J Korean Hip Soc.  2010 Jun;22(2):143-150. 10.5371/jkhs.2010.22.2.143.

Analysis of Failure Cause of Acetabular Components Among Total Hip Replacement Arthroplasties Using RB Wagner Acetabular Cup

• Kim YC
• Kim YB
• Park DH
• Moon SW

• KMID: 1461136
• DOI: http://doi.org/10.5371/jkhs.2010.22.2.143

Abstract

PURPOSE
The purpose of this study was to analyze the cause of failure of acetabular component cases after metal-on-metal primary total hip arthroplasty using RB Wagner acetabular cup.
MATERIALS AND METHODS
Between January 1993 and January 2005, we retrospectively studied failure cause of 27 patients who underwent acetabular revision surgery among 468 consecutive cementless total hip arthroplasties using RB Wagner acetabular component. The duration of primary arthroplasty to revision ranged from 5.1 years to 11.5 years (mean 9.2 years). The clinical evaluation was performed using preoperative and last follow-up modified Harris hip scores. The radiological evaluation was performed in terms of the stability, such as inclination, anteversion, cup size, acetabular bone coverage, osteolysis, radiolucency and gap.
RESULTS
The average Harris hip scores was 49.6 preoperatively and 91.3 at the most recent follow-up. In revision cases, the score was 41.2 to 51.7. Among 468 cases, 27 patients underwent revision surgery (7%, 27/468) and there was no osseointegration in all cases. The radiological evaluation in revision cases revealed inclination (46.04+/-5.328, p=0.0031), anteversion (14.14+/-2.95, p=0.584), cup size (54 mm+/-2.5, p=0.042) and acetabular bone coverage (67.9%+/-4.77, p=0.003). Focusing on the relation between disease entities, there was relatively high risk in patients with hip dysplasia (Fisher's exact test, p=0.0095).
CONCLUSION
Although Wagner acetabular cup relatively showed as high survival rate as 93%, failure rate is significantly high in dysplastic hip patients.

Keyword

Dysplastic hip; Total hip arthroplasty; RB Wagner acetabular cup

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Hip
Follow-Up Studies
Hip
Humans
Osseointegration
Osteolysis
Retrospective Studies
Survival Rate

Figure

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  Fig. 1 A RB Wagner acetabular cup has a titanium shell with sandblasted outer surface for promotion of osseointegration. The proximal half has openings for optional screws for initial stability and distal half has sharp-edged pegs for penetration into cancellous bone.

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  Fig. 2 A 66 years old woman with hip dysplasia underwent primary total hip arthroplasty using RB Wagner acetabular cup and cone stem. After 6 years, she visited us with symptom of limping and inguinal pain. Modified Harris hip score was 42 point at postoperative one year and it was shift to 52 point at last follow up. On plain radiographs, inclination was 45, anteversion was 15.5, acetabular coverage was 68% and cup size was 54mm at one year after surgery. At last follow up, the cup showed migration into superolaterally and increased inclination. She was performed revision surgery and we have taken close observation to her. (A) preoperative radiograph of left side dysplastic hip (B) postoperative one year follow up radiograph (C) postoperative 6 year follow up radiograph in failure (D) after revision with Ganz cup with cemented technique.

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