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Area of Science:

  • Orthopedic Surgery
  • Epidemiology
  • Public Health

Background:

  • Long-term mortality following primary total hip arthroplasty (THA) is lower than in the general population.
  • It remains unclear if this survival benefit extends to patients undergoing revision THA.

Purpose of the Study:

  • To investigate long-term mortality rates after revision THA.
  • To analyze mortality variations based on the reasons for revision (infection, fracture, aseptic loosening/wear/dislocation).
  • To examine mortality trends concerning age at surgery, time since surgery, and surgical calendar year.

Main Methods:

  • Retrospective analysis of 5417 revision THAs in 4532 patients (1969-2011).
  • Patients categorized by revision indication: periprosthetic joint infections (17%), fractures (12%), and aseptic loosening/wear/dislocation (71%).
  • Comparison of observed deaths to expected deaths using standardized mortality ratios (SMRs) against the US general population, with follow-up until December 31, 2016.

Main Results:

  • Overall age- and sex-adjusted mortality post-revision THA was slightly higher than the general population (SMR 1.09).
  • Significantly increased mortality risk observed for revision due to infection (SMR 1.35) and fractures (SMR 1.23).
  • Mortality risk was similar to the general population for aseptic loosening/wear/dislocation (SMR 1.01), but increased over time (8-10 years post-surgery).

Conclusions:

  • Revision THA for periprosthetic joint infections and fractures is associated with excess long-term mortality.
  • Mortality patterns shift over time, particularly for aseptic indications, necessitating long-term follow-up.
  • Comprehensive long-term monitoring is crucial for both implant survival and overall patient health after revision THA.