Risk of revision following cemented, cementless, hybrid and resurfacing hip implants in 46 867 patients - a retrospective comparison study using data from the National Joint Registry

Abstract

Introduction: Following in-depth analysis of the market leading brand combinations in which we identified implant influences on risk of revision, we compared revision in patients implanted with different categories of hip replacement in order to find implant with the lowest revision risk, once known flawed options were removed. Methods: All patients with osteoarthritis who underwent a hip replacement (2003–2010) using an Exeter-Contemporary (cemented), Corail-Pinnacle (cementless), Exeter-Trident (Hybrid) or a Birmingham Hip resurfacing (BHR) were initially included within the analysis. Operations involving factors that were significant predictors of revision were excluded. Cox proportional hazard models were then used to assess the relative risk of revision for a category of implant (compared with cemented), after adjustment for patient covariates. Results: In males, overall 5-year revision was 1.4%. Implant category did not significantly influence revision risk (p=0.615) in < 60 after adjustment. In the 60–75 year group, resurfacing implants were a significant influence for revision (Hazard ratio (HR)=2.63, p< 0.001), and with a trend in cementless (HR=1.63, p=0.057). In males >75 years, cementless implants significantly influenced revision risk (HR=3.48, p=0.002). In females, overall 5-year revision was 1.0%. After adjustment, in < 60 group implant category did not significantly influence revision (p=0.199), although there was a trend towards higher revision in resurfacing implants (HR=3.53, p=0.065). In over 60 year olds, cementless implants were a significant influence for revision risk (60–75 years: HR=1.80, p=0.010, >75 years: HR=2.26, p=0.010. In the older group, there was also a trend towards higher revision with hybrid implants (HR=3.25, p=0.053). Discussion: In summary, after implant optimisation of the market leaders and patient risk adjustment we found that cementless implants had a higher revision compared with cemented in males over 75 and females over 60 years old. In males under 60 years, there were no significant differences in revision risk between implant types.