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Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty.

Publication ,  Journal Article
Penrose, CT; Seyler, TM; Wellman, SS; Bolognesi, MP; Lachiewicz, PF
Published in: Clin Orthop Relat Res
October 2016

BACKGROUND: Isolated revision of the acetabular component in the setting of total hip arthroplasty has an increased risk of dislocation. With local soft tissue destruction frequently associated with failed metal-on-metal (MoM) bearings, it is presumed that acetabular revision of these hips will have even greater risk of complications. However, no study directly compares the complications of MoM with metal-on-polyethylene (MoP) acetabular revisions. QUESTIONS/PURPOSES: In the context of a large database analysis, we asked the following questions: (1) Are there differences in early medical or wound complications after isolated acetabular revision of MoM and MoP bearing surfaces? (2) Are there differences in the frequency of dislocation, deep infection, and rerevision based on the bearing surface of the original implant? METHODS: A review of the 100% Medicare database from 2005 to 2012 was performed using International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. We identified 451 patients with a MoM bearing and 628 patients with a MoP bearing who had an isolated acetabular revision and a minimum followup of 2 years. The incidence, odds ratios, and 95% confidence intervals for early medical or wound complications were calculated using a univariate analysis at 30 days with patient sex and age group-adjusted analysis for blood transfusion. The incidence, odds ratio, and 95% confidence intervals for dislocation, deep infection, and rerevision were calculated using a univariate analysis at 30 day, 90 days, 1 year, and 2 years using a subgroup analysis with the Cochran-Mantel-Haenszel test to adjust for patient gender and age groups. RESULTS: There were no differences between the MoM and MoP isolated acetabular revisions in the incidence of 30-day local complications. There was a greater risk of transfusion in the MoP group than the MoM group (134 of 451 [30%] versus 230 of 628 [37%]; odds ratio [OR], 0.731; 95% confidence interval [CI], 0.565-0.948; p = 0.018). There were no differences at 2 years between the MoM and MoP acetabular revisions in the incidence of dislocation, infection, or rerevision. When analyzed by patient sex and age group, there were more infections in the age 70 to 79 years MoP group compared with MoM (10 of 451 [5%] versus 29 of 628 [10%]; OR, 4.47; CI, 1.699-11.761; p = 0.001). CONCLUSIONS: There were high rates of dislocation, infection, and rerevision in both revision cohorts. The rate of dislocation was not greater after acetabular revision of MoM bearings at 2 years. Based on these findings, clinicians should counsel these patients preoperatively about the risks of these complications. Dual-mobility and constrained components have specific advantages and disadvantages in these settings and should be further studied. LEVEL OF EVIDENCE: Level III, therapeutic study.

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Published In

Clin Orthop Relat Res

DOI

EISSN

1528-1132

Publication Date

October 2016

Volume

474

Issue

10

Start / End Page

2134 / 2142

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Prosthesis Design
  • Postoperative Complications
  • Polyethylene
  • Orthopedics
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Penrose, C. T., Seyler, T. M., Wellman, S. S., Bolognesi, M. P., & Lachiewicz, P. F. (2016). Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty. Clin Orthop Relat Res, 474(10), 2134–2142. https://doi.org/10.1007/s11999-016-4793-4
Penrose, Colin T., Thorsten M. Seyler, Samuel S. Wellman, Michael P. Bolognesi, and Paul F. Lachiewicz. “Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty.Clin Orthop Relat Res 474, no. 10 (October 2016): 2134–42. https://doi.org/10.1007/s11999-016-4793-4.
Penrose CT, Seyler TM, Wellman SS, Bolognesi MP, Lachiewicz PF. Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty. Clin Orthop Relat Res. 2016 Oct;474(10):2134–42.
Penrose, Colin T., et al. “Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty.Clin Orthop Relat Res, vol. 474, no. 10, Oct. 2016, pp. 2134–42. Pubmed, doi:10.1007/s11999-016-4793-4.
Penrose CT, Seyler TM, Wellman SS, Bolognesi MP, Lachiewicz PF. Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty. Clin Orthop Relat Res. 2016 Oct;474(10):2134–2142.
Journal cover image

Published In

Clin Orthop Relat Res

DOI

EISSN

1528-1132

Publication Date

October 2016

Volume

474

Issue

10

Start / End Page

2134 / 2142

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Prosthesis Design
  • Postoperative Complications
  • Polyethylene
  • Orthopedics