• Jetse Jelsma, van KuijkS M JSMJDepartment of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht, The Netherlands., A Spekenbrink-Spooren, B Grimm, I C Heyligers, and SchotanusM G MMGMDepartment of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard, 6162 BG, Geleen, The Netherlands.Faculty of Health, Medicine and Life Sciences, School of Care and Public Health Research I.
• Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard, 6162 BG, Geleen, The Netherlands. jetsejelsma@gmail.com.
• Arch Orthop Trauma Surg. 2022 Dec 1; 142 (12): 4025-4032.

BackgroundPreliminary results of metal-on-metal (MoM) hip arthroplasty were satisfactory, but since 2004 data showed high failure rates. National joint replacement registries are multi-centre databases comprised of thousands of subjects and implants which allow for identifying variables predictive of implant failure. The aim of the current study was to estimate re-revision rates after revision of a primary MoM hip arthroplasty in the Dutch Arthroplasty Register (LROI) and to assess potential predictor variables of re-revision of these MoM hip arthroplasties.MethodsEligible procedures were those with a revision for any reason except infection, after an initial primary surgery with a hip resurfacing (HRA) or large-head MoM (LH-MoM) total hip arthroplasty (THA). The probability of re-revision for both types of MoM hip arthroplasty over time was estimated using the cumulative incidence function taking mortality as a competing risk into account. A proportional sub-distribution hazards regression model was used to assess potential predictor variables of re-revision of these MoM hip arthroplasties.ResultsA total of 3476 records of revised implants were included, of which 873 (25.2%) were MoM implants. Over the course of follow-up, 101 (11.5%) MoM implants were re-revised. During follow-up 36 (4.3%) patients who received a MoM-implant at primary arthroplasty and a revision afterwards had died. The regression model showed that for primary MoM implants a MoM articulation after revision (HR 2.48; 95% CI 1.53-4.03, p < 0.001), femoral-only revisions (HR 3.20; 95% CI 2.06-4.99, p < 0.001) and periprosthetic fractures (HR 1.98; 95% CI 1.03-3.82, p = 0.042) as reason for the first revision were statistically significant risk factors for re-revision.ConclusionBoth types of large-head MoM hip arthroplasties have shown high revision and re-revision rates; risk factors were identified. The outcome of this study can be helpful in managing expectations of patients and orthopaedic surgeons.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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