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Long-term clinical outcome of acetabular cup revision surgery: comparison of cemented cups, cementless cups, and cemented cups with reinforcement devices

  • Original Article • HIP - ARTHROPLASTY
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Abstract

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.

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Author’s contribution

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.

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Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Matsuoka Shimoaizuki 23, Eiheiji, Fukui, 910-1193, Japan

    Yasuo Kokubo, Hisashi Oki, Daisuke Sugita, Kohei Negoro, Kenichi Takeno, Tsuyoshi Miyazaki & Hideaki Nakajima

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  1. Yasuo Kokubo
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  2. Hisashi Oki
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  3. Daisuke Sugita
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  4. Kohei Negoro
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  5. Kenichi Takeno
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  6. Tsuyoshi Miyazaki
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  7. Hideaki Nakajima
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Correspondence to Yasuo Kokubo.

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All authors declare no conflict of interest.

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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.

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Informed consent was obtained from all individual participants included in the study.

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Kokubo, Y., Oki, H., Sugita, D. et al. Long-term clinical outcome of acetabular cup revision surgery: comparison of cemented cups, cementless cups, and cemented cups with reinforcement devices. Eur J Orthop Surg Traumatol 26, 407–413 (2016). https://doi.org/10.1007/s00590-016-1763-1

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  • DOI: https://doi.org/10.1007/s00590-016-1763-1

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