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Unfortunately, wear debris, primarily generated from the prosthetic joint articular surface, remains the major factor limiting the survival of joint implants.
The Kaplan-Meier method, the gold standard for estimating the survival of joint replacements (with results often presented in terms of cumulative revision risk), was developed for studying events that eventually occur in all subjects, i.e. death.
In Finland, life expectancy at the age of 80 is 8.5 years for women and 7.0 years for men (Official Statistics of Finland 2003), and in general, the survival of joint replacement recipients is better than that of general population (Robertsson et al. 2007, Pedersen et al. 2011).
Use of bisphosphonates has received some attention in earlier literature, 21 22 and Danish researchers have analysed the effects of diabetes 23 and use of diuretics 24 and statins 25 on survival of hip replacements, but otherwise to the best of our knowledge there are no studies on the effects of specific comorbidities on the survival of joint replacements, except for some descriptive case series.
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Relative to many other areas, however, survival analysis of joint replacements is problematic.
Long-term survival of total joint replacements depends on secure and lasting fixation.
Outcome measurement of the postoperative survival of the hip joints until the primary outcome reoperation (total hip replacement or fusion) and secondary outcome diagnosis of symptomatic osteoarthritis were performed.
An important difference between the Cox and Kaplan Meier models is that factors are rarely independent, and the Cox model permits estimation of joint effects on survival in the full group of patients.
The recommendations within the IIW guideline concerning the Hot Spot Stress Approach were found to give accurate approximations for the probability of survival of fatigue-loaded welded joints.
In a setting where the longitudinal observations may be correlated with survival, joint models of longitudinal and survival processes have been increasingly proposed in the past decade to recover information from these potentially informative censorings [ 10- 26].
In summary, survival analysis has been used extensively for reporting of joint register data.
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