The “true” 1-year incidence of dislocation after primary total hip arthroplasty: validation of an algorithm identifying dislocations in the Danish National Patient Register based on 5,415 patients from the Danish Hip Arthroplasty Register
DOI:
https://doi.org/10.2340/17453674.2024.41064Keywords:
Arthroplasty, Dislocation, Hip, Implants, OsteoarthrosisAbstract
Background and purpose: Dislocations continue to be a serious complication after primary total hip arthroplasty (THA). Our primary aim was to report the “true” incidence of dislocations in Denmark and secondarily to validate a previously developed algorithm designed to identify THA dislocations in the updated version of the Danish National Patient Register (DNPR), based on data from the Danish Hip Arthroplasty Register (DHR).
Methods: We included 5,415 primary THAs from the DHR performed from July 1 to December 31, 2019. Version 3 of the DNPR was launched in February 2019, and a combination of data from the DNPR and a comprehensive national review of 1,762 hospital contacts enabled us to identify every dislocation occurring during the 1st year after THA to determine the “true” 1-year incidence of dislocation. The results were presented as proportions with 95% confidence intervals (CI), and validation was performed by calculating sensitivity and predictive values.
Results: The “true” 1-year incidence of dislocation was 2.8% (CI 2.4–3.3). Of these, 37% suffered recurrent dislocations during the follow-up period. Between-hospital variation ranged from 0.0% to 9.6%. The algorithm demonstrated a sensitivity close to 95%, while maintaining a positive predictive value of above 94%.
Conclusion: The “true” 1-year incidence of dislocation of 2.8% is comparable to earlier findings, and large variation among hospitals continues to be evident. We have proven the algorithm to be valid in the latest DNPR (version 3), enabling it to be employed as a new quality indicator in future annual DHR reports.
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Hermansen L L, Viberg B, Overgaard S. Patient-reported outcome after dislocation of primary total hip arthroplasties: a cross-sectional study derived from the Danish Hip Arthroplasty Register. Acta Orthop 2022; 93: 29-36. 10.1080/17453674.2021.1983973 DOI: https://doi.org/10.1016/j.arth.2020.10.004
DHR. Danish Hip Arthroplasty Register—Annual Report. Available from: http://danskhoftealloplastikregisterdk/wp-content/uploads/2022/07/DHR-aarsrapport-2021_Udgivet-2022_offentliggjort-versionpdf 2022
Moon J K, Kim Y, Hwang K T, Yang J H, Kim Y H. The incidence of hip dislocation and suture failure according to two different types of posterior soft tissue repair techniques in total hip arthroplasty: a prospective randomized controlled trial. Int Orthop 2018; 42(9): 2049-56. doi: 10.1007/s00264-018-3884-0 DOI: https://doi.org/10.1007/s00264-018-3884-0
Amado O, Bautista M, Moore J, Bonilla G, Jimenez N, Llinas A. A multimodal approach prevents instability after total hip arthroplasty: a 1 year follow-up prospective study. J Clin Orthop Trauma 2018; 9(2): 137-41. doi: 10.1016/j.jcot.2016.11.004 DOI: https://doi.org/10.1016/j.jcot.2016.11.004
Jones C W, De Martino I, D’Apolito R, Nocon A A, Sculco P K, Sculco T P. The use of dual-mobility bearings in patients at high risk of dislocation. Bone Joint J 2019; 101-B(1_Supple_A): 41-5. doi: 10.1302/0301-620X.101B1.BJJ-2018-0506.R1 DOI: https://doi.org/10.1302/0301-620X.101B1.BJJ-2018-0506.R1
Pincus D, Jenkinson R, Paterson M, Leroux T, Ravi B. Association between surgical approach and major surgical complications in patients undergoing total hip arthroplasty. JAMA 2020; 323(11): 1070-6. doi: 10.1001/jama.2020.0785 DOI: https://doi.org/10.1001/jama.2020.0785
Hermansen L L, Viberg B, Overgaard S. Large hospital variation in the risk of dislocation after primary total hip arthroplasty for primary osteoarthritis: 31,105 patients in 59 hospitals from the Danish Hip Arthroplasty Register. Acta Orthop 2022; 93: 503-8. doi: 10.2340/17453674.2022.2754 DOI: https://doi.org/10.2340/17453674.2022.2754
Hermansen L L, Viberg B, Hansen L, Overgaard S. “True” cumulative incidence of and risk factors for hip dislocation within 2 years after primary total hip arthroplasty due to osteoarthritis: a nationwide population-based study from the Danish Hip Arthroplasty Register. J Bone Joint Surg Am 2021; 103(4): 295-302. doi: 10.2106/JBJS.19.01352 DOI: https://doi.org/10.2106/JBJS.19.01352
