An estimation of re-revision rate following isolated acetabular revision: A systematic review and meta-analysis

Abstract Background Aseptic loosening of the previously retained component and recurrent dislocation are two main concerns following isolated acetabular revision. The aim of this meta-analysis and systematic review was to estimate the re-revision rate following isolated acetabular revision. Methods The PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched until June 2019. Data were extracted by two independent investigators, and consensus was reached with the involvement of a third. Rates of re-revision from twenty studies were aggregated using random effects models after a double arcsine transformation and were grouped by study- and population-level characteristics. Results Re-revision rates following isolated acetabular revision were reported in 20 studies involving 1601 cases. The pooled re-revision rate was 7.8% with an average 8-year follow-up. Asian studies reported a lower re-revision rate (3.5%) compared with the rest of the world. Approximately 0.8% of isolated acetabular revision cases underwent re-revision due to aseptic loosening of the femoral component, while 0.6% underwent re-revision due to dislocation. Studies with longer follow-up reported a relatively higher rate of aseptic loosening of the femoral stems. The pooled re-revision rate due to aseptic loosening was 0.9% in cemented stems and 0% in cementless stems. Conclusion Based on this exploratory analysis, isolated acetabular revision generally has a low risk of failure due to recurrent dislocation or aseptic loosening of the previously well-fixed femoral stem.