GLORY Publications

Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events: findings from the Global Orthopaedic Registry

David Warwick et al. — Wed, 21 Sep 2011 13:03:52 PDT

Patients who have undergone total hip or knee replacement (THR and TKR, respectively) are at high risk of venous thromboembolism. We aimed to determine the time courses of both the incidence of venous thromboembolism and effective prophylaxis. Patients with elective primary THR and TKR were enrolled in the multi-national Global Orthopaedic Registry. Data on the incidence of venous thromboembolism and prophylaxis were collected from 6639 THR and 8326 TKR patients. The cumulative incidence of venous thromboembolism within three months of surgery was 1.7% in the THR and 2.3% in the TKR patients. The mean times to venous thromboembolism were 21.5 days (sd 22.5) for THR, and 9.7 days (sd 14.1) for TKR. It occurred after the median time to discharge in 75% of the THR and 57% of the TKA patients who developed venous thromboembolism. Of those who received recommended forms of prophylaxis, approximately one-quarter (26% of THR and 27% of TKR patients) were not receiving it seven days after surgery, the minimum duration recommended at the time of the study. The risk of venous thromboembolism extends beyond the usual period of hospitalisation, while the duration of prophylaxis is often shorter than this. Practices should be re-assessed to ensure that patients receive appropriate durations of prophylaxis.

Physician compliance with guidelines for deep-vein thrombosis prevention in total hip and knee arthroplasty

Richard J. Friedman et al. — Wed, 21 Sep 2011 13:03:50 PDT

OBJECTIVE: Despite evidence-based guidelines for venous thromboembolism (VTE) prevention after total hip or knee arthroplasty (THA/TKA), many patients may not receive effective prophylaxis. Our objective was to analyze data from the multinational Global Orthopaedic Registry (GLORY) to evaluate the compliance of surgeons with the American College of Chest Physicians (ACCP) guidelines for VTE prevention.

RESEARCH DESIGN AND METHODS: Data from 8160 patients who had undergone a primary, unilateral, elective THA (n = 3950) or TKA (n = 4210), and had at least 3 months of follow-up were analyzed.

RESULTS: Almost all patients received a form of recommended prophylaxis. Compliance with guidelines in terms of type, duration, start time, and dose was achieved for 47% of THA and 61% of TKA patients in the USA, and 62% of THA and 69% of TKA patients outside the USA. Warfarin use, mostly in the USA, was fully compliant in 33% of THA and 48% of TKA patients. Low-molecular-weight heparin use was fully compliant in 63% of THA and 72% of TKA patients in the USA, and 67% of THA and 73% of TKA patients outside the USA.

CONCLUSION: Although almost all THA and TKA patients both inside and outside the USA received prophylaxis, a large proportion did not receive treatment in accordance with the ACCP guidelines. Our study may have overestimated the use of recommended prophylaxis as some participating investigators may have had a specific interest in VTE prophylaxis. Furthermore, although analyses were restricted to approximately three-quarters of patients who had outpatient follow-up data, their characteristics were similar to those in the entire population.

Lessons learned from the global orthopaedic registry: study design, current practice patterns, and future directions

David Warwick et al. — Wed, 21 Sep 2011 13:03:49 PDT

Complications and functional outcomes after total hip arthroplasty and total knee arthroplasty: results from the Global Orthopaedic Registry (GLORY)

Fred Cushner et al. — Wed, 21 Sep 2011 13:03:47 PDT

The Global Orthopaedic Registry (GLORY) has been designed to monitor a broad range of complications and outcomes that occur following total hip arthroplasty (THA) and total knee arthroplasty (TKA). GLORY provides global 'real-world' data, in contrast to the data generated by the controlled conditions of clinical trials. The results to date show an overall incidence of both in-hospital and post-discharge complications of approximately 7% in THA patients and 8% in TKA patients. The most common in-hospital complications in THA patients are fractures (0.6%) and deep-vein thrombosis (DVT) (0.6%), whereas in TKA patients DVT (1.4%) and cardiac events (0.8%) are most common. The most common post-discharge complications in both THA and TKA patients are reoperation due to bleeding, wound necrosis, wound infection, or other causes; and DVT. Bleeding complications were less common than other adverse events in both groups (in-hospital rates of 0.48% and 0.83%, respectively). Functional outcomes improved after surgery in both groups, as expected. Younger patients and patients who had been discharged directly to their homes seemed to have the greatest improvement in functional outcome after surgery.

Practice patterns in the use of venous thromboembolism prophylaxis after total joint arthroplasty--insights from the Multinational Global Orthopaedic Registry (GLORY)

Richard J. Friedman et al. — Wed, 21 Sep 2011 13:03:46 PDT

The Global Orthopaedic Registry (GLORY) offers insights into multinational practice patterns of venous thromboembolism (VTE) prophylaxis in orthopedic surgery, based on data from 15,020 patients undergoing primary total knee arthroplasty or primary total hip arthroplasty from 2001 to 2004. Registry data show that the first choice for in-hospital VTE prophylaxis was low-molecular-weight heparin. Multimodal prophylaxis was common. Warfarin was more widely used in the USA than elsewhere in the world. GLORY data suggest that real-world practice often fails to meet the standards for prophylaxis recommended in the American College of Chest Physicians evidence-based guidelines, particularly in the USA. However, many US orthopedic surgeons may follow other practice guidelines, causing an underestimation of prophylaxis us in this study. Warfarin in the USA often failed to achieve recommended target International Normalized Ratio (INR) values. This paper reviews the GLORY practice findings in light of the contemporary literature on best practices for VTE prophylaxis in orthopedic patients.

Orthopaedic practice in total hip arthroplasty and total knee arthroplasty: results from the Global Orthopaedic Registry (GLORY)

James Waddell et al. — Wed, 21 Sep 2011 13:03:44 PDT

The Global Orthopaedic Registry (GLORY) offers global and country-specific insights into the management of patients undergoing total hip arthroplasty and total knee arthroplasty by drawing on data, from June 2001 to December 2004, of 15,020 patients in 13 countries. GLORY achieved a 70% follow-up rate at 3 and/or 12 months, allowing longer-term findings to be reported. This paper reports data from GLORY on patient demographics, surgical approaches to patient management, selection of implants, anesthetic and analgesic practices, blood management, length of hospital stay, and patient disposition at discharge. Some aspects of orthopedic practice differ between countries. There was notable variation in the choice and selection of prosthesis, fixation of implants, length of hospital stay, and discharge disposition.

Overview of the GLOBAL Orthopaedic Registry (GLORY)

Frederick A. Anderson Jr. — Wed, 21 Sep 2011 13:03:42 PDT