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Травматология и ортопедия России. 2015; : 5-20

Обеспечивают ли новые и более дорогие имплантаты лучший результат эндопротезирования тазобедренного сустава?

Коваленко А. Н., Шубняков И. И., Тихилов Р. М., Чёрный А. Ж.

https://doi.org/10.21823/2311-2905-2015-0-1-30-36

Аннотация

Эндопротезирование тазобедренного сустава является одним из самых успешных хирургических вмешательств за всю историю медицины. Однако возрастающая потребность в этих операциях создает значительную нагрузку на национальные системы здравоохранения всего мира, что обусловило возрастающий интерес к экономической стороне этой проблемы. Появление новых конструкций также вносит вклад в удорожание эндопротезирования. Однако всегда ли использование новых и более дорогих имплантатов улучшает клинический результат? Ответ на этот вопрос и является целью нашей работы. Мы изучали в базе MedLine литературу по проблеме влияния на эффективность лечения основных трендов в разработке новых эндопротезов тазобедренного сустава. Кроме того, был произведен анализ данных РНИИТО им. Р.Р. Вредена для сравнения сроков, структуры и частоты использования специальных ревизионных конструкций при первых ревизиях отечественных и импортных эндопротезов. Согласно полученным результатам, новизна и стоимость конструкции не является основным фактором долговременной функциональной службы эндопротеза.
Список литературы

1. Тихилов Р.М., Шубняков И.И., Плиев Д.Г Общие вопросы трибологии и свойства различных пар трения. В кн.: Тихилов Р.М., Шубняков И.И., ред. Руководство по хирургии тазобедренного сустава. СПб.: РНИИТО им. Р.Р. Вредена; 20і4. Т. 1. С. 344-366.

2. Тихилов Р.М., Шубняков И.И. Основные факторы, влияющие на эффективность эндопротезирования тазобедренного сустава. В кн.: Тихилов Р.М., Шубняков И.И., ред. Руководство по хирургии тазобедренного сустава. СПб.: РНИИТО им. Р.Р. Вредена; 2014. Т. 1. С. 221-256.

3. Тихилов Р.М., Шубняков И.И., Коваленко А.Н., Тотоев З.А., Лю Бо, Билык С.С. Структура ранних ревизий эндопротезирования тазобедренного сустава. Травматология и ортопедия России. 2014. № 2 (72). С. 5-13.

4. Тихилов Р.М., Шубняков И.И., Коваленко А.Н., Черный А.Ж., Муравьева Ю.В., Гончаров М.Ю. Данные регистра эндопротезирования тазобедренного сустава РНИИТО им. Р.Р. Вредена за 2007-2012 годы. Травматология и ортопедия России. 2013. № 3 (69). С. 167-190.

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6. Травматизм, ортопедическая заболеваемость, состояние травматолого-ортопедической помощи населению России в 2013 году. ЦИТО Москва 2014.

7. Abdulkarim A., Ellanti P., Motterlini N., Fahey T., O’Byrne J.M. Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials. Orthop Rev (Pavia). 2013; 5(1):e8.

8. Anand R., Graves S.E., de Steiger R.N., Davidson D.C., Ryan P., Miller L.N., Cashman K. What is the benefit of introducing new hip and knee prostheses? J Bone Joint Surg Am. 2011; 93 Suppl 3(E):51-54.

9. Australian Orthopaedic Association National Joint Replacement Registry. Annual Report 2014. www.dmac. adelaide.edu.au/aoanjrr/

10. Bozic K.J., Kurtz S., Lau E., Ong K., Chiu V., Vail T.P., Rubash H.E., Berry D.J. The epidemiology of bearing surface usage in total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009; 91(7):1614-1620.

11. Bozic K.J., Morshed S., Silverstein M.D., Rubash H.E., Kahn J.G. Use of cost-effectiveness analysis to evaluate new technologies in orthopaedics. The case of alternative bearing surfaces in total hip arthroplasty. J Bone Joint Surg Am. 2006; 88:706-714.

