Australian Orthopaedic

Association National Joint

Replacement Registry

Partial Hip Arthroplasty

ANNUAL
REPORT
2020
 AOANJRR | 2020 ANNUAL REPORT

Director: Professor Stephen Graves AOANJRR

E: segraves@aoanjrr.org.au SAHMRI,
North Terrace
Manager: Ms Cindy Turner ADELAIDE SA 5000
E: cturner@aoanjrr.org.au T: +61 8 8128 4280

The AOANJRR is funded by the Australian Government Department of Health

Suggested citation:
Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Primary Partial
Hip Replacement: Supplementary Report, in Hip, Knee & Shoulder Arthroplasty: 2020 Annual Report,
AOA, Adelaide; 2020: 1-30. [Accessed from: https://aoanjrr.sahmri.com/annual-reports-
2020/supplementary]

www.aoa.org.au
© Australian Orthopaedic Association National Joint Replacement Registry 2020

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 AOANJRR | 2020 ANNUAL REPORT

Australian Orthopaedic Association

National Joint Replacement Registry

2020 Primary Partial Hip Replacement

Data Period 1 September 1999 – 31 December 2019 Page | 3

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 AOANJRR | 2020 ANNUAL REPORT

Acknowledgements
The Registry continues to receive support and invaluable assistance from the Commonwealth
Government, state and territory health departments and orthopaedic companies.

The Registry acknowledges the cooperation and support provided by those undertaking the surgery
and completing the data forms, in particular, all orthopaedic surgeons, registrars and nursing staff.

The Registry would also like to acknowledge the ongoing support of all hospitals, both public and
private, that undertake arthroplasty surgery nationally. The support provided by each hospital through
their nominated coordinator(s) is appreciated. A complete list of participating hospitals and
coordinators is presented at the end of the Hip, Knee and Shoulder Arthroplasty Annual Report.

The Registry greatly appreciates the participation of all joint replacement patients throughout
Australia. It is their contribution that allows ongoing improvements in arthroplasty outcomes to be
achieved.

DIRECTOR AOANJRR
Professor Stephen Graves Ms Cindy Turner (Registry Manager)
Dr Sophie Rainbird
DEPUTY DIRECTORS Ms Rianne Thompson
Professor Richard de Steiger
Mr Peter Lewis AOANJRR COMMITTEE
Professor Ian Harris Neil Bergman Chairperson
Professor Richard Page Stephen Graves Director
Richard de Steiger Deputy Director (Victoria)
ASSISTANT DEPUTY DIRECTORS Ian Harris Deputy Director (New South Wales)
Mr James D Stoney Peter Lewis Deputy Director (South Australia)
Dr Bill Donnelly Matt Lyons New South Wales
Fraser Taylor Queensland
CLINICAL ADVISORS Paul Smith Australian Capital Territory
Mr Andrew Beischer Marcus Kuster Western Australia
Michael Pritchard Tasmania
PROJECT TEAM Bill Donnelly President, Arthroplasty Society of Australia
Ms Tamara Hooper Peter McEwen Australian Knee Society
Ms Grace O’Donohue Richard Page Shoulder & Elbow Society Representative
Ms Durga Anandan Andrew Beischer Foot & Ankle Society Representative
Ms Libby Gepp Matthew Scott-Young Spine Society of Australia Representative
Ms Zoe Grivell James Stoney Assistant Deputy Director
Ms Tania Alland
Ms Katherine Duszynski - UniSA
Ms Aarti Gulyani - UniSA

SOUTH AUSTRALIAN HEALTH & MEDICAL RESEARCH INSTITUTE

Ms Liddy Griffith Ms Alana Cuthbert Ms Kirsty Modystach
Ms Emma Heath Ms Andrea Peng Mr Anh Pham
Ms Michelle Lorimer Ms Chelsea Dyer Ms Thu Ha Dang
Ms Janey Barrow Mr Carl Holder Mr Courtney Cullen
Mr Robert Armitage Ms Kara Cashman Mr James Hartley
Dr Primali De Silva Ms Georgina Daynes Ms Natalie Morrall

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 AOANJRR | 2020 ANNUAL REPORT

Contents


INTRODUCTION .................................................................................................................................................... 6
Classes Of Partial Hip Replacement ............................................................................................................. 6
Use Of Partial Hip Replacement .................................................................................................................... 6
Unipolar Monoblock........................................................................................................................................ 9
Demographics ................................................................................................................................................. 9
Outcome for Fractured Neck of Femur...................................................................................................... 10
Unipolar Modular ........................................................................................................................................... 15
Demographics ............................................................................................................................................... 15
Outcome for Fractured Neck of Femur...................................................................................................... 18
Bipolar……. . ................................................................................................................................................... 23
Demographics ............................................................................................................................................... 23
Outcome for Fractured Neck of Femur ....................................................................................................... 26
LIST OF TABLES................................................................................................................................................... 30
LIST OF FIGURES ................................................................................................................................................. 30

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Primary Partial Hip Replacement

INTRODUCTION
This supplementary report provides detailed information on partial hip replacement. Previously, this
information was included in the Hip, Knee & Shoulder Arthroplasty Annual Report. In 2018, it was
replaced with a summary of partial hips with the aim of streamlining the Annual Report. The Partial Hip
Arthroplasty Report is one of 13 supplementary reports to complete the AOANJRR Annual Report for
2020 and is available on the AOANJRR website.

CLASSES OF PARTIAL HIP REPLACEMENT

The Registry identifies four classes of primary In 2019, there is a slight increase in the use of
partial hip replacement. These are defined by bipolar and unipolar modular partial hip
the type of prostheses used. replacements. The use of unipolar monoblock
continues to decline (Figure SHP1).
Partial resurfacing involves the use of one or
more button prostheses to replace part of the
natural articulating surface on one or both sides At 10 years, bipolar hip replacement has the
of the hip joint. lowest cumulative percent revision, followed
Unipolar monoblock involves the use of a by unipolar modular and unipolar
femoral stem prosthesis with a fixed large head monoblock.
that replaces the natural femoral head.
Unipolar modular involves the use of a femoral Detailed demographic information on primary partial hip
replacement is available in the supplementary report
stem and exchangeable large head prosthesis ‘Demographics of Hip, Knee & Shoulder Arthroplasty’ on the
that replaces the natural femoral head. AOANJRR website: https://aoanjrr.sahmri.com/annual-
Bipolar involves the use of a femoral stem and reports-2020
standard head prosthesis that articulates with a
non-fixed component replacing the natural Figure SHP1 Primary Partial Hip Replacement by Class
femoral head. 5000
Unipolar Monoblock
4500 Unipolar Modular
Bipolar
4000
USE OF PARTIAL HIP REPLACEMENT
3500
The most common class of primary partial hip 3000
replacement is unipolar modular. This accounts
2500
for 45.6% of all partial hip procedures, followed
by unipolar monoblock (28.5%) and bipolar 2000

(25.9%) (Table SHP1). 1500

1000
Table SHP1 Primary Partial Hip Replacement by Class
500
Hip Class Number Percent
0
Unipolar Monoblock 28995 28.5
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20

Unipolar Modular 46303 45.6

Fractured neck of femur is the principal
Bipolar 26338 25.9
diagnosis for the three main classes of primary
TOTAL 101636 100.0
partial hip replacement: unipolar monoblock
Note: Excludes 15 partial resurfacing procedures (97.6%), unipolar modular (95.6%) and bipolar
(92.3%).
Detailed information on Partial Resurfacing Hip
Replacement is available in the supplementary report
‘Prosthesis Types No Longer Used’ on the AOANJRR website: A comparative analysis of partial hip
https://aoanjrr.sahmri.com/annual-reports-2020 replacement and total conventional hip
replacement was undertaken for fractured
neck of femur and is presented in the primary
total hip replacement chapter of the Annual
Report.

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The outcome of primary partial hip At 10 years, bipolar has the lowest cumulative
replacement varies depending on the class. percent revision for fractured neck of femur,
Outcomes are restricted to 10 years because of followed by unipolar monoblock, and unipolar
the high mortality in this group. The prosthesis modular (Table SHP3 and Figure SHP2). The
class variation in mortality is almost certainly difference in outcome between classes is most
due to patient selection (Table SHP2). apparent in patients aged <75 years (Table
SHP4 and Figure SHP3).

