Patient-Reported Outcome Measures (PROMs)
PROMs calculate the health gains after surgical treatment from a patient perspective. This can contribute to the analysis of revision rates, identifying patients with persistent pain or disability as well as measuring patient satisfaction after surgery. Therefore, many registries and hospitals have started to record PROMs data. There is a growing demand for feasible methods and instruments to collect comprehensive PROMs and to enable data comparison between the registries.
In 2022, the Australian Registry starts to report PROMs in a supplementary report. The Australian Registry uses the EQ-VAS and EQ-5D-5L to measure quality of life and uses Oxford Hip Score (OHS) to assess pain and function. In general, a large improvement of quality of life, joint-specified pain and function has been achieved for all classes of joint replacement. Of all recorded 22,130 primary total conventional hip replacements with primary diagnosis OA, mean pre-operative EQ-VAS is 66.20 ± 20.01, and mean post-operative of 14,502 procedures is 80.86 ± 15.83. The mean pre-operative OHS of 22,139 primary total conventional is 20.92 ± 8.98 and this improves to 41.45 ± 7.23 for 14,521 total conventional post-operatively. 90.9% of patients were either very satisfied or satisfied, while 96.7% of patients believed that their hip much better or a little better post-operatively.2
The NZJR was one of the first joint registries to collect PROMs data. The validated Oxford Hip outcome questionnaires were sent out on a random selection basis to achieve an annual response rate of 20%. Oxford-12 questionnaire which includes 12 questions with score points ranging from 0 to 4. The maximum score of 48 indicates normal function, 0 stands for most severe disability.
According to the statistic recorded in the NZJR Annual Report 2023, the average scores at six months are 40.3, 84% had an excellent or good score (>34), 89% of these patients achieved an excellent or good score with an average of 42.4 after 5 years, after 10 years 87% of these patients are still recognized as excellent or good function with an average of 41.9, 83% got an excellent or good score with an average of 40.7 after twenty years.5
The LROI uses NRS (rest), NRS (activity), EQ5D index score, EQ5D thermometer, HOOS-PS score, Oxford Hip score, Anchor question: Daily functioning to measure PROMs for patients underwent hip arthroplasty procedures. According to the LROI, the response rate of pre-operative PROMs achieved 66.7% in 2022. The response rate of all three pre-operative, 3 and 12 months postoperative in 2021 achieved 35.7%.7
Metal resurfacing is still restricted to a carefully monitored patient selection. Women are mostly excluded from this procedure. Ceramic resurfacing procedures are recorded by the NJR and AOA NJRR.
Revision rate of CoC resurfacing is recorded by the NJR for the first time in 2022, although this construct is still undergone in small numbers (N=249). The early revision rate at 1 year for CoC resurfacing is similar to that for MoM resurfacing (1.27% (0.41%-3.87%) vs. 1.18% (1.08%-1.29%)), and lower at 3 years (1.91% (0.71%-5.11%) vs. 2.90% (2.74%-3.06%)) and 5 years (1.91% (0.71%-5.11%) vs. 5.06% (4.85%-5.28%)).
The revision rate (at 1 year) of the MatOrtho ReCerf® CoC resurfacing has been reported for the first time by the AOA NJRR in 2020. In 2022, 42 new procedures have been reported. The Australian Registry showed that the revision rate at 1 year of MatOrtho ReCerf® CoC resurfacing (0.3% (0.0%, 2.1%)) and at 3 years (0.3% (0.0%, 2.1%)), with only 1 revision of all 346 procedures, was lower than other MoM resurfacing.
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2. Paoli E, Bergadano D, Sheng S, Pandit H. National Registry data analysis on a unique highly-crosslinked polyethylene for total hip arthroplasty. Arthroplast Today. 2023;24:101267. doi:10.1016/j.artd.2023.101267.
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13. Vercruysse LYG, Milne LP, Harries DTC, de Steiger RN, Wall CJ. Lower revision rates and improved stability with a monoblock ceramic acetabular cup. J Arthroplasty. doi:10.1016/j.arth.2023.10.032.
