Does choice of bearings influence the survival of cementless total hip arthroplasty in patients aged 20–55 years? Comparison of 21,594 patients reported to the Nordic Arthroplasty Register Association dataset 2005–2017

Authors

  • Rasmus Tyrsted Mikkelsen Department of Orthopedic Surgery, Lillebaelt Hospital—Vejle, University Hospital of Southern Denmark, Denmark; Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark https://orcid.org/0000-0001-6086-4263
  • Søren Overgaard Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; The Danish Hip Arthroplasty Register, Århus, Denmark https://orcid.org/0000-0001-6829-4787
  • Alma B Pedersen Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark https://orcid.org/0000-0002-3288-9401
  • Johan Kärrholm Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Swedish Arthroplasty Register, Gothenburg, Sweden https://orcid.org/0000-0003-4782-7999
  • Ola Rolfson Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Swedish Arthroplasty Register, Gothenburg, Sweden https://orcid.org/0000-0001-6534-1242
  • Anne Marie Fenstad The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway https://orcid.org/0000-0002-6429-0153
  • Ove Furnes The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway https://orcid.org/0000-0001-8223-2515
  • Geir Hallan The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
  • Keijo Mäkelä Department of Orthopedics and Traumatology, Turku University Hospital, Turku, and University of Turku, Finland; The Finnish Arthroplasty Registry, Helsinki, Finland
  • Antti Eskelinen The Finnish Arthroplasty Registry, Helsinki, Finland; Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland https://orcid.org/0000-0003-0302-0253
  • Claus Varnum Department of Orthopedic Surgery, Lillebaelt Hospital—Vejle, University Hospital of Southern Denmark, Denmark; Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark; The Danish Hip Arthroplasty Register, Århus, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark https://orcid.org/0000-0002-0625-5691

DOI:

https://doi.org/10.2340/17453674.2023.13384

Keywords:

ceramic-on-ceramic, ceramic-on-highly-crosslinked-polyethylene, metal-on-highly-crosslinked-polyethylene, metal-on-metal, total hip arthroplasty, young adult

Abstract

Background and purpose: The bearings with the best survivorship for young patients with total hip arthroplasty (THA) should be identified. We compared hazard ratios (HR) of revision of primary stemmed cementless THAs with metal-on-metal (MoM), ceramic-on-ceramic (CoC), and ceramic-on-highly-crosslinked-polyethylene (CoXLP) with that of metal-on-highly-crosslinked-polyethylene (MoXLP) bearings in patients aged 20–55 years with primary osteoarthritis or childhood hip disorders.
Patients and methods: From the Nordic Arthroplasty Register Association dataset we included 1,813 MoM, 3,615 CoC, 5,947 CoXLP, and 10,219 MoXLP THA in patients operated on between 2005 and 2017 in a prospective cohort study. We used the Kaplan–Meier estimator for THA survivorship and Cox regression to estimate HR of revision adjusted for confounders (including 95% confidence intervals [CI]). MoXLP was used as reference. HRs were calculated during 3 intervals (0–2, 2–7, and 7–13 years) to meet the assumption of proportional hazards.
Results: Median follow-up was 5 years for MoXLP, 10 years for MoM, 6 years for CoC, and 4 years for CoXLP. 13-year Kaplan–Meier survival estimates were 95% (CI 94–95) for MoXLP, 82% (CI 80–84) for MoM, 93% (CI 92–95) for CoC, and 93% (CI 92–94) for CoXLP bearings. MoM had higher 2–7 and 7–13 years’ adjusted HRs of revision (3.6, CI 2.3–5.7 and 4.1, CI 1.7–10). MoXLP, CoC, and CoXLP had similar HRs in all 3 periods. The 7–13-year adjusted HRs of revision of CoC and CoXLP were statistically non-significantly higher.
Conclusion: In young patients, MoXLP for primary cementless THA had higher revision-free survival and lower HR for revision than MoM bearings. Longer follow-up is needed to compare MoXLP, CoC, and CoXLP.

Downloads

Download data is not yet available.

References

Australian Orthopaedic Association. National Joint Replacement Registry Annual Report 2021. Available from: https://aoanjrr.sahmri.com/annual-reports-2021.

