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Total hip arthroplasty revision etiologies: a cross-sectional study in Isfahan, Iran
Mehdi Teimouri1, Mehdi Motififard1, Sahar Sadat Lalehzar2
1Department of Orthopedic Surgery, School of Medicine, Isfahan, Iran.
Insights
Complications like instability and infection are common reasons for total hip arthroplasty (THA) revision. Higher BMI and wound discharge also significantly increase revision rates after primary THA.
Area of Science:
- Orthopedic Surgery
- Medical Complications
- Arthroplasty Research
Background:
- Complications following primary total hip arthroplasty (THA) are the leading cause for revision surgeries.
- Investigating the frequency and risk factors of post-THA complications is crucial due to the high prevalence of revision procedures.
Purpose of the Study:
- To determine the frequency of complications after primary total hip arthroplasty (THA).
- To identify risk factors associated with revision surgery following primary THA.
Main Methods:
- A cohort study was conducted from 2011-2019, including patients who underwent primary THA and were readmitted for complications.
- Demographic data, surgical history, and Harris Hip Scores (HHS) were collected and analyzed.
- Statistical tests were employed to compare outcomes between study groups.
Main Results:
- Among 1006 patients, common complications included instability (56.4%), prosthesis infection (53.8%), periprosthetic fracture (30.8%), and aseptic loosening (6%).
- Higher body mass index (BMI), wound discharge, and nosocomial infections significantly increased revision rates.
- Instability, infection, periprosthetic fractures, and aseptic loosening were all significant risk factors for revision (P < 0.001).
Conclusions:
- Instability, prosthetic infections, periprosthetic fractures, and aseptic loosening are the primary drivers for revision THA.
- Factors such as elevated BMI, persistent wound discharge, and hospital-acquired infections elevate the risk of revision after primary THA.
Background:
Complications after primary total hip arthroplasty (THA) are the most common reason for revision. Due to the high prevalence of revision surgery, we investigated the frequency of postprimary THA complications and related risk factor revision surgery.
Materials And Methods:
This is a cohort study that was performed in 2011-2019 on all patients who underwent primary THA surgery re-admitted to the Kashani and Saadi Hospital affiliated to Isfahan University of Medical Science, Iran, due to some complications after THA. Demographic and basic data were collected from patient's medical documents. Harris hip score (HHS) was calculated for all patients 6 months after the last surgery. The obtained data were analyzed using SPSS software version 21. Appropriate statistical tests were conducted to compare the results between the study groups.
Results:
Among 1260 patients who underwent primary THA, 1006 of them entered the study after applying the exclusion criteria. Thirty nine patients were under revision, 53.8% had prosthesis infection, 56.4% had instability, 6% had aseptic loosening, and 30.8% had periprosthetic fracture. Odds ratio for the above complications were 45.5, 45, 6.4, and 15.5, respectively. HHS postoperatively was also significantly (P < 0.001) higher in patients without revision. No correlation between gender or surgeon experience and revision was detected; however wound discharge (P < 0.001), body mass index (BMI) (P = 0.003), and Infection during hospitalization (P < 0.001) affect revision rate significantly. All four postsurgery complications, i.e., instability, postoperative prothesis infections, periprosthetic fractures, and aseptic loosening, significantly increased the risk of revision (P < 0.001, for all).
Conclusion:
Instability, prosthetic infections, periprosthetic fractures, and aseptic loosening were the most common causes for increasing revision rates after THA, respectively. Higher BMI, persistent wound discharge, and nosocomial infections during the first hospitalization also increased the rate of revision after primary THA.
