title: 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).
authors.affiliation: St Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1WB, Canada. vassilios.nikolaou@gmail.com
authors.forename: V S
authors.initials: VS
authors.lastname: Nikolaou
authors.forename: M R
authors.initials: MR
authors.lastname: Edwards
authors.forename: E
authors.initials: E
authors.lastname: Bogoch
authors.forename: E H
authors.initials: EH
authors.lastname: Schemitsch
authors.forename: J P
authors.initials: JP
authors.lastname: Waddell
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods; D002516:Ceramics; D002857:Chromium; D003035:Cobalt; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D020959:Polyethylene; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002857:Chromium; D003035:Cobalt; D020959:Polyethylene