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No increased risk of early revision during the implementation phase of new cup designs: Analysis of 52,903 hip arthroplasties reported to the Swedish Hip Arthroplasty Register

Journal article
Authors Maziar Mohaddes
Mathias Björk
Szilard Nemes
Ola Rolfson
Per Jolbäck
Johan Kärrholm
Published in Acta Orthopaedica
Volume 87
Pages 31-36
ISSN 1745-3674
Publication year 2016
Published at Institute of Clinical Sciences, Department of Orthopaedics
Pages 31-36
Language en
Keywords association, Orthopedics
Subject categories Orthopedics


Background and purpose In Sweden, less than 5% of patients who undergo total hip arthroplasty (THA) have revision. Younger patients have an increased risk of revision. New prosthetic designs are being introduced in order to improve outcomes further. We investigated whether the introductory phase of new cup designs would increase the revision rate.Patients and methods All THAs and first-time cup revisions performed from 1993 through 2011 were identified in the Swedish Hip Arthroplasty Register. The 15 types of cups used in more than 500 operations and inserted in more than 50 cases in each hospital (n = 52,903) were selected. All cups were given an order number, based on the order in which the cup had been inserted at each hospital. The influence of order number on the risk of revision was analyzed in a regression model, which was adjusted for potentially confounding demographic and surgical data. Revision within 2 years for all reasons (n = 940) was used as primary endpoint. Changes in the risk of revision based on the order number were analyzed using a spline.Results The order number of the cup had no influence on the risk of early revision (p 0.7). Categorizing the order number using cutoff values obtained from the splines did not result in any statistically significant changes in risk of revision (p 0.2).Interpretation We did not find any increased risk of early revision during the implementation phase of new cup designs. This finding is unexpected, and partly conflicts with data from other registries. The structured and stepwise introduction of new prosthesis designs, facilitated by the annual feedback from the Swedish Hip Arthroplasty Register, may partly explain this discrepancy.

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