The study, “Why Are Contemporary Revision Total Hip Arthroplasties Failing? An Analysis of 2,500 Cases,” appears in the January 23, 2019 edition of The Journal of Arthroplasty.
Award Winning Paper Has Tips for Avoiding Re-Revision
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#totalhiparthroplastySecondary#polyethylenewear#acetabularacepticloosening
This work was the winner of the Lawrence D. Dorr Surgical Techniques & Technologies Award.
Co-author Matthew Abdel, M.D., professor of orthopedic surgery and consultant in the Department of Orthopedic Surgery at Mayo Clinic in Rochester, Minnesota, explained that two coincidental but tangentially related trends in hip revision surgery appear to be occurring in orthopedics.
According to Dr. Abdel, “We completed this investigation given the fact that revision total hip arthroplasties (THAs) are increasing; however, revision implants and techniques have evolved and improved. As such, we were interested in the most common indications for re-revision THA in a contemporary series.”
To understand these trends, the authors retrospectively reviewed 2,589 aseptic revision THAs that were completed at the Mayo Clinic between 2005 and 2015 and were included in the Mayo total joint registry. Of those revision surgeries, 39% were isolated acetabular revisions, 22% isolated femoral revisions, 18% were both component revisions, and 21% were head/liner component exchanges.
Dr. Abdel and his team found that there were 211 re-revision THAs during the study period. Theyreported that the overall survivorship free of any re-revision at 2, 5, and 10 years was 94%, 92%, and 88%, respectively.
And they reported that the most common reasons for re-revision were hip instability (52%), peri-prosthetic fracture (11%), femoral aseptic loosening (11%), acetabular aseptic loosening (9%), infection (6%), polyethylene wear (3%), and other (8%).
According to Dr. Abdel, the most important finding was “that as implant fixation has improved, aseptic loosening has become less common. As a result, instability has come to account for more than half of re-revisions. Surgeons should consider higher stability implants during revision THAs.”
Dr. Abdel informed OTW that he is a paid consultant for Stryker.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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