Holleyman, Richard J., Critchley, Rebecca J., Mason, James, Jameson, Simon S., Reed, Mike R. and Malviya, Ajay (2021) Ceramic bearings are associated with a significantly reduced revision rate in primary hip arthroplasty : an analysis From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. The Journal of Arthroplasty, 36 (10). pp. 3498-3506. doi:10.1016/j.arth.2021.05.027 ISSN 0883-5403.

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Abstract

Background:
Prosthetic joint infection (PJI) is a devastating complication. Studies have suggested reduction in PJI with the use of ceramic bearings.
Methods:
Adult patients who underwent total hip arthroplasty (THA) using an uncemented acetabular component with ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP), or metal-on-polyethylene (MoP) bearing surfaces between 2002 and 2016 were extracted from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. A competing risk regression model to investigate predictors of each revision outcome was used. Time-to-event was determined by duration of implantation since primary surgery with competing risks being death or revision. The results were adjusted for age, gender, American Association of Anaesthesiologists grade, body mass index, surgical indication, intraoperative complications, and implant data.
Results:
In total, 456,457 THAs (228,786 MoP, 128,403 CoC, and 99,268 CoP) were identified. Multivariable modeling showed that the risk of revision for PJI was significantly lower with CoC (risk ratio 0.748, P < .001) and CoP (risk ratio 0.775, P < .001) compared to MoP. Significant reduction in risk of aseptic and all-cause revision was also seen. The significant protective effect of ceramic bearing was predominantly seen 2 years after implantation. Aseptic revision beyond 2 years reduced by 18.1% and 24.8% for CoC and CoP (P < .001), respectively. All-cause revision rate beyond 2 years reduced by 21.6% for CoC and 27.1% for CoP (P < .001)
Conclusion:
This study demonstrates an association between the use of ceramic as part of the bearing, with lower rates of revision for all causes, revision for infection, and revision for aseptic causes, supporting ceramic bearings in THA.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RD Surgery T Technology > TJ Mechanical engineering and machinery
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Artificial hip joints, Artificial hip joints -- Complications, Prosthesis -- Complications, Artificial joints, Artificial joints -- Infections, Total hip replacement, Ceramic bearings , Tribology , Biomedical materials , Ceramics in surgery
Journal or Publication Title:	The Journal of Arthroplasty
Publisher:	Elsevier Inc.
ISSN:	0883-5403
Official Date:	1 October 2021
Dates:	Date Event 1 October 2021 Published 15 June 2021 Available 13 May 2021 Accepted
Volume:	36
Number:	10
Page Range:	pp. 3498-3506
DOI:	10.1016/j.arth.2021.05.027
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Date of first compliant deposit:	9 July 2021
Date of first compliant Open Access:	15 June 2022

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