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. 2018 Apr;89(2):163-169.
doi: 10.1080/17453674.2017.1405669. Epub 2017 Nov 21.

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

Rinne M Peters  1   2 , Liza N Van Steenbergen  3 , Martin Stevens  2 , Paul C Rijk  1 , Sjoerd K Bulstra  2 , Wierd P Zijlstra  1
Affiliations

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

Rinne M Peters et al. Acta Orthop. 2018 Apr.

Abstract

Background and purpose - Alternative 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 methods - Using 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. Results - After 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. Interpretation - We found a mid-term lower risk of revision for CoHXLPE, CoC, and Ox(HXL)PE bearings compared with traditional MoPE-bearing surfaces.

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Figures

Figure 1.
Figure 1.
Cumulative incidence of revision according to bearing type of THA in the Netherlands in the period 2007–2016.
Figure 2.
Figure 2.
Cumulative incidence of revision according to bearing type for patients aged younger than 60.
See this image and copyright information in PMC

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