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New alternate bearing surfaces in total hip arthroplasty: A review of the current literature.

ABSTRACT: As indications for total hip arthroplasty (THA) have expanded, the incidence of THA has increased among younger patients, who live longer and tend to place more strain on implants via higher activity levels. This demographical shift accentuates the importance of advancing innovation to ensure implant longevity for younger and more active patients. Future innovation, as it pertains to THA components, is likely to focus on modifying implant designs and tribology in conjunction with identification and application of newer biomaterials. By reviewing the literature for development status of various materials and novel design advancements in THA component outside of the standard highly cross-linked polyethylene, this investigation provided an update on the current and future status of design initiatives as they pertain to THA. Though the highlighted alternative bearing surfaces have shown promising in vitro and limited, yet encouraging clinical data, they lack larger and longer-term clinical trial results. Further research and innovation is warranted to identify the optimal bearing surface to most effectively accommodate for the trend of younger and more active patients undergoing THA. Implant longevity is crucial if the clinical success of THA is to be maintained.

SUBMITTER: Grieco PW

PROVIDER: S-EPMC5884051 | biostudies-other | 2018 Jan-Mar

REPOSITORIES: biostudies-other

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New alternate bearing surfaces in total hip arthroplasty: A review of the current literature.

Grieco Preston W PW Pascal Scott S Newman Jared M JM Shah Neil V NV Stroud Sarah G SG Sheth Neil P NP Maheshwari Aditya V AV

Journal of clinical orthopaedics and trauma 20171027 1

As indications for total hip arthroplasty (THA) have expanded, the incidence of THA has increased among younger patients, who live longer and tend to place more strain on implants via higher activity levels. This demographical shift accentuates the importance of advancing innovation to ensure implant longevity for younger and more active patients. Future innovation, as it pertains to THA components, is likely to focus on modifying implant designs and tribology in conjunction with identification ...[more]

PMID: 29628677

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Project description:BackgroundBoth minimally invasive surgery (MIS) and computer-assisted surgery (CAS) for total hip arthroplasty (THA) have gained popularity in recent years. We conducted a qualitative and systematic review to assess the effectiveness of MIS, CAS and computer-assisted MIS for THA.MethodsAn extensive computerised literature search of PubMed, Medline, Embase and OVIDSP was conducted. Both randomised clinical trials and controlled clinical trials on the effectiveness of MIS, CAS and computer-assisted MIS for THA were included. Methodological quality was independently assessed by two reviewers. Effect estimates were calculated and a best-evidence synthesis was performed.ResultsFour high-quality and 14 medium-quality studies with MIS THA as study contrast, and three high-quality and four medium-quality studies with CAS THA as study contrast were included. No studies with computer-assisted MIS for THA as study contrast were identified. Strong evidence was found for a decrease in operative time and intraoperative blood loss for MIS THA, with no difference in complication rates and risk for acetabular outliers. Strong evidence exists that there is no difference in physical functioning, measured either by questionnaires or by gait analysis. Moderate evidence was found for a shorter length of hospital stay after MIS THA. Conflicting evidence was found for a positive effect of MIS THA on pain in the early postoperative period, but that effect diminished after three months postoperatively. Strong evidence was found for an increase in operative time for CAS THA, and limited evidence was found for a decrease in intraoperative blood loss. Furthermore, strong evidence was found for no difference in complication rates, as well as for a significantly lower risk for acetabular outliers.ConclusionsThe results indicate that MIS THA is a safe surgical procedure, without increases in operative time, blood loss, operative complication rates and component malposition rates. However, the beneficial effect of MIS THA on functional recovery has to be proven. The results also indicate that CAS THA, though resulting in an increase in operative time, may have a positive effect on operative blood loss and operative complication rates. More importantly, the use of CAS results in better positioning of acetabular component of the prosthesis.

Project description:BACKGROUND:Metal-on-metal hip resurfacing was developed for younger, active patients as an alternative to THA, but it remains controversial. Study heterogeneity, inconsistent outcome definitions, and unstandardized outcome measures challenge our ability to compare arthroplasty outcomes studies. QUESTIONS/PURPOSES:We asked how early revisions or reoperations (within 5 years of surgery) and overall revisions, adverse events, and postoperative component malalignment compare among studies of metal-on-metal hip resurfacing with THA among patients with hip osteoarthritis. Secondarily, we compared the revision frequency identified in the systematic review with revisions reported in four major joint replacement registries. METHODS:We conducted a systematic review of English language studies published after 1996. Adverse events of interest included rates of early failure, time to revision, revision, reoperation, dislocation, infection/sepsis, femoral neck fracture, mortality, and postoperative component alignment. Revision rates were compared with those from four national joint replacement registries. Results were reported as adverse event rates per 1000 person-years stratified by device market status (in use and discontinued). Comparisons between event rates of metal-on-metal hip resurfacing and THA are made using a quasilikelihood generalized linear model. We identified 7421 abstracts, screened and reviewed 384 full-text articles, and included 236. The most common study designs were prospective cohort studies (46.6%; n = 110) and retrospective studies (36%; n = 85). Few randomized controlled trials were included (7.2%; n = 17). RESULTS:The average time to revision was 3.0 years for metal-on-metal hip resurfacing (95% CI, 2.95-3.1) versus 7.8 for THA (95% CI, 7.2-8.3). For all devices, revisions and reoperations were more frequent with metal-on-metal hip resurfacing than THA based on point estimates and CIs: 10.7 (95% CI, 10.1-11.3) versus 7.1 (95% CI, 6.7-7.6; p = 0.068), and 7.9 (95% CI, 5.4-11.3) versus 1.8 (95% CI, 1.3-2.2; p = 0.084) per 1000 person-years, respectively. This difference was consistent with three of four national joint replacement registries, but overall national joint replacement registries revision rates were lower than those reported in the literature. Dislocations were more frequent with THA than metal-on-metal hip resurfacing: 4.4 (95% CI, 4.2-4.6) versus 0.9 (95% CI, 0.6-1.2; p = 0.008) per 1000 person-years, respectively. Adverse event rates change when discontinued devices were included. CONCLUSIONS:Revisions and reoperations are more frequent and occur earlier with metal-on-metal hip resurfacing, except when discontinued devices are removed from the analyses. Results from the literature may be misleading without consistent definitions, standardized outcome metrics, and accounting for device market status. This is important when clinicians are assessing and communicating patient risk and when selecting which device is most appropriate for individual patients.

Dataset Information

New alternate bearing surfaces in total hip arthroplasty: A review of the current literature.

Publications

New alternate bearing surfaces in total hip arthroplasty: A review of the current literature.

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