scholarly journals Causes of Revision Total Hip Arthroplasty in Twenty Years: an Analysis of 1,353 Revisions 

2020 ◽  
Author(s):  
Jianming Gu ◽  
Xiao Feng ◽  
Hongyi Shao ◽  
Yixin Zhou
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Infection Rate ◽  
Hip Arthroplasty ◽  
Periprosthetic Fracture ◽  
National Database ◽  
Revision Total Hip Arthroplasty ◽  
Revision Thas ◽  
Total Hip ◽  
Revision Tha

Abstract BackgroundWith the increase in revision total hip arthroplasty (THA) cases, understanding its causes is essential for a surgeons' clinical decision-making. Studies have reported on revision THA epidemiology in developed countries; however, its epidemiology in China remains unclear. We reviewed revision THA causes in a tertiary center in China. MethodsWe retrospectively identified 1,353 revision THAs at our institution from January 1999 to December 2018 (20 years). The causes for revision THA were compared among patients who were grouped based on the time of revision surgery, age at revision, and number of revisions, using the Student's t-test. ResultsAseptic loosening (826 hips, 61.0%) and infection (151 hips, 11.2%) were the most common reasons for revision THA. Compared with the number of cases from January 1999 to December 2008, the number of cases from January 2009 to December 2018 increased 2.4-fold; the proportion of revisions due to aseptic loosening, periprosthetic fracture, instability, and osteolysis increased, and infection rate decreased. The infection rate was higher among patients aged over 60 years, whereas the incidence rate of aseptic loosening, periprosthetic fracture, and instability was higher among those aged 60 years or less. Infections (52.8%) were more common than aseptic loosening (37.4%) in second or subsequent revisions.ConclusionAseptic loosening and infection remain the most common causes of revision THAs at our center. Although the proportion of infections has decreased in the recent decade, a national database is necessary for a more comprehensive understanding of the causes of revision THAs in China. This work provides an understanding and comparison of the causes of revision THA in an orthopedic center among the Chinese population. This may reveal a potential change in revision THAs causes in the future, reminding surgeons to find a proper way to treat them.

Cementation of a dual-mobility cup into a well-fixed cementless shell in patients with high risk of dislocation undergoing revision total hip arthroplasty

2019 ◽  
pp. 112070001987361 ◽  
Author(s):  
Jesús Moreta ◽  
Iker Uriarte ◽  
Xabier Foruria ◽  
Ioar Urra ◽  
Urko Aguirre ◽  
...  
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Recurrent Dislocation ◽  
Revision Total Hip Arthroplasty ◽  
Dual Mobility ◽  
Total Hip ◽  
Revision Tha

Background: Cementation of polyethylene liners into well-fixed cementless metal shells has become an option during revision total hip arthroplasty (THA). We report the results of cementing a dual-mobility (DM) component into a stable acetabular shell in high-risk patients undergoing revision THA. Methods: A single-centre series of 10 patients undergoing revision THA with a DM cup cemented into an existing well-fixed shell between 2012 and 2016 were retrospectively reviewed. Failure due to aseptic loosening or instability and implant survival at last follow-up were analysed. The average age was 79.2 years and mean follow-up was 3.5 years. Indications were recurrent hip dislocation in 8 cases and intraoperative instability with moderate abductor insufficiency in 2 cases. In cases with recurrent dislocation, the aetiology of instability was classified by Wera type. Results: At the latest follow-up, Harris Hip Scores had improved from 49.3 preoperatively to 71.3 postoperatively ( p = 0.098). In the 8 patients with recurrent dislocation, 4 cases (50%) had an unclear aetiology (Wera type 6), 2 (25%) abductor deficiency (Wera type 3) and 2 (25%) late polyethylene wear (type 5). Postoperative recurrent dislocation occurred in 1 hip (10%). No cases of intraprosthetic dislocation, aseptic loosening of the previous shell or dissociation at the cement-cup interface were identified. Conclusion: Although the follow-up of this series is short, cementation of a DM cup into a previous well-fixed socket seems to be a viable option to treat and prevent instability after revision THA, without providing constraint at the cement-cup interface.

Aseptic revision total hip arthroplasty in the elderly

2018 ◽  
Vol 100-B (2) ◽  
pp. 143-151 ◽  
Author(s):  
P. Bovonratwet ◽  
R. Malpani ◽  
T. D. Ottesen ◽  
V. Tyagi ◽  
N. T. Ondeck ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Event ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
National Database ◽  
Revision Total Hip Arthroplasty ◽  
Serious Adverse Event ◽  
Total Hip ◽  
Revision Tha ◽  
Aseptic Revision

AimsThe aim of this study was to compare the rate of perioperative complications following aseptic revision total hip arthroplasty (THA) in patients aged ≥ 80 years with that in those aged < 80 years, and to identify risk factors for the incidence of serious adverse events in those aged ≥ 80 years using a large validated national database.Patients and MethodsPatients who underwent aseptic revision THA were identified in the 2005 to 2015 National Surgical Quality Improvement Program (NSQIP) database and stratified into two age groups: those aged < 80 years and those aged ≥ 80 years. Preoperative and procedural characteristics were compared. Multivariate regression analysis was used to compare the risk of postoperative complications and readmission. Risk factors for the development of a serious adverse event in those aged ≥ 80 years were characterized.ResultsThe study included 7569 patients aged < 80 years and 1419 were aged ≥ 80 years. Multivariate analysis showed a higher risk of perioperative mortality, pneumonia, urinary tract infection and the requirement for a blood transfusion and an extended length of stay in those aged ≥ 80 years compared with those aged < 80 years. Independent risk factors for the development of a serious adverse event in those aged ≥ 80 years include an American Society of Anesthesiologists score of ≥ 3 and procedures performed under general anaesthesia.ConclusionEven after controlling for patient and procedural characteristics, aseptic revision THA is associated with greater risks in patients aged ≥ 80 years compared with younger patients. This is important for counselling and highlights the need for medical optimization in these vulnerable patients. Cite this article: Bone Joint J 2018;100-B:143–51.

scholarly journals Promising results of revision total hip arthroplasty using a hexagonal, modular, tapered stem in cases of aseptic loosening

PLoS ONE ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. e0233035
Author(s):  
Jan Schwarze ◽  
Christoph Theil ◽  
Georg Gosheger ◽  
Ralf Dieckmann ◽  
Burkhard Moellenbeck ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Tapered Stem

scholarly journals Cement Removal from the Femur Using the ROBODOC System in Revision Total Hip Arthroplasty

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Mitsuyoshi Yamamura ◽  
Nobuo Nakamura ◽  
Hidenobu Miki ◽  
Takashi Nishii ◽  
Nobuhiko Sugano
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Cement ◽  
Hip Arthroplasty ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Revision Tha ◽  
Cement Removal

Introduction. The perforation and fracture of the femur during the removal of bone cement in revision total hip arthroplasty (THA) are serious complications. The ROBODOC system has been designed to selectively remove bone cement from the femoral canal, but results have not been reported yet. The purpose of our study was to evaluate the clinical and radiographic results of revision THA using the ROBODOC system for cement removal.Materials and Methods. The subjects comprised 19 patients who underwent revision THA using the ROBODOC system. The minimum duration of follow-up was 76 months (median, 109 months; range, 76–150 months). The extent of remaining bone cement on postoperative radiography, timing of weight bearing, and the complications were evaluated.Results. The mean Merle d’Aubigne and Postel score increased from 10 points preoperatively to 14 points by final follow-up. Bone cement was completely removed in all cases. Full weight bearing was possible within 1 week after surgery in 9 of the 19 cases and within 2 months in all remaining cases. No instances of perforation or fracture of the femur were encountered.Conclusions. Bone cement could be safely removed using the ROBODOC system, and no serious complications occurred. Full weight bearing was achieved early in the postoperative course because of circumferential preservation of the femoral cortex.

