Replacement Arthroplasty: Della Valle CJ

Della Valle CJ. · No affiliation provided · J Knee Surg. · Pubmed #18979925 No free full text.

This publication has no abstract.

Della Valle CJ, Nunley RM, Barrack RL. · Departemnt of Orthopaedic Surgery, Rush University Medical Center, 1725 West Harrison, Suite 1063, Chicago, IL 60612, USA. · Orthopedics. · Pubmed #19298021 No free full text.

Abstract: With the recent approval of 2 metal-on-metal hip resurfacing devices in the United States, hip resurfacing is being performed more commonly. As with most orthopedic procedures, appropriate indications are the key to successful outcomes and avoiding complications such as femoral neck fracture. A review of the literature suggests that optimal results, and the lower risk of early failure, are obtained in men with osteoarthritis who are younger than age 55 years. This article reviews general considerations for choosing appropriate candidates for metal-on-metal hip resurfacing, including relative and suggested contraindications to the procedure.

Nunley RM, Della Valle CJ, Barrack RL. · Department of Orthopaedic Surgery, Washington University, St Louis, MO 63130-4899, USA. · Clin Orthop Relat Res. · Pubmed #18941859 No free full text.

Abstract: The optimal implant option for hip arthroplasty in the young, active patient remains controversial. There has been renewed interest for metal-on-metal hip resurfacing due to improved design and manufacturing of implants, better materials, enhanced implant fixation, theoretical advantages over conventional total hip arthroplasty, and recent Food and Drug Administration approval of two devices. Recent studies indicate satisfactory short- and midterm clinical results (1- to 10-year followup) with low complication rates, but there is a learning curve associated with this procedure, a more extensive surgical approach is necessary, and long-term results have yet to be determined. Proper patient selection may help avoid complications and improve patient outcomes. Patient selection criteria in the literature appear based predominantly on theoretical considerations without any consensus on stratifying patient risk. The most commonly reported complications encountered with hip resurfacing include femoral neck fracture, acetabular component loosening, metal hypersensitivity, dislocation, and nerve injury. At the time of clinical evaluation, patient age; gender; diagnosis; bone density, quality, and morphology; activity level; leg lengths; renal function; and metal hypersensitivity are important factors when considering a patient for hip resurfacing. Based on our review, we believe the best candidates for hip resurfacing are men under age 65 with osteoarthritis and relatively normal bony morphology. Level of Evidence: Level V, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Levine B, Sporer S, Della Valle CJ, Jacobs JJ, Paprosky W. · Rush University Medical Center, Chicago, Ill, USA. · J Knee Surg. · Pubmed #17665779 No free full text.

Abstract: Porous tantalum represents an alternative metal for primary and revision total knee arthroplasty (TKA) with several unique properties. Tantalum is a transition metal, which in its bulk form has shown excellent biocompatibility and is safe to use in vivo as evidenced by its current application in pacemaker electrodes, cranioplasty plates, and as radiopaque markers. Current designs for orthopedic implants maintain a high volumetric porosity (70%-80%), low modulus of elasticity (3 MPa), and high frictional characteristics, making this metal conducive to biologic fixation. The low modulus of elasticity of such components allows for more physiologic load transfer and relative preservation of bone stock. Its more bioactive nature and ingrowth properties have led to its use in primary as well as revision knee components with good early clinical results reported. In revision arthroplasty, it has been used as a structural bone graft substitute. Formation of a bone-like apatite coating in vivo affords strong fibrous ingrowth properties and allows for substantial soft-tissue attachment with the potential for use in cases such as mega-prostheses and patella salvage. Although porous tantalum is in its early stages of evolution, the initial clinical data and basic science studies support its use as an alternative to traditional orthopedic implant materials.

Levine B, Della Valle CJ, Jacobs JJ. · Rush University Medical Center, Chicago, IL, USA. · J Am Acad Orthop Surg. · Pubmed #17077337 No free full text.

