Fate of the Retained Acetabular Component During Revision Total Hip Arthroplasty: A Meta-Analysis and Systematic Review

The aim of this meta-analysis and systematic review is to estimate re-revision rates due to aseptic loosening of retained acetabular components after revision total hip arthroplasty. PubMed, EMBASE, Cochrane Library, and Web of Science were searched until June 11, 2018. Data were extracted by 2 independent investigators and consensus was reached with the involvement of a third investigator. Rates of re-revision due to aseptic loosening from 6 studies were aggregated using random effects model after a logit transformation and were grouped by study and population level characteristics. An assessment of the re-revision rates of retained acetabular components due to aseptic loosening in revision total hip arthroplasty was reported in 6 studies involving 669 cases. The pooled re-revision rate was 12.6% (95% confidence interval 8.4-18.4) with a mean study follow-up of 8.6 years. The rate of re-revision due to aseptic loosening of retained acetabular components was 6.8% (95% confidence interval 3.4-13.3). In the univariate meta-regression analysis, mean age at index revision surgery was significantly associated with the rate of re-revision due to aseptic loosening (R2 = 99.98%, P < .0001). Based on this exploratory analysis, revision hip procedures with retentions of well-fixed acetabular components generally have a low risk of failure during mid-term to long-term follow-ups.