title: Risk of revision following total hip arthroplasty: metal-on-conventional polyethylene compared with metal-on-highly cross-linked polyethylene bearing surfaces: international results from six registries.
abstract: The results of randomized controlled trials and systematic reviews have suggested reduced radiographic wear in highly cross-linked polyethylene compared with conventional polyethylene in primary total hip arthroplasty. However, longer-term clinical results have not been thoroughly examined, to our knowledge. The purpose of this study was to compare the risk of revision for metal-on-conventional and metal-on-highly cross-linked total hip arthroplasty bearing surfaces with use of a distributed data network of six national and regional registries (Kaiser Permanente, HealthEast, the Emilia-Romagna region in Italy, the Catalan region in Spain, Norway, and Australia). Inclusion criteria were osteoarthritis as the primary diagnosis, cementless implant fixation, and a patient age of forty-five to sixty-four years. These criteria resulted in a sample of 16,571 primary total hip arthroplasties. Multivariate meta-analysis was performed with use of linear mixed models, with survival probability as the unit of analysis. The results of a fixed-effects model suggested that there was insufficient evidence of a difference in risk of revision between bearing surfaces (hazard ratio, 1.20 [95% confidence interval, 0.80 to 1.79]; p = 0.384). Highly cross-linked polyethylene does not appear to have a reduced risk of revision in this subgroup of total hip arthroplasty patients. Arthroplasties involving highly cross-linked polyethylene do not appear to have an increased risk of revision in this subgroup of total hip arthroplasty patients.
authors.affiliation: Surgical Outcomes & Analysis Department, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA 92108.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Paxton
authors.affiliation: Surgical Outcomes & Analysis Department, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA 92108.
authors.forename: Guy
authors.initials: G
authors.lastname: Cafri
authors.affiliation: The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Mollendalsbakken 11, N-5021 Bergen, Norway.
authors.forename: Leif
authors.initials: L
authors.lastname: Havelin
authors.affiliation: Register of the Orthopaedic Prosthetic Implants (RIPO), c/o Medical Technology Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Stea
authors.affiliation: Clínic de l'Aparell locomotor, Cap de servei de COT, Hospital de Santa Maria, Gestió de Serveis Sanitaris, Alcalde Rovira Roure, 44 Lleida, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Pallisó
authors.affiliation: Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Graves
authors.affiliation: Summit Orthopedics, 2090 Woodwinds Drive, St. Paul, MN 55125.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hoeffel
authors.affiliation: Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D011095:Polyethylenes; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals; D011095:Polyethylenes