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Survival of Hard-on-Hard Bearings in Total Hip Arthroplasty: A Systematic Review

  • Symposium: Update on Hard-on-Hard Bearings in Hip Arthroplasty
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Improvements in prosthetic materials, designs, and implant fixation for THA have led to bearing surface wear being the limitation of this technology. Hard-on-hard bearings promise decreased wear rates and increased survival. However, there may be different survival rates based on bearing materials, manufacturing technologies, and femoral component designs. Additionally, survival rate variability may be based on study design.

Questions/purposes

We determined survival rates and study levels of evidence and quality for the following bearings: stemmed metal-on-metal THA, metal-on-metal hip resurfacing, ceramic-on-ceramic THA, and ceramic-on-metal THA.

Methods

We performed a systematic review of the peer-reviewed literature addressing THA hard-on-hard bearings. Quality for Level I and II studies was assessed.

Results

The four Level I or II second-generation stemmed metal-on-metal THA studies reported between 96% and 100% mean survival at 38 to 60 months. The two Level I hip resurfacing studies reported 94% and 98% mean survival at 56 and 33 months. The four Level I studies of ceramic-on-ceramic THA reported survival from 100% at mean 51 months to 96% at 8 years.

Conclusions

While hard-on-hard bearing survival rates have generally been variable with earlier designs, contemporary implants have demonstrated survival of 95% or greater at followup of between 3 and 10 years. Some variability in survival may be due to differences in surgical technique, component positioning, and implant designs. As bearing designs continue to improve with modified materials and manufacturing techniques, use will increase, especially in young and active patients, though concerns remain about the increased reports of adverse events after metal-on-metal bearings.

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Authors and Affiliations

  1. Center for Joint Preservation and Replacement, The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA

    Michael G. Zywiel MD, Siraj A. Sayeed MD, Aaron J. Johnson MD & Michael A. Mont MD

  2. Joint Replacement Institute at St. Vincent Medical Center, Los Angeles, CA, USA

    Thomas P. Schmalzried MD

Authors
  1. Michael G. Zywiel MD
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  2. Siraj A. Sayeed MD
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  3. Aaron J. Johnson MD
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  4. Thomas P. Schmalzried MD
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  5. Michael A. Mont MD
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Correspondence to Michael A. Mont MD.

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Michael A. Mont is a consultant for Stryker Orthopaedics (Mahwah, NJ) and Wright Medical Technology, Inc (Arlington, TN), receives royalties from Stryker, and receives research or institutional support from Stryker, Wright Medical, the National Institutes of Health (NIAMS and NICHD), and TissueGene, Inc (Rockville, MD). Thomas P. Schmalzried is a board member of the Orthopaedic Research and Education Foundation, is a member of the editorial board for Orthopedics Today, receives royalties from DePuy Orthopaedics, Inc (Warsaw, IN) and Stryker, is a consultant for Stryker, receives research or institutional support from DePuy and Stryker, and holds stock or stock options in Johnson and Johnson, Smith and Nephew, Stryker, and Zimmer, Inc (Warsaw, IN). Michael G. Zywiel serves on the editorial board of Expert Review of Medical Devices. The remaining authors certify that they have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

This work was performed at Sinai Hospital of Baltimore.

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Zywiel, M.G., Sayeed, S.A., Johnson, A.J. et al. Survival of Hard-on-Hard Bearings in Total Hip Arthroplasty: A Systematic Review. Clin Orthop Relat Res 469, 1536–1546 (2011). https://doi.org/10.1007/s11999-010-1658-0

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