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Background: Periprosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Although some risk factors of PJI were well studied, the association between trauma and PJI remains unknown in revision patients. Materials and methods: Between 2015 and 2018, a total of 71 patients with trauma history before revisions (trauma cohort) were propensity score matched (PSM) at a ratio of 1 to 5 with a control cohort of revision patients without a history of trauma. Then, the cumulative incidence rate of PJI within 3 years after operation between the two groups was compared. The secondary endpoints were aseptic revisions within 3 postoperative years, complications up to 30 postoperative days, and readmission up to 90 days. During a minimal 3-year follow-up, the survival was comparatively analyzed between the trauma cohort and the control cohort. Results: The cumulative incidence of PJI was 40.85% in patients with trauma history against 27.04% in the controls (P = 0.02). Correspondingly, the cumulative incidence of aseptic re-revisions was 12.68% in patients with trauma history compared with 5.07% in the control cohort (P = 0.028). Cox regression revealed that trauma history was a risk factor of PJI (HR, 1.533 [95%CI, (1.019,2.306)]; P = 0.04) and aseptic re-revisions (HR, 3.285 [95%CI, (1.790,6.028)]; P < 0.0001). Conclusions: Our study demonstrated that revision patients with trauma history carried a higher risk of PJI compared to those without trauma history. Moreover, after revisions, the trauma patients were still at higher risk for treatment failure due to PJI, periprosthetic joint fracture, and mechanical complications. [ABSTRACT FROM AUTHOR]

Background: Worldwide, the majority of total hip arthroplasties (THAs) placed in patients <55 years are uncemented. However, little is known about the preferred method of fixation in revision hip arthroplasty in young patients. The aim of this study was to assess potential differences in the method of fixation used between primary and revision THA in young patients using data from the Dutch Arthroplasty Register. Methods: All primary THA placed in patients younger than 55 years, registered in the LROI between 2007 and 2019 were included n = 28,516). Kaplan-Meier survival analyses were used to estimate the survival of primary THA by method of fixation. Additionally, survival of revision procedures that changed or did not change in method of fixation were estimated. McNemar's test was used to assess differences in the proportion of cemented and uncemented fixation between primary and revision THA. Results: In all acetabular revisions, the use of cemented fixation increased statistically significant with 39% (95% CI, 34–45, p < 0.001) from 23% in primary THA to 62% in revision procedures. In all femoral revisions, the increase of cemented fixation was also statistically significant with 25% (95% CI, 19–31, p < 0.001), from 11% in primary THA to 36% in revision surgery. For both revised acetabular and femoral components, we found no statistically significant difference in the 5-year survival between revision procedures that changed or did not change in method of fixation. Conclusions: There was a significant change towards cemented fixation between primary and revision THA in young patients in the Netherlands, which was especially pronounced in acetabular revisions. No significant difference in short-term survival was found between revision procedures that changed or did not change in method of fixation. Long-term follow-up data are needed to evaluate the effect of this change in fixation method on the outcome of revision procedures in young patients. [ABSTRACT FROM AUTHOR]

Background: Pigmented villonodular synovitis (PVNS) is a condition affecting larger joints such as the hip and knee. Little is known regarding the impact of PVNS on total hip arthroplasty (THA). Therefore, the aim of this study is to determine if patients with PVNS of the hip undergoing primary THA experience greater (1) in-hospital lengths of stay (LOS); (2) complications; (3) readmission rates; and (4) costs.Methods: Patients undergoing primary THA for PVNS of the hip from the years 2005 to 2014 were identified using a nationwide claims registry. PVNS patients were matched to a control cohort in a 1:5 ratio by age, gender, and various comorbidities. The query yielded 7440 patients with (n = 1240) and without (n = 6200) PVNS of the hip undergoing primary THA. Endpoints analyzed included LOS, complications, readmission rates, and costs. Multivariate logistic regression was used to determine odds ratios (OR) of developing complications. Welch's t-tests were used to test for significance in LOS and cost between the cohorts. A P-value less than .001 was considered statistically significant.Results: PVNS patients had approximately 8% longer in-hospital LOS (3.8 vs 3.5 days, P = .0006). PVNS patients had greater odds of (OR 1.60, P < .0001) medical and (OR 1.81, P < .0001) implant-related complications. Furthermore, PVNS patients were found to have higher odds (OR 1.84, P < .0001) of 90-day readmissions. PVNS patients also incurred higher day of surgery ($13,119 vs $11,983, P < .0001) and 90-day costs ($17,169 vs $15,097, P < .0001).Conclusion: Without controlling for global trends in LOS, complications, readmissions, or costs between 2005 and 2014, the findings of the study suggest that PVNS of the hip is associated with worse outcomes and higher costs following primary THA. The study is useful as orthopedic surgeons can use the study to educate patients of the complications which may occur following their hip surgery. [ABSTRACT FROM AUTHOR]

Few studies provide an analysis of conservative two-stage revision of hip periprosthetic joint infection (PJI) and its impact on final outcome. A conservative revision is defined when soft tissues and bone quality enable the use of primary prosthetic components. Data of patients treated for chronic hip PJI who underwent two-stage revision between 2009 and 2016 and had a minimum of 2 years of follow-up were collected. Oxford Hip Score (OHS), Harris Hip Score (HHS) and radiological and microbiological data were retrieved and analysed. Clinical and functional outcome, survival, mortality, eradication, reinfection and re-revision rates within subgroups of patients with primary components and revision components are reported herein. A total of 148 patients underwent two-stage hip exchange with a mean follow-up of 55.6 ± 23.1 months and a mean age at surgery of 64.3 ± 12.7 years. Forty-four percent of patients underwent conservative revision. The mean HHS significantly improved from 40.6 ± 9.4 points to the final value of 87.8 ± 10.5 points (p =.002), and the mean OHS went from 20.3 ± 3.8 points to 40.3 ± 5. points (p<.001). Patients who were treated with primary components or isolated revision stems in the second stage had a significant reduction in surgical times (p<.001). The mortality rate for all causes of death was 6.8%, the eradication rate was 89.9%, the reinfection rate was 4.7% and the reoperation rate was 7.4% without differences between conservative and non-conservative revisions. Two-stage exchange arthroplasty for total hip arthroplasty (THA) PJI is a good strategy that provides satisfactory results, high eradication rates and no further need for revision. The conservative two-stage revision in patients with adequate bone stock represents a feasible option with good results and survival rates. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess survival rate, functional and radiological outcomes when using a hydroxyapatite-ceramic fully coated primary femoral stem in revision total hip arthroplasty. Methods: Patients who underwent revision total hip arthroplasty using the Furlong hydroxyapatite-ceramic (HAC)-coated (Joint Replacement Instrumentation Ltd., Sheffield, UK) primary stem were retrospectively identified between 2013 and 2017. A total of 30 hips in 27 patients were identified and the mean follow-up duration was 44 months. Post-operative radiographs were scrutinized for signs of component loosening by two independent assessors. Patient's functional outcomes were assessed using the Oxford hip score and compared pre- and post-operatively. The prevalence of thigh pain was assessed at the latest follow-up. Results: The most common cause of revision was adverse reactions to metal debris (ARMD) (46.6%). The overall complication rate was 13.3%. Results at final follow-up demonstrated 100% survival rate and no reported incidence of thigh pain. Using paired t test, all patients had a statistically significant (P < 0.05) improvement in post-operative mean Oxford hip score of 35 compared to a mean pre-operative score of 14. Radiographic analysis of the latest follow-up radiographs revealed no signs of component loosening or component subsidence. Conclusion: With a 100% survival rate and excellent reported functional outcomes, we believe that our experience and results support the use of primary cementless stems in selected revision cases. [ABSTRACT FROM AUTHOR]

Introduction: Over the last years, the design of implants, the surgical approaches, and diagnostic tools changed in primary and revision of total hip arthroplasty. A knowledge of the different causes for revision after total hip arthroplasty is essential to avoid complications and failures. The purpose of this study was to determine trends of the etiology of implant failures over the last years by analyzing indications of revision hip arthroplasty.Methods: All the patients who performed revision hip arthroplasties in our institution between 2001 and 2015 were reviewed retrospectively. Patient demographics, the indication for revision surgery as well as the procedure were assessed. Descriptive statistical analyses and association analyses were performed.Results: Within our collective of 3450 revision hip arthroplasties, a total of 20 different indications were identified and categorized. Overall, 80.8% of the revisions were categorized as aseptic, 19.2% as septic implant failures. Some recently debated diagnoses like low-grade infection showed a high increase in incidence, whereas classic failure mechanisms like polyethylene wear showed a decrease over the time. In addition, the data revealed that cup loosening caused more revision surgeries than stem loosening.Conclusion: This study successfully updated the current knowledge of different failure mechanisms in revision hip arthroplasties. The data proved that cup loosening was the most common failure mechanism in older patients, while in young patients, septic complications showed a high incidence. Probably, due to improved diagnostic tools, the percentage of infection in revision hip arthroplasty increased over the years. [ABSTRACT FROM AUTHOR]

