Matharu, G, Judge, A, Pandit, HG orcid.org/0000-0001-7392-8561 et al. (1 more author) (2017) Which factors influence the rate of failure following metal-on-metal hip arthroplasty revision surgery performed for adverse reactions to metal debris? AN ANALYSIS FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND AND WALES. Bone and Joint Journal, 99-B (8). pp. 1020-1027. ISSN 2049-4394
Abstract
Aims
To determine the outcomes following revision surgery of metal-on-metal hip arthroplasties (MoMHA) performed for adverse reactions to metal debris (ARMD), and to identify factors predictive of re-revision.
Patients and Methods
We performed a retrospective observational study using National Joint Registry (NJR) data on 2535 MoMHAs undergoing revision surgery for ARMD between 2008 and 2014. The outcomes studied following revision were intra-operative complications, mortality and rerevision surgery. Predictors of re-revision were identified using competing-risk regression modelling.
Results
Intra-operative complications occurred in 40 revisions (1.6%). The cumulative five-year patient survival rate was 95.9% (95% confidence intervals (CI) 92.3 to 97.8). Re-revision surgery was performed in 192 hips (7.6%). The cumulative five-year implant survival rate was 89.5% (95% CI 87.3 to 91.3). Predictors of re-revision were high body mass index at revision (subhazard ratio (SHR) 1.06 per kg/m2 increase, 95% CI 1.02 to 1.09), modular component only revisions (head and liner with or without taper adapter; SHR 2.01, 95% CI 1.19 to 3.38), ceramic-on-ceramic revision bearings (SHR 1.86, 95% CI 1.23 to 2.80), and acetabular bone grafting (SHR 2.10, 95% CI 1.43 to 3.07). These four factors remained predictive of re-revision when the missing data were imputed.
Conclusion
The short-term risk of re-revision following MoMHA revision surgery performed for ARMD was comparable with that reported in the NJR following all-cause non-MoMHA revision surgery. However, the factors predictive of re-revision included those which could be modified by the surgeon, suggesting that rates of failure following ARMD revision may be reduced further.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | (c) 2017 Matharu et al. This is an open-access article distributed under the terms of the Creative Commons (CC-BY) license, which permits copying and redistributing the material in any medium or format, remixing, transforming and building upon the material for any purpose, even commercially, provided the original author and source are credited, and changes made are indicated. This may be done in a reasonable manner, but not in any way that suggests the licensor endorses you or your use. |
Keywords: | Adverse reactions to metal debris; Complications; Metal-on-metal hip arthroplasty; Mortality; Outcomes; Revision surgery |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Orthopaedics (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 03 Mar 2017 11:52 |
Last Modified: | 23 Jun 2023 22:24 |
Status: | Published |
Publisher: | British Editorial Society of Bone and Joint Surgery |
Identification Number: | 10.1302/0301-620X.99B8.BJJ-2016-0889.R1 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:113199 |