Revision Risk of Unipolar and Bipolar Hemiarthroplasties in the Dutch Arthroplasty Register.

BACKGROUND: Hemiarthroplasty (HA) for hip fractures can be performed with a unipolar or bipolar head. We describe the use of unipolar and bipolar HA after a hip fracture in the Netherlands and determined revision rates and risk factors. METHODS: All HAs for an acute hip fracture registered in the Dutch Arthroplasty Register (LROI) during 2007 to 2021 were included; 44,127(88%) unipolar and 6,013(12%) bipolar HAs. Competing risk survival analyses were performed with revision for any reason as the endpoint. Multivariable Cox regression analyses were performed adjusting for patient and surgery-related factors. RESULTS: The 1-year, 5-year, and 10-year revision rates were comparable for unipolar and bipolar HA. Cox regression analysis showed a hazard ratio of 1.2 (95% confidence interval (CI) 1.0 to 1.4)) after adjustment for confounders for bipolar heads. In cases of a cemented stem, the 1-year cumulative incidence of revision was lower (1.5% (CI 1.4 to 1.7%) compared to uncemented stems (2.4% (CI 2.1 to 2.7%); uncemented stems showed higher risks for revision after adjustment compared to cemented stems (hazard ratio 1.4 (CI 1.2 to 1.5)). The anterior, antero-lateral, and straight-lateral approach showed lower risk for revision compared to the postero-lateral approach. CONCLUSION: The revision rate for bipolar HA and unipolar HA was comparable. However, after adjustment for potential confounders the risk for revision showed an estimated 20% increased revision risk for bipolar heads, although not statistically significant. For both head types, the risk for revision was significantly higher when an uncemented stem was chosen or the postero-lateral approach was used.

Comparable mortality but higher revision rate after uncemented compared with cemented total hip arthroplasties in patients 80 years and older: report of 43,053 cases of the Dutch Arthroplasty Register.

Background and purpose - Mortality and revision risks are important issues during shared decision-making for total hip arthroplasty (THA) especially in elderly patients. We examined mortality and revision rates as well as associated patient and prosthesis factors in primary THA for osteoarthritis (OA) in patients ≥ 80 years in the Netherlands. Patients and methods - We included all primary THAs for OA in patients ≥ 80 years in the period 2007-2019. Patient mortality and prosthesis revision rates were calculated using Kaplan-Meier survival analyses. Risk factors for patient mortality and prosthesis revision were analyzed using multivariable Cox regression analysis adjusted for age, sex, ASA class, fixation method, head size, and approach. Results - Mortality was 0.2% at 7 days, 0.4% at 30 days, 2.7% at 1 year, and 20% at 5 years. Mortality was higher in males and higher ASA class, but did not differ between fixation methods. The 1-year revision rate was 1.6% (95% CI 1.5-1.7) and 2.6% (CI 2.5-2.7) after 5 years. Multivariable Cox regression analysis showed a higher risk of revision for uncemented (hazard ratio [HR] 1.6; CI 1.4-1.8) and reverse hybrid THAs (HR 2.9; CI 2.1-3.8) compared with cemented THAs. Periprosthetic fracture was the most frequently registered reason for revision in uncemented THAs. Interpretation - Mortality is comparable but revision rate is higher after uncemented compared with cemented THA in patients 80 years and older, indicating that cemented THA might be a safer option in this patient group.

Low revision rate of dual mobility cups after arthroplasty for acute hip fractures: report of 11,857 hip fractures in the Dutch Arthroplasty Register (2007-2019).

Background and purpose - Dislocation is one of the most frequent reasons for cup revision after total hip arthroplasty (THA) for an acute fracture. A dual mobility cup (DMC) might reduce this risk. We determined the cup revision rate after THA for an acute fracture according to type of cup.Patients and methods - All THAs for an acute fracture registered in the Dutch Arthroplasty Register (LROI) during 2007-2019 were included (n = 11,857). Type of cup was divided into DMC and unipolar cup (UC). Competing risk analyses were performed with cup revision for any reason as endpoint. Multivariable Cox regression analyses with outcome cup revision were performed adjusted for sex, age, ASA class, and surgical approach, stratified for UC THA with femoral head size of 32 mm and 22-28 mm.Results - A DMC was used in 1,122 (9%) hips. The overall 5-year cup revision rate for any reason after THA for acute fracture was 1.9% (95% CI 1.6-2.2). Cup revision for dislocation within 5 years was performed in 1 of 6 DMC THAs versus 108 of 185 (58%) UC THAs. Univariable Cox regression analyses showed no statistically significant difference in cup revision rate between DMC and UC (HR = 0.8; CI 0.4-1.5). Multivariable Cox regression analyses showed lower risk of cup revision in DMC THA (n = 1,122) compared with UC THA with 22-28 mm femoral head size (n = 2,727) (HR = 0.4; CI 0.2-0.8).Interpretation - The 5-year cup cumulative incidence of revision after THA for acute fracture was comparable for DMC and UC THA. However, DMC THA had a lower risk of cup revision than UC THA with 22-28 mm femoral head.

Lower 5-year cup re-revision rate for dual mobility cups compared with unipolar cups: report of 15,922 cup revision cases in the Dutch Arthroplasty Register (2007-2016).

Background and purpose - During revision hip arthroplasty the dual mobility cup (DMC) is widely used to prevent dislocation despite limited knowledge of implant longevity. We determined the 5-year cup re-revision rates of DMC compared with unipolar cups (UC) following cup revisions in the Netherlands. Patients and methods - 17,870 cup revisions (index cup revision) were registered in the Dutch Arthroplasty Register during 2007-2016. Due to missing data 1,948 revisions were excluded and the remaining 15,922 were divided into 2 groups: DMC (n = 4,637) and UC (n = 11,285). Crude competing risk and multivariable Cox regression analysis were performed with cup re-revision for any reason as endpoint. Adjustments were made for known patient characteristics. Results - The use of DMC (in index cup revisions) increased from 23% (373/1,606) in 2010 to 47% (791/1,685) in 2016. Patients in the index DMC cup revision group generally had a higher ASA score and the cups were mainly cemented (89%). The main indication for index cup revision was loosening. In the DMC group dislocation was the 2nd main indication for revision. Overall 5-year cup re-revision rate was 3.5% (95% CI 3.0-4.2) for DMC and 6.7% (CI 6.3-7.2) for UC. Cup re-revision for dislocation was more frequent in the UC group compared with the DMC group (32% [261/814] versus 18% [28/152]). Stratified analyses for cup fixation showed a higher cup re-revision rate for UC in both the cemented and uncemented group. Multivariable regression analyses showed a lower risk for cup re-revision for DMC compared with UC (HR 0.5 [CI 0.4-0.6]). Interpretation - The use of DMC in cup revisions increased over time with differences in patient characteristics. The 5-year cup re-revision rates for DMC were statistically significantly lower than for UC.

Dual mobility cups in primary total hip arthroplasties: trend over time in use, patient characteristics, and mid-term revision in 3,038 cases in the Dutch Arthroplasty Register (2007-2016).

Background and purpose - We noticed an increased use of dual mobility cups (DMC) in primary total hip arthroplasty (THA) despite limited knowledge of implant longevity. Therefore, we determined the trend over time and mid-term cup revision rates of DMC compared with unipolar cups (UC) in primary THA. Patients and methods - All primary THA registered in the Dutch Arthroplasty Register (LROI) during 2007-2016 were included (n = 215,953) and divided into 2 groups - DMC THA (n = 3,038) and UC THA (n = 212,915). Crude competing risk and multivariable Cox regression analyses were performed with cup revision for any reason as primary endpoint. Adjustments were made for sex, age, diagnosis at primary THA, previous operation, ASA score, type of fixation, surgical approach, and femoral head size. Results - The proportion of primary DMC THA increased from 0.8% (n = 184) in 2010 to 2.6% (n = 740) in 2016. Patients who underwent DMC THA more often had a previous operation on the affected hip, a higher ASA score, and the diagnosis acute fracture or late posttraumatic status compared with the UC THA group. Overall 5-year cup revision rate was 1.5% (95% CI 1.0-2.3) for DMC and 1.4% (CI 1.3-1.4) for UC THA. Stratified analyses for patient characteristics showed no differences in cup revision rates between the 2 groups. Multivariable regression analyses showed no statistically significantly increased risk for revision for DMC THA (HR 0.9 [0.6-1.2]). Interpretation - The use of primary DMC THA increased with differences in patient characteristics. The 5-year cup revision rates for DMC THA and UC THA were comparable.