What Are the Long-term Results of Cemented Revision THA with Use of Both Acetabular and Femoral Impaction Bone Grafting in Patients Younger Than 55 Years?
The increasing number of THAs in younger patients will inevitably result in an increase of revision procedures. However, there is little evidence about the outcome of revision procedures in this patient group. Therefore, we updated a previous study conducted 5 years ago about the outcome of revision...
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| description | The increasing number of THAs in younger patients will inevitably result in an increase of revision procedures. However, there is little evidence about the outcome of revision procedures in this patient group. Therefore, we updated a previous study conducted 5 years ago about the outcome of revision procedures in patients younger than 55 years.
We sought to provide a concise update on the previously reported (1) long-term failure rate as defined by repeat revision, (2) clinical outcome as defined by the Oxford Hip score and the Harris Hip score, and (3) radiographic outcome of cemented revision THA performed with impaction bone grafting on both the acetabular and femoral sides in one surgery in patients younger than 55 years old.
Between 1991 and 2007, we performed 86 complete THA revisions in patients younger than 55 years. In 38% (33 of 86) of revisions, bone impaction grafting was used on both the acetabular and femoral side because of acetabular and femoral bone stock loss. Mean age at time of revision was 46 ± 8 years. No patient was lost to follow-up, but six patients died during follow-up, including three since 2015. Still, the hips of all 33 patients were included in analysis at a mean of 17 ± 5 years. Failure was calculated using competing risk analysis. For clinical outcome, we assessed the Harris Hip score and the Oxford Hip score from our longitudinally maintained institutional database. Radiographic analysis was performed to evaluate radiographic loosening, defined as radiolucencies ≥ 2 mm in all zones or ≥ 5 mm migration for both components. The acetabular component was also considered loose with tilting ≥ 5°.
The 15-year failure rate of revision THA was 27% (95% CI 13 to 44) for re-revision of any component for any reason and 10% (95% CI 3 to 25) for re-revision of any component for aseptic loosening. The mean Harris Hip score increased from 55 ± 18 preoperatively to 74 ± 22 at latest follow-up. Eight cups were considered radiographically loose, seven of which were re-revised. No stems were considered radiographically loose. Failure rate with endpoint radiographic loosening at 15 years was 23% (95% CI 10 to 39).
We found that impaction bone grafting with a cemented cup and a cemented stem is a valuable biological revision technique that results in a stable and durable solution, after one or even multiple previous revision THAs. Although current implants may prove sufficient in most cases, they do not promote bone stock preservation. We belie |
| doi_str_mv | 10.1097/CORR.0000000000001462 |
| format | Article |
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We sought to provide a concise update on the previously reported (1) long-term failure rate as defined by repeat revision, (2) clinical outcome as defined by the Oxford Hip score and the Harris Hip score, and (3) radiographic outcome of cemented revision THA performed with impaction bone grafting on both the acetabular and femoral sides in one surgery in patients younger than 55 years old.
Between 1991 and 2007, we performed 86 complete THA revisions in patients younger than 55 years. In 38% (33 of 86) of revisions, bone impaction grafting was used on both the acetabular and femoral side because of acetabular and femoral bone stock loss. Mean age at time of revision was 46 ± 8 years. No patient was lost to follow-up, but six patients died during follow-up, including three since 2015. Still, the hips of all 33 patients were included in analysis at a mean of 17 ± 5 years. Failure was calculated using competing risk analysis. For clinical outcome, we assessed the Harris Hip score and the Oxford Hip score from our longitudinally maintained institutional database. Radiographic analysis was performed to evaluate radiographic loosening, defined as radiolucencies ≥ 2 mm in all zones or ≥ 5 mm migration for both components. The acetabular component was also considered loose with tilting ≥ 5°.
The 15-year failure rate of revision THA was 27% (95% CI 13 to 44) for re-revision of any component for any reason and 10% (95% CI 3 to 25) for re-revision of any component for aseptic loosening. The mean Harris Hip score increased from 55 ± 18 preoperatively to 74 ± 22 at latest follow-up. Eight cups were considered radiographically loose, seven of which were re-revised. No stems were considered radiographically loose. Failure rate with endpoint radiographic loosening at 15 years was 23% (95% CI 10 to 39).
We found that impaction bone grafting with a cemented cup and a cemented stem is a valuable biological revision technique that results in a stable and durable solution, after one or even multiple previous revision THAs. Although current implants may prove sufficient in most cases, they do not promote bone stock preservation. We believe that in young patients with bone stock loss, impaction bone grafting can be used as long as the defect can be contained adequately with a metal mesh and viable bone bed is available for revascularization.
