Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2010 Sep;468(9):2357-62.
doi: 10.1007/s11999-010-1262-3.

Risk of complication and revision total hip arthroplasty among Medicare patients with different bearing surfaces

Kevin J Bozic  1 , Kevin Ong, Edmund Lau, Steven M Kurtz, Thomas P Vail, Harry E Rubash, Daniel J Berry
Affiliations
Comparative Study

Risk of complication and revision total hip arthroplasty among Medicare patients with different bearing surfaces

Kevin J Bozic et al. Clin Orthop Relat Res. 2010 Sep.

Abstract

Background: To address the long-term problems of bearing surface wear and osteolysis associated with conventional metal-polyethylene (M-PE) total hip arthroplasty (THA), metal-metal (M-M), and ceramic-ceramic (C-C) bearings have been introduced. These bearing surfaces are associated with unique risks and benefits and higher costs. However the relative risks of these three bearings in an older population is unknown.

Questions/purposes: We compared the short-term risk of complication and revision THA among Medicare patients having a primary THA with metal-polyethylene (M-PE), metal-metal (M-M), and ceramic-ceramic (C-C) bearings.

Methods: We used the 2005 to 2007 100% Medicare inpatient claim files to perform a matched cohort analysis in three separate cohorts of THA patients (M-PE, M-M, and C-C) who were matched by age, gender, and US census region. Multivariate Cox proportional-hazards models were constructed to compare complication and revision THA risk among cohorts, adjusting for medical comorbidities, race, socioeconomic status, and hospital factors.

Results: After adjusting for patient and hospital factors, M-M bearings were associated with a higher risk of periprosthetic joint infection (hazard ratio, 3.03; confidence interval, 1.02-9.09) when compared with C-C bearings (0.59% versus 0.32%, respectively). There were no other differences among bearing cohorts in the adjusted risk of revision THA or any other complication.

Conclusions: The risk of short-term complication (including dislocation) and revision THA were similar among appropriately matched Medicare THA patients regardless of bearing surface. Hard-on-hard THA bearings are of questionable value in Medicare patients, given the higher cost associated with their use and uncertain long-term benefits in older patients.

Level of evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
The bearing surface frequency in Medicare THA patients by age is shown.
Fig. 2
Fig. 2
The bearing surface frequency in Medicare THA patients by gender is shown.
Fig. 3
Fig. 3
The bearing surface frequency in Medicare THA patients by US census region is shown.
Fig. 4
Fig. 4
This graph shows trends of higher overall rates of DVT for M-M versus C-C bearings (unadjusted). (T) = percentage of patients without the complication (DVT) at the given time points.
Fig. 5
Fig. 5
This graph shows trends of higher overall rates of revision for M-M versus C-C bearings (unadjusted). (T) = percentage of patients without the complication (revision) at the given time points.
See this image and copyright information in PMC

References

    1. Agency for Healthcare Research and Quality. HCUP Databases. Healthcare Cost and Utilization Project (HCUP). 2007. Available at: http://hcupnet.ahrq.gov/. Accessed January 9, 2009.
    1. Australian Orthopaedic Association National Joint Replacement Registry Web site. Hip and Knee Arthroplasty. Annual Report 2009. Available at: http://www.dmac.adelaide.edu.au/aoanjrr/publications.jsp. Accessed January 9, 2009.
    1. Berger RA, Jacobs JJ, Quigley LR, Rosenberg AG, Galante JO. Primary cementless acetabular reconstruction in patients younger than 50 years old. 7- to 11-year results. Clin Orthop Relat Res. 1997;344:216–226. doi: 10.1097/00003086-199711000-00022. - DOI - PubMed
    1. Berry DJ, Harmsen WS, Cabanela ME, Morrey BF. Twenty-five-year survivorship of two thousand consecutive primary Charnley total hip replacements: factors affecting survivorship of acetabular and femoral components. J Bone Joint Surg Am. 2002;84:171–177. - PubMed
    1. Berry DJ, von Knoch M, Schleck CD, Harmsen WS. The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am. 2004;86:9–14. - PubMed

Publication types

MeSH terms