EPRD publishes its 2023 annual report
25.10.2023 16:29
The Endoprosthesis Register Germany (EPRD) has published its annual report for 2023. For the first time, the number of hip and knee endoprosthesis operations reported to the EPRD exceeded the pre-pandemic level with 347,702 documents. This means an increase of almost nine percent compared to the peak value from 2019. A total of 177,826 initial hip implantations and 137,030 initial knee implantations were documented in 2022.
Significant decrease in the proportion of implant loosening and decreasing probability of failure in knee arthroplasty
With the current annual report, the EPRD is publishing 10-year results for the first time. They provide new information about developments, for example in follow-up procedures on the hip joint: While in 2012/2013 a loose implant was responsible for every second replacement operation, this figure has fallen to around 23 percent in 2022. Similar to the follow-up procedures on the hip joint, there is also a decrease in loosening over time in those on the knee. Compared to follow-up hip procedures, this is “only” eleven percentage points lower, from almost 34 percent in 2014 to almost 23 percent in 2022. The short to medium-term service life results for the first years of the register can now be compared and compared. In contrast to THA replacements, for which there are no clear trends, a decrease in the probability of failure of THA replacements becomes apparent in the three-year results at the latest.
Highest risk of mortality: femoral neck fracture and replacement surgery
In the current EPRD annual report, the scientists looked for the first time at the mortality of patients after final prosthetic treatment. It should be taken into account that there is not necessarily a connection between the endoprosthetic treatment and the death of the respective patient. The patient groups also differ significantly in terms of their middle age. What is striking, however, is the serious consequences that a femur fracture near the hip joint (femoral neck fracture) can have. Patients who are treated as an emergency with a total hip endoprosthesis (THA) or a hemiendoprosthesis have the highest mortality rate among all endoprosthetic procedures considered. Even with replacement procedures there is a significantly higher mortality rate than with endoprosthetic operations carried out for the first time, although it is not as high as in emergencies. Overall, the mortality risk with primary total knee arthroplasty (TKA) turns out to be somewhat lower than with elective hip replacement. Although patients who underwent standard THA were on average older than those who received elective THA with a cementless stem. Nevertheless, for most forms of primary care documented in the EPRD, patient mortality is below the comparative values for the entire population in Germany.
Detecting mismatches for more patient safety
A so-called “mismatch” occurs when the combination of the implanted components is not suitable. In 2022, for example, 27 cases of hip joint implantation were recorded in which the femoral head was too large for the insert or socket and in 28 cases it was too small. The combination of unsuitable components can lead to hip dislocations if the heads are too large, and serious damage to the socket insert or the head if the heads are too small. The EPRD has not yet been able to detect a sustained decline in annual mismatch cases. The number of mismatches has actually increased significantly compared to 2021. To counteract this tendency and to support clinics in avoiding mismatches or correcting them immediately, the EPRD has developed software that issues a warning immediately after the implants are detected. Furthermore, the EPRD is further expanding its testing rules in order to make an even greater contribution to patient safety.
About the endoprosthesis register in Germany
The Endoprosthesis Register Germany (EPRD) is a voluntary register. The aim is to measure and present the quality of endoprosthetic care in Germany. The EPRD was set up in 2010 on the initiative of the German Society for Orthopedics and Orthopedic Surgery eV (DGOOC) together with the AOK-Bundesverband GbR, the Association of Replacement Funds eV (vdek) and the Federal Association of Medical Technology eV (BVMed). The operator of the EPRD is the non-profit EPRD Deutsche Endoprothesesregister gGmbH, a wholly owned subsidiary of DGOOC. With more than 2.6 million documented documents, the EPRD is the second largest endoprosthetic registry in Europe and the third largest worldwide.