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The Journal of Bone and Joint Surgery, Vol 67, Issue 4 517-526, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc
Revision total hip arthroplasty
BF Kavanagh, DM Ilstrup and RH Fitzgerald
Two hundred and ten hips in 206 patients who had an initial total hip
arthroplasty performed at the Mayo Clinic between 1969 and 1978 required
revision of the arthroplasty at the Mayo Clinic for reasons other than
infection. One hundred and sixty-two of the patients (166 hips) were
followed both clinically and roentgenographically for two years or more.
One hundred and forty-five (90 per cent) reported that they had improvement
after the surgical revision. Complications that occurred with revision
included deep sepsis, superficial would infection, dislocation,
intraoperative femoral fracture, and postoperative femoral fracture.
Roentgenographic analysis showed probable loosening in thirty-three
acetabular components (20.1 per cent) and seventy-two femoral components
(44 per cent). Symptomatic loosening (moderate to severe pain and probable
roentgenographic loosening) was seen in thirty-five patients. Eight
patients required a second revision for this reason, and seven others
required a second revision for other reasons. Modified Harris hip scores,
calculated for 108 hips, showed a good or excellent result in sixty-seven
hips (62 per cent), a fair result in twelve (11 per cent), and a poor
result in twenty-nine (27 per cent). Using a new Mayo Clinic hip score that
incorporates roentgenographic data (which will be described) in the
evaluation of 165 revised hips, there was a good or excellent result in
eighty-five (52 per cent), a fair result in thirty-two (19 per cent), and a
poor result in forty-eight hips (29 per cent). Although 90 per cent of the
patients thought that their condition had improved, the high incidence of
roentgenographic signs of probable loosening of a component is of serious
concern.
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