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Acetabular bone impaction grafting provided acceptable 25-year results
Two survivorship analyses showed the survival rate for the procedure at 27 years follow-up was 72%.
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With more patients undergoing total hip replacement revisions at a younger age, there is considerable need for information about long-term results with acetabular replacement techniques. Therefore, a study conducted by Martijn A.J. Te Stroet, MD, and colleagues examined whether a biologic treatment — bone impaction grafting of the acetabulum — is effective in the long-term.
According to Te Stroet, who presented the study findings at the 16th EFORT Congress, acetabular bone impaction grafting has a 72.1% survival rate at the 27-year follow-up.
Te Stroet and colleagues received the silver free paper award at the meeting for their research.
“Acetabular bone impaction grafting revisions provide acceptable clinical results at over 25 years. The Kaplan-Meier (KM) analysis overestimates the probability of revision surgery severely, due to ignoring competing risks,” Te Stroet said.
Long-term follow-up
Te Stroet and colleagues prospectively followed 58 patients (13 men and 45 women) with a mean age at revision of 59.2 years. The surgeries were performed between January 1979 and March 1986. In all, 62 revisions were performed due to aseptic loosening (58 cases) or septic loosening (4 cases).
Minimum follow-up was 25 years, with a range of 25 years to 30 years. No patients were lost to follow-up. After a mean follow-up of 27 years, 10 patients were alive and had not undergone revision surgery. They had mean Harris Hip scores of 76 points and a mean satisfaction score of 81 points, according to Te Stroet.
Nine of the surviving hips had radiological data and, for two of them, although there were signs of radiographic loosening, the hips were not revised since the patients’ symptoms were mild. In two other hips, there were signs of radiolucent lines in one or two hip zones.
Competing analyses
Te Stroet and colleagues conducted a KM analysis and a competing risks (CR) survival analysis for all the patients.
“The KM survival after 27 years [of] follow-up was 58%, with a failure rate of 42%. However, when we did the CR analysis, the failure rate — because of all the deaths in our group — was 24%. This means the KM overestimates the failure rate by 74%. When we looked at endpoint re-revision for aseptic loosening, it is even higher. We had a failure rate with the KM at 28% and with the CR at 15%, which means a 93% failure overestimation,” Te Stroet said.
The KM did not take into account competing risks, such as death, which accounted for the failure overestimation. Therefore, CR analysis is a suitable alternative to the KM analysis to determine the probability of revision surgery in cases like these, according to the researchers. – by Robert Linnehan
- Reference:
- Te Stroet M, et al. Paper #1558. Presented at: 16th EFORT Congress; May 27-29, 2015; Prague.
- For more information:
- Martijn A.J. Te Stroet, MD, can be reached at Radboud University Medical Center, Geert Grooteplein 10, 6500 HB, Nijmegen, The Netherlands; email: martijn.testroet@radboudumc.nl.
Disclosure: Te Stroet reports benefits have been or will be received related to this study, but they will be directed solely to a research fund, foundation, educational institution or other non-profit organization with which one or more of the authors are associated.