Is Retention of the Acetabular Component at Revision Surgery a Long-Term Solution?
Background: Acetabular retention in revision total hip arthroplasty (THA) may be advantageous, yet long-term survival data is limited. Thus, we investigated long-term survivorship of retained acetabular components in revision THA with analysis of rerevision rate, instability risk, and clinical outco...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-10-01
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| Series: | Arthroplasty Today |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344123001024 |
| _version_ | 1797653941503131648 |
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| author | Elizabeth Lieberman, MD Lee Sasala, MD Tanner Thornton, MS Robert Barrack, MD Ryan Nunley, MD Susan Thapa, PhD John Clohisy, MD |
| author_facet | Elizabeth Lieberman, MD Lee Sasala, MD Tanner Thornton, MS Robert Barrack, MD Ryan Nunley, MD Susan Thapa, PhD John Clohisy, MD |
| author_sort | Elizabeth Lieberman, MD |
| collection | DOAJ |
| description | Background: Acetabular retention in revision total hip arthroplasty (THA) may be advantageous, yet long-term survival data is limited. Thus, we investigated long-term survivorship of retained acetabular components in revision THA with analysis of rerevision rate, instability risk, and clinical outcomes. Methods: We reviewed 98 hips with polyethylene wear and/or osteolysis that were revised with retained acetabular components. Acetabular inclination and anteversion were measured from prerevision radiographs. A retrospective chart review was performed, collecting outcomes of interest including Harris hip score, instability events, and rerevision surgery. Kaplan-Meier analysis was used to calculate the risk of revision over time. Predictors of survival including acetabular component position were analyzed by multiple logistic regression. Results: Average follow-up was 13 years (range, 5-24). Survivorship rates at 5, 10, 15, and 20 years were 89.7%, 81.6%, 70.8%, and 63.8%, respectively. There was improvement in average Harris hip score (61 to 76, P < .0001). There was a 9% rate of dislocation, and 6 hips (6%) were rerevised for recurrent instability. Overall, there were 23 (23%) rerevisions at an average of 6.1 years with the most common reasons being instability (6%) and aseptic loosening (6%). Use of conventional polyethylene was the only identified independent predictor of rerevision (P = .025). Conclusions: Retention of a well-fixed acetabular component in revision THA provides acceptable long-term outcomes with a 15-year survivorship of 71%. Instability and aseptic loosening were the most common reasons for rerevision. Surgeons may consider retaining the acetabular component at revision surgery if the implant is well-fixed and well-positioned. |
| first_indexed | 2024-03-11T16:52:09Z |
| format | Article |
| id | doaj.art-28b5efc8b550448e8e1734557cc4fb0c |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-03-11T16:52:09Z |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-28b5efc8b550448e8e1734557cc4fb0c2023-10-21T04:22:47ZengElsevierArthroplasty Today2352-34412023-10-0123101197Is Retention of the Acetabular Component at Revision Surgery a Long-Term Solution?Elizabeth Lieberman, MD0Lee Sasala, MD1Tanner Thornton, MS2Robert Barrack, MD3Ryan Nunley, MD4Susan Thapa, PhD5John Clohisy, MD6Adventist Health, Orthopaedic Surgery, Portland, OR, USAUniversity of Pittsburgh Medical Center, Orthopaedic Surgery, Pittsburgh, Philadelphia, USADepartment of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USADepartment of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USADepartment of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USADepartment of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USADepartment of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA; Corresponding author. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 823, St. Louis, MO 63110, USA. Tel.: +1 314 747 2556.Background: Acetabular retention in revision total hip arthroplasty (THA) may be advantageous, yet long-term survival data is limited. Thus, we investigated long-term survivorship of retained acetabular components in revision THA with analysis of rerevision rate, instability risk, and clinical outcomes. Methods: We reviewed 98 hips with polyethylene wear and/or osteolysis that were revised with retained acetabular components. Acetabular inclination and anteversion were measured from prerevision radiographs. A retrospective chart review was performed, collecting outcomes of interest including Harris hip score, instability events, and rerevision surgery. Kaplan-Meier analysis was used to calculate the risk of revision over time. Predictors of survival including acetabular component position were analyzed by multiple logistic regression. Results: Average follow-up was 13 years (range, 5-24). Survivorship rates at 5, 10, 15, and 20 years were 89.7%, 81.6%, 70.8%, and 63.8%, respectively. There was improvement in average Harris hip score (61 to 76, P < .0001). There was a 9% rate of dislocation, and 6 hips (6%) were rerevised for recurrent instability. Overall, there were 23 (23%) rerevisions at an average of 6.1 years with the most common reasons being instability (6%) and aseptic loosening (6%). Use of conventional polyethylene was the only identified independent predictor of rerevision (P = .025). Conclusions: Retention of a well-fixed acetabular component in revision THA provides acceptable long-term outcomes with a 15-year survivorship of 71%. Instability and aseptic loosening were the most common reasons for rerevision. Surgeons may consider retaining the acetabular component at revision surgery if the implant is well-fixed and well-positioned.http://www.sciencedirect.com/science/article/pii/S2352344123001024RevisionArthroplastyComponentsAcetabularLong-termPolyethylene |
| spellingShingle | Elizabeth Lieberman, MD Lee Sasala, MD Tanner Thornton, MS Robert Barrack, MD Ryan Nunley, MD Susan Thapa, PhD John Clohisy, MD Is Retention of the Acetabular Component at Revision Surgery a Long-Term Solution? Arthroplasty Today Revision Arthroplasty Components Acetabular Long-term Polyethylene |
| title | Is Retention of the Acetabular Component at Revision Surgery a Long-Term Solution? |
| title_full | Is Retention of the Acetabular Component at Revision Surgery a Long-Term Solution? |
| title_fullStr | Is Retention of the Acetabular Component at Revision Surgery a Long-Term Solution? |
| title_full_unstemmed | Is Retention of the Acetabular Component at Revision Surgery a Long-Term Solution? |
| title_short | Is Retention of the Acetabular Component at Revision Surgery a Long-Term Solution? |
| title_sort | is retention of the acetabular component at revision surgery a long term solution |
| topic | Revision Arthroplasty Components Acetabular Long-term Polyethylene |
| url | http://www.sciencedirect.com/science/article/pii/S2352344123001024 |
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