Rapid decline of yearly number of hip arthroscopies in Sweden: a retrospective time series of 6,105 hip arthroscopies based on a national patient data register.

Background and purpose - Hip arthroscopies (HAs) have increased exponentially worldwide and are expected to continue rising. We describe time trends in HA procedures in Sweden (10 million inhabitants) between 2006 and 2018 with a focus on procedure rates, surgical procedures, and patient demographics such as age and sex distribution.Patients and methods - We retrospectively collected data from the Swedish National Patient Register (NPR) for all surgeries including surgical treatment codes considered relevant for HA from 2006 to 2018. Surgical codes were validated through a multiple-step procedure and classified into femoroacetabular impingement syndrome (FAIS) related or non-FAIS related procedure. Frequencies, sex differences, and time trends of surgical procedures and patient demographics are presented.Results - After validation of HA codes, 6,105 individual procedures, performed in 4,924 patients (mean age 34 years [SD 12]) were confirmed HAs and included in the analysis. Yearly HA procedure rates increased from 15 in 2006 to 884 in 2014, after which a steady decline was observed with 469 procedures in 2018. The majority (65%) of HAs was performed in males. Male patients were younger, and surgeries on males more frequently included an FAIS-related procedure.Interpretation - Similar to previous studies in other parts of the world, we found dramatic increases in HA procedures in Sweden between 2006 and 2014. Contrary to existing predictions, HA rates declined steadily after 2014, which may be explained by more restrictive patient selection based on refined surgical indications, increasing evidence, and clinical experience with the procedure.

Risk Factors for Septic Arthritis After Anterior Cruciate Ligament Reconstruction: A Nationwide Analysis of 26,014 ACL Reconstructions.

BACKGROUND: Septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) is a rare yet severe complication. The samples in previous studies have been small and without nationwide coverage, making analysis uncertain with a risk of bias. Conclusions to recommend preventive measures are therefore difficult to draw, and it has not been possible to perform a comprehensive risk factor analysis. PURPOSE: To study the incidence of SA after ACLR in a large, nationwide population and to study the risk factors for SA after ACLR. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: All ACLRs, primary and revision, in the Swedish Knee Ligament Registry between 2006 and 2013 were linked with data from the Swedish National Board of Health and Welfare. The incidence of SA events was determined using entries from the day of surgery until 90 days postoperatively based on diagnosis codes and the prescription of antibiotics. All events of SA were verified via a review of medical records. Risk factors were analyzed based on data from the registries. Descriptive statistics were used to describe the findings, while logistic regression analysis was used for the risk analysis. RESULTS: The cohort consisted of 26,014 primary and revision ACLRs. During the study period, 298 events of SA (1.1%) were identified. The high-volume units (≥500 ACLRs during the study period) had a distribution of SA between 2 and 47 (0.2%-2.9%). Independent risk factors of SA were male sex (OR, 1.65; 95% CI, 1.28-2.13), operating time ≥70 minutes (OR, 1.83; 95% CI, 1.42-2.36), hamstring tendon autograft (OR, 2.23; 95% CI, 1.21-4.08), and clindamycin as perioperative antibiotic prophylaxis (OR, 1.94; 95% CI, 1.10-3.41). CONCLUSION: The incidence of SA after ACLR in this nationwide cohort was 1.1%. Male sex, hamstring tendon autografts, and a longer operating time were all independent risk factors for SA. The use of clindamycin as perioperative antibiotic prophylaxis was a risk factor compared with the use of cloxacillin. Some high-volume units had a very low infection rate (0.2%).

There is no general use of thromboprophylaxis and prolonged antibiotic prophylaxis in anterior cruciate ligament reconstruction: a nation-wide survey of ACL surgeons in Sweden.

PURPOSE: The use of prophylaxis for thromboembolism and infection in anterior cruciate ligament (ACL) reconstruction is not well documented and no general guidelines have been established. The aim of this study was to evaluate the ACL surgeons' individual strategies of thromboprophylaxis, use of prolonged antibiotic prophylaxis and vancomycin-soaked ACL grafts, and if its use is supported in the current literature. Additionally, the rationale for use of tourniquet was analysed. METHODS: Questionnaires were distributed to all Swedish ACL surgeons who are registered in the Swedish Knee Ligament Register (SKLR), asking about prescription of thromboprophylaxis, prolonged antibiotic prophylaxis, the use of vancomycin-soaked graft and the use of a tourniquet during surgery. The responses were assessed for agreement and the thromboprophylaxis data were analysed in relation to the 2016 SKLR data. RESULTS: 115 (75%) ACL surgeons responded to the survey. 81.7% prescribed thromboprophylaxis only when risk factors, such as history of thrombosis and the use of oral contraceptives, were present. Female gender, older age and admitted patient were considered the risk factors with the lowest impact. The respondents were generally restrictive regarding the use of prolonged antibiotic prophylaxis. The use of vancomycin-soaked graft was used by only nine (8%) surgeons representing 406 (13%) of the surgeries. CONCLUSION: Swedish ACL surgeons are generally restrictive using thromboprophylaxis and only when risk factors are present. However, there is a lack of consensus in how to weigh the different risk factors and it does not completely adhere to the existing literature. Prolonged antibiotic prophylaxis is rarely used and the use of vancomycin soaking of graft is very limited and applies only to a small number of surgeons. The use of tourniquet is common. There is a need for ACL-specific guidelines regarding the use of thromboprophylaxis. LEVEL OF EVIDENCE: IV.

A non-response analysis of 2-year data in the Swedish Knee Ligament Register.

PURPOSE: To analyse the non-response group in the Swedish Knee Ligament Register (SKLR). METHODS: All 3588 patients in the SKLR who had undergone anterior cruciate ligament surgery in 2010 were included. Respondents (n = 1865) and non-respondents (n = 1723) at the 2-year follow-up survey were assessed for potential differences in demographics and baseline data. KOOS/EQ5D questionnaires were sent to non-respondents together with a non-response survey asking questions about reasons for dropout. RESULTS: Respondents had a significantly higher mean age (27.8 years, range 9-64) than non-respondents (25.9 years, range 12-65) (p < 0.001). Women had a higher rate of response 927 (62.8 %) than men 938 (44.4 %) even after correction for age (p < 0.001). Alpine/telemark skiing was the only activity at time of injury that showed higher rate of respondents 280 (62.5 %) compared to non-respondents 168 (37.5 %) (p < 0.001). No differences in EQ5D at 2-year follow-up were found between the groups. The change in KOOS from 0 to 2 years showed difference in the subscale pain with 9.4 in the response group compared to 6.3 in the late-response group (p < 0.05) and the subscale quality of life with a difference of 26.1 and 22.6, respectively (p < 0.05). The non-response questionnaire showed shortcomings in patient information regarding the importance of the SKLR. CONCLUSION: The register is valid concerning baseline surgical data, but higher age, female gender and perhaps higher socioeconomic status improve the response rates. KOOS showed small differences of questionable clinical significance. The SKLR patient information could be improved. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.