Cementless acetabular revision for aseptic failure of cemented hip arthroplasty

Point-of-Care Coating of Revision Femoral Stems With Antibiotic-Loaded Calcium Sulfate: Reduction in Infection After 2nd Stage Reimplantation but Not With Aseptic Revisions

Background

Infection rates in revision total hip arthroplasty are lower when antibiotic loaded cemented stems are utilized. Inspired by this technique, a point-of-care coating of antibiotic-loaded calcium sulfate (CaSO4) was applied to cementless revision stems in aseptic revision and 2nd stage reimplantation total hip arthroplasty.

Methods

One hundred eleven consecutive femoral stems were coated. Just prior to insertion, 10 cc of CaSO4 was mixed with 1 g vancomycin and 240 mg tobramycin with the paste applied to the stem. The results were compared to a matched cohort (N = 104) performed across the previous 5 years. The surgical methods were comparable, but for the stem coating. The study group was followed for a minimum of 3 years.

Results

In the study cohort of 111 patients, there were 69 aseptic revisions with one periprosthetic joint infection (PJI) (1.4%) and 42 second-stage reimplantations with 2 PJIs (4.8%). In the control cohort of 104 patients, there were 74 aseptic revisions with one PJI (1.4%) and 30 second-stage reimplantations with 7 PJIs (23.3%). There was no significant reduction in PJI rate in the aseptic revision subgroup (1.4% study vs 1.4% control group), P = 1.000. Antibiotic stem coating reduced PJI rate in the 2nd stage reimplantation subgroup (23.3% control vs 4.8% study group), P = .028. In both groups, there were no cases of aseptic stem loosening.

Conclusions

Point-of-care antibiotic coating of cementless revision femoral stems reduces PJI infection rate in 2nd stage reimplantations only. We theorize that microbes persist in the endosteal cortices after resection and may contribute to infection recurrence.

Hemispheric hydroxyapatite-coated cups with impacted graft for severe bone defects in acetabular reconstruction: ten year follow-up

Cementless acetabular reconstruction with bone grafting has been limited to moderate bone defects. We report the outcomes of 57 acetabular revisions in 45 patients with severe bone defects (Paprosky type IIIA) using hemispheric hydroxyapatite (HA)-coated cups and impacted graft. After a mean follow-up of 10 years, all but 2 cups (3.5%) remained radiologically stable. There was clear radiological consolidation and medial wall remodelling of the graft in 62% of the cases. In 2 cases (3.5%), nonprogressive lucencies were found; in 3 cases (5.3%) a medial gap of 2 mm, detected postoperatively, was progressively filled by newly formed bone during follow-up. Mean MDA score rose from 7.3 points preoperatively to 16.8 points in the last evaluation, with an excellent pain relief report. These results suggest that the combined use of HA-coated hemispheric cups with impacted graft to treat Paprosky IIIA defects provides a long-lasting stable implant, restores bone stock, and yields excellent clinical results.

The use of ceramic-on-ceramic bearings in isolated revision of the acetabular component

The practice of removing a well-fixed cementless femoral component is associated with high morbidity. Ceramic bearing couples are low wearing and their use minimises the risk of subsequent further revision due to the production of wear debris. A total of 165 revision hip replacements were performed, in which a polyethylene-lined acetabular component was revised to a new acetabular component with a ceramic liner, while retaining the well-fixed femoral component. A titanium sleeve was placed over the used femoral trunnion, to which a ceramic head was added. There were 100 alumina and 65 Delta bearing couples inserted. The mean Harris hip score improved significantly from 71.3 (9.0 to 100.0) pre-operatively to 91.0 (41.0 to 100.0) at a mean follow up of 4.8 years (2.1 to 12.5) (p < 0.001). No patients reported squeaking of the hip. There were two fractures of the ceramic head, both in alumina bearings. No liners were seen to fracture. No fractures were observed in components made of Delta ceramic. At 8.3 years post-operatively the survival with any cause of failure as the endpoint was 96.6% (95% confidence interval (CI) 85.7 to 99.3) for the acetabular component and 94.0% (95% CI 82.1 to 98.4) for the femoral component. The technique of revising the acetabular component in the presence of a well-fixed femoral component with a ceramic head placed on a titanium sleeve over the used trunnion is a useful adjunct in revision hip practice. The use of Delta ceramic is recommended.

