Skip to main content

Postoperative Ergebnisse und Überlebensraten nach aseptischem Hüft-TEP-Wechsel

Was können Patient*innen von einem Revisionseingriff erwarten?

Postoperative outcomes and survival rates after aseptic revision total hip arthroplasty

What can patients expect from revision surgery?

Zusammenfassung

Hintergrund

Im Jahr 2020 wurden in Deutschland mehr als 14.000 aseptische Revisionseingriffe an Hüfttotalendoprothesen registriert. Patient*innen haben an diese Folgeoperationen ähnlich hohe Erwartungen wie an die primäre hüftendoprothetische Versorgung. Tatsächlich sind diese Revisionseingriffe mit erhöhten Komplikationsraten und einem höheren Anteil postoperativ unzufriedener Patienten assoziiert.

Outcome

Im Vergleich zum Outcome nach Primärhüftendoprothetik wurden nach solchen Revisionsoperationen insbesondere eine schlechtere Gelenkfunktion, eine schlechtere Mobilisierung sowie ein erhöhtes Schmerzniveau beschrieben. Auch die Lebensqualität und die Rückkehr in das Berufsleben können beeinträchtigt sein.

Überlebensraten

Die Überlebensrate der Prothesen nach der Revision wird durch Alter, BMI und Komorbiditäten der Patient*innen, aber auch durch die zum Operationszeitpunkt bestehende knöcherne Defektsituation, den Zustand periprothetischer Weichteile sowie die Wahl des Revisionsimplantats beeinflusst. Darüber hinaus korreliert die Anzahl der Revisionsoperationen umgekehrt mit der Standzeit der Prothesen. Nach vorangegangenen Wechseloperationen steigen die Risiken für Implantatlockerungen, Instabilität und periprothetische Infektionen.

Abstract

Background

In 2020, more than 14,000 aseptic revision procedures for total hip arthroplasty (THA) were registered in Germany. Patient expectations of revision hip arthroplasty are not substantially different from expectations of primary hip replacement.

Outcome

However, revision surgery is associated with increased complication rates and a higher proportion of dissatisfied patients. In particular, poorer postoperative function and mobility as well as increased pain levels following revision THA have been described compared to the outcome after primary THA. Quality of life and return-to-work can also be impaired.

Survival rate

Implant survival is influenced by age, BMI, and comorbidities of the patients, but also by the size and complexity of bone defects, the extent of periprosthetic soft tissue compromise and the choice of revision implant(s). In addition, the number of previous revision surgeries inversely correlates with the survival rates. Previous revisions have been shown to be associated with increased risks of aseptic loosening, instability and periprosthetic infection.

This is a preview of subscription content, access via your institution.

Abb. 1

Abbreviations

ARMD:

„Adverse reactions to metal debris“

ASA :

American Society of Anesthesiologists

BMI :

Body-Mass-Index

EPRD :

Endoprothesenregister Deutschland

HHS :

Harris Hip Score

MoM :

„Metal-on-metal“

PROM :

„Patient related outcome measures“

TEP :

Totalendoprothese

Literatur

  1. Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370:1508–1519. https://doi.org/10.1016/S0140-6736(07)60457-7

    Article  PubMed  Google Scholar 

  2. Weber M, Craiovan B, Woerner ML et al (2018) Predictors of outcome after primary total joint replacement. J Arthroplasty 33:431–435. https://doi.org/10.1016/j.arth.2017.08.044

    Article  PubMed  Google Scholar 

  3. Pivec R, Johnson AJ, Mears SC, Mont MA (2012) Hip arthroplasty. Lancet 380:1768–1777. https://doi.org/10.1016/S0140-6736(12)60607-2

    Article  PubMed  Google Scholar 

  4. EPRD Endoprothesenregister Deutschland (2021) EPRD Jahresbericht 2021. EPRD gGmbH

    Google Scholar 

  5. Schreurs BW, Hannink G (2017) Total joint arthroplasty in younger patients: heading for trouble? Lancet 389:1374–1375. https://doi.org/10.1016/S0140-6736(17)30190-3

    Article  PubMed  Google Scholar 

  6. Keeney JA, Nunley RM, Baca GR, Clohisy JC (2015) Are younger patients undergoing THA appropriately characterized as active? Clin Orthop 473:1083–1092. https://doi.org/10.1007/s11999-014-3952-8

    Article  PubMed  Google Scholar 

  7. Mei XY, Gong YJ, Safir O et al (2019) Long-term outcomes of total hip arthroplasty in patients younger than 55 years: a systematic review of the contemporary literature. Can J Surg 62:249–258. https://doi.org/10.1503/cjs.013118

