Hip Resurfacing Data from National Joint Registries: What Do They Tell Us? What Do They Not Tell Us?

Abstract

Current-generation metal-on-metal hip resurfacing implants (SRAs) have been in widespread global use since the 1990s, and in the United States, specific implants have recently been approved for clinical use. Many recent publications describe short-term survivorship achieved by either implant-designing surgeons or high-volume centers. National joint replacement registries (NJRRs) on the other hand report survivorship achieved from the orthopaedic community at large. We therefore reviewed SRA survivorship from national registry data and compared with that reported from individual centers. Additionally, we compared SRA survivorship reported by registries and compared prognosticators for failure with those of conventional total hip arthroplasty (THA). Although resurfacing was associated with an overall increased failure rate in comparison to THA (Australian registry 5-year cumulative revision rate [CRR], 3.7% and 2.7%, respectively), there were exceptions to this. Male patients younger than 65 years with primary osteoarthritis had equivalent results with SRA and THA (Australian registry 5-year CRR, 2.5% and 2.8%, respectively). Head size over 50 mm in diameter was a predictor of surface replacement arthroplasty survivorship and only females with a head diameter of 50 mm or greater (14% of females) had a comparable survivorship to males. Diagnoses other than primary osteoarthritis bear a higher risk of early revision of SRA as compared with THA. Revision of SRA does not lead to reproducible results with rerevision rates of 11% at 5 years. Given these predictors of failure, our review of data from the NJRR suggests stringent patient selection criteria might enhance the survival rates of SRA.

High Revision Rate at 5 Years after Hip Resurfacing with the Durom Implant

“…They reported three revisions (2.3%) at a mean followup of 29 months; one femoral neck fracture, one femoral loosening, and one septic loosening [11]. Overall, the failure modes observed in our study are well known and were proportionally similar to those reported from national registries (Australia, England-Wales, Sweden): femoral neck fracture accounted for 37% of the revisions, component loosening for 27%, persistent pain for 18%, and impingement for 18% [8]. Also in line with other studies, female patients had an increased failure risk; revisions were necessary in 17% of women after 5 years [3,18].…”

“…Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. [8], and these results together with the conceptual features led to an escalated development of new implants by almost all orthopaedic companies. However, there is growing evidence that different HRA implants perform variably well in terms of survival and revision rates [33].…”

Management of failed metal-on-metal total hip arthroplasty

“…Registries and long-term clinical studies have provided outcomes relating to the survivorship of metal bearing surfaces [22] . Several clinical series have reported good survivorship with certain implant designs.…”

Hip resurfacing arthroplasty: current status and future perspectives

“…However, no comparison to age-and gendermatched cohorts following THA was provided (Table 2). This comparison was possible from the data provided in the NJRR (Corten and MacDonald, 2010;McGrory et al, 2010). After adjustment for age and gender, HRA had a three-to fivefold increased risk for revision in comparison to THA in England, Wales and Sweden at 1 to 3 years (Web ref.…”

“…The indication for surgery, gender, component size and age have all been identified as important patient related prognosticators for HRA failure (Corten and MacDonald, 2010;McGrory et al, 2010). Post-childhood hip disorders and avascular necrosis (AVN) were associated with a significantly higher risk of HRA failure compared to primary osteoarthritis (OA) and the 5-year revision risk of HRA for hip dysplasia (DDH) and AVN were respectively four and two times higher than that of THA (3%) (Web ref.…”