Implant choices, technique, and results in revision acetabular surgery: a review

Acetabular reconstruction in revision total hip arthroplasty can successfully be achieved with hemispherical components featuring a porous or roughened ingrowth surface and options for placement of multiple screws. Most defects can be reconstructed with large hemispherical or "jumbo" cups. Achieving component stability and sufficient contact area on adequate host bone is mandatory. Defects with greater bony loss or compromised columns require either the use of modular augments combined with a hemispherical shell, reconstruction cages, structural allografts, or custom triflange acetabular components. This paper will detail the necessary pre-operative evaluation, the intra-operative details, and the reported results of these acetabular revisions.

Total hip revision using a cup design with a peg to treat severe pelvic bone defects

When dealing with severe bone loss during acetabular revision of a total hip arthroplasty, it can be difficult to find a reliable anatomical structure to ensure high-quality primary fixation of the cup. Since 2003, we have been using an implant with a long peg that is anchored into the iliac isthmus. This structure is usually intact, even in the most severe situations of bone loss. The use of this specially designed component provides satisfactory mechanical reconstruction in cases that can be quite challenging (Paprosky and SOFCOT stage 3). The length and postoperative care for the procedure remain the same and early weight bearing is possible. The specific principles applying to this procedure, along with the anatomical features of the iliac isthmus, the implantation technique and our initial results are described in detail.

Revision of failed total hip arthroplasty acetabular cups to porous tantalum components: a 5-year follow-up study

We reviewed 263 consecutive patients with failed acetabular components after total hip arthroplasty that were revised using porous tantalum acetabular components and augments when necessary. The mean follow-up was 73.6 months (range, 60-84 months). The improvement of mean Harris hip score, Western Ontario and McMaster Osteoarthritis Index, and University of California Los Angeles activity scales were statistically significant (P < .001). Subjective assessments showed that 87.3% of patients reported "improvement" and 85.9% were "very or fairly pleased" with the results. At the most recent follow-up, all acetabular components were radiographically stable and none required rerevision for loosening. The acetabular revision was considered successful in 87% of cases. From this study, we conclude that the acetabular component used was reliable in creating a durable composite without failure for a minimum of 5 years.

Acetabular cup revision with the use of the medial protrusio technique at an average follow-up of 6.6 years

A significant rim defect encountered during revision surgery can make stable cementless cup fixation difficult. One approach to this problem is to medialize the acetabular cup to improve the degree of rim contact. In this study, we investigate this technique, termed the medial protrusio technique, for acetabular fixation in revision hip arthroplasty. A retrospective review of 25 patients (25 hips) who underwent medialization was performed. Clinical and radiographic evaluation was performed. At an average follow-up of 6.6 years, the overall patient function and satisfaction were good to excellent, with a mean Harris hip score of 85.2. This demonstrates that the medial protrusio technique can be a valuable option in addressing acetabular cup failure.

Revision of the acetabulum with a contemporary cementless component

We evaluated the performance of a contemporary cementless acetabular component at a minimum of 5 years postoperatively. One hundred eighty-seven consecutive acetabular component revisions were performed using a hemispherical porous-coated component. Patients were followed prospectively with radiographs and Harris hip scores. Twenty patients died, leaving 158 patients (166 hips) available for follow-up at a mean of 91 months. No patients were lost. Eleven acetabular components (7%) required repeated revision, including 4 (2%) for aseptic loosening. Seven of the 145 unrevised acetabular components with radiographic follow-up (5%) were loose. The results of acetabular revision with this contemporary acetabular component were good but inferior to those of earlier-generation implants. This difference is likely multifactorial.