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26. Szymski D, Walter N, Krull P, et al. Comparison of mortality rate and septic and aseptic revisions in total hip arthroplasties for osteoarthritis and femoral neck fracture: an analysis of the German Arthroplasty Registry. J Orthop Traumatol. 2023;24(1):29. doi:10.1186/s10195-023-00711-9.
27. Grimberg AW, Steinbrück A. 10 Jahre Endoprothesenregister Deutschland (EPRD): was wurde erreicht? [10 years of the German Arthroplasty Registry-EPRD: what has been achieved?]. Orthopadie (Heidelb). 2023;52(6):463-471. doi:10.1007/s00132-023-04385-3.
28. Szymski D, Walter N, Krull P, et al. Infection after intracapsular femoral neck fracture - does antibiotic-loaded bone cement reduce infection risk after hemiarthroplasty and total hip arthroplasty?. Bone Joint Res. 2023;12(5):331-338. doi:10.1302/2046-3758.125.BJR-2022-0314.R1.
29. Szymski D, Walter N, Krull P, et al. The prophylactic effect of single vs. dual antibiotic-loaded bone cement against periprosthetic joint infection following hip arthroplasty for femoral neck fracture: an analysis of the German Arthroplasty Registry. Antibiotics (Basel). 2023;12(4):732. doi:10.3390/antibiotics12040732.
30. Osmanski-Zenk K, Klinder A, Malzahn J, et al. 3-Jahres-Revisionsrate von zertifizierten EndoProthetikZentren nach EndoCert: Risikoadjustierte Analyse der Ergebnisqualität und Vergleich mit anderen Qualitätssicherungssystemen [Three-year revision rate of certified centres for joint replacement according to EndoCert: risk-adjusted analysis of outcome quality and comparison with other quality assurance systems]. Orthopadie (Heidelb). 2023;52(4):320-331. doi:10.1007/s00132-023-04360-y.
31. Krull P, Steinbrück A, Grimberg AW, Melsheimer O, Morlock MM, Perka C. Standard- und Spezialinlays in primärer Hüftendoprothetik: Aktuelle Studien- und Umfrageergebnisse aus dem Endoprothesenregister Deutschland (EPRD) [Standard and special liner in primary hip arthroplasty: current study and survey results from the German Arthroplasty Registry (EPRD)]. Orthopadie (Heidelb). 2023;52(3):222-232. doi:10.1007/s00132-022-04333-7.
32. Springer BD, Mullen K, Donnelly P, Tucker K, Caton E, Huddleston J. Is American Joint Replacement Registry data consistent with international survivorship in Hip and Knee Arthroplasty? A comparative analysis. J Arthroplasty. doi:10.1016/j.arth.2024.02.055.
33. Kelly M, Chen AF, Ryan SP, et al. Femoral component design is associated with the risk of periprosthetic femur fracture after cementless THA in patients 65 years or older. Clin Orthop Relat Res. doi:10.1097/CORR.0000000000002985.
34. Carender CN, Gulley ML, De A, Bozic KJ, Callaghan JJ, Bedard NA. Outcomes vary significantly using a tiered approach to define success after total hip arthroplasty. Iowa Orthop J. 2023;43(1):45-54.
35. Otero JE, Heckmann ND, Jaffri H, et al. Dual mobility articulation in revision total hip arthroplasty: an American Joint Replacement Registry Analysis of patients aged 65 years and older. J Arthroplasty. 2023;38(7 Suppl 2):S376-S380. doi:10.1016/j.arth.2023.05.023.
36. Ackerman SJ, Vigdorchik JM, Siljander BR, Gililland JM, Sculco PK, Polly DW. Projected savings associated with lowering the risk of total hip arthroplasty revision due to dislocation in patients with spinopelvic pathology. Clinicoecon Outcomes Res. 2023;15:321-330. doi:10.2147/CEOR.S410453.
