This article is more than 5 years old. Information may no longer be current.
Uncemented jumbo acetabular cups provided good long-term survivorship
According to a surgeon, the current version of the prosthesis may be a practical benchmark in the future for new cups made of highly porous metal.
Click Here to Manage Email Alerts
Uncemented jumbo cups are commonly used in acetabular revision surgery, but do not provide substantial restoration of bone stock restoration in patients, according to an orthopaedic surgeon.
However, Philipp Von Roth, MD, who is at Charité Hospital, in Berlin, said in a presentation the lack of good bone stock restoration with these cups is offset by their good long-term performance and survivorship.
Von Roth and colleagues retrospectively studied uncemented Harris-Galante jumbo acetabular cups (Zimmer; Warsaw, Ind., USA) used during total hip arthroplasty revision and found they provided good 20-year outcomes and a low risk of aseptic loosening (ASL) as a cause for revision.
Philipp Von Roth
Long-term survivorship is key
“The survivorship, free from any acetabular revision at 20 years, was 83% estimated. The survivorship, free from ASL as a specific indication for revision was 88% at 20 years,” Von Roth said at the American Association of Hip and Knee Surgeons Annual Meeting, in Dallas.
In addition, survivorship was 83% without acetabular metal shell revision done for any reason, he said.
Von Roth and colleagues included in the study 89 patients with uncemented jumbo cups who were 74 years old on average at the time of revision. The investigators evaluated the patients based on Harris Hip scores (HHS) and used radiographs and Kaplan-Meier curves to track survivorship.
The men received cups with a 68-mm median diameter and the women received cups with a 62-mm mean diameter.
Findings for revised cups
The average HHS increased from 53 points preoperatively to 71 points postoperatively (P = 0.001). The findings showed seven cups were revised during the 20-year follow-up; five for ASL, one for infection and one for recurrent dislocation. The average time to revision was 11 years.
Other revisions were required in association with use of these cups, according to Von Roth. This included eight liners revised in conjunction with metal shell retention and six femoral stem revisions. One revision each was performed for wear and recurrent dislocation.
None of the implants exhibited migration or screw breakage, but Von Roth and colleagues identified 18 complications at the 20-year follow-up, with instability being the most common complication.
“Eight patients required surgical revisions, with one acetabular shell revision. Of note, all of these complications were within the first 2 years of the surgery,” Von Roth said.
The radiographic analysis showed one unrevised patient had radiographic acetabular loosening and three patients had radiographic acetabular osteolysis without loosening.
Benchmark for new technology
Despite these complications, the implants provide good clinical and radiographic outcomes, which justifies their use in acetabular revisions, according to Von Roth.
“Jumbo cups can show good, but not perfect, long-term survivorship with conventional porous surfaces, and the results still leave room for improvement with newer technology. Therefore, jumbo cups can serve as a benchmark for comparison for advances, such as highly porous metals,” he said. – by Robert Linnehan
- Reference:
- Von Roth P, et al. Paper #26. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 6-9, 2014; Dallas.
- For more information:
- Philipp Von Roth, MD, can be reached at Department of Orthopaedic Surgery, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; email: philipp.roth@charite.de.
Disclosure: Von Roth reports no relevant financial disclosures.