Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations

Abstract

Objective To assess the failure rate of cemented, uncemented, hybrid, and reverse hybrid total hip replacements in patients aged 55 years or older. Design Register study.Setting Nordic Arthroplasty Register Association database (combined data from Sweden, Norway, Denmark, and Finland).Participants 347 899 total hip replacements performed during 1995-2011.Main outcome measures Probability of implant survival (Kaplan-Meier analysis) along with implant survival with revision for any reason as endpoint (Cox multiple regression) adjusted for age, sex, and diagnosis in age groups 55-64, 65-74, and 75 years or older. ResultsThe proportion of total hip replacements using uncemented implants increased rapidly towards the end of the study period. The 10 year survival of cemented implants in patients aged 65 to 74 and 75 or older (93.8%, 95% confidence interval 93.6% to 94.0% and 95.9%, 95.8% to 96.1%, respectively) was higher than that of uncemented (92.9%, 92.3% to 93.4% and 93.0%, 91.8% to 94.0%), hybrid (91.6%, 90.9% to 92.2% and 93.9%, 93.1% to 94.5%), and reverse hybrid (90.7%, 87.3% to 93.2% and 93.2%, 90.7% to 95.1%) implants. The survival of cemented (92.2%, 91.8% to 92.5%) and uncemented (91.8%, 91.3% to 92.2%) implants in patients aged 55 to 64 was similar. During the first six months the risk of revision with cemented implants was lower than with all other types of fixation in all age groups. ConclusionThe survival of cemented implants for total hip replacement was higher than that of uncemented implants in patients aged 65 years or older. The increased use of uncemented implants in this age group is not supported by these data. However, because our dataset includes only basic information common to all national registers there is potential for residual confounding.

Implant survival of the most common cemented total hip devices from the Nordic Arthroplasty Register Association database

“…2014a). In younger patients, uncemented implants do not perform better regarding overall revision rate, but they have a lower long-term risk of revision due to aseptic loosening (Pedersen et al.…”

(i) Why do total hip replacements fail?

“…The most common endpoint utilised in the literature to define THR failure is revision surgery. 8,9 The most common indications for revision surgery include persistent pain, recurrent instability, infection and aseptic loosening. 4, 10 We discuss current concepts, mechanisms and strategies employed to reduce the incidence of THR failures over three disciplines: 1) Patient-related factors; 2) Surgical technique; and 3) Implant design factors.…”

The implant infection paradox: why do some succeed when others fail? Opinion and discussion paper

“…Clinically, it has been observed that oral mucosal wounds demonstrate faster healing with minimal scar formation as compared with epidermal wounds (Häkkinen et al, 2000;McKeown et al, 2007;Schrementi et al, 2008), despite similar spatial and temporal processes being involved (McKeown et al, 2007;Schrementi et al, 2008;Sciubba et al, 1978). For example, 3 days after injury, collagen fibrils in wounded oral mucosa already appear to be similar to those of unwounded mucosa, whilst fibrils in skin wounds are still smaller and less uniform than unwounded skin even at 14 days post-injury (Schrementi et al, 2008).…”

“…The Nordic Arthroplasty Register, including 432,168 total hip arthroplasties reported a failure rate due to infection of 0.6 %, with the highest risk occurring in the first three months after surgery (Dale et al, 2012). In a review of 347,889 total hip arthroplasties with a follow up period of 10 years, general implant failure rates of 4.1-10.0 % were reported within 10 years, dependent upon implant type (Makela et al, 2014), of which 0.1-1.1 % were identified as infection-associated failure within the first six months after surgery. Note that in the case of joint arthroplasties, the term "sterile" tissue should be used cautiously as tissue surrounding orthopaedic implant sites is almost certainly contaminated by low levels of bacteria during surgery or later, possibly from haematogenous sources.…”