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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 12/2014

01-12-2014 | Symposium: ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements

How Have Alternative Bearings and Modularity Affected Revision Rates in Total Hip Arthroplasty?

Authors: William M. Mihalko, MD, PhD, Markus A. Wimmer, PhD, Carol A. Pacione, BS, Michel P. Laurent, PhD, Robert F. Murphy, MD, Carson Rider, BS

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2014

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Abstract

Background

Total hip arthroplasty (THA) continues to be one of the most successful surgical procedures in the medical field. However, over the last two decades, the use of modularity and alternative bearings in THA has become routine. Given the known problems associated with hard-on-hard bearing couples, including taper failures with more modular stem designs, local and systemic effects from metal-on-metal bearings, and fractures with ceramic-on-ceramic bearings, it is not known whether in aggregate the survivorship of these implants is better or worse than the metal-on-polyethylene bearings that they sought to replace.

Questions/purposes

Have alternative bearings (metal-on-metal and ceramic-on-ceramic) and implant modularity decreased revision rates of primary THAs?

Methods

In this systematic review of MEDLINE and EMBASE, we used several Boolean search strings for each topic and surveyed national registry data from English-speaking countries. Clinical research (Level IV or higher) with ≥ 5 years of followup was included; retrieval studies and case reports were excluded. We included registry data at ≥ 7 years followup. A total of 32 studies (and five registry reports) on metal-on-metal, 19 studies (and five registry reports) on ceramic-on-ceramic, and 20 studies (and one registry report) on modular stem designs met inclusion criteria and were evaluated in detail. Insufficient data were available on metal-on-ceramic and ceramic-on-metal implants, and monoblock acetabular designs were evaluated in another recent systematic review so these were not evaluated here.

Results

There was no evidence in the literature that alternative bearings (either metal-on-metal or ceramic-on-ceramic) in THA have decreased revision rates. Registry data, however, showed that large head metal-on-metal implants have lower 7- to 10-year survivorship than do standard bearings. In THA, modular exchangeable femoral neck implants had a lower 10-year survival rate in both literature reviews and in registry data compared with combined registry primary THA implant survivorship.

Conclusions

Despite improvements in implant technology, there is no evidence that alternative bearings or modularity have resulted in decreased THA revision rates after 5 years. In fact, both large head metal-on-metal THA and added modularity may well lower survivorship and should only be used in select cases in which the mission cannot be achieved without it. Based on this experience, followup and/or postmarket surveillance studies should have a duration of at least 5 years before introducing new alternative bearings or modularity on a widespread scale.
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Metadata
Title
How Have Alternative Bearings and Modularity Affected Revision Rates in Total Hip Arthroplasty?
Authors
William M. Mihalko, MD, PhD
Markus A. Wimmer, PhD
Carol A. Pacione, BS
Michel P. Laurent, PhD
Robert F. Murphy, MD
Carson Rider, BS
Publication date
01-12-2014
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 12/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-014-3816-2

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