Background: To date, only limited literature exists regarding revision of total hip arthroplasty (THA) through the direct anterior approach (DAA). However, as the popularity of the DAA for primary surgery is increasing, surgeons will be confronted with the challenge of performing revision surgery through the DAA. The aim of this study was to review the potential of the DAA in the revision setting and to report the clinical results, radiologic outcomes and complication rates of 63 patients undergoing revision THA through the DAA. Methods: From 01/2009 to 08/2017, 63 patients underwent revision THA through the DAA. Depending on the performed procedure, patients were separated into 4 groups: liner and head exchange (21 patients), revision of the acetabular cup (26 patients), revision of the femoral stem (13 patients) or revision of both components (3 patients). Postoperative complications as well as the clinical and radiological outcome were assessed retrospectively. Results: At a mean follow-up of 18 months, the overall complication and re-operation rates were 14.3% and 12.7%, respectively. Specifically, the complication and re-operation rates were 14.2% and 9.5% after liner and head exchange, 15.4% after revision of the acetabular cup, 15.3% after revision of the femoral stem and 0% after revision of both components. The mean postoperative HHS at 1 year postoperatively was 91 (range 74–100). Conclusion: The DAA offers appropriate exposure for exchange of mobile liners and acetabular cup revision. In selected cases with appropriate stem design, femoral stem revision through the DAA is feasible. However, surgeons should be aware of the technical difficulties related to femoral revision and be prepared to extend the approach distally or perform a trochanteric osteotomy. [ABSTRACT FROM AUTHOR]

Background: The impact of comorbidity on the risk of revision in patients undergoing Total Knee arthroplasty (TKA) and Total Hip Arthroplasty (THA) is not currently well known. The aim of this study was to analyze the impact of comorbidity on the risk of revision in TKA and THA.Methods: Patients recorded in the Catalan Arthroplasty Register (RACat) between 01/01/2005 and 31/12/2016 undergoing TKA (n = 49,701) and THA (n = 17,923) caused by osteoarthritis were included. As main explanatory factors, comorbidity burden was assessed by the Elixhauser index, categorized, and specific comorbidities from the index were taken into account. Descriptive analyses for comorbidity burden and specific conditions were done. Additionally, incidence at 1 and 5 years' follow-up was calculated, and adjusted Competing Risks models were fitted.Results: A higher incidence of revision was observed when the number of comorbidities was high, both at 1 and 5 years for THA, but only at 1 year for TKA. Of the specific conditions, only obesity was related to the incidence of revision at 1 year in both joints, and at 5 years in TKA. The risk of revision was related to deficiency anemia and liver diseases in TKA, while in THA, it was related to peripheral vascular disorders, metastatic cancer and psychoses.Conclusions: Different conditions, depending on the joint, might be related to higher revision rates. This information could be relevant for clinical decision-making, patient-specific information and improving the results of both TKA and THA. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess patients treated for interprosthetic femoral fractures (IFFs).Method: Based on our database, we performed a retrospective single-center analysis of patients who underwent surgery for the treatment of IFFs. We evaluated patient demographics, fracture patterns, type of surgery, revision, and mortality for a minimum of one year after treatment. Outcomes were assessed via telephone using the Parker score.Results: Fifty consecutive patients were enrolled. An analysis of fracture patterns revealed three different types: proximal (n = 19), intermediate (n = 13), and distal (n = 18). Treatment included internal fixation for stable components and revision arthroplasty for loose implants; and a lateral locking plate was the most commonly applied device. The mean follow-up time of the total sample was 5.7 years after the operation. The total revision rate was 22%, and the highest revision rate was documented for revision arthroplasty. The one year mortality rate for the sample was 14%, and fracture patterns and treatment revealed no effects on mortality. Living patients (n = 23) were followed up for an average of 4.9 years after treatment. Only six patients reported the best Parker score (mean, 5.0; range 0-9).Conclusion: IFFs can be divided into three groups irrespective of the type of stem or bone quality, but fixation (stable or loose) must also be considered to determine the treatment. Fracture patterns and treatment revealed no effects on mortality. There are many treatment options but no single solution for IFFs. [ABSTRACT FROM AUTHOR]

Radiostereometric analysis (RSA) is the most accurate method of measuring component migration using radiographs but is restricted to use in prospective studies. Ein‐Bild‐Roentgen‐analyze (EBRA)‐Cup can be used retrospectively, but its accuracy to measure component migration following revision is unknown. This study aimed to determine the accuracy of EBRA‐Cup measurements of uncemented acetabular component migration after revision total hip replacement (THR). The secondary aim was to compare the number of cases identified using EBRA‐Cup and RSA as having proximally migrated above and below 1 mm at 2 years postoperatively. EBRA‐Cup measurements were performed on plain antero‐posterior pelvic radiographs taken at the same time as RSA radiographs in a prospective cohort of 53 hips undergoing acetabular revision. At 2 years, the mean difference between the RSA and EBRA‐Cup measurements for 17 components used to treat pelvic discontinuity was 0.90 mm, significantly greater than the mean difference of 0.28 mm for 36 components without discontinuity (P =.0001). The mean difference between the RSA and EBRA‐Cup measurements at 2 years for hips that were reconstructed with an acetabular component alone, 0.28 mm, was significantly lower than hips that were reconstructed with an acetabular component in combination with an augment and/or cage, 0.74 mm (P =.0005). In conclusion, EBRA‐Cup can accurately measure migration of uncemented acetabular components used at revision THR. The presence of pelvic discontinuity, and addition of augments and cages, significantly influenced the accuracy of EBRA‐Cup measurements. EBRA‐Cup and RSA had good agreement on classification of components that migrated proximally above or below 1 mm at 2 years, with 100% sensitivity, and 87% specificity. [ABSTRACT FROM AUTHOR]

Background: Both cylindrical and tapered stems are commonly used in revision total hip arthroplasty. However, whether the geometry of prosthesis stem has an effect on patient prognosis is unclear. We assume that the tapered stem results in better clinical outcome than the cylindrical stem.Methods: A multicenter review of 120 femoral revisions with Paprosky I, II, and III defects using cobalt chrome cylindrical stem (54 hips) or titanium tapered stem (66 hips) was performed with an average follow-up of 6 years. Demographic data were comparable between groups.Results: No significant group differences were found in surgery time, bleeding volume, postoperative Harris Hip Score, level of overall satisfaction, and 8-year cumulative survival. However, intraoperative fractures occurred significantly less in the tapered group (4.5%) than in the cylindrical group (14.8%), and stem subsidence was significantly less in the tapered group (2.17 mm) than in the cylindrical group (4.17 mm). A higher ratio of bone repair and lower bone loss were observed in the tapered group compared with the cylindrical group. The postoperative thigh pain rate was higher in the cylindrical group (12.9%) than in the tapered group (4.5%).Conclusion: Both cylindrical stem and tapered stem can achieve satisfactory mid-term clinical results in revision total hip arthroplasty. The tapered stem has better bone restoration of proximal femur, lower incidence of intraoperative fractures, and lower postoperative thigh pain rate compared with the cylindrical stem. [ABSTRACT FROM AUTHOR]

Background: Modular stems are widely used in revision total hip arthroplasty (THA) with aseptic loosening being a common reason for revision. Despite the good results reported on the use of modular stem designs, there are only few studies focusing on aseptic revisions and few studies on a hexagonal stem design. The goal of this study is to determine stem survival, clinical and functional outcome along with possible risk factors for implant failure in aseptic revision THA. Methods: We retrospectively identified 53 patients with aseptic THA revision using a modular hexagonal stem with a minimum follow-up of two years. Femoral bone loss, radiographic and clinical outcomes as well as function measured using the Harris Hip Score (HHS) was assessed. Patients' previous medical history was analyzed for comorbidities and the body mass index. Stem survival was calculated using the Kaplan-Meier method. Possible risk factors for implant failure were analyzed using the log-rank test. The median age at revision was 69 (IQR 62–73) with a median follow up of 74 months. Results: Implant survival rates amounted to 90.4% at 3 and 5 years. The median HHS improved by 47 points (34 (IQR 22–47) vs 81 (IQR 59–90) p<0.001). There was a reduced implant survival after 5 years when the revision stem was used following a previous cemented stem (83.4% vs 100%, p = 0.04). Conclusion: A modular, hexagonal stem can be successfully used in aseptic revision THA with remarkable functional results and excellent survivorship. Revision of a cemented stem using this implant might result in reduced survival which must be considered when planning treatment. [ABSTRACT FROM AUTHOR]

Purpose: There is no consensus regarding systematic screening for infection in aseptic revision total hip arthroplasty (THA). The rationale for systematic intra-operative samples is to increase the sensitivity of latent infections detection, which may require specific treatment. However, the incidence of occult infection in revision THAs is not precisely known. As such, the aim of the study was to evaluate the incidence of occult infection in presumed aseptic revision THAs and identify associated risk factors.Method: Bacteriological samples from 523 aseptic THA revisions performed for five years were analyzed. Revisions performed for periprosthetic joint infection (PJI) or clinical suspicion of PJI were excluded. Microbiological cultures were performed using tissue samples in 505 cases (97%), synovial fluid in blood culture vials in 158 (30%), and in dry tubes in 263 (50%). Implants were sent for sonication in 12 cases (2.6%). The mean number of microbiological samples per patient was 3.6 (range, 1-15). Histology samples were collected for 300 patients (57%).Results: The incidence of occult infection was 7% (36 cases) and contamination 8% (42 cases). Among occult infections, the primary reasons for revision were dislocation (42%), aseptic loosening (25%), fracture (19%), and others (14%). The infection rate in the dislocation group was significantly higher than that of other reasons for revision (p < 0.001). Among the patients determined with PJI, the revision THA was performed less than a year after primary in 19 (53%).Conclusion: The incidence of occult PJI justifies systematic intraoperative sampling. A short time between primary arthroplasty and revision or an early postoperative dislocation is a factor to suspect infections. [ABSTRACT FROM AUTHOR]

