Survival of 11,390 Continuum cups in primary total hip arthroplasty based on data from the Finnish Arthroplasty Register

Matias Hemmilä, Mikko Karvonen, Inari Laaksonen, Markus Matilainen, Antti Eskelinen, Jaason Haapakoski, Ari-Pekka Puhto, Jukka Kettunen, Mikko Manninen, Keijo T Mäkelä, Matias Hemmilä, Mikko Karvonen, Inari Laaksonen, Markus Matilainen, Antti Eskelinen, Jaason Haapakoski, Ari-Pekka Puhto, Jukka Kettunen, Mikko Manninen, Keijo T Mäkelä

Abstract

Background and purpose - The use of trabecular metal (TM) cups for primary total hip arthroplasty (THA) is increasing. Some recent data suggest that the use of TM in primary THA might be associated with an increased risk of revision. We compared implant survival of Continuum acetabular cups with other commonly used uncemented cups. Patients and methods - Data on 11,390 primary THAs with the Continuum cup and 30,372 THAs with other uncemented cups (reference group) were collected from the Finnish Arthroplasty Register. Kaplan-Meier survival estimates were calculated; the endpoint was revision for any reason, for infection, or for dislocation. Revision risks were assessed with adjusted Cox multiple regression models. A subgroup analysis on the use of neutral or elevated liners in the Continuum group was made. Results - The 7-year survivorship of the Continuum group was 94.6% (95% CI 94.0-95.2) versus 95.6% (CI 95.3-95.8) in the reference group for revision for any reason. The risk for revision was higher in the Continuum group than in the reference group both for revision for any reason (HR 1.3 [CI 1.2-1.5)]) and for revision for dislocation (HR 1.9 [CI 1.5-2.3]). There was no difference in the rates of revision because of infection (HR 0.99 [CI 0.78-1.3]). Use of a neutral liner increased the risk for revision due to dislocation in comparison with the use of an elevated rim liner in the Continuum group (HR 1.7 [CI 1.2-2.5]). Interpretation - THA with Continuum cups is associated with an increased risk of revision compared with other uncemented cups, mainly due to revisions because of dislocation. Our results support the use of an elevated liner when Continuum cups are used for primary THA.

Figures

Figure 1.
Figure 1.
Kaplan–Meier survival for Continuum group and reference group with revision for any reason as the endpoint. 95% CI levels presented in blue and red.
Figure 2.
Figure 2.
Kaplan–Meier survival for Continuum group and reference group with revision for infection as endpoint. 95% CI levels presented in blue and red.
Figure 3.
Figure 3.
Kaplan–Meier survival for Continuum group and reference group with revision for dislocation as endpoint. 95% CI levels presented in blue and red.
Figure 4.
Figure 4.
Kaplan–Meier survival by subgroup analysis of Continuum THA with or without elevated liner. Endpoint: revision for dislocations. 95% CI levels presented in blue and red.

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