Skip to main content

Advertisement

SpringerLink
Log in

Total hip arthroplasties: What are the reasons for revision?

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Primary total hip arthroplasties have reported success rates of greater than 95% in many series with a longer than 10-year follow-up. Revision total hip arthroplasty due to such factors as increased high-activity levels, younger patients undergoing the procedure and increasing life expectancy has become more prevalent. An understanding of the mechanisms and timing of total hip arthroplasty failure can direct efforts aimed at reducing revision rates. This study was conducted to evaluate the indications for revision hip arthroplasty and relate these to the time after the index primary hip arthroplasty. A review of all revision hip arthroplasties at two centres over a 6-year time period identified 225 patients who underwent 237 revisions. The overall mean time to revision was 83 months (range: 0–360 months). The cause of failure was aseptic loosening in 123 hips (51.9%), instability in 40 hips (16.9%) and infection in 37 hips (5.5%). When stratified into two groups (less than 5 years, more than 5 years after the index primary hip arthroplasty), 118 of 237 (50%) revisions occurred in less than 5 years, with 33% due to instability and 24% resulting from infection. The majority of the causes of failure within 5 years in these early revisions were instability and deep infection. The success of hip arthroplasty is likely to be compromized if technical aspects of the surgery for appropriate component positioning and critical protocols to minimise complications such as infection are not given the proper attention.

Résumé

A dix ans de recul moyen les prothèses totales de hanches ont un taux de 95% de réussite dans la plupart des séries. Les facteurs ayant entraînés une réintervention, de type révision dépendent du niveau d’activité des sujets, de leurs jeunes âges, et de l’augmentation de la durée de vie. La compréhension des mécanismes d’échecs des prothèses totales de hanche devrait permettre de réduire le taux de révision. Cette étude a pour but d’évaluer les indications de révisions des prothèses totales de hanche. Pour cela, ont été revus, dans deux centres, avec six ans de recul moyen 225 patients qui ont bénéficié de 237 révisions. Le temps moyen pour la révision a été de 83 mois (0 à 360 mois). La cause de l’échec a été le descellement aseptique 123 hanches (51.9%), instabilité sur 40 hanches (16.9%) et infection sur 37 hanches (5.5%). Si l’on reclasse ces patients en deux groupes à moins et plus de 5 ans, 118 des 237 révisions (50%) surviennent dans une période de moins de 5 ans, 33% sont dues à l’instabilité, 24% à l’infection. Les causes d’échecs majeures avant 5 ans avec révisions, sont donc l’instabilité de la hanche et les infections profondes. Le succès d’une arthroplastie totale de hanche passe donc par le bon positionnement des implants et le respect du protocole de façon à éviter les complications infectieuses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Mahomed NN, Barrett JA, Katz JN et al (2003) Rates and outcomes of primary and revision total hip replacement in the United States medicare population. J Bone Jnt Surg Am 85-A(1):27–32

    Google Scholar 

  2. Eisler T, Svensson O, Tengstrom A et al (2002) Patient expectation and satisfaction in revision total hip arthroplasty. J Arthroplasty 17(4):457–462

    Article  PubMed  CAS  Google Scholar 

  3. Wroblewski BM (1984) Current trends in revision of total hip arthroplasty. Int Orthop 8(2):89–93

    Article  PubMed  CAS  Google Scholar 

  4. Furnes O, Lie SA, Espehaug B et al (2001) Hip disease and the prognosis of total hip replacements. A review of 53,698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987–99. J Bone Jnt Surg Br 83(4):579–586

    Article  CAS  Google Scholar 

  5. Older J (2002) Charnley low-friction arthroplasty: a worldwide retrospective review at 15 to 20 years. J Arthroplasty 17(6):675–680

    Article  PubMed  Google Scholar 

  6. Kuster MS (2002) Exercise recommendations after total joint replacement: a review of the current literature and proposal of scientifically based guidelines. Sports Med 32(7):433–445

    Article  PubMed  Google Scholar 

  7. Seyler TM, Mont MA, Ragland PS et al (2006) Sports activity after total hip and knee arthroplasty: specific recommendations concerning tennis. Sports Med 36(7):571–583

    Article  PubMed  Google Scholar 

  8. Mont MA, LaPorte DM, Mullick T et al (1999) Tennis after total hip arthroplasty. Am J Sports Med 27(1):60–64

    PubMed  CAS  Google Scholar 

  9. Meek RM, Allan DB, McPhillips G et al (2006) Epidemiology of dislocation after total hip arthroplasty. Clin Orthop Relat Res 447:9–18

    Article  PubMed  CAS  Google Scholar 

  10. Berry DJ, Harmsen WS, Cabanela ME et al (2002) Twenty-five-year survivorship of two thousand consecutive primary Charnley total hip replacements: factors affecting survivorship of acetabular and femoral components. J Bone Jnt Surg Am 84-A(2):171–177

    Google Scholar 

  11. Ong A, Wong KL, Lai M et al (2002) Early failure of precoated femoral components in primary total hip arthroplasty. J Bone Jnt Surg Am 84-A(5):786–792

    Google Scholar 

  12. Sarvilinna R, Huhtala HS, Puolakka TJ et al (2003) Periprosthetic fractures in total hip arthroplasty: an epidemiologic study. Int Orthop 27(6):359–361

    Article  PubMed  Google Scholar 

  13. Bohm P, Bischel O (2001) Femoral revision with the Wagner SL revision stem: evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years. J Bone Jnt Surg Am 83-A(7):1023–1031

    CAS  Google Scholar 

  14. Vichinsky EP, Neumayr LD, Haberkern C et al (1999) The perioperative complication rate of orthopedic surgery in sickle cell disease: report of the National Sickle Cell Surgery Study Group. Am J Hematol 62(3):129–138

