ABSTRACT
BACKGROUND AND PURPOSE: This study aims to assess time trends in case-mix and to evaluate the risk of revision and causes following primary THA, TKA, and UKA in private and public hospitals in the Netherlands. METHODS: We retrospectively analyzed 476,312 primary arthroplasties (public: n = 413,560 and private n = 62,752) implanted between 2014 and 2023 using Dutch Arthroplasty Register data. We explored patient demographics, procedure details, trends over time, and revisions per hospital type. Adjusted revision risk was calculated for comparable subgroups (ASA I/II, age ≤ 75, BMI ≤ 30, osteoarthritis diagnosis, and moderate-high socioeconomic status (SES). RESULTS: The volume of THAs and TKAs in private hospitals increased from 4% and 9% in 2014, to 18% and 21% in 2022. Patients in private hospitals were younger, had lower ASA classification, lower BMI, and higher SES compared with public hospital patients. In private hospitals, age and ASA II proportion increased over time. Multivariable Cox regression demonstrated a lower revision risk for primary THA (HR 0.7, CI 0.7-0.8), TKA (HR 0.8, CI 0.7-0.9), and UKA (HR 0.8, CI 0.7-0.9) in private hospitals. After initial arthroplasty in private hospitals, 49% of THA and 37% of TKA revisions were performed in public hospitals. CONCLUSION: Patients in private hospitals were younger, had lower ASA classification, lower BMI, and higher SES com-pared with public hospital patients. The number of arthroplasties increased in private hospitals, with a lower revision risk compared with public hospitals.
Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Hospitals, Private , Hospitals, Public , Registries , Reoperation , Humans , Arthroplasty, Replacement, Knee/statistics & numerical data , Arthroplasty, Replacement, Hip/statistics & numerical data , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/trends , Netherlands/epidemiology , Hospitals, Private/statistics & numerical data , Male , Female , Hospitals, Public/statistics & numerical data , Reoperation/statistics & numerical data , Aged , Middle Aged , Retrospective Studies , Cross-Sectional Studies , Diagnosis-Related Groups , Risk Factors , Aged, 80 and overABSTRACT
BACKGROUND: The Kudo total elbow prosthesis (TEP) is a well-established implant with good mid-term results. The ulnar component can be placed with or without cement, and the humeral component is normally placed without cement. METHODS: 89 Kudo type-5 total elbow prostheses were evaluated after a mean follow-up of 6 (1.7-11) years. The indication for joint replacement was rheumatoid arthritis in all cases. 49 prostheses were placed without cement. In 40 cases, the ulnar component was cemented and the humeral component was uncemented. RESULTS: In the uncemented group, 7 revisions had taken place. 3 of these ulnar components were shortstemmed and 4 were long-stemmed. No revisions had been performed in the hybrid group. In the uncemented group another 7 patients showed progressive radiolucencies, while 3 patients in the hybrid group showed progressive radiolucencies. INTERPRETATION: In this group of RA patients, the survivorship of the cemented ulnar component was better than that of the uncemented ulnar component.
