Ceramic-on-ceramic bearing surface and risk of revision due to dislocation after primary total hip replacement

Sexton, Shaun; Walter, William K.; Jackson, Mark; Steiger, Richard de; Stanford, Tyman

doi:10.1302/0301-620x.91b11.22100

Cited by 29 publications

(29 citation statements)

References 35 publications

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“…On the other hand, younger patients (\ 65 years) and smaller head size (B 28 mm) showed high rates of revision with CoC. A similar finding is reported by the Australian Registry [20]. The retrospective nature of this study carries inherent limitations.…”

Section: Discussionsupporting

confidence: 62%

“…Dislocation after THA constitutes a prominent reason for revision surgery [5,20,21]. Early dislocation is frequently associated with patient and mechanical factors, whereas late dislocation can be associated with biological factors [7,11].…”

Section: Discussionmentioning

confidence: 99%

“…A recent clinical trial showed that CoC bearing couples decrease the cumulative risk of late dislocation as compared with CoP [9]. The Australian Orthopaedic Association National Joint Replacement Registry reported a higher rate of revision for dislocation in CoC THAs than in MoP THAs in some subgroups of patients [20]. Alumina ceramic is a histologically inert biomaterial, and the limited articular wear debris generated in THA stimulates a fibrocytic reaction that can increase the stability of the joint pseudocapsule [4,14,18].…”

Section: Discussionmentioning

confidence: 99%

“…In a long-term study, Hernigou et al [9] found that alumina-onalumina bearing couples decrease the cumulative risk of late dislocation as compared with alumina-on-polyethylene (PE). On the other hand, Sexton et al [20] from the Australian Orthopaedic Association National Joint Replacement Registry reported a higher rate of revision for dislocation in ceramic-on-ceramic THAs than in metal-on-PE THAs in some subgroups of patients. Risk factors for dislocation are thought to differ between early and late events with patient and mechanical factors playing a larger role in early dislocation and biological factors affecting late dislocation [7,11].…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of dislocation is highest in the first year after surgery and then continues at a relatively constant rate over the life of the arthroplasty [2,5]. Recurrent dislocation is a frequent reason for revision [20]. Surgical approach, component orientation, offset reconstruction, femoral head size, and patient neurological status are common factors associated with a potential risk of dislocation [3,13].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Are Ceramic-on-ceramic Bearings in Total Hip Arthroplasty Associated With Reduced Revision Risk for Late Dislocation?

Pitto

Garland

Sedel

2015

Clinical Orthopaedics &Amp; Related Research

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Background Dislocation is a major complication after primary total hip arthroplasty (THA), but little is known about the potential relationships between bearing materials and risk of dislocation. Dislocation within the first year after surgery is typically related to either surgical error or patient inattention to precautions, but the reasons for dislocation after the first year are often unclear, and whether ceramic bearings are associated with an increased or decreased likelihood of late dislocation is controversial. Questions/purposes The purpose of this study was to use a national registry to assess whether the choice of bearings-metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), ceramic-on-ceramic (CoC), or metal-onmetal (MoM)-is associated with differences in the risk of late dislocation. Methods Data from primary THAs were extracted from the New Zealand Joint Registry over a 10-year period. The mean age of patients was 69 years (SD ± 12 years), and 53% were women. The median followup in this population was 7 years (range, 1-13 years). The surgical approach used was posterior in 66% of THAs, lateral in 29%, and anterior in 5%. The primary endpoint was late revision for dislocation with ''late'' defined as greater than 1 year postoperatively. A total of 73,386 hips were available for analysis: 65% MoP, 17% CoP, 10% CoC, and 7% MoM. In general, patients receiving CoC and MoM bearings were younger compared with patients receiving CoP and MoP bearings. Results Four percent of the hips were revised (3130 THAs); 867 THAs were revised for dislocation. Four hundred seventy THAs were revised for dislocation after the first postoperative year. After adjusting for head size, age, and surgical approach, only CoP (hazard ratio [HR], 2.10; p = 0.021) demonstrated a higher proportion of revision, whereas MoP did not (HR, 1.76; 95% p = 0.075). There were no differences of revisions for dislocation in the CoC (HR, 1.60; p = 0.092) and MoM cohorts (HR, 1.54; p = 0.081). Conclusions Dislocation is a common reason for revision after THA. The relationships between bearing materials and risk of revision for late dislocation remain controversial. This large registry study demonstrated that bearing surface had little association with the incidence of late dislocation. Future studies with longer followups should continue to investigate this question. Level of Evidence Level III, therapeutic study.

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Section: Discussionsupporting

confidence: 62%