Abstract: Porous tantalum is an alternative metal for total joint arthroplasty components that offers several unique properties. Its high volumetric porosity (70% to 80%), low modulus of elasticity (3 MPa), and high frictional characteristics make it conducive to biologic fixation. Tantalum has excellent biocompatibility and is safe to use in vivo. The low modulus of elasticity allows for more physiologic load transfer and relative preservation of bone stock. Because of its bioactive nature and ingrowth properties, tantalum is used in primary as well as revision total hip arthroplasty components, with good to excellent early clinical results. In revision arthroplasty, standard and custom augments may serve as a structural bone graft substitute. Formation of a bone-like apatite coating in vivo affords strong fibrous ingrowth properties and allows for substantial soft-tissue attachment, indicating potential for use in cases requiring reattachment of muscles and tendons to a prosthesis. Development of modular components and femoral stems also is being evaluated. The initial clinical data and basic science studies support further investigation of porous tantalum as an alternative to traditional implant materials.

Della Valle CJ, Zuckerman JD, Di Cesare PE. · Rush-Presbyterian-St. Luke's Medical Center, 1725 West Harrison, Suite 1063, Chicago, IL 60612, USA. · Clin Orthop Relat Res. · Pubmed #15057075 No free full text.

Abstract: The diagnosis of septic implant failure can be difficult to make, yet is imperative for optimal patient outcomes in revision total hip arthroplasty. In most cases, a thorough history and physical examination combined with preoperative laboratory tests and an intraoperative frozen section are sufficient to differentiate septic from aseptic failure. If preoperative laboratory test values are elevated, preoperative aspiration of the hip can be used in selected patients to confirm or exclude the diagnosis of infection. Nuclear medicine studies comprise a second-line investigation to evaluate patients with a painful total hip arthroplasty in whom revision surgery otherwise is not indicated. Intraoperative tissue appearance in combination with intraoperative Gram stains are unreliable for detecting periprosthetic sepsis, and neither is adequate when considered alone for ruling out infection at the time of revision total hip arthroplasty. It is imperative that the surgeon doing revision total hip arthroplasty thoroughly understands the relative utility of preoperative and intraoperative tests used to diagnose periprosthetic sepsis.

Della Valle CJ, Momberger NG, Paprosky WG. · Department of Orthopaedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA. · Instr Course Lect. · Pubmed #12690856 No free full text.

Abstract: Periprosthetic fractures of the acetabulum that occur in association with a total hip arthroplasty are unusual injuries that present several challenges to successful management. As the number of total hip arthroplasties performed each year increases along with the number of patients with severe bone loss who require revision surgery, periprosthetic fractures of the acetabulum are becoming more prevalent. However, there is little information available to guide the orthopaedic surgeon in the management of these injuries. A comprehensive classification of these injuries is presented that is useful for guiding the management of these complex problems.

Della Valle CJ, Di Cesare PE. · NYU-Hospital for Joint Diseases, Department of Orthopaedic Surgery, New York, New York 10003, USA. · Bull Hosp Jt Dis. · Pubmed #12102400 links to  free full text

This publication has no abstract.

Jazrawi LM, Della Valle CJ, Kummer FJ, Adler EM, Di Cesare PE. · Musculoskeletal Research Center, Department of Orthopaedic Surgery, New York University Medical Center-Hospital for Joint Diseases, New York City, NY 10003, USA. · J Bone Joint Surg Am. · Pubmed #10391549 No free full text.

This publication has no abstract.

Della Valle CJ, Jazrawi LM, Di Cesare PE, Steiger DJ. · Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases Orthopaedic Institute, New York City 10003, USA. · J Bone Joint Surg Am. · Pubmed #9973060 No free full text.

This publication has no abstract.

Della Valle CJ, Mesko NW, Quigley L, Rosenberg AG, Jacobs JJ, Galante JO. · Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA. · J Bone Joint Surg Am. · Pubmed #19411461 No free full text.

Abstract: We previously reported the seven and fifteen-year results of the use of a porous-coated acetabular metal shell inserted without cement in a consecutive series of 204 primary total hip arthroplasties. In the present study, we evaluated the longer-term outcomes of these arthroplasties at a minimum follow-up time of twenty years. One hundred and fourteen (92%) of the 124 hips available for study had retained the original acetabular metal shell. A total of five acetabular components had been revised for aseptic loosening or had radiographic evidence of definite loosening. Fourteen hips with well-fixed acetabular shells required a change of the modular acetabular liner because of excessive wear and/or for the treatment of osteolysis, and liner changes have been recommended for another eight hips. The twenty-year rate of survival of the metal shell, with failure defined as revision because of loosening or radiographic evidence of loosening, was 96% (95% confidence interval, 94% to 98%). Cementless acetabular reconstruction continues to provide durable fixation at twenty years postoperatively. Wear-related complications continue to be the major mode of failure.

