIFIT REFLECTION UNCEMENTE TI-FIT ABG II ABG I TRILOGY ANATOMIC HIP IGLOO KAREY OPTI-FIX TI-FIT TROPIC ZWEYMÜLLER PCA PCA DURALOC ABG I

39 The Norwegian Arthroplasty Register Hybrid primary prostheses Table 19: Hybrid primary prostheses, cemented stem (The 20 most common) Aceetabulum Femur TROPIC TITAN MORSCHER MS TRILOGY CHARNLEY ENDLER TITAN TRILOGY EXETER DURALOC CHARNLEY REFLECTION UNCEMENTE BIO-FIT REFLECTION UNCEMENTE SPECTRON-EF ATOLL TITAN IP IP TRILOGY CPT HG II ANATOMIC CC UTGÅTT CHARNLEY TRIDENT EXETER TI-FIT BIO-FIT TROPIC EXETER AVANTAGE SPECTRON-EF TRILOGY CENTRALIGN TITAN TITAN COXA CHARNLEY TRILOGY LONGEVITY Table 20: Hybrid primary prostheses, uncemented stem (The 20 most common) Aceetabulum Femur ELITE CORAIL REFLECTION CEMENTED A CORAIL TITAN CORAIL KRONOS CORAIL REFLECTION CEMENTED A HACTIV EXETER ABG II REFLECTION CEMENTED A TAPERLOC REFLECTION CEMENTED A FILLER CHARNLEY CORAIL EXETER CORAIL OPERA CORAIL ELITE SCP/UNIQUE IP CORAIL CONTEMPORARY CORAIL REFLECTION CEMENTED A ECHELON ELITE HACTIV SHP TAPERLOC CHARNLEY FILLER CHARNLEY SCP/UNIQUE KRONOS SCP/UNIQUE

40 Report 2009 Acetabular prostheses in primary operations Table 21: Acetabular prostheses in primary operations (The 45 most common) Aceetabulum CHARNLEY REFLECTION CEMENTED ALL POLY EXETER TITAN ELITE TROPIC SPECTRON IP TRILOGY CONTEMPORARY IGLOO KRONOS REFLECTION UNCEMENTED ATOLL DURALOC BICON-PLUS ZCA MODULAR HIP SYSTEM WEBER ALLO PRO MORSCHER ENDLER UTGÅTT OPERA EUROPEAN CUP SYSTEM TI-FIT PEARL PLASMACUP PINNACLE SPIROFIT LMT (Usementert) BIRMINGHAM HIP RESURFACING HARRIS/GALANTE MÜLLER TYPE PE-PLUS AVANTAGE ABG II COXA LMT (Sementert) ABG I SECURFIT PARHOFER OPTI-FIX HG II TRIDENT UKJENT WATSON FARRAR

41 The Norwegian Arthroplasty Register Acetabular prostheses in revisions Table 22: Acetabular prostheses in revisions (The 45 most common) Aceetabulum CHARNLEY TROPIC ELITE TRILOGY EXETER REFLECTION CEMENTED ALL POLY AVANTAGE TITAN ATOLL IGLOO PINNACLE SPIROFIT KRONOS IP CHRISTIANSEN SPECTRON HARRIS/GALANTE ZCA MODULAR HIP SYSTEM OPERA CONTEMPORARY DURALOC EUROPEAN CUP SYSTEM REFLECTION UNCEMENTED CAPTIV LMT (Usementert) ENDLER HG II UTGÅTT BICON-PLUS SECURFIT UKJENT MORSCHER OCTOPUS TRIDENT TI-FIT PARHOFER PCA S-ROM COXA ORIGINAL M.E. MÜLLER WEBER ALLO PRO TRABECULAR METAL OPTI-FIX ABG II OMNIFIT

42 Report 2009 Femoral prostheses in primary operations Table 23: Femoral prostheses in primary operations (The 45 most common) Femur CHARNLEY EXETER TITAN CORAIL SPECTRON-EF ITH SP II FILLER BIO-FIT MS SCP/UNIQUE CPT ELITE HACTIV ZWEYMÜLLER PROFILE IP TAPERLOC (Usementert) CHARNLEY MODULAR OMNIFIT FJORD IP LUBINUS C-STEM CPS-PLUS TAPERLOC (Sementert) BICONTACT ABG II ABG I TI-FIT MÜLLER TYPE UKJENT FEMORA HARRIS/GALANTE PARHOFER KAREY MÜLLER TYPE V ECHELON ANATOMIC CC KAR CENTRALIGN ANATOMIC HIP SCAN HIP LONGEVITY PCA BI-METRIC

43 The Norwegian Arthroplasty Register Femoral prostheses in revisions Table 24: Femoral prostheses in revisions (The 45 most common) Femur CHARNLEY KAR EXETER CORAIL TITAN FJORD CPT ELITE SPECTRON-EF REEF FILLER ANATOMIC BR ITH BIO-FIT SP II TAPERLOC (Usementert) RESTORATION HA ZWEYMÜLLER HACTIV IP SCAN HIP ECHELON BI-METRIC IP LUBINUS HARRIS/GALANTE FEMORA PARHOFER TTHR MP RECONSTRUCTION MÜLLER TYPE LANDOS (Reconstruction) OMNIFIT MS REACTIV CPS-PLUS CENTRALIGN TAPERLOC (Sementert) AURA PROFILE TI-FIT MÜLLER TYPE V CHARNLEY MODULAR C-STEM SL-REVISJONSPROTESE (Wagner) BIAS THP

44 Report 2009 Monoblock and modular caput Table 25: Monoblock and modular - Cemented femur (Primary operations and revisions) Caput Monoblock Modular Missing information Table 26: Monoblock and modular - Uncemented femur (Primary operations and revisions) Caput Monoblock Modular Missing information Figure 10: Proportion (%) modular femoral prostheses Proportion (%) of femoral prostheses Year of operation % Modular - Cemented femur % Modular - Uncemented femur 32

45 The Norwegian Arthroplasty Register Caput diameter on modular prostheses Table 27: Caput diameter on modular prostheses (Primary operations and revisions) Year 22 mm 26 mm 28 mm 30 mm 32 mm 36 mm >36 mm Other Missing Figure 11: Caput diameter on modular prostheses (Primary operations and revisions) Proportion (%) of modular prostheses with modular caput Year of operation 22mm 26mm 28mm 30mm 32mm 36mm >36mm Other Missing 33

46 Report 2009 Modular caput prostheses Table 28: Modular caput prostheses - All operations (The 45 most common) Prosthesis LANDOS EXETER UNIVERSAL FJORD SP II ELITE PROTEK CERAMTEC IGLOO CPT PROFILE PLUS ENDO SCANOS TAPERLOC HARRIS/GALANTE BIOTECHNI ZIRCONIA OMNIFIT MALLORY-HEAD BICONTACT SURGIVAL OXINIUM ABG I ZWEYMÜLLER BIRMINGHAM HIP RESURFACING CERAMIC OSTEO FEMORA " OSTEONICS Hoder", C-taper head PARHOFER TI-FIT CHRISTIANSEN PCA ASR ABG II LINK Rippensystem HIPBALL PREMIUM LFIT ANATOMIC VERSYS HASTINGS HIP WEBER AURA II KOTZ BIOLOX ALLO PRO LORD HODE

47 The Norwegian Arthroplasty Register ASA classification Table 29: ASA classification - Primary operations Year ASA 1 ASA 2 ASA 3 ASA 4 ASA 5 Missing Tabell 30: ASA klasse - ReoperasjonerTable 30: ASA classification - Revisions Year ASA 1 ASA 2 ASA 3 ASA 4 ASA 5 Missing Figure 12: ASA classification - Primary operations Figure 13: ASA classification - Revisions 100 % 90 % 80 % 70 % 60 % 50 % 40 % 30 % 20 % 10 % 0 % Missing ASA 5 ASA 4 ASA 3 ASA 2 ASA % 90 % 80 % 70 % 60 % 50 % 40 % 30 % 20 % 10 % 0 % ASA 1 = A normal healthy patient ASA 2 = A patient with mild systemic disease ASA 3 = A patient with severe systemic disease ASA 4 = A patient with severe systemic disease that is a constant threat to life ASA 5 = A moribund patient who is not expected to survive the operation Registration started in

48 Report 2009 Thrombosis prophylaxis Table 31: Thrombosis prophylaxis - Primary operations Year Missing (45%) 3055 (45%) 571 (8%) 8 (0%) 75 (1%) (53%) 2429 (36%) 526 (8%) 10 (0%) 143 (2%) (62%) 1544 (24%) 677 (11%) 15 (0%) 155 (2%) (67%) 678 (10%) 1093 (17%) 6 (0%) 423 (6%) 6591 Table 32: Thrombosis prophylaxis - Revisions Year Missing (42%) 531 (48%) 92 (8%) 5 (0%) 15 (1%) (48%) 408 (39%) 106 (10%) 1 (0%) 35 (3%) (58%) 273 (27%) 122 (12%) 4 (0%) 21 (2%) (67%) 122 (12%) 162 (15%) 4 (0%) 64 (6%) 1058 Figure 14: Thrombosis prophylaxis - Primary operations Figure 15: Thrombosis prophylaxis - Revisions 100 % 90 % 80 % 70 % 60 % 50 % 40 % 30 % 20 % 10 % Missing % 90 % 80 % 70 % 60 % 50 % 40 % 30 % 20 % 10 % 0 % % = Yes - Medication started preoperatively 2 = Yes - Medication started postoperatively 3 = Yes - Missing information on medication start 4 = No Registration started in

49 The Norwegian Arthroplasty Register Thrombosis prophylaxis Table 33: Thrombosis prophylaxis - All operations Drugs Albyl-E 1 (0,0%) 4 (0,1%) 9 (0,1%) Arixtra 2 (0,0%) Asasantin Retard 1 (0,0%) Clinical study 33 (0,4%) 124 (1,7%) 26 (0,3%) 85 (1,1%) Cyclocapron 3 (0,0%) 2 (0,0%) Dextran 4 (0,1%) 6 (0,1%) Exanta 61 (0,8%) 13 (0,2%) 2 (0,0%) 6 (0,1%) Fragmin (Dalteparin) (45,6%) (48,5% (54,9% (60,9% Heparin 1 (0,0%) 1 (0,0%) 2 (0,0%) 2 (0,0%) Klexane (Enoksaparin) (41,7%) (44,6% (41,2% (35,2% Marevan 11 (0,1%) 9 (0,1%) 6 (0,1%) 5 (0,1%) Melagatran (Ximelagatran) 25 (0,3%) 11 (0,2%) Re-Novate 186 (2,4%) 22 (0,3%) 18 (0,2%) Combination of 2 drugs 132 (1,7%) 103 (1,4%) 74 (1,0%) 93 (1,2%) No drugs 3 (0,0%) 3 (0,0%) Missing information 522 (6,8%) 223 (3,0%) 170 (2,2%) 76 (1,0%) Figure 16: Thrombosis prophylaxis - Drugs - All operations 100 % 90 % 80 % 70 % 60 % 50 % 40 % 30 % 20 % 10 % 0 % Missing No drugs Combination of 2 drugs Other Re-Novate Melagatran (Ximelagatran) Marevan Clinical study Klexane (Enoksaparin) Fragmin (Dalteparin) Exanta Albyl-E Table 34: Thrombosis prophylaxis - Duration - All operations Year Days: >35 No drugs Missing Registration started in

50 Report 2009 Trombosis prophylaxis Table 35: Trombosis prophylaxis - Stockings - All operations Year Leg Leg + Thigh No Missing (17,4%) (34,3%) (31,2%) (17,1%) (21,3%) (36,5%) (23,4%) (18,8%) (24,4%) (34,2%) (21,4%) (20,0%) (23,7%) (29,1%) (22,5%) (24,7%) Table 36: Trombosis prophylaxis - Mechanical foot pump - All operations Year Foot Leg No Missing (0,3%) 7 (0,1%) (59,5%) (40,1%) (0,4%) 3 (0,0%) (55,8%) (43,7%) (0,3%) 6 (0,1%) (51,2%) (48,4%) (0,8%) 11 (0,1%) (50,1%) (48,9%) Mini-invasive surgery Table 37: Mini-invasive surgery - Primary operations Year Yes No Missing (0,1%) (99,6%) 18 (0,3%) (0,1%) (98,6%) 86 (1,3%) (0,9%) (95,0%) 255 (4,0%) (2,2%) (88,2%) 638 (9,7%) Computernavigation Table 38: Computernavigation - Primary operations Year Yes No Missing (0,0%) (99,7%) 17 (0,2%) (98,6%) 90 (1,4%) (1,2%) (94,7%) 262 (4,1%) (1,2%) (88,5%) 682 (10,3%) Registration of use of stockings, mechanical foot pump, MIS and CAOS started in

51 The Norwegian Arthroplasty Register Bone loss at revision Table 39: Bone loss at revision - Acetabulum* Year Type I Type IIA Type IIB Type IIC Type IIIA Type IIIB Missing Table 40: Bone loss at revision - Femur* Year Type I Type II Type IIIA Type IIIB Type IV Missing *Paprosky's classification Registration of bone loss at revisions started in

52 Report 2009 Articulation Table 41: Articulation - Primary operations - All patients Cup + Caput Alumina + Alumina Alumina + Alumina/Zirconium¹ Cobalt-chrome + Cobalt-chrome Highly crosslinked PE + Alumina Highly crosslinked PE + Alumina/Zirconium¹ Highly crosslinked PE + Cobalt-chrome Highly crosslinked PE + Oxinium Missing + Alumina Missing + Cobalt-chrome Missing + Missing Missing + Steel Missing + Titanium UHMWPE + Alumina UHMWPE + Alumina/Zirconium¹ UHMWPE + Cobalt-chrome UHMWPE + Missing UHMWPE + Oxinium UHMWPE + Steel UHMWPE + Titanium UHMWPE + Zirconium Other (n<50) ¹Alumina/Zirconium = Aluminum oxide and zirconium oxide composite. 40

53 The Norwegian Arthroplasty Register Articulation Table 42: Articulation - Primary operations - Patients <60 years Cup + Caput Alumina + Alumina Alumina + Alumina/Zirconium¹ Cobalt-chrome + Cobalt-chrome Highly crosslinked PE + Alumina Highly crosslinked PE + Cobalt-chrome Highly crosslinked PE + Oxinium Missing + Alumina Missing + Cobalt-chrome Missing + Missing UHMWPE + Alumina UHMWPE + Cobalt-chrome UHMWPE + Missing UHMWPE + Steel UHMWPE + Titanium UHMWPE + Zirconium Other (n<50) Table 43: Articulation - Primary operations - Patients >=60 years Cup + Caput Alumina + Alumina Alumina + Alumina/Zirconium¹ Cobalt-chrome + Cobalt-chrome Highly crosslinked PE + Alumina Highly crosslinked PE + Alumina/Zirconium¹ Highly crosslinked PE + Cobalt-chrome Highly crosslinked PE + Oxinium Missing + Alumina Missing + Cobalt-chrome Missing + Missing Missing + Steel Missing + Titanium UHMWPE + Alumina UHMWPE + Alumina/Zirconium¹ UHMWPE + Cobalt-chrome UHMWPE + Missing UHMWPE + Oxinium UHMWPE + Steel UHMWPE + Titanium UHMWPE + Zirconium Other (n<50) ¹Alumina/Zirconium = Alumina oxide and ziconium oxide composite. 41

54 Report

55 Knee prostheses Table 1: Annual number of operations Year The Norwegian Arthroplasty Register Primary operations Revisions (91,7%) 362 (8,3%) (92,3%) 301 (7,7%) (92,1%) 265 (7,9%) (92,8%) 251 (7,2%) (90,2%) 316 (9,8%) (92,4%) 250 (7,6%) (91,3%) 218 (8,7%) (91,9%) 197 (8,1%) (91,6%) 171 (8,4%) (91,1%) 155 (8,9%) (91,6%) 129 (8,4%) (90,9%) 125 (9,1%) (91,0%) 107 (9,0%) (92,7%) 86 (7,3%) (93,1%) 74 (6,9%) (91,8%) (8,2%) Figure 1: Annual number of operations Number of operations Primary operations Revisions 45,8 % of the operations where performed on the left side. 31,8 % of the operations were performed on men. Mean age was: 69,3 år. Figure 2: Incidence of primary knee prostheses Number of operations per inhabitants Women 2000 Women 2005 Women 1995 Men 2000 Men 2005 Men Age < > 79 43

56 Report 2009 Age by year of operation Figure 3: Age by year of operation - Primary operations - knee prostheses 50 Proportion (%) of primary total knee prostheses Year of operation Age: < > 79 Figure 4: Age by year of operation - Primary operations - Unicondylar knee prostheses 50 Proportion (%) of primary unicondylar knee prostheses Year of operation 44

57 The Norwegian Arthroplasty Register Types of knee prostheses Table 2: Prosthesis type used - Primary operations Year with patella without Patellofemoramental Bicompart- patella Unikondylar Missing (2,9%) (85,5%) 435 (10,9%) 21 (0,5%) 1 (0,0%) 8 (0,2%) (4,1%) (82,7%) 462 (12,9%) 8 (0,2%) 1 (0,0%) 2 (0,1%) (3,6%) (83,1%) 399 (12,9%) 11 (0,4%) (3,6%) (82,1%) 456 (14,0%) 9 (0,3%) 2 (0,1%) (4,0%) (80,5%) 446 (15,4%) 3 (0,1%) (6,5%) (77,9%) 469 (15,5%) 4 (0,1%) (7,7%) (79,3%) 290 (12,8%) 5 (0,2%) (11,1%) (77,0%) 267 (11,9%) (14,3%) (72,7%) 242 (12,9%) 1 (0,1%) 1 (0,1%) (24,4%) (67,3%) 129 (8,1%) 3 (0,2%) (30,7%) 891 (63,0%) 87 (6,2%) 2 (0,1%) (35,0%) 742 (59,7%) 63 (5,1%) 2 (0,2%) (37,8%) 582 (54,1%) 87 (8,1%) (33,1%) 615 (56,4%) 109 (10,0%) 5 (0,5%) (35,8%) 529 (53,2%) 107 (10,8%) 3 (0,3%) (11,5%) (76,2%) (12,0%) 77 (0,2%) 2 (0,0%) 13 (0,0%) Figure 5: Prosthesis type used - Primary operation Proportion (%) of primary operations 100 % 90 % 80 % 70 % 60 % 50 % 40 % 30 % 20 % 10 % 0 % Year of operation with patella without patella Unicondylar Patellofemoral Bi-compartmental Missing Classification - primary total prostheses Table 3: Classification - prostheses - Primary operations Year PCR PCS Rotating platform Hinged prostheses Nonclassified (59%) 125 (4%) (37%) 8 (0%) (59%) 115 (4%) (37%) 4 (0%) (58%) 115 (4%) (37%) 2 (0%) 1 (0%) (57%) 88 (3%) (40%) 2 (0%) 10 (0%) (62%) 73 (3%) 836 (34%) 1 (0%) 18 (1%) (68%) 110 (4%) 691 (27%) 1 (0%) 7 (0%) (66%) 56 (3%) 597 (30%) 3 (0%) 17 (1%) (65%) 71 (4%) 595 (30%) 3 (0%) 13 (1%) (75%) 36 (2%) 357 (22%) 2 (0%) 20 (1%) (78%) 39 (3%) 263 (18%) 2 (0%) 14 (1%) (84%) 26 (2%) 174 (13%) 5 (0%) 6 (0%) (91%) 10 (1%) 89 (8%) 6 (1%) (93%) 16 (2%) 46 (5%) 4 (0%) (96%) 5 (1%) 27 (3%) 2 (0%) (98%) 7 (1%) 5 (1%) 4 (0%) 878 PCR = Posterior cruciate retaining prostheses PS = Posterior cruciate stabilising prostheses 45

58 Report 2009 Knee disease - Primary total knee prostheses Table 4: Knee disease - Primary total knee prostheses Year Primary osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Sequelae, meniscal tear Acute fracture Sequelae, infection Psoriasis arthritis Operation causes are not mutually exclusive Other Missing Figure 6: Knee disease - Primary total knee prostheses Proportion (%) of primary operations Primary osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Sequelae, meniscal tear Acute fracture Sequelae, infection Psoriasis arthritis Other Missing Operasjonsår

59 The Norwegian Arthroplasty Register Knee disease - Primary unicondylar knee prostheses Table 5: Knee disease - Primary unicondylar knee prostheses Year Primary osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Sequelae, meniscal tear Sequele, infection Operation causes are not mutually exclusive Other Missing Figure 7: Knee disease - Primary unicondylar knee prostheses 100 Proportion (%) of primary operations Primary osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Sequelae, meniscal tear Sequele, infection Other Missing Year of operation 47

60 Report 2009 Use of cement - Primary total knee prostheses Figure 8: Use of cement - Primary total knee prostheses - Femur 100 % Proportion (%) of primary operations 80 % 60 % 40 % 20 % 0 % Figure 9: Use of cement - Primary total knee prostheses - Tibia 100 % Proportion (%) of primary operations 80 % 60 % 40 % 20 % 0 % Figure 10: Use of cement - Primary total knee prostheses - Patella 100 % Proportion (%) of primary operations 80 % 60 % 40 % 20 % 0 % With antibiotics Without antibiotics Uncemented Missing 48

61 The Norwegian Arthroplasty Register Use of cement - Revision total knee prostheses Figure 11: Use of cement - Revision total knee prostheses - Femur Proportion (%) of revisions 100 % 90 % 80 % 70 % 60 % 50 % 40 % 30 % 20 % 10 % 0 % Figure 12: Use of cement - Revision total knee prostheses - Tibia 100 % Proportion (%) of revisions 80 % 60 % 40 % 20 % 0 % Figure 13: Use of cement - Revision total knee prostheses - Patella 100 % Proportion (%) of revisions 80 % 60 % 40 % 20 % 0 % With antibiotics Without antibiotics Uncemented Missing 49

62 Report 2009 knee prostheses Table 6: Femoral prostheses - Primary operations Prosthesis Profix LCS LCS Complete AGC Genesis I Duracon NexGen Tricon -C Kinemax E-motion Tricon M Interax I.S.A Scorpio Triathlon Advance Search Kotz NexGen Rotating Hinge Other (n<10) Table 7: Femoral prostheses - Revisions Prosthesis Profix Genesis I LCS LCS Complete AGC NexGen Duracon Dual Articular NexGen Rotating Hinge Scorpio Tricon -C Kinemax Tricon revision E-motion Kotz Other (n<10)

63 The Norwegian Arthroplasty Register knee prostheses Table 8: Tibial prostheses - Primary operations Prosthesis Profix LCS LCS Complete AGC Genesis I Tricon II Duracon NexGen Kinemax E-motion LCS Universal Interax I.S.A Scorpio Triathlon Advance Search Kotz NexGen Rotating Hinge Other (n<10) Table 9: Tibial prostheses - Revisions Prosthesis Profix Genesis I LCS LCS Complete AGC NexGen Tricon II Duracon Dual Articular NexGen Rotating Hinge Scorpio Maxim Kinemax E-motion Other (n<10)

64 Report 2009 Unicondylar knee prostheses Table 10: Femoral prostheses - Primary operations Prosthesis Oxford UNI (III) Genesis UNI Miller/Galante UNI MOD III Preservation Duracon Oxford UNI (II) LINK Schlitten UNI ZUK (Unicondylær) 9 9 Duracon Profix 2 2 "Marmor-protese" 1 1 Link endo-model 1 1 LCS Complete Table 11: Tibial prostheses - Primary operations Prosthesis Oxford UNI (III) Genesis UNI Miller/Galante UNI MOD III Preservation Duracon Oxford UNI (II) LINK Schlitten UNI Profix 2 2 Duracon 1 1 LCS Complete 1 1 Vanguard M 1 1 ZUK (Unicondylær) Patellofemoral prostheses Table 12: Femoral prostheses - Primary operations Prosthesis Patella Mod III / II Journey PFJ LCS PFJ Link Lubinus patella 3 3 Avon-Patellofemoral 3 3 Vanguard PFR Table 13: Patella prostheses- Primary operations Prosthesis Patella Mod III / II LCS PFJ Journey PFJ Link Lubinus patella 3 3 Avon-Patellofemoral 3 3 Vanguard PFR

65 The Norwegian Arthroplasty Register Reason for revision Table 14: Reason for revision of total knee prostheses with patella Year of revision Loose proximal comp. Loose distal comp. Loose patella comp. Dislocation of patella Dislocation (not patella) Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene t Revision causes are not mutually exclusive Other Missing Figure 14: Reason for revision of total knee prostheses with patella 70 Number of operations Missing Other Defect polyethylene Pain Fracture (near implant) Deep infection Malalignment Instability Dislocation (not patella) Dislocation of patella Loose patella comp. Loose distal comp Year of revsion Loose proximal comp. 53

66 Report 2009 Reason for revision Table 15: Reason for revision of total knee prostheses without patella Year of revision Loose proximal comp. Loose distal comp. Dislocation of patella Dislocation (not patella) Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene Revision causes are not mutually exclusive Other Missing Figure 15: Reason for revision of total knee prostheses without patella 300 Number of revisions Missing Other Defect polyethylene Pain Fracture (near implant) Deep infection Malalignment Instability Dislocation (not patella) Dislocation of patella Loose distal comp Year of revision Loose proximal comp. 54

67 The Norwegian Arthroplasty Register Reason for revision Table 16: Reason for revision of unicondylar knee prostheses Year of revision Loose proximal comp. Loose distal comp. Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene Revision causes are not mutually exclusive Other Missing Figure 16: Reason for revision of unicondylar knee prostheses 140 Number of revisions Missing Other Defect polyethylene Pain Fracture (near implant) Deep infection Malalignment Instability Dislocation LLoose distal comp Year of revision Loose proximal comp. 55

68 Report 2009 Type of revision Table 17: Type of revision - knee prostheses with patella Year of primary operation Exchange, distal Exchange, distal+tibial ins. Exchange, distal+proximal Exchange, whole prosthesis Exchange, patella Exchange, tibial ins. Bytte, proximal Exchange, proximal+tibial ins Removal, whole prosthesis Removal, prosthetic part(s) Other Missing 248 Figure 17: Type of revision - knee prostheses with patella Other 23 % Missing 2 % Exchange, distal 13 % Exchange, w hole prosthesis 20 % Removal, w hole prosthesis 10 % 56 Removal, prosthetic part(s) 4 % Exchange, proximal+tibial ins. 3 % Exchange, distal+proximal 11 % Exchange, tibial ins. 14 %

69 The Norwegian Arthroplasty Register Type of revision Table 18: Type of revision - knee prostheses without patella Year of primary operation Exchange, distal Exchange, distal+tibial ins. Exchange, whole prosthesis Exchange, tibial ins.+ins.patella Exchange, tibial ins Exchange, proximal Exchange, proximal+tibial ins. Removal, whole prosthesis Removal, prosthetic part(s) Insertion of patella Other Missing Figure 18: Type of revision - knee prostheses without patella Other 12 % Missing 2 % Exchange, distal 8 % Removal, w hole prosthesis 5 % Removal, prosthetic part(s) 1 % Exchange, w hole prosthesis 19 % Exchange, tibial ins. 16 % Insertion of patella 29 % Exchange, tibial ins.+ins.patella 3 % Exchange, distal+tibial ins. 5 % 57

70 Report 2009 Type of revision Table 19: Type of revision - Unicondylar prostheses Year of primary operation Exchange, distal Exchange, whole prosthesis Exchange, tibial ins Bytte, proximal Removal, whole prosthesis Removal, prosthetic part(s) Other Missing Figure 19: Type of revision - Unicondylar prostheses Removal, w hole prosthesis 2 % Other 1 % Missing 6 % Exchange, distal 5 % Exchange, proximal 2 % Exchange, tibial ins. 8 % Exchange, w hole prosthesis 76 % 58

71 The Norwegian Arthroplasty Register ASA classification Table 22: ASA classification - Primary operations Year ASA 1 ASA 2 ASA 3 ASA 4 ASA 5 Missing Table 23: ASA classification - Revisions Year ASA 1 ASA 2 ASA 3 ASA 4 ASA 5 Missing Figure 20: ASA classification - Primary operations Figure 21: ASA classification - Revisions 100 % Missing 100 % 80 % ASA 5 80 % 60 % ASA 4 60 % 40 % ASA 3 40 % 20 % ASA 2 20 % 0 % ASA 1 0 % ASA 1 = A normal healthy patient ASA 2 = A patient with mild systemic disease ASA 3 = A patient with severe systemic disease ASA 4 = A patient with severe systemic disease that is a constant threat to life ASA 5 = A moribund patient who is not expected to survive the operation Registration started in

72 Report 2009 Thrombosis prophylaxis Table 22: Thrombosis prophylaxis - Primary operations Year Missing Table 23: Thrombosis prophylaxis - Revisions Year Missing Figure 22: Thrombosis prophylaxis - Primary operations Figure 23: Thrombosis prophylaxis - Revisions 100 % 100 % 80 % Missing 80 % 60 % 40 % % 40 % 20 % 1 20 % 0 % % = Yes - Medication started preoperatively 2 = Yes - Medication started postoperatively 3 = Yes - Missing information on medication start 4 = No Registration started in

73 The Norwegian Arthroplasty Register Thrombosis prophylaxis Table 24: Thrombosis prophylaxis - All operations Drug Albyl-E 7 (0,2%) 1 (0,0%) Exanta 46 (1,3%) 8 (0,2%) Fragmin (Dalteparin) (48,0%) (51,3%) (56,1%) (57,2%) Klexane (Enoksaparin) (42,2%) (42,8%) (39,6%) (38,2%) Klinisk studie 8 (0,2%) 28 (0,7%) 48 (1,1%) Makrodex 3 (0,1%) 4 (0,1%) 2 (0,1%) 6 (0,1%) Marevan 7 (0,2%) 7 (0,2%) 1 (0,0%) 2 (0,0%) Melagatran (Ximelagatran) 11 (0,3%) 14 (0,4%) Persantin 1 (0,0%) Plavix 5 (0,1%) 1 (0,0%) 2 (0,1%) 2 (0,0%) Re-Novate 3 (0,1%) 1 (0,0%) 3 (0,1%) Ingen medikamentell beh. 12 (0,3%) 17 (0,5%) 9 (0,2%) 21 (0,5%) Medikamentkombinasjon 90 (2,6%) 67 (2,0%) 50 (1,3%) 50 (1,2%) Mangler 161 (4,6%) 70 (2,1%) 75 (1,9%) 70 (1,6%) Figure 24: Thrombosis prophylaxis - All operations Missing Clinical study No drugs 2 drugs Other Melagatran (Ximelagatran) Klexane (Enoksaparin) Fragmin (Dalteparin) Exanta Table 25: Thrombosis prophylaxis - Duration - All operations Year Days: >35 No drugs Missing Registration started in

74 Report 2009 Trombosis prophylaxis Table 26: Trombosis prophylaxis - Stockings - All operations Year Leg Leg + Thigh No Missing (16,4%) (36,1%) (31,4%) 703 (16,2%) (19,7%) (37,9%) (27,7%) 572 (14,7%) (16,1%) (39,5%) 909 (27,0%) 586 (17,4%) (19,9%) (32,0%) 982 (28,0%) 706 (20,1%) Table 27: Trombosis prophylaxis - Mechanical foot pump - All operations Year Foot Leg No Missing (0,2%) 3 (0,1%) (60,0%) (39,8%) (0,4%) 1 (0,0%) (60,9%) (38,7%) (0,5%) 6 (0,2%) (58,3%) (41,0%) (1,4%) 15 (0,4%) (53,9%) (44,3%) Mini-invasive surgery Table 28: Mini-invasive surgery - knee prostheses Primary operations Revisions Year Yes No Missing Yes No Missing (0%) (95%) 155 (4%) (0%) 313 (95%) 14 (4%) (1%) (95%) 129 (4%) (0%) 246 (96%) 10 (4%) (0%) (96%) 115 (4%) (1%) 211 (93%) 14 (6%) (0%) (89%) 300 (11%) (0%) 190 (88%) 25 (12%) 216 Table 29: Mini-invasive surgery - Unicondylar knee prostheses Primary operations Revisions Year Yes No Missing Yes No Missing (52%) 203 (47%) 6 (1%) (43%) 4 (57%) (32%) 300 (65%) 12 (3%) (22%) 7 (78%) (26%) 276 (69%) 19 (5%) (36%) 6 (55%) 1 (9%) (39%) 244 (54%) 33 (7%) (40%) 2 (40%) 1 (20%) 5 Computernavigation Table 30: Computernavigation - knee prostheses Year Primary operations Revisions Yes No Missing Yes No Missing (21%) (75%) 145 (4%) (4%) 302 (92%) 14 (4%) (12%) (84%) 119 (4%) (3%) 239 (93%) 10 (4%) (9%) (87%) 109 (4%) (2%) 207 (91%) 15 (7%) (7%) (84%) 272 (10%) (3%) 186 (86%) 24 (11%) 216 Table 31: Computernavigation - Unicondylar knee prostheses Year Primary operations Revisions Yes No Missing Yes No Missing (3%) 411 (94%) 9 (2%) (100%) (1%) 444 (96%) 14 (3%) (100%) (4%) 364 (91%) 20 (5%) (91%) 1 (9%) (0%) 419 (92%) 35 (8%) (80%) 1 (20%) 5 Registration of use of stockings, mechanical foot pump, MIS and CAOS started in

75 The Norwegian Arthroplasty Register Elbow prostheses Table 1: Annual number of prostheses Year Primary operations Revisions (60,7%) 22 (39,3%) (58,4%) 32 (41,6%) (58,1%) 31 (41,9%) (65,4%) 27 (34,6%) (61,7%) 23 (38,3%) (84,7%) 9 (15,3%) (61,1%) 21 (38,9%) (75,0%) 13 (25,0%) (75,5%) 12 (24,5%) (79,0%) 13 (21,0%) (82,4%) 9 (17,6%) (81,2%) 13 (18,8%) (93,2%) 4 (6,8%) (86,5%) 10 (13,5%) (87,5%) 10 (12,5%) (73,9%) 249 (26,1%) 954 Figure 1: Annual number of operations Number of operations Year of operation Revisions Primary operations Table 2: Elbow disease - Primary operations Year of operation Primary osteoarthritis Rheumatoid arthritis Operation causes are not mutually exclusive Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Acute fracture Sequele, infection Other Missing information

76 Report 2009 Elbow prostheses - Use of cement Table 3: Elbow prostheses - Use of cement - All operations - Humerus Year With antibiotics Without antibiotics Uncemented Missing (82,1%) 2 (7,1%) 3 (10,7%) (88,2%) (75,0%) (59,0%) (48,5%) (56,8%) 3 (6,8%) 4 (11,8%) 8 (25,0%) 16 (41,0%) 17 (51,5%) 16 (36,4%) (48,3%) 3 (10,3%) 11 (37,9%) 1 (3,4%) (31,6%) 3 (7,9%) (52,8%) 5 (13,9%) 23 (60,5%) 12 (33,3%) (32,7%) 14 (28,6%) 18 (36,7%) 1 (2,0%) (61,0%) 8 (19,5%) 7 (17,1%) 1 (2,4%) (60,8%) 5 (9,8%) (50,0%) 17 (32,7%) (65,5%) 13 (22,4%) 15 (29,4%) 9 (17,3%) 7 (12,1%) (59,1%) 23 (34,8%) 2 (3,0%) 2 (3,0%) (57,3%) 94 (14,9%) 167 (26,5%) 8 (1,3%) 630 Table 4: Elbow prostheses - Use of cement - All operations - Forearm component Year With antibiotics Without antibiotics Uncemented Missing (82,4%) 3 (8,8%) 3 (8,8%) (91,1%) 3 (6,7%) 1 (2,2%) (81,4%) (82,4%) (75,7%) 8 (18,6%) 9 (17,6%) 9 (24,3%) (82,0%) 4 (8,0%) 4 (8,0%) 1 (2,0%) (63,3%) 3 (10,0%) (78,9%) 3 (7,9%) 8 (26,7%) 5 (13,2%) (67,6%) 5 (13,5%) 6 (16,2%) 1 (2,7%) (69,4%) 13 (26,5%) 1 (2,0%) 1 (2,0%) (78,6%) 8 (19,0%) (78,6%) 6 (10,7%) (61,8%) 17 (30,9%) (70,3%) 13 (20,3%) 1 (2,4%) 6 (10,7%) 4 (7,3%) 6 (9,4%) (58,6%) 23 (32,9%) 5 (7,1%) 1 (1,4%) 520 (74,2%) 95 (13,6%) 78 (11,1%) 8 (1,1%)

77 The Norwegian Arthroplasty Register Elbow prostheses - Prostheses used Table 5: Elbow prostheses - Prostheses used - All operations - Humerus Prostheses Coonrad/Morrey 1 Discovery GSB III IBP IBP Reconstruction Kudo Mark II 2 NES Norway Radial Head 1 3 rhead Souter Strathclyde Table 6: Elbow prostheses - Prostheses used - All operations - Forearm component Prostheses Coonrad/Morrey 1 Discovery Evolve 1 1 GSB III IBP IBP Reconstruction Kudo Liverpool Radial Head 1 Mark II 2 NES Norway Radial Head rhead Silastic H.P Souter Strathclyde Elbow prostheses - Reason for revision Table 7: Elbow prostheses - Reason for revision Year Loose proximal comp. Loose distal comp. Dislocation Instability Revision causes are not mutually exclusive Malalignment Deep infection Fractu re (near implant) Pain Defect polyethylene 22% 25% 4% 4% 3% 7% 10% 9% 4% 10% 1% Other Missing 65

78 Report

79 The Norwegian Arthroplasty Register Ankle prostheses Table 1: Annual number of operations Year Primary operations Revisions (80,7%) 16 (19,3%) (80,6%) 14 (19,4%) (86,3%) 10 (13,7%) (80,0%) 10 (20,0%) (83,0%) 8 (17,0%) (78,1%) 7 (21,9%) (80,0%) 9 (20,0%) (88,9%) 4 (11,1%) (86,4%) 3 (13,6%) (95,7%) 1 (4,3%) (66,7%) 1 (33,3%) (72,7%) 3 (27,3%) (89,5%) 2 (10,5%) (88,9%) 1 (11,1%) (91,7%) 1 (8,3%) (83,2%) 90 (16,8%) 537 Figure 1: Annual number of operations Number of operations Year of operation Revisions Primary operations Table 2: Ankle disease - Primary operations Year of operation Primary osteoarthritis Rheumatoid arthritis Operation causes are not mutually exclusive Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Acute fracture Sequele, infection Other Missing 67

80 Report 2009 Ankle prostheses - Use of cement Table 3: Ankle prostheses - Use of cement - All operations - Tibia Year With antibiotics Without antibiotics Uncemented Missing (1,5%) 61 (91,0%) 5 (7,5%) (2,5%) (4,0%) (37,5%) (41,2%) 3 (17,6%) (62,5%) 3 (37,5%) 58 (100,0%) 63 (100,0%) 39 (97,5%) 39 (100,0%) 24 (96,0%) 36 (100,0%) 32 (100,0%) 19 (100,0%) 22 (100,0%) 2 (100,0%) 5 (62,5%) 7 (41,2%) (54,5%) 4 (36,4%) 1 (9,1%) 24 (5,4%) 10 (2,2%) 407 (91,1%) 6 (1,3%) Table 4: Ankle prostheses - Use of cement - All operations - Foot Year With antibiotics Without antibiotics Uncemented Missing (1,5%) 61 (91,0%) 5 (7,5%) (1,6%) (2,5%) (4,0%) 1 (4,0%) (2,8%) (37,5%) (41,2%) 3 (17,6%) (62,5%) 3 (37,5%) (63,6%) 4 (36,4%) 58 (100,0%) 62 (98,4%) 39 (97,5%) 39 (100,0%) 23 (92,0%) 35 (97,2%) 32 (100,0%) 19 (100,0%) 22 (100,0%) 2 (100,0%) 5 (62,5%) 7 (41,2%) 27 (6,0%) 11 (2,5%) 404 (90,4%) 5 (1,1%)

81 The Norwegian Arthroplasty Register Ankle prostheses - Prostheses used Table 5: Ankle prostheses - Prostheses used - All operations - Tibia Prostheses AES CCI Hintegra Link S.T.A.R Mobility 4 Norwegian TPR Table 6: Ankle prostheses - Prostheses used - All operations - Foot Prostheses AES CCI Hintegra Link S.T.A.R Mobility 4 Norwegian TPR Ankle prostheses - Reason for revision Table 7: Ankle prostheses - Reason for revision Year of revision Loose proximal comp. Loo se distal comp. Dislocation Instability Malalignment Deep infection Fractu re (near implant) Pain Defect polyethylene Other Missing Revision causes are not mutually exclusive

82 Report

83 The Norwegian Arthroplasty Register Finger joint prostheses Table 1: Annual number of operations - MCP Year Primary operations Revisions (70,4%) 37 (29,6%) (61,4%) 56 (38,6%) (77,8%) 30 (22,2%) (72,7%) 42 (27,3%) (65,8%) 53 (34,2%) (83,3%) 29 (16,7%) (71,4%) 44 (28,6%) (79,7%) 36 (20,3%) (83,9%) 38 (16,1%) (88,5%) 33 (11,5%) (92,0%) 20 (8,0%) (90,9%) 22 (9,1%) (83,6%) 37 (16,4%) (88,1%) 32 (11,9%) (95,9%) 14 (4,1%) (83,0%) 523 (17,0%) 3071 Table 2: Annual number of operations - PIP Year Primary operations Revisions (40,0%) 3 (60,0%) (85,7%) 1 (14,3%) (87,5%) 1 (12,5%) (85,7%) 1 (14,3%) (87,5%) 1 (12,5%) (100,0%) (100,0%) (100,0%) (100,0%) (100,0%) (80,0%) 1 (20,0%) (100,0%) (83,3%) 1 (16,7%) (100,0%) (100,0%) 1 59 (80,8%) 14 (19,2%) 73 Figure 1: Annual number of operations Number of operations Year of operation MCP Revisions MCP Primary operations 71

84 Report 2009 Finger prostheses - Finger disease Table 3: MCP prostheses - Finger disease - Primary operations Year of operation Primary osteoarthritis Rheumatoid arthritis Operation causes are not mutually exclusive Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Acute fracture Sequelae, infection Other Missing Table 4: PIP prostheses - Finger disease - Primary operations Year of operation Primary osteoarthritis Rheumatoid arthritis Operation causes are not mutually exclusive Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Acute fracture Sequelae, infection Other Missing 72

85 The Norwegian Arthroplasty Register MCP prostheses - Use of cement Table 5: MCP prostheses - Use of cement - All operations - Proximal Year of operation With antibiotics Without antibiotics Uncemented Missing (1,1%) (98,9%) 89 (100,0%) (99,0%) 1 (1,0%) (1,8%) 109 (97,3%) 1 (0,9%) (1,0%) (99,0%) 145 (100,0%) (99,1%) 1 (0,9%) (0,7%) (0,5%) (99,3%) 197 (99,5%) 255 (100,0%) 229 (100,0%) (98,6%) 3 (1,4%) (100,0%) 238 (100,0%) (99,4%) 2 (0,6%) 3 (0,1%) 3 (0,1%) (99,5%) 8 (0,3%) Table 6: MCP prostheses - Use of cement - All operations - Distal Year of operation With antibiotics Without antibiotics Uncemented Missing (100,0%) (100,0%) (100,0%) (100,0%) (100,0%) (100,0%) (100,0%) (100,0%) (100,0%) (100,0%) (100,0%) 4 36 (100,0%) 36 73

86 Report 2009 PIP prostheses - Use of cement Table 7: PIP prostheses - Use of cement - All operations - Proximal Year of operation With antibiotics Without antibiotics Uncemented Missing (100,0% (100,0% (100,0% (100,0% (100,0% (100,0% (100,0% (100,0% (100,0% (100,0% (100,0% (100,0% (100,0% 1 58 (100,0% 58 Table 8: PIP prostheses - Use of cement - All operations - Distal Year of operation With antibiotics Without antibiotics Usementert Missing (100,0% 2 (100,0% (80,0%) 1 (20,0%) (100,0% 5 (100,0% 1 (100,0% 3 (100,0% 1 (100,0% (95,7%) 1 (4,3%) 23 74

87 The Norwegian Arthroplasty Register MCP Prostheses Table 9: MCP prostheses - All operations - Proximal Prostheses Ascension MCP Avanta MCS 7 Moje 1 NeuFlex Silastic HP SR Avanta Table 10: MCP prostheses - All operations - Distal Prostheses Ascension MCP MCS 7 Moje PIP Prostheses Table 11: PIP prostheses - All operations - Proximal Prostheses Ascension MCP Avanta 3 MCS 4 Moje NeuFlex Silastic HP SR Avanta Table 12: PIP prostheses - All operations - Distal Prostheses Ascension MCP MCS 4 Moje

88 Report 2009 Finger prostheses - Reason for revision Table 13: MCP prostheses - Reason for revision Year Loose proximal comp. Loose distal comp. Dislocation Instability Malalignment % 5% 7% 15% 16% 2% 4% 29% 4% 53% 12% 5% Revision reasons are not mutually exclusive Deep infection Fracture (near implant) Pain Defect polyethylene Broken/defecte d component Other Missing Table 14: PIP prostheses - Reason for revision Year Loose proximal comp. Loose distal comp. Dislocation Instability Malalignment Deep infection Fraktur nær protesen Pain Defect polyethylene Broken/defect ed component % 19% 6% 13% 13% 0% 0% 19% 0% 38% 6% 0% Revision reasons are not mutually exclusive Other Missing 76

89 The Norwegian Arthroplasty Register Wrist prostheses Table 1: Annual number of operations Year Primary operations Revisions (58,8%) 7 (41,2%) (51,6%) 15 (48,4%) (78,0%) 9 (22,0%) (83,3%) 3 (16,7%) (72,7%) 3 (27,3%) (80,0%) 3 (20,0%) (80,0%) 1 (20,0%) (84,2%) 3 (15,8%) (94,4%) 1 (5,6%) (93,8%) 2 (6,3%) (100,0%) (66,7%) 1 (33,3%) (80,0%) 1 (20,0%) (78,5%) 49 (21,5%) 228 Figure 1: Annual number of operations Number of operations Year of operation Revisions Primary operations Table 2: Wrist disease - Primary operations Year Primary osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Acute fracture Sequelae, infection Operation causes are not mutually exclusive Other Missing 77

90 Report 2009 Wrist prostheses - Use of cement Table 3: Wrist prostheses - Use of cement - All operations - Proximal Year With antibiotics Without antibiotics Uncemented Missing (25,0%) (8,3%) (6,3%) 1 (6,3%) (17,6%) 10 (100,0%) 16 (100,0%) 32 (100,0%) 15 (100,0%) 6 (75,0%) 11 (91,7%) 4 (100,0%) 14 (87,5%) 14 (82,4%) (96,7%) 1 (3,3%) (100,0%) 2 (100,0%) 4 (100,0%) (3,9%) 1 (0,6%) 170 (95,0%) 1 (0,6%) 179 Table 4: Wrist prostheses - Use of cement - All operations - Distal Year With antibiotics Without antibiotics Uncemented Missing (50,0%) (25,0%) (6,7%) (5,9%) (100,0%) 15 (100,0%) 32 (100,0%) 15 (100,0%) 4 (50,0%) 9 (75,0%) 3 (100,0%) 14 (93,3%) 16 (94,1%) 30 (100,0%) 13 (100,0%) (5,3%) 160 (94,7%) 169 Wrist prostheses - Prosthesis brand Table 5: Wrist prostheses - Prosthesis brand - All operations - Proximal Prosthesis Biax Gibbon Scheker Radio-ulnar 1 Silastic ulnar head 6 TMW Table 6: Wrist prostheses - Prosthesis brand - All operations - Distal Prosthesis Biax Gibbon TMW

91 The Norwegian Arthroplasty Register Wrist prostheses - Reason for revision Table 7: Wrist prostheses - Reason for revision Year of revision Loose proximal comp. Loose distal comp. Dislocation Instability Malalignment Revision reasons are not mutually exclusive Deep infection Fracture (near implant) Pain Defect polyethylene Other Missing 7% 33% 3% 4% 10% 16% 0% 18% 1% 6% 0% 67 79

92 Report

93 The Norwegian Arthroplasty Register Carpometacarpal prostheses (CMC I) Table 1: Annual number of operations Year Primary operations Revisions (80,0%) 5 (20,0%) (85,2%) 4 (14,8%) (95,5%) 1 (4,5%) (70,4%) 8 (29,6%) (74,2%) 8 (25,8%) (96,9%) 1 (3,1%) (96,3%) 1 (3,7%) (87,5%) 5 (12,5%) (82,9%) 7 (17,1%) (93,8%) 2 (6,3%) (95,8%) 1 (4,2%) (77,8%) 6 (22,2%) (97,1%) 1 (2,9%) (96,3%) 1 (3,7%) (95,0%) 1 (5,0%) (88,1%) 52 (11,9%) 437 Figure 1: Annual number of operations Number of operations Year of operation Revisions Primary operations Table 2: Carpometacarpal disease - Primary operations Year Primary osteoarthritis Rheumatoid arthritis Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Acute fracture Sequelae, infection Operation causes are not mutually exclusive Other Missing 81

94 Report 2009 Carpometacarpal prostheses - Use of cement Table 3: Carpometacarpal prostheses - Use of cement - All operations - Proximal (Single-component) Year With antibiotics Without antibiotics Uncemented Missing (3,2%) (3,8%) (3,3%) (100,0%) 23 (100,0%) 21 (100,0%) 19 (100,0%) 23 (100,0%) 30 (96,8%) 25 (96,2%) 35 (100,0%) 34 (100,0%) 29 (96,7%) 23 (100,0%) 21 (100,0%) 34 (100,0%) 26 (100,0%) (94,7%) 1 (5,3%) (0,8%) 381 (99,0%) 1 (0,3%) 385 Carpometacarpal prostheses - Prosthesis brand Table 4: Carpometacarpal prostheses - All operations - Proximal (Single-component) Prostheses Avanta Trapezium Custom made Elektra 2 Motec 1 Silastic Trapezium Swanson Titanium Basal Carpometacarpal prostheses - Reason for revision Table 5: Carpometacarpal prostheses - Reason for revision Year of revision Loose prox. comp. Loose distal comp. Dislocation Instability Malalignment Deep infection Fracture near implant) Pain Defect polyethylene % 0% 29% 9% 0% 0% 0% 43% 3% 12% 1% Revision reasons are not mutually exclusive Other Missing 82

95 The Norwegian Arthroplasty Register Lumbar disc prostheses Table 1: Annual number of operations Year Primary operations Revisions (100,0%) (100,0%) (98,1%) 1 (1,9%) (98,8%) 1 (1,2%) (100,0%) (100,0%) (100,0%) (99,2%) 2 (0,8%) 253 Figure 1: Annual number of operations Number of operations Year of operation Revisions Primary operations Table 2: Back disease - Primary operations Year Primary osteoarthritis Sequelae after fracture Spondylitis Prolapse Disc degeneration Sequelae, infection Operation causes are not mutually exclusive. Other Missing 83

96 Report 2009 Lumbar disc prostheses - Fixation Table 3: Lumbar disc prostheses - Fixation - Primary operations - Proximal Year With antibiotics Without antibiotics Uncemented Missing (100,0%) 12 (100,0%) 53 (100,0%) 80 (100,0%) 64 (100,0%) 29 (100,0%) 3 (100,0%) (100,0%) 251 Table 4: Lumbar disc prostheses - Fixation - Primary operations - Distal Year With antibiotics (20,0%) Without antibiotics Uncemented Missing 8 (80,0%) (91,7%) 1 (8,3%) (1,9%) 51 (96,2%) 1 (1,9%) (100,0%) 64 (100,0%) 29 (100,0%) 3 (100,0%) (1,2%) 246 (98,0%) 2 (0,8%) 251 Lumbar disc prostheses - Prosthesis brand Table 5: Lumbar disc prostheses - Prosthesis brand - Proximal Prostheses Charité Prodisc Table 6: Lumbar disc prostheses - Prosthesis brand - Distal Prostheses Charité Prodisc

97 The Norwegian Arthroplasty Register Shoulder prostheses Table 1: Shoulder prostheses - Annual number of prostheses - -prostheses Year Primary operations Revisions (83,7%) 23 (16,3%) (80,2%) 23 (19,8%) (76,5%) 19 (23,5%) (72,3%) 13 (27,7%) (71,4%) 12 (28,6%) (75,7%) 9 (24,3%) (90,6%) 3 (9,4%) (69,6%) 7 (30,4%) (84,4%) 5 (15,6%) (88,5%) 3 (11,5%) (71,4%) 4 (28,6%) (100,0%) (84,4%) 5 (15,6%) (85,3%) 5 (14,7%) (90,3%) 3 (9,7%) (80,9%) 134 (19,1%) 703 Table 2: Shoulder prostheses - Annual number of prostheses - Hemi-prostheses Year Primary operations Revisions (94,7%) 10 (5,3%) (95,6%) 10 (4,4%) (96,9%) 7 (3,1%) (98,0%) 4 (2,0%) (95,5%) 8 (4,5%) (96,2%) 6 (3,8%) (94,6%) 7 (5,4%) (94,2%) 8 (5,8%) (94,3%) 7 (5,7%) (90,0%) 15 (10,0%) (88,1%) 16 (11,9%) (95,0%) 7 (5,0%) (92,2%) 8 (7,8%) (94,6%) 5 (5,4%) (95,9%) 4 (4,1%) (94,6%) 122 (5,4%) 2275 Figure 1: Shoulder prostheses - Annual number of operations - - and hemi-prosthese Number of operations Year of operation Revisions Primary operations 85

98 Report 2009 Shoulder prostheses - Shoulder disease Table 3: Shoulder disease - Primary operations - -prostheses Year Primary osteoarthritis Rheumatoid arthritis Operation causes are not mutually exclusive Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Acute fracture Sequele, infection Other Missing Table 4: Shoulder disease - Primary operations - Hemi-prostheses Year Primary osteoarthritis Rheumatoid arthritis Operation causes are not mutually exclusive Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Acute fracture Sequelae, infection Other Missing 86

99 The Norwegian Arthroplasty Register Shoulder prostheses - Use of cement Table 5: Use of cement - All operations - -prostheses - Glenoid Year With antibiotics Without antibiotics Uncemented Missing (26,7%) 68 (58,6%) 17 (14,7%) (30,4%) 1 (1,1%) 63 (68,5%) (20,0%) 41 (74,5%) 3 (5,5%) (29,4%) 24 (70,6%) (13,3%) 26 (86,7%) (10,7%) 25 (89,3%) (17,2%) 24 (82,8%) (6,3%) 15 (93,8%) (7,4%) 1 (3,7%) 24 (88,9%) (8,7%) 21 (91,3%) (100,0% (100,0% (7,4%) 1 (3,7%) 24 (88,9%) (100,0% (7,1%) 1 (3,6%) 25 (89,3%) 101 (18,1%) 4 (0,7%) 434 (77,6%) 20 (3,6%) 559 Table 6: Use of cement - All operations - -prostheses - Humerus Year With antibiotics Without antibiotics Uncemented Missing (68,4%) 22 (18,8%) 15 (12,8%) (67,7%) 30 (32,3%) (51,6%) 26 (41,9%) 4 (6,5%) (47,1%) 17 (50,0%) 1 (2,9%) (60,7%) 10 (35,7%) 1 (3,6%) (57,1%) 12 (42,9%) (27,6%) 21 (72,4%) (12,5%) 14 (87,5%) (19,2%) 1 (3,8%) 20 (76,9%) (13,0%) 20 (87,0%) (100,0%) (6,7%) 14 (93,3%) (29,2%) 17 (70,8%) (4,8%) 20 (95,2%) (10,7%) 1 (3,6%) 24 (85,7%) 254 (45,8%) 2 (0,4%) 277 (50,0%) 21 (3,8%) 554 Table 7: Use of cement - All operations - Hemi-prostheses - Humerus Year With antibiotics Without antibiotics Uncemented Missing (49,4%) 2 (1,1%) 47 (27,0%) 39 (22,4%) (57,4%) 48 (23,0%) 41 (19,6%) (49,1%) 59 (27,3%) 51 (23,6%) (52,1%) 42 (21,9%) 50 (26,0%) (55,0%) 36 (21,1%) 41 (24,0%) (56,2%) 39 (25,5%) 28 (18,3%) (66,4%) 1 (0,8%) 34 (27,9%) 6 (4,9%) (65,4%) 44 (33,8%) 1 (0,8%) (60,5%) 3 (2,6%) 42 (36,8%) (52,2%) 2 (1,5%) 62 (46,3%) (46,6%) 2 (1,7%) 61 (51,7%) (38,6%) 3 (2,3%) 78 (59,1%) (48,9%) 2 (2,1%) 46 (48,9%) (52,9%) 10 (11,5%) 31 (35,6%) (37,6%) 17 (18,3%) 41 (44,1%) (52,8%) 42 (2,0%) 710 (33,2%) 257 (12,0%)

100 Report 2009 Shoulder prostheses - Prosthesis brand Table 8: Shoulder prostheses - Primary operations - -prostheses - Prosthesis brand - Glenoid Prostheses Aequalis 3 15 Aequalis-Reversed 6 Bigliani/Flatow 1 3 Bio - Modular Copeland 2 1 Delta III Delta Xtend Elos EPOCA Global Global Advantage Monosperical 1 Mutars Nottingham 13 Tess Reversed Tess-Anatomic Table 9: Shoulder prostheses - Primary operations - -prostheses - Prosthesis brand - Caput humeri Prostheses Aequalis 3 15 Aequalis-Reversed 3 Bigliani/Flatow 1 3 Bio - Modular Delta I 1 Delta III Delta Xtend EPOCA Global 1 Global Advantage Mutars Nottingham Tess Reversed Tess-Anatomic Table 10: Shoulder prostheses - Primary operations - -prostheses - Prosthesis brand - Humerus Prostheses Aequalis 3 15 Aequalis-Reversed 6 Bigliani/Flatow 1 3 Bio - Modular Copeland Delta I 1 Delta III Delta Xtend EPOCA Global 1 Global Advantage Global Fx 1 Monosperical 1 Mutars Nottingham Tess Reversed Tess-Anatomic

101 The Norwegian Arthroplasty Register Shoulder prostheses - Hemi-prostheses - Prosthesis brand Table 11: Shoulder prostheses - Primary operations - Hemi-prostheses - Prosthesis brand - Caput humeri Prostheses Aequalis 1 4 Aequalis Resurfacing 6 Aequalis-Fracture 3 Articula Bigliani/Flatow Bio - Modular Biomet-Bi-Polar Delta I Global Global Advantage Global Fx Modular 33 Modular Resection 3 2 Mutars 1 1 Nottingham Nottingham Table 12: Shoulder prostheses - Primary operations - Hemi-prostheses - Prosthesis brand - Humerus Produktnavn Aequalis 1 4 Aequalis-Fracture 3 Articula Bigliani/Flatow Bio - Modular Copeland Delta I Global Global Advantage Global C.A.P Global Fx Modular 33 Modular Resection 3 Monosperical 13 2 Mutars 1 2 Neer 2 Neer II Nottingham Nottingham Scan Shoulder

102 Report 2009 Shoulder prostheses - Reason for revision Table 13: Shoulder prostheses - Reason for revision - -prostheses Year of primary operation Loose proximal comp. Loose distal comp. Dislocation Instability Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene Revision causes are not mutually exclusive 25% 7% 21% 7% 1% 11% 1% 12% 7% 7% 0% Other Missing Table 14: Shoulder prostheses - Reason for revision - Hemi-prostheses Year of primary operation Loose proximal comp. Loose distal comp. Dislocation Instability Revision causes are not mutually exclusive Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene 2% 7% 8% 9% 1% 6% 2% 49% 1% 16% 2% Other Missing 90

103 The Norwegian Arthroplasty Register Toe joint prostheses Table 1: Toe joint prostheses - Annual number of operations Year Primary operations Revisions (61,7%) 23 (38,3%) (70,1%) 20 (29,9%) (79,8%) 19 (20,2%) (79,0%) 17 (21,0%) (84,4%) 10 (15,6%) (71,6%) 19 (28,4%) (79,8%) 17 (20,2%) (83,6%) 12 (16,4%) (76,7%) 20 (23,3%) (83,3%) 15 (16,7%) (76,5%) 20 (23,5%) (90,8%) 7 (9,2%) (90,8%) 8 (9,2%) (89,9%) 8 (10,1%) (92,2%) 7 (7,8%) (81,2%) 222 (18,8%) Figure 1: Toe joint prostheses - Annual number of operations Number of operations Year of operation Revisions Primary operations Table 2: Toe disease - Primary operations Year Primary osteoarthritis Rheumatoid arthritis Operation causes are not mutually exclusive Sequelae after fracture Mb. Bechterew Sequelae, ligament tear Acute fracture Sequelae, infection Other Missing 91

104 Report 2009 Toe joint prostheses - Use of cement Table 3: Toe joint prostheses - All operations - Use of cement - Proximal Year With antibiotics Without antibiotics Uncemented Missing (100,0%) 46 (100,0%) (98,7%) 1 (1,3%) (1,9%) (2,1%) 64 (100,0%) 53 (98,1%) 47 (97,9%) (1,5%) 65 (97,0%) 1 (1,5%) (1,6%) (3,0%) (98,4%) 64 (97,0%) 75 (100,0%) 65 (100,0%) 69 (100,0%) 79 (100,0%) 71 (100,0%) (97,6%) 2 (2,4%) 6 (0,6%) 950 (99,0%) 4 (0,4%) Table 4: Toe joint prostheses - All operations - Use of cement - Distal Year With antibiotics Without antibiotics Uncemented Missing (9,1%) (6,7%) (9,1%) (100,0%) 5 (100,0%) 13 (100,0%) 6 (100,0%) 7 (100,0%) 4 (100,0%) 10 (90,9%) 14 (93,3%) 10 (90,9%) 2 (100,0%) (100,0%) (100,0%) 3 (3,7%) 75 (92,6%) 3 (3,7%)

105 The Norwegian Arthroplasty Register Toe joint prostheses - Prosthesis brand Table 5: Toe joint prostheses - All operations - Prosthesis brand - Proximal Prostheses Biomet Toe 20 5 LaPorta LPT Moje Silastic HP Sutter Swanson Titanium Toefit-plus Table 6: Toe joint prostheses - All operations - Prosthesis brand - Distal Prostheses Biomet Toe 20 Moje 8 Silastic HP Toefit-plus Toe joint prostheses - Reason for revision Table 7: Toe joint prostheses - Reason for revision Year of revision Loose proximal comp. Loose distal comp. Dislocation Instability Revision causes are not mutually exclusive Malalignment Deep infection Fracture (near implant) Pain Defect polyethylene 2% 6% 2% 4% 20% 7% 1% 32% 2% 23% 3% Other Missing 93

106 Report

107 The Norwegian Hip Fracture Register THE NORWEGIAN HIP FRACTURE REGISTER The hip fracture register are functioning well. There is an increase in the number of reported primary operations (4.5 %) and a decrease in the number reported revisions (6.5 %). The latter can be due to fewer revisions for displaced fractures because of the increase in use of hemiprostheses for these patients. If the hemiprostheses do not need more revisions later on, this could be a positive change in method. The decrease of reported revisions could also be due to lack of reporting revisions. We will like to remind you that all revisions after operations for femoral neck fractures, should be reported, including soft tissue revisions for infection and closed or open reduction of dislocated hemiprostheses. This is different from the reporting to the Hip Arthroplasty Register where only operations with removal or changing of implant should be reported. Also deaths peroperative should be reported, including deaths during the cementing of the hemiprosthesis. Only half of the surgeons have reported the time of the fracture. The time from fracture until surgery is important when we are analyzing the reason for the fall. We have got an approval for compiling data from the Hip Fracture Register with data from the Receipt Register. The actual time of the fracture is important when investigating if there is a connection between taking the drug (for instance blood pressure medicine and sleeping medicine) and the fall leading to the fracture. When investigating the importance of the duration from fracture to operation regarding the risk for death or reoperation, the actual time of the fall is important. In addition we want to encourage all to use the implant product stickers since this makes the registering of these easier. This last year has been a success scientifically. Many talks have been given based on data from the Hip Fracture Register, both nationally and internationally. Two papers are published in 2008 and Jan Erik Gjertsen defended his medical PhD April 17 th 2009 on data mainly from The Hip Fracture Register. All members of the Norwegian Orthopedic Association receive a copy (pfd file) electronically together with the annual report from the Register. We are working on several possible joint projects with orthopedics across the country. We own the data together and we are very interested in increasing the use, so don t hesitate to contact us if you have any ideas. We believe that The Hip Fracture Register contribute to the improvement of the treatment of this important patient group. Thank you all for excellent reporting and great cooperation! Bergen, 28 th May

108 Report

109 The Norwegian Hip Fracture Register HIP FRACTURES Table 1: number of operations Primary operations Reoperations ( 87,8% ) 1143 ( 12,2% ) 7867 ( 86,6% ) 1222 ( 13,4% ) 7533 ( 86,0% ) 1227 ( 14,0% ) 5895 ( 83,3% ) 1184 ( 16,7% ) t ( 86,1% ) 4776 ( 13,9% ) 34292* * 585 primary operations and 2174 reoperations were operations with total hip prostheses reported to the arthroplasty register. 51,0 % of the primary operations were performed on the right side. 70,4 % of the primary operations were performed on women. Mean age by primary operation was 79,8 years. Figure 1: number of operations Number of hips Primary operations Reoperations Figure 2: Incidence of hip fractures (2006) Primary operations per inhabitants Women Men < year year year year > 89 Age Figure 3: Age by primary operation (2006) Number Women Men < year year year year > 89 Age 97

110 Report 2009 Time from fracture to operation in hours - primary operations* Table 2: Time from fracture to operation in hours 0-6 >6-12 >12-24 >24-48 >48 Missing ,7% 16,1% 34,5% 26,8% 15,7% 2,2% ,9% 18,6% 33,8% 24,3% 15,4% 2,0% ,3% 20,2% 35,9% 22,8% 13,3% 1,5% ,7% 22,4% 34,2% 19,9% 14,0% 1,8% ,0% 19,1% 34,6% 23,7% 14,7% 1,9% * Excl. total hip prostheses Figure 4: Time from fracture to operation - grouped by hours Number of hip operations > 6-12 > > > 48 Missing Hours Figure 5: Time from fracture to operation - continuous ( n = ) 800 Number of hip operations Hours 98

111 The Norwegian Hip Fracture Register Cognitive impairment * Table 3: Cognitive impairment - Primary operation No Yes Uncertain Missing t ( 63,3% ) 1982 ( 24,6% ) 780 ( 9,7% ) 197 ( 2,4% ) ( 62,8% ) 1863 ( 24,2% ) 836 ( 10,9% ) 166 ( 2,2% ) ( 65,7% ) 1675 ( 22,7% ) 721 ( 9,8% ) 140 ( 1,9% ) ( 62,5% ) 1384 ( 24,0% ) 649 ( 11,2% ) 130 ( 2,3% ) ( 23,9% ) ( 2,2% ) * Excl. total hip prostheses. Figure 6: Cognitive impairment - Primary operations Number of patients No Yes Uncertain Missing Cognitive impairment Type of anaesthesia * Table 4: Type of anaesthesia - primary operations General anaesthesia Spinal Other Missing ( 7,3% ) 7157 ( 88,7% ) 179 ( 2,2% ) 144 ( 1,8% ) ( 7,2% ) 6837 ( 88,8% ) 187 ( 2,4% ) 125 ( 1,6% ) ( 6,4% ) 6638 ( 89,8% ) 137 ( 1,9% ) 140 ( 1,9% ) ( 5,6% ) 5227 ( 90,5% ) 122 ( 2,1% ) 104 ( 1,8% ) ( 6,7% ) ( 89,4% ) 625 ( 2,2% ) 513 ( 1,8% ) * Excl. total hip prostheses Figure 7: Type of Anaesthesia - Primary operations 8000 Number of operations General anaesthesia Spinal Other Missing

112 Report 2009 ASA-classification (ASA = American Society of Anesthesiologists) Tabell 5: ASA-classification - primary and reoperation ASA 1 ASA 2 ASA 3 ASA 4 ASA 5 Missing ( 8,4% ) 3231 ( 34,5% ) 4614 ( 49,3% ) 559 ( 6,0% ) 9 ( 0,1% ) 163 ( 1,7% ) ( 9,3% ) 3226 ( 35,5% ) 4365 ( 48,0% ) 477 ( 5,2% ) 7 ( 0,1% ) 171 ( 1,9% ) ( 10,6% ) 3205 ( 36,6% ) 4032 ( 46,0% ) 401 ( 4,6% ) 13 ( 0,1% ) 177 ( 2,0% ) ( 11,6% ) 2638 ( 37,3% ) 3072 ( 43,4% ) 344 ( 4,9% ) 13 ( 0,2% ) 193 ( 2,7% ) ( 9,9% ) ( 35,9% ) ( 46,9% ) 1781 ( 5,2% ) 42 ( 0,1% ) 704 ( 2,1% ) Figure 8: ASA-classification - primary and reoperation 100 % Number of operations 80 % 60 % 40 % 20 % Missing ASA 5 ASA 4 ASA 3 ASA 2 ASA 1 0 % ASA CLASSIFICATION (ASA = American Society of Anesthesiologists) ASA 1: Healthy patients that smoke less than 5 cigarettes a day. ASA 2: Patients with an asymptomatic medical condition that can be treated with medication (e.g. hypertension) or with diet (e.g. Type 2 diabetes mellitus) or healthy patients who smoke more than 5 cigarettes daily. ASA 3: Patients with a medical condition that is symptomatic but that is controlled with medication (e.g. moderate angina pectoris or mild asthma) ASA 4: Patients with a medical condition that is out of control (e.g. heart failure, severe asthma). ASA 5: Moribund patients. 100

113 The Norwegian Hip Fracture Register Type of fracture Table 6: Type of fracture ( reason for primary operation) Type 1 Type 2 Type 3 Type 4 Type 5 Type 6 Type 7 Type 8 Other Missing ,8% 38,4% 4,2% 17,6% 14,7% 5,3% 1,8% 0,1% 1,0% 0,2% ,0% 38,0% 4,9% 17,2% 13,3% 5,6% 2,0% 0,1% 0,8% 0,1% ,7% 37,5% 4,5% 17,4% 13,4% 5,5% 1,8% 0,1% 0,9% 0,1% ,2% 38,9% 4,6% 17,1% 12,9% 5,4% 1,8% 0,2% 0,6% 0,2% ,6% 38,2% 4,6% 17,3% 13,6% 5,4% 1,9% 0,1% 0,8% 0,1% Figure 9: Type of primary fracture (total) number of operations Type 1 Type 2 Type 3 Type 4 Type 5 Type 6 Type 7 Type 8 Other Missing Type 1: Intracapsular fracture, undisplaced (Garden 1 and 2) Type 2: Intracapsular fracture, displaced (Garden 3 and 4) Type 3: Basocervical fracture Type 4: Trochanteric fracture (2 fragments) Type 5: Trochanteric fracture (multifragment) Type 6: Subtrochanteric fracture Type 7: Femoral neck fracture unspecified (from the arthroplasty register) Type 8: Trochanteric fracture unspecified (from the arthroplasty register) 101

114 Report 2009 Reason for reoperation* Table 7: Reason for reoperation Å1 Å2 Å3 Å4 Å5 Å6 Å7 Å8 Å9 Å10 Å11 Å12 Å13 Å ,0% 7,6% 4,7% 5,8% 0,7% 0,7% 7,2% 1,3% 3,0% 3,1% 4,1% 0,7% 2,4% 40,7% ,7% 8,8% 5,8% 7,4% 0,7% 0,7% 5,3% 0,9% 2,2% 2,7% 3,3% 0,6% 2,0% 40,1% ,3% 8,8% 4,5% 7,1% 0,5% 0,6% 5,3% 1,4% 1,5% 2,1% 2,3% 0,5% 1,5% 41,6% ,2% 7,7% 5,1% 6,2% 0,6% 0,9% 3,6% 1,2% 1,8% 1,9% 2,4% 0,1% 1,6% 46,7% ,1% 8,2% 5,0% 6,6% 0,6% 0,7% 5,3% 1,2% 2,1% 2,4% 3,0% 0,5% 1,9% 42,3% Figure 10: Reason for reoperation (total) 2500 number of operations Å 1 Å 2 Å 3 Å 4 Å 5 Å 6 Å 7 Å 8 Å 9 Å 10 Å 11 Å 12 Å 13 Å 14 Å1: Osteosynthesis failure Å2: Nonunion Å3: Avascular necrosis (segmental collaps) Å4: Local pain due to osteosynthesis material Å5: Malunion Å6: Infection - superficial Å7: Infection - deep Å8: Haematoma Å9: Dislocation of hemiprosthesis Å10: Penetration of osteosynthesis material through caput Å11: New fracture around implant Å12: Loosening of hemiprosthesis Å13: Other Å14: Reported reoperations to arthroplasty register except Deep infection that is included in Å7: Infection deep. * Reasons are not mutually exclusive 102

115 The Norwegian Hip Fracture Register Reason for reoperation vs. reason for primary operation Patients where both the primary operation and the first reoperation are in the register. Reasons are not mutually exclusive. Table 8: Reason for reoperation vs. primary operation Type of primary fracture Reason for reoperation Intracapsular fracture, undisplaced Intracapsular fracture, displaced Basocervical fracture Trochanteric fracture (2 fragments) Trochanteric fracture (multifragment) Osteosynthesis failure Subtrochanteric fracture Other Missing Nonunion Avascular necrosis Local pain due to osteosynthesis material Malunion Infection - superficial Infection - deep Haematoma Dislocation of hemiprosthesis Penetration of osteosynthesis material through caput New fracture around implant Loosening of hemiprosthesis Other

116 Report 2009 Type of primary operation vs. reason for primary operation Patients where both the primary operation and the first reoperation are in the register. Reasons are not mutually exclusive. Table 9: Type of primary operation vs. reason for primary operatio Type of primary fracture Reason for primary operation Intracapsular fracture, undisplaced Intracapsular fracture, displaced Basocervical fracture Trochanteric fracture (2 fragments) Trochanteric fracture (multifragment) Subtrochanteric fracture Intracapsular fracture - unspecified* Trochanteric fracture - unspecified* Two screws or pins Three screws or pins Other Missing Bipolar hemiprosthesis Unipolar hemiprosthesis Hip compression screw and plate Hip compression screw with lateral support plate Angle plate Short intramedullary nail without distal locking Short intramedullary nail with distal locking Long intramedullary nail without distal locking Long intramedullary nail with distal locking hip prosthesis Other:Hip compression screw system and additional anti-rotational screw Other Missing * hip prostheses reported to the arthroplasty register 104

117 The Norwegian Hip Fracture Register Type of primary operation - all fractures Table 10: Type of primary operation - all fractures T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 T13 T ,3% 0,8% 29,1% 0,9% 21,3% 8,3% 0,0% 0,8% 8,0% 0,1% 3,2% 1,9% 2,3% 0,0% ,7% 0,6% 26,8% 0,6% 23,7% 8,2% 0,0% 0,5% 5,5% 0,1% 2,0% 2,1% 2,2% 0,0% ,8% 0,8% 21,8% 0,5% 25,1% 8,4% 0,0% 0,6% 3,6% 0,1% 1,7% 1,9% 2,8% 0,0% ,5% 0,9% 18,8% 0,5% 25,3% 8,0% 0,0% 0,5% 3,6% 0,1% 0,9% 2,0% 2,9% 0,0% ,5% 0,8% 24,6% 0,6% 23,7% 8,2% 0,0% 0,6% 5,3% 0,1% 2,0% 2,0% 2,5% 0,0% Figure 11: Type of primary operation - all fractures 3000 Number of operations > T1 T2 T3 T4 T5 T6 T8 T9 T10 T11 T12 T T1: Two screws or pins T2: Three screws or pins T3: Bipolar hemiprosthesis T4: Unipolar hemiprosthesis T5: Hip compression screw and plate T6: Hip compression screw with lateral support plate T7: Angle plate T8: Short intramedullary nail without distal locking T9: Short intramedullary nail with distal locking T10: Long intramedullary nail without distal locking T11: Long intramedullary nail with distal locking T12: hip prosthesis T13: Other* T14: Missing * Including hip compression screw system and additional anti-rotational screw (n = 506) 105

118 Report 2009 Type of reoperation* Table 11: Type of reoperation R1 R2 R3 R4 R5 R6 R7 R8 R9 R ,5% 3,1% 26,1% 0,1% 7,0% 6,5% 0,9% 1,2% 6,1% 41,5% ,3% 2,2% 29,2% 0,1% 6,2% 5,0% 0,4% 0,9% 4,8% 41,9% ,0% 2,9% 29,1% 0,5% 6,5% 5,9% 0,6% 0,4% 3,3% 42,8% ,1% 2,0% 26,2% 2,8% 3,6% 3,6% 0,7% 0,6% 2,8% 48,5% ,5% 2,6% 27,7% 0,8% 5,8% 5,2% 0,7% 0,8% 4,3% 43,7% Figure 12: Type of reoperation Number of operations R1 R2 R3 R4 R5 R6 R7 R8 R9 R R1: Removal of implant (when only procedure) R2: Girdlestone (= Removal of implant/hemiprosthesis and caput) R3: Bipolar hemiprosthesis R4: Unipolar hemiprosthesis R5: Re-osteosynthesis R6: Drainage of hematoma or infection R7: Closed reduction of dislocated hemiprosthesis R8: Open reduction of dislocated hemiprosthesis R9: Other R10: hip prosthesis *Reasons are not mutually exclusive. 106

119 The Norwegian Hip Fracture Register Type of revision with primary uni/bipolar hemiprosthesis * Table 12: Type of revison with primary uni/bipolar hemiprosthesis R1 R2 R3 R4 R5 R6 R7 R8 R9 R ,8% 7,3% 5,7% 0,0% 1,6% 31,7% 4,1% 8,9% 30,1% 9,8% ,0% 5,7% 8,0% 0,0% 0,0% 27,3% 3,4% 11,4% 38,6% 5,7% ,0% 8,5% 2,8% 0,0% 0,0% 43,7% 5,6% 4,2% 31,0% 4,2% ,0% 2,9% 2,9% 0,0% 0,0% 41,2% 8,8% 8,8% 29,4% 5,9% ,3% 6,6% 5,4% 0,0% 0,6% 34,2% 4,7% 8,5% 32,6% 7,0% R1: Removal of implant (when only procedure) R2: Girdlestone (= Removal of implant/hemiprosthesis and caput) R3: Bipolar hemiprosthesis R4: Unipolar hemiprosthesis R5: Re-osteosynthesis R6: Drainage of hematoma or infection R7: Closed reduction of dislocated hemiprosthesis R8: Open reduction of dislocated hemiprosthesis R9: Other R10: hip prosthesis *Reasons are not mutually exclusive Table 13: Specification of R9 - Others Cable Ready plate + possibly cerclage Cerclage Closure of fascie/skin 1 1 Exchange of femoral component 2 2 Exchange of head/cup Fixation of the major trochanter (Dall Miles) 1 1 LCP plate + possibly cerclage Reaming of acetabulum 1 1 Removal of cement in acetabulum 1 1 Removal of drain 1 1 Suture of muscle/fascie

120 Report 2009 Type of revision with primary screw * Table 14: Type of revision with primary screw R1 R2 R3 R4 R5 R6 R7 R8 R9 R ,6% 3,3% 43,8% 0,0% 5,5% 1,1% 0,0% 0,0% 0,6% 36,1% ,5% 1,9% 46,0% 0,2% 3,5% 0,5% 0,0% 0,0% 1,2% 32,2% ,5% 1,3% 49,2% 1,3% 5,4% 0,8% 0,0% 0,0% 0,3% 32,2% ,1% 2,8% 58,1% 5,5% 2,8% 2,8% 0,0% 0,0% 1,4% 21,7% ,4% 2,2% 48,2% 1,3% 4,4% 1,1% 0,0% 0,0% 0,8% 31,6% R1: Removal of implant (when only procedure) R2: Girdlestone (= Removal of implant/hemiprosthesis and caput) R3: Bipolar hemiprosthesis R4: Unipolar hemiprosthesis R5: Re-osteosynthesis R6: Drainage of hematoma or infection R7: Closed reduction of dislocated hemiprosthesis R8: Open reduction of dislocated hemiprosthesis R9: Other R10: hip prosthesis *Reasons are not mutually exclusive 108

121 The Norwegian Hip Fracture Register Hemiprosthesis Table 15: Cemented hemiprosthesis - primary operations Femur Caput Hemicup Charnley Hastings hemikopp Charnley Modular Elite Cupule Mobile Charnley Modular Elite Hastings hemikopp ETS Exeter/V40 Exeter/V40 UHR SP II (Link) CoCrMo (Link) Vario-Cup (Link) Spectron Cobalt Chrom (S&N) Biarticular cup (Biothechni) Spectron Cobalt Chrom (S&N) Cupule Mobile Spectron Cobalt Chrom (S&N) Tandem Spectron Cobalt Chrom (S&N) Universal bipolar Spectron Cobalt Chrom (S&N) Vario-Cup (Link) Spectron Cobalt chrome (DePuy) Cupule Mobile Titan Articul/Eze Cupule Mobile Titan Caput ukjent Cupule Mobile Titan Cobalt chrome (DePuy) Bi-Polar Head (DePuy) Titan Cobalt chrome (DePuy) Cupule Mobile Others Unknown "Other" contains combinations with less than 10 occurrences Table 16: Uncemented hemiprosthesis - primary operations Femur Caput Hemicup Corail Articul/Eze Bi-Polar Head (DePuy) Corail Articul/Eze Cupule Mobile Corail Cobalt chrome (DePuy) Bi-Polar Head (DePuy) Corail Cobalt chrome (DePuy) Cupule Mobile Filler Cobalt-Chrome (Biotechni) Biarticular cup (Biothechni) Filler Hipball Premium Biarticular cup (Biothechni) HACTIV HACTIV head Moonstone MS-30 Protasul/Metasul UHR SL-PLUS HACTIV head Bipolar-PLUS SL-PLUS Metal Endocast PLUS Bipolar-PLUS Others Unknown "Other" contains combinations with less than 10 occurrences

122 Report 2009 Tabell 17: Cemented hemiprosthesis - reoperations Femur Screws Table 19: Scews - primary operations Caput Hemicup Charnley Hastings hemikopp Charnley Modular Elite Cupule Mobile 5 5 Charnley Modular Elite Hastings hemikopp CPS-PLUS Rev. stem Metal Endocast PLUS Bipolar-PLUS 5 5 ETS 8 8 Exeter/V40 Exeter/V40 UHR SP II (Link) CoCrMo (Link) Vario-Cup (Link) Spectron Cobalt Chrom (S&N) Cupule Mobile 5 5 Spectron Cobalt Chrom (S&N) Tandem Spectron Cobalt Chrom (S&N) Universal bipolar 9 9 Titan Cobalt chrome (DePuy) Bi-Polar Head (DePuy) 5 5 Titan Cobalt chrome (DePuy) Cupule Mobile Others Unknown "Other" contains combinations with less than 5 occurrences. Table 18: Uncemented hemiprosthesis - reoperations Femur Caput Hemicup Bicontact Aesculap Aesculap Isodur 6 6 Corail Articul/Eze Cupule Mobile Corail Cobalt chrome (DePuy) Cupule Mobile Filler Cobalt chrome (DePuy) Cupule Mobile 5 5 Filler Cobalt-Chrome (Biotechni) Biarticular cup (Biothechni) Filler Hipball Premium Biarticular cup (Biothechni) KAR Cobalt chrome (DePuy) Cupule Mobile Restoration-HA C-Taper Head Cupule Mobile 5 5 Others Unknown "Other" contains combinations with less than 5 occurrences Product Asnis III LIH pin Olmed Richards CHP

123 The Norwegian Hip Fracture Register Hip compression screws Table 20: Hip compression screws - primary operations Product CHS (DePuy) 1 1 DHS LCP DHS Omega Omega Plus Richards CHS Nails Table 21: Nails - primary operations Product ACE CFN 1 1 Gamma Gamma IMHS IMHS CP LFN PFN PFNA Russell-Taylor T T2 recon 1 1 TriGen Trigen Intertan Unknown Fixation Table 22: Primary hemiprosthesis Uncemented Cement with antibiotics Cement without antibiotics Missing ( 16,2% ) 1949 ( 79,2% ) 20 ( 0,8% ) 93 ( 3,8% ) ( 17,9% ) 1706 ( 79,1% ) 12 ( 0,6% ) 53 ( 2,5% ) ( 19,4% ) 1314 ( 78,3% ) 10 ( 0,6% ) 30 ( 1,8% ) ( 20,5% ) 883 ( 77,7% ) 4 ( 0,4% ) 17 ( 1,5% ) ( 78,7% ) 46 ( 0,6% ) 193 ( 2,6% )

124 Report 2009 Table 23: Cement with antibiotics - primary operations Product Cemex System Genta FAST Cemex w/gentamycin Missing information Optipac Other Palacos 1 1 Palacos R + G Palacos w/gentamycin Refobacin Bone Cement R Refobacin-Palacos Simplex Table 24: Primary hemiprosthesis - uncemented With HA Without HA Missing ( 75,2% ) 38 ( 9,5% ) 61 ( 15,3% ) ( 76,0% ) 27 ( 7,0% ) 66 ( 17,1% ) ( 65,8% ) 42 ( 12,9% ) 69 ( 21,2% ) ( 61,4% ) 29 ( 12,4% ) 61 ( 26,2% ) 951 ( 70,8% ) 136 ( 10,1% ) 257 ( 19,1% ) Fracture * Table 25: Non-pathological fracture/pathological fracture (excluding osteoporosis) - primary operations No Yes Missing ( 90,0% ) 100 ( 1,2% ) 709 ( 8,8% ) ( 90,2% ) 93 ( 1,2% ) 661 ( 8,6% ) ( 90,1% ) 91 ( 1,2% ) 639 ( 8,6% ) ( 89,0% ) 64 ( 1,1% ) 574 ( 9,9% ) ( 89,9% ) 348 ( 1,2% ) 2583 ( 8,9% ) * Excl. total hip prostheses 112

125 The Norwegian Hip Fracture Register Operative approach Table 26: Operative approach to hip joint when primary hemiprosthesis Anterolateral Lateral Posterolateral Other Missing ( 6,2% ) 2099 ( 85,3% ) 176 ( 7,1% ) 1 ( 0,0% ) 34 ( 1,4% ) ( 7,5% ) 1773 ( 82,2% ) 200 ( 9,3% ) 0 ( 0,0% ) 23 ( 1,1% ) ( 14,7% ) 1223 ( 72,8% ) 189 ( 11,3% ) 1 ( 0,1% ) 19 ( 1,1% ) ( 11,8% ) 863 ( 75,9% ) 135 ( 11,9% ) 0 ( 0,0% ) 5 ( 0,4% ) ( 9,3% ) 5958 ( 80,1% ) 700 ( 9,4% ) 2 ( 0,0% ) 81 ( 1,1% ) 7436 Figure 13: Operative approach to hip joint when primary hemiprosthesis Number of operations Anterolateral Lateral Posterolateral Other Annet Missing Mangler Approach to hip joint - definition: Anterolateral: approach anterior/inferior to m. gluteus medius. Lateral: approach through m. gluteus medius with or without trochanteric osteotomy. Posterolateral: approach posterior to m. gluteus medius Peroperative complications Table 27: Peroperative complications - primary operations Yes No Missing ( 4,3% ) 7603 ( 92,5% ) 262 ( 3,2% ) 273 ( 3,5% ) 7355 ( 93,5% ) 239 ( 3,0% ) 243 ( 3,2% ) 7038 ( 93,4% ) 252 ( 3,4% ) 189 ( 3,2% ) 5573 ( 94,5% ) 133 ( 2,3% ) ( 3,6% ) ( 93,4% ) 886 ( 3,0% )

126 Report 2009 Systemic antibiotic prophylaxis Table 28: Screw - primary operation Yes No Missing ( 46,7% ) 1033 ( 52,1% ) 24 ( 1,2% ) 905 ( 40,6% ) 1298 ( 58,2% ) 26 ( 1,2% ) 816 ( 32,3% ) 1662 ( 65,7% ) 51 ( 2,0% ) 534 ( 24,2% ) 1627 ( 73,8% ) 45 ( 2,0% ) ( 35,6% ) 5620 ( 62,8% ) 146 ( 1,6% ) 8947 Table 29: Hemiprosthesis - primary operation Yes No Missing ( 99,1% ) 13 ( 0,5% ) 9 ( 0,4% ) 2144 ( 99,4% ) 7 ( 0,3% ) 7 ( 0,3% ) 1667 ( 99,3% ) 9 ( 0,5% ) 3 ( 0,2% ) 1131 ( 99,5% ) 2 ( 0,2% ) 4 ( 0,4% ) ( 99,3% ) 31 ( 0,4% ) 23 ( 0,3% ) 7436 Table 30: Hip compression screw and plate (including angle plate) - primary operatio Yes No Missing ( 95,9% ) 83 ( 3,4% ) 16 ( 0,7% ) 2356 ( 93,9% ) 139 ( 5,5% ) 13 ( 0,5% ) 2345 ( 93,0% ) 161 ( 6,4% ) 16 ( 0,6% ) 1825 ( 92,9% ) 121 ( 6,2% ) 18 ( 0,9% ) ( 94,0% ) 504 ( 5,3% ) 63 ( 0,7% ) 9430 Tabell 31: Nail - primary operation Yes No Missing ( 89,1% ) 102 ( 10,3% ) 6 ( 0,6% ) 574 ( 91,3% ) 53 ( 8,4% ) 2 ( 0,3% ) 397 ( 89,0% ) 48 ( 10,8% ) 1 ( 0,2% ) 236 ( 79,5% ) 56 ( 18,9% ) 5 ( 1,7% ) 2091 ( 88,5% ) 259 ( 11,0% ) 14 ( 0,6% ) Table 32: Reoperation Yes No Missing ( 89,2% ) 104 ( 9,1% ) 19 ( 1,7% ) 1090 ( 89,2% ) 125 ( 10,2% ) 7 ( 0,6% ) 1087 ( 88,6% ) 123 ( 10,0% ) 17 ( 1,4% ) 1063 ( 89,8% ) 113 ( 9,5% ) 8 ( 0,7% ) ( 89,2% ) 465 ( 9,7% ) 51 ( 1,1% )

127 The Norwegian Hip Fracture Register Table 33: Drug (primary and reoperation) Antibiotic Amoxicillin 0,05% 0,04% Ampicillin (Doktacillin, Pentrexyl) 0,25% 0,30% 0,29% 0,12% Apocillin 0,01% Bactrim (Trimetoprim Sulfa) 0,02% 0,01% Cefalexin (Keflex) 0,29% 0,21% 0,09% 0,02% Cefalotin (Keflin) 81,62% 82,89% 83,24% 84,35% Cefolaxim (Claforan) 0,43% 0,19% 0,17% 0,15% Cefuroxim (Zinacef, Lifurox) 6,03% 5,97% 5,33% 4,47% Ciprofloxacin(Ciproxin) 0,08% 0,09% 0,24% 0,15% Clindamycin (Dalacin) 1,85% 1,98% 2,16% 2,62% Dikloxacillin (Diclocil) 6,79% 5,57% 5,02% 5,03% Doxycyklin (Vibramycin, Dumoxin, Doylin) 0,02% 0,06% 0,04% Elizol(metronidazul) 0,01% Erymax (Erythromycin,Abboticin) 0,06% 0,03% 0,05% 0,01% Flagyl 0,06% 0,04% 0,05% 0,05% Fortum 0,01% Gentamicin (Garamycin) 0,14% 0,27% 0,34% 0,26% Keflin - Abboticin 0,01% Keflin - Ekvacillin 600mg = 0,6(006) 0,01% 0,07% Kloxacillin (Ekvacillin) 1,11% 1,04% 0,95% 1,58% Kloxacillin - Ampicillin 0,04% 0,01% 0,01% Kloxacillin - Penicillin 0,03% 0,05% Linezolid (Zyvoxid) 0,02% Meronem 0,02% 0,01% Nebcina (Tobramycin) 0,14% 0,06% 0,08% 0,04% Netilmicin (Netylen) 0,02% Penicillin G (Crystal) 0,21% 0,12% 0,15% 0,09% Pentrexyl 0,12% 0,07% 0,20% 0,16% Rifampicin (Rimactan) 0,03% 0,03% Selexid 0,08% 0,06% 0,07% 0,02% Tazozin 0,02% 0,01% 0,01% 0,02% Tienam 0,01% Vancomycin (Vancocin) 0,12% 0,10% 0,09% 0,17% Missing 0,45% 0,49% 0,44% 0,35% Thrombosis prophylaxis Table 34: Primary operation Yes No Missing ( 98,9% ) 62 ( 0,8% ) 29 ( 0,4% ) 7758 ( 98,6% ) 78 ( 1,0% ) 31 ( 0,4% ) 7357 ( 97,7% ) 131 ( 1,7% ) 45 ( 0,6% ) 5824 ( 98,8% ) 49 ( 0,8% ) 22 ( 0,4% ) ( 98,5% ) 320 ( 1,1% ) 127 ( 0,4% )

128 Report 2009 Table 35: Use of drugs One drug Two drugs ( 97,9% ) 164 ( 2,0% ) 7603 ( 98,0% ) 153 ( 2,0% ) 7232 ( 98,3% ) 124 ( 1,7% ) 5693 ( 97,8% ) 130 ( 2,2% ) ( 98,0% ) 571 ( 2,0% ) Table 36: Thrombosis prophylaxis - One drug Albyl-E 0,06% 0,06% Clinical study 0,02% 0,04% Exanta 0,04% Fragmin (Dalteparin) 54,01% 47,82% 52,97% 63,66% Heparin 0,05% Klexane (Enoksaparin) 44,42% 50,95% 46,18% 35,41% Makrodex 0,04% 0,01% 0,05% Marevan 0,84% 0,77% 0,59% 0,52% Melagatran (Ximelagatran) 0,03% Plavix 0,01% 0,03% Re-Novate 0,01% No drugs 0,33% 0,15% 0,12% 0,10% Missing 0,25% 0,17% 0,12% 0,18% Table 37: Thrombosis prophylaxis - Two drugs Albyl-E + Fragmin (Dalteparin) 0,81% Albyl-E + Persantin 0,65% 0,61% Albyl-E + Plavix 0,61% Dextran + Fragmin (Dalteparin) 0,81% Dextran + Klexane (Enoksaparin) 0,77% Fragmin (Dalteparin) + Albyl-E 7,69% 7,26% 3,92% 6,10% Fragmin (Dalteparin) + Asasantin Retard 0,61% Fragmin (Dalteparin) + Klexane (Enoksaparin) 0,65% 0,61% Fragmin (Dalteparin) + Makrodex 1,54% Fragmin (Dalteparin) + Marevan 40,77% 39,52% 33,33% 45,73% Fragmin (Dalteparin) + Plavix 1,61% 1,83% Klexane (Enoksaparin) + Albyl-E 12,31% 8,87% 11,76% 6,71% Klexane (Enoksaparin) + Dextran 1,54% 0,65% Klexane (Enoksaparin) + Fragmin (Dalteparin) 1,31% 1,22% Klexane (Enoksaparin) + Makrodex 4,62% 3,23% 1,31% Klexane (Enoksaparin) + Marevan 22,31% 33,06% 41,83% 33,54% Klexane (Enoksaparin) + Persantin 0,65% Klexane (Enoksaparin) + Plavix 0,65% 1,83% Makrodex + Fragmin (Dalteparin) 0,77% 0,65% Makrodex + Klexane (Enoksaparin) 6,15% 4,03% Marevan + Fragmin (Dalteparin) 0,61% Marevan + Klexane (Enoksaparin) 0,77% 1,31% Marevan + Plavix 0,65% Plavix + Albyl-E 0,65% Missing + Marevan 0,77% 0,81% 116

129 The Norwegian Hip Fracture Register Table 38: Stockings - primary operation No Calf Cal + thigh Missing ( 37,4% ) 1034 ( 12,7% ) 2314 ( 28,5% ) 1736 ( 21,4% ) ( 32,3% ) 1390 ( 17,9% ) 2327 ( 30,0% ) 1539 ( 19,8% ) ( 32,7% ) 1616 ( 22,0% ) 2004 ( 27,2% ) 1333 ( 18,1% ) ( 31,2% ) 1476 ( 25,3% ) 1383 ( 23,7% ) 1146 ( 19,7% ) ( 33,6% ) 5516 ( 19,0% ) 8028 ( 27,6% ) 5754 ( 19,8% ) Figure 14: Thrombosis prophylaxis - Stockings - Primary operations 3500 Number of operations Calf Calf + thigh Missing No Table 39: Mechanical pump - primary operation No Foot Calf Missing ( 63,4% ) 59 ( 0,7% ) 7 ( 0,1% ) 2903 ( 35,7% ) ( 63,8% ) 38 ( 0,5% ) 5 ( 0,1% ) 2762 ( 35,6% ) ( 66,1% ) 37 ( 0,5% ) 0 ( 0,0% ) 2456 ( 33,4% ) ( 63,1% ) 34 ( 0,6% ) 1 ( 0,0% ) 2113 ( 36,3% ) ( 64,2% ) 168 ( 0,6% ) 13 ( 0,0% ) ( 35,2% ) Table 40: First dosis preoperatively - primary operation Yes No Missing 3462 ( 42,6% ) 3351 ( 41,2% ) 1292 ( 15,9% ) 2931 ( 37,8% ) 3466 ( 44,7% ) 1345 ( 17,3% ) 2944 ( 40,0% ) 2982 ( 40,5% ) 1430 ( 19,5% ) 2235 ( 38,4% ) 2058 ( 35,3% ) 1529 ( 26,3% ) ( 39,8% ) ( 40,8% ) 5596 ( 19,3% )

130 Report

131 The Norwegian Cruciate Ligament Register The National Cruciate Ligament Register gives you important data! The management and secretariat of The National Cruciate Ligament Register are proud of being able to present the register s 5th yearly report. From the beginning June 10 th 2004 the reporting has exceeded steadily. The amount of registrations indicates a very good attendance from our colleagues. We have now more than 7000 cruciate ligament operated in our database! In the report you can find many interesting numbers, for instance that there are many patients 20 years and below who has a cruciate ligament reconstruction. Further many patients have earlier had an injury in the knee or in the opposite knee. There are also a significant number of cartilage and meniscus injuries. In June 2006 we started sending out KOOS forms after two years of follow up. The preliminary data shows that patients with cruciate ligament surgery have a good improvement in quality of life and level of activity. We are still not satisfied with compliance here it is right above 60 % after two years of follow up. We are happy to see that there is an increase in use of the register. Many projects are presented since the beginning and Lars Petter Granan finished his dissertation on the register in In 2008 the paper on the initiative and operation of the register was printed in American Journal of Sport Medicine as the world s first cruciate ligament register. Two new papers will be published in Am J Sports Medicine and one with data from the Nordic countries will appear in Acta. PhD candidate number two is in progress with supervisor Asbjørn Årøen. In this work one will look at the consequence of additional injuries. Further we continue an active cooperation with registers in Sweden and Denmark. We are also working on a corporate project with the MOON group which is a cruciate ligament register collaboration of 5 large American University clinics. From this collaboration a paper comparing American and Norwegian conditions will come. The steering group for the National Ligament Register will encourage you all to use the register for scientific studies. You can send an inquiry including a protocol of the study to the office in Bergen. The inquiries will quickly be considered by the Steering group. We want the register to be used by all the hospitals in the country, not only the University environments. On behalf of the register we wish to thank Oslo Sports Trauma Research Center which has contributed more than NOK through the Environment capital they received from Helse Øst in

132 Report

133 The Norwegian Cruciate Ligament Register ALL CATEGORIES OF OPERATIONS Table 1 Primary reconstruction of cruciate ligament Revision reconstruction Only other procedures ( 87,6% ) 120 ( 6,5% ) 111 ( 6,0% ) 1625 ( 88,7% ) 110 ( 6,0% ) 97 ( 5,3% ) 1475 ( 88,1% ) 126 ( 7,5% ) 74 ( 4,4% ) 1528 ( 88,8% ) 121 ( 7,0% ) 71 ( 4,1% ) 770 ( 89,6% ) 46 ( 5,4% ) 43 ( 5,0% ) ( 88,4% ) 523 ( 6,6% ) 396 ( 5,0% ) 7947 Registration complete from ,8% of the operations were performed on the rigth knee. 43,1% of the operations were peformed on females. 6,9% of the patients had a previous ACL/PCL-injury in the opposite knee. ( 12,1% was missing). Mean age was 28,6. Median value for duration of primary ACL reconstruction was 70 min. Figure: 1 number of operations Number of operations Year of operation Primary reconstruction of cruciate ligament Revision reconstruction Only other procedures Figure 2: Incidence of primary reconstruction of cruciate ligament Number of operations per inhabitants Age Females Males 121

134 Report 2009 The number of other procedures for all categories of surgeries Table 2 Meniscus surgery Cartilage surgery Synovectomy Arthroscopic debridement Mobilizing in narcosis Surgery due to infection Remove implant Bone transplantation Osteotomy Bone resection (Notch plasty) Osteosynthesis Artrodesis Distribution of other procedures in combination with primary reconstruction of cruciate ligament Table 3 Meniscus surgery Cartilage surgery Synovectomy Arthroscopic debridement Mobilizing in narcosis Surgery due to infection Remove implant Bone transplantation Osteotomy Bone resection (Notch plasty) Osteosynthesis Artrodesis 2554 x 152 x x 116 x 62 x x 62 x 31 x 21 x x x 16 x x 15 x 13 x 10 x x 10 x x X indicates applied procedure and each row gives the number of operations that is carried out with this combination of procedures. The table shows only combinations that have a number of ten or more. 122

135 The Norwegian Cruciate Ligament Register Distribution of other procedures in combination with reconstruction Table Meniscus surgery Cartilage surgery Synovectomy Arthroscopic debridement Mobilizing in narcosis Surgery due to infection x x x x x Remove implant Bone transplantation Osteotomy Bone resection (Notch plasty) X indicates applied procedure and each row gives the number of operations that is carried out with this combination of procedures. The table shows only combinations that have a number of ten or more. Osteosynthesis Artrodesis Distribution of other procedures when this is the only procedure Table 5 Meniscus surgery Cartilage surgery Synovectomy Arthroscopic debridement Mobilizing in narcosis Surgery due to infection Remove implant Bone transplantation Osteotomy Bone resection (Notch plasty) Osteosynthesis Artrodesis 101 x 35 x 30 x 23 x 14 x x 12 x x 10 x x x X indicates applied procedure and each row gives the number of operations that is carried out with this combination of procedures. The table shows only combinations that have a number of ten or more. Per operative complications for all categories of surgeries Table Yes No Missing 60 ( 3,2% ) 1748 ( 93,9% ) 53 ( 2,8% ) 62 ( 3,4% ) 1708 ( 93,2% ) 62 ( 3,4% ) 65 ( 3,9% ) 1569 ( 93,7% ) 41 ( 2,4% ) 65 ( 3,8% ) 1634 ( 95,0% ) 21 ( 1,2% ) 31 ( 3,6% ) 825 ( 96,0% ) 3 ( 0,3% ) ( 3,6% ) 7484 ( 94,2% ) 180 ( 2,3% )

136 Report 2009 PRIMARY RECONSTRUCTION OF CRUCIATE LIGAMENT Figure 3: Age by operation Number of patients Age (in year) Figur 4: Activity that lead to injury Activities (count < 100) Alpine/Telemark Cross country skiing Handball Martial art Other Other recreational activities Outdoor Life Snow board Soccer Traffic Unknown/Missing Work

137 The Norwegian Cruciate Ligament Register Actual injury Table 7 ACL PCL MCL LCL PLC Cartilage Meniscus Figure 5: Actual injury 1800 number of injuries ACL PCL MCL LCL PLC Cartilage Meniscus Further injuries: Vascular Table 8 Arteria Vena poplitea Nerve Table 9 N.tibialis N.peroneus Fracture Table 10 Femur Tibia Fibula Patella Not sure Rupture in extensor apparatus Table 11 Quadricepstendon Patellartendor

138 Report 2009 ACL with additional injuries Table 12 Number ACL PCL MCL LCL PLC Meniscus Cartilage 2743 x 2118 x x 972 x x x 596 x x 132 x x 93 x x x 59 x x x x 53 x x x 26 x x x 18 x x 16 x x x x 12 x x 12 x x x x x 10 x x x 10 x x x 9 x x x 9 x x x 8 x x x x 7 x x x x 6 x x 6 x x x x 5 x x x x x x 5 x x x x indicates registered injury and each row tell the number of incidences of different combination of injuries. The first row gives the number of records where ACL where the only injury. The table shows only combinations that have a number of five or more. PCL with additional injuries Table 13 Number ACL PCL MCL LCL PLC Meniscus Cartilage 32 x 26 x x x 16 x x x x 12 x x x x x 12 x x 9 x x x 9 x x 8 x x x x 7 x x x x 5 x x x x x x 5 x x x x indicates registered injury and each row tell the number of incidences of different combination of injuries. The first row gives the number of records where PCL where the only injury. The table shows only combinations that have a number of five or more. 126

139 The Norwegian Cruciate Ligament Register Choice of graft Table 14 BPTB ACL PCL MCL LCL PLC Table 15 ST - double ACL PCL MCL LCL PLC Table 16 * ST -quadruple ACL PCL MCL LCL PLC * The registration started in Table 17 STGR - double ** ACL PCL MCL LCL PLC ** STGR - single and STGR - quadruple are counted as STGR-double Table 18 Double bundle *** ACL PCL MCL LCL PLC t *** Registration began in

140 Report 2009 Table 19 BQT ACL PCL MCL LCL PLC Table 20 BQT-A ACL PCL MCL LCL PLC Table 21 BPTB-A ACL PCL MCL LCL PLC Table 22 BACH-A ACL PCL MCL LCL PLC Table 23 Suture ACL PCL MCL LCL PLC

141 The Norwegian Cruciate Ligament Register Table 24 Synthetic graft ACL PCL MCL LCL PLC Table 25 Other ACL PCL MCL LCL PLC Figure 6: Choice of graft 1200 number of operations BPTP ST-double ST-quadruple STGR-double BQT BQT-A BPTP-A BACH-A Suture Synthetic graft Other

142 Report 2009 Fixation femur ACL Table 26 Product ACL Interference Screw 1 1 Acufex EndoFix 1 1 AO Screw Bilok Interference screw Bio-Interference Screw BIORCI Screw BioRCI-HA BioScrew Biosteon Wedge Screw 1 1 Bone Mulch Screw Cross-Screw EndoButton CL Endobutton CL BTB 1 1 EndoButton CL ULTRA EZLoc Guardsman Femoral Inion Hexalon 2 2 Interference Screw 1 1 Interferenzschraube Linvatec Cannulated Merete Titanium TioFin Tendon Soft 1 1 Milagro 1 1 Profile Interference Screw Propel Cannulated RCI Screw Resorbable cross pin 2 2 RetroButton Rigidfix BTB cross pin Rigidfix ST cross pin Kit Soft Screw SoftSilk SoftSilk ToggleLoc 8 8 Transfix II TunneLoc Universal Wedge Screw Xtendobutton 1 1 UNKNOWN

143 The Norwegian Cruciate Ligament Register Fixation tibia ACL Table 27 Product ACL Interference Screw AO Screw Bilok Interference screw Biocryl 1 1 Bio-Interference Screw Bio-Intrafix Screw BIORCI Screw BioRCI-HA BioScrew Calaxo interference screw 6 6 CentralLoc Screw 6 6 Cramp Delta Tapered Bio-Interference screw Guardsman Femoral Inion Hexalon 1 1 Interference Screw Interferenzschraube Inter-Lock Pin Intrafix Screw Linvatec Cannulated Low Profile Cancellous 1 1 Merete Titanium TioFin Tendon Soft 7 7 Milagro Profile Interference Screw Propel Cannulated RCI Screw Regular Fixation Staple Rigidfix BTB cross pin Rigidfix ST cross pin Kit 1 1 Soft Screw SoftSilk SoftSilk Tibial Bio-Interference screw Tibial Retro Screw 2 2 TunneLoc Universal Wedge Screw WasherLoc Screw UNKNOWN

144 Report 2009 Fixation femur PCL Table 28 Product Fixation tibia PCL 2008 EndoButton CL EndoButton CL ULTRA 9 9 Guardsman Femoral 1 1 Linvatec Cannulated Propel Cannulated RCI Screw Rigidfix ST cross pin Kit 1 1 SoftSilk Transfix II 1 1 TunneLoc 1 1 UNKNOWN Table 29 Product AO Screw Bio-Intrafix Screw 1 1 Cramp 1 1 Intrafix Screw 1 1 Propel Cannulated RCI Screw SoftSilk TunneLoc 1 1 WasherLoc Screw 1 1 UNKNOWN

145 The Norwegian Cruciate Ligament Register Fixation femur and tibia ACL Table 30 Femur Tibia Bone Mulch Screw Intrafix Screw Bone Mulch Screw WasherLoc Screw EndoButton CL Bilok Interference screw EndoButton CL Bio-Intrafix Screw EndoButton CL BIORCI Screw EndoButton CL Intrafix Screw EndoButton CL RCI Screw EndoButton CL ULTRA Intrafix Screw EndoButton CL ULTRA Milagro EndoButton CL ULTRA RCI Screw EZLoc Bio-Intrafix Screw EZLoc WasherLoc Screw Guardsman Femoral Propel Cannulated Interferenzschraube Interferenzschraube Propel Cannulated Propel Cannulated RCI Screw RCI Screw RCI Screw SoftSilk RCI Screw SoftSilk RetroButton Soft Screw Rigidfix BTB cross pin Linvatec Cannulated Rigidfix BTB cross pin Propel Cannulated Rigidfix ST cross pin Kit Bio-Intrafix Screw Rigidfix ST cross pin Kit Intrafix Screw Rigidfix ST cross pin Kit RCI Screw SoftSilk SoftSilk Transfix II Bio-Intrafix Screw Transfix II Delta Tapered Bio-Interference screw Transfix II Intrafix Screw Transfix II RCI Screw Transfix II Soft Screw Transfix II Tibial Bio-Interference screw TunneLoc TunneLoc Universal Wedge Screw Inter-Lock Pin Universal Wedge Screw Universal Wedge Screw UNKNOWN UNKNOWN Other* "Other" includes combinations with less than 15 occurrences for all given years 133

146 Report 2009 Meniscal lesion Table 31 Year Resection Suture Synthetic fixation Meniscus Transplant. Trepanation None 2008 Lateral Medial Lateral Medial Lateral Medial Lateral Medial Lateral Medial It became possible to register "Trepanation" and "None" from There have been forms where this has been an additional information. This information have been registered, but the registration is not complete before There are 27 forms where there are registered a meniscus surgery that is not described under actual treatment of meniscal lesion. 9of these are an old form. There are 139 forms where there are registered a meniscus injuy that is not described under actual treatment of meniscal lesion or other procedures. 88of these are old forms. In table 8 : Actual injury has less. The reason for this is that we distinguish between the lateral and medial injury and some injuries are registreded in both groups. Figure 7: Meniscal lesion 700 number of operations Resection Suture Synthetic fixation Meniscus Transplant. Trepanation None 134

147 The Norwegian Cruciate Ligament Register Fixation Meniscal lesion - synthetic Table 32 Product Contour Meniscus arrow Meniscus arrow Meniskcal Dart Meniskcal Dart Stick UNKNOWN Fixation Meniscal lesion - suture Table 33 Product FAST-FIX Rapidloc UNKNOWN

148 Report 2009 Cartilage lesion: ICRS Grade ICRS Grade: 1. Nearly normal: Superficial lesions, soft indentation and/or superficial fissures and cracks. 2. Abnormal: Lesions extending down to <50% of cartilage depth. 3. Severely abnormal: Cartilage defects extending down >50% of cartilage depth as well as down to calcified layer. 4. Severely abnormal: Osteochondral injuries, lesions extending just through the subchondral boneplate or deeper defects down into trabecular bone. Table 34 Patella MF Code 1 Code 2 Code 3 Code 4 Missing ,3% 60,8% 5,9% 0,0% 0,0% ,6% 40,3% 11,7% 0,0% 6,5% ,1% 31,8% 11,8% 1,2% 1,2% ,6% 34,2% 16,5% 1,3% 2,5% ,8% 42,9% 12,2% 2,0% 4,1% Patella LF ,5% 56,8% 2,7% 0,0% 0,0% ,0% 38,3% 8,5% 2,1% 17,0% ,2% 26,8% 11,3% 0,0% 2,8% ,8% 33,9% 11,9% 3,4% 0,0% ,4% 42,4% 15,2% 3,0% 0,0% Trochlea.fem ,3% 42,9% 21,4% 2,4% 0,0% ,0% 32,5% 22,5% 2,5% 7,5% ,1% 17,8% 6,7% 2,2% 2,2% ,1% 24,4% 12,2% 7,3% 0,0% ,4% 40,7% 11,1% 3,7% 0,0% Med.fem.cond ,2% 49,8% 22,2% 4,9% 0,0% ,5% 48,0% 15,8% 7,9% 1,8% ,4% 35,8% 16,5% 9,1% 3,3% ,4% 42,8% 22,5% 5,5% 0,7% ,6% 39,4% 18,9% 6,3% 0,8% Med.tib.plat ,5% 39,0% 11,7% 1,3% 2,6% ,4% 38,1% 8,7% 4,0% 4,8% ,2% 28,4% 4,3% 5,2% 0,9% ,2% 36,7% 10,8% 3,3% 0,0% ,5% 33,3% 10,6% 4,5% 0,0% Lat.fem.cond ,9% 50,0% 14,7% 7,4% 0,0% ,2% 33,6% 13,8% 6,9% 3,4% ,1% 29,1% 11,8% 6,4% 3,6% ,3% 36,7% 15,6% 6,4% 0,0% ,5% 37,2% 14,0% 7,0% 2,3% Lat.tib.plat ,2% 54,5% 10,4% 3,9% 0,0% ,2% 37,8% 10,2% 1,6% 3,1% ,3% 29,4% 4,0% 0,8% 1,6% ,0% 38,3% 9,2% 2,5% 0,0% ,0% 35,3% 9,8% 3,9% 0,0% 136

149 The Norwegian Cruciate Ligament Register Cartilage lesion: Probable cause Probable cause: 1. Trauma; 2. CM: chondromalacia patellae; 3. OCD: osteochondritis dissecans; 4. OA: primary osteoarthritis; 5. Other. Table 35 Patella MF Code 1 Code 2 Code 3 Code 4 Code 5 Missing ,8% 22,9% 0,0% 35,4% 2,1% 20,8% ,0% 20,8% 0,0% 23,4% 2,6% 27,3% ,3% 16,5% 0,0% 20,0% 2,4% 45,9% ,1% 27,8% 0,0% 12,7% 3,8% 26,6% ,4% 22,4% 0,0% 24,5% 6,1% 28,6% Patella LF ,0% 21,2% 0,0% 42,4% 3,0% 30,3% ,8% 6,4% 0,0% 29,8% 4,3% 46,8% ,3% 14,1% 0,0% 23,9% 1,4% 49,3% ,6% 25,4% 0,0% 16,9% 3,4% 35,6% ,1% 15,2% 0,0% 36,4% 3,0% 33,3% Trochlea fem ,3% 13,5% 0,0% 35,1% 0,0% 27,0% ,5% 5,0% 0,0% 40,0% 2,5% 45,0% ,1% 2,2% 0,0% 17,8% 2,2% 66,7% ,6% 14,6% 0,0% 22,0% 4,9% 43,9% ,8% 3,7% 0,0% 37,0% 7,4% 37,0% Med.fem.cond ,1% 0,5% 0,5% 16,1% 2,6% 6,2% ,1% 0,0% 1,1% 17,6% 3,2% 18,0% ,6% 0,4% 1,2% 13,6% 3,3% 25,9% ,0% 0,0% 1,1% 12,2% 3,7% 21,0% ,3% 0,0% 0,0% 11,0% 3,1% 16,5% Med.tib.plat ,6% 0,0% 0,0% 40,8% 8,5% 14,1% ,3% 0,0% 0,0% 29,4% 6,3% 23,0% ,6% 0,0% 0,0% 31,0% 6,9% 34,5% ,7% 0,0% 0,0% 20,0% 5,0% 23,3% ,5% 3,0% 0,0% 19,7% 1,5% 30,3% Lat. fem. cond ,1% 0,0% 1,6% 17,7% 0,0% 14,5% ,1% 0,0% 0,9% 15,4% 2,6% 23,1% ,1% 0,0% 0,0% 10,9% 1,8% 38,2% ,6% 0,0% 0,0% 11,0% 4,6% 23,9% ,2% 0,0% 0,0% 20,9% 2,3% 25,6% Lat. tib. lat ,9% 0,0% 1,4% 28,6% 5,7% 11,4% ,0% 0,0% 0,0% 22,0% 3,9% 22,0% ,4% 0,8% 0,0% 13,5% 5,6% 35,7% ,8% 0,8% 0,0% 14,2% 5,8% 23,3% ,9% 0,0% 0,0% 19,6% 3,9% 23,5% 137

150 Report 2009 Cartilage lesion: Treatment code Treatment code: 1. Debridement 2. Micro fracture 3. Mosaic 4. Biopsy for cultivation 5. Cell transplantation 6. Cell transplantation with matrix 7. Periosteum transplantation 8. No treatment; 9. Other Table 36 Patella MF Code 1 Code 2 Code 3 Code 4 Code 5 Code 6 Code 7 Code 8 Code 9 Missing ,9% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 59,1% 0,0% 25,0% ,9% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 57,1% 0,0% 39,0% ,5% 1,2% 0,0% 0,0% 0,0% 1,2% 1,2% 24,7% 0,0% 68,2% ,9% 1,3% 0,0% 0,0% 0,0% 0,0% 7,6% 40,5% 0,0% 41,8% ,1% 0,0% 0,0% 0,0% 0,0% 0,0% 2,0% 24,5% 0,0% 67,3% Patella MF ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 62,1% 0,0% 37,9% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 38,3% 0,0% 61,7% ,4% 0,0% 0,0% 0,0% 0,0% 0,0% 1,4% 18,6% 1,4% 77,1% ,1% 0,0% 0,0% 0,0% 0,0% 0,0% 1,7% 35,6% 0,0% 57,6% ,0% 0,0% 0,0% 0,0% 3,0% 0,0% 0,0% 18,2% 3,0% 72,7% Trochlea fem ,6% 2,9% 0,0% 0,0% 0,0% 0,0% 0,0% 54,3% 0,0% 34,3% ,5% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 45,0% 0,0% 52,5% ,2% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 13,3% 0,0% 84,4% ,4% 2,4% 0,0% 0,0% 0,0% 0,0% 0,0% 29,3% 0,0% 65,9% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 18,5% 0,0% 81,5% Med.fem.cond ,0% 4,4% 0,0% 0,0% 0,5% 0,0% 0,0% 62,3% 0,5% 9,3% ,6% 3,2% 0,0% 0,0% 0,0% 0,0% 0,0% 60,8% 0,4% 23,0% ,8% 7,4% 0,0% 0,0% 0,0% 0,0% 0,4% 46,1% 0,8% 32,5% ,9% 5,5% 0,0% 0,0% 0,0% 0,0% 4,1% 46,1% 0,7% 34,7% ,8% 5,5% 0,0% 0,0% 0,0% 0,0% 3,1% 29,1% 0,8% 49,6% Med.tib.plat ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 71,6% 0,0% 19,4% ,1% 0,8% 0,0% 0,0% 0,0% 0,0% 0,0% 63,5% 0,0% 28,6% ,6% 0,9% 0,0% 0,0% 0,0% 0,0% 0,0% 42,6% 0,9% 53,0% ,0% 0,8% 0,0% 0,0% 0,0% 0,0% 0,8% 50,0% 0,8% 42,5% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 3,0% 24,2% 0,0% 69,7% Lat.fem.cond ,8% 5,2% 0,0% 0,0% 0,0% 0,0% 0,0% 60,3% 0,0% 20,7% ,7% 2,6% 0,0% 0,0% 0,0% 0,0% 0,9% 59,8% 0,0% 29,1% ,3% 1,8% 0,0% 0,0% 0,0% 0,0% 0,9% 44,5% 0,0% 45,5% ,3% 3,7% 0,0% 0,0% 0,0% 0,0% 4,6% 46,8% 0,0% 37,6% ,0% 0,0% 0,0% 0,0% 2,3% 0,0% 4,7% 32,6% 0,0% 46,5% Lat.tib.plat ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 77,6% 1,5% 14,9% ,1% 0,8% 0,0% 0,0% 0,0% 0,0% 0,0% 70,9% 0,0% 25,2% ,4% 0,0% 0,0% 0,0% 0,0% 0,0% 0,8% 50,8% 0,0% 46,0% ,3% 0,0% 0,0% 0,0% 0,0% 0,0% 6,7% 44,2% 0,8% 45,0% ,9% 0,0% 0,0% 0,0% 0,0% 0,0% 5,9% 25,5% 2,0% 62,7% 138

151 The Norwegian Cruciate Ligament Register Age of Cartilage injuries Table 37 New Old Undefined Missing * The registration started in There are 35forms that have surgeries from 2005 that is registered on an old form and will therefore have no registration here. All Cartilage injuries Table 38 Patella MF Patella LF Trochlea fem. Med. fem. cond. Med. tib. plat. Lat. fem. cond. Lat. tib. plat There are 325 cartilage lesions where the size is missing. Figure 8: All Cartilage injuries (total) 5,80% 13,32% 33,41% Medial Lateral Lateral Medial 10,17% 7,37% 14,92% 15,01% 139

152 Report 2009 All Cartilage injuries with area greater than 2 cm 2 Tabell 39 Patella MF Patella LF Trochlea fem. Med. fem. cond. Med. tib. plat. Lat. fem. cond. Lat. tib. plat Figure 9: All Cartilage injuries with area greater than 2 cm (total) 4,58% 12,42% 33,54% Medial Lateral Lateral Medial 6,52% 5,12% 18,71% 19,10% All Cartilage injuries with area greater than 2 cm and ICRS equal 3 or 4 2 Table 40 Patella MF Patella LF Trochlea fem. Med. fem. cond. Med. tib. plat. Lat. fem. cond. Lat. tib. plat

153 The Norwegian Cruciate Ligament Register 2 Figure 10: All Cartilage injuries with area greater than 2 cm and ICRS equal 3 or 4 (total) 5,78% 13,00% 50,18% Medial Lateral Lateral Medial 4,33% 5,05% 8,30% 13,36% Outpatient surgery Table Yes No Missing 734 ( 45,0% ) 887 ( 54,4% ) 9 ( 0,6% ) 656 ( 40,4% ) 953 ( 58,6% ) 16 ( 1,0% ) 627 ( 42,5% ) 836 ( 56,7% ) 12 ( 0,8% ) 485 ( 31,7% ) 1036 ( 67,8% ) 7 ( 0,5% ) 243 ( 31,6% ) 527 ( 68,4% ) 0 ( 0,0% ) ( 39,1% ) 4239 ( 60,3% ) 44 ( 0,6% ) 7028 Per operative complications Table Yes No Missing 57 ( 3,5% ) 1533 ( 94,0% ) 40 ( 2,5% ) 53 ( 3,3% ) 1518 ( 93,4% ) 54 ( 3,3% ) 59 ( 4,0% ) 1381 ( 93,6% ) 35 ( 2,4% ) 59 ( 3,9% ) 1450 ( 94,9% ) 19 ( 1,2% ) 27 ( 3,5% ) 740 ( 96,1% ) 3 ( 0,4% ) ( 3,6% ) 6622 ( 94,2% ) 151 ( 2,1% )

154 Report 2009 Systemic antibiotic prophylaxis Table Yes No Missing 1617 ( 99,2% ) 9 ( 0,6% ) 4 ( 0,2% ) 1603 ( 98,6% ) 14 ( 0,9% ) 8 ( 0,5% ) 1459 ( 98,9% ) 10 ( 0,7% ) 6 ( 0,4% ) 1504 ( 98,4% ) 24 ( 1,6% ) 0 ( 0,0% ) 764 ( 99,2% ) 6 ( 0,8% ) 0 ( 0,0% ) ( 98,8% ) 63 ( 0,9% ) 18 ( 0,3% ) 7028 Table 44 Antibiotic prophylaxis Ampicillin (Doktacillin, Pentrexyl) 0,07% 2008 Cefalexin (Keflex) 0,26% 0,07% 0,07% Cefalotin (Keflin) 86,48% 85,57% 89,09% 92,27% 87,96% Cefuroxim (Zinacef, Lifurox) 4,03% 4,04% 2,86% 1,56% 1,36% Cephazolin 0,06% Ciprofloxacin(Ciproxin) 0,06% Clindamycin (Dalacin) 0,65% 1,13% 1,50% 0,75% 5,43% Dalacin-ciproxin 0,06% Dikloxacillin (Diclocil) 8,06% 8,67% 5,52% 5,11% 4,20% Doxycyklin (Vibramycin, Dumoxin, Doylin) 0,07% Erymax (Erythromycin,Abboticin) 0,14% Gentamicin (Garamycin) 0,06% Keflin - Zinacef 0,07% Kloxacillin (Ekvacillin) 0,13% 0,07% 0,06% Missing 0,26% 0,34% 0,12% 0,25% Pentrexyl 0,06% Vancomycin (Vancocin) 0,06% Zinacef - Trimetropin/sulfa 0,43% 142

155 The Norwegian Cruciate Ligament Register Thrombosis prophylaxis Table 45 Yes No Missing ( 79,3% ) 324 ( 19,9% ) 17 ( 1,0% ) 1275 ( 78,9% ) 320 ( 19,8% ) 30 ( 1,8% ) 1147 ( 82,3% ) 223 ( 16,0% ) 105 ( 7,1% ) 1179 ( 79,4% ) 305 ( 20,6% ) 44 ( 2,9% ) ( 78,1% ) 1172 ( 18,7% ) 196 ( 3,1% ) 6258 There are 139 old forms that are filled out so that thrombosis prophylaxis can not be registered. These are added to missing. Table 46 One drug Two drugs ( 100,0% ) 0 ( 0,0% ) 1274 ( 99,9% ) 1 ( 0,1% ) 1131 ( 98,6% ) 16 ( 1,4% ) 1150 ( 97,5% ) 29 ( 2,5% ) ( 99,1% ) 46 ( 0,9% ) 4890 Table 47 Drug Exanta 1,70% 0,78% Fragmin (Dalteparin) 61,32% 56,50% 52,94% 63,23% Klexane (Enoksaparin) 29,60% 35,92% 38,90% 34,99% Makrodex 0,08% Melagatran (Ximelagatran) 0,08% No drug treatment* 4,58% 4,88% 7,84% 0,39% Missing 0,25% 0,52% 0,16% 1,40% Two drugs 2,46% 1,39% 0,08% * No drug treatment are used as code for stocking during thrombosis prophylaxis. Included in both table 46 and 47. Registration of stocking expire because of form change NSAID's Table 48 Yes No Missing ( 34,4% ) 412 ( 25,3% ) 658 ( 40,4% ) 94 ( 5,8% ) 75 ( 4,6% ) 1456 ( 89,6% ) ( 20,1% ) 487 ( 15,0% ) 2114 ( 64,9% ) 3255 Table 49 Drug Brexidol 2,13% 0,18% Diclofenac 5,32% 10,71% Toradol 1,43% Voltaren 91,49% 84,11% Missing 1,06% 2,86% 143

156 Report 2009 REVISION RECONSTRUCTION Figure 11: Age by operation 30 Number of patients Age Figur 12: Activity that lead to injury Alpine/Telemark Basketball Cross country skiing Dance Floor ball Handball Ishockey/bandy/inline skating Martial art Motocross Other Other recreational activities Outdoor life Recretional activities Skateboard Snow board Soccer Traffic Trampoline Unknown/Missing Violence Volleyball Work 144

157 The Norwegian Cruciate Ligament Register Actual injury Table 50 ACL PCL MCL LCL PLC Cartilage Meniscus Figure 13: Actual injury 140 number of injuries ACL PCL MCL LCL PLC Cartilage Meniscus Previous surgery in actual knee Table 51 ACL PCL MCL LCL PLC Cartilage Meniscus Further injuries: Vascular Table 52 Arteria Vena poplitea Nerve Table 53 N.tibialis N.peroneus

158 Report 2009 Fracture Table 54 Femur Tibia Fibula Patella Not sure Rupture in extensor apparatus Table 55 Quadricepstendon Patellartendon ACL with additional injuries Table 56 Number ACL PCL MCL LCL PLC Meniscus Cartilage 207 x 108 x x 86 x x 85 x x x 5 x x 4 x x x x 4 x x x 3 x x x 2 x x x x 1 x x x 1 x x x 1 x x x x indicates registered injury and each row tell the number of incidences of different combination of injuries. The first row gives the number of records were ACL where the only injury. The total number will be identical to the total number of registered ACL injuries. PCL with additional injuries Table 57 Number ACL PCL MCL LCL PLC Menisus Cartilage 3 x x x 3 x 2 x x x x 2 x x 1 x x x 1 x x x 1 x x x x indicates registered injury and each row tell the number of incidences of different combination of injuries. The total number will be identical to the total number of registered PCL injuries. 146

159 The Norwegian Cruciate Ligament Register Reason for revision reconstruction Table 58 Cause 1 Cause 2 Cause 3 Cause 4 Cause 5 Cause Cause 1: Infection Cause 2: Fixation failure Cause 3: Untreated ligamentinjury Cause:4: Graft failure Cause 5: New trauma Cause 6: Other Choice of graft Table 59 BPTB ACL PCL MCL LCL PLC Table 60 ST - double ACL PCL MCL LCL PLC Tabble 61 * ST - quadruple ACL PCL MCL LCL PLC * The registration started in Table 62 STGR - double ** ACL PCL MCL LCL PLC ** STGR - single and STGR - quadruple are counted as STGR-double. 147

160 Report 2009 Table 63 Double bundle *** ACL PCL MCL LCL PLC ***The registration started in 2007 Table 64 BQT ACL PCL MCL LCL PLC Table 65 BQT-A ACL PCL MCL LCL PLC Table 66 BPTB-A ACL PCL MCL LCL PLC t Table 67 BACH-A ACL PCL MCL LCL PLC

161 The Norwegian Cruciate Ligament Register Table 68 Suture ACL PCL MCL LCL PLC Totat Table 69 Synthetic graft ACL PCL MCL LCL PLC Table 70 Other ACL PCL MCL LCL PLC Figure 14: Choice of graft 90 number of operations BPTP ST-double ST-quadruple STGR-double BQT BQT-A BPTP-A BACH-A Suture Synthetic graft Other

162 Report 2009 Fixation femur ACL Table 71 Product AO Screw 1 1 BIORCI Screw Bone Mulch Screw Cross-Screw 1 1 EndoButton CL EndoButton CL ULTRA EZLoc Guardsman Femoral Interferenzschraube Profile Interference Screw 1 1 Propel Cannulated RCI Screw Resorbable cross pin 3 3 RetroButton Rigidfix ST cross pin Kit Soft Screw SoftSilk Transfix II TunneLoc Universal Wedge Screw UNKNOWN Fixation femur PCL Table 72 Product Allograft cross pin 1 EndoButton CL RCI Screw SoftSilk

163 The Norwegian Cruciate Ligament Register Fixation tibia ACL Table 73 Product ACL Interference Screw 1 1 AO Screw Bilok Interference screw Bio-Interference Screw 1 1 Bio-Intrafix Screw BIORCI Screw Cramp Delta Tapered Bio-Interference screw GTS Tapered Screw 1 1 Guardsman Femoral Interferenzschraube Inter-Lock Pin Intrafix Screw Linvatec Cannulated 1 1 Profile Interference Screw 1 1 Propel Cannulated RCI Screw Rigidfix ST cross pin Kit 1 1 Soft Screw SoftSilk SoftSilk TunneLoc WasherLoc Screw UNKNOWN Fixation tibia PCL Table 74 Product AO Screw 2 1 RCI Screw

164 Report 2009 Fixation femur and tibia ACL Table 75 Femur Tibia Bone Mulch Screw WasherLoc Screw EndoButton CL BIORCI Screw 5 5 EndoButton CL Intrafix Screw EndoButton CL RCI Screw EndoButton CL ULTRA RCI Screw EZLoc WasherLoc Screw Guardsman Femoral Propel Cannulated Interferenzschraube Interferenzschraube 7 7 RCI Screw RCI Screw 6 6 Rigidfix ST cross pin Kit Bio-Intrafix Screw 5 5 SoftSilk SoftSilk Transfix II Soft Screw TunneLoc TunneLoc Other* "Other" includes combinations with less than five occurrences for all given years Meniscal lesion Table 76 Year Resection Suture Synthetic fixation Meniscus Transplant. Trepanation None 2008 Lateral Medial Lateral Medial Lateral Medial Lateral Medial Lateral Medial It became possible to register "Trepanation" and "None" from There have been forms where this has been additional information. This information have been registered, but the registration is not complete before There are 10 forms registered with a meniscus injuy that is not described under actual treatment of meniscal lesion or where meniscus operation is checked. In table 49 : Actual injury has less. The reason for this is that we distinguish between the lateral and medial injury and some injuries are registreded in both groups. 152

165 The Norwegian Cruciate Ligament Register Figure 15: Meniscal lesion number of operations Resection Suture Synthetic fixation Meniscus Transplant. Trepanation None Fixation Meniscal lesion - Synthetic Table 77 Product Contour Meniscus arrow Meniscus arrow Fixation Meniscal lesion - Suture Table 78 Product FAST-FIX Rapidloc

166 Report 2009 Cartilage lesion: ICRS Grade ICRS Grade: 1. Nearly normal: Superficial lesions, soft indentation and/or superficial fissures and cracks. 2. Abnormal: Lesions extending down to <50% of cartilage depth. 3. Severely abnormal: Cartilage defects extending down >50% of cartilage depth as well as down to calcified layer. 4. Severely abnormal: Osteochondral injuries, lesions extending just through the subchondral boneplate or deeper defects down into trabecular bone. Table 79 Patella MF Code 1 Code 2 Code 3 Code 4 Missing ,8% 61,1% 11,1% 0,0% 0,0% ,1% 54,5% 27,3% 0,0% 9,1% ,2% 44,4% 33,3% 0,0% 0,0% ,6% 50,0% 21,4% 0,0% 0,0% ,0% 50,0% 25,0% 0,0% 0,0% Patella LF ,5% 50,0% 12,5% 0,0% 0,0% ,2% 54,5% 9,1% 9,1% 9,1% ,3% 33,3% 33,3% 0,0% 0,0% ,0% 58,3% 16,7% 0,0% 0,0% ,6% 57,1% 14,3% 0,0% 0,0% Trochlea.fem ,4% 71,4% 7,1% 0,0% 0,0% ,7% 58,3% 8,3% 8,3% 8,3% ,3% 27,3% 27,3% 18,2% 0,0% ,7% 14,3% 28,6% 21,4% 0,0% ,0% 75,0% 25,0% 0,0% 0,0% Med.fem.cond ,8% 56,8% 29,7% 2,7% 0,0% ,2% 45,9% 29,7% 5,4% 2,7% ,0% 37,8% 31,1% 6,7% 4,4% ,8% 57,9% 21,1% 5,3% 0,0% ,7% 41,7% 25,0% 8,3% 8,3% Med.tib.plat ,6% 48,1% 22,2% 0,0% 0,0% ,0% 52,0% 16,0% 8,0% 4,0% ,0% 56,5% 17,4% 13,0% 0,0% ,8% 43,5% 17,4% 4,3% 0,0% ,0% 85,7% 14,3% 0,0% 0,0% Lat.fem.cond ,0% 52,4% 23,8% 4,8% 0,0% ,8% 52,6% 21,1% 0,0% 10,5% ,3% 36,8% 26,3% 10,5% 0,0% ,8% 55,6% 5,6% 5,6% 5,6% ,0% 40,0% 60,0% 0,0% 0,0% Lat.tib.plat ,3% 45,5% 27,3% 0,0% 0,0% ,3% 45,5% 18,2% 0,0% 9,1% ,7% 42,9% 14,3% 7,1% 0,0% ,4% 42,1% 10,5% 0,0% 0,0% ,0% 62,5% 25,0% 12,5% 0,0% 154

167 The Norwegian Cruciate Ligament Register Cartilage lesion: Probable cause Probable cause: 1. Trauma; 2. CM: chondromalacia patellae; 3. OCD: osteochondritis dissecans; 4. OA: primary osteoarthritis; 5. Other. Table 80 Patella MF Code 1 Code 2 Code 3 Code 4 Code 5 Missing ,7% 0,0% 0,0% 53,8% 15,4% 23,1% ,2% 0,0% 0,0% 45,5% 18,2% 18,2% ,3% 22,2% 0,0% 33,3% 0,0% 11,1% ,3% 35,7% 0,0% 21,4% 21,4% 7,1% ,5% 37,5% 0,0% 50,0% 0,0% 0,0% Patella LF ,0% 0,0% 0,0% 63,6% 18,2% 18,2% ,2% 0,0% 0,0% 45,5% 9,1% 27,3% ,2% 22,2% 0,0% 44,4% 0,0% 11,1% ,7% 33,3% 0,0% 25,0% 16,7% 8,3% ,3% 28,6% 0,0% 57,1% 0,0% 0,0% Trochlea fem ,0% 0,0% 0,0% 66,7% 0,0% 33,3% ,7% 8,3% 0,0% 41,7% 8,3% 25,0% ,3% 9,1% 0,0% 36,4% 9,1% 18,2% ,3% 21,4% 0,0% 28,6% 35,7% 0,0% ,0% 0,0% 0,0% 75,0% 0,0% 0,0% Med.fem.cond ,9% 0,0% 0,0% 45,2% 6,5% 6,5% ,5% 2,7% 0,0% 32,4% 10,8% 13,5% ,4% 2,2% 0,0% 31,1% 13,3% 8,9% ,8% 0,0% 0,0% 34,2% 18,4% 10,5% ,7% 0,0% 0,0% 50,0% 8,3% 0,0% Med.tib.plat ,7% 0,0% 0,0% 54,5% 9,1% 13,6% ,0% 4,0% 0,0% 44,0% 16,0% 8,0% ,1% 0,0% 0,0% 47,8% 26,1% 0,0% ,7% 0,0% 0,0% 43,5% 30,4% 4,3% ,6% 0,0% 0,0% 71,4% 0,0% 0,0% Lat. fem. cond ,0% 0,0% 0,0% 62,5% 0,0% 12,5% ,3% 0,0% 0,0% 42,1% 10,5% 21,1% ,6% 0,0% 0,0% 31,6% 15,8% 21,1% ,3% 0,0% 0,0% 22,2% 22,2% 22,2% ,0% 0,0% 0,0% 40,0% 0,0% 0,0% Lat. tib. lat ,5% 0,0% 0,0% 58,8% 5,9% 11,8% ,8% 0,0% 0,0% 31,8% 13,6% 22,7% ,6% 0,0% 0,0% 35,7% 14,3% 21,4% ,6% 0,0% 0,0% 31,6% 31,6% 5,3% ,0% 0,0% 0,0% 50,0% 0,0% 0,0% 155

168 Report 2009 Cartilage lesion: Treatment code Treatment code: 1. Debridement 2. Micro fracture 3. Mosaic 4. Biopsy for cultivation 5. Cell transplantation 6. Cell transplantation with matrix 7. Periosteum transplantation 8. No treatment; 9. Other Table 81 Patella MF Code 1 Code 2 Code 3 Code 4 Code 5 Code 6 Code 7 Code 8 Code 9 Missing ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 62,5% 0,0% 37,5% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 72,7% 0,0% 27,3% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 33,3% 0,0% 66,7% ,1% 0,0% 0,0% 0,0% 0,0% 0,0% 7,1% 57,1% 0,0% 28,6% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 50,0% 0,0% 50,0% Patella MF ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 66,7% 0,0% 33,3% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 72,7% 0,0% 27,3% ,1% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 11,1% 0,0% 77,8% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 8,3% 58,3% 0,0% 33,3% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 42,9% 0,0% 57,1% Trochlea fem ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 40,0% 0,0% 60,0% ,0% 8,3% 0,0% 0,0% 0,0% 0,0% 0,0% 66,7% 0,0% 25,0% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 36,4% 0,0% 63,6% ,3% 7,1% 0,0% 0,0% 0,0% 0,0% 14,3% 35,7% 0,0% 28,6% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 75,0% Med.fem.cond ,4% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 73,1% 0,0% 11,5% ,8% 2,8% 0,0% 0,0% 0,0% 0,0% 0,0% 69,4% 0,0% 25,0% ,4% 8,9% 0,0% 0,0% 2,2% 0,0% 2,2% 44,4% 0,0% 37,8% ,6% 2,6% 0,0% 0,0% 0,0% 0,0% 5,3% 57,9% 0,0% 31,6% ,7% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 50,0% 0,0% 33,3% Med.tib.plat ,8% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 64,7% 0,0% 23,5% ,0% 4,2% 0,0% 0,0% 0,0% 0,0% 0,0% 70,8% 0,0% 25,0% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 43,5% 0,0% 56,5% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 8,7% 60,9% 0,0% 30,4% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 42,9% 0,0% 57,1% Lat.fem.cond ,2% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 72,7% 0,0% 9,1% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 63,2% 0,0% 36,8% ,3% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 36,8% 0,0% 57,9% ,0% 5,6% 0,0% 0,0% 0,0% 0,0% 5,6% 50,0% 0,0% 38,9% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 40,0% 0,0% 40,0% Lat.tib.plat ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 91,7% 0,0% 8,3% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 77,3% 0,0% 22,7% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 28,6% 0,0% 71,4% ,3% 5,3% 0,0% 0,0% 0,0% 0,0% 10,5% 52,6% 0,0% 26,3% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 50,0% 12,5% 37,5% 156

169 The Norwegian Cruciate Ligament Register Age of Cartilage injuries Table 82 New Old Undefined Missing The registration started in There are 2 forms that have surgeries from 2005 that is registered on an old form and will therefore have no registration here. All Cartilage injuries Table 83 Patella MF Patella LF Trochlea fem. Med. fem. cond. Med. tib. plat. Lat. fem. cond. Lat. tib. plat There are 80 cartilage lesions where the size is missing. Figure 16: All Cartilage injuries (total) 9,02% 13,28% 27,70% Medial Lateral Lateral Medial 9,84% 9,02% 13,93% 17,21% 157

170 Report 2009 All Cartilage injuries with area greater than 2 cm 2 Table 84 Patella MF Patella LF Trochlea fem. Med. fem. cond. Med. tib. plat. Lat. fem. cond. Lat. tib. plat Figure 17: All Cartilage injuries with area greater than 2 cm (total) 8,26% 11,62% 27,22% Medial Lateral Lateral Medial 7,65% 7,03% 15,90% 22,32% All Cartilage injuries with area greater than 2 cm and ICRS equal 3 or 4 2 Table 85 Patella MF Patella LF Trochlea fem. Med. fem. cond. Med. tib. plat. Lat. fem. cond. Lat. tib. plat

171 The Norwegian Cruciate Ligament Register 2 Figure 18: All Cartilage injuries with area greater than 2 cm and ICRS equal 3 or 4 (total) 9,78% 11,96% 33,70% Medial Lateral Lateral Medial 7,61% 6,52% 10,87% 19,57% Outpatient surgery Table Yes No Missing 41 ( 34,2% ) 77 ( 64,2% ) 2 ( 1,7% ) 45 ( 40,9% ) 65 ( 59,1% ) 0 ( 0,0% ) 31 ( 24,6% ) 94 ( 74,6% ) 1 ( 0,8% ) 28 ( 23,1% ) 92 ( 76,0% ) 1 ( 0,8% ) 6 ( 13,0% ) 40 ( 87,0% ) 0 ( 0,0% ) ( 28,9% ) 368 ( 70,4% ) 4 ( 0,8% ) 523 Per operative complications Table Yes No Missing 3 ( 2,5% ) 107 ( 89,2% ) 10 ( 8,3% ) 7 ( 6,4% ) 98 ( 89,1% ) 5 ( 4,5% ) 5 ( 4,0% ) 120 ( 95,2% ) 1 ( 0,8% ) 6 ( 5,0% ) 113 ( 93,4% ) 2 ( 1,7% ) 3 ( 6,5% ) 43 ( 93,5% ) 0 ( 0,0% ) ( 4,6% ) 481 ( 92,0% ) 18 ( 3,4% )

172 Report 2009 Systemic antibiotic prophylaxis Table 88 Yes No Missing l ( 97,5% ) 2 ( 1,7% ) 1 ( 0,8% ) 109 ( 99,1% ) 1 ( 0,9% ) 0 ( 0,0% ) 124 ( 98,4% ) 1 ( 0,8% ) 1 ( 0,8% ) 120 ( 99,2% ) 1 ( 0,8% ) 0 ( 0,0% ) 45 ( 97,8% ) 1 ( 2,2% ) 0 ( 0,0% ) 515 ( 98,5% ) 6 ( 1,1% ) 2 ( 0,4% ) Table 89 Antibiotic prophylaxis Cefalotin (Keflin) 82,61% 91,67% 92,80% 92,73% 94,07% Cefuroxim (Zinacef, Lifurox) 1,67% 0,80% 0,91% Clindamycin (Dalacin) 4,35% 3,20% 0,91% 4,24% Dikloxacillin (Diclocil) 8,70% 5,83% 2,40% 4,55% 0,85% Kloxacillin (Ekvacillin) 4,35% Missing 0,83% 0,80% Zinacef - Trimetropin/sulfa 0,85% Thrombosis prophylaxis Table 90 Yes No Missing ( 80,0% ) 22 ( 18,3% ) 2 ( 1,7% ) 86 ( 78,2% ) 22 ( 20,0% ) 2 ( 1,8% ) 102 ( 83,6% ) 19 ( 15,6% ) 5 ( 4,0% ) 101 ( 86,3% ) 16 ( 13,7% ) 4 ( 3,3% ) 385 ( 80,7% ) 79 ( 16,6% ) 13 ( 2,7% ) 477 There are 8 old forms that are filled out so that thrombosis prophylaxis can not be registered. These are added to missing Table 91 One drug Two drugs ( 100,0% ) 0 ( 0,0% ) 86 ( 100,0% ) 0 ( 0,0% ) 102 ( 100,0% ) 0 ( 0,0% ) 99 ( 98,0% ) 2 ( 2,0% ) 383 ( 99,5% ) 2 ( 0,5% )

173 The Norwegian Cruciate Ligament Register Table 92 Thrombosis prophylaxis - one drug Exanta 1,98% 0,98% Fragmin (Dalteparin) 66,34% 74,51% 65,12% 65,63% Klexane (Enoksaparin) 26,73% 21,57% 32,56% 32,29% No drug treatment* 2,97% 2,94% 2,33% Missing 2,08% Two drugs 1,98% * No drug treatment are used as code for stocking during thrombosis prophylaxis. Included in both table 46 and 47. Registration of stocking expire because of form change Tabell 93 NSAID's Yes No Missing 24 ( 20,0% ) 66 ( 55,0% ) 30 ( 25,0% ) 13 ( 11,8% ) 11 ( 10,0% ) 86 ( 78,2% ) ( 16,1% ) 77 ( 33,5% ) 116 ( 50,4% ) 230 Tabell 94 Drug Diclofenac (Diclofenac, Voltaren) 100,00% 87,50% Toradol 4,17% Missing 8,33% 161

174 Report 2009 OTHER PROCEDURES Figure 19: Age by operation 25 Number of patients Age Figur 20: Activity that lead to injury Alpine/Telemark Basketball Cross country skiing Dance Floor ball Handball Ishockey/bandy/inline skating Martial art Motocross Other Other recreational activities Outdoor life Recretional activities Skateboard Snow board Soccer Traffic Trampoline Unknown/Missing Violence Volleyball Work

175 The Norwegian Cruciate Ligament Register Actual injury Table 95 ACL PCL MCL LCL PLC Cartilage Meniscus Previous surgery in index knee Table 96 ACL PCL MCL LCL PLC Cartilage Meniscus Further injuries: Vascular Table 97 Arteria Vena poplitea Nerve Table 98 N.tibialis N.peroneus Fracture Table 99 Femur Tibia Fibula Patella Not sure Rupture in extensor apparatus Table 100 Quadricepstendon Patellatendon

176 Report 2009 ACL with additional injuries Table 101 Number ACL PCL MCL LCL PLC Meniscus Cartilage 36 x 32 x x 25 x x x 17 x x 2 x x x 1 x x x x 1 x x 1 x x 1 x x x x 1 x x x 1 x x x x 1 x x x x 1 x x 1 x x x x 1 x x x x x x 1 x x x x indicates registered injury and each row tell the number of incidences of different combination of injuries. The total will be identical to the total number of ACL injuries PCL with additional injuries Table 102 Number ACL PCL MCL LCL PLC Meniscus Cartilage 1 x x x x 1 x x x x x x 1 x x x x 1 x x 1 x x x 1 x x 1 x x indicates registered injury and each row tell the number of incidences of different combination of injuries. The total will be identical to the total number of PCL injuries 164

177 The Norwegian Cruciate Ligament Register Meniscal lesion Table 103 Year Resection Suture Synthetic fixation Meniscus Transplant. Trepanation None 2008 Lateral Medial Lateral Medial Lateral Medial Lateral Medial Lateral Medial It became possible to register "Trepanation" and "None" from There have been forms where this has been an additional information. This information have been registered, but the registration is not complete before There are 6 forms where there are registered a meniscus surgery that is not described under actual treatment of meniscal lesion. There are 7 forms where there are registered a meniscus injuy that is not described under actual treatment of meniscal lesion or other procedures. In table 91: Actual injury has less. The reason for this is that we distinguish between the lateral and medial injury and some injuries are registreded in both groups. Figure 21: Meniscal lesion 35 number of operations Resection Suture Synthetic fixation Meniscus Transplant. None 165

178 Report 2009 Fixation Meniscal lesion - synthetic Table 104 Product Contour Meniscus arrow Fixation Meniscal lesion - suture Table 105 Product FAST-FIX Rapidloc

179 The Norwegian Cruciate Ligament Register Cartilage lesion: ICRS Grade ICRS Grade: 1. Nearly normal: Superficial lesions, soft indentation and/or superficial fissures and cracks. 2. Abnormal: Lesions extending down to <50% of cartilage depth. 3. Severely abnormal: Cartilage defects extending down >50% of cartilage depth as well as down to calcified layer. 4. Severely abnormal: Osteochondral injuries, lesions extending just through the subchondral boneplate or deeper defects down into trabecular bone. Table106 Patella MF Code 1 Code 2 Code 3 Code 4 Missing ,3% 66,7% 20,0% 0,0% 0,0% ,5% 45,5% 9,1% 0,0% 0,0% ,4% 45,5% 18,2% 0,0% 0,0% ,3% 66,7% 25,0% 0,0% 0,0% ,9% 42,9% 14,3% 0,0% 0,0% Patella LF ,3% 64,3% 21,4% 0,0% 0,0% ,6% 57,1% 14,3% 0,0% 0,0% ,0% 60,0% 10,0% 0,0% 0,0% ,7% 66,7% 16,7% 0,0% 0,0% ,7% 16,7% 16,7% 0,0% 0,0% Trochlea.fem ,9% 52,9% 17,6% 23,5% 0,0% ,2% 11,1% 66,7% 0,0% 0,0% ,0% 30,0% 30,0% 10,0% 0,0% ,1% 44,4% 0,0% 44,4% 0,0% ,7% 16,7% 66,7% 0,0% 0,0% Med.fem.cond ,6% 23,5% 23,5% 32,4% 2,9% ,3% 42,9% 32,1% 10,7% 0,0% ,0% 35,0% 25,0% 15,0% 0,0% ,6% 32,1% 21,4% 17,9% 0,0% ,5% 19,0% 61,9% 9,5% 0,0% Med.tib.plat ,7% 56,5% 8,7% 26,1% 0,0% ,1% 42,1% 31,6% 5,3% 0,0% ,5% 27,3% 18,2% 9,1% 0,0% ,3% 52,6% 10,5% 10,5% 0,0% ,4% 36,4% 18,2% 9,1% 0,0% Lat.fem.cond ,3% 33,3% 14,3% 14,3% 4,8% ,7% 33,3% 41,7% 8,3% 0,0% ,5% 23,1% 30,8% 7,7% 0,0% ,8% 62,5% 18,8% 0,0% 0,0% ,1% 14,3% 14,3% 14,3% 0,0% Lat.tib.plat ,2% 41,2% 11,8% 5,9% 0,0% ,3% 36,4% 27,3% 9,1% 0,0% ,7% 58,3% 25,0% 0,0% 0,0% ,0% 66,7% 8,3% 0,0% 0,0% ,9% 28,6% 0,0% 28,6% 0,0% 167

180 Report 2009 Cartilage lesion: Probable cause Probable cause: 1. Trauma; 2. CM: chondromalacia patellae; 3. OCD: osteochondritis dissecans; 4. OA: primary osteoarthritis; 5. Other. Table 107 Patella MF Code 1 Code 2 Code 3 Code 4 Code 5 Missing ,8% 22,9% 0,0% 35,4% 2,1% 20,8% ,0% 20,8% 0,0% 23,4% 2,6% 27,3% ,3% 16,5% 0,0% 20,0% 2,4% 45,9% ,1% 27,8% 0,0% 12,7% 3,8% 26,6% ,4% 22,4% 0,0% 24,5% 6,1% 28,6% Patella LF ,0% 0,0% 0,0% 40,0% 40,0% 0,0% ,3% 0,0% 0,0% 57,1% 28,6% 0,0% ,0% 0,0% 0,0% 10,0% 20,0% 50,0% ,0% 0,0% 0,0% 66,7% 16,7% 16,7% ,3% 33,3% 0,0% 16,7% 0,0% 16,7% Trochlea fem ,8% 0,0% 0,0% 23,1% 46,2% 0,0% ,2% 11,1% 0,0% 44,4% 22,2% 0,0% ,0% 10,0% 0,0% 10,0% 30,0% 30,0% ,1% 0,0% 0,0% 44,4% 33,3% 11,1% ,7% 0,0% 0,0% 33,3% 0,0% 0,0% Med.fem.cond ,9% 0,0% 7,1% 21,4% 28,6% 0,0% ,7% 0,0% 0,0% 25,0% 7,1% 7,1% ,0% 0,0% 0,0% 10,0% 30,0% 15,0% ,4% 0,0% 3,6% 17,9% 25,0% 7,1% ,4% 0,0% 4,8% 23,8% 14,3% 4,8% Med.tib.plat ,6% 0,0% 5,3% 31,6% 31,6% 0,0% ,4% 0,0% 0,0% 36,8% 10,5% 5,3% ,4% 0,0% 0,0% 18,2% 45,5% 0,0% ,1% 0,0% 0,0% 21,1% 26,3% 10,5% ,5% 0,0% 0,0% 9,1% 45,5% 0,0% Lat. fem. cond ,0% 0,0% 0,0% 26,7% 26,7% 6,7% ,7% 0,0% 0,0% 33,3% 16,7% 8,3% ,5% 0,0% 0,0% 7,7% 38,5% 15,4% ,0% 0,0% 0,0% 31,3% 31,3% 12,5% ,9% 14,3% 0,0% 14,3% 28,6% 0,0% Lat. tib. lat ,1% 0,0% 0,0% 38,5% 38,5% 0,0% ,5% 0,0% 0,0% 36,4% 18,2% 0,0% ,0% 0,0% 0,0% 8,3% 41,7% 0,0% ,7% 0,0% 0,0% 33,3% 33,3% 16,7% ,6% 0,0% 0,0% 14,3% 57,1% 0,0% 168

181 The Norwegian Cruciate Ligament Register Cartilage lesion: Treatment code Treatment code: 1. Debridement 2. Micro fracture 3. Mosaic 4. Biopsy for cultivation 5. Cell transplantation 6. Cell transplantation with matrix 7. Periosteum transplantation 8. No treatment; 9. Other Table108 Patella MF Code 1 Code 2 Code 3 Code 4 Code 5 Code 6 Code 7 Code 8 Code 9 Missing ,7% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 66,7% 16,7% 0,0% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 63,6% 0,0% 36,4% ,2% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 18,2% 0,0% 63,6% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 8,3% 41,7% 0,0% 50,0% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 71,4% 0,0% 28,6% Patella MF ,7% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 66,7% 16,7% 0,0% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 57,1% 0,0% 42,9% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 10,0% 0,0% 70,0% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 16,7% 0,0% 83,3% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 66,7% 0,0% 33,3% Trochlea fem ,0% 10,0% 0,0% 0,0% 0,0% 0,0% 0,0% 80,0% 10,0% 0,0% ,1% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 33,3% 0,0% 55,6% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 30,0% 0,0% 50,0% ,0% 33,3% 0,0% 0,0% 0,0% 0,0% 0,0% 11,1% 0,0% 55,6% ,0% 16,7% 0,0% 0,0% 0,0% 0,0% 0,0% 50,0% 0,0% 33,3% Med.fem.cond ,7% 17,4% 0,0% 0,0% 0,0% 0,0% 0,0% 56,5% 4,3% 0,0% ,3% 3,6% 0,0% 0,0% 0,0% 3,6% 0,0% 53,6% 0,0% 25,0% ,0% 5,0% 0,0% 0,0% 0,0% 0,0% 0,0% 40,0% 0,0% 35,0% ,1% 17,9% 0,0% 0,0% 0,0% 0,0% 3,6% 42,9% 0,0% 28,6% ,0% 14,3% 0,0% 0,0% 0,0% 0,0% 0,0% 38,1% 0,0% 28,6% Med.tib.plat ,7% 8,3% 0,0% 0,0% 0,0% 0,0% 0,0% 58,3% 16,7% 0,0% ,5% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 57,9% 0,0% 31,6% ,1% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 63,6% 0,0% 27,3% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 5,3% 52,6% 5,3% 36,8% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 72,7% 0,0% 27,3% Lat.fem.cond ,7% 16,7% 0,0% 0,0% 0,0% 0,0% 0,0% 50,0% 8,3% 8,3% ,2% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 45,5% 0,0% 36,4% ,4% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 46,2% 0,0% 38,5% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 6,3% 56,3% 0,0% 37,5% ,3% 14,3% 0,0% 0,0% 0,0% 0,0% 0,0% 28,6% 0,0% 42,9% Lat.tib.plat ,0% 10,0% 0,0% 0,0% 0,0% 0,0% 0,0% 70,0% 20,0% 0,0% ,2% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 54,5% 0,0% 27,3% ,3% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 66,7% 0,0% 25,0% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 8,3% 41,7% 0,0% 50,0% ,0% 0,0% 0,0% 0,0% 0,0% 0,0% 0,0% 57,1% 0,0% 42,9% 169

182 Report 2009 Age of Cartilage injuries Table 109 New Old Undefined Missing * The registration started in There are 1forms that have surgeries from 2005 that is registered on an old form and will therefore have no registration here. All Cartilage injuries Table 110 Patella MF Patella LF Trochlea fem. Med. fem. cond. Med. tib. plat. Lat. fem. cond. Lat. tib. plat There are 62 cartilage lesions where the size is missing. Figure 22: All Cartilage injuries (total) 10,34% 14,00% 26,57% Medial Lateral Lateral Medial 11,36% 8,72% 12,17% 16,84% 170

183 The Norwegian Cruciate Ligament Register All Cartilage injuries with area greater than 2 cm 2 Table 111 Patella MF Patella LF Trochlea fem. Med. fem. cond. Med. tib. plat. Lat. fem. cond. Lat. tib. plat Figure 23: All Cartilage injuries with area greater than 2 cm (total) 10,93% 13,58% 26,82% Medial Lateral Lateral Medial 8,61% 7,62% 14,24% 18,21% All Cartilage injuries with area greater than 2 cm and ICRS equal 3 or 4 2 Table 112 Patella MF Patella LF Trochlea fem. Med. fem. cond. Med. tib. plat. Lat. fem. cond. Lat. tib. plat

184 Report Figure 24: All Cartilage injuries with area greater than 2 cm and ICRS equal 3 or 4 (total) 14,53% 12,82% 38,46% Medial Lateral Lateral Medial 5,13% 3,42% 9,40% 16,24% Outpatient surgery Table Yes No Missing 59 ( 53,2% ) 51 ( 45,9% ) 1 ( 0,9% ) 64 ( 66,0% ) 31 ( 32,0% ) 2 ( 2,1% ) 46 ( 62,2% ) 24 ( 32,4% ) 4 ( 5,4% ) 32 ( 45,1% ) 39 ( 54,9% ) 0 ( 0,0% ) 21 ( 48,8% ) 22 ( 51,2% ) 0 ( 0,0% ) ( 56,1% ) 167 ( 42,2% ) 7 ( 1,8% ) 396 Per operative complications Table Yes No Missing 0 ( 0,0% ) 108 ( 97,3% ) 3 ( 2,7% ) 2 ( 2,1% ) 92 ( 94,8% ) 3 ( 3,1% ) 1 ( 1,4% ) 68 ( 91,9% ) 5 ( 6,8% ) 0 ( 0,0% ) 71 ( 100,0% ) 0 ( 0,0% ) 1 ( 2,3% ) 42 ( 97,7% ) 0 ( 0,0% ) ( 1,0% ) 381 ( 96,2% ) 11 ( 2,8% )

185 The Norwegian Cruciate Ligament Register Systemic antibiotic prophylaxis Table 115 Yes No Missing ( 36,9% ) 68 ( 61,3% ) 2 ( 1,8% ) 29 ( 29,9% ) 63 ( 64,9% ) 5 ( 5,2% ) 17 ( 23,0% ) 51 ( 68,9% ) 5 ( 6,8% ) 16 ( 22,5% ) 55 ( 77,5% ) 0 ( 0,0% ) 13 ( 30,2% ) 30 ( 69,8% ) 0 ( 0,0% ) 116 ( 29,3% ) 267 ( 67,4% ) 12 ( 3,0% ) Table 116 Antibiotic prophylaxis Cefalotin (Keflin) 85,71% 93,75% 77,78% 93,10% 92,50% Cefuroxim (Zinacef, Lifurox) 2,50% Clindamycin (Dalacin) 7,14% 3,45% 2,50% Dikloxacillin (Diclocil) 7,14% 11,11% 3,45% 2,50% Erymax (Erythromycin,Abboticin) 5,56% Gentamicin (Garamycin) 5,56% Missing 6,25% Thrombosis prophylaxis Table 117 Yes No Missing ( 34,2% ) 69 ( 62,2% ) 4 ( 3,6% ) 26 ( 26,8% ) 65 ( 67,0% ) 6 ( 6,2% ) 21 ( 28,4% ) 51 ( 68,9% ) 2 ( 2,7% ) 33 ( 47,1% ) 37 ( 52,9% ) 0 ( 0,0% ) 118 ( 33,4% ) 222 ( 62,9% ) 13 ( 3,7% ) 353 There are 1 old forms that are filled out so that thrombosis prophylaxis can not be registered. These are added to missing Table 118 One drug Two drugs ( 100,0% ) 0 ( 0,0% ) 26 ( 100,0% ) 0 ( 0,0% ) 21 ( 100,0% ) 0 ( 0,0% ) 33 ( 100,0% ) 0 ( 0,0% ) 118 ( 100,0% ) 0 ( 0,0% )

186 Report 2009 Table 119 Drug Fragmin (Dalteparin) 60,61% 66,67% 73,08% 84,21% Klexane (Enoksaparin) 36,36% 23,81% 19,23% 13,16% No drug treatment* 3,03% 9,52% 7,69% Missing 2,63% * No drug treatment are used as code for stocking during thrombosis prophylaxis. Included in both table 118 and 119. Registration of stocking expire because of form change Table 120 NSAID's Yes No Missing 37 ( 33,3% ) 43 ( 38,7% ) 31 ( 27,9% ) 15 ( 15,5% ) 4 ( 4,1% ) 78 ( 80,4% ) ( 25,0% ) 47 ( 22,6% ) 109 ( 52,4% ) 208 Table 121 Drug Diclofenac (Diclofenac, Voltaren) 93,33% 97,30% Missing 6,67% 2,70% 174

187 PUBLICATIONS Theses The Norwegian Arthroplasty Register 1. Havelin LI. Hip arthroplasty in Norway The Norwegian Arthroplasty Register [dissertation]. Bergen, Norway: University of Bergen, Espehaug B. Quality of total hip replacements in Norway The Norwegian Arthroplasty Register [dissertation]. Bergen, Norway: University of Bergen, Furnes O. Hip and knee replacement in Norway The Norwegian Arthroplasty Register [dissertation]. Bergen, Norway: University of Bergen, Lie SA. Survival studies of total hip replacements and postoperative mortality [dissertation]. Bergen, Norway: University of Bergen, Flugsrud GB. Risk factors for disabling osteoarthritis of the hip and for revision hip surgery. An epidemiological investigation [dissertation]. Oslo, Norway: University of Oslo, Hallan G. Wear, fixation, and revision of total hip prostheses [dissertation]. Bergen, Norway: University of Bergen, Monstad K. Essays on the Economics of health and fertility [dissertation]. Bergen, Norway: The Norwegian school of economics and business administration, Arthursson A J. Surgical approach and muscle strength in total hip arthroplasty [dissertation]. Bergen, Norway: University of Bergen, The Norwegian Hip Fracture Register 9. Gjertsen JE. Surgical treatment of hip fractures in Norway [dissertation]. Bergen, Norway: University of Bergen, Articles The Norwegian Arthroplasty Register 1. Engesæter LB, Havelin LI, Espehaug B, Vollset SE. [Artificial hip joints in Norway. A national registry of total hip arthroplasties.] Tidsskr Nor Laegefor 1992;112: Havelin LI, Espehaug B, Vollset SE, Engesæter LB, Langeland N. The Norwegian 175

188 Report 2009 Arthroplasty Register. A survey of 17,444 total hip replacements. Acta Orthop Scand 1993;64: Havelin LI, Espehaug B, Vollset SB, Engesæter LB. Early failures among 14,009 cemented and 1,326 uncemented prostheses for primary coxarthrosis. The Norwegian Arthroplasty Register, Acta Orthop Scand 1994;65: Havelin LI, Espehaug B, Vollset SE, Engesæter LB. Early aseptic loosening of uncemented femoral components in primary total hip replacement. A review based on the Norwegian Arthroplasty Register. J Bone Joint Surg 1995;77-B: Havelin LI, Espehaug B, Vollset SE, Engesaeter LB. The effect of cement type on early revision of Charnley total hip prostheses. A review of 8,579 primary arthroplasties from the Norwegian Arthroplasty Register. J Bone Joint Surg 1995;77-A: Havelin LI, Vollset SE, Engesæter LB. Revision for aseptic loosening of uncemented cups in primary total hip prostheses. A report from the Norwegian Arthroplasty Register. Acta Orthop Scand 1995;66: Espehaug B, Havelin LI, Engesæter LB, Vollset SE, Langeland N. Early revision among 12,179 hip prostheses. A comparison of 10 different prosthesis brands reported to the Norwegian Arthroplasty Register, Acta Orthop Scand 1995;66: Engesæter LB, Furnes A, Havelin LI, Lie SA, Vollset SE. [The hip registry. Good economy for society.] Tidsskr Nor Lægefor 1996;116: Skeide BE, Lie SA, Havelin LI, Engesæter LB. [ hip arthroplasty after femoral neck fractures. Results from the national registry on joint prostheses.] Tidsskr Nor Lægefor 1996;116: Furnes A, Lie SA, Havelin LI, Engesæter LB, Vollset SE. The economic impact of failures in total hip replacement surgery. The Norwegian Arthroplasty Register Acta Orthop Scand 1996;67: Furnes A, Lie SA, Havelin LI, Engesæter LB. [Quality control of prosthetic replacements of knee, ankle, toe, shoulder, elbow and finger joints in Norway A report after the first year of registration of joint prostheses in the national registry.] Tidsskr for Nor Lægefor 1996;116: Espehaug B, Havelin LI, Engesæter LB, Langeland N, Vollset SE. Patient-related risk factors for early revision of total hip replacements - A population registerbased case-control study. Acta Orthop Scand 1997;68: Espehaug B, Engesæter LB, Vollset SE, Havelin LI, Langeland N. Antibiotic prophylaxis in total hip arthroplasty. Review of 10,905 primary cemented total hip replacements reported to the Norwegian Arthroplasty Register, J Bone Joint Surg 1997;79-B: Furnes O, Lie SA, Havelin LI, Vollset SE, Engesæter LB. Exeter and Charnley 176

189 arthroplasties with Boneloc or high viscosity cement. Comparison of 1127 arthroplasties followed for 5 years in the Norwegian Arthroplasty Register. Acta Orthop Scand 1997;68: Espehaug B, Havelin LI, Engesæter LB, Langeland N, Vollset SE. Patient satisfaction and function after primary and revision total hip replacement. Clin Orthop 1998;351: Espehaug B, Havelin LI, Engesæter LB, Vollset SE. The effect of hospital-type and operating volume on the survival of hip replacements. A review of 39,505 primary total hip replacements reported to the Norwegian Arthroplasty Register, Acta Orthop Scand 1999;70: Havelin LI. The Norwegian Joint Registry. Bull Hosp Jt Dis. 1999;58: Havelin LI, Espehaug B, Lie SA, Engesæter LB, Furnes O, Vollset SE. The Norwegian Arthroplasty Register. 11 years and 73,000 arthroplasties. Acta Orthop Scand 2000;71: Lie SA, Havelin LI, Engesæter LB, Gjessing HK, Vollset SE. Mortality after total hip replacement: 0-10 year follow-up of 39,543 patients in the Norwegian Arthroplasty Register. Acta Orthop Scand 2000;71: Lie SA. [Mortality after total hip replacements]. Nordisk Geriatrik 2000;4: Furnes O, Lie SA, Espehaug B, Vollset SE, Engesæter LB, Havelin LI. Hip disease and the prognosis of total hip replacements. A review of primary total hip replacements reported to the Norwegian Arthroplasty Register J Bone Joint Surg 2001;83-B: Espehaug B, Furnes O, Havelin LI, Engesæter LB, Vollset SE. The type of cement and failure of total hip replacements. J Bone Joint Surg 2002;84-B: Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Meyer HE. Risk factors for total hip replacement due to primary osteoarthritis: a cohort study in 50,034 persons. Arthritis Rheum 2002;46: Furnes O, Espehaug B, Lie SA, Vollset SE, Engesæter LB, Havelin LI. Early failures among 7174 primary total knee replacements. A follow-up study from The Norwegian Arthroplasty Register Acta Orthop Scand 2002;73: Lie SA, Engesæter LB, Havelin LI, Furnes O, Vollset SE. Early postoperative mortality after 67,548 total hip replacements. Causes of death and tromboprophylaxis in 68 hospitals in Norway from 1987 to Acta Orthop Scand 2002;73: Havelin LI, Espehaug B, Engesæter LB. The performance of two hydroxyapatitecoated acetabular cups compared with Charnley cups. From the Norwegian Arthroplasty Register. J Bone Joint Surg 2002;84-B: Lie SA. [Patients in the Norwegian Arthroplasty Register]. Revmatikeren 2003;5:

190 Report Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Meyer HE. Weight change and the risk of total hip replacements. Epidemiology 2003;14: Furnes O, Havelin LI, Espehaug B, Engesæter LB, Lie SA, Vollset SE. [The Norwegian registry of joint prostheses--15 beneficial years for both the patients and the health care]. Tidsskr Nor Lægeforen 2003;123: Engesæter LB, Lie SA, Espehaug B, Furnes O, Vollset SE, Havelin LI. Antibiotic prophylaxis in total hip arthroplasty: effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of 22,170 primary hip replacements followed 0-14 years in the Norwegian Arthroplasty Register. Acta Orthop Scand 2003;74: Byström S, Espehaug B, Furnes O, Havelin LI. Femoral head size is a risk factor for total hip luxation: a study of 42,987 primary hip arthroplasties from the Norwegian Arthroplasty Register. Acta Orthop Scand 2003;74: Lie SA. Havelin LI, Engesæter LB, Furnes O, Vollset SE. Failure rates for 4762 revision total hip arthroplasties in the Norwegian Arthroplasty Register. J Bone Joint Surg 2004;86-B: Lie SA, Furnes O, Havelin LI, Espehaug B, Engesæter LB, Vollset SE. [The Norwegian Arthroplasty Register. Beneficial for the patients and the Norwegian health care system]. The Norwegian Journal of Epidemiology 2004;14: Lie SA, Havelin LI, Engesæter LB, Gjessing HK, Vollset SE. Dependency issues in survival analyses of primary hip replacements from patients. Stat Med 2004;23: Småbrekke A, Espehaug B, Havelin LI, Furnes O. Operating time and survival of primary total hip replacements. A review of 31,745 primary cemented and uncemented total hip replacements from local hospitals reported to the Norwegian Arthroplasty Register Acta Orthop Scand 2004;75: Furnes O. Hofteproteser og sementer. Tidsskr Nor Lægeforen 2004;124: Aamodt A, Nordsletten L, Havelin LI, Indrekvam K, Utvåg SE, Hviding K. Documentation of hip prostheses used in Norway. A critical review of the literature from Acta Orthop Scand 2004;75: Arthursson AJ, Furnes O, Espehaug B, Havelin LI, Søreide JA. Validation of data in the Norwegian Arthroplasty Register and the Norwegian Patient Register primary total hip arthroplasties and revisions operated at a single hospital between 1987 and Acta Orthop 2005;76: Espehaug B, Furnes O, Havelin LI, Engesæter LB, Vollset SE, Kindseth O. Registration completeness to the Norwegian Arthroplasty Register. Acta Orthop 2006;77:

191 40. Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Engeland A, Meyer HE. The impact of body mass index on later osteoarthritis of the hip varies with age at screening. A cohort study in 1.2 million persons. Arthritis Rheum 2006;54: Lie SA. Early mortality after elective hip surgery [guest editorial]. Acta Orthop 2006;77: Engesæter LB, Espehaug B, Lie SA, Furnes O, Havelin LI. Does cement increase the risk for infection in primary total hip arthroplasty. Revision rates in cemented and uncemented primary THAs followed for 0-16 years in the Norwegian Arthroplasty register. Acta Orthop 2006; 77: Lohmander LS, Engesæter LB, Herberts P, Ingvarsson T, Lucht U, Puolakka TJS. Standardized incidence rates of total hip replacement for primary hip osteoarthritis in the 5 Nordic countries:similarities and differences. Acta Orthop 2006;77: Slover J, Espehaug B, Havelin LI, Engesæter LB, Furnes O, Tomek I, Tosteson A. Cost-effectiveness of unicompartmental and total knee arthroplasty in elderly low-demand patients. J Bone Joint Surg 2006;88-A: Furnes O, Espehaug B, Lie SA, Vollset SE, Engesæter LB, Havelin LI. Failure mechanisms after unicompartmental and tricompartmental primary knee replacement with cement. J Bone Joint Surg 2007;89-A: Fevang BT, Lie SA, Havelin LI, Engesæter LB, Furnes O. Reduction in orthopedic surgery among patients with chronic inflammatory joint disease in Norway, Arthritis Rheum 2007;57: Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Meyer HE. The effect of middle-age body weight and physical activity on the risk for early revision hip arthroplasty. A cohort study in 1535 persons. Acta Orthop 2007;78: Lie SA, Hallan G, Engesæter LB, Havelin LI, Furnes O. Isolated acetabular liner exchange compared with complete acetabular component revision in revision of primary uncemented acetabular components. A study of 1649 revisions from the Norwegian Arthroplasty register. J Bone Joint Surg 2007;89-B: Kurtz S, Ong K, Scheimer J, Mowat F, Kaled S, Dybvik E, Kärrholm J, Garellick G, Havelin LI, Furnes O, Malchaug H, Lau E. Future clinical and economic impact of revision THA and TKA. J Bone Joint Surg 2007;89-B(Suppl 3): Fevang BT, Lie SA, Havelin LI, Brun JG, Skredderstuen A, Furnes O. 257 ankle arthroplasties performed in Norway between 1994 to Acta Orthop 2007;78: Figved W, Dybvik E, Frihagen F, Furnes O, Madsen JE, Havelin LI, Nordsletten L. Conversion from failed hemiarthroplasties to total hip arthroplasty. A Norwegian Arthroplasty Register analysis of 595 hips with previous femoral neck fractures. Acta Orthop 2007;78:

