Long-term clinical outcome of acetabular cup revision surgery: comparison of cemented cups, cementless cups, and cemented cups with reinforcement devices
- 786 Downloads
The aim of the present study was to analyze the clinical and radiographic outcomes and Kaplan–Meier survivorship of patients who underwent revision surgeries of the acetabular cup that had sustained aseptic loosening. We reviewed 101 consecutive patients (120 hips; 10 men 11 hips; 91 women 109 hips; age at surgery 66 years; range 45–85) who underwent acetabular component revision surgery, at a follow-up period of 15.6 years (range 10–32). To evaluate the state of the acetabulum, acetabular bony defects were classified according to the AAOS classification based on intraoperative findings: type I (segmental deficiencies n = 24 hips), type II (cavity deficiency n = 48), type III (combined deficiency n = 46), and type IV (pelvic discontinuity n = 2). The Harris hip score improved from 42.5 ± 10.8 (mean ± SD) before surgery to 74.9 ± 14.6 points at follow-up. The survival rates of the acetabular revision surgery with cemented, cementless, and cemented cups plus reinforcement devices were 74, 66, and 82 %, respectively. The difference in the survival rate between the cemented and cementless group was marginal (p = 0.048 Gehan–Breslow–Wilcoxon, p = 0.061 log-rank), probably due to the early-stage failure cases in the cementless group. The cementless and reinforcement groups included nine early-stage failure cases. To prevent early-stage failure, we recommend the cementless cups for types I and II acetabular bone defects with adequate contact between host bone and acetabular component, and the cemented cup with or without reinforcement devices, together with restoration of bone stock by impaction or structured bone grafting, for cases lacking such contact.
KeywordsRevision total hip arthroplasty Acetabulum Bony defect Cementless cup Cemented cup Reinforcement device Bone grafting
YK designed the study. YK drafted the manuscript. YK and HO performed surgical treatment. KN, KT, TM, and HN performed managed the clinical and radiological evaluation. DS performed statistical analysis.
Compliance with the ethical standards
Conflict of interest
All authors declare no conflict of interest.
All procedures performed in this report were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.Kawahara H, Kokubo Y, Yayama T, Uchida K, Kobayashi S, Nakajima H, Oki H, Negoro K, Mwaka ES, Orwotho NT, Baba H (2010) Metaphyseal-loading anterolaterally-flared femoral stem in cementless total hip arthroplasty: five- to eleven-year follow-up evaluation. Artif Organs 34:377–383CrossRefPubMedGoogle Scholar
- 3.Kokubo Y, Uchida K, Oki H, Negoro K, Nagamune K, Kawaguchi S, Takeno K, Yayama T, Nakajima H, Sugita D, Yoshida A, Baba H (2013) Modified metaphyseal-loading anterolaterally flared anatomic femoral stem: five- to nine-year prospective follow-up evaluation and results of three-dimensional finite element analysis. Artif Organs 37:175–182CrossRefPubMedGoogle Scholar
- 4.Kremers HM, Howard JL, Loechler Y, Schleck CD, Harmsen WS, Berry DJ, Cabanela ME, Hanssen AD, Pagnano MW, Trousdale RT, Lewallen DG (2012) Comparative long-term survivorship of uncemented acetabular components in revision total hip arthroplasty. J Bone Joint Surg 94A:e82Google Scholar
- 7.Schreurs BW, Luttjeboer J, Thien TM, de Waal Malefijt MC, Buma P, Veth RP, Slooff TJ (2009) Acetabular revision with impacted morselized cancellous bone graft and a cemented cup in patients with rheumatoid arthritis. A concise follow-up, at eight to nineteen years, of a previous report. J Bone Joint Surg 91A:646–651CrossRefGoogle Scholar
- 21.Nakashima Y, Sato T, Yamamoto T, Motomura G, Ohishi M, Hamai S, Akiyama M, Hirata M, Hara D, Iwamoto Y (2013) Results at a minimum of 10 years of follow-up for AMS and PerFix HA-coated cementless total hip arthroplasty: impact of cross-linked polyethylene on implant longevity. J Orthop Sci 18:962–968CrossRefPubMedGoogle Scholar