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Scientific Articles   |    
Comparative Long-Term Survivorship of Uncemented Acetabular Components in Revision Total Hip Arthroplasty
Hilal Maradit Kremers, MD, MSc1; James L. Howard, MD, MSc2; Youlonda Loechler1; Cathy D. Schleck, BS1; William S. Harmsen, MS1; Daniel J. Berry, MD1; Miguel E. Cabanela, MD1; Arlen D. Hanssen, MD1; Mark W. Pagnano, MD1; Robert T. Trousdale, MD1; David G. Lewallen, MD1
1 Departments of Health Sciences Research (H.M.K, C.D.S., and W.S.H) and Orthopedic Surgery (Y.L., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), College of Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for H.M. Kremers: maradit@mayo.edu
2 Division of Orthopedic Surgery, London Health Sciences Centre-University Campus, 339 Windermere Road, London, ON N6A 5A5, Canada
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

  • Disclosure statement for author(s): PDF

Departments of Health Sciences Research (H.M.K, C.D.S., and W.S.H) and Orthopedic Surgery (Y.L., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), College of Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for H.M. Kremers: maradit@mayo.edu
Division of Orthopedic Surgery, London Health Sciences Centre-University Campus, 339 Windermere Road, London, ON N6A 5A5, Canada
Investigation performed at the Mayo Clinic, Rochester, Minnesota

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jun 20;94(12):e82 1-8. doi: 10.2106/JBJS.K.00549
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Abstract

Background: 

It is unknown whether the long-term survival of uncemented acetabular components in revision total hip arthroplasty varies according to component type. The purpose of this study was to compare the survivorship of historical and current uncemented acetabular components following revision total hip arthroplasty.

Methods: 

The study population included 3236 patients who underwent 3448 revision total hip arthroplasty procedures with an uncemented acetabular component at a large United States medical center between January 1, 1984, and December 31, 2004. Patients were actively followed up at regular intervals to ascertain details of subsequent revision surgical procedures, including cup (metal shell plus liner) and liner revisions. The overall survival and the cause-specific survival of ten different acetabular components were compared with use of Cox proportional-hazards regression models, adjusting for age and sex.

Results: 

A total of 605 repeat revisions, including 386 cup revisions, were performed. The corresponding overall survival rate at fifteen years was 69% (95% confidence interval [CI], 67% to 72%). Compared with titanium wire mesh designs, cup revision for aseptic loosening was significantly more common with beaded designs (hazard ratio [HR], 2.01; 95% CI, 1.44 to 2.80) but less common with trabecular metal designs (HR, 0.25; 95% CI, 0.06 to 1.04). There were no liner revisions for wear and/or osteolysis during a median of 5.2 years of follow-up of 534 total hip arthroplasties with cross-linked polyethylene liners, resulting in a significantly lower risk of wear-related revision with cross-linked polyethylene compared with conventional liners. Femoral head size and use of an elevated liner were not associated with the risk of repeat revision.

Conclusions: 

In the setting of revision total hip arthroplasty, cup survival was worse with beaded acetabular designs compared with titanium wire mesh or highly porous designs. Cross-linked polyethylene liners were associated with a reduced risk of wear-related liner revision.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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