The Lawrence D. Dorr Surgical Techniques & Technologies Award: Why Are Contemporary Revision Total Hip Arthroplasties Failing? An Analysis of 2500 Cases

Ashton H. Goldman, Rafael J. Sierra, Robert T. Trousdale, David G. Lewallen, Daniel J. Berry, Matthew Abdel

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: As revision implants and techniques have evolved and improved, understanding why contemporary revision total hip arthroplasties (THAs) fail is important to direct further improvement and innovation. As such, the goals of this study are to determine the implant survivorship of contemporary revision THAs, as well as the most common indications for re-revision. Methods: We retrospectively reviewed 2589 aseptic revision THAs completed at our academic institution between 2005 and 2015 through our total joint registry. Thirty-nine percent were isolated acetabular revisions, 22% isolated femoral revisions, 18% both component revisions, and 21% head/liner component exchanges. The mean age at index revision THA was 66 years, and 46% were male. The indications for the index revision THA were aseptic loosening (21% acetabular, 15% femoral, 5% both components), polyethylene wear and osteolysis (18%), instability (13%), fracture (11%), and other (17%). Mean follow-up was 6 years. Results: There were 211 re-revision THAs during the study period. The overall survivorship free of any re-revision at 2, 5, and 10 years was 94%, 92%, and 88%, respectively. The most common reasons for re-revision were hip instability (52%), peri-prosthetic fracture (11%), femoral aseptic loosening (11%), acetabular aseptic loosening (9%), infection (6%), polyethylene wear (3%), and other (8%). Conclusion: Compared to historical series, the 88% survivorship free of any re-revision at 10 years in a revision cohort at a referral center is notably improved. As implant fixation has improved, aseptic loosening has become much less common after revision THA, and instability has come to account for more than half of re-revisions.

Original languageEnglish (US)
Pages (from-to)S11-S16
JournalJournal of Arthroplasty
Volume34
Issue number7
DOIs
StatePublished - Jul 1 2019

Fingerprint

Arthroplasty
Hip
Technology
Polyethylene
Thigh
Osteolysis
Femoral Fractures
Registries
Referral and Consultation
Joints
Head
Infection

Keywords

  • aseptic loosening
  • dislocation
  • instability
  • peri-prosthetic fracture
  • revision total hip arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

The Lawrence D. Dorr Surgical Techniques & Technologies Award : Why Are Contemporary Revision Total Hip Arthroplasties Failing? An Analysis of 2500 Cases. / Goldman, Ashton H.; Sierra, Rafael J.; Trousdale, Robert T.; Lewallen, David G.; Berry, Daniel J.; Abdel, Matthew.

In: Journal of Arthroplasty, Vol. 34, No. 7, 01.07.2019, p. S11-S16.

Research output: Contribution to journalArticle

Goldman, Ashton H. ; Sierra, Rafael J. ; Trousdale, Robert T. ; Lewallen, David G. ; Berry, Daniel J. ; Abdel, Matthew. / The Lawrence D. Dorr Surgical Techniques & Technologies Award : Why Are Contemporary Revision Total Hip Arthroplasties Failing? An Analysis of 2500 Cases. In: Journal of Arthroplasty. 2019 ; Vol. 34, No. 7. pp. S11-S16.
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abstract = "Background: As revision implants and techniques have evolved and improved, understanding why contemporary revision total hip arthroplasties (THAs) fail is important to direct further improvement and innovation. As such, the goals of this study are to determine the implant survivorship of contemporary revision THAs, as well as the most common indications for re-revision. Methods: We retrospectively reviewed 2589 aseptic revision THAs completed at our academic institution between 2005 and 2015 through our total joint registry. Thirty-nine percent were isolated acetabular revisions, 22{\%} isolated femoral revisions, 18{\%} both component revisions, and 21{\%} head/liner component exchanges. The mean age at index revision THA was 66 years, and 46{\%} were male. The indications for the index revision THA were aseptic loosening (21{\%} acetabular, 15{\%} femoral, 5{\%} both components), polyethylene wear and osteolysis (18{\%}), instability (13{\%}), fracture (11{\%}), and other (17{\%}). Mean follow-up was 6 years. Results: There were 211 re-revision THAs during the study period. The overall survivorship free of any re-revision at 2, 5, and 10 years was 94{\%}, 92{\%}, and 88{\%}, respectively. The most common reasons for re-revision were hip instability (52{\%}), peri-prosthetic fracture (11{\%}), femoral aseptic loosening (11{\%}), acetabular aseptic loosening (9{\%}), infection (6{\%}), polyethylene wear (3{\%}), and other (8{\%}). Conclusion: Compared to historical series, the 88{\%} survivorship free of any re-revision at 10 years in a revision cohort at a referral center is notably improved. As implant fixation has improved, aseptic loosening has become much less common after revision THA, and instability has come to account for more than half of re-revisions.",
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AU - Goldman, Ashton H.

AU - Sierra, Rafael J.

AU - Trousdale, Robert T.

AU - Lewallen, David G.

AU - Berry, Daniel J.

AU - Abdel, Matthew

PY - 2019/7/1

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N2 - Background: As revision implants and techniques have evolved and improved, understanding why contemporary revision total hip arthroplasties (THAs) fail is important to direct further improvement and innovation. As such, the goals of this study are to determine the implant survivorship of contemporary revision THAs, as well as the most common indications for re-revision. Methods: We retrospectively reviewed 2589 aseptic revision THAs completed at our academic institution between 2005 and 2015 through our total joint registry. Thirty-nine percent were isolated acetabular revisions, 22% isolated femoral revisions, 18% both component revisions, and 21% head/liner component exchanges. The mean age at index revision THA was 66 years, and 46% were male. The indications for the index revision THA were aseptic loosening (21% acetabular, 15% femoral, 5% both components), polyethylene wear and osteolysis (18%), instability (13%), fracture (11%), and other (17%). Mean follow-up was 6 years. Results: There were 211 re-revision THAs during the study period. The overall survivorship free of any re-revision at 2, 5, and 10 years was 94%, 92%, and 88%, respectively. The most common reasons for re-revision were hip instability (52%), peri-prosthetic fracture (11%), femoral aseptic loosening (11%), acetabular aseptic loosening (9%), infection (6%), polyethylene wear (3%), and other (8%). Conclusion: Compared to historical series, the 88% survivorship free of any re-revision at 10 years in a revision cohort at a referral center is notably improved. As implant fixation has improved, aseptic loosening has become much less common after revision THA, and instability has come to account for more than half of re-revisions.

AB - Background: As revision implants and techniques have evolved and improved, understanding why contemporary revision total hip arthroplasties (THAs) fail is important to direct further improvement and innovation. As such, the goals of this study are to determine the implant survivorship of contemporary revision THAs, as well as the most common indications for re-revision. Methods: We retrospectively reviewed 2589 aseptic revision THAs completed at our academic institution between 2005 and 2015 through our total joint registry. Thirty-nine percent were isolated acetabular revisions, 22% isolated femoral revisions, 18% both component revisions, and 21% head/liner component exchanges. The mean age at index revision THA was 66 years, and 46% were male. The indications for the index revision THA were aseptic loosening (21% acetabular, 15% femoral, 5% both components), polyethylene wear and osteolysis (18%), instability (13%), fracture (11%), and other (17%). Mean follow-up was 6 years. Results: There were 211 re-revision THAs during the study period. The overall survivorship free of any re-revision at 2, 5, and 10 years was 94%, 92%, and 88%, respectively. The most common reasons for re-revision were hip instability (52%), peri-prosthetic fracture (11%), femoral aseptic loosening (11%), acetabular aseptic loosening (9%), infection (6%), polyethylene wear (3%), and other (8%). Conclusion: Compared to historical series, the 88% survivorship free of any re-revision at 10 years in a revision cohort at a referral center is notably improved. As implant fixation has improved, aseptic loosening has become much less common after revision THA, and instability has come to account for more than half of re-revisions.

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KW - dislocation

KW - instability

KW - peri-prosthetic fracture

KW - revision total hip arthroplasty

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