Acetabular reconstruction with impaction bone grafting and cemented polyethylene socket in total hip revision arthroplasty.

BACKGROUND AND AIMS: Bone deficiency in revision total hip arthroplasty is a challenge to the surgeon. One option for restoration of the bone stock is impaction bone grafting and use of a cemented socket. The aim of this study was to evaluate the mid-term clinical outcome of impaction bone grafting and cemented socket revisions. MATERIAL AND METHODS: A total of 59 patients (60 hips) underwent revision arthroplasty with impaction bone grafting and application of a cemented socket on the acetabular side in the Turku University Hospital from 1999 to 2004. The study end-point was re-revision for any reason. The cumulative percentages for survival were followed and estimated with Kaplan-Meier curves. Associations between occurrence of re-revision and potential risk factors were analyzed with logistic regression. Results were quantified by odd ratios and 95% confidence intervals. The mean age of the patients was 69 years (33% male). A total of 3% of the patients had a class I Paprosky acetabular defect, 38% had class II, and 55% had class III. RESULTS: The overall survival rate was 73%. The mean follow-up time was 7 years. The most common reason for re-revision was aseptic loosening of the acetabular component (13 patients, 81% of re-revisions). Cox's regression analysis did not identify any risk factors for re-revision. CONCLUSION: Our results were inferior compared to some previous studies. Impaction bone grafting of acetabular defects in revision total hip arthroplasty may not always provide a reliable bone stock in long-term.

Hip resurfacing arthroplasty versus large-diameter head metal-on-metal total hip arthroplasty: comparison of three designs from the Finnish Arthroplasty Register.

BACKGROUND AND AIMS: Large headed metal-on-metal total hip arthroplasty may produce more metal ions than hip resurfacing arthroplasty. Increased metal-ion levels may be associated with higher revision rates due to adverse reaction to metal debris. The purpose of our study was to compare the survivorship of three hip resurfacing arthroplasty designs with their analogous cementless large-diameter head metal-on-metal total hip arthroplasties. MATERIAL AND METHODS: Based on data obtained from the Finnish Arthroplasty Register, the revision risks of three metal-on-metal hip resurfacing arthroplasty/total hip arthroplasty design couples performed during 2001-2011 were analyzed using the Cox regression model. RESULTS: In the Cox regression analysis for compared design pairs adjusted for age, gender, operated side, head size, diagnosis, and implant, there was no statistically significant difference in revision risk between ReCap hip resurfacing arthroplasty and Bimetric/ReCap total hip arthroplasty (risk ratio = 1.43, confidence interval = 0.95-2.14, p = 0.09) or between Birmingham hip resurfacing arthroplasty and Synergy/Birmingham hip resurfacing total hip arthroplasty (risk ratio = 1.35, confidence interval = 0.75-2.43, p = 0.31). However, the revision risk of Corail and Summit/articular surface replacement total hip arthroplasty (ASR HRA) was significantly increased compared to ASR HRA. (risk ratio = 0.73, confidence interval = 0.54-0.98, p = 0.04). CONCLUSION: We conclude that the short-term revision risk of large headed metal-on-metal total hip arthroplasties was not increased compared to analogous hip resurfacing arthroplasties in two out of three devices studied at a nationwide level. There may be implant-related factors having an effect on the success of single manufacturer devices. However, more information on the incidence of adverse soft-tissue reactions in these patient cohorts is needed.

Early results of large head metal-on-metal hip arthroplasties.

BACKGROUND AND AIMS: Total hip arthroplasty significantly improves patient's life quality. However, total joint replacement is associated with possible complications, such as dislocations, infections, fractures and periprosthetic osteolysis. The goal of this study was to evaluate a large head metal-on-metal total hip arthroplasties and analyse short term complications related to them. MATERIAL AND METHODS: Between 9/2005 and 6/2009, a total of 691 hip replacements were performed on 635 patients with the use of Magnum M2 large head cementless metal-on-metal prosthesis in Turku University Hospital. All patients had a scheduled follow-up at two to three months, and at one year. The results were evaluated using X-rays, Harris Hip Score (HHS), and evaluating post-operative complications and reasons for re-operations. RESULTS: During our follow-up the HHS median raised from its preoperative value of 59.8 to 86.4 two to three months after the operation, and to 93.9 one year after the operation. As a complication we had five infections requiring single open debridement (early infection) or a two stage revision. Seven patients had a periprosthetic femoral fracture that was operated and 11 patients were reoperated because of acetabular component malposition, fracture or early loosening. We did not observe any dislocations, n. ischiadicus damages, squeeking or complications related to high metal ion release (ALVAL-reactions (Aseptic Lymphocyte-dominated Vasculitis-Associated Lesion) or pseudotumours). CONCLUSIONS: The metal-on-metal bearing pair allows large femoral head size, which decreases the risk for dislocation. It may also decrease the risk for osteolysis and aseptic loosening in a long run. Early complication rate related to the bearing surface is minimal. Metal-on-metal prosthesis is a good choice for young and active patients with good bone quality.