ISHKS REGISTRY:

ROAD TRAVELLED &

JOURNEY AHEAD
Dr Vaibhav Bagaria
MBBS MS FCPS DIP SICOT
CARE HOSPITAL & ORIGYN CLINIC
NAGPUR, INDIA
www.drbagaria.com

Monday, 14 April 14 1
 The Road Travelled...

Monday, 14 April 14 2
 The Road Travelled...

Monday, 14 April 14 2
 ISHKS REGISTRY
CONCEIVED: 2006

CONTRIBUTORS: 72

TOTAL NO OF TKR: 66352

TOTAL NO OF THR: 5784

REVISION KNEE: 544

REVISION HIP: 584

Monday, 14 April 14 3
 EXPANDING FOOT PRINT
ISHKS%
2006%

Monday, 14 April 14 4
 CONTRIBUTION TREND
2006 2012 2013

80 72

52
60

40
25

20

0
SURGEONS

Monday, 14 April 14 5
 RECORDED CASES
2012 2013

70000 66352

51232
52500

35000

17500

4958 5784
0
HIPS KNEES

Monday, 14 April 14 6
 Year on Year Knees
Cases

70000
66352
52500
51232
35000
34478

17500 23886
15471
9951
0 5811
1899
2006 2007 2008 2009 2010 2011 2012 2013

Monday, 14 April 14 7
 MANUFACTURERS
J&J ZIMMER S&N MAX STRYKER REST

J& J 42.20%
Zimmer 34.03%
S & N 8.48%
4.9 5.0 Max 5.40%
5.4 Stryker 4.88%
Exatac 1.60%
8.5 Biomet 1.05%
B Braun 0.77%
42.2 Indus 0.70%
B P 0.68%
Wright Medical 0.06%
Endo plus 0.05%
34.0 Others 0.09%

Monday, 14 April 14 8
 TKR TREND
MALES OA RA OTHERS
FEMALES

3.4
2.1
26.5

73.5

94.5

Monday, 14 April 14 9
 TKRS
COUNTRY
INDIA SWEDISH AUSTRALIA
PARA

69(D)/70(N)/
AGE 64.3 68.2
71(S)

BMI 29.15 28.4 29.6

BILATERAL 16.48% 20% 13.3%

Monday, 14 April 14 10
 Bilateral Simultaneous
Bilateral Total No

70000

66532
52500
51232

35000

17500
23886

10291
0 5219
2147
Prior 2011 2012 2013
Monday, 14 April 14 11
 Surgeon Preference
PS PS
CR CR
All Poly PS All Poly PS
All Poly CR

3.7% 4.4%
21.3% 26.1%
7.3%
67.7% 69.4%

J&J Zimmer

Monday, 14 April 14 12
 Patella -J & J
Resurfacing Not Resurfacing

19%
44%
56%
81%

2012 2013

Monday, 14 April 14 13
 Patella -J & J
Resurfacing Not Resurfacing

19%
44%
56%
81%

2012 2013

Monday, 14 April 14 13
 Patella - Zimmer
Resurfacing Not Resurfacing

19% 19%

81% 81%

Aus registry 2013

2012

Monday, 14 April 14 14
 Cement Used
Palacos Smart Set CMW Simplex antibiotic Others

0.4%

15% 3%
36%

19%

27%

Monday, 14 April 14 15
 KNEE REVISIONS

150

112.5
112 109 113
98
75

37.5 44
36
20
0 11
1
2006 2007 2008 2009 2010 2011 2012 2013 2014*

Monday, 14 April 14 16
 Reason for Knee Revision
Aseptic loosening Septic Loosening Fractures Others

8%
4%

29%
59%

Monday, 14 April 14 17
 THR
No of Cases Total So far: 5784

1500

1354
1125 1260
1036
750 826
611
375
348
174 175
0
2006 2007 2008 2009 2010 2011 2012 2013

Monday, 14 April 14 18
 Reason For THR
AVN ANK SPOND RA FAILED HEMI # DISLOCATION
FAILED #FIX DYSPLASIA # NF PRIMARY OA OTHERS

AVN 50.36%
Ankylosing spondyliOs 7.11%
8.7 RA 6.94%
9.9 Failed Hemi 1.38%
Fracture dislocaOon 3.43%
6.6 Failed fractures 3.50%
1.9 Dysplasia 1.97%
3.5 50.3 Fresh fracture neck 6.60%
3.4
1.3 Primary OA 9.98%
6.9 Others 8.76%
7.1

Monday, 14 April 14 19
 THR DEMOGRAPHICS
Male Female

Male 61.20%
38.8% Female 38.80%
BMI 25.82
61.2%

Monday, 14 April 14 20
 THR TECHNIQUE
Uncemented Cemented Hybrid Resurfacing Others 2012

