Highly Porous Acetabular Cup and Augment Constructs in Complex Revision Total Hip Arthroplasty: What Predicts 10-Year Implant Survivorship?

Thomas D Alter; Matthew L Hadley; Cory G Couch; Kristin M Fruth; Nicholas A Bedard; Kevin I Perry; Rafael J Sierra; David G Lewallen

doi:10.1016/j.arth.2024.03.071

Highly Porous Acetabular Cup and Augment Constructs in Complex Revision Total Hip Arthroplasty: What Predicts 10-Year Implant Survivorship?

J Arthroplasty. 2024 Apr 9:S0883-5403(24)00318-8. doi: 10.1016/j.arth.2024.03.071. Online ahead of print.

Authors

Thomas D Alter¹, Matthew L Hadley¹, Cory G Couch¹, Kristin M Fruth¹, Nicholas A Bedard¹, Kevin I Perry¹, Rafael J Sierra¹, David G Lewallen¹

Affiliation

¹ Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.

PMID: 38599525
DOI: 10.1016/j.arth.2024.03.071

Abstract

Background: Porous tantalum acetabular cup and augment constructs have demonstrated favorable outcomes up to 5 years postsurgery despite severe bone loss during revision total hip arthroplasty (THA). Prior literature lacks long-term studies with substantial case numbers. This study aims to assess long-term clinical and radiographic outcomes 10 years postsurgery in patients undergoing revision THA with porous tantalum acetabular cup-augment constructs and determine factors associated with long-term survivorship.

Methods: Between 2000 and 2012, 157 revision THAs were performed in cases with major acetabular defects (mainly Paprosky type IIIA and IIIB) utilizing porous tantalum cup-augment constructs. Pelvic discontinuity was noted intraoperatively in 17 hips (11%). Postoperative radiographs were evaluated at regular intervals for implant stability and radiolucent lines. There were 49 patients who had complete radiographic follow-up at 10 years or longer postsurgery.

Results: The 10-year survivorship free of revision of the cup-augment construct for aseptic loosening was 93%, free of any acetabular construct revision was 91%, free of any hip rerevision was 77%, and free of any reoperation was 75%. Pelvic discontinuity was associated with increased risk of reoperation (hazard ratio [HR] = 2.8), any hip rerevision (HR = 3.2), any cup-augment construct revision (HR = 11.8), and aseptic construct revision (HR = 10.0). Of unrevised cases with radiographs at 10 years, 4 hips showed radiographic loosening. Mean Harris hip scores improved from 47 preoperatively to 79 at 10 years.

Conclusions: Porous tantalum acetabular cup-augment constructs used in revision THA with severe acetabular bone loss provide excellent implant survivorship at 10 years when the acetabulum is intact. Due to lower survivorship of cup-augment constructs in cases of pelvic discontinuity, additional construct fixation or stabilization methods are recommended, when a discontinuity is present.

Level of evidence: IV.

Keywords: acetabular bone loss; pelvic discontinuity; porous tantalum augment; porous tantalum cup; revision; total hip arthroplasty.