TY - JOUR
T1 - The Lawrence D. Dorr Surgical Techniques & Technologies Award
T2 - Why Are Contemporary Revision Total Hip Arthroplasties Failing? An Analysis of 2500 Cases
AU - Goldman, Ashton H.
AU - Sierra, Rafael J.
AU - Trousdale, Robert T.
AU - Lewallen, David G.
AU - Berry, Daniel J.
AU - Abdel, Matthew P.
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/7
Y1 - 2019/7
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.
KW - aseptic loosening
KW - dislocation
KW - instability
KW - peri-prosthetic fracture
KW - revision total hip arthroplasty
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U2 - 10.1016/j.arth.2019.01.031
DO - 10.1016/j.arth.2019.01.031
M3 - Article
C2 - 30765230
AN - SCOPUS:85061297295
SN - 0883-5403
VL - 34
SP - S11-S16
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 7
ER -