Bearings in hip arthroplasty: Joint Registries vs precision medicine

Research output: Contribution to journalArticle

Colleges, School and Institutes

External organisations

  • Royal Orthopaed Hosp

Abstract

Background
Precision medicine has been adopted in a range of clinical settings where omics data have led to greater characterisation of disease and stratification of patients into sub-categories of phenotypes and pathologies. However, in orthopaedics, precision medicine lags behind other disciplines such as cancer.
Joint registries have now amassed a huge body of data pertaining to implant performance which can be broken down into performance statistics for different material types in different cohorts of patients. The National Joint Registry of England, Wales and Northern Ireland (NJR) is now one of the largest data sets available. Other registries such as those from Sweden and Australia however contain longer follow up. Together these registries can provide a wealth of informative for the orthopaedics community when considering which implant to give to any particular patient.
Questions/purpose
We aim to explore the benefits of combining multiple large data streams including joint registries, published data on OA pathogeneis and pathology, and data concerning performance of each implant material combination in terms of biocompatibility. We believe that taking into account the wealth of information from each of these streams will provide the most comprehensive overview of implant performance and allow surgeons to make more informed choices about which implant should be used in which patient.
Methods
Data from three joint registries were combined with established literature to highlight the heterogeneity of OA disease and the different clinical outcomes following arthroplasty with a range of material types.
Results
However, joint registries only go so far and don’t consider differences in arthritis presentation or underlying drivers of pathology. It is inappropriate to consider all OA patients to have the same pathology and this is reflected in the large body of work which has now identified hallmarks of OA and how they affect different patient populations.
Equally, just as OA is a heterogeneous disease, there are disparate responses to wear debris from different material combinations used in joint replacement surgery. This has been highlighted by recent high-profile scrutiny of early failure of metal-on-metal total hip replacement (THR) implants. Indeed our own work has highlighted the difference in response to implant debris from metal-on-metal implants.
Conclusions
Bringing together data from joint registries, biomarker analysis, phenotyping of OA patients and knowledge of how different patients respond to implant debris will lead to a
truly personalised approach to treating OA patients, ensuring that the correct implant is given to the correct patient at the correct time.

Details

Original languageEnglish
Pages (from-to)20-27
JournalThe Musculoskeletal Journal of Hospital for Special Surgery
Volume13
Issue number1
Early online date14 Nov 2016
Publication statusPublished - Feb 2017

Keywords

  • Precision medicine, osteoarthritis, joint registry, total hip replacement