Table SHP2 Cumulative Percent Mortality of Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF)

N N
Hip Class 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Deceased Total
Unipolar Monoblock 24705 27593 36.9 (36.4, 37.5) 50.0 (49.4, 50.6) 60.8 (60.2, 61.4) 76.8 (76.3, 77.3) 86.1 (85.6, 86.5) 93.2 (92.9, 93.6)
Unipolar Modular 28126 42795 25.6 (25.2, 26.0) 36.4 (35.9, 36.9) 46.0 (45.5, 46.5) 61.9 (61.3, 62.4) 73.3 (72.8, 73.8) 83.6 (83.1, 84.1)
Bipolar 14528 23655 22.7 (22.2, 23.3) 32.8 (32.2, 33.5) 41.7 (41.0, 42.4) 56.4 (55.7, 57.1) 67.5 (66.7, 68.2) 78.9 (78.1, 79.6)
TOTAL 67359 94043

Table SHP3 Cumulative Percent Revision of Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF)

N N
Hip Class 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
Unipolar Monoblock 1075 28312 2.9 (2.7, 3.1) 3.9 (3.7, 4.2) 4.6 (4.4, 5.0) 5.7 (5.3, 6.1) 6.4 (6.0, 6.9) 7.8 (7.2, 8.5)
Unipolar Modular 1514 44275 2.0 (1.9, 2.1) 2.8 (2.6, 2.9) 3.4 (3.2, 3.6) 4.7 (4.4, 5.0) 6.0 (5.6, 6.3) 7.6 (7.1, 8.2)
Bipolar 829 24314 2.3 (2.1, 2.5) 3.1 (2.9, 3.4) 3.7 (3.4, 3.9) 4.3 (4.0, 4.6) 4.9 (4.5, 5.3) 6.2 (5.6, 6.8)
TOTAL 3418 96901

Figure SHP2 Cumulative Percent Revision of Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF)
HR - adjusted for age and gender
24%
Unipolar Monoblock Unipolar Monoblock vs Unipolar Modular
22% Unipolar Modular
Entire Period: HR=1.36 (1.26, 1.48),p<0.001
Bipolar
20%
Unipolar Monoblock vs Bipolar
18% 0 - 2Wk: HR=1.67 (1.27, 2.19),p<0.001
Cumulative Percent Revision

2Wk - 3Mth: HR=0.99 (0.84, 1.16),p=0.903

16%
3Mth+: HR=1.79 (1.60, 2.02),p<0.001
14%
Bipolar vs Unipolar Modular
12%
0 - 3Mth: HR=1.17 (1.03, 1.33),p=0.014
10% 3Mth - 2.5Yr: HR=0.88 (0.77, 1.01),p=0.063
2.5Yr+: HR=0.62 (0.52, 0.74),p<0.001
8%

6%

4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

Unipolar Monoblock 28312 17270 13407 10315 5791 3238 1326
Unipolar Modular 44275 30167 23618 18332 10595 5827 2164
Bipolar 24314 16501 12900 10088 6042 3843 2037

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Table SHP4 Cumulative Percent Revision of Primary Partial Hip Replacement in Patients Aged <75 Years by Class (Primary
Diagnosis Fractured NOF)

N N
Hip Class 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
Unipolar Monoblock 240 2458 4.4 (3.6, 5.4) 7.3 (6.2, 8.6) 9.6 (8.3, 11.2) 12.8 (11.2, 14.6) 14.5 (12.7, 16.5) 17.0 (14.8, 19.5)
Unipolar Modular 562 6816 3.0 (2.6, 3.4) 4.6 (4.1, 5.2) 6.3 (5.6, 7.0) 9.2 (8.4, 10.1) 11.8 (10.8, 12.9) 14.6 (13.4, 16.0)
Bipolar 294 4634 3.2 (2.7, 3.8) 4.8 (4.2, 5.5) 5.7 (5.0, 6.5) 6.6 (5.8, 7.5) 7.8 (6.9, 8.9) 9.4 (8.2, 10.6)
TOTAL 1096 13908

Figure SHP3 Cumulative Percent Revision of Primary Partial Hip Replacement in Patients Aged <75 Years by Class (Primary
Diagnosis Fractured NOF)
HR - adjusted for age and gender
24%
Unipolar Monoblock Unipolar Monoblock vs Bipolar
22% Unipolar Modular
0 - 3Mth: HR=1.04 (0.74, 1.48),p=0.816
Bipolar
20% 3Mth+: HR=2.14 (1.78, 2.59),p<0.001

18% Unipolar Monoblock vs Unipolar Modular

Cumulative Percent Revision

Entire Period: HR=1.32 (1.14, 1.54),p<0.001

16%

14% Unipolar Modular vs Bipolar

0 - 2.5Yr: HR=1.02 (0.86, 1.21),p=0.796
12%
2.5Yr+: HR=2.29 (1.85, 2.84),p<0.001
10%

8%

6%

4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

Unipolar Monoblock 2458 1667 1381 1144 779 563 315
Unipolar Modular 6816 5183 4342 3642 2554 1736 854
Bipolar 4634 3472 2907 2463 1779 1342 924

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UNIPOLAR MONOBLOCK
DEMOGRAPHICS
The Registry has recorded 28,995 unipolar The proportion of patients aged ≥85 years has
monoblock procedures. This is an additional 166 increased from 51.0% in 2003 to 58.2% in 2019.
procedures compared to the previous report. The mean age of patients is 84.5 years (Table
SHP5, Figure SHP4 and Figure SHP5).
The use of monoblock hip replacement in
Figure SHP5 Primary Unipolar Monoblock Hip
Australia continues to decline. The number of
Replacement by Age
procedures reported in 2019 has decreased by
100%
39.5% compared to 2018 and by 94.4% <55 55-64
90% 65-74 75-84
compared to 2003. ≥85
80%
Fractured neck of femur is the principal 70%
diagnosis for primary unipolar monoblock hip
60%
replacement (97.6%).
50%

The majority of patients are female (72.8%) and 40%

aged ≥75 years (91.3%). 30%

20%
Figure SHP4 Primary Unipolar Monoblock Hip
Replacement by Gender 10%
100% 0%
Male
90% Female
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
80%

70%
The three types of unipolar monoblock
60% prostheses are: the Exeter Trauma Stem (ETS),
50% Austin-Moore Type and Thompson Type. In 2019,
the use of the Austin-Moore Type decreased by
40%
56.9% compared to 2018 and by 98.7%
30%
compared to 2003. The Thompson Type
20% decreased by 83.3% compared to 2018 and by
10% 99.6% compared to 2003. In 2019, the use of the
ETS decreased by 30.1% compared to 2018 and
0%
accounts for 80.9% of all unipolar monoblock
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19

prostheses (Table SHP6).

20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20

Table SHP5 Age and Gender of Primary Unipolar Monoblock Hip Replacement

Gender Number Percent Minimum Maximum Median Mean Std Dev

Male 7879 27.2% 32 107 84 83.4 7.8
Female 21116 72.8% 16 108 86 85.0 7.2
TOTAL 28995 100.0% 16 108 85 84.5 7.4

Table SHP6 Most Used Prostheses in Primary Unipolar Monoblock Hip Replacement

2003 2016 2017 2018 2019

N Model N Model N Model N Model N Model
1988 Austin-Moore Type 263 ETS 231 ETS 163 ETS 114 ETS
526 Thompson Type 198 Austin-Moore Type 100 Austin-Moore Type 58 Austin-Moore Type 25 Austin-Moore Type
105 Thompson Type 70 Thompson Type 12 Thompson Type 2 Thompson Type
Most Used
2514 (2) 100.0% 566 (3) 100.0% 401 (3) 100.0% 233 (3) 100.0% 141 (3) 100.0%

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OUTCOME FOR FRACTURED NECK OF FEMUR

The cumulative percent revision at 10 years for Fixation is a risk factor for revision. In the first 2.5
unipolar monoblock replacement undertaken years, cementless fixation has a higher rate of
for fractured neck of femur is 7.8% (Table SHP7 revision compared to cemented fixation. After
and Figure SHP6). this time, the rate of revision for cementless
fixation is lower (Table SHP12 and Figure SHP9).
The main reason for revision is loosening (42.4%),
followed by fracture (20.1%) and prosthesis The Thompson Type prosthesis, though
dislocation (11.2%) (Table SHP8). Of the revisions designed to be cemented, has been inserted
of unipolar monoblock hip replacements, the without cement in 591 procedures. This has the
majority are revised to a total hip replacement highest rate of revision (Table SHP12 and Figure
(60.4%). Revision to another unipolar hip SHP10).
replacement (femoral component only) has
occurred in 18.1% of revisions (Table SHP9). The Thompson Type cemented and Austin-
Moore Type cementless have a higher rate of
Age is a risk factor for revision. The rate of revision compared to the (cemented) ETS, but
revision decreases with increasing age (Table there is no difference for the Austin-Moore Type
SHP10 and Figure SHP7). when it is used with cement (Figure SHP10).

There is no difference in the outcome between

males and females (Table SHP11 and Figure
SHP8).

Table SHP7 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement (Primary Diagnosis Fractured
NOF)

N N
Hip Type 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
Unipolar Monoblock 1075 28312 2.9 (2.7, 3.1) 3.9 (3.7, 4.2) 4.6 (4.4, 5.0) 5.7 (5.3, 6.1) 6.4 (6.0, 6.9) 7.8 (7.2, 8.5)
TOTAL 1075 28312

Figure SHP6 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement (Primary Diagnosis Fractured NOF)
24%
Unipolar Monoblock
22%

20%

18%
Cumulative Percent Revision

16%

14%

12%

10%

8%

6%

4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

Unipolar Monoblock 28312 17270 13407 10315 5791 3238 1326

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Table SHP8 Primary Unipolar Monoblock Hip Table SHP9 Primary Unipolar Monoblock Hip
Replacement by Reason for Revision (Primary Replacement by Type of Revision (Primary
Diagnosis Fractured NOF) Diagnosis Fractured NOF)

Reason for Revision Number Percent Type of Revision Number Percent

Loosening 456 42.4 THR (Femoral/Acetabular) 649 60.4
Fracture 216 20.1 Femoral Component 195 18.1
Prosthesis Dislocation 120 11.2 Bipolar Head and Femoral 101 9.4
Infection 116 10.8 Removal of Prostheses 56 5.2
Pain 79 7.3 Cement Spacer 47 4.4
Chondrolysis/Acetab. Erosion 52 4.8 Minor Components 18 1.7
Malposition 12 1.1 Reinsertion of Components 6 0.6
Lysis 9 0.8 Incomplete 1 0.1
Other 15 1.4 Bipolar Only 1 0.1
TOTAL 1075 100.0 Insert Only 1 0.1
TOTAL 1075 100.0
Note: Femoral heads are usually replaced when the acetabular
component and/or femoral stem is revised

