How I choose a Bearing Surface for my patients.

There is insufficient clinical data to demonstrate the overall superiority of any one Bearing couple for all total hip cases. It is therefore reasonable to individualize the choice of Bearing Surface. The fundamental exercise in choosing a Bearing Surface is maximizing the benefit to risk ratio. There are at least 3 perspectives to consider: the patient’s, the surgeon’s, and that of the health care delivery system. The following question should be addressed on a patient-by-patient basis: what available Bearing is most likely to meet the needs of this patient, with an acceptable risk of revision surgery during his or her lifetime, is accepted in my community, and is there a means to pay for it?

Bearing Surface options for total hip replacement in young patients

Total hip arthroplasty is one of the most successful and cost-effective surgical interventions in medicine1 and is the most effective treatment for osteoarthritis of the hip joint. Long-term studies of selected patient cohorts2-4 and the Scandinavian hip registries5,6 have demonstrated high survivorship rates after more than twenty years. On the basis of this success, total hip replacement is being performed on increasingly younger and more active patients. However, there are at least two problems that a young or active patient faces with regard to the prosthetic joint. First, the use of the implant is more intense in proportion to their physical activities7. Second, the patient’s life expectancy is longer and the potential total number of loading cycles is increased proportionally.

Patient-related factors contribute to implant wear regardless of the type of Bearing8. Higher patient activity results in higher wear rates8. Follow-up studies of young patients have demonstrated a relationship between the amount of wear and the age of the patient9,10, the revision rate11, osteolysis9,12,13, and aseptic loosening12. The overall rate of survival of total hip arthroplasty implants in young patients is reduced compared with that in average patient groups3. The survival rate of artificial joints in patients younger than fifty years of age is approximately 80% after ten years or more, regardless of the fixation technique and Bearing combination11,12,14-18. To our knowledge, only one recent study, by Kim et al.10, demonstrated a survival rate of 99% after ten years in patients less than fifty years of age.

In chronological order, the categorical factors limiting the function and longevity of a total hip prosthesis are the surgical technique, fixation of the implant to the bone, osteolysis (often associated with wear of the Bearing), fatigue failure of the implants, and long-term skeletal remodeling. No implant system can overcome inadequate surgical technique. A …

the epidemiology of Bearing Surface usage in total hip arthroplasty in the united states

Background: Hard-on-hard Bearings offer the potential to improve the survivorship of total hip arthroplasty implants. However, the specific indications for the use of these advanced technologies remain controversial. The purpose of this study was to characterize the epidemiology of Bearing Surface utilization in total hip arthroplasty in the United States with respect to patient, hospital, geographic, and payer characteristics.

Methods: The Nationwide Inpatient Sample database was used to analyze Bearing type and demographic characteristics associated with 112,095 primary total hip arthroplasties performed in the United States between October 1, 2005, and December 31, 2006. The prevalence of each type of total hip arthroplasty Bearing was calculated for population subgroups as a function of age, sex, census region, payer class, and hospital type.

Results: The most commonly reported Bearing was metal-on-polyethylene (51%) followed by metal-on-metal (35%) and ceramic-on-ceramic (14%). Metal-on-polyethylene Bearings were most commonly reported in female Medicare patients who were sixty-five to seventy-four years old, while metal-on-metal and ceramic-on-ceramic Bearings were most commonly reported in privately insured male patients who were less than sixty-five years old. Thirty-three percent of patients over sixty-five years old had a hard-on-hard Bearing reported. There was substantial regional variation in Bearing usage; the highest prevalence of metal-on-polyethylene Bearings was reported in the Northeast and at nonteaching hospitals, and the highest prevalence of metal-on-metal Bearings was reported in the South and at teaching hospitals.

Conclusions: The usage of total hip arthroplasty Bearings varies considerably by patient characteristics, hospital type, and geographic location throughout the United States. Despite uncertain advantages in older patients, hard-on-hard Bearings are commonly used in patients over the age of sixty-five years. Further study is necessary to define the appropriate indications for these advanced technologies in total hip arthroplasty.

Bearing Surface options for total hip replacement in young patients

Total hip arthroplasty is one of the most successful and cost-effective surgical interventions in medicine1 and is the most effective treatment for osteoarthritis of the hip joint. Long-term studies of selected patient cohorts2-4 and the Scandinavian hip registries5,6 have demonstrated high survivorship rates after more than twenty years. On the basis of this success, total hip replacement is being performed on increasingly younger and more active patients. However, there are at least two problems that a young or active patient faces with regard to the prosthetic joint. First, the use of the implant is more intense in proportion to their physical activities7. Second, the patient’s life expectancy is longer and the potential total number of loading cycles is increased proportionally.

Patient-related factors contribute to implant wear regardless of the type of Bearing8. Higher patient activity results in higher wear rates8. Follow-up studies of young patients have demonstrated a relationship between the amount of wear and the age of the patient9,10, the revision rate11, osteolysis9,12,13, and aseptic loosening12. The overall rate of survival of total hip arthroplasty implants in young patients is reduced compared with that in average patient groups3. The survival rate of artificial joints in patients younger than fifty years of age is approximately 80% after ten years or more, regardless of the fixation technique and Bearing combination11,12,14-18. To our knowledge, only one recent study, by Kim et al.10, demonstrated a survival rate of 99% after ten years in patients less than fifty years of age.

In chronological order, the categorical factors limiting the function and longevity of a total hip prosthesis are the surgical technique, fixation of the implant to the bone, osteolysis (often associated with wear of the Bearing), fatigue failure of the implants, and long-term skeletal remodeling. No implant system can overcome inadequate surgical technique. A …