Ceramic-on-polyethylene showed higher revision rate vs metal-on-polyethylene THA implants
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Patients who underwent total hip arthroplasty with ceramic-on-polyethylene implants had a higher risk of revision compared with those who had metal-on-polyethylene implants, according to results presented at the Virtual EFORT Congress.
Claus Varnum, MD, PhD, and colleagues assessed implant survival and estimated the adjusted relative risk of revision among 310,000 patients who underwent primary THA between January 1995 and December 2015. Researchers separately analyzed ceramic-on-conventional polyethylene vs. metal-on-conventional polyethylene and ceramic-on-crosslinked polyethylene vs. metal-on-crosslinked polyethylene due to differences in follow-up.
In his presentation, which received the Bronze Award for Orthopedics, Varnum noted patients with ceramic-on-conventional polyethylene had a significant higher adjusted risk for any revision compared with patients with metal-on-conventional polyethylene.
“There was no difference in risk of revision due to aseptic loosening between the two bearing groups,” Varnum said.
He added no differences in relative risk for any revision or in risk of revision due to aseptic loosening between the ceramic- and metal-on-crosslinked polyethylene groups.
“In perspective, we found no good indication for the continuous use of ceramic-on-crosslinked polyethylene,” Varnum said.
Perspective
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Thomas P. Schmalzried, MD
Please note that only an abstract was available for review. The strength of this study is the large sampling from Scandinavian countries. As always, it is challenging to compare outcomes over 20 years where contributing surgeons, indications for surgery, surgical techniques and non-bearing technology evolve, in addition to widely variable lengths of follow-up. The significantly higher adjusted relative risk of ceramic-on-polyethylene due to periprosthetic fracture and dislocation is curious. With large data sets, a statistically significant difference may not represent a practical difference. As expected, it appears that crosslinked polyethylene is associated with improved survivorship regardless of femoral bearing material (presumably reduced osteolysis/aseptic loosening). Taper corrosion was not mentioned and may have been included in the “other” causes.
Regardless, in this Scandinavian experience, taper corrosion does not appear to be a major cause of revision (nor does ceramic head fracture). I suspect a predominance of cemented femoral fixation in this data set, which is opposite to that in the United States, and may influence the occurrence of taper corrosion, periprosthetic joint infection and periprosthetic fracture. Such detail may be available in the complete report.
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Varnum C, et al. Paper 2552. Presented at: Virtual EFORT Congress; Oct. 28-30, 2020.
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