Risk of Complication and Revision THA Among Medicare Patients
with Different Bearing Surfaces
Kevin J. Bozic MD, MBA, Kevin Ong PhD, Edmund Lau MS, Steven M. Kurtz PhD, Thomas P. Vail MD, Harry E. Rubash MD, Daniel J. Berry MD
Clinical Orthopaedics and Related Research1 Volume 468, Number 9, September 2010
Background To address the long-term problems of bearing surface wear and osteolysis associated with conventional metal-polyethylene (M-PE) total hip arthroplasty (THA), metal-metal (M-M), and ceramic-ceramic (C-C) bearings have been introduced. These bearing surfaces are associated with unique risks and benefits and higher costs.However the relative risks of these three bearings in an older population is unknown.
Questions/purposes We compared the short-term risk of complication and revision THA among Medicare patients having a primary THA with metal-polyethylene (M-PE), metal-metal (M-M), and ceramic-ceramic (C-C) bearings.
Methods We used the 2005 to 2007 100% Medicare inpatient claim files to perform a matched cohort analysis in three separate cohorts of THA patients (M-PE, M-M, and C-C) who were matched by age, gender, and US census region. Multivariate Cox proportional-hazards models were constructed to compare complication and revision THA risk among cohorts, adjusting for medical comorbidities, race, socioeconomic status, and hospital factors.
Results After adjusting for patient and hospital factors, M-M bearings were associated with a higher risk of periprosthetic joint infection (hazard ratio, 3.03; confidence interval, 1.02–9.09) when compared with C-C bearings (0.59% versus 0.32%, respectively). There were no other differences among bearing cohorts in the adjusted risk of revision THA or any other complication.
Conclusions The risk of short-term complication (including dislocation) and revision THA were similar among appropriately matched Medicare THA patients regardless of bearing surface. Hard-on-hard THA bearings are of questionable value in Medicare patients, given the higher cost associated with their use and uncertain longterm benefits in older patients.
Level of Evidence Level II, prognostic study.
- Minimal Incision Surgery as a Risk Factor for Early Failure of Total Hip Arthroplasty
- Wear and Range of Motion of Different Femoral Head Sizes
- Restoration of the Center of Rotation in Revision Total Hip Arthroplasty
- The Prevalence of Groin Pain After Metal-on-Metal THA and Total Hip Resurfacing
- Metal-on-Metal Hip Arthroplasty in Patients Thirty Years of Age or Younger
- Current Concepts Review Metal-on-Metal Total Hip Arthroplasty
- Revision of Failed Total Hip Arthroplasty Acetabular Cups to Porous Tantalum Components
- Risk of Complication and Revision THA Among Medicare Patients
- Optimal acetabular orientation for hip resurfacing