The result of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a polyethylene liner.
BACKGROUND
Wear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition.


METHODS
Twenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated.


RESULTS
The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively.


CONCLUSIONS
The survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.
Department of Orthopedic Surgery, Joint and Spine Center, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
Hong Suk
HS
Kwak
Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
Jeong Joon
JJ
Yoo
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Young-Kyun
YK
Lee
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Kyung-Hoi
KH
Koo
Department of Orthopedic Surgery, Joint and Spine Center, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
Kang Sup
KS
Yoon
Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea. ; Medical Research Center, Seoul National University, Seoul, Korea.
Hee Joong
HJ
Kim
D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip; D001672:Biocompatible Materials; D005260:Female; D000075322:Heavy Metal Poisoning; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008670:Metals / Q000009:adverse effects; D008875:Middle Aged; D010014:Osteolysis / Q000209:etiology / Q000601:surgery; D011041:Poisoning / Q000209:etiology / Q000601:surgery*; D020959:Polyethylene / Q000009:adverse effects; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000209:etiology; D011859:Radiography; D012086:Reoperation; D055815:Young Adult
D001672:Biocompatible Materials; D008670:Metals; D020959:Polyethylene
Metallosis; Polyethylene wear; Revision total hip arthroplasty; Total hip arthroplasty