Method of Fixation Does Not Influence the Overall Risk of Rerevision in First-time Cup Revisions
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Clin Orthop Relat Res DOI 10.1007/s11999-013-2872-3
A Publication of The Association of Bone and Joint Surgeons®
SYMPOSIUM: 2012 INTERNATIONAL HIP SOCIETY PROCEEDINGS
Method of Fixation Does Not Influence the Overall Risk of Rerevision in First-time Cup Revisions Maziar Mohaddes MD, Go¨ran Garellick MD, PhD, Johan Ka¨rrholm MD, PhD
Ó The Association of Bone and Joint Surgeons1 2013
Abstract Background During the last two decades, uncemented fixation has been increasingly preferred worldwide during cup revision surgery. In Sweden, the number of uncemented cup revisions has been increasing during the last decade. However, it is unclear whether the risk of rerevision differs between cemented and uncemented cups. Question/purposes We determined (1) the risk of rerevision after cemented and uncemented fixation; (2) the influence of concomitant stem revision on the risk of rerevision of the cup; (3) the difference in risk of rerevision of an uncemented cup revision compared with liner revision only; and (4) whether the surgical incision influenced the risk of rerevision. Methods Between 1979 and 2010, 19,342 first-time cup revisions were reported to the Swedish Hip Arthroplasty
Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. M. Mohaddes (&), G. Garellick, J. Ka¨rrholm Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, NA 413 45, Sweden e-mail: [email protected] G. Garellick, J. Ka¨rrholm Swedish Hip Arthroplasty Register, Gothenburg, Sweden
Register. From these, 749 were excluded (hip resurfacing, cases with tumor diagnoses, and missing data) leaving 18,593 (73% cemented) for further analysis. We used a Cox regression model adjusted for age, sex, primary diagnosis, method of fixation, concomitant stem revision, and cemented/uncemented fixation to assess risk of rerevision. Results The relative risk for rerevision for any reason did not differ between cemented and uncemented fixation (relative risk [RR], 0.94). If the stem was not revised at index revision, the risk of further cup revision increased twofold (RR, 1.91). Liner revisions were associated with a 70% increased risk for rerevision of the cup as a result of any reason and especially because of dislocation (RR, 2.94). The surgical incision did not influence the overall risk for rerevision (dire
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