What is the Prognosis of Revision Total Hip Arthroplasty in Patients 55 Years and Younger?

Adelani, Muyibat A.; Crook, Karla; Barrack, Robert L.; Maloney, William J.; Clohisy, John C.

doi:10.1007/s11999-013-3377-9

Cited by 49 publications

(30 citation statements)

References 18 publications

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“…But these events are also very costly to society with increased medical costs, sick leave, etc. It has also been reported that results following revision surgery are less likely to be as good as the first operation [7].…”

Section: Introductionmentioning

confidence: 99%

Can patient-reported outcomes predict re-operations after total hip replacement?

Eneqvist

Nemes

Bülow

et al. 2018

International Orthopaedics (SICOT)

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Purpose We investigated if patient-reported outcomes (PROMs) one year after total hip replacement (THR) can predict the risk of re-operation using data from the Swedish Hip Arthroplasty Register. Methods A total of 75,899 patients with THR due to osteoarthritis operated in 2002-2014 were included. We used Kaplan-Meier and Cox regression to investigate the relationship between one-year post-operative PROMs and risk of re-operation (all types of further hip surgery). The predictive power of the model and post-operative PROMs were evaluated by concordance index (C). Results Kaplan-Meier estimates for not being re-operated at eight years was 95.5% (95%CI; 95.3-95.8). Cox regression analyses showed that all PROMs, except for EQ-VAS, were associated with re-operation. The full model had a concordance index of 0.68. Satisfaction (C = 0.65) and pain (C = 0.65) in isolation had the highest predictive power. Conclusions Worse PROMs predicted higher risk of re-operation. Therefore, we believe PROMs may be helpful in identifying patients at risk for re-operation and timely address their problems.

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Section: Introductionmentioning

confidence: 99%

Can patient-reported outcomes predict re-operations after total hip replacement?

Eneqvist

Nemes

Bülow

et al. 2018

International Orthopaedics (SICOT)

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“…Each author certifies that his or her institution approved or waived approval for the reporting of this case and that all investigations were conducted in conformity with ethical principles of research. 20 years [1,26,40]. Despite the clinical success of the arthroplasties, aseptic loosening is one of the major causes of failure [29,45].…”

Section: Introductionmentioning

confidence: 99%

What Host Factors Affect Aseptic Loosening After THA and TKA?

Cherian

Jauregui

Banerjee

et al. 2015

Clinical Orthopaedics &Amp; Related Research

174

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Background Aseptic loosening is the most common cause for revisions after lower-extremity total joint arthroplasties, however studies differ regarding the degree to which host factors influence loosening. Questions/purpose We performed a systematic review to determine which host factors play a role in the development of clinical and/or radiographic failure from aseptic loosening after (1) THA and (2) TKA. Methods Two searches on THA and TKA, respectively, using four electronic databases (EMBASE, CINAHL Plus, PubMed, and Scopus) were conducted. We identified a total of 209 reports that encompassed nine potential host factors affecting aseptic loosening. Inclusion criteria for consideration of scientific clinical reports were that 20 or more patients were involved, with more than 1-year followup, with at least three studies pertaining to each factor, and at least six of the Methodological Index for Non-randomized Studies criteria met, and with raw data for odds ratio (OR) calculations. Twenty-one studies (16 THA studies with 45,779 hips and five TKA studies with 288 knees, respectively) were used to calculate weighted OR and CIs (using the random effects theory) and study heterogeneity for four different host factors in THAs (male sex, high activity level, obesity defined as BMI C 30 kg/m 2 , and current or former tobacco use) and one factor in TKA (BMI C 30 kg/m 2 ), which were placed in a forest plot. Results For THA, male sex (OR, 1.39; 95% CI, 1.22-1.58; p = 0.001) and high activity level (University of California Los Angeles [UCLA] activity score C 8 points; OR, 4.24; 95% CI, 2.46-7.31; p = 0.001) were associated with aseptic loosening. However, obesity (OR, 1.01; 95% CI, 0.73-1.40; p = 0.96), and tobacco use (OR, 1.96; 95% CI, 0.43-8.97; p = 0.39) were not associated with an increased risk of aseptic loosening after THA with the numbers available. For TKA, we found no host factors associated with loosening. In particular, obesity (BMI C 30 kg/m 2

