Countrywise results of total hip replacement

Figures & data

Figure 1. Flow chart of exclusion of hip replacements according to the study criteria.

Table 1. Demographic data, and data concerning fixation technique, surgical approach, cause of revision, and procedure performed at revision for each country

	Denmark	Sweden	Norway	Finland
No. of THRs	92,078	180,839	86,076	79,740
Follow-up time (years), mean	5.9	6.7	6.4	6.6
(range)	(0–17)	(0–17)	(0–17)	(0–17)
Male sex, %	41.9	40.0	31.8	41.1
Age groups, %
< 55	10.8	9.0	10.7	11.9
55–64	22.7	21.8	20.6	24.1
65–74	34.8	34.4	34.3	37.8
≥ 75	31.6	34.8	34.5	26.3
Diagnosis, %
Primary osteoarthritis	76.4	78.7	73.0	82.4
Hip fracture	13.9	12.3	11.7	3.7
Nontraumatic femoral head necrosis	2.6	3.1	1.6	1.1
Inflammatory arthritis	1.6	2.3	2.4	4.6
Pediatric hip disease	3.1	1.8	9.0	1.2
Other	2.3	1.9	2.3	7.0
Fixation, %
Cemented	36.9	84.1	70.8	39.3
Uncemented	40.3	7.5	15.3	47.8
Hybrid	21.9	3.1	3.3	9.6
Reverse hybrid	0.9	5.3	10.6	3.4
Approach, %
Posterior	92.2	57.2	24.6	NA
Cause of revision, %
Aseptic loosening	36.2	53.3	48.8	48.5
Deep infection	15.4	14.1	15.6	6.7
Periprosthetic femoral fracture	8.2	8.2	4.0	7.7
Dislocation	28.5	19.6	20.1	19.3
Pain only	3.6	0.6	3.0	NA
Other	8.1	4.3	8.7	17.8
Procedure at revision, %,
Total revision	16.7	31.5	20.6	NA
Only stem revised	22.3	22.5	23.9	NA
Only cup or liner revised	44.2	32.1	37.0	NA
Extraction of the prosthesis	8.4	5.8	7.8	NA
Other	8.5	8.2	10.7	NA

NA: not available.

Figure 2. Sex distribution in total hip replacement in 4 Nordic countries.

Figure 3. Distribution of age groups in total hip replacement in 4 Nordic countries.

Figure 4. Distribution of type of fixation in total hip replacement in 4 Nordic countries.

Table 2. Kaplan-Meier 10- and 15-year survival data with 95% CI for all THRs, cemented THR, uncemented THR, hybrid THR, and reverse hybrid THR by country. The 7.3-year survival of reverse hybrid THR in Denmark was 92.8% (95% CI: 90.3–94.7)

THR Country	No. of THRs	No. of revisions	10-year survival		15-year survival
			(%)	95% CI	(%)	95% CI
All
Denmark	92,078	5,167	92.1	91.8–92.3	86.3	85.7–86.9
Sweden	180,839	7,471	94.2	94.0–94.3	88.0	87.6–88.3
Norway	86,076	4,656	92.8	92.6–93.1	86.9	86.4–87.4
Finland	79,740	5,556	90.9	90.6–91.1	83.5	82.9–84.1
Cemented
Denmark	34,003	1,896	93.1	92.7–93.4	87.9	87.2–88.6
Sweden	152,024	5,970	94.6	94.4–94.8	89.0	88.6–89.4
Norway	60,957	3,171	93.4	93.1–93.6	88.8	88.2–89.3
Finland	31,331	2,002	92.0	91.6–92.4	86.6	85.7–87.4
Uncemented
Denmark	37,098	1,734	92.4	91.9–92.9	86.0	84.5–87.3
Sweden	13,552	582	91.7	90.8–92.6	82.7	80.5–84.7
Norway	13,208	946	91.0	90.3–91.7	80.6	79.0–82.1
Finland	38,082	2,742	90.0	89.5–90.4	80.8	79.9–81.8
Hybrid
Denmark	20,170	1,485	90.5	90.0–91.0	83.8	82.5–85.0
Sweden	5,684	613	90.2	89.3–91.0	80.0	78.2–81.7
Norway	2,827	274	90.6	89.2–91.8	82.2	79.6–84.4
Finland	7,641	598	91.0	90.2–91.8	84.5	82.8–85.9
Reverse hybrid
Denmark	807	52	NA	NA	NA	NA
Sweden	9,579	306	91.8	90.0–93.3	NA	NA
Norway	9,084	265	92.9	91.2–94.2	NA	NA
Finland	2,686	214	87.4	85.4–89.2	NA	NA

NA: not available.

Figure 5. Kaplan-Meier survival for all total hip replacements in the NARA database (by country), with any reason for revision as endpoint.

Figure 6. Kaplan-Meier survival for cemented total hip replacement in the NARA database (by country), with any reason for revision as endpoint.

Figure 7. Kaplan-Meier survival for uncemented total hip replacement in the NARA database (by country), with any reason for revision as endpoint.

Figure 8. Kaplan-Meier survival for hybrid total hip replacement (cemented cup, cementless stem) in the NARA database, by country, with any reason for revision as endpoint.

