National Joint Replacement Registry. Demographics and Outcome of Elbow & Wrist Arthroplasty
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- Lee Doyle
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1 National Joint Replacement Registry Demographics and Outcome of Elbow & Wrist Arthroplasty SUPPLEMENTARY REPORT 2015
2 CONTENTS INTRODUCTION... 1 ELBOW REPLACEMENT... 2 Categories of Elbow Replacement... 2 Demographics... 3 Primary Partial Elbow Replacement... 5 Demographics... 5 Primary Radial Elbow Replacement... 6 Primary Uni Humeral Elbow Replacement... 7 Primary Uni Humeral with Radial Elbow Replacement... 7 Primary Humeral Hemiarthroplasty... 8 Primary Total Elbow Replacement... 9 Demographics... 9 Primary Total Elbow without Radial Replacement Primary Total Elbow with Radial Replacement Revision Elbow Replacement Demographics Revision of Known Primary Partial Elbow Replacement Known Primary Radial Elbow Replacement Known Primary Uni Humeral with Radial Elbow Replacement Known Primary Humeral Hemiarthroplasty Revision of Known Primary Total Elbow Replacement Known Primary Total Elbow without Radial Replacement Known Primary Total Elbow with Radial Replacement WRIST REPLACEMENT Categories of Wrist Replacement Demographics Primary Partial Wrist Replacement Demographics Primary Lunate Wrist Replacement Primary Partial Ulna Wrist Replacement Primary DRUJ with Ulna Only Replacement Primary DRUJ with Ulna and Radial Replacement Primary Scaphoid Interspacer Replacement Primary Total Wrist Replacement Demographics Revision Wrist Replacement Demographics Revision of Known Primary Partial Wrist Replacement Known Primary DRUJ with Ulna Only Replacement Revision of Known Primary Total Wrist Replacement... 28
3 LIST OF TABLES Table EG1 Number of Elbow Replacements by Gender... 3 Table EG2 Number of Elbow Replacements by... 3 Table EG3 Time between Procedures for Bilateral Primary Elbow Replacement... 3 Table EG4 All Elbow Replacement by and Gender... 3 Table EG5 Revision Rates of Primary Elbow Replacement by Elbow Class... 4 Table EG6 Yearly Cumulative Percent Revision of Primary Elbow Replacement by Elbow Class... 4 Primary Partial Elbow Replacement... 5 Table EP1 Primary Partial Elbow Replacement by and Gender... 5 Table EP2 Primary Partial Elbow Replacement by Primary Diagnosis... 5 Table EP3 Primary Radial Elbow Replacement by and Gender... 6 Table EP4 Primary Radial Elbow Replacement by Primary Diagnosis... 6 Table EP5 Most Used Radial Head/Stem Prostheses in Primary Radial Elbow Replacement... 6 Table EP6 Primary Uni Humeral Elbow Replacement by and Gender... 7 Table EP7 Primary Uni Humeral Elbow Replacement Primary Diagnosis... 7 Table EP8 Primary Uni Humeral with Radial Elbow Replacement by and Gender... 7 Table EP9 Primary Uni Humeral with Radial Elbow Replacement by Primary Diagnosis... 7 Table EP10 Primary Humeral Hemiarthroplasty by and Gender... 8 Table EP11 Primary Humeral Hemiarthroplasty by Primary Diagnosis... 8 Table EP12 Most Used Humeral Prostheses in Primary Humeral Hemiarthroplasty... 8 Primary Total Elbow Replacement... 9 Table ET1 Primary Total Elbow Replacement by and Gender... 9 Table ET2 Primary Total Elbow Replacement by Primary Diagnosis... 9 Table ET3 Primary Total Elbow without Radial Replacement by and Gender Table ET4 Primary Total Elbow without Radial Replacement by Primary Diagnosis Table ET5 Most Used Humeral Prostheses in Primary Total Elbow without Radial Replacement Table ET6 Primary Total Elbow with Radial Replacement by and Gender Table ET7 Primary Total Elbow with Radial Replacement by Primary Diagnosis Table ET8 Most Used Radial Head/Humeral Prostheses in Primary Total Elbow with Radial Elbow Replacement Revision Elbow Replacement Table ER1 All Revision Elbow Replacement by and Gender Table ER2 Type of Revision of All Revision Elbow Replacement Table ER3 Reason for Revision of All Revision Elbow Replacement Revision of Known Primary Partial Elbow Replacement Table EPR1 Revision of Known Primary Radial Elbow Replacement by and Gender Table EPR2 Type of Revision of Known Primary Radial Elbow Replacement Table EPR3 Reason for Revision of Known Primary Radial Elbow Replacement Table EPR4 Revision of Known Primary Uni Humeral with Radial Elbow Replacement by and Gender Table EPR5 Type of Revision of Known Primary Uni Humeral with Radial Elbow Replacement Table EPR6 Reason for Revision of Known Primary Uni Humeral with Radial Elbow Replacement Table EPR7 Revision of Known Primary Humeral Elbow Replacement by and Gender Table EPR8 Type of Revision of Known Primary Humeral Elbow Replacement Table EPR9 Reason for Revision of Known Primary Humeral Elbow Replacement Revision of Known Primary Total Elbow Replacement Table ETR1 Revision of Known Primary Total Elbow without Radial Replacement by and Gender Table ETR2 Reason for Revision of Known Primary Total Elbow without Radial Replacement Table ETR3 Revision of Known Primary Total Elbow with Radial Replacement by and Gender Table ETR4 Type of Revision of Known Primary Total Elbow with Radial Replacement Table ETR5 Reason for Revision of Known Primary Total Elbow with Radial Replacement... 17