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“…This is the first study that describes satisfying results of revision THA performed in patients aged < 55 years. This study fills a gap in the revision THA literature, because the reported results in younger patients have been disappointing until now [ 1 , 16 , 22 ]. The 10-year survivorship was 97% for rerevision for aseptic loosening and 87% for rerevision for any reason.…”

Section: Discussionmentioning

confidence: 97%

“…This comparable to the improvement in clinical scores reported by other revision series performed in younger patients. Adelani et al [ 1 ] reported a mean improvement in HHS of 19.2 points and Lee et al [ 22 ] reported an improvement of 36 points in the modified HHS (no physical examination is necessary for this modified scoring system).…”

Section: Discussionmentioning

confidence: 99%

“…The increasing number of THAs performed in patients younger than 55 years will inevitably generate a larger number of revision procedures for this specific group of patients. Unfortunately, data on the recent results of revision THA in younger patients are limited, and survivorship data from studies of younger patients are not encouraging [ 1 , 16 , 22 ]. The single long-term survival study reports a disappointing outcome of 63% at 10 years for patients when the endpoint was rerevision for any reason [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

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Satisfying Outcomes Scores and Survivorship Achieved With Impaction Grafting for Revision THA in Young Patients

Stroet

Gardeniers

Kampen

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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BackgroundThe increasing number of total hip arthroplasties (THAs) performed in younger patients will inevitably generate larger numbers of revision procedures for this specific group of patients. Unfortunately, no satisfying revision method with acceptable survivorship 10 years after revision has been described for these patients so far.Questions/purposesThe purposes of this study were to (1) analyze the clinical outcome; (2) complication rate; (3) survivorship; and (4) radiographic outcome of cemented revision THA performed with impaction bone grafting (IBG) on both the acetabular and femoral sides in one surgery in patients younger than 55 years old.MethodsDuring the period 1991 to 2007, 86 complete THA revisions were performed at our institution in patients younger than 55 years. In 34 of these 86 revisions (40%), IBG was used on both the acetabular and femoral sides in 33 patients. Mean patient age at revision surgery was 46.4 years (SD 7.6). No patient was lost to followup, but three patients died during followup. None of the deaths were related to the revision surgery. The mean followup for the surviving hips was 11.7 years (SD 4.6). We also analyzed complication rate.ResultsThe mean Harris hip score improved from 55 (SD 18) preoperatively to 80 points (SD 16) at latest followup (p = 0.009). Six hips underwent a rerevision (18%): in four patients, both components were rerevised; and in two hips, only the cup was revised. Patient 10-year survival rate with the endpoint of rerevision for any component for any reason was 87% (95% confidence interval [CI], 67%–95%) and with the endpoint of rerevision for aseptic loosening, the survival rate was 97% (95% CI, 80%–100%). In total six cups were considered radiographically loose, of which four were rerevised. Three stems were radiographically loose, of which none was rerevised.ConclusionsIBG is a valuable biological revision technique that may restore bone stock in younger patients. Bone stock reconstruction is important, because these patients likely will outlive their revision implants. Bone reconstruction with impaction grafting may facilitate future revisions.Level of EvidenceLevel IV, therapeutic study.

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What is the Prognosis of Revision Total Hip Arthroplasty in Patients 55 Years and Younger?

Cited by 49 publications

References 18 publications

Can patient-reported outcomes predict re-operations after total hip replacement?

Can patient-reported outcomes predict re-operations after total hip replacement?

What Host Factors Affect Aseptic Loosening After THA and TKA?

Satisfying Outcomes Scores and Survivorship Achieved With Impaction Grafting for Revision THA in Young Patients

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