Symposium: Complications of Hip Arthroplasty

Clinical Orthopaedics and Related Research®

, Volume 468, Issue 9, pp 2357-2362

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Risk of Complication and Revision Total Hip Arthroplasty Among Medicare Patients with Different Bearing Surfaces

  • Kevin J. BozicAffiliated withDepartment of Orthopaedic Surgery, University of CaliforniaPhilip R. Lee Institute for Health Policy Studies, University of California Email author 
  • , Kevin OngAffiliated withExponent, Inc
  • , Edmund LauAffiliated withExponent, Inc
  • , Steven M. KurtzAffiliated withExponent, Inc
  • , Thomas P. VailAffiliated withDepartment of Orthopaedic Surgery, University of California
  • , Harry E. RubashAffiliated withDepartment of Orthopaedic Surgery, Massachusetts General Hospital
  • , Daniel J. BerryAffiliated withDepartment of Orthopaedic Surgery, Mayo Clinic



To address the long-term problems of bearing surface wear and osteolysis associated with conventional metal-polyethylene (M-PE) total hip arthroplasty (THA), metal-metal (M-M), and ceramic-ceramic (C-C) bearings have been introduced. These bearing surfaces are associated with unique risks and benefits and higher costs. However the relative risks of these three bearings in an older population is unknown.


We compared the short-term risk of complication and revision THA among Medicare patients having a primary THA with metal-polyethylene (M-PE), metal-metal (M-M), and ceramic-ceramic (C-C) bearings.


We used the 2005 to 2007 100% Medicare inpatient claim files to perform a matched cohort analysis in three separate cohorts of THA patients (M-PE, M-M, and C-C) who were matched by age, gender, and US census region. Multivariate Cox proportional-hazards models were constructed to compare complication and revision THA risk among cohorts, adjusting for medical comorbidities, race, socioeconomic status, and hospital factors.


After adjusting for patient and hospital factors, M-M bearings were associated with a higher risk of periprosthetic joint infection (hazard ratio, 3.03; confidence interval, 1.02–9.09) when compared with C-C bearings (0.59% versus 0.32%, respectively). There were no other differences among bearing cohorts in the adjusted risk of revision THA or any other complication.


The risk of short-term complication (including dislocation) and revision THA were similar among appropriately matched Medicare THA patients regardless of bearing surface. Hard-on-hard THA bearings are of questionable value in Medicare patients, given the higher cost associated with their use and uncertain long-term benefits in older patients.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.