Why revision total hip arthroplasty fails

Abstract

Current outcomes data on revision total hip arthroplasty focuses on specific implants and techniques rather than more general outcomes. We therefore examined a large consecutive series of failed THAs undergoing revision to determine if survivorship and modes of failure differ in comparison to the current data. We retrospectively reviewed the medical records of 1100 revision THAs. The minimum followup was 2 years (mean, 6 years; range, 0-20.4 years). Eighty-seven percent of revision total hips required no further surgery; however, 141 hips (13%) underwent a second revision at a mean of 3.7 years (range, 0.025-15.9 years). Seventy percent (98 hips) had a second revision for a diagnosis different from that of their index revision, while 30% (43 hips) had a second revision for the same diagnosis. The most common reasons for failure were instability (49 of 141 hips, 35%), aseptic loosening (42 of 141 hips, 30%), osteolysis and/or wear (17 of 141 hips, 12%), infection (17 of 141 hips, 12%), miscellaneous (13 of 141 hips, 9%), and periprosthetic fracture (three of 141 hips, 2%). Survivorship for revision total hip arthroplasty using second revision as endpoint was 82% at 10 years. Aseptic loosening and instability accounted for 65% of these failures.

Level of evidence: Level IV, therapeutic (retrospective) study. See the Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

The Kaplan-Meier survivorship for 1100 hips undergoing index revision total hip arthroplasty from 1985 to 2005 used second revision for any reason as an endpoint. Survivorship at 10 years was 82% and at 15 years was 72.6%.

Fig. 2A–D

The Kaplan-Meier survivorship for index revision total hip arthroplasty based on initial index revision diagnosis is shown. Results presented are based on (A) a diagnosis of aseptic loosening; (B) a diagnosis of infection; (C) a diagnosis of instability; and (D) a diagnosis of wear-lysis.

Fig. 3

The most common modes of failure for revision total hip arthroplasty for three equivalent time periods during the study were determined. Instability and infection remained common modes of failure throughout the study, while aseptic loosening and wear/osteolysis were more common modes of failure for those patients revised early in the study.