The result of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a polyethylene liner

Abstract

Background: Wear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition.

Methods: Twenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated.

Results: The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively.

Conclusions: The survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.

Keywords: Metallosis; Polyethylene wear; Revision total hip arthroplasty; Total hip arthroplasty.

Fig. 1

Metallosis following catastrophic failure of polyethylene liner. (A) Grade III metallosis was observed around the hip joint during revision total hip arthroplasty (THA). (B) A photomicrograph of a specimen taken during revision THA shows histiocytic infiltration with abundant metallic debris (H&E, ×400).

Fig. 2

(A) Catastrophic polyethylene wear and osteolysis were observed 10 years after primary total hip arthroplasty (THA). (B) Revision THA was performed using a ceramic-on-ceramic bearing. (C) There was no osteolysis or loosening 11 years after revision THA.

Fig. 3

(A) Catastrophic polyethylene (PE) wear and osteolysis were observed 8 years after primary total hip arthroplasty (THA). (B) Revision THA was performed using a ceramic head and a PE liner. Due to loosening of the acetabular cup (C), re-revision THA was performed 9 years after revision THA (D).

Fig. 4

Flowchart demonstrating the clinical and radiographic results of 13 hips with osteolysis after revision total hip arthroplasty following metallosis from catastrophic liner wear.

Fig. 5

The Kaplan-Meier survival curve with osteolysis (A) and loosening (B) as the end points.