PROGNOSIS OF TOTAL HIP-REPLACEMENT IN SWEDEN - FOLLOW-UP OF 92,675 OPERATIONS PERFORMED 1978-1990

A prospective, national multi-center study of all reoperations after t otal hip replacement (THR) was started by the Swedish Orthopedic Assoc iation in 1979. The material comprises all THR performed in Sweden, pr esently more than 10,000 yearly or 130 THR per 100,000 inhabitants; un cemented implants have been used in less than 2 percent. The main reas ons for revision have been aseptic loosening 79 percent, infection 10 percent, technical error 6 percent, and dislocation 2 percent. The cum ulative rate of revision for deep infection has dropped from 0.9 perce nt to < 0.5 percent for implants inserted 1979 and 1983, respectively. With the Charnley prosthesis as the gold, standard the performance of other prostheses was analyzed. Improved cementation techniques and an ti-infection measures have continuously reduced the revision risk. The register demonstrates that the average ortopedic surgeon cannot match the results achieved by experts. However, the vast majority of THR, w orldwide, are not performed by experts. Quality-assurance in this sect or of orthopedics demands a continuous analysis of the outcome of thes e operations.