Comparative Effectiveness of Metal-On-Metal and Metal-On-Polyethylene Bearings in Medicare Total Hip Arthroplasty Patients

Abstract The purpose of this study was to compare the risk of complication and revision total hip arthroplasty (THA) in Medicare THA patients with different bearings. Using the 100% Medicare database (2005-2009), the adjusted risk of complication and revision THA was calculated for 148 827 THA patie...

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Bibliographic Details
Published in:The Journal of arthroplasty 2012-09, Vol.27 (8), p.37-40
Main Authors: Bozic, Kevin J., MD, MBA, Lau, Edmund C., MS, Ong, Kevin L., PhD, Vail, Thomas P., MD, Rubash, Harry E., MD, Berry, Daniel J., MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
comparative effectiveness
Female
Hip Prosthesis - adverse effects
Humans
Male
Medicare
Metal-on-Metal Joint Prostheses - adverse effects
Orthopedics
Polyethylene
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Prosthesis Design - adverse effects
Reoperation - statistics & numerical data
Risk Assessment
THA bearings
United States
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Summary:Abstract The purpose of this study was to compare the risk of complication and revision total hip arthroplasty (THA) in Medicare THA patients with different bearings. Using the 100% Medicare database (2005-2009), the adjusted risk of complication and revision THA was calculated for 148 827 THA patients (93 929 metal-on-polyethylene, 49 646 metal-on-metal, 5252 ceramic-on ceramic). Adjusted risk of deep vein thrombosis, dislocation, periprosthetic joint infection (PJI), mechanical loosening, periprosthetic fracture, and revision THA at up to 4 years postoperatively was compared using Cox regression. After adjusting for patient and hospital factors, metal-on-metal bearings were associated with higher risk of PJI ( P = .001), mechanical loosening ( P < .001), and deep vein thrombosis ( P = .031) than metal-on-polyethylene bearings and higher risk of PJI ( P = .014) than ceramic-on-ceramic bearings. Overall short-term revision rates did not vary significantly across bearing types, consistent with registry data. The benefits of hard-on-hard bearings in Medicare patients remain unproven, and further study is needed to compare long-term complication and revision rates in Medicare THA patients with different bearing types.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2012.03.031