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The Norwegian National Network for Arthroplasty and Hip Fractures
The registers continuously collect data from all over Norway on joint replacements, hip fractures, ACL injuries and congenital hip disorders in children.
The Norwegian Arthroplasty Register was established in 1987 by the Norwegian Orthopaedic Association after the use of poor hip prostheses was discovered in the early 1980s. The register was expanded to include all joint replacements in 1994 and was approved as a national medical quality register in 2009.
The Norwegian Knee Ligament Register was established in 2004 and The Norwegian Hip Fracture Register in 2005. Both registrens were approved as national medical quality registers in 2009.
In 2010, the Norwegian Paediatric Hip Register began to record all new cases of hip disorders in children and was approved as a national medical quality register in 2015.
In 2002, the Norwegian Arthroplasty Register was upgraded to a National Advisory Unit by the Ministry of Health and Care Services (HOD). In 2010, HOD changed the Unit’s name to the Norwegian National Advisory Unit on Arthroplasty and Hip Fractures. The name changed again from January 2023 to The Norwegian National Network for Arthroplasty and Hip Fractures.
The Norwegian Paediatric Hip Register began to record paediatric hip dysplasia, Legg-Calvé-Perthes disease (LCPD) and slipped capital femoral epiphysis (SCFE) in 2010 and open and arthroscopic hip surgery (not arthroplasty) in 2013.
The National Network operates the national registers for arthroplasty and hip fractures, and aims to build and disseminate expertise in arthroplasty and hip fractures, in order to enhance the quality and cost effectiveness of treatment.
The aim of the registers is to detect poor prostheses, cements and surgical procedures as early as possible and to provide knowledge of epidemiology. With increased expertise in the field and monitoring of the effects of implants and surgical procedures, the quality of treatment is expected to improve. The Advisory Unit also operates the Norwegian Cruciate Ligament Register and the Norwegian Paediatric Hip Register. All registers are initiated by the Norwegian Orthopaedic Association, while the operation of the registers takes place in the Orthopedic Clinic of Haukeland University Hospital, Bergen. Results can be found in our annual report and on the website of the National Service Centre for Medical Quality Registers: www.kvalitetsregistre.no.
The operation of the registers is funded by the health trusts Helse Vest RHF and Helse Bergen HF.
What information is recorded?
We record information when a prosthesis is inserted for the first time and also for subsequent revisions if the prosthesis proves to be unsuccessful, for example if it loosens. Revisions are operations where one or more parts of the prosthesis are replaced, inserted or removed. Surgeons fill out a standard form for each operation and send this to the register.
How many arthroplasties are performed?
Incidence of hip prostheses:
Incidence of knee prostheses:
Every year, we receive information on about 10 000 primary arthroplasties of the hip, about 7000 of the knee, 850 of the shoulder and 150 of other joints. .
Reporting
The government has stated that operations must be reported to the register. However, written consent from the patient is required. Compared with operations notified to the Norwegian Patient Register , more than 95% of primary hip and knee arthroplasties are notified to the Norwegian Arthroplasty Register.
Why do we need an arthroplasty register?
In the early 1980s, it was found that several of the prostheses in use in Norway were unsuccessful. These had been inserted in many patients in Norway and abroad before their poor outcome was known. At that time, many other prostheses were being used without any knowledge of whether these would be successful or not. This gave cause for concern, and there were calls for a national institution which could continuously monitor the quality of arthroplasty in Norway. It is still permitted to use of new types of prosthesis which have not been tested in studies.
Objectives
The main objective of the Norwegian Arthroplasty Register is to prevent the use of poor prostheses in patients. In addition, it is important to provide an overview of the products and surgical procedures in use at any time and the patient groups who need arthroplasty.
Communicating information to patients and hospitals
The communication of information to the public is mainly in the form of scientific publications from the register and presentations at seminars and conferences. Every hospital in Norway receives regular reports based on data in the register, both for the hospital itself and for the country as a whole, to enable the hospital to assess the quality of its operations. Every year, the results for each hospital are published on the website of the National Service Centre for Medical Quality Registers:
www.kvalitetsregistre.no.
Statistical methods
The quality of joint prostheses is often based on their lifetime, i.e. the time from the insertion of the prosthesis until a possible need for replacement (event history analysis). When the register receives information about a revision operation, this information is linked to the data reported on the first operation.
The purpose of the Register
The Norwegian Hip Fracture Register is a national quality register. The purpose of the Register is to develop new knowledge that can help to prevent illnesses and injuries that lead to hip fractures, as well as improving and quality assuring treatment methods and patient care. The main aim is thus to improve the quality of treatment of people with various types of hip fractures. The register also forms an important basis for research. Emphasis is placed on patients’ quality of life and satisfaction. A further goal is to provide information and advice to surgeons and public agencies on the best treatment for the various types of hip fractures.
The Register contain these data
•General information: name, date of birth and ID number, address and gender. The National Population Register will be consulted to ensure that your personal data are correct.
•Health information: type of hip fracture, year of surgery, date of fracture, information on the implant and surgical method, etc.
•Patient-reported information on quality of life following a hip fracture (PROM).
