No functional benefit of larger femoral heads and alternative bearings at 6 months following primary hip replacement.
Background and purpose - There has been a recent trend towards the use of greater femoral head sizes in an attempt to improve function and enhance stability after primary hip replacement. This has been associated with the use of alternative bearings, theoretically to reduce wear and improve implant...
| Publicado en: | Acta Orthopaedica Vol. 86; no. 1; pp. 32 - 41 |
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| Autores principales: | , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Medical Journals Sweden AB
Feb2015
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103878800&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 103878800 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 17453674 1BVL jtl: Acta Orthopaedica issn: 17453674 maglogo: N pubinfo: dt: Feb2015 vid: 86 iid: 1 pid: 59195 pub: Medical Journals Sweden AB artinfo: ui: 103878800 100576960 10.3109/17453674.2014.972259 NLM25301437 103878800 ppf: 32 ppct: 9 formats: fmt: @attributes: type: P tig: atl: No functional benefit of larger femoral heads and alternative bearings at 6 months following primary hip replacement. aug: au: Jameson, Simon S Mason, James M Baker, Paul N Gregg, Paul J Deehan, David J Reed, Mike R affil: The National Joint Registry for England and Wales; School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, Stockton-on-Tees sug: subj: Arthroplasty, Replacement, Hip Surgical Equipment and Supplies Treatment Outcomes Osteoarthritis, Hip Surgery Human Postoperative Complications Confidence Intervals Prospective Studies United Kingdom Odds Ratio Data Analysis Software Descriptive Statistics One-Way Analysis of Variance Analysis of Covariance Kruskal-Wallis Test Chi Square Test Multiple Logistic Regression Male Female Adult Middle Age Aged Aged, 80 and Over Funding Source Questionnaires Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: Background and purpose - There has been a recent trend towards the use of greater femoral head sizes in an attempt to improve function and enhance stability after primary hip replacement. This has been associated with the use of alternative bearings, theoretically to reduce wear and improve implant longevity. Methods - We examined the influence of these variables on patient-reported outcome measures (PROMs) for a consecutive series of primary hip replacements using National Joint Registry (NJR) and PROMs-linked data. To minimize the confounding influence of implant design factors, the single most commonly used brand in England and Wales (DePuy Corail Pinnacle) was examined. Improvement in patient hip-specific outcomes (Oxford hip score, OHS), general health outcomes (Euroqol, EQ-5D), and rates of self-reported complications (bleeding, wound problems, re-admission, and reoperation) were compared for different head sizes (28-mm, 32-mm, and 36-mm) and bearings (metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), and ceramic-on-ceramic (CoC)), adjusting for differences in case mix. Results - At a mean follow-up of 7 months, improvements in OHS and EQ5D index were similar for 28-mm and 36-mm heads. A 32-mm head was associated with poorer function (OHS: 20, 99% CI: 19-21, p = 0.002; EQ5D index: 0.39, 99% CI: 0.36-0.42, p = 0.004), although these small differences may not be of clinical importance. There were no statistically significant benefits of either CoP or CoC bearings compared to a MoP bearing. Complication rates were similar within comparisons of head sizes or bearings. Interpretation - In this short-term study, we did not find any functional benefits of larger head sizes or alternative bearings, after adjusting for other influences. We question their use in routine primary hip replacement given the lack of evidence of improved long-term survival in the literature. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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