Outcome of revised metal-on-metal hip arthroplasties: a Dutch arthroplasty register study

• Published in: Archives of orthopaedic and trauma surgery Vol. 142; no. 12; pp. 4025 - 4032
• Main Authors: Jelsma, Jetse, van Kuijk, S. M. J., Spekenbrink-Spooren, A., Grimm, B., Heyligers, I. C., Schotanus, M. G. M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2022; Springer Nature B.V
• Subjects: Arthritis; Bone surgery; Hip Arthroplasty; Hip joint; Joint replacement surgery; Medicine; Medicine & Public Health; Mortality; Orthopedics; Patient satisfaction; Polyethylene; Risk factors; Surgical outcomes; Re-revision rates; Registry; Revision arthroplasty; Metal-on-metal; Survival; Hip arthroplasty
• ISSN: 1434-3916; 0936-8051; 1434-3916
• DOI: 10.1007/s00402-021-04257-5

Background Preliminary results of metal-on-metal (MoM) hip arthroplasty were satisfactory, but since 2004 data showed high failure rates. National joint replacement registries are multi-centre databases comprised of thousands of subjects and implants which allow for identifying variables predictive of implant failure. The aim of the current study was to estimate re-revision rates after revision of a primary MoM hip arthroplasty in the Dutch Arthroplasty Register (LROI) and to assess potential predictor variables of re-revision of these MoM hip arthroplasties. Methods Eligible procedures were those with a revision for any reason except infection, after an initial primary surgery with a hip resurfacing (HRA) or large-head MoM (LH-MoM) total hip arthroplasty (THA). The probability of re-revision for both types of MoM hip arthroplasty over time was estimated using the cumulative incidence function taking mortality as a competing risk into account. A proportional sub-distribution hazards regression model was used to assess potential predictor variables of re-revision of these MoM hip arthroplasties. Results A total of 3476 records of revised implants were included, of which 873 (25.2%) were MoM implants. Over the course of follow-up, 101 (11.5%) MoM implants were re-revised. During follow-up 36 (4.3%) patients who received a MoM-implant at primary arthroplasty and a revision afterwards had died. The regression model showed that for primary MoM implants a MoM articulation after revision (HR 2.48; 95% CI 1.53–4.03, p  < 0.001), femoral-only revisions (HR 3.20; 95% CI 2.06–4.99, p  < 0.001) and periprosthetic fractures (HR 1.98; 95% CI 1.03–3.82, p  = 0.042) as reason for the first revision were statistically significant risk factors for re-revision. Conclusion Both types of large-head MoM hip arthroplasties have shown high revision and re-revision rates; risk factors were identified. The outcome of this study can be helpful in managing expectations of patients and orthopaedic surgeons.