An epidemiological analysis of revision aetiologies in total hip arthroplasty at a single high-volume centre

Abstract

Aims Advances in surgical technique and implant design may influence the incidence and mechanism of failure resulting in revision total hip arthroplasty (rTHA). The purpose of the current study was to characterize aetiologies requiring rTHA, and to determine whether temporal changes existed in these aetiologies over a ten-year period. Methods All rTHAs performed at a single institution from 2009 to 2019 were identified. Demographic information and mode of implant failure was obtained for all patients. Data for rTHA were stratified into two time periods to assess for temporal changes: 2009 to 2013, and 2014 to 2019. Operative reports, radiological imaging, and current procedural terminology (CPT) codes were cross-checked to ensure the accurate classification of revision aetiology for each patient. Results In all, 2,924 patients with a mean age of 64.6 years (17 to 96) were identified. There were 1,563 (53.5%) female patients, and the majority of patients were Caucasian (n = 2,362, 80.8%). The three most frequent rTHA aetiologies were infection (27.2%), aseptic loosening (25.2%), and wear (15.2%). The frequency of rTHA for adverse local tissue reaction (ALTR) was significantly greater from 2014 to 2019 (4.7% vs 10.0%; p < 0.001), while the frequency of aseptic loosening was significantly greater from 2009 to 2013 (28.6% vs 21.9%; p < 0.001). Conclusion Periprosthetic joint infection was the most common cause for rTHA in the current cohort of patients. Complications associated with ALTR necessitating rTHA was more frequent between 2014 to 2019, while aseptic loosening necessitating rTHA was significantly more frequent between 2009 to 2013. Optimizing protocols for prevention and management of infection and ALTR after THA may help to avoid additional financial burden to institutions and healthcare systems. Cite this article: Bone Joint Open 2020;2(1):16–21.

Estimating incidence rates of periprosthetic joint infection after hip and knee arthroplasty for osteoarthritis using linked registry and administrative health data

“…5 Aside from the health impact, PJI often leads to readmissions to hospital and in some cases revision surgeries, which add to the significant economic burden of PJI. [6][7][8] Despite the clinical and health economic significance of PJI, the exact incidence rate is unknown. Arthroplasty registries have been used to estimate the incidence rate of PJI, but these registries only report a revision if a component of the implant was removed or added.…”

Patient-reported outcome measures, complication rates, and re-revision rates are not associated with the indication for revision total hip arthroplasty

“…Other less well-defined diagnoses, such as unexplained pain, psoas impingement, and malposition, are also reported. [6][7][8][9][10][11] The scientific literature regarding the outcome of rtHa lacks prospective data about the relationship between patient-reported outcome measures…”

“…Other less well-defined diagnoses, such as unexplained pain, psoas impingement, and malposition, are also reported. 6-11…”

Biphasic bone graft substitute in revision total hip arthroplasty with significant acetabular bone defects

“…1 Revision procedures are difficult, and large acetabular bone defects are especially challenging. 2 The well-established options to restore acetabular defects are the use of autologous and allogenic bone. Autologous bone, considered the optimal graft material, has many limitations including available graft volume and surgical risk independent of the revision surgery.…”