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Large Joints Feature

Hip Replacement / Sources: Wikimedia Commons and Nuno Nogueira

Study Examines Move to Ceramic Heads in Primary THA

Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, December 19th, 2016

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Is using a pricier ceramic-on-polyethylene implant in primary total hip arthroplasty (THA) worth it? Or should you stick with metal-on-polyethylene? New work from the University of North Carolina at Charlotte and the OrthoCarolina Research Institute, suggests that perhaps the entire orthopedic field shouldn’t switch to ceramic all at once.

Thomas K. Fehring, M.D. is an orthopedic surgeon with the OrthoCarolina Hip and Knee Center and a co-author on the research entitled, “Cost Analysis of Ceramic Heads in Primary Total Hip Arthroplasty.” Dr. Fehring told OTW, “As we move away from using metal-on-metal bearings and face a relatively rare condition called ‘trunnionosis’ (caused by fretting and crevice corrosion at the modular junction of a cobalt-chromium femoral head and a titanium trunnion) surgeons are increasing the use of ceramic heads as a safe alternative. Some thought leaders even suggest using ceramic hip balls in all total hip cases to prevent the rare occurrence of trunnionosis. This strategy should be protective against trunnionsis, however, a wholesale move in this direction comes with an economic price as ceramic heads are more expensive than metal heads. As surgeons we must be mindful of not only clinical issues, but also economic ramifications of implant selection decisions. We did this study to understand the cut off level where using ceramic heads would be both clinically and economically effective.”

“Orthopedic surgeons need to understand that a wholesale switch to ceramic bearings regardless of age or cost differential may result in an economic burden to the healthcare system. Therefore, the purpose of our study was to establish the age and price cut off levels to help orthopedic surgeons decide when the use of a ceramic hip ball was clinically and economically appropriate.”

Co-author Susan Odum, Ph.D. told OTW, “The most interesting thing we found in our study was the wide variation of pricing structures across individual hospitals resulting in wide range of the cost of ceramic heads. By considering the age of the patient we were able to examine the interaction of age, failure rate and cost of ceramic heads in our Markov decision modeling. At a cost differential of $325.00 or less ceramic-on-polyethylene bearings are cost effective for patients less than 85 years of age. At a cost differential of $600.00, it is cost effective to utilize ceramic-on-polyethylene bearings in patients less than 65 years of age, and finally at $1, 000.00 ceramic-on-polyethylene bearings are not cost effective at any age. Therefore, it is important for orthopedic surgeons to understand the pricing structure of the ceramic heads at their hospital before making a shared-decision to use them.”

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