Association of acetabular implants with sensitive radiographic surveillance on revision rates: a study based on 5 hip arthroplasty registries
DOI:
https://doi.org/10.2340/17453674.2026.45292Keywords:
Arthroplasty, EBRA, Hip, Implants, Radiological imaging, RSAAbstract
Background and purpose: National joint arthroplasty registries are the gold standard for monitoring long-term acetabular implant survivorship. Sensitive radiographic surveillance (SRS) has been recommended as a complementary surveillance approach, but no study has investigated whether implants introduced with no sensitive radiographic surveillance (NSRS) are associated with higher revision rates. Therefore, we investigated whether acetabular implants with NSRS are associated with higher revision rates than those with SRS.
Methods: Acetabular implants with SRS were defined as those with published evidence of stability measurements assessed using either radiostereometric analysis or “Ein Bild Röntgen Analyse.” Evidence of SRS of acetabular implant designs was sourced from 2 literature reviews. A mixed-effects model was used to pool and compare the revision rate of acetabular implants with SRS and NSRS at 5 and 10 years from 5 arthroplasty registries.
Results: There were 29 unique acetabular implant designs with SRS and 86 designs with NSRS that had matching 5- and 10-year revision rates. At 5 years, there was a mean difference of 0.8% (95% confidence interval [CI] 0.5–1.1) in mean all-cause revision rates favoring implants with SRS. Mean all-cause revision rates at 10 years for acetabular implants with SRS and NSRS were 5.2% (CI 4.9–5.5) and 7.4% (CI 7.0–7.9) respectively, with a mean difference of 1.8% (CI 1.2–2.3) favoring implants with SRS.
Conclusion: Acetabular implants with NSRS were associated with 1.8% higher pooled revision rates than those with SRS at 10 years, which represents a relative increase in acetabular revision burden of approximately 36%.
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Kynaston-Pearson F, Ashmore A, Malak T, Rombach I, Taylor A, Beard D, et al. Primary hip replacement prostheses and their evidence base: systematic review of literature. BMJ 2013; 347. doi: 10.1136/bmj.f6956.. DOI: https://doi.org/10.1136/bmj.f6956
von Schewelov T, Sanzén L, Onsten I, Carlsson A. Catastrophic failure of an uncemented acetabular component due to high wear and osteolysis: an analysis of 154 Omnifit prostheses with mean 6-year follow-up. Acta Orthop Scand 2004; 75(3): 283-94. doi: 10.1080/00016470410001213.. DOI: https://doi.org/10.1080/00016470410001213
EU regulation 2017/745 of the European Parliament and the Council of 5 April 2017 on medical devices. Official Journal of the European Union; 2023.
Malak T T, Broomfield J A, Palmer A J, Hopewell S, Carr A, Brown C, et al. Surrogate markers of long-term outcome in primary total hip arthroplasty: a systematic review. Bone Joint Res 2016; 5(6): 206-14. doi: 10.1302/2046-3758.56.2000568.. DOI: https://doi.org/10.1302/2046-3758.56.2000568
Pijls B G, Nieuwenhuijse M J, Fiocco M, Plevier J W, Middeldorp S, Nelissen R G, et al. Early proximal migration of cups is associated with late revision in THA: a systematic review and meta-analysis of 26 RSA studies and 49 survival studies. Acta Orthop 2012; 83(6): 583-91. doi: 10.3109/17453674.2012.745353.. DOI: https://doi.org/10.3109/17453674.2012.745353
Nelissen R G, Pijls B G, Kärrholm J, Malchau H, Nieuwenhuijse M J, Valstar E R. RSA and registries: the quest for phased introduction of new implants. J Bone Joint Surg Am 2011; 93(Suppl 3): 62-5. doi: 10.2106/JBJS.K.00907.. DOI: https://doi.org/10.2106/JBJS.K.00907
Pijls B G, Nelissen R G. The era of phased introduction of new implants. Bone Joint Res 2016; 5(6): 215-17.doi: 10.1302/2046-3758.56.2000653.. DOI: https://doi.org/10.1302/2046-3758.56.2000653
Dunbar M, Ryd L. The power of registries and radiostereometric analysis (RSA). Acta Orthop 2025; 96: 11-12. doi: 10.2340/17453674.2024.41169.. DOI: https://doi.org/10.2340/17453674.2024.41169
Arthroplasty Registries in Europe: European Federation of National Associations of Orthopaedics and Traumatology; 2023. Available from: https://nore.efort.org/arthroplasty-registries.