Hermansen L L, Viberg B, Overgaard S. Development of a diagnostic algorithm identifying cases of dislocation after primary total hip arthroplasty-based on 31,762 patients from the Danish Hip Arthroplasty Register. Acta Orthop 2021; 92(2): 137-42. doi: 10.1080/17453674.2020.1868708 DOI: https://doi.org/10.1080/17453674.2020.1868708
Benchimol E I, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLoS Med 2015; 12(10): e1001885. doi: 10.1371/journal.pmed.1001885. DOI: https://doi.org/10.1371/journal.pmed.1001885
Ranstam J, Robertsson O. Statistical analysis of arthroplasty register data. Acta Orthop 2010; 81(1): 10-14. doi: 10.3109/17453671003587168 DOI: https://doi.org/10.3109/17453671003587168
Schmidt M, Schmidt S A, Sandegaard J L, Ehrenstein V, Pedersen L, Sorensen H T. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015; 7: 449-90. doi: 10.2147/CLEP.S91125 DOI: https://doi.org/10.2147/CLEP.S91125
Lynge E, Sandegaard J L, Rebolj M. The Danish National Patient Register. Scand J Public Health 2011; 39(7 Suppl): 30-3. doi: 10.1177/1403494811401482 DOI: https://doi.org/10.1177/1403494811401482
Gundtoft P H, Varnum C, Pedersen A B, Overgaard S. The Danish Hip Arthroplasty Register. Clin Epidemiol 2016; 8: 509-14. doi: 10.2147/CLEP.S99498 DOI: https://doi.org/10.2147/CLEP.S99498
Hjelholt T J, Edwards N M, Vesterager J D, Kristensen P K, Pedersen A B. The positive predictive value of hip fracture diagnoses and surgical procedure codes in the Danish Multidisciplinary Hip Fracture Registry and the Danish National Patient Registry. Clin Epidemiol 2020; 12: 123-31. doi: 10.2147/CLEP.S238722 DOI: https://doi.org/10.2147/CLEP.S238722
Skjoth F, Nielsen H, Bodilsen J. Validity of algorithm for classification of in- and outpatient hospital contacts in the Danish National Patient Registry. Clin Epidemiol 2022; 14: 1561-70. doi: 10.2147/CLEP.S380023 DOI: https://doi.org/10.2147/CLEP.S380023
Harvey L A. REDCap: web-based software for all types of data storage and collection. Spinal Cord 2018; 56(7): 625. doi: 10.1038/s41393-018-0169-9 DOI: https://doi.org/10.1038/s41393-018-0169-9
van Erp J H J, Husken M F T, Filipe M D, Snijders T E, Kruyt M C, de Gast A, et al. Did the dislocation risk after primary total hip arthroplasty decrease over time? A meta-analysis across six decades. Arch Orthop Trauma Surg 2023; 143(7): 4491-500. doi: 10.1007/s00402-022-04678-w DOI: https://doi.org/10.1007/s00402-022-04678-w
Sirignano M N, Nessler J M, Rhea E B, Ong K L, Watson H N, Yakkanti M R, et al. Incidence of instability following primary total hip arthroplasty continues to decline in the Medicare population. J Arthroplasty 2023; 38(7S): S89-S94 e1. doi: 10.1016/j.arth.2023.04.035 DOI: https://doi.org/10.1016/j.arth.2023.04.035
Edelstein A I, Dillingham T R, McGinley E L, Pezzin L E. Hemiarthroplasty versus total hip arthroplasty for femoral neck fracture in elderly patients: twelve-month risk of revision and dislocation in an instrumental variable analysis of Medicare data. J Bone Joint Surg Am 2023; 105(21): 1695-702. doi: 10.2106/JBJS.23.00247 DOI: https://doi.org/10.2106/JBJS.23.00247
Tohidi M, Mann S M, McIsaac M A, Groome P A. Comparative effectiveness of total hip arthroplasty and hemiarthroplasty for femoral neck fracture: a propensity-score-matched cohort study. J Bone Joint Surg Am 2023; 105(8): 591-9. doi: 10.2106/JBJS.22.01193 DOI: https://doi.org/10.2106/JBJS.22.01193
HEALTH Investigators; Bhandari M, Einhorn T A, Guyatt G, Schemitsch E H, Zura R D, et al. Total hip arthroplasty or hemiarthroplasty for hip fracture. N Engl J Med 2019; 381(23): 2199-208. doi: 10.1056/NEJMoa1906190 DOI: https://doi.org/10.1056/NEJMoa1906190
Malkani A L, Ong K L, Lau E, Kurtz S M, Justice B J, Manley M T. Early- and late-term dislocation risk after primary hip arthroplasty in the Medicare population. J Arthroplasty 2010; 25(6 Suppl): 21-5. doi: 10.1016/j.arth.2010.04.014 DOI: https://doi.org/10.1016/j.arth.2010.04.014
Varnum C, Pedersen A B, Gundtoft P H, Overgaard S. The what, when and how of orthopaedic registers: an introduction into register-based research. EFORT Open Rev 2019; 4(6): 337-43. doi: 10.1302/2058-5241.4.180097 DOI: https://doi.org/10.1302/2058-5241.4.180097
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Copyright (c) 2024 Lars L Hermansen, Thomas F Iversen, Pernille Iversen, Bjarke Viberg, Søren Overgaard
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