Journal article
Outcomes following revision surgery performed for adverse reactions to metal debris in non-metal-on-metal hip arthroplasty patients: analysis of 185 revisions from the National Joint Registry for England and Wales
- Abstract:
- Objectives Few studies have assessed outcomes following non-metal-on-metal hip arthroplasty (nonMoMHA) revision surgery performed for adverse reactions to metal debris (ARMD). We assessed outcomes following non-MoMHA revision surgery performed for ARMD, and identified predictors of re-revision. Methods We performed a retrospective observational study using data from the National Joint Registry for England and Wales. All non-MoMHAs undergoing revision surgery for ARMD between 2008 and 2014 were included (185 hips in 185 patients). Outcome measures following ARMD revision were intra-operative complications, mortality and re-revision surgery. Predictors of re-revision were identified using Cox regression. Results Intra-operative complications occurred in 6.0% (n = 11) of the 185 cases. The cumulative four-year patient survival rate was 98.2% (95% CI 92.9 to 99.5). Re-revision surgery was performed in 13.5% (n = 25) of hips at a mean time of 1.2 years (0.1 to 3.1 years) following ARMD revision. Infection (32%; n = 8), dislocation/subluxation (24%; n = 6), and aseptic loosening (24%; n = 6) were the most common re-revision indications. The cumulative fouryear implant survival rate was 83.8% (95% CI 76.7 to 88.9). Multivariable analysis identified three predictors of re-revision: multiple revision indications (hazard ratio (HR) = 2.78; 95% CI 1.03 to 7.49; p = 0.043); selective component revisions (HR = 5.76; 95% CI 1.28 to 25.9; p = 0.022); and ceramic-on-polyethylene revision bearings (HR = 3.08; 95% CI 1.01 to 9.36; p = 0.047). Conclusions Non-MoMHAs revised for ARMD have a high short-term risk of re-revision, with important predictors of future re-revision including selective component revision, multiple revision indications, and ceramic-on-polyethylene revision bearings. Our findings may help counsel patients about the risks of ARMD revision, and guide reconstructive decisions. Future studies attempting to validate the predictors identified should also assess the effects of implant design (metallurgy and modularity), given that this was an important study limitation potentially influencing the reported prognostic factors.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Access Document
- Files:
-
-
(Preview, Version of record, pdf, 528.0KB, Terms of use)
-
- Publisher copy:
- 10.1302/2046-3758.67.BJR-2017-0017.R2
Authors
- Publisher:
- British Editorial Society of Bone and Joint Surgery
- Journal:
- Bone & Joint Research More from this journal
- Volume:
- 6
- Issue:
- 7
- Pages:
- 405-413
- Publication date:
- 2017-07-14
- Acceptance date:
- 2017-04-11
- DOI:
- EISSN:
-
2046-3758
- ISSN:
-
2046-3758
- Keywords:
- Pubs id:
-
pubs:689212
- UUID:
-
uuid:503b329a-123f-4cd0-bbc4-814c1edb3ed5
- Local pid:
-
pubs:689212
- Deposit date:
-
2017-07-13
Terms of use
- Copyright holder:
- Matharu et al
- Copyright date:
- 2017
- Notes:
-
Copyright © 2017 Matharu et al.
This is an open-access article distributed under the terms of the Creative Commons (CC-BY) license, which permits copying and redistributing the material in any medium or format, remixing, transforming and building upon the material for any purpose, even commercially, provided the original author and source are credited, and changes made are indicated. This may be done in a reasonable manner, but not in any way that suggests the licensor endorses you or your use.
If you are the owner of this record, you can report an update to it here: Report update to this record