Figure 9. Kaplan-Meier survival for reverse hybrid total hip replacement (uncemented cup, cemented stem) in the NARA database, by country, with any reason for revision as endpoint.

Table 3. Kaplan-Meier 10- and 15-year survival data with 95% confidence intervals from subgroup analyses performed separately for female and male patients aged < 60 years and ≥ 60 years and for cemented and uncemented THR, by country. The 9.7-year survival of uncemented THR in Sweden for female patients aged ≥ 60 years was 91.4% (95% CI: 86.5–94.5)

THR Country	No. of THRs	No. of revisions	10-year survival		15-year survival
			(%)	95% CI	(%)	95% CI
Females < 60 years of age
Cemented THR
Denmark	1,139	128	89.1	86.7–91.0	81.5	77.8–84.6
Sweden	8,882	691	92.2	91.5–92.9	83.0	81.5–84.4
Norway	3,318	299	89.8	88.4–91.1	79.6	76.6–82.2
Finland	847	99	88.2	85.4–90.6	NA	NA
Uncemented THR
Denmark	5,970	386	90.8	89.6–91.8	82.3	79.4–84.7
Sweden	4,114	216	91.2	89.6–92.6	81.3	77.8–84.3
Norway	3,842	355	90.6	89.3–91.7	79.3	76.8–81.5
Finland	7,017	722	87.4	86.2–88.4	75.5	73.4–77.5
Males < 60 years of age
Cemented THR
Denmark	1,057	163	86.1	83.5–88.2	77.0	73.2–80.4
Sweden	7,088	629	91.2	90.3–92.0	79.9	77.9–81.7
Norway	1,990	189	88.4	86.4–90.1	80.1	76.3–83.4
Finland	662	86	84.9	81.1–88.0	NA	NA
Uncemented THR
Denmark	6,815	346	93.0	92.1–93.9	87.2	84.8–89.2
Sweden	4,678	221	92.0	90.5–93.3	82.1	78.5–85.2
Norway	2,948	292	89.9	88.4–91.2	78.0	75.0–80.7
Finland	7,083	631	89.3	88.3–90.2	80.1	78.1–81.9
Females ≥ 60 years of age
Cemented THR
Denmark	20,462	930	94.4	94.0–94.8	90.7	89.8–91.5
Sweden	85,109	2,416	96.0	95.8–96.2	92.3	91.8–92.8
Norway	39,844	1,612	95.0	94.7–95.2	91.8	91.2–92.3
Finland	19,998	1,166	92.7	92.2–93.2	88.4	87.5–89.2
Uncemented THR
Denmark	12,903	547	93.2	92.3–94.0	NA	NA
Sweden	2,148	61	NA	NA	NA	NA
Norway	4,111	175	93.3	92.0–94.4	87.2	83.9–90.0
Finland	12,889	747	91.5	90.7–92.2	85.0	83.4–86.5
Males ≥ 60 years of age
Cemented THR
Denmark	11,345	675	92.2	91.5–92.8	86.4	84.9–87.7
Sweden	50,945	2,234	93.5	93.2–93.8	87.7	86.9–88.4
Norway	15,805	1,071	90.6	90.0–91.2	84.0	82.5–85.4
Finland	9,824	651	91.5	90.7–92.2	84.5	82.6–86.1
Uncemented THR
Denmark	11,410	455	93.1	92.1–94.0	NA	NA
Sweden	2,612	84	92.9	90.3–94.9	NA	NA
Norway	2,307	124	92.0	90.0–93.6	NA	NA
Finland	11,093	642	91.4	90.5–92.2	82.4	80.3–84.4

NA: not available.

Figure 10. Countrywise hazard ratio (HR) for risk of revision of all THRs compared to the reference country, Sweden (HR = 1). HRs are presented in 1-year time periods, except that the first year has been divided into 2 periods. If there were less than 20 cases in the group, the HRs were not included in the graphs due to the intervals being too wide. The model was stratified by sex, age group, and diagnosis.

Figure 11. Countrywise hazard ratio (HR) for risk of revision of cemented THA compared to the reference country, Sweden (HR = 1). HRs are presented in 1-year time periods, except that the first year has been divided into 2 periods. If there were less than 20 cases in the group, the HRs were not included in the graphs due to the intervals being too wide. The model was stratified by sex, age group, and diagnosis.

Figure 12. Countrywise hazard ratio (HR) for risk of revision of uncemented THA compared to the reference country, Sweden (HR = 1). HRs are presented in 1-year time periods, except that the first year has been divided into 2 periods. If there were less than 20 cases in the group, the HRs were not included in the graphs due to the intervals being too wide. The model was stratified by sex, age group, and diagnosis.

Figure 13. Kaplan-Meier survival analysis of cemented total hip replacement in 3 time periods with revision for any reason as the endpoint. A. Denmark. B. Norway. C. Sweden. D. Finland.

Figure 14. Kaplan-Meier survival analysis of uncemented total hip replacement in 3 time periods with revision for any reason as the endpoint. A. Denmark. B. Norway. C. Sweden. D. Finland.