The choice of bearings in revision total hip arthroplasty : rationale, algorithm, and outcome.

Abstract

Aims: The aim of this study was to determine the success of an algorithm designed to guide the choice of bearing based on gluteus medius deficiency to be used in revision total hip arthroplasty (THA).

Methods: Dislocation following revision THA remains a leading cause of failure, and while bearings which offer enhanced stability are available, the indications for their use remain unclear. The integrity of the abductor muscles is a major contributor to stability. We describe the use of an algorithm based on gluteus medius deficiency to determine the choice of bearing in revision THA. The default choice in patients with no damage to gluteus medius was a large head, defined as one with a diameter of ≥ 36 mm. Those with gluteus medius deficiency but with preservation of the posterior muscle and tendon were treated with a dual-mobility bearing. A constrained acetabular liner was used in those with complete gluteus medius deficiency. This was a series of consecutive revision THAs undertaken by a single surgeon using this algorithm. The patients were followed to report the rates of dislocation, all-cause re-revision, and Oxford Hip Score (OHS).

Results: A total of 311 revision THAs were performed in 259 patients (26 were bilateral) with a mean age of 70 years (32 to 95). At a mean follow-up of 4.8 years (1.0 to 9.0), the dislocation rate for the whole cohort was 4.1% (95% CI 2.4 to 7.0), and Kaplan-Meier survival analysis revealed a 96.1% (95% CI 93.0 to 97.8) dislocation-free survival at 60 months. A large diameter head was the most commonly used bearing, in 164 revisions (53%). There was no significant difference in the dislocation-free survival between the bearings (p = 0.46). The survival free of all-cause re-revision for the whole cohort was 94.2% (95% CI 96.3 to 91.0). The mean OHS improved from 19.6 (2 to 47) preoperatively to 33.9 (4 to 48) at the final follow-up.

Conclusion: The findings suggest that the algorithm which we describe, based on soft-tissue deficiency at the time of surgery, can allow the successful choice of bearing to be used in revision THA.