Total Hip Arthroplasty Bearing Surface Trends in the United States From 2007 to 2014: The Rise of Ceramic on Polyethylene

Heckmann, Nathanael; Sivasundaram, Lakshmanan; Stefl, Michael; Kang, Haeyoun; Basler, Eric T.; Lieberman, Jay R.

doi:10.1016/j.arth.2017.12.040

Cited by 39 publications

(30 citation statements)

References 31 publications

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“…Since that time, there has been a dramatic rise in the use of ceramic on polyethylene bearings in the United States, with ceramic on polyethylene bearings now surpassing metal on polyethylene bearings as the most popular bearing surface. 17 …”

Section: Discussionmentioning

confidence: 99%

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<p>Three Femoral Stem Designs Without Corrosion: A Review of 2095 Stems</p>

Naudie

Ndoja

Wood

et al. 2020

ORR

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Introduction Corrosion at the head–neck interface of modular components in total hip arthroplasty (THA) has been reported as a cause of failure of modern total hip replacement implants. While this method of failure has been well described, it remains poorly understood. The purpose of this study is to review the three most commonly used uncemented femoral stems at our institution over the last fifteen years and to correlate any established risk factors with rates of revision, particularly corrosion. Methods We reviewed 2095 patients from March 2000 to September 2015 who underwent total hip arthroplasty with one of three uncemented femoral stem designs. All stems were made of a Ti6Al4V alloy with a 12/14 taper design. We included only those stems coupled with a CoCr head and a highly crosslinked polyethylene liner. We evaluated age, gender, body mass index (BMI), femoral head size, head length, neck angle and offset and correlated these to the incidence of all cause revision, as well as revision excluding infection. Results There were no recognized corrosion-related revisions identified. There was no association between age, BMI, gender, head length, neck angle and offset to all cause revision or revision with infection excluded (p>0.05). Femoral head size less than 32mm was associated with higher all cause revision rates (OR 4.60 (95% CI 1.8, 11.8)) and when excluding infection as a reason for revision (OR 4.94 (95% CI 1.7, 14.41)). Conclusion Over the last fifteen years, we have not identified any cases of corrosion with the three most commonly used femoral stems used at out institution. While we acknowledge that no femoral stem is immune to corrosion, certain femoral stem designs may be uniquely resistant to this mode of failure. Level of Evidence III.

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Section: Discussionmentioning

confidence: 99%

“…9 – 14 There have also been reported trends of increased usage of ceramic heads, which may be less susceptible to trunnion corrosion, but more expensive in some health-care environments. 9 , 12 , 15 - 17 …”

Section: Introductionmentioning

confidence: 99%

<p>Three Femoral Stem Designs Without Corrosion: A Review of 2095 Stems</p>

Naudie

Ndoja

Wood

et al. 2020

ORR

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“…Often the implant costs are seen as a source for cost containment in the episode of care but with concerns of using MoP for trunnionosis and wear-related issues outside of the 90-day bundle, the use of CoP has seen an increase in utilization over the last 10 years. 5 Previous studies have demonstrated that the costs associated with CoP over MoP have been reduced over time and the use of CoP can be seen as cost-effective in the bundled payment era. 13,16 With concerns over ceramic fracture, the use of the OxZr bearing has seen an increase as a result.…”

Section: Discussionmentioning

confidence: 99%

“…4 As a result of the MoM failures, alternative bearing surfaces including metalon-polyethylene (MoP) and ceramic-on-polyethylene (CoP) have seen increases in utilization in recent years. 5 While MoP articulations may provide good results at midterm survival from a wear standpoint, recent reports of taper corrosion at the head-neck junction continue to surface. 6,7 Due to these concerns, the utilization of MoP articulations has seen a decrease while there has been an increase in utilization of CoP.…”

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confidence: 99%

“…6,7 Due to these concerns, the utilization of MoP articulations has seen a decrease while there has been an increase in utilization of CoP. 5 While improvements have been made to resist fracture, failures of the ceramic liners continue to exist even in the BIOLOX delta bearing articulation. 8 Oxidized zirconium (OxZr) heads were developed to help eliminate this fracture rate and also treat those patients with a nickel allergy needing joint replacement.…”

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confidence: 99%

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Can the Choice of Cementless Implants and Bearings during Total Hip Arthroplasty Have an Impact on the Overall Costs within a Bundled Payment Model?

Duncan

Delhougne

et al. 2020

The Journal of Hip Surgery

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The comprehensive care for joint replacement model from the Center for Medicare and Medicaid Services and similar programs from other payers make hospitals and health care systems more responsible for better clinical and economic outcomes of total hip arthroplasty (THA) patients. The objective of the study was to evaluate hospital-related clinical and economic outcomes of using the cementless R3 cup and Polarstem with an oxidized zirconium bearing compared with other cementless hip systems using a ceramic bearing in THA patients. We retrospectively reviewed primary THA patients from the premier perspective database between 2014 and 2018Q3. Patients with R3 cup and Polarstem with an oxidized zirconium bearing were identified using appropriate keywords from billing records and compared against cementless and ceramic-on-polyethylene (CoP) THA patients who did not meet the keywords' criteria. Patients were excluded if they were < 21 years of age; outpatient hospital discharges; evidence of revision THA; bilateral THA in same discharge or different discharges. 1:3 propensity score matching was used to control patients' demographic, clinical, and hospital characteristics. Generalized estimating equation model with appropriate distribution and link function was used to estimate hospital-related cost while logistic regression models were used to estimate discharged status, transfusion, and 30-days readmission. The study matched 818 R3/Polarstem with oxidized zirconium bearing patients with 2,454 CoP cementless THA patients. Length of stay for the R3/Polarstem patients (mean = 1.61 days; confidence interval [CI] = 1.41–1.80) was significantly lower (p-value ≤ 0.0001) than CoP THA patients (mean = 2.06 days; CI = 1.95–2.17). R3/Polarstem hip patients were 36% (odds ratio [OR] = 1.36; CI = 1.07–1.72; p-value = 0.0112) more likely to be discharged to home/home health care, 18% (OR = 0.82; CI = 0.63–1.06; p-value = 0.1235) less likely to be discharged to a skilled nursing facility (SNF), 84% less likely to have transfusion (OR = 0.16; CI = 0.09–0.29; p-value ≤ 0.0001), and 44% (OR = 0.56; CI = 0.32–0.98; p-value = 0.0412) less likely to readmitted within 30 days than CoP THA patients. Mean total hospital costs was marginally higher for R3/Polarstem patients (mean = $15,611; vs. $15,002; p-value = 0.0041) than CoP THA patients. While the total hospital costs for the R3/Polarstem was higher than CoP, the reduced length of stay, reduced discharge to SNF, and lower readmission rates can help to save money in the bundled payment and make the use of certain cementless hip systems a potential cost saving solution.

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