Association Between Total Hip Replacement Characteristics and 3-Year Prosthetic Survivorship: A Population-Based Study.
OBJECTIVE
Total hip replacement (THR) is successful in treating hip arthritis. Prosthetic survivorship may depend on characteristics of the implant, notably THR fixation technique and bearing surface type.


OBJECTIVE
To compare THR short-term survivorship according to cement type and bearing surface.


METHODS
The cohort included all French patients aged 40 years or older covered by the general scheme of the French national health insurance system who had undergone THR from April 1, 2010, through December 31, 2011, for arthritis, according to French national health insurance databases. The cohort was followed up until December 31, 2013. The THR survivorship was assessed according to cement type and bearing surface in univariate and multivariate Cox proportional hazards regression models adjusted for patient and implanting center characteristics.


METHODS
Antibiotic-free cemented THRs and antibiotic-impregnated cemented THRs were compared with uncemented THRs. Ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP), and metal-on-metal (MoM) THRs were compared with metal-on-polyethylene (MoP) THRs.


METHODS
Revision, including any surgical reintervention in which the implant or any of its components was changed or removed.


RESULTS
The study cohort comprised 100 191 individuals: mean age at baseline, 69.5 years; women, 56.6%; uncemented THR, 74.8%; antibiotic-free cemented THR, 3.8%; antibiotic-impregnated cemented THR, 21.4%; CoC, 40.9%; MoP, 33.9%; CoP, 20.8%; and MoM, 4.4%. During the median 33-month follow-up period, 3142 individuals underwent prosthetic revision. Antibiotic-impregnated cemented THRs had a better prognosis than uncemented THRs: cumulative revision rates were 2.4% and 3.3%, respectively (P < .001), and the multivariate adjusted hazard ratio was 0.75 (95% CI, 0.67-0.84; P < .001). This association was particularly significant in women. The CoP and CoC THRs were no different from the MoP THR. The MoM THR had slightly shorter survivorship compared with the MoP THR (adjusted hazard ratio, 1.20; 95% CI, 1.01-1.43; P < .001).


CONCLUSIONS
Characteristics of THR are related to early prosthetic revision: antibiotic-impregnated cemented THRs have a better prognosis and MoM THRs a worse one. These findings are useful in helping surgeons select a THR fixation technique and helpful for both patient and surgeon in the decision-making process.
Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France.
Sandrine
S
Colas
Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France.
Cédric
C
Collin
Department of Health Science, University Simone Veil, Saint-Quentin-en-Yvelines, France.
Philippe
P
Piriou
Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France.
Mahmoud
M
Zureik
D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D001843:Bone Cements; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D013997:Time Factors
D001843:Bone Cements