Ten-year life expectancy after primary total hip replacement

Ramiah, R D; Ashmore, A M; Whitley, Elise; Bannister, G.C.

doi:10.1302/0301-620x.89b10.18735

Cited by 28 publications

(19 citation statements)

References 17 publications

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“…The overall and site-specific risk of death was not higher in the metal-on-metal cohort than in the non-metal-on-metal cohort, not even after the patient selection bias had ceased after the first 5 years of follow-up. The findings concerning risk of death agree with previously published results (Visuri et al 1994, 2010b, Lie et al 2000, Ramiah et al 2007, McMinn et al 2012). The risk of soft-tissue sarcoma and basalioma in the metal-on-metal cohort was higher than in the non-metal-on-metal cohort, as in our previous report (Mäkelä et al 2012).…”

Section: Discussionsupporting

confidence: 92%

Cancer incidence and cause-specific mortality in patients with metal-on-metal hip replacements in Finland

Mäkelä¹,

Visuri²,

Pulkkinen³

et al. 2014

Acta Orthopaedica

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Background and purposeMetal-on-metal hip implants have been widely used, especially in the USA, Australia, England and Wales, and Finland. We assessed risk of death and updated data on the risk of cancer related to metal-on-metal hip replacements.Patients and methodsA cohort of 10,728 metal-on-metal hip replacement patients and a reference cohort of 18,235 conventional total hip replacement patients were extracted from the Finnish Arthroplasty Register for the years 2001–2010. Data on incident cancer cases and causes of death until 2011 were obtained from the Finnish Cancer Registry and Statistics Finland. The relative risk of cancer and death were expressed as standardized incidence ratio (SIR) and standardized mortality ratio (SMR). SIR/SIR ratios and SMR/SMR ratios, and Poisson regression were used to compare the cancer risk and the risk of death between cohorts.ResultsThe overall risk of cancer in the metal-on-metal cohort was not higher than that in the non-metal-on-metal cohort (RR = 0.91, 95% CI: 0.82–1.02). The risk of soft-tissue sarcoma and basalioma in the metal-on-metal cohort was higher than in the non-metal-on-metal cohort (SIR/SIR ratio = 2.6, CI: 1.02–6.4 for soft-tissue sarcoma; SIR/SIR ratio = 1.3, CI: 1.1–1.5 for basalioma). The overall risk of death in the metal-on-metal cohort was less than that in the non-metal-on-metal cohort (RR = 0.78, CI: 0.69–0.88).InterpretationThe overall risk of cancer or risk of death because of cancer is not increased after metal-on-metal hip replacement. The well-patient effect and selection bias contribute substantially to the findings concerning mortality. Arthrocobaltism does not increase mortality in patients with metal-on-metal hip implants in the short term. However, metal-on-metal hip implants should not be considered safe until data with longer follow-up time are available.

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Section: Discussionsupporting

confidence: 92%

Cancer incidence and cause-specific mortality in patients with metal-on-metal hip replacements in Finland

Mäkelä¹,

Visuri²,

Pulkkinen³

et al. 2014

Acta Orthopaedica

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“…At latest follow-up 88 patients (95 hips) had died (50%), which is comparable to other published data. 4,16 One further patient underwent a hindquarter amputation for occlusive vascular disease, leaving 95 hips in 86 patients available for review (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

Clinical and radiological results of the collarless polished tapered stem at 15 years follow-up

Burston¹,

Barnett²,

Amirfeyz

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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We prospectively followed 191 consecutive collarless polished tapered (CPT) femoral stems, implanted in 175 patients who had a mean age at operation of 64.5 years (21 to 85). At a mean follow-up of 15.9 years (14 to 17.5), 86 patients (95 hips) were still alive. The fate of all original stems is known. The 16-year survivorship with re-operation for any reason was 80.7% (95% confidence interval 72 to 89.4). There was no loss to follow-up, with clinical data available on all 95 hips and radiological assessment performed on 90 hips (95%). At latest follow-up, the mean Harris hip score was 78 (28 to 100) and the mean Oxford hip score was 36 (15 to 48). Stems subsided within the cement mantle, with a mean subsidence of 2.1 mm (0.4 to 19.2). Among the original cohort, only one stem (0.5%) has been revised due to aseptic loosening. In total seven stems were revised for any cause, of which four revisions were required for infection following revision of the acetabular component. A total of 21 patients (11%) required some sort of revision procedure; all except three of these resulted from failure of the acetabular component. Cemented acetabular components had a significantly lower revision burden (three hips, 2.7%) than Harris Galante uncemented components (17 hips, 21.8%) (p < 0.001).The CPT stem continues to provide excellent radiological and clinical outcomes at 15 years following implantation. Its results are consistent with other polished tapered stem designs.

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“…The question of patient survival following arthroplasty of the lower limb had been recently looked at by Ramiah et al, 3 but the measure of comorbidity was not included in their calculations, and they provided ranges of age rather than the actual ages at which revision arthroplasty or the patient dying became more likely. We feel that a more detailed analysis is required.…”

mentioning

confidence: 99%

Age at hip or knee joint replacement surgery predicts likelihood of revision surgery

Wainwright

Theis

Garneti

et al. 2011

The Journal of Bone and Joint Surgery. British volume

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We compared revision and mortality rates of 4668 patients undergoing primary total hip and knee replacement between 1989 and 2007 at a University Hospital in New Zealand. The mean age at the time of surgery was 69 years (16 to 100). A total of 1175 patients (25%) had died at follow-up at a mean of ten years post-operatively. The mean age of those who died within ten years of surgery was 74.4 years (29 to 97) at time of surgery. No change in comorbidity score or age of the patients receiving joint replacement was noted during the study period. No association of revision or death could be proven with higher comorbidity scoring, grade of surgeon, or patient gender. We found that patients younger than 50 years at the time of surgery have a greater chance of requiring a revision than of dying, those around 58 years of age have a 50:50 chance of needing a revision, and in those older than 62 years the prosthesis will normally outlast the patient. Patients over 77 years old have a greater than 90% chance of dying than requiring a revision whereas those around 47 years are on average twice as likely to require a revision than die. This information can be used to rationalise the need for long-term surveillance and during the informed consent process.

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Ten-year life expectancy after primary total hip replacement

Cited by 28 publications

References 17 publications

Cancer incidence and cause-specific mortality in patients with metal-on-metal hip replacements in Finland

Cancer incidence and cause-specific mortality in patients with metal-on-metal hip replacements in Finland

Clinical and radiological results of the collarless polished tapered stem at 15 years follow-up

Age at hip or knee joint replacement surgery predicts likelihood of revision surgery

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