Is Head and Liner Exchange an Acceptable Option for THA Revision?
Dr. Ran Schwarzkopf answers ICJR’s questions about a study in which he and his NYU Langone Orthopedic Hospital colleagues evaluated 2-year outcomes of isolated head and liner exchange versus full acetabular revision.
ICJR: What question did you and your co-authors want to answer with this study?
Ran Schwarzkopf, MD, MSc: One of the benefits of an isolated head and liner exchange in revision total hip arthroplasty (THA) is that it preserves bone stock compared with a full acetabular revision, and it’s often used for patients with an acute infection or liner wear. However, research has shown a higher rate of complications and re-revision with head/liner exchange in the short term.
For this study, we wanted to compare outcomes at 2 years after isolated head and liner versus full acetabular component revision in patients who underwent these procedures at our institution, focusing on re-revision-free survivorship in aseptic revision THA in properly selected patients and indications.
What did you conclude about outcomes of head-liner exchange vs. full acetabular revision?
Dr. Schwarzkopf: We found that isolated head and liner exchange is a viable option for revision THA. The 2-year survivorship was non-inferior to that of full acetabular revision for properly selected and indicated patients – such as polyethylene wear, liner fracture, some instances of instability, trunnionosis, and metal-on-metal cases – correcting for surgical indication and prior revision.
ICJR: How did you reach your conclusions? What was your study cohort and what did you find with your analysis?
Dr. Schwarzkopf: Our study cohort included 124 head and liner exchanges and 141 full acetabular cup revisions performed at NYU Langone Orthopedic Hospital between 2011 and 2018. Patients in this cohort had at least 2 years of follow-up.
We compared the early revision rate between groups using a logistic regression model of subsequent revision within 2 years, correcting for surgical indication and history of a prior revision. In the head and liner exchange group, re-revision-free survivorship at 2 years was 77% for all causes and 84% for aseptic reasons. In the full acetabular component revision group, re-revision-free survivorship at 2 years was 77% for all causes (P>0.99) and 87% for aseptic reasons (P=0.54).
The 2-year survivorship of the head and liner group was determined to be non-inferior to that of the acetabular revision group, correcting for surgical indication and history of prior revision (adj-OR=1.05, 95% CI 0.59 – 1.89, P=0.85).
Average time to failure was 6.9 months (range=0.0-20.7 months) in the head and liner exchange group and 7.0 months (range=0.3-20.8 months) in the full acetabular component revision group (P=0.94). If a patient had a prior revision procedure, time to failure for acetabular revision was nearly 2 times longer than for head and liner exchange, although this difference was not significant (P=0.10).
ICJR: Why are your findings significant for clinical practice?
Dr. Schwarzkopf: Although a prospective, randomized study is needed to compare these 2 types of revision THA head-to-head, our study provides preliminary data suggesting that the less-invasive isolated head and liner exchange may exhibit early outcomes comparable to those of a full acetabular revision in properly selected indications and patients.
Berlingberg EJ, Roof MA, Feder O, Meftah M, Long WJ, Schwarzkopf R. Outcomes of isolated head-liner exchange vs. full acetabular revision in revision total hip arthroplasty (Paper 770). Presented at the 2021 Annual Meeting of the American Academy of Orthopaedic Surgeons, August 31-September 3, San Diego, California.
About the Expert
Ran Schwarzkopf, MD, MSc, is Professor of Orthopedic Surgery, Associate Chief of the Division of Adult Reconstruction, Director of the Adult Reconstruction Research Center, and Associate Director of the Orthopedic Surgery Residency Program at NYU Langone Health, New York, New York.
Disclosures: Dr. Schwarzkopf has disclosed that he has stock or stock options in Gauss Surgical and PSI; that he receives royalties and research support from and that he is a paid consultant for Smith & Nephew; and that he has stock or stock options in and is a paid consultant for Intellijoint Surgical