    Article  PubMed  PubMed Central  Google Scholar 

  8. Crawford DA, Adams JB, Hobbs GR et al (2021) Does activity level after primary total hip arthroplasty affect aseptic survival? Arthroplasty Today 11:68–72. https://doi.org/10.1016/j.artd.2021.07.005

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kurtz SM, Lau E, Ong K et al (2009) Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop 467:2606–2612. https://doi.org/10.1007/s11999-009-0834-6

    Article  PubMed  PubMed Central  Google Scholar 

  10. Schwarzkopf R, Thompson SL, Adwar SJ et al (2012) Postoperative complication rates in the “super-obese” hip and knee arthroplasty population. J Arthroplasty 27:397–401. https://doi.org/10.1016/j.arth.2011.04.017

    Article  PubMed  Google Scholar 

  11. Namba RS, Paxton L, Fithian DC, Stone ML (2005) Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty 20:46–50. https://doi.org/10.1016/j.arth.2005.04.023

    Article  PubMed  Google Scholar 

  12. Guofeng C, Chen Y, Rong W et al (2020) Patients with metabolic syndrome have a greater rate of complications after arthroplasty: a systematic review and meta-analysis. Bone Joint Res 9:120–129. https://doi.org/10.1302/2046-3758.93.BJR-2019-0138.R1

    Article  PubMed  PubMed Central  Google Scholar 

  13. Zmistowski B, Dizdarevic I, Jacovides CL et al (2013) Patients with uncontrolled components of metabolic syndrome have increased risk of complications following total joint arthroplasty. J Arthroplasty 28:904–907. https://doi.org/10.1016/j.arth.2012.12.018

    Article  PubMed  Google Scholar 

  14. Edelstein AI, Lovecchio F, Delagrammaticas DE et al (2017) The impact of metabolic syndrome on 30-day complications following total joint arthroplasty. J Arthroplasty 32:362–366. https://doi.org/10.1016/j.arth.2016.08.007

    Article  PubMed  Google Scholar 

  15. Patil S, Garbuz DS, Greidanus NV et al (2008) Quality of life outcomes in revision vs primary total hip arthroplasty: a prospective cohort study. J Arthroplasty 23:550–553. https://doi.org/10.1016/j.arth.2007.04.035

    Article  PubMed  Google Scholar 

  16. Eisler T, Svensson O, Tengström A, Elmstedt E (2002) Patient expectation and satisfaction in revision total hip arthroplasty. J Arthroplasty 17:457–462. https://doi.org/10.1054/arth.2002.31245

    CAS  Article  PubMed  Google Scholar 

  17. Winther SB, Foss OA, Wik TS et al (2015) 1‑year follow-up of 920 hip and knee arthroplasty patients after implementing fast-track. Acta Orthop 86:78–85. https://doi.org/10.3109/17453674.2014.957089

    Article  PubMed  PubMed Central  Google Scholar 

  18. Postler AE, Beyer F, Wegner T et al (2017) Patient-reported outcomes after revision surgery compared to primary total hip arthroplasty. Hip Int 27:180–186. https://doi.org/10.5301/hipint.5000436

    Article  PubMed  Google Scholar 

  19. van der Wees PJ, Wammes JJG, Akkermans RP et al (2017) Patient-reported health outcomes after total hip and knee surgery in a Dutch university hospital setting: results of twenty years clinical registry. BMC Musculoskelet Disord 18:97. https://doi.org/10.1186/s12891-017-1455-y

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wik TS, Klaksvik J, Husby OS et al (2022) Patient-reported outcome after primary and aseptic revision hip arthroplasty: 1‑year follow-up of 3,559 primary and 406 revision THAs in an institutional registry. Acta Orthop 93:132–137. https://doi.org/10.2340/17453674.2021.852

    Article  PubMed  PubMed Central  Google Scholar 

  21. Laughlin MS, Vidal EA, Drtil AA et al (2021) Mortality after revision total hip arthroplasty. J Arthroplasty 36:2353–2358. https://doi.org/10.1016/j.arth.2021.01.022

    Article  PubMed  Google Scholar 

  22. Bleß H‑H, Kip M (2017) Weißbuch Gelenkersatz: Versorgungssituation bei endoprothetischen Hüft- und Knieoperationen in Deutschland. Springer, Berlin, Heidelberg

