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Invited Commentary
October 2015

Short-term Analysis vs Long-term Data on Total Hip Replacement Survivorship

Author Affiliations
  • 1Department of Orthopedic Surgery, Stanford University, School of Medicine, Redwood City, California
JAMA Surg. 2015;150(10):989. doi:10.1001/jamasurg.2015.1337

Total hip replacement (THR) predictably relieves pain and restores mobility to people with hip arthritis and is considered one of the most significant medical advances of the 20th century. Large population and long-term studies1,2 show 85% or better revision-free 10-year survival. Because of the high morbidity and cost of revision THR, efforts to improve implant survival remain important for optimizing patient care and health economics. The investigation in this issue of JAMA Surgery by Colas et al3 examined data from the French national health insurance system to evaluate whether total hip fixation technique and bearing surface type affect prosthetic survivorship. In a short follow-up of less than 3 years, they found a 3% revision rate consistent with other studies.1,4 On the basis of this small fraction of the cohort representing early failures, they concluded that antibiotic-impregnated cemented THRs have a better prognosis, whereas metal-on-metal THRs have a slightly worse one.3 However, the extremely short follow-up, combined with other data and methodology issues, does not justify a prognostic claim based on this study alone. This is especially pertinent regarding fixation technique, with most THRs in the cemented groups having an uncemented hip socket component and where substantial long-term data supporting uncemented femoral stem fixation exists.1,2,4

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