The data are collected from an electronic form completed by the surgeon immediately after operation; the surgeon then sends the form to the Hip Fracture Register. When patient are discharged from hospital, another form is filled in with information about the medical treatment, any complications that occurred during the hospital stay, and where the patient are going after discharge. In addition, at 4, 12 and 36 months after the operation patient will be asked to complete a questionnaire about the quality of life, pain and satisfaction with the result of the operation. This is entirely voluntary. For some health issues, we may wish to contact patients to ask further questions.
Comparison with information from other sources
In connection with research projects or to ensure that the data in the Hip Fracture Register are complete and correct, it may be appropriate to obtain data related to hip fractures from other public registers. Each time another register is consulted, this will be announced on our website. Relevant registers for accessing such data are the Norwegian Prescription Database, the Norwegian Cardiovascular Disease Registry, the Medical Birth Registry of Norway, the Norwegian Cancer Registry, the Cause of Death Registry, the Norwegian Information System for the Nursing and Care Sector (IPLOS) and the Norwegian Patient Registry (this contains data on all patients admitted to hospital or treated at outpatient clinics or by specialist doctors).
Personal data will not be used for research, unless the study has been approved by the Regional Committees for Medical and Health Research Ethics, the privacy officer of the institution responsible for the research or the Norwegian Data Protection Authority.
Disclosure of data from the Hip Fracture Register will only be permitted when this is in accordance with the aim of the Register. Names, dates of birth and ID numbers are replaced by a code when data are disclosed. In this way, the data are de-identified and cannot be traced back to patients. The data are stored indefinitely. All information collected is treated confidentially, and all those whose work involves data in the Register are bound by confidentiality obligations regarding any information that may be available to them. Helse Bergen, the data controller, will ensure that patients privacy rights are protected at all times.
Right of access, modification and deletion of data
Patients have the right of access to information held about them If they believe that the information about them are incorrect, they can ask for it to be corrected. They also have the right to request deletion of their personal data from the Register.
Patients can exercise their rights by contacting the Norwegian Hip Fracture Register on
55 97 64 50, or at
nrl@helse-bergen.no
The anterior cruciate ligament
The anterior cruciate ligament (ACL) is located inside the knee. We have two cruciate ligaments in each knee, one at the front and one at the back. Their function is to support and stabilise the knee. The main task of the front (anterior) cruciate ligament is to prevent the shin bone from sliding too far forward in relation to the femur. The main task of the back (posterior) cruciate ligament is to prevent the shin bone from sliding too far back relative to the femur. The cruciate ligaments also stabilise rotation in the knee.
How do ACL injuries occur?
90% of all cruciate ligament injuries are to the anterior cruciate ligament. The injury occurs most frequently when the foot is standing on the ground and the knee is bent, while the person turns the body and femur. In Norway, ⅔ of the injuries are in connection with football, handball and skiing. ACL may be the only knee injury, but most commonly it occurs with other knee injuries, such as injuries to the meniscus, cartilage and lateral ligaments.
Signs of an ACL injury
If the injury is acute, there is immediate pain. The knee swells up very rapidly, usually within seconds. The pain is often so strong that it seems impossible to move or put weight on the knee.
Sometimes the condition is chronic. This is usually when a previous cruciate ligament injury has not been properly treated. For the patient, it feels as if the knee is failing and is often unreliable. The pain is rarely as strong as in an acute injury.
How is it diagnosed?
The injury is often easy to diagnose using medical history and simple examinations. It may be too difficult to conduct a knee examination during the first few days, because of the pain and swelling. Then a new examination will be called for in four or five days’ time. In the final examination, the injury will be confirmed with either an MRI scan of the knee or optical diagnostics (arthroscopy).
Treatment
ACL injuries should be treated, either with surgery or conservatively with rehabilitation. The aim of the treatment is to stabilise the knee to enable the patient to return to a normal level of activity. Surgical treatment is usually offered to sports professionals or others who are highly physically active, whose knee function and stability are of vital importance on a daily basis.
Surgical treatment involves a graft to replace the damaged ligament. In Norway, this graft usually comes from the patient, and is either part of the patellar tendon between the kneecap and the shinbone or part of the hamstring tendon in the back of the thigh. After surgery, physiotherapy-led rehabilitation is important. The rehabilitation period usually lasts from 6 to 12 months and the goal is to restore mobility, strength and balance.
Conservative treatment is also physiotherapy which lasts from 6 to 12 months and aims to restore mobility, strength and balance.
The Norwegian Paediatric Hip Register started with a nationwide registration of the child hip diseases of hip dysplasia, Legg-Calvé-Perthes disease (LCPD) and slipped capital femoral epiphysis (SCFE) on 01.01.2010, and of open and arthroscopic hip surgery (not arthroplasty) in 2013.
Included are all children in Norway diagnosed with Legg-Calvé-Perthes disease, hip dysplasia, or slipped capital femoral epiphysis. In addition, all children, adolescents and young adults undergoing hip preservation surgery (not hip replacements or revisions of these or trauma/fractures) are included. Patients with co-morbid conditions such as neurological disorders, injuries or after-effects of injuries that may lead to hip disorders, are not included in the register.
A public report on all the registers including hospital results is available on the website of the National Service Centre for Medical Quality Registers:
https://www.kvalitetsregistre.no/.
All hospitals that treat child hip diseases report each treatment and operation to the Paediatric Hip Register. Registration requires consent by patients.
