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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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Prosthesis survival with revision of either cup or stem for any cause (a), revision of either cup or stem due to aseptic loosening (b), revision of cup due to aseptic loosening (c), or revision of stem due to aseptic loosening, (d) as endpoint, for 10 cemented prostheses operated 1998–2007.
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Figure 0005: Prosthesis survival with revision of either cup or stem for any cause (a), revision of either cup or stem due to aseptic loosening (b), revision of cup due to aseptic loosening (c), or revision of stem due to aseptic loosening, (d) as endpoint, for 10 cemented prostheses operated 1998–2007.

Mentions: All 10 prosthesis brand combinations had been used in more than 250 operations during this period (Table 3), totaling 37,577 THAs. The relative differences in prosthesis survival as compared to Charnley during this period (1998–2007) increased relative to our findings for the first time period (1987–1997). This was mainly due to a marked improvement in results for the Charnley from an estimated 8-year revision percentage of 5.3% (4.9–5.7) in the first period to 2.7% (2.3–3.1) in the last period with any revision as endpoint, and from 3.6% (3.3–4.0) to 0.7% (0.5–0.9) with revision due to aseptic loosening as endpoint. Except for Spectron/ITH and IP/SP, all prostheses had statistically significantly higher revision rates due to aseptic loosening than the Charnley (5b, Table Figure 5). 9 cups were investigated. Compared with the Charnley and with revision due to aseptic loosening of the cup as endpoint, beyond 5 years we found higher revision rates for all cups except for the IP (5c, Table Figure 6). Compared to the Charnley, the highest revision rates due to aseptic loosening were found for Reflection All-Poly (RR = 14; 7.2–28) and Elite (RR = 23; 7.8–67) cups. 6 stems were investigated and 2 of these, the Spectron-EF (RR = 6.1; 3.1 - 12) and Titan (RR = 5.5; 2.9–11) had inferior results to Charnley (5d, Table Figure 6).


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)

Prosthesis survival with revision of either cup or stem for any cause (a), revision of either cup or stem due to aseptic loosening (b), revision of cup due to aseptic loosening (c), or revision of stem due to aseptic loosening, (d) as endpoint, for 10 cemented prostheses operated 1998–2007.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0005: Prosthesis survival with revision of either cup or stem for any cause (a), revision of either cup or stem due to aseptic loosening (b), revision of cup due to aseptic loosening (c), or revision of stem due to aseptic loosening, (d) as endpoint, for 10 cemented prostheses operated 1998–2007.
Mentions: All 10 prosthesis brand combinations had been used in more than 250 operations during this period (Table 3), totaling 37,577 THAs. The relative differences in prosthesis survival as compared to Charnley during this period (1998–2007) increased relative to our findings for the first time period (1987–1997). This was mainly due to a marked improvement in results for the Charnley from an estimated 8-year revision percentage of 5.3% (4.9–5.7) in the first period to 2.7% (2.3–3.1) in the last period with any revision as endpoint, and from 3.6% (3.3–4.0) to 0.7% (0.5–0.9) with revision due to aseptic loosening as endpoint. Except for Spectron/ITH and IP/SP, all prostheses had statistically significantly higher revision rates due to aseptic loosening than the Charnley (5b, Table Figure 5). 9 cups were investigated. Compared with the Charnley and with revision due to aseptic loosening of the cup as endpoint, beyond 5 years we found higher revision rates for all cups except for the IP (5c, Table Figure 6). Compared to the Charnley, the highest revision rates due to aseptic loosening were found for Reflection All-Poly (RR = 14; 7.2–28) and Elite (RR = 23; 7.8–67) cups. 6 stems were investigated and 2 of these, the Spectron-EF (RR = 6.1; 3.1 - 12) and Titan (RR = 5.5; 2.9–11) had inferior results to Charnley (5d, Table Figure 6).

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