Is the Use of New Ceramic Heads with Titanium Sleeves on Retained Femoral Stems in Revision Total Hip Arthroplasty Associated with Femoral Head or Neck Junction Failure at Mean Eight-year Follow-up?

Abstract

Ceramic heads used in revision total hip arthroplasty (rTHA) typically utilize a titanium sleeve adapter to protect from damage by the retained femoral stem taper; however, there is sparse mid- to long-term data on this practice, and risk factors for failure remain relatively unknown. The purpose of this study was to determine revision-free survival, specifically for failure of the head and/or neck junction (HNJ) and all-cause re-revision in this patient population, and to identify factors associated with failure. We retrospectively identified all consecutive aseptic rTHA that used a new ceramic head with a titanium sleeve on a retained femoral stem at our institution between 2011 and 2022. A total of 316 rTHA (295 patients) were included with a mean follow-up of 7.7 years (range, 2.1 to 14.3). The mean age was 65 years, and 57% were women. The main indications for rTHA were adverse local tissue reaction (46%), instability (29%), and acetabular aseptic loosening (12%). Isolated modular component exchange was performed in 38% of revisions. Kaplan-Meier analysis was used to determine survivorship. We aimed to use multivariate logistic regressions to identify risk factors for HNJ failure and all-cause re-revision. There were no re-revisions for HNJ failure. The re-revision-free survival for HNJ failure was 100%. There were 66 hips (21%) that underwent re-revision at a mean time of 1.8 years, most commonly for instability (39 of 66), infection (17 of 66), and aseptic loosening (eight of 66). The 5- and 10-year all-cause re-revision-free survival was 81.1 and 77.0%, respectively. There were no implant or surgical factors associated with HNJ failure. Multivariate analyses identified not undergoing cup revision (P = 0.027) and rTHA for instability (P = 0.042) as risk factors for re-revision. New ceramic heads with titanium sleeves on retained femoral stems in rTHA are safe at a mean eight-year follow-up with no failures of the HNJ. Acetabular component retention and revision for instability were risk factors for all-cause re-revision.