Background: The aim of this retrospective study was to evaluate the clinical, radiologic, and survival results of dual mobility (DM) sockets in revision total hip arthroplasty (THA) performed for instability versus revision THAs performed for other reasons.Methods: From a computerized database, we identified 84 revision THAs using a modern DM socket performed in 81 patients with a mean age of 71 years. Indication for revision was recurrent dislocation in 47 hips, and other reasons in the remaining 37 hips. A survivorship analysis according to the actuarial method was carried out on the entire series using revision for any cause, revision for dislocation, and radiological cup loosening revised or not, as the end points.Results: Of the 81 patients, twelve died, six were lost to follow-up, eight had been revised, and 55 patients (58 hips) were unrevised and alive at a mean follow-up of 6.4 years. Dislocation occurred in four of the 47 (8.5%) hips for which indication for revision was dislocation versus one of the remaining 37 (2.7%) hips [odds ratio = 3.4 (0.4-31.3), p = 0.07]. According to our criteria, three acetabular components of which one was revised were considered as loosened. When using revision for dislocation as the end-point, the survival rate at seven years was 90.4 ± 5.3% (IC95%, 79.9-100) in the 47 hips for which the indication for revision was dislocation versus 100% in the remaining 37 hips (log-rank, p = 0.5).Conclusions: The current study indicated that DM sockets represent an interesting solution to prevent dislocation in revision THAs at mid-term follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Severe acetabular bone loss, both with or without pelvic discontinuity, remains a challenge in revision total hip arthroplasty (RTHA). The goal of our study was to evaluate the mid-term results for consecutive patients with Paprosky III acetabular bone loss with or without pelvic discontinuity who needed RTHA with custom-made acetabular implants and to compare the results to those of other studies.Materials and Methods: Sixty-eight (68) patients with severe acetabular bone loss (Paprosky Type IIIa and IIIb), who required RTHA, were included in our study. All prostheses were constructed on the basis of thin-layer computed tomography (CT) scans of the pelvis. The visual analogue scale (VAS), Harrison hip score (HHS), and clinical and radiographic follow-up assessments were used to evaluate the outcome.Results: The average follow-up time was 43 months (range 1-120 months). Implant survival at last follow-up was 75% (51 of 68). Kaplan-Meier survival analysis, with explantation as the endpoint, revealed survival rates of 82.7% (3 years) and 77% (5 years). Patients with revision of the acetabular component only had a significant higher survival rate (p 0.012). Overall revision rate was 36.7%. Reinfection rate was 34.4%. Complications included 15 (22%) periprosthetic joint infections (PJI), 7 dislocations (10.2%), and 2 aseptic loosenings (2.9%). Mean VAS at last follow-up was 1.45 compared to 3.2 preoperatively, while mean HHS improved from 21.1 points preoperatively to 61 at last follow-up. The change in both scores was thus significant (p < 0.001).Conclusion: Defect reconstruction with custom-made modular acetabular implants can be a good, nevertheless expensive, treatment option with clinically and radiologically satisfying results in comparison to recent studies in the literature. Nevertheless, high postoperative complication rates, especially in terms of PJI, remain a challenge. [ABSTRACT FROM AUTHOR]

Background: Periprosthetic femur fractures (PFFs) following hip arthroplasty can lead to significant morbidity due to their impact on mobility and the need for surgery. Its incidence often measured by the prosthesis revision rate reported in joint replacement registries. However, many PFFs are also treated with prosthesis retention and internal fixation. Minimally displaced and stable fractures may be treated without surgery. Knowledge of the difference between the number of femoral revisions for PFF (well reported in registries) and the number of surgeries for PFF overall would allow us to estimate the overall surgical burden. This study aims to determine the number of post‐operative PFF in three hospitals and compare those treated with revision surgery to those PFF treated with internal fixation and femoral stem retention. By determining this difference, we can ascertain a more accurate estimate of the overall surgical burden of PFF. Method: Patients 50 years and older who sustained a post‐operative PFF between 1 January 2011 and 31 December 2017 at three public hospitals were extracted from hospital records. The number of revision procedures was compared to the number of re‐operations of any type. Results: There were 200 patients admitted for management of PFF. One hundred and forty‐three (71.5%) required an operation of which 67 (47%) were revision arthroplasty. Conclusion: The overall surgical burden of PFF is approximately twice that represented by the revision rate. [ABSTRACT FROM AUTHOR]

Background: Cementless femoral stems are currently used in revision total hip arthroplasty (THA) with the surgeon choosing between various fixation modes. The outcomes are good in the medium term; however, some failures have been attributed to technical errors during implantation. When the decision has been made to use a press-fit implant, the impact of the surgeon's technique on the functional outcomes have not been explored in-depth. This led us to carry out a retrospective study on a large population of total hip arthroplasty patients which aims were achieved press-fit to (1) determine the impact of the type of primary fixation (with and without press-fit) on the functional outcomes; (2) specify the effect of stem length on the functional scores when diaphyseal press-fit is achieved and (3) analyse the main reasons why a true press-fit effect was not achieved (three-point fixation).Hypothesis: There is a relationship between the primary fixation method by press-fit of a revision femoral stem and the functional outcomes.Patients and Methods: We performed a retrospective analysis of a continuous cohort of 244 THA revision cases with a mean follow-up of 6.1 ± 3.5 years (range, 2-18). The femoral area in which close contact was achieved (shared interface between the bone and implant) was used to define various types of press-fit fixation. The functional outcomes were determined using the Harris Hip Score (HHS) and the Merle d'AubignéPostel score (MAP score) out of 12 points (pain and walking items).Results: The post-operative HHS averaged 90.83 ± 7.51 for proximal press-fit and 80.14 ± 14.93 with no press-fit (p = 0.01). The MAP averaged 10.83 ± 1.03 for proximal press-fit and 9.75 ± 2.09 with no press-fit (p = 0.09). The MAP score was worse for long diaphyseal press-fit than for short press-fit (p = 0.02). Use of a long stem with an endofemoral route or an overly small femoral window in patients with a curved femur is the main reason that three-point fixation occurred instead of press-fit.Conclusions: While press-fit is an effective concept, it is a demanding one that requires the surgeon to choose the correct surgical strategy for the patient's anatomy. A meticulous surgical technique is required to achieve proximal press-fit or at a minimum, short diaphyseal press-fit. [ABSTRACT FROM AUTHOR]

Purpose: Acetabular revision of failed total hip arthroplasty (THA) is often associated with severe bone loss. Therefore, a variety of revision implant systems has been developed during recent years, with the augment-and-modular-cage system being one of the newest additions to this portfolio. Together with biologic downsizing by means of impaction bone grafting, this uncemented system promises a high modularity and versatility to treat all acetabular defects up to Paprosky types IIIa and IIIb without pelvic discontinuity. The aim of the present study was to evaluate first short-term results of its clinical application, both clinical functional and patient-reported as well as radiographic.Methods: Forty-four patients (28 female, 16 male, mean age 70.9 ± 11.5 years) could be followed for a mean of 26 ± 10 months after acetabular revision with a novel augment-and-modular-cage system. Indications for revision included aseptic loosening (68%), septic loosening (16%), or others (16%) with bone loss Paprosky IIa up to IIIb without discontinuity. The modified Harris Hip Score (mHHS) served as a primary outcome parameter. In addition, a number of patient-reported outcome measurements (PROMs) were collected including the Short Form 36 (SF-36), Hip disability and Osteoarthritis Outcome Score (HOOS), and Visual Analogue Scale for Hip Pain (VAS Hip) as well as overall satisfaction. Radiographic changes between the pre- and postoperative center of rotation (COR) and various criteria of implant failure served as secondary outcome parameters.Results: No patients were lost to follow-up. Two implant-associated complications (partial flange breakage) without a need for revision surgery were detected, which represent a failure rate of 4.5%. Functional outcome as measured by mHHS increased from 49.4 ± 2.9 pre-operatively to 74.4 ± 3.1 at the latest follow-up (p < 0.001). PROMs showed significant improvements in all pain-related categories, while other quality-of-life measurements only exhibited positive tendencies towards improvement. VAS Hip significantly improved from 6.5 ± 0.7 pre-operatively to 2.2 ± 0.6 at the latest follow-up (p < 0.001). Radiographic evaluation showed that reconstruction of the COR was possible, referenced to the contralateral side. The COR could be lateralized by 5.0 mm (n.s.) and caudalized by 10.3 mm (p < 0.001) comparing pre-operative and post-operative states, with complete osseointegration in 95% of the cases.Conclusions: Treatment with the augment-and-modular-cage system significantly improved clinical functional and patient-reported outcomes in cases of acetabular revision after failed THA. In addition, a good reconstruction of the COR could also be achieved. Therefore, this highly modular system can be considered as an effective treatment option in almost all cases of acetabular bone loss except for those of pelvic discontinuity. It offers the unique possibility of intra-operative implant customization according to the existing bone defect and host bone quality. [ABSTRACT FROM AUTHOR]

