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Fixation, survival, and dislocation of jumbo acetabular components in revision hip arthroplasty
Paul F Lachiewicz1, Elizabeth S Soileau
1Chapel Hill Orthopedic Surgery and Sports Medicine, 101 Conner Drive, Suite 200, Chapel Hill, NC 27514, USA.
Insights
Jumbo acetabular components show good survival in hip revision surgery, with low infection and loosening rates. Dislocation is the main complication, linked to smaller femoral head sizes.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Reconstructive Surgery
Background:
- Revision total hip arthroplasty (THA) with jumbo acetabular components addresses significant bone loss.
- Limited long-term data exists on the survival and complications of these large implants.
Purpose of the Study:
- To evaluate the long-term survival and complication rates of jumbo acetabular components in revision THA.
- To identify factors associated with implant survival and dislocation.
Main Methods:
- Retrospective analysis of prospectively collected data from 120 patients (129 hips) undergoing revision THA with jumbo cups.
- Kaplan-Meier survivorship analysis at 10 and 15 years, assessing infection, aseptic loosening, reoperation, and dislocation.
- Evaluation of demographic and operative factors influencing outcomes.
Main Results:
- Low rates of infection (3.1%) and aseptic loosening (3.1%) were observed.
- Implant survival was 97.3% at 10 years and 82.8% at 15 years (defined by cup revision).
- Dislocation occurred in 9.3% of hips, with larger femoral head sizes (≥32 mm) showing a reduced risk.
Conclusions:
- Jumbo acetabular components with screw fixation demonstrate favorable long-term outcomes in revision THA.
- Reoperation rates for wear and loosening increased in the second decade post-surgery.
- Dislocation is the most frequent complication, significantly associated with smaller femoral head sizes.
Background:
Acetabular revision of a total hip arthroplasty using jumbo components (Mayo definition, ≥62 mm in women and ≥66 mm in men) offers distinct advantages in patients with notable acetabular bone loss. However, there are little data on the long-term survival and complications associated with use of these components.
Methods:
This retrospective study of prospectively collected data included 120 patients who underwent 129 revision total hip arthroplasties with jumbo cups. Data on infection, aseptic loosening, reoperation, and dislocation were analyzed. One hundred and one patients (108 hips) with a mean follow-up of 8.1 years (range, two to twenty years) were evaluated with use of the Harris hip score and radiographic evidence of loosening, radiolucent lines, and osteolysis. Kaplan-Meier survivorship was calculated at ten and fifteen years with use of three different end points. Demographic and operative factors associated with implant survival and dislocation were analyzed with use of chi-square and Wilcoxon tests.
Results:
Four (3.1%) of the jumbo components were removed for infection and four hips (3.1%) had aseptic implant loosening. Reoperation for any reason was performed in twenty hips. With failure defined as cup revision for aseptic loosening or radiographic evidence of loosening, implant survival was 97.3% (95% confidence interval [CI], 89.6% to 99.3%) at ten years and 82.8% (95% CI, 59% to 97.6%) at fifteen years. With failure defined as cup removal for any reason, implant survival was 93.8% (95% CI, 83.4% to 97.2%) at ten years and 79.8% (95% CI, 61.1% to 95.4%) at fifteen years. There was no significant association between Paprosky type, component coating, or patient characteristics and failure. Dislocation occurred in twelve (9.3%) of the hips (10% of the patients) and three underwent reoperation. A femoral head size of ≥32 mm was associated with a significantly lower risk of dislocation compared with smaller sizes.
Conclusions:
Jumbo acetabular components with screw fixation were associated with low rates of infection and loosening after revision total hip arthroplasty and had high survival at fifteen years. Reoperation for wear and loosening increased in the second decade. Dislocation was the most common complication and was significantly associated with smaller femoral head sizes.