Ceramic bearings tied to reduced revision rate in Primary Hip Arthroplasty: Study

The study is published in the Journal of Arthroplasty.

Prosthetic joint infection (PJI) is a devastating complication. Studies have suggested reduction in PJI with the use of ceramic bearings.

Hence, Richard Holleyman and associates from the Newcastle University Institute of Cellular Medicine, Newcastle, UK carried out the present study to assess the association Ceramic bearings and revision rate in Primary Hip Arthroplasty.

Adult patients who underwent total hip arthroplasty (THA) using an uncemented acetabular component with ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP ) or metal-on-polyethylene (MoP) bearing surfaces were extracted from the National Joint Registry for England, Wales, Nortern Ireland and the Isle of Man.

A competing risk regression model to investigate predictors of each revision outcome was used. Time-to-event was determined by duration of implantation since primary surgery with competing risks being death or revision.

The results were adjusted for age, gender, American Association of Anaesthesiologists grade (ASA), Body Mass Index (BMI), surgical indication, intraoperative complications and implant data.

The findings highlighted were as follows-

a. 456,457 THA (228,786 MoP, 128,403 CoC and 99,268 CoP) were identified.

b. Multivariable modelling showed the risk of revision for PJI was significantly lower with CoC (Risk Ratio (RR) 0.748, p<0.001) and CoP (RR 0.775, p<0.001) compared to MoP.

c. Significant reduction in risk of aseptic and all cause revision was also seen.

d. The significant protective effect of ceramic bearing was predominantly seen two years after implantation.

d. Aseptic revision beyond two years reduced by 18.1% and 24.8% for CoC & CoP (p<0.001), respectively.

e. All cause revision rate beyond two years reduced by 21.6% for CoC & 27.1% for CoP (p<0.001).

Therefore, the authors concluded that "there is an association between the use of ceramic as part of the bearing, with lower rates of revision for all causes, revision for infection and revision for aseptic causes, supporting ceramic bearings in THA."