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Analysis of multiple studies, registries finds no clear advantage for various hip replacement implants

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Art Sedrakyan

An FDA-funded data analysis of several hip replacement implants has found no clear advantage of one implant over another in terms of effectiveness. The findings were published in BMJ.

The analysis, spanning 3,139 patients bearing 3,404 replacement and hips enrolled in 18 comparative studies — as well as more than 830,000 surgeries in national registries — compared device effectiveness and quality of life for metal-on-metal, ceramic-on-ceramic, metal-on-polyethylene and ceramic-on-polyethylene bearings.

“Before any claims of benefit are made, there should be large, peer-reviewed clinical trials comparing these treatments,” study author Art Sedrakyan, MD, PhD, stated in a news release from the Weill Cornell Medical College. “Until then, national registries provide important real-world data that is critical for the safety and future comparative safety and effectiveness evaluation.”

According to the analysis, the authors found disease-specific functional outcomes and general quality of life scores across the various trials were either no different or favored those patients who received metal-on-polyethylene implants vs. those who received metal-on-metal implants. Mean age range for the patients included in the trials was 42 years to 71 years.

Although the overall results show no clear advantage, according to the release, the authors reported the data are complex.

Metal-on-metal implants were cited as being involved in fewer cases of dislocation for one clinical study, but the authors added that the three largest national registries, including more than 700,000 patients, all indicated metal-on-metal implants displayed higher rates of implant revision than those found in metal-on-polyethylene implants.

Ceramic-on-ceramic, when compared with metal-on-polyethylene, was found in one trial to be involved with fewer revisions — but the authors also noted national registry data did not support this finding.

The analysis did not summarize evidence related to metal sensitivity or toxicity because, according to the release, Sedrakyan noted its clinical relevance and implications on quality of life are currently being established.

Sedrakyan noted in the release that since the registries are not harmonized, the results are tentative and represent “an indication of what we hope to be a much more complete picture.”

Reference:

• Sedrakyan A, Normand ST, Dabic S, et al. Comparative assessment of implantable hip devices with different bearing surfaces: Systematic appraisal of evidence. BMJ. 2011. doi: 10.1136/bmj.d7434.

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