12. Brodner W., Bitzan P., Meisinger V. et al. Elevated serum cobalt with metal-on-metal articulating surfaces. J Bone Joint Surg Br. 1997; 79:316-321.

13. Case C.P., Langkamer V.G., Howell R.T. et al. Preliminary observations on possible premalignant changes in bone marrow adjacent to worn total hip arthroplasty implants. Clin Orthop Relat Res. 1996; 329(Suppl):S269-S279.

14. Clarke I.C., Good V., Williams P. et al. Ultra-low wear rates for rigid-on-rigid bearings in total hip replacements. Proc Inst Mech Eng H. 2000; 214:331-347.

15. Corten K., Bourne R., Charron K., Au K., Rorabeck C. What Works Best, a Cemented or Cementless Primary Total Hip Arthroplasty?: Minimum 17-year Followup of a Randomized Controlled Trial. Clin Orthop Relat Res. 2011; 469(1): 209-217.

16. Doorn P.F., Mirra J.M., Campbell P.A. et al. Tissue reaction to metal on metal total hip prostheses. Clin Orthop Relat Res. 1996; S187-S205.

17. Ethgen O., Bruyere O., Richy F., Dardennes C., Reginster J.Y. Healthrelated quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004; 86-A:963-974.

18. Faulkner A., Kennedy L.G., Baxter K., Donovan J., Wilkinson M., Bevan G. Effectiveness of hip prostheses in primary total hip replacement: a critical review of evidence and an economic model. Health Technol Assess. 1998; 2:1-133.

19. Finkbone P.R., Severson E.P., Cabanela M.E., Trousdale R.T. Ceramic-On-Ceramic Total Hip Arthroplasty in Patients Younger Than 20 Years. J Arthroplasty. 2012; 27(2):213-219.

20. Fitzpatrick R., Shortall E., Sculpher M. et al. Primary total hip replacement surgery: a systematic review of outcomes and modelling of cost-effectiveness associated with different prostheses. Health Technol Assess. 1998; 2:1-64.

21. Gillespie W.J., Pekarsky B., O’Connell D.L. Evaluation of new technologies for total hip replacement. Economic modelling and clinical trials. J Bone Joint Surg Br. 1995; 77:528-33.

22. Gioe T.J., Sharma A., Tatman P., Mehle S. Do «premium» joint implants add value? : analysis of high cost joint implants in a community registry. Clin Orthop Relat Res. 2011; 469(1):48-54.

23. Hannouche D., Zaoui A., Zadegan F., Sedel L., Nizard R. Thirty years of experience with alumina-on-alumina bearings in total hip arthroplasty. Int Orthop. 2011; 35(2):207-213.

24. Iorio R., Robb W.J., Healy W.L., Berry D.J., Hozack W.J., Kyle R.F., Lewallen D.G., Trousdale R.T., Jiranek W.A., Stamos V.P., Parsley B.S. Orthopaedic surgeon workforce and volume assessment for total hip and knee replacement in the United States: preparing for an epidemic. J Bone Joint Surg Am. 2008; 90(7):1598-1605.

25. Iwakiri K., Iwaki H., Minoda Y., Ohashi H., Takaoka K. Alumina inlay failure in cemented polyethylene-backed total hip arthroplasty. Clin Orthop Relat Res. 2008; 466(5):1186-1192.

26. Jacobs J.J., Gilbert J.L., Urban R.M. Corrosion of metal orthopaedic implants. J Bone Joint Surg Am. 1998; 80:268-282.

27. Jeffers J.R., Walter W.L. Ceramic-on-ceramic bearings in hip arthroplasty: state of the art and the future. J Bone Joint Surg Br. 2012; 94(6):735-745. Review.

28. Johanson P.E., Digas G., Herberts P., Thanner J., Kärrholm J. Highly crosslinked polyethylene does not reduce aseptic loosening in cemented THA 10-year findings of a randomized study. Clin Orthop Relat Res. 2012; 470(11):3083-3093.

29. Kelly M.P., Bozic K.J. Cost drivers in total hip arthroplasty: effects of procedure volume and implant selling price. Am J Orthop (Belle Mead NJ). 2009; 38(1):E1-4.

