Knee arthroplasty in Denmark, Norway and Sweden. A pilot study from the Nordic Arthroplasty Register Association

Abstract

Background and purpose: The number of national arthroplasty registries is increasing. However, the methods of registration, classification, and analysis often differ.

Methods: We combined data from 3 Nordic knee arthroplasty registers, comparing demographics, methods, and overall results. Primary arthroplasties during the period 1997-2007 were included. Each register produced a dataset of predefined variables, after which the data were combined and descriptive and survival statistics produced.

Results: The incidence of knee arthroplasty increased in all 3 countries, but most in Denmark. Norway had the lowest number of procedures per hospital-less than half that of Sweden and Denmark. The preference for implant brands varied and only 3 total brands and 1 unicompartmental brand were common in all 3 countries. Use of patellar button for total knee arthroplasty was popular in Denmark (76%) but not in Norway (11%) or Sweden (14%). Uncemented or hybrid fixation of components was also more frequent in Denmark (22%) than in Norway (14%) and Sweden (2%). After total knee arthroplasty for osteoarthritis, the cumulative revision rate (CRR) was lowest in Sweden, with Denmark and Norway having a relative risk (RR) of 1.4 (95% CI: 1.3-1.6) and 1.6 (CI: 1.4-1.7) times higher. The result was similar when only including brands used in more than 200 cases in all 3 countries (AGC, Duracon, and NexGen). After unicompartmental arthroplasty for osteoarthritis, the CRR for all models was also lowest in Sweden, with Denmark and Norway having RRs of 1.7 (CI: 1.4-2.0) and 1.5 (CI: 1.3-1.8), respectively. When only the Oxford implant was analyzed, however, the CRRs were similar and the RRs were 1.2 (CI: 0.9-1.7) and 1.3 (CI: 1.0-1.7).

Interpretation: We found considerable differences between the 3 countries, with Sweden having a lower revision rate than Denmark and Norway. Further classification and standardization work is needed to permit more elaborate studies.

Figure 1.

Incidence of primary knee arthroplasties. The solid lines show the incidence and the dotted lines show the age-standardized incidence for the “European” standard population (Waterhouse et al. 1976). Note that due to reduced coverage, the Danish incidence was approximately10–15% higher than shown here.

Figure 2.

Proportion of age groups each year for primary knee arthroplasty.

Figure 3.

Incidence of arthroplasty for rheumatoid arthritis. Note that due to reduced coverage, the Danish incidence was probably 10–15% higher than shown here.

Figure 4.

Proportion of implant types used for primary knee arthroplasty.

Figure 5.

Proportion of fixation methods for primary TKA.

Figure 6.

Cumulative revision rate (CRR; lines) with 95% CI (colored areas) after total knee arthroplasty performed for osteoarthritis.

Figure 7.

Cumulative revision rate (CRR; lines) with 95% CI (colored areas) for osteoarthritis cases only including the 3 implant brands that were used frequently in all 3 countries.

Figure 8.

Cumulative revision rate (CRR; lines) with 95% CI (colored areas) after unicompartmental knee arthroplasty performed for osteoarthritis.

Figure 9.

Cumulative revision rate (CRR; lines) with 95% CI (colored areas) for the Oxford unicompartmental implant inserted for osteoarthritis.