title: Multi-state models and arthroplasty histories after unilateral total hip arthroplasties: introducing the Summary Notation for Arthroplasty Histories.
abstract: OBJECTIVE
  An increasing number of patients have several joint replacement procedures during their lifetime. We investigated the use and suitability of multi-state model techniques in providing a more comprehensive analysis and description of complex arthroplasty histories held in arthroplasty registries than are allowed for with traditional survival methods.
  
  
  METHODS
  We obtained data from the Australian Orthopaedic Association National Joint Replacement Registry on patients (n = 84,759) who had undergone a total hip arthroplasty for osteoarthritis in the period 2002-2008. We set up a multi-state model where patients were followed from their first recorded arthroplasty to several possible states: revision of first arthroplasty, either a hip or knee as second arthroplasty, revision of the second arthroplasty, and death. The Summary Notation for Arthroplasty Histories (SNAH) was developed in order to help to manage and analyze this type of data.
  
  
  RESULTS
  At the end of the study period, 12% of the 84,759 patients had received a second hip, 3 times as many as had received a knee. The estimated probabilities of having received a second arthroplasty decreased with age. Males had a lower transition rate for receiving a second arthroplasty, but a higher mortality rate.
  
  
  CONCLUSIONS
  Multi-state models in combination with SNAH codes are well suited to the management and analysis of arthroplasty registry data on patients who experience multiple joint procedures over time. We found differences in the progression of joint replacement procedures after the initial total hip arthroplasty regarding type of joint, age, and sex.
authors.affiliation: School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia. marianne.gillam@adelaide.edu.au
authors.forename: Marianne H
authors.initials: MH
authors.lastname: Gillam
authors.forename: Philip
authors.initials: P
authors.lastname: Ryan
authors.forename: Amy
authors.initials: A
authors.lastname: Salter
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Graves
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D001315:Australia / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006622:Hip Prosthesis / Q000706:statistics & numerical data; D006801:Humans; D007720:Knee Prosthesis / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000401:mortality / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D024162:Second-Look Surgery / Q000401:mortality / Q000706:statistics & numerical data; D017678:Sex Distribution