Introduction: In the last three decades, total hip replacement in young patient became a habitual procedure. Principles of bone preservation are pushing many surgeons to implant conservative femoral components in patient younger than 65 years. Despite an overall good survivorship and clinical outcomes of conservative implants, failed cases are reported and the need to revise a conservative femoral component became an occasional procedure (with high prevalence of failed resurfacing implants).Methods: During conservative femoral component revisions, we analyzed proximal bone stock preservation, considering the type of original component removed, etiology of failure, timing of revision, and femoral explantation technique.Results: We identified four patterns of proximal femoral changes (types I-IV). We suggest, for each of them, a revision strategy directed toward a "conservative revision procedure" using conservative or primary component. Out of our 21 cases, none underwent further revision due to mechanical failure (follow-up ranging from 6 to 152 months, mean 54 months). We had two case of re-operation: one for early septic loosening and one for prosthetic modular neck fracture.Conclusions: If literature offers well-established guidelines to femoral revision of conventional stems, there is, on the other hand, a lack of data about revision strategies in presence of failed conservative implants. Although the mean follow-up of our procedures is still too short (4.5 years) to give final conclusions, we would leave a message: a conservative hip arthroplasty is not a "one-time" opportunity for young and active people. A "conservative revision" is a valid option for at least a part of them, when an early failure of primary procedure occurred. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the clinical outcomes, complications, and survival of a long cementless titanium femoral stem in revision total hip arthroplasty (THA) at a minimum five year follow-up. Methods: Between 2000 and 2010, 114 patients (116 hips), with a mean age of 68 ± 12 years, underwent revision THA using a KAR® stem (DePuy, Leeds, UK). The main reasons for revision were aseptic loosening (82%), periprosthetic joint infections (PJI) (11%), and periprosthetic fractures (6%). Mean follow-up was ten ± three years (range, 5–16). Harris Hip Score (HHS), Oxford Hip Score (OHS), and Postel-Merle d'Aubigné (PMA) score were recorded. Radiographic analysis assessed stem osseointegration and subsidence. Survival was analyzed using the Kaplan-Meier (KM) method and cumulative incidence function (CIF). Results: Post-operative HHS was 83 ± 15 (range, 35–99) and OHS was 37 ± 8 (range, 8–48). PMA score significantly increased from 12 ± 2 (range, 5–18) pre-operatively to 14.6 ± 2 (range, 9–18) post-operatively (p = 0.0004). The radiographic Engh score was 15 ± 8 (range, 7–22). Stem subsidence was observed in two cases (3%). At ten years, five stems had been revised, three for infections and two for periprosthetic fractures. Using the KM method, ten year survival free of stem revision for aseptic loosening was 100%, free of revision for any reason 95%, and free of any re-operation 81%. Conclusions: The present study reported satisfactory outcomes and survival of a long tapered unlocked cementless femoral stem in revision THA at a minimum follow-up of five years. [ABSTRACT FROM AUTHOR]

Purpose: Proximal femoral replacements (PFRs) have been recently utilized in complex revision arthroplasties where proximal femoral bone is compromised. The purpose of this study is to evaluate the clinical outcomes, complications, and survivorship of PFRs as a salvage treatment for severe bone loss after non-oncologic revision total hip arthroplasty.Methods: This is a retrospective review of all patients who underwent femoral revision surgery using a single design PFR between 2004 and 2013 at our institution. Forty patients (41 hips) were included with a mean age of 64 years (29-90). According to Paprosky classification, 15 femurs had type IIIB defect, and 26 had type IV defect. Patients were followed for a mean of five years (2-10). The average length of reconstruction was 150 mm (81-261). A Kaplan-Meier analysis was used to determine the survival of the PFR.Results: A total of nine patients (9 PFRs, 22%) were re-operated upon. Three re-operations were for infection, two for dislocation, two for aseptic loosening, and two for periprosthetic fracture. The survivorship at five years was 95.1% for revision of the femoral stem for aseptic loosening. We did not find length of the segmental reconstruction or the indication for revision, to be a risk factor for implant failure or re-revision.Conclusions: Proximal femoral replacements have shown an acceptable survivorship in non-oncologic revision hip arthroplasties for severe proximal femoral bone loss. The frequent use of constrained liners may decrease the risk of dislocation due to the loss of the abductor mechanism encountered in these complex reconstructions. [ABSTRACT FROM AUTHOR]

Introduction: Instability is a major complication in revision total hip arthroplasty (THA). Dual mobility (DM) cups were shown to reduce the risk of post-operative implant dislocation. Few case-series studies assessed the outcomes of cemented DM cups when associated to acetabular reconstruction antiprotrusio cages. No published comparative studies were found to look for outcome differences between standard cups (SC) and DM cups in first revision THA associated with a Kerboull plate (KP) and acetabular bone grafting.Materials and Methods: This is a retrospective comparative study of two groups of patients in two institutions. All cases were first revision THA with KP reconstruction; a cemented standard cup (SC) was used in one institution (THA-SC group) while a cemented DM cup was used in the second institution (THA-DM group). The posterolateral approach and the same technique for KP placement, the cross technique, were performed in both groups. Primary outcomes were dislocation and revision rates. Survivorship and clinical and radiological results were set to be secondary outcomes. There were ten patients (13 hips) in the first group and 16 patients (16 hips) in the second with a mean follow-up clinical and radiological evaluation of 74.2 ± 47.9 months.Results: Besides age, no significant demographic differences were present between both groups. There were three dislocations (23%) in the first group treated with close reduction compared to none in the second (p = 0.04). No further episode of dislocation or revision surgery occurred until the last follow-up in both groups. The mean Harris Hip Scores for the THA-SC and THA-DM groups were 87.5 ± 10.9 and 87.4 ± 12.1, respectively. When present, radiolucent lines were less than 1 mm thick and were non-progressive in both groups. In all patients, complete trabeculation remodeling or cortical repair of the graft was observed.Conclusion: The cup type was the single variable which could account for the observed dislocation rate difference. The mid-term results of using DM cups with KP in first revision THA seem very encouraging. Our findings add to the previously published results on the excellent outcomes in terms of stability in revision THA when using DM cups. [ABSTRACT FROM AUTHOR]

Purpose: In revision hip arthroplasty, custom-made implants are one option in patients with acetabular Paprosky III defects.Methods: In a retrospective analysis, we identified 11 patients undergoing cup revision using a custom-made implant. The accuracy of the intended position of the implant was assessed on post-operative 3D CT and compared to the pre-operative 3D planning in terms of inclination, anteversion, and centre of rotation. In addition, the accuracy of post-operative plain radiographs for measuring implant position was evaluated in relation to the 3D CT standard.Results: We found a mean deviation between the planned and the final position of the custom-made acetabular implant on 3D CT of 3.6° ± 2.8° for inclination and of - 1.2° ± 7.0° for anteversion, respectively. Restoration of center of rotation succeeded with an accuracy of 0.3 mm ± 3.9 mm in the mediolateral (x) direction, - 1.1 mm ± 3.8 mm in the anteroposterior (y) direction, and 0.4 mm ± 3.2 mm in the craniocaudal (z) direction. The accuracy of the post-operative plain radiographs in measuring the position of the custom-made implant in relation to 3D CT was 1.1° ± 1.7° for implant inclination, - 2.6° ± 1.3° for anteversion and 1.3 mm ± 3.5 mm in the x-direction, and - 0.9 mm ± 3.8 mm in the z-direction for centre of rotation.Conclusion: Custom-made acetabular implants can be positioned with good accuracy in Paprosky III defects according to the pre-operative planning. Plain radiographs are adequate for assessing implant position in routine follow-up. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the mid‐term clinical and radiographic results of revision total hip arthroplasty (THA) using jumbo cups in Chinese patients. Methods: We retrospectively studied 61 patients (63 hips; 29 men [30 hips], 32 women [33 hips]) who underwent acetabular revision with jumbo cups between January 2001 and April 2016 at our institution. The mean age at the index operation was 59.4 ± 11.4 years. The mean body mass index of the patients was 24.9 ± 3.8 kg/m2. Clinical evaluation was determined using the Harris hip score preoperatively and at follow up. Major complications (including instability, sepsis, and revision of the femoral or acetabular component) were recorded. Radiographic measurements included inclination and anteversion angles of the acetabular components, and the vertical and horizontal distances of the centers of rotation (V‐COR and H‐COR, respectively). In the 42 patients with normal contralateral hip joints, the postoperative V‐COR and H‐COR were compared between right and left sides. Their improvement in leg‐length discrepancy (LLD) after revision THA was also evaluated. Cup survival was evaluated using the Kaplan–Meier analysis. Clinical and radiographic outcomes were analyzed. Results: Mean follow up was 5.7 years (2–16 years). At the latest follow‐up, the average Harris hip score (preoperative vs postoperative values) had improved from 46 to 83 (P < 0.001). No acetabular component was radiographically defined as loosened. Four hips (6.3%) had major complications: one hip was revised because of periprosthetic infection (at 3 months); one underwent femoral open reduction and internal fixation (with implant retention) because of a periprosthetic femoral fracture (at 13 months); one operated hip developed a deep infection (at 2.5 years), which was treated with antibiotics; one hip experienced recurrent dislocation (at 4.5 years). The average cup inclination angle was 40.8° ± 6.8° and the average anteversion angle was 14.9° ± 6.6°. Average V‐COR decreased from 29.7 ± 10.4 mm to 22.3 ± 7.6 mm (P < 0.001). The average postoperative H‐COR was 29.5 ± 3.7 mm compared with 30.8 ± 6.6 mm preoperatively (P = 0.145). Among the 42 patients with normal contralateral hips, the average postoperative V‐COR were 22.2 ± 8.3 mm (operated side) and 14.0 ± 3.7 mm (contralateral side) (P < 0.001). LLD improved from −16.8 ± 17.1 mm to −5.6 ± 11.8 mm (P < 0.001). When failure was defined as any reoperation involving the hip, the mean 16‐year hip survival was 96.8% (95% confidence interval [CI] 87.9%–99.2%). When defined as any hip reoperation or major complication, it was 92.7% (95%CI 81.2%–97.2%). Conclusion: Use of jumbo cups for revision THA resulted in excellent mid‐term cup survival and helped restore the COR. [ABSTRACT FROM AUTHOR]

