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 Adult Hip Reconstruction Test 2: Revision Total Hip Arthroplasty
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The Journal of Bone and Joint Surgery (American) 85:825-830 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Revision Total Hip Arthroplasty Performed After Fracture of a Ceramic Femoral Head

A Multicenter Survivorship Study

Jérôme Allain, MD, Françoise Roudot-Thoraval, MD, Joel Delecrin, MD, Philippe Anract, MD, Henri Migaud, MD and Daniel Goutallier, MD

Investigation performed at Service de Chirurgie Orthopédique, Hôpital Henri Mondor, Créteil, France

Jérôme Allain, MD
Françoise Roudot-Thoraval, MD
Daniel Goutallier, MD
Service de Chirurgie Orthopédique (J.A. and D.G.) and Service de Santé Publique (F.R.-T.), Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil CEDEX, France. E-mail address for J. Allain: jalortho{at}aol.com

Joel Delecrin, MD
Service de Chirurgie Orthopédique, Centre Hospitalo-Universitaire Saint-Jacques, 85 rue Saint-Jacques, 44035 Nantes CEDEX 1, France

Philippe Anract, MD
Service de Chirurgie Orthopédique, Centre Hospitalo-Universitaire Cochin, 27 rue du Faubourg Saint Jacques, 75014 Paris, France

Henri Migaud, MD
Service de Chirurgie Orthopédique B, Centre Hospitalo-Universitaire Roger Sallengro, 2 Avenue Oscar Lambrey, 59037 Lille CEDEX, France

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The alumina ceramic femoral head was introduced for total hip arthroplasty approximately thirty years ago. One of its main drawbacks was the risk of implant fracture. The aim of this study was to examine the results of revision total hip replacement performed specifically to treat a fracture of a ceramic femoral head and to identify technical factors that affected the outcomes.

Methods: One hundred and five surgical revisions to treat a fracture of a ceramic femoral head, performed at thirty-five institutions, were studied. The patients were examined clinically by the operating surgeon at the time of the last follow-up. The surgeon provided the latest follow-up radiographs, which were compared with the immediate postoperative radiographs. The success of the revisions was assessed with Kaplan-Meier survivorship analysis, with the need for repeat revision as the end point. We evaluated the complication rate and radiographic changes indicative of implant loosening. The average duration of follow-up between the index revision and the last clinical and radiographic review was 3.5 years (range, six months to twenty years).

Results: Following the revisions, radiographic evidence of cup loosening was seen in twenty-two hips (21%) and radiographic evidence of femoral loosening was seen in twenty-two (21%). One or several repeat revisions were necessary in thirty-three patients (31%) because of infection (four patients), implant loosening (twenty), osteolysis (eight), or fracture of the revision femoral head component (one). The survival rate at five years was 63% (95% confidence interval, 51% to 75%). The survival rate was significantly worse when the cup had not been changed, when the new femoral head was made of stainless steel, when a total synovectomy had not been done, and when the patient was less than fifty years old.

Conclusions: Fracture of a ceramic femoral head component is a rare but potentially serious event. A suitable surgical approach, including total synovectomy, cup exchange, and insertion of a cobalt-chromium or new ceramic femoral ball minimizes the chance of early loosening of the implants and the need for one or more repeat revisions.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.



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