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This retrospective cohort study using the American Joint Replacement Registry (AJRR) evaluated the impact of mixing femoral and acetabular components from different manufacturers in primary THA on revision risk. Analyzing 434,985 THAs in patients ≥65 years old with a minimum 2-year follow-up, the study found that while mixing components increased from 2012-2021, there was no significant difference in all-cause revision, aseptic loosening, infection, instability, or periprosthetic fracture between mixed and matched component groups. The mixed cohort more commonly utilized dual mobility bearings and triple-tapered femoral stem designs.
Mixing THA components from different manufacturers does not increase the risk of early revision compared to using matched components.
BACKGROUND As implants in primary total hip arthroplasty (THA) continue to evolve, surgeons may elect to combine femoral and acetabular components from different manufacturers. However, the prevalence of mixing implants in contemporary hip arthroplasty is unknown, as is the consequence that this may or may not have on implant survival. METHODS A nationwide registry was used to select patients 65 years or older who underwent primary THA between 2012 and 2021 and who had a minimum 2-year follow-up to create a retrospective cohort comparison of patients who had matched versus mixed manufacturer components. A total of 434,985 cases were identified [matched: 413,607 (95%), mixed: 21,378 (5%)]. The unadjusted and adjusted risk of all-cause revision, as well as revision for aseptic loosening, infection, instability, and periprosthetic fracture, were modeled with cause-specific Cox models. RESULTS Mixing THA components increased over time from less than 2% of cases in 2012 to nearly 17% in 2021 (P < 0.001). The mixed cohort more commonly utilized dual mobility bearings (27%, 4,956 versus 7%, 24,631; P < 0.001) and triple-tapered femoral stem designs (18%, 7,185 versus 9%, 27,987; P < 0.001). After controlling for potential confounding variables, there was no difference between the two groups in terms of all-cause revision (hazard ratio (HR) 1.0, 95% confidence interval (CI) 0.9 to 1.1), revision for aseptic loosening (HR 1.2, 95% CI 0.9 to 1.6), revision for infection (HR 1.2, 95% CI 0.9 to 1.4), revision for instability (HR 1.0, 95% CI 0.8 to 1.2), or revision for periprosthetic fracture (HR 0.9, 95% CI 0.7 to 1.2). There was no difference in revision-free survival time between groups. CONCLUSION Mixing implants from different manufacturers in primary THA does not result in an associated difference in the risk of early revision between mixed versus matched manufacturer components.
