The association of bearing surface materials with the risk of revision following primary total hip replacement: A cohort analysis of 1,026,481 hip replacements from the National Joint Registry.
<h4>Background</h4>The risk of re-operation, otherwise known as revision, following primary hip replacement depends in part on the prosthesis implant materials used. Current performance evidences are based on a broad categorisation grouping together different materials with potentially v...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2024-11-01
|
| Series: | PLoS Medicine |
| Online Access: | https://doi.org/10.1371/journal.pmed.1004478 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850033566816141312 |
|---|---|
| author | Michael R Whitehouse Rita Patel Jonathan M R French Andrew D Beswick Patricia Navvuga Elsa M R Marques Ashley W Blom Erik Lenguerrand |
| author_facet | Michael R Whitehouse Rita Patel Jonathan M R French Andrew D Beswick Patricia Navvuga Elsa M R Marques Ashley W Blom Erik Lenguerrand |
| author_sort | Michael R Whitehouse |
| collection | DOAJ |
| description | <h4>Background</h4>The risk of re-operation, otherwise known as revision, following primary hip replacement depends in part on the prosthesis implant materials used. Current performance evidences are based on a broad categorisation grouping together different materials with potentially varying revision risks. We investigated the revision rate of primary total hip replacement (THR) reported in the National Joint Registry by specific types of bearing surfaces used.<h4>Methods and findings</h4>We analysed THR procedures across all orthopaedic units in England and Wales. All patients who received a primary THR between 2003 and 2019 in the public and private sectors were included. We investigated the all-cause and indication-specific risks of revision using flexible parametric survival analyses to estimate adjusted hazard ratios (HRs). We identified primary THRs with heads and monobloc cups or modular acetabular component THRs with head and shell/liner combinations. A total of 1,026,481 primary THRs were analysed (Monobloc: n = 378,979 and Modular: n = 647,502) with 20,869 (2%) of these primary THRs subsequently undergoing a revision episode (Monobloc: n = 7,381 and Modular: n = 13,488). For monobloc implants, compared to implants with a cobalt chrome head and highly crosslinked polyethylene (HCLPE) cup, the all-cause risk of revision for monobloc acetabular implant was higher for patients with cobalt chrome (hazard rate at 10 years after surgery: 1.28 95% confidence intervals [1.10, 1.48]) or stainless steel head (1.18 [1.02, 1.36]) and non-HCLPE cup. The risk of revision was lower for patients with a delta ceramic head and HCLPE cup implant, at any postoperative period (1.18 [1.02, 1.36]). For modular implants, compared to patients with a cobalt chrome head and HCLPE liner primary THR, the all-cause risk of revision for modular acetabular implant varied non-constantly. THRs with a delta ceramic (0.79 [0.73, 0.85]) or oxidised zirconium (0.65 [0.55, 0.77]) head and HCLPE liner had a lower risk of revision throughout the entire postoperative period. Similar results were found when investigating the indication-specific risks of revision for both the monobloc and modular acetabular implants. While this large, nonselective analysis is the first to adjust for numerous characteristics collected in the registry, residual confounding cannot be rule out.<h4>Conclusions</h4>Prosthesis revision is influenced by the prosthesis materials used in the primary procedure with the lowest risk for implants with delta ceramic or oxidised zirconium head and an HCLPE liner/cup. Further work is required to determine the association of implant bearing materials with the risk of rehospitalisation, re-operation other than revision, mortality, and the cost-effectiveness of these materials. |
| format | Article |
| id | doaj-art-84bf4c5a42ed4df4b77b6c433cca7334 |
| institution | DOAJ |
| issn | 1549-1277 1549-1676 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Medicine |
| spelling | doaj-art-84bf4c5a42ed4df4b77b6c433cca73342025-08-20T02:58:10ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762024-11-012111e100447810.1371/journal.pmed.1004478The association of bearing surface materials with the risk of revision following primary total hip replacement: A cohort analysis of 1,026,481 hip replacements from the National Joint Registry.Michael R WhitehouseRita PatelJonathan M R FrenchAndrew D BeswickPatricia NavvugaElsa M R MarquesAshley W BlomErik Lenguerrand<h4>Background</h4>The risk of re-operation, otherwise known as revision, following primary hip replacement depends in part on the prosthesis implant materials used. Current performance evidences are based on a broad categorisation grouping together different materials with potentially varying revision risks. We investigated the revision rate of primary total hip replacement (THR) reported in the National Joint Registry by specific types of bearing surfaces used.<h4>Methods and findings</h4>We analysed THR procedures across all orthopaedic units in England and Wales. All patients who received a primary THR between 2003 and 2019 in the public and private sectors were included. We investigated the all-cause and indication-specific risks of revision using flexible parametric survival analyses to estimate adjusted hazard ratios (HRs). We identified primary THRs with heads and monobloc cups or modular acetabular component THRs with head and shell/liner combinations. A total of 1,026,481 primary THRs were analysed (Monobloc: n = 378,979 and Modular: n = 647,502) with 20,869 (2%) of these primary THRs subsequently undergoing a revision episode (Monobloc: n = 7,381 and Modular: n = 13,488). For monobloc implants, compared to implants with a cobalt chrome head and highly crosslinked polyethylene (HCLPE) cup, the all-cause risk of revision for monobloc acetabular implant was higher for patients with cobalt chrome (hazard rate at 10 years after surgery: 1.28 95% confidence intervals [1.10, 1.48]) or stainless steel head (1.18 [1.02, 1.36]) and non-HCLPE cup. The risk of revision was lower for patients with a delta ceramic head and HCLPE cup implant, at any postoperative period (1.18 [1.02, 1.36]). For modular implants, compared to patients with a cobalt chrome head and HCLPE liner primary THR, the all-cause risk of revision for modular acetabular implant varied non-constantly. THRs with a delta ceramic (0.79 [0.73, 0.85]) or oxidised zirconium (0.65 [0.55, 0.77]) head and HCLPE liner had a lower risk of revision throughout the entire postoperative period. Similar results were found when investigating the indication-specific risks of revision for both the monobloc and modular acetabular implants. While this large, nonselective analysis is the first to adjust for numerous characteristics collected in the registry, residual confounding cannot be rule out.<h4>Conclusions</h4>Prosthesis revision is influenced by the prosthesis materials used in the primary procedure with the lowest risk for implants with delta ceramic or oxidised zirconium head and an HCLPE liner/cup. Further work is required to determine the association of implant bearing materials with the risk of rehospitalisation, re-operation other than revision, mortality, and the cost-effectiveness of these materials.https://doi.org/10.1371/journal.pmed.1004478 |
| spellingShingle | Michael R Whitehouse Rita Patel Jonathan M R French Andrew D Beswick Patricia Navvuga Elsa M R Marques Ashley W Blom Erik Lenguerrand The association of bearing surface materials with the risk of revision following primary total hip replacement: A cohort analysis of 1,026,481 hip replacements from the National Joint Registry. PLoS Medicine |
| title | The association of bearing surface materials with the risk of revision following primary total hip replacement: A cohort analysis of 1,026,481 hip replacements from the National Joint Registry. |
| title_full | The association of bearing surface materials with the risk of revision following primary total hip replacement: A cohort analysis of 1,026,481 hip replacements from the National Joint Registry. |
| title_fullStr | The association of bearing surface materials with the risk of revision following primary total hip replacement: A cohort analysis of 1,026,481 hip replacements from the National Joint Registry. |
| title_full_unstemmed | The association of bearing surface materials with the risk of revision following primary total hip replacement: A cohort analysis of 1,026,481 hip replacements from the National Joint Registry. |
| title_short | The association of bearing surface materials with the risk of revision following primary total hip replacement: A cohort analysis of 1,026,481 hip replacements from the National Joint Registry. |
| title_sort | association of bearing surface materials with the risk of revision following primary total hip replacement a cohort analysis of 1 026 481 hip replacements from the national joint registry |
| url | https://doi.org/10.1371/journal.pmed.1004478 |
| work_keys_str_mv | AT michaelrwhitehouse theassociationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT ritapatel theassociationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT jonathanmrfrench theassociationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT andrewdbeswick theassociationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT patricianavvuga theassociationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT elsamrmarques theassociationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT ashleywblom theassociationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT eriklenguerrand theassociationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT michaelrwhitehouse associationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT ritapatel associationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT jonathanmrfrench associationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT andrewdbeswick associationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT patricianavvuga associationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT elsamrmarques associationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT ashleywblom associationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry AT eriklenguerrand associationofbearingsurfacematerialswiththeriskofrevisionfollowingprimarytotalhipreplacementacohortanalysisof1026481hipreplacementsfromthenationaljointregistry |