Danish Hip Arthroplasty Register. Annual Report 2021. Available from: danskhoftealloplastikregister.dk/wp-content/uploads/2021/08/ DHR-aarsrapport-2021_Offentliggoerelse.pdf.

National Joint Registry 17th Annual Report 2020—National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. PMID: 33439585. Available from: www.njrcentre.org.uk.

Saleh K J, Celebrezze M, Kassim R, Dykes D C, Gioe T J, Callaghan J J, et al. Functional outcome after revision hip arthroplasty: a meta-analysis. Clin Orthop Relat Res 2003; (416): 254-64. doi: 10.1097/01.blo.0000093006.90435.43. DOI: https://doi.org/10.1097/01.blo.0000093006.90435.43

Jacobs J J, Shanbhag A, Glant T T, Black J, Galante J O. Wear debris in total joint replacements. J Am Acad Orthop Surg 1994; 2(4): 212-20. doi: 10.5435/00124635-199407000-00004. DOI: https://doi.org/10.5435/00124635-199407000-00004

Zagra L, Gallazzi E. Bearing surfaces in primary total hip arthroplasty. EFORT Open Rev 2018; 3(5): 217-2. doi: 10.1302/2058-5241.3.180300. DOI: https://doi.org/10.1302/2058-5241.3.180300

Australian Orthopaedic Association. National Joint Replacement Registry Annual Report 2012. Available from: https://aoanjrr.sahmri.com/annual-reports-2012.

Varnum C, Pedersen A B, Mäkelä K, Eskelinen A, Havelin L I, Furnes O, et al. Increased risk of revision of cementless stemmed total hip arthroplasty with metal-on-metal bearings. Acta Orthop 2015; 86(4): 491-7. doi: 10.3109/17453674.2015.1023132. DOI: https://doi.org/10.3109/17453674.2015.1023132

Matharu G S, Judge A, Eskelinen A, Murray D W, Pandit H G. What is appropriate surveillance for metal-on-metal hip arthroplasty patients?: a clinical update. Acta Orthop 2018; 89(1): 29-39. doi: 10.1080/17453674.2017.1398011. DOI: https://doi.org/10.1080/17453674.2017.1398011

Heckmann N D, Sivasundaram L, Stefl M D, Kang H P, Basler E T, Lieberman J R. Total hip arthroplasty bearing surface trends in the United States from 2007 to 2014: the rise of ceramic on polyethylene. J Arthroplasty 2018; 33(6): 1757-63.e1. doi: 10.1016/j.arth.2017.12.040. DOI: https://doi.org/10.1016/j.arth.2017.12.040

Holleyman R J, Critchley R J, Mason J M, Jameson S S, Reed M R, Malviya A. Ceramic bearings are associated with a significantly reduced revision rate in primary hip arthroplasty: an analysis from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. J Arthroplasty 2021; 36(10): 3498-506. doi: 10.1016/j.arth.2021.05.027. DOI: https://doi.org/10.1016/j.arth.2021.05.027

Davis E T, Pagkalos J, Kopjar B. Effect of bearing surface on survival of cementless and hybrid total hip arthroplasty: study of data in the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. JB JS open access 2020; 5(2): e0075. doi: 10.2106/JBJS.OA.19.00075. DOI: https://doi.org/10.2106/JBJS.OA.19.00075

Sedrakyan A, Graves S, Bordini B, Pons M, Havelin L, Mehle S, et al. Comparative effectiveness of ceramic-on-ceramic implants in stemmed hip replacement: a multinational study of six national and regional registries. J Bone Joint Surg Am 2014; 96(Suppl. 1): 34-41. doi: 10.2106/JBJS.N.00465. DOI: https://doi.org/10.2106/JBJS.N.00465

The Nordic Council of Ministers. Formal Nordic Co-Operation. Available from: http//www.norden.org/en.