    Book  Google Scholar 

  23. Hu D, Yang X, Tan Y et al (2015) Ceramic-on-ceramic versus ceramic-on-polyethylene bearing surfaces in total hip arthroplasty. Orthopedics 38:e331–338. https://doi.org/10.3928/01477447-20150402-63

    Article  PubMed  Google Scholar 

  24. Zeng M, Xie J, Li M et al (2015) Cementless femoral revision in patients with a previous cemented prosthesis. Int Orthop 39:1513–1518. https://doi.org/10.1007/s00264-015-2696-8

    Article  PubMed  Google Scholar 

  25. Badarudeen S, Shu AC, Ong KL et al (2017) Complications after revision total hip arthroplasty in the medicare population. J Arthroplasty 32:1954–1958. https://doi.org/10.1016/j.arth.2017.01.037

    Article  PubMed  Google Scholar 

  26. Mahomed NN, Barrett JA, Katz JN et al (2003) Rates and outcomes of primary and revision total hip replacement in the United States medicare population. J Bone Joint Surg Am 85:27–32. https://doi.org/10.2106/00004623-200301000-00005

    Article  PubMed  Google Scholar 

  27. Zhan C, Kaczmarek R, Loyo-Berrios N et al (2007) Incidence and short-term outcomes of primary and revision hip replacement in the United States. J Bone Joint Surg Am 89:526–533. https://doi.org/10.2106/JBJS.F.00952

    Article  PubMed  Google Scholar 

  28. Oronce CIA, Shao H, Shi L (2015) Disparities in 30-day readmissions after total hip arthroplasty. Med Care 53:924–930. https://doi.org/10.1097/MLR.0000000000000421

    Article  PubMed  Google Scholar 

  29. Ramkumar PN, Chu CT, Harris JD et al (2015) Causes and rates of unplanned readmissions after elective primary total joint arthroplasty: a systematic review and meta-analysis. Am J Orthop 44:397–405

    PubMed  Google Scholar 

  30. Schairer WW, Sing DC, Vail TP, Bozic KJ (2014) Causes and frequency of unplanned hospital readmission after total hip arthroplasty. Clin Orthop 472:464–470. https://doi.org/10.1007/s11999-013-3121-5

    Article  PubMed  Google Scholar 

  31. Cantrell CK, DeBell HA, Lehtonen EJ et al (2020) Risk factors for readmission within thirty days following revision total hip arthroplasty. J Clin Orthop Trauma 11:38–42. https://doi.org/10.1016/j.jcot.2018.10.017

    Article  PubMed  Google Scholar 

  32. Saleh KJ, Celebrezze M, Kassim R et al (2003) Functional outcome after revision hip arthroplasty: a metaanalysis. Clin Orthop Relat Res 416:254–264. https://doi.org/10.1097/01.blo.0000093006.90435.43

    Article  Google Scholar 

  33. Cleveland Clinic OME Arthroplasty Group, Siddiqi A, Warren J et al (2021) Do patient-reported outcome measures improve after aseptic revision total hip arthroplasty? Hip Int. https://doi.org/10.1177/11207000211036320

    Article  Google Scholar 

  34. Zhang S, Chen JY, Pang HN et al (2021) Revision total hip arthroplasty is associated with poorer clinically meaningful improvements and patient satisfaction compared to primary total hip arthroplasty. J Orthop 28:96–100. https://doi.org/10.1016/j.jor.2021.11.008

    Article  PubMed  Google Scholar 

  35. Philpott A, Weston-Simons JS, Grammatopoulos G et al (2014) Predictive outcomes of revision total hip replacement—a consecutive series of 1176 patients with a minimum 10-year follow-up. Maturitas 77:185–190. https://doi.org/10.1016/j.maturitas.2013.10.019

    CAS  Article  PubMed  Google Scholar 

  36. Ong KL, Lau E, Suggs J et al (2010) Risk of subsequent revision after primary and revision total joint arthroplasty. Clin Orthop 468:3070–3076. https://doi.org/10.1007/s11999-010-1399-0

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kenney C, Dick S, Lea J et al (2019) A systematic review of the causes of failure of revision total hip arthroplasty. J Orthop 16:393–395. https://doi.org/10.1016/j.jor.2019.04.011

    Article  PubMed  PubMed Central  Google Scholar 

  38. Jafari SM, Coyle C, Mortazavi SMJ et al (2010) Revision hip arthroplasty: infection is the most common cause of failure. Clin Orthop 468:2046–2051. https://doi.org/10.1007/s11999-010-1251-6