Uncemented 70.35%
Cemeneted 19%
18.0
Hybrid 6.79%
0.1
3.6 Resurfacing 3.66%
6.7 (this year only 10 has been added)
Others 0.18%
70.3
19.0

Monday, 14 April 14 21
 THR TECHNIQUE
Uncemented Cemented Hybrid Resurfacing Others 2012

Uncemented 70.35%
Cemeneted 19%
18.0
Hybrid 6.79%
0.1
3.6 Resurfacing 3.66%
6.7 (this year only 10 has been added)
Others 0.18%
70.3
19.0

Monday, 14 April 14 21
 THR TECHNIQUE
Uncemented Cemented Hybrid Resurfacing Others 2012

Uncemented 70.35%
Cemeneted 19%
18.0
Hybrid 6.79%
0.1
3.6 Resurfacing 3.66%
6.7 (this year only 10 has been added)
Others 0.18%
70.3
19.0

Aus registry

Monday, 14 April 14 21
 THR - IMPLANTS
J&J ZIMMER B BRAUN STRYKER S& N BIOMET
EXATAC EVOLOUTIS OTHERS

J & J 34.45%
Zimmer 28.05%
4 211 B Braun 12.26%
Stryker 12.16%
12
34 Smith & Nephew 4.37%
Biomet 3.97%
12 Exatac 2.48%
Evolutus 1.46%
Others 0.8%
28

Monday, 14 April 14 22
 THR Revisions
Aseptic Loosening Dislocation Infection Others

6%
13% AsepOc loosening 70.80%
DislocaOon 10.21%
InfecOon 12.89%
10% Others 6.10%

71%

Monday, 14 April 14 23
 The Road Ahead
Realise the potential

Increased Participation.

Detailed Analysis.

Better Use of technology: Mobile, Softwares.

Industry Participation & Legislations

One world One Registry

Monday, 14 April 14 24
 Realise the potential

US reports 620000 knees implanted in 2009

Indian equivalent would be: 4940000 knees /year.

Australian and Swedish registry record less than 100000/

combined hip and knee procedures/yr

Revision pool after 5 years likely to be equiv to primary of some

famous registry.

Monday, 14 April 14 25
 Increased Participation

Pull all stops to increase member participation.

Aggressive marketing

Colour coded forms

Involve Youngsters

Display the coverage data

Monday, 14 April 14 26
 Increased Participation

Pull all stops to increase member participation.

Aggressive marketing

Colour coded forms

Involve Youngsters

Display the coverage data

Monday, 14 April 14 26
 Detailed Analysis

In depth analysis is needed.

Devil lies in details

Different publication levels: Surgeons, Industry, Public, Govt.

Statistical analysis

Monday, 14 April 14 27
 Detailed Analysis

In depth analysis is needed.

Devil lies in details

Different publication levels: Surgeons, Industry, Public, Govt.

Statistical analysis

Monday, 14 April 14 27
 Detailed Analysis

In depth analysis is needed.

Devil lies in details

Different publication levels: Surgeons, Industry, Public, Govt.

Statistical analysis

Monday, 14 April 14 27
 Detailed Analysis

In depth analysis is needed.

Devil lies in details

Different publication levels: Surgeons, Industry, Public, Govt.

Statistical analysis

Monday, 14 April 14 27
 Detailed Analysis

In depth analysis is needed.

Devil lies in details

Different publication levels: Surgeons, Industry, Public, Govt.

Statistical analysis

Monday, 14 April 14 27
 Detailed Analysis

In depth analysis is needed.

Devil lies in details

Different publication levels: Surgeons, Industry, Public, Govt.

Statistical analysis

Monday, 14 April 14 27
 Better Use of technology

Keep It Simple attitude

User friendly.

Accessible

Cost effective

Attitude: We are the pioneers

Monday, 14 April 14 28
 Better Use of technology

Keep It Simple attitude

User friendly.

Accessible

Cost effective

Attitude: We are the pioneers

Monday, 14 April 14 28
 Industry Participation

Voluntary

? Mandatory

Enlist benefits, come out with white papers.

Close cooperation, Advisory Role.

Financial Support

Monday, 14 April 14 29
 Legislations

Can Adverse event reporting be made compulsory

Can recommendations be made?

India specific comments on prosthesis?

Dealing with Indian Bureaucracy :-(

Monday, 14 April 14 30
 One world One Registry

Taking it too far?

Global registry is the way forward..

Collaboration,innovation and quest for excellence is the way

forward...

Monday, 14 April 14 31
 It started with conviction

The team certainly deserve an Applause !

Monday, 14 April 14 32
 Thank You!

Monday, 14 April 14 33