Level IV, therapeutic study.</description><identifier>ISSN: 0009-921X</identifier><identifier>EISSN: 1528-1132</identifier><identifier>DOI: 10.1097/CORR.0000000000001462</identifier><identifier>PMID: 32898047</identifier><language>eng</language><publisher>United States: Wolters Kluwer</publisher><subject>Acetabulum ; Acetabulum - diagnostic imaging ; Acetabulum - physiopathology ; Acetabulum - surgery ; Adult ; Age Factors ; Arthroplasty, Replacement, Hip - adverse effects ; Arthroplasty, Replacement, Hip - instrumentation ; Bone Cements - adverse effects ; Bone Cements - therapeutic use ; Bone grafts ; Bone implants ; Bone surgery ; Bone Transplantation - adverse effects ; Clinical Research ; Databases, Factual ; Female ; Femur ; Femur - diagnostic imaging ; Femur - physiopathology ; Femur - surgery ; Hip Joint - diagnostic imaging ; Hip Joint - physiopathology ; Hip Joint - surgery ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Patients ; Postoperative Complications - diagnostic imaging ; Postoperative Complications - physiopathology ; Postoperative Complications - surgery ; Prosthesis Failure ; Reoperation ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Skin & tissue grafts ; Surgical mesh ; Time Factors ; Treatment Outcome</subject><ispartof>Clinical orthopaedics and related research, 2021-01, Vol.479 (1), p.84-91</ispartof><rights>Wolters Kluwer</rights><rights>Copyright © 2020 by the Association of Bone and Joint Surgeons.</rights><rights>2020 by the Association of Bone and Joint Surgeons</rights><rights>2020 by the Association of Bone and Joint Surgeons 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5366-cc59cd07e3c1fcf0042000b33f2281f9bb4d161c6625829c1cf94816d5f573ab3</citedby><cites>FETCH-LOGICAL-c5366-cc59cd07e3c1fcf0042000b33f2281f9bb4d161c6625829c1cf94816d5f573ab3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899485/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899485/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32898047$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Verspeek, Jason</creatorcontrib><creatorcontrib>Nijenhuis, Thijs A.</creatorcontrib><creatorcontrib>Kuijpers, Martijn F. L.</creatorcontrib><creatorcontrib>Rijnen, Wim H. C.</creatorcontrib><creatorcontrib>Schreurs, B. Willem</creatorcontrib><title>What Are the Long-term Results of Cemented Revision THA with Use of Both Acetabular and Femoral Impaction Bone Grafting in Patients Younger Than 55 Years?</title><title>Clinical orthopaedics and related research</title><addtitle>Clin Orthop Relat Res</addtitle><description>The increasing number of THAs in younger patients will inevitably result in an increase of revision procedures. However, there is little evidence about the outcome of revision procedures in this patient group. Therefore, we updated a previous study conducted 5 years ago about the outcome of revision procedures in patients younger than 55 years.
We sought to provide a concise update on the previously reported (1) long-term failure rate as defined by repeat revision, (2) clinical outcome as defined by the Oxford Hip score and the Harris Hip score, and (3) radiographic outcome of cemented revision THA performed with impaction bone grafting on both the acetabular and femoral sides in one surgery in patients younger than 55 years old.
Between 1991 and 2007, we performed 86 complete THA revisions in patients younger than 55 years. In 38% (33 of 86) of revisions, bone impaction grafting was used on both the acetabular and femoral side because of acetabular and femoral bone stock loss. Mean age at time of revision was 46 ± 8 years. No patient was lost to follow-up, but six patients died during follow-up, including three since 2015. Still, the hips of all 33 patients were included in analysis at a mean of 17 ± 5 years. Failure was calculated using competing risk analysis. For clinical outcome, we assessed the Harris Hip score and the Oxford Hip score from our longitudinally maintained institutional database. Radiographic analysis was performed to evaluate radiographic loosening, defined as radiolucencies ≥ 2 mm in all zones or ≥ 5 mm migration for both components. The acetabular component was also considered loose with tilting ≥ 5°.
The 15-year failure rate of revision THA was 27% (95% CI 13 to 44) for re-revision of any component for any reason and 10% (95% CI 3 to 25) for re-revision of any component for aseptic loosening. The mean Harris Hip score increased from 55 ± 18 preoperatively to 74 ± 22 at latest follow-up. Eight cups were considered radiographically loose, seven of which were re-revised. No stems were considered radiographically loose. Failure rate with endpoint radiographic loosening at 15 years was 23% (95% CI 10 to 39).
We found that impaction bone grafting with a cemented cup and a cemented stem is a valuable biological revision technique that results in a stable and durable solution, after one or even multiple previous revision THAs. Although current implants may prove sufficient in most cases, they do not promote bone stock preservation. We believe that in young patients with bone stock loss, impaction bone grafting can be used as long as the defect can be contained adequately with a metal mesh and viable bone bed is available for revascularization.
