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Online ISSN 1827-1707
Myra TRIVELLAS, Kaitlin M. CARROLL, Michael B. CROSS
Hospital for Special Surgery, New York, NY, USA
Total hip arthroplasty (THA) is one of the most successful and cost-effective surgeries performed, with a clinical success rate greater than 90% at 10 years. Late failure, however, continues to be a challenge. Even as surgical techniques and implant technology improve, the absolute number of revision THAs in the United States and the percentage of revision THAs (compared to the number of primary THAs) performed each year has continued to rise. The most common reasons for failure after primary THA include instability, aseptic loosening, and infection. Selection of the proper implant to accomplish the goals of revision is essential. Cemented implants are generally much less expensive than uncemented components, however cementless options grant the surgeon greater flexibility, along with an easier and faster implantation technique. An option that combines the two techniques where the stem is cemented and the cup is uncemented is the hybrid revision THA, which has shown encouraging mid-term results. Acetabular management in a revision THA is a difficult undertaking with a continuum of potential challenges and complications. Simple revisions can still be performed with conventional cemented or uncemented hemispherical cups, depending on the surgeon’s experience and preference, as both options have supportive data proving reliability and longevity. As the revisions become more complex, different reconstructive options can be considered based on the varying defects and pelvic anatomy. However, the basis for adoption of highly porous-coated augments in the setting of complex revision surgery is reliance on mid-term evidence of success, so long-term follow-up will be beneficial in understanding the mechanisms of success and failure of these implants and techniques and will ultimately guide surgical decision making.