Aebi, M.

Ambrose, T.

Busato, A.

Eggli, S.

EL-Kerdi, A.

Müller, U.

Röder, C.

Röösli, E.

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In 1993 Sir Dennis Paterson wrote an editorial on the In-ternational Documentation and Evaluation System(IDES) [9]. He outlined the principles of IDES as con-sensus, hierarchical information, radiographic evaluationand acceptability. IDES was established by the Interna-tional Society of Orthopaedic Surgery and Traumatology(SICOT) Standing Committee on Documentation andEvaluation, which was founded in 1990 with Prof. M.E.Müller as chairman, and presented at the American As-sociation of Orthopedic Surgeons (AAOS) 61st annualmeeting in 1994. The nomenclature used on the threeIDES sheets for primary total hip arthroplasty (THA), re-vision THA and followup is based on the consensus pa-per by the Hip Society, the SICOT Commission on Doc-umentation and Evaluation and the Task Force on Out-come Studies of the AAOS [6]. This consensus paperprovided a terminology named CART (Clinical and Ra-diographic Terminology), in which each term, whetherapplying to a functional or radiographic parameter, wasspecifically defined to have a constant meaning. The ini-tial impulse to create such a terminology was alreadygiven in 1985 when J. Galante [4] called for a uniformmethod of evaluating and reporting the results of hip-re-placement surgery in order to compare the results on acommon standardized basis.In this article the authors report their 10-years experi-ence with the IDES system, which has been the basis ofa European-wide hip arthroplasty registry, and describethe influence of the initially stated axioms-consensus, hi-erarchical information, radiographic evaluation, and ac-ceptability—on the documentation system and introducethe newly developed version of the IDES documentationsystem with Internet technology.– Consensus: The parameters of IDES represent theprobably broadest consensus ever achieved in the dis-cussion about documentation of hip arthroplasty. Aglobal committee consisting of representatives of themajor orthopaedic societies had agreed on the clini-cal, functional and radiographic parameters to be re-corded. These parameters cover the three most impor-tant influential factors on the outcome of THA—thepatient, the surgical measures and techniques, and theimplanted components. When financial pressures andlegal needs for postmarket implant surveillance, theprinciples of evidence-based medicine and the out-comes movement initiated a broader discussion aboutoutcome documentation, not only were the earliermade efforts and agreements ignored but also the fo-cus was significantly shifted towards a more patient-based assessment. This is in favor of the busy clini-cians, since documentation burden is reduced and as-signed to the patient. Unfortunately, the few parame-ters left for description of implants and details of in-tervention mostly represent a minimal data set, whichis suitable for comparison of component survival butnot for quality assessment of hospitals and treatmentmethods. As opposed to the achieved standardizationof patient questionnaires like the Western Ontario andMcMaster Universities Arthritis Index (WOMAC) [2]and the short form (SF) instruments [13], no uniformset of questions for surgical measures is in use,whereby establishing reference databases for bench-marking remains difficult. In addition, manual de-scription of implants is error-prone and many changesin design during the lifetime of a prosthetic compo-nent are not properly recorded [1]. Therefore, theunique consensus found in establishing CART shouldbe adopted by all other researchers interested in com-paring their results with each other by using a com-mon scientific terminology.C. Röder (✉) · A. EL-Kerdi · U. Müller · T. Ambrose · E. RöösliA. Busato · M. AebiMaurice E. Müller Center for Research in Orthopaedic Surgery,Institute for Evaluative Research in Orthopaedic Surgery,University of Bern, Switzerlande-mail: christoph.roeder@memcenter.unibe.chTel.: +41-31-6320935Fax: +41-31-6320928S. EggliDepartment of Orthopaedic Surgery, Inselspital,University of Bern, SwitzerlandInternational Orthopaedics (SICOT) (2003) 27:259–261DOI 10.1007/s00264-003-0498-xR E V I E W  A RT I C L EC. Röder · S. Eggli · A. EL-Kerdi · U. MüllerT. Ambrose · E. Röösli · A. Busato · M. AebiThe International Documentation and Evaluation System (IDES)—10-years experienceAccepted: 4 July 2003 / Published online: 7 August 2003© Springer-Verlag 2003– Hierarchical information: The classification of datainto three categories—essential, important, and of in-terest—is a valuable tool to satisfy the differentneeds, interests, and time constraints of the users. Theessential questions can be considered as the minimaldata set necessary to fulfill the basic pretensions ofthe IDES software. Essential questions are highlight-ed on the IDES sheets for easy recognition and han-dling. The completion of these essential questionswas mandatory for the user in order to have a minimaland valid data set forming the common scientific ba-sis for comparison of interventions and outcomes.Questions of importance and of interest represent op-tional information. There is strong evidence that themajority of the participating surgeons accepted theIDES essential questions for their day-to-day docu-mentation, sharing the opinion that this minimal dataset provided sufficient information about physical sta-tus of patients, implant characteristics and surgicalmeasures. Consequently, statistical evaluation basedon the essential questions showed highest reliabilityof results.– Radiographic evaluation: Relevant X-rays were sentto the documentation center, digitized, linked with es-sential clinical information and printed on X-raycards in slide format or stored electronically. The X-ray cards always existed in double version, of whichone resided at the center and one was sent back to therespective hospital after it had been updated with newfollow-up or revision images. That way all radio-graphs of a case were shown in consecutive order onan index card that was quickly and easily available inthe orthopedic department independent of the X-raydepartment, and also at the central documentation of-fice in Bern. Tools for digital picture manipulation arein place at the scanner station and in future, the hospi-tals will have direct access to the digital picture dat-abase via the Internet.