Peter L. Lewis

The 2026 Demographics of Spinal Disc Arthroplasty Supplementary Report is based on the analysis of 14,733 spinal disc procedures recorded by the Registry with a procedure date up to and including 31 December 2025. This supplementary report provides summary data and demographic information on spinal disc replacement surgery. Data are broken down into the five classes of spinal disc replacement: spinal segment, spinal ball trough, insert and endplate, cervical intervertebral disc and lumbar intervertebral disc. Revision rates are not provided for spinal disc replacement. The Spinal Disc Arthroplasty Report is one of 14 supplementary reports to complete the AOANJRR Annual Report for 2026. Information on the background, purpose, aims, benefits and governance of the Registry can be found in the Introductory chapter of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report . The Registry data quality processes, including data collection, validation and outcome assessment, are provided in detail in the Data Quality chapter of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report: https://registry.aoa.org.au/annual-reports-2026.

This summary is an explanation of the major findings of the Australian Orthopaedic Association National Joint Replacement Registry 2026 Annual Report for Hip, Knee and Shoulder Arthroplasty (replacement). This is the major clinical report produced by the Registry each year. The full version of the 2026 Annual Report on Hip, Knee and Shoulder Arthroplasty is available in the ‘Publications’ section of the Registry website https://registry.aoa.org.au/annual-reports-2026. The Lay Summary is provided to ensure that a clear, concise, and easily understood explanation of the published findings is available to all those who may be interested. The Lay Summary also provides guidance for those who may wish to further review the full extent of the data published by the Registry in the Annual Report. The Australian Orthopaedic Association (AOA) believes this is especially important because of the high level of community interest in the Registry and the need to ensure that reports are accessible to all. This Report is one of 14 supplementary reports to complete the AOANJRR Annual Report for 2026. Information on the background, purpose, aims, benefits and governance of the Registry can be found in the Introductory chapter of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report. The Registry data quality processes, including data collection, validation and outcomes assessment, are provided in detail in the Data Quality section of the introductory chapter of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report: https://registry.aoa.org.au/annual-reports-2026.

This Ankle Arthroplasty Supplementary Report is based on the analysis of 7,103 ankle procedures with a procedure date from 2006 up to and including 31 December 2025. This Report is one of 14 supplementary reports to complete the AOANJRR Annual Report for 2026. Information on the background, purpose, aims, benefits and governance of the Registry can be found in the Introductory chapter of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report. The Registry data quality processes, including data collection, validation and outcomes assessment, are provided in detail in the Data Quality section of the introductory chapter of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report: https://registry.aoa.org.au/annual-reports-2026

The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) is proud to announce the release of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report, which provides a comprehensive analysis of joint replacement procedures in Australia. This marks the Registry's 27th Annual Report and continues our commitment to enhancing orthopaedic care through data-driven insights. In addition to the main report, the AOANJRR is proud to present 14 supplementary reports that complement the 2026 Annual Report. These reports cover a wide range of arthroplasty topics, including demographics, revision rates, and prosthetic performance All reports are available for download on our website via the 'Publications' tab on the menu ribbon on the AOANJRR website: https://registry.aoa.org.au/annual-reports-2026

Background and purpose: Unicompartmental knee arthroplasty (UKA) is advocated to achieve greater satisfaction and improved function when compared with total knee arthroplasty (TKA), but there is little evidence from large-scale cohorts to support this contention. We aimed to determine, from the patients’ perspective, if UKA leads to postoperative differences in satisfaction, knee pain, function, and quality of life when compared with TKA.Methods: Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) compared PROMs scores for patients with either a UKA or TKA. EQ-5D-5L, Oxford Knee Scores (OKS), and a knee pain rating were recorded preoperatively and 6 months after surgery with additional assessments of satisfaction and patient-perceived change. Comparisons were made for change in mean score after surgery, while percentage change and proportions achieving minimal clinically important change (MCIC) were compared using odds ratios (OR).Results: 3,329 UKAs and 56,816 TKAs were included. UKA patients had higher mean scores for all PROMs measures before surgery, and scores increased similarly to or less than for TKA patients after surgery. Mean OKS was 39 (95% confidence interval [CI] 39–39) after UKA and 38 (CI 38–38) after TKA. Compared with TKA there was a smaller change in mean OKS for the UKA group (–1.3, CI –1.6 to –1.0), which was below the threshold for MCIC. Similar proportions of patients achieved an OKS improvement which met the MCIC threshold. Quality of life improvement after surgery was equivalent for both groups (EQ-5D-5L utility change 0.3 units) as was knee pain improvement (OR 1.1, CI 0.9–1.4) with the UKA group having higher odds of being satisfied (OR 1.2, CI 1.0–1.3) and feeling better (OR 1.12, CI 1.0–1.4), compared with the TKA group.Conclusion: Based on patient assessments, the difference between UKA and TKA did not achieve the published threshold for a minimal important difference.

