Survival analysis of the femoral component retained in isolated acetabular revision of the hip prosthesis

Introduction Isolated acetabular revision with the retention of a well-fixed and aligned femoral component is the priority treatment method in aseptic acetabular loosening.

The aim of the research was to predict the survival rate of a well-fixed and aligned femoral component retained during the
isolated acetabular revision surgery.

Material and methods We used the survival tables and the Kaplan-Meier method to create the survival curves. The object of the study was the database of 44 patients (45 interventions) who underwent isolated acetabular revision surgeries with their well-fixed and aligned femoral components that was retained. The average age of the patients was 59.5 [50; 69.5] years. The ratio of women to men was 25:19, respectively. The observation period was 1374 days. The creation of tables and graphs was carried out in Statistica 13.3 software package.

Results The survival rate of the retained well-fixed and aligned femoral component in isolated acetabular revision within the period up to 4 years was high and amounted to 0.9524 ± 0.03. The probability density and the hazard rates were 0.0017 and 0.00320, respectively.

Discussion The retention of a well-fixed and aligned stem in acetabular revision features high survival of the components as well as a low risk of endoprosthesis failure within 3 to 4 years. This fact confirms the need to maintain a stable and correctly oriented stem to reduce the surgical trauma, obtain good functional results and reduce rehabilitation terms.

Conclusion Isolated acetabular revision in isolated aseptic cup loosening is a priority method of surgical treatment with a low risk of complications in the postoperative period.

1. Nikolaev I.A. Tekhnologii zameshcheniia kostnykh defektov pri revizii vertluzhnogo komponenta tazobedrennogo sustava. Avtoref. diss. … kand. med. nauk [Technologies for replacing bone defects during revision of the hip acetabular component. Cand. med. sci. diss. abstr.]. M., 2015, 24 p. (in Russian)

2. Shesternia N.A., Lazarev A.F., Ivannikov S.V., Zharova T.A., Solod E.I., Abdul A.M. Endoprotezirovanie tazobedrennogo sustava: nestabilnost vertluzhnogo komponenta [Arthroplasty of the hip: acetabular component instability]. Kafedra Travmatologii i Ortopedii, 2016, no. 3 (19), pp. 39-44. (in Russian)

3. Waewsawangwong W., Ruchiwit P., Huddleston J.I., Goodman S.B. Hip arthroplasty for treatment of advanced osteonecrosis: comprehensive review of implant options, outcomes and complications. Orthop. Res. Rev., 2016, vol. 8, pp. 13-29. DOI: 10.2147/ORR.S35547.

4. Kumar A., Soni M., Patel J., Rawat S. Aseptic loosening of isolated cemented acetabular cup. International Journal of Advanced Research, 2016, vol. 4, no. 5, pp. 1320-1322. DOI: 10.21474/IJAR01/422.

5. Hallab N.J., Jacobs J.J. Biologic effects of implant debris. Bull. NYU Hosp. Jt. Dis., 2009, vol. 67, no. 2, pp. 182-188.

6. Rozhnova O.M., Prokhorenko V.M., Sadovoi M.A., Samokhin A.G., Ageeva T.A. Patogeneticheskie faktory formirovaniia asepticheskoi nestabilnosti endoprotezov sustavov (obzor literatury) [Pathogenetic factors of forming aseptic instability of joint implants (Review of the literature)]. Sibirskii Nauchnyi Meditsinskii Zhurnal, 2015, vol. 35, no. 5, pp. 85-88. (in Russian)

7. Riabova M.N. Asepticheskaia nestabilnost atsetabuliarnogo komponenta pri bestsementnom endoprotezirovanii tazobedrennogo sustava [Aseptic instability of acetabular component in cementless arthroplasty of the hip]. Nauka Molodykh, 2016, no. 4, pp. 117-125. (in Russian)

8. Hartmann E.S., Köhler M.I., Huber F., Redeker J.I., Schmitt B., Schmitt-Sody M., Summer B., Fottner A., Jansson V., Mayer-Wagner S. Factors regulating bone remodeling processes in aseptic implant loosening. J. Orthop. Res., 2017, vol. 35, no. 2, pp. 248-257. DOI: 10.1002/jor.23274.

9. Gankina M.S. Vikoristannia metodu tablits vizhivannia v doslіdzhennі stanu sanatorіiu Ukraїni [Using the method of survival tables in the study of the state of the sanatorium of Ukraine]. Bіznesіnform, 2016, no. 11, pp. 128-133. (in Ukrainian) Available at: http://nbuv.gov.ua/UJRN/binf_2016_11_23.

10. Kim Y.H. Acetabular Cup Revision. Hip Pelvis, 2017, vol. 29, no. 3, pp. 155-158. DOI: 10.5371/hp.2017.29.3.155.

11. Markov D.A., Zvereva K.P., Sertakova A.V., Belonogov V.N., Troshkin A.Iu. Khirurgicheskoe lechenie izolirovannoi asepticheskoi nestabilnosti vertluzhnogo komponenta u patsientov so stabilnym femoralnym komponentom [Surgical treatment of isolated aseptic instability of an acetabular component in patients with a stable femoral component]. Vestnik Rossiiskoi Akademii Meditsinskikh Nauk, 2018, vol. 73, no. 3, pp. 164-171. (in Russian)

12. Kaku N., Tabata T., Tagomori H., Tsumura H. Isolated acetabular revision with femoral stem retention after bipolar hip arthroplasty. Arch. Orthop. Trauma Surg., 2017, vol. 137, no. 3, pp. 425-430. DOI: 10.1007/s00402-017-2633-y.

