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Does the Risk of Rerevision Vary Between Porous Tantalum Cups and Other Cementless Designs After Revision Hip Arthroplasty?

Abstract：

BACKGROUND:Earlier results with porous tantalum acetabular cups in revision THA generally have been favorable. Recently there has been some evidence presented that porous tantalum cups might decrease the risk of rerevision in the setting of revision hip surgery performed owing to prosthetic joint infection (PJI). As the data supporting this assertion come from a study with a limited study population, examining this issue with a large registry approach may be enlightening. QUESTIONS/PURPOSES:By combining results from two large, national registries, we asked: (1) Do porous tantalum cups show improved survival after revision THA compared with other cementless designs? (2) Does the use of porous tantalum cups influence survivorship when rerevision for PJI is the endpoint? METHODS:A total of 2442 first-time THA revisions with porous tantalum cups and 4401 first-time revisions with other uncemented cups were included in this collaborative study between the Australian and Swedish national joint registries. The mean age of the patients was 69 years (range, 19-97 years), 3754 (55%) of the patients were women, and the mean followup for the porous tantalum and uncemented control groups were 3.0 years (SD, ± 2.1 years) and 3.4 years (SD, ± 2.3 years), respectively. Concomitant stem revision was more common in the porous tantalum group (43% versus 36%). The use of porous tantalum augments also was analyzed as a proxy for more complex acetabular reconstructions. In an attempt to further reduce selection bias, we performed subgroup analysis for primary operations attributable to osteoarthritis and first revision attributable to aseptic loosening. RESULTS:Kaplan-Meier survivorship with rerevisison for any reason up to 7 years was comparable between the porous tantalum cup group and the uncemented cup control group (86% [95% CI, 85%-89%] and 87% [95% CI, 85%-89%], respectively; p = 0.85) and the overall survivorship up to 7 years with a second revision for PJI as the endpoint (97% [95% CI, 95%-98%] and 97% [95% CI, 96%-98%], respectively; p = 0.64). Excluding procedures where augments had been used or studying primary osteoarthritis and first revision owing to aseptic loosening subgroups did not change this result. CONCLUSIONS:Implant survival for a porous tantalum cup in first-time THA revision was similar to the survival of the uncemented cup control group. With the numbers available, no benefit in survival with rerevision for infection as the endpoint could be ascribed to the porous tantalum cup group, as has been suggested by earlier work. Further studies with acetabular bone deficiency data, greater insight into host comorbidity factors, and a longer followup are needed to corroborate or refute these results. LEVEL OF EVIDENCE:Level III, therapeutic study.

journal_name

Clin Orthop Relat Res

journal_title

Clinical orthopaedics and related research

authors

Laaksonen I,Lorimer M,Gromov K,Rolfson O,Mäkelä KT,Graves SE,Malchau H,Mohaddes M

doi

10.1007/s11999-017-5417-3

subject

Has Abstract

pub_date

2017-12-01 00:00:00

pages

3015-3022

issue

eissn

0009-921X

issn

1528-1132

pii

10.1007/s11999-017-5417-3

journal_volume

475

pub_type

杂志文章,多中心研究

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Does the Risk of Rerevision Vary Between Porous Tantalum Cups and Other Cementless Designs After Revision Hip Arthroplasty?