Proximal femoral replacement may effectively salvage complex revision THA cases
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Key takeaways:
- Results showed survivorship free from all-cause re-revision was 87% at 2 years and 82% at 5 years.
- The speaker said 75% of patients with a standard or elevated liner sustained a dislocation.
DALLAS — Data presented at the American Association of Hip and Knee Surgeons Annual Meeting showed proximal femoral replacement may be a reasonable salvage option in complex revision total hip arthroplasty cases.
“It is important to try to do everything we can to mitigate the common causes of re-revision in these complex patients,” Brian P. Chalmers, MD, orthopedic surgeon at Hospital for Special Surgery, said in his presentation.
Chalmers and colleagues retrospectively analyzed data for 49 patients (50 hips) who underwent revision THA to evaluate the survivorship of proximal femoral replacement. The mean follow-up was 5 years, with a minimum follow-up of 2 years.
Outcomes measured included all-cause reoperation, all-cause re-revision, survivorship free from dislocation and risk factors for poor outcomes.
Chalmers said survivorship free from all-cause reoperation was 78% at both 2 and 5 years.
In addition, he said survivorship free from all-cause re-revision was 87% at 2 years and 82% at 5 years.
Survivorship free from dislocation was 84% at both 2 and 5 years, according to Chalmers.
He said indications, bearing designs, as well as construct length and body length ratios, were not found to be risk factors for reoperation. However, he noted there was a trend toward increased rates of dislocation in patients who had a standard or elevated liner vs. a constrained liner. Chalmers said 75% of patients who had a proximal femoral replacement with a standard or elevated liner sustained a dislocation.
In terms of patient-reported outcomes, Chalmers said Hip Injury and Osteoarthritis Outcome Score for Joint Replacement scores increased from 48 preoperatively to 77 at 2 years postoperatively.
“When we performed a radiographic assessment for component loosening or radiolucencies, about 10% of unrevised proximal femoral replacements had some radiolucencies around the stem interface but without migration or signs of loosening,” Chalmers said.
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Chalmers BP, et al. Paper 51. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 7-10, 2024; Dallas.
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