Ceramic-on-ceramic versus ceramic-on-polyethylene bearing in primary press-fit total hip arthroplasties: A target trial emulation using the Dutch Arthroplasty Register (LROI)
Approval date: November 25th 2025
RW Poolman, D Haverkamp, IN Sierevelt, RAJ Post, N O'Hara, N McKibben
Research proposal abstract:
The risk of long-term revision of an uncemented THA is primarily determined by wear of the liner material. Ceramic-on-polyethylene (CoPE) is the most commonly used articulation in the Netherlands. Other articulations, such as ceramic-on-ceramic (CoC), show even less wear. However, the stiffness of the CoC articulation may jeopardises osseointegration and therefore increase the risk of early revision due to aseptic cup loosening.
This study aims to evaluate the risk of cup revision within 2 years of CoC and CoPE articulations for all primary press-fit THA registered in the LROI from 2007 to June 1 2023. We propose to re-analyze this previously conducted study according to the target trial emulation framework without changing the original question. Using causal inference would help adjust for previously uncontrolled confounding and add support to the study findings. Secondarily, we would aim to investigate