    Article  PubMed  PubMed Central  Google Scholar 

  39. Duman S, Çamurcu İY, Uçpunar H et al (2021) Comparison of clinical characteristics and 10-year survival rates of revision hip arthroplasties among revision time groups. Arch Med Sci 17:382–389. https://doi.org/10.5114/aoms.2019.88563

    Article  PubMed  Google Scholar 

  40. Beckmann NA, Weiss S, Klotz MCM et al (2014) Loosening after acetabular revision: comparison of trabecular metal and reinforcement rings. A systematic review. J Arthroplasty 29:229–235. https://doi.org/10.1016/j.arth.2013.04.035

    Article  PubMed  Google Scholar 

  41. Kandahari AM, Yang X, Laroche KA et al (2016) A review of UHMWPE wear-induced osteolysis: the role for early detection of the immune response. Bone Res 4:1–13. https://doi.org/10.1038/boneres.2016.14

    Article  Google Scholar 

  42. Sheth NP, Rozell JC, Paprosky WG (2019) Evaluation and treatment of patients with acetabular osteolysis after total hip arthroplasty. J Am Acad Orthop Surg 27:e258–e267. https://doi.org/10.5435/JAAOS-D-16-00685

    Article  PubMed  Google Scholar 

  43. Rakow A, Schoon J (2020) Systemic effects of metals released from arthroplasty implants—a brief summary. Z Orthop Unfall 158:501–507. https://doi.org/10.1055/a-1187-1751

    Article  PubMed  Google Scholar 

  44. Perino G, De Martino I, Zhang L et al (2021) The contribution of the histopathological examination to the diagnosis of adverse local tissue reactions in arthroplasty. EFORT Open Rev 6:399–419. https://doi.org/10.1302/2058-5241.6.210013

    Article  PubMed  PubMed Central  Google Scholar 

  45. Chang JS, Haddad FS (2020) Revision total hip arthroplasty for metal-on-metal failure. J Clin Orthop Trauma 11:9–15. https://doi.org/10.1016/j.jcot.2019.09.021

    Article  PubMed  Google Scholar 

  46. Jennings JM, White S, Martin JR et al (2019) Revisions of modular metal-on-metal THA have a high risk of early complications. Clin Orthop 477:344–350. https://doi.org/10.1097/CORR.0000000000000363

    Article  PubMed  Google Scholar 

  47. Lombardi AV, Berend KR, Adams JB, Satterwhite KL (2016) Adverse reactions to metal on metal are not exclusive to large heads in total hip arthroplasty. Clin Orthop 474:432–440. https://doi.org/10.1007/s11999-015-4539-8

    Article  PubMed  Google Scholar 

  48. Castagnini F, Bordini B, Cosentino M et al (2021) The influence of bearing surfaces on revisions due to dislocations in total hip arthroplasty. J Mater Sci Mater Med 32:123. https://doi.org/10.1007/s10856-021-06598-4

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  49. Matharu GS, Berryman F, Dunlop DJ et al (2019) Has the threshold for revision surgery for adverse reactions to metal debris changed in metal-on-metal hip arthroplasty patients? A cohort study of 239 patients using an adapted risk-stratification algorithm. Acta Orthop 90:530–536. https://doi.org/10.1080/17453674.2019.1659661

    Article  PubMed  PubMed Central  Google Scholar 

  50. Lainiala O, Reito A, Nieminen J, Eskelinen A (2020) Complications and re-revisions after revisions of 528 metal-on-metal hips because of adverse reaction to metal debris. Acta Orthop 91:365–371. https://doi.org/10.1080/17453674.2020.1748351

    Article  PubMed  PubMed Central  Google Scholar 

  51. Matharu GS, Berryman F, Dunlop DJ et al (2019) No threshold exists for recommending revision surgery in metal-on-metal hip arthroplasty patients with adverse reactions to metal debris: a retrospective cohort study of 346 revisions. J Arthroplasty 34:1483–1491. https://doi.org/10.1016/j.arth.2019.03.022

    Article  PubMed  PubMed Central  Google Scholar 

  52. Bonner B, Arauz P, Klemt C, Kwon Y‑M (2020) Outcome of re-revision surgery for adverse local tissue reaction in metal-on-polyethylene and metal-on-metal total hip arthroplasty. J Arthroplasty 35:S284–S288. https://doi.org/10.1016/j.arth.2020.02.006

    Article  PubMed  Google Scholar 

  53. Munro JT, Masri BA, Duncan CP, Garbuz DS (2014) High complication rate after revision of large-head metal-on-metal total hip arthroplasty. Clin Orthop 472:523–528. https://doi.org/10.1007/s11999-013-2979-6

