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. 2021 Jul 9:10:51-56.
doi: 10.1016/j.artd.2021.05.017. eCollection 2021 Aug.

National Trends in Total Hip Arthroplasty Bearing Surface Usage in Extremely Young Patients Between 2006 and 2016

Christopher M Hart  1 , Clark Chen  2 , Peter P Hsiue  1 , Reza Farshchi  3 , Mauricio Silva  1 , Erik Zeegen  1 , Rachel Thompson  1 , Alexandra Stavrakis  1
Affiliations

National Trends in Total Hip Arthroplasty Bearing Surface Usage in Extremely Young Patients Between 2006 and 2016

Christopher M Hart et al. Arthroplast Today. .

Abstract

Background: Long-term implant durability is a key concern when considering total hip arthroplasty (THA) in young patients. The ideal bearing surface used in these patients remains unknown. The purpose of this study was to analyze trends in THA bearing surface use from 2006 to 2016 using a large, pediatric national database.

Methods: This was a retrospective review from January 1, 2006, to December 31, 2016, using the Kids' Inpatient Database. International Classification of Diseases, 9th revision and 10th revision codes were used to identify patients who underwent THA and create cohorts based on bearing surfaces: metal-on-metal, metal-on-polyethylene, ceramic-on-polyethylene (CoP), and ceramic-on-ceramic (CoC). Annual utilization of each bearing surface and associated patient and hospital demographics were analyzed.

Results: A total of 1004 THAs were identified during the 11-year study period. The annual number of THAs performed increased by 169% from 2006 to 2016. The mean patient age was 17.1 years. The most prevalent bearing surface used in 2006 was CoC (37.3%), metal-on-metal (31.8%) in 2009, and CoP in 2012 and 2016 (50.6% and 64.8%, respectively). From 2006 to 2016, utilization of CoP increased from 5.0% to 64.8%, representing a 1196% increase over the study period.

Conclusions: The number of THAs performed in pediatric patients is increasing significantly. Although CoC was previously the most commonly used bearing surface in this patient population, CoP is currently the most common. Further investigation is needed to determine whether bearing longevity and clinical outcomes with CoP are superior to other bearing surfaces.

Keywords: Bearing surface trends; Pediatric; Total hip arthroplasty.

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Figures

Figure 1
Figure 1
Flowchart of patient study population. Patients aged <21 years who underwent THA were separated into groups based on bearing types. Patients without bearing type designation were excluded.
Figure 2
Figure 2
Incidence of pediatric total hip arthroplasty 2006-2016. There was an overall 169% increase in the number of pediatric THA cases. The increase was statistically significant if P < .05 using the Cochran-Armitage trend test.
Figure 3
Figure 3
Indications over time for pediatric total hip arthroplasty: Avascular necrosis and osteoarthritis were the primary 2 causes for pediatric total hip arthroplasty. There was a decreased rate of avascular necrosis as reason for surgery over the study period.
Figure 4
Figure 4
Ratio of bearing type in pediatric total hip arthroplasty from 2006 to 2016. There was a 57% decrease in rate of MoP used as well as a 90% decrease in the rate of MoM used. There was a 1196% increase in the rate of CoP used. ∗Statistically significant if P < .05 using Cochran-Armitage trend test.
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