    Article  PubMed  CAS  Google Scholar 

  15. Kobayashi S, Saito N, Horiuchi H et al (2000) Poor bone quality or hip structure as risk factors affecting survival of total-hip arthroplasty. Lancet 355(9214):1499–1504

    Article  PubMed  CAS  Google Scholar 

  16. Phillips CB, Barrett JA, Losina E et al (2003) Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. J Bone Jnt Surg Am 85-A(1):20–26

    Google Scholar 

  17. Alberton GM, High WA, Morrey BF (2002) Dislocation after revision total hip arthroplasty : an analysis of risk factors and treatment options. J Bone Jnt Surg Am 84-A(10):1788–1792

    Google Scholar 

  18. Parvizi J, Wade FA, Rapuri V et al (2006) Revision hip arthroplasty for late instability secondary to polyethylene wear. Clin Orthop Relat Res 447:66–69

    Article  PubMed  Google Scholar 

  19. Ibrahim T, Hobson S, Beiri A et al (2005) No influence of body mass index on early outcome following total hip arthroplasty. Int Orthop 29(6):359–361

    Article  PubMed  CAS  Google Scholar 

  20. Malik MH, Gray J, Kay PR (2004) Early aseptic loosening of cemented total hip arthroplasty: the influence of non-steroidal anti-inflammatory drugs and smoking. Int Orthop 28(4):211–213

    Article  PubMed  CAS  Google Scholar 

  21. McLaughlin JR, Lee KR (2006) The outcome of total hip replacement in obese and non-obese patients at 10- to 18-years. J Bone Jnt Surg Br 88(10):1286–1292

    Article  CAS  Google Scholar 

  22. Espehaug B, Havelin LI, Engesaeter LB et al (1997) Patient-related risk factors for early revision of total hip replacements. A population register-based case-control study of 674 revised hips. Acta Orthop Scand 68(3):207–215

    Article  PubMed  CAS  Google Scholar 

  23. Meldrum RD, Wurtz LD, Feinberg JR et al (2005) Does smoking affect implant survivorship in total hip arthroplasty? A preliminary retrospective case series. Iowa Orthop J 25:17–24

    PubMed  Google Scholar 

  24. Persson PE, Nilsson OS, Berggren AM (2005) Do non-steroidal anti-inflammatory drugs cause endoprosthetic loosening? A 10-year follow-up of a randomized trial on ibuprofen for prevention of heterotopic ossification after hip arthroplasty. Acta Orthop 76(6):735–740

    Article  PubMed  Google Scholar 

  25. Crawford SA, Siney PD, Wroblewski BM (2000) Revision of failed total hip arthroplasty with a proximal femoral modular cemented stem. J Bone Jnt Surg Br 82(5):684–688

    Article  CAS  Google Scholar 

  26. Templeton JE, Callaghan JJ, Goetz DD et al (2001) Revision of a cemented acetabular component to a cementless acetabular component. A ten to fourteen-year follow-up study. J Bone Jnt Surg Am 83-A(11):1706–1711

    CAS  Google Scholar 

  27. Lind M, Krarup N, Mikkelsen S et al (2002) Exchange impaction allografting for femoral revision hip arthroplasty: results in 87 cases after 3.6 years’ follow-up. J Arthroplasty 17(2):158–164

    Article  PubMed  Google Scholar 

  28. Weeden SH, Paprosky WG (2002) Minimal 11-year follow-up of extensively porous-coated stems in femoral revision total hip arthroplasty. J Arthroplasty 17[4 Suppl 1]:134–137

    Article  PubMed  Google Scholar 

  29. Ullmark G, Hallin G, Nilsson O (2002) Impacted corticocancellous allografts and cement for revision of the femur component in total hip arthroplasty. J Arthroplasty 17(2):140–149

    Article  PubMed  CAS  Google Scholar 

  30. Lachiewicz PF, Soileau ES (2005) Changing indications for revision total hip arthroplasty. J Surg Orthop Adv 14(2):82–84

    PubMed  Google Scholar 

  31. Khatod M, Barber T, Paxton E et al (2006) An analysis of the risk of hip dislocation with a contemporary total joint registry. Clin Orthop Relat Res 447:19–23

    Article  PubMed  Google Scholar 

  32. Clohisy JC, Calvert G, Tull F et al (2004) Reasons for revision hip surgery: a retrospective review. Clin Orthop Relat Res (429):188–192

  33. Sharkey PF, Hozack WJ, Rothman RH et al (2002) Insall award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res (404):7–13

Download references

Author information

Authors and Affiliations

  1. Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA

    Slif D. Ulrich, Thorsten M. Seyler, Derek Bennett, Ronald E. Delanois & Michael A. Mont

  2. University of Virginia, Charlottesville, VA, USA

    Khaled J. Saleh

  3. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA

    Issada Thongtrangan, Michael Kuskowski & Edward Y. Cheng

  4. Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA

    Peter F. Sharkey & Javad Parvizi

  5. Columbia St. Mary’s Centers for Joint Replacement, Columbia St. Mary’s, Milwaukee, WI, USA

    James B. Stiehl

Authors
  1. Slif D. Ulrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thorsten M. Seyler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Derek Bennett
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ronald E. Delanois
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Khaled J. Saleh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Issada Thongtrangan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Kuskowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Edward Y. Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Peter F. Sharkey
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Javad Parvizi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. James B. Stiehl
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Michael A. Mont
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thorsten M. Seyler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ulrich, S.D., Seyler, T.M., Bennett, D. et al. Total hip arthroplasties: What are the reasons for revision?. International Orthopaedics (SICO 32, 597–604 (2008). https://doi.org/10.1007/s00264-007-0364-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-007-0364-3

Keywords

Search

Navigation