Background and purpose: Adding antioxidant to highly cross-linked polyethylene (XLPE) is proposed to improve oxidation resistance and decrease wear in total hip replacements (THR), but long-term performance is unknown. We aimed to compare the revision rates of THR using cementless acetabular components where the insert was made of either XLPE with antioxidant (AOXLPE) or XLPE, using data from a large national registry.Methods: The population was THR from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) in the 10-year period 2014–2023 with modular cementless acetabular components and ceramic or metal femoral heads used for osteoarthritis. We compared primary THR using XLPE with antioxidant (AOXLPE) acetabular inserts with XLPE acetabular inserts. The outcome measured was all-cause revision. Cumulative percentage revision (CPR) was calculated using the Kaplan–Meier method, and comparisons made using Cox proportional hazards models.Results: There were 198,073 THRs, of which 35,309 had AOXLPE inserts. There were 769 and 4,327 revisions with AOXLPE and XLPE inserts, respectively. While there was no early difference, the AOXLPE group had a lower revision rate after 3 years (HR 0.64, 95% confidence interval [CI] 0.48–0.84). When adjusted for multiple factors the AOXLPE group still had a lower revision rate after 3 years (HR 0.63, CI 0.47–0.83). Revisions for loosening, wear-related causes, and fracture were proportionately lower in the AOXLPE group, but no difference was found with revisions for dislocation/instability or infection.Conclusion: While there was no early difference, THR with AOXLPE acetabular inserts had a lower revision rate after 3 years than XLPE. This suggests a possible clinical benefit using AOXLPE but the difference may, in part, be related to the associated femoral or acetabular components.

The following reported tables and figures represent analyses of Shoulder Replacement data from AOANJRR. The comparisons do not find a significant difference between the illustrated cohorts. These additional accounts of Shoulder Replacement revision rates are complimentary records to the AOANJRR Annual Report and Shoulder Replacement in Australia supplementary report. This Report is one of 14 supplementary reports to complete the AOANJRR Annual Report for 2025. Information on the background, purpose, aims, benefits and governance of the Registry can be found in the Introductory chapter of the 2025 Hip, Knee and Shoulder Arthroplasty Annual Report. The Registry data quality processes, including data collection, validation and outcomes assessment, are provided in detail in the Data Quality section of the introductory chapter of the 2025 Hip, Knee and Shoulder Arthroplasty Annual Report: https://aoanjrr.sahmri.com/annual-reports-2025.

This supplementary report provides detailed information on partial shoulder replacement. The Partial Shoulder Arthroplasty Report is one of 14 supplementary reports to complete the AOANJRR Annual Report for 2025. Information on the background, purpose, aims, benefits and governance of the Registry can be found in the Introductory chapter of the 2025 Hip, Knee and Shoulder Arthroplasty Annual Report. The Registry data quality processes, including data collection, validation and outcomes assessment, are provided in detail in the Data Quality section of the introductory chapter of the 2025 Hip, Knee and Shoulder Arthroplasty Annual Report: https://aoanjrr.sahmri.com/annual-reports-2025.

This report provides summary data and outcomes for hip, knee and shoulder prosthesis types with no or minimal use in Australia. There are two classes of hip replacement no longer used: partial resurfacing and thrust plate. These are defined in the following section on hip replacement. These two classes of implants have not been used since 2014 and 2012, respectively. There are two bearing surfaces used in total conventional hip replacement that have no or little use: procedures performed with ceramic heads on metal bearings and procedures performed with metal heads on ceramic bearings. The rates of revision, reasons for revision and types of revision for procedures using ceramic head/metal bearings are provided. The number of procedures using metal heads/ceramic bearings is very low, so only a summary is provided for this combination. There is one prosthesis type used in total conventional hip replacement that has minimal use: exchangeable neck prostheses. The proportion of procedures using exchangeable necks continues to decline. There are three classes of partial knee replacement that are no longer used: Partial resurfacing, unispacer and bicompartmental. These are defined in the second section of this report on knee replacement. Unispacer and bicompartmental have not been used since 2005 and 2012, respectively. Partial resurfacing is also no longer used with the last procedure recorded in 2022. There is one class of shoulder replacement no longer used: total resurfacing anatomic. This class is defined in the section on shoulder replacement. Total resurfacing anatomic shoulder replacement was last used in 2020. This Report is one of 14 supplementary reports to complete the AOANJRR Annual Report for 2025. Information on the background, purpose, aims, benefits and governance of the Registry can be found in the Introductory chapter of the 2025 Hip, Knee and Shoulder Arthroplasty Annual Report. The Registry data quality processes including data collection, validation and outcomes assessment, are provided in detail in the Data Quality section of the introductory chapter of the 2025 Hip, Knee and Shoulder Arthroplasty Annual Report: https://aoanjrr.sahmri.com/annual-reports-2025.

The Australian Orthopaedic National Joint Replacement Registry (AOANJRR) presents the supplementary report Shoulder Replacement in Australia for the first time in 2025. This publication represents an important milestone, bringing together in one consolidated document the full scope of the Registry’s shoulder replacement analyses from the following 2025 annual and supplementary reports: • Main Annual Report:  10, 15, 20 Year Chapter  Revision Arthroplasty Chapter  Shoulder Replacement Chapter  HTARR Chapter • PROMs Supplementary report • Mortality Supplementary Report • Partial Shoulder Supplementary Report • Comparative Prostheses Performance Supplementary Report • Prosthesis Types with No or Minimal Use Supplementary Report The purpose of this report is to enhance the accessibility of shoulder data in a streamlined and comprehensive format. Amalgamating these data sources provides the most complete account of shoulder arthroplasty outcomes available in Australia.