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Head Material Influences Survival of a Cemented Total Hip Prosthesis in the Norwegian Arthroplasty Register

  • Symposium: Papers Presented at the 2011 Meeting of the International Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

High prosthesis survival is reported for total hip prostheses with metal and alumina heads, but direct comparisons of a single prosthesis design with one of two different head materials has seldom been studied. Prostheses with zirconia heads are less commonly used than metal and alumina heads, and the few reports suggest variable results with zirconia heads.

Questions/Purposes

We therefore asked: (1) Would metal heads provide better survival of a cemented total hip arthroplasty (THA) than alumina heads? (2) Would metal heads provide better survival of a cemented THA than zirconia heads?

Methods

We searched in the Norwegian Arthroplasty Register for cemented primary THA cup/stem combinations that simultaneously had been used with different head materials. The only THA that fulfilled these inclusion criteria was the cemented Reflection All-Poly/Spectron EF (cup/stem) that had during 2001 to 2006 been used both with alumina (n = 448) and cobalt-chromium (n = 5229) heads; that implant had also been used with zirconia (n = 275) and cobalt-chromium heads (n = 3195) during 1997 to 2003, and we included patients with this THA from these two time intervals in the study. All cups were conventional polyethylene. We estimated prosthesis survival and relative revision risks adjusting for age, sex, and diagnosis. The followup in the two study materials was until December 2010.

Results

The survival at 8 years of the Spectron EF/Reflection THAs, inserted with alumina and cobalt-chromium heads during 2001 to 2006, was 92.3% and 94.0%, respectively. The Reflection/Spectron EF THA had inferior survival with zirconia heads compared with cobalt-chromium heads (relative risk, 1.7). At 12 years, the survival rate was 88.1% with cobalt-chromium heads and 74.8% with zirconia heads.

Conclusions

Alumina femoral heads provided no advantage over cobalt-chromium heads on midterm prosthesis survival. THAs with zirconia heads had inferior survival.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank all of the orthopaedic surgeons in our country who have contributed by reporting their operations to our national hip register.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, 5021, Norway

    Thomas Kadar MD & Leif Ivar Havelin MD, PhD

  2. The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway

    Eva Dybvik MSc

  3. Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway

    Geir Hallan MD, PhD & Ove Furnes MD, PhD

  4. Department of Surgical Sciences, University of Bergen, Bergen, Norway

    Leif Ivar Havelin MD, PhD

Authors
  1. Thomas Kadar MD
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  2. Eva Dybvik MSc
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  3. Geir Hallan MD, PhD
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  4. Ove Furnes MD, PhD
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  5. Leif Ivar Havelin MD, PhD
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Corresponding author

Correspondence to Leif Ivar Havelin MD, PhD.

Additional information

The Norwegian Arthroplasty Register is financed by the Norwegian government through Haukeland University Hospital.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

This work was performed at Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway, and at the Department of Surgical Sciences, University of Bergen, Bergen, Norway.

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Kadar, T., Dybvik, E., Hallan, G. et al. Head Material Influences Survival of a Cemented Total Hip Prosthesis in the Norwegian Arthroplasty Register. Clin Orthop Relat Res 470, 3007–3013 (2012). https://doi.org/10.1007/s11999-012-2396-2

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  • DOI: https://doi.org/10.1007/s11999-012-2396-2

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