A Registry Study on Acetabular Revisions Using Jumbo Cups: Do We Really Need a More Complex Revision Strategy?

Claudio D'Agostino; Alberto Di Martino; Piergiorgio Cataldi; Francesco Schilardi; Matteo Brunello; Giuseppe Geraci; Barbara Bordini; Francesco Traina; Cesare Faldini

doi:10.1016/j.arth.2024.08.041

A Registry Study on Acetabular Revisions Using Jumbo Cups: Do We Really Need a More Complex Revision Strategy?

J Arthroplasty. 2024 Sep 2:S0883-5403(24)00885-4. doi: 10.1016/j.arth.2024.08.041. Online ahead of print.

Authors

Claudio D'Agostino¹, Alberto Di Martino¹, Piergiorgio Cataldi¹, Francesco Schilardi¹, Matteo Brunello¹, Giuseppe Geraci², Barbara Bordini³, Francesco Traina⁴, Cesare Faldini¹

Affiliations

¹ 1st Orthopaedic and Traumatology Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
² 1st Orthopaedic and Traumatology Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy.
³ Medical Technology Laboratory, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy.
⁴ Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; Department of Orthopaedics and Traumatology and Hip and Knee Arthroplasty and Revisions, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy.

PMID: 39233106
DOI: 10.1016/j.arth.2024.08.041

Abstract

Background: The increasing global performance of total hip arthroplasty (THA) has led to a rise in revision surgeries, primarily due to cup failure, with aseptic loosening and periprosthetic infection being common causes. Various techniques and implants, including jumbo cups (JCs), manage residual bone loss post-cup removal, facilitating enhanced surface area for improved host bone contact, and osteointegration. The purpose of the study was to determine the outcomes of acetabular revision arthroplasty using JC implants over a 20-year follow-up period by reporting overall survivorships, complications leading to re-revision, and surgical strategies in re-revision.

Methods: A cohort study based on a large regional registry was conducted, examining revision THA surgeries utilizing JCs between 2000 and 2020. The study included all the revision acetabular procedures performed with cementless JCs, identified with a diameter ≥ 62 millimeters (mm) in women or ≥ 66 mm in men. All iliac fixation cups were excluded. Data on demographics, revision surgery indications, components, fixation types, causes of failure, and reintervention strategies were collected and analyzed. A total of 541 JCs implanted from January 2000 to December 2020 were evaluated. The most common revision indications were "cup aseptic loosening" (54.5%) and "total aseptic loosening," which included both the cup and stem (32%).

Results: The JC survival rates were 92.5% at 5 years, 85.8% at 10 years, and 81.5% at 15 years. Among the 70 failures, the main causes were "cup aseptic loosening" (40%), "total aseptic loosening" (17.1%), and "septic loosening" (12.8%). Revisions primarily involved acetabular cup revision surgery (54 cases), component explantation (11 cases), or insert or head revision (five cases).

Conclusions: This registry-based study of JCs in revision THA demonstrates excellent 15-year survival rates and acceptable failure rates. It supports JCs as a viable option, offering relative surgical simplicity compared to alternatives like antiprotrusion cages, bone grafts, and augments.

Keywords: THA failure; THA survival; giant cup; hip arthroplasty; jumbo cup; revision arthroplasty.