Which factors influence the rate of failure following metal-on-metal hip arthroplasty revision surgery performed for adverse reactions to metal debris? an analysis from the National Joint Registry for England and Wales

Gulraj S Matharu, Andy Judge, H.G. Pandit, D.W. Murray

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Abstract

To determine the outcomes following revision surgery of metal-on-metal hip arthroplasties (MoMHA) performed for adverse reactions to metal debris (ARMD), and to identify factors predictive of re-revision.We performed a retrospective observational study using National Joint Registry (NJR) data on 2535 MoMHAs undergoing revision surgery for ARMD between 2008 and 2014. The outcomes studied following revision were intra-operative complications, mortality and re-revision surgery. Predictors of re-revision were identified using competing-risk regression modelling.Intra-operative complications occurred in 40 revisions (1.6%). The cumulative five-year patient survival rate was 95.9% (95% confidence intervals (CI) 92.3 to 97.8). Re-revision surgery was performed in 192 hips (7.6%). The cumulative five-year implant survival rate was 89.5% (95% CI 87.3 to 91.3). Predictors of re-revision were high body mass index at revision (subhazard ratio (SHR) 1.06 per kg/m2 increase, 95% CI 1.02 to 1.09), modular component only revisions (head and liner with or without taper adapter; SHR 2.01, 95% CI 1.19 to 3.38), ceramic-on-ceramic revision bearings (SHR 1.86, 95% CI 1.23 to 2.80), and acetabular bone grafting (SHR 2.10, 95% CI 1.43 to 3.07). These four factors remained predictive of re-revision when the missing data were imputed.The short-term risk of re-revision following MoMHA revision surgery performed for ARMD was comparable with that reported in the NJR following all-cause non-MoMHA revision surgery. However, the factors predictive of re-revision included those which could be modified by the surgeon, suggesting that rates of failure following ARMD revision may be reduced further. Cite this article: Bone Joint J 2017;99-B:1020-7.
Original languageEnglish
Pages (from-to)1020-1027
Number of pages8
JournalBone and Joint Journal
Volume99-B
Issue number8
Early online date1 Aug 2017
DOIs
Publication statusPublished - 10 Aug 2017

Keywords

  • Humans
  • Foreign-Body Reaction
  • Prosthesis Failure
  • Treatment Outcome
  • Arthroplasty, Replacement, Hip
  • Reoperation
  • Registries
  • Incidence
  • Risk Factors
  • Retrospective Studies
  • Prosthesis Design
  • Hip Prosthesis
  • Middle Aged
  • England
  • Wales
  • Female
  • Male
  • Metal-on-Metal Joint Prostheses

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