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Total hip arthroplasty revision: a decade of change
H David Homesley1, John M Minnich, Javad Parvizi
1Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Insights
Total hip arthroplasty (THA) revision patterns shifted over time. While aseptic loosening remained the primary cause, revisions for wear and instability increased, while those for infection and hemiarthroplasty conversion decreased.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Clinical Epidemiology
Background:
- Total hip arthroplasty (THA) is a common procedure for hip joint disease.
- Understanding trends in THA revision is crucial for improving long-term outcomes.
- Previous studies have highlighted various reasons for THA failure, but temporal shifts require ongoing investigation.
Purpose of the Study:
- To analyze and compare the incidence, indications, and changing patterns of total hip arthroplasty revision over two distinct time periods.
- To identify specific trends in THA failure modes and their potential underlying causes.
Main Methods:
- Retrospective cohort study comparing THA revisions from July 1989 to June 1991 with those from January 2000 to December 2000 at a single institution.
- Data collection included patient demographics, primary diagnosis, reason for revision, and surgical procedure.
- Statistical analysis was performed to compare revision rates and indications between the two periods.
Main Results:
- Aseptic loosening was the predominant indication for THA revision in both study periods.
- Significant increases in revision rates were observed for polyethylene wear, instability, and leg-length discrepancy.
- A significant decrease in revisions for conversion of failed hemiarthroplasty to THA and for deep infection was noted.
Conclusions:
- The patterns of total hip arthroplasty revision have evolved, with increasing concerns regarding wear and instability.
- Decreased revisions for infection and hemiarthroplasty conversion may reflect improvements in surgical techniques and implant materials.
- Further research into preventable causes of wear and instability is warranted to optimize long-term THA performance.
Abstract:
We studied the incidence, indications, and changing patterns of total hip arthroplasty (THA) revision by comparing all consecutive THA revisions performed at a single institution between July 1989 and June 1991 with all those performed at the same institution between January 2000 and December 2000. Aseptic loosening was the main reason for THA failure during both periods. Between the periods, the number of revisions for polyethylene wear, instability, and leg-length discrepancy increased, and the number of revisions for conversion of failed hemiarthoplasty to THA and for deep infection decreased significantly. We evaluate the reasons for these trends in an attempt to identify preventable causes of failure and to stimulate further research on prevention.
