TY - JOUR
T1 - The effect of cemented acetabular component geometry on the risk of revision for instability or loosening : a study of 224,874 primary hip arthroplasties from the National Joint Registry.
AU - Divecha, HM
AU - O'Neill, TW
AU - Lunt, M
AU - Board, TN
N1 - Funding Information:
We thank the patients and staff of all the hospitals who have contributed data to the National Joint Registry. We are grateful to the Healthcare Quality Improvement Partnership (HQIP), the NJR Research Committee and staff at the NJR Centre for facilitating this work. The authors have conformed to the NJR's standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or the Healthcare Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented. The HQIP and the NJR take no responsibility for the accuracy, currency, reliability, and correctness of any data used or referred to in this report, nor for the accuracy, currency, reliability, and correctness of links or references to other information sources and disclaims all warranties in relation to such data, links, and references to the maximum extent permitted by legislation. The study was supported by the NIHR Manchester Biomedical Research Centre. The views expressed are those of the authors alone and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, or Public Health England.
Funding Information:
T. W. O'Neill reports a grant from NIHR related to the study. T. Board reports institutional research grants from the John Charnley Trust and Wrightington Wish Fund, related to the study. T. Board also reports consultancy payments from DePuy Synthes, grants from NIHR and Symbios, payment for lectures including service on speakers bureaus from DePuy Synthes, Corin, and Symbios, patents from DePuy Synthes, and expenses from DePuy Synthes, Corin, Symbios, and MatOrtho, all unrelated to the study. H. M. Divecha reports payment towards research from the John Charnley Trust, related to the study.
Funding Information:
This work was partly funded by The John Charnley Trust, Registered Charity No. 326395. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Funding Information:
We thank the patients and staff of all the hospitals who have contributed data to the National Joint Registry. We are grateful to the Healthcare Quality Improvement Partnership (HQIP), the NJR Research Committee and staff at the NJR Centre for facilitating this work. The authors have conformed to the NJR’s standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or the Healthcare Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented. The HQIP and the NJR take no responsibility for the accuracy, currency, reliability, and correctness of any data used or referred to in this report, nor for the accuracy, currency, reliability, and correctness of links or references to other information sources and disclaims all warranties in relation to such data, links, and references to the maximum extent permitted by legislation. The study was supported by the NIHR Manchester Biomedical Research Centre. The views expressed are those of the authors alone and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, or Public Health England.
Publisher Copyright:
© 2021 The British Editorial Society of Bone & Joint Surgery
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Aims To determine if primary cemented acetabular component geometry (long posterior wall (LPW), hooded, or offset reorientating) influences the risk of revision total hip arthroplasty (THA) for instability or loosening. Methods The National Joint Registry (NJR) dataset was analyzed for primary THAs performed between 2003 and 2017. A cohort of 224,874 cemented acetabular components were included. The effect of acetabular component geometry on the risk of revision for instability or for loosening was investigated using log-binomial regression adjusting for age, sex, American Society of Anesthesiologists grade, indication, side, institution type, operating surgeon grade, surgical approach, polyethylene crosslinking, and prosthetic head size. A competing risk survival analysis was performed with the competing risks being revision for other indications or death. Results The distribution of acetabular component geometries was: LPW 81.2%; hooded 18.7%; and offset reorientating 0.1%. There were 3,313 (1.5%) revision THAs performed, of which 815 (0.4%) were for instability and 838 (0.4%) were for loosening. Compared to the LPW group, the adjusted subhazard ratio of revision for instability in the hooded group was 2.31 (p < 0.001) and 4.12 (p = 0.047) in the offset reorientating group. Likewise, the subhazard ratio of revision for loosening was 2.65 (p < 0.001) in the hooded group and 13.61 (p < 0.001) in the offset reorientating group. A time-varying subhazard ratio of revision for instability (hooded vs LPW) was found, being greatest within the first three months. Conclusion This registry-based study confirms a significantly higher risk of revision after cemented THA for instability and for loosening when a hooded or offset reorientating acetabular component is used, compared to a LPW component. Further research is required to clarify if certain patients benefit from the use of hooded or offset reorientating components, but we recommend caution when using such components in routine clinical practice.
AB - Aims To determine if primary cemented acetabular component geometry (long posterior wall (LPW), hooded, or offset reorientating) influences the risk of revision total hip arthroplasty (THA) for instability or loosening. Methods The National Joint Registry (NJR) dataset was analyzed for primary THAs performed between 2003 and 2017. A cohort of 224,874 cemented acetabular components were included. The effect of acetabular component geometry on the risk of revision for instability or for loosening was investigated using log-binomial regression adjusting for age, sex, American Society of Anesthesiologists grade, indication, side, institution type, operating surgeon grade, surgical approach, polyethylene crosslinking, and prosthetic head size. A competing risk survival analysis was performed with the competing risks being revision for other indications or death. Results The distribution of acetabular component geometries was: LPW 81.2%; hooded 18.7%; and offset reorientating 0.1%. There were 3,313 (1.5%) revision THAs performed, of which 815 (0.4%) were for instability and 838 (0.4%) were for loosening. Compared to the LPW group, the adjusted subhazard ratio of revision for instability in the hooded group was 2.31 (p < 0.001) and 4.12 (p = 0.047) in the offset reorientating group. Likewise, the subhazard ratio of revision for loosening was 2.65 (p < 0.001) in the hooded group and 13.61 (p < 0.001) in the offset reorientating group. A time-varying subhazard ratio of revision for instability (hooded vs LPW) was found, being greatest within the first three months. Conclusion This registry-based study confirms a significantly higher risk of revision after cemented THA for instability and for loosening when a hooded or offset reorientating acetabular component is used, compared to a LPW component. Further research is required to clarify if certain patients benefit from the use of hooded or offset reorientating components, but we recommend caution when using such components in routine clinical practice.
KW - Acetabulum
KW - Aged
KW - Aged, 80 and over
KW - Arthroplasty, Replacement, Hip
KW - Bone Cements
KW - Female
KW - Hip Prosthesis
KW - Humans
KW - Male
KW - Middle Aged
KW - Postoperative Complications/epidemiology
KW - Prosthesis Design
KW - Prosthesis Failure
KW - Reoperation/statistics & numerical data
KW - Risk Assessment
UR - http://europepmc.org/abstract/med/34719277
U2 - 10.1302/0301-620x.103b11.bjj-2021-0061.r1
DO - 10.1302/0301-620x.103b11.bjj-2021-0061.r1
M3 - Article
C2 - 34719277
SN - 2049-4394
VL - 103 B
SP - 1669
EP - 1677
JO - The Bone & Joint Journal
JF - The Bone & Joint Journal
IS - 11
ER -