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Original Investigation |

Association Between Total Hip Replacement Characteristics and 3-Year Prosthetic Survivorship  A Population-Based Study

Sandrine Colas, MSc, MPH1; Cédric Collin, PharmD, PhD1; Philippe Piriou, MD, PhD2; Mahmoud Zureik, MD, PhD1
[+] Author Affiliations
1Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
2Department of Health Science, University Simone Veil, Saint-Quentin-en-Yvelines, France
JAMA Surg. 2015;150(10):979-988. doi:10.1001/jamasurg.2015.1325.
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Importance  Total hip replacement (THR) is successful in treating hip arthritis. Prosthetic survivorship may depend on characteristics of the implant, notably THR fixation technique and bearing surface type.

Objective  To compare THR short-term survivorship according to cement type and bearing surface.

Design, Setting, and Participants  The cohort included all French patients aged 40 years or older covered by the general scheme of the French national health insurance system who had undergone THR from April 1, 2010, through December 31, 2011, for arthritis, according to French national health insurance databases. The cohort was followed up until December 31, 2013. The THR survivorship was assessed according to cement type and bearing surface in univariate and multivariate Cox proportional hazards regression models adjusted for patient and implanting center characteristics.

Exposures  Antibiotic-free cemented THRs and antibiotic-impregnated cemented THRs were compared with uncemented THRs. Ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP), and metal-on-metal (MoM) THRs were compared with metal-on-polyethylene (MoP) THRs.

Main Outcomes and Measures  Revision, including any surgical reintervention in which the implant or any of its components was changed or removed.

Results  The study cohort comprised 100 191 individuals: mean age at baseline, 69.5 years; women, 56.6%; uncemented THR, 74.8%; antibiotic-free cemented THR, 3.8%; antibiotic-impregnated cemented THR, 21.4%; CoC, 40.9%; MoP, 33.9%; CoP, 20.8%; and MoM, 4.4%. During the median 33-month follow-up period, 3142 individuals underwent prosthetic revision. Antibiotic-impregnated cemented THRs had a better prognosis than uncemented THRs: cumulative revision rates were 2.4% and 3.3%, respectively (P < .001), and the multivariate adjusted hazard ratio was 0.75 (95% CI, 0.67-0.84; P < .001). This association was particularly significant in women. The CoP and CoC THRs were no different from the MoP THR. The MoM THR had slightly shorter survivorship compared with the MoP THR (adjusted hazard ratio, 1.20; 95% CI, 1.01-1.43; P < .001).

Conclusions and Relevance  Characteristics of THR are related to early prosthetic revision: antibiotic-impregnated cemented THRs have a better prognosis and MoM THRs a worse one. These findings are useful in helping surgeons select a THR fixation technique and helpful for both patient and surgeon in the decision-making process.

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Figure 1.
Study Population Flowchart

The initial population was living French residents (excluding overseas territories) 40 years or older admitted to the hospital and billed for total hip replacement (THR) components with coding of a hip arthroplasty from April 1, 2010, through December 31, 2011. All health insurance schemes were combined. All patients received at least 1 health insurance reimbursement after the hospital stay for the implant procedure. PMSI indicates Programme de médicalisation des systèmes d'information.

Graphic Jump Location
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Figure 2.
Cumulative Revision Risk According to Cement Type

Patients at risk are given at baseline and yearly in the first 3 years. At the maximum follow-up time of 44 months, there were 5378 patients at risk at 44 months of follow-up. THR indicates total hip replacement.

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