Association between patient survival following reoperation after total hip replacement and the reason for reoperation: an analysis of 9,926 patients in the Swedish Hip Arthroplasty Register

Abstract

Background and purpose — The association between long-term patient survival and elective primary total hip replacement (THR) has been described extensively. The long-term survival following reoperation of THR is less well understood. We investigated the relative survival of patients undergoing reoperation following elective THR and explored an association between the indication for the reoperation and relative survival. Patients and methods — In this observational cohort study we selected the patients who received an elective primary THR and subsequent reoperations during 1999–2017 as recorded in the Swedish Hip Arthroplasty Register. The selected cohort was followed until the end of the study period, censoring or death. The indications for 1st- and eventual 2nd-time reoperations were analyzed and the relative survival ratio of the observed survival and the expected survival was determined. Results — There were 9,926 1st-time reoperations and of these 2,558 underwent further reoperations. At 5 years after the latest reoperation, relative survival following 1st-time reoperations was 0.94% (95% CI 0.93–0.96) and 0.90% (CI 0.87–0.92) following 2nd-time reoperations. At 5 years patients with a 1st-time reoperation for aseptic loosening had higher survival than expected; however, reoperations performed for periprosthetic fracture, dislocation, and infection had lower survival. Interpretation — The relative survival following 1st- and 2nd-time reoperations in elective THR patients differs by reason for reoperation. The impact of reoperation on life expectancy is more obvious for infection/dislocation and periprosthetic fracture.

Periprosthetic femoral fractures in Total Hip Arthroplasty (THA): a comparison between osteosynthesis and revision in a retrospective cohort study

“…The treatment of PPFx has been associated with high risk of failure, poor outcomes and worst survival outcome compared to the general population 1 year after surgery. This still applies 5-8 years after the surgery [ 10 , 21 ].…”

“…It has been reported that undergoing revision surgery for periprosthetic fractures results in worse survival outcomes than the general population within 1 year, and this negative influence extends for several years after the surgery [ 10 ]. Non-operative management is usually not appropriate for the well-known complications produced by immobilization and for the high percentages of non-unions in fractures around a cemented stem [ 11 ].…”

Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the ­Norwegian Arthroplasty Register

“…Revision risk due to these causes is higher after uncemented THAs (Hailer et al 2010, Stea et al 2014, Dale et al 2019. Such complications may implicate a poorer functional outcome, increased morbidity, and long-term mortality (Lindahl et al 2007, Gundtoft et al 2017, Cnudde et al 2019.…”

“…The exception was that uncemented THA in females over 55 years of age had a higher risk of revision due to aseptic loosening, periprosthetic fracture, and dislocation. Patients may have increased long-term mortality after such revisions (Gundtoft et al 2017, Cnudde et al 2019). 3-day and 10-year mortality was similar for all fixations in our study, indicating that perioperative-, short-term, or long-term mortality risk should not dictate what fixation principle to choose in primary THA, even in high-risk patients.…”

Causes of Revision Total Hip Arthroplasty in Twenty Years: an Analysis of 1,353 Revisions 

“…Cnudde et al [12] reported that the proportion of all-cemented implants decreased from 92% in 1999 to 68% in 2012. In 2019, Cnudde et al [16] retrospectively analyzed 9,926 patients from the SHAR who underwent revision THA and reported aseptic loosening as the leading cause of failure, followed by infection, periprosthetic fracture, and instability (3558, 2065, 1574, and 1782 cases, respectively). These data are of great bene t in improving patient clinical outcomes.…”