Can some early revision total hip arthroplasties be avoided?

Abstract

Aims Studying the indications for revision total hip arthroplasty (THA) may enable surgeons to change their practice during the initial procedure, thereby reducing the need for revision surgery. The aim of this study was to identify and describe the potentially avoidable indications for revision THA within five years of the initial procedure. Patients and Methods A retrospective review of 117 patients (73 women, 44 men; mean age 61.5 years (27 to 88)) who met the inclusion criteria was conducted. Three adult reconstruction surgeons independently reviewed the radiographs and medical records, and they classified the revision THAs into two categories: potentially avoidable and unavoidable. Baseline demographics, perioperative details, and quality outcomes up to the last follow-up were recorded. Results A total of 60 revision THAs (51.3%) were deemed potentially avoidable and 57 (48.7%) were deemed unavoidable. The following were identified as avoidable factors: suboptimal positioning of the acetabular component (29; 48%), intraoperative fracture or a fracture missed on an intraoperative radiograph (20; 33%), early (less than two weeks) aseptic loosening (seven; 11.7%), and symptomatic leg length discrepancy of > 1 cm (four; 6.7%). Conclusion A surprisingly large proportion of acute revision THAs are potentially avoidable. Surgeons must carefully evaluate the indications for revision THAs in their practice and identify new methods to address these issues. Cite this article: Bone Joint J 2019;101-B(6 Supple B):97–103.

Novel Measure of Acetabular Cup Inclination and Anteversion During Total Hip Arthroplasty

“… 2–4 Specifically, malpositioning of the acetabular cup has been associated with adverse outcomes, with the consequences including reduced range of motion, 5–7 increased risk of dislocation, 8 , 9 increased component wear, 10 increased impingement, 5 , 6 increased pain, and a resultant higher rate of revision. 11 In fact, it has been suggested that 48% of avoidable revision THAs were the result of malpositioning of the acetabular cup. 11 Improving acetabular cup orientation may, therefore, reduce adverse outcomes.…”

“… 11 In fact, it has been suggested that 48% of avoidable revision THAs were the result of malpositioning of the acetabular cup. 11 Improving acetabular cup orientation may, therefore, reduce adverse outcomes.…”

Are there avoidable causes of early revision total knee arthroplasty?

“…This methodology was adapted from a 2019 study by Novikov et al. looking at potentially avoidable causes of rTHA [ 14 , 15 ].…”

“…Avoidable revisions indications are defined as those that result from an insufficiency of care by the medical provider as determined by the provider’s peers [ 13 ]. Potential avoidable indications for revision have been investigated in total hip arthroplasty (THA), but from our literature review, no studies have been published looking at potential avoidable indications for rTKA [ 14 ].…”

Predicting Cementless Stem Fixation in Total Hip Arthroplasty Using Radiodensity Mapping

“…Over the years there have been a significant advance in prosthesis design ranging from the shape, coating and modality of fixation [2]. However, post-operative complications due to mechanical failure of implants still occur and component loosening is considered as one of the most common failure modes in cementless THA [3][4][5]. Although the risk of femoral loosening can be minimised by optimal component positioning, other factors such as patient age, weight, gender, osteopenia, stem design and Dorr-C bone have all been proposed as risk factors for poor fixation and subsequent stem subsidence and poor outcome [6][7][8][9].…”