Acetabular revision with bone graft and cementless cup

Cementless acetabular components are routinely used in revision hip surgery. Nevertheless, few investigators have assessed their retention and efficacy over the long term. This occurs mainly in cases which originate from moderate to severe bone losses (cavitary and or segmental) requiring the use of morselized and or bulk bone graft. Our objective in the present study is to report the outcome of 42 patients with 43 cementless acetabular revisions with bone graft who were operated by the same surgeon. The report is based on the clinical and radiographic evaluation of the patients alive at 167 months of follow-up.

Porous tantalum uncemented acetabular shells in revision total hip replacement: two to four year clinical and radiographic results

In cementless revision total hip arthroplasty (THA), achieving initial implant stability and maximising host bone contact is key to the success of reconstruction. Porous tantalum acetabular shells may represent an improvement from conventional porous coated uncemented cups in revision acetabular reconstruction associated with severe acetabular bone defects. We reviewed the results of 46 acetabular revisions with Paprosky 2 and 3 acetabular bone defects done with a hemispheric, tantalum acetabular shell and multiple supplementary screws. At a mean follow-up of 40 (24-51) months, one acetabular shell had been revised in a patient with a Paprosky 3B defect. Cementless acetabular revision with the tantalum acetabular shell demonstrated excellent early clinical and radiographic results and warrants further evaluation in revision acetabular reconstruction associated with severe acetabular bone defects.

Revision of the acetabular component without cement. A concise follow-up, at twenty to twenty-four years, of a previous report

We previously reported the results of the use of a cementless acetabular shell for revision total hip arthroplasty in 138 hips at a minimum of three, seven, and fifteen years postoperatively. The current report presents the long-term outcomes of this group at a minimum follow-up of twenty years. Since the last report, two additional hips required repeat revision, both for infection; no additional acetabular shell was loose. In the entire series to date, repeat acetabular revision was performed in twenty-one (15%) of the original 138 hips. Twenty of the twenty-one shells were well fixed at the time of repeat revision, and one had become aseptically loose. The most common reasons for repeat revision were infection (eight hips) and recurrent instability (eight hips). In the metal shells that were well fixed, an isolated liner change for polyethylene wear and/or osteolysis was performed in a total of six hips; four of these liner exchanges were performed since the time of our last report. A liner change had been recommended because of severe wear in four additional hips; thus, 18% of the fifty-six unrevised metal shells were associated with polyethylene wear-related problems. Survivorship, with revision of the shell for aseptic loosening or radiographic evidence of loosening as the end point, was 95% at twenty years (95% confidence interval, 83% to 98%). Reoperations for wear and osteolysis were first seen at approximately twelve years postoperatively. At the time of the present long-term follow-up, the reoperation rate for polyethylene wear and/or osteolysis had increased. We continue to use a hemispherical, titanium metal shell with multiple screws for fixation in the majority of acetabular revisions.

Cementless hemispheric acetabular component for acetabular revision arthroplasty: a 5- to 19-year follow-up study

This study evaluated the 5- to 19-year clinical and radiographic results of cementless acetabular revision. Between 1986 and 1998, 130 hips (125 patients) underwent cementless acetabular revisions. Ten patients were lost to follow-up; 6 patients died. One hundred nine patients (114 hips) were reviewed at a mean follow-up of 8.8 years. The mean Harris hip score improved from 62.1 to 90.7 at final follow-up. Two hips underwent repeat revision. Twenty-two hips developed cavitary osteolysis. Kaplan-Meier survivorship at 121 months was 98.2% with repeat revision for any reason as the end point and 89.5% with repeat revision or radiographic loosening as the end point. Cementless acetabular revision provides favorable clinical and radiographic results, and the initial disease and age may adversely affect the outcomes.

