Over the past year, there have been many changes in hip arthroplasty. Some of the new information further solidifies practices such as the use of tranexamic acid for blood conservation and the detection of infection through alpha defensins, and other studies have enhanced our knowledge of surgical approaches and the modes of failure of implants. Compared with the past, the biggest changes have not been in surgical materials or techniques but in how surgeons will practice in the future with respect to outcomes.
Factors That May Alter Outcomes Following Total Hip Replacement
Total hip arthroplasty is increasingly being utilized in younger, more active patients with long life expectancies. Researchers have conducted studies using different bearing couples in the hopes of improving the longevity of implants. In one report, the authors conducted a Level-I study to determine if there was a short-term to intermediate-term survivorship difference among common total hip arthroplasty bearings used in patients younger than 65 years of age1. This report described the survivorship of ceramic on ceramic, ceramic on highly cross-linked polyethylene, and metal on highly cross-linked polyethylene. Direct-comparison meta-analysis found no differences among the bearing surfaces in terms of the risk of revision. Network meta-analysis likewise found no differences in survivorship across the three implant types, suggesting that, at least in the short term, any of the bearing combinations functioned well in younger patients. Another randomized controlled trial compared the results of ceramic-on-ceramic bearing with those of ceramic-on-polyethylene bearings2. At the 10-year follow-up, there were no group differences (p > 0.48) in both the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and the SF-12 (RAND 12-Item Health Survey). There were no failures or loss of fixation related to bearing surfaces or wear in either group. Comparing ceramic-on-ceramic bearings with ceramic-on-polyethylene bearings, there were few short-term differences in function or wear. These …
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