4 WRIST REPLACEMENT Table WG1 Number of Wrist Replacements by Gender Table WG2 Number of Wrist Replacements by Table WG3 All Wrist Replacement by and Gender Table WG4 Revision Rates of Primary Wrist Replacement by Class Table WG5 Yearly Cumulative Percent Revision of Primary Wrist Replacement by Class Primary Partial Wrist Replacement Table WP1 Primary Partial Wrist Replacement by and Gender Table WP2 Primary Partial Wrist Replacement by Primary Diagnosis Table WP3 Primary Lunate Wrist Replacement by and Gender Table WP4 Primary Lunate Wrist Replacement by Primary Diagnosis Table WP5 Primary Partial Ulna Wrist Replacement by Gender Table WP6 Primary Partial Ulna Wrist Replacement by Primary Diagnosis Table WP7 Primary DRUJ with Ulna Only Replacement by and Gender Table WP8 Primary DRUJ with Ulna Only Replacement by Primary Diagnosis Table WP9 Most Used Ulna Prostheses in Primary DRUJ with Ulna Only Replacement Table WP10 Primary DRUJ with Ulna and Radial Replacement by and Gender Table WP11 Primary DRUJ with Ulna and Radial Replacement by Primary Diagnosis Table WP12 Primary Scaphoid Interspacer Replacement by and Gender Table WP13 Primary Scaphoid Interspacer Replacement by Primary Diagnosis Primary Total Wrist Replacement Table WT1 Primary Total Wrist Replacement by and Gender Table WT2 Primary Total Wrist Replacement by Primary Diagnosis Table WT3 Most Used Carpal/Radial Prostheses in Primary Total Wrist Replacement Revision Wrist Replacement Table WR1 All Revision Wrist Replacement by and Gender Table WR2 Type of Revision of All Revision Wrist Replacement Table WR3 Reason for Revision of All Revision Wrist Replacement Revision of Known Primary Partial Wrist Replacement Table WPR1 Revision of Primary DRUJ with Ulna Only Replacement by and Gender Table WPR2 Type of Revision of Known Primary DRUJ with Ulna Only Replacement Table WPR3 Reason for Revision of Known Primary DRUJ with Ulna Only Replacement Table WTR1 Revision of Known Primary Total Wrist Replacement by and Gender Table WTR2 Type of Revision of Known Primary Total Wrist Replacement Table WTR3 Reason for Revision of Known Primary Total Wrist Replacement... 28
5 LIST OF FIGURES ELBOW REPLACEMENT... 2 Figure EG1 All Elbow Replacement by and Gender... 4 Primary Partial Elbow Replacement... 5 Figure EP1 Primary Partial Elbow Replacement by and Gender... 5 Figure EP2 Primary Radial Elbow Replacement by and Gender... 6 Figure EP3 Primary Uni Humeral Elbow Replacement by and Gender... 7 Figure EP4 Primary Uni Humeral with Radial Elbow Replacement by and Gender... 7 Figure EP5 Primary Humeral Hemiarthroplasty by and Gender... 8 Primary Total Elbow Replacement... 9 Figure ET1 Primary Total Elbow Replacement by and Gender... 9 Figure ET2 Primary Total Elbow without Radial Replacement by and Gender Figure ET3 Primary Total Elbow with Radial Replacement by and Gender Revision Elbow Replacement Revision of Known Primary Partial Elbow Replacement Figure EPR1 Revision of Known Primary Radial Elbow Replacement by and Gender Figure EPR2 Revision of Known Primary Uni Humeral with Radial Elbow Replacement by and Gender Figure EPR3 Revision of Known Primary Humeral Hemiarthroplasty by and Gender Revision of Known Primary Total Elbow Replacement Figure ETR1 Revision of Known Primary Total Elbow without Radial Replacement by and Gender Figure ETR2 Type of Revision of Known Primary Total Elbow without Radial Replacement Figure ETR3 Revision of Known Primary Total Elbow with Radial Replacement by and Gender WRIST REPLACEMENT Figure WG1 All Wrist Replacement by and Gender Primary Partial Wrist Replacement Figure WP1 Primary Partial Wrist Replacement by and Gender Figure WP2 Primary Lunate Wrist Replacement by and Gender Figure WP3 Primary Partial Ulna Wrist Replacement by and Gender Figure WP4 Primary DRUJ with Ulna Only Replacement by and Gender Figure WP5 Primary DRUJ with Ulna and Radial Replacement by and Gender Figure WP6 Primary Scaphoid Interspacer Replacement by and Gender Primary Total Wrist Replacement Figure WT1 Primary Total Wrist Replacement by and Gender Revision Wrist Replacement Revision of Known Primary Partial Wrist Replacement Figure WPR1 Revision of Known Primary DRUJ with Ulna Only Replacement by and Gender Figure WTR1 Revision of Primary Total Wrist Replacement by and Gender... 28
