Is There a Difference in Revision Risk Between Metal and Ceramic Heads on Highly Crosslinked Polyethylene Liners?

Abstract

Background The most common bearing surface used among primary THAs worldwide is a metal or ceramic femoral head that articulates against a highly crosslinked ultrahigh-molecular-weight polyethylene (HXLPE) acetabular liner. Despite their widespread use, relatively little is known about the comparative effectiveness of ceramic versus metal femoral heads with respect to risk of revision and dislocation as well as the role of head size in this relationship. Questions/purposes The purpose of this study was to evaluate the risk of (1) all-cause revision in metal versus ceramic femoral heads when used with an HXLPE liner, including an evaluation of the effect of head size; and (2) dislocation in metal versus ceramic femoral heads when used with an HXLPE liner as well as an assessment of the effect of head size. Methods Data were collected as part of the Kaiser Permanente Total Joint Replacement Registry between 2001 and 2013. Patients in this study were on average overweight (body mass index = 29 kg/m 2 ), 67 years old, mostly female (57%), and had osteoarthritis (93%) as the primary indication for surgery. The material of the femoral head (metal, ceramic) was crossed with head size (\ 32, 32, 36, [ 36 mm), yielding eight device groupings. Only uncemented devices were evaluated. The primary outcome was all-cause revision (n = 28,772) and the secondary outcome was dislocation within 1 year (n = 19,623). Propensity Conclusions The results did not provide evidence for use of one femoral head material over another when used with HXLPE liners for the outcome of revision, but for dislocation, metal performed better than ceramic with \ 32-mm heads. Overall, the findings suggest increased risk of revision/dislocation with head sizes \ 32 mm. Level of Evidence Level III, therapeutic study.

Surgical research using national databases

“…These databases should not be confused with smaller registries that typically collect data prospectively for a particular diagnosis (diabetes) or procedure (joint replacement) (7,8). While smaller registries often record disease or procedure-specific outcomes such as functional scores, patient-satisfaction, and radiographic reports; largevolume databases contain more generalized information such as demographics, comorbidities, cost, length of stay, as well as procedure and diagnosis codes.…”

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

“…9 , 14 , 32 However, other studies have shown no difference in all-cause revision between ceramic and metal (CoCr) heads when used in combination with a highly cross-linked liner. 33 While theoretical models comparing cost of metal toxicity work-up in the US health care system may justify a switch to ceramic heads, this has remained theoretical. 34 Because there can be a significant cost differential with ceramic (compared to metal) heads, a wholesale switch to ceramic femoral heads to decrease the risk of corrosion may not be justified as this may result in an economic burden to socialized health-care systems.…”

Acetabulum Protrusion Following Ceramic Liner Fracture: A Case Report

“…Hip arthroplasty is being applied at increasing frequency worldwide. Various materials are used to prolong the survival of the components in parallel with increasing human life expectancy 2 , 3 . In hip arthroplasty applications throughout the world, there is an increasing frequency of selection of ceramic head and ceramic liner as osteolysis occurs at a lower rate and at a later stage 1 .…”

“…In hip arthroplasty applications throughout the world, there is an increasing frequency of selection of ceramic head and ceramic liner as osteolysis occurs at a lower rate and at a later stage 1 . Fracture is one of the most commonly observed complications in patients where ceramic materials are used 2 . However, new ceramic materials are more resistant 1 .…”