The risk of prosthetic joint infection with oxidised zirconium-on-polyethylene components in total hip arthroplasty: a comparison to conventional bearings

INTRODUCTION: Oxidised zirconium-on-polyethylene (OxZroP) total hip arthroplasty prostheses are increasing in popularity as an alternative to other bearing types. The surface characteristics and wear properties of OxZroP result in less metal and polyethylene wear which may be protective against microbiological seeding of the synovial joint space. The purpose of this study was to compare the rates of infection and inflammatory diagnoses between THAs using OxZroP heads with ceramic-on-polyethylene (CoP) and metal-on-polyethylene (MoP) designs. METHODS: This study queried the Premier PINC AI Healthcare Database (PHD) (Premier Inc.) for all primary total hip arthroplasties from 2017 to 2022. Infection-related ICD10 codes were collected at 30 days, 3, 6, 12 months and 2 years postoperatively. Positive results were noted to be either PJI-related diagnosis codes, or the combination of an arthroplasty-related code with infection-related procedure codes. The rates of infection/inflammatory reaction were reported. RESULTS: OxZroP THA bearings demonstrated a decreased rate of prosthetic joint infection or inflammatory reaction diagnoses, at up to 2 years post-surgery, compared to MoP bearings an effect that was maintained when cross-referenced with imaging procedure codes. When compared to CoP hips OxZroP demonstrated lower odds reduction of infection or inflammatory reaction with diagnosis codes at up to 6 months, however, showed equal odds to CoP at later timepoints. CONCLUSIONS: OxZroP bearings for primary total hip arthroplasty demonstrated a reduced odds ratio of prosthetic joint infection and inflammatory-related diagnoses than ceramic-on-polyethylene bearings before 6 months and maintained lower odds than metal-on-polyethylene bearings at up to 2 years. Further studies are needed to obtain longer-term follow-up and understand the mechanism for this observed reduction in prosthetic joint infection and inflammatory-related diagnoses.