Table SHP10 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Age (Primary Diagnosis
Fractured NOF)

N N
Age 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
<75 240 2458 4.4 (3.6, 5.4) 7.3 (6.2, 8.6) 9.6 (8.3, 11.2) 12.8 (11.2, 14.6) 14.5 (12.7, 16.5) 17.0 (14.8, 19.5)
75-84 480 10541 3.3 (2.9, 3.7) 4.6 (4.1, 5.1) 5.4 (4.9, 5.9) 6.3 (5.7, 6.9) 7.0 (6.4, 7.8) 8.4 (7.4, 9.4)
≥85 355 15313 2.3 (2.0, 2.6) 2.8 (2.5, 3.1) 3.0 (2.7, 3.4) 3.5 (3.1, 3.9) 3.7 (3.3, 4.2) 4.3 (3.5, 5.1)
TOTAL 1075 28312

Figure SHP7 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Age (Primary Diagnosis
Fractured NOF)
HR - adjusted for gender
24%
<75 <75 vs ≥85
22% 75-84
0 - 3Mth: HR=1.29 (0.93, 1.81),p=0.131
≥85
20% 3Mth - 1Yr: HR=3.10 (2.22, 4.33),p<0.001
1Yr - 1.5Yr: HR=6.52 (4.19, 10.13),p<0.001
18%
1.5Yr - 2Yr: HR=4.32 (2.44, 7.68),p<0.001
Cumulative Percent Revision

16% 2Yr+: HR=7.16 (5.38, 9.54),p<0.001

14% <75 vs 75-84

12% 0 - 1Yr: HR=1.29 (1.02, 1.63),p=0.032
1Yr - 1.5Yr: HR=2.77 (1.80, 4.25),p<0.001
10%
1.5Yr+: HR=2.77 (2.19, 3.51),p<0.001
8%
75-84 vs ≥85
6% 0 - 3Mth: HR=1.03 (0.82, 1.28),p=0.823
3Mth+: HR=2.35 (1.96, 2.84),p<0.001
4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

<75 2458 1667 1381 1144 779 563 315
75-84 10541 6877 5520 4391 2718 1596 679
≥85 15313 8726 6506 4780 2294 1079 332

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Table SHP11 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Gender (Primary Diagnosis
Fractured NOF)

N N
Gender 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
Male 281 7695 3.5 (3.0, 4.0) 4.8 (4.2, 5.5) 5.9 (5.2, 6.7) 7.1 (6.2, 8.1) 7.9 (6.8, 9.1) 9.4 (7.8, 11.4)
Female 794 20617 2.7 (2.5, 3.0) 3.7 (3.4, 4.0) 4.3 (4.0, 4.7) 5.3 (4.9, 5.7) 6.0 (5.6, 6.5) 7.4 (6.7, 8.2)
TOTAL 1075 28312

Figure SHP8 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Gender (Primary Diagnosis
Fractured NOF)
HR - adjusted for age
24%
Male Male vs Female
22% Female
Entire Period: HR=1.14 (0.99, 1.31),p=0.061

20%

18%
Cumulative Percent Revision

16%

14%

12%

10%

8%

6%

4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

Male 7695 3650 2516 1779 880 475 200
Female 20617 13620 10891 8536 4911 2763 1126

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Table SHP12 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Femoral Fixation and
Prosthesis Type (Primary Diagnosis Fractured NOF)

Femoral Prosthesis N
N Total 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Fixation Type Revised
Cementless 788 17681 3.7 (3.4, 4.1) 5.0 (4.6, 5.4) 5.8 (5.4, 6.2) 6.5 (6.1, 7.0) 7.4 (6.8, 8.0) 8.3 (7.6, 9.1)
Austin-Moore 738 17090 3.6 (3.3, 4.0) 4.9 (4.6, 5.3) 5.7 (5.2, 6.1) 6.3 (5.8, 6.8) 7.2 (6.6, 7.8) 8.0 (7.3, 8.8)
Thompson 50 591 6.4 (4.5, 9.0) 7.3 (5.2, 10.1) 9.0 (6.6, 12.3) 12.3 (9.0, 16.6) 13.0 (9.5, 17.5)
Cemented 287 10627 1.5 (1.3, 1.8) 2.2 (1.9, 2.6) 2.8 (2.5, 3.3) 4.3 (3.7, 4.9) 4.9 (4.2, 5.6) 7.1 (5.9, 8.4)
Austin-Moore 21 969 1.5 (0.8, 2.8) 2.4 (1.4, 4.0) 3.2 (2.0, 5.2) 4.5 (2.8, 7.2) 4.5 (2.8, 7.2)
ETS 76 3474 1.4 (1.1, 1.9) 1.9 (1.4, 2.5) 2.3 (1.8, 3.0) 3.1 (2.4, 4.0) 3.9 (2.9, 5.1) 5.4 (3.8, 7.7)
Thompson 190 6184 1.5 (1.2, 1.9) 2.4 (2.0, 2.8) 3.1 (2.6, 3.7) 4.9 (4.1, 5.7) 5.4 (4.6, 6.4) 8.1 (6.5, 10.0)
TOTAL 1075 28308
Note: Four ETS procedures that were cementless have been excluded

Figure SHP9 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Femoral Fixation (Primary
Diagnosis Fractured NOF)
HR - adjusted for age and gender
24%
Cementless Cementless vs Cemented
22% Cemented
0 - 3Mth: HR=1.95 (1.54, 2.47),p<0.001

20% 3Mth - 9Mth: HR=4.33 (2.87, 6.53),p<0.001

9Mth - 1.5Yr: HR=2.33 (1.64, 3.31),p<0.001
18%
1.5Yr - 2.5Yr: HR=1.65 (1.11, 2.45),p=0.012
Cumulative Percent Revision

16% 2.5Yr+: HR=0.74 (0.56, 0.97),p=0.029

14%

12%

10%

8%

6%

4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

Cementless 17681 10478 8055 6205 3499 1978 876
Cemented 10627 6791 5352 4110 2292 1260 450

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Figure SHP10 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Prosthesis Type and Femoral
Fixation (Primary Diagnosis Fractured NOF)
HR - adjusted for age and gender
24%
Austin-Moore Cementless Austin-Moore Cementless vs ETS Cemented
22% Austin-Moore Cemented
Entire Period: HR=2.18 (1.72, 2.76),p<0.001
ETS Cemented
20% Thompson Cementless
Austin-Moore Cemented vs ETS Cemented
Thompson Cemented
18% Entire Period: HR=1.27 (0.78, 2.06),p=0.330
Cumulative Percent Revision

16% Thompson Cementless vs ETS Cemented

14% Entire Period: HR=3.80 (2.66, 5.44),p<0.001

12% Thompson Cemented vs ETS Cemented

Entire Period: HR=1.41 (1.08, 1.84),p=0.011
10%

8%

6%

4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs

Austin-Moore Cementless 17090 10104 7758 5973 3366 1893 841
Cemented 969 514 396 297 153 73 17
ETS Cemented 3474 2231 1735 1328 727 412 129
Thompson Cementless 591 374 297 232 133 85 35
Cemented 6184 4046 3221 2485 1412 775 304

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UNIPOLAR MODULAR
DEMOGRAPHICS
There have been 46,303 unipolar modular Figure SHP12 Primary Unipolar Modular Hip Replacement
by Age
procedures reported to the Registry. This is an
100%
additional 3,187 procedures compared to the <55 55-64
90% 65-74 75-84
previous report. ≥85
80%
In 2019, the number of unipolar modular 70%
procedures decreased by 460 procedures
60%
(13.0%) compared to 2018 and increased by
360.4% since 2003. 50%

40%
Fractured neck of femur is the principal 30%
diagnosis for primary unipolar modular hip 20%
replacement (95.6%).
10%

Figure SHP11 Primary Unipolar Modular Hip Replacement 0%

by Gender

03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
100%
Male
90% Female Overall, there have been 239 unipolar modular
80%
head and stem combinations recorded by the
Registry. The 10 most frequently used unipolar
70%
modular head prostheses and femoral stems
60% are listed in Table SHP14 and Table SHP15.
50%

40%
In 2019, 16 different unipolar modular head
prostheses were used. The Unitrax head is the
30%
most frequently used (61.4%). The 10 most used
20% unipolar modular head prostheses account for
10% 99.8% of all primary unipolar modular hip
0%
procedures (Table SHP14).
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19

There were 29 different stem prostheses used in

20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20

2019. The most frequently used stem in 2019 is

The majority of patients are female (70.4%) and
the Exeter V40 (59.2%). The 10 most used
aged ≥75 years (84.2%). The proportion of
femoral stems account for 97.2% of all primary
patients aged ≥85 years has increased from
unipolar modular hip procedures (Table SHP15).
32.1% in 2003 to 55.5% in 2019. The mean age of
patients is 82.5 years (Table SHP13, Figure SHP11
The cumulative percent revision of unipolar
and Figure SHP12)
modular head/stem prosthesis combinations
with more than 100 procedures is detailed in
Table SHP1.

