Revision Hip Arthroplasty: Infection is the Most Common Cause of Failure
Revision total hip arthroplasty (THA), although relieving pain and restoring function, fails in some patients. In contrast to failures in primary THA, the frequency of the causes of failure in revision THA has been less well established.
We therefore determined the rate of each failure mode and the survivorship of revision THAs.
We retrospectively reviewed the charts of 1366 revision THAs performed between 2000 and 2007. There were 609 (44.5%) men and 757 (55.5%) women with a mean age of 66 years. The indications for the revision surgery were mainly aseptic loosening (51%), instability (15%), wear (14%), and infection (8%). The minimum followup was 1 day (mean, 5.5 years; range, 1 day to 9 years).
Two hundred fifty-six of the revisions (18.7%) failed with an average time to failure of 16.6 months (range, 1 day to 7.5 years). Among 256 failed hips, infection was the most common cause of failure (30.2%) followed by instability (25.1%) and aseptic loosening (19.4%). At 5 years, the survivorships of septic and aseptic groups were 67% and 84.8%, respectively. Revision for infection or instability appears to have a considerably lower survivorship when compared to revision for aseptic causes.
The lower survivorship of revision for infection or instability highlights the importance of implementing better preventative methods that can minimize the impact of these two major causes of failure.
Level of Evidence
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
- Alberton, GM, High, WA, Morrey, BF (2002) Dislocation after revision total hip arthroplasty: an analysis of risk factors and treatment options. J Bone Joint Surg Am 84: pp. 1788-1792
- Barrack, RL (1995) Economics of revision total hip arthroplasty. Clin Orthop Relat Res 319: pp. 209-214
- Barrack, RL, Hoffman, GJ, Tejeiro, WV, Carpenter, LJ (1995) Surgeon work input and risk in primary versus revision total joint arthroplasty. J Arthroplasty 10: pp. 281-286 CrossRef
- Barrack, RL, Sawhney, J, Hsu, J, Cofield, RH (1999) Cost analysis of revision total hip arthroplasty. A 5-year followup study. Clin Orthop Relat Res 369: pp. 175-178 CrossRef
- Berbari, EF, Hanssen, AD, Duffy, MC, Steckelberg, JM, Ilstrup, DM, Harmsen, WS, Osmon, DR (1998) Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 27: pp. 1247-1254 CrossRef
- Bozic, KJ, Kurtz, SM, Lau, E, Ong, K, Vail, TP, Berry, DJ (2009) The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 91: pp. 128-133 CrossRef
- Crowe, JF, Sculco, TP, Kahn, B (2003) Revision total hip arthroplasty: hospital cost and reimbursement analysis. Clin Orthop Relat Res 413: pp. 175-182 CrossRef
- Della Valle, CJ, Shuaipaj, T, Berger, RA, Rosenberg, AG, Shott, S, Jacobs, JJ, Galante, JO (2005) Revision of the acetabular component without cement after total hip arthroplasty. A concise follow-up, at fifteen to nineteen years, of a previous report. J Bone Joint Surg Am 87: pp. 1795-1800 CrossRef
- Dorey, F, Amstutz, HC (1986) Survivorship analysis in the evaluation of joint replacement. J Arthroplasty 1: pp. 63-69 CrossRef
- Hummel, MT, Malkani, AL, Yakkanti, MR, Baker, DL (2009) Decreased dislocation after revision total hip arthroplasty using larger femoral head size and posterior capsular repair. J Arthroplasty 24: pp. 73-76 CrossRef
- Kaplan, EL, Meier, P (1958) Nonparametric estimation from incomplete data. J Am Stat Assoc 53: pp. 457-481 CrossRef
- Kurtz, S, Ong, K, Lau, E, Mowat, F, Halpern, M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89: pp. 780-785 CrossRef
- Lavernia, CJ, Drakeford, MK, Tsao, AK, Gittelsohn, A, Krackow, KA, Hungerford, DS (1995) Revision and primary hip and knee arthroplasty. A cost analysis. Clin Orthop Relat Res 311: pp. 136-141
- Levine, DB, Cole, BJ, Rodeo, SA (1995) Cost awareness and cost containment at the Hospital for Special Surgery. Strategies and total hip replacement cost centers. Clin Orthop Relat Res 311: pp. 117-124
- Lie, SA, Havelin, LI, Furnes, ON, Engesaeter, LB, Vollset, SE (2004) Failure rates for 4762 revision total hip arthroplasties in the Norwegian Arthroplasty Register. J Bone Joint Surg Br 86: pp. 504-509
- McCarthy, JC, Lee, JA (2007) Complex revision total hip arthroplasty with modular stems at a mean of 14 years. Clin Orthop Relat Res 465: pp. 166-169
- Ong, KL, Mowat, FS, Chan, N, Lau, E, Halpern, MT, Kurtz, SM (2006) Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res 446: pp. 22-28 CrossRef
- Parvizi, J, Picinic, E, Sharkey, PF (2008) Revision total hip arthroplasty for instability: surgical techniques and principles. J Bone Joint Surg Am. 90: pp. 1134-1142
- Ritter, MA, Carr, KD, Keating, EM, Faris, PN, Bankoff, DL, Ireland, PM (1996) Revision total joint arthroplasty: does medicare reimbursement justify time spent?. Orthopedics 19: pp. 137-139
- Springer, BD, Fehring, TK, Griffin, WL, Odum, SM, Masonis, JL (2009) Why revision total hip arthroplasty fails. Clin Orthop Relat Res 467: pp. 166-173 CrossRef
- Suh, KT, Roh, HL, Moon, KP, Shin, JK, Lee, JS (2008) Posterior approach with posterior soft tissue repair in revision total hip arthroplasty. J Arthroplasty 23: pp. 1197-1203 CrossRef
- Revision Hip Arthroplasty: Infection is the Most Common Cause of Failure
Clinical Orthopaedics and Related Research®
Volume 468, Issue 8 , pp 2046-2051
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA, 19107, USA
- 2. Department of Orthopaedic Surgery, Imam University Hospital, Tehran University of Medical Sciences, End of keshavarz Blvd, Tehran, 1419733141, Iran