Mäkelä K T, Matilainen M, Pulkkinen P, Fenstad A M, Havelin L I, Engesaeter L, et al. Countrywise results of total hip replacement. Acta Orthop 2014; 85(2): 107-16. doi: 10.3109/17453674.2014.893498. DOI: https://doi.org/10.3109/17453674.2014.893498

Mäkelä K T, Furnes O, Hallan G, Fenstad A M, Rolfson O, Kärrholm J, et al. The benefits of collaboration: the Nordic Arthroplasty Register Association. EFORT Open Rev 2019; 4(6): 391-400. doi: 10.1302/20585241.4.180058. DOI: https://doi.org/10.1302/2058-5241.4.180058

Engesæter L B, Engesæter I O, Fenstad A M, Havelin L I, Kärrholm J, Garellick G, et al. Low revision rate after total hip arthroplasty in patients with pediatric hip diseases. Acta Orthop 2012; 83(5): 436-41. doi: 10.3109/17453674.2012.736171. DOI: https://doi.org/10.3109/17453674.2012.736171

Howard D P, Wall P D H, Fernandez M A, Parsons H, Howard P W. Ceramic-on-ceramic bearing fractures in total hip arthroplasty. Bone Joint J 2017; 99(8): 1012-9. doi: 10.1302/0301-620X.99B8.BJJ-20170019.R1. DOI: https://doi.org/10.1302/0301-620X.99B8.BJJ-2017-0019.R1

de Steiger R N, Hatton A, Peng Y, Graves S. What is the risk of THA revision for ARMD in patients with non-metal-on-metal bearings? A study from the Australian National Joint Replacement Registry. Clin Orthop Relat Res 2020; 478(6): 1244-53. doi: 10.1097/CORR.0000000000001277. DOI: https://doi.org/10.1097/CORR.0000000000001277

Hoskins W, Rainbird S, Peng Y, Lorimer M, Graves S E, Bingham R. Incidence, risk factors, and outcome of ceramic-on-ceramic bearing breakage in total hip arthroplasty. J Arthroplasty 2021; 36(8): 2992–7. doi: 10.1016/j.arth.2021.03.021. DOI: https://doi.org/10.1016/j.arth.2021.03.021

Hallan G, Fenstad A M, Furnes O. What is the frequency of fracture of ceramic components in THA? Results from the Norwegian Arthroplasty Register from 1997 to 2017. Clin Orthop Relat Res 2020; 478(6): 1254-61. doi: 10.1097/CORR.0000000000001272. DOI: https://doi.org/10.1097/CORR.0000000000001272

Wyles C C, Jimenez-Almonte J H, Murad M H, Norambuena-Morales G A, Cabanela M E, Sierra R J, et al. There are no differences in short- to mid-term survivorship among total hip-bearing surface options: a network meta-analysis. Clin Orthop Relat Res 2015; 473(6): 2031-41. doi: 10.1007/s11999-014-4065-0. DOI: https://doi.org/10.1007/s11999-014-4065-0

Varnum C, Pedersen A B, Kjærsgaard-Andersen P, Overgaard S. Do different types of bearings and noise from total hip arthroplasty influence hip-related pain, function, and quality of life postoperatively? Acta Orthop 2016; 87(6): 567-74. doi: 10.1080/17453674.2016.1225649. DOI: https://doi.org/10.1080/17453674.2016.1225649

Owen D H, Russell N C, Smith P N, Walter W L. An estimation of the incidence of squeaking and revision surgery for squeaking in ceramicon-ceramic total hip replacement: a meta-analysis and report from the Australian Orthopaedic Association National Joint Registry. Bone Joint J 2014; 96-B(2): 181-7. doi: 10.1302/0301-620X.96B2.32784. DOI: https://doi.org/10.1302/0301-620X.96B2.32784

Cafri G, Paxton E W, Love R, Bini S A, Kurtz S M. Is there a difference in revision risk between metal and ceramic heads on highly crosslinked polyethylene liners? Clin Orthop Relat Res 2017; 475(5): 1349-55. doi: 10.1007/s11999-016-4966-1. DOI: https://doi.org/10.1007/s11999-016-4966-1

Published

2023-06-05

How to Cite

Mikkelsen, R. T., Overgaard, S., Pedersen, A. B., Kärrholm, J., Rolfson, O., Fenstad, A. M., … Varnum, C. (2023). Does choice of bearings influence the survival of cementless total hip arthroplasty in patients aged 20–55 years? Comparison of 21,594 patients reported to the Nordic Arthroplasty Register Association dataset 2005–2017. Acta Orthopaedica, 94, 266–273. https://doi.org/10.2340/17453674.2023.13384

Issue

Section

Articles

Categories