30. Kurtz S., Mowat F., Ong K., Chan N., Lau E., Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005; 87:1487-1497.

31. Kurtz S., Ong K., Lau E., Mowat F., Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89:780-785.

32. Kwon Y.M., Xia Z., Glyn-Jones S., Beard D., Gill H.S., Murray D.W. Dose-dependent cytotoxicity of clinically relevant cobalt nanoparticles and ions on macrophages in vitro. Biomed Mater. 2009; 4(2).doi:10.1088/1748-6041/4/2/025081.

33. McClure M., Heeckt P. Letter to the editor: Do «premium» joint implants add value? : analysis of high cost joint implants in a community registry. Clin Orthop Relat Res. 2011; 469(1):303-304.

34. Merle C., Clarius M., Aldinger P.R. Long-term results of uncemented stems in total hip arthroplasty: analysis of survival rates with a minimum 15-year follow-up. Orthopade. 2010; 39(1):80-86.

35. Mikko Peltola, Antti Malmivaara, Mika Paavola. Hip prosthesis introduction and early revision risk: A nationwide population-based study covering 39,125 operations. Acta Orthop. 2013; 84(1): 25-31.

36. Morscher E.W. Failures and successes in total hip replacement - why good ideas may not work. Rev. Scand. J. Surg. 2003; 92:113-120.

37. Nakashima Y., Sato T., Yamamoto T., Motomura G., Ohishi M., Hamai S., Akiyama M., Hirata M., Hara D., Iwamoto Y. Results at a minimum of 10 years of follow-up for AMS and PerFix HA-coated cementless total hip arthroplasty: impact of cross-linked polyethylene on implant longevity. J Orthop Sci. 2013; 18(6):962-968.

38. National Joint Registry for England and Wales. 11th Annual Report. 2014. http://www.njrcentre.org.uk/ njrcentre/default.aspx

39. Pandit H., Glyn-Jones S., McLardy-Smith P. et al. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. 2008; 90:847-851.

40. Pennington M., Grieve R., Sekhon J.S., Gregg P., Black N., van der Meulen J.H. Cemented, cementless, and hybrid prostheses for total hip replacement: cost effectiveness analysis. BMJ. 2013; 346.doi: 10.1136/bmj.f1026.

41. Petsatodis G.E., Papadopoulos P.P., Papavasiliou K.A., Hatzokos I.G., Agathangelidis F.G., Christodoulou A.G. Primary cementless total hip arthroplasty with an alumina ceramic-on-ceramic bearing: results after a minimum of twenty years of follow-up. J Bone Joint Surg Am. 2010; 92(3):639-644.

42. Piscitelli P., Iolascon G., Di Tanna G., Bizzi E., Chitano G., Argentiero A., Neglia C., Giolli L., Distante A., Gimigliano R., Brandi M.L., Migliore A. Socioeconomic burden of total joint arthroplasty for symptomatic hip and knee osteoarthritis in the Italian population: a 5-year analysis based on hospitalization records. Arthritis Care Res (Hoboken). 2012; 64(9):1320-1327.

43. Porat M., Parvizi J., Sharkey P.F., Berend K.R., Lombardi A.V. Jr., Barrack R.L. Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties. Clin Orthop Relat Res. 2012; 470(2):382-387.

44. Rana A.J., Iorio R., Healy W.L. Hospital economics of primary THA decreasing reimbursement and increasing cost, 1990 to 2008. Clin Orthop Relat Res. 2011; 469(2):355-361.

45. Sedrakyan A., Graves S., Bordini B., Pons M., Havelin L., Mehle S., Paxton E., Barber T., Cafri G. Comparative Effectiveness of Ceramic-on-Ceramic Implants in Stemmed Hip Replacement: A Multinational Study of Six National and Regional Registries. J Bone Joint Surg Am. 2014; 96 Suppl 1:34-41.

46. Smith A.J., Dieppe P., Vernon K., Porter M., Blom A.W. Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. Lancet. 2012; 379(9822):1199-1204.