    Article  PubMed  Google Scholar 

  54. Grammatopoulos G, Grammatopolous G, Pandit H et al (2009) Hip resurfacings revised for inflammatory pseudotumour have a poor outcome. J Bone Joint Surg Br 91:1019–1024. https://doi.org/10.1302/0301-620X.91B8.22562

    CAS  Article  PubMed  Google Scholar 

  55. Matharu GS, Judge A, Pandit HG, Murray DW (2017) Which factors influence the rate of failure following metal-on-metal hip arthroplasty revision surgery performed for adverse reactions to metal debris? an analysis from the national joint registry for England and Wales. Bone Joint J 99:1020–1027. https://doi.org/10.1302/0301-620X.99B8.BJJ-2016-0889.R1

    Article  PubMed  Google Scholar 

  56. Matharu GS, Judge A, Murray DW, Pandit HG (2018) Outcomes after metal-on-metal hip revision surgery depend on the reason for failure: a propensity score-matched study. Clin Orthop 476:245–258. https://doi.org/10.1007/s11999.0000000000000029

    Article  PubMed  PubMed Central  Google Scholar 

  57. Rakow A, Schoon J, Dienelt A et al (2016) Influence of particulate and dissociated metal-on-metal hip endoprosthesis wear on mesenchymal stromal cells in vivo and in vitro. Biomaterials 98:31–40. https://doi.org/10.1016/j.biomaterials.2016.04.023

    CAS  Article  PubMed  Google Scholar 

  58. Wyles CC, Van Demark RE, Sierra RJ, Trousdale RT (2014) High rate of infection after aseptic revision of failed metal-on-metal total hip arthroplasty. Clin Orthop 472:509–516. https://doi.org/10.1007/s11999-013-3157-6

    Article  PubMed  Google Scholar 

  59. Howard DP, Wall PDH, Fernandez MA et al (2017) Ceramic-on-ceramic bearing fractures in total hip arthroplasty: an analysis of data from the national joint registry. Bone Joint J 99:1012–1019. https://doi.org/10.1302/0301-620X.99B8.BJJ-2017-0019.R1

    Article  PubMed  Google Scholar 

  60. Skinner JA, Haddad FS (2017) Ceramics in total hip arthroplasty: a bearing solution? Bone Joint J 99:993–995. https://doi.org/10.1302/0301-620X.99B8.BJJ-2017-0771

    Article  PubMed  Google Scholar 

  61. Fox KA, Phillips TM, Yanta JH, Abesamis MG (2016) Fatal cobalt toxicity after total hip arthroplasty revision for fractured ceramic components. Clin Toxicol (Phila) 54:874–877. https://doi.org/10.1080/15563650.2016.1214274

    CAS  Article  Google Scholar 

  62. Crutsen JRW, Koper MC, Jelsma J et al (2022) Prosthetic hip-associated cobalt toxicity: a systematic review of case series and case reports. EFORT Open Rev 7:188–199. https://doi.org/10.1530/EOR-21-0098

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  63. Finke JF (2018) Zusammenhang des ossären und muskulären Defizits in der Revisionsendoprothetik der Hüfte https://doi.org/10.17169/refubium-6004

    Book  Google Scholar 

  64. von Roth P, Abdel MP, Wauer F et al (2014) Significant muscle damage after multiple revision total hip replacements through the direct lateral approach. Bone Joint J 96:1618–1622. https://doi.org/10.1302/0301-620X.96B12.34256

    Article  Google Scholar 

  65. Scott CEH, Turnbull GS, Powell-Bowns MFR et al (2018) Activity levels and return to work after revision total hip and knee arthroplasty in patients under 65 years of age. Bone Joint J 100:1043–1053. https://doi.org/10.1302/0301-620X.100B8.BJJ-2017-1557.R2

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Georgi I. Wassilew.

Ethics declarations

Interessenkonflikt

M. Hoffmann, J.C. Reichert, A. Rakow, J. Schoon und G.I. Wassilew geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hoffmann, M., Reichert, J.C., Rakow, A. et al. Postoperative Ergebnisse und Überlebensraten nach aseptischem Hüft-TEP-Wechsel. Orthopädie (2022). https://doi.org/10.1007/s00132-022-04274-1

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00132-022-04274-1

Schlüsselwörter

  • Postoperative Komplikationen
  • Prothesenlockerung
  • Revision, Gelenk
  • Überlebensraten
  • Totaler Hüftgelenkersatz

Keywords

  • Postoperative complications
  • Prosthesis loosening
  • Revision, joint
  • Survival rate
  • Total hip replacement