Title

High early major complication rate after revision for mechanically assisted crevice corrosion in metal-on-polyethylene total hip arthroplasty.

Document Type

Article

Publication Date

12-1-2017

Institution/Department

Surgery

Journal Title

The Journal of arthroplasty.

MeSH Headings

Acetabulum, Aged, Arthroplasty, Replacement, Hip, Cohort Studies, Corrosion, Debridement, Female, Hip Dislocation, Hip Prosthesis, Humans, Male, Metals, Middle Aged, Periprosthetic Fractures, Polyethylene, Prosthesis Design, Prosthesis Failure, Reoperation, Seroma

Abstract

BACKGROUND: Failed total hip arthroplasty caused by mechanically assisted crevice corrosion (MACC) has serious consequences such as adverse local tissue reaction. Revision is currently indicated for significant hip pain, stiffness, and dysfunction; hip instability; progressive bone loss; and soft tissue destruction. Outcomes of this revision surgery are not yet completely understood.

METHODS: We examined the surgical outcomes at a minimum of 6 months (average, 25; range, 7-68 months) in a cohort of 27 consecutive patients who underwent revision total hip arthroplasty for MACC associated with a single implant vendor and taper type.

RESULTS: Major orthopedic complications occurred in 7 of 27 patients (25.9%), each after the original revision surgery. Five additional major complications occurred in subsequent surgeries. Postoperative hip dislocation occurred in 6 of 27 (22.2%), deep infection occurred in 3 of 27 (11.1%), and aseptic acetabular loosening, seroma requiring irrigation and debridement, pulmonary embolism, periprosthetic fracture, and reintubation each occurred in 1 of 27 (3.7%). Harris hip scores improved significantly with surgery (P = .0002), but overall, scores were lower for those who had major complications (70.9 vs 89.2), and only 20 of 27 patients (74.1%) had good or excellent outcomes.

CONCLUSION: Symptomatic MACC is a potentially devastating diagnosis, because of decreased soft tissue and bone viability associated with adverse local tissue reaction. This leads to a high early major complication rate.

ISSN

1532-8406

First Page

3704

Last Page

3710

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