47. Swedish Hip Arthroplasty Register. Annual Report 2010. http://www.shpr.se/en/Publications/DocumentsReports. aspx

48. The Norwegian Arthroplasty Register. Report. June 2010. http://nrlweb.ihelse.net/eng/default.htm

49. Toossi N., Adeli B., Timperley A.J., Haddad F.S., Maltenfort M., Parvizi J. Acetabular components in total hip arthroplasty: is there evidence that cementless fixation is better? J Bone Joint Surg Am. 2013; 95(2):168-174.

50. Urban R.M., Jacobs J.J., Tomlinson M.J. et al. Peoc’h M. Dissemination of wear particles to the liver, spleen, and abdominal lymph nodes of patients with hip or knee replacement. J Bone Joint Surg Am. 2000; 82:457.

51. van Oldenrijk J., Sierevelt I.N., Schafroth M.U., Poolman R.W. Design considerations in implant-related randomized trials. J Long Term Eff Med Implants. 2007; 17(2):153-163.

52. Visuri T. Long-term results and survivorship of the McKee-Farrar total hip prosthesis. Arch Orthop Trauma Surg. 1987; 106:368.

53. Wilson N.A., Schneller E.S., Montgomery K., Bozic K.J. Hip and knee implants: current trends and policy considerations. Health Aff (Millwood). 2008;27: 1587-1598.

54. Zywiel M.G., Sayeed S.A., Johnson A.J., Schmalzried T.P., Mont M.A. Survival of hard-on-hard bearings in total hip arthroplasty: a systematic review. Clin Orthop Relat Res. 2011; 469(6):1536-1546.

Traumatology and Orthopedics of Russia. 2015; : 5-20

Do new and more expensive implants provide better outcomes in total hip arthroplasty?

Kovalenko A. N., Shubnyakov I. I., Tikhilov R. M., Cherny A. Z.

https://doi.org/10.21823/2311-2905-2015-0-1-30-36

Abstract

Total hip arthroplasty (THA) is one of the most successful surgeries in medical history. But rising demand in such procedures creates significant burden on national health systems all over the world so that researhers more often pay attention to economic impaction of THA. The use of new implants also increases a cost of arthroplasty. But it is a question whether new and more expensive implants could improve clinical outcomes. It became the purpose of our study. We studied available literature in Medline database about main trends of new hip endoprosthetic developments in previous decade and how they can impact to outcomes. Furthermore we studied our data of first revisions of domestic and import implants with comparison terms, structure and frequency of special revision implants using. According to our results new and expensive implants are not basic factor of reliable functioning of hip endoprosthesis.
References

1. Tikhilov R.M., Shubnyakov I.I., Pliev D.G Obshchie voprosy tribologii i svoistva razlichnykh par treniya. V kn.: Tikhilov R.M., Shubnyakov I.I., red. Rukovodstvo po khirurgii tazobedrennogo sustava. SPb.: RNIITO im. R.R. Vredena; 20і4. T. 1. S. 344-366.

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7. Abdulkarim A., Ellanti P., Motterlini N., Fahey T., O’Byrne J.M. Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials. Orthop Rev (Pavia). 2013; 5(1):e8.

8. Anand R., Graves S.E., de Steiger R.N., Davidson D.C., Ryan P., Miller L.N., Cashman K. What is the benefit of introducing new hip and knee prostheses? J Bone Joint Surg Am. 2011; 93 Suppl 3(E):51-54.

9. Australian Orthopaedic Association National Joint Replacement Registry. Annual Report 2014. www.dmac. adelaide.edu.au/aoanjrr/

10. Bozic K.J., Kurtz S., Lau E., Ong K., Chiu V., Vail T.P., Rubash H.E., Berry D.J. The epidemiology of bearing surface usage in total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009; 91(7):1614-1620.

11. Bozic K.J., Morshed S., Silverstein M.D., Rubash H.E., Kahn J.G. Use of cost-effectiveness analysis to evaluate new technologies in orthopaedics. The case of alternative bearing surfaces in total hip arthroplasty. J Bone Joint Surg Am. 2006; 88:706-714.

