Registry study on failure incidence in 1,127 revised hip implants with stem trunnion re-use after 10 years of follow-up: limited influence of an adapter sleeve

New Ceramic Heads With Titanium Sleeves on Retained Femoral Components: Results of Over 500 Revision Total Hip Arthroplasties

BACKGROUND

Ceramic heads are frequently combined with titanium sleeves in revision total hip arthroplasties (THAs), ostensibly to protect the ceramic head from existing damage to the retained trunnion. Although widely adopted, data on the performance and safety of this construct are minimal. The purpose of this study was to describe implant survivorships, radiographic results, and clinical outcomes of patients who underwent revision THA with a ceramic head and titanium sleeve on a retained femoral component.

METHODS

We identified 516 revision THAs with femoral component retention (328 acetabular-only revisions and 188 bearing surface exchanges) treated with a new ceramic head and titanium sleeve between 2000 and 2020. Mean age at revision was 64 years, 56% were women, and mean body mass index was 30. The indications for revision THA were adverse local tissue reaction (25%), acetabular loosening (24%), dislocation (17%), infection (5%), and other (29%). Kaplan-Meier survivorships were analyzed, radiographs reviewed, and Harris Hip Scores evaluated. Mean follow-up was 4 years (range, 2 to 10).

RESULTS

There were no reoperations or failures for ceramic head fracture, taper corrosion, or head/sleeve disengagement. The 10-year survivorship free of any re-revision was 85%. Indications for the 57 re-revisions included dislocation (33), infection (13), acetabular component loosening (7), periprosthetic fracture (2), psoas impingement (1), and sciatic nerve irritation (1). The 10-year survivorship free of any reoperation was 82%. There were an additional 14 reoperations. Radiographically, 1.9% had progressive femoral radiolucent lines, and 4.7% had progressive acetabular radiolucent lines. Mean Harris Hip Score was 81 at 2 years.

CONCLUSIONS

New ceramic heads with titanium sleeves in revision THAs with retained femoral components were durable and reliable with no cases of ceramic head fracture or taper complications at mean 4-year follow-up, including those revised for adverse local tissue reaction.

LEVEL OF EVIDENCE

IV.

Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review

PURPOSE

Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data.

METHODS

Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs.

RESULTS

One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies.

CONCLUSIONS

This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.

The impact of retaining the femoral stem in revision total hip arthroplasty: a systematic review, meta-analysis, and meta-regression

INTRODUCTION

The management of well-fixed femoral stems in revision total hip arthroplasty (rTHA) remains a subject of debate, with concerns over potential complications arising from stem retention. This study aimed to investigate the re-revision rates due to aseptic loosening of the stem, overall re-revision rates, dislocation rates, and factors influencing these outcomes in rTHA with a retained well-fixed femoral stem.

MATERIALS AND METHODS

A systematic search was conducted across several databases including PubMed, EMBASE, and CENTRAL to identify pertinent publications from their inception through 2023. We specifically focused on studies that reported outcomes of rTHA with retained well-fixed femoral stems. The study designs incorporated in our research encompassed both cohort studies and case series studies. Thirty-five studies involving isolated acetabular revision and retaining the stem were included, representing a total of 3497 patients. Data extraction was tailored to the study questions. Meta-analyses, meta-regression, and subgroup analyses were conducted to evaluate the outcomes and their relationship with various factors. Pooled results, meta-regression, and subgroup analyses were performed using random-effects models. To assess and reduce bias, we employed Egger's test and the trim and fill method.

RESULTS

The meta-analysis included 3497 patients with a mean follow-up of 9.28 years. The 10-year risk of re-revision after retaining femoral stem using highly cross-linked polyethylene was 1.7% (95% CI 1.1%-2.3%; I2: 60%) for stem aseptic loosening and 8.8% (95% CI 6.2%-11.4%; I2: 78%) overall re-revision. Dislocation risk was 5.7% (95% CI 4.1-7.0%; I2: 61%). Ceramic heads showed lower stem failure risk than metal heads in long-term follow-ups (P < 0.001). The posterolateral approach in revision surgery resulted in better long-term outcomes compared to the direct lateral approach (P < 0.001). Follow-up duration, timeline of study, Harris Hip Score, type of stem fixation, femoral head material, BMI, age, stem age, and surgical approach were evaluated as influential factors on these outcomes.

CONCLUSION

The re-revision rate due to aseptic loosening of the retained stem during rTHA was found to be significantly low, supporting the idea of retaining well-fixed stems during rTHA. The overall re-revision and dislocation rates also presented comparable or better outcomes to prior studies. A range of factors, including the use of highly cross-linked polyethylene and ceramic femoral heads, was found to influence these outcomes.

