Is a Higher Number of Total Hip and Knee Arthroplasty Revisions Associated With Increased Mortality?

It remains uncertain whether patients who undergo numerous total hip arthroplasty (THA) and/or knee arthroplasty (TKA) revisions exhibit decreased survival. Therefore, we sought to determine if the number of revisions per patient was a mortality predictor.

We retrospectively reviewed 978 consecutive THA and TKA revision patients from a single institution (from January 5, 2015-November 10, 2020). Dates of first-revision or single revision during study period and of latest follow-up or death were collected, and mortality was assessed. Number of revisions per patient and demographics corresponding to first revision or single revision were determined. Kaplan-Meier, univariate, and multivariate Cox-regressions were utilized to determine mortality predictors. The mean follow-up was 893 days (range, 3-2,658).

Mortality rates were 5.5% for the entire series, 5.0% among patients who only underwent TKA revision(s), 5.4% for only THA revision(s), and 17.2% for patients who underwent TKA and THA revisions (P = .019). In univariate Cox-regression, number of revisions per patient was not predictive of mortality in any of the groups analyzed. Age, body mass index (BMI), and American Society of Anesthesiologists (ASA) were significant mortality predictors in the entire series. Every 1 year of age increase significantly elevated expected death by 5.6% while per unit increase in BