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The Philadelphia Meeting – Surgery and Rehabilitation of the Hand: with Emphasis on Trauma
03/07/2015 - 03/10/2015
Hand Rehabilitation Foundation, Jefferson Health System & Moss Rehab

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Registry Shows High Mid-Term Survivorship Rates for Hip, Knee Procedures | NEWS-Line for Orthopedic and Rehabilitation Specialists
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Registry Shows High Mid-Term Survivorship Rates for Hip, Knee Procedures

A recently published prospective study of 85,000 knee and hip joint replacements and ACL reconstructions performed in a large community-based practice and tracked in Kaiser Permanente’s national implant registries showed mid-term survivorship of 97.1% for total knees, 97.3% for total hips and 90.7% for ACL reconstructions.

The study also sheds light on patient risk factors and other variables associated with reduced survivorship and postoperative problems, such as revision.

According to a Kaiser Permanente press release on the research, a detailed and standardized national registry of commonly used joint replacement devices would improve patient outcomes, patient safety and quality of care.

“Our findings demonstrate the critical impact of registries and the important role they play in counseling patients, identifying risk factors, tracking implanted devices during recalls and assessing comparative effectiveness of devices,” Elizabeth W. Paxton, MA, a lead author of the study and director of surgical outcomes and analysis at Kaiser Permanente, stated in the release.

The study was recently published in the Journal of Bone and Joint Surgery.

Surgical decision-making

Investigator Robert S. Namba, MD, told the that he hopes the report from the surgeon-initiated registry, which represents a summation of eight years of data, will help orthopedists and their patients make good decisions about the timing of surgery.

“The vast major of total joint replacement in the United States are performed by community doctors,” Namba, who is an attending physician for Kaiser Permanente and helped found the registry in 2001, said. “Our conglomeration of data involve community surgeons and community hospitals, so I think our data will actually help the average orthopedic surgeon who does hip and knee replacement very well, because these are perhaps the type of results that are applicable to what they may experience themselves.”

Namba and his colleagues tracked 80,000 total joint replacements and 5,000 ACL reconstructions.

Reasons for revisions

Based on the study abstract, the analysis of the register-recorded total knee arthroplasties (TKAs) completed between April 2001 and March 2008, included 2,458 revisions. Factors such as age less than 55 years, diabetes and uncemented fixation put patients at-risk for aseptic revision.

From the 21,548 primary total hip arthroplasty (THA) cases and 2,809 revision THAs done during the same study period, investigators identified risk factors of aseptic revision which included conventional polyethylene inserts, femoral heads less than 28 mm diameter and female gender.

The investigators also found that the most common reasons for re-operations of ACL reconstructions were meniscus injury, stiffness and device removal, according to the release.


The orthopedic implant registries were used to track eight recalls and advisories during the study period, which were critical in identifying impacted patients, according to the release.

Namba said the investigators observed some regional differences both in access to care and some of the outcomes.

“We haven’t completely identified the underlying causes for these regional differences, but they do exist,” he said. “I would have to say though, the main limitation of our study is the short time frame. With nine years in a joint replacement, we are expecting to last 20 years plus. It’s still short-term,” he said.

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