title: Long-term clinical outcome of acetabular cup revision surgery: comparison of cemented cups, cementless cups, and cemented cups with reinforcement devices.
abstract: The aim of the present study was to analyze the clinical and radiographic outcomes and Kaplan-Meier survivorship of patients who underwent revision surgeries of the acetabular cup that had sustained aseptic loosening. We reviewed 101 consecutive patients (120 hips; 10 men 11 hips; 91 women 109 hips; age at surgery 66 years; range 45-85) who underwent acetabular component revision surgery, at a follow-up period of 15.6 years (range 10-32). To evaluate the state of the acetabulum, acetabular bony defects were classified according to the AAOS classification based on intraoperative findings: type I (segmental deficiencies n = 24 hips), type II (cavity deficiency n = 48), type III (combined deficiency n = 46), and type IV (pelvic discontinuity n = 2). The Harris hip score improved from 42.5 ± 10.8 (mean ± SD) before surgery to 74.9 ± 14.6 points at follow-up. The survival rates of the acetabular revision surgery with cemented, cementless, and cemented cups plus reinforcement devices were 74, 66, and 82 %, respectively. The difference in the survival rate between the cemented and cementless group was marginal (p = 0.048 Gehan-Breslow-Wilcoxon, p = 0.061 log-rank), probably due to the early-stage failure cases in the cementless group. The cementless and reinforcement groups included nine early-stage failure cases. To prevent early-stage failure, we recommend the cementless cups for types I and II acetabular bone defects with adequate contact between host bone and acetabular component, and the cemented cup with or without reinforcement devices, together with restoration of bone stock by impaction or structured bone grafting, for cases lacking such contact.
authors.affiliation: Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Matsuoka Shimoaizuki 23, Eiheiji, Fukui, 910-1193, Japan. kokubo@u-fukui.ac.jp.
authors.forename: Yasuo
authors.identifier: http://orcid.org/0000-0002-6927-0514
authors.initials: Y
authors.lastname: Kokubo
authors.affiliation: Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Matsuoka Shimoaizuki 23, Eiheiji, Fukui, 910-1193, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Oki
authors.affiliation: Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Matsuoka Shimoaizuki 23, Eiheiji, Fukui, 910-1193, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sugita
authors.affiliation: Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Matsuoka Shimoaizuki 23, Eiheiji, Fukui, 910-1193, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Negoro
authors.affiliation: Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Matsuoka Shimoaizuki 23, Eiheiji, Fukui, 910-1193, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Takeno
authors.affiliation: Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Matsuoka Shimoaizuki 23, Eiheiji, Fukui, 910-1193, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Matsuoka Shimoaizuki 23, Eiheiji, Fukui, 910-1193, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nakajima
mesh_terms: D000077:Acetabulum / Q000293:injuries* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods; D001843:Bone Cements; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data
chemical_list: D001843:Bone Cements
keywords: Acetabulum; Bone grafting; Bony defect; Cemented cup; Cementless cup; Reinforcement device; Revision total hip arthroplasty