12. Brodner W., Bitzan P., Meisinger V. et al. Elevated serum cobalt with metal-on-metal articulating surfaces. J Bone Joint Surg Br. 1997; 79:316-321.

13. Case C.P., Langkamer V.G., Howell R.T. et al. Preliminary observations on possible premalignant changes in bone marrow adjacent to worn total hip arthroplasty implants. Clin Orthop Relat Res. 1996; 329(Suppl):S269-S279.

14. Clarke I.C., Good V., Williams P. et al. Ultra-low wear rates for rigid-on-rigid bearings in total hip replacements. Proc Inst Mech Eng H. 2000; 214:331-347.

15. Corten K., Bourne R., Charron K., Au K., Rorabeck C. What Works Best, a Cemented or Cementless Primary Total Hip Arthroplasty?: Minimum 17-year Followup of a Randomized Controlled Trial. Clin Orthop Relat Res. 2011; 469(1): 209-217.

16. Doorn P.F., Mirra J.M., Campbell P.A. et al. Tissue reaction to metal on metal total hip prostheses. Clin Orthop Relat Res. 1996; S187-S205.

17. Ethgen O., Bruyere O., Richy F., Dardennes C., Reginster J.Y. Healthrelated quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004; 86-A:963-974.

18. Faulkner A., Kennedy L.G., Baxter K., Donovan J., Wilkinson M., Bevan G. Effectiveness of hip prostheses in primary total hip replacement: a critical review of evidence and an economic model. Health Technol Assess. 1998; 2:1-133.

19. Finkbone P.R., Severson E.P., Cabanela M.E., Trousdale R.T. Ceramic-On-Ceramic Total Hip Arthroplasty in Patients Younger Than 20 Years. J Arthroplasty. 2012; 27(2):213-219.

20. Fitzpatrick R., Shortall E., Sculpher M. et al. Primary total hip replacement surgery: a systematic review of outcomes and modelling of cost-effectiveness associated with different prostheses. Health Technol Assess. 1998; 2:1-64.

21. Gillespie W.J., Pekarsky B., O’Connell D.L. Evaluation of new technologies for total hip replacement. Economic modelling and clinical trials. J Bone Joint Surg Br. 1995; 77:528-33.

22. Gioe T.J., Sharma A., Tatman P., Mehle S. Do «premium» joint implants add value? : analysis of high cost joint implants in a community registry. Clin Orthop Relat Res. 2011; 469(1):48-54.

23. Hannouche D., Zaoui A., Zadegan F., Sedel L., Nizard R. Thirty years of experience with alumina-on-alumina bearings in total hip arthroplasty. Int Orthop. 2011; 35(2):207-213.

24. Iorio R., Robb W.J., Healy W.L., Berry D.J., Hozack W.J., Kyle R.F., Lewallen D.G., Trousdale R.T., Jiranek W.A., Stamos V.P., Parsley B.S. Orthopaedic surgeon workforce and volume assessment for total hip and knee replacement in the United States: preparing for an epidemic. J Bone Joint Surg Am. 2008; 90(7):1598-1605.

25. Iwakiri K., Iwaki H., Minoda Y., Ohashi H., Takaoka K. Alumina inlay failure in cemented polyethylene-backed total hip arthroplasty. Clin Orthop Relat Res. 2008; 466(5):1186-1192.

26. Jacobs J.J., Gilbert J.L., Urban R.M. Corrosion of metal orthopaedic implants. J Bone Joint Surg Am. 1998; 80:268-282.

27. Jeffers J.R., Walter W.L. Ceramic-on-ceramic bearings in hip arthroplasty: state of the art and the future. J Bone Joint Surg Br. 2012; 94(6):735-745. Review.

28. Johanson P.E., Digas G., Herberts P., Thanner J., Kärrholm J. Highly crosslinked polyethylene does not reduce aseptic loosening in cemented THA 10-year findings of a randomized study. Clin Orthop Relat Res. 2012; 470(11):3083-3093.

29. Kelly M.P., Bozic K.J. Cost drivers in total hip arthroplasty: effects of procedure volume and implant selling price. Am J Orthop (Belle Mead NJ). 2009; 38(1):E1-4.

