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Independent predictors of failure up to 7.5 years after 35 386 single-brand cementless total hip replacements : a retrospective cohort study using National Joint Registry data.

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Jameson, S. S., Baker, P. N., Mason, James, Rymaszewska, M., Gregg, P. J., Deehan, D. J. and Reed, M. R. (2013) Independent predictors of failure up to 7.5 years after 35 386 single-brand cementless total hip replacements : a retrospective cohort study using National Joint Registry data. The Bone & Joint Journal, 95-B (6). pp. 747-757. doi:10.1302/0301-620X.95B6.31378

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Official URL: http://dx.doi.org/10.1302/0301-620X.95B6.31378

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Abstract

The popularity of cementless total hip replacement (THR) has surpassed cemented THR in England and Wales. This retrospective cohort study records survival time to revision following primary cementless THR with the most common combination (accounting for almost a third of all cementless THRs), and explores risk factors independently associated with failure, using data from the National Joint Registry for England and Wales. Patients with osteoarthritis who had a DePuy Corail/Pinnacle THR implanted between the establishment of the registry in 2003 and 31 December 2010 were included within analyses. There were 35 386 procedures. Cox proportional hazard models were used to analyse the extent to which the risk of revision was related to patient, surgeon and implant covariates. The overall rate of revision at five years was 2.4% (99% confidence interval 2.02 to 2.79). In the final adjusted model, we found that the risk of revision was significantly higher in patients receiving metal-on-metal (MoM: hazard ratio (HR) 1.93, p < 0.001) and ceramic-on-ceramic bearings (CoC: HR 1.55, p = 0.003) compared with the best performing bearing (metal-on-polyethylene). The risk of revision was also greater for smaller femoral stems (sizes 8 to 10: HR 1.82, p < 0.001) compared with mid-range sizes. In a secondary analysis of only patients where body mass index (BMI) data were available (n = 17 166), BMI ≥ 30 kg/m(2) significantly increased the risk of revision (HR 1.55, p = 0.002). The influence of the bearing on the risk of revision remained significant (MoM: HR 2.19, p < 0.001; CoC: HR 2.09, p = 0.001). The risk of revision was independent of age, gender, head size and offset, shell, liner and stem type, and surgeon characteristics. We found significant differences in failure between bearing surfaces and femoral stem size after adjustment for a range of covariates in a large cohort of single-brand cementless THRs. In this study of procedures performed since 2003, hard bearings had significantly higher rates of revision, but we found no evidence that head size had an effect. Patient characteristics, such as BMI and American Society of Anesthesiologists grade, also influence the survival of cementless components.

Item Type: Journal Article
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
Journal or Publication Title: The Bone & Joint Journal
Publisher: British Editorial Society of Bone and Joint Surgery
ISSN: 2049-4394
Official Date: June 2013
Dates:
DateEvent
June 2013Published
Volume: 95-B
Number: 6
Page Range: pp. 747-757
DOI: 10.1302/0301-620X.95B6.31378
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access

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