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Scientific Articles   |    
A Scandinavian Experience of Register Collaboration: The Nordic Arthroplasty Register Association (NARA)
Leif I. Havelin, MD, PhD1; Otto Robertsson, MD, PhD2; Anne M. Fenstad, MSc1; Søren Overgaard, MD, PhD3; Göran Garellick, MD, PhD4; Ove Furnes, MD, PhD1
1 The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, 5021 Bergen, Norway. E-mail address for L.I. Havelin: leif.havelin@helse-bergen.no. E-mail address for A.M. Fenstad: anne.marie.fenstad@helse-bergen.no. E-mail address for O. Furnes: ove.furnes@helse-bergen.no
2 The Swedish Knee Arthroplasty Register, Department of Orthopaedics, Clinical Sciences, Lund University, 221 85 Lund, Sweden. E-mail address: otto.robertsson@med.lu.se
3 Department of Orthopaedic Surgery and Clinical Institute, Odense University Hospital, 5000 Odense, Denmark. E-mail address: Soeren.Overgaard@ouh.regionsyddanmark.dk
4 The Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, University of Gothenburg, 413 45 Mölndal, Sweden. E-mail address: goran.garellick@registercentrum.se
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the Norwegian Arthroplasty Register, Haukeland University Hospital and Department of Surgical Sciences, University of Bergen, Bergen, Norway; the Swedish Knee Arthroplasty Register, Department of Orthopaedics, Lund University, Lund, Sweden; the Danish Hip Arthroplasty Register, Center for Clinical Databases, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Orthopaedic Surgery and Clinical Institute, Odense University Hospital, Odense, Denmark; and the Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, University of Gothenburg, Mölndal, Sweden

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Dec 21;93(Supplement 3):13-19. doi: 10.2106/JBJS.K.00951
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Abstract

Background: 

The Nordic (Scandinavian) countries have had working arthroplasty registers for several years. However, the small numbers of inhabitants and the conformity within each country with respect to preferred prosthesis brands and techniques have limited register research.

Methods: 

A collaboration called NARA (Nordic Arthroplasty Register Association) was started in 2007, resulting in a common database for Denmark, Norway, and Sweden with regard to hip replacements in 2008 and primary knee replacements in 2009. Finland joined the project in 2010. A code set was defined for the parameters that all registers had in common, and data were re-coded, within each national register, according to the common definitions. After de-identification of the patients, the anonymous data were merged into a common database. The first study based on this common database included 280,201 hip arthroplasties and the second, 151,814 knee arthroplasties. Kaplan-Meier and Cox multiple regression analyses, with adjustment for age, sex, and diagnosis, were used to calculate prosthesis survival, with any revision as the end point. In later studies, specific reasons for revision were also used as end points.

Results: 

We found differences among the countries concerning patient demographics, preferred surgical approaches, fixation methods, and prosthesis brands. Prosthesis survival was best in Sweden, where cement implant fixation was used more commonly than it was in the other countries.

Conclusions: 

As the comparison of national results was one of the main initial aims of this collaboration, only parameters and data that all three registers could deliver were included in the database. Compared with each separate register, this combined register resulted in reduced numbers of parameters and details. In future collaborations of registers with a focus on comparing the performances of prostheses and articulations, we should probably include only the data needed specifically for the predetermined purposes, from registers that can deliver these data, rather than compiling all data from all registers that are willing to participate.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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