Outcomes of Ceramic Versus Metal Heads After Primary Hip Hemiarthroplasty in a National Cohort Up to 10 Years of Follow-up

Speaker(s)

Ku LJ1, Liao YH1, Tsai YY1, Chang CW2, Wang JD3
1National Cheng Kung University College of Medicine, Tainan, TNN, Taiwan, 2National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,, Tainan, Taiwan, 3National Cheng Kung University College of Medicine, Tainan, TNQ, Taiwan

Presentation Documents

OBJECTIVES: This is a comparative analysis of clinical effectiveness of hip hemiarthroplasty using different heads, ceramic versus metal, to treat patients with femoral neck fractures. To investigate whether the choice of head material is associated with any adverse outcomes, including mortality, all-cause reoperations and medical complications after surgery, a national health claims database was employed.

METHODS: The study sample contained patients with an index femur neck fracture admission and underwent hip hemiarthroplasty since 2010 and followed for 10 years. To compare these two groups using different heads, a 1:2 matching of the ceramic versus metal group was performed according to age, gender, index year, and six major comorbidities associated with premature mortality. We also estimated life expectancy (LE) and the loss-of-LE for the two groups using lifetime survival extrapolation methods.

RESULTS: 2559 ceramic users and 5118 metal users were included after matching; 69.7% of the samples were female, and the mean age was 73.4 years. Compared to the metal users at 1 yr after hemiarthroplasty, the ceramic users had lower sub-distribution (sub) hazard ratios (HR) both in reoperation (sub-HR=0.64，P<0.01) and medical complications (sub-HR=0.68, P<0.01). However, there was insignificant different reoperation rate between two groups at 10 yrs (sub-HR=0.84, P=0.06). The ceramic group was found with lower mortality both at 1 yr (HR=0.63, P<0.01) and 10 yrs (HR=0.74, P<0.01) after hemiarthroplasty. The LE and loss-of-LE for the metal group were 8.6 yrs and 5.8 yrs respectively, while that of the ceramic group were 10.4 yrs and 4.1 yrs. The difference in loss-of-LE of 1.7 yr between the two groups was not significant (P=0.15) after lifetime extrapolation.

CONCLUSIONS: For femoral neck fractures, surgical intervention with hip hemiarthroplasties using ceramic heads seemed to have better outcomes than those using metal heads at 1 yr while the differences were not significant after 10 yrs.

Code

CO136

Topic

Clinical Outcomes

Topic Subcategory

Clinical Outcomes Assessment, Comparative Effectiveness or Efficacy

Disease

No Additional Disease & Conditions/Specialized Treatment Areas