The best method for acetabular revisions in patients with severe bone loss remains controversial; typical approaches include jumbo cups, cages, cup-cages, and custom components. Tantalum (TM) components have good results at midterm followup, but the longer term survival and complications are not available. We previously reported on a series of such reconstructions; here we provide additional followup on that group along with a larger study cohort.Questions/purposes
(1) What is the survival at a minimum followup of 5 years of these components implanted in difficult revisions and what is the mechanism of failure? (2) What is the most common complication of these reconstructions, and what hip scores did these patients achieve?Methods
Between 2001 and 2010, one surgeon performed 150 acetabular revisions, of which 74 (49%) were done using TM components. The general indication for use of these devices was the surgeon’s perception that there was sufficient bone loss to place the reconstruction at a high risk of mechanical failure (generally Paprosky Type 3 or 4 or lower Paprosky type with < 50% host bone coverage or morbid obesity). No cages were used during this time. Fifteen patients died and 11 were lost or did not return, leaving 48 hips (46 patients) with a mean followup of 8 years (range, 5-14 years). Of these, 39 were reported on in our previous series, and nine are new in the present series; the overall group here has an additional median of 5 years followup (range, 3-7 years). Five hips had six augments placed to obtain stability. Patients were evaluated by the Harris hip score and standard radiographs; survivorship was estimated using the cumulative incidence competing risks survival analysis. The primary outcome was fixation and survival of the TM component and the secondary outcome was complications.Results
Cumulative incidence competing risks estimate survival free from aseptic loosening was 92% at 10 years (95% confidence interval [CI], 0.81-0.98). Dislocation, the most common complication, occurred in seven of 48 (15%) patients, and five of 48 (10%) had a reoperation for it. Survival free from any reoperation was 84% at 10 years (95% CI, 0.72-0.92). The Harris hip score improved from a mean of 50 points (SD 17) before surgery to 85 points (SD 10; p < 0.001) at latest followup.Conclusions
Given the findings of this study, TM components appear to provide durable fixation at midterm followup in complex acetabular revisions. Steps to minimize dislocation, the most frequent complication of these revisions, may include the routine use of larger femoral heads. Future studies likely will need to be multisurgeon or multicenter and should evaluate different techniques and components for long-term fixation and the prevention of dislocation.Level of Evidence:
Level IV, therapeutic study.