ABSTRACT
Revision of a well-fixed cemented femoral stem is technically challenging. The Exeter Short Revision Stem (SRS) was developed to facilitate cement-in-cement revision mitigating some of these challenges. We present the short to mid-term results of 50 cement-in-cement revisions performed with this implant. A retrospective review of all cement-in-cement revision with the Exeter SRS, at our institution, over a seven-year period between 2007 and 2014 was conducted. Records were assessed for radiological and clinical component loosening at greater than 12 months follow-up and for revision and complications at all time points. An Oxford Hip Score (OHS) and Numeric Rating Scale (NRS) for groin and thigh pain at rest and initial mobilisation were obtained. 50 implants in 46 patients were identified. Radiographic and clinical follow-up was available for 42 and 38 implants respectively at greater than 12 months. Mean radiographic follow-up was 5.1 years and clinical 4.9 years. There was no radiographic or clinical evidence of loosening. 3 revisions were performed, one for each of recurrent dislocation, infection and stem breakage. Median OHS was 39 (IQR 12) and mean NRS for groin pain at rest and initial mobilisation was 1.7 and 1.7 respectively and NRS for thigh pain at rest and initial mobilisation was 1.3 and 1.6 respectively with mean follow-up of 6.9 years. The Exeter SRS provides a viable option for cement-in-cement stem revision, with low revision, complication and loosening rates and good patient reported outcomes at short to mid-term follow up.
ABSTRACT
BACKGROUND: Total hip arthroplasty with cement remains a difficult procedure in patients with osteoarthritis secondary to developmental dysplasia of the hip as it is associated with high rates of aseptic loosening of the acetabular component. The purpose of the present study was to evaluate the rate of revision of the acetabular component in this group of patients and the variables that are associated with it. METHODS: We retrospectively reviewed the records and radiographs of 292 hips in 206 patients who had undergone total hip arthroplasty with cement for the treatment of osteoarthritis secondary to developmental dysplasia of the hip. The average age of the patients at the time of the index procedure was 42.6 years, and the average duration of follow-up was 15.7 years (range, 2.2 to 31.2 years). Fourteen patients were lost to follow-up, and seven patients died from causes unrelated to surgery. A 22.25-mm head was used in all cases, and bone-grafting of the acetabulum was performed in forty-eight hips. Survival of the acetabular component was calculated with revision for aseptic loosening as the end point. Individual survival rates based on age, component type, previous surgery, and annual polyethylene wear also were calculated. RESULTS: The most common reason for revision was aseptic loosening of the acetabular component, which led to 87.2% of the revision procedures. The overall rate of survival of the acetabular component was 90.6% at ten years and 63% at twenty years. A higher rate of acetabular revision was noted in association with previous acetabular surgery, the offset-bore cup, younger age, and accelerated polyethylene wear (p < 0.05 for all comparisons). CONCLUSIONS: Aseptic loosening of the acetabular component affects the longevity of total hip replacements in patients with osteoarthritis secondary to developmental dysplasia of the hip. The present study identified the risk factors associated with the long-term survival of the acetabular component in this group of patients.