Table SHP13 Age and Gender of Primary Unipolar Modular Hip Replacement

Gender Number Percent Minimum Maximum Median Mean Std Dev

Male 13689 29.6% 5 106 83 81.5 9.5
Female 32614 70.4% 18 108 84 83.0 8.5
TOTAL 46303 100.0% 5 108 84 82.5 8.8

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Table SHP14 10 Most Used Unipolar Head Prostheses in Primary Unipolar Modular Hip Replacement

2003 2016 2017 2018 2019

N Model N Model N Model N Model N Model
193 Unitrax 2091 Unitrax 1893 Unitrax 1968 Unitrax 1882 Unitrax
Unipolar Head
142 658 Unipolar Head (S&N) 556 Unipolar Head (S&N) 583 Unipolar Head (S&N) 448 Unipolar Head (S&N)
(Zimmer)
127 Unipolar Head (S&N) 256 Cathcart 437 Cathcart 387 Cathcart 333 Cathcart
75 VerSys 170 VerSys 174 VerSys 241 BioBall 133 BioBall
Unipolar Head
64 63 Unipolar Head (Corin) 160 BioBall 166 VerSys 106 VerSys
(Mathys)
Unipolar Head Unipolar Head Unipolar Head Unipolar Head
46 Elite 53 135 87 53
(Signature) (Signature) (Signature) (Signature)
Unipolar Head Unipolar Head
16 Ultima 25 Endo II 37 Endo II 42 47
(Mathys) (Mathys)
Unipolar Head Unipolar Head
1 Metasul 17 Endo Head 28 36 Unipolar Head (Corin) 46
(Corin) (Corin)
Unipolar Head Femoral Head Femoral Head
1 Optimom 12 BioBall 19 9 9
(Mathys) (Stryker) (Stryker)
Unipolar Head
1 10 Unipolar Head (Lima) 13 Endo Head 2 Articul/Eze 3 Articul/Eze
(Sulzer)
10 Most Used
666 (10) 100.0% 3355 (10) 99.1% 3452 (10) 99.2% 3521 (10) 99.9% 3060 (10) 99.8%
Remainder
0 (0) 0% 32 (9) 0.9% 28 (8) 0.8% 5 (4) 0.1% 6 (6) 0.2%
TOTAL
666 (10) 100.0% 3387 (19) 100.0% 3480 (18) 100.0% 3526 (14) 100.0% 3066 (16) 100.0%

Table SHP15 10 Most Used Femoral Stem Prostheses in Primary Unipolar Modular Hip Replacement

2003 2016 2017 2018 2019

N Model N Model N Model N Model N Model
180 Exeter V40 2062 Exeter V40 1866 Exeter V40 1920 Exeter V40 1814 Exeter V40
111 Alloclassic 512 CPCS 449 CPCS 495 CPCS 361 CPCS
91 CPT 144 C-Stem AMT 360 C-Stem AMT 344 C-Stem AMT 295 C-Stem AMT
70 Spectron EF 138 CPT 192 Absolut 271 Absolut 161 Absolut
49 Fullfix 114 CORAIL 145 CPT 141 CPT 100 CPT
Short Exeter
38 SL-Plus 94 Spectron EF 75 CORAIL 52 67 Short Exeter V40
V40
33 Elite Plus 53 Metafix 74 Spectron EF 51 Spectron EF 61 Spectron EF
18 Basis 31 Short Exeter V40 50 E2 45 CORAIL 43 Taper Fit
15 CCA 29 E2 43 Evolve 38 twinSys (ctd) 40 twinSys (ctd)
Thompson
15 25 Sirius 36 Sirius 34 Taper Fit 39 CORAIL
Modular Stem
10 Most Used
620 (10) 93.1% 3202 (10) 94.5% 3290 (10) 94.5% 3391 (10) 96.2% 2981 (10) 97.2%
Remainder
46 (13) 6.9% 185 (27) 5.5% 190 (29) 5.5% 135 (18) 3.8% 85 (19) 2.8%
TOTAL
666 (23) 100.0% 3387 (37) 100.0% 3480 (39) 100.0% 3526 (28) 100.0% 3066 (29) 100.0%

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Table SHP16 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Prosthesis Combination

Femoral N N
Unipolar Head 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Component Revised Total
BioBall Absolut 12 555 2.2 (1.2, 3.9) 2.8 (1.5, 5.1)
Cathcart C-Stem AMT 21 1424 1.3 (0.8, 2.1) 1.4 (0.9, 2.4) 2.4 (1.4, 4.1) 2.4 (1.4, 4.1)
CORAIL 93 1520 3.1 (2.3, 4.2) 4.4 (3.4, 5.7) 5.7 (4.5, 7.3) 7.1 (5.6, 9.0) 10.3 (8.1, 13.0) 13.1 (10.1, 17.0)
Endo II Taperloc 7 103 5.1 (2.2, 11.8) 5.1 (2.2, 11.8) 5.1 (2.2, 11.8)
Metasul Alloclassic 17 345 2.5 (1.3, 4.9) 2.9 (1.5, 5.5) 3.7 (2.1, 6.7) 4.3 (2.4, 7.5) 7.3 (4.4, 12.2)
CPT 4 215 1.6 (0.5, 4.9) 1.6 (0.5, 4.9) 2.5 (0.9, 6.6) 2.5 (0.9, 6.6)
Pharo Pharo 6 144 3.1 (1.2, 8.0) 5.0 (2.3, 10.9) 5.0 (2.3, 10.9)
U2 E2 3 232 0.0 (0.0, 0.0) 0.7 (0.1, 4.9) 1.5 (0.4, 5.9) 2.5 (0.8, 7.7) 2.5 (0.8, 7.7)
Thompson
Ultima 1 133 0.8 (0.1, 5.5) 0.8 (0.1, 5.5) 0.8 (0.1, 5.5) 0.8 (0.1, 5.5) 0.8 (0.1, 5.5)
Modular Stem
Unipolar Head (Corin) Metafix 20 482 2.2 (1.1, 4.2) 3.2 (1.8, 5.6) 3.6 (2.1, 6.1) 6.3 (3.7, 10.5) 7.1 (4.3, 11.8)
Taper Fit 21 401 2.3 (1.2, 4.6) 3.5 (1.9, 6.3) 5.5 (3.3, 9.2) 7.0 (4.3, 11.3) 7.9 (4.8, 12.7) 10.4 (6.4, 16.9)
Tri-Fit 10 288 1.5 (0.6, 4.0) 2.1 (0.9, 5.0) 2.6 (1.2, 5.9) 2.6 (1.2, 5.9) 4.7 (2.2, 10.0) 6.5 (3.0, 13.5)
Unipolar Head (JRI) Furlong LOL 11 132 6.4 (3.1, 13.0) 9.7 (5.3, 17.4) 9.7 (5.3, 17.4)
Unipolar Head
CCA 10 357 1.0 (0.3, 3.0) 2.1 (1.0, 4.7) 2.6 (1.2, 5.3) 2.6 (1.2, 5.3) 3.5 (1.7, 7.4) 3.5 (1.7, 7.4)
(Mathys)
Fullfix 8 226 1.5 (0.5, 4.7) 2.8 (1.1, 6.5) 2.8 (1.1, 6.5) 2.8 (1.1, 6.5) 6.1 (3.0, 12.4) 6.1 (3.0, 12.4)
twinSys (ctd) 5 111
Unipolar Head (Plus) SL-Plus 8 193 2.2 (0.8, 5.8) 2.9 (1.2, 6.9) 3.6 (1.6, 8.0) 4.6 (2.2, 9.7) 5.9 (2.9, 11.9) 5.9 (2.9, 11.9)
Unipolar Head (S&N) Anthology 6 102 4.5 (1.7, 11.5) 4.5 (1.7, 11.5) 4.5 (1.7, 11.5)
Basis 31 578 2.0 (1.1, 3.7) 2.0 (1.1, 3.7) 3.4 (2.0, 5.6) 7.6 (5.2, 11.1) 9.1 (6.3, 13.0) 9.1 (6.3, 13.0)
CPCS 154 5941 1.8 (1.5, 2.2) 2.2 (1.9, 2.7) 2.8 (2.3, 3.3) 3.8 (3.2, 4.5) 4.7 (3.8, 5.7) 5.4 (4.3, 6.9)
Platform 6 110 4.1 (1.5, 10.5) 4.1 (1.5, 10.5) 4.1 (1.5, 10.5) 6.0 (2.4, 14.5)
Polarstem 7 112 2.1 (0.5, 8.2) 3.5 (1.1, 10.6) 7.4 (3.0, 17.5)
SL-Plus 50 1108 2.3 (1.5, 3.4) 3.2 (2.3, 4.6) 4.5 (3.2, 6.1) 4.9 (3.6, 6.7) 5.8 (4.2, 8.0) 11.8 (7.3, 18.9)
Spectron EF 111 3039 1.6 (1.2, 2.1) 2.5 (2.0, 3.2) 2.9 (2.3, 3.7) 4.1 (3.3, 5.0) 5.5 (4.4, 6.8) 7.8 (6.1, 9.8)
Unipolar Head
E2 1 105 1.0 (0.1, 6.7) 1.0 (0.1, 6.7)
(Signature)
Evolve 5 120 3.0 (1.0, 9.2)
Unipolar Head
Alloclassic 69 1085 3.2 (2.2, 4.5) 4.1 (3.0, 5.6) 4.5 (3.4, 6.1) 6.0 (4.6, 7.9) 8.4 (6.5, 10.9) 9.3 (7.1, 12.1)
(Zimmer)
CPT 11 173 1.9 (0.6, 5.8) 3.3 (1.4, 7.7) 4.1 (1.8, 8.8) 5.9 (3.0, 11.6) 7.2 (3.7, 13.7) 9.0 (4.7, 16.9)
Unitrax Accolade I 10 130 1.7 (0.4, 6.7) 5.7 (2.6, 12.3) 6.8 (3.3, 13.7) 6.8 (3.3, 13.7)
Exeter V40 622 19752 1.9 (1.7, 2.1) 2.6 (2.4, 2.9) 3.2 (3.0, 3.6) 4.7 (4.3, 5.1) 5.8 (5.3, 6.4) 7.6 (6.8, 8.6)
Omnifit 7 256 2.7 (1.2, 5.8) 3.2 (1.5, 6.6) 3.2 (1.5, 6.6) 3.2 (1.5, 6.6) 3.2 (1.5, 6.6)
Short Exeter
2 205 0.5 (0.1, 3.8) 0.5 (0.1, 3.8)
V40
VerSys CPT 163 4646 2.0 (1.6, 2.5) 2.9 (2.4, 3.5) 3.5 (2.9, 4.1) 4.6 (3.9, 5.5) 5.7 (4.8, 6.8) 6.2 (5.1, 7.4)
VerSys 6 180 3.6 (1.5, 8.5) 3.6 (1.5, 8.5) 3.6 (1.5, 8.5)
Other (205) 99 1800 3.5 (2.7, 4.6) 4.9 (3.8, 6.1) 5.5 (4.4, 6.9) 7.1 (5.7, 8.8) 9.0 (7.2, 11.3) 11.2 (8.6, 14.5)
TOTAL 1617 46303
Note: Only combinations with over 100 procedures have been listed

