Outcomes following revision surgery performed for adverse reactions to metal debris in non-metal-on-metal hip arthroplasty patients: analysis of 185 revisions from the National Joint Registry for England and Wales

摘要

Few studies have assessed outcomes following non-metal-on-metal hip arthroplasty (nonMoMHA)revision surgery performed for adverse reactions to metal debris (ARMD). Weassessed outcomes following non-MoMHA revision surgery performed for ARMD, and identifiedpredictors of re-revision.We performed a retrospective observational study using data from the National Joint Registryfor England and Wales. All non-MoMHAs undergoing revision surgery for ARMD between2008 and 2014 were included (185 hips in 185 patients). Outcome measures followingARMD revision were intra-operative complications, mortality and re-revision surgery. Predictorsof re-revision were identified using Cox regression.Intra-operative complications occurred in 6.0% (n = 11) of the 185 cases. The cumulativefour-year patient survival rate was 98.2% (95% CI 92.9 to 99.5). Re-revision surgery wasperformed in 13.5% (n = 25) of hips at a mean time of 1.2 years (0.1 to 3.1 years) followingARMD revision. Infection (32%; n = 8), dislocation/subluxation (24%; n = 6), and asepticloosening (24%; n = 6) were the most common re-revision indications. The cumulative fouryearimplant survival rate was 83.8% (95% CI 76.7 to 88.9). Multivariable analysis identifiedthree predictors of re-revision: multiple revision indications (hazard ratio (HR) = 2.78; 95%CI 1.03 to 7.49; p = 0.043); selective component revisions (HR = 5.76; 95% CI 1.28 to 25.9;p = 0.022); and ceramic-on-polyethylene revision bearings (HR = 3.08; 95% CI 1.01 to 9.36;p = 0.047).Non-MoMHAs revised for ARMD have a high short-term risk of re-revision, with importantpredictors of future re-revision including selective component revision, multiple revisionindications, and ceramic-on-polyethylene revision bearings. Our findings may help counselpatients about the risks of ARMD revision, and guide reconstructive decisions. Future studiesattempting to validate the predictors identified should also assess the effects of implantdesign (metallurgy and modularity), given that this was an important study limitationpotentially influencing the reported prognostic factors.