Revision Total Hip Arthroplasty: Tantalum May be Protective Against Infection

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Authors: Tokarski AT, Novack TA, Deirmengian GK, Austin MS, Parvizi J.
The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA

Title: Revision Total Hip Arthroplasty: Tantalum May be Protective Against Infection

Background: Revision total hip arthroplasty (THA) can be a challenging procedure. Reconstruction of the acetabulum may involve the use of titanium (Ti) or tantalum (Ta) uncemented components.

Hypothesis/Purpose: The hypothesis of this study was that the use of Ta acetabular components was protective against subsequent failure due to infection.

Methods: Using our institutional database, 757 patients (782 joints) undergoing revision THA from 2000-2012, during which time acetabular reconstruction was performed using either Ti or Ta uncemented components, were identified. There were 334 men and 424 women with an average age of 64.3 years (range: 28-90) and 64.3 years (range 26-90) respectively. Clinical and radiographic records were reviewed to extract relevant information. Ti acetabular components were used in 448 hips while Ta components were used in 334 hips. There was no difference in demographic factors between the two groups. Aseptic loosening was the surgical indication in 413 hips (52.8%) while 90 hips (11.5%) were revised for periprosthetic joint infection. Multivariate logistic regression was used to determine causes of subsequent failure. 

Results: In total, 57 (7.3%) hips experienced subsequent acetabular failure. The incidence of failure was significantly lower in Ta group at 3.9% (13/334) compared to 9.8% (44/448) in the Ti group (p=0.001, 95% CI: 0.16-0.65).

Discussion: Among the 90 hips (44 Ta, and 46 Ti) initially revised because of infection, the failure due to subsequent infection was also lower in the Ta group at 2.3% (1/44) compared to 19.6% (9/46) for the Ti group (p = 0.015). Multivariate analysis identified Ti acetabular component (OR = 3.03), Charlson Comorbidity Index per point increase (1.4) and younger age per year (OR = 1.04) as independent factors for subsequent failure.

Conclusion: This study demonstrated that the use of Ta acetabular components during revision THA was associated with a lower incidence of failure from all causes, and in particular infection. It appears that the use of tantalum may be protective against subsequent infection.