Association of acetabular implants with sensitive radiographic surveillance on revision rates: a study based on 5 hip arthroplasty registries

BACKGROUND AND PURPOSE: National joint arthroplasty registries are the gold standard for monitoring long-term acetabular implant survivorship. Sensitive radiographic surveillance (SRS) has been recommended as a complementary surveillance approach, but no study has investigated whether implants introduced with no sensitive radiographic surveillance (NSRS) are associated with higher revision rates. Therefore, we investigated whether acetabular implants with NSRS are associated with higher revision rates than those with SRS. METHODS: Acetabular implants with SRS were defined as those with published evidence of stability measurements assessed using either radiostereometric analysis or "Ein Bild Röntgen Analyse." Evidence of SRS of acetabular implant designs was sourced from 2 literature reviews. A mixed-effects model was used to pool and compare the revision rate of acetabular implants with SRS and NSRS at 5 and 10 years from 5 arthroplasty registries. RESULTS: There were 29 unique acetabular implant designs with SRS and 86 designs with NSRS that had matching 5- and 10-year revision rates. At 5 years, there was a mean difference of 0.8% (95% confidence interval [CI] 0.5-1.1) in mean all-cause revision rates favoring implants with SRS. Mean all-cause revision rates at 10 years for acetabular implants with SRS and NSRS were 5.2% (CI 4.9-5.5) and 7.4% (CI 7.0-7.9) respectively, with a mean difference of 1.8% (CI 1.2-2.3) favoring implants with SRS. CONCLUSION: Acetabular implants with NSRS were associated with 1.8% higher pooled revision rates than those with SRS at 10 years, which represents a relative increase in acetabular revision burden of approximately 36%.