Accelerated polyethylene wear and early failure of the uncemented Reflection acetabular component: a ten to fifteen-year follow-up study

• Published in: International orthopaedics Vol. 37; no. 12; pp. 2337 - 2343
• Main Authors: Clement, Nicholas D., Mitchell, Martin, Trayner, Morag E., Porter, Daniel E., Lawson, Graham M., Burnett, Richard
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2013
• Subjects: Acetabulum - diagnostic imaging; Acetabulum - surgery; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - instrumentation; Cohort Studies; Female; Follow-Up Studies; Hip Joint - diagnostic imaging; Hip Joint - physiology; Hip Joint - surgery; Hip Prosthesis - adverse effects; Humans; Kaplan-Meier Estimate; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Orthopedics; Osteoarthritis, Hip - surgery; Patient Satisfaction; Polyethylene - adverse effects; Prospective Studies; Prosthesis Design; Prosthesis Failure; Radiography; Range of Motion, Articular - physiology; Retrospective Studies; Time Factors; Treatment Outcome; Acetabular; Outcome; Wear; Reflection; Survival; Total hip arthroplasty; Failure; Uncemented
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-013-2058-3

Purpose The Reflection® second-generation uncemented acetabular component was designed to address increased rates of failure observed with the early acetabular designs. However, the reported survivorship of this acetabular component has been conflicting. The aim of this study was to describe the ten to 15-year survivorship and polyethylene wear rate for the uncemented Reflection® acetabular component performed as part of a primary total hip replacement. Methods One hundred and four consecutive Reflection® uncemented acetabular components in 97 patients were identified from a prospective arthroplasty database with a minimum of ten years of follow-up. No patient was lost to follow-up. Mean cohort age was 59.1 years. Results There were 24 revisions of the acetabular component. The all-cause survival rate at ten years was 77.2 % [95 % confidence interval (CI) 73.9–80.5]. Mean linear wear was 0.20 mm [standard deviation (SD) 0.08] per year and the volumetric wear was 106.2 mm 3 per year. At final follow-up, more than half the patients had osteolysis identified around the femoral component. The mean Oxford Hip Score was 35.6 (SD 9.8) at a mean follow-up of 11.9 years, with six (11.1 %) excellent, 26 (48.1 %) good, 17 (31.5 %) fair and five (9.3 %) poor outcomes. Despite the fact that more than a third had a fair or poor outcome, only four (7.4 %) were not satisfied with their hip. Conclusions Due to the high rate of relatively asymptomatic polyethylene wear and osteolysis associated with this acetabular component, in our department, we now review all surviving patients both clinically and radiographically on an annual basis.