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EFORT Open Rev. 2019 Jun 3;4(6):391-400. doi: 10.1302/2058-5241.4.180058. eCollection 2019 Jun.

The benefits of collaboration: the Nordic Arthroplasty Register Association.

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Turku University Hospital and University of Turku, Finland, and the Finnish Arthroplasty Register.
Haukeland University Hospital, Bergen, Norway, and the Norwegian Arthroplasty Register.
Sahlgrenska University Hospital and University of Gothenburg, Sweden, and the Swedish Hip Arthroplasty Register.
Department of Orthopedics, Skåne University Hospital, Department of Clinical Sciences Malmö, Lund University, and the Swedish Hip Arthroplasty Register, Sweden.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark, and the Danish Hip Arthroplasty Register.
The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skåne University Hospital, and Department of Clinical Sciences, Orthopedics, Lund University, Sweden.
Coxa Hospital for Joint Replacement, Tampere, Finland, and the Finnish Arthroplasty Register.
Department of Orthopaedic Surgery, Naestved Hospital, Denmark, and the Danish Knee Arthroplasty Register.
Department of Orthopaedic Surgery, Herlev Hospital, University of Copenhagen, Denmark, and the Danish Shoulder Arthroplasty Register.
Department of Orthopedics, Karolinska Institutet, Danderyds Sjukhus AB, Sweden, and the Swedish Shoulder Arthroplasty Register.
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, and the Danish Hip Arthroplasty Register.


The Nordic Arthroplasty Register Association (NARA) was established in 2007 by arthroplasty register representatives from Sweden, Norway and Denmark with the overall aim to improve the quality of research and thereby enhance the possibility for quality improvement with arthroplasty surgery. Finland joined the NARA collaboration in 2010.NARA minimal hip, knee and shoulder datasets were created with variables that all countries can deliver. They are dynamic datasets, currently with 25 variables for hip arthroplasty, 20 for knee arthroplasty and 20 for shoulder arthroplasty.NARA has published statistical guidelines for the analysis of arthroplasty register data. The association is continuously working on the improvement of statistical methods and the application of new ones.There are 31 published peer-reviewed papers based on the NARA databases and 20 ongoing projects in different phases. Several NARA publications have significantly affected clinical practice. For example, metal-on-metal total hip arthroplasty and resurfacing arthroplasty have been abandoned due to increased revision risk based on i.a. NARA reports. Further, the use of uncemented total hip arthroplasty in elderly patients has decreased significantly, especially in Finland, based on the NARA data.The NARA collaboration has been successful because the countries were able to agree on a common dataset and variable definitions. The collaboration was also successful because the group was able to initiate a number of research projects and provide answers to clinically relevant questions. A number of specific goals, set up in 2007, have been achieved and new one has emerged in the process. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180058.


Nordic Arthroplasty Register Association (NARA); minimal dataset; revision surgery; statistical analyses; total joint arthroplasty

Conflict of interest statement

ICMJE Conflict of interest statement: CR declares payments from Zimmer-Biomet, Depuy, Johnson & Johnson, Swemac, outside the submitted work. AE declares institutional research funding from Zimmer Biomet and DePuy Synthes and payments from Zimmer Biomet, outside the submitted work. RH declares payments from Zimmer Biomet, outside the submitted work. SO declares grants from Zimmer Biomet, Heraeus and payments from Johnson & Johnson, outside the submitted work. All other authors declare no conflict of interest.

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