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.

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Published

2023-06-05

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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

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Vol. 94 (2023): Acta Orthopaedica

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Copyright (c) 2023 Rasmus Tyrsted Mikkelsen, Søren Overgaard, Alma B Pedersen, Johan Kärrholm, Ola Rolfson, Anne Marie Fenstad, Ove Furnes, Geir Hallan, Keijo Mäkelä, Antti Eskelinen, Claus Varnum

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Acta Orthopaedica (Scandinavica) content is available freely online as from volume 1, 1930. The journal owner owns the copyright for all material published until volume 80, 2009. As of June 2009, the journal has however been published fully Open Access, meaning the authors retain copyright to their work. As of June 2009, articles have been published under CC-BY-NC or CC-BY licenses, unless otherwise specified.
 
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