Does combining components from different manufacturers have an impact on the survival rate of total hip replacements? A systematic review

Abstract

Background: Revisions in hip arthroplasty are not uncommon. Infections, aseptic loosening, dislocations or fractures are often indications for replacement of the hip prosthesis. In most cases, however, only one of the components needs to be revised. The off-label practice of mix & match has therefore enjoyed increasing popularity among surgeons for many years. It offers a considerable advantage, as it shortens the operating time and is sometimes even associated with less blood loss. Surgeons' experience shows that at least equally good results have been achieved in terms of survival rates. However, as the data on the combination of mixed prostheses is still very limited, it is important to compile the experience to date and draw conclusions regarding the safety of the practice of mix & match. Methods: The method chosen is a systematic review in which existing data from the “PubMed” and “EMBASE” databases are compiled and interpreted. In the process, previously published studies with the same effect measure were presented, summarized and interpreted with the utmost care and in compliance with the inclusion and exclusion criteria. A total of 772 potential publications were found, which were carefully examined on several levels with regard to their quality and suitability for this review. In the end, only four registry studies from Slovenia, the Netherlands, New Zealand, and England and Wales remained, whose data were compiled and compared in terms of review rates. Results: It was shown that the practice of mix & match produced at least equally good results in terms of survival rates compared with non-mixed prostheses. In particular, when avoiding impermissible combinations, which were already known from the past to be associated with higher revision rates, even higher survival rates were recorded in some cases for the mixed prostheses. A “mismatch” mainly affected metal-on-metal bearing pairings as well as the combination of head and stem and different manufacturers, which was most likely due to the unique taper geometry that is standardized on both components. Conclusion: The good results of the mixed prostheses show comparable results and could be used more and more frequently in the future. This increases the importance of consistent documentation in the corresponding arthroplasty registers in order to identify possible unacceptable combinations.

Datum der Bewilligung	2025
Originalsprache	Englisch
Gradverleihende Hochschule	Medizinische Universität Graz
Betreuer/-in	Patrick Sadoghi (Betreuer*in)