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To determine the outcomes following revision surgery of metal-on-metal hip arthroplasties (MoMHA) performed for adverse reactions to metal debris (ARMD), and to identify factors predictive of re-revision.We performed a retrospective observational study using National Joint Registry (NJR) data on 2535 MoMHAs undergoing revision surgery for ARMD between 2008 and 2014. The outcomes studied following revision were intra-operative complications, mortality and re-revision surgery. Predictors of re-revision were identified using competing-risk regression modelling.Intra-operative complications occurred in 40 revisions (1.6%). The cumulative five-year patient survival rate was 95.9% (95% confidence intervals (CI) 92.3 to 97.8). Re-revision surgery was performed in 192 hips (7.6%). The cumulative five-year implant survival rate was 89.5% (95% CI 87.3 to 91.3). Predictors of re-revision were high body mass index at revision (subhazard ratio (SHR) 1.06 per kg/m2 increase, 95% CI 1.02 to 1.09), modular component only revisions (head and liner with or without taper adapter; SHR 2.01, 95% CI 1.19 to 3.38), ceramic-on-ceramic revision bearings (SHR 1.86, 95% CI 1.23 to 2.80), and acetabular bone grafting (SHR 2.10, 95% CI 1.43 to 3.07). These four factors remained predictive of re-revision when the missing data were imputed.The short-term risk of re-revision following MoMHA revision surgery performed for ARMD was comparable with that reported in the NJR following all-cause non-MoMHA revision surgery. However, the factors predictive of re-revision included those which could be modified by the surgeon, suggesting that rates of failure following ARMD revision may be reduced further. Cite this article: Bone Joint J 2017;99-B:1020-7.

Original publication

DOI

10.1302/0301-620x.99b8.bjj-2016-0889.r1

Type

Journal article

Journal

The bone & joint journal

Publication Date

08/2017

Volume

99-B

Pages

1020 - 1027

Addresses

University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK.

Keywords

Humans, Foreign-Body Reaction, Prosthesis Failure, Treatment Outcome, Arthroplasty, Replacement, Hip, Reoperation, Registries, Incidence, Risk Factors, Retrospective Studies, Prosthesis Design, Hip Prosthesis, Middle Aged, England, Wales, Female, Male, Metal-on-Metal Joint Prostheses