Elsevier

The Journal of Arthroplasty

Volume 32, Issue 10, October 2017, Pages 3102-3107
The Journal of Arthroplasty

Revision Arthroplasty
Constrained Acetabular Components Used in Revision Total Hip Arthroplasty: A Registry Analysis

https://doi.org/10.1016/j.arth.2017.04.043Get rights and content

Abstract

Background

Constrained acetabular components have a mechanism to lock in the femoral head. They have been developed to control postoperative dislocation, particularly in revision total hip arthroplasty (THA). Although these components may reduce dislocation, there are durability concerns: with reports of locking mechanism failures and loosening. We wanted to determine the outcome of constrained components in controlling dislocation, and if these components had a higher rate of second revision when compared with standard nonconstrained components.

Methods

Revision THA procedures from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) with a recorded primary procedure and initial diagnosis of osteoarthritis were used to compare constrained and standard nonconstrained components. Kaplan-Meier estimates of survivorship were calculated, and hazard ratios using Cox proportional hazard models were used to compare groups.

Results

There were 9509 THA first-revision procedures and 700 constrained components. Constrained components had a significantly higher revision rate after 3 months when large-head metal-on-metal components were included (hazard ratio = 1.37; P = .005). When large-head metal-on-metal components were excluded, there was no difference in the rate of second revision between the 2 groups. When the analysis was limited to first revision for dislocation, constrained components had a higher second revision rate for further dislocation after 9 months.

Conclusion

Constrained acetabular components had similar second-revision rates when compared with standard nonconstrained components, both for all first-revision reasons and when used to treat dislocation. Although possibly used for the more difficult unstable hips, constrained components had a higher rate of second revision for further dislocation.

Section snippets

Materials and Methods

The AOANJRR commenced data collection on September 1, 1999, achieving complete national implementation by mid-2002. Since then, the AOANJRR has collected data on almost 100% of hip and knee arthroplasty procedures performed in Australia. AOANJRR data are externally validated against patient-level data provided by all Australian state and territory health departments. A sequential, multilevel, matching process is used to identify any missing data which are subsequently retrieved by contacting

Results

A total of 9509 revision hip arthroplasty procedures of known primary THAs performed for OA were included. Of these, 700 used constrained acetabular components. These included 72 constrained cups and 628 constrained acetabular liners.

When the large-head metal-on-metal (MoM) components were included, constrained components had a significantly higher rate of revision after 3 months (HR = 1.37 [1.10-1.70]; P = .005). When large-head MoM components were excluded from the analysis, constrained hips

Discussion

This large Registry analysis has shown that when used in revision hip arthroplasty, constrained devices have similar results when compared with revisions using nonconstrained components. Studies reporting good results for constrained devices often have short follow-up periods with mean of <4 years [4], [17], [18], [19], [20], [21], [22], [23], [24], while 10-year minimum follow-up reports showed poorer results with a rerevision rate of 21%-42.1% [16], [25], [26]. In this study, constrained hips

Conclusions

This study of constrained acetabular components compared with nonconstrained components used for revision hip arthroplasty has shown similar second-revision rates, but a significant difference is evident after 3 months, where large-head MoM components were included. Disappointingly, when used specifically for treatment of dislocation, there is no difference in the overall second-revision rates, while constrained components have a higher second-revision rate for repeated dislocation. Although it

Acknowledgments

The authors thank the Australian Orthopaedic Association National Joint Replacement Registry and the hospitals, orthopedic surgeons, and patients whose data made this work possible.

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.04.043.

    The Australian Government funds the Australian Orthopaedic Association National Joint Replacement Registry through the Department of Health and Ageing.

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