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OUTCOME FOR FRACTURED NECK OF FEMUR

The cumulative percent revision at 10 years for Age, gender and femoral stem fixation are risk
unipolar modular hip replacement, when factors for revision. The rate of revision
undertaken for fractured neck of femur, is 7.6% decreases with increasing age (Table SHP20
(Table SHP1 and Figure SHP13). and Figure SHP14). Males have a higher rate of
revision in the first 1.5 years (Table SHP21 and
The Registry has recorded 1,514 revisions of Figure SHP15).
primary unipolar modular hip replacement with
a primary diagnosis of fractured neck of femur. The cumulative incidence for loosening,
chondrolysis and fracture is higher for
The main reasons for revision are infection cementless compared to cemented
(20.4%), prosthesis dislocation (19.3%), fracture fixation.
(17.1%), chondrolysis/acetabular erosion
(16.4%), loosening (11.6%), and pain (11.2%)
(Table SHP17). Table SHP18 Primary Unipolar Modular Hip Replacement
by Type of Revision (Primary Diagnosis
Fractured NOF)
Most revisions are acetabular only (43.7%),
followed by total hip replacement Type of Revision Number Percent
(femoral/acetabular) (17.3%) (Table SHP18). Acetabular Component 661 43.7
THR (Femoral/Acetabular) 262 17.3
Table SHP17 Primary Unipolar Modular Hip Replacement
Head Only 195 12.9
by Reason for Revision (Primary Diagnosis
Fractured NOF) Femoral Component 169 11.2
Cement Spacer 60 4.0
Reason for Revision Number Percent
Bipolar Head and Femoral 57 3.8
Infection 309 20.4
Minor Components 47 3.1
Prosthesis Dislocation 292 19.3
Removal of Prostheses 43 2.8
Fracture 259 17.1
Bipolar Only 14 0.9
Chondrolysis/Acetab. Erosion 248 16.4
Reinsertion of Components 4 0.3
Loosening 175 11.6
Head/Insert 1 0.1
Pain 169 11.2
Cement Only 1 0.1
Lysis 18 1.2
TOTAL 1514 100.0
Malposition 4 0.3
Other 40 2.6 Note: Femoral heads are usually replaced when the acetabular
component and/or femoral stem is revised
TOTAL 1514 100.0

Cementless fixation has a higher rate of revision

compared to cemented fixation (Table SHP22
and Figure SHP16). The cumulative incidence
for loosening, fracture and chondrolysis is higher
for cementless compared to cemented fixation
(Figure SHP17).

Data Period 1 September 1999 – 31 December 2019 Page | 18

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Table SHP19 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement (Primary Diagnosis Fractured NOF)

N N
Hip Type 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
Unipolar Modular 1514 44275 2.0 (1.9, 2.1) 2.8 (2.6, 2.9) 3.4 (3.2, 3.6) 4.7 (4.4, 5.0) 6.0 (5.6, 6.3) 7.6 (7.1, 8.2)
TOTAL 1514 44275

Figure SHP13 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement (Primary Diagnosis Fractured NOF)
24%
Unipolar Modular
22%

20%

18%
Cumulative Percent Revision

16%

14%

12%

10%

8%

6%

4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

Unipolar Modular 44275 30167 23618 18332 10595 5827 2164

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Table SHP20 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Age (Primary Diagnosis
Fractured NOF)

N N
Age 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
<75 562 6816 3.0 (2.6, 3.4) 4.6 (4.1, 5.2) 6.3 (5.6, 7.0) 9.2 (8.4, 10.1) 11.8 (10.8, 12.9) 14.6 (13.4, 16.0)
75-84 609 16765 2.1 (1.9, 2.4) 3.0 (2.7, 3.2) 3.5 (3.2, 3.9) 4.6 (4.2, 5.1) 5.6 (5.1, 6.2) 6.7 (6.0, 7.4)
≥85 343 20694 1.5 (1.3, 1.7) 1.8 (1.6, 2.0) 2.0 (1.8, 2.2) 2.4 (2.1, 2.7) 2.7 (2.3, 3.1) 3.2 (2.5, 4.1)
TOTAL 1514 44275

Figure SHP14 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Age (Primary Diagnosis Fractured
NOF)
HR - adjusted for gender
24%
<75 <75 vs ≥85
22% 75-84
0 - 3Mth: HR=1.42 (1.13, 1.78),p=0.002
≥85
20% 3Mth - 6Mth: HR=2.91 (1.80, 4.71),p<0.001
6Mth - 1.5Yr: HR=5.53 (4.10, 7.45),p<0.001
18%
1.5Yr - 2Yr: HR=5.67 (3.62, 8.86),p<0.001
Cumulative Percent Revision

16% 2Yr+: HR=8.06 (6.34, 10.24),p<0.001

14% <75 vs 75-84

12% 0 - 2Yr: HR=1.51 (1.30, 1.76),p<0.001
2Yr - 4.5Yr: HR=2.51 (1.98, 3.16),p<0.001
10%
4.5Yr+: HR=3.21 (2.46, 4.18),p<0.001
8%
75-84 vs ≥85
6% 0 - 3Mth: HR=1.08 (0.89, 1.30),p=0.435
3Mth+: HR=2.87 (2.34, 3.52),p<0.001
4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

<75 6816 5183 4342 3642 2554 1736 854
75-84 16765 12243 9966 8061 4990 2823 1011
≥85 20694 12741 9310 6629 3051 1268 299

Data Period 1 September 1999 – 31 December 2019 Page | 20

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Table SHP21 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Gender (Primary Diagnosis
Fractured NOF)

N
Gender N Total 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised
Male 479 13067 2.6 (2.3, 2.9) 3.5 (3.1, 3.9) 4.3 (3.8, 4.7) 5.9 (5.3, 6.6) 7.1 (6.4, 8.0) 9.0 (7.8, 10.3)
Female 1035 31208 1.8 (1.6, 1.9) 2.5 (2.3, 2.7) 3.1 (2.8, 3.3) 4.3 (4.0, 4.6) 5.6 (5.2, 6.0) 7.2 (6.6, 7.8)
TOTAL 1514 44275

Figure SHP15 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Gender (Primary Diagnosis
Fractured NOF)
HR - adjusted for age
24%
Male Male vs Female
22% Female
0 - 1.5Yr: HR=1.34 (1.17, 1.54),p<0.001

20% 1.5Yr+: HR=1.06 (0.89, 1.27),p=0.504

18%
Cumulative Percent Revision

16%

14%

12%

10%

8%

6%

4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

Male 13067 7700 5600 4087 2130 1081 412
Female 31208 22467 18018 14245 8465 4746 1752

Data Period 1 September 1999 – 31 December 2019 Page | 21

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Table SHP22 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Femoral Fixation (Primary
Diagnosis Fractured NOF)

N
Femoral Fixation N Total 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised
Cementless 356 6391 2.9 (2.5, 3.4) 4.0 (3.5, 4.6) 4.9 (4.3, 5.6) 6.2 (5.5, 7.0) 8.2 (7.3, 9.2) 10.6 (9.2, 12.1)
Cemented 1158 37884 1.8 (1.7, 2.0) 2.5 (2.3, 2.7) 3.1 (2.9, 3.3) 4.4 (4.1, 4.7) 5.5 (5.1, 5.9) 6.9 (6.3, 7.5)
TOTAL 1514 44275

Figure SHP16 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Femoral Fixation (Primary
Diagnosis Fractured NOF)
HR - adjusted for age and gender
24%
Cementless Cementless vs Cemented
22% Cemented
Entire Period: HR=1.51 (1.34, 1.70),p<0.001

20%

18%
Cumulative Percent Revision

16%

14%

12%

10%

8%

6%

4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

Cementless 6391 4706 3947 3262 2099 1245 505
Cemented 37884 25461 19671 15070 8496 4582 1659

