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The Swedish Knee Arthroplasty Register
(SKAR)wasestablishedin1975incollaboration
with the Swedish Orthopedic Association
(SOF) and is the oldest national arthroplasty
register in the world. The orthopedic surgeons
realized that it was impossible for the single
surgeon, based on his own experiences, to
select suitable implants and surgical techniques.
The SKAR started with the purpose to gather,
analyze and give feed-back on inferior
techniques and implants.
Knee reconstruction surgery for OA has more
than doubled in Sweden since year 2000 and is
dominated by total knee arthroplasty (TKA).
Uni-compartmental knee arthroplasty (UKA)
and high tibial osteotomy (HTO) are dicreasing.
In 2013 more than 13 000 primary knee
arthroplasties were performed in Sweden with a
population of about 9,5 million (SKAR 2013).
However knee reconstruction surgery in the
younger patients is seen as a challenge. The
challenge is not technical aspects but the life
situation of younger patients with high demands
on knee function, longer life expectancy and
thereby an increased risk of revision. We define
younger patients as those below 55 years of
age. These patients have at least 10 more years
before retirement, and their working life,
leisure time, family and economic situation is
quite different from those close to retirement or
those already retired.
Since the late 90’s the knee reconstruction
surgery has increased substantially in patients
<55 years of age. This may reflect that knee OA
is an increasing among the younger or that their
OA has increased in severity but also that the
orthopedic surgeons nowadays are more
confident to offer younger patients re
construction. Further, it may even be an effect
of goverment decisions.
Around the millennium, TKA in younger
patients started to increase and this has
continued. The substantial increase of knee
arthroplasty coincided with the time when
knee arthroplasty became industrialized in
Sweden by introduction of high volume
units and a guarantee to patients of having
surgical treatment within 3 month after
being put on a waiting list. Although there
was an initial increase in UKA, its use has
diminished during the last years and HTO
which was the most commonly used
alternative for the younger patients until the
millennium has decreased substantially
(fig. 1). In 2013 the younger patients
constituted 7% of the knee reconstruction
surgery in Sweden.
The use of TKA in younger patients has
increased by 8 times during the last 15 years
and amounted for 6.6% of the TKA surgery in
2013.
TKA, UKAand HTO in the
Swedish register
A. W-Dahl, L. Lidgren, M. Sundberg, O. Robertsson