[Acetabular revision for aseptic loosening in total hip arthroplasty using cementless cup and impacted morselized allograft]

PURPOSE OF THE STUDY

Impaction grafting can be used in cementless fixation with morsellized bone, bone graft, and hemispherical cup. The first goal of impaction grafting in revision of total hip arthroplasty is to transform segmental defects into cavitary defects and obtain a full compaction of the graft in order to restore the bone stock. The second goal is to achieve primary stability of the cup. The third goal is to restore the hip center of rotation with a cup anatomically located in the acetabulum. The aim of our study was to evaluate the results of a surgical technique with impacted morsellized bone graft and a cementless press-fit cup for the revision with defect type III according to the AAOS classification.

MATERIAL AND METHODS

We performed a retrospective study including 34 hip reconstructions during revision of acetabular aseptic loosening with type III AAOS acetabular defects. All the revisions were performed in the same center by two senior surgeons. Mean age at surgery was 58 years. There were 23 women and 11 men. All reconstructions were performed with a cementless cup and a morsellized impacted bone graft. The analysis of the acetabular defects was done preoperatively according to the AAOS classification. We analyzed postoperatively and at follow-up: position and stability of the acetabular cup, restoration of the hip center and graft integration.

RESULTS

Mean follow-up was 6.6 years (range 3-13 years). Complications included three dislocations, two trochaanteric nonunions. Two acetabular components were revised for septic loosening. According to the Kaplan-Meier survival curves, with endpoint criteria defined as acetabular cup removal, survival was 91.3% at 10 years (95CI: 86.3-96.3). The preoperative Harris hip score was 53 points (range 26-86) and at last follow-up 94 (47-100). Concerning the subjective clinical outcome, 96% of patients were satisfied or very satisfied at last follow-up. 100% of cups were considered stable at follow-up and bone integration was good in 100%. The center of rotation was located in anatomic position mediolaterally in 66% and in the craniopodal plane in 44%.

DISCUSSION

Restoration of bone stock is one of the main goals during hip reconstruction after aseptic loosening. Clinical experience in our series has shown the reliability of the impacted morsellized bone graft allowing relocation of the center of rotation and good cup stability. Biological fixation of the cup and graft integration seems good at mid-term follow-up. The cup that we used in our series combined the advantages of a press-fit cup and those of a reinforcement ring. The combination of this type of cup with morsellized bone graft seems to be a reliable solution for restoring bone stock, relocating the hip center, and stabilizing the cup in revision total hip arthroplasty with type III acetabular defect according to the AAOS classification.

Acetabular revisions using a cementless oblong cup: five to ten year results

The purpose of this paper was to evaluate the results of acetabular revisions with the use of an oblong revision cup that is designed with its longitudinal diameter elongated relative to its transverse diameter. Between 1996 and 2001, 62 hips in 60 patients underwent an acetabular revision with the insertion of a LOR acetabular component. Seven hips were lost to follow-up or the patients died; the remaining 55 hips (53 patients) remained in follow-up for an average of 7.2 years (range: 5.0-10.1 years). One socket was revised for aseptic loosening, and another was operated on for a late polyethylene liner dissociation. The average Harris hip score (HHS) improved from 34 to 79. Results were rated as excellent in 16 hips, good in 28, fair in six and poor in three. Radiographic analysis demonstrated an improvement in the average vertical displacement of the hip centre: 49 hips had a well-fixed, bone-ingrown cup and four had a stable fibrous union. For large superolateral acetabular bone deficiencies, this implant facilitated a complex reconstruction without the need for bulk structural acetabular bone grafts, provided good clinical results and showed satisfactory stability at the midterm follow-up.

Long-term results of 58 hip cup revision arthroplasties using a threaded ring implant

INTRODUCTION

There is still a discussion whether cementless hip cup revisions should be performed with a press fit cup or a threaded ring implant.

MATERIALS AND METHODS

The results of 58 hip cup changes using the spherical, threaded ring "Munich" are presented. In 16 cases, the ring "Munich I" with a smooth surface and in 42 cases the ring "Munich II" with a corundum-blasted surface were implanted. Mean follow-up was 7.5 years; radiological signs of loosening and the Harris Hip Score were examined.