Figure SHP17 Cumulative Incidence Revision Diagnosis of Primary Unipolar Modular Hip Replacement by Femoral Fixation
(Primary Diagnosis Fractured NOF)
Cementless Cemented

3.0% 3.0%
Infection Infection
Prosthesis Dislocation Prosthesis Dislocation
2.5% Fracture 2.5% Fracture
Chondrolysis/Acetab. Erosion Chondrolysis/Acetab. Erosion
Loosening Loosening
Cumulative Incidence

Cumulative Incidence

2.0% 2.0%

1.5% 1.5%

1.0% 1.0%

0.5% 0.5%

0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure Years Since Primary Procedure

Data Period 1 September 1999 – 31 December 2019 Page | 22

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BIPOLAR
DEMOGRAPHICS
There have been 26,338 bipolar hip The mean age of patients is 81.0 years (Table
replacement procedures reported to the SHP23, Figure SHP18 and Figure SHP19).
Registry. This is an additional 2,713 procedures
compared to the previous report. Figure SHP19 Primary Bipolar Hip Replacement by Age
100%
<55 55-64
Since 2010, there has been an increase in the 90% 65-74 75-84
≥85
number of bipolar procedures undertaken 80%
each year, with 14.8% more procedures in 2019
70%
compared to 2018. The total number of bipolar
procedures has increased by 96.0% since 2003. 60%

50%
Fractured neck of femur is the principal 40%
diagnosis for bipolar hip replacement (92.3%).
30%

20%
The majority of patients are female (70.2%) and
aged ≥75 years (79.2%). The proportion of 10%

patients aged ≥85 years has increased from 0%

26.0% in 2003 to 49.0% in 2019.
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Figure SHP18 Primary Bipolar Hip Replacement by Gender
Overall, there have been 287 bipolar head and
100%
Male stem combinations recorded by the Registry. In
90% Female
2019, there were 9 different bipolar heads and
80% 39 different femoral stem prostheses used.
70%
In 2019, the UHR remains the most frequently
60%
used bipolar head (45.3%) (Table SHP24). The
50% Exeter V40 is the most frequently used femoral
40% stem (42.0%). The 10 most used femoral stems
30%
account for 94.9% of all bipolar hip procedures
(Table SHP25).
20%

10% The cumulative percent revision of bipolar

0% head/stem prosthesis combinations with more
than 100 procedures is detailed in Table SHP26.
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20

Table SHP23 Age and Gender of Primary Bipolar Hip Replacement

Gender Number Percent Minimum Maximum Median Mean Std Dev

Male 7859 29.8% 16 103 82 80.2 10.7
Female 18479 70.2% 9 107 83 81.4 9.6
TOTAL 26338 100.0% 9 107 83 81.0 9.9

Data Period 1 September 1999 – 31 December 2019 Page | 23

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Table SHP24 Most Used Bipolar Head Prostheses in Primary Bipolar Hip Replacement

2003 2016 2017 2018 2019

N Model N Model N Model N Model N Model
760 UHR 914 UHR 830 UHR 996 UHR 1191 UHR
140 Hastings 676 Multipolar Bipolar 627 Multipolar Bipolar 531 Multipolar Bipolar 657 Multipolar Bipolar
115 Convene 217 Self-Centering 312 Tandem 357 Tandem 383 Tandem
Bipolar Head
91 154 Tandem 279 Self-Centering 268 Self-Centering 282 Self-Centering
(Zimmer)
Bipolar Head Bipolar Head Bipolar Head Bipolar Head
87 Self-Centering 91 81 101 67
(Medacta) (Medacta) (Medacta) (Medacta)
Bipolar Head Bipolar Head
59 Multipolar Bipolar 25 23 Ringloc 22 20 BioBall
(Lima) (Lima)
Bipolar Head Bipolar Head Bipolar Head Bipolar Head
39 13 Ringloc 16 15 15
(Mathys) (Lima) (Implantcast) (Mathys)
Bipolar Head Bipolar Head Bipolar Head Bipolar Head
19 5 4 9
(Lima) (Implantcast) (Implantcast) (Lima)
Bipolar Head Bipolar Head Bipolar Head
19 Ringloc 4 2 5
(Mathys) (Mathys) (Implantcast)
5 UHL
Most Used
1334 (10) 99.5% 2099 (9) 100.0% 2174 (9) 100.0% 2290 (7) 100.0% 2629 (9) 100.0%
Remainder
7 (2) 0.5% 0 (0) 0% 0 (0) 0% 0 (0) 0% 0 (0) 0%
TOTAL
1341 (12) 100.0% 2099 (9) 100.0% 2174 (9) 100.0% 2290 (7) 100.0% 2629 (9) 100.0%

Table SHP25 10 Most Used Femoral Stem Prostheses in Primary Bipolar Hip Replacement

2003 2016 2017 2018 2019

N Model N Model N Model N Model N Model
630 Exeter V40 865 Exeter V40 775 Exeter V40 917 Exeter V40 1104 Exeter V40
94 Elite Plus 614 CPT 577 CPT 479 CPT 608 CPT
75 Alloclassic 129 CORAIL 262 CPCS 311 CPCS 357 CPCS
65 CPCS 125 CPCS 164 CORAIL 118 CORAIL 177 C-Stem AMT
61 C-Stem 62 Quadra-C 74 C-Stem AMT 114 C-Stem AMT 100 CORAIL
59 Omnifit 42 C-Stem AMT 59 Quadra-C 83 Quadra-C 55 Quadra-C
33 VerSys 24 H-Max 24 Paragon 31 Short Exeter V40 36 Accolade II
26 ABGII 21 Summit 22 Spectron EF 23 H-Max 28 Short Exeter V40
25 CCA 20 X-Acta 16 X-Acta 21 Absolut 16 MS 30
25 Spectron EF 18 Accolade II 15 Accolade I 20 GMRS 14 Absolut
10 Most Used
1093 (10) 81.5% 1920 (10) 91.5% 1988 (10) 91.4% 2117 (10) 92.4% 2495 (10) 94.9%
Remainder
248 (46) 18.5% 179 (31) 8.5% 186 (30) 8.6% 173 (29) 7.6% 134 (29) 5.1%
TOTAL
1341 (56) 100.0% 2099 (41) 100.0% 2174 (40) 100.0% 2290 (39) 100.0% 2629 (39) 100.0%

Data Period 1 September 1999 – 31 December 2019 Page | 24

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Table SHP26 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Prosthesis Combination

