Comparative Effectiveness of Metal-On-Metal and Metal-On-Polyethylene Bearings in Medicare Total Hip Arthroplasty Patients

作者：Bozic Kevin J^*; Lau Edmund C; Ong Kevin L; Vail Thomas P; Rubash Harry E; Berry Daniel J

来源：Journal of Arthroplasty, 2012, 27(8): 37-40.

DOI：10.1016/j.arth.2012.03.031

• THA bearings
• comparative effectiveness
• Medicare

The purpose of this study was to compare the risk of complication and revision total hip arthroplasty (THA) in Medicare THA patients with different bearings. Using the 100% Medicare database (2005-2009), the adjusted risk of complication and revision THA was calculated for 148 827 THA patients (93 929 metal-on-polyethylene, 49 646 metal-on-metal, 5252 ceramic-on ceramic). Adjusted risk of deep vein thrombosis, dislocation, periprosthetic joint infection (PJI), mechanical loosening, periprosthetic fracture, and revision THA at up to 4 years postoperatively was compared using Cox regression. After adjusting for patient and hospital factors, metal-on-metal bearings were associated with higher risk of PJI (P = .001), mechanical loosening (P < .001), and deep vein thrombosis (P = .031) than metal-on-polyethylene bearings and higher risk of PH (P = .014) than ceramic-on-ceramic bearings. Overall short-term revision rates did not vary significantly across bearing types, consistent with registry data. The benefits of hard-on-hard bearings in Medicare patients remain unproven, and further study is needed to compare long-term complication and revision rates in Medicare THA patients with different bearing types.

• 出版日期2012-9