title: Comparative effectiveness of metal-on-metal and metal-on-polyethylene bearings in Medicare total hip arthroplasty patients.
abstract: The purpose of this study was to compare the risk of complication and revision total hip arthroplasty (THA) in Medicare THA patients with different bearings. Using the 100% Medicare database (2005-2009), the adjusted risk of complication and revision THA was calculated for 148,827 THA patients (93,929 metal-on-polyethylene, 49,646 metal-on-metal, 5252 ceramic-on ceramic). Adjusted risk of deep vein thrombosis, dislocation, periprosthetic joint infection (PJI), mechanical loosening, periprosthetic fracture, and revision THA at up to 4 years postoperatively was compared using Cox regression. After adjusting for patient and hospital factors, metal-on-metal bearings were associated with higher risk of PJI (P = .001), mechanical loosening (P < .001), and deep vein thrombosis (P = .031) than metal-on-polyethylene bearings and higher risk of PJI (P = .014) than ceramic-on-ceramic bearings. Overall short-term revision rates did not vary significantly across bearing types, consistent with registry data. The benefits of hard-on-hard bearings in Medicare patients remain unproven, and further study is needed to compare long-term complication and revision rates in Medicare THA patients with different bearing types.
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, MUW320, San Francisco, California 94143-0728, USA
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bozic
authors.forename: Edmund C
authors.initials: EC
authors.lastname: Lau
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Ong
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Vail
authors.forename: Harry E
authors.initials: HE
authors.lastname: Rubash
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Berry
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D006278:Medicare; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects; D020959:Polyethylene; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011474:Prosthesis Design / Q000009:adverse effects; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D014481:United States
chemical_list: D020959:Polyethylene