Isolated Polyethylene Exchange versus Acetabular Revision for Polyethylene Wear

Restrepo, Camilo; Ghanem, Elie; Houssock, Carrie; Austin, Mathew; Parvızı, Javad; Hozack, William J.

doi:10.1007/s11999-008-0533-8

Cited by 33 publications

(27 citation statements)

References 21 publications

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“…The reported failure rate for revisions or dislocations in the literature is between 6% and 30% [5,6,24,28,36]. Four patients in the head and liner exchange group required subsequent surgery, two of whom underwent repeat head and liner exchange and two of whom underwent full acetabular revision.…”

Section: Discussionmentioning

confidence: 99%

The Fate of Grafting Acetabular Defects During Revision Total Hip Arthroplasty

Mall

Nunley

Smith

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Acetabular defects are frequently grafted during revision THA. Previous studies using plain radiographs report high rates of graft incorporation. However, given plain radiographs underestimate osteolysis, it is unclear whether plain radiographs adequately reflect graft fill or incorporation. Questions/purposes We determined if (1) graft fill; or (2) incorporation (measured as graft-bone contact) differed with complete revision and grafting compared to liner exchange and grafting; (3) defect fill and incorporation could be assessed on plain radiographs; and (4) the cost of bone grafting differed with these two procedures. Methods We identified 40 patients who underwent revision THA for aseptic loosening or polyethylene wear and osteolysis, either with retention of a well-fixed cup or complete acetabular revision in which bone graft was used. Lesion size, percent fill, and graft healing was quantified from CT scans. A limited cost analysis was performed using the current hospital costs for implants, bone grafts, and bone graft substitutes. The minimum followup was 1 year (mean, 4.8 years; range, 1-11 years). Results The average defect fill was 30% (range, 0%-81%). The average percent of healing to host bone was 24% (range, 0-66%). Complete revisions had a higher percent defect fill compared to head/liner changes (47% versus 17%) as well as a higher degree of graft healing to host bone compared to head/liner changes (36% versus 14%). High resolution CT demonstrated lower percentages of defect fill and graft healing than previous reports based on plain radiographs. Bone grafting costs exceeded implant costs in the head/liner exchange group; however, the overall cost was higher in the complete revision group. Conclusions Higher degrees of defect fill and healing were seen with complete revisions compared to head/liner exchanges. Compared to CT scans, plain radiograph assessment tended to overestimate defect fill and healing. Level of Evidence Level III, therapeutic study. See the guidelines online for a complete description of level of evidence.

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Section: Discussionmentioning

confidence: 99%

The Fate of Grafting Acetabular Defects During Revision Total Hip Arthroplasty

Mall

Nunley

Smith

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…Nine articles remained after 460 were screened. One additional article was identified during the review of the bibliographies from the nine articles, resulting in a total of 10 articles for this topic [5,6,19,21,25,31,36,39,40,45] (Fig. 1).…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…The most frequently reported procedures for treating hip polyethylene wear with or without osteolysis were cup revision and isolated polyethylene exchange (Table 1) [5,6,19,21,25,31,36,39,40,45]. The mean followup in these articles ranged from 2.5 to 4.8 years.…”

Section: Polyethylene Wear In the Hipmentioning

confidence: 99%

“…When a cup revision was done to treat wear, a common mechanism of failure leading to rerevision was aseptic acetabular loosening reported to occur between 0.4 and 2.7 years after the initial revision [25,39,40]. Recurrent dislocation was also reported as a failure mode in two articles [5,40].…”

Section: Polyethylene Wear In the Hipmentioning

confidence: 99%

“…Seven articles reported rerevisions for aseptic cup loosening after the initial polyethylene exchange was done, with rates ranging from 0% to 8% [5,6,19,21,31,36,39]. Four of the articles mentioned the timing of the rerevisions, which ranged from 2.3 to 6.5 years after the initial polyethylene exchange [6,21,36,39].…”

Section: Polyethylene Wear In the Hipmentioning

confidence: 99%

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The Surgical Options and Clinical Evidence for Treatment of Wear or Corrosion Occurring With THA or TKA

Engh

Padgett

2014

Clin Orthop Relat Res

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Background Wear and corrosion occurring in patients with hip and knee arthroplasty are common causes of failure leading to revision surgery. A variety of surgical approaches to these problems have been described, with varying efficacy. Polyethylene wear, metal-on-metal (MoM) hip bearing wear, and problems associated with modular taper corrosion are the areas of greatest clinical impact; results of revisions for these problems are likely to dictate a large portion of revision resources for the foreseeable future, and so they call for specific study. Questions/purposes We identified the most frequently reported procedures to treat hip polyethylene wear, knee polyethylene wear, MoM wear after THA, and modular taper corrosion and determined the timing and reasons these failed. Methods We performed systematic reviews of the published literature on the four topics using MEDLINE 1 and Embase in October 2013; searches were supplemented by hand searches of bibliographies. Prespecified criteria resulted in the identification of 38 relevant articles, of which 33 were either case reports or Level IV evidence. Followup was generally at short term and ranged from 0.2 to 8 years. Results The most frequently reported procedures for treating clinically important wear were a partial or complete revision. When treating polyethylene wear, the more frequently reported reasons for hip and knee rerevisions were loosening, continued wear, and instability. Soft tissue reactions were more common and occasionally extensive in patients with MoM or modular taper corrosion. Patients with soft tissue reactions had more complications and higher rerevision rates. Conclusions Studies with longer followup and higher levels of evidence are needed to direct the treatment of wear and corrosion. When soft tissue damage secondary to MoM wear or taper corrosion is present, the results of treatment can be poor. There is an urgent need to better understand these two mechanisms of failure.

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