The effect of bearing type on the outcome of total hip arthroplasty

Abstract

Background and purposeAlternative bearing surfaces such as ceramics and highly crosslinked polyethylene (HXLPE) were developed in order to further improve implant performance of total hip arthroplasties (THAs). Whether these alternative bearing surfaces result in increased longevity is subject to debate.Patients and methodsUsing the Dutch Arthroplasty Register (LROI), we identified all patients with a primary, non-metal-on-metal THA implanted in the Netherlands in the period 2007–2016 (n = 209,912). Cumulative incidence of revision was calculated to determine differences in survivorship of THAs according to bearing type: metal-on-polyethylene (MoPE), metal-on-HXLPE (MoHXLPE), ceramic-on-polyethylene (CoPE), ceramic-on-HXLPE (CoHXLPE), ceramic-on-ceramic (CoC), and oxidized-zirconium-on-(HXL)polyethylene (Ox(HXL)PE). Multivariable Cox proportional hazard regression ratios (HRs) were used for comparisons.ResultsAfter adjustment for confounders, CoHXLPE, CoC, and Ox(HXL)PE resulted in a statistically significantly lower risk of revision compared with MoPE after 9 years follow-up (HR =0.8–0.9 respectively, compared with HR =1.0). For small (22–28 mm) femoral head THAs, lower revision rates were found for CoPE and CoHXLPE (HR =0.9). In the 36 mm femoral head subgroup, CoC-bearing THAs had a lower HR compared with MoHXLPE (HR =0.7 versus 1.0). Crude revision rates in young patients (< 60 years) for CoHXLPE, CoC, and Ox(HXL)PE (HR =0.7) were lower than MoPE (HR =1.0). However, after adjustment for case mix and confounders these differences were not statistically significant.InterpretationWe found a mid-term lower risk of revision for CoHXLPE, CoC, and Ox(HXL)PE bearings compared with traditional MoPE-bearing surfaces.

Patient Characteristics Influence Revision Rate of Total Hip Arthroplasty: American Society of Anesthesiologists Score and Body Mass Index Were the Strongest Predictors for Short-Term Revision After Primary Total Hip Arthroplasty

“…1). This was similar to previous studies using LROI data [4,8,9,14]. Smoking status, BMI, and Charnley score were registered since 2014 in the LROI.…”

Effect of Bearing Surface on Survival of Cementless and Hybrid Total Hip Arthroplasty

“…To our knowledge, this is the first study utilizing NJR data that differentiated between XLPE and conventional PE when comparing different bearing combinations. Our analysis confirms a significant association between modern bearing surface combinations and THA survival, and corroborates previous analyses using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) 7 and the Dutch Arthroplasty Register (LROI) 10 . However, registry data that do not stratify for PE modifications are used to inform policy 17 , 18 .…”

“…The LROI performed a similar analysis of THA survival with different bearings 10 . With MoP as the reference in a multivariate model, they also reported a reduction in the risk of revision in association with CMoXLPE.…”

“…Authors of previous registry studies have combined the outcomes of cemented and uncemented acetabular components when reporting bearing survivorship 7 , 10 . However, using an uncemented acetabular component provides the ability to use a ceramic-on-ceramic (CoC) bearing.…”

Early failure for wear after ceramic-on-highly cross-linked polyethylene total hip arthroplasty: a case report

“…HXLPE was developed to reduce wear in conventional PE liners. Meanwhile, the incidence and severity of osteolysis secondary to wear would also be decreased [ 4 ]. Mutimer et al [ 5 ] reported that HXLPE had a lower revision rate compared with traditional PE with an average follow-up period of 5.5 years.…”