37. Kelly M, Chen AF, Ryan SP, et al. Cemented femoral fixation in total hip arthroplasty reduces the risk of periprosthetic femur fracture in patients 65 years and older: an analysis from the American Joint Replacement Registry. J Arthroplasty. 2023;38(7 Suppl 2):S351-S354. doi:10.1016/j.arth.2023.04.039.
38. Coombs S, Oakley CT, Buehring W, Arraut J, Schwarzkopf R, Rozell JC. Hospital teaching status and patient-reported outcomes following primary total hip arthroplasty: an American Joint Replacement Registry study. J Arthroplasty. 2023;38(7 Suppl 2):S289-S293. doi:10.1016/j.arth.2023.04.022.
39. Wilson JM, Broida SE, Kremers HM, et al. Can the American Joint Replacement Registry utilize administrative claims data to accurately classify revision total hip arthroplasty (THA) surgical diagnoses?. J Arthroplasty. 2023;38(7S):S179-S183.e2. doi:10.1016/j.arth.2023.04.021.
40. Cieremans D, Shah A, Slover J, Schwarzkopf R, Meftah M. Trends in complications and outcomes in patients aged 65 years and younger undergoing total hip arthroplasty: data from the American Joint Replacement Registry. J Am Acad Orthop Surg Glob Res Rev. 2023;7(3):e22.00256. doi:10.5435/JAAOSGlobal-D-22-00256.
41. Nessler JM, Malkani AL, Yep PJ, Mullen KJ, Illgen RL 2nd. Dislocation rates of primary total hip arthroplasty in patients with prior lumbar spine fusion and lumbar degenerative disk disease with and without utilization of dual mobility cups: an American Joint Replacement Registry study. J Am Acad Orthop Surg. 2023;31(5):e271-e277. doi:10.5435/JAAOS-D-22-00767.
42. Oakley CT, Arraut J, Lygrisse K, Schwarzkopf R, Slover JD, Rozell JC. The effect of surgeon and hospital volume on total hip arthroplasty patient-reported outcome measures: an American Joint Replacement Registry study. J Am Acad Orthop Surg. 2023;31(4):205-211. doi:10.5435/JAAOS-D-22-00525.
43. English RT, Munro JT, Monk AP. Increasing femoral head size from 32 mm to 36 mm does not increase the revision risk for total hip replacement: a New Zealand joint registry study. Hip Int. 2024;34(1):66-73. doi:10.1177/11207000231210487.
44. Lingard MCH, Willis J, Frampton CMA, Hooper GJ. Survey of New Zealand arthroplasty surgeons on surgeon-level outcome reporting. J Arthroplasty. 2023;38(11):2254-2258. doi:10.1016/j.arth.2023.05.069.
45. Boyle AB, Zhu M, Frampton C, Poutawera V, Vane A. Comparing modern uncemented, hybrid and cemented implant combinations in older patients undergoing primary total hip arthroplasty, a New Zealand Joint Registry study. Arch Orthop Trauma Surg. 2023;143(6):3597-3604. doi:10.1007/s00402-022-04610-2.
46. Foxall-Smith M, Wyatt MC, Frampton C, Kieser D, Hooper G. The 45-year evolution of the Mathys RM monoblock cups: have the paradigm shifts been worthwhile?. Hip Int. 2023;33(2):193-202. doi:10.1177/11207000211067507.
47. Wolf O, Ghukasyan Lakic T, Ljungdahl J, et al. Reoperation-free survival after hip screws or hip arthroplasty for undisplaced femoral neck fractures in the elderly. Bone Jt Open. 2024;5(2):87-93. doi:10.1302/2633-1462.52.BJO-2023-0143.R1.
48. Cnudde PHJ, Nåtman J, Rolfson O, Hailer NP. The true dislocation incidence following elective total hip replacement in Sweden: how does it relate to the revision rate?. J Clin Med. 2024;13(2):598. doi:10.3390/jcm13020598.
