The National Register of Joint Replacements of the Czech Republic

The National Register of Joint Replacements of the Czech Republic was established as part of the National Health Information System in 2002. The register's administrator is the Institute of Health Information and Statistics of the Czech Republic, the Czech Society for Orthopaedics and Traumatology acts as its guarantee for scientific standard. The register is financed from state resources. It was launched into full operation in 2003 and it currently focuses on hip joint replacements. Register of knee and shoulder joint replacements is being prepared. The register provides aggregate epidemiological data and other statistics, including the Revision Rate - RR and survival curves (Kaplan Meier) for the main monitored groups of patients and implants used. More complex analytical evaluation methods are being set up. In years 2003-2009 there were 72 hospitals participating in the register's activities, 63 037 primary implantations and 8 931 revision surgeries were registered. In terms of gender share there is a prevalence of females amounting to 59,9% in primary implantations and to 64,7% in revision surgeries. The age structure covers the entire range of adult population, however, more than 50% of the replacements are being implanted between 60-74 years of age. Most frequent indications for primary implantation are idiopathic osteoarthritis 68,6%, post-traumatic conditions 13,53% and post-dysplasia arthritis 9,39%. The most frequent indications for revision surgery are aseptic loosening of acetabular component 40,9%, aseptic loosening of femoral component - 21,65% and recurrent luxation - 6,37%. 29 650 (47,04%) of primary implantations were cemented, 22 028 (34,94%) non-cemented, 10 924 (17,33%) hybrid with cemented femur and 435 (0,69%) were hybrid with cemented acetabulum. Most widely used is the classic anterolateral approach -77,76% in primary implantations and 52,35% in revision surge-ries. Bone grafts were used in 24,37% of primary implantations and 43,03% of revisions. Most widely used implants in primary implantations were cemented cup Muller (Aesculap) 10 196 pcs, cemented steel stem Poldi AK (Beznoska) 9 932 pcs, from the non-cemented models the cup Plasmacup SC (Aesculap) 6 738 pcs and stem SL Zweyrni.iller Alloclassic (Zimmer) 2 708 pcs. Most widely used implants in revision surgeries in general are noncemented oval cup Medin (HA) 740 pcs and non-cemented stem Wagner (Zimmer) 407 pcs. The Revision Rates of primary implantations indicated for infection in the samples from individual years were at the close of their monitoring in June 2010 as follows: 2003 - RR 0, 37%, 2004 - RR 0,36%, 2005 - RR 0,35%, 2006 - RR 0,28%, 2007 - RR 0,18%, 2008 - RR 0,10%, 2009 - RR 0,10%. The cumulated survival probability (Kaplan-Meier) in year 8 of the monitoring represent 97,27% for cemented implants, 96,53% for non-cemented, 96,73% for hybrid with cemented femur and 95,08% for hybrid with cemented cup.