30. Kurtz S., Mowat F., Ong K., Chan N., Lau E., Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005; 87:1487-1497.

31. Kurtz S., Ong K., Lau E., Mowat F., Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89:780-785.

32. Kwon Y.M., Xia Z., Glyn-Jones S., Beard D., Gill H.S., Murray D.W. Dose-dependent cytotoxicity of clinically relevant cobalt nanoparticles and ions on macrophages in vitro. Biomed Mater. 2009; 4(2).doi:10.1088/1748-6041/4/2/025081.

33. McClure M., Heeckt P. Letter to the editor: Do «premium» joint implants add value? : analysis of high cost joint implants in a community registry. Clin Orthop Relat Res. 2011; 469(1):303-304.

34. Merle C., Clarius M., Aldinger P.R. Long-term results of uncemented stems in total hip arthroplasty: analysis of survival rates with a minimum 15-year follow-up. Orthopade. 2010; 39(1):80-86.

35. Mikko Peltola, Antti Malmivaara, Mika Paavola. Hip prosthesis introduction and early revision risk: A nationwide population-based study covering 39,125 operations. Acta Orthop. 2013; 84(1): 25-31.

36. Morscher E.W. Failures and successes in total hip replacement - why good ideas may not work. Rev. Scand. J. Surg. 2003; 92:113-120.

37. Nakashima Y., Sato T., Yamamoto T., Motomura G., Ohishi M., Hamai S., Akiyama M., Hirata M., Hara D., Iwamoto Y. Results at a minimum of 10 years of follow-up for AMS and PerFix HA-coated cementless total hip arthroplasty: impact of cross-linked polyethylene on implant longevity. J Orthop Sci. 2013; 18(6):962-968.

38. National Joint Registry for England and Wales. 11th Annual Report. 2014. http://www.njrcentre.org.uk/ njrcentre/default.aspx

39. Pandit H., Glyn-Jones S., McLardy-Smith P. et al. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. 2008; 90:847-851.

40. Pennington M., Grieve R., Sekhon J.S., Gregg P., Black N., van der Meulen J.H. Cemented, cementless, and hybrid prostheses for total hip replacement: cost effectiveness analysis. BMJ. 2013; 346.doi: 10.1136/bmj.f1026.

41. Petsatodis G.E., Papadopoulos P.P., Papavasiliou K.A., Hatzokos I.G., Agathangelidis F.G., Christodoulou A.G. Primary cementless total hip arthroplasty with an alumina ceramic-on-ceramic bearing: results after a minimum of twenty years of follow-up. J Bone Joint Surg Am. 2010; 92(3):639-644.

42. Piscitelli P., Iolascon G., Di Tanna G., Bizzi E., Chitano G., Argentiero A., Neglia C., Giolli L., Distante A., Gimigliano R., Brandi M.L., Migliore A. Socioeconomic burden of total joint arthroplasty for symptomatic hip and knee osteoarthritis in the Italian population: a 5-year analysis based on hospitalization records. Arthritis Care Res (Hoboken). 2012; 64(9):1320-1327.

43. Porat M., Parvizi J., Sharkey P.F., Berend K.R., Lombardi A.V. Jr., Barrack R.L. Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties. Clin Orthop Relat Res. 2012; 470(2):382-387.

44. Rana A.J., Iorio R., Healy W.L. Hospital economics of primary THA decreasing reimbursement and increasing cost, 1990 to 2008. Clin Orthop Relat Res. 2011; 469(2):355-361.

45. Sedrakyan A., Graves S., Bordini B., Pons M., Havelin L., Mehle S., Paxton E., Barber T., Cafri G. Comparative Effectiveness of Ceramic-on-Ceramic Implants in Stemmed Hip Replacement: A Multinational Study of Six National and Regional Registries. J Bone Joint Surg Am. 2014; 96 Suppl 1:34-41.

46. Smith A.J., Dieppe P., Vernon K., Porter M., Blom A.W. Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. Lancet. 2012; 379(9822):1199-1204.

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