Level IV, therapeutic study.</description><subject>Acetabulum</subject><subject>Acetabulum - diagnostic imaging</subject><subject>Acetabulum - physiopathology</subject><subject>Acetabulum - surgery</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Arthroplasty, Replacement, Hip - adverse effects</subject><subject>Arthroplasty, Replacement, Hip - instrumentation</subject><subject>Bone Cements - adverse effects</subject><subject>Bone Cements - therapeutic use</subject><subject>Bone grafts</subject><subject>Bone implants</subject><subject>Bone surgery</subject><subject>Bone Transplantation - adverse effects</subject><subject>Clinical Research</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Femur</subject><subject>Femur - diagnostic imaging</subject><subject>Femur - physiopathology</subject><subject>Femur - surgery</subject><subject>Hip Joint - diagnostic imaging</subject><subject>Hip Joint - physiopathology</subject><subject>Hip Joint - surgery</subject><subject>Hip Prosthesis</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Postoperative Complications - diagnostic imaging</subject><subject>Postoperative Complications - physiopathology</subject><subject>Postoperative Complications - surgery</subject><subject>Prosthesis Failure</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Skin & tissue grafts</subject><subject>Surgical mesh</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0009-921X</issn><issn>1528-1132</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkdtu1DAQhiMEotvCI4AsccNNio853IC2q56klYpWW7W9shxnsklJ7MV2uuJVeFoctlSlvrFn_P-fZvQnyQeCjwku8y-Lq9XqGD87hGf0VTIjghYpIYy-TmaxW6YlJbcHyaH397FkXNC3yQGjRVlgns-S3zetCmjuAIUW0NKaTRrADWgFfuyDR7ZBCxjABKhj76HznTVofTFHuy606NrDpDix8T3XEFQ19sohZWp0BoN1qkeXw1bpMLlOrAF07lQTOrNBnUHfVegi2aM7O5oNOLRulUFCoDtQzn97l7xpVO_h_eN9lFyfna4XF-ny6vxyMV-mWrAsS7UWpa5xDkyTRjcYcxoXrRhrKC1IU1YVr0lGdJZRUdBSE92UvCBZLRqRM1Wxo-TrnrsdqwFqHUeKg8ut6wblfkmrOvn_j-laubEPMi_KSBIR8PkR4OzPEXyQQ-c19L0yYEcvKeeEFrRgPEo_vZDe29GZuJ6kAuc8I4xMQLFXaWe9d9A8DUOwnNKXU_ryZfrR9_H5Jk-uf3FHAd8LdraPMfsf_bgDJ1tQfWj_8hguspRiSjCJVTqRM_YHz6-6YQ</recordid><startdate>20210101</startdate><enddate>20210101</enddate><creator>Verspeek, Jason</creator><creator>Nijenhuis, Thijs A.</creator><creator>Kuijpers, Martijn F. L.</creator><creator>Rijnen, Wim H. C.</creator><creator>Schreurs, B. Willem</creator><general>Wolters Kluwer</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210101</creationdate><title>What Are the Long-term Results of Cemented Revision THA with Use of Both Acetabular and Femoral Impaction Bone Grafting in Patients Younger Than 55 Years?</title><author>Verspeek, Jason ; Nijenhuis, Thijs A. ; Kuijpers, Martijn F. L. ; Rijnen, Wim H. C. ; Schreurs, B. Willem</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5366-cc59cd07e3c1fcf0042000b33f2281f9bb4d161c6625829c1cf94816d5f573ab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acetabulum</topic><topic>Acetabulum - diagnostic imaging</topic><topic>Acetabulum - physiopathology</topic><topic>Acetabulum - surgery</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Arthroplasty, Replacement, Hip - adverse effects</topic><topic>Arthroplasty, Replacement, Hip - instrumentation</topic><topic>Bone Cements - adverse effects</topic><topic>Bone Cements - therapeutic use</topic><topic>Bone grafts</topic><topic>Bone implants</topic><topic>Bone surgery</topic><topic>Bone Transplantation - adverse effects</topic><topic>Clinical Research</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Femur</topic><topic>Femur - diagnostic imaging</topic><topic>Femur - physiopathology</topic><topic>Femur - surgery</topic><topic>Hip Joint - diagnostic imaging</topic><topic>Hip Joint - physiopathology</topic><topic>Hip Joint - surgery</topic><topic>Hip Prosthesis</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Postoperative Complications - diagnostic imaging</topic><topic>Postoperative Complications - physiopathology</topic><topic>Postoperative Complications - surgery</topic><topic>Prosthesis Failure</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Skin & tissue grafts</topic><topic>Surgical mesh</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Verspeek, Jason</creatorcontrib><creatorcontrib>Nijenhuis, Thijs A.</creatorcontrib><creatorcontrib>Kuijpers, Martijn F. L.</creatorcontrib><creatorcontrib>Rijnen, Wim H. C.</creatorcontrib><creatorcontrib>Schreurs, B. Willem</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical orthopaedics and related research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Verspeek, Jason</au><au>Nijenhuis, Thijs A.