title: Outcomes of Ceramic Bearings After Revision Total Hip Arthroplasty in the Medicare Population.
abstract: The purpose of this study was to analyze the utilization and outcomes of ceramic bearings used in revision total hip arthroplasty (R-THA) in the Medicare population.
  
  
  
  A total of 31,809 patients aged >65 years at the time of revision surgery who underwent R-THA between 2005 and 2013 were identified from the United States Medicare 100% national administrative claims database. Outcomes of interest included relative risk of readmission (90 days) or infection, dislocation, rerevision, or mortality at any time point after revision. Propensity scores were developed to adjust for selection bias in the choice of bearing type at revision surgery.
  
  
  
  The utilization of ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) bearings in R-THA increased from 5.3% to 26.6% and from 1.8% to 2.5% in between 2005 and 2013, respectively. For R-THA patients treated with C-PE bearings, there was reduced risk of 90-day readmission (hazard ratio, HR: 0.90, P = .007). We also observed a trend for reduced risk of infection with C-PE (HR: 0.88) that did not reach statistical significance (P = .14). For R-THA patients treated with COC bearings, there was reduced risk of dislocation (HR: 0.76, P = .04). There was no significant difference in risk of rerevision or mortality for either the C-PE or COC bearing cohorts when compared with the metal-on-polyethylene bearing cohort.
  
  
  
  Medicare patients treated in a revision scenario with ceramic bearings exhibit similar risk of rerevision, infection, or mortality as those treated with metal-on-polyethylene bearings. Conversely, we found an association between the use of specific ceramic bearings in R-THA and reduced risk of readmission (C-PE) and dislocation (COC).
authors.affiliation: Exponent, Inc, Philadelphia, Pennsylvania.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kurtz
authors.affiliation: Exponent, Inc, Menlo Park, California.
authors.forename: Edmund C
authors.initials: EC
authors.lastname: Lau
authors.affiliation: Exponent, Inc, Menlo Park, California.
authors.forename: Doruk
authors.initials: D
authors.lastname: Baykal
authors.affiliation: OrthoCarolina Hip and Knee Center, Charlotte, North Carolina.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Springer
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002516:Ceramics; D016208:Databases, Factual; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D006278:Medicare; D008670:Metals; D008875:Middle Aged; D020959:Polyethylene; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012086:Reoperation; D012306:Risk; D014481:United States
chemical_list: D008670:Metals; D020959:Polyethylene
keywords: ceramic bearings; dislocation; infection; mortality; readmission; revision total hip arthroplasty