Park DK, Della Valle CJ, Quigley L, Moric M, Rosenberg AG, Galante JO. · Department of Orthopaedic Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612, USA. · J Bone Joint Surg Am. · Pubmed #19181979 No free full text.

Abstract: We previously reported the results of the use of a cementless acetabular shell for revision total hip arthroplasty in 138 hips at a minimum of three, seven, and fifteen years postoperatively. The current report presents the long-term outcomes of this group at a minimum follow-up of twenty years. Since the last report, two additional hips required repeat revision, both for infection; no additional acetabular shell was loose. In the entire series to date, repeat acetabular revision was performed in twenty-one (15%) of the original 138 hips. Twenty of the twenty-one shells were well fixed at the time of repeat revision, and one had become aseptically loose. The most common reasons for repeat revision were infection (eight hips) and recurrent instability (eight hips). In the metal shells that were well fixed, an isolated liner change for polyethylene wear and/or osteolysis was performed in a total of six hips; four of these liner exchanges were performed since the time of our last report. A liner change had been recommended because of severe wear in four additional hips; thus, 18% of the fifty-six unrevised metal shells were associated with polyethylene wear-related problems. Survivorship, with revision of the shell for aseptic loosening or radiographic evidence of loosening as the end point, was 95% at twenty years (95% confidence interval, 83% to 98%). Reoperations for wear and osteolysis were first seen at approximately twelve years postoperatively. At the time of the present long-term follow-up, the reoperation rate for polyethylene wear and/or osteolysis had increased. We continue to use a hemispherical, titanium metal shell with multiple screws for fixation in the majority of acetabular revisions.

Della Valle CJ, Nunley RM, Raterman SJ, Barrack RL. · Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA. · Clin Orthop Relat Res. · Pubmed #18949528 No free full text.

Abstract: In May 2006, the US Food and Drug Administration approved the first metal-on-metal total hip resurfacing. Surgeons wanting to implant this device were required to undergo formal industry-sponsored training before performing their first case and a technical specialist attended their initial 10 cases. Safety surveys were completed on the first 537 cases performed and included patient age, gender, diagnosis, and occurrence of any unexpected events perioperatively or postoperatively. Intraoperative data were available for all 537 cases (100%), hospital discharge and six-week data were available for 524 cases (97.6%), three-month data were available for 523 cases (97.4%), six-month data were available for 509 cases (94.3%) and one-year data were available for 449 cases (83.6%); the mean followup was 10.4 months. We documented adverse events in 40 (32 major, 8 minor) of the 537 cases including nine nerve injuries and eight dislocations. There were 14 component revisions (3.1%) [corrected] within the first year, including 10 for femoral neck fracture, two for dislocations, and two for acetabular component loosening. Complications were frequently seen among patients older than 55 years of age and in women, emphasizing the importance of appropriate patient selection for the procedure. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Springer BD, Della Valle CJ. · OrthoCarolina Hip and Knee Center, Charlotte, North Carolina, USA. · J Arthroplasty. · Pubmed #18922372 No free full text.

Abstract: Disruption of the extensor mechanism is an infrequent but catastrophic complication after total knee arthroplasty. Treatment is technically challenging. For patellar tendon ruptures, multiple treatment options having been described with inconsistent results. Allograft tissue may provide the best means to adequately reconstruct the disrupted patellar tendon. Options for allograft reconstruction include an Achilles tendon bone block allograft or a whole extensor mechanism allograft. Important surgical principals include rigid fixation of the host allograft junction, coverage of the allograft tissue with as much autogenous tissue as possible to reduce the risk of infection, tensioning the graft in full extension, and not testing the completed repair is crucial. Current results with proper surgical technique show acceptable functional outcome for this devastating complication.

