Not all cemented hips are the same: a register-based (NJR) comparison of taper-slip and composite beam femoral stems

Background and purpose - No difference in outcome has been demonstrated comparing cemented taper-slip and composite beam designs in short-term randomised trials; we assessed outcome differences using a registry analysis. Patients and methods - All cemented stems with > 100 implantations were iden...

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Bibliographic Details
Published in:Acta orthopaedica 2019-05, Vol.90 (3), p.214-219
Main Authors: Kazi, Hussain A, Whitehouse, Sarah L, Howell, Jonathan R, Timperley, A John
Format: Article
Language:English
Subjects:
Aged
Arthroplasty, Replacement, Hip
Cementation
Cohort Studies
England - epidemiology
Female
Hip Prosthesis - statistics & numerical data
Humans
Kaplan-Meier Estimate
Male
Proportional Hazards Models
Prosthesis Design
Prosthesis Failure
Prosthesis-Related Infections - epidemiology
Reoperation - statistics & numerical data
Retrospective Studies
Treatment Outcome
Wales - epidemiology
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Description
Summary:Background and purpose - No difference in outcome has been demonstrated comparing cemented taper-slip and composite beam designs in short-term randomised trials; we assessed outcome differences using a registry analysis. Patients and methods - All cemented stems with > 100 implantations were identified in the National Joint Registry of England and Wales from April 1, 2003 to September 31, 2013 and categorised as taper-slip or composite beam. Survival analyses using Kaplan-Meier and Cox regression were performed. Results - We identified 292,987 cemented arthroplasties, of which 16% (47,586) were composite beam stems, with taper-slip stems making up the remainder (n = 245,401). There was a statistically significant increased chance of revision in the composite beam group compared with the taper-slip group (1.7% vs 1.3%, p < 0.001) but statistically no significant differences of survival estimates (p = 0.06). When the 2 groups were segregated to delineate the most implanted model in each category, the differences became more profound with the most implanted taper-slip stem (Exeter V40) showing statistically and clinically significant superior 8-year survival: 97.9% compared with 97.6% for all other taper-slip; 97.5% for the most implanted composite beam (Charnley cemented stem); and 97.7% for all other composite beam. Interpretation - There was an increased incidence of revision for composite beam stems. The most implanted taper-slip stem demonstrated significant survival advantage vs. all other stems.
ISSN:1745-3674
1745-3682
DOI:10.1080/17453674.2019.1582680