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The influence of bearing surfaces on periprosthetic hip infections: analysis of thirty nine thousand, two hundred and six  cementless total hip arthroplasties

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Abstract

Purpose

Periprosthetic hip infection (PHI) is a devastating complication. The association between PHI and bearing surfaces as well as patient-related factors has been recently investigated, with contradictive outcomes. The dataset of Emilia-Romagna region Registry for Orthopaedic Prosthetic Implants (RIPO) has been assessed to investigate, if the bearing choice influenced the risk of septic loosening occurrence.

Methods

RIPO data about 39,206 cementless total hip arthroplasties (THA), collected since 2003, were analysed. Age, gender, BMI, diabetes and bearing surfaces were evaluated. The end point of the study was the revision of at least a single component due to sepsis.

Results

Adjusted and unadjusted survival rates showed that ceramic-on-ceramic (COC) implants had the lower incidence of PHIs, whereas metal-on-metal (MOM) THAs were significantly more prone to infection. In MOM cohort, stemmed implants were involved in 28 out of 30 cases. Among the demographical features and comorbid conditions, only diabetes statistically influenced the rate of sepsis.

Conclusions

Bearing surfaces influenced the rate of PHI; in particular, stemmed MOM implants were at higher risk, probably due to metal debris consequent to taperosis. Despite the preliminary results, stemmed MOM THAs should be used with care, and diabetic patients should be warned about increased septic risks.

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Authors and Affiliations

  1. Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 10, 40136, Bologna, Italy

    Barbara Bordini, Susanna Stea & Aldo Toni

  2. Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d’anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy

    Francesco Castagnini, Luca Busanelli, Federico Giardina & Aldo Toni

Authors
  1. Barbara Bordini
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  2. Susanna Stea
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  3. Francesco Castagnini
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  4. Luca Busanelli
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  5. Federico Giardina
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  6. Aldo Toni
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Corresponding author

Correspondence to Francesco Castagnini.

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Conflict of interest

The senior author is paid consultant for Zimmer (Warsaw, US), Adler Ortho (Milan, Italy) and CeramTec (Plochingen, Germany). The other authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was not necessary as the registry collects personal data as standard practice and conceals the identity of the patients.

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Bordini, B., Stea, S., Castagnini, F. et al. The influence of bearing surfaces on periprosthetic hip infections: analysis of thirty nine thousand, two hundred and six  cementless total hip arthroplasties. International Orthopaedics (SICOT) 43, 103–109 (2019). https://doi.org/10.1007/s00264-018-4097-2

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  • DOI: https://doi.org/10.1007/s00264-018-4097-2

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