A new study reveals that pairing a delta ceramic or oxidised zirconium head with a highly crosslinked polyethylene (HCLPE) liner or cup provides the lowest risk of revision surgery within 15 years of a hip replacement.
Published in PLOS Medicine and led by experts from the University of Bristol, the research highlights the long-term durability of modern hip replacements when the optimal materials are used.
It offers valuable insights to help patients, surgeons and hospitals make informed decisions about the most durable hip replacement materials.
The study analysed data from 1,026,481 hip replacements registered in the National Joint Registry (NJR), encompassing surgeries performed in the NHS and private healthcare sectors in England and Wales from 2003 to 2019.
Dr Erik Lenguerrand, Senior Lecturer in Medical Statistics and Quantitative Epidemiology at Bristol Medical School: Translational Health Sciences (THS), said:
‘Our research has shown that the risk of hip replacement revision is significantly influenced by the materials used in the bearing surfaces of the implants. Delta ceramic or oxidised zirconium heads combined with a highly crosslinked polyethylene liner or cup offer the lowest revision rates.’
The team also analysed the specific causes leading to revision surgeries and discovered that only 2% (20,869 patients) of the cohort required a revision procedure.
Professor Michael Whitehouse, a senior author and Professor of Trauma and Orthopaedics at Bristol Medical School: THS, added: ‘By using one of the world’s largest joint replacement registries, our study provides highly generalisable data. It underscores the importance of evaluating the entire implant structure rather than focusing solely on individual components when making clinical decisions.’
Tim Wilton, medical director of the National Joint Registry, said: ‘The NJR data offers unparalleled insights into the long-term performance of hip implant materials. This study illustrates how material combinations directly influence revision risks. Surgeons should consider these findings carefully during pre-operative patient discussions, ensuring informed decisions are made.’
Although the study was observational and not a randomised controlled trial, it provides valuable real-world evidence.
The categorisation of implants in national registries can sometimes obscure material-specific revision risks, making this research a critical step forward.
Joint replacement surgery is a highly effective procedure for treating conditions like osteoarthritis and trauma. In the UK alone, over 110,000 hip replacements are performed annually.
With demand expected to surge by 40% by 2060, ensuring the longevity of implants will be increasingly crucial.
The study’s findings highlight the importance of material choice in improving patient outcomes and reducing the need for costly and invasive revision surgeries.
The research, independently conducted and funded by CeramTec, received additional support from the National Institute for Health and Care Research (NIHR) and the NIHR Bristol Biomedical Research Centre (Bristol BRC).
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