Background: Despite increased interest in one-stage revision arthroplasty for periprosthetic joint infection (PJI) of the hip, the reported infection-free proportions after the one-stage approach are still comparable to that of two-stage revision. However, we still lack studies that analyze factors associated with any re-revision after one-stage revision arthroplasty for PJI.Questions/purposes: After one-stage revision arthroplasty for PJI of the hip, what factors were associated with an increased risk of re-revision, and what factors were associated with an increased risk of reinfection?Methods: We performed a single-center retrospective case-control analysis. Patients who underwent one-stage revision arthroplasty for PJI of the hip in our hospital between 2009 and 2017, and who were subsequently re-revised due to any reason, including reinfection, were identified from our electronic medical records. A total of 121 patients who underwent repeat revision for any reason after one-stage exchange for PJI of the hip were identified. The re-revision procedures were performed after a mean of 407 days. The primary reasons for re-revision were repeated hip dislocation in 53 of 121 patients (44%), reinfection including both new and persistent infections in 40 of 121 patients (33%), and aseptic loosening in 16 patients (13%). Forty-three patients underwent another revision procedure after the re-revision procedure (43 of 121; 36%). More than 40 potential patient-, joint- and surgery-related risk factors were investigated and compared with a 1:1 matched control participants by age, sex and year of the one-stage revision. Similar to the re-revision patients, controls were treated for PJI with one-stage revision arthroplasty; however, they did not undergo subsequent revision for any reason by the latest followup examination. The mean followup of the control group was 66 months (range, 17-119 months). The mean length of hospital stay was 26 days in the re-revised group (SD, 11.6 days) compared with 22 days for the controls (SD, 6.6 days). All analyses were performed to identify factors associated with general re-revision and reinfection.Results: The independent factors associated with repeat revision for any reason were persistent wound drainage for at least 1 week (odds ratio [OR], 7.4; 95% CI, 2.6-20.6; p < 0.001), isolation of enterococci (OR, 4.8; 95% CI, 1.4-15.7; p = 0.010), and prior surgery due to infection before the one-stage hip revision (OR, 3.6; 95% CI, 2.0-6.4; p < 0.001). The factors associated with reinfection including both new and persistent infections were prolonged wound drainage (OR, 6.9; 95% CI, 2.2-21.5; p = 0.001) and prior surgery due to infection (OR, 4.3; 95% CI, 1.9-9.5; p < 0.001).Conclusions: Prolonged wound drainage after the one-stage revision arthroplasty for PJI of the hip must be treated rigorously. Patients with a history of a prior surgical procedure due to hip infection should be informed about the risk of further re-revision when deciding for the one-stage exchange. In case of enterococcal isolation, surgeons may consider another treatment approach rather than the one-stage exchange. Furthermore, we recommend the use of dual mobility cups when performing the one-stage revision hip arthroplasty to reduce the risk of dislocation.Level of Evidence Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Introduction: Prior to being largely abandoned due to unacceptably high failure rates and the adverse physiologic reactions to metal ions, metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacing (HR) were in widespread use throughout the USA, and the potential benefit of decreased volumetric wear rates made it of particular interest to those who serve a young active population, such as military surgeons. The aim of our study was to determine the revision rate of metal on metal hip implants performed at our military institution and obtain current patient reported outcomes from this cohort.Materials and Methods: We conducted a retrospective review of patients who underwent MoM total hip arthroplasty (THA) or hip resurfacing (HR) at our institution from 2006 to 2012. Revision status and component type were determined, and patients were contacted to obtain current HOOS JR scores.Results: We identified 103 THAs in 88 patients and 38 HRs in 33 patients, with mean follow up of 10.2 years. Average age at time of surgery was 48 years, and 85% of the patients were male. The mean HOOS JR score in the THA and HR groups were 84.9 ± 17.6 and 75.8 ± 24.9, respectively (p = 0.38), and were not significantly lower in those who were revised. Two THA revisions occurred for metallosis and one for aseptic loosening of the femoral component. One HR revision occurred for breach of the anterior femoral neck, and one occurred for heterotopicossification.Conclusions: Revision rates of MoM THA and HR in this young, predominantly male population were 2.9% and 5.3%, respectively, and patients maintained generally good hip-specific outcomes. [ABSTRACT FROM AUTHOR]

Background: The Birmingham Hip Resurfacing (BHR) system (Smith and Nephew) was developed as an alternative to conventional total joint replacement for younger, more active patients. Among other complications exists the risk for femoral component failure. The only marketed revision option for such a complication involves exchange of all components for a total replacement arthroplasty. This presents as a considerable and potentially unnecessary operative burden where revision of only the femoral prosthesis would suffice. We have analysed revision options for BHR in the context of periprosthetic femoral fractures with a stable acetabular component. Methods: Technical details of dual mobility hip systems available in Australia were collated and analysed to assess for potential 'off label' use with an existing BHR acetabular component. These data were then compared with the custom‐made Smith and Nephew dual mobility implant with respect to clearance and sizing. Results: Two dual mobility articulation modalities from two companies were identified as appropriate for potential usage with four products analysed in detail. These two demonstrated acceptable sizing and clearance measurements. Conclusion: Comparison between readily available dual mobility prostheses with custom‐made implants showed off label dual mobility prosthetic use to be a viable alternative for femoral‐only revisions with in situ BHR. Single component revision has several advantages which include: a less complex surgical procedure, shorter operative time, decreased blood loss and the expectation of resultant lower morbidity. Furthermore, this less complex revision surgery should give comparable results to that of primary total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Background: The dual-mobility acetabular cup (DMC) has an additional bearing consisting of a mobile polyethylene component between the prosthetic head and the outer metal shell. This design has gained popularity in revision total hip arthroplasty (THA) and in primary treatment of femoral neck fractures with the anticipation of a reduced risk of THA instability. Our primary aim was to evaluate the overall revision risk of these cups on the basis of data from the Nordic Arthroplasty Register Association (NARA) database, and our secondary aim was to study specific revision causes including dislocation.Methods: Propensity score matching for age, sex, fixation of the cup and stem, and the year of surgery (2001 to 2014) was used to match 4,520 hip fractures treated with a DMC to 4,520 hip fractures treated with conventional THA (control group). Competing risk regression analyses with revision or death as the end point were used. Revision was defined as a secondary surgical procedure in which any component of the implant was removed or exchanged. In addition, revision of the cup was analyzed.Results: The DMCs had a lower risk of revision compared with conventional THA, with an adjusted hazard ratio (AHR) of 0.75 (95% confidence interval [CI] = 0.62 to 0.92). This was consistent after adjusting for surgical approach. DMCs had a lower risk of revision due to dislocation (AHR = 0.45 [95% CI = 0.30 to 0.68]) but we found no difference regarding revision for deep infection. Revision of the acetabular component, both in general and due to dislocation, was more frequent with the use of conventional cups. The risk of death was higher in the DMC group (AHR = 1.49 [95% CI = 1.40 to 1.59]).Conclusions: The use of a DMC as primary treatment for hip fracture was associated with a lower risk of revision in general and due to dislocation in particular. The total number of DMCs analyzed (4,520) likely exceeds any cohort of DMC-treated fractures published to date.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Postoperative infection remains a major challenge in revision total hip arthroplasty (THA) and revision total knee arthroplasty (TKA). Wound irrigation with dilute povidone-iodine (PI) solution has emerged as a simple, inexpensive, and potentially successful means of reducing postoperative infections. The aim of this study was to assess its effectiveness in reducing infection following revision THA and TKA in, to our knowledge, the largest revision cohort to date.Methods: Using our institution's total joint registry, we identified 1,402 revision THAs and 1,482 revision TKAs performed during the study period (2013, when the PI irrigation protocol was first implemented, to 2017). The PI lavage protocol was employed in 27% of the revision THA cases and 34% of the revision TKA cases; in the remaining cases, the protocol was not used. Demographics, comorbid conditions, underlying surgical diagnoses, and whether the revision was for a septic or an aseptic etiology were compared between the groups (use or no use of PI irrigation). Any reoperation due to infection, as assessed at 3 and 12 months following revision arthroplasty, was compared between the groups and propensity scores were calculated to account for differences in baseline characteristics between the groups.Results: After adjusting for baseline differences between the groups using the propensity-score weighted models, we found no significant difference in the rate of reoperation for infection at 3 months (p = 0.58 for revision THA, and p = 0.06 for revision TKA) and at 12 months (p = 0.78 for revision THA, and p = 0.06 for revision TKA). Nonetheless, the hazard ratios from the propensity-score model trended higher for patients who received PI lavage: 1.6 and 1.3 for revision THA at 3 and 12 months, respectively, and 2.9 at both 3 and 12 months for revision TKA.Conclusions: PI wound lavage demonstrated no benefit in reducing any reoperation for infection following revision THA and TKA. Moreover, the trend toward higher rates for reoperation for infection among patients who received PI irrigation merit further consideration.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Introduction: Surgical instrument contamination during total joint replacement is a matter of major concern. Available recommendations suggest changing suction tips, gloves and avoiding light handle manipulation during the procedure. There is a paucity of data regarding surgical gown contamination. The aim of the present study was to evaluate the contamination rate of surgical gowns (SGs) during total hip arthroplasty (THA) and secondarily compare it with other orthopedic procedures.Materials and Methods: One hundred and forty surgical gowns (from 70 surgeries) were screened for bacterial contamination using thioglycolate (a high-sensitivity culture broth). The THA contamination rate was compared with those of knee and spine procedures. Controls were obtained at the beginning of every surgery and from the culture broth. The procedure's duration and the level of training of the surgeon were evaluated as potential risk factors for contamination.Results: Bacterial contamination was identified on 12% of surgical gowns (22% of surgical procedures). The contamination rate during THA was 4.1% (2% in primary THA and 8.3% in revisions) vs 21.67% during other surgeries (spine and knee) (OR 6.15, p = 0.012). There were no contaminated SGs during THAs performed in ≤ 2 h (0/33 SGs) vs 7.5% (3/40) for THAs that took ≥ 2 h (p = 0.25).Conclusion: There was a high rate of SG contamination during orthopedic procedures that was higher during non-arthroplasty procedures and prolonged THAs. There were no contaminated surgical gowns in THAs under 120 min, efforts should point keeping primary THAs under this cutoff time. As a general recommendation, SGs should be changed every time there is concern about potential contamination. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the factors that led to re-revision surgeries in patients who underwent revision total hip arthroplasties (THA). Methods: A total of 352 revision THAs in 274 hips of 252 patients (January 2001-December 2012) were retrospectively analyzed. Patients with a history of a major component revision surgery, replacement of the modular components, debridement and irrigation with liner exchange in the presence of infection and a two-stage revision surgery were included in the study. The mean follow-up period after the revision surgery was 7.5 (range: 2 to 15) years. Results: A re-revision surgery was required in 17.6% of the index THA revision patients (62 THA re-revisions/352 THA revisions). The mean time between the index revision and re-revision surgeries was 60.4 (range: 0.5 to 348) months. The most common reason for the second revision surgery was aseptic loosening (38 THA revisions; 61.2%), followed by instability (8 THA revisions; 12.9%) and infection (6 THA revisions; 9.1%). When the re-revision surgery was taken as end point for assessing the survival rate after the index revision surgery, the cumulative survival rate 10 years after the first revision surgery was found 70.8%. No significant relationship was established between age, gender and the type of fixation and the rate of repeat revisions. However, re-revision rates were significantly higher in acetabular-only component revision cases in comparison to other or both component revisions. Conclusion: In our revision series, the major factor that necessitated a re-revision following index revision surgery was aseptic loosening, followed by instability. [ABSTRACT FROM AUTHOR]

