Revision Prospects After THR or Resurfacing

[Canadian-Ice]

Fact of the matter is, the topic of Revision durability is often dismissed as irrelevant to those of us not facing one.

But it matters to us all, because we cannot evaluate our current need for restrictions without understanding the consequences of our choices.

To this end, we need to know more than just success and failure rates of our current device. We need to understand what could follow.

I have tried to find studies and anecdotes for people post THR and Post Resurfacing failures but haven't been very successful.

Until I came across this large scale study that looked at the survivability of over 1000 THR Revisions performed between 1986 and 2005.

This study found a 72.6% survival rate over 15 years. An encouraging stat overall. Major cause of revision was aseptic loosening but other culprits too.

Data could be parsed further, as could the methodology of course.

But it might be likely that Revisions in future decades will last longer.

Hope to hear from someone!

CI

http://www.ncbi.nlm.nih.gov/pubmed/?term=Why+Revision+Total+Hip+Arthroplasty+Fails

[Tim Bratten]

Hi CI
Maybe I have one thing to add. Like I said in my message I sent you, I'm only two years post revision so I have nothing in the way of personal information to add about longevity. However, it's my understanding that aseptic loosening is mainly associated with metal on plastic THR and is a real problem for younger, more active patients because that activity produces more debris. This is one of the main reasons some surgeons (namely De Smet) prefer ceramic on ceramic THR. I know for a fact that when De Smet started out with resurfacing, he was also using ceramic on ceramic THR system with smaller diameter heads (28 mm) and he was not very happy with his results. He changed the THR system some years ago, to bigger diameter heads with a modular neck and he now seems quite happy with the results he is getting ("practically" as good as resurfacing, he said). He personally told me he was not so sure he would now choose HR over his THR system for himself, if he was to need a hip replacement. At any rate, whatever problems I may have with longevity, I'm thinking that aseptic lossening should not be an issue   

[Canadian-Ice]

Hi Tim,

Since reading your post, I emailed Koen and he indicated that there are no issues with longevity of the ceramic-ceramic THR. He said the BHRs may well not fail in one's lifetime but if it did, the ceramic THR would certainly last, in my case, the rest of my life. So, he certainly has confidence in the ceramic THR whether as a first or second device.