International Orthopaedics

, Volume 43, Issue 1, pp 103–109 | Cite as

The influence of bearing surfaces on periprosthetic hip infections: analysis of thirty nine thousand, two hundred and six  cementless total hip arthroplasties

  • Barbara Bordini
  • Susanna Stea
  • Francesco CastagniniEmail author
  • Luca Busanelli
  • Federico Giardina
  • Aldo Toni
Original Paper



Periprosthetic hip infection (PHI) is a devastating complication. The association between PHI and bearing surfaces as well as patient-related factors has been recently investigated, with contradictive outcomes. The dataset of Emilia-Romagna region Registry for Orthopaedic Prosthetic Implants (RIPO) has been assessed to investigate, if the bearing choice influenced the risk of septic loosening occurrence.


RIPO data about 39,206 cementless total hip arthroplasties (THA), collected since 2003, were analysed. Age, gender, BMI, diabetes and bearing surfaces were evaluated. The end point of the study was the revision of at least a single component due to sepsis.


Adjusted and unadjusted survival rates showed that ceramic-on-ceramic (COC) implants had the lower incidence of PHIs, whereas metal-on-metal (MOM) THAs were significantly more prone to infection. In MOM cohort, stemmed implants were involved in 28 out of 30 cases. Among the demographical features and comorbid conditions, only diabetes statistically influenced the rate of sepsis.


Bearing surfaces influenced the rate of PHI; in particular, stemmed MOM implants were at higher risk, probably due to metal debris consequent to taperosis. Despite the preliminary results, stemmed MOM THAs should be used with care, and diabetic patients should be warned about increased septic risks.


Septic loosening Articular coupling Diabetes Ceramic Metal Polyethylene 


Compliance with ethical standards

Conflict of interest

The senior author is paid consultant for Zimmer (Warsaw, US), Adler Ortho (Milan, Italy) and CeramTec (Plochingen, Germany). The other authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was not necessary as the registry collects personal data as standard practice and conceals the identity of the patients.


