Trabecular metal acetabular components in primary total hip arthroplasty

TY - JOUR

T1 - Trabecular metal acetabular components in primary total hip arthroplasty

AU - Laaksonen, Inari

AU - Lorimer, Michelle

AU - Gromov, Kirill

AU - Eskelinen, Antti

AU - Rolfson, Ola

AU - Graves, Stephen E

AU - Malchau, Henrik

AU - Mohaddes, Maziar

PY - 2018

Y1 - 2018

N2 - Background and purpose - Trabecular metal (TM) cups have demonstrated favorable results in acetabular revision and their use in primary total hip arthroplasty (THA) is increasing. Some evidence show that TM cups might decrease periprosthetic infection (PPI) incidence. We compared the survivorship of TM cups with that of other uncemented cups in primary THA, and evaluated whether the use of TM cups is associated with a lower risk of PPI. Patients and methods - 10,113 primary THAs with TM cup and 85,596 THAs with other uncemented cups from 2 high-quality national arthroplasty registries were included. The mean follow-up times were 3.0 years for the TM cups and 3.8 years for the other uncemented cups. Results - The overall survivorship up to 8 years for TM cups and other uncemented cups was 94.4% and 96.2%, respectively (p = < 0.001). Adjusting for relevant covariates in a Cox regression model the TM cups had a persistently higher revision risk than other uncemented cups (HR =1.5, 95% CI 1.4-1.7, p = < 0.001). There was a slightly higher, though not statistically significant, revision rate for PPI in the TM group (1.2, 95% CI 1.0-1.6, p = 0.09). Interpretation - Risk of revision for any reason was higher for the TM cup than for other uncemented cups in primary THA. In contrast to our hypothesis, there was no evidence that the revision rate for PPI was lower in the TM cup patients. Regardless of the promising early and mid-term results for TM cups in hip revision arthroplasty, we would like to sound a note of caution on the increasing use of the TM design, especially in uncomplicated primary THAs, where uncemented titanium cups are considered to provide a reliable outcome.

AB - Background and purpose - Trabecular metal (TM) cups have demonstrated favorable results in acetabular revision and their use in primary total hip arthroplasty (THA) is increasing. Some evidence show that TM cups might decrease periprosthetic infection (PPI) incidence. We compared the survivorship of TM cups with that of other uncemented cups in primary THA, and evaluated whether the use of TM cups is associated with a lower risk of PPI. Patients and methods - 10,113 primary THAs with TM cup and 85,596 THAs with other uncemented cups from 2 high-quality national arthroplasty registries were included. The mean follow-up times were 3.0 years for the TM cups and 3.8 years for the other uncemented cups. Results - The overall survivorship up to 8 years for TM cups and other uncemented cups was 94.4% and 96.2%, respectively (p = < 0.001). Adjusting for relevant covariates in a Cox regression model the TM cups had a persistently higher revision risk than other uncemented cups (HR =1.5, 95% CI 1.4-1.7, p = < 0.001). There was a slightly higher, though not statistically significant, revision rate for PPI in the TM group (1.2, 95% CI 1.0-1.6, p = 0.09). Interpretation - Risk of revision for any reason was higher for the TM cup than for other uncemented cups in primary THA. In contrast to our hypothesis, there was no evidence that the revision rate for PPI was lower in the TM cup patients. Regardless of the promising early and mid-term results for TM cups in hip revision arthroplasty, we would like to sound a note of caution on the increasing use of the TM design, especially in uncomplicated primary THAs, where uncemented titanium cups are considered to provide a reliable outcome.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Arthroplasty, Replacement, Hip/adverse effects

KW - Child

KW - Female

KW - Hip Prosthesis

KW - Humans

KW - Joint Diseases/surgery

KW - Male

KW - Metals

KW - Middle Aged

KW - Proportional Hazards Models

KW - Prosthesis Design

KW - Prosthesis-Related Infections/epidemiology

KW - Registries

KW - Reoperation

KW - Sweden

KW - Young Adult

U2 - 10.1080/17453674.2018.1431445

DO - 10.1080/17453674.2018.1431445

M3 - Journal article

C2 - 29400118

SN - 1745-3674

VL - 89

SP - 259

EP - 264

JO - Acta Orthopaedica

JF - Acta Orthopaedica

IS - 3

ER -