192 Report Arthursson A, Furnes O, Espehaug B, Havelin LI, Søreide JA. Prosthesis survival after total hip arthroplasty - does surgical approach matter? Analysis of Charnley and 6002 Exeter primary total hip arthroplasties reported to the Norwegian Arthroplasty Register. Acta Ortop 2007;78: Hallan G, Furnes O, Lie SA, Engesæter LB, Havelin LI. Medium and long-term performance of uncemented primary femoral stems from the Norwegian Arthroplasty register. J Bone Joint Surg 2007;89-B: Engesæter LB, Furnes O, Havelin LI. Developmental dysplasia of the hip good results of later total hip Arthroplasty: 7135 primary total hip arthroplasties after developmental dysplasia of the hip compared with total hip arthroplasties in idiopathic coxarthrosis followed for 0 to 15 years in the Norwegian Arthroplasty Register. J Arthroplasty 2008;23: Reigstad O, Siewers P, Røkkum M, Espehaug B. Excellent long-term survival of an uncemented press-fit stem an screw cup in young patients. Follow-up of 75 hips for years. Acta Ortop 2008;79: Engesæter IØ, Lie SA, Lehmann TG, Furnes O, Vollset SE, Engesæter LB. Neonatal hip instability and risk of total hip replacement in younger adulthood. Follow-up of 2,218,596 newborns from the Medical Birth Registry of Norway in the Norwegian Arthroplasty Register. Acta Orthop. 2008; 79: Hulleberg G, Aamodt A, Espehaug B, Benum P. A clinical and radiographic 13- year follow-up study of 138 Charnley hip arthroplasties in patients years old. Comparison of university hospital data and registry data. Acta Orthop. 2008; 79: Fevang BT, Lie SA, Havelin LI, Skredderstuen A, Furnes O. Risk factors for revision after shoulder arthroplasty shoulder arthroplasties from the Norwegian Arthroplasty Register. Acta Orthop. 2009;80:1, Fevang BT, Lie SA, Havelin LI, Skredderstuen A, Furnes O. Results after 562 total elbow replacements: A report from the Norwegian Arthroplasty Register. J Shoulder Elbow Surg. 2009;18: Cummins JS, Tomek IM, KantorSR, Furnes O, Engesaeter LB, Finlayson SR. Cost-effectiveness of antibiotic-impregnated bone cement used in primary total hip arthroplasty. J Bone Joint Surg Am Mar 1;91(3): Espehaug B, Furnes O, Engesæter LB, Havelin LI. 18 years of results with cemented primary hip prostheses in the Norwegian Arthroplasty Register. In press Acta Orthop Havelin LI, Fenstad AM, Salomonsson R, Mehnert F, Furnes O, Overgaard S, Pedersen AB, Herberts P, Kärrholm J, Garellick G. The Nordic Arthroplasty Register Association. A unique collaboration between 3 national hip arthroplasty registries with 280, 201 THRs. In press Acta Orthop

193 The Norwegian Cruciate Ligament Register 63. Granan LP, Engebretsen L, Bahr R. Kirurgi ved fremre korsbåndskader i Norge. Tidsskr Nor Lægeforen 2004;124: Granan LP, Engebretsen L, Bahr R. Kirurgi ved fremre korsbåndskader i Norge - sett fra et idrettsmedisinsk perspektiv. Norsk Idrettsmedisin 2004;4: Solumshengslet K, Granan LP, Furnes O, Steindal K, Engebretsen L. Registreringsgrad i Nasjonalt Korsbåndregister. Norsk Idrettsmedisin 2007;2:7, Granan LP, Bahr R, Steindal K, Furnes O, Engebretsen L. Development of a national cruciate ligament surgery registry the Norwegian National Knee Ligament registry. Am J Sports Med 2008;36: Moksnes H, Engebretsen L, Risberg MA. Performance-baced functional outcome for children 12 years or younger following anterior cruciate ligament injury: a two to nine-year follow-up study. Knee Surg Sports Traumatol Arthrosc, 16(3): Årøen A, Hjermundrud V, Kvist T, Engebretsen L, Risberg MA. Preoperatively no significant difference in functional scoring (KOOS) in anterior cruciate ligamentinjured knees with and without a full-thickness cartilage lesion. BJSM The Journal of Sport and Exercise Medicine, June 2008, Vol. 42, No Engebretsen L, Forssblad M. Why knee ligament registries are important. Knee Surg Sports Traumatol Arthrosc Feb;17(2): Granan LP, Bahr R, Lie SA, Engebretsen L. Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: a cohort study based on the Norwegian National Knee Ligament Registry. Am J Sports Med May;37(5): The Norwegian Hip Fracture Register 71. Gjertsen JE, Fevang J, Vinje T, Engesæter LB, Steindal K, Furnes O. Nasjonalt hoftebruddregister. Norsk Epidemiologi 2006;16: Gjertsen JE, Lie SA, Fevang J, Vinje T, Engesæter LB, Havelin LI, Furnes O. hip replacement after femoral neck fractures in elderly patients: results of 8,577 fractures reported to the Norwegian Arthroplasty Register. Acta Orthop 2007;78: Gjertsen JE, Vinje T, Lie SA, Engesæter LB, Havelin LI, Furnes O, Fevang J. A comparison of 663 fractures treated with internal screw fixation and 906 with bipolar hemiarthroplasty reported to the Norwegian Hip Fracture Register. Acta Orthop. 2008;79: Gjertsen JE, Vinje T, Furnes O, Engesæter LB, Havelin LI, Fevang J. The Norwegian Hip Fracture Register. Experiences after the first 2 years and 15,

194 Report 2009 reported operations. Acta Orthop. 2008;79: Clinical Studies 75. Hallan G, Lie SA, Havelin LI. High wear rates and extensive osteolysis in 3 types of uncemented total hip arthroplasty: a review of the PCA, the Harris Galante and the Profile/Tri-Lock Plus arthroplasties with a minimum of 12 years median followup in 96 hips. Acta Orthop 2006;77: Hallan G, Aamodt A, Furnes O, Skredderstuen A, Haugan K, Havelin LI. Palamed G compared with Palacos R with gentamicin in Charnley total hip replacement. A randomised, radiostereometric study of 60 hips. J Bone Joint Surg 2006;88- B: Textbooks and bookchapthers 1. Havelin LI. The Norwegian Arthroplasty Register. In: Jacob RP, Fulford P, Horan F, editors. European Instructional Course Lectures, Volume 4, London: The British Society of Bone and Joint Surgery, 1999: Furnes O, Havelin LI, Espehaug B. Effect of type of bone cement and antibiotic prophylaxis on early revision of cemented total hip replacement. Presentation from the Norwegian Arthroplasty Register In: Walenkamp GHIM, Murray DW, editors. Bone Cements and Cementing Technique. Heidelberg, Germany: Springer Verlag, Havelin LI, Espehaug B, Furnes O, Engesæter LB, Lie SA, Vollset SE. Register studies. In: Pynset P, Fairbank J, Carr A, editors. Outcome Measures in Orthopaedics and Orthopaedic Trauma. London, England: Edward Arnold ltd., 2004; Furnes O, Havelin LI, Espehaug B. Which cement should we choose for primary THA? In: The well-cemented total hip arthroplasty (eds. Breusch S J, Malchau H). Heidelberg, Germany. Springer Verlag Furnes O, Havelin LI, Espehaug B. Femoral components: Cemented stems for everybody? In: The well-cemented total hip arthroplasty (eds. Breusch S J, Malchau H). Heidelberg, Germany. Springer Verlag Engesæter LB. The Norwegian Hip register The influence of cement and antibiotics on the clinical results of primary prostheses. Chapter 16 in: Local Antibiotics in Arthroplasty. State of the art from an interdisciplinary point of view. Geert H.I.M Walenkamp (editor), Georg Thieme Verlag, Stuttgart, Germany Witsø E, Engesæter LB. Revision of infected total hip prostheses in Norway and Sweden. Chapter 15 in: Local Antibiotics in Arthroplasty. State of the art from an interdisciplinary point of view. Geert H.I.M Walenkamp (editor), Georg Thieme Verlag, Stuttgart, Germany

195 8. Havelin LI, Nordsletten L, Furnes O. Status og utfordringer for protesekirurgien i Norge 2007; in ed. Hole K. Norsk Ortopedisk Forening 60 år. ISBN Utgiver Tidsskr Nor Lægeforen Aamodt A, Furnes O, Lønne G. Protesekirurgi i hofte og kne. Legeforlaget ISBN Furnes O. Primære hofteproteser. Standard protese sementert eller usementert. Kap 1.10 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Havelin LI. Primære hofteproteser. Resurfacing. Kap 1.12 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Havelin LI. Primære hofteproteser. Finnes det dårlige proteser? Kap 1.13 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Furnes O. Primære kneleddsproteser. Anatomi og biomekanikk i kneleddet. Kap 3.1 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Furnes O. Primære kneleddsproteser. Skåringssystemer for kneleddsfunksjon. Kap 3.2 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Furnes O. Primære kneleddsproteser. Indikasjon for kneprotese. Kap 3.3 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Furnes O. Primære kneleddsproteser. Designprinsipper for kneproteser. Kap 3.5 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Furnes O. Primære kneleddsproteser. Valg av totalprotese i kne. Kap 3.6 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Furnes O. Primære kneleddsproteser. Nye teknikker: MIS og navigasjon. Kap 3.12 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Furnes O. Nasjonalt Register for Leddproteser. Historikk og organisering. Kap 5.1 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Havelin LI. Nasjonalt Register for Leddproteser. Resultater etter primære hofteproteser. Kap 5.2 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Havelin LI. Nasjonalt Register for Leddproteser. Resultater av sekundære hofteproteser. Kap 5.3 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Furnes O. Nasjonalt Register for Leddproteser. Resultater etter primære kneproteser. Kap 5.4 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Furnes O. Nasjonalt Register for Leddproteser. Resultater etter sekundære kneproteser. Kap 5.5 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN Havelin LI. Implantatlære. Artikulasjoner, overflatestruktur og coating. Kap 7.4 s i Aamodt A, Furnes O, Lønne G (ed) Protesekirurgi i hofte og kne. Legeforlaget ISBN

196 Report 2009 Scientific exhibitions The Norwegian Arthroplasty Register 1. Havelin LI, Espehaug B, Lie SA, Engesæter LB, Furnes O, Vollset SE. Prospective studies of hip prostheses and cements. A presentation of the Norwegian Arthroplasty Register Scientific exhibition presented at the 67 th Annual Meeting of the American Academy of Orthopaedic Surgeons, March 15-19, 2000, Orlando, USA. 2. Furnes O, Espehaug B, Lie SA, Engesæter LB, Vollset SE, Hallan G, Fenstad AM, Havelin LI. Prospective studies of hip and knee prostheses. The Norwegian Arthroplasty Register Scientific exhibition presented at the 72nd Annual Meeting of the American Academy of Orthopaedic Surgeons, February 23-27, 2005, Washington DC, USA. Abstracts and lectures 2008 June 2009 The Norwegian Arthroplasty Register 1. Furnes O. Protesekirurgi hvor står vi i dag? Strykers protesemøte; januar; Lillehammer. 2. Furnes O. Exeter overlevelsesdata fra leddregisteret. Strykers protesemøte; januar; Lillehammer. 3. Furnes O, Havelin LI. Unicondylar or Knee Arthroplasty? What can Registries tell us? AAOS; 2008 February 6; San Francisco, CA. 4. Furnes O. Betyr sykehus og operatør noe for resultatene av Charnley protesen. Charnleys praktiske hoftekurs; februar; Ålesund. 5. Furnes O. Skal diagnose og alder påvirke valg av protese. Charnleys praktiske hoftekurs; februar; Ålesund. 6. Furnes O. Infeksjonsprofylakse. Charnleys praktiske hoftekurs; februar; Ålesund. 7. Havelin LI, Salomonsson R, Fenstad AM, Mehnert F, Furnes O, Overgaard S, Herberts P, Kärrholm J, Garellick G. The Nordic arthroplasty register association. The first report from a unique collaboration. Nordic Orthopaedic Federation, 54 rd Congress; 2008 June ; Amsterdam, Netherland. 8. Havelin LI, Dybvik E, Hallan G, Furnes O. Metal-on-metal hips in the Norwegian Arthroplasty Register. Nordic Orthopaedic Federation, 54 rd Congress; 2008 June ; Amsterdam, Netherland. 184

197 9. Hallan G, Dybvik E, Furnes O, Havelin LI. Modular uncemented acetabular cups with UHMW polyethylene liners. Results from the Norwegian Arthroplasty Register. Nordic Orthopaedic Federation, 54 rd Congress; 2008 June ; Amsterdam, Netherland. 10. Dybvik E, Hallan G, Furnes O, Havelin LI. Ceramic-on-ceramic hips in the Norwegian Arthroplasty Register. Nordic Orthopaedic Federation, 54 rd Congress; 2008 June ; Amsterdam, Netherland. 11. Lygre SHL, Espehaug B, Havelin LI, Vollset SE, Furnes O. Does patella resurfacing matter? Pain and function in 1259 patients with primary total knee replacement. Nordic Orthopaedic Federation, 54 rd Congress; 2008 June ; Amsterdam, Netherland. 12. Dale H, Espehaug B, Havelin LI, Engesæter LB. The impact of changed antibiotic prophylaxis on revision risk of THAs. Nordic Orthopaedic Federation, 54 rd Congress; 2008 June ; Amsterdam, Netherland. 13. Havelin LI, Dybvik E, Hallan G, Furnes O, Engesæter LB. Survival of metal-onmetal total hip protheses in the Norwegian Arthroplasty register. At the meeting of the International Hip Society/SICOT; 2008 August 25; Hong Kong. 14. Espehaug B. Forskningsmuligheter med utgangspunkt I leddproteseregisterdata- Nasjonalt register for leddproteser. Forskningsnettverk innen pasientsikkerhet. Nasjonalt kunnskapssenter for helsetjenesten. 2008; 11. september; Oslo. 15. Blomquist J, Solheim E, Havelin L. Registrering av skulderstabiliserende kirurgi. Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. 16. Espehaug B, Furnes O, Engesæter LB, Havelin LI. Stor variasjon i revisjonsrisiko for sementerte hofteproteser En studie av primære totalproteser. Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. 17. Havelin LI, Fenstad AM, Furnes O, Salomonsson R, Mehnert F, Overgaard S, Pedersen A, Herberts P, Kärrholm J, Garellick G. The Nordic Arthroplasty register association. Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. 18. Havelin LI. Offentlige sykehusvise rapporter, jeg er imot. Symposium Nasjonalt Register for Leddproteser (NRL). Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. 19. Dale H, Hallan G, Espehaug B, Havelin LI, Engesæter LB. Økende risiko for revisjon på grunn av dyp infeksjon etter insetting av hofteprotese. Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. 20. Langvatn H, Schrama JC, Lutro O, Hallan G, Dale H, Espehaug B, Engesæter LB. Studie på mikrobiologi ved infiserte hofteproteser. Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. 21. Apold H, Meyer H, Nordsletten L, Espehaug B, Havelin L, Flugsrud G. Spontan vektendring og risiko for totalprotese i hoften. Høstmøtet i Norsk Ortopedisk 185

198 Report 2009 Forening; oktober; Oslo. 22. Dybvik E, Furnes O, Fosså SD, Trovik C, Lie SA. Langtids risiko for total hofteprotese hos kreftpasienter. En kobling mellom leddproteseregisteret og kreftregisteret. Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. 23. Lygre SH, Espehaug B, Havelin L, Vollset SE, Furnes O. Smerte og funksjon hos pasienter med totale og unikondylære kneproteser. Høstmøtet i Norsk Ortopedisk Forening. Oslo, oktober Skredderstuen A, Fevang BTS, Lie SA, Havelin LI, Furnes O. Resultater ved 562 albueproteser. En rapport fra Nasjonalt Register for Leddproteser. Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. 25. Engesæter LB, Lehmann TG, Engesæter IØ, Espehaug B. Hofteproteser etter barnehoftelidelser Protesevalget er viktigere enn primærlidelsen. Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. 26. Havelin LI, Hallan G, Lie SA, Furnes O, Dybvik E. Results from the Norwegian Arthroplasty Register , with focus on uncemented femoral stems. Read at the meeting of the Corail Society; 2008 October 30; Annecy, France. 27. Havelin LI. Hvilken nytte har faget hatt av vårt register? Legeforeningens fagkonferanse; november; Gardemoen. 28. Havelin LI, Fenstad AM, Furnes O, Overgaard S, Pedersen A, Herberts P, Kärrholm J, Garellick G. A Scandinavian hip Arthroplasty Register Collaboration. AAOS meeting; 2009 February; Las Vegas, USA. 29. Espehaug B. Exeter survivaldata in the Register. Scientific Evaluation, Exeter 25 years at Martina Hansens Hospital; 2009 May 6; Holmen Fjordhotel, Asker. 30. Espehaug B. Bone Impaction Grafting vs Uncemented Revisions. Scientific Evaluation, Exeter 25 years at Martina Hansens Hospital; 2009 May 6; Holmen Fjordhotel, Asker. 31. Havelin LI. The Norwegian Arthroplasty Register. Background, methods and results. EFORT Spring Travelling Fellowship in Norway; 2009 May 11; Bergen. 32. Espehaug B. Results of cemented primary total hip arthroplasty. EFORT Spring Travelling Fellowship in Norway; 2009 May 11; Bergen. 33. Dale H. Presentasjon av Nasjonalt register for leddproteser. Nasjonalt møte for leger i spesialisering i spesialiteten Fysikalsk medisin og rehabilitering. Interaktivt foredrag; mai; Bergen. 34. Havelin LI, Fenstad AM, Furnes O, Overgaard S, Pedersen A, Herberts P, Kärrholm J, Garellick G. The Nordic Arthroplasty Register Association. A unique collaboration of three national hip Arthroplasty registries with 280, 201 THRs. In abstract from the 10 th EFORT Congress; 2009, June 3 6; Vienna. 186

199 35. Espehaug B, Furnes O, Engesæter LB, Havelin LI. Satisfactory 20 years results for cemented primary hip prostheses in the Norwegian Arthroplasty Register but concern is raised over some of the newer implants. 10 th EFORT Congress; 2009, June 3 6; Vienna. 36. Lygre S H, Espehaug B, Furnes O, Havelin L I, Vollset S E. Unicompartemental vs total knee arthoplasty. Pain and function in 1643 patients with primary knee arthroplasty reported to the Norwegian Arthroplasty Register. 10 th EFORT Congress; 2009, June 3 6; Vienna. 37. Dybvik E, Furnes O, Fosså SD, Trovik C, Lie SA. Long term risk for receiving a total hip replacement in cancer patients. A linkage study between The Cancer Register of Norway and The Norwegian Arthroplasty Register. 10 th EFORT Congress; 2009, June 3 6; Vienna. The Norwegian Cruciate Ligament Register 38. Engebretsen L. Kneskader hos barn. Kne- og idrettstraumer. Universitetskurs; januar. 39. Engebretsen L. Epidemiologi: ACL-registry. Non-contact ACL-injuries in the Female Athlete Consensus Meeting, IOC; 2008 February 7; Lausanne. 40. Engebretsen L. PCL reconstruction. 5 th World Congress of Sports Trauma & 6 th Asia-Pacific Orthopaedic Society for Sports Medicine Meeting. Asia-Pacific Orthopaedic Society for Sports Medicine Asian Shoulder Association; 2008 April Engebretsen L. Introduction and state of the art. 13 th ESSKA 2000 Congress; 2008 May 22; Porto, Portugal. 42. Granan LP. Symposium: The potential impact of the Scandinavian Knee Ligament Registries Scandinavia. The results from the Norwegian Registry. 13 th ESSKA 2000 Congress; 2008 May 22; Porto, Portugal. 43. Engebretsen L. Symposium: Return to sport following anterior cruciate ligament injury International Convention on Science, Education and Medicine in Sport. IC SEMIS; 2008 August 1 4; Guangzhou, China. 44. Engebretsen L. Symposium: Prevention of sports injuries International Convention on Science, Education and Medicine in Sport. IC SEMIS; 2008 August 1 4; Guangzhou, China. 45. Engebretsen L. Keynote Lecture: Prevention through sport and exercise: an economic and health impact. Sportsmedica th EISCSA Congress; 2008 October Engebretsen L. Offentlige sykehusvise rapporter, jeg er for. Symposium Nasjonalt Register for Leddproteser (NRL). Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. 187

200 Report Granan LP, Bahr R, Lie SA, Engebretsen L. Timing av korsbåndkirurgi. Artroskopi symposium på Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. 48. Granan LP. Nasjonalt Korsbåndregister. Artroskopi symposium på Høstmøtet i Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. 49. Engebretsen L. Research on ACL Injury Incidence & Prevention in Norway. Hawkeye Sports Medicine Symposium & Iowa Orthopaedic Society Fall Meeting; 2008 December 5 6; University of Iowa. The Norwegian Hip Fracture Register 50. Matre K, Havelin LI, Furnes O, Engesæter LB, Gjertsen JE, Vinje T, B Espehaug, Fevang J. Factors influencing 1-year mortality in trochanteric and subtrochanteric fractures. Nordic Orthopaedic Federation, 54 rd Congress; 2008 June 11 13; Amsterdam, Netherland. 51. Engesæter LB, Espehaug B, Vinje T, Gjertsen JE, Fevang J, Furnes O, Havelin LI. Femoral neck fractures no relation between time from fracture until operation and risk for reoperation or for death. Results from 8038 femoral neck fractures reported to the Norwegian hip fracture register. Nordic Orthopaedic Federation, 54 rd Congress; 2008 June 11 13; Amsterdam, Netherland. 52. Gjertsen JE, Vinje T, Lie SA, Engesæter LB, Havelin LI, Furnes O, Matre K, Fevang J. Quality of life pain and patient satisfaction four and twelve months after displaced femoral neck fracture hemiarthroplasty versus internal screw fixation. Nordic Orthopaedic Federation, 54 rd Congress; 2008 June 11 13; Amsterdam, Netherland. 53. Meling T, Matre K, Gjertsen JE, Engesæter L. Intertrokantær vs subtrokantær fraktur Hva er forskjellen og hvorfor bør man skille mellom disse? Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. Clinical Studies 54. Kadar T, Hallan G, Aamodt A, Haugan K, Indrekvam K, Bierling R, Birketvedt R, Badawy M, Skredderstuen A, Stokke T, Havelin LI, Furnes O. En randomisert RSA-studie av to sementerte hofteproteser mellom 5 ulike artikulasjoner: Koppslitasje etter 2 års oppfølging. Høstmøtet i Norsk Ortopedisk Forening; oktober; Oslo. 188

201 Report 2009 Furnes O, Havelin LI, Espehaug B, Steindal K, Sørås TE. The Norwegian Arthroplasty Register. Report ISBN , ISSN Bergen, Norway: Other 1. Skeide, BI. protese etter fractura colli femoris. Særoppgave for stud.med. September SAMDATA Sykehus Rapport Sykehussektoren på 1990-tallet. Sterk vekst stabile fylkesvise forskjeller. ISBN SINTEF Unimed NIS SAMDATA NIS-rapport 1/100 Sept Havelin LI. Fraktur av Zirkonium femurhoder. Norsk Ortopedpost 2001; 3: Eikrem, M. Vakuum miksing av sement og overlevelse av hofteproteser. Særoppgave for stud.med. Oktober Furnes O. Brekkasje av Duracon Posterior Stabilised (PS) tibia polyethylene gammasterilisert i luft. Norsk Ortopedpost 2002; 1: Havelin LI. Melding fra Helsetilsynet og Leddproteseregisteret. Norsk Ortopedpost 2002; 1: Furnes O. 15 år med hofteregisteret - Nasjonalt Register for leddproteser. Kirurgen 1/ Furnes O. 15 år med hofteregisteret - Nasjonalt Register for leddproteser. Norsk Ortopedpost 1/ RIKSREVISJONEN. Dokument nr. 3:3 ( ). Riksrevisjonens undersøkelse av effektivitet i sykehus en sammenligning av organiseringen av hofteoperasjoner. November Engesæter IØ. Neonatal Hofteinstabilitet og risiko for senere coxartrose. Særoppgave for stud.med. Mai Furnes O. De nye hofte-og kneprotese registreringsskjemaene. Norsk Ortopedpost 2006;1: Furnes O. Forbedringen av resultatene for Charnley hofteprotese over tid. Hva et opplæringsprogram for kirurgene har betydd. OrtoMedia nr.60 september 2006: Granan LP. Norwegian National Knee Ligament Registry. Forskerlinjeoppgave desember Hættea AM, Hættea EM, Steindal K, Engebretsen L. Insidensen av korsbåndskader hos fotballspillere I Norge- en sammeligning mellom kvinnelige og mannlige utøvere. Masteroppgave, Medisinsk fakultet UiO

202 Nasjonalt Register for Leddproteser Report 2009Ortopedisk klinikk, Helse Bergen HF Haukeland Universitetssykehus Møllendalsbakken BERGEN tlf / HOFTEPROTESER F.nr. (11 sifre)... Navn:... (Skriv tydelig ev. pasient klistrelapp spesifiser sykehus.) Sykehus:... ALLE TOTALPROTESER I HOFTELEDD REGISTRERES (ved hemiproteser etter hoftebrudd sendes hoftebruddskjema til Hoftebruddregisteret). Innsetting, skifting eller fjerning av protese eller protesedeler. TIDLIGERE OPERASJON I AKTUELLE HOFTE (ev. flere kryss) 0 Nei 1 Osteosyntese for fraktur i prox. femurende 2 Hemiprotese pga. fraktur 3 Osteotomi 4 Artrodese 5 protese(r) 6 Annen operasjon. OPERASJONSDATO (dd.mm.åå) AKTUELLE OPERASJON (ett kryss) 1 Primæroperasjon (også hvis hemiprotese tidligere) 2 Reoperasjon (totalprotese tidligere) AKTUELLE SIDE (ett kryss) (Bilateral opr.= 2 skjema) 1 Høyre 2 Venstre AKTUELLE OPERASJON (KRYSS AV ENTEN I A ELLER B) A. Primæroperasjon pga. (ev. flere kryss) 1 Idiopatisk coxartrose 2 Rheumatoid artritt 3 Sekvele etter frakt. colli. fem. 4 Sekv. dysplasi 5 Sekv. dysplasi med total luksasjon 6 Sekv. Perthes/Epifysiolyse 7 Mb. Bechterew 8 Akutt fraktura colli femoris Annet (f.eks caputnekrose, tidl. artrodese o.l) B. Reoperasjon pga. (ev. flere kryss) 1 Løs acetabularkomponent 2 Løs femurkomponent 3 Luksasjon 4 Dyp infeksjon 5 Fraktur (ved protesen) 6 Smerter 7 Osteolyse i acetab. uten løsning 8 Osteolyse i femur uten løsning Annet.. (f.eks Girdlestone etter tidl. infisert protese) REOPERASJONSTYPE (ev. flere kryss) 1 Bytte av femurkomponent 2 Bytte av acetabularkomponent 3 Bytte av hele protesen 4 Fjernet protese (f.eks Girdlestone) Angi hvilke deler som ble fjernet. 5 Bytte av plastforing 6 Bytte av caput Andre operasjoner TILGANG (ett kryss) 1 Fremre (Smith-Petersen) 3 Lateral 2 Anterolateral 4 Posterolateral 5 Annen.. LEIE 0 Sideleie 1 Rygg TROCHANTEROSTEOTOMI 0 Nei 1 Ja BENTRANSPLANTASJON (ev. flere kryss) Acetabulum 0 Nei 1 Ja 2 Benpakking Femur 0 Nei 1 Ja 2 Benpakking a.m. Ling/Gie BENTAP VED REVISJON (Paprosky s klassifikasjon se baksiden) Acetabulum Femur 1 Type I 4 Type II C 1 Type I 4 Type III B 2 Type II A 5 Type III A 2 Type II 5 Type IV 3 Type II B 6 Type III B 3 Type III A 190 PROTESE NAVN / DESIGN / COATING (spesifiser nøyaktig eller bruk klistrelapp på baksiden) Acetabulum Navn/Type. ev. katalognummer. Med hydroksylapatitt Uten hydroksylapatitt 1 Sement med antibiotika Navn. 2 Sement uten antibiotika Navn. 3 Usementert Femur Navn/Type. ev. katalognummer. Med hydroksylapatitt Uten hydroksylapatitt 1 Sement med antibiotika Navn. 2 Sement uten antibiotika Navn. 3 Usementert Caput 1 Fastsittende caput 2 Separat caput - Navn/Type. ev. katalognummer. Diameter MINI INVASIV KIRURGI (MIS) 0 Nei 1 Ja COMPUTERNAVIGERING (CAOS) 0 Nei 1 Ja Type navigering.. TROMBOSEPROFYLAKSE 0 Nei 1 Ja, hvilken type Dosering opr.dag..første dose gitt preopr 0 Nei 1 Ja Senere dosering.antatt varighet.. døgn Ev. i kombinasjon med Dosering.... Antatt varighet... døgn Strømpe 0 Nei 1 Legg 2 Legg + Lår Antatt varighet.. døgn Mekanisk pumpe 0 Nei 1 Fot 2 Legg Antatt varighet...døgn SYSTEMISK ANTIBIOTIKAPROFYLAKSE 0 Nei 1 Ja, hvilken (A)... Dose (A)... t antall doser... Varighet...timer Ev. i kombinasjon med (B)... Dose (B)...t antall doser... Varighet...timer OPERASJONSSTUE 1 Green house 2 Operasjonsstue med laminær luftstrøm 3 Vanlig operasjonsstue OPERASJONSTID (hud til hud) min PEROPERATIV KOMPLIKASJON 0 Nei 1 Ja,hvilke(n)... ASA KLASSE (se baksiden for definisjon) 1 Frisk 2 Asymptomatisk tilstand som gir økt risiko 3 Symptomatisk sykdom 4 Livstruende sykdom 5 Moribund Lege... Legen som har fylt ut skjemaet (navnet registreres ikke i databasen). Bergen Grafisk as

