This article is from a year ago, but its message seems more than worthy of a re-vist.
Basically, the authors contrasted the revision rates obtained from case series with those from registries. The bottom line was that revision rates from arthroplasty registry data were significantly higher than those from clinical case series. The authors also noted that in clinical case series, the preponderance of the data came from the institution at which the arthroplasty implant was developed - these data had a major influence on the observed rates of arthroplasty revision. This phenomenon was particularly common for implants developed in the U.S.
The observation that the attractively low revision rates reported by the implant developers were not replicated by the registry data that reflects 'routine' patient treatment makes two important points:
(1) data from case series authored by implant developers may not be applicable to the general practice of orthopaedic surgery and
(2) there is a critical need for arthroplasty implant registries in the U.S. as championed by the American Joint Replacement Registry.
Joint registries give us the best chance to live up to the admonition of Codman: to follow every patient long enough to determine if our treatment was a success and if not to determine why not. They keep us from putting our heads in the sand as shown in his depiction of the goose ostrich, which continues to lay golden eggs even though she cannot see the results.
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