Prohibitive failure rate of the total articular replacement arthroplasty at five to ten years

Five- to 10-year follow-up was obtained on a series of total articular replacement arthroplasties performed at a single university-affiliated teaching hospital. Eighty arthroplasties were performed on 64 patients. Twelve patients (accounting for 14 hip arthroplasties) died. Follow-up was obtained on 62 of the 66 remaining hips (94%). Thirty-five hips had been revised (56%), 32 for acetabular loosening and 3 for femoral loosening, 1 of which led to femoral stem fracture. The average time to revision was 72 months (22 to 132 months). The revision procedures were extensive in terms of operative time, blood loss, and necessity of acetabular bone grafting. Follow-up of the 27 that had not been revised averaged 84 months and revealed 1 hip excellent, 5 good, 1 fair, and 20 poor results. The overall clinical failure rate (revisions plus clinically poor results) was 89% (55/62 hips). These results are far inferior to conventional total hip replacement, and the extent of the revision procedures indicates that this is not a conservative alternative to conventional total hip replacement.