Epidemiology of Revision Total Hip Arthroplasty: An Indian Experience

With increasing numbers of primary total hip replacement (THR), there has been a substantial increase in revision total hip replacement (RTHR) surgeries. RTHR are complex joint reconstruction surgeries involving significant cost, expertise and infrastructure. With its significant socioeconomic impact, we need to keep a close watch on the epidemiological trends of these procedures.

We prospectively studied the first-time RTHR performed at our institution for a 7-year period (2011-2017). We looked at patient demographics, the workload of RTHR and its etiology. We reviewed the microbiological profiles of septic revisions.

Of the 1244 THR procedures performed, 260 (21%) were first-time revisions. The predominant cause of revisions was a prosthetic infection (38%) followed by aseptic loosening (33%), instability (15%), peri-prosthetic fracture (11%) and implant breakage (3%). In the aseptic loosening group, 55% of cases had primary cemented implant, 44% had only stem loosening, 31% had cup loosening and 25% had both cup and stem loosening. In the early, midterm, and late-failure groups, prosthetic infection remained the main cause of failure. In 60% of the septic revisions, the offending organisms could not be identified and of those identified most (77%) were gram negative.

In our study, the RTHR burden was 21%, which is similar to historic revision data from the west (1998-2001) and twice as compared to recent trends from the west (9-11%). Unlike western data, which show aseptic loosening (30-60%) as the predominant cause of hip revisions, in our study infection was the number one cause (38%).