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Method of Fixation Does Not Influence the Overall Risk of Rerevision in First-time Cup Revisions

  • Symposium: 2012 International Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

During the last two decades, uncemented fixation has been increasingly preferred worldwide during cup revision surgery. In Sweden, the number of uncemented cup revisions has been increasing during the last decade. However, it is unclear whether the risk of rerevision differs between cemented and uncemented cups.

Question/purposes

We determined (1) the risk of rerevision after cemented and uncemented fixation; (2) the influence of concomitant stem revision on the risk of rerevision of the cup; (3) the difference in risk of rerevision of an uncemented cup revision compared with liner revision only; and (4) whether the surgical incision influenced the risk of rerevision.

Methods

Between 1979 and 2010, 19,342 first-time cup revisions were reported to the Swedish Hip Arthroplasty Register. From these, 749 were excluded (hip resurfacing, cases with tumor diagnoses, and missing data) leaving 18,593 (73% cemented) for further analysis. We used a Cox regression model adjusted for age, sex, primary diagnosis, method of fixation, concomitant stem revision, and cemented/uncemented fixation to assess risk of rerevision.

Results

The relative risk for rerevision for any reason did not differ between cemented and uncemented fixation (relative risk [RR], 0.94). If the stem was not revised at index revision, the risk of further cup revision increased twofold (RR, 1.91). Liner revisions were associated with a 70% increased risk for rerevision of the cup as a result of any reason and especially because of dislocation (RR, 2.94). The surgical incision did not influence the overall risk for rerevision (direct lateral/posterolateral: RR, 1.02) or the risk of rerevision resulting from dislocation (RR, 0.91).

Conclusions

We found no difference in the overall risk of rerevision between cemented and uncemented fixation. Liner exchange had a higher risk for rerevision when compared with cases being rerevised with a new uncemented cup.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank the Swedish Orthopaedic surgeons, the secretaries at the individual hospitals, and the local staff at the Swedish Hip Arthroplasty Register who, by reporting and compiling data for more than three decades, made this study possible.

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Authors and Affiliations

  1. Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, NA, 413 45, Sweden

    Maziar Mohaddes MD, Göran Garellick MD, PhD & Johan Kärrholm MD, PhD

  2. Swedish Hip Arthroplasty Register, Gothenburg, Sweden

    Göran Garellick MD, PhD & Johan Kärrholm MD, PhD

Authors
  1. Maziar Mohaddes MD
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  2. Göran Garellick MD, PhD
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  3. Johan Kärrholm MD, PhD
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Correspondence to Maziar Mohaddes MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or 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.

Each author certifies that his institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Mohaddes, M., Garellick, G. & Kärrholm, J. Method of Fixation Does Not Influence the Overall Risk of Rerevision in First-time Cup Revisions. Clin Orthop Relat Res 471, 3922–3931 (2013). https://doi.org/10.1007/s11999-013-2872-3

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  • DOI: https://doi.org/10.1007/s11999-013-2872-3

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