Femoral N N
Bipolar Head 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Component Revised Total
Bipolar Head
H-Max 5 134 2.4 (0.8, 7.3) 3.5 (1.3, 9.1) 3.5 (1.3, 9.1)
(Lima)
Bipolar Head
Quadra-C 11 405 2.8 (1.5, 5.3) 3.3 (1.8, 5.9) 3.3 (1.8, 5.9) 3.3 (1.8, 5.9)
(Medacta)
X-Acta 3 109 3.3 (1.1, 10.1) 3.3 (1.1, 10.1)
Bipolar Head
Alloclassic* 19 358 0.9 (0.3, 2.8) 2.0 (0.9, 4.3) 2.3 (1.1, 4.9) 2.8 (1.4, 5.4) 3.4 (1.7, 6.6) 7.7 (4.4, 13.3)
(Zimmer)
Centrax Exeter* 7 200 2.1 (0.8, 5.5) 2.7 (1.1, 6.5) 2.7 (1.1, 6.5) 2.7 (1.1, 6.5) 2.7 (1.1, 6.5) 3.9 (1.7, 8.9)
Convene CPCS* 16 347 2.2 (1.1, 4.6) 3.3 (1.8, 6.1) 3.3 (1.8, 6.1) 5.2 (3.1, 8.8) 5.9 (3.5, 9.8) 6.7 (4.0, 11.0)
Spectron EF* 8 123 2.6 (0.9, 8.0) 2.6 (0.9, 8.0) 3.8 (1.4, 10.1) 6.6 (2.9, 14.4) 6.6 (2.9, 14.4)
Hastings C-Stem* 10 208 2.5 (1.1, 5.9) 5.0 (2.6, 9.4) 5.7 (3.1, 10.4) 5.7 (3.1, 10.4) 5.7 (3.1, 10.4) 5.7 (3.1, 10.4)
CORAIL* 18 361 3.3 (1.8, 5.8) 3.6 (2.1, 6.3) 4.0 (2.3, 6.8) 4.6 (2.7, 7.7) 4.6 (2.7, 7.7) 7.5 (4.3, 12.7)
Charnley* 7 118 0.0 (0.0, 0.0) 3.6 (1.2, 10.8) 3.6 (1.2, 10.8) 6.4 (2.7, 14.8)
Elite Plus* 15 298 1.9 (0.8, 4.6) 3.3 (1.7, 6.5) 4.3 (2.3, 7.9) 5.5 (3.1, 9.5) 6.8 (4.1, 11.4) 6.8 (4.1, 11.4)
Summit* 3 102 2.5 (0.6, 9.6) 2.5 (0.6, 9.6) 2.5 (0.6, 9.6)
Multipolar
Alloclassic 8 211 3.7 (1.8, 7.6) 3.7 (1.8, 7.6) 3.7 (1.8, 7.6) 4.7 (2.3, 9.5)
Bipolar
CPT 112 3645 2.7 (2.2, 3.4) 3.6 (2.9, 4.3) 3.8 (3.1, 4.6) 4.4 (3.5, 5.5) 5.1 (3.7, 6.9)
MS 30 0 103 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
VerSys 5 257 1.1 (0.3, 4.3) 2.5 (0.9, 6.7) 2.5 (0.9, 6.7) 2.5 (0.9, 6.7) 2.5 (0.9, 6.7)
VerSys
12 275 1.7 (0.6, 4.5) 3.2 (1.5, 6.7) 3.2 (1.5, 6.7) 4.0 (2.0, 7.9) 4.0 (2.0, 7.9)
Heritage*
Ringloc Mallory-Head* 4 120 2.0 (0.5, 7.9) 2.0 (0.5, 7.9) 2.0 (0.5, 7.9) 3.8 (1.2, 11.9)
Self-Centering C-Stem AMT 13 458 2.5 (1.4, 4.7) 4.3 (2.4, 7.8) 4.3 (2.4, 7.8)
C-Stem* 3 113 0.0 (0.0, 0.0) 1.2 (0.2, 8.2) 1.2 (0.2, 8.2) 1.2 (0.2, 8.2)
CORAIL 38 929 3.8 (2.7, 5.4) 4.8 (3.4, 6.6) 5.0 (3.6, 6.9) 5.0 (3.6, 6.9) 6.2 (3.9, 9.6)
Elite Plus* 4 238 0.0 (0.0, 0.0) 0.6 (0.1, 3.9) 0.6 (0.1, 3.9) 1.3 (0.3, 5.2) 2.5 (0.8, 7.8) 2.5 (0.8, 7.8)
Tandem Basis* 15 114 2.0 (0.5, 7.7) 7.5 (3.6, 15.1) 12.3 (7.0, 21.2) 15.6 (9.3, 25.7)
CPCS 52 2175 1.7 (1.2, 2.5) 2.3 (1.7, 3.2) 2.9 (2.1, 4.0) 3.8 (2.7, 5.2) 4.9 (3.5, 6.9) 5.4 (3.8, 7.7)
Spectron EF 8 194 2.2 (0.8, 5.9) 3.7 (1.7, 8.1) 4.4 (2.1, 9.2) 5.5 (2.7, 11.0) 5.5 (2.7, 11.0)
UHR ABGII* 20 177 4.3 (2.1, 8.9) 4.3 (2.1, 8.9) 5.1 (2.6, 10.0) 10.8 (6.5, 17.9) 13.4 (8.2, 21.4)
Accolade I* 18 337 2.9 (1.5, 5.5) 4.1 (2.3, 7.1) 4.6 (2.7, 7.8) 5.1 (3.0, 8.6) 5.9 (3.5, 9.9)
Exeter V40 323 10775 2.1 (1.9, 2.5) 2.8 (2.4, 3.1) 3.4 (3.0, 3.8) 3.9 (3.4, 4.4) 4.4 (3.9, 5.0) 5.2 (4.5, 6.0)
Exeter* 12 205 1.6 (0.5, 4.9) 2.2 (0.8, 5.8) 3.5 (1.6, 7.7) 4.9 (2.5, 9.7) 4.9 (2.5, 9.7) 4.9 (2.5, 9.7)
GMRS 12 160 2.7 (1.0, 7.0) 4.8 (2.1, 10.6) 4.8 (2.1, 10.6) 10.4 (5.2, 20.4)
Omnifit* 24 375 5.2 (3.3, 8.1) 5.6 (3.6, 8.6) 5.9 (3.8, 9.0) 6.3 (4.2, 9.6) 7.5 (5.0, 11.3) 7.5 (5.0, 11.3)
Other (256) 126 2714 3.2 (2.6, 4.0) 4.0 (3.3, 4.9) 4.7 (3.9, 5.7) 5.4 (4.4, 6.5) 5.9 (4.9, 7.2) 8.0 (6.4, 9.9)
TOTAL 931 26338
Note: Only combinations with over 100 procedures have been listed
*denotes prosthesis combination with no recorded use in primary bipolar hip replacement in 2019

Data Period 1 September 1999 – 31 December 2019 Page | 25

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OUTCOME FOR FRACTURED NECK OF FEMUR

The cumulative percent revision at 10 years for Age is a risk factor for revision. Patients aged
primary bipolar hip replacement undertaken for <75 years have a higher rate of revision
fractured neck of femur is 6.2% (Table SHP27 compared to the two older age groups (Table
and Figure SHP20). SHP30 and Figure SHP21). Males have a higher
rate of revision than females (Table SHP31 and
The Registry has recorded 829 revisions of Figure SHP22).
primary bipolar hip replacement procedures
with a primary diagnosis of fractured neck of
femur. Cementless fixation has a higher rate of
revision compared to cemented fixation.
The main reasons for revision are fracture
(24.5%), infection (21.8%), prosthesis dislocation
(21.0%), and loosening (14.2%) (Table SHP28). Fixation is a risk factor for revision. Cementless
fixation has a higher rate of revision compared
The most frequent type of revision is acetabular to cemented fixation (Table SHP32 and Figure
component only (33.4%), followed by total hip SHP23). The cumulative incidence of fracture
replacement (femoral/acetabular) (21.8%), for cementless fixation is higher than for
bipolar only (13.4%) and bipolar head and cemented fixation (Figure SHP24).
femoral stem replacement (12.7%) (Table
SHP29).

Table SHP27 Cumulative Percent Revision of Primary Bipolar Hip Replacement (Primary Diagnosis Fractured NOF)

N N
Hip Type 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
Bipolar 829 24314 2.3 (2.1, 2.5) 3.1 (2.9, 3.4) 3.7 (3.4, 3.9) 4.3 (4.0, 4.6) 4.9 (4.5, 5.3) 6.2 (5.6, 6.8)
TOTAL 829 24314

Figure SHP20 Cumulative Percent Revision of Primary Bipolar Hip Replacement (Primary Diagnosis Fractured NOF)
20%
Bipolar
18%

16%

14%
Cumulative Percent Revision

12%

10%

8%

6%

4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

Bipolar 24314 16501 12900 10088 6042 3843 2037

Data Period 1 September 1999 – 31 December 2019 Page | 26

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Table SHP28 Primary Bipolar Hip Replacement by Reason Table SHP29 Primary Bipolar Hip Replacement by Type of
for Revision (Primary Diagnosis Fractured Revision (Primary Diagnosis Fractured NOF)
NOF)
Type of Revision Number Percent
Reason for Revision Number Percent Acetabular Component 277 33.4
Fracture 203 24.5 THR (Femoral/Acetabular) 181 21.8
Infection 181 21.8 Bipolar Only 111 13.4
Prosthesis Dislocation 174 21.0 Bipolar Head and Femoral 105 12.7
Loosening 118 14.2 Femoral Component 44 5.3
Chondrolysis/Acetab. Erosion 71 8.6 Cement Spacer 42 5.1
Pain 58 7.0 Removal of Prostheses 23 2.8
Lysis 5 0.6 Minor Components 23 2.8
Malposition 4 0.5 Head Only 23 2.8
Other 15 1.8
TOTAL 829 100.0
TOTAL 829 100.0
Note: Femoral heads are usually replaced when the acetabular
component and/or femoral stem is revised

Table SHP30 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Age (Primary Diagnosis Fractured NOF)

N N
Age 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
<75 294 4634 3.2 (2.7, 3.8) 4.8 (4.2, 5.5) 5.7 (5.0, 6.5) 6.6 (5.8, 7.5) 7.8 (6.9, 8.9) 9.4 (8.2, 10.6)
75-84 320 9311 2.3 (2.0, 2.6) 3.1 (2.8, 3.6) 3.6 (3.2, 4.0) 4.2 (3.7, 4.7) 4.5 (4.0, 5.1) 5.7 (4.9, 6.5)
≥85 215 10369 1.9 (1.7, 2.3) 2.1 (1.8, 2.5) 2.6 (2.3, 3.0) 3.0 (2.6, 3.5) 3.2 (2.7, 3.8) 4.0 (3.0, 5.4)
TOTAL 829 24314

Figure SHP21 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Age (Primary Diagnosis Fractured NOF)
HR - adjusted for gender
20%
<75 <75 vs ≥85
75-84
18% 0 - 3Mth: HR=1.46 (1.11, 1.90),p=0.005
≥85
3Mth - 1.5Yr: HR=2.79 (2.00, 3.89),p<0.001
16% 1.5Yr+: HR=3.22 (2.36, 4.40),p<0.001

14%
Cumulative Percent Revision

<75 vs 75-84
Entire Period: HR=1.60 (1.37, 1.88),p<0.001
12%
75-84 vs ≥85
10%
0 - 3Mth: HR=1.06 (0.83, 1.35),p=0.645
3Mth+: HR=1.73 (1.34, 2.25),p<0.001
8%

6%

4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

<75 4634 3472 2907 2463 1779 1342 924
75-84 9311 6744 5432 4403 2787 1827 914
≥85 10369 6285 4561 3222 1476 674 199

Data Period 1 September 1999 – 31 December 2019 Page | 27

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Table SHP31 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Gender (Primary Diagnosis Fractured NOF)

N N
Gender 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
Male 249 7168 2.7 (2.3, 3.1) 3.7 (3.2, 4.2) 4.5 (3.9, 5.2) 5.4 (4.7, 6.2) 5.8 (5.0, 6.8) 7.0 (5.8, 8.3)
Female 580 17146 2.2 (2.0, 2.5) 2.9 (2.6, 3.2) 3.4 (3.1, 3.7) 4.0 (3.6, 4.3) 4.6 (4.2, 5.0) 5.9 (5.3, 6.6)
TOTAL 829 24314