Schinsky MF, Della Valle CJ, Sporer SM, Paprosky WG. · Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. · J Bone Joint Surg Am. · Pubmed #18762646 No free full text.

Abstract: BACKGROUND: While multiple tests are used to determine the presence of infection at the site of a total hip arthroplasty, few studies have applied a consistent algorithm to determine the utility of the various tests that are available. The purpose of the present study was to evaluate the utility of commonly available tests for determining the presence of periprosthetic infection in patients undergoing revision total hip arthroplasty. METHODS: Two hundred and thirty-five consecutive total hip arthroplasties in 220 patients were evaluated by one of two surgeons using a consistent algorithm to identify infection and were treated with reoperation. Receiver-operating-characteristic curve analysis was used to determine the optimal cut-point values for the white blood-cell count and the percentage of polymorphonuclear cells of intraoperatively aspirated hip synovial fluid. Sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were determined. Patients were considered to have an infection if two of three criteria were met; the three criteria were a positive intraoperative culture, gross purulence at the time of reoperation, and positive histopathological findings. RESULTS: Thirty-four arthroplasties were excluded because of the presence of a draining sinus, incomplete data, or a preoperative diagnosis of inflammatory arthritis, leaving 201 total hip arthroplasties available for evaluation. Fifty-five hips were judged to be infected. No hip in a patient with a preoperative erythrocyte sedimentation rate of <30 mm/hr and a C-reactive protein level of <10 mg/dL was determined to be infected. Receiver-operating-characteristic curve analysis of the synovial fluid illustrated optimal cut-points to be >4200 white blood cells/mL for the white blood-cell count and >80% polymorphonuclear cells for the differential count. However, when combined with an elevated erythrocyte sedimentation rate and C-reactive protein level, the optimal cut-point for the synovial fluid cell count was >3000 white blood cells/mL, which yielded the highest combined sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the tests studied. DISCUSSION: A synovial fluid cell count of >3000 white blood cells/mL was the most predictive perioperative testing modality in our study for determining the presence of periprosthetic infection when combined with an elevated preoperative erythrocyte sedimentation rate and C-reactive protein level in patients undergoing revision total hip arthroplasty.

Levine BR, Della Valle CJ, Deirmengian CA, Breien KM, Weeden SH, Sporer SM, Paprosky WG. · Midwest Orthopaedic Center, Peoria, Illinois; Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois 60612, USA. · J Arthroplasty. · Pubmed #18534484 No free full text.

Abstract: A retrospective cohort study of 31 hips revised with a tripolar articular construct was performed. Patient demographics and preoperative and postoperative information were recorded. Indications for a tripolar construct were recurrent dislocation and the inability to attain intraoperative stability during hip revision. Nine patients (29%) were revised to the tripolar construct after failure of a constrained liner. Twenty patients (65%) had at least one episode of instability before the most recent revision. At a mean follow-up of 38 months, modified Postel scores improved from a mean of 5.28 to 9.64 (P < .01). Radiographic follow-up revealed no evidence of component loosening/migration, osteolysis, or polyethylene wear. Two patients (7%) required further revision surgery for recurrent instability. A tripolar construct was effective in eliminating or preventing instability in 93% of the complex cases treated. These early results support the use of a tripolar construct in treating recurrent instability or instability encountered at the time of revision hip arthroplasty.

Levine BR, Della Valle CJ, Hamming M, Sporer SM, Berger RA, Paprosky WG. · Department of Orthopaedic Surgery, Midwest Orthopaedic Center, Peoria, Illinois 61614, USA. · J Arthroplasty. · Pubmed #18534433 No free full text.

Abstract: The goal of this study is to evaluate the efficacy of using an extended trochanteric osteotomy (ETO) as part of a 2-stage exchange procedure for prosthetic hip infections. Twenty-three consecutive infected total hip arthroplasties in which an ETO was used as part of a 2-stage exchange procedure were retrospectively reviewed. An ETO was used when the femoral component could not be extracted using standard techniques. Clinical and radiographic parameters were evaluated at an average of 49 months of follow-up. Postoperatively, 20 of 23 (87%) patients had resolution of their infection, with healing of the ETO in 22 of 23 patients at a mean of 11.5 weeks. Preoperative modified D'Aubigne and Postel score means of 2.4 for pain and 2.6 for walking ability significantly improved (P < .001) to 5.3 and 4.9. Use of an ETO as part of a 2-stage exchange arthroplasty can be performed safely and effectively in appropriately selected cases.

