Articular noise after THA using delta CoC bearings has little impact on quality of life

Abstract Background To report clinical outcomes and survival at a minimum of 10 years of a consecutive series of uncemented THA with fourth-generation CoC bearings, and determine the incidence of articular noises, their risk factors and impact on quality of life (QoL). Methods From a series of 456 CoC THAs, there were 25 revisions, 38 deceased and 36 lost to follow-up. The remaining 357 hips were assessed at 11.1±0.7 years (range, 10–14) using the forgotten joint score (FJS), Oxford hip score (OHS) and a questionnaire on articular noises. Kaplan-Meier (KM) survival was calculated and multi- variable analysis was performed to determine associations between articular noise and patient/surgical factors. Results The 10-year survival was 96.3% for the cup, 96.5% for the stem, and 94.2% for all components. The FJS was 79±26(range, 0–100) and OHS was 16±7(range, 12–60). The mean impact of articular noises on QoL was 1.8±2.9 (range, 0–9): considered ‘negligible’ in 60 hips (16%), ‘moderate’ in 27 hips (7%), and ‘severe’ in only 13 hips (4%). Multivariable analyses revealed the incidence of articular noise decreased with age (Odds Ratio (OR), 0.94; p=0.001), BMI (OR, 0.85; p=0.001), and in hips implanted with 32mm (vs 36 mm) heads (OR, 0.18; p=0.030). Conclusion Of 100 hips (28%) that reported some articular noises 10 years following CoC THA, the impact of articular noises on QoL was ‘negligible’ formost patients. Although larger heads can improve mobility and reduce risks of dislocations, surgeons must be aware that increasing head size could also increase risks of articular noises, notably in young and active patients.