What Are the Contemporary Etiologies for Revision Surgery and Revision After Primary, Noncemented Total Hip Arthroplasty?

INTRODUCTION: Contemporary failure etiologies of primary total hip arthroplasties (THAs) have not been precisely defined because of heterogeneity of referral practices. METHODS: A single-institution registry of 4,555 primary, noncemented THAs performed by subspecialty trained arthroplasty surgeons between 2000 and 2012 was analyzed. Only revision surgeries and revisions that occurred after THAs initially performed at the institution were included. RESULTS: The estimated 10-year survivorships free from THA revision surgery, modular implant revision, and nonmodular implant revision were 98.2%, 98.1%, and 96.3%, respectively. The most common reasons for revision surgeries were wound-related complications (49%), periprosthetic fracture (25%), and pain (18%). Hip instability (53%) and acute periprosthetic joint infection (26%) were the most common etiologies of revision procedures with isolated exchange of at least one modular implant. The most common reasons for replacement or removal of nonmodular implant were periprosthetic fracture (32%), aseptic loosening (22%), and adverse tissue reaction (17%). DISCUSSION: Focusing on primary THAs initially performed by a contemporary, subspecialty practice allowed an accurate determination of etiologies and rates of failure (defined by revision surgery or revision) after THA.Level IV.