</au><au>Kuijpers, Martijn F. L.</au><au>Rijnen, Wim H. C.</au><au>Schreurs, B. Willem</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>What Are the Long-term Results of Cemented Revision THA with Use of Both Acetabular and Femoral Impaction Bone Grafting in Patients Younger Than 55 Years?</atitle><jtitle>Clinical orthopaedics and related research</jtitle><addtitle>Clin Orthop Relat Res</addtitle><date>2021-01-01</date><risdate>2021</risdate><volume>479</volume><issue>1</issue><spage>84</spage><epage>91</epage><pages>84-91</pages><issn>0009-921X</issn><eissn>1528-1132</eissn><abstract>The increasing number of THAs in younger patients will inevitably result in an increase of revision procedures. However, there is little evidence about the outcome of revision procedures in this patient group. Therefore, we updated a previous study conducted 5 years ago about the outcome of revision procedures in patients younger than 55 years.
We sought to provide a concise update on the previously reported (1) long-term failure rate as defined by repeat revision, (2) clinical outcome as defined by the Oxford Hip score and the Harris Hip score, and (3) radiographic outcome of cemented revision THA performed with impaction bone grafting on both the acetabular and femoral sides in one surgery in patients younger than 55 years old.
Between 1991 and 2007, we performed 86 complete THA revisions in patients younger than 55 years. In 38% (33 of 86) of revisions, bone impaction grafting was used on both the acetabular and femoral side because of acetabular and femoral bone stock loss. Mean age at time of revision was 46 ± 8 years. No patient was lost to follow-up, but six patients died during follow-up, including three since 2015. Still, the hips of all 33 patients were included in analysis at a mean of 17 ± 5 years. Failure was calculated using competing risk analysis. For clinical outcome, we assessed the Harris Hip score and the Oxford Hip score from our longitudinally maintained institutional database. Radiographic analysis was performed to evaluate radiographic loosening, defined as radiolucencies ≥ 2 mm in all zones or ≥ 5 mm migration for both components. The acetabular component was also considered loose with tilting ≥ 5°.
The 15-year failure rate of revision THA was 27% (95% CI 13 to 44) for re-revision of any component for any reason and 10% (95% CI 3 to 25) for re-revision of any component for aseptic loosening. The mean Harris Hip score increased from 55 ± 18 preoperatively to 74 ± 22 at latest follow-up. Eight cups were considered radiographically loose, seven of which were re-revised. No stems were considered radiographically loose. Failure rate with endpoint radiographic loosening at 15 years was 23% (95% CI 10 to 39).
We found that impaction bone grafting with a cemented cup and a cemented stem is a valuable biological revision technique that results in a stable and durable solution, after one or even multiple previous revision THAs. Although current implants may prove sufficient in most cases, they do not promote bone stock preservation. We believe that in young patients with bone stock loss, impaction bone grafting can be used as long as the defect can be contained adequately with a metal mesh and viable bone bed is available for revascularization.
Level IV, therapeutic study.</abstract><cop>United States</cop><pub>Wolters Kluwer</pub><pmid>32898047</pmid><doi>10.1097/CORR.0000000000001462</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Acetabulum Acetabulum - diagnostic imaging Acetabulum - physiopathology Acetabulum - surgery Adult Age Factors Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Hip - instrumentation Bone Cements - adverse effects Bone Cements - therapeutic use Bone grafts Bone implants Bone surgery Bone Transplantation - adverse effects Clinical Research Databases, Factual Female Femur Femur - diagnostic imaging Femur - physiopathology Femur - surgery Hip Joint - diagnostic imaging Hip Joint - physiopathology Hip Joint - surgery Hip Prosthesis Humans Male Middle Aged Patients Postoperative Complications - diagnostic imaging Postoperative Complications - physiopathology Postoperative Complications - surgery Prosthesis Failure Reoperation Retrospective Studies Risk Assessment Risk Factors Skin & tissue grafts Surgical mesh Time Factors Treatment Outcome |
| title | What Are the Long-term Results of Cemented Revision THA with Use of Both Acetabular and Femoral Impaction Bone Grafting in Patients Younger Than 55 Years? |
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