scholarly journals Structural and Morselized Allografting Combined with a Cementless Cup for Acetabular Defects in Revision Total Hip Arthroplasty: A 4- to 14-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hou-Tsung Chen ◽  
Cheng-Ta Wu ◽  
Tsan-Wen Huang ◽  
Hsin-Nung Shih ◽  
Jun-Wen Wang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Type Ii ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Press Fit ◽  
Cementless Cup ◽  
Revision Tha ◽  
Acetabular Defects

Using morselized and structural allograft to restore bone stock for massive acetabular bone defect in revision total hip arthroplasty (THA) is an appealing procedure. However, concerns about inability to achieve long-term stability following allograft resorption remained. From 2003 to 2012, 59 hips in 58 patients undergoing revision THA for Paprosky type II or III acetabular defects were retrospectively reviewed. The acetabular defects were managed with deep-frozen morselized and structural allografts, and a press-fit cementless cup along with supplementary screws. Clinical outcomes and radiographic results were analyzed with a mean follow-up of 8.7 years. The clinical successful rate was 100% for hips with Paprosky type II defect, 95.2% for IIIA defect, and 92.8% for IIIB defect. Three hips with type III defect failed at 4, 7, and 9 years, respectively. Harris Hip Score improved significantly from 60.1 preoperatively to 91.3 at the latest follow-up. All hips with good clinical results showed trabecular bridging in the allograft-host bone interface. Deep-frozen structural and morselized allograft in combination with a press-fit cementless cup represented a viable option to reconstruct acetabular defects in revision THA.

scholarly journals Extended Trochanteric Osteotomy with Intermediate Resection Arthroplasty Is Safe for Use in Two-Stage Revision Total Hip Arthroplasty for Infection

2021 ◽  
Vol 11 (1) ◽  
pp. 36
Author(s):  
Sebastian Hardt ◽  
Vincent Justus Leopold ◽  
Thilo Khakzad ◽  
Matthias Pumberger ◽  
Carsten Perka ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Femoral Fractures ◽  
Revision Total Hip Arthroplasty ◽  
Trochanteric Osteotomy ◽  
Two Stage ◽  
Total Hip ◽  
Extended Trochanteric Osteotomy ◽  
Revision Tha

Background: This study sought to compare the results of two-stage revision total hip arthroplasty (THA) for periprosthetic infection (PJI) in patients with and without the use of an extended trochanteric osteotomy (ETO) for removal of a well-fixed femoral stem or cement. Methods: Thirty-two patients who had undergone an ETO as part of a two-stage revision without spacer placement were matched 1:2 with a cohort of sixty-four patients of the same sex and age who had stem removal without any osteotomy. Clinical outcomes including interim revision, reinfection and aseptic failure rates were evaluated. Modified Harris hip scores (mHHS) were calculated. Minimum follow-up was two years. Results: Patients undergoing ETO had a significantly lower rate of interim re-debridement compared to non-ETO patients (0% vs. 14.1%, p = 0.026). Reinfection following reimplantation was similar in both groups (12.5% in ETO patients vs. 9.4% in non-ETO patients, p = 0.365). Revision for aseptic reason was necessary in 12.5% in the ETO group and 14.1% in the non-ETO group (p = 0.833). Periprosthetic femoral fractures were seen in three patients (3.1%), of which all occurred in non-ETO patients. Dislocation was the most common complication, which was equally distributed in both groups (12.5%). The mean mHHS was 37.7 in the ETO group and 37.3 in the non-ETO group, and these scores improved significantly in both groups following reimplantation (p < 0.01). Conclusion: ETO without the use of spacer is a safe and effective method to manage patients with well-fixed femoral stems and for thorough cement removal in two-stage revision THA for PJI. While it might reduce the rate of repeated debridement in the interim period, the use of ETO appears to lead to similar reinfection rates following reimplantation.

scholarly journals REDUCED INFECTION RATE AFTER ASEPTIC REVISION TOTAL HIP ARTHROPLASTY WITH EXTENDED ORAL ANTIBIOTIC PROTOCOL

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Amer Mohiuddin, BS ◽  
Justin Rice, BA ◽  
Mary Ziemba-Davis, BA ◽  
R. Michael Meneghini, MD
Keyword(s):  
Total Hip Arthroplasty ◽  
Infection Rate ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Deep Infection ◽  
Oral Antibiotic ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Aseptic Revision ◽  
One Year

Background and Hypothesis: Periprosthetic joint infection (PJI is a leading cause of failure after aseptic revision total hip arthroplasty (RTHA). While well documented in the primary setting, perioperative antibiotic duration is not well described in RTHA where the risk of PJI was recently reported to be 8% one-year post-revision. The study purpose was to evaluate whether extended oral antibiotic prophylactic protocol minimizes PJI in aseptic RTHA patients compared to the published literature.   Project Methods: 169 consecutive aseptic RTHAs performed with modern perioperative and infection-prevention protocols by a single surgeon at a single center were retrospectively reviewed. 80% of patients were discharged on 7-day oral antibiotic prophylaxis while intra-operative cultures were incubating. Infections and reoperations were documented.   Results: Average age and BMI were 63 years and 30 kg/m2.  67% percent of patients were ASA-III/IV, signifying the severity of comorbidities in this revision cohort. There we no cases of PJI in the 90-day postoperative period. Ninety-eight percent of cases were infection free at mean follow-up of 45 months. Three (1.8%) cases underwent reoperation for deep infection at 110, 161 and 581 days.    Conclusion and Potential Impact: Our observed infection rate of 0.0% is lower than published infection rates following RTHA and a 1.5% infection rate in primary THA in patients with no identifiable risk factors for PJI.  Based on this clinically meaningful decrease in PJI in this challenging cohort, we encourage further study regarding extended antibiotic protocol weighed appropriately against potential consequences.   

Outcomes of dual mobility components in total hip arthroplasty

2018 ◽  
Vol 100-B (1) ◽  
pp. 11-19 ◽  
Author(s):  
B. Darrith ◽  
P. M. Courtney ◽  
C. J. Della Valle
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
English Language ◽  
Final Analysis ◽  
Dual Mobility ◽  
Revision Thas ◽  
Total Hip ◽  
Intraprosthetic Dislocation

Aims Instability remains a challenging problem in both primary and revision total hip arthroplasty (THA). Dual mobility components confer increased stability, but there are concerns about the unique complications associated with these designs, as well as the long-term survivorship. Materials and Methods We performed a systematic review of all English language articles dealing with dual mobility THAs published between 2007 and 2016 in the MEDLINE and Embase electronic databases. A total of 54 articles met inclusion criteria for the final analysis of primary and revision dual mobility THAs and dual mobility THAs used in the treatment of fractures of the femoral neck. We analysed the survivorship and rates of aseptic loosening and of intraprosthetic and extra-articular dislocation. Results For the 10 783 primary dual mobility THAs, the incidence of aseptic loosening was 1.3% (142 hips); the rate of intraprosthetic dislocation was 1.1% (122 hips) and the incidence of extra-articular dislocation was 0.46% (41 hips). The overall survivorship of the acetabular component and the dual mobility components was 98.0%, with all-cause revision as the endpoint at a mean follow-up of 8.5 years (2 to 16.5). For the 3008 revision dual mobility THAs, the rate of aseptic acetabular loosening was 1.4% (29 hips); the rate of intraprosthetic dislocation was 0.3% (eight hips) and the rate of extra-articular dislocation was 2.2% (67 hips). The survivorship of the acatabular and dual mobility components was 96.6% at a mean of 5.4 years (2 to 8). For the 554 dual mobility THAs which were undertaken in patients with a fracture of the femoral neck, the rate of intraprosthetic dislocation was 0.18% (one hip), the rate of extra-articular dislocation was 2.3% (13 hips) and there was one aseptic loosening. The survivorship was 97.8% at a mean of 1.3 years (0.75 to 2). Conclusion Dual mobility articulations are a viable alternative to traditional bearing surfaces, with low rates of instability and good overall survivorship in primary and revision THAs, and in those undertaken in patients with a fracture of the femoral neck. The incidence of intraprosthetic dislocation is low and limited mainly to earlier designs. High-quality, prospective, comparative studies are needed to evaluate further the use of dual mobility components in THA. Cite this article: Bone Joint J 2018;100-B:11–19.

scholarly journals Defensive antibacterial coating in revision total hip arthroplasty: new concept and early experience

2020 ◽  
Vol 30 (1_suppl) ◽  
pp. 7-11
Author(s):  
Massimo Franceschini ◽  
N Amir Sandiford ◽  
Vincenzo Cerbone ◽  
Lucio Cappelli Toledo de Araujo ◽  
Daniel Kendoff
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Total Hip Arthroplasty ◽  
Short Term ◽  
Total Hip ◽  
Antibacterial Coating ◽  
Revision Tha ◽  
Detailed Function ◽  
New Strategies

Background: Infections remains the most feared complication in total hip arthroplasty (THA). New strategies of PJI prevention includes coating of conventional implants. Defensive Antibacterial Coating (DAC), an antibacterial hydrogel coating made of hyaluronan, poly-D and L-lactide can protect biomaterials as an effective barrier at the time of implantation. In addition, it can be used with topical antibiotics to prevent early colonisation of the implant. Scope: This manuscript describes the detailed function of the DAC in general as well as an analysis of its use in revision THA in a series of 28 patients in a short-term follow-up. Its use in patients undergoing cementless re-implantation after 2-staged procedures in THA is described in detail within the manuscript. Conclusion: DAC found to be effective in terms of infection control and safety in our patient cohort and has been expanded for cementless 1-staged revisions in PJI of the hip in our institution.

Incidence and risk factors for perioperative death after revision total hip arthroplasty: a 20-year analysis

2020 ◽  
pp. 112070002092135
Author(s):  
Matthew J Best ◽  
Raj M Amin ◽  
Son Nguyen ◽  
Keith T Aziz ◽  
Robert S Sterling ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Revision Tha ◽  
The Us

Introduction: The number of revision total hip arthroplasty (THA) procedures is increasing in the US. Revision THA is associated with higher complication rates compared with primary THA. We describe patterns in incidence and risk factors for perioperative death after revision THA. Methods: Using the National Hospital Discharge Survey, we identified nearly 700,000 cases of revision THA from 1990 through 2010. Procedure incidence, perioperative mortality rates, comorbidities, discharge disposition, and duration of hospital stay were analysed. Multivariable logistic regression was used to identify independent risk factors for perioperative death. Alpha = 0.01. Results: Population-adjusted incidence of revision THA per 100,000 people increased from 9.2 cases in 1990 to 15 cases in 2010 ( p < 0.001). The rate of perioperative death was 0.9% during the study period and decreased from 1.5% during the “first” period (1990–1999) to 0.5% during the “second” period (2000–2010) ( p < 0.001), despite an increase in comorbidity burden over time. Factors associated with the greatest odds of perioperative death were acute myocardial infarction (odds ratio [OR], 37; 95% confidence interval [CI], 33–40; p < 0.001), pneumonia (OR, 16; 95% CI, 15–18; p < 0.001), and pulmonary embolism (OR, 13; 95% CI, 11–15; p < 0.001). Conclusions: The rate of perioperative death in patients undergoing revision THA in the US decreased from 1990 to 2010 despite an increase in comorbidities. Acute myocardial infarction, pneumonia, and pulmonary embolism were associated with the highest odds of perioperative death after revision THA.

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