RESEARCH ARTICLE


Multiple Acetabular Revisions in THA - Poor Outcome Despite Maximum Effort



O Bischel*, 1, JB Seeger1, M Krüge2, BG Bitsch2
1 Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen-Marburg, UKGM, Klinikstrasse 33, D-35392 Giessen, Germany
2 Department of Orthopaedics and Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany


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Creative Commons License
© Bischel et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen-Marburg, Klinikstrasse 33, D-35392 Giessen, Germany; Tel: +49-641-985-42616; Fax: +49- 641-985-42629; E-mail: Oliver.Bischel@ortho.med.uni-giessen.de


Abstract

A consecutive series of 52 acetabular revisions was evaluated retrospectively. Inclusion criteria for all patients were at least one former exchange of the acetabular component. Reconstruction was performed with reliable techniques and implants other than extensively porous coated device (e.g. tantalum). The mean follow up was 5.63 (0.01-14.05) years. Cumulative survival at 14.05 years with removal of the acetabular component due to aseptic loosening or the worst case criterion (removal of the acetabular component for any cause and/or lost to follow-up) as the end point was 66.38 (95 % C.-I.: 47.80-84.96) % and 58.42 (95 % C.-I.: 41.01-75.83) %, respectively. The cumulative survival rate with mechanical failure of the acetabular reconstruction as the endpoint was significantly lower in patients with two or more previous revisions in comparison to those with only one former procedure (log rank test: p=0,0112 respectively). The mean Merle d’Aubignée-score improved from 7.3 (0-14) preoperatively to 10.6 (0-17) points at latest follow up examination.

Survival of acetabular reconstructions with common techniques and implants is decreasing with the number of previous revisions. This may cause major concerns with regard to the rising number of patients needing repeated revisions. Maximizing durability of primary THA, precise preoperative planning as well as improved techniques and implants for revision may decrease this problem in the long term.

Keywords: Hip arthroplasty, revision, tantalum, porous metal device, acetabular reconstruction.