  1. 1.
    Kuzyk PR, Dhotar HS, Sternheim A, Gross AE, Safir O, Backstein D (2014) Two-stage revision arthroplasty for management of chronic periprosthetic hip and knee infection: techniques, controversies, and outcomes. J Am Acad Orthop Surg 22(3):153–164CrossRefGoogle Scholar
  2. 2.
    Kobayashi S, Kubo T, Iwamoto Y, Fukushima W, Sugano N. (2018) Nationwide multicenter follow-up cohort study of hip arthroplasties performed for osteonecrosis of the femoral head. Int Orthop. 2018 may 12. doi:
  3. 3.
    Triantafyllopoulos GK, Soranoglou VG, Memtsoudis SG, Sculco TP, Poultsides LA (2017) Rate and risk factors for periprosthetic joint infection among 36,494 primary total hip arthroplasties. J Arthroplast.
  4. 4.
    Merollini KM, Zheng H, Graves N (2013) Most relevant strategies for preventing surgical site infection after total hip arthroplasty: guideline recommendations and expert opinion. Am J Infect Control 41(3):221–226CrossRefGoogle Scholar
  5. 5.
    Abdelaziz H, Zahar A, Lausmann C, Gehrke T, Fickenscher H, Suero EM, Gebauer M, Citak M (2018) High bacterial contamination rate of electrocautery tips during total hip and knee arthroplasty. Int Orthop 42(4):755–760. CrossRefGoogle Scholar
  6. 6.
    Lass R, Giurea A, Kubista B, Hirschl AM, Graninger W, Presterl E, Windhager R, Holinka J (2014) Bacterial adherence to different components of total hip prosthesis in patients with prosthetic joint infection. Int Orthop 38(8):1597–1602CrossRefGoogle Scholar
  7. 7.
    Lee YK, Yoon BH, Choi YS, Jo WL, Ha YC, Koo KH (2016) Metal on metal or ceramic on ceramic for cementless total hip arthroplasty: a meta-analysis. J Arthroplasty 31(11):2637–2645.e1CrossRefGoogle Scholar
  8. 8.
    Pitto RP, Sedel L (2016) Periprosthetic joint infection in hip arthroplasty: is there an association between infection and bearing surface type? Clin Orthop Relat Res 474(10):2213–2218CrossRefGoogle Scholar
  9. 9.
    Australian Orthopaedic Association National Joint Replacement Registry. Annual report 2017. Accessed 18 Febraury 2018
  10. 10.
    Nandi S (2016) CORR insights(®): periprosthetic joint infection in hip arthroplasty: is there an association between infection and bearing surface type? Clin Orthop Relat Res 474(10):2219–2220CrossRefGoogle Scholar
  11. 11.
    RIPO. Annual Report 2015., Accessed 19 February 2018
  12. 12.
    Ali A, Sundberg M, Robertsson O, Dahlberg LE, Thorstensson CA, Redlund-Johnell I, Kristiansson I, Lindstrand A (2014) Dissatisfied patients after total knee arthroplasty: a registry study involving 114 patients with 8-13 years of followup. Acta Orthop 85(3):229–233CrossRefGoogle Scholar
  13. 13.
    Pedersen AB, Mehnert F, Johnses SP, Sorensen HT (2010) Risk of revision of a total hip replacement in patients with diabetes mellitus. A population-based follow up study. J Bone Joint Surg 92-B:929–934CrossRefGoogle Scholar
  14. 14.
    Tao R, Liu F, Liu YK, Lu Y, Xu H, Cao Y, Zhou ZY, Wang W (2018) A prospective comparative study of hip resurfacing arthroplasty and large-diameter head metal-on-metal total hip arthroplasty in younger patients-a minimum of five year follow-up. Int Orthop.
  15. 15.
    Bozic KJ, Ong K, Lau E, Kurtz SM, Vail TP, Rubash HE, Berry DJ (2010) Risk of complication and revision total hip arthroplasty among medicare patients with different bearing surfaces. Clin Orthop Relat Res 468(9):2357–2362CrossRefGoogle Scholar
  16. 16.
    National Joint Registry. Annual report 2017. Accessed 19 February 2018
  17. 17.
    Grammatopoulos G, Munemoto M, Inagaki Y, Tanaka Y, Athanasou NA (2016) The diagnosis of infection in metal-on-metal hip arthroplasties. J Arthroplast 31(11):2569–2573CrossRefGoogle Scholar
  18. 18.
    Mahendra G, Pandit H, Kliskey K, Murray D, Gill HS, Athanasou N (2009) Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties. Acta Orthop 80(6):653–659CrossRefGoogle Scholar
  19. 19.
    Huk OL, Catelas I, Mwale F, Antoniou J, Zukor DJ, Petit A (2004) Induction of apoptosis and necrosis by metal ions in vitro. J Arthroplast 19(8 Suppl 3):84–87CrossRefGoogle Scholar
  20. 20.
    Lanting BA, Teeter MG, Howard JL, MacDonald SJ, Van Citters DW (2017) Metal-on-metal compared with metal-on-polyethylene: the effect on trunnion corrosion in total hip arthroplasty. J Arthroplast 32(8):2574–2579CrossRefGoogle Scholar
  21. 21.
    Daniel J, Holland J, Quigley L, Sprague S, Bhandari M (2012) Pseudotumors associated with total hip arthroplasty. J Bone Joint Surg Am 94(1):86–93CrossRefGoogle Scholar
  22. 22.
    Mutimer J, Devane PA, Adams K, Horne JG (2010) Highly crosslinked polyethylene reduces wear in total hip arthroplasty at 5 years. Clin Orthop Relat Res 468(12):3228–3233CrossRefGoogle Scholar
  23. 23.
    Bozic KJ, Ward DT, Lau EC, Chan V, Wetters NG, Naziri Q, Odum S, Fehring TK, Mont MA, Gioe TJ, Della Valle CJ (2014) Risk factors for periprosthetic joint infection following primary total hip arthroplasty: a case control study. J Arthroplast 29(1):154–156CrossRefGoogle Scholar
  24. 24.
    Zhu M, Ravi S, Frampton C, Luey C, Young S (2016) New Zealand Joint Registry data underestimates the rate of prosthetic joint infection. Acta Orthop 87(4):346–350CrossRefGoogle Scholar
  25. 25.
    Whitehouse MR, Endo M, Zachara S, Nielsen TO, Greidanus NV, Masri BA, Garbuz DS, Duncan CP (2015) Adverse local tissue reactions in metal-on-polyethylene total hip arthroplasty due to trunnion corrosion: the risk of misdiagnosis. Bone Joint J 97(8):1024–1030CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Laboratorio di Tecnologia MedicaIRCCS Istituto Ortopedico RizzoliBolognaItaly
  2. 2.Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d’anca e di ginocchioIRCCS Istituto Ortopedico RizzoliBolognaItaly

Personalised recommendations