49. Eneqvist T, Persson L, Kojer E, Gunnarsson L, Gerdhem P. Spinal surgery and the risk of reoperation after total hip arthroplasty: a cohort study based on Swedish spine and hip arthroplasty registers. Acta Orthop. 2024;95:25-31. doi:10.2340/17453674.2024.35228.
50. Lagergren J, Strøm Rönnquist S, Wolf O, et al. The different strategies in treating displaced femoral neck fractures: mid-term surgical outcome in a register-based cohort of 1,283 patients aged 60-69 years. Acta Orthop. 2023;94:505-510. doi:10.2340/17453674.2023.20284.
51. Persson A, Sköldenberg O, Mohaddes M, Eisler T, Gordon M. Increased mortality after total hip prosthetic joint infection is mainly caused by the comorbidities rather than the infection itself. Acta Orthop. 2023;94:484-489. doi:10.2340/17453674.2023.18619.
52. Schaufelberger M, Rolfson O, Kärrholm J. Outcome of patients with osteoarthritis aged 90 to 101 years after cemented total hip arthroplasty: 1,385 patients from the Swedish Arthroplasty Register. Acta Orthop. 2023;94:477-483. doi:10.2340/17453674.2023.18656.
53. Sattar A, Kärrholm J, Möller M, Chatziagorou G. Fracture pattern and risk factors for reoperation after treatment of 156 periprosthetic fractures around an anatomic cemented hip stem. Acta Orthop. 2023;94:438-446. doi:10.2340/17453674.2023.18263.
54. Dale H, Fenstad AM, Hallan G, et al. Increasing risk of revision due to infection after primary total hip arthroplasty: results from the Nordic Arthroplasty Register Association. Acta Orthop. 2023;94:307-315. doi:10.2340/17453674.2023.13648.
55. Mikkelsen RT, Overgaard S, Pedersen AB, et al. Does choice of bearings influence the survival of cementless total hip arthroplasty in patients aged 20-55 years? Comparison of 21,594 patients reported to the Nordic Arthroplasty Register Association dataset 2005-2017. Acta Orthop. 2023;94:266-273. doi:10.2340/17453674.2023.13384.
56. Cornell CN. CORR Insights®: What is the role of stem size and offset in the risk of nonseptic revision of the Exeter® 150-mm stem? A study from the Swedish Arthroplasty Register. Clin Orthop Relat Res. 2023;481(9):1700-1702. doi:10.1097/CORR.0000000000002708.
57. Gustafsson K, Kvist J, Eriksson M, Rolfson O. What factors identified in initial osteoarthritis management are associated with poor patient-reported outcomes after THA? A register-based study. Clin Orthop Relat Res. 2023;481(9):1732-1742. doi:10.1097/CORR.0000000000002681.
58. Jolbäck P, Bedeschi Rego De Mattos C, Rogmark C, Chen AF, Nauclér E, Tsikandylakis G. Patient-reported outcomes after primary total hip arthroplasty are not affected by the sex of the surgeon: a register-based study of 8,383 procedures in western Sweden. J Am Acad Orthop Surg. 2023;31(13):692-700. doi:10.5435/JAAOS-D-22-00840.
59. Teni FS, Burström K, Devlin N, Parkin D, Rolfson O; Swedish Quality Register (SWEQR) Study Group. Experience-based health state valuation using the EQ VAS: a register-based study of the EQ-5D-3L among nine patient groups in Sweden. Health Qual Life Outcomes. 2023;21(1):34. doi:10.1186/s12955-023-02115-z.
60. Bongers J, Belt M, Spekenbrink-Spooren A, Smulders K, Schreurs BW, Koeter S. Smoking is associated with higher short-term risk of revision and mortality following primary hip or knee arthroplasty: a cohort study of 272,640 patients from the Dutch Arthroplasty Registry. Acta Orthop. 2024;95:114-120. doi:10.2340/17453674.2024.39966.
