Benchmarking THA Implant Combinations Using Data From a US Total Joint Replacement Registry

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Health services research

Background:

• Benchmarking is a surveillance method to assess implant performance against set standards.
• Successful benchmarking indicates acceptable revision-free survivorship.
• This evaluation provides insights for surgeons, industry, and regulatory bodies.

Purpose of the Study:

• Apply International Society of Arthroplasty Registries (ISAR) benchmarking standards to a US total joint replacement registry.
• Identify total hip arthroplasty (THA) implant constructs meeting benchmarks at 2, 5, 10, and 15 years.
• Evaluate benchmark consistency across gender and age demographics.

Main Methods:

• Utilized a US-based total joint replacement registry for a cohort study of 155,123 primary THAs (2001-2024).
• Employed Kaplan-Meier estimates to calculate cumulative percent revision (CPR) and 95% confidence intervals (CIs).
• Compared implant performance against ISAR benchmarking standards at 2, 5, 10, and 15 years, considering superiority and noninferiority.

Main Results:

• 86% of THA constructs met the 2-year benchmark (≤2% revision rate); 90% met the 5-year benchmark (≤3% revision rate).
• At 10 years, 13 constructs achieved superior benchmarks (≤5% revision rate) and 5 achieved noninferiority (≤6% revision rate).
• Seven of eight constructs met the 15-year superior benchmark (≤6.5% revision rate); specific Zimmer-Biomet constructs consistently failed to meet benchmarks.

Conclusions:

• The ISAR benchmarking methodology successfully identified superior, adequate, and underperforming THA implant combinations in a US registry.
• Findings should inform implant selection for primary THA, with underperforming implants requiring scrutiny.
• Incorporating this benchmarking methodology into US registries is recommended for improved implant surveillance.