The Journal of Bone and Joint Surgery (American). 2009;91:350-355.
doi:10.2106/JBJS.H.00302
© 2009 The Journal of Bone and Joint Surgery, Inc.
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 Adult Hip Reconstruction Test 32: Spring 2009 (publication date May 15, 200...
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Revision of the Acetabular Component without Cement

A Concise Follow-up, at Twenty to Twenty-four Years, of a Previous Report*

Daniel K. Park, MD1, Craig J. Della Valle, MD1, Laura Quigley, RN1, Mario Moric, PhD1, Aaron G. Rosenberg, MD1 and Jorge O. Galante, MD1

1 Department of Orthopaedic Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612. E-mail address for C.J. Della Valle: craigdv{at}yahoo.com

Investigation performed at the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois

* Original Publications

Padgett DE, Kull L, Rosenberg A, Sumner DR, Galante JO. Revision of the acetabular component without cement after total hip arthroplasty. Three to six-year follow-up. J Bone Joint Surg Am. 1993;75:663-73.

Silverton CD, Rosenberg AG, Sheinkop MB, Kull LR, Galante JO. Revision of the acetabular component without cement after total hip arthroplasty. A follow-up note regarding results at seven to eleven years. J Bone Joint Surg Am. 1996;78:1366-70.

Della Valle CJ, Shuaipaj T, Berger RA, Rosenberg AG, Shott S, Jacobs JJ, Galante JO. Revision of the acetabular component without cement after total hip arthroplasty. A concise follow-up, at fifteen to nineteen years, of a previous report. J Bone Joint Surg Am. 2005;87:1795-800.

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Zimmer. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Zimmer) and payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from commercial entities (Smith and Nephew and Stryker). Also, a commercial entity (Zimmer) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

We previously reported the results of the use of a cementless acetabular shell for revision total hip arthroplasty in 138 hips at a minimum of three, seven, and fifteen years postoperatively. The current report presents the long-term outcomes of this group at a minimum follow-up of twenty years.

Since the last report, two additional hips required repeat revision, both for infection; no additional acetabular shell was loose. In the entire series to date, repeat acetabular revision was performed in twenty-one (15%) of the original 138 hips. Twenty of the twenty-one shells were well fixed at the time of repeat revision, and one had become aseptically loose. The most common reasons for repeat revision were infection (eight hips) and recurrent instability (eight hips). In the metal shells that were well fixed, an isolated liner change for polyethylene wear and/or osteolysis was performed in a total of six hips; four of these liner exchanges were performed since the time of our last report. A liner change had been recommended because of severe wear in four additional hips; thus, 18% of the fifty-six unrevised metal shells were associated with polyethylene wear-related problems. Survivorship, with revision of the shell for aseptic loosening or radiographic evidence of loosening as the end point, was 95% at twenty years (95% confidence interval, 83% to 98%).

Reoperations for wear and osteolysis were first seen at approximately twelve years postoperatively. At the time of the present long-term follow-up, the reoperation rate for polyethylene wear and/or osteolysis had increased. We continue to use a hemispherical, titanium metal shell with multiple screws for fixation in the majority of acetabular revisions.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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