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7 INTRODUCTION Data presented in this report have been submitted to the Registry by both public and private hospitals. Currently this involves 305 hospitals nationally but varies from time to time due to hospital closures, new hospitals or changes to services within hospitals. Most hospitals began providing data on elbow and wrist arthroplasty procedures on or after the official commencement date of 15 November The Registry had approval to collect these additional arthroplasty procedures from a number of hospitals prior to the commencement date. These data have also been included. Consequently, there is variation in the starting date for these procedures. The following table shows the reporting period for each type of joint replacement. TYPE OF JOINT REPLACEMENT START OF REPORTING PERIOD END OF REPORTING PERIOD Elbow 2 May December 2014 Wrist 7 July December 2014 End Data Period: 31 Dec 2014 Page 1
8 ELBOW REPLACEMENT Categories of Elbow Replacement The Registry groups elbow replacement into three broad categories, primary partial, primary total and revision elbow replacement. A primary replacement is the initial replacement procedure undertaken on a joint and involves replacing either part (partial) or all (total) of the articular surface. Primary partial and primary total elbow replacement are further sub-categorised into classes depending on the type of prostheses used. Partial elbow classes are radial, uni humeral, uni humeral plus radial and humeral elbow replacement. Total elbow classes are total and total plus radial elbow replacement. Definitions for each of these are detailed in the relevant chapters. Revision procedures are re-operations of previous elbow replacements where one or more of the prosthetic components are replaced, removed, or another component is added. Revisions include reoperations of primary partial, primary total or previous revision procedures. Elbow revisions are sub-categorised into three classes, minor, major partial and major total revisions. These are defined in the chapter on revisions. ELBOW REPLACEMENT PARTIAL TOTAL REVISION RADIAL MINOR UNI HUMERAL TOTAL MAJOR PARTIAL UNI HUMERAL WITH RADIAL TOTAL WITH RADIAL MAJOR TOTAL HUMERAL HEMIARTHROPLASTY End Data Period: 31 Dec 2014 Page 2
9 Demographics Table EG1 Number of Elbow Replacements by Gender TOTAL Elbow Replacement N % N % N % Radial Uni Humeral Uni Humeral & Radial Humeral Hemiarthroplasty Primary Partial Total Elbow Total Elbow & Radial Primary Total Revision TOTAL Table EG2 Number of Elbow Replacements by < TOTAL Elbow Replacement N % N % N % N % N % N % Radial Uni Humeral Uni Humeral & Radial Humeral Hemiarthroplasty Primary Partial Total Elbow Total Elbow & Radial Primary Total Revision TOTAL Table EG3 Time between Procedures for Bilateral Primary Elbow Replacement Same Day 1day-6months 6months TOTAL Bilateral Procedures N Total% N Total% N Total% N Total% Both - Radial Both - Total Elbow Uni Humeral & Radial & Total Elbow TOTAL Table EG4 All Elbow Replacement by and Gender % % TOTAL End Data Period: 31 Dec 2014 Page 3
10 Figure EG1 All Elbow Replacement by and Gender 5 45% 4 35% 3 25% 2 15% 5% Table EG5 Revision Rates of Primary Elbow Replacement by Elbow Class Elbow Class N Revised N Total Obs. Years Revisions/100 Obs. Yrs (95% CI) Radial (0.57, 1.15) Uni Humeral (0.00, 12.68) Uni Humeral & Radial (4.58, 27.19) Humeral Hemiarthroplasty (1.25, 4.81) Total Elbow (2.04, 3.40) Total Elbow & Radial (2.15, 11.02) TOTAL (1.41, 2.04) Table EG6 Yearly Cumulative Percent Revision of Primary Elbow Replacement by Elbow Class CPR 1 Yr 2 Yrs 3 Yrs 4 Yrs 5 Yrs 6 Yrs 7 Yrs Radial 1.7 (1.1, 2.7) 3.0 (2.1, 4.2) 3.2 (2.3, 4.5) 3.2 (2.3, 4.5) 3.2 (2.3, 4.5) 3.2 (2.3, 4.5) Uni Humeral 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) Uni Humeral & Radial 17.5 (6.0, 45.1) 23.8 (9.6, 51.9) 39.0 (19.4, 67.8) 39.0 (19.4, 67.8) Humeral Hemiarthroplasty 4.1 (1.7, 9.5) 6.1 (2.9, 12.4) 8.9 (4.6, 16.7) Total Elbow 2.9 (1.9, 4.5) 4.8 (3.4, 6.8) 8.3 (6.2, 10.9) 10.6 (8.1, 13.7) 10.9 (8.4, 14.1) 14.0 (10.6, 18.4) Total Elbow & Radial 5.9 (1.5, 21.5) 16.3 (7.1, 35.1) 20.1 (9.5, 39.7) 24.1 (12.2, 44.4) 24.1 (12.2, 44.4) 24.1 (12.2, 44.4) End Data Period: 31 Dec 2014 Page 4