Figure SHP22 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Gender (Primary Diagnosis Fractured NOF)
HR - adjusted for age
20%
Male Male vs Female
Female
18% Entire Period: HR=1.19 (1.02, 1.38),p=0.025

16%

14%
Cumulative Percent Revision

12%

10%

8%

6%

4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

Male 7168 4193 3072 2207 1189 701 350
Female 17146 12308 9828 7881 4853 3142 1687

Data Period 1 September 1999 – 31 December 2019 Page | 28

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Table SHP32 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Femoral Fixation (Primary Diagnosis
Fractured NOF)

N
Femoral Fixation N Total 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised
Cementless 195 3900 3.4 (2.8, 4.1) 4.2 (3.5, 4.9) 4.7 (4.0, 5.5) 5.6 (4.8, 6.6) 6.2 (5.3, 7.3) 8.5 (7.0, 10.2)
Cemented 634 20414 2.1 (1.9, 2.4) 2.9 (2.6, 3.2) 3.4 (3.2, 3.8) 4.0 (3.7, 4.4) 4.6 (4.2, 5.1) 5.7 (5.1, 6.3)
TOTAL 829 24314

Figure SHP23 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Femoral Fixation (Primary Diagnosis
Fractured NOF)
HR - adjusted for age and gender
20%
Cementless Cementless vs Cemented
Cemented
18% Entire Period: HR=1.47 (1.25, 1.72),p<0.001

16%

14%
Cumulative Percent Revision

12%

10%

8%

6%

4%

2%

0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure

Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

Cementless 3900 2804 2289 1843 1150 733 366
Cemented 20414 13697 10611 8245 4892 3110 1671

Figure SHP24 Cumulative Incidence Revision Diagnosis of Primary Bipolar Hip Replacement by Femoral Fixation (Primary
Diagnosis Fractured NOF)

Cementless Cemented

5.0% 5.0%
Fracture Fracture
Infection Infection
Prosthesis Dislocation Prosthesis Dislocation
4.0% Loosening 4.0% Loosening
Chondrolysis/Acetab. Erosion Chondrolysis/Acetab. Erosion
Cumulative Incidence

Cumulative Incidence

3.0% 3.0%

2.0% 2.0%

1.0% 1.0%

0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years Since Primary Procedure Years Since Primary Procedure

Data Period 1 September 1999 – 31 December 2019 Page | 29

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List of Tables
Table SHP1 Primary Partial Hip Replacement by Class ............................................................................................................................ 6
Table SHP2 Cumulative Percent Mortality of Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF) ....... 7
Table SHP3 Cumulative Percent Revision of Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF) ........ 7
Table SHP4 CPR of Primary Partial Hip Replacement in Patients Aged <75 Years by Class (NOF) ..................................................... 8
Table SHP5 Age and Gender of Primary Unipolar Monoblock Hip Replacement ............................................................................... 9
Table SHP6 Most Used Prostheses in Primary Unipolar Monoblock Hip Replacement ......................................................................... 9
Table SHP7 CPR of Primary Unipolar Monoblock Hip Replacement (Primary Diagnosis Fractured NOF) ....................................... 10
Table SHP8 Primary Unipolar Monoblock Hip Replacement by Reason for Revision (Primary Diagnosis Fractured NOF) ............ 11
Table SHP9 Primary Unipolar Monoblock Hip Replacement by Type of Revision (Primary Diagnosis Fractured NOF) .................. 11
Table SHP10 CPR of Primary Unipolar Monoblock Hip Replacement by Age (Primary Diagnosis Fractured NOF) .......................... 11
Table SHP11 CPR of Primary Unipolar Monoblock Hip Replacement by Gender (Primary Diagnosis Fractured NOF) ................... 12
Table SHP12 CPR Primary Unipolar Monoblock Hip Repl by Femoral Fixation & Prosthesis Type (Fractured NOF) .......................... 13
Table SHP13 Age and Gender of Primary Unipolar Modular Hip Replacement .................................................................................. 15
Table SHP14 10 Most Used Unipolar Head Prostheses in Primary Unipolar Modular Hip Replacement ............................................. 16
Table SHP15 10 Most Used Femoral Stem Prostheses in Primary Unipolar Modular Hip Replacement .............................................. 16
Table SHP16 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Prosthesis Combination ................ 17
Table SHP17 CPR of Primary Unipolar Modular Hip Replacement (Primary Diagnosis Fractured NOF) ............................................. 19
Table SHP18 Primary Unipolar Modular Hip Replacement by Reason for Revision (Primary Diagnosis Fractured NOF) .................. 18
Table SHP19 Primary Unipolar Modular Hip Replacement by Type of Revision (Primary Diagnosis Fractured NOF) ....................... 18
Table SHP20 CPR of Primary Unipolar Modular Hip Replacement by Age (Primary Diagnosis Fractured NOF) ............................... 20
Table SHP21 CPR of Primary Unipolar Modular Hip Replacement by Gender (Primary Diagnosis Fractured NOF) ......................... 21
Table SHP22 CPR of Primary Unipolar Modular Hip Replacement by Femoral Fixation (Primary Diagnosis Fractured NOF) .......... 22
Table SHP23 Age and Gender of Primary Bipolar Hip Replacement .................................................................................................... 23
Table SHP24 Most Used Bipolar Head Prostheses in Primary Bipolar Hip Replacement ....................................................................... 24
Table SHP25 10 Most Used Femoral Stem Prostheses in Primary Bipolar Hip Replacement ................................................................ 24
Table SHP26 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Prosthesis Combination .................................. 25
Table SHP27 Cumulative Percent Revision of Primary Bipolar Hip Replacement (Primary Diagnosis Fractured NOF) .................... 26
Table SHP28 Primary Bipolar Hip Replacement by Reason for Revision (Primary Diagnosis Fractured NOF) .................................... 27
Table SHP29 Primary Bipolar Hip Replacement by Type of Revision (Primary Diagnosis Fractured NOF) ......................................... 27
Table SHP30 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Age (Primary Diagnosis Fractured NOF) ....... 27
Table SHP31 CPR of Primary Bipolar Hip Replacement by Gender (Primary Diagnosis Fractured NOF) ........................................... 28
Table SHP32 CPR of Primary Bipolar Hip Replacement by Femoral Fixation (Primary Diagnosis Fractured NOF) ............................ 29

List of Figures
Figure SHP1 Primary Partial Hip Replacement by Class ............................................................................................................................ 6
Figure SHP2 Cumulative Percent Revision of Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF) ........ 7
Figure SHP3 CPR of Primary Partial Hip Replacement in Patients Aged <75 Years by Class (Fractured NOF) ................................... 8
Figure SHP4 Primary Unipolar Monoblock Hip Replacement by Gender............................................................................................... 9
Figure SHP5 Primary Unipolar Monoblock Hip Replacement by Age ..................................................................................................... 9
Figure SHP6 CPR of Primary Unipolar Monoblock Hip Replacement (Primary Diagnosis Fractured NOF) ....................................... 10
Figure SHP7 CPR of Primary Unipolar Monoblock Hip Replacement by Age (Primary Diagnosis Fractured NOF) .......................... 11
Figure SHP8 CPR of Primary Unipolar Monoblock Hip Replacement by Gender (Primary Diagnosis Fractured NOF) ................... 12
Figure SHP9 CPR of Primary Unipolar Monoblock Hip Replacement by Femoral Fixation (Fractured NOF) .................................... 13
Figure SHP10 CPR of Primary Unipolar Monoblock Hip Replacement by Prosthesis Type and Femoral Fixation (Fractured NOF) . 14
Figure SHP11 Primary Unipolar Modular Hip Replacement by Gender .................................................................................................. 15
Figure SHP12 Primary Unipolar Modular Hip Replacement by Age ........................................................................................................ 15
Figure SHP13 CPR of Primary Unipolar Modular Hip Replacement (Primary Diagnosis Fractured NOF) ............................................. 19
Figure SHP14 CPR of Primary Unipolar Modular Hip Replacement by Age (Primary Diagnosis Fractured NOF) ............................... 20
Figure SHP15 CPR of Primary Unipolar Modular Hip Replacement by Gender (Primary Diagnosis Fractured NOF) ......................... 21
Figure SHP16 CPR of Primary Unipolar Modular Hip Replacement by Femoral Fixation (Primary Diagnosis Fractured NOF) .......... 22
Figure SHP17 CI Revision Diagnosis of Primary Unipolar Modular Hip Replacement by Femoral Fixation (Fractured NOF)............. 22
Figure SHP18 Primary Bipolar Hip Replacement by Gender .................................................................................................................... 23
Figure SHP19 Primary Bipolar Hip Replacement by Age .......................................................................................................................... 23
Figure SHP20 Cumulative Percent Revision of Primary Bipolar Hip Replacement (Primary Diagnosis Fractured NOF) .................... 26
Figure SHP21 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Age (Primary Diagnosis Fractured NOF) ....... 27
Figure SHP22 CPR of Primary Bipolar Hip Replacement by Gender (Primary Diagnosis Fractured NOF) ........................................... 28
Figure SHP23 CPR of Primary Bipolar Hip Replacement by Femoral Fixation (Primary Diagnosis Fractured NOF) ............................ 29
Figure SHP24 CI Revision Diagnosis of Primary Bipolar Hip Replacement by Femoral Fixation (Fractured NOF) ............................... 29

Data Period 1 September 1999 – 31 December 2019 Page | 30

30  ao a. o r g. au D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 9