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Outcomes of different bearings in total hip arthroplasty - implant survival, revision causes, and patient-reported outcome.

Abstract Total hip arthroplasty (THA) is a common and successful treatment of patients suffering from severe osteoarthritis that significantly reduces pain and improves hip function and quality of life. Traditionally, the outcome of THA has been evaluated by orthopaedic surgeons and assessed in morbidity and mortality rates, and implant survival. As patients and surgeons may assess outcome after THA differently, patient-reported outcomes (PROMs) have gained much more interest and are today recognized as very important tools for evaluating the outcome and satisfaction after THA. One of the prognostic factors for the outcome of THA is the type of bearings. This PhD thesis focuses on the influence of different types of bearings on implant survival, revision causes, PROMs, and noises from THA. The aims of the thesis were: Study I: To examine the revision risk and to investigate the causes of revision of cementless ceramic-on-ceramic (CoC) THAs comparing them to those of "standard" metal-on-polyethylene (MoP) THAs. Study II: To compare the six-year revision risk for metal-on-metal (MoM) with that for MoP bearings in cementless stemmed THA, and further to study the revision risk for different designs of stemmed MoM THAs and the causes of revision. Study III: To examine the association between CoC, MoM, and MoP bearings and both generic and disease-specific PROMs, and furthermore to examine the incidence and types of noises from the three types of bearings and identify the effect of noises on PROM scores. In study I and III, we used data from the Danish Hip Arthroplasty Registry combined with data from the Civil Registration System and the Danish National Patient Registry. In study II, data from the Nordic Arthroplasty Register Association, containing data from hip arthroplasty registries in Denmark, Norway, Sweden, and Finland, was used. In study I, 11,096 patients operated from 2002 through 2009 with cementless THA were included. Of these, 16% had CoC THA and 84% had MoP THA. At 8.7-year follow-up, no difference in RR of revision for any cause was found for CoC compared to MoP THA. One cause of revision related only to CoC THA is ceramic fracture. Medical records were reviewed for patients who had revision surgery due to component failure, and six patients (0,34%) had been revised due to ceramic fracture. No other difference in prevalence of causes of revision was found when comparing CoC to MoP THA. Study II included 32,678 patients who were operated from 2002 through 2010 with cementless stemmed THA with either MoM bearings (11,567 patients, 35%) or MoP bearings (21,111 patients, 65%). At six-year follow-up, the RR of revision for any cause was significantly higher for MoM compared to MoP THA. When comparing different combinations of cup/stem with MoM to MoP bearings, there was an increased RR of revision for any cause for the ASR/Summit, ASR/Corail, and "other" combinations. There was a higher prevalence of revision due to aseptic loosening for MoM compared to MoP THA. In contrast, the prevalence of revision due to dislocation was lower for MoM THA. In study III, a set of questionnaires including HOOS, EQ-5D, UCLA activity score, and a questionnaire about noises from the THA was sendt to patients having THA with CoC, MoM, or MoP bearings. The response rate was 85% and among the 3,089 patients responding, 45% received CoC, 17% MoM, and 38% MoP THA. No differences in mean subscale scores were found for CoC and MoM compared to MoP THA, except for CoC THA that had a lower mean HOOS symptoms score than MoP THA. 27% of patients with CoC, 29% of patients with MoM, and 12% of patients with MoP bearings had experienced noises from the THA. For the three types of bearings, PROM scores from patients with noisy THA were significantly lower when compared to silent MoP THA, except for noisy CoC and MoM THA that had the same mean UCLA activity score as silent MoP THA.
PMID
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Authors

Mayor MeshTerms

Prosthesis Failure

Keywords
Journal Title danish medical journal
Publication Year Start




PMID- 28260601
OWN - NLM
STAT- MEDLINE
DA  - 20170306
DCOM- 20170313
LR  - 20170313
IS  - 2245-1919 (Electronic)
IS  - 2245-1919 (Linking)
VI  - 64
IP  - 3
DP  - 2017 Mar
TI  - Outcomes of different bearings in total hip arthroplasty - implant survival,
      revision causes, and patient-reported outcome.
LID - B5350 [pii]
AB  - Total hip arthroplasty (THA) is a common and successful treatment of patients
      suffering from severe osteoarthritis that significantly reduces pain and improves
      hip function and quality of life. Traditionally, the outcome of THA has been
      evaluated by orthopaedic surgeons and assessed in morbidity and mortality rates, 
      and implant survival. As patients and surgeons may assess outcome after THA
      differently, patient-reported outcomes (PROMs) have gained much more interest and
      are today recognized as very important tools for evaluating the outcome and
      satisfaction after THA. One of the prognostic factors for the outcome of THA is
      the type of bearings. This PhD thesis focuses on the influence of different types
      of bearings on implant survival, revision causes, PROMs, and noises from THA. The
      aims of the thesis were: Study I: To examine the revision risk and to investigate
      the causes of revision of cementless ceramic-on-ceramic (CoC) THAs comparing them
      to those of "standard" metal-on-polyethylene (MoP) THAs. Study II: To compare the
      six-year revision risk for metal-on-metal (MoM) with that for MoP bearings in
      cementless stemmed THA, and further to study the revision risk for different
      designs of stemmed MoM THAs and the causes of revision. Study III: To examine the
      association between CoC, MoM, and MoP bearings and both generic and
      disease-specific PROMs, and furthermore to examine the incidence and types of
      noises from the three types of bearings and identify the effect of noises on PROM
      scores. In study I and III, we used data from the Danish Hip Arthroplasty
      Registry combined with data from the Civil Registration System and the Danish
      National Patient Registry. In study II, data from the Nordic Arthroplasty
      Register Association, containing data from hip arthroplasty registries in
      Denmark, Norway, Sweden, and Finland, was used. In study I, 11,096 patients
      operated from 2002 through 2009 with cementless THA were included. Of these, 16% 
      had CoC THA and 84% had MoP THA. At 8.7-year follow-up, no difference in RR of
      revision for any cause was found for CoC compared to MoP THA. One cause of
      revision related only to CoC THA is ceramic fracture. Medical records were
      reviewed for patients who had revision surgery due to component failure, and six 
      patients (0,34%) had been revised due to ceramic fracture. No other difference in
      prevalence of causes of revision was found when comparing CoC to MoP THA. Study
      II included 32,678 patients who were operated from 2002 through 2010 with
      cementless stemmed THA with either MoM bearings (11,567 patients, 35%) or MoP
      bearings (21,111 patients, 65%). At six-year follow-up, the RR of revision for
      any cause was significantly higher for MoM compared to MoP THA. When comparing
      different combinations of cup/stem with MoM to MoP bearings, there was an
      increased RR of revision for any cause for the ASR/Summit, ASR/Corail, and
      "other" combinations. There was a higher prevalence of revision due to aseptic
      loosening for MoM compared to MoP THA. In contrast, the prevalence of revision
      due to dislocation was lower for MoM THA. In study III, a set of questionnaires
      including HOOS, EQ-5D, UCLA activity score, and a questionnaire about noises from
      the THA was sendt to patients having THA with CoC, MoM, or MoP bearings. The
      response rate was 85% and among the 3,089 patients responding, 45% received CoC, 
      17% MoM, and 38% MoP THA. No differences in mean subscale scores were found for
      CoC and MoM compared to MoP THA, except for CoC THA that had a lower mean HOOS
      symptoms score than MoP THA. 27% of patients with CoC, 29% of patients with MoM, 
      and 12% of patients with MoP bearings had experienced noises from the THA. For
      the three types of bearings, PROM scores from patients with noisy THA were
      significantly lower when compared to silent MoP THA, except for noisy CoC and MoM
      THA that had the same mean UCLA activity score as silent MoP THA.
FAU - Varnum, Claus
AU  - Varnum C
AD  - [email protected]
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Denmark
TA  - Dan Med J
JT  - Danish medical journal
JID - 101576205
RN  - 9002-88-4 (Polyethylene)
SB  - IM
MH  - Age Factors
MH  - Arthroplasty, Replacement, Hip/*methods/*statistics & numerical data
MH  - Ceramics/therapeutic use
MH  - Female
MH  - Follow-Up Studies
MH  - Hip Prosthesis/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Metal-on-Metal Joint Prostheses
MH  - Osteoarthritis/*surgery
MH  - Osteoarthritis, Hip
MH  - Patient Reported Outcome Measures
MH  - Polyethylene/therapeutic use
MH  - *Prosthesis Failure
MH  - Quality of Life
MH  - Registries
MH  - Reoperation/*statistics & numerical data
MH  - Risk Factors
MH  - Scandinavian and Nordic Countries
MH  - Sex Factors
MH  - Treatment Outcome
EDAT- 2017/03/07 06:00
MHDA- 2017/03/14 06:00
CRDT- 2017/03/07 06:00
AID - B5350 [pii]
PST - ppublish
SO  - Dan Med J. 2017 Mar;64(3). pii: B5350.

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