RESULTS

The re-revision rate for aseptic loosening of the ring was 12/58 overall (Munich I: 5/16, Munich II: 7/42). The average Harris Hip Score was 76.2 overall (Munich I: 74.4, Munich II: 76.8). Higher survival rates were achieved with the "Munich II" ring due to improved construction details.

CONCLUSION

These rates are still below those reported for press-fit cups, the technique described by Slooff or reinforcement rings.

Five-year follow-up of socket movements and loosening after revision with impacted morselized allograft bone and cement: a radiostereometric and radiographic analysis

In 1999, we reported on the 2-year results of a series of 21 first-time socket revisions using impacted morselized allograft bone. Seven still migrated between 1.5 and 2 years. Seventeen remained for the current 5-year follow-up. No socket had been rerevised. Five sockets showed signs of radiographic loosening. These 5 cases also exhibited radiographic signs of allograft resorption as well as high rates of socket migration and rotation as measured by radiostereometric analysis. Of the 6 remaining sockets that had migrated between 1.5 and 2 years, 3 stabilized and 3 were among those with signs of radiographic loosening. Fifteen patients (15 hips) revealed pain reduction at the 5-year follow-up. Three had slight pain on walking that disappeared immediately at rest (pain score 4). All the others revealed either no pain (pain score 6) or slight pain that disappeared with activity (pain score 5). No pattern of early socket migration according to radiostereometric analysis could be identified, predicting later socket migration or loosening. The rate of cases with signs of radiographic loosening (29%, 5/17) was comparable to that reported by the Nijmegen group but the follow-up was shorter in the current study. The rate of cases with signs of radiographic loosening was comparable to both conventionally cemented socket revisions and cementless revisions. The future will show if further sockets loosen and if the loose sockets up to date will end up in rerevisions.

Management of types III and IV acetabular deficiencies with the longitudinal oblong revision cup

Thirty-five longitudinal oblong revision (LOR) cups were used to reconstruct 29 type III and 6 type IV acetabular defects. Intraoperatively, we considered that cup contact was complete when we achieved a continuous contact between the cup periphery and the acetabular rim. When there were areas with a lack of contact, we considered that the contact was partial or incomplete. All patients were followed up for 4 to 8 years (mean = 6.3 years). At the latest follow-up, 30 cups were stable (85.8%) and 5 had migrated (14.2%). We found a significant relation between incomplete cup contact with the acetabular rim and subsequent failure (P = .042). The abduction angle was significantly increased in the group of unstable cups (P = .032) because of the migration of the acetabular component that became more vertical. Pain, limp, use of walking aids, functional level, and limb-length discrepancy significantly improved postoperatively (P < .0001). The Harris hip score improved from a mean preoperative score of 37 points to that of 79 points (P < .01). This implant showed satisfactory stability at early to midterm follow-up.

Acetabular reconstruction in revision hip surgery using femoral head block allograft

This prospective study analyzed the clinical and radiological results of 140 consecutive cases of acetabular revision using large frozen femoral head allografts and cemented all-polyethylene acetabular components. Mean follow-up was 10 years (range: 5-16 years). Thirty patients died, seven were lost to follow-up, and 26 had failed and undergone further surgery. Nineteen failures were due to aseptic failure and collapse of the graft. Kaplan-Meier survival analysis calculated a mean survival at 10 years of 88.5% for revision for any reason. We compared all reported techniques of acetabular reconstruction for similar defects and recommend a surgical strategy based on the available evidence, but weighted towards a preference to reconstitute bone stock rather than removing further bone in the revision situation.

A stemmed acetabular component in the management of severe acetabular deficiency

We evaluated the use of a stemmed acetabular component in the treatment of severe acetabular deficiency during revision and complex primary total hip arthroplasty.

