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. 2021 Sep 15;32(9):123.
doi: 10.1007/s10856-021-06598-4.

The influence of bearing surfaces on revisions due to dislocations in total hip arthroplasty

Francesco Castagnini  1 , Barbara Bordini  2 , Monica Cosentino  2 , Cristina Ancarani  2 , Federica Mariotti  3 , Federico Biondi  3 , Cesare Faldini  4   5 , Francesco Traina  5   6
Affiliations

The influence of bearing surfaces on revisions due to dislocations in total hip arthroplasty

Francesco Castagnini et al. J Mater Sci Mater Med. .

Abstract

Introduction: Recurrent dislocations are still the most frequent reason for revision in total hip arthroplasty (THA). The impact of bearing surfaces on dislocations is still controversial. We hypothesized that: (1) bearing surfaces influence the revisions due to dislocations; (2) ceramic-on-ceramic reduced the revisions for dislocations in adjusted models; (3) Delta-on-Delta bearings reduced the revisions for dislocations in comparison to surfaces with cross-linked polyethylene.

Materials and methods: The regional arthroplasty registry was enquired about bearing surfaces and revisions for dislocations and instability. Unadjusted and adjusted rates were provided, including sex, age (<65 years or ≥65 years), head diameter (≤28 mm or >28 mm; <36 mm or ≥36 mm) as variables. 44,065 THAs were included.

Results: The rate of revisions for dislocations was significantly lower in ceramic-on-ceramic and metal-on-metal bearings (unadjusted rates). After adjusting for age, sex, and head size (36 and 28 mm), hard-on-hard bearings were protective (p < 0.05): ceramic-on-ceramic had a lower risk of revisions due to dislocation than ceramic-on-polyethylene (HR 1.6, 95% CI 1.2-2.2 p = 0.0009). The rate of revisions for dislocation was similar in bearings with cross-linked polyethylene and Delta-on-Delta articulations, in unadjusted and adjusted models.

Conclusion: Bearings with conventional polyethylene were more predisposed to dislocations. Currently adopted bearings exerted no significant influence on revisions due to dislocations. These findings could be primarily related to wear, but due to the time distribution, soft tissue envelopes and surface tension may also play a role. Pre-clinical biomechanical evaluations and prospective matched cohort studies are required to draw definitive conclusions.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The Kaplan–Meier curves (endpoint: revisions due to recurrent dislocations and primary instability) showed that COC implants were significantly less prone to dislocations than COP THAs (unadjusted rates). COC: red line; COP: green line; MOM: blue line; MOP: orange line
Fig. 2
Fig. 2
Recent couplings did not show significant differences in terms of revision due to dislocation (Kaplan–Meier curves, endpoint: revisions due to recurrent dislocations and primary instability). Delta-on-Delta: red line. Delta-on-XLPE: green line. Metal-on-XLPE: blue line
See this image and copyright information in PMC

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