Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics

Abstract

Objectives To compare 10 year mortality rates among patients undergoing metal-on-metal hip resurfacing and total hip replacement in England.Design Retrospective cohort study.Setting English hospital episode statistics database linked to mortality records from the Office for National Statistics.Population All adults who underwent primary elective hip replacement for osteoarthritis from April 1999 to March 2012. The exposure of interest was prosthesis type: cemented total hip replacement, uncemented total hip replacement, and metal-on-metal hip resurfacing. Confounding variables included age, sex, Charlson comorbidity index, rurality, area deprivation, surgical volume, and year of operation.Main outcome measures All cause mortality. Propensity score matching was used to minimise confounding by indication. Kaplan-Meier plots estimated the probability of survival up to 10 years after surgery. Multilevel Cox regression modelling, stratified on matched sets, described the association between prosthesis type and time to death, accounting for variation across hospital trusts.Results 7437 patients undergoing metal-on-metal hip resurfacing were matched to 22 311 undergoing cemented total hip replacement; 8101 patients undergoing metal-on-metal hip resurfacing were matched to 24 303 undergoing uncemented total hip replacement. 10 year rates of cumulative mortality were 271 (3.6%) for metal-on-metal hip resurfacing versus 1363 (6.1%) for cemented total hip replacement, and 239 (3.0%) for metal-on-metal hip resurfacing versus 999 (4.1%) for uncemented total hip replacement. Patients undergoing metal-on-metal hip resurfacing had an increased survival probability (hazard ratio 0.51 (95% confidence interval 0.45 to 0.59) for cemented hip replacement; 0.55 (0.47 to 0.65) for uncemented hip replacement). There was no evidence for an interaction with age or sex.Conclusions Patients with hip osteoarthritis undergoing metal-on-metal hip resurfacing have reduced mortality in the long term compared with those undergoing cemented or uncemented total hip replacement. This difference persisted after extensive adjustment for confounding factors available in our data. The study results can be applied to matched populations, which exclude patients who are very old and have had complex total hip replacements. Although residual confounding is possible, the observed effect size is large. These findings require validation in external cohorts and randomised clinical trials. IntroductionTotal hip replacement was introduced in the 1960s and has developed into one of the most successful treatments in modern medicine. [1] [2] Historically, the operation involves replacingCorrespondence to: A Carr andrew.carr@ndorms.ox.ac.uk Extra material supplied by the author (see

The risk of cardiac failure following metal-on-metal hip arthroplasty

“…15,16 The findings have, however, been inconsistent. 13,17,18 The symptoms and signs of cardiac failure are common in patients undergoing total hip arthroplasty (THA) and any association between the type of prosthesis and cardiac failure presenting at a later date, and usually to a different clinician, could easily be overlooked. 19 Record-linkage studies have been used to investigate the relationship between death due to cancer in patients who have undergone MoM THA, concluding that there is no increased risk.…”

Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up

“…A recent analysis of registry data demonstrated a significantly lower mortality rate following BHR compared with uncemented and cemented THR in men of all ages [40]. These findings were subsequently independently confirmed in both male and female patients by an analysis of data from the English Hospital Episode Statistics database and Office for National Statistics [41].…”

Einfluss von Registern auf die Versorgungsqualität

“…1. Umso überraschender waren spätere Beobachtungen, dass auch nach multivariater Adjustierung ein Oberflächenersatz mit Metall-Metall-Paarungen im Vergleich zu einer zementierten Totalendoprothese (TEP) mit höheren 10-JahresÜberlebensraten vergesellschaftet war [10].…”

“…a Ergebnisse des australischen Endoprothesenregisters, b Ergebnisse des Endoprothesenregisters in England und Wales[10] ter von der Unfallstelle über den Eintritt in die Klinik, die operative und intensivmedizinische Behandlung bis hin zur Entlassung dokumentiert. Das Engagement der Initiatoren, späteren und aktuell Verantwortlichen kann nicht genug betont werden.Tatsächlich gewinnen Register insbesondere für die Zulassung neuer Medizinprodukte eine zunehmend wichtigere Bedeutung.…”