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Elisabeth Walton Paxton


Elisabeth Walton Paxton

Postadress: Avd för Ortopedi vid Inst för Kliniska vetenskaper, 41345 Göteborg
Besöksadress: Bruna stråket 11b, vån 5, SU Sahlgrenska , 41345 Göteborg

Avd för ortopedi vid Institutionen för kliniska vetenskaper (Mer information)
Göteborgsvägen 31
431 80 Mölndal
Besöksadress: R-huset, plan 7 , 431 80 Mölndal

Om Elisabeth Walton Paxton

Doctoral theses - International Outcomes of Total Hip Arthroplasty: Influence of Patient, Implant, and Surgical factors on Total Hip Arthroplasty Survivorship in Sweden, the US, and Australia

The public defence:  2019-06-13 kl 09:00 - 11:30
Place: Aulan i R-huset, Sahlgrenska Universitetssjukhuset/ Mölndals sjukhus, Göteborgsvägen 33

Link to doctoral theses and short summary on this profile page

NOTE The public defence will be held in English

Importance factor for implant survival
Although total hip arthroplasty (THA) is a successful treatment for osteoarthritis (OA), numerous factors influence the success of THA including patient, surgical, hospital and implant factors. Understanding the influence of these factors on THA risk of revision is critical for prevention of revision surgery. Collaborations of regional and national arthroplasty registries provide an opportunity to evaluate differences in THA patients, clinical practices, risk factors, and outcomes between countries to improve THA outcomes internationally.

- We examined international, in US Sweden and Australia, total hip arthroplasty outcomes and factors associated with the need for revision surgery following elective primary total hip, says Elizabeth Walton-Paxton, director of the Kaiser Permanente National Implant registries* and with masters in Clinical psychology and in Industrial/organization psychology.

Primary THAs with an OA diagnosis were identified using Swedish, Australian, and American registries**. The study time period was 2003–2015 for studies I, II, and III. Study IV’s timeframe was 2001– 2016 and study V’s time period was 2008–2016.

Comorbidities identified as increased risk of total hip revision
- Patients with comorbidities identified as increased risk of total hip revision should be counseled about this prior to their elective surgery. Also, the identification of patients at higher risk should be used in shared decision making at the point of care. In addition, knowing which patients are at risk for revision surgery can help with medically optimizing patients prior to surgery for enhancement of clinical outcomes.

Her results also showed that; meta-analysis is a viable method for enhancing international registry collaboration. In comparing THA survival across countries, implant selection plays a critical role. Predictors of THA revision differ between countries most likely due to variation in clinical practices and implant selection. The number of patient co-morbidities and higher risk comorbidities should be considered by surgeons and patients prior to THA surgery.

- What surprised me was that risk factors of revision surgery differed by country moist likely related to the Variation in implants and clinical practices.

Numerous of potential future projects
Now there are numerous potential future projects generated from this body of work.

- First, our work supports increased international collaborations between registries from different countries. The coordination of clinical trials nested in international registries also provides another opportunity for future studies in orthopaedics. And international benchmarking of implant performance is third area.

A fourth potential area for future studies is the linkage of registry data to implant retrieval analysis. Coordinating this on a global level may provide additional insight into the mechanisms of failure for specific devices helping advance development of improved THA implant designs.

* The Kaiser Permanente (KP) National Implant Registries . Kaiser Permanente, one of America’s leading health care providers and not-for-profit health plans. Currently serve 12.2 million members in 8 states and the District of Columbia.

**Registers used: The Swedish Hip Arthroplasty Register (SHAR), Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) Kaiser Permanente (KP) National Total Joint Replacement Registry

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Meta-analysis of individual registry results enhances international registry collaboration
Elizabeth W. Paxton, Maziar Mohaddes, I. Laaksonen, M. Lorimer, S. E. Graves et al.
Acta Orthopaedica, Artikel i vetenskaplig tidskrift 2018
Artikel i vetenskaplig tidskrift

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