Early failures in total hip arthroplasty -- a changing paradigm

Area of Science:

• Orthopedic Surgery
• Biomaterials Science

Background:

• Early failure of total hip arthroplasty (THA) is a significant clinical concern.
• Previous studies indicated high rates of early revisions due to instability and aseptic loosening.

Purpose of the Study:

• To analyze the trends and causes of early failures in revision hip arthroplasty.
• To compare early failure rates between different time periods and identify emerging failure modes.

Main Methods:

• Retrospective review of 1168 revision hip arthroplasties performed between 2001 and 2011.
• Analysis of failure modes occurring within 5 years of the index total hip arthroplasty (THA).
• Comparison with historical data from 1986 to 2000.

Main Results:

• 24.1% of THAs underwent revision within 5 years of the index procedure.
• Common failure modes included aseptic loosening, infection, instability, metallosis, and fracture.
• The proportion of early revisions decreased by 9% compared to the previous study period (1986-2000).
• Metallosis and aseptic loosening of metal-on-metal shells emerged as leading causes of early failure.

Conclusions:

• Despite a decrease in the proportion of early revisions, the rate remains concerning.
• The rise of metallosis and aseptic loosening associated with metal-on-metal shells requires attention.
• Caution is advised regarding the rapid adoption of new surgical innovations without robust evidence-based medicine justification.