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Outcome of Re-Revision Surgery for Adverse Local Tissue Reaction in Metal-on-Polyethylene and Metal-on-Metal Total Hip Arthroplasty

Abstract:

Background: Adverse local tissue reactions (ALTRs), initially described as a complication of metal-on-metal (MoM) total hip arthroplasty (THA), have also become an important risk factor for implant failure requiring revision surgery in metal-on-polyethylene (MoP) THA due to modular taper corrosion. This study aims to report early complication rates and outcomes as well as potential risk factors for a re-revision. Methods: A total of 252 consecutive THA patients who underwent revision for ALTR were reviewed. There were 40 patients (16%) who underwent a second revision: (1) 26 MoP patients with modular taper corrosion and (2) 14 MoM patients. Patient demographics as well as clinical information were analyzed. Binary logistic regression was used to test for associations between re-revision surgery and clinical parameters. Results: The overall complication rate following initial revision for ALTR was 21%. Sixteen percent of these revision patients required a re-revision. The most common indication for re-revision was dislocation (45%). The complication rate was 35% following a re-revision which included dislocation (36%), infection (36%), fracture (14%), and implant loosening (14%). The rate of patients requiring a third revision was 23% with the most common indications being dislocation (33%) and infection (33%) (P = .032). Conclusion: High rate of early complications (35%) and third revisions (23%) were observed following re-revision of symptomatic ALTR patients with those requiring re-revision associated with extensive intraoperative tissue necrosis. These findings provide clinically useful information that may assist surgeons in clinical decision making and preoperative counseling of both MoM and MoP patients undergoing re-revision surgery for ALTR.