Abstract
Introduction:
Endoprosthetic replacement of the proximal femur is common in the management of bone tumours and failed revision arthroplasty. This study seeks to compare those patients undergoing acetabular resurfacing at the time of femoral replacement with those patients where the native acetabulum was preserved.
Methods:
All proximal femoral replacements from 2004 to 2009 with a five year follow up were included. Case files were interrogated to identify those that had either revision surgery or dislocation of the hip.
Results:
87 patients met the inclusion criteria with an average age of 53 years. 25 operations were for failed revision arthroplasty, 61 for tumours and 1 for osteomyelitis. In 60 patients the acetabulum was resurfaced at surgery, and in 27 patients the acetabulum was preserved. 36 of 60 patients (60%) undergoing immediate resurfacing of the acetabulum had tumours.
In patients who did not undergo acetabular resurfacing at surgery 4 sustained dislocations; 1 had surgery for failed revision arthroplasty and 3 tumour resections. Dislocations were significantly lower in the group undergoing immedicate resurfacing p<0.05. There were no dislocations in the acetabular resurfacing cohort p=0.0034.
Eighteen of the 87 patients underwent revision surgery (20.7%) although none of these were for recurrent dislocation. 9 of the 27 patients (33.3%) that had a native acetabulum went on to have revision surgery in comparison with 9 (15%) revisions performed in those undergoing acetabular resurfacing at the time of surgery p= 0.02. 83% of revisions were for acetabular wear p<0.05.
Conclusions:
Revision and dislocation rates for proximal femoral replacement are significantly lower in those who undergo resurfacing of the acetabulum.
