Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study

McMinn, Derek J. W.; Snell, Kym I E; Daniel, Joseph; Treacy, R. B. C.; Pynsent, Paul; Riley, Richard D

doi:10.1136/bmj.e3319

Cited by 137 publications

(105 citation statements)

References 57 publications

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“…However, this increased risk of revision needs to be balanced with other advantages that hip resurfacing may provide to elderly patients. A recent analysis of registry data demonstrated a significantly lower mortality rate following BHR compared with uncemented and cemented THR in men of all ages [40]. These findings were subsequently independently confirmed in both male and female patients by an analysis of data from the English Hospital Episode Statistics database and Office for National Statistics [41].…”

Section: Discussionmentioning

confidence: 60%

“…This consecutive series was performed by a designing surgeon; therefore, it is important to recognise the results achieved with this technically demanding procedure may not be achievable and reproducible when the surgery is performed by others. However, the series includes the surgeon's learning curve with the BHR and spans a period during which subtle nuances of anteversion, combined anteversion and aiming for an acetabular inclination angle <45°were not fully appreciated when performing hip resurfacing [40]. As radiographic analysis was not available in all cases at latest follow-up, it is possible that some individuals may have radiological evidence suggestive of implant failure despite implant and functional outcome determination in all cases.…”

Section: Discussionmentioning

confidence: 99%

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Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up

Pailhé

Matharu

Sharma

et al. 2013

International Orthopaedics (SICOT)

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Purpose Limited evidence exists regarding the outcomes of hip resurfacing in elderly patients. The primary study aims were to determine the survival and functional outcome following Birmingham Hip Resurfacing (BHR) in patients ≥65 years at up to ten years of follow-up. Secondary aims were to explore factors affecting survival and functional outcome. Methods Between 1997 and 2012, data were prospectively collected on 180 BHR (162 patients; mean age 69.2 years; 62 % male) implanted by one designing surgeon. Mean follow-up was six (range one to 14.4) years with no loss to follow-up. Outcomes of interest were implant survival, functional outcome [Oxford Hip Score (OHS)] and radiological evidence of implant failure. Results Three hips were revised, giving an overall cumulative survival of 96.4 % [95 % confidence interval (CI) 90.3-100] at ten years. Survival of 111 male BHR was 98.9 % (95 % CI 94.8-100) at ten years (one revision) compared with 91.9 % (95 % CI 77.0-100) in 69 female BHR (two revisions). Survival was affected by age (p=0.014) and femoral head size (p=0.024) but not by gender (p=0.079). Median pre-operative OHS was 50.0 % [interquartile range (IQR) 37.5-68.8], improving to 4.4 % (IQR 0-10.4) postoperatively. Men had significantly better postoperative OHSs compared with women (median male OHS 2.1 % versus 6.3 % female OHS; p=0.021). Conclusions Good survival and functional outcomes were achieved with the BHR at ten years in men and women ≥65 years. Despite registry findings to the contrary, age alone should not be a contraindication for hip resurfacing in centres with expertise in this procedure.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up

Pailhé

Matharu

Sharma

et al. 2013

International Orthopaedics (SICOT)

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“…It seems that the increasing use of uncemented fixation worldwide is not backed by evidence that can be generalized to predict the outcome of an entire nation of surgeons performing THAs. Contrary to this thought, studies of large cohorts of patients have suggested inferiority of uncemented fixation [6,10,16], and thus it seems that a continuing increase in the use of uncemented fixation is unwarranted. A drawback of the decreasing use of cemented fixation is that the skills to perform an optimal cemented THA potentially are deteriorating among hip surgeons.…”

Section: Discussionmentioning

confidence: 89%

“…A meta-analysis on register-based studies of revision risk after primary THA identified that uncemented implants may have a higher 10-year revision rate regardless of age [6]. In a recent register-based cohort study reporting the outcome of 275,000 THAs comparing adjusted mortality and revision rates of cemented compared with uncemented THAs, a statistically significant lower risk of revision was found for cemented THAs [16]. However, a statistically significant lower mortality rate was observed in uncemented THAs compared with cemented THAs.…”

Section: Discussionmentioning

confidence: 99%

A Review of Current Fixation Use and Registry Outcomes in Total Hip Arthroplasty: The Uncemented Paradox

