Problems of revision hip arthroplasty in Poland and around the world

Background. Total hip arthroplasty (THA) is the most common surgical procedure in orthopedic surgery. The number of hip replacements per year is estimated at 150,000 in the US, 80,000 in Germany, and 40,000 in Great Britain. Given the population of Poland one would expect 30,000 per year.
Material and methods. In order to find the actual number of hip prosthesis operations we sent a targeted questionnaire to every orthopedic center in Poland 9a total of 220), to every manufacturer supplying implants to the Polish market, and to the national Consultant for Orthopedics and Traumatology. Completed questionnaires were returned by 67 centers, i.e. 30,5%.
Results. The data we obtained included 29,380 THA and 2,102 revision THA operations. Thus the number of revisions represents 10,0% (7,2% revision THA and 2,8% implant removal). Based on data from the questionnaires, information from the National Consultant, and numerous conversations with representatives of companies that manufacture prostheses, the number of operations can be estimated, with a fairly high margin of error, at ca. 12,000 annually.
The number of revisions performed is described by the widely-used "rate of survival" of the implant. In highly specialized centers, such as the Centre for Hip Surgery in Wrightington, the rate of survival at 10 years is estimated at 100%; at 15 years, 98%; at 20 years, 93%. Optimistic data can also be found in the Swedish National Hip Arthroplasty Registry (138 centers, 138,830 implants). The 9-year survival rate is 94%, while after 16 years the rate is 84,1%. The survival rate for the Weller prosthesis has been calculated at 75% after 10 years. This poor outcome is the result of the size of the head (32 mm), which causes excessive wear on the polyethylene.
Conclusions. The problems of revision hip arthroplasty are essentially the some around the world. Intensive research is still in progress on the pathogenesis of loosening, material (polyethylene) wear, the quality of cement, and new types of uncemented and cemented prostheses. More and more work is being done one surgical techniques, bone defect filling, and the application of various additional implants (rings, meshes). Revision hip arthroplasty with septic loosening continues to be a difficult problem.