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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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Time trends in the use of the 10 most common cemented prosthesis brands in Norway 1989–2007.
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Figure 0002: Time trends in the use of the 10 most common cemented prosthesis brands in Norway 1989–2007.

Mentions: Survival analyses used revision of either cup or stem, revision of cup, or revision of stem as endpoints. Separate analyses were performed for revisions for any cause and revisions due to aseptic loosening. Information on deaths or emigrations was retrieved from Statistics Norway, Oslo, until December 31, 2007. The survival times of implants in patients who had died or emigrated without revision of the prosthesis were censored at the date of death or emigration. Survival times of unrevised prostheses were otherwise censored at the end of the study on December 31, 2007. Use of prosthesis brands changed throughout the study period (Figure 2). To ensure that prosthesis brands were compared within the same time period, separate analyses were performed for THAs done before 1998 (with follow-up through 2007) and from 1998 through 2007. For the first time period, we studied 5 prosthesis combinations that had been used in more than 250 hips (5 different cups and 5 different stems). For the second time period, all 10 prosthesis combinations were studied (9 different cups and 6 different stems).


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)

Time trends in the use of the 10 most common cemented prosthesis brands in Norway 1989–2007.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: Time trends in the use of the 10 most common cemented prosthesis brands in Norway 1989–2007.
Mentions: Survival analyses used revision of either cup or stem, revision of cup, or revision of stem as endpoints. Separate analyses were performed for revisions for any cause and revisions due to aseptic loosening. Information on deaths or emigrations was retrieved from Statistics Norway, Oslo, until December 31, 2007. The survival times of implants in patients who had died or emigrated without revision of the prosthesis were censored at the date of death or emigration. Survival times of unrevised prostheses were otherwise censored at the end of the study on December 31, 2007. Use of prosthesis brands changed throughout the study period (Figure 2). To ensure that prosthesis brands were compared within the same time period, separate analyses were performed for THAs done before 1998 (with follow-up through 2007) and from 1998 through 2007. For the first time period, we studied 5 prosthesis combinations that had been used in more than 250 hips (5 different cups and 5 different stems). For the second time period, all 10 prosthesis combinations were studied (9 different cups and 6 different stems).

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