Research Identifies Best Hip Implant Materials for Long-Term Success

A new study from the University of Bristol reveals that hip implants made with delta ceramic or oxidized zirconium heads and highly crosslinked polyethylene liners offer the lowest risk of revision surgery over 15 years. This research is crucial for helping patients and surgeons select the best implants for long-lasting hip replacement outcomes.

Nov 8, 2024 - 18:37
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Research Identifies Best Hip Implant Materials for Long-Term Success

A groundbreaking study by the University of Bristol has revealed the best materials for long-lasting hip implants. According to the research, implants made with a delta ceramic or oxidized zirconium head, paired with a highly crosslinked polyethylene (HCLPE) liner or cup, show the lowest risk of needing revision surgery within 15 years of the initial operation. This vital information could assist hospitals, surgeons, and patients in making informed decisions when choosing the right hip implant for replacement surgery.

The primary goal of this study was to determine which hip implant materials are at the highest risk for requiring revision surgery, ultimately helping orthopedic surgeons and patients improve decision-making before surgery.

Published in PLOS Medicine on November 7, 2024, the research was independently conducted and funded by CeramTec, with additional support from the National Institute for Health and Care Research (NIHR) and the NIHR Bristol Biomedical Research Centre (Bristol BRC).

The study analyzed data from the National Joint Registry (NJR), which included over one million hip replacement surgeries performed in both public and private sectors across England and Wales. Researchers reviewed the outcomes of 1,026,481 patients who underwent hip replacement surgeries between 2003 and 2019, following them for up to 15 years after their procedures.

Key Findings:

The team found that the type of material used for the implant's bearing surface (the parts that move against each other during activity) significantly affects the risk of revision surgery. Implants with a delta ceramic or oxidized zirconium head combined with a HCLPE liner or cup showed the lowest likelihood of needing revision surgery over the 15-year follow-up period.

Further investigation into the reasons behind revision surgeries confirmed these results, showing that 20,869 (2%) of patients needed a second procedure after their initial hip replacement.

Dr. Erik Lenguerrand, Senior Lecturer in Medical Statistics and Quantitative Epidemiology at the University of Bristol and a senior author of the study, commented, "Our research has shown that the risk of hip replacement revision depends heavily on the materials used in the initial surgery. Implants with a delta ceramic or oxidized zirconium head and a HCLPE liner or cup have the lowest risk of revision."

However, he noted that more research is needed to assess other factors, such as the association between implant materials and the risk of rehospitalization, re-operation, mortality, and the overall cost-effectiveness of these materials.

Impact and Application:

Professor Michael Whitehouse, Professor of Trauma and Orthopaedics at Bristol Medical School and senior clinical lead for the study, explained, "Our study used data from one of the largest joint registries globally, including all healthcare sectors in England and Wales. This comprehensive data makes our findings more applicable than previous studies, which were limited by smaller sample sizes and broader groupings of implant types."

The findings are particularly valuable in guiding hospitals, surgeons, and patients toward selecting hip implants that carry the lowest risk of failure. By understanding the materials' role in revision risk, decision-making for hip replacement surgery can be more precise.

A Growing Need:

Joint replacement surgeries, especially hip replacements, are commonly performed to treat musculoskeletal issues like osteoarthritis and trauma. In the UK alone, more than 110,000 hip replacements are done annually, and by 2060, the demand is expected to rise by nearly 40%. Fortunately, joint replacements are durable, with more than half of hip and knee replacements lasting over 25 years.

The research team also emphasized that while their study provided important insights, it was not a randomized controlled trial, meaning it could not control for all possible factors that could influence the risk of revision. Additionally, the categorization of hip implants used in national joint registries is often too broad to reveal subtle differences in revision risks between materials.

Conclusion:

This study underscores the importance of choosing the right materials for hip implants, particularly in reducing the risk of revision surgery. It highlights the need for continued research into the long-term performance of hip replacements and the materials used, with the aim of improving patient outcomes and ensuring that hip replacements continue to provide lasting relief to those in need.

The research team extends its gratitude to the patients and staff of hospitals across England, Wales, and Northern Ireland for their contributions to the NJR, and to the Healthcare Quality Improvement Partnership, the NJR Research Committee, and NJR staff for facilitating this valuable research.

Reference:

Whitehouse, M. R., et al. (2024). The association of bearing surface materials with the risk of revision following primary total hip replacement: A cohort analysis of 1,026,481 hip replacements from the National Joint Registry. PLOS Medicine. https://doi.org/10.1371/journal.pmed.1004478

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