Method of Fixation Does Not Influence the Overall Risk of Rerevision in First-time Cup Revisions

Abstract

Background During the last two decades, uncemented fixation has been increasingly preferred worldwide during cup revision surgery. In Sweden, the number of uncemented cup revisions has been increasing during the last decade. However, it is unclear whether the risk of rerevision differs between cemented and uncemented cups. Question/purposes We determined (1) the risk of rerevision after cemented and uncemented fixation; (2) the influence of concomitant stem revision on the risk of rerevision of the cup; (3) the difference in risk of rerevision of an uncemented cup revision compared with liner revision only; and (4) whether the surgical incision influenced the risk of rerevision. Methods Between 1979 and 2010, 19,342 first-time cup revisions were reported to the Swedish Hip Arthroplasty Register. From these, 749 were excluded (hip resurfacing, cases with tumor diagnoses, and missing data) leaving 18,593 (73% cemented) for further analysis. We used a Cox regression model adjusted for age, sex, primary diagnosis, method of fixation, concomitant stem revision, and cemented/uncemented fixation to assess risk of rerevision. Results The relative risk for rerevision for any reason did not differ between cemented and uncemented fixation (relative risk [RR], 0.94). If the stem was not revised at index revision, the risk of further cup revision increased twofold (RR, 1.91). Liner revisions were associated with a 70%

Short-term survival of the trabecular metal cup is similar to that of standard cups used in acetabular revision surgery

“…Using the same technique on 142 acetabular reconstructions, Comba et al (2006) reported a survival rate of 96% at a mean follow-up time of 4.3 years. In a recently published study ( Mohaddes et al 2013 ) from the SHAR, we could not find any difference in risk of re-revision between cemented and uncemented first-time cup revisions. According to the current analysis, the risk of re-revision was lower for the cemented Lubinus cup than for the Trilogy cup.…”

“…According to several reports ( Kurtz et al 2007 , Pabinger and Geissler 2014 ) an increase in revision hip arthroplasties is expected. During the past 2 decades, the number of hip revision surgeries reported to the Swedish Hip Arthroplasty Register (SHAR) has doubled ( Mohaddes et al 2013 ).…”

Outcome of revision hip arthroplasty in patients younger than 55 years: an analysis of 1,037 revisions in the Dutch Arthroplasty Register

“…Approximately 70% of all index revisions were a partial revision, where in the majority of these procedures either the cup or the stem was replaced (major partial revision). Failure rate of the minor partial revisions (replacement of head and/or insert) was higher when compared with major partial revisions or total revisions, which is supported by data from the Swedish Hip Arthroplasty Register (Mohaddes et al 2013). A possible explanation for this might be the high percentage of index revisions with reason given as infection using this method, or the exchange of heads to prevent further dislocations.…”

Does the Risk of Rerevision Vary Between Porous Tantalum Cups and Other Cementless Designs After Revision Hip Arthroplasty?

“…Third, our mean followup was only 3 years, which is a relatively short time in a hip implant's lifespan. However, uncemented revision cups more often are associated with higher early revision rates, whereas cemented cups often are associated with later wear-related problems [11]. In addition, the risk of rerevision resulting from infection is higher during the early period after the first revision [14].…”

“…Research suggesting inferior implant survival when cemented acetabular components are used in revision THA led to increased use of uncemented acetabular cups in first-time revision THA during the last two decades [17]. Although uncemented cups made from porous tantalum initially were designed to help manage challenging bone deficiencies, there is evidence that they are seeing wide use for revision and primary THAs [11,13]. Porous tantalum has been shown to provide higher porosity, increased initial stability, and better bone ingrowth qualities [2].…”