Total Hip Arthroplasty Bearing Surface Trends in the United States From 2007 to 2014: The Rise of Ceramic on Polyethylene

• Published in: The Journal of arthroplasty 2018-06, Vol.33 (6), p.1757-1763.e1
• Main Authors: Heckmann, Nathanael D., Sivasundaram, Lakshmanan, Stefl, Michael D., Kang, Hyunwoo Paco, Basler, Eric T., Lieberman, Jay R.
• Format: Article
• Language: English
• Subjects: Aged; Arthroplasty, Replacement, Hip - instrumentation; Arthroplasty, Replacement, Hip - statistics & numerical data; bearing surface; Ceramics; Databases, Factual; Female; Femur Head; Hip Prosthesis - trends; Hospitals - statistics & numerical data; Humans; implant; Male; Metals; Middle Aged; Multivariate Analysis; Polyethylene; Retrospective Studies; THA; total hip arthroplasty; trend; United States; utilization
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.12.040

Wear of the bearing surface is a critical element in determining the longevity of a total hip arthroplasty (THA). Over the past decade, concerns related to modern metal-on-metal (MoM) bearings and corrosion at the femoral head-neck interface have influenced surgeon selection of bearing surfaces. The purpose of this study is to analyze trends in THA bearing surface selection from 2007 through 2014 using a large national database. The Nationwide Inpatient Sample database was used to extract bearing surface data from patients who underwent a primary THA between 2007 and 2014. Patients were grouped by bearing surface type: metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), MoM, and ceramic-on-ceramic (CoC) bearings. Descriptive statistics were employed to describe trends. Univariate and multivariate analyses were performed to identify differences between bearing surface groups. During the study period, 2,460,640 THA discharges were identified, of which 1,059,825 (43.1%) had bearing surface data. A total of 496,713 (46.9%) MoP, 307,907 (29.1%) CoP, 210,381 (19.9%) MoM, and 44,823 (4.2%) CoC cases were identified. MoM utilization peaked in 2008 representing 40.1% of THAs implanted that year and steadily declined to 4.0% in 2014. From 2007 to 2014, the use of CoP bearing surfaces increased from 11.1% of cases in 2007 to 50.8% of cases in 2014. In 2014, CoP utilization surpassed MoP which represented 42.1% of bearing surfaces that year. During the study period, MoM bearing surfaces decreased precipitously, while CoP surpassed MoP as the most popular bearing surface used in a THA.