Ceramic heads are frequently used in revision total hip arthroplasty (rTHA) when the femoral stem is retained to treat or reduce the risk of trunnion corrosion. The ceramic heads used in rTHA typically utilize a titanium sleeve adapter to protect the ceramic head from damage by the retained femoral stem taper. However, there is sparse mid- to long-term data on this practice, and factors associated with failure remain largely unknown. The purpose of this study was to determine survival free from revision for failure of the head and/or neck junction (HNJ) and all-cause revision when using a ceramic head with a titanium sleeve on a retained femoral stem in rTHA, and to identify factors associated with failure. We retrospectively reviewed our institutional database to identify all consecutive aseptic rTHA that used a new ceramic head with a titanium sleeve on a retained femoral stem from 2011 to 2022. Septic revisions were excluded, as were seven patients with less than two-year follow-up, none of whom underwent re-revision. A total of 317 revisions (296 patients) were included in the study with a mean follow-up of 7.3 years (range 2.1–13.8). Mean patient age was 65.7 (34.8–94.2), BMI was 28.7 (17.9–49.9), and 57.4% were female. The most common indications for rTHA were adverse local tissue reaction to metal debris (ALTR) (45.7%), instability (28.4%), and acetabular aseptic loosening (AL) (11.7%). An isolated modular exchange was performed in 37.5% of revisions and the remaining 62.5% also underwent acetabular revision. Kaplan Meier Analysis was used to determine survival for the entire cohort, with failure of the HNJ and all-cause re-revision as the endpoints. Additionally, survival was compared between cohorts stratified by indication for rTHA and femoral head size (< 3 6mm and ≥36mm). There were no re-revisions for failure of the HNJ. Sixty-seven hips (21.1%) underwent re-revision at a mean time of years 1.7 years (0–9.6). The most common reasons for re-revision were instability (39 of 67), infection (18 of 67), and aseptic loosening (7 of 67). The 10-year survival free from re-revision for failure of the HNJ was 100%. The all-cause re-revision-free survival was 80.7% (95% CI 78.5–82.9) at five-years and 76.2% (95% CI 73.4–79.0) at 10-years. By indication for rTHA, the 10-year all-cause re-revision free survival was 91.9% for AL, 86.4% for ALTR, 77.5% for “other”, and 54.7% for instability. The differences in re-revision free survival by indication were statistically significant (p femoral head cohort (79.7% versus 71.9%, p=0.022). No factors were associated with failure at the HNJ. The use of new ceramic heads with titanium sleeves when the femoral stem is retained in rTHA is a safe practice. There were no cases of re-revision for femoral head, HNJ, or taper complications in this large cohort at mid-term follow-up. Indication for rTHA and femoral head size were associated with all-cause re-revision.
MacDonell et al. (Wed,) studied this question.