Revision of the Acetabular Component without Cement After Total Hip Arthroplasty

We previously reported our results at a minimum of three and seven years after use of a porous-coated acetabular metal shell in a consecutive series of 138 revision total hip arthroplasties. The current report presents the longer-term outcomes of these procedures, at fifteen to nineteen years postoperatively. A total of twenty metal shells (14%) underwent repeat revision. Seven of the repeat revisions were performed because of recurrent dislocation, seven were done at the time of femoral revision surgery, and six were done because of infection. Nineteen of the revised shells were well fixed, and one was aseptically loose. Of the sixty-seven hips in which the acetabular component survived for more than fifteen years after the index operation, two (3%) required a change of the modular acetabular liner because of wear or osteolysis. Nine (16%) of the fifty-seven hips with at least fifteen years of radiographic follow-up had an osteolytic lesion of >1 cm in diameter. The fifteen-year survival rate of the metal shells, with failure defined as revision because of loosening or as radiographic evidence of loosening, was 97%. Revision total hip arthroplasty with this cementless acetabular component has been followed by excellent component survivorship at fifteen years; the most common reasons for repeat revision were recurrent dislocation and infection. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. Background e previously reported the three-to-six-year and sevento-eleven-year results following the insertion of a porous-coated acetabular metal shell without cement (Harris-Galante I; Zimmer, Warsaw, Indiana) in a consecutive series of 138 revision total hip arthroplasties performed in 132 patients by four surgeons at our institution. The acetabular metal shell is hemispherical, made of commercially pure titanium, and fully coated with sintered titanium fiber-metal mesh. The surgical technique included reaming of the acetabulum with hemispherical reamers to the same diameter as the component to be inserted and the use of three to six bone screws for fixation. The median size of the acetabular components was 62 mm (range, 46 to 78 mm). A bulk allograft was used in two hips with segmental defects, and cancellous grafts were used in 107 hips with contained defects. In eighteen hips, only the acetabular component was revised. In the remaining hips, the femoral component was revised with a variety of components: forty-eight cementless Harris-Galante stems, forty-three cementless Gustilo-Kyle stems, twenty-one cementless BIAS stems, seven cemented Harris Precoat stems, and one allograft-prosthesis composite (all manufactured by Zimmer). The mean age of the patients in this cohort was fiftyfive years old (range, twenty to eighty-two years old) at the time of the index revision surgery. At the time of the most recent report, no acetabular component had been revised because of aseptic loosening, there had been no operations because of wear of the polyethW *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.