61. Rietbergen L, Dooren BV, Zijlstra WP, et al. The rise of the direct anterior approach: trends, learning curves, and patient characteristics of 63,182 primary total hip arthroplasties in the Dutch Arthroplasty Register (LROI). J Arthroplasty. doi:10.1016/j.arth.2024.01.017.
62. van Veghel MHW, Belt M, Spekenbrink-Spooren A, et al. Validation of the incidence of reported periprosthetic joint infections in total hip and knee arthroplasty in the Dutch Arthroplasty Register. J Arthroplasty. doi:10.1016/j.arth.2023.10.040.
63. Bos PK, Spekenbrink-Spooren A, Croughs P, Bierma-Zeinstra SMA, Reijman M, Van Oldenrijk J. Risk for re-revision and type of antibiotic-loaded bone cement in hip or knee arthroplasty revisions: report of the Dutch Arthroplasty Register. Acta Orthop. 2023;94:471-476. doi:10.2340/17453674.2023.18645.
64. Schmitz PP, Hannink G, Somford MP, Schreurs BW, Van Susante JLC. Revision risk of salvage compared with acute total hip arthroplasty following femoral neck fracture: an analysis from the Dutch Arthroplasty Register. Acta Orthop. 2023;94:399-403. doi:10.2340/17453674.2023.17743.
65. Bonsel JM, Reijman M, Verhaar JAN, van Steenbergen LN, Janssen MF, Bonsel GJ. Socioeconomic inequalities in patient-reported outcome measures of Dutch primary hip and knee arthroplasty patients for osteoarthritis. Osteoarthritis Cartilage. 2024;32(2):200-209. doi:10.1016/j.joca.2023.07.004.
66. Van Veghel MHW, Hannink G, Van Oldenrijk J, Van Steenbergen LN, Schreurs BW. A comparison of uncemented short versus standard stem length in total hip arthroplasty: results from the Dutch Arthroplasty Register. Acta Orthop. 2023;94:330-335. doi:10.2340/17453674.2023.13652.
67. Van Dooren B, Peters RM, Jutte PC, Stevens M, Schreurs BW, Zijlstra WP. Similar revision rate after cemented and cementless femoral revisions for periprosthetic femoral fractures in total hip arthroplasty: analysis of 1,879 revision hip arthroplasties in the Dutch Arthroplasty Register. Acta Orthop. 2023;94:260-265. doi:10.2340/17453674.2023.13211.
68. Van Dooren B, Peters RM, Ettema HB, et al. Revision risk by using the direct superior approach (DSA) for total hip arthroplasty compared with postero-lateral approach: early nationwide results from the Dutch Arthroplasty Register (LROI). Acta Orthop. 2023;94:158-164. doi:10.2340/17453674.2023.11959.
69. van Steenbergen LN, de Reus IM, Hannink G, Vehmeijer SB, Schreurs BW, Zijlstra WP. Femoral head size and surgical approach affect dislocation and overall revision rates in total hip arthroplasty: up to 9-year follow-up data of 269,280 procedures in the Dutch Arthroplasty Register (LROI). Hip Int. 2023;33(6):1056-1062. doi:10.1177/11207000231160223.
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71. van Loon J, Sierevelt IN, Spekenbrink-Spooren A, et al. Higher risk of 2-year cup revision of ceramic-on-ceramic versus ceramic-on-polyethylene bearing: analysis of 33,454 primary press-fit total hip arthroplasties registered in the Dutch Arthroplasty Register (LROI). Hip Int. 2023;33(2):280-287. doi:10.1177/11207000211064975.
72. Kuijpers MF, Hannink G, van Steenbergen LN, Schreurs BW. A significant change towards cemented fixation in revision total hip arthroplasty in patients younger than 55 years in the Netherlands: results of an observational cohort study in the Dutch Arthroplasty Register in 28,516 primary hip replacements and 1285 revision procedures. Hip Int. 2023;33(2):288-297. doi:10.1177/11207000211020002.