Hasan S, Marang-van de Mheen P J, Kaptein B L, Nelissen R, Pijls B G. RSA-tested TKA implants on average have lower mean 10-year revision rates than non-RSA-tested designs. Clin Orthop Relat Res 2020; 478(6): 1232-41. doi: 10.1097/CORR.0000000000001209.. DOI: https://doi.org/10.1097/CORR.0000000000001209
Cho C H, Pijls B G, Abrahams J M, Roerink A, Katembwe R, Baker A, et al. Migration patterns of acetabular cups: a systematic review and meta-analysis of RSA studies. Acta Orthop 2023; 94: 626-34. doi: 10.2340/17453674.2023.24580.. DOI: https://doi.org/10.2340/17453674.2023.24580
Stihsen C, Rath C, Radl R, Saalabian A A, Materna W, Rehak P, et al. Early migration characteristics of a 180° porous-coated cup with 1-mm press fit. Arch Orthop Trauma Surg 2013; 133(5): 707-12. doi: 10.1007/s00402-013-1713-x.. DOI: https://doi.org/10.1007/s00402-013-1713-x
Roda R, Whittingham-Jones P M, Lee J, Ryu J J, Beaulé P E. Migration pattern of a cobalt-chrome monoblock acetabular component after metal-on-metal hip resurfacing. Hip Int 2016; 26(3): 220-5. doi: 10.5301/hipint.5000331.. DOI: https://doi.org/10.5301/hipint.5000331
Dammerer D, Blum P, Putzer D, Tscholl A, Liebensteiner M C, Thaler M. Good mid-term results with the Trident peripheral self-locking cup: a clinical evaluation and migration measurement with EBRA. Arch Orthop Trauma Surg 2021; 141(2): 327-32. doi: 10.1007/s00402-020-03639-5.. DOI: https://doi.org/10.1007/s00402-020-03639-5
Hozo S P, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13. doi: 10.1186/1471-2288-5-13.. DOI: https://doi.org/10.1186/1471-2288-5-13
Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw 2010; 36(3): 1-48. doi: 10.18637/jss.v036.i03. DOI: https://doi.org/10.18637/jss.v036.i03
Amrhein V, Greenland S, McShane B. Scientists rise up against statistical significance. Nature 2019; 567(7748): 305-7. doi: 10.1038/d41586-019-00857-9.. DOI: https://doi.org/10.1038/d41586-019-00857-9
Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty 2022 Annual Report. Australian Orthopaedic Association National Joint Replacement Registry; 2022.
LROI. Dutch Arthoplasty Register: LROI; 2023. Available from: https://www.lroi.nl/.
FAR. The Finnish Arthroplasty Register; 2023. Available from: https://www2.thl.fi/endo/report/#index.
NJR. National Joint Registry; 2023. Available from: https://reports.njrcentre.org.uk/.
RIPO. Register of Orthopaedic Prosthetic Implants: Istituto Ortopedico Rizzoli; 2023. Available from: https://www.ior.it/en/curarsi-al-rizzoli/register-orthopaedic-prosthetic-implants.
Hoogervorst L A, van Tilburg M M, Lübbeke A, Wilton T, Nelissen R, Marang-van de Mheen P J. Validating Orthopaedic Data Evaluation Panel (ODEP) ratings across 9 orthopaedic registries: total hip implants with an ODEP rating perform better than those without an ODEP rating. J Bone Joint Surg Am 2024; 106(17): 1583-93. doi: 10.2106/JBJS.23.00793.. DOI: https://doi.org/10.2106/JBJS.23.00793
Salemyr M, Muren O, Eisler T, Bodén H, Chammout G, Stark A, et al. Porous titanium construct cup compared to porous coated titanium cup in total hip arthroplasty: a randomised controlled trial. Int Orthop 2015; 39(5): 823-32. doi: 10.1007/s00264-014-2571-z.. DOI: https://doi.org/10.1007/s00264-014-2571-z
Kaptein B L, Pijls B, Koster L, Karrholm J, Hull M, Niesen A, et al. Guideline for RSA and CT-RSA implant migration measurements: an update of standardizations and recommendations. Acta Orthop 2024; 95: 256-67. doi: 10.2340/17453674.2024.40709. DOI: https://doi.org/10.2340/17453674.2024.40709
Brodén C, Olivecrona H, Maguire GQ Jr, Noz M E, Zeleznik M P, Sköldenberg O. Accuracy and precision of three-dimensional low dose CT compared to standard RSA in acetabular cups: an experimental study. Biomed Res Int 2016; 2016: 5909741. doi: 10.1155/2016/5909741. DOI: https://doi.org/10.1155/2016/5909741
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Copyright (c) 2026 Chan Hee Cho, John M Abrahams, Deepti K Sharma, Lucian B Solomon, Christopher J Wall, Bart G Pijls, Stuart A Callary
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