Is reverse hybrid hip replacement the solution?

Figures & data

Figure 1. Flowchart of the study.

Table 1. Breakdown of numbers of different combinations of prosthesis components in the reverse hybrid group during the study period

Combination of cup and stem (reverse hybrid)
Year	Elite/Corail	Titan/Corail	Kronos/Corail	Reflection PE^a/Corail	Exeter/Corail	Charnley/Corail	Exeter/ABG II	Reflection PE^a/Hactiv	Reflection PE^a/Taperloc	Total
2000	38	3	3	6	1	6	0	0	0	57
2001	43	22	14	13	2	4	0	0	0	98
2002	45	46	6	37	3	7	0	0	0	144
2003	61	50	9	55	8	2	61	0	0	246
2004	83	72	14	63	16	9	50	12	0	319
2005	178	79	39	69	10	5	61	37	34	512
2006	269	82	66	18	11	14	0	29	49	538
2007	365	75	98	26	18	34	0	18	29	663
2008	362	113	157	5	28	13	0	16	0	694
2009	318	180	121	3	45	11	0	14	0	692
Total	1762	722	527	295	142	105	172	126	112	3963

^a Full brand name: Reflection Cemented All-Poly.

Table 2. Comparison of different combinations of prosthesis components in the reverse hybrid group

Brand name cup/stem	Manufacturer cup/stem	N	Revisions	Median follow-up (range)	Mean age (min–max)	% < 60 year	% male	No. of hospitals (max % at hospital)
Elite/Corail	Landos Depuy/Depuy	1762	40	2.6 (0–10)	60 (21–92)	48	40	15 (34%)
Titan/Corail	Landos Depuy/Depuy	722	21	3.0 (0–9.8)	63 (27–91)	36	36	11 (34%)
Kronos/Corail	Landos Depuy/Depuy	527	12	1.8 (0–9.7)	63 (20–92)	33	32	4 (83%)
RPE ^a/Corail	Smith & Nephew/Depuy	295	17	5.6 (0–9.9)	58 (18–90)	58	37	11 (35%)
Exeter/ ABG II	Stryker ^b /Stryker	172	6	5.4 (1.4–7.0)	73 (50–88)	2	37	2 (82%)
RPE ^a/Hactiv	Smith & Nephew/Scanos ^c	126	5	3.6 (0–5.6)	64 (19–91)	38	37	2 (97%)
Exeter/Corail	Stryker ^b/Depuy	142	2	1.9 (0–9.9)	64 (19–87)	35	18	5 (67%)
Charnley/Corail	Depuy/Depuy	105	2	2.8 (0.4–9.9)	58 (21–86)	61	21	14 (46%)
RPE ^a/Taperloc	Smith & Nephew/Biomet	112	3	3.8 (2.5–4.7)	61 (40–82)	36	33	1 (100%)

^a Full brand name: Reflection Cemented All-Poly.

^b Full brand name: Stryker, Osteonics, Howmedica

^c Full brand name: Scanos Evolutis

Table 3. Cup/stem combinations in the cemented group. These have been thoroughly described by Espehaug et al. (2009)

	Manufacturer	Number of prostheses
Charnley/Charnley	Depuy	12,192
Exeter/Exeter	Stryker, Osteonics, Howmedica	6,419
Reflection PE/Spectron	Smith & Nephew	8,618
Titan/Titan	Landos, Depuy	2,736
Spectron/ITH	Smith & Nephew	162
Link IP/Lubinus SP(I,II)	Waldemar Link	2,203
Contemporary/Exeter	Stryker, Osteonics, Howmedica	2,707
Kronos/Titan	Landos, Depuy	1,073
Elite/Titan	Depuy/Landos Depuy	1,139
Reflection/ITH	Smith & Nephew	417

Table 4. Details of the characteristics of the uncemented femoral stems used in the reverse hybrid group. 97% had HA coating

Stem	Material	Shape	Surface	Thickness of HA	Company
Corail	Ti6A14V	Straight, tapered	Fully HA-coated	155 µm	DePuy
ABG II	Ti alloy	Anatomic	HA-coated proximal, polished distally	50 µm	Stryker
Hactiv	Ti6A14V	Straight, tapered	Fully HA-coated	155 µm	Evolutis
Taperloc	Ti6A14V	Straight, tapered	Without HA in this study, proximal plasma spray coating		Biomet

Table 5. Comparison of demographic data for cemented and reverse hybrid THRs, both for total material and for patients aged < 60 years. Comparison of survival (in %) and relative risk (RR) of revision for cemented and reverse hybrid THRs, with all revisions as endpoint, for total material and for patients aged < 60 years

	Total material			Age < 60 years
	Cemented	Reverse hybrid	p-value	Cemented	Reverse hybrid	p-value
n	37,666	3,963		3,480	1,647
Revisions	1,140	108		135	41
Median follow-up (range)	4.7 (0–10)	2.9 (0–10)	< 0.001 ^b	5.2 (0–10)	3.4 (0–10)	< 0.001 ^b
Mean age (min–max)	73 (16–98)	61 (18–92)	< 0.001 ^b	54 (16–60)	52 (18–60)	< 0.001 ^b
% < 60 years	9	42	< 0.001 ^a	100	100
% male	29	36	< 0.001 ^a	36	39	0.06 ^a
Deceased	5,928 (15.7%)	104 (2.6%)		229 (6.6%)	25 (1.5%)
Emigrated	58 (0.2%)	8 (0.2%)		21 (0.6%)	4 (0.4%)
Missing	2	0		0	0
Alive	31,678 (84.1%)	3,851 (97.2%)		3,230 (92.8%)	1,618 (98.2%)
Diagnosis			< 0.001 ^a			< 0.001 ^a
Osteoarthritis	78.6%	70.9%		56.6%	55.9%
RA/Inflammatory	3.3%	4.2%		8.0%	6.0%
Sequelae hip fracture	8.9%	5.2%		7.1%	4.8%
Dysplasia	4.3%	11.6%		16.5%	20.4%
Perthes'	0.6%	2.2%		3.1%	4.5%
Other	4.4%	5.9%		8.7%	8.4%
3-year survival (95%CI)	97.9 (97.7–98.0)	97.7 (97.2–98.2)		98.0 (97.5–98.5)	98.3 (97.7–99.0)
5-year survival (95%CI)	97.0 (96.8–97.2)	96.7 (96.0–97.4)		96.7 (96.0–97.3)	97.5 (96.6–98.5)
7-year survival (95%CI)	96.0 (95.7–96.2)	95.6 (94.4–96.7)		94.9 (94.0–95.9)	96.2 (94.6–97.8)
RR ^c (95%CI)	1 (Reference)	1.1 (0.9–1.4)	0.3	1 (Reference)	0.9 (0.6–1.3)	0.5

^a Chi-squared test.

^b Non-parametric Mann-Whitney.

^c RR adjusted for age, sex, and diagnosis.

Figure 2. Cox survival curves. Endpoint was any revision of the implant for the total material. Adjusted for age, sex, and diagnosis. Age: < 50, 50–59, 60–69, 70–79 and > 80. Diagnosis: OA, RA/inflammatory, or other.

Figure 3. Cox survival curves. Endpoint was any revision of the implant. Age < 60 years. Adjustment for age, sex, and diagnosis. Age: <50, 50–60. Diagnosis: OA, RA/inflammatory, or other.

Espehaug B, Furnes O, Engesaeter LB, Havelin LI. 18 years of results with cemented primary hip prostheses in the Norwegian Arthroplasty Register. Acta Orthop 2009; 80 (4): 402-12.

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