1. Vercruysse LYG, Milne LP, Harries DTC, de Steiger RN, Wall CJ. Lower revision rates and improved stability with a monoblock ceramic acetabular cup. J Arthroplasty. doi:10.1016/j.arth.2023.10.032.
This study investigates the survival rate and the reasons for revision of the DeltaMotion cup using data from the Australian Orthopedic National Joint Replacement Registry (AOANJRR) between 2001-2021. Monoblock ceramic/ceramic cups designed for LDHs have the potential to preserve acetabular bone stock, eliminating issues seen in metal-on-metal bearings.
Of 486,946 primary conventional THR procedures undertaken for any reasons, 4,033 used DeltaMotion cups and 482,913 were modular designs (107,758 CoC, 131,906 CoXLPE, 208,917 MoXLPE and 34,332 CMoXLPE). The result shows that the DeltaMotion cup had significantly lower cumulative percent revision compared to the modular bearings, also with a significantly lower revision rate for prosthetic dislocations and no revision for squeaking compared to other modular bearings. 175 ceramic breakages were recorded for the modular bearing group and only 1 ceramic breakage was recorded for the DeltaMotion group. This study demonstrated that DeltaMotion cup is suitable for younger and more active patients based on their ongoing follow-up, although this cup is no longer manufactured.
2. van Loon J, Sierevelt IN, Spekenbrink-Spooren A, et al. Higher risk of 2-year cup revision of ceramic-on-ceramic versus ceramic-on-polyethylene bearing: analysis of 33,454 primary press-fit total hip arthroplasties registered in the Dutch Arthroplasty Register (LROI). Hip Int. 2023;33(2):280-287. doi:10.1177/11207000211064975.
This study describes 2-year cup revision rates of CoC and CoPE for primary press-fit THRs with one of the three most used cups recorded in the Dutch Arthroplasty Register (LROI) between 2007-2019. A total of 33,454 of press-fit THRs used one of the three most used cup types available with both CoC and CoPE bearing were included in this study, of which 12,535 were CoC and 20,919 were CoPE. The results showed that the overall 2-year cumulative cup revision rate was 0.53% (95%CI, 0.45-0.60). Overall, 84 THRs with CoC were revised at 2 years, a revision rate of 0.67% (95%CI, 0.54-0.81). CoPE had a total of 91 revisions with a revision rate of 0.44% (95%CI, 0.34-0.54). This result remained significant (HR 0.64 (95%CI, 0.44-0.93)) after adjusting for confounders (age, gender, cup type, head size) and CoPE was favored over CoC (p=0.019). In terms of revision reasons, cup revisions were only different because more cups were revised due to loosening (p=0.030) in the CoC (26.2% vs. 13.2%) compared to CoPE. There were 19 cases of cup revision due to aseptic loosening observed in CoC, with a revision rate of 0.153% (95%CI, 0.075-0.231). Revision rate of CoPE was 0.058% (95%CI, 0.019-0.097), with a total of 12 cup revisions for aseptic loosening.
