Risk Factors Associated With Early Complications of Revision Surgery for Head-Neck Taper Corrosion in Metal-on-Polyethylene Total Hip Arthroplasty

Abstract

Background: Adverse local tissue reactions (ALTRs) due to tribocorrosion of head-neck taper junctions in contemporary metal-on-polyethylene (MoP) total hip arthroplasty (THA) are emerging as an important reason for failure requiring revision surgery. This study aimed at: (1) reporting early complication rates and outcome, and (2) identifying risk factors associated with complications of revision surgery for head-neck taper corrosion in patients with MoP THA.

Methods: Forty consecutive revision surgeries in 39 patients (male, 16; female, 23) with MoP THA were evaluated. The follow-up period after revision was a minimum of 14 months (range, 14-45). The indication for revision surgery was the presence of symptomatic ALTR on magnetic resonance imaging (MRI) with elevated metal ion levels.

Results: The overall complication rate was 25% and the reoperation rate was 10%. The median serum level of cobalt ions decreased significantly 8.2 μg/L (1.2-56.1 μg/L) pre-revision to 3.1 μg/L (0.2-14.0 μg/L) post-revision (P < .01). High fretting and corrosion grades (Goldberg score ≥ 3) were observed in 82% of retrieved implants. MRI findings of solid lesion(s) with abductor deficiency (P < .01) and intraoperative tissue damage at revision (P = .02) were significantly associated with post-revision complications.

Conclusion: A high rate of early complications (25%) and re-revisions (10%) was observed after revision of ALTR associated with head-neck taper corrosion. Pre-revision MRI findings of solid lesion(s) with abductor deficiency and intraoperative tissue damage were risk factors associated with the occurrence of a complication after revision surgery. This information provides clinically useful information for clinical decision-making and preoperative counseling of MoP THA patients undergoing revision surgery for head-neck taper corrosion.

Keywords: adverse local tissue reaction; complications; head-neck taper corrosion; metal-on-polyethylene total hip arthroplasty; revision surgery; risk factors.