There were 31 hips of which 24 were revisions (20 for aseptic loosening, four for infection) and the remainder were complex primary arthroplasties. At a mean follow-up of 10.7 years (6 to 12.8), no component had been revised for aseptic loosening; one patient had undergone a revision of the polyethylene liner for wear. There was one failure because of infection. At the latest follow-up, the cumulative survival rate for aseptic loosening, with revision being the end-point, was 100%; for radiographic loosening it was 92% and for infection and radiographic loosening it was 88%. These results justify the continued use of this stemmed component for the reconstruction of severe acetabular deficiency.

Outcome of acetabular revision using an uncemented hydroxyapatite-coated component: two- to five-year results and review

This is a retrospective review of 50 uncemented acetabular revisions with porous, hydroxyapatite-coated cups. The acetabulum alone was revised in 22 hips and both components were revised in 28 hips. The majority of hips (26) had type 2A (Paprosky) acetabular bone loss. All the revisions were carried out through a posterior approach. The mean duration of follow-up was 32 months (range, 24-52 months). Clinically, there was significant improvement in pain and moderate improvement in movement and mobility, and there is no radiological sign of failure of any cup so far. Re-revision was performed in 3 hips (6%) for recurrent dislocation. Our early results favor the use of this type of cup in acetabular revisions with moderate bone loss, but longer-term follow-up will be required. Key words: acetabulum, hydroxyapatite, revision, bone deficiency, complications.

Effect of the initial implant fitting on the predicted secondary stability of a cementless stem

A numerical model able to investigate the influence of biomechanical factors on the long-term secondary stability of implants would be extremely useful for the design of new cementless prosthetic devices. A purely biomechanical model of osseo-integration has been developed, formulated as a rule-based adaptation scheme. Due to its complexity, the problem was divided into three steps: preliminary implementation of the model (proof of concept); implementation of the complete model and investigation of the model solution; and model validation. The paper describes the first of these three steps. The model was implemented as a discrete-states machine, and the few parameters required were derived from the literature. It was then applied to a real clinical case. The study was conducted using the frictional contact finite element model of a human femur implanted with a cementless anatomical stem. A stable solution was achieved after between three and 15 iterations for all initial positions considered. Similar initial conditions yielded similar final configurations. The model predicted all initial configurations, with the exception of a partial osseo-integration, ranging between 62% (distal fit) and 78% (proximal fit) of the viable interface. This is in good agreement with the values reported in the literature that never exceed 75%, even in the best conditions, and report better clinical results for proximal fit. For the varus configuration, which lacks cortical support, the algorithm predicted a completed loosening.

Cementless acetabular reconstruction in revision total hip arthroplasty

Reconstruction of the failed acetabular component in total hip arthroplasty (THA) can be challenging. Although there are multiple reconstructive options available, a cementless acetabular component inserted with screws has been shown to have good intermediate-term results and is the reconstructive method of choice for the majority of acetabular revisions. We reviewed the results of 138 consecutive acetabular revisions done with a hemispheric, cementless acetabular component that is sintered with Ti fiber metal mesh and was inserted with line-to-line reaming and multiple screws for fixation. At a mean of 15 years, 19 acetabular components had been revised (13.8%); seven were revised for recurrent instability, six were revised for deep periprosthetic infection, five well-fixed cups were removed at the time of femoral revision, and one cup was fixed by fibrous tissue only at the time of femoral revision and was removed. One acetabular component was radiographically loose. Survivorship of the component was 81% at 15 years when revision for any reason was considered as an end point and 96% when revision for loosening or radiographic evidence of loosening was considered as a second end point. Cementless acetabular revision provides durable results at 15 years with a low rate of failure for loosening.

