Cumulative risk of revision after primary total hip arthroplasty in registries internationally: systematic review and meta-analysis of selected hip stems and cups.

Abstract

Purpose: The objective was to investigate the consistency in cumulative revision rates (CRRs) for a selection of total hip arthroplasty cups and stems across national/regional hip arthroplasty registries worldwide.

Methods: Ten cups and ten stems from total hip systems were randomly selected. Two frequently used implants across registries were added, totalling 11 cups and 11 stems. CRRs and 95% CIs were extracted from the latest annual registry reports using these implants. CRRs were pooled for each cup or stem, and differences between cup-stem combinations and between registries were investigated.

Results: CRRs were available for ten cups and eight stems from eight registries, totalling 552,148 cups and 727,447 stems. Follow-up was 1-20 years. The 5-year CRR pooled for all cups was 2.9% (95% CI: 2.3-3.6) and for all stems, 3.0% (95% CI: 2.4-3.8). Homogeneous (consistent) CRRs with respect to both associated implant and country were observed for two cups and three stems. Significant differences in CRR were identified in one cup by associated implant only, in one cup by registry only, and in two cups and four stems for both. Sparse data prevented evaluation of four cups and one stem.

Conclusion: Registries' annual reports provide a large amount of publicly available information on CRRs of specific implants. These CRRs can be synthesised to improve the assessment of implant performance over time. Our CRR analysis represents a promising approach to detect implants with a consistent low- or high-risk pattern across registries.