Davis, JB JS Open Access 2020 - Effect of Bearing Surface on Survival of Cementless and Hybrid Total Hip Arthroplasty

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Effect of Bearing Surface on Survival of Cementless and Hybrid Total Hip Arthroplasty

Davis, Kopjar, et al.·JB JS Open Access·2020·31 citations·Retrospective cohort

Free Full Text·DOI·PubMed

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Background

Modern bearing surface options have increased implant survivorship after total hip arthroplasty (THA). We utilized data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to analyze implant survivorship after THAs with uncemented acetabular components with different bearing combinations.

Methods

Polyethylene (PE) manufacturing properties supplied by the manufacturers were used to subdivide the NJR data set into cross-linked PE (XLPE) and conventional PE groups. Overall and cause-specific revisions for various bearing combinations were analyzed using Kaplan-Meier and multivariate Cox proportional hazard regression survival analyses.

Results

Of 420,339 primary THAs, 8,025 were revised during an average follow-up period of 4.4 years (maximum, 13.3 years).
In the Cox regression model with metal on conventional PE as the reference, the lowest risk of revision for any reason was for ceramicized metal on XLPE (hazard ratio [HR] = 0.58, 95% confidence interval [CI] = 0.48, 0.71), followed by ceramic on XLPE (HR = 0.66, 95% CI = 0.60, 0.72), ceramic on PE (HR = 0.74, 95% CI = 0.66, 0.82), ceramic on ceramic (HR = 0.77, 95% CI = 0.72, 0.82), and metal on XLPE (HR = 0.81, 95% CI = 0.76, 0.87).
A similar pattern was observed when patients under the age of 55 years were analyzed independently.
Younger age, male sex, and cementless stem fixation were associated with a higher risk of revision.

Conclusions

In a fully adjusted model, ceramicized metal on XLPE and ceramic on XLPE were associated with the lowest risk of revision for any reason. This finding was sustained when patients under the age of 55 years were analyzed independently. On the basis of the NJR data set, use of XLPE markedly reduces the risk of revision.

Level of evidence: Therapeutic Level III. Copyright remains with the authors and publisher.

Effect of Bearing Surface on Survival of Cementless and Hybrid Total Hip Arthroplasty

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|

Effect of Bearing Surface on Survival of Cementless and Hybrid Total Hip Arthroplasty

Davis, Kopjar, et al.·JB JS Open Access·2020·31 citations·Retrospective cohort

Free Full Text·DOI·PubMed

|

Background

Modern bearing surface options have increased implant survivorship after total hip arthroplasty (THA). We utilized data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to analyze implant survivorship after THAs with uncemented acetabular components with different bearing combinations.

Methods

Polyethylene (PE) manufacturing properties supplied by the manufacturers were used to subdivide the NJR data set into cross-linked PE (XLPE) and conventional PE groups. Overall and cause-specific revisions for various bearing combinations were analyzed using Kaplan-Meier and multivariate Cox proportional hazard regression survival analyses.

Results

Of 420,339 primary THAs, 8,025 were revised during an average follow-up period of 4.4 years (maximum, 13.3 years).
In the Cox regression model with metal on conventional PE as the reference, the lowest risk of revision for any reason was for ceramicized metal on XLPE (hazard ratio [HR] = 0.58, 95% confidence interval [CI] = 0.48, 0.71), followed by ceramic on XLPE (HR = 0.66, 95% CI = 0.60, 0.72), ceramic on PE (HR = 0.74, 95% CI = 0.66, 0.82), ceramic on ceramic (HR = 0.77, 95% CI = 0.72, 0.82), and metal on XLPE (HR = 0.81, 95% CI = 0.76, 0.87).
A similar pattern was observed when patients under the age of 55 years were analyzed independently.
Younger age, male sex, and cementless stem fixation were associated with a higher risk of revision.

Conclusions

In a fully adjusted model, ceramicized metal on XLPE and ceramic on XLPE were associated with the lowest risk of revision for any reason. This finding was sustained when patients under the age of 55 years were analyzed independently. On the basis of the NJR data set, use of XLPE markedly reduces the risk of revision.

Level of evidence: Therapeutic Level III. Copyright remains with the authors and publisher.

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