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

Abstract

Background Total hip arthroplasty (THA) continues to be one of the most successful surgical procedures in the medical field. However, over the last two decades, the use of modularity and alternative bearings in THA has become routine. Given the known problems associated with hardon-hard bearing couples, including taper failures with more modular stem designs, local and systemic effects from metal-on-metal bearings, and fractures with ceramic-onceramic bearings, it is not known whether in aggregate the survivorship of these implants is better or worse than the metal-on-polyethylene bearings that they sought to replace. Questions/purposes Have alternative bearings (metal-onmetal and ceramic-on-ceramic) and implant modularity decreased revision rates of primary THAs?Methods In this systematic review of MEDLINE and EMBASE, we used several Boolean search strings for each topic and surveyed national registry data from Englishspeaking countries. Clinical research (Level IV or higher) with C 5 years of followup was included; retrieval studies and case reports were excluded. We included registry data at C 7 years followup. A total of 32 studies (and five registry reports) on metal-on-metal, 19 studies (and five registry reports) on ceramic-on-ceramic, and 20 studies (and one registry report) on modular stem designs met inclusion criteria and were evaluated in detail. Insufficient data were available on metal-on-ceramic and ceramic-onmetal implants, and monoblock acetabular designs were evaluated in another recent systematic review so these were not evaluated here.One of the authors (WMM) receives royalty payments, during the study period, an amount of USD 10,000 to USD 100,000 from B Braun/Aesculap Inc (Center Valley, PA, USA) and less than USD 10,000 from Elsevier Inc (Philadelphia, PA, USA); receives USD 10,000 to USD 100,000 as a consultant for B Braun/Aesculap Inc and less than USD 10,000 from Medtronic Inc (Memphis, TN, USA); receives research funding, during the study period, an amount of less than USD 10,000 from B Braun/Aesculap Inc and less than USD 10,000 Stryker Inc (Mahwah, NJ, USA); and serves on the editorial boards for the Journal of Arthroplasty, The Knee, the International Journal of Orthopaedics, and The Journal of Long Term Effects of Medical Implants. One of the authors (MAW) receives institutional funding in the amount of less than USD 10,000 from Biomet, Inc (Warsaw, IN, USA), USD 10,000 to USD 100,000 from CeramTec GmbH (Lauf, Germany), and material support from Zimmer Inc (Warsaw, Inc, USA) and B Braun/Aesculap AG. He is an unpaid consultant for Endolab GmbH and a paid consultant receiving an amount of less than USD 10,000 from Irwing Fritche Urquhart & Moore LLC (New Orleans, LA, USA). One of the authors (MPL) owns Zimmer Holdings, Inc stock but received no payments during the study period. Results There was no evidence in the literature that alternative bearings (either metal-on-metal or ceramic-onceramic) in THA have decreased revision rates. Registry data, however, showed that large he...

Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty

“…The rates of survival have been reported from 92% to 100% at 5 years and 82% to 100% at 10 years [1,13,30,40]. The most common indications for revision of MoM hips include adverse local tissue reaction (ALTR), aseptic loosening of the acetabular component, infection, and persistent groin pain [7].…”

The effect of contact load on CoCrMo wear and the formation and retention of tribofilms

“…A steadily growing patient population, being younger of age at the time of surgery and having increased activity demands, did raise the proportion of so-called ‘metal-on-metal’ (MoM) joints in hip arthroplasty during the last decade. Unfortunately, failure rates of some of these metal-on-metal (MoM) devices have been reportedly high [2–5], and many of these failures have been attributed to adverse local tissue reactions [6–8]. The high failure rates and the – in some cases – drastic soft tissue reactions are unexpected since MoM hip arthroplasty has been in clinical use since the 1960s, and has often been cited as a low wearing alternative to conventional polyethylene.…”

“…The high failure rates and the – in some cases – drastic soft tissue reactions are unexpected since MoM hip arthroplasty has been in clinical use since the 1960s, and has often been cited as a low wearing alternative to conventional polyethylene. Particularly, the so-called second generation of MoM devices with a ‘small’ 28 mm diameter CoCr balls and matching, hemispherical cups functioned reasonably well over the years with good survival rates [5]. …”

Grave fraudulence in medical device research: a narrative review of the PIN seeding study for the Pinnacle hip system

“…Unfortunately, unscientific findings like those reported in the PIN Study can spread through the literature like ink in milk. According to the Web of Science as of July 2017, 27 publications directly cite PIN Study publications (Bernasek et al 2013;Burge et al 2015;Dhotare et al 2016;Greiner et al 2016;Hosny et al 2013;Klingenstein et al 2012Klingenstein et al , 2013Lainiala et al 2014;Langton et al 2016;Liudahl et al 2013;Lohmann et al 2013;Lombardi et al 2015;Maloney, Ha, and Miller 2015;Matharu et al 2014;Mihalko et al 2014;Plummer et al 2016;Reito et al 2016;Ricciardi et al 2016;Schmitz et al 2013;Singh et al 2013Singh et al , 2015Stihsen et al 2013;Stryker et al 2015;Tsukagoshi et al 2015;Tvermoes et al 2015;Wagner et al 2012;Wyles et al 2014). J&J/DePuy also included PIN Study publications in their 2012 presentation to the FDA on the safety of Metal-on-Metal hip implants, suggesting the potential for mismanaged and manipulated seeding trials to influence regulatory decision making (Voorhorst 2012).…”