New JAMA study finds women have higher risk of hip implant failure

Highly cross-linked polyethylene-bearing surfaces have proven to be less likely to produce microscopic debris that can lead to inflammation. Metal on metal hip implants have been found to also produce small metal particles that can produce inflammation. Some metal on metal hip replacements can introduce toxic metals into a person’s body. The higher rate of metal on metal hip replacement failure has produced a move to highly cross-linked polyethylene-bearing surfaces as a preference.Implant failures can result from dislocation. Part of this problem is patient related but research has found that fewer dislocations occur with surgeons that have more experience with hip replacement surgery. Anterior insertion of small diameter head implants has been shown to produce a lower rate of dislocation. The key to preventing dislocation is removing as little natural tissue as possible.The researchers assert that some of the causes of the higher hip implant failure rate in women are the result of the physiological and anatomical differences in men and women’s hip joints. Women are more prone to have osteoarthritis and osteoporosis. Osteoporosis is a physiological response to menopause and involves microarchitectural bone deterioration that is not preventable or reversible. Diet, alcohol consumption, vitamin D deficiency, smoking, lack of exercise, and high dietary protein have all been linked to osteoporosis.View the list »
n A-P X-ray of a pelvis showing a total hip joint replacement.

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Maria C. S. Inacio, M.S., of the Southern California Permanente Medical Group, San Diego, and colleagues published new research in the Feb. 18, 2013, issue of the journal JAMA Internal Medicine that indicates women have a higher risk of hip implant failure than men.

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The results were based on an examination of patients that were enrolled in a total joint replacement registry from April 2001 through December 2010. Total hip replacement, also known as total hip arthroplasty (THA), is more often performed in women than men.

A total of 35,140 THAs with three years of median follow-up were identified in a study population in which 57.5 percent of the patients were women and the average age of the patients was almost 66 years.

"In our analyses of a large THA cohort, including a diverse sample within 46 hospitals, we found that at the median follow up of 3.0 years women have a higher risk of all-cause (HR [hazard ratio], 1.29) and aseptic (HR, 1.32) revision but not septic revision (HR, 1.17)," the authors comment.

“A higher proportion of women received 28-mm femoral heads (28.2 percent vs. 13.1 percent) and had metal on highly cross-linked polyethylene-bearing surfaces (60.6 percent vs. 53.7 percent) than men. Men had a higher proportion of 36-mm or larger heads (55.4 percent vs. 32.8 percent) and metal on metal-bearing surfaces (19.4 percent vs. 9.6 percent). At five-year follow-up, implant survival was 97.4 percent. Device survival for men (97.7 percent) vs. woman (97.1 percent) was significantly different. After adjustments, the hazard ratios for women were 1.29 for all-cause revision, 1.32 for aseptic revision and 1.17 for septic revision, according to the study results.”

View the list
  • The researchers assert that some of the causes of the higher hip implant failure rate in women are the result of the physiological and anatomical differences in men and women’s hip joints. Women are more prone to have osteoarthritis and osteoporosis. Osteoporosis is a physiological response to menopause and involves microarchitectural bone deterioration that is not preventable or reversible. Diet, alcohol consumption, vitamin D deficiency, smoking, lack of exercise, and high dietary protein have all been linked to osteoporosis.
  • Implant failures can result from dislocation. Part of this problem is patient related but research has found that fewer dislocations occur with surgeons that have more experience with hip replacement surgery. Anterior insertion of small diameter head implants has been shown to produce a lower rate of dislocation. The key to preventing dislocation is removing as little natural tissue as possible.
  • Highly cross-linked polyethylene-bearing surfaces have proven to be less likely to produce microscopic debris that can lead to inflammation. Metal on metal hip implants have been found to also produce small metal particles that can produce inflammation. Some metal on metal hip replacements can introduce toxic metals into a person’s body. The higher rate of metal on metal hip replacement failure has produced a move to highly cross-linked polyethylene-bearing surfaces as a preference.
View the list

, Birmingham Top News Examiner

Bryan Hamaker is a Chemist and Mathematician.

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