11 Primary Partial Elbow Replacement Demographics The Registry sub-categorises primary partial shoulder replacement into three classes. These are defined as: 1. Radial involves resection of the radial head and replacement with a stemmed radial prosthesis. 2. Uni humeral involves replacement of the capitellum. 3. Uni humeral with radial involves replacement of the capitellum and radial head. 4. Humeral Hemiarthroplasty involves resection of the distal humerus and replacement with a stemmed humeral prosthesis. Table EP1 Primary Partial Elbow Replacement by and Gender % % TOTAL Figure EP1 Primary Partial Elbow Replacement by and Gender Table EP2 Primary Partial Elbow Replacement by Primary Diagnosis 6 5 Primary Diagnosis Number Percent Fracture/Dislocation Osteoarthritis Instability Rheumatoid Arthritis Osteonecrosis Tumour Other Inflammatory Arthritis Other TOTAL End Data Period: 31 Dec 2014 Page 5
12 Primary Radial Elbow Replacement Table EP3 Primary Radial Elbow Replacement by and Gender % % TOTAL Figure EP2 Primary Radial Elbow Replacement by and Gender Table EP4 Primary Radial Elbow Replacement by Primary Diagnosis Primary Diagnosis Number Percent Fracture/Dislocation Osteoarthritis Instability Rheumatoid Arthritis Tumour Other Inflammatory Arthritis Osteonecrosis Other TOTAL Table EP5 Most Used Radial Head/Stem Prostheses in Primary Radial Elbow Replacement N Model N Model N Model N Model N Model 50 Evolve 53 Anatomic Radial Stem (Ascension) 37 Anatomic 41 Radial Stem (Ascension) 45 Evolve 51 Evolve 41 Radial Stem (Ascension) 48 Anatomic 50 Anatomic Radial Stem (Ascension) 40 Radial Stem (Ascension) 49 Anatomic 40 Evolve 28 Evolve 21 MOPYC 19 MOPYC 22 MOPYC 18 MOPYC 24 MOPYC 10 RHS 6 rhead 4 rhead 2 ExploR 2 rhead 4 rhead 3 RHS 3 RHS 1 RHS 1 Custom Made (ExploR) 3 ExploR 1 ExploR 1 Generic Radial Stem 1 ExploR 1 Solar 1 Solar 1 RHS 1 Swanson Ten Most Used 173 (7) (9) (8) (6) (8) 100. Remainder 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) TOTAL 173 (7) (9) (8) (6) (8) 100. End Data Period: 31 Dec 2014 Page 6
13 Primary Uni Humeral Elbow Replacement Table EP6 Primary Uni Humeral Elbow Replacement by and Gender % % TOTAL Figure EP3 Primary Uni Humeral Elbow Replacement by and Gender Table EP7 Primary Uni Humeral Elbow Replacement Primary Diagnosis Primary Diagnosis Number Percent Osteoarthritis Fracture/Dislocation Osteonecrosis TOTAL Primary Uni Humeral with Radial Elbow Replacement Table EP8 Primary Uni Humeral with Radial Elbow Replacement by and Gender % % TOTAL Figure EP4 Primary Uni Humeral with Radial Elbow Replacement by and Gender Table EP9 Primary Uni Humeral with Radial Elbow Replacement by Primary Diagnosis Primary Diagnosis Number Percent Osteoarthritis Osteonecrosis Fracture/Dislocation TOTAL End Data Period: 31 Dec 2014 Page 7
14 Primary Humeral Hemiarthroplasty Table EP10 Primary Humeral Hemiarthroplasty by and Gender % % TOTAL Figure EP5 Primary Humeral Hemiarthroplasty by and Gender Table EP11 Primary Humeral Hemiarthroplasty by Primary Diagnosis Primary Diagnosis Number Percent Fracture/Dislocation Osteoarthritis Rheumatoid Arthritis Tumour TOTAL Table EP12 Most Used Humeral Prostheses in Primary Humeral Hemiarthroplasty N Model N Model N Model N Model N Model 16 Latitude 21 Latitude 20 Latitude 22 Latitude 15 Latitude Ten Most Used 16 (1) (1) (1) (1) (1) 100. Remainder 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) TOTAL 16 (1) (1) (1) (1) (1) 100. End Data Period: 31 Dec 2014 Page 8
15 Primary Total Elbow Replacement Demographics The Registry sub-categorises primary total elbow replacement into two classes. These are defined as: 1. Total elbow without radial includes resection of the olecranon and distal humerus and replacement with a stemmed ulna and stemmed humeral prosthesis. 2. Total elbow with radial includes resection of the olecranon and distal humerus and replacement with a stemmed ulna and stemmed humeral prosthesis combined with replacement of the radial head with a radial prosthesis. Table ET1 Primary Total Elbow Replacement by and Gender % % TOTAL Figure ET1 Primary Total Elbow Replacement by and Gender Table ET2 Primary Total Elbow Replacement by Primary Diagnosis Primary Diagnosis Number Percent Osteoarthritis Fracture/Dislocation Rheumatoid Arthritis Other Inflammatory Arthritis Instability Tumour Osteonecrosis Other TOTAL End Data Period: 31 Dec 2014 Page 9
16 Primary Total Elbow without Radial Replacement Table ET3 Primary Total Elbow without Radial Replacement by and Gender % % TOTAL Figure ET2 Primary Total Elbow without Radial Replacement by and Gender Table ET4 Primary Total Elbow without Radial Replacement by Primary Diagnosis 6 5 Primary Diagnosis Number Percent Fracture/Dislocation Osteoarthritis Rheumatoid Arthritis Other Inflammatory Arthritis Tumour Instability Osteonecrosis Other TOTAL Table ET5 Most Used Humeral Prostheses in Primary Total Elbow without Radial Replacement N Model N Model N Model N Model N Model 61 Coonrad/Morrey 67 Coonrad/Morrey 68 Coonrad/Morrey 59 Coonrad/Morrey 61 Coonrad/Morrey 22 Latitude 26 Latitude 26 Latitude 21 Latitude 19 Latitude 10 Discovery 8 Discovery 14 Discovery 9 Nexel 14 Nexel 1 IBP 2 Souter Strathclyde 1 Souter Strathclyde 4 Discovery 11 Discovery 1 Souter Strathclyde Ten Most Used 95 (5) (4) (4) (4) (4) 100. Remainder 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) TOTAL 95 (5) (4) (4) (4) (4) 100. End Data Period: 31 Dec 2014 Page 10
17 Primary Total Elbow with Radial Replacement Table ET6 Primary Total Elbow with Radial Replacement by and Gender % % TOTAL Figure ET3 Primary Total Elbow with Radial Replacement by and Gender Table ET7 Primary Total Elbow with Radial Replacement by Primary Diagnosis Primary Diagnosis Number Percent Osteoarthritis Rheumatoid Arthritis Fracture/Dislocation Other Inflammatory Arthritis Instability TOTAL Table ET8 Most Used Radial Head/Humeral Prostheses in Primary Total Elbow with Radial Elbow Replacement N Model N Model N Model N Model N Model 6 Latitude 2 Latitude 2 Latitude 1 Latitude 3 Latitude Ten Most Used 6 (1) (1) (1) (1) (1) 100. Remainder 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) TOTAL 6 (1) (1) (1) (1) (1) 100. End Data Period: 31 Dec 2014 Page 11
18 Revision Elbow Replacement Demographics The Registry sub-categorises elbow revisions into three classes. These are defined as: 1. Major total revision is the insertion, removal and/or replacement of a major component on both the proximal and distal side of the joint. 2. Major partial revision is the insertion, removal and/or replacement of a major component on either the proximal or distal side of the joint. Major components are prostheses that are fixed to bone. These are the humeral prosthesis and the ulna prosthesis in elbow replacement. Although the radial prosthesis is fixed to bone, it is not considered a major prosthesis. Different types of major partial and minor revisions are identified based on the specific prostheses or implants used in the revision. 3. Minor revision is the insertion, removal and/or replacement of any other prostheses or implant in elbow replacement. Table ER1 All Revision Elbow Replacement by and Gender % % TOTAL Table ER2 Type of Revision of All Revision Elbow Replacement Table ER3 Reason for Revision of All Revision Elbow Replacement Revision Type Number Percent Humeral/Ulnar Radial Component Humeral Component Elbow Pin Only Ulna Component Cement Spacer Removal of Prostheses Radial Head Only Reoperation Ulna Cap Only Radial Neck Only Uni Humeral/Radius Reinsertion of Components Radial/Ulnar Cement Only Minor Components TOTAL Revision Diagnosis Number Percent Loosening/Lysis Infection Fracture Instability Prosthesis Dislocation Pain Progression Of Disease Implant Breakage Ulna Implant Breakage Humeral Malposition Incorrect Sizing Arthrofibrosis Metal Related Pathology Heterotopic Bone Synovitis Wear Humeral Wear Ulna Implant Wear Pin/Bushing Other TOTAL End Data Period: 31 Dec 2014 Page 12
19 Revision of Known Primary Partial Elbow Replacement Known Primary Radial Elbow Replacement Table EPR1 Revision of Known Primary Radial Elbow Replacement by and Gender % % TOTAL Figure EPR1 Revision of Known Primary Radial Elbow Replacement by and Gender Table EPR2 Type of Revision of Known Primary Radial Elbow Replacement Type of Revision Number Percent Radial Component Humeral/Ulnar Radial Neck Only Removal of Prostheses Uni Humeral/Radius Reinsertion of Components Reoperation Radial Head Only TOTAL Table EPR3 Reason for Revision of Known Primary Radial Elbow Replacement Reason for Revision Number Percent Loosening/Lysis Instability Fracture Infection Incorrect Sizing Pain Arthrofibrosis Prosthesis Dislocation Progression Of Disease Other TOTAL End Data Period: 31 Dec 2014 Page 13
20 Known Primary Uni Humeral with Radial Elbow Replacement Table EPR4 Revision of Known Primary Uni Humeral with Radial Elbow Replacement by and Gender TOTAL Table EPR5 Type of Revision of Known Primary Uni Humeral with Radial Elbow Replacement Figure EPR Revision of Known Primary Uni Humeral with Radial Elbow Replacement by and Gender Type of Revision Number Percent Humeral/Ulnar Removal of Prostheses Radial Component TOTAL Table EPR6 Reason for Revision of Known Primary Uni Humeral with Radial Elbow Replacement Reason for Revision Number Percent Loosening/Lysis Fracture Progression Of Disease TOTAL End Data Period: 31 Dec 2014 Page 14
21 Known Primary Humeral Elbow Replacement Table EPR7 Revision of Known Primary Humeral Elbow Replacement by and Gender TOTAL Figure EPR3 Revision of Known Primary Humeral Elbow Replacement by and Gender Table EPR8 Type of Revision of Known Primary Humeral Elbow Replacement Type of Revision Number Percent Ulna Component Humeral/Ulnar Radial/Ulnar Reinsertion of Components Cement Spacer TOTAL Table EPR9 Reason for Revision of Known Primary Humeral Elbow Replacement Reason for Revision Number Percent Instability Infection Loosening/Lysis Prosthesis Dislocation Pain Progression Of Disease TOTAL End Data Period: 31 Dec 2014 Page 15
22 Revision of Known Primary Total Elbow Replacement Known Primary Total Elbow without Radial Replacement Table ETR1 Revision of Known Primary Total Elbow without Radial Replacement by and Gender % % TOTAL Figure ETR Revision of Known Primary Total Elbow without Radial Replacement by and Gender Figure ETR2 Type of Revision of Known Primary Total Elbow without Radial Replacement Type of Revision Number Percent Humeral Component Humeral/Ulnar Ulna Component Cement Spacer Elbow Pin Only Radial Component Reoperation Ulna Cap Only Removal of Prostheses Minor Components TOTAL Table ETR2 Reason for Revision of Known Primary Total Elbow without Radial Replacement Reason for Revision Number Percent Infection Loosening/Lysis Fracture Malposition Progression Of Disease Instability Prosthesis Dislocation Metal Related Pathology Arthrofibrosis Other TOTAL End Data Period: 31 Dec 2014 Page 16
23 Known Primary Total Elbow with Radial Replacement Table ETR3 Revision of Known Primary Total Elbow with Radial Replacement by and Gender % % TOTAL Table ETR4 Type of Revision of Known Primary Total Elbow with Radial Replacement Figure ETR Revision of Known Primary Total Elbow with Radial Replacement by and Gender Type of Revision Number Percent Humeral/Ulnar Radial Head Only Removal of Prostheses Cement Spacer Ulna Cap Only TOTAL Table ETR5 Reason for Revision of Known Primary Total Elbow with Radial Replacement Reason for Revision Number Percent Infection Instability Prosthesis Dislocation Loosening/Lysis TOTAL End Data Period: 31 Dec 2014 Page 17
24 WRIST REPLACEMENT Categories of Wrist Replacement The Registry groups wrist replacement into three broad categories, primary partial, primary total and revision wrist replacement. A primary replacement is the initial replacement procedure undertaken on a joint and involves replacing either part (partial) or all (total) of the articular surface. Primary partial wrist replacement is further subcategorised into four classes depending on the type of prostheses used. Partial wrist classes are lunate, partial ulna, distal radial ulna joint (DRUJ) with ulna only replacement and DRUJ with ulna and radial replacement. Definitions for each of these are detailed in the relevant chapters. Revision procedures are re-operations of previous wrist replacements where one or more of the prosthetic components are replaced, removed, or another component is added. Revisions include re-operations of primary partial, primary total or previous revision procedures. Wrist revisions are sub-categorised into three classes, minor, major partial and major total revisions. These are defined in the chapter on revisions. WRIST REPLACEMENT PARTIAL TOTAL REVISION LUNATE PARTIAL ULNA MINOR DRUJ WITH ULNA ONLY REPLACEMENT TOTAL MAJOR PARTIAL DRUJ WITH ULNA AND RADIAL REPLACEMENT MAJOR TOTAL SCAPHOID INTERSPACER REPLACEMENT End Data Period: 31 Dec 2014 Page 18
25 Demographics Table WG1 Number of Wrist Replacements by Gender TOTAL Wrist Replacement N % N % N % Lunate Partial Ulnar DRUJ - Ulnar Only DRUJ - Ulnar & Radial Scaphoid Interspacer Primary Partial Primary Total Revision TOTAL Table WG2 Number of Wrist Replacements by < TOTAL Wrist Replacement N % N % N % N % N % N % Lunate Partial Ulnar DRUJ - Ulnar Only DRUJ - Ulnar & Radial Scaphoid Interspacer Primary Partial Primary Total Revision TOTAL Table WG3 All Wrist Replacement by and Gender TOTAL Figure WG1 All Wrist Replacement by and Gender End Data Period: 31 Dec 2014 Page 19