13. Wu K.T., Wang J.W., Lu Y.D., Yen S.H., Lee M.S. Isolated revision of the acetabular component using alumina-on-alumina bearings without a metal sleeve: A preliminary study. J. Orthop. Surg. (Hong Kong), 2017, vol. 25, no. 2, 2309499017721041. DOI: 10.1177/2309499017721041.

14. De Thomasson E., Conso C., Mazel C. A well-fixed femoral stem facing a failed acetabular component: to exchange or not? A 5- to 15-year follow-up study. Orthop. Traumatol. Surg. Res., 2012, vol. 98, no. 1, pp. 24-29. DOI: 10.1016/j.otsr.2011.08.014.

15. Laffosse J.M. Removal of well-fixed fixed femoral stems. Orthop. Traumatol. Surg. Res., 2016, vol. 102, no. 1 Suppl., pp. S177-S187. DOI: 10.1016/j.otsr.2015.06.029.

16. Sharashova E.E., Kholmatova K.K., Gorbatova M.A., Grzhibovskii A.M. Primenenie analiza vyzhivaemosti v zdravookhranenii s ispolzovaniem paketa statisticheskikh programm SPSS [Application of survival analysis in healthcare using the SPSS statistical software package]. Nauka i Zdravookhranenie, 2017, no. 5, pp. 5-28. (in Russian)

17. Slinin A.S., Bydanov O.I., Karachunskii A.I. Analiz vyzhivaemosti i veroiatnosti vozniknoveniia otdelnykh sobytii u patsientov s ostrym leikozom [Analysis of survival and the likelihood of individual events in patients with acute leukemia]. Voprosy Gematologii/Onkologii i Immunopatologii v Pediatrii, 2016, vol. 15, no. 3, pp. 34-39. (in Russian)

18. Chen X.D., Waddell J.P., Morton J., Schemitsch E.H. Isolated acetabular revision after total hip arthroplasty: results at 5-9 years of follow-up. Int. Orthop., 2005, vol. 29, no. 5, pp. 277-280. DOI: 10.1007/s00264-005-0674-2.

19. Kim Y.H., Park J.W., Kim J.S. Isolated revision of an acetabular component to a ceramic-on-ceramic bearing in patients under 50 years of age. Bone Joint J., 2015, vol. 97-B, no. 9, pp. 1197-1203. DOI: 10.1302/0301-620X.97B9.35748.

20. Marongiu G., Podda D., Mastio M., Capone A. Long-term results of isolated acetabular revisions with reinforcement rings: a 10- to 15-year follow-up. Hip Int., 2019, vol. 29, no. 4, pp. 385-392. DOI: 10.1177/1120700018802750.

21. Greiner J.J., Callaghan J.J., Bedard N.A., Liu S.S., Gao Y., Goetz D.D. Fixation and wear with contemporary acetabular components and cross-linked polyethylene at 10-years in patients aged 50 and under. J. Arthroplasty, 2015, vol. 30, no. 9, pp. 1577-1585. DOI: 10.1016/j.arth.2015.05.011.

22. Piolanti N., Andreani L., Parchi P.D., Bonicoli E., Niccolai F., Lisanti M. Clinical and radiological results over the medium term of isolated acetabular revision. ScientificWorldJournal, 2014, vol. 2014, 148592. DOI: 10.1155/2014/148592. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/

23. Fukui K., Kaneuji A., Sugimori T., Ichiseki T., Kitamura K., Matsumoto T. Should the well-fixed, uncemented femoral components be revised during isolated acetabular revision? Arch. Orthop. Trauma Surg., 2011, vol. 131, no. 4, pp. 481-485. DOI: 10.1007/s00402-010-1152-x.

24. Megas P., Georgiou C.S., Panagopoulos A., Kouzelis A. Removal of well-fixed components in femoral revision arthroplasty with controlled segmentation of the proximal femur. J. Orthop. Surg. Res., 2014, vol. 9, pp. 137. DOI: 10.1186/s13018-014-0137-9.

25. Kerboull L. Selecting the surgical approach for revision total hip arthroplasty. Orthop. Traumatol. Surg. Res., 2015, vol. 101, no. 1 Suppl., pp. S171-S178. DOI: 10.1016/j.otsr.2014.07.031.

26. Fink B., Oremek D. The Transfemoral Approach for Removal of Well-Fixed Femoral Stems in 2-Stage Septic Hip Revision. J. Arthroplasty, 2016, vol. 31, no. 5, pp. 1065-1071. DOI: 10.1016/j.arth.2015.11.008.

27. Nabors E.D., Liebelt R., Mattingly D.A., Bierbaum B.E. Removal and reinsertion of cemented femoral components during acetabular revision. J. Arthroplasty, 1996, vol. 11, no. 2, pp. 146-152. DOI: 10.1016/s0883-5403(05)80008-7.

28. Paprosky W.G., Weeden S.H., Bowling J.W. Jr. Component removal in revision total hip arthroplasty. Clin. Orthop. Relat. Res., 2001, no. 393, pp. 181- 193. DOI: 10.1097/00003086-200112000-00021.

29. Fink B. The transfemoral approach for controlled removal of well-fixed femoral stems in hip revision surgery. J. Clin. Orthop. Trauma, 2020, vol. 11, no. 1, pp. 33-37. DOI: 10.1016/j.jcot.2019.11.001.

30. Puget J. Extraction des tiges fémorales difficilement extirpables [Extraction of hard to remove femoral stems]. Rev. Chir. Orthop. Repar. Appar. Mot., 2007, vol. 93, no. 6 Suppl., pp. 145-160. (in French)