Introduction:

Isolated head and liner exchange in aseptic revision total hip arthroplasty (rTHA) is an appealing option rather than full acetabular component revision; however, early outcome reports suggest high rates of complications requiring re-revision. This study seeks to compare the outcomes of these procedures.

Methods:

This retrospective study assessed 124 head and liner exchanges and 59 full acetabular cup revisions conducted at a single center between 2011 and 2019 with at least 2 years of follow-up. Baseline demographics did not vary by group. Mean follow-up was 3.7 (range 2.0–8.6) years.

Results:

In the head and liner exchange group, re-revision-free survivorship at 2 years was 79% for all-causes and 84% for aseptic reasons. In the full acetabular revision group, it was 80% for all causes (p > 0.99) and 83% for aseptic reasons (p > 0.99). The 2-year survivorship of head and liner exchange was non-inferior to that of full acetabular revision, correcting for surgical indication and history of prior revision (adj-OR 0.1.39, 95% CI, 0.62–3.28, p = 0.99). A best-fit multivariable model found that revision for instability (adj-OR=3.03, 95% CI 1.40–6.66, p = 0.005), prior revision (adj-OR 2.15; 95% CI, 0.87–5.32; p = 0.10), current smoking (adj-OR 2.07; 95% CI, 0.94–4.57; p = 0.07), and obesity (adj-OR 0.58; 95% CI, 0.24–1.36; p = 0.22) were associated with failure within 2 years.

Conclusions:

In this analysis, 2-year outcomes for isolated head and liner exchange were non-inferior to full acetabular component revision. A future randomised prospective study should be conducted to better assess the optimal approach to revision in an aseptic failed hip arthroplasty.

中文翻译：

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无菌翻修全髋关节置换术中孤立顶衬更换与全髋臼假体翻修的结果

介绍：

无菌翻修全髋关节置换术 (rTHA) 中的孤立头和内衬更换是一种吸引人的选择，而不是全髋臼假体翻修；然而，早期结果报告表明需要重新修订的并发症发生率很高。本研究旨在比较这些程序的结果。

方法：

这项回顾性研究评估了 2011 年至 2019 年间在单个中心进行的 124 次头部和内衬更换以及 59 次全髋臼杯翻修，并进行了至少 2 年的随访。基线人口统计数据没有因组而异。平均随访时间为 3.7（范围 2.0-8.6）年。

结果：

在头部和内衬更换组中，2 年无再翻修生存率为 79%（全因）和 84%（无菌原因）。在全髋臼翻修组中，所有原因的发生率为 80%（p > 0.99），无菌原因为 83%（p > 0.99）。头部和衬垫更换的 2 年生存率不劣于完全髋臼翻修，校正了手术适应症和既往翻修史（adj-OR 0.1.39, 95% CI, 0.62–3.28, p = 0.99） . 最佳拟合多变量模型发现，不稳定性修正（adj-OR=3.03, 95% CI 1.40–6.66, p = 0.005），先前修正（adj-OR 2.15；95% CI，0.87–5.32；p = 0.10） , 当前吸烟 (adj-OR 2.07; 95% CI, 0.94–4.57; p =0.07）和肥胖（adj-OR 0.58；95% CI，0.24-1.36；p = 0.22）与 2 年内失败有关。

结论：

在这项分析中，孤立的头部和衬垫更换的 2 年结果不劣于全髋臼假体翻修。未来应进行随机前瞻性研究，以更好地评估无菌性髋关节置换术失败的最佳翻修方法。