– Acceptability: Documentation is time consuming andexpensive, but it is slowly being recognized as an im-portant and essential part of clinical practice. Inmany countries—like Sweden [7], Germany, Canada[3], New Zealand [12], Norway [5], England andmany eastern European countries—registries havebeen or are now being set up for documentation ofTHA, sponsored or mandated by governmental bod-ies for reasons of quality assurance. Features of thecurrent—and to an even greater extent of the newlydeveloped—IDES software increase the value anduser acceptance of documentation significantly byoffering automatically generated clinical reports,overviews of implant usage, statistics about patientdemographics, number and type of interventions,possibilities of benchmarking of outcomes and per-formance and remote X-ray viewing and manipula-tion via the Internet. Consequently, time invested fordocumentation can be regained and data, though cen-trally stored, is available 24/7 from any computerwith Web access.Today, the International Documentation and EvaluationSystem represents one of the most valuable hip arthro-plasty databases and documentation applications exist-ing. During the past 4 decades, extensive informationabout 50,000 primary THA, 12,000 revision THA and77,000 follow-ups was collected. In 2001, the new direc-tor of the Institute for Evaluative Research in Ortho-paedic Surgery at the University of Bern initiated a con-sequent and detailed analysis of the IDES database.Within a short time, the first peer reviewed articles [8,11] were published or awarded (Swiss Society of Ortho-paedic Surgery: Marathon Award 2002; The Hip Society:Frank Stinchfield Award 2003). Originally initiated bythe pioneering work of Prof. Maurice E. Müller, theIDES database provides clinically valuable and relevantinformation about treatment of hip disease and long-termresults and will contribute substantially to a further im-provement of hip surgery and outcome research.Based on our experiences with the IDES application, anew generation documentation system with Internet tech-nology was developed during the last 3 years. Data cap-ture at source is possible for all users assigned to the doc-umentation process, independent from each other andwith different on-line and off-line data collection tools.These tools are interdependent, which means that all datais finally routed to the Web interface for final submission,querying and analysis. That way, the documentation pro-cess becomes highly flexible and dynamic and can beadapted to the workflow of the respective department.Even questionnaires can be customized and extended be-yond the essentials data set, with an online question gen-erator for individual research endeavors. An automatedimplant tracking and registration system with barcodetechnology (Secure Data Integration Concept; SEDICO)allows the direct identification of the implants used dur-ing surgery and offers an integrated order service for theimplant manufacturers. This powerful application will en-sure a further evolution of the IDES hip and knee regis-tries and provides the interested orthopedic communitywith a platform that can also be used for setting up andconducting other orthopaedic or medical studies.Several multicenter projects dealing with implant per-formance, children fracture treatment, spine trauma etc.are ongoing. Simultaneously, discussions with differentorthopaedic societies were initiated to form a new Euro-pean or multinational network based on the available In-ternet technology. In collaboration with the Spine Soci-ety of Europe (SSE), a similar effort is already estab-lished and was launched in 2002 (Spine Tango: a Euro-pean Spine Registry) [10].The authors think that in the “Bone and Joint Decade”,IDES and the newly developed documentation technolo-gy available under www.orthoglobe.ch can contribute sig-nificantly to improve collection and evaluation of clinicaland implant data. By making use of the offered tools, theorthopaedic community is enabled to collect and comparedata more easily and accurately, perform clinical studiesmore transparently and therefore finally improve thequality and efficiency of medical treatments.260References1. Ahnfelt L, Herberts P, Malchau H, Andersson GB (1990)Prognosis of total hip replacement. A Swedish multicenterstudy of 4,664 revisions. Acta Orthop Scand [Suppl] 238:1–262. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, StittLW (1988) Validation study of WOMAC: a health status in-strument for measuring clinically important patient relevantoutcomes to antirheumatic drug therapy in patients with osteo-arthritis of the hip or knee. J Rheumatol 15:1833–18403. Bourne RB (1999) The planning and implementation of theCanadian Joint Replacement Registry. Bull Hosp Jt Dis 58:128–1324. Galante J (1985) The need for a standardized system for eval-uating results of total hip surgery. J Bone Joint Surg [Am]67:511–5125. Havelin LI (1999) The Norwegian Joint Registry. Bull Hosp JtDis 58:139–1476. Johnston RC, Fitzgerald RH, Harris WH, Poss R, Muller ME,et al (1990) Clinical and radiographic evaluation of total hip261replacement. A standard system of terminology for reportingresults. J Bone Joint Surg [Am] 72:161–1687. Malchau H, Herberts P, Söderman P, Odén A (2000) Prognosisof total hip replacement. Update and validation of results fromthe Swedish National Hip Arthroplasty Registry 1979–1998. De-partment of Orthopaedics, Göteborg University, Sweden 1–168. Müller U, Gautier E, Röder C, Busato A (2003) Influence ofcup design on radiographic signs of aseptic loosening in totalhip arthroplasty. J Bone Joint Surg [Br] 83:31–369. Paterson D (1993) The International Documentation and Eval-uation System (IDES). Int Orthop 16:11–1410. Röder C, El-Kerdi A, Grob D, Aebi A (2002) A Europeanspine registry. Eur Spine J 11:303–30711. Röder C, Eggli S, Aebi M, Busato A (2003) The validity ofclinical examination in diagnosing component loosening inTHA. J Bone Joint Surg [Br] 85:37–4412. Rothwell AG (1999) Development of the New Zealand JointRegister. Bull Hosp Jt Dis 58:148–16013. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and itemselection. Med Care 30:473–483

The International Documentation and Evaluation System (IDES)—10-years experience

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The International Documentation and Evaluation System (IDES)—10-years experience

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