LEVEL OF EVIDENCE

IV.

PROSPERO REGISTRATION NUMBER

CRD42022351157.

Survival rates and reasons for revision of different stem designs in total hip arthroplasty for developmental dysplasia: a regional registry study

INTRODUCTION

Total hip arthroplasty (THA) in dysplastic hips is challenging, and each specific implant used in this context has been associated with specific complications. A registry study was performed to query survival rates, hazard ratios, and reasons for revision of different stem designs in THAs after developmental dysplasia of the hip.

MATERIALS AND METHODS

A regional arthroplasty registry was inquired about cementless THAs performed for hip dysplasia from 2000 to 2017. Patients were stratified according to stem design in tapered (TAP; wedge and rectangular), anatomic (ANAT), and conical (CON), and divided on the basis of modularity (modular, M; nonmodular, NM). In total, 2039 TAP stems (548 M and 1491 NM), 1435 ANAT (1072 M and 363 NM), and 2287 CON (1020 M and 1267 NM) implants were included. Survival rates and reasons for revisions were compared.

RESULTS

The groups were homogeneous for demographics, but not fully comparable in terms of implant features. NM-CON stems showed the highest risk of failure (significant) and a high risk for cup aseptic loosening (2.5%). The adjusted risk ratio showed that NM-CON was more prone to failure (HR versus NM-ANAT: 3.30; 95%CI 1.64-7.87; p = 0.0003). Revision rates for dislocations and stem aseptic loosening did not differ between cohorts.

CONCLUSIONS

NM-CON stems showed the highest risk of failure, especially high rates of cup aseptic loosening. NM-CON implants were not more prone to dislocations and stem aseptic loosening. Clinical comparative studies are required to investigate the causes of NM-CON failures, which may be due to abnormal acetabular morphology or imperfect restoration of the proximal biomechanics.

Revisions for Periprosthetic Hip Infections Do Not Fail More Than Revisions for Aseptic Loosening, but Mortality is Higher

BACKGROUND

The influence of the reasons for revision on the outcomes of revision hip arthroplasties is controversial and poorly described. A registry study was designed to compare the revision hips performed for periprosthetic hip infection (PHI) to the revision hips performed for aseptic loosening. The aims of this study were the long-term assessment and comparison of survival rates, reasons for rerevisions, and mortality rates between these two cohorts.

METHODS

By using an arthroplasty registry, revision hips were stratified according to the reasons for revision (aseptic loosening and PHI). Preoperative and intraoperative, demographic and implant-related features were recorded. Survival rates, reasons for revision and mortality rates were assessed and compared.

RESULTS

The two cohorts were homogenous for preoperative and intraoperative parameters, apart from age at revision, time elapsed between THA and revision, bearing surfaces, and head size. At 10 years, the survival rates were similar between the two groups (P = .51). Half of the rerevisions occurred in the first two years in both the groups. The reasons for rerevision were similar: when rerevision for infection was adopted as an end point, the two cohorts showed nonsignificant differences. The mortality rate was statistically higher in the PHI cohort (P .0015, hazard ratio adjusted for age and gender: 1.42).

CONCLUSION

Aseptic and septic revisions achieved similar outcomes at long-terms, rerevisions tended to fail for the same reason for revision. The mortality rate was significantly higher in the septic cohort. These findings are useful to modify and tune the preoperative, intraoperative, and postoperative managements of revisions.

A Perspective on Biotribology in Arthroplasty: From In Vitro toward the Accurate In Silico Wear Prediction

Nowadays hip arthroplasty is recognized as one of the most successful orthopedic surgical procedures, even if it involves challenges to overcome, such that lately, younger and more active patients are in need of total arthroplasty. Wear is still one of the main issues affecting joint prostheses endurance, and often causes loosening accompanied by implant failures. Actual in vitro wear tests executed by mechanical simulators have a long duration, are very expensive, and do not take into account all the possible daily activities of the patients; thus, the challenge to obtain a complete in silico tribological and dynamical model of (bio) tribo-systems could give the possibility to overcome the actual testing procedures and could contribute as a tool for a more accurate tribological design of human prostheses. This prospective paper is intended to underline actual research trends toward the challenge of having accurate numerical algorithms to be used both in preclinical testing and in the optimizations of the prostheses design. With this aim we depicted the possible in silico approach in artificial joints’ wear assessment over time, accounting for contact mechanics, numerical stress–strain analysis, musculoskeletal multibody, and synovial lubrication modelling (boundary/mixed, hydrodynamic, and elastohydrodynamic).