Wysocki RW, Sheinkop MB, Virkus WW, Della Valle CJ. · Department of Orthopaedic Surgery, Investigation Performed at Rush University Medical Center, Chicago, Illinois, USA. · J Arthroplasty. · Pubmed #18358390 No free full text.

Abstract: Computer-assisted total knee arthroplasty has been gaining popularity given the proposed benefits of increased accuracy of the femoral and tibial cuts, quantitative feedback on soft tissue balancing, and the potential for performing the procedure through smaller incisions with decreased soft tissue trauma. Most navigation systems require femoral and tibial threaded pin insertion for placement of guidance trackers, which when removed leave behind defects in the bone that may act as stress risers. We present 2 cases of a femoral fracture through a previous pin site where a guidance tracker had been placed for computer-assisted total knee arthroplasty. Both patients were informed that data concerning the cases would be submitted for publication. To our knowledge, this complication has not previously been reported for this procedure.

Della Valle CJ, Sporer SM, Jacobs JJ, Berger RA, Rosenberg AG, Paprosky WG. · Department of Orthopaedic Surgery, Rush Uiversity Medical Center, Chicago, Illinois 60612, USA. · J Arthroplasty. · Pubmed #17823024 No free full text.

Abstract: One hundred five consecutive painful knee arthroplasties were evaluated by a single surgeon for the presence of infection using a uniform protocol that included an erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), perioperative aspiration with synovial fluid white blood cell (WBC) count and differential, intraoperative frozen section analysis, and culture. A synovial fluid WBC count of greater than 3000 was the most precise test with a sensitivity of 100%, specificity of 98%, and accuracy of 99%. The preoperative use of an ESR and CRP proved to be an excellent screening modality with only one infection identified with both values being normal. A rational approach to perioperative testing for sepsis includes a screening ESR and CRP, and if elevated, aspiration with synovial fluid WBC count or an intraoperative frozen section.

Della Valle CJ, Berger RA, Rosenberg AG. · Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. · Clin Orthop Relat Res. · Pubmed #16672873 No free full text.

Abstract: Safely obtaining adequate exposure at the time of revision total knee arthroplasty is an integral step in successfully performing the procedure. A medial capsular approach combined with an extensive intraarticular synovectomy provides adequate exposure for most patients. If further exposure is required, a quadriceps snip can be used to free the proximal extensor mechanism. The benefits of this approach include its technically simple nature and an unaltered postoperative rehabilitation regimen. We report a series of 126 consecutive revision knee procedures in which a medial capsular approach was adequate in 111 cases, representing 92% of the patients with an intact extensor mechanism. A quadriceps snip was required in nine cases. If more extensive exposure is required for an excessively stiff or difficult to expose knee, a tibial tubercle osteotomy or V-Y quadricepsplasty provides wider exposure. Level of Evidence: Therapeutic study, level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Berger RA, Sanders S, D'Ambrogio E, Buchheit K, Deirmengian C, Paprosky W, Della Valle CJ, Rosenberg AG. · Department of Orthopedic Surgery, Rush Medical College, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL 60612, USA. · J Knee Surg. · Pubmed #16642894 No free full text.

This publication has no abstract.

Berger RA, Deirmengian CA, Della Valle CJ, Paprosky WG, Jacobs JJ, Rosenberg AG. · Department of Orthopedic Surgery, Rush Medical College, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL 60612, USA. · J Knee Surg. · Pubmed #16468498 No free full text.

This publication has no abstract.

Della Valle CJ, Chang D, Sporer S, Berger RA, Rosenberg AG, Paprosky WG. · Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA. · J Arthroplasty. · Pubmed #16214010 No free full text.

