Re-revision total hip arthroplasty: Epidemiology and factors associated with outcomes

S Yu; H Saleh; N Bolz; J Buza; R Iorio; P A Rathod; R Schwarzkopf; A J Deshmukh

doi:10.1016/j.jcot.2018.08.021

Re-revision total hip arthroplasty: Epidemiology and factors associated with outcomes

J Clin Orthop Trauma. 2020 Jan-Feb;11(1):43-46. doi: 10.1016/j.jcot.2018.08.021. Epub 2018 Aug 28.

Authors

S Yu¹, H Saleh¹, N Bolz¹, J Buza¹, R Iorio¹, P A Rathod¹, R Schwarzkopf¹, A J Deshmukh¹

Affiliation

¹ New York University, Langone Medical Center, Langone Orthopaedic Hospital, Department of Orthopaedic Surgery, 301 E 17th Street, New York, NY, 10003, USA.

Abstract

Introduction: The epidemiology of re-revision total hip arthroplasty (THA) is not yet well-understood. We aim to investigate the epidemiology and risk-factors that are associated with re-revision THA.

Methods: 288 revision THA were analyzed between 1/2012 and 12/2013. Patients who underwent two or greater revision THA were included. Hips with first-revision due to periprosthetic joint infection (PJI) were excluded. Failure was defined as reoperation.

Results: 51 re-revision patients were available. Mean age was 59.6 (±14.2 years), 32 (67%) females, average BMI of 28.8 (±5.4), and median ASA 2 (23; 55%). The most common re-revision indications were acetabular component loosening (15; 29%), PJI (13; 25%) and instability (9; 18%). The most common indications for first revision in the re-revision population were acetabular component loosening (11; 27%), polyethylene wear (8; 19%) and instability (8; 19%). There was an increased risk of re-revision failure if the re-revision involved exchanging only the head and polyethylene liner (RR = 1.792; p = 0.017), instability was the first-revision indication (RR = 3.000; p < 0.001), and instability was the re-revision indication (RR = 1.867; p = 0.038). If isolated femoral component revision was indicated during the re-revision, there was a decreased risk of failure (RR = 0.268, p = 0.046). 1-year re-revision survival was 54% (23/43).

Discussion: Acetabular component loosening, instability, and PJI were the most common indications for re-revision. Revision due to instability is a recurrent problem that leads to re-revision failure. There was a higher infection rate in the re-revision population compared to published revision PJI. A better understanding of the indications and patient factors that are associated with re-revision failures can help align surgeon and patient expectations in this challenging population.

Keywords: Epidemiology; Revision; Risk-factors; Total hip arthroplasty.