Multinational comprehensive evaluation of the fixation method used in hip replacement: Interaction with age in context

Susanna Stea, Thomas Comfort, Art Sedrakyan, Leif Havelin, Marcella Marinelli, Thomas Barber, Elizabeth Paxton, Samprit Banerjee, Abby J. Isaacs, Stephen Graves

Research output: Contribution to journalArticle

Abstract

Background: Fixation in total hip replacements remains a controversial topic, despite the high level of its success. Data obtained from major orthopaedic registries indicate that there are large differences among preferred fixation and survival results. Methods: Using a distributed registry data network, primary total hip arthroplasties performed for osteoarthritis from 2001 to 2010 were identified from six national and regional total joint arthroplasty registries. A multivariate meta-analysis was performed using linear mixed models with the primary outcome revision for any reason. Survival probabilities and their standard errors were extracted from each registry for each unique combination of the covariates. Fixation strategies were compared with regard to age group, sex, bearing, and femoral-head diameter. All comparisons were based on the random-effects model and the fixed-effects model. Results: In patients who were seventy-five years of age and older, uncemented fixation had a significantly higher risk of revision (p <0.001) than hybrid fixation, with a hazard ratio of 1.575 (95% confidence interval, 1.389 to 1.786). We found a similar, if lesser, effect in the intermediate age group of sixty-five to seventy-four years (hazard ratio, 1.16 [95% confidence interval, 1.023 to 1.315]; p = 0.021) and in the younger age group of forty-five to sixty-four years (hazard ratio, 1.205 [95% confidence interval, 1.008 to 1.442]; p = 0.041). There were no significant differences between hybrid and cemented bearings across age groups. Conclusions: We conclude that cementless fixation should be avoided in older patients (those seventy-five years of age or older), although this evidence is less strong in patients of intermediate and younger ages.

Original languageEnglish
Pages (from-to)42-51
Number of pages10
JournalJournal of Bone and Joint Surgery - Series A
Volume96
DOIs
Publication statusPublished - Dec 17 2014

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Registries
Hip
Age Groups
Confidence Intervals
Arthroplasty
Survival
Hip Replacement Arthroplasties
Thigh
Osteoarthritis
Orthopedics
Meta-Analysis
Linear Models
Multivariate Analysis
Joints
Head

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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Multinational comprehensive evaluation of the fixation method used in hip replacement : Interaction with age in context. / Stea, Susanna; Comfort, Thomas; Sedrakyan, Art; Havelin, Leif; Marinelli, Marcella; Barber, Thomas; Paxton, Elizabeth; Banerjee, Samprit; Isaacs, Abby J.; Graves, Stephen.

In: Journal of Bone and Joint Surgery - Series A, Vol. 96, 17.12.2014, p. 42-51.

Research output: Contribution to journalArticle

Stea, S, Comfort, T, Sedrakyan, A, Havelin, L, Marinelli, M, Barber, T, Paxton, E, Banerjee, S, Isaacs, AJ & Graves, S 2014, 'Multinational comprehensive evaluation of the fixation method used in hip replacement: Interaction with age in context', Journal of Bone and Joint Surgery - Series A, vol. 96, pp. 42-51. https://doi.org/10.2106/JBJS.N.00463
Stea, Susanna ; Comfort, Thomas ; Sedrakyan, Art ; Havelin, Leif ; Marinelli, Marcella ; Barber, Thomas ; Paxton, Elizabeth ; Banerjee, Samprit ; Isaacs, Abby J. ; Graves, Stephen. / Multinational comprehensive evaluation of the fixation method used in hip replacement : Interaction with age in context. In: Journal of Bone and Joint Surgery - Series A. 2014 ; Vol. 96. pp. 42-51.
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AU - Comfort, Thomas

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AU - Havelin, Leif

AU - Marinelli, Marcella

AU - Barber, Thomas

AU - Paxton, Elizabeth

AU - Banerjee, Samprit

AU - Isaacs, Abby J.

AU - Graves, Stephen

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N2 - Background: Fixation in total hip replacements remains a controversial topic, despite the high level of its success. Data obtained from major orthopaedic registries indicate that there are large differences among preferred fixation and survival results. Methods: Using a distributed registry data network, primary total hip arthroplasties performed for osteoarthritis from 2001 to 2010 were identified from six national and regional total joint arthroplasty registries. A multivariate meta-analysis was performed using linear mixed models with the primary outcome revision for any reason. Survival probabilities and their standard errors were extracted from each registry for each unique combination of the covariates. Fixation strategies were compared with regard to age group, sex, bearing, and femoral-head diameter. All comparisons were based on the random-effects model and the fixed-effects model. Results: In patients who were seventy-five years of age and older, uncemented fixation had a significantly higher risk of revision (p <0.001) than hybrid fixation, with a hazard ratio of 1.575 (95% confidence interval, 1.389 to 1.786). We found a similar, if lesser, effect in the intermediate age group of sixty-five to seventy-four years (hazard ratio, 1.16 [95% confidence interval, 1.023 to 1.315]; p = 0.021) and in the younger age group of forty-five to sixty-four years (hazard ratio, 1.205 [95% confidence interval, 1.008 to 1.442]; p = 0.041). There were no significant differences between hybrid and cemented bearings across age groups. Conclusions: We conclude that cementless fixation should be avoided in older patients (those seventy-five years of age or older), although this evidence is less strong in patients of intermediate and younger ages.

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