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The Journal of Bone and Joint Surgery 81:1682-91 (1999)
© 1999 The Journal of Bone and Joint Surgery, Inc.

The Fate of Stable Cemented Acetabular Components Retained During Revision of a Femoral Component of a Total Hip Arthroplasty*

RICHARD A. BERGER, M.D.{dagger}, LAURA R. QUIGLEY, M.S.{dagger}, JOSHUA J. JACOBS, M.D.{dagger}, MITCHELL B. SHEINKOP, M.D.{dagger}, AARON G. ROSENBERG, M.D.{dagger} and JORGE O. GALANTE, M.D.{dagger}, CHICAGO, ILLINOIS

Investigation performed at the Department of Orthopaedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago

Background: The decision as to whether to revise or retain a well fixed cemented acetabular component during revision of a femoral component is especially difficult; the rate of loosening of cemented acetabular components is high, whereas that of porous-coated acetabular components inserted during revision is low. However, removal of a well fixed cemented acetabular component can result in increased operative morbidity and cost and in loss of acetabular bone. Data that can be used to predict the long-term survival of retained well fixed cemented acetabular components are therefore needed. Methods: We studied the five to thirteen-year clinical and radiographic results in a group of twenty-six consecutive patients in whom a well fixed cemented acetabular component had been retained during revision of a femoral component. Typical demographic data on the patients and information about the components were recorded, and the cemented acetabular components were graded as A through F, according to the system of Ranawat et al., at the time of the femoral revision. The average duration of follow-up was 8.4 years (range, 5.0 to 12.7 years). No patient was lost to follow-up. Results: Four acetabular components (15 percent) had progressive radiolucency (at forty-eight, forty-eight, fifty-nine, and seventy-five months after the femoral revision) and were considered radiographically loose despite not being associated with symptoms. All four components were graded as either E or F at the time that they were retained during the femoral revision; radiographic loosening was significantly related to these two grades (p < 0.01). No acetabular component with a grade of A, B, C, or D loosened. The components that loosened had been in vivo for a relatively shorter, as opposed to longer, duration before the femoral revision compared with the components that did not loosen (p < 0.05). Conclusions: Retention of the well fixed cemented acetabular components was associated with good clinical results but with a 15 percent rate of loosening. Revision of a cemented acetabular component solely on the basis of the duration that it was in vivo or whether a previous revision had been done does not appear to be warranted. Our findings suggest that acetabular components with a grade of A, B, C, or D at the time of a femoral revision may be retained, as these components continued to function at the time of the five to thirteen-year follow-up in the current study.


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P. E. Beaule, M. J. LeDuff, F. J. Dorey, and H. C. Amstutz
Fate of Cementless Acetabular Components Retained During Revision Total Hip Arthroplasty
J. Bone Joint Surg. Am., December 1, 2003; 85(12): 2288 - 2293.
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