Paul F Lachiewicz1, Elizabeth S Soileau. 1. Chapel Hill Orthopedic Surgery and Sports Medicine, 101 Conner Drive, Suite 200, Chapel Hill, NC 27514, USA.
Abstract
BACKGROUND: Acetabular revision of a total hip arthroplasty using jumbo components (Mayo definition, ≥62 mm in women and ≥66 mm in men) offers distinct advantages in patients with notable acetabular bone loss. However, there are little data on the long-term survival and complications associated with use of these components. METHODS: This retrospective study of prospectively collected data included 120 patients who underwent 129 revision total hip arthroplasties with jumbo cups. Data on infection, aseptic loosening, reoperation, and dislocation were analyzed. One hundred and one patients (108 hips) with a mean follow-up of 8.1 years (range, two to twenty years) were evaluated with use of the Harris hip score and radiographic evidence of loosening, radiolucent lines, and osteolysis. Kaplan-Meier survivorship was calculated at ten and fifteen years with use of three different end points. Demographic and operative factors associated with implant survival and dislocation were analyzed with use of chi-square and Wilcoxon tests. RESULTS: Four (3.1%) of the jumbo components were removed for infection and four hips (3.1%) had aseptic implant loosening. Reoperation for any reason was performed in twenty hips. With failure defined as cup revision for aseptic loosening or radiographic evidence of loosening, implant survival was 97.3% (95% confidence interval [CI], 89.6% to 99.3%) at ten years and 82.8% (95% CI, 59% to 97.6%) at fifteen years. With failure defined as cup removal for any reason, implant survival was 93.8% (95% CI, 83.4% to 97.2%) at ten years and 79.8% (95% CI, 61.1% to 95.4%) at fifteen years. There was no significant association between Paprosky type, component coating, or patient characteristics and failure. Dislocation occurred in twelve (9.3%) of the hips (10% of the patients) and three underwent reoperation. A femoral head size of ≥32 mm was associated with a significantly lower risk of dislocation compared with smaller sizes. CONCLUSIONS: Jumbo acetabular components with screw fixation were associated with low rates of infection and loosening after revision total hip arthroplasty and had high survival at fifteen years. Reoperation for wear and loosening increased in the second decade. Dislocation was the most common complication and was significantly associated with smaller femoral head sizes.
BACKGROUND: Acetabular revision of a total hip arthroplasty using jumbo components (Mayo definition, ≥62 mm in women and ≥66 mm in men) offers distinct advantages in patients with notable acetabular bone loss. However, there are little data on the long-term survival and complications associated with use of these components. METHODS: This retrospective study of prospectively collected data included 120 patients who underwent 129 revision total hip arthroplasties with jumbo cups. Data on infection, aseptic loosening, reoperation, and dislocation were analyzed. One hundred and one patients (108 hips) with a mean follow-up of 8.1 years (range, two to twenty years) were evaluated with use of the Harris hip score and radiographic evidence of loosening, radiolucent lines, and osteolysis. Kaplan-Meier survivorship was calculated at ten and fifteen years with use of three different end points. Demographic and operative factors associated with implant survival and dislocation were analyzed with use of chi-square and Wilcoxon tests. RESULTS: Four (3.1%) of the jumbo components were removed for infection and four hips (3.1%) had aseptic implant loosening. Reoperation for any reason was performed in twenty hips. With failure defined as cup revision for aseptic loosening or radiographic evidence of loosening, implant survival was 97.3% (95% confidence interval [CI], 89.6% to 99.3%) at ten years and 82.8% (95% CI, 59% to 97.6%) at fifteen years. With failure defined as cup removal for any reason, implant survival was 93.8% (95% CI, 83.4% to 97.2%) at ten years and 79.8% (95% CI, 61.1% to 95.4%) at fifteen years. There was no significant association between Paprosky type, component coating, or patient characteristics and failure. Dislocation occurred in twelve (9.3%) of the hips (10% of the patients) and three underwent reoperation. A femoral head size of ≥32 mm was associated with a significantly lower risk of dislocation compared with smaller sizes. CONCLUSIONS: Jumbo acetabular components with screw fixation were associated with low rates of infection and loosening after revision total hip arthroplasty and had high survival at fifteen years. Reoperation for wear and loosening increased in the second decade. Dislocation was the most common complication and was significantly associated with smaller femoral head sizes.
Authors: Matthew G Teeter; Douglas D R Naudie; James L Howard; Richard W McCalden; Steven J MacDonald Journal: Can J Surg Date: 2015-02 Impact factor: 2.089