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Clinical Orthopaedics and Related Research®

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01-12-2017 | Clinical Research

Does the Risk of Rerevision Vary Between Porous Tantalum Cups and Other Cementless Designs After Revision Hip Arthroplasty?

Authors: Inari Laaksonen, MD, PhD, Michelle Lorimer, BSc, Kirill Gromov, MD, PhD, Ola Rolfson, MD, PhD, Keijo T. Mäkelä, MD, PhD, Stephen E. Graves, MD, DPhil, Henrik Malchau, MD, PhD, Maziar Mohaddes, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2017

Abstract

Background

Earlier results with porous tantalum acetabular cups in revision THA generally have been favorable. Recently there has been some evidence presented that porous tantalum cups might decrease the risk of rerevision in the setting of revision hip surgery performed owing to prosthetic joint infection (PJI). As the data supporting this assertion come from a study with a limited study population, examining this issue with a large registry approach may be enlightening.

Questions/purposes

By combining results from two large, national registries, we asked: (1) Do porous tantalum cups show improved survival after revision THA compared with other cementless designs? (2) Does the use of porous tantalum cups influence survivorship when rerevision for PJI is the endpoint?

Methods

A total of 2442 first-time THA revisions with porous tantalum cups and 4401 first-time revisions with other uncemented cups were included in this collaborative study between the Australian and Swedish national joint registries. The mean age of the patients was 69 years (range, 19–97 years), 3754 (55%) of the patients were women, and the mean followup for the porous tantalum and uncemented control groups were 3.0 years (SD, ± 2.1 years) and 3.4 years (SD, ± 2.3 years), respectively. Concomitant stem revision was more common in the porous tantalum group (43% versus 36%). The use of porous tantalum augments also was analyzed as a proxy for more complex acetabular reconstructions. In an attempt to further reduce selection bias, we performed subgroup analysis for primary operations attributable to osteoarthritis and first revision attributable to aseptic loosening.

Results

Kaplan-Meier survivorship with rerevisison for any reason up to 7 years was comparable between the porous tantalum cup group and the uncemented cup control group (86% [95% CI, 85%–89%] and 87% [95% CI, 85%–89%], respectively; p = 0.85) and the overall survivorship up to 7 years with a second revision for PJI as the endpoint (97% [95% CI, 95%–98%] and 97% [95% CI, 96%–98%], respectively; p = 0.64). Excluding procedures where augments had been used or studying primary osteoarthritis and first revision owing to aseptic loosening subgroups did not change this result.

Conclusions

Implant survival for a porous tantalum cup in first-time THA revision was similar to the survival of the uncemented cup control group. With the numbers available, no benefit in survival with rerevision for infection as the endpoint could be ascribed to the porous tantalum cup group, as has been suggested by earlier work. Further studies with acetabular bone deficiency data, greater insight into host comorbidity factors, and a longer followup are needed to corroborate or refute these results.

Level of Evidence

Level III, therapeutic study.

Australian Orthopaedic Association National Joint Replacement Registry. Annual Report 2015 - Hip and Knee Arthroplasty. Available at: https://aoanjrr.sahmri.com/annual-reports-2016. Accessed May 10, 2017.

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Title: Does the Risk of Rerevision Vary Between Porous Tantalum Cups and Other Cementless Designs After Revision Hip Arthroplasty?
Authors: Inari Laaksonen, MD, PhD
Michelle Lorimer, BSc
Kirill Gromov, MD, PhD
Ola Rolfson, MD, PhD
Keijo T. Mäkelä, MD, PhD
Stephen E. Graves, MD, DPhil
Henrik Malchau, MD, PhD
Maziar Mohaddes, MD, PhD
Publication date: 01-12-2017
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 12/2017
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-017-5417-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Does the Risk of Rerevision Vary Between Porous Tantalum Cups and Other Cementless Designs After Revision Hip Arthroplasty?

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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