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. 2025 Aug 11;6(8):915-923.
doi: 10.1302/2633-1462.68.BJO-2025-0067.

Impact of prior osteotomy and osteosynthesis on long-term outcomes after total hip arthroplasty : a 1:1 Mahalanobis distance-matched registry study of 5,392 patients

Nele Wagener  1 , Yinan Wu  2 , Alexander Grimberg  2 , Christian Hipfl  1 , Sebastian Hardt  1
Affiliations

Impact of prior osteotomy and osteosynthesis on long-term outcomes after total hip arthroplasty : a 1:1 Mahalanobis distance-matched registry study of 5,392 patients

Nele Wagener et al. Bone Jt Open. .

Abstract

Aims: Patients with a history of osteotomy or osteosynthesis pose distinct challenges in total hip arthroplasty (THA) due to altered anatomy and biomechanics. Although THA is an established intervention for degenerative hip disease, limited evidence exists on its long-term outcomes in this cohort, especially regarding revision rates, mortality, and complications. This registry study aimed to determine these outcomes using data from a large national registry.

Methods: This registry study analyzed data from the German Arthroplasty Registry (EPRD), which captures approximately 70% of all hip arthroplasties in Germany. Among 418,409 patients undergoing THA between November 2012 and March 2024, 5,392 were included after 1:1 Mahalanobis distance matching for age, sex, BMI, and comorbidities: 2,696 patients with a history of osteotomy or osteosynthesis compared with 2,696 patients without. Kaplan-Meier survival curves estimated revision and mortality risks over an eight-year follow-up.

Results: Over eight years, patients with prior osteotomy or osteosynthesis had significantly higher revision (6.8%, n = 183/2,696 vs 3.9%, n = 105/2,696, p = 0.002) and mortality (25.2%, n = 679/2,696 vs 20.4%, n = 550/2,696, p < 0.001) rates than those without prior hip surgery. Infection (17%, n = 22/131 vs 16%, n = 15/94), periprosthetic fracture (14%, n = 18/131 vs 12%, n = 11/94), and dislocation (14%, n = 18/131 vs 8.5%, n=8/94) were leading causes of revision. For cementless femoral components, prior-surgery patients had an eight-year revision rate of 7.3%, n = 143/1,957 compared with 3.6%, n = 71/1,958 (p = 0.003) and a mortality rate of 17.3%, n = 339/1,957 compared with 10.9%, n = 213/1,958 (p < 0.001). For cemented femoral components, revision rates were 4.9%, n = 36/739, compared with 4.7%, n = 35/738 (p = 0.330), and mortality 46.3%, n = 342/739, compared with 43.0%, n = 317/738 (p < 0.001). At one year, the revision rate in the prior-surgery group was already elevated at 3.7% (95% CI 3.1 to 4.5; n = 100/2,696) compared with 2.6% (95% CI 2.0 to 3.3; n = 70/2,696) in controls, diverging further over time.

Conclusion: Patients with prior osteotomy or osteosynthesis undergoing THA face higher long-term revision and mortality risks, particularly with cementless stem fixation. Infection, periprosthetic fracture, and dislocation are key causes of revision.

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Conflict of interest statement

A. Grimberg is a participant in the Implant-Outlier-Workgroup of the German Arthroplasty Registry (EPRD).

Figures

Fig. 1
Fig. 1
Patient flow of study population. EPRD, Endoprothesenregister Deutschland; THA, total hip arthroplasty.
Fig. 2
Fig. 2
Endpoint revision of all total hip arthroplasties. Kaplan–Meier estimates of cumulative revision rates at one to eight years following total hip arthroplasty in patients with and without prior osteotomy or osteosynthesis. 95% CIs and numbers at risk are shown below the figure.
Fig. 3
Fig. 3
Endpoint revision of uncemented femoral components. Kaplan–Meier estimates of the cumulative revision rate for total hip arthroplasty in patients with previous osteotomy and osteosynthesis compared to those without prior surgery, reported annually up to eight years postoperatively. The estimates are accompanied by their respective 95% CIs.
Fig. 4
Fig. 4
Endpoint revision of cemented femoral components. Kaplan–Meier curves showing eight-year revision rates for cemented femoral components in patients with (red curve) and without (blue curve) a history of osteotomy or osteosynthesis.
Fig. 5
Fig. 5
Endpoint mortality of all total hip arthroplasties. Kaplan–Meier estimates of the cumulative revision rate for total hip arthroplasty in patients with prior osteotomy or osteosynthesis compared to those without prior surgery, reported annually up to eight years postoperatively. Estimates are shown with their 95% CIs.
Fig. 6
Fig. 6
Endpoint mortality of uncemented femoral components. Kaplan–Meier curves showing the eight-year cumulative mortality in total hip arthroplasty patients with (red curve) and without (blue curve) a history of osteotomy or osteosynthesis.
Fig. 7
Fig. 7
Endpoint mortality of cemented femoral components. Kaplan–Meier estimates of the eight-year cumulative mortality for cemented femoral components in patients with (red curve) and without (blue curve) a history of osteotomy or osteosynthesis, including 95% CIs.
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