Hip resurfacing arthroplasty: risk factors for failure over 25 years

Abstract

Many early metal-on-polyethylene hip resurfacing arthroplasty designs were abandoned after reports of high short-term and midterm failure rates. To investigate factors associated with failure, we retrospectively reviewed our experience with early-design hip resurfacing implants in 75 patients during a 25-year period (median followup, 7.9 years; range, 0.1-25.2 years). Implant failure was defined as revision for any reason. One of 75 patients was lost to followup. The estimated rate of implant survival was 73% at 5 years, 34% at 10 years, 27% at 15 years, 12% at 20 years, and 8% at 25 years. Of the many clinical and radiographic factors considered, only age, implant type, and gender were associated with implant survival independent of other variables considered. Hip resurfacing arthroplasty showed poor overall long-term survival in this series. Particular attention should be paid to the identified risk factors as long-term followup data become available for modern designs.

Level of evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

Overall estimated implant survival is summarized in this graph. With longer followup, implant failure increased. The dashed lines represent 95% confidence intervals.

Fig. 2

There was strong evidence of increased risk of implant failure in younger patients (relative risk, 1.42 [10-year decrease]; 95% confidence interval, 1.19–1.71; p < 0.001).

Fig. 3

Evidence of increased risk of implant failure in patients with a THARIES implant (relative risk, 2.17; 95% confidence interval, 1.19–3.95; p = 0.011) as compared with an Indiana implant is shown. THARIES = total hip articular replacement using internal eccentric shells.

Fig. 4

There was weak evidence of increased risk of implant failure in women (relative risk, 1.61; 95% confidence interval, 0.98–2.66; p = 0.062).

Fig. 5A–B

(A) The radiograph shows aseptic loosening of the femoral component with fracture of the bone at the base of the implant in a 43-year-old woman with a history of developmental hip dysplasia 1.5 years after implantation. (B) This radiograph of a 50-year-old man who underwent arthroplasty for severe osteoarthritis shows aseptic loosening of an acetabular component 8 years after implantation.