Troelsen

Malchau

Sillesen

et al. 2013

Clinical Orthopaedics &Amp; Related Research

184

147

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Background The majority (86%) of THAs performed in the United States are uncemented. This may increase the revision burden if uncemented fixation is associated with a higher risk of revision than other approaches. Question/purposes We sought to investigate trends for use of uncemented fixation and to analyze age-stratified risk of revision comparing cemented, hybrid, and uncemented fixation as reported by national hip arthroplasty registries. Methods Data were extracted from the annual reports of seven national hip arthroplasty registries; we included all national registries for which annual reports were available in English or a Scandinavian language, if the registry had a history of more than 5 years of data collection. Results Current use of uncemented fixation in primary THAs varies between 15% in Sweden and 82% in Canada.From 2006 to 2010 the registries of all countries reported overall increases in the use of uncemented fixation; Sweden reported the smallest absolute increase (from 10% to 15%), and Denmark reported the greatest absolute increase (from 47% to 68%). Looking only at the oldest age groups, use of uncemented fixation also was increasing during the period. In the oldest age group of each of the registries we surveyed (age older than 65 years for England-Wales; age older than 75 years in three registries), cemented fixation was associated with a lower risk of revision than was uncemented fixation. Conclusions Increasing use of uncemented fixation in THA is a worldwide phenomenon. This trend is paradoxic, given that registry data, which represent nationwide THA outcomes, suggest that cemented fixation in patients older than 75 years results in the lowest risk of revision. Level of Evidence Level II, systematic review.

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“…The potential for biological fixation as well as extensive marketing and excellent outcomes in single-center studies of cementless femoral components may account for the increasing worldwide use of cementless fixation [16]. Such increased use of cementless components might be considered paradoxical because some registry data suggest inferior survival of cementless THA [7,19,21,27].…”

Section: Introductionmentioning

confidence: 99%

Do Rerevision Rates Differ After First-time Revision of Primary THA With a Cemented and Cementless Femoral Component?

Gromov

Pedersen

Overgaard

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Worldwide use of cementless fixation for total hip arthroplasty (THA) is on the rise despite some evidence from the world's registries suggesting inferior survivorship compared with cemented techniques. The patterns of bone loss associated with failed cementless and cemented THAs may prejudice the results of future revision procedures; however, this has not been documented. Questions/purposes The purpose of this study was to compare (1) the risk for rerevision of first revision THA; (2) the patterns of femoral bone loss at the time of first revision of primary THA; (3) the reasons for first revision of primary THA; and (4) the time to first revision of primary THA between primary cementless and cemented femoral components. Methods Primary THAs with cemented (n = 1791) and uncemented (n = 805) femoral components that subsequently sustained first revision of the femoral component were identified from the Danish Hip Arthroplasty Registry (DHR). As of 2012, 120,988 primary THAs and 19,282 revisions were registered in the DHR with completeness of 97% and 90% for primary and revision THA, respectively. Median followup for revisions of primary THA with cemented and cementless femoral component was 4 years (range, 0-17 years) and 2 years (range, 0-16 years), respectively. Survival of first revision THA, with second revision of the femur as outcome, was evaluated using hazard ratios (HRs) with 95% confidence interval (CI) adjusting for potential confounding. All patient-and surgery-related data are collected from Danish medical databases. Recording of bone defects in the DHR is based on surgeons' intraoperative findings. Results With the numbers studied, we found no differences in the risk of second revision between the overall cohort between cementless and cemented techniques (HR, 1.32; 95% CI, 0.97-1.80; p = 0.076); however, a second revision for Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution 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. Conclusions We found no differences in the risk of second revision in the overall cohort between cementless and cemented techniques; however, we observed an increased risk for rerevision THA performed on patients \ 70 years whose index THAs were performed using cementless components when looking at all causes for revision, even after adjusting for the most likely confounding factors. Our data suggest that increased use of cemen...

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Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study

Cited by 137 publications

References 57 publications

Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up

Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up

A Review of Current Fixation Use and Registry Outcomes in Total Hip Arthroplasty: The Uncemented Paradox

Do Rerevision Rates Differ After First-time Revision of Primary THA With a Cemented and Cementless Femoral Component?

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