Benchmarking total and unicondylar knee arthroplasty constructs across multiple national registries

Approval date: December 2022
Starting date: January 6th 2023
Amendment date: December 1st 2023

RGHH Nelissen, LA Hoogervorst, PJ Marang-van de Mheen

Research proposal abstract 

Not all total hip arthroplasties (THA) constructs and total knee arthroplasties (TKA) constructs perform equally well. In addition, there have been some incidents in the past concerning the safety of implants, with the case of the Metal-on-Metal hip implants being well-known.

Benchmarking THA and TKA implants in whether they perform equally well as other comparable implants with regard to revision risks provides important information to be used in daily clinical practice. Some registries (e.g. Australia, Denmark, Sweden and the Netherlands) already have outlier procedures on implant, hospitals and/or surgeons performance in place. For that matter all implants and performing above a certain preset benchmark (i.e. more revisions) are identified as a potential safety issue for that 
particular implant. The mix-match (off-label) use of primary total joint constructs (i.e. two or three different manufacturers for one total joint implant) is potentially also a risk for more revisions from an implant point of view although literature gives conflicting results, which may be due to the short followup of these studies. Even more complex is that data from a recent systematic review revealed that different registries identify different outlier implants across these registries, which raises questions whether the higher revision risk is due to the implant itself, a mix-match within the same total joint or the surgical expertise with that implant in the different countries or even the definition of what constitutes an outlier. Benchmarking implants with data across registries could help to provide an answer. The purpose of this multi registry-based study is to: 1) examine the performance of different types of implants (e.g. mobile / fixed bearing) with otherwise comparable design, to assess whether certain types of implants consistently have higher revision risks across registries; 2) compare the performance of specific implant constructs to comparable constructs across registries.