26 Table WG4 Revision Rates of Primary Wrist Replacement by Class Wrist Class N Revised N Total Obs. Years Revisions/100 Obs. Yrs (95% CI) Lunate (0.21, 45.22) Partial Ulnar (0.00, 6.33) DRUJ - Ulnar Only (0.83, 4.92) DRUJ - Ulnar & Radial (0.00, 9.44) Scaphoid Interspacer (0.00, 5.56) Total Wrist (0.20, 2.81) TOTAL (0.64, 2.44) Table WG5 Yearly Cumulative Percent Revision of Primary Wrist Replacement by Class CPR 1 Yr 2 Yrs 3 Yrs 4 Yrs 5 Yrs 6 Yrs 7 Yrs 8 Yrs DRUJ - Ulnar Only 4.2 (1.4, 12.4) 7.4 (3.1, 16.8) 7.4 (3.1, 16.8) 9.7 (4.4, 20.7) 9.7 (4.4, 20.7) 9.7 (4.4, 20.7) Scaphoid Interspacer 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) Total Wrist 0.0 (0.0, 0.0) 3.0 (0.8, 11.5) 3.0 (0.8, 11.5) 3.0 (0.8, 11.5) 3.0 (0.8, 11.5) 8.4 (2.2, 29.1) Other (3) 2.7 (0.4, 17.7) 2.7 (0.4, 17.7) 2.7 (0.4, 17.7) 2.7 (0.4, 17.7) 2.7 (0.4, 17.7) Note: Only Wrist Classes with over 20 procedures have been listed End Data Period: 31 Dec 2014 Page 20
27 Primary Partial Wrist Replacement Demographics The Registry sub-categorises primary partial wrist replacement into five classes. These are defined as: 1. Lunate involves replacement of the lunate bone with a lunate prosthesis. 2. Partial Ulna involves the replacement of part of the distal ulnar surface with a stemmed ulnar prosthesis. 4. Distal Radial Ulna Joint (DRUJ) with ulna and radial replacement involves resection of the ulna head and replacement with a stemmed ulna prosthesis and a distal radial notch and plate. 5. Scaphoid Interspacer is used to replace the proximal pole in the scaphoid. 3. Distal Radial Ulna Joint (DRUJ) with ulna only replacement involves resection of the ulna head and replacement with a stemmed ulna prosthesis. Table WP1 Primary Partial Wrist Replacement by and Gender % % TOTAL Figure WP1 Primary Partial Wrist Replacement by and Gender Table WP2 Primary Partial Wrist Replacement by Primary Diagnosis Primary Diagnosis Number Percent Osteoarthritis Fracture/Dislocation Rheumatoid Arthritis Instability Osteonecrosis Tumour Other Inflammatory Arthritis Other TOTAL End Data Period: 31 Dec 2014 Page 21
28 Primary Lunate Wrist Replacement Table WP3 Primary Lunate Wrist Replacement by and Gender TOTAL Figure WP2 Primary Lunate Wrist Replacement by and Gender Table WP4 Primary Lunate Wrist Replacement by Primary Diagnosis Primary Diagnosis Number Percent Osteonecrosis Fracture/Dislocation Osteoarthritis TOTAL Primary Partial Ulna Wrist Replacement Table WP5 Primary Partial Ulna Wrist Replacement by Gender % % TOTAL Figure WP3 Primary Partial Ulna Wrist Replacement by and Gender Table WP6 Primary Partial Ulna Wrist Replacement by Primary Diagnosis Primary Diagnosis Number Percent Osteoarthritis Rheumatoid Arthritis Fracture/Dislocation Instability TOTAL End Data Period: 31 Dec 2014 Page 22
29 Primary DRUJ with Ulna Only Replacement Table WP7 Primary DRUJ with Ulna Only Replacement by and Gender % % TOTAL Figure WP4 Primary DRUJ with Ulna Only Replacement by and Gender Table WP8 Primary DRUJ with Ulna Only Replacement by Primary Diagnosis 6 5 Primary Diagnosis Number Percent Osteoarthritis Rheumatoid Arthritis Fracture/Dislocation Instability Tumour Other Inflammatory Arthritis Other TOTAL Table WP9 Most Used Ulna Prostheses in Primary DRUJ with Ulna Only Replacement N Model N Model N Model N Model N Model 5 uhead 3 DRUJ (Ascension) 7 uhead 5 Herbert UHP 5 Herbert UHP 4 Herbert UHP 2 Herbert UHP 5 Herbert UHP 2 Eclypse 3 DRUJ (Ascension) 3 DRUJ (Ascension) 1 E-Centrix 3 DRUJ (Ascension) 2 Eclypse 1 Eclypse 1 uhead 1 uhead Ten Most Used 13 (4) (4) (3) (2) (4) 100. Remainder 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) TOTAL 13 (4) (4) (3) (2) (4) 100. End Data Period: 31 Dec 2014 Page 23
30 Primary DRUJ with Ulna and Radial Replacement Table WP10 Primary DRUJ with Ulna and Radial Replacement by and Gender % % TOTAL Figure WP5 Primary DRUJ with Ulna and Radial Replacement by and Gender Table WP11 Primary DRUJ with Ulna and Radial Replacement by Primary Diagnosis Primary Diagnosis Number Percent Osteoarthritis Instability Fracture/Dislocation Rheumatoid Arthritis Other TOTAL Primary Scaphoid Interspacer Replacement Table WP12 Primary Scaphoid Interspacer Replacement by and Gender TOTAL Figure WP6 Primary Scaphoid Interspacer Replacement by and Gender Table WP13 Primary Scaphoid Interspacer Replacement by Primary Diagnosis Primary Diagnosis Number Percent Osteoarthritis Fracture/Dislocation Rheumatoid Arthritis Instability TOTAL End Data Period: 31 Dec 2014 Page 24
