Results of selective hip arthroplasty revision in isolated acetabular failure

Controversy exists over whether to remove well-fixed components at the time of revision of a failed total hip arthroplasty (THA). The purpose of this study was to evaluate the results of selective acetabular revision after acetabular failure in which only the failed component was replaced.

Thirty-six isolated acetabular component revisions were performed and prospectively followed for a mean of 4.7 y (range, 2-9.3 y). The components had been in place for a mean of 10.8 y. All femoral components and some metal-backed acetabular shells were well fixed at the time of revision and left in place. Surgery involved cementation of an acetabular liner into a well-fixed acetabular shell in 16 cases, and acetabular revision in 20 cases. Morselized cancellous allograft was used to fill acetabular defects in 27 hips, and proximal femoral defects in 17 hips. Bulk allografts were used to reconstruct the proximal femur in two hips.

The mean Harris hip score improved from 57.8 preoperatively to 89.1 at the final follow-up visit. The results were rated excellent in 24 patients, good in nine patients, and fair in three patients. The unrevised femoral components and acetabular shells remained well fixed, and final follow-up radiographs revealed no cases of osteolytic lesion progression around the femoral and acetabular components.

Revision of only the failed acetabular component is recommended in cases of isolated acetabular failure, providing excellent results over the medium term, and allowing preservation of bone stock with lower surgical morbidity.