Revision arthroplasty of the hip joint

Summary During the period 1974–1983, 768 total hip arthroplasties were performed at the Surgical Hospital, University Central Hospital in Helsinki. Brunswik prostheses were used until 1980, and after this the operations were routinely performed with Lubinus prostheses. Additionally, from 1977 to 1981 Wagner and Freeman resurfacing prostheses were used in 107 cases. Of all these patients, 44 (5.7%) needed revision arthroplasty. The average interval between the primary operation and revision arthroplasty was 3.7 years and the follow-up period after the second operation averaged 2.9 years. The patients who underwent revision arthroplasty were compared with a matched control group. In the revision group, radiographs revealed that the medial cement packing was complete in 28% of the hips, this being the case in 78% of the controls (P < 0.001). Also, the cement tip packing was more often incomplete in the revision hips than in the controls (P < 0.01). Regarding the lateral cement packing there was no statistical difference between the two groups. The revision rate of the resurfacing prostheses was 14.9%, compared with 7.8% of the Brunswik prostheses which were inserted at the same time. At the follow-up, the patients with revised hips had less pain than before the primary operation (P < 0.001) and their mobility was similarly improved. We conclude that adequate medial and tip cement packing must be emphasized in the primary arthroplasty. Resurfacing prostheses have a relatively high loosening tendency. Revision arthroplasty is the treatment of aseptic loosening after total hip replacement and it gives good clinical results.Aseptic loosening is the most common long-term complication after total hip replacement surgery. Clinical loosening rates are mostly judged by the number of patients who have been reoperated on, this probably leading to somewhat low figures. Reports on prosthesis loosening usually concern cemented prostheses, and both analyses based on radiographical evidence and revision rates have been published [1, 3, 4, 10, 12, 14]. It appears that most of the prostheses, at least as concerns femoral components, loosen during the first 5 years, and the numbers increase only slowly between 5 and 10 years postoperatively [16, 17].A certain proportion of prostheses will loosen even when the most progressive operative methods are used, and revision arthroplasties of the hip joint are part of the routine of orthopedic departments. We have analyzed our total hip revision arthroplasties, focusing on the factors leading to prosthesis loosening and on the outcome of hip revision operations.