Outcome and Risk Factors Associated with Failures of Isolated Bearing Exchange for Osteolysis in Well-Fixed Cementless Total Hip Arthroplasty

Background: It is often challenging to decide whether to revise only the bearing or femoral acetabular component in the setting of progressive osteolysis without component loosening in revision total hip arthroplasty (THA). In this study, we aimed to (1) compare the survivorship of isolated bearing exchange and single/both component revision for patients with periprosthetic osteolysis without component loosening, and (2) identify potential risk factors associated with failures of isolated bearing exchange.

Methods: A total of 228 consecutive cases of revision THA for progressive osteolysis without component loosening was evaluated in 2 groups: (1) 124 component revision and (2) 104 isolated bearing exchange. The primary outcome was survival, with failure defined as repeat revision or reoperation for any reason. Patient risk factors, such as demographics and medical comorbidities, were also analyzed.

Results: There was no significant difference in survivorship between the component revision group and the bearing exchange group at 10 years (85% vs 82%; P = .89). There was no progression of osteolysis on radiographs at last follow-up for patients with isolated bearing change. Univariate regression modeling demonstrated that renal disease was associated with failure of isolated bearing exchange after revision THA.

Conclusion: This study demonstrated that isolated bearing exchange is associated with similar outcomes compared with component revision for aseptic osteolysis without loosening, demonstrating that isolated bearing exchange is a viable option for selected patients with osteolysis in the setting of well-fixed THA components. This provides clinically useful information for surgeons in the surgical treatment of THA patients with wear and osteolysis without component loosening.