203 RETTLEDNING TIL HOFTEPROTESER Registreringen gjelder innsetting, skifting og fjerning av totalproteser i hofteledd. Ett skjema fylles ut for hver operasjon. Pasientens fødselsnummer (11sifre) og sykehus må være påført. Aktuelle ruter markeres med kryss. Pasientene skal på eget skjema gi samtykke til registrering i Leddregisteret, samtykkeskjema skal lagres i pasientjournalen. Kommentarer til de enkelte punktene AKTUELLE OPERASJON Kryss av enten i A eller B.I B må en krysse av for alle årsakene til reoperasjon, eller forklare dette med tekst på linjen. REOPERASJONSTYPE Fjerning av protesedeler (f.eks. Girdlestone opr.) må føres opp. BENTRANSPLANTASJON Benpropp som sementstopper regnes ikke som bentransplantat. PROTESE. Acetabulum. Her anføres kommersielle navn, materiale, størrelse og design, f.eks. Ceraver, Titan, 50 mm, skru. Eller f.eks. Charnley, large, OGEE, LPW. Vær nøye med å anføre om protesen har belegg av f.eks. hydroksylapatitt. Alternativt kan en benytte klistrelapp som følger med de fleste protesene eller føre opp protesenavn og katalognr.,. Klistrelappen bør helst limes på baksiden av skjemaet (vennligst ikke plasser klistrelapper på markeringskryss, som brukes ved scanning av skjema). Navnet på sementen må anføres, f.eks. Simplex Erythromycin/colistin. PROTESE. Femur Utfylles tilsvarende, f.eks. Charnley, flanged 40 og eventuelt anføres spesialutførelse som long neck, magnum, long stem, krage etc. Alternativt kan en benytte klistrelapp som følger med de fleste protesene eller føre opp protesenavn og katalognr (på baksiden av skjema). Sementnavn må anføres. PROTESE. Caput Ved separat caput (evt. også separat collum) må navn, materiale, diameter, halslengde og lateralisering anføres. F.eks. Ceraver, keramikk, 32 mm, standard neck. Alternativt anføres bare protesenavn og katalognr., eller en benytter klistrelapp fra produsenten. KOMPLIKASJONER Dersom det foreligger komplikasjon i form av stor blødning, må mengden angis. Vi ønsker også meldt pasienter som dør på operasjonsbordet eller rett etter operasjon. ASA-KLASSE American Society of Anesthesiologists klassifikasjon ASA-klasse 1: Friske pasienter som ikke røker ASA-klasse 2: Pasienter som har asymptomatisk tilstand som behandles medikamentelt, som for eksempel hypertensjon eller med kost (diabetes mellitus type 2) og ellers friske pasienter som røker ASA-klasse 3: Pasienter med tilstand som kan gi symptomer, men som holdes under kontroll medikamentelt for eksempel moderat angina pectoris og mild astma ASA-klasse 4: Pasienter med tilstand som ikke er under kontroll, for eksempel hjertesvikt og astma ASA-klasse 5: Moribund/døende pasient. Skal normalt ikke forekomme i vår pasientgruppe som er opererte pasienter COMPUTERNAVIGERING (CAOS = Computer Aided Orthopaedic Surgery.) Vi ber om å få angitt type computernavigeringsutstyr som CT-veiledet, rtg. gjennomlysningveiledet eller andre teknikker som bruk av hofteleddets sentrum. MINIINVASIV KIRURGI (MIS = Minimally Invasive Surgery) Her menes at kirurgen har brukt kort snitt pluss at det er brukt spesialinstrument laget for MIS SYSTEMISK ANTIBIOTIKAPROFYLAKSE Her føres det på hvilket antibiotikum som er blitt benyttet i forbindelse med operasjonen. Det anføres hvor stor dose, hvor mange doser og profylaksens varighet. Hvis en f.eks. kun har gitt 2g Keflin 4 ganger operasjonsdagen med 4 timers mellomrom dvs. 12 timer mellom første og siste dose, så angis det i skjema: Hvilken (A) Keflin Dose(A) 2g t antall doser 4 Varighet 12 timer. BEINTAP VED REVISJON Femur (Paprosky`s klassifikasjon) Type I: Minimalt tap av metafysært ben og intakt diafyse. Type II: Stort tap av metafysært ben, men intakt diafyse. Type IIIA: Betydelig tap av metafysært ben uten mulighet for proximal mekanisk støtte. Over 4 cm intakt corticalis i isthmusområdet. Type IIIB: Betydelig tap av metafysært ben uten mulighet for proximal mekanisk støtte. Under 4 cm intakt corticalis i isthmusområdet. Type IV: Betydelig tap av metafysært ben uten mulighet for proximal mekanisk støtte. Bred isthmus med liten mulighet for cortical støtte. Acetabulum (Paprosky`s klassifikasjon) Type I: Hemisfærisk acetabulum uten kantdefekter. Intakt bakre og fremre kolonne. Defekter i forankringshull som ikke ødelegger den subchondrale benplate. Type IIA: Hemisfærisk acetabulum uten store kantdefekter, intakt bakre og fremre kolonne, men med lite metafysært ben igjen. Type IIB: Hemisfærisk acetabulum uten store kantdefekter, intakt bakre og fremre kolonne, men med lite metafysært ben igjen og noe manglende støtte superiort. Type IIC: Hemisfærisk acetabulum uten store kantdefekter, intakt bakre og fremre kollonne, men med defekt i medial vegg. Type IIIA: Betydelig komponentvandring, osteolyse og bentap. Bentap fra kl. 10 til 2. Type IIIB: Betydelig komponentvandring, osteolyse og bentap. Bentap fra kl. 9 til 5. Kopi beholdes til pasientjournalen, originalen sendes Haukeland Universitetssykehus. Kontaktpersoner vedrørende registreringsskjema er Overlege Leif Ivar Havelin, tlf.: og klinikkoverlege Ove Furnes, tlf.: Ortopedisk klinikk, Haukeland Universitetssykehus. Besøksadresse: Møllendalsbakken 11. Sekretærer i Nasjonalt Register for Leddproteser, Ortopedisk klinikk, Helse Bergen: Ingunn Vindenes, tlf.: og Ruth Wasmuth, tlf.: eller Sentralbordet, Haukeland Universitetssykehus: Fax: Epost Ingunn Vindenes: ingunn.elin.vindenes@helse-bergen.no Internet: 191

204 Nasjonalt Register for Leddproteser Report 2009 Ortopedisk klinikk, Helse Bergen HF Haukeland Universitetssykehus Møllendalsbakken BERGEN tlf / KNEPROTESER og andre leddproteser Innsetting, skifting eller fjerning av protese eller protesedeler. F.nr. (11 sifre)... Navn:... (Skriv tydelig ev. pasient klistrelapp spesifiser sykehus.) Sykehus:... LOKALISASJON, AKTUELL OPERASJON 1 Kne 6 Håndledd 2 Ankel 7 Fingre (angi ledd). 3 Tær (angi ledd).. 8 Annet.. 4 Skulder 9 Rygg (angi nivå).. 5 Albue AKTUELLE SIDE (ett kryss) (Bilateral opr. = 2 skjema) 1 Høyre 2 Venstre TIDLIGERE OPERASJON I AKTUELLE LEDD (ev. flere kryss) 0 Nei 1 Osteosyntese for intraartikulær/leddnær fraktur 2 Osteotomi 3 Artrodese 4 Protese 5 Synovectomi 6 Annet (f.eks menisk og leddbåndsop.). OPERASJONSDATO (dd.mm.åå) AKTUELLE OPERASJON (ett kryss) 1 Primæroperasjon 2 Reoperasjon (protese tidligere) AKTUELLE OPERASJON (KRYSS AV ENTEN I A ELLER B) A. Primæroperasjon pga. B. Reoperasjon pga. (ev. flere kryss) (ev. flere kryss) 1 Idiopatisk artrose 1 Løs prox.protesedel 2 Rheumatoid artritt 2 Løs distal protesedel 3 Fraktursequele 3 Løs patellaprotese 4 Mb. Bechterew 4 Luksasjon av patella 5 Sequele ligamentskade 5 Luksasjon (ikke patella) 6 Sequele meniskskade 6 Instabilitet 7 Akutt fraktur 7 Aksefeil 8 Infeksjonssequele 8 Dyp infeksjon 9 Spondylose 9 Fraktur (nær protesen) 10 Sequele prolaps kirurgi 10 Smerter 11 Degenerativ skivesykdom 11 Defekt plastforing 12 Annet Hvilken. 12 Annet (f.eks tidl fjernet prot.) REOPERASJONSTYPE (ev. flere kryss) 1 Bytte av distal komponent 6 Fjernet protesedeler 2 Bytte av proximal protesedel Angi hvilke deler.. 3 Bytte av hele protesen... 4 Bytte av patellaprotese 7 Annet 5 Bytte av plastforing Insetting av patellakomp. (f.eks tibia, ulna, humerus) BENTRANSPLANTASJON (ev. flere kryss) Proximalt 0 Nei 1 Ja 2 Benpakking Distalt 0 Nei 1 Ja 2 Benpakking SYSTEMISK ANTIBIOTIKAPROFYLAKSE 0 Nei 1 Ja, Hvilken (A)... Dose (A)....t antall doser......varighet....timer Ev. i kombinasjon med (B)... Dose (B)......t antall doser......varighet......timer OPERASJONSTID (hud til hud) minutter PEROPERATIV KOMPLIKASJON 0 Nei 1 Ja,hvilke(n)... TROMBOSEPROFYLAKSE 0 Nei 1 Ja, hvilken type Dosering opr.dag.første dose gitt preopr 0 Nei 1 Ja Senere dosering.antatt varighet.. døgn Ev. i kombinasjon med Dosering.... Antatt varighet... døgn Strømpe 0 Nei 1 Legg 2 Legg + Lår Antatt varighet.. døgn Mekanisk pumpe 0 Nei 1 Fot 2 Legg Antatt varighet...døgn MINI INVASIV KIRURGI (MIS) 0 Nei 1 Ja COMPUTERNAVIGERING 192 (CAOS) 0 Nei 1 Ja Type navigering.. ASA KLASSE (se baksiden for definisjon) 1 Frisk 2 Asymptomatisk tilstand som gir økt risiko 3 Symptomatisk sykdom 4 Livstruende sykdom 5 Moribund PROTESE, NAVN, TYPE (spesifiser nøyaktig eller bruk ev. klistrelapp på baksiden) KNE PROTESETYPE 1 prot. m/patella 3 Unicondylær prot. 4 Patellofemoralledd prot. 2 prot. u/patella Medial Lateral FEMUR KOMPONENT Navn/Type/Str... ev. katalognummer. Sentral stamme 0 Nei 1 Ja, ev. lengde.mm Metallforing 0 Nei 1 Ja Stabilisering 0 Nei 1 Ja, bakre 2 Ja, annen 1 Sement med antibiotika Navn. 2 Sement uten antibiotika Navn. 3 Usementert TIBIAKOMPONENT (metallplatå) Navn/Type/Str... ev. katalognummer. Stabiliseringsplugger 0 Nei 1 Ja,plast 2 Ja,metall 3 Ja,1 + 2 Forlenget sentral stamme 0 Nei 1 Ja, ev. lengde mm Metallforing 0 Nei 1 Ja 1 Sement med antibiotika Navn. 2 Sement uten antibiotika Navn. 3 Usementert TIBIA KOMPONENT (plastkomponent) Navn/Type/Str.. ev. katalognummer.. Tykkelse.. mm Stabilisering 0 Nei 1 Ja, bakre 2 Ja, annen PATELLA KOMPONENT Navn/Type/Str... ev. katalognummer. Metallrygg 0 Nei 1 Ja 1 Sement med antibiotika Navn. 2 Sement uten antibiotika Navn. 3 Usementert KORSBÅND Intakt fremre korsbånd før operasjon 0 Nei 1 Ja Intakt fremre korsbånd etter operasjon 0 Nei 1 Ja Intakt bakre korsbånd før operasjon 0 Nei 1 Ja Intakt bakre korsbånd etter operasjon 0 Nei 1 Ja ANDRE LEDD PROTESETYPE 1 protese 2 Hemiprotese 3 Enkomponentprotese PROKSIMAL KOMPONENT Navn/Type/Str. ev. katalognummer. 1 Sement med antibiotika Navn. 2 Sement uten antibiotika Navn. 3 Usementert DISTAL KOMPONENT Navn/Type/Str... ev. katalognummer. 1 Sement med antibiotika Navn. 2 Sement uten antibiotika Navn. 3 Usementert INTERMEDIÆR KOMPONENT (f.eks. caput humeri) Navn/Type/Str/Diameter. ev. katalognummer. Lege... Legen som har fylt ut skjemaet (navnet registreres ikke i databasen). Bergen Grafisk as

205 RETTLEDNING KNEPROTESER og andre leddproteser Registreringen gjelder innsetting, skifting eller fjerning av protese i kne, skuldre og andre ledd med unntak av hofter som har eget skjema. Ett skjema fylles ut for hver operasjon. Pasientens fødselsnummer (11 sifre) og sykehus må være påført. Aktuelle ruter markeres med kryss. Pasienten skal på eget skjema gi samtykke til registrering, samtykkeskjemaet skal lagres i pasientjournalen. Kommentarer til de enkelte punktene AKTUELLE OPERASJON Kryss av enten i A eller i B. Kryss av for alle årsakene til operasjonen. REOPERASJONSTYPE Fjerning av protesedeler må spesifiseres og føres opp, også fjerning ved infeksjon. BENTRANSPLANTASJON Påsmøring av benvev rundt protesen regnes ikke som bentransplantat. SYSTEMISK ANTIBIOTIKAPROFYLAKSE Her føres det på hvilket antibiotikum som er blitt benyttet i forbindelse med operasjonen. Det anføres hvor stor dose, hvor mange doser og profylaksens varighet. Hvis en f.eks. kun har gitt 2g Keflin 4 ganger operasjonsdagen med 4 timers mellomrom dvs. 12 timer mellom første og siste dose, så angis det i skjema: Hvilken (A) Keflin Dose(A) 2g t antall doser 4 Varighet 12 timer. PEROPERATIV KOMPLIKASJON Dersom det foreligger komplikasjon i form av stor blødning, må mengden angis. Dersom pasienten dør under eller like etter operasjonen, ønsker vi også melding om operasjonen. ASA-KLASSE American Society of Anesthesiologists klassifikasjon ASA-klasse 1: Friske pasienter som ikke røker ASA-klasse 2: Pasienter som har asymptomatisk tilstand som behandles medikamentelt, som for eksempel hypertensjon eller med kost (diabetes mellitus type 2) og ellers friske pasienter som røker ASA-klasse 3: Pasienter med tilstand som kan gi symptomer, men som holdes under kontroll medikamentelt for eksempel moderat angina pectoris og mild astma ASA-klasse 4: Pasienter med tilstand som ikke er under kontroll, for eksempel hjertesvikt og astma ASA-klasse 5: Moribund/døende pasient. PROTESETYPE Dersom det er gjort revisjon av totalprotese uten patellakomponent og REOPERASJONSTYPE er pkt. 7: innsetting av patellakomponent, skal det krysses av for pkt. 1: protese med patellakomponent (dvs. protesen har nå blitt en totalprotese med patellakomponent). Ved revisjon av unicondylær protese til totalprotese brukes enten pkt. 1 eller 2. PROTESEKOMPONENTER Her anføres kommersielle navn, materiale, størrelse og design. Vær nøye med å anføre om protesen har belegg av f.eks. hydroksylapatitt. Alternativt kan en føre opp protesenavn og katalognummer eller benytte klistrelapp som følger med de fleste protesene. Denne kan limes på baksiden av skjemaet (vennligst ikke plasser klistrelapper på markeringskryss, som brukes ved scanning av skjema). Navnet på sementen som evt. brukes må anføres, f.eks. Palacos m/gentamicin. Under femurkomponent skal evt. påstøpt/påsatt femurstamme anføres med lengde. Med metallforing under femur og tibia komponent menes bruk av en eller flere separate metallkiler (wedges) som erstatning for manglende benstøtte. Stabilisering er bruk av proteser med stabilisering som kompensasjon for sviktende båndapparat. Forlenget sentral stamme under tibiakomponent (metallplatå) skal bare anføres ved bruk av en lengre påstøpt/påsatt stamme enn standardkomponenten. ANDRE LEDD. PROTESETYPE Ved bruk av hemiprotese med bare en komponent, f.eks. i skulder, skrives dette på DISTAL KOMPONENT. Dersom det er en separat caputkomponent, føres denne på INTERMEDIÆR KOMPONENT. Enkomponent-protese i finger/tå, skrives på PROKSIMAL KOMPONENT. COMPUTERNAVIGERING (CAOS = Computer Aided Orthopaedic Surgery) Vi ber om å få angitt type computernavigeringsutstyr som CT-veiledet, rtg. gjennomlysningveiledet eller andre teknikker som bruk av hofteleddets sentrum. MINI INVASIV KIRURGI (MIS = Minimally Invasive Surgery) Her menes at kirurgen har brukt kort snitt pluss at det er brukt spesialinstrument laget for MIS. Kopi beholdes til pasientjournalen, originalen sendes Haukeland Universitetssykehus. Kontaktpersoner vedrørende registreringsskjema er Klinikkoverlege Ove Furnes, tlf og overlege Leif Ivar Havelin, tlf.: Ortopedisk klinikk, Haukeland Universitetssykehus. Besøksadresse: Møllendalsbakken 11. Sekretærer i Nasjonalt Register for Leddproteser, Ortopedisk klinikk, Helse Bergen: Ingunn Vindenes, tlf.: og Ruth Wasmuth, tlf.: eller Sentralbordet, Haukeland Universitetssykehus: Fax: Epost Ruth Wasmuth: ruth.wasmuth@helse-bergen.no Internet: 193

206 NASJONALT HOFTEBRUDDREGISTER Nasjonalt Register for Leddproteser Report 2009 Helse Bergen HF, Ortopedisk klinikk Haukeland Universitetssykehus Møllendalsbakken BERGEN Tlf: HOFTEBRUDD F.nr. (11 sifre)... Navn:... (Skriv tydelig ev. pasient klistrelapp spesifiser sykehus.) Sykehus:... PRIMÆRE OPERASJONER PÅ BRUDD I PROKSIMALE FEMURENDE og ALLE REOPERASJONER, inkludert lukket reponering av hemiproteser. Ved primæroperasjon med totalprotese og ved reoperasjon til totalprotese brukes kun hofteproteseskjema. Alle produktklistrelapper settes i merket felt på baksiden av skjemaet. AKTUELLE OPERASJON 1 Primæroperasjon 2 Reoperasjon SIDE (ett kryss) (Bilateral opr.= 2 skjema) 1 Høyre 2 Venstre OPR TIDSPUNKT (dd.mm.åå) kl BRUDD TIDSPUNKT (dd.mm.åå) kl Dersom det er usikkerhet om brudd tidspunkt, fyll ut neste punkt. TID FRA BRUDD TIL OPERASJON I TIMER > > > >48 DEMENS 0 Nei 1 Ja (Se test på baksiden) 2 Usikker ASA-KLASSE (se bakside av skjema for definisjon) 1 Frisk 2 Asymptomatisk tilstand som gir økt risiko 3 Symptomatisk sykdom 4 Livstruende sykdom 5 Moribund TYPE PRIMÆRBRUDD (ÅRSAK TIL PRIMÆROPERASJON) (Kun ett kryss) Se baksiden for klassifikasjon 1 Lårhalsbrudd udislokert (Garden 1 og 2) 2 Lårhalsbrudd dislokert (Garden 3 og 4) 3 Lateralt lårhalsbrudd 4 Pertrokantært tofragment (AO klassifikasjon A1) 5 Pertrokantært flerfragment (AO klassifikasjon A2) 9 Intertrokantært (AO klassifikasjon A3) 6 Subtrokantært 7 Annet TYPE REOPERASJON (Flere enn ett kryss kan brukes) (Spesifiser nøyaktig produkt eller fest evt produktklistrelapp på baksiden) 1 Fjerning av implantat (Brukes når dette er eneste prosedyre) 2 Girdlestone (= fjerning av osteosyntesemateriale/hemiprot. og caputresten) 3 Bipolar hemiprotese 4 Unipolar hemiprotese 5 Re-osteosyntese 6 Drenasje av hematom eller infeksjon 7 Lukket reposisjon av luksert hemiprotese 8 Åpen reposisjon av luksert hemiprotese 9 Annet, spesifiser. Navn / størrelse ev. katalognummer.. FIKSASJON AV HEMIPROTESE (For totalprotese sendes eget skjema til hofteproteseregisteret) 1 Usementert 1 med HA 2 uten HA 2 Sement med antibiotika Navn.. 3 Sement uten antibiotika Navn.. PATOLOGISK BRUDD (Annen patologi enn osteoporose) 0 Nei 1 Ja, type.... TILGANG TIL HOFTELEDDET VED HEMIPROTESE (Kun ett kryss) 1 Anterolateral 2 Lateral 3 Posterolateral 4 Annet, spesifiser ANESTESITYPE 1 Narkose 2 Spinal 3 Annet, spesifiser... TYPE PRIMÆROPERASJON (Kun ett kryss) (Fylles ut bare ved primæroperasjon - eget skjema for totalproteser) (Spesifiser nøyaktig produkt eller fest evt produktklistrelapp på baksiden) 1 To skruer eller pinner 2 Tre skruer eller pinner 3 Bipolar hemiprotese 4 Unipolar hemiprotese 5 Glideskrue og plate 6 Glideskrue og plate med trochantær støtteplate 7 Vinkelplate 8 Kort margnagle uten distal sperre 9 Kort margnagle med distal sperre 10 Lang margnagle uten distal sperre 11 Lang margnagle med distal sperre 12 Annet, spesifiser Navn / størrelse ev. katalognummer ÅRSAK TIL REOPERASJON (Flere enn ett kryss kan brukes) 1 Osteosyntesesvikt/havari 2 Ikke tilhelet brudd (non-union/pseudartrose) 3 Caputnekrose (segmentalt kollaps) 4 Lokal smerte pga prominerende osteosyntesemateriale 5 Brudd tilhelet med feilstilling 6 Sårinfeksjon overfladisk 7 Sårinfeksjon dyp 8 Hematom 9 Luksasjon av hemiprotese 10 Osteosyntesematerialet skåret gjennom caput 11 Nytt brudd rundt implantat Løsning av hemiprotese 13 Annet, spesifiser.... PEROPERATIVE KOMPLIKASJONER 0 Nei 1 Ja, hvilke(n)..... OPERASJONSTID (hud til hud)...minutter. SYSTEMISK ANTIBIOTIKAPROFYLAKSE 0 Nei 1 Ja, Hvilken (A)... Dose (A)....t antall doser......varighet....timer Ev. i kombinasjon med (B)... Dose (B)......t antall doser......varighet......timer TROMBOSEPROFYLAKSE 0 Nei 1 Ja, hvilken type Dosering opr.dag..første dose gitt preopr 0 Nei 1 Ja Senere dosering.antatt varighet.. døgn Ev. i kombinasjon med Dosering.....Antatt varighet... døgn Strømpe 0 Nei 1 Legg 2 Legg + Lår Antatt varighet.. døgn Mekanisk pumpe 0 Nei 1 Fot 2 Legg Antatt varighet....døgn Lege... Legen som har fylt ut skjemaet (navnet registreres ikke i databasen). Bergen Grafisk as

207 RETTLEDNING Registreringen gjelder alle operasjoner for hoftebrudd (lårhals, pertrokantære og subtrokantære) og alle reoperasjoner, også reposisjoner, på pasienter som er primæroperert og reoperert for hoftebrudd. Ved primæroperasjon med totalprotese og ved reoperasjon til totalprotese sendes bare skjema til hofteproteseregisteret. Ett skjema fylles ut for hver operasjon. Pasientens fødselsnummer (11 sifre) og sykehuset må være påført. Aktuelle ruter markeres med kryss. Pasienten skal på eget skjema gi samtykke til registrering i Nasjonalt hoftebruddregister og samtykkeerklæringen lagres i pasientens journal på sykehuset. Kommentarer til enkelte punkt: OPERASJONS- OG BRUDDTIDSPUNKT Operasjonstidspunkt (dato og klokkeslett) må føres opp på alle primæroperasjoner. Det er også sterkt ønskelig at dato og klokkeslett for bruddtidspunkt føres opp. Dette bl.a for å se om tid til operasjon har effekt på prognose. (Hvis en ikke kjenner klokkeslettet lar en feltet stå åpent. En må da prøve å angi omtrentlig tidsrom fra brudd til operasjon på neste punkt). Ved reoperasjon er ikke klokkeslett nødvendig. DEMENS Demens kan eventuelt testes ved å be pasienten tegne klokken når den er 10 over 10. En dement pasient vil ha problemer med denne oppgaven. ASA-KLASSE (ASA=American Society of Anesthesiologists) ASA-klasse 1: Friske pasienter som røyker mindre enn 5 sigaretter daglig. ASA-klasse 2: Pasienter med en asymptomatisk tilstand som behandles medikamentelt (f.eks hypertensjon) eller med kost (f.eks diabetes mellitus type 2) og ellers friske pasienter som røyker 5 sigaretter eller mer daglig. ASA-klasse 3: Pasienter med en tilstand som kan gi symptomer, men som holdes under kontroll medikamentelt (f.eks moderat angina pectoris og mild astma). ASA-klasse 4: Pasienter med en tilstand som ikke er under kontroll (f.eks hjertesvikt og astma). ASA-klasse 5: Moribund/døende pasient GARDENS KLASSIFISERING AV LÅRHALSBRUDD Garden 1: Ikke komplett brudd av lårhalsen (såkalt innkilt) Garden 2: Komplett lårhalsbrudd uten dislokasjon Garden 3: Komplett lårhalsbrudd med delvis dislokasjon. Fragmentene er fortsatt i kontakt, men det er feilstilling av lårhalsens trabekler. Caputfragmentet ligger uanatomisk i acetabulum. Garden 4: Komplett lårhalsbrudd med full dislokasjon. Caputfragmentet er fritt og ligger korrekt i acetabulum slik at trabeklene er normalt orientert. AO KLASSIFIKASJON AV TROKANTÆRE BRUDD A1: Pertrokantært tofragment brudd A2: Pertrokantært flerfragment brudd A3: Intertrokantært brudd Subtrokantære brudd: Hovedbruddlinje mellom nedre kant av trokanter minor og til 5 cm distalt for denne. IMPLANTAT Implantattype må angis entydig. Produktklistrelapp er ønskelig for å angi katalognummer for osteosyntesematerialet eller protesen som er brukt. PEROPERATIVE KOMPLIKASJONER Vi ønsker også å få meldt dødsfall på operasjonsbordet og peroperativ transfusjonstrengende blødning. ANTIBIOTIKAPROFYLAKSE Her føres det på hvilket antibiotikum som er blitt benyttet i forbindelse med operasjonen. Det anføres hvor stor dose, hvor mange doser og profylaksens varighet. Hvis en f.eks. har gitt 2g Keflin 4 ganger operasjonsdagen med 4 timers mellomrom dvs. 12 timer mellom første og siste dose, så angis det i skjema: Hvilken (A) Keflin Dose(A) 2g t antall doser 4 Varighet 12 timer. Kontaktpersoner vedrørende registreringsskjema er: Kst. Overlege Jan-Erik Gjertsen, Ortopedisk klinikk, Haukeland Universitetssykehus. Tlf ( jan-erik.gjertsen@helse-bergen.no) Professor Lasse Engesæter, Ortopedisk klinikk, Haukeland Universitetssykehus. Tlf Prosjektkoordinator Nasjonalt Hoftebrudddregister: Lise Kvamsdal. Tlf ( lise.kvamsdal@helse-bergen.no) Internett: PRODUKTKLISTRELAPPER: 195