Risk factors for revision of primary total hip arthroplasty: a systematic review

Prokopetz, Julian J. Z.; Losina, Elena; Bliss, Robin; Wright, John; Baron, John A.; Katz, Jeffrey N.

doi:10.1186/1471-2474-13-251

Cited by 191 publications

(166 citation statements)

References 94 publications

(110 reference statements)

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“…The revision TKAs were mostly attributable to mechanical loosening and periprosthetic joint infection in younger patients (younger than 75 years), which may represent an emerging age shift, given that an increasing proportion of primary TKAs are being performed in younger patients [18,58]. The similar patient age trends in revision THA also may represent an emerging age shift in the burden of revision, given that an increasing proportion of primary THAs are being performed in younger patients [11,19,23,42,44]. It is estimated that by 2030, patients younger than 65 years will comprise 52% of primary THAs being performed [23].…”

Section: Discussionmentioning

confidence: 98%

“…The etiology of the increase in the number of revision procedures is multifactorial. The increasing absolute number of primary arthroplasties [21,44,53,58], expansion of the indications to include younger and more active individuals [11,18,19,23,29,30,34,42,44,46,49], and certain patient factors such as obesity [55,60], all likely contribute to overall revision rates. Projections based on population studies point to continued increases in the prevalence of revision procedures [22].…”

Section: Introductionmentioning

confidence: 99%

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Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

Bozic

Kamath

Ong

et al. 2015

Clinical Orthopaedics &Amp; Related Research

387

235

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Background Revision THA and TKA are growing and important clinical and economic challenges. Healthcare systems tend to combine revision joint replacement procedures into a single service line, and differences between revision THA and revision TKA remain incompletely characterized. These differences carry implications for guiding care and resource allocation. We therefore evaluated epidemiologic trends associated with revision THAs and TKAs. Questions/purposes We sought to determine differences in (1) the number of patients undergoing revision TKA and THA and respective demographic trends; (2) differences in the indications for and types of revision TKA and THA; (3) differences in patient severity of illness scoring between THA and TKA; and (4) differences in resource utilization (including cost and length of stay [LOS]) between revision THA and TKA. Methods The Nationwide Inpatient Sample (NIS) was used to evaluate 235,857 revision THAs and 301,718 revision TKAs between October 1, 2005 and December 31, 2010. Patient characteristics, procedure information, and resource utilization were compared across revision THAs and TKAs. A revision burden (ratio of number of revisions to total number of revision and primary surgeries) was calculated for hip and knee procedures. Severity of illness scoring and cost calculations were derived from the NIS. As our study was principally descriptive, statistical analyses generally were not performed; however, owing to the large sample size available to us through this NIS analysis, even small observed differences presented are likely to be highly statistically significant.One or more of the authors (SMK, KO, EL) are employees of Exponent, Inc, Menlo Park, CA, USA, and Philadelphia, PA, USA. One of the authors certifies that he (DJB), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,001-USD 1,000,000, from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (TPV) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of USD 10,001-USD 100,000 from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (HER) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,001-USD 1,000,000, from Zimmer, Inc (Warsaw, IN, USA Clin Orthop Relat Res (2015) 473:2131-2138 DOI 10.1007/s11999-014-4078-8 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons®Results Revision TKAs increased by 39% (revision burden, 9.1%-9.6%) and THAs increased by 23% (revision burden, 15.4%-14.6%). Revision THAs were performed more often in older patients compared with revision TKAs. Periprosthetic joint infection (25%) and mechanical loosening (19%) were the most common reasons for revision TKA compared with dislocation (22%) and mechanical loosening (20%) for revision THA. Full (all-component) revision was more common i...

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

Bozic

Kamath

Ong

et al. 2015

Clinical Orthopaedics &Amp; Related Research

387

235

View full text Add to dashboard Cite

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“…Previously published studies focusing on THA in younger aged patients have reported successful pain relief, functional improvement, and implant survivorship with a variety of implant designs and bearing surfaces [9, 10, 12, 15-17, 22, 23, 33]. Although revision rates for THA have been reported more frequently among younger patients undergoing THA, it is difficult to determine whether the higher failure rate reflects demographic considerations for this group or failures of older implant systems or surgical techniques in this patient group [1,8,12,[24][25][26]. Among studies with well-performing contemporary cementless implants, wear of conventional polyethylene has been identified as the major cause of revision surgery or impending concern for younger patients who have undergone THA [6,15,16,32].…”

Section: Introductionmentioning

confidence: 99%

Are Younger Patients Undergoing THA Appropriately Characterized as Active?

Keeney

Nunley

Baca

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Surgeons perform THA to address a variety of conditions in younger patients, including osteoarthritis (OA), osteonecrosis, inflammatory arthritis, and congenital deformities. Younger patients aged 50 years or younger have been characterized as active in the literature, but a direct relationship between age and activity level has not been well substantiated. Younger patients with OA may engage in higher activity levels; however, associated medical conditions in patients with other surgical indications may not support a generalization that age is a surrogate for activity level. We recently evaluated these issues in younger patients undergoing total knee arthroplasty (TKA) and noted that the majority would not be considered active. Given this observation, we considered whether younger patients undergoing THA are characterized by high activity levels, which is relevant to understanding the long-term risk of wear-related failures.Questions/purposes (1) Do demographic features of younger patients undergoing THA support high activity expectations? (2) Do preoperative or postoperative functional activity measures support projections that younger patients are active after THA? Methods We retrospectively compared demographic characteristics and functional activity profiles (as determined by preoperative and postoperative UCLA activity scores, Harris hip scores [HHS], and SF-12 and WOMAC physical function subscores) of 704 patients who had undergone THA and were aged younger than 50 years (822 hips) with those of 484 patients (516 hips) aged between 65 and 75 years, who had undergone THA, with a minimum followup at 1 year after surgery (range, 12-160 months). Results Compared with patients aged 65 to 75 years, younger patients undergoing THA were more often men (51%, 95% confidence interval [CI], 48.8%-53.2% versus 40%, 95% CI, 37.1%-42.9% women; p \ 0.01) or had undergone surgery for osteonecrosis (29% versus 4%; 95% CI, 2.8%-5.

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“…A systematic review conducted by Prokopetz et al (2012) investigated the risk factors for revision total arthroplasty after primary THA. The risk factors identified, which were consistent and statistically significant across the studies evaluated, included younger patient ages at the time of primary replacement, increased comorbidity, the presence of bone necrosis (rather than osteoarthritis) and the surgeon's experience (number of joint operations carried out) and larger femoral heads.…”

Section: J Reasons For Revision Total Arthroplastymentioning

confidence: 99%

“…The review does not state the size of the femoral head from which point the level of risk increases. In two of the three studies examined, the maximum femoral head size of the implanted femoral component was 28 mm (Prokopetz et al 2012). The review conducted by Prokopetz et al (2012) shows that alongside wear and tear, other factors such as the surgeons' experience constitute a significant risk of revision surgery.…”

Section: J Reasons For Revision Total Arthroplastymentioning

confidence: 99%