Abstract
The authors hypothesized that unplanned readmissions, which are often caused by infections
and dislocation, may be reduced with ceramic bearing usage. They also sought to confirm
that the readmission rates for ceramic bearings were associated with the year of surgery.
They identified 245,077 elderly patients (65+) who underwent primary total hip arthroplasty
(THA) between 2010 and 2015 with known bearing types (ceramic-on-polyethylene [C-PE]
ceramic-on-ceramic [COC], and metal-on-polyethylene [M-PE]) from the Medicare 100%
inpatient database. Outcomes included relative risk of 30- and 90-day readmission.
Propensity scores were developed to adjust for selection bias in the choice of bearing
type at index surgery. Cox regression incorporating propensity score stratification
(10 levels) was used to evaluate the impact of bearing selection on outcomes, after
adjusting for patient-, hospital-, surgeon-related factors, as well as the year of
surgery. With C-PE bearings, the unadjusted (crude) 90-day readmission rate decreased
from 8.7% in 2010 to 8.3% in 2015. For COC bearings, the crude 90-day readmission
rate decreased from 10.5 to 9.1% from 2010 to 2015. After adjustment, year of surgery
was associated with reduced readmission risk for both types of ceramic bearings in
30-day readmissions (p < 0.05) and COC in 90-day readmissions (p < 0.001). The authors also found that C-PE bearings were associated with significantly
reduced readmission risk relative to M-PE at 30 days (hazard ratio [HR]: 0.91, p < 0.001) and 90 days (HR: 0.93, p < 0.001). In terms of strength of association with 90-day readmission, however, it
was ranked the ninth most associated independent factor. To the authors' knowledge, this is the first study to demonstrate
an association between THA implant characteristics (in this case C-PE bearing usage)
and reduced readmission rates in this context along with patient- and clinical-related
factors. The readmission rates for COC were found to be comparable to M-PE.
Keywords
total hip arthroplasty - Medicare database - health care reform - ceramic-on-ceramic
- ceramic-on-polyethylene
