Early Outcomes of Revision Surgery for Taper Corrosion of Dual Taper Total Hip Arthroplasty in 187 Patients

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• 作者：Dimitris Dimitriou ; MD^a ; Ming Han Lincoln Liow ; MD^a ; Tsung-Yuan Tsai ; PhD^a ; William A. Leone ; MD^b ; Guoan Li ; PhD^a ; Young-Min Kwon ; MD ; PhD^a ;
• 关键词：revision total hip arthroplasty ; taper corrosion ; clinical outcomes ; modular femoral neck stem ; dual taper ; systematic evaluation
• 刊名：The Journal of Arthroplasty
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：31
• 期：7
• 页码：1549-1554
• 全文大小：1629 K

文摘

Modular dual taper femoral neck designs have been associated with taper corrosion requiring revision surgery. However, outcomes after revision dual taper total hip arthroplasty in patients with symptomatic adverse local tissue reaction due to taper corrosion remain largely unknown.

Methods

A total of 198 revision surgeries in 187 patients with dual taper femoral stem total hip arthroplasty with minimum 12-month follow-up were evaluated.

Results

At mean follow-up of 18 months, at least 1 complication had occurred in 39 patients (20%) of 198 revisions. Single episode of dislocation, treated with close reduction, occurred in 16, whereas 2 patients required rerevision due to multiple dislocations. Infection requiring rerevision occurred in 3 patients. Adverse local tissue reaction recurrence requiring reoperation occurred in 6 patients. Implant survivorship for revision for any cause was 86% at 30 months. The reoperation rate of revised dual taper was 8% (16 out of 198 hips). The median serum levels of cobalt, chromium, and cobalt/chromium ratio decreased (P < .01) from 5.3 μg/L (range: 2.3-48.5 μg/L), 2.6 μg/L (range: 0.2-64 μg/L), and 4.7 (range: 2.1-35) prerevision to 1.4 μg/L (range: 0.2-8.8 μg/L), 0.7 μg/L (range: 0.1-3.9 μg/L), and 2.2 (range: 0.4-8.8) postrevision, respectively.

Conclusion

This pilot study demonstrates that intraoperative tissue necrosis was associated with a high rate of early complications (20%) and revisions (8%), suggesting the importance of a systematic evaluation of these patients including metal ion levels and metal artifact reduction sequence magnetic resonance imaging in optimizing revision outcome, as early diagnosis will facilitate the initiation of appropriate treatment before significant adverse tissue necrosis.