BackgroundNumerous papers have been published examining risk factors for revision of primary total hip arthroplasty (THA), but there have been no comprehensive systematic literature reviews that summarize the most recent findings across a broad range of potential predictors.MethodsWe performed a PubMed search for papers published between January, 2000 and November, 2010 that provided data on risk factors for revision of primary THA. We collected data on revision for any reason, as well as on revision for aseptic loosening, infection, or dislocation. For each risk factor that was examined in at least three papers, we summarize the number and direction of statistically significant associations reported.ResultsEighty-six papers were included in our review. Factors found to be associated with revision included younger age, greater comorbidity, a diagnosis of avascular necrosis (AVN) as compared to osteoarthritis (OA), low surgeon volume, and larger femoral head size. Male sex was associated with revision due to aseptic loosening and infection. Longer operating time was associated with revision due to infection. Smaller femoral head size was associated with revision due to dislocation.ConclusionsThis systematic review of literature published between 2000 and 2010 identified a range of demographic, clinical, surgical, implant, and provider variables associated with the risk of revision following primary THA. These findings can inform discussions between surgeons and patients relating to the risks and benefits of undergoing total hip arthroplasty.

BackgroundMost research on failure leading to revision total hip arthroplasty (THA) is reported from single centers. We searched PubMed between January 2000 and August 2010 to identify population- or community-based studies evaluating ten-year revision risks. We report ten-year revision risk using the Kaplan-Meier method, stratifying by age and fixation technique.ResultsThirteen papers met the inclusion criteria. Cemented prostheses had Kaplan-Meier estimates of revision-free implant survival of ten years ranging from 88% to 95%; uncemented prostheses had Kaplan-Meier estimates from 80% to 85%. Estimates ranged from 72% to 86% in patients less than 60 years old and from 90 to 96% in older patients.ConclusionData reported from national registries suggest revision risks of 5 to 20% ten years following primary THA. Revision risks are lower in older THA recipients. Uncemented implants may have higher ten-year rates of revision, regardless of age.

Objective To study risk factors for revision of primary total hip replacement (THR) in a US population-based sample. Methods Using Medicare claims, we identified beneficiaries from 29 US states who underwent primary THR between 7/1/1995 and 6/30/1996, and followed them through 12/31/2008. Potential cases had ICD-9 codes indicating revision THR. Each case was matched by state with one control THR recipient who was alive and unrevised when the case had revision THR. We abstracted hospital records to document potential risk factors. We examined associations between preoperative factors and revision risk using multivariate conditional logistic regression. Results The analysis data set consisted of 719/836 case-control pairs with complete data for analysis variables. Factors associated with higher revision odds in multivariate models were age ≤75 at primary surgery (OR 1.52, 95% CI 1.20, 1.92), height in highest tertile (OR 1.40, 95% CI 1.06, 1.85), weight in highest tertile (OR 1.66, 95% CI 1.24, 2.22), cemented femoral component (OR 1.44, 95% CI 1.10, 1.87), prior contralateral primary THR (OR 1.36, 95% CI 1.05, 1.76), other prior orthopedic surgery (OR 1.45, 95% CI 1.13, 1.84), and living with others (versus alone; OR 1.26, 95% CI 0.99, 1.61). Conclusion This first US population-based case-control study of risk factors for revision of primary THR showed that younger, taller, and heavier patients and those receiving a cemented femoral component had greater likelihood of revision THR over twelve-year follow-up. Effects of age and body size on revision risk should be addressed by clinicians with patients considering primary THR.

Lisa Lehmann and colleagues discuss how “grateful patient” programs that solicit donations from wealthy individuals who receive care may be problematic for physicians and propose policies that mitigate these risks. Please see later in the article for the Editors' Summary