Paper13-Faiure-rates-4762-revision-total-hip-Norwegian-registry-J-Bone-and-Joint-Surgery-VOL86-B(4)-

Paper13-Faiure-rates-4762-revision-total-hip-Norwegian-registry-J-Bone-and-Joint-Surgery-VOL86-B(4)-

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504 THE JOURNAL OF BONE AND JOINT SURGERY Failure rates for 4762 revision total hip arthroplasties in the Norwegian Arthroplasty Register S. A. Lie, L. I. Havelin, O. N. Furnes, L. B. Enges±ter, S. E. Vollset From the University of Bergen and Haukeland University Hospital, Bergen, Norway n S. A. Lie, MD n S. E. Vollset, MD Section for Medical Statistics, Department of Public Health and Primary Health Care, University of Bergen, Kalfarveign 31, N-5018 Bergen, Norway. n L. I. Havelin, MD n O. N. Furnes, MD n L. B. Enges±ter, MD Department of Orthopaedics, Haukeland University Hospital, N-5021 Bergen, Norway. Correspondence should be sent to Dr S. A. Lie. ©2004 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.86B4. 14799 $2.00 J Bone Joint Surg [Br] 2004;86-B:504-9. Received 18 July 2003; Accepted 10 September 2003 We present the results for 4762 revision total hip arthroplasties with no previous infection in the hip, which were reported to the Norwegian Arthroplasty Register between 1987 and 2003. The ten-year failure rate for revised prostheses was 26% (95% CI 25 to 26). Cox regression analyses were undertaken separately for acetabular and femoral revision components. Cemented revision components without allograft was the reference category. For acetabular components, we found a signi±cantly reduced risk of failure for uncemented revisions both with (relative risk (RR) = 0.66; 95% CI 0.43 to 0.99) and without (RR = 0.37; 95% CI 0.22 to 0.61) allograft. For femoral components, we found a signi±cantly reduced risk of failure for uncemented revisions, both with (RR = 0.27; 95% CI 0.16 to 0.46) and without (RR = 0.22; 95% CI 0.11 to 0.46) unimpacted allograft. This reduced risk of failure also applied to cemented revision components with allograft (RR = 0.53; 95% CI 0.33 to 0.84) and with impaction bone grafting (RR = 0.34; 95% CI 0.19 to 0.62). Revision prostheses have generally inferior results when compared with primary prostheses. Recementation without allograft, and uncemented revision with bone impaction, were associated with worse results than the other revision techniques which we studied. Within ten years, 11% of all primary prosthe- ses in the Norwegian Arthroplasty Register failed. The treatment of patients with a revised prosthesis is a challenge to the orthopaedic sur- geon. Documentation of the results for revision prostheses is sparse, although some studies have been undertaken. 1-10 There are also stud- ies from the Swedish National Hip Arthro- plasty Register with results from a large number of revision hip prostheses. 11-14 In terms of both function and survival the results of revision surgery have been regarded as in- ferior to primary total hip arthroplasty (THA). 15 Different techniques have been des- cribed on how to approach revision hip arthro- plasty. Traditionally, recementation of both the acetabulum and the femur have been com- mon. 13,14 In the 1990s, impaction cancellous allografting and cementing was introduced for both components.
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Paper13-Faiure-rates-4762-revision-total-hip-Norwegian-registry-J-Bone-and-Joint-Surgery-VOL86-B(4)-

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