Efficacy of Revision Surgery for the Dislocating Total Hip Arthroplasty: Report From a Large Community Registry

Abstract

Background Historically, achieving stability for the unstable total hip arthroplasty (THA) with revision surgery has been achieved inconsistently. Most of what we know about this topic comes from reports of high-volume surgeons' results; the degree to which these results are achieved in the community is largely unknown, but insofar as most joint replacements are done by community surgeons, the issue is important.Questions/purposes We used a community joint registry to determine: (1) the frequency of repeat revision after surgery to treat the unstable THA; (2) what surgical approaches to this problem are in common use in the community now; (3) are there differences in repeat revision frequency that vary by approach used; and (4) has the frequency of repeat revision decreased over time as surgical technique and implant options have evolved? Methods We reviewed 6801 primary THAs performed in our community joint registry over the last 20 years. One hundred eighteen patients (1.7%) with a mean age of 67 years were revised within the registry for instability/ dislocation. Failure was defined as a return to the operating room for rerevision surgery for instability. Minimum followup was 2 years (average, 9.4 years; range, 2-20 years) with six patients having incomplete followup. The frequency of rerevisions was calculated and compared using Pearson's chi-square test. Cumulative rerevision rates were calculated using the Kaplan-Meier method and types of revision procedures were compared using the log-rank test. Results The initial revision procedure was successful in 108 patients (92%); 10 patients underwent repeat surgery for recurrent dislocation after their initial revision surgery. The most frequently performed procedure was revision of the head and liner only (35 of 118 [30%]); constrained devices were used in 19% (22 of 118) of the procedures. There was no difference in the cumulative rerevision rates for instability or dislocation by type of revision procedure performed. Six of 22 constrained liners were rerevised for varying indications. There was no difference in frequency of repeat revision for instability between those patients revised for THAs performed before 2003 and those managed more recently. Conclusions Revision surgery for unstable THA is successfully managed in the community with a variety of

Revision Total Hip Arthoplasty: Factors Associated with Re-Revision Surgery

“…Instability was the leading cause for initial revision total hip arthroplasty for aseptic reasons and continued to be the leading cause for re-revision total hip arthroplasty, similar to a recent report on revision total hip arthroplasty 27 .…”

“…Although instability may have been prevented in the very short term, there is a possibility that these constrained liners do not reduce re-revision risk in a longer follow-up. A recent study from a large U.S. community registry revealed the same increased risk in re-revision with the use of constrained liners 27 .…”

Biological and osseointegration capabilities of hierarchically (meso-/micro-/nano-scale) roughened zirconia

“…Clinical outcomes for titanium implants are acceptable, but a significant number of cases still require revision surgery after implant failure. [1][2][3][4][5][6][7][8][9][10][11] Implant therapy-related complications such as disability and long-lasting dependence caused by implant loosening remain significant, [11][12][13] and unfavorable anatomical and physiological states of the host bone can preclude implant therapy. [14][15][16][17][18][19][20][21][22] Further, the protracted healing time required by implants to anchor into bone limits the application of implant therapy and reduces therapeutic benefit, particularly for dental implants.…”

Soft tissue reinforcement with a Leeds-Keio artificial ligament in revision surgery for dislocated total hip arthroplasty

“…However recurrent dislocation after revision THA reportedly occurs in 18%-35% of cases, demonstrating that revision surgery does not always resolve the issue (3)(4)(5). There are several surgical options in revision surgery, such as hooded liner (6,7), constrained liner (5,8,9), large femoral head (3,10), and dual mobility cup (11)(12)(13). Use of constrained liner has the drawback of frequent postoperative breakage (5,8,9,14), large femoral head (15,16) and dual mobility cup (17,18) have no hospitals were referred to our hospital for the purpose of revision THAs.…”

“…There are several surgical options in revision surgery, such as hooded liner (6,7), constrained liner (5,8,9), large femoral head (3,10), and dual mobility cup (11)(12)(13). Use of constrained liner has the drawback of frequent postoperative breakage (5,8,9,14), large femoral head (15,16) and dual mobility cup (17,18) have no hospitals were referred to our hospital for the purpose of revision THAs. During revision surgery for these 53 (23 + 30) hips of 53 patients, we performed intrasurgical evaluation of stability; (i) gross findings of positive joint capsule and/ or soft tissue defect, and (ii) resistance to dislocation at 90° flexion and <60° internal rotation.…”