, Volume 470, Issue 11, pp 3094-3100
Date: 24 Apr 2012

Alumina Heads Minimize Wear and Femoral Osteolysis Progression After Isolated Simple Acetabular Revision

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Topic
Hip

Abstract

Background

Patients with THA requiring cup revision for acetabular osteolysis may have a stable stem component without loosening. However, it is unclear whether isolated cup revision halts femoral osteolysis progression.

Question/purposes

We asked (1) whether and to what degree osteolysis progresses after isolated acetabular revision with a change of the femoral head and (2) whether an alumina or metal bearing better reduces osteolysis progression and wear with a polyethylene (PE) cup.

Methods

We retrospectively evaluated 150 patients who underwent 165 acetabular revisions but no treatment for proximal femoral osteolysis in hips with stable femoral components. Mean age at revision was 63 years (range, 48–74 years). All hips received a new PE cup; 83 hips received new alumina heads and 82 new metal heads. Radiographs (mean followup, 15 years; range, 10–25 years) were assessed to measure osteolysis, loosening, and PE wear. Revisions of the femoral stem were recorded.

Results

An isolated cup revision with a change of the femoral head halted femoral osteolysis progression for 10 years in 133 hips (81%), with a greater percentage without progression in hips with alumina heads (99% versus 62% with metal head). Alumina heads were better than metal heads at reducing the area of osteolysis progression (47 versus 250 mm2) and wear (0.07 versus 0.14 mm/year) and increasing the survival probability before femoral revision (98% versus 85% at 15 years’ followup).

Conclusions

An isolated cup revision with a new alumina femoral head (in hips that have a stable stem component without loosening) usually halts femoral osteolysis progression (no change or osseous restoration) over 10 years if the osteolysis is less than 1000 mm2.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.
Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
This work was performed at the Hospital Henri Mondor, Creteil, France.