Acetabular revision without cement

We reviewed the clinical and radiologic results of 47 cementless acetabular revisions performed by a single surgeon. The mean follow-up period was 58 months. The American Academy of Orthopaedic Surgeons (AAOS) acetabular defect classification was type I in 4 hips, type II in 9 hips, and type III in 32 hips. All patients received AML (Depuy, Warsaw, IN) Duraloc cup implants. Morcellized allograft was used in 23 hips (49%), and screw augmentation in 22 hips (47%). The Harris Hip score improved from 72 to 90 points. No revisions were performed for aseptic loosening. Nonprogressive thin radiolucent lines were found in a single zone in 10 hips (21%) and in all 3 zones in 5 hips (11%). No migration was found in any cups with radiolucent lines, and the presence of a radiolucent line was considered clinically unimportant. Progressive loosening with migration of the cup was found in 1 hip (2%). Kaplan-Meier survivorship using revision for aseptic loosening or radiologic loosening as end points was 92% at 72 months. No statistically significant difference was found in the survival of the cups fixed with or without screws. These encouraging midterm results confirm the role of cementless acetabular revision.

Cementless acetabular components: the gold standard for socket revision

Hemispherical ingrowth sockets are used for acetabular revision in over 90% of cases. Multiple experiences now show the success of this technique in both consecutive series and specific settings. In addition to understanding the technique required to implant these components successfully, the surgeon must be aware of the settings in which the construct is not likely to work and plan for alternative techniques when needed.

Extra-large press-fit cups without screws for acetabular revision

This retrospective study reports the 4- to 6-year results of clinical and radiologic follow-up of 60 acetabular revisions using extra-large hemispherical press-fit cups without additional screw fixation. Bone grafts were used in 17 cases. One cup loosened and required re-revision after 12 months. Initial migration was noted in 6 cases, but showed no progression after less than 2 years. In 2 hips that were revised for deep infection, the cups were found incorporated. At final follow-up, 57 hips (95%) were found firmly fixed radiologically. The Harris Hip score improved from a mean of 58.7 points preoperatively to 90.6 points. Provided a high friction coefficient is present, extra-large hemispherical cups offer sufficient stability even in severe cases. Most do not require additional screw fixation.

Revision of a cemented acetabular component to a cementless acetabular component. A ten to fourteen-year follow-up study

BACKGROUND

Although cementless acetabular components are routinely used in revision hip surgery, few investigators have evaluated the retention and efficacy of these components in the long term. In the current study, the clinical and radiographic outcomes of a series of arthroplasties performed by one surgeon with a cementless acetabular component were assessed at a minimum of ten years.

METHODS

From 1986 through 1988, sixty-one consecutive revision total hip arthroplasties were performed in fifty-five patients because of aseptic failure of one or both components of a prosthesis in which both components had been cemented. Twenty-eight patients (thirty-two hips) were alive at a mean of 12.9 years (range, 11.5 to 14.3 years) after the operation. In all of the patients, the acetabular component was revised to a porous-coated Harris-Galante component inserted without cement, and the femoral component was revised to an Iowa component affixed with contemporary cementing techniques. The hips were evaluated clinically and radiographically at a minimum of ten years subsequent to the index revision. No hips were lost to follow-up.

RESULTS

None of the acetabular components required revision because of aseptic loosening. Two hips (3%) demonstrated radiographic evidence of aseptic loosening of the acetabular component. The polyethylene liner was exchanged during the follow-up period in eight hips.

CONCLUSION

After a minimum of ten years of follow-up, cementless acetabular fixation in revision hip arthroplasty had produced durable results that were markedly better than those reported for acetabular fixation with cement.

Hybrid revision total hip arthroplasty: a 7-year follow-up study

The hybrid method for fixation of total hip arthroplasty (THA) has shown excellent results during the first decade in primary operations. To investigate its role in revision surgery, data on 48 revision THAs in 45 patients that met the inclusion criteria were gathered prospectively, using HGP cementless acetabular components and precoated cemented femoral components inserted with so-called second generation femoral cementing technique in each case. For the 48 hips during an average follow-up period of 7.4 years, no acetabular components was loose or had pelvic lysis. One acetabular component was revised for recurrent dislocation; 1 of 48 femoral components was revised for aseptic loosening and 1 for periprosthetic fracture. Three additional femoral stems (6%) were loose. In this small series, the hybrid concept for revision of failed nonseptic THAs has shown excellent results.