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Italian Regional Registry Study – Modular head-neck adapter system & ceramic heads in revision hip arthroplasty

The study published by Rizzoli’s group investigated the survival rates and reasons for re-revisions, with a focus on implant-related failures.

354 modular head-neck adapter systems (BioBall® Merete modular adapter system, Merete Medical GmbH, Berlin, Germany) coupled with ceramic heads (BIOLOX®delta) were included, which had been used in revision surgery performed between 2007 –2019. The data was collected from the Registry of Prosthetic Orthopedic Implants of Emilia Romagna (RIPO).

To investigate eventual failures related to handling, 395 factory-assembled sleeved heads (e.g. BIOLOX®OPTION) were chosen as a control group by Pardo et al. due to the reduction in risk related to factory assembly.

Their results showed:

  • 5-year survival rate for the modular adapter system was 87.9% (95%CI 83.6%-91.2%)
  • 7-year survival rate was 86.9% (95%CI 82.3%-90.4%)
  • 10-year survival rate was 85.7% (95%CI 80.6%-89.7%)
  • Total number of re-revisions was 40, aseptic loosening (12) and dislocation (10) were the most common reasons for re-revision
  • Demographic- and implant-release features (like offset and skirted devices) did not impact the failure rate

In comparison to the control group of the BIOLOX®OPTION system, no differences could be found between the two groups in terms of survival rates. This similarity of performance could provide adapter system users a scientific indication that a modular adapter system coupled with BIOLOX®delta sleeved head shows a good survival rate at 5 to 7 years. When using re-revision for dislocations and cup aseptic loosening as endpoint, the two groups still have similar outcomes.

Of note, the authors considered a modular adapter system and a factory-assembled ceramic sleeved heads system not as alternatives, but rather as complementary, because the two systems have different features (e.g, different sizes and offset configurations).


📚 Reference: Pardo F, Castagnini F, Bordini B, Cosentino M, Lucchini S, Traina F. A modular head-neck adapter system and ceramic heads in revision hip arthroplasty: a registry study on 354 implants. J Arthroplasty. 2023;38(8):1578-1583. doi: 10.1016/j.arth.2023.01.055.

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