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Failures of total hip arthroplasty and probable incidence of revision surgery in the future

Calculations according to a mathematical model based on a ten years' experience in total hip arthroplasty

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Summary

From November 1970 to February 1982, 2669 Charnley-Mueller total hip arthroplasties were performed in 2260 patients at the Orthopaedic Department of the University of Basle, Switzerland. During this time period with an average observation time of 5.4 years, 141 patients (5.3%) required a revision arthroplasty.

The annual incidence of rearthroplasty increased from 0.7% in the time period 0–1 year to 2.2% in the time period 9–10 years after implantation. The cumulative failure rate for patients with an observation time of 10 years was 12.8%.

The principal factors leading to revision arthroplasty were as follows: 0–3 years after implantation, infection, 3–8 years, femoral stem fracture and loosening, 8 years and beyond, acetabular cup loosening.

Acetabular cup loosening showed a strong increase of incidence 8 years and more after implantation. Regarding patients with an observation time of 20 years we estimate that acetabular cup loosening will be over 50% exclusively and in 75% partly responsible for rearthroplasty.

Femoral stem fracture (79%) and loosening (73%) predominated in males, acetabular cup loosening (75%) occurred most often in females. Acetabular cup loosening was found significantly more often in patients with bilateral arthroplasty (45%). Age, body weight and primary disease did not show significant correlation with the incidence of revision.

Based on curve analyses the incidence of rearthroplasty will double in our clinic within 8 years. The ratio of arthroplasty to rearthroplasty will fall from 4:1 in the year 1982 to 2:1 in the year 1990.

Revision of arthroplasties performed primarily elsewhere (74) and revisions of arthroplasties according to a method other than Charnley-Mueller are not considered in this paper (31 McKee, 60 isoelastic prostheses, 11 Wagner cup arthroplasties, 23 cephalic prostheses).

Zusammenfassung

Von November 1970 bis Februar 1982 wurden an der Orthopädischen Universitätsklinik Basel (Schweiz) 2669 Charnley-Mueller totale Hüftprothesen bei 2260 Patienten eingesetzt. Während dieser Zeitspanne mit einer mittleren Beobachtungszeit von 5,4 Jahren mußten in 141 Fällen (=5,3%) eine Rearthroplastik durchgeführt werden.

Die jährliche Häufigkeit der Rearthroplastik nahm von 0,7% in der Zeitspanne 0–1 Jahr auf 2,2% in der Zeitspanne 9–10 Jahre nach der Implantation zu. Patienten mit einer Beobachtungszeit von 10 Jahren hatten eine Mißerfolgsrate von 12,8%.

Die Infektion war hauptsächlich verantwortlich für die Rearthroplastik in der ersten Zeitspanne 0–3 Jahre, der Bruch und die Lockerung des Prothesenschaftes in der zweiten Zeitspanne 3–8 Jahre und die Pfannenlockerung in der dritten Zeitspanne 8 und mehr Jahre nach Implantation.

Die Pfannenlockerung zeigte einen starken Häufigkeitsanstieg 8 Jahre und mehr nach der Implantation. Für Patienten mit einer Beobachtungszeit von 20 Jahren wurde geschätzt, daß die Pfannenlockerung in über 50% ausschließlich und in 75% teilweise für die Rearthroplastik verantwortlich ist.

Männer dominieren beim Bruch (79%) und bei der Lockerung (73%) des Prothesenschaftes, Frauen (75%) bei der Pfannenlockerung.

Patienten mit einer Pfannenlockerung hatten signifikant gehäuft eine bilaterale Arthroplastik (45%). Alter, Körpergewicht und Grundkrankheit zeigten keine signifikanten Resultate.

Auf Grund von Kurvenanalysen wird sich die Häufigkeit der Rearthroplastik in unserer Klinik in den nächsten 8 Jahren verdoppeln, das Verhältnis Arthroplastik zu Rearthroplastik wird sich von 4: 1 im Jahre 1982 auf 2: 1 im Jahre 1990 senken.

Reoperationen von Arthroplastiken, die primär an einem anderen Spital operiert worden sind (74), sowie Reoperationen von anderen Arthroplastiken als derjenigen von Charnley-Mueller wurden in dieser Arbeit nicht berücksichtigt (31 McKee, 60 isoelastische Prothesen, 11 Wagner-Cups, 23 Kopfprothesen etc.).

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Authors and Affiliations

  1. Orthopaedic Division, Department of Surgery of the University of Basle, Felix-Platter-Spital, CH-4055, Basle, Switzerland

    E. Morscher & A. Schmassmann

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  1. E. Morscher
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  2. A. Schmassmann
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Morscher, E., Schmassmann, A. Failures of total hip arthroplasty and probable incidence of revision surgery in the future. Arch. Orth. Traum. Surg. 101, 137–143 (1983). https://doi.org/10.1007/BF00433274

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