title: Socket position determines hip resurfacing 10-year survivorship.
abstract: BACKGROUND
  Modern metal-on-metal hip resurfacing arthroplasty designs have been used for over a decade. Risk factors for short-term failure include small component size, large femoral head defects, low body mass index, older age, high level of sporting activity, and component design, and it is established there is a surgeon learning curve. Owing to failures with early surgical techniques, we developed a second-generation technique to address those failures. However, it is unclear whether the techniques affected the long-term risk factors.
  
  
  OBJECTIVE
  We (1) determined survivorship for hips implanted with the second-generation cementing technique; (2) identified the risk factors for failure in these patients; and (3) determined the effect of the dominant risk factors on the observed modes of failure.
  
  
  METHODS
  We retrospectively reviewed the first 200 hips (178 patients) implanted using our second-generation surgical technique, which consisted of improvements in cleaning and drying the femoral head before and during cement application. There were 129 men and 49 women. Component orientation and contact patch to rim distance were measured. We recorded the following modes of failure: femoral neck fracture, femoral component loosening, acetabular component loosening, wear, dislocation, and sepsis. The minimum followup was 25 months (mean, 106.5 months; range, 25-138 months).
  
  
  RESULTS
  Twelve hips were revised. Kaplan-Meier survivorship was 98.0% at 5 years and 94.3% at 10 years. The only variable associated with revision was acetabular component position. Contact patch to rim distance was lower in hips that dislocated, were revised for wear, or were revised for acetabular loosening. The dominant modes of failure were related to component wear or acetabular component loosening.
  
  
  CONCLUSIONS
  Acetabular component orientation, a factor within the surgeon's control, determines the long-term success of our current hip resurfacing techniques. Current techniques have changed the modes of failure from aseptic femoral failure to wear or loosening of the acetabular component.
  
  
  METHODS
  Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Joint Replacement Institute, St Vincent Medical Center, The S Mark Taper Building, 2200 West Third Street, Suite 400, Los Angeles, CA 90057, USA. harlanamstutz@dochs.org
authors.forename: Harlan C
authors.initials: HC
authors.lastname: Amstutz
authors.forename: Michel J
authors.initials: MJ
authors.lastname: Le Duff
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D011379:Prognosis; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult