Midterm analysis of the seleXys cup with ceramic inlay

Background: Ceramic-on-ceramic (CoC) articulations in total hip replacement (THR) has been accepted as giving reliable mid-term results; however recent studies have reported higher revision rates of some implants. This study analyses the nationwide results of the seleXys TPS cup and the Bionit2 liner (Mathys, Bettlach, Switzerland) with respect to implant survival, cause for revision and mortality rates compared to other CoC articulations using the same stem. Methods: Utilising the New Zealand Joint Registry, we compared the seleXys TPS cup with Bionit2 liner used with an uncemented Twinsys femoral stem to every other uncemented CoC THR using the same stem. Multivariate analysis was used to determine the effects of patient age, gender, ASA score and implant head size on these rates. Results: Between 2006 and 2013 a total of 1035 seleXys THRs were performed on 862 patients. The comparison group had 375 THRs on 280 patients. There were 77 revisions (1.4/100 component years) in the study group and two in the comparison group (0.12/100 component years). Overall hazards ratio for revision was 12.22 times higher and female gender was associated with an increased risk (hazards ratio 1.77). Causes for revision were disturbing noises (23.4%), acetabular loosening (20.8%), and fracture of the liner (18.2%). Mortality rates were not significantly different (P = .567). Conclusions: The seleXys TPS cup with the Bionit2 ceramic inlay coupling has an unacceptably high failure rate. We recommend avoiding this implant coupling and would advise that patients treated with this implant need close clinical and radiological follow-up