Abstract: Fifty-five consecutive revision total hip arthroplasties (THAs) in 51 patients in which a constrained acetabular liner was used (Duraloc Constrained Liner, DePuy, Warsaw, Ind) were reviewed. In these revisions, 41 constrained liners were placed for recurrent instability and 14 for inadequate stability at the time of revision THA. The mean age of the cohort was 62 years, and 38 of the hips were in female patients (69%). At a minimum of 2 years, 9 of the 55 hips (16%) dislocated. Of these 9 dislocations, 8 occurred in patients who had undergone revision to a constrained liner for recurrent instability without femoral or acetabular component revision. Revision THA for recurrent instability by placing a constrained liner without optimizing other aspects of the reconstruction leads to a high rate of recurrent failure.

Burnett RS, Berger RA, Della Valle CJ, Sporer SM, Jacobs JJ, Paprosky WG, Rosenberg AG. · Department of Orthopaedic Surgery, Barnes Jewish Hospital, Washington University, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110, USA. · J Bone Joint Surg Am. · Pubmed #16140793 No free full text.

Abstract: BACKGROUND: Disruption of the extensor mechanism is an uncommon but catastrophic complication of total knee arthroplasty. We evaluated two techniques of reconstructing a disrupted extensor mechanism with the use of an extensor mechanism allograft in revision total knee arthroplasty. METHODS: Twenty consecutive reconstructions with the use of an extensor mechanism allograft consisting of the tibial tubercle, patellar tendon, patella, and quadriceps tendon were performed. The first seven reconstructions (Group I) were done with the allograft minimally tensioned. The thirteen subsequent procedures (Group II) were performed with the allograft tightly tensioned in full extension. All surviving allografts were evaluated clinically and radiographically after a minimum duration of follow-up of twenty-four months. RESULTS: All of the reconstructions in Group I were clinical failures, with an average postoperative extensor lag of 59 degrees (range, 40 degrees to 80 degrees ) and an average postoperative Hospital for Special Surgery knee score of 52 points. All thirteen reconstructions in Group II were clinical successes, with an average postoperative extensor lag of 4.3 degrees (range, 0 degrees to 15 degrees ) (p < 0.0001) and an average Hospital for Special Surgery score of 88 points. Postoperative flexion did not differ significantly between Group I (average, 108 degrees ) and Group II (average, 104 degrees ) (p = 0.549). CONCLUSIONS: The results of reconstruction with an extensor mechanism allograft after total knee arthroplasty depend on the initial tensioning of the allograft. Loosely tensioned allografts result in a persistent extension lag and clinical failure. Allografts that are tightly tensioned in full extension can restore active knee extension and result in clinical success. On the basis of the number of knees that we studied, there was no significant loss of flexion. Use of an extensor mechanism graft for the treatment of a failure of the extensor mechanism will be successful only if the graft is initially tensioned tightly in full extension.

Della Valle CJ, Shuaipaj T, Berger RA, Rosenberg AG, Shott S, Jacobs JJ, Galante JO. · Department of Orthopaedic Surgery, Rush University Medical Center, Professional Building, 1725 West Harrison Street, Suite 1063, Chicago, Illinois 60612, USA. · J Bone Joint Surg Am. · Pubmed #16085621 No free full text.

Abstract: We previously reported our results at a minimum of three and seven years after use of a porous-coated acetabular metal shell in a consecutive series of 138 revision total hip arthroplasties. The current report presents the longer-term outcomes of these procedures, at fifteen to nineteen years postoperatively. A total of twenty metal shells (14%) underwent repeat revision. Seven of the repeat revisions were performed because of recurrent dislocation, seven were done at the time of femoral revision surgery, and six were done because of infection. Nineteen of the revised shells were well fixed, and one was aseptically loose. Of the sixty-seven hips in which the acetabular component survived for more than fifteen years after the index operation, two (3%) required a change of the modular acetabular liner because of wear or osteolysis. Nine (16%) of the fifty-seven hips with at least fifteen years of radiographic follow-up had an osteolytic lesion of >1 cm in diameter. The fifteen-year survival rate of the metal shells, with failure defined as revision because of loosening or as radiographic evidence of loosening, was 97%. Revision total hip arthroplasty with this cementless acetabular component has been followed by excellent component survivorship at fifteen years; the most common reasons for repeat revision were recurrent dislocation and infection.