Aims

The burden of revision total hip arthroplasty (rTHA) continues to grow. The surgery is complex and associated with significant costs. Regional rTHA networks have been proposed to improve outcomes and to reduce re-revisions, and therefore costs. The aim of this study was to accurately quantify the cost and reimbursement for a rTHA service, and to assess the financial impact of case complexity at a tertiary referral centre within the NHS.

Aims

The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction.

Between 1990 and 2000, 123 hips in 110 patients were reconstructed for aseptic loosening using impaction bone grafting with frozen, irradiated, morsellised femoral heads and cemented acetabular components. This series was reported previously at a mean follow-up of five years. We have extended this follow-up and now describe the outcome of 86 hips in 74 patients at a mean of ten years. There have been 19 revisions, comprising nine for infection, seven for aseptic loosening and three for dislocation. In surviving acetabular reconstructions, union of the graft had occurred in 64 of 67 hips (95.5%).

Survival analysis for all indications at ten years was 83.3% (95% confidence interval (CI) 68 to 89) and 71.3% (95% CI 58 to 84) at 15 years.

Acetabular reconstruction using irradiated allograft and a cemented acetabular component is an effective method of reconstruction, providing results in the medium- to long-term comparable with those of reported series where non-irradiated freshly-frozen bone was used.

Aims: Dislocation is one of the commonest complications following total hip arthroplasty. A significant proportion of these patients go on to have recurrent dislocations. Many factors have been identified as contributing to the risk of dislocation but treatment of recurrent dislocation is challenging. The use of semicaptive acetabular components is a potential solution to the problem of recurrent dislocation but there are few studies into the efficacy of these implants.

Methods: Patients who underwent revision of their total hip arthroplasty to a semi-captive socket at the Lower Limb Arthroplasty Unit, Northern General Hospital, Sheffield between 2001 and March 2006 were studied. A proforma was designed and data was obtained from patients’ medical records. The number of dislocations both prior to revision to a semi-captive component and the following revision to a semi-captive acetabular component were recorded including the method of reduction Reasons for revision and the number and reasons for previous revisions were noted.

Results: Average time of follow up was 22 months (range 2 months – 5 years 1 month). Following revision of total hip arthroplasty to a semi-captive component, 78% suffered no further dislocations. Of those patients who went on to redislocate, three went on to have recurrent dislocations and all were reduced by closed reduction. One patient redislocated and underwent a second revision to a semi-captive acetabular component, which was successful and underwent no further dislocations.

Discussion. The results of this study show the use of semicaptive acetabular components in revision surgery for dislocation following total hip arthroplasty to be a highly effective solution to the problem of recurrent dislocation.

We report the results of the revision of 123 acetabular components for aseptic loosening treated by impaction bone grafting using frozen, morsellised, irradiated femoral heads and cemented sockets. This is the first large series using this technique to be reported. A survivorship of 88% with revision as the end-point after a mean of five years is comparable with that of other series.