Total hip arthroplasties: What are the reasons for revision?

Abstract

Primary total hip arthroplasties have reported success rates of greater than 95% in many series with a longer than 10-year follow-up. Revision total hip arthroplasty due to such factors as increased high-activity levels, younger patients undergoing the procedure and increasing life expectancy has become more prevalent. An understanding of the mechanisms and timing of total hip arthroplasty failure can direct efforts aimed at reducing revision rates. This study was conducted to evaluate the indications for revision hip arthroplasty and relate these to the time after the index primary hip arthroplasty. A review of all revision hip arthroplasties at two centres over a 6-year time period identified 225 patients who underwent 237 revisions. The overall mean time to revision was 83 months (range: 0-360 months). The cause of failure was aseptic loosening in 123 hips (51.9%), instability in 40 hips (16.9%) and infection in 37 hips (5.5%). When stratified into two groups (less than 5 years, more than 5 years after the index primary hip arthroplasty), 118 of 237 (50%) revisions occurred in less than 5 years, with 33% due to instability and 24% resulting from infection. The majority of the causes of failure within 5 years in these early revisions were instability and deep infection. The success of hip arthroplasty is likely to be compromized if technical aspects of the surgery for appropriate component positioning and critical protocols to minimise complications such as infection are not given the proper attention.

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

“…Our findings of indications for revision echo previous epidemiologic studies of revision total joint arthroplasties [7,8]; however, our findings for revision THAs differ from prior observational cohort studies [3,54] and international registry reports [33,43] that identified aseptic loosening, bearing surface wear, and osteolysis as primary causes of TKA failure. Likewise, our revision TKA findings differ from those of prior reports implicating aseptic etiologies, including polyethylene wear, prosthetic loosening, and instability as the primary mechanisms for failed TKA [16,36,37,41,51,52].…”

The John Charnley Award: Highly Crosslinked Polyethylene in Total Hip Arthroplasty Decreases Long-term Wear: A Double-blind Randomized Trial

“…Aseptic loosening continues to be the predominant mode of failure of hip arthroplasty with over 50% of the revisions being performed for this reason alone [42]. Particulate debris generated by wear of the liner in implants with metal-on-polyethylene bearing surfaces is one of the main stimulators of periprosthetic osteolysis and eventual aseptic loosening [8,17,20,29].…”

Is Routine Mid-term Total Hip Arthroplasty Surveillance Beneficial?

“…Second-decade failure of THA components has implicated specific acetabular component designs [1,12,15] and undersizing cementless femoral components [1]. Mechanical weakness of conventional polyethylene resulting from sterilization processes also can contribute to an increased risk of prosthetic failure [19,25,28]. Higher failure rates also have been associated with acetabular component malposition, younger age, and male gender [6,21,29].…”