TY - JOUR

T1 - Does choice of bearings influence the survival of cement-less total hip arthroplasty in patients aged 20–55 years? Comparison of 21,594 patients reported to the Nordic Arthroplasty Register Association dataset 2005–2017

AU - Mikkelsen, Rasmus Tyrsted

AU - Overgaard, Søren

AU - Pedersen, Alma B.

AU - Kärrholm, Johan

AU - Rolfson, Ola

AU - Fenstad, Anne Marie

AU - Furnes, Ove

AU - Hallan, Geir

AU - Mäkelä, Keijo

AU - Eskelinen, Antti

AU - Varnum, Claus

N1 - Funding Information: This study was approved by the Record of Data Processing Activities in the Region of Southern Denmark, journal number 19/48212. The ethical approval for the NARA dataset was approved by the appointed authorities in each country: the Swedish Ethical Review Authority (Dnr: 1184-18/2019-00812), the Finnish National Institute of Health and Welfare (Dnro THL/1743/5.05.00/2014), the Norwegian Data Inspectorate (ref 24.1.2017: 16/01622-3/CDG and Ethical approval 2015/880/REK Vest), and the Danish Data protection agency (1-16-02-54-17). We acknowledge support from the Region of Southern Denmark (grant number 20/14821), which had no role in the study design, data collection and analysis, or in the preparation of the manuscript. The authors of this study have no conflicts of interest related to this study. Completed disclosure forms for this article following the ICMJE template are available on the article page, doi: 10.2340/17453674.2023.13384 Publisher Copyright: © 2023 The Author(s).

PY - 2023

Y1 - 2023

N2 - Background and purpose — The bearings with the best survivorship for young patients with total hip arthroplasty (THA) should be identified. We compared hazard ratios (HR) of revision of primary stemmed cementless THAs with metal-on-metal (MoM), ceramic-on-ceramic (CoC), and ceramic-on-highly-crosslinked-polyethylene (CoXLP) with that of metal-on-highly-crosslinked-polyethylene (MoXLP) bearings in patients aged 20–55 years with primary osteoar-thritis or childhood hip disorders. Patients and methods — From the Nordic Arthroplasty Register Association dataset we included 1,813 MoM, 3,615 CoC, 5,947 CoXLP, and 10,219 MoXLP THA in patients operated on between 2005 and 2017 in a prospective cohort study. We used the Kaplan–Meier estimator for THA sur-vivorship and Cox regression to estimate HR of revision adjusted for confounders (including 95% confidence intervals [CI]). MoXLP was used as reference. HRs were calcu-lated during 3 intervals (0–2, 2–7, and 7–13 years) to meet the assumption of proportional hazards. Results — Median follow-up was 5 years for MoXLP, 10 years for MoM, 6 years for CoC, and 4 years for CoXLP. 13-year Kaplan–Meier survival estimates were 95% (CI 94–95) for MoXLP, 82% (CI 80–84) for MoM, 93% (CI 92–95) for CoC, and 93% (CI 92–94) for CoXLP bearings. MoM had higher 2–7 and 7–13 years’ adjusted HRs of revi-sion (3.6, CI 2.3–5.7 and 4.1, CI 1.7–10). MoXLP, CoC, and CoXLP had similar HRs in all 3 periods. The 7–13-year adjusted HRs of revision of CoC and CoXLP were statisti-cally non-significantly higher. Conclusion — In young patients, MoXLP for primary cementless THA had higher revision-free survival and lower HR for revision than MoM bearings. Longer follow-up is needed to compare MoXLP, CoC, and CoXLP.

AB - Background and purpose — The bearings with the best survivorship for young patients with total hip arthroplasty (THA) should be identified. We compared hazard ratios (HR) of revision of primary stemmed cementless THAs with metal-on-metal (MoM), ceramic-on-ceramic (CoC), and ceramic-on-highly-crosslinked-polyethylene (CoXLP) with that of metal-on-highly-crosslinked-polyethylene (MoXLP) bearings in patients aged 20–55 years with primary osteoar-thritis or childhood hip disorders. Patients and methods — From the Nordic Arthroplasty Register Association dataset we included 1,813 MoM, 3,615 CoC, 5,947 CoXLP, and 10,219 MoXLP THA in patients operated on between 2005 and 2017 in a prospective cohort study. We used the Kaplan–Meier estimator for THA sur-vivorship and Cox regression to estimate HR of revision adjusted for confounders (including 95% confidence intervals [CI]). MoXLP was used as reference. HRs were calcu-lated during 3 intervals (0–2, 2–7, and 7–13 years) to meet the assumption of proportional hazards. Results — Median follow-up was 5 years for MoXLP, 10 years for MoM, 6 years for CoC, and 4 years for CoXLP. 13-year Kaplan–Meier survival estimates were 95% (CI 94–95) for MoXLP, 82% (CI 80–84) for MoM, 93% (CI 92–95) for CoC, and 93% (CI 92–94) for CoXLP bearings. MoM had higher 2–7 and 7–13 years’ adjusted HRs of revi-sion (3.6, CI 2.3–5.7 and 4.1, CI 1.7–10). MoXLP, CoC, and CoXLP had similar HRs in all 3 periods. The 7–13-year adjusted HRs of revision of CoC and CoXLP were statisti-cally non-significantly higher. Conclusion — In young patients, MoXLP for primary cementless THA had higher revision-free survival and lower HR for revision than MoM bearings. Longer follow-up is needed to compare MoXLP, CoC, and CoXLP.

U2 - 10.2340/17453674.2023.13384

DO - 10.2340/17453674.2023.13384

M3 - Journal article

C2 - 37291896

AN - SCOPUS:85163205614

VL - 94

SP - 266

EP - 273

JO - Acta Orthopaedica

JF - Acta Orthopaedica

SN - 1745-3674

ER -