AJRR: The American Joint Replacement Registry
AOA NJRR: The Australian Orthopaedic Association National Joint Replacement Registry
CI: Confidence Interval
CMoP: Ceramicised Metal-on-Polyethylene
CoC: Ceramic-on-Ceramic
CoM: Ceramic-on-Metal
CoP: Ceramic-on-Polyethylene (including both conventional polyethylene and cross-linked polyethylene)
CoPoM: Ceramic-on-Polyethylene-on-Metal (Dual Mobility - only used by the NJR)
CoXLPE: Ceramic-on-Cross-Linked Polyethylene
CohXLPE: Ceramic-on-Highly Cross-Linked Polyethylene (only used by the EPRD)
DM: Dual Mobility
EPRD: Endoprothesenregister Deutschland (The German Arthroplasty Registry)
EQ-5D: European Quality of Life 5 Dimensions
EQ-5D-5L: European Quality of Life 5 Dimensions 5 Level Version
EQ VAS Health: EuroQol-Visual Analogue Scales
HOOS JR. Score: Hip Disability and Osteoarthritis Outcome Score for Joint Replacement Score
HR: Hazard Ratio
ISAR: International Society of Arthroplasty Registries
MoM: Metal-on-Metal
MoP: Metal-on-Polyethylene (including both conventional polyethylene and cross-linked polyethylene)
MoPoM: Metal-on-Polyethylene-on-Metal (Dual Mobility - only used by the NJR)
MoXLPE: Metal-on-Cross-Linked Polyethylene
MohXLPE: Metal-on-Highly Cross-Linked Polyethylene (only used by the EPRD)
NHS: The National Health Service
NJR: The National Joint Registry, which covers England, Wales, Northern Ireland, the Isle of Man and the States
of Guernsey
NZJR: The New Zealand Joint Registry
OA: Osteoarthritis
PROMs: Patient-Reported Outcome Measures
PROMIS-10: Patient-Reported Outcomes Measurement Information System-10
SAR: The Swedish Arthroplasty Register (Merger of the Swedish Hip Arthroplasty Register and the Swedish Knee Arthroplasty Register)
SD: Standard Deviation
THA: Total Hip Arthroplasty
THR: Total Hip Replacement
VR-12: The Veterans RAND 12 Item Health Survey
References
National Joint Registry. 20th Annual Report 2023. Surgical data to 31 December 2022. ISSN 2054-183X (Online). 2023:1-370.
Smith PN, Gill DR, McAuliffe MJ, McDougall C, Stoney JD, Vertullo CJ, Wall CJ, Corfield S, Page R, Cuthbert AR, Du P, Harries D, Holder C, Lorimer MF, Cashman K, Lewis PL. Hip, Knee and Shoulder Arthroplasty: 2023 Annual Report, Australian Orthopaedic Association National Joint Replacement Registry, AOA: Adelaide, South Australia. 2023. https://doi.org/10.25310/YWQZ9375
Endoprothesenregister Deutschland (EPRD). Jahresbericht 2023. Mit Sicherheit mehr Qualität. ISBN: 978-3-949872-02-0. 2023:1-196.
American Academy of Orthopaedic Surgeons (AAOS). American Joint Replacement Registry (AJRR): 2023 Annual Report. ISSN 2375-9119 (Online). 2023: 1-125.
The New Zealand Joint Registry. Twenty-four Year Report January 1999 to December 2022. 2023:1-211.
Swedish Arthroplasty Register. Annual report 2023. ISSN 16454-5982. 2023: 1-310.
Dutch Arthroplasty Register (LROI). Online LROI annual report 2023. Joint arthroplasty data to 31 December 2022. 2023: 1-249.
Endoprothesenregister Deutschland (EPRD). Statusbericht 2014 Mit Sicherheit mehr Qualität. 2015: 1-60.
Endoprothesenregister Deutschland (EPRD). Jahresbericht 2015 Mit Sicherheit mehr Qualität. ISBN: 978-3-9817673-1-5. 2016: 1-65.
Endoprothesenregister Deutschland (EPRD). Jahresbericht 2016 Mit Sicherheit mehr Qualität. 2017: 1-64.
Endoprothesenregister Deutschland (EPRD). Jahresbericht 2017 Mit Sicherheit mehr Qualität. ISBN: 978-3-9817673-3-9. 2018: 1-80.
German Arthroplasty Registry (EPRD). 2019 Annual Report. 2020: 1-125. doi:10.36186/reporteprd01202.
Endoprothesenregister Deutschland (EPRD). Jahresbericht 2020 Mit Sicherheit mehr Qualität. 2020: 1-128. doi:10.36186/reporteprd022020.
Endoprothesenregister Deutschland (EPRD). Jahresbericht 2021 Mit Sicherheit mehr Qualität. ISBN: 978-3-9817673-9-1 2021: 1-193.
Endoprothesenregister Deutschland (EPRD). Jahresbericht 2022. Mit Sicherheit mehr Qualität. ISBN: 978-3-949872-00-6 2022:1-175.