The Journal of Bone and Joint Surgery (American) 83:1352-1357 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Extra-Large Uncemented Hemispherical Acetabular Components for Revision Total Hip Arthroplasty
Andrew L. Whaley, MD,
Daniel J. Berry, MD and
W. Scott Harmsen, MS
Investigation performed at the Department of Orthopedics, Mayo
Clinic, Rochester, Minnesota
Andrew L. Whaley, MD
Daniel J. Berry, MD
W. Scott Harmsen, MS
Department of Orthopedics, Mayo Clinic, 200 First Street S.W.,
Rochester, MN 55905. E-mail address for D.J. Berry: berry.daniel{at}mayo.edu
No benefits in any form have been received or will be received from
a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Background: Extra-large uncemented components
provide several advantages for acetabular revision, but limited
information is available on the results of their use. The purpose
of this study was to evaluate, at a minimum of five years, the results
associated with the use of an extra-large uncemented porous-coated
component for acetabular revision in the presence of bone loss.
Methods: Eighty-nine extra-large uncemented hemispherical
acetabular components were used for revision after aseptic failure
of a total hip arthroplasty in forty-six men and forty-three
women (mean age at revision, fifty-nine years; range, thirty
to eighty-three years). The revision implant (a Harris-Galante-I or
II cup fixed with screws) had an outside diameter of 66 mm in men
and 62 mm in women. Seventy-nine patients had a segmental
or combined segmental and cavitary acetabular bone deficiency before
the revision. Particulate bone graft was used in fifty-four
hips and bulk bone graft, in nine.
Results: One patient died with the acetabular component
intact and two patients were lost to follow-up within five
years after the operation. At the time of the last follow-up,
four acetabular components had been removed or revised again (two
for aseptic loosening). All of the remaining patients were followed clinically
for at least five years (mean, 7.2 years; range, 5.0 to 11.3 years).
In the hips that were not revised again, only two sockets had definite
radiographic evidence of loosening. All four of the sockets that
loosened were in hips that had had combined cavitary and segmental
bone loss preoperatively. In the hips that were not revised again,
the mean modified Harris hip score increased from 56 points preoperatively
to 83 points at the time of the most recent follow-up.
The most frequent complication, dislocation of the hip, occurred
in eleven patients. The probability of survival of the acetabular
component at eight years was 93% (95% confidence
interval, 85% to 100%) with removal for any reason
as the end point, 98% (95% confidence interval,
92% to 100%) with revision for aseptic loosening
as the end point, and 95% (95% confidence interval,
88% to 100%) with radiographic evidence of loosening
or revision for aseptic loosening as the end point.
Conclusions: This study demonstrates that extra-large
uncemented components used for acetabular revision in the presence
of bone loss perform very well and have a low rate of aseptic loosening
at the time of intermediate-term follow-up.
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