(i) International epidemiology of revision THR

SummaryThe worldwide number of primary total hip replacements has increased over the last decade, and as the number of primary total hip arthroplasties (THAs) increases each year, the number of revision THAs can also be expected to increase. Revision THAs often lead to suboptimal results, more complications and high costs. The rapid growth of new surgical techniques and new hip implants warrants a continuous and objective monitoring of the results to lower revision rates and improve outcomes. From an international standpoint, the revision burden is one of the possible key figures that allow crude comparisons between different countries and health systems. Evidence based information and revision rates can be derived from national joint registry data. In countries without registries, data can be collected from large data sets used for billing, national hospital discharge surveys and quality surveys. In addition single- and multicentre data regarding revision THA in combination with randomised control trials (RCTs) can be used. However, certain strengths and weaknesses apply to non-registry data sources which will be discussed. It was shown that the overall revision burden which is as high as 17.5% in some countries, could be improved in countries with national joint registries. One way to lower revision rates in the future is to use evidence-based primary implants. Registry data have the power to identify such implants, surgical techniques and processes. Thus it can guide surgeons in an evidence-based fashion to the benefit of patient outcome.