Mid-term survivorship and clinical outcomes of cobalt-chrome and oxidized zirconium on highly crosslinked polyethylene.

BACKGROUND The choice of bearing articulation for total hip arthroplasty in younger patients is amenable to debate. We compared mid-term patient-reported outcomes and survivorship across 2 different bearing articulations in a young patient cohort. METHODS We reviewed patients with cobalt-chrome or oxidized zirconium on highly crosslinked polyethylene who were followed prospectively between 2004 and 2012. Kaplan-Meier analysis was used to determine predicted cumulative survivorship at 5 years with all-cause and aseptic revisions as the outcome. We compared patient-reported outcomes, including the Harris hip score (HHS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Short-form 12 (SF-12) scores. RESULTS A total of 622 patients were followed during the study period. Mean follow-up was 8.2 (range 2.0-10.6) years for cobalt-chrome and 7.8 (range 2.1-10.7) years for oxidized zirconium. Mean age was 54.9 ± 10.6 years for cobalt-chrome and 54.8 ± 10.7 years for oxidized zirconium. Implant survivorship was 96.0% (95% confidence interval [CI] 94.9%-97.1%) for cobalt-chrome and 98.7% (95% CI 98.0%-99.4%) for oxidized zirconium on highly crosslinked polyethylene for all-cause revisions, and 97.2% (95% CI 96.2%-98.2%) for cobalt-chrome and 99.0% (95% CI 98.4%-99.6%) for oxidized zirconium for aseptic revisions. An age-, sex- and diagnosis-matched comparison of the HHS, WOMAC and SF-12 scores demonstrated no significant changes in clinical outcomes across the groups. CONCLUSION Both bearing surface couples demonstrated excellent mid-term survivorship and outcomes in young patient cohorts. Future analyses on wear and costs are warranted to elicit differences between the groups at long-term follow-up.

[1]  W. Capello,et al.  Continued Improved Wear with an Annealed Highly Cross-linked Polyethylene , 2011, Clinical orthopaedics and related research.

[2]  C. Moore,et al.  Comparison of mid-term clinical outcomes after primary total hip arthroplasty with Oxinium vs cobalt chrome femoral heads. , 2008, Orthopedics.

[3]  F. Kummer,et al.  Surface damage to an Oxinium femoral head prosthesis after dislocation. , 2007, The Journal of bone and joint surgery. British volume.

[4]  R. Bourne,et al.  Comparison of steady state femoral head penetration rates between two highly cross-linked polyethylenes in total hip arthroplasty. , 2010, The Journal of arthroplasty.

[5]  C. Goldsmith,et al.  Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. , 1988, The Journal of rheumatology.

[6]  J. Davidson,et al.  Characteristics of metal and ceramic total hip bearing surfaces and their effect on long-term ultra high molecular weight polyethylene wear. , 1993, Clinical orthopaedics and related research.

[7]  J. Charnley,et al.  Radiological demarcation of cemented sockets in total hip replacement. , 1976, Clinical orthopaedics and related research.

[8]  J. Martell,et al.  Wear Analysis in THA Utilizing Oxidized Zirconium and Crosslinked Polyethylene , 2009, Clinical orthopaedics and related research.

[9]  J O Galante,et al.  In vivo comparative wear study of traditional and highly cross-linked polyethylene in total hip arthroplasty. , 2005, The Journal of arthroplasty.

[10]  J. D’Antonio,et al.  Ceramic materials as bearing surfaces for total hip arthroplasty. , 2009, The Journal of the American Academy of Orthopaedic Surgeons.

[11]  V. Goldberg,et al.  Diagnosis and management of infection after total knee arthroplasty. , 2003, The Journal of bone and joint surgery. American volume.

[12]  M. Silva,et al.  Short-term in vivo wear of cross-linked polyethylene. , 2004, The Journal of bone and joint surgery. American volume.

[13]  W. Harris,et al.  Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. , 1969, The Journal of bone and joint surgery. American volume.

[14]  E. Matzkin,et al.  National trends in primary total hip arthroplasty in extremely young patients: a focus on bearing surface usage. , 2012, The Journal of arthroplasty.

[15]  N. Bellamy,et al.  Minimal perceptible clinical improvement with the Western Ontario and McMaster Universities osteoarthritis index questionnaire and global assessments in patients with osteoarthritis. , 2000, The Journal of rheumatology.

[16]  B. Morrey.  Wear is Reduced in THA Performed with Highly Cross-linked Polyethylene , 2010 .

[17]  M. Drummond.  Introducing economic and quality of life measurements into clinical studies , 2001, Annals of medicine.

[18]  J. Galante,et al.  How have alternative bearings (such as metal‐on‐metal, highly cross‐linked polyethylene, and ceramic‐on‐ceramic) affected the prevention and treatment of osteolysis? , 2008, The Journal of the American Academy of Orthopaedic Surgeons.

[19]  C. Jenkinson,et al.  Development and testing of the UK SF-12 (short form health survey). , 1997, Journal of health services research & policy.

[20]  F. Kummer,et al.  Surface oxidized zirconium total hip arthroplasty head damage due to closed reduction effects on polyethylene wear. , 2009, The Journal of arthroplasty.

[21]  I. Clarke,et al.  Role of ceramic implants. Design and clinical success with total hip prosthetic ceramic-to-ceramic bearings. , 1992, Clinical orthopaedics and related research.

[22]  M. Gleitz,et al.  Ceramic Femoral Head Fractures in Total Hip Arthroplasty , 1996, Clinical orthopaedics and related research.

[23]  W. Harris,et al.  Periprosthetic bone loss in total hip arthroplasty. Polyethylene wear debris and the concept of the effective joint space. , 1992, The Journal of bone and joint surgery. American volume.

[24]  M J Buxton,et al.  Evaluating patient-based outcome measures for use in clinical trials. , 1998, Health technology assessment.

[25]  B. Masri,et al.  Classification of the hip. , 1999, The Orthopedic clinics of North America.

[26]  D. Holdsworth,et al.  Damage of an Oxinium femoral head and polyethylene liner following 'routine' total hip replacement. , 2011, The Journal of bone and joint surgery. British volume.

[27]  M. Galetz,et al.  Potential for adhesive wear in friction couples of UHMWPE running against oxidized zirconium, titanium nitride coatings, and cobalt-chromium alloys. , 2010, Journal of biomedical materials research. Part B, Applied biomaterials.

[28]  V. Good,et al.  Arthroplasty Options for the Young Patient: Oxinium on Cross-linked Polyethylene , 2005, Clinical orthopaedics and related research.

[29]  H. Willert,et al.  Comparison of alumina-polyethylene and metal-polyethylene in clinical trials. , 1992, Clinical orthopaedics and related research.

[30]  H. Gill,et al.  The seven-year wear of highly cross-linked polyethylene in total hip arthroplasty: a double-blind, randomized controlled trial using radiostereometric analysis. , 2011, The Journal of bone and joint surgery. American volume.

[31]  H. Amstutz,et al.  "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. , 1979, Clinical orthopaedics and related research.

[32]  V. Good,et al.  Reduced Wear with Oxidized Zirconium Femoral Heads , 2003, The Journal of bone and joint surgery. American volume.

[33]  P. Devane,et al.  A double-blind, prospective, randomized controlled trial comparing highly cross-linked and conventional polyethylene in primary total hip arthroplasty. , 2009, The Journal of arthroplasty.