31 Primary Total Wrist Replacement Demographics The Registry sub-categorises primary total wrist replacement into one class. This is defined as: 1. Total Wrist includes resection of the distal radius and replacement with a radial prosthesis combined with replacement of the carpal bones with a carpal prosthesis and carpal spacer. Table WT1 Primary Total Wrist Replacement by and Gender % % TOTAL Figure WT1 Primary Total Wrist Replacement by and Gender Table WT2 Primary Total Wrist Replacement by Primary Diagnosis 6 5 Primary Diagnosis Number Percent Osteoarthritis Rheumatoid Arthritis Fracture/Dislocation Other Inflammatory Arthritis Osteonecrosis Other TOTAL Table WT3 Most Used Carpal/Radial Prostheses in Primary Total Wrist Replacement N Model N Model N Model N Model N Model 10 Re-Motion 10 Re-Motion 5 Re-Motion 7 Re-Motion 4 Re-Motion 4 Universal 2 3 Universal 2 1 Universal 2 3 Universal 2 3 Motec 2 Universal 2 Ten Most Used 14 (2) (2) (2) (2) (3) 100. Remainder 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) TOTAL 14 (2) (2) (2) (2) (3) 100. End Data Period: 31 Dec 2014 Page 25
32 Revision Wrist Replacement Demographics The Registry sub-categorises wrist revisions into three classes. These are defined as: 1. Major total revision is the insertion, removal and/or replacement of a major component on both the proximal and distal side of the joint. 2. Major partial revision is the insertion, removal and/or replacement of a major component on either the proximal or the distal side of the joint. 3. Minor revision is the insertion removal and/or replacement of any other prostheses or implant in wrist replacement. Major components are prostheses that are fixed to bone. These are the radial prosthesis and the carpal prosthesis in wrist replacement. The ulna and individual carpal prostheses are not considered major prostheses. Different types of major partial and minor revisions are identified based on the specific prostheses or implants used in the revision. Table WR1 All Revision Wrist Replacement by and Gender TOTAL Table WR2 Type of Revision of All Revision Wrist Replacement Table WR3 Reason for Revision of All Revision Wrist Replacement Revision Type Number Percent Removal of Prostheses Ulna Component Ulna Head Only Carpal Component Sigmoid Notch Reoperation Fusion Carpal/Radius Cement Spacer Carpal Insert Sigmoid Notch/Ulna Unclassified - No components TOTAL Revision Diagnosis Number Percent Loosening/Lysis Pain Instability Infection Contracture Progression Of Disease Malposition Implant Breakage Wrist Plate Other TOTAL End Data Period: 31 Dec 2014 Page 26
33 Revision of Known Primary Partial Wrist Replacement Known Primary DRUJ with Ulna Only Replacement Table WPR1 Revision of Primary DRUJ with Ulna Only Replacement by and Gender TOTAL Figure WPR1 Revision of Known Primary DRUJ with Ulna Only Replacement by and Gender Table WPR2 Type of Revision of Known Primary DRUJ with Ulna Only Replacement Table WPR3 Reason for Revision of Known Primary DRUJ with Ulna Only Replacement Type of Revision Number Percent Ulna Component Carpal/Radius Ulna Head Only Removal of Prostheses Sigmoid Notch TOTAL Reason for Revision Number Percent Loosening/Lysis Progression Of Disease Instability TOTAL End Data Period: 31 Dec 2014 Page 27
34 Revision of Known Primary Total Wrist Replacement Table WTR1 Revision of Known Primary Total Wrist Replacement by and Gender % % TOTAL Figure WTR1 Revision of Primary Total Wrist Replacement by and Gender Table WTR2 Type of Revision of Known Primary Total Wrist Replacement Table WTR3 Reason for Revision of Known Primary Total Wrist Replacement Type of Revision Number Percent Carpal/Radius Carpal Component Reoperation Fusion TOTAL Reason for Revision Number Percent Loosening/Lysis Implant Breakage Wrist Plate TOTAL End Data Period: 31 Dec 2014 Page 28
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METAL HEMI Great Toe Implant SURGICAL TECHNIQUE Contents Chapter 1 4 Product Information 4 Device Description Chapter 2 5 Intended Use 5 Indications 5 Contraindications Chapter 3 6 Surgical Technique
I have been provided with information to answer your request by Ms Lyn McDonald, Site Director, Royal Infirmary of Edinburgh.
Lothian NHS Board = Waverley Gate 2-4 Waterloo Place Edinburgh EH1 3EG = Telephone: 0131 536 9000 www.nhslothian.scot.nhs.uk Date: 15/06/2015 Our Ref: 5229 Enquiries to : Bryony Pillath Extension: 35676