Revision outcomes after failed hip resurfacing arthroplasty vary by failure indication and component strategy: A systematic review
Srikar Reddy Namireddy, Hariharan Subbiah Ponniah, Milos Brjklac, Justin Cobb, Kartik LogishettyAbstract
Purpose
Hip resurfacing arthroplasty (HRA) is a bone‐conserving procedure indicated for end‐stage osteoarthritis in younger, active patients. The widespread failure of metal‐on‐metal (MoM) bearings due to adverse reactions to metal debris has generated a large and complex revision cohort. The recent regulatory approval of ceramic‐on‐ceramic (CoC) resurfacing devices necessitates an updated synthesis of HRA revision outcomes.
Methods
Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, a systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Library and HMIC was conducted. Studies reporting outcomes of primary HRA revision with a minimum of 12 months of follow‐up and extractable re‐revision or functional outcome data were included. Studies reporting primary HRA survivorship only were excluded. Data were extracted on revision strategy, indications, serum metal ion levels, patient‐reported outcome measures and re‐revision rates.
Results
Twenty‐three studies were included, encompassing 2320 reported HRA revision procedures. Across 1705 hips with longitudinal data, 157 re‐revisions or major reoperations occurred (9.2%). Both‐component revision had the lowest crude strategy‐specific rate (59/828; 7.1%), followed by femoral‐only revision (63/486; 13.0%) and isolated acetabular revision (10/52; 19.2%). Strategy was indication‐dependent: femoral‐only revision predominated for fracture (239/325; 73.5%), whereas both‐component revision predominated for metal‐related pathology (245/368; 66.6%) and loosening/osteolysis (268/416; 64.4%). Post‐revision, cobalt and chromium concentrations decreased in both studies reporting paired data; HHS improved from 64.4 to 92.5. Instability/dislocation/intraprosthetic dislocation was the commonest complication (32/118; 27.1%), followed by periprosthetic joint infection (24/118; 20.3%). Primary CoC resurfacing had 98.0% 5‐year survivorship, with predominantly mechanical failures and no re‐revision data.
Conclusions
HRA revision can provide functional recovery and metal ion reduction, but outcomes depend on indication, component status and construct. Both‐component revision had the lowest crude observed re‐revision proportion. Femoral‐only revision may be considered when the shell is fixed, well‐oriented, undamaged, and biologically uninvolved. Retained‐cup dual mobility is a component‐preserving option but carries risks of intraprosthetic dislocation and uncertain long‐term polyethylene wear.
Level of Evidence
Level IV.