Background: Revision total hip arthroplasty (revision THA) occurs for a wide variety of indications and in the United States it is coded under Diagnosis-Related Groups (DRGs) 466, 467, and 468, which do not account for revision etiology, a potentially substantial driver of cost. This study investigates revision THA costs and 30-day complications by indication, both locally and nationally.Methods: Hospitalization costs and complication rates for 1,422 aseptic revision THAs performed at a high-volume center between 2009 and 2014 were retrospectively reviewed. Additionally, charges for 28,133 revision THAs in the National Inpatient Sample (NIS) were converted to costs using the Healthcare Cost and Utilization Project cost-to-charge ratios, and 30-day complication rates for 3,224 revision THAs were obtained with use of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Costs and complications were compared between revision THAs performed for fracture, wear/loosening, and dislocation/instability with use of simultaneous and pairwise comparisons and a multivariable model accounting for American Society of Anesthesiologists (ASA) score, age, and sex.Results: Local hospitalization costs for fracture (median, $25,672) were significantly higher than those for wear/loosening ($20,228; p < 0.001) or dislocation/instability ($17,911; p < 0.001), with differences remaining significant even after adjusting for patient comorbidities (p < 0.001). NIS costs for fracture (median, $27,596) were higher than those for other aseptic indications (wear/loosening: $21,176, p < 0.001; dislocation/instability: $16,891, p< 0.001). Local 30-day orthopaedic complication rates for fracture (20.7%) were higher those than for dislocation/instability (9.0%; p = 0.007) and similar to those for wear/loosening (17.6%; p = 0.434). Nationally, combined medical and surgical complication rates for fracture (71.3% of patients with ≥1 complication) were significantly higher than those for wear/loosening (35.2%; p < 0.001) or dislocation/instability (35.1%; p < 0.001).Conclusions: Hospitalization costs for revision THA for fracture were 33% to 48% higher than for all other aseptic revision THAs, both locally and nationally. This increased cost persisted even after multivariable comorbidity adjustment, the current DRG basis for stratifying revision THA reimbursement. Additionally, 30-day complication rates suggest that increased resource utilization for fracture patients continues even after discharge. Indication-specific coding and reimbursement systems are necessary to maintain sustainable access to revision THA for all patients.Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

➤ Modular fluted titanium stems have become the implant of choice for most femoral component revisions as they have a lower risk of subsidence, thigh pain, femoral fracture, and stress shielding compared with previously used extensively coated cobalt-chromium stems. ➤ Modularity of the femoral component allows for optimal and independent fit and fill of the proximal and distal femoral segments, permitting immediate axial and rotational stability in shorter diaphyseal segments (<4 cm of scratch fit), thus reducing the risk of subsidence. Modularity also allows for independent adjustment of version of the proximal body relative to the distal stem, thus improving joint stability. The ability to make small adjustments in vertical and lateral offset further reduces the potential for instability and leg-length discrepancy, and the use of a titanium implant minimizes the risk of stress shielding compared with cobalt-chromium stems. ➤ In several retrospective case series, excellent mid-term to long-term outcomes and low complication rates have been observed with the use of modular fluted titanium stems in femoral revisions. ➤ The major disadvantages to the routine use of modular fluted titanium stems are the potential for taper junction failure (corrosion or fracture) and the increased cost of these stems compared with nonmodular stems. [ABSTRACT FROM AUTHOR]

Background: With the growing number of total hip arthroplasty (THA) procedures performed, revision surgery is also proportionately increasing, resulting in greater health care expenditures. The purpose of this study was to assess clinical outcomes and cost when using a collared, fully hydroxyapatite-coated primary femoral stem for revision THA compared to commonly used revision femoral stems.Methods: We retrospectively identified patients who underwent revision THA with a primary stem between 2011 and 2016 and matched them on demographic variables and reason for revision to a similar cohort who underwent revision THA. We extracted operative data and information on in-hospital resource use from the patients’ charts to calculate average cost per procedure. Patient-reported outcomes were recorded preoperatively and 1 year postoperatively.Results: We included 20 patients in our analysis, of whom 10 received a primary stem and 10, a typical revision stem. There were no significant between-group differences in mean Western Ontario and McMaster Universities Osteoarthritis Index score, Harris Hip Score, 12-Item Short Form Health Survey (SF-12) Mental Composite Scale score or Physical Composite Scale score at 1 year. Operative time was significantly shorter and total cost was significantly lower (mean difference –3707.64, 95% confidence interval –5532.85 to –1882.43) with a primary stem than with other revision femoral stems.Conclusion: We found similar clinical outcomes and significant institutional cost savings with a primary femoral stem in revision THA. This suggests a role for a primary femoral stem such as a collared, fully hydroxyapatite-coated stem for revision THA. [ABSTRACT FROM AUTHOR]

Background: Prior work suggests that computer-assisted navigation improves acetabular component position during primary total hip arthroplasty (THA). However, it is not known whether this translates to improvements in clinical outcomes. The purpose of this study was to test for associations between navigation use and the risk of dislocation, aseptic revision of the acetabular component, aseptic revision of the femoral component, aseptic revision of either component, and acute periprosthetic joint infection (PJI).Methods: This was a retrospective cohort study, conducted using the 100% Medicare Part A claims data set. Inclusion criteria were an age of ≥65 years and primary THA for osteoarthritis. First, the association between navigation use and patient and hospital characteristics was assessed. Second, while controlling for these characteristics, multivariate regression was used to test for the association of navigation use and the outcomes listed above.Results: A total of 803,732 primary THA procedures were identified; 14,540 (1.81%) involved the use of navigation. Navigation use was associated with younger age, other/unknown race, the Western census region, higher socioeconomic status, lower Charlson Comorbidity Index, shorter length of stay, private hospitals, teaching hospitals, and larger hospitals (p < 0.05 for each). Navigation use was associated with a lower rate of dislocation (1.00% versus 1.70% for no navigation; adjusted hazard ratio [HR] = 0.69; 95% confidence interval [CI] = 0.58 to 0.82; p < 0.001) and aseptic revision of the acetabular component (1.03% versus 1.55%; adjusted HR = 0.75; 95% CI = 0.64 to 0.88; p < 0.001). Navigation was not associated with aseptic revision of the femoral component (1.54% versus 1.87%; p = 0.064), aseptic revision of either component (1.91% versus 2.31%; p = 0.077), acute PJI at 6 weeks (0.34% versus 0.45%; p = 0.121), or acute PJI at 90 days (0.50% versus 0.66%; p = 0.458).Conclusions: The findings of this study suggest that navigation is associated with reductions in the rates of dislocation and aseptic acetabular revision following primary THA. However, these results should be interpreted carefully in the setting of potential confounding by unmeasured variables, such as surgeon volume, family support, and patient compliance. Causality cannot be inferred until further prospective trials can vet this technology.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: The dual mobility acetabular cup (DMC) was designed to reduce prosthetic instability and has gained popularity for both primary and revision total hip arthroplasty (THA). We compared the risk of revision of primary THA for primary osteoarthritis between patients treated with a DMC and those who received a metal-on-polyethylene (MoP) or ceramic-on-polyethylene (CoP) bearing.Methods: A search of the Nordic Arthroplasty Register Association (NARA) database identified THAs performed with a DMC during 1995 to 2013. With use of propensity score matching, 2,277 of these patients were matched (1:1), with regard to sex, age, component fixation, and year of surgery, with patients with an MoP or CoP bearing. We estimated the cumulative incidence of revision taking death as a competing risk into consideration and performed competing risk regression with revision or death as end points.Results: There was no difference in the overall risk of revision between the DMC group and the propensity-score-matched MoP/CoP group (adjusted hazard ratio [HR] = 1.18; 95% confidence interval [95% CI] = 0.87 to 1.62). Patients with a DMC bearing had a lower risk of revision due to dislocation (adjusted HR = 0.09; 95% CI = 0.03 to 0.29) but a higher risk of revision caused by infection (adjusted HR = 3.20; 95% CI = 1.49 to 6.85).Conclusions: There was no difference in overall risk of revision between the DMC and MoP/CoP groups. The DMCs protected against revision due to dislocation but THAs performed with this bearing were more commonly revised because of infection. There may have been a selection bias toward placing DMC implants in patients with greater frailty as the mortality rates were higher in the DMC group than in the age and sex-matched MoP/CoP group.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Introduction: Modular revision stems with a short distal component can prevent the bypassing of the femoral isthmus and hereby theoretically have advantages concerning risk of periprosthetic fractures, breakage of the junction and a technically easier revision procedure.Materials and Methods: Radiological evaluation of 202 stem revision operations with the modular curved revision stem "Revitan Curved" with a 2° taper was carried out after a mean follow-up period of 7.44 ± 2.09 years (3-13 years) to investigate whether short-stem combinations are effective in Paprosky 2 and 3A defects with respect to rate of subsidence and loosening.Results: Sixty of 62 endofemoral (96.8%) and 137 of 140 transfemoral implantations (97.9%) involved the short, 140 mm distal component. Significant subsidence was seen in 3.3% of cases following endofemoral implantation and in 2.1% of cases following transfemoral implantation. Neither aseptic loosening nor periprosthetic fracture were observed.Conclusion: The use of combinations of short modular components leads to reproducibly good outcomes in femoral revision with respect to subsidence and loosening. [ABSTRACT FROM AUTHOR]

Introduction: The minimally invasive direct anterior approach (DAA) is an established approach for primary total hip arthroplasty (THA). The complication rates in hip revision arthroplasty are much higher in comparison with primary THA. A right positioning of the implants and a soft tissue, especially the abductors spearing approach, is important to get good functional results and low complication rates. The aim of this study was to show the clinical and radiological outcome of isolated revision hip arthroplasty of the cup by using the DAA.Materials and Methods: Aseptic cup revisions were carried out in 48 patients using the DAA. A decision to exchange the stem was made intraoperatively in seven cases. Complications, radiological and functional outcome were assessed. All of the data were collected retrospectively. The mean follow-up period was 65 months.Results: In most of the cases the standard DAA was used. A proximal extension was nescessary in 15 patients (31%). The mean cup inclination angle after revision was 44° (min. 25°, max. 62°). Six implants (12.5%) were located outside of the Lewinnek safe zone. The centers of rotation of the revision implants were a mean of 0.6 cm superior (min. 0, max. 2.2 cm) and 0.5 cm lateral (min. 0.2 cm, max 1.2 cm) in comparison with the center of rotation in the healthy hip on the contralateral side. Harris Hip Score improved significantly from 50 to 91 (P = 0.03). Complications noted consisted of two periprosthetic infections (4.2%), one aseptic cup loosening (2.1%), two hematomas requiring revision (4.2%), and one case each of femoral nerve injury, lower-leg venous thrombosis, and pneumonia. No dislocations were observed and there were no cases of heterotopic ossification based on the Brooker classification. No persistent damage of the nervus cutaneus femoris lateralis was found at the follow-up examinations.Conclusions: The DAA represents a feasible option in hip revision arthroplasty. Anatomic reconstruction of the cup is reproducibly possible. Good medium-term results can also be achieved. Particularly in relation to dislocation, the complication rates are low. Due to the learning curve, the DAA should only be used in hip revision arthroplasty by those with sufficient experience in primary THA. Adequate data regarding stem revisions through the DAA are not available at the moment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) revision with cementless stems using a numeric global radiological score (GRxS) that summarizes two previously validated scores: secondary bone stock (SBS) and osseointegration-secondary stability (O-SS).Method: One hundred fifty cases of THA were evaluated at a mean follow-up of 6.5 ± 3.7 years. The GRxS combines the SBS, which evaluated cortical bone thickness, bone density and bone defects in each Gruen zone and the O-SS, which evaluated the location and extent of a single radiolucent line. To calculate the GRxS, the SBS and O-SS were each expressed on a 10-point scale and given equal weighing. The final result was a number out of 20. The GRxS was used to assign a radiological grade to each THA case: very good (20), good (18-15), average (13-12), or poor (≤ 10). The numerical mean (Nm) was calculated for each grade. The inter- and intra-observer reproducibility was evaluated.Results: The inter-observer reproducibility was good (0.8) and the intra-observer reproducibility was very good (0.9). The GRxS was considered very good in 46 cases (Nm 20), good in 57 cases (Nm 16.6), average in 25 cases and poor in 22 cases. There was a significant relationship between the GRxS and the Harris Hip and Postel Merle d'Aubigné scores (p < 0.0001), and the initial bone stock (p = 0.0001).Conclusions: The GRxS is reliable and reproducible. This information can be used by surgeons to adapt the surgical technique to bone characteristics (especially during revision cases) and to compare the outcomes of different implant designs. [ABSTRACT FROM AUTHOR]

Purpose: Revision of failed modular metal-on-metal total hip replacement (MoM-THA) can be technically difficult. A dual mobility liner can help to salvage a well-fixed acetabular component. The present paper reports the clinical and radiographic outcome of revision of failed Birmingham modular MoM-THA using a dual mobility liner.Methods: The present study reports on ten patients (3 female and 7 male) with 11 revision THAs. Patients underwent revision an average of 51 months (range 40-73 months) after index procedure. Mean follow-up after the revision was 31 months (range 24-37 months) and all patients underwent an MRI with metal artifact reduction software (MARS) at least two years after revision to assess for local polyethylene wear and osteolysis.Results: The Harris Hip score improved from 92.2 (range 63.0-100.0) to 100.0 (p = 0.072). One patient had a one-time dislocation within seven days of surgery. No patient required additional surgeries. Radiographs showed no signs of component loosening and osteolysis and MRI imaging revealed no evidence of polyethylene wear or osteolysis.Conclusion: A dual mobility liner in an existing Birmingham cup can provide excellent clinical and radiological short-term results without MRI evidence of increased polyethylene wear. Post-operative hip precautions should be enforced. [ABSTRACT FROM AUTHOR]

Purpose: Removal of an infected prosthesis was considered the gold standard for eradication of infection. However, removal of well-fixed components can result in structural bone damage and compromised reconstruction. In these situations we questioned whether the infection after the total hip arthroplasty could be treated effectively and retain the well-fixed implant in a single-stage exchange.Methods: A retrospective analysis which included 31 patients with chronic infected THA who underwent major partial single-stage revision, including routinely exchanged femoral head and liner components, aggressive soft tissue debridement, removal of the femoral stem or acetabular cup and retention of the well-fixed component, thorough exposed component brushing, and adequate surgical soaking. Powdered Vancomycin was poured into the surgical area and the infection control rate and clinical outcomes were evaluated. The failure to treat the infection was defined as a recurrence of infection in the same hip. The average follow-up was five years (2-15 years).Result: There were four (12.9 %) failures during the study period at an average of 15 months (9-21 months) after partial single-stage revision. Of the 31 patients, 27 (87.1 %) patients had a satisfactory outcome and required no additional surgical or medical treatment for recurrence of infection. Acetabular cups were revised in 22 patients and femoral stems in nine patients. The mean post-operative Harris hip score at the most recent assessment was 74.6 (68-82).Conclusions: Treatment of chronic infected THA with retention of the well-fixed implant in a single-stage exchange can be fairly effective in the treatment of infection and achieving acceptable functional outcomes, which indicated that this may be an attractive alternative in highly selected patients.Level Of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

The potential advantages of contemporary MoM THA implants include less volumetric wear with subsequent reduction of polyethylene wear-induced osteolysis and greater component stability with use of large-diameter femoral heads. However, there have been concerns regarding significantly elevated revision rates in MoM THA due to MoM-related complications such as adverse local tissue reaction (pseudotumour) formation. The increased failure rate in MoM hip arthroplasty is associated with the generation of biologically active, nanometer sized metal particles from the MoM bearing surfaces and taper junctions, which result in the development of a localized, adverse periprosthetic soft tissue response. The focus of this article is to provide an update on (1) implant, surgical and patient factors associated with adverse local tissue reactions (pseudotumours) and (2) the clinical systematic evaluation and management of patients with MoM hip arthroplasty based on the currently available evidence. There should be a low threshold to conduct a systematic clinical evaluation of patients with MoM hip arthroplasty as early recognition and diagnosis will allow the initiation of prompt and appropriate treatment. As a symptomatic MoM total hip arthroplasty may have intrinsic and extrinsic causes, patients should be evaluated systematically, utilizing risk stratification algorithms. Although specialized laboratory tests such as metal ion levels and cross sectional imaging modalities such as MARS MRI can be used to facilitate clinical decision making, over-reliance on any single investigative tool in the clinical decision-making process should be avoided. Further research is required to obtain a better understanding of implant and patient risk factors associated with tribocorrosion in MoM total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Introduction: Recent studies have reported short-term favourable results of tantalum-made components in acetabular revisions with bone loss. However, there is a lack of information regarding the mid to long-term results of such components.Objectives: The objective of this study was to analyse the outcome and survivorship of acetabular revision hip arthroplasty using tantalum components for loosening associated with bone loss at a minimum of five-year follow-up.Methods: We retrospectively reviewed 51 consecutive patients (51 hips) who had an acetabular revision using porous tantalum components at a minimum follow-up of five years. The mean age was 64 years (range, 31-87). There were 27 males and 24 females, 47 right hips and four left hips. Twenty-five (49 %) included a femoral revision. According to Paprosky's classification 18 hips were classified type 2A, 11 type 2B, ten type 2C, seven type 3A and five type 3B. No bone grafting was performed. Sixteen hips (31.3 %) required the use of additional tantalum-made augments stabilized by screws and cement at the cup-augment interface.Results: At a mean followup of 6.8 years (range, 5.1-10 years), the Harris hip score improved from 44 pre- operatively (range, 23-72) to 84 post-operatively (range, 33-98). The mean post-operative hip centre position in relation to the teardrop was 29 mm (range, 20-43 mm) horizontally and 21 mm (range, 8-36 mm) vertically. The mean acetabular inclination was 42° (range, 17-60°). Six hips (11.7 %) required a re-operation without component revision (two for chronic instability, one ossification removal, one haematoma, one deep infection and one periprosthetic femoral fracture). One patient required a cup re-revision for septic loosening. No aseptic loosening occurred. At last followup the radiological analysis showed one evolutive osteolysis and one screw breakage. The global survivorship was 92.3 % at 64 months. If only aseptic loosening was defined as the end-point the survivorship was 100 % at 64 months.Conclusions: When facing an acetabular revision with severe bone loss, tantalum-made components can provide a stable fixation. This study at a minimum five-year follow-up compares favourably with other reconstruction techniques, but longer follow-up is still required. [ABSTRACT FROM AUTHOR]

Revision THA is increasingly performed especially in the elderly population. The surgeon's challenge is to provide a solution that supports immediate full weight-bearing, despite poor bone quality. Shape-closed revision stems facilitate that by combining cement fixation with additional press-fit anchoring. The design tolerates varying cement mantle thickness and inconsistent cancellous bone lining of the femoral canal. Following that philosophy, we present our mid-term results using a long version of a cemented Charnley- Kerboull type stem. From 2010 to 2017, 38 long Charnley-Kerboull revision stems (Centris®, Mathys European Orthopaedics, Bettlach, Switzerland) were implanted and followed prospectively. Surgery was performed via a Hardinge approach in supine position with a third generation cementing technique. Patients were mobilized using full-weight bearing as early as possible. Survival was determined for stem revision for aseptic loosening and stem and/or cup revision for any reason. 20 stems had a minimum follow-up (f/u) of 2 years and were included for further radiological analysis. Detailed subsidence analysis as an early predictor for later aseptic loosening was performed using EBRA-FCA software. Further, the presence of osteolysis and cement debonding was evaluated. Mean follow- up was 4 years. No patient was lost to f/u.18 died of causes unrelated to THA. Stem survival was 100%. Survival for any re-operation was 82.2% (two early infections, one soft-tissue debridement, one cup exchange for recurrent dislocations). None of the cases revised for septic loosening showed signs of persistent infection at final f/u. EBRA-FCA revealed two oligosymptomatic cases of subsidence of 5mm and 6mm over a course of 2 and 12 months, respectively, with stable implants thereafter. Neither required revision. There was no development of osteolysis or debonding. The stem provides a reliable early fullweight bearing solution for revision THA with excellent mid-term survival in an elderly population. Even in two cases where subsidence was present, mobility was not impaired and re-revision could be avoided. [ABSTRACT FROM AUTHOR]

The article offers information on the risk of repeat revision of Patellofemoral replacement (PFR) to total knee arthroplasty (TKA) and an analysis of of cases from a Large National Arthroplasty Registry. It mentions PFR as an attractive alternative to TKA in patients who have arthritis confined to the patellofemoral compartment and also mentions a meta-analysis that found more than three-fold annual increased risk of revision for PFR compared to primary TKAs.

Preclinical studies of vitamin E diffused highly cross-linked polyethylene (E-XLPE) has shown enhanced mechanical properties with less wear. The purpose of our study was to document the early clinical outcome of E-XLPE to ensure, for the safety of patients, that there are no unforeseen early adverse events from using this new biomaterial.~Purpose~Objective~The enrolled patients (n = 977) have received either a porous titanium coated or porous plasma sprayed acetabular shell with either a E-XLPE liner or a medium cross-linked (AXL) liner. At each follow-up 5 patient-reported outcome measures (PROMs) were completed: Harris Hip Score, Case Mix Indicator, UCLA Activity Score, SF-36, and EQ-5D. Radiographs were measured for cup and stem position, as well as femoral head penetration into the liner (wear). Postoperative complications and revisions were collected.~Methods~Methods~At 3 years follow-up, there were 13 revisions due to: 4 periprosthetic fractures; 1 sepsis; 6 instabilities; and 2 implant mismatches at surgery. Wear of the hip implant, calculated by software analysis of pelvis x-rays, from the postoperative interval to 3 years showed a liner penetration rate of 0.027 mm/year for AXL and 0.005¿mm/year for E-XLPE with no significant difference between the 2 (p = 0.24). Improvement was seen in all PROMs from the preoperative interval to 3 years after surgery (p<0.0001).~Results~Results~Early follow-up of the E-XLPE and AXL liners show low penetration. PROMs indicate improvement after total hip arthroplasty in functionality and quality of life across the centers. We have not observed any early in vivo adverse effects from diffusing the liners with vitamin E.~Conclusions~Conclusions~ClinicalTrials.gov Identifier: NCT00545285.~Trial Registration~Background [ABSTRACT FROM AUTHOR]

Purpose: Recently, concerns have arisen about metal-on-metal (MoM) total hip arthroplasty (THA). Therefore, the purpose of this cross-sectional cohort study was to describe the incidence of pain, pseudotumours, revisions and the relation between elevated metal ion levels, functional outcome and quality of life after MoM THA. Methods: In 351 patients, 377 MoM THA with a fixed-size 38-mm head were evaluated with a mean follow-up of 30 months (range 11-58). Evaluation included pain, serum metal ions, patient-reported questionnaires (Short Form-36 [SF-36], Hip disability and Osteoarthritis Outcome Score [HOOS] and the Oxford Hip Score [OHS]) and radiological imaging. Sixteen patients did not participate in the screening. Results: One hundred and eighteen (35 %) patients reported pain and showed significantly higher cobalt and chromium levels compared to patients without pain. Median serum cobalt levels were 4.4 μg/l (interquartile range [IQR] 6.6) and chromium levels were 3.6 μg/l (IQR 4.8). Patients with cobalt levels of ≤5 μg/l reported significantly better outcome on the SF-36 and HOOS. Fifty-seven pseudotumours were identified in 227 THAs. A revision rate of 19 % was observed. Conclusions: In conclusion, 35 % of the patients experienced pain after MoM THA. These patients showed significantly higher serum metal ion levels. The patient-reported questionnaires indicated significantly better outcome in patients with cobalt levels ≤5 μg/l. [ABSTRACT FROM AUTHOR]

Background: The articular surface replacement (ASR) hip resurfacing system, now withdrawn, has the highest all-cause revision rate (24.2 % at 7 years) compared with other resurfacing brands. We present our experience with the ASR articulation and the implant recall process. Methods: We reviewed the medical records and examined all 55 patients (57 hips) who had THA by the senior author between March 2005 and November 2008. We recorded the Oxford Hip scores, metal ion levels, need for revision, the indication for revision, and the intra-operative findings. Radiographs were performed at the time of recall to detect component failure. Results: Survival at 5 years with revision for any reason as the endpoint was 85.1 % for all patients. At the time of recall, 10 (17.5 %) of fifty-seven THAs were already revised. Four (40 %) of the ten revisions were performed within 1 month of the operation due to a periprosthetic fracture. Three other revisions were due to avascular necrosis at a mean time of 3.6 years. One patient was revised due to infection. The two remaining revisions were due to ongoing groin pain, in one of whom the cup was found to be loose. Conclusions: Our data indicate an overall high revision rate, comparable with recently published studies. Even though most of our revisions were attributed to causes that are not specific to the metal-on-metal articulation, we do expect to find more cases of failures in the future. Therefore, continued close clinical surveillance and laboratory monitoring of these patients is warranted. [ABSTRACT FROM AUTHOR]

The article offers a study that highlights the role of Trabecular Metal Acetabular components in reducing the risk of revision after revision Total hip arthroplasty (THA) performed for Periprosthetic Joint Infection. It mentions THA implants comes from the strides made in biomechanics and the relentless improvements in biomedical materials and also highlights that THA experience a lower likelihood of clinical success.