A prospective randomised controlled trial comparing three alternative bearing surfaces in primary total hip replacement

Abstract

The ideal bearing surface for young patients undergoing total hip replacement (THR) remains controversial. We report the five-year results of a randomised controlled trial comparing the clinical and radiological outcomes of 102 THRs in 91 patients who were < 65 years of age. These patients were randomised to receive a cobalt-chrome on ultra-high-molecular-weight polyethylene, cobalt-chrome on highly cross-linked polyethylene, or a ceramic-on-ceramic bearing. In all, 97 hip replacements in 87 patients were available for review at five years. Two hips had been revised, one for infection and one for peri-prosthetic fracture. At the final follow-up there were no significant differences between the groups for the mean Western Ontario and McMaster Universities osteoarthritis index (pain, p = 0.543; function, p = 0.10; stiffness, p = 0.99), Short Form-12 (physical component, p = 0.878; mental component, p = 0.818) or Harris hip scores (p = 0.22). Radiological outcomes revealed no significant wear in the ceramic group. Comparison of standard and highly cross-linked polyethylene, however, revealed an almost threefold difference in the mean annual linear wear rates (0.151 mm/year versus 0.059 mm/year, respectively) (p < 0.001).

Mid-term survivorship and clinical outcomes of cobalt-chrome and oxidized zirconium on highly crosslinked polyethylene

“…17 More recently, cobalt-chrome has demonstrated reduced wear rates using this bearing surface, and highly crosslinked polyethylene has been recommended for younger patients undergoing total hip arthroplasty. [29][30][31][32] Our study demonstrates that excellent clinical outcomes are achievable with cobalt-chrome and oxidized zirconium femoral head articulations on a highly crosslinked polyethylene liner.…”

How Have Alternative Bearings and Modularity Affected Revision Rates in Total Hip Arthroplasty?

“…In general, the use of both modularity and alternative bearings increases implant costs. With questions being raised concerning corrosion of modular taper junctions and use of some hard-on-hard bearings increasing the risk of complications, we sought to answer the question of whether either of these implant design features has produced improvements in the survivorship or risk of revision at 5 years or longer after the index procedure [9,10,15,16,22,25,27,32,33,36,42,46,50,52,60,69,77]. In general, both alternative bearings and modularity showed no evidence of improvements in survivorship in either the literature or registry reports.…”

“…However, some metal-on-metal (MoM) THA designs have been associated with premature revisions related to acute local reactions and high systemic metal ion levels, and reports of ceramic component breakage and squeaking have raised questions about the cost-benefit balance with those implants as well [10,16,32,33,36,38,50,52,60,66,69,77].…”

There Are No Differences in Short- to Mid-term Survivorship Among Total Hip-bearing Surface Options: A Network Meta-analysis

“…At both stages of selection, we estimated chance-adjusted agreement statistics among reviewers with a j statistic (j = 0.917 for abstract review; j = 1.000 for full-text review), and all disagreements were settled by the opinion of a third senior reviewer (GAN-M). Eleven articles [2,4,5,8,14,22,28,33,40,41,49] were deemed eligible through this process and seven studies [9,[16][17][18][19][20][21] were added following a manual search of the bibliographies of the 11 chosen articles for a final study cohort of 18 manuscripts (Fig. 1).…”

“…We contacted the corresponding author from one report that required data clarification, which was provided after the first attempt [41]. This RCT compared three implant types (CoC, MoPxl, MoPc) and had two patients revised but did not specify which treatment arm was revised.…”