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18 years of results with cemented primary hip prostheses in the Norwegian Arthroplasty Register: concerns about some newer implants.

Espehaug B, Furnes O, Engesaeter LB, Havelin LI - Acta Orthop (2009)

Bottom Line: For stems, beyond 10 years we did not find statistically significant differences comparing Charnley with Titan, ITH, and SP stems, but the Exeter stem had better results (RR = 05). 10 prosthesis brands (9 cups in combination with 6 stems; n = 37,577) were investigated with 0-10 years of follow-up (inserted from 1998 through 2007).The analyses also showed a marked improvement in Charnley results between the periods 1987-1997 and 1998-2007.The results were, however, satisfactory according to international standards.

View Article: PubMed Central - PubMed

Affiliation: The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway. birgitte.espehaug@helse-bergen.no

ABSTRACT

Background and purpose: Few studies have compared the long-term survival of cemented primary total hip arthroplasties (THAs), and several prostheses have been used without adequate knowledge of their endurance. We studied long-term outcome based on data in the Norwegian Arthroplasty Register.

Patients and methods: The 10 most used prosthesis brands in 62,305 primary Palacos or Simplex cemented THAs reported to the Register from 1987 through 2007 were included. Survival analyses with revision as endpoint (for any cause or for aseptic loosening) were performed using Kaplan-Meier and multiple Cox regression with time-dependent covariates. Revision rate ratios (RRs) were estimated for the follow-up intervals: 0-5, 6-10, and > 10 years.

Results: 5 prosthesis brands (cup/stem combinations) (Charnley, Exeter, Titan, Spectron/ITH, Link IP/Lubinus SP; n = 24,728) were investigated with 0-20 year follow-up (inserted 1987-1997). After 18 years, 11% (95% CI: 10.6-12.1) were revised for any cause and 8.4% (7.7-9.1) for aseptic loosening. Beyond 10 years of follow-up, the Charnley cup had a lower revision rate due to aseptic loosening than Exeter (RR = 1.8) and Spectron (RR = 2.4) cups. For stems, beyond 10 years we did not find statistically significant differences comparing Charnley with Titan, ITH, and SP stems, but the Exeter stem had better results (RR = 05). 10 prosthesis brands (9 cups in combination with 6 stems; n = 37,577) were investigated with 0-10 years of follow-up (inserted from 1998 through 2007). The Charnley cup had a lower revision rate due to aseptic loosening than all cups except the IP. Beyond 5 years follow-up, the Reflection All-Poly cup had a 14 times higher revision rate. For stems, beyond 5 years the Spectron-EF (RR = 6.1) and Titan (RR = 5.5) stems had higher revision rates due to aseptic loosening than Charnley. The analyses also showed a marked improvement in Charnley results between the periods 1987-1997 and 1998-2007.

Interpretation: We observed clinically important differences between cemented prosthesis brands and identified inferior results for previously largely undocumented prostheses, including the commonly used prosthesis combination Reflection All-Poly/ Spectron-EF. The results were, however, satisfactory according to international standards.

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Related in: MedlinePlus

Description of the study selection procedure.a Palacos cement types: Palacos plain, Palacos with gentamycin, Refobacin – Palacos, Palacos R + G, and Refobacin Bone Cement R, and Simplex cement: Simplex plain, Simplex with erythromycin/ colistin, and Simplex with tobramycin. Same cement brand in acetabulum and femur.
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Figure 0001: Description of the study selection procedure.a Palacos cement types: Palacos plain, Palacos with gentamycin, Refobacin – Palacos, Palacos R + G, and Refobacin Bone Cement R, and Simplex cement: Simplex plain, Simplex with erythromycin/ colistin, and Simplex with tobramycin. Same cement brand in acetabulum and femur.

Mentions: By December 31, 2007, 110,882 primary THAs had been reported to the Register, 8,094 of which (7.3%) were revised by 2007. Only THAs with cemented acetabular and femoral components were eligible for inclusion in the present study (78%). Furthermore, THAs with unknown information on prosthesis brand or cement brand (n = 114), or on whether the components were cemented with two different cement brands (n = 2,373), were excluded. An exclusion criterion was also that the prosthesis components should be cemented with either a Palacos type cement (Palacos plain, Palacos with gentamycin, Refobacin-Palacos, Palacos R+G, or Refobacin Bone Cement R), or a Simplex cement (Simplex plain, Simplex with erythromycin and colistin, or Simplex with tobramycin) (n = 74,861). Furthermore, only the 10 most common prosthesis brand combinations were studied, totaling 62,305 THAs (Figure 1).


18 years of results with cemented primary hip prostheses in the Norwegian Arthroplasty Register: concerns about some newer implants.

Espehaug B, Furnes O, Engesaeter LB, Havelin LI - Acta Orthop (2009)

Description of the study selection procedure.a Palacos cement types: Palacos plain, Palacos with gentamycin, Refobacin – Palacos, Palacos R + G, and Refobacin Bone Cement R, and Simplex cement: Simplex plain, Simplex with erythromycin/ colistin, and Simplex with tobramycin. Same cement brand in acetabulum and femur.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823190&req=5

Figure 0001: Description of the study selection procedure.a Palacos cement types: Palacos plain, Palacos with gentamycin, Refobacin – Palacos, Palacos R + G, and Refobacin Bone Cement R, and Simplex cement: Simplex plain, Simplex with erythromycin/ colistin, and Simplex with tobramycin. Same cement brand in acetabulum and femur.
Mentions: By December 31, 2007, 110,882 primary THAs had been reported to the Register, 8,094 of which (7.3%) were revised by 2007. Only THAs with cemented acetabular and femoral components were eligible for inclusion in the present study (78%). Furthermore, THAs with unknown information on prosthesis brand or cement brand (n = 114), or on whether the components were cemented with two different cement brands (n = 2,373), were excluded. An exclusion criterion was also that the prosthesis components should be cemented with either a Palacos type cement (Palacos plain, Palacos with gentamycin, Refobacin-Palacos, Palacos R+G, or Refobacin Bone Cement R), or a Simplex cement (Simplex plain, Simplex with erythromycin and colistin, or Simplex with tobramycin) (n = 74,861). Furthermore, only the 10 most common prosthesis brand combinations were studied, totaling 62,305 THAs (Figure 1).

Bottom Line: For stems, beyond 10 years we did not find statistically significant differences comparing Charnley with Titan, ITH, and SP stems, but the Exeter stem had better results (RR = 05). 10 prosthesis brands (9 cups in combination with 6 stems; n = 37,577) were investigated with 0-10 years of follow-up (inserted from 1998 through 2007).The analyses also showed a marked improvement in Charnley results between the periods 1987-1997 and 1998-2007.The results were, however, satisfactory according to international standards.

View Article: PubMed Central - PubMed

Affiliation: The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway. birgitte.espehaug@helse-bergen.no

ABSTRACT

Background and purpose: Few studies have compared the long-term survival of cemented primary total hip arthroplasties (THAs), and several prostheses have been used without adequate knowledge of their endurance. We studied long-term outcome based on data in the Norwegian Arthroplasty Register.

Patients and methods: The 10 most used prosthesis brands in 62,305 primary Palacos or Simplex cemented THAs reported to the Register from 1987 through 2007 were included. Survival analyses with revision as endpoint (for any cause or for aseptic loosening) were performed using Kaplan-Meier and multiple Cox regression with time-dependent covariates. Revision rate ratios (RRs) were estimated for the follow-up intervals: 0-5, 6-10, and > 10 years.

Results: 5 prosthesis brands (cup/stem combinations) (Charnley, Exeter, Titan, Spectron/ITH, Link IP/Lubinus SP; n = 24,728) were investigated with 0-20 year follow-up (inserted 1987-1997). After 18 years, 11% (95% CI: 10.6-12.1) were revised for any cause and 8.4% (7.7-9.1) for aseptic loosening. Beyond 10 years of follow-up, the Charnley cup had a lower revision rate due to aseptic loosening than Exeter (RR = 1.8) and Spectron (RR = 2.4) cups. For stems, beyond 10 years we did not find statistically significant differences comparing Charnley with Titan, ITH, and SP stems, but the Exeter stem had better results (RR = 05). 10 prosthesis brands (9 cups in combination with 6 stems; n = 37,577) were investigated with 0-10 years of follow-up (inserted from 1998 through 2007). The Charnley cup had a lower revision rate due to aseptic loosening than all cups except the IP. Beyond 5 years follow-up, the Reflection All-Poly cup had a 14 times higher revision rate. For stems, beyond 5 years the Spectron-EF (RR = 6.1) and Titan (RR = 5.5) stems had higher revision rates due to aseptic loosening than Charnley. The analyses also showed a marked improvement in Charnley results between the periods 1987-1997 and 1998-2007.

Interpretation: We observed clinically important differences between cemented prosthesis brands and identified inferior results for previously largely undocumented prostheses, including the commonly used prosthesis combination Reflection All-Poly/ Spectron-EF. The results were, however, satisfactory according to international standards.

Show MeSH
Related in: MedlinePlus