Mid-term outcomes of the R3™ delta ceramic acetabular system in total hip arthroplasty

Edward T Davis, Ville Remes, Petri Virolainen, Peter Gebuhr, Bart Van Backlé, Matthew P Revell, Branko Kopjar, Edward T Davis, Ville Remes, Petri Virolainen, Peter Gebuhr, Bart Van Backlé, Matthew P Revell, Branko Kopjar

Abstract

Background: Whilst bony fixation of hip replacement has stable solutions, there remains controversy over which bearing best optimizes longevity and function. Ceramic-on-ceramic (CoC) bearing combinations are associated with lower risk of revision due to aseptic loosening and dislocation. Evidence for long-term functional outcomes of modern, 4th generation CoC bearings is limited. The aim of this study was to analyze outcomes and complications of the R3™ Acetabular System (Smith & Nephew, Inc., Cordova, TN, USA) in combination with BIOLOX® Delta ceramic femoral head in patients undergoing primary total hip arthroplasty (THA).

Methods: Between June 2009 and May 2011, 175 patients (178 hips) were enrolled into a prospective, study at 6 sites in Europe and prospectively followed-up at 3 months and 1, 3, 5, and 7 years postoperative.

Results: Total WOMAC score improved from 63 (range, 22-91) preoperative to 8 (range, 0-8) at 1-year follow-up and remained unchanged at 7-year follow-up. Modified Harris hip score improved from 45 (range, 10-87) preoperative to 83 (range, 25-100) at 3 months, 91 (range, 42-100) at 1 year, and 92 (range, 46, 100) at 7 years. UCLA Activity Rating Scale score improved from 3.3 (range, 1-8) preoperative to 6.2 (range, 2-8) at 1 year; it marginally declined to 5.8 (range, 3-8) at 7-year follow-up. There were 4 trochanteric fractures and 5 patients died of unrelated reasons. Three hips were revised (2 periprosthetic fractures and 1 subluxation). The 7-year cumulative survival rate was 98.3%.

Conclusion: Clinical and functional improvements of THA with CoC bearing are maintained at 7 years postoperative.

Trial registration: ClinicalTrials.Gov, NCT03566082 , Registered 10 January 2018-retrospectively registered.

Keywords: Bearing; Ceramic-on-ceramic (CoC); Complications; Delta ceramic; Modified Harris hip score (mHHS); Outcomes; R3™ delta Ceramic Acetabular System; Total hip arthroplasty (THA); UCLA Activity Rating Scale (UCLA ARS); Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC®).

Conflict of interest statement

Prof Edward T. Davis, MB, ChB, MSc, PGCME, FRCS(T&O) reports research funding and payment as speaker for Smith & Nephew, Inc. All other authors declare no potential competing interests. All other authors declare they have no potential competing interests.

Figures

Fig. 1
Fig. 1
Cumulative incidence of revision at 7 years
Fig. 2
Fig. 2
Modified Harris hip score by follow-up visit
Fig. 3
Fig. 3
WOMAC score by follow-up visit
Fig. 4
Fig. 4
UCLA activity rating scale score by follow-up visit

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