What does this research mean for the field?

There are substantial differences in implant design, surgical approach, and cementation practices for hemiarthroplasties after hip fractures between Norway and Sweden, despite both countries having similar five-year implant survival rates. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 2, 2014Open Access

Hemiarthroplasties after Hip Fractures in Norway and Sweden: A Collaboration between the Norwegian and Swedish National Registries

JGJan‐Erik GjertsenHaukeland University Hospital AFAnne Marie FenstadHaukeland University Hospital OLOlof LeonardssonSkåne University Hospital

Structured PICO

Do demographics, implant selection, surgical approaches, and reoperation rates differ between hemiarthroplasty patients in Norway and Sweden?

Population

36,989 patients with acute hip fractures undergoing primary hemiarthroplasties reported to the Norwegian Hip Fracture Register (n = 12,761) and the Swedish Hip Arthroplasty Register (n = 24,228) between 2005-2010.

Intervention

Hemiarthroplasty practices in Sweden (predominantly cemented, unipolar/monoblock designs, posterior approach common).

Comparator

Hemiarthroplasty practices in Norway (predominantly cemented, bipolar design, lateral approach).

Outcome

Reoperation (defined as any further open surgery, including open reduction of dislocated HAs and soft tissue reoperations without removal or exchange of prosthesis components).hard clinical

There are surprisingly large differences in implant design, surgical technique, and demographics for hemiarthroplasties between Norway and Sweden, highlighting the impact of national traditions on surgical practice.

Abstract

National registration of hemiarthroplasties after hip fractures has been established in both Norway and Sweden. We aimed to investigate differences in demographics, choice of implant selection, surgical approaches, and reoperations between the Norwegian Hip Fracture Register (NHFR) and the Swedish Hip Arthroplasty Register (SHAR). As part of the Nordic Arthroplasty Register Association (NARA) project a common hemiarthroplasty dataset has been established. 36,989 primary hemiarthroplasties (HAs) for acute hip fractures reported to NHFR (n = 12,761) and SHAR (n = 24,228) for the period 2005-2010 were included. Cemented prostheses were used in 78% of the operations in Norway and in 95% of the patients in Sweden. In Norway HAs almost exclusively had bipolar design (98%), whereas in Sweden HAs with unipolar design were used in 42% of the cases. Monoblock (non-modular) prostheses were uncommon, but still more frequently used in Sweden than in Norway (6.9% and 2.1% respectively). The lateral approach was more common in Norway (83%) than in Sweden (52%), where the posterior approach was used in 42% of the cases. The five-year survival of all HAs was 95.5% (95% CI: 94.8-96.2) in Norway and 94.8% (95% CI: 94.4-95.3) in Sweden. We concluded that surprisingly large differences between the two countries in demographics, implant design, and surgical technique had been revealed. This common dataset enables further investigations of the impact of these differences on revision rates and mortality.

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