Choice of Bearings Influences the Implant Survival of Total Hip Arthroplasty in Patients Who Have Osteoarthritis Aged 55 Years or More: Results of 158,044 Patients from the Nordic Arthroplasty Register Association from 2005 to 2017

Oskari Pakarinen; Ville Ponkilainen; Claus Varnum; Alma B Pedersen; Søren Overgaard; Johan Kärrholm; Ola Rolfson; Anne Marie Fenstad; Ove Furnes; Geir Hallan; Keijo Mäkelä; Antti Eskelinen

doi:10.1016/j.arth.2024.08.015

Choice of Bearings Influences the Implant Survival of Total Hip Arthroplasty in Patients Who Have Osteoarthritis Aged 55 Years or More: Results of 158,044 Patients from the Nordic Arthroplasty Register Association from 2005 to 2017

J Arthroplasty. 2024 Aug 20:S0883-5403(24)00838-6. doi: 10.1016/j.arth.2024.08.015. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland. Electronic address: oskari.pakarinen@gmail.com.
² Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland.
³ Department of Orthopedic Surgery, Lillebaelt Hospital - Vejle, University Hospital of Southern Denmark, Denmark; Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark; The Danish Hip Arthroplasty Register.
⁴ Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
⁵ The Danish Hip Arthroplasty Register; Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark; University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Denmark.
⁶ Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Swedish Arthroplasty Register, Gothenburg, Sweden.
⁷ The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.
⁸ The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
⁹ Department of Orthopedics and Traumatology, Turku University Hospital, Turku, and University of Turku, Finland; The Finnish Arthroplasty Registry, Helsinki, Finland.
¹⁰ Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland.

PMID: 39173975
DOI: 10.1016/j.arth.2024.08.015

Abstract

Background: The aim of our study was to compare implant survival rates of different total hip arthroplasty (THA) bearings in the Nordic Arthroplasty Register Association.

Methods: All conventional primary THAs performed between 2005 and 2017 in patients over 55 years of age who had primary osteoarthritis were studied. Metal-on-highly crosslinked polyethylene (MoXLP), ceramic-on-highly crosslinked polyethylene (CoXLP), ceramic-on-ceramic (CoC), and metal-on-metal (MoM) bearings were included. The outcome was a revision. Kaplan-Meier (KM) estimates were calculated at 5 and 10 years. The risk for revision was analyzed using a flexible parametric survival model (FPSM) adjusted for nation, age, sex, femoral head size, and femoral fixation.

Results: A total of 158,044 THAs were included. The 5-year KM estimates were 95.9% (95% confidence interval [CI] 95.8 to 96.1) in MoXLP, 95.8% (95.6 to 96.1) in CoXLP, 96.7% (96.4 to 97.0) in CoC, and 93.9% (93.5 to 94.4) in MoM. The 10-year KM estimates were 94.2% (94.0 to 94.5) in MoXLP, 94.3% (93.9 to 94.8) in CoXLP, 95.4% (95.0 to 95.9) in CoC, and 85.5% (84.9 to 86.2) in MoM. Compared with MoXLP, the adjusted risk for revision was lower in CoC (hazard ratio [HR] 0.6, CI 0.5 to 0.6), similar in CoXLP (1.0, 0.9 to 1.0), and higher in MoM (1.3, 1.2 to 1.4).

Conclusions: We found that MoXLP, CoXLP, and CoC bearings evinced comparably high implant survival rates up to 10 years, and they can all be regarded as safe options in this patient group. The MoM bearings were associated with clearly lower survivorship. The CoC bearings had the highest implant survival and a lower adjusted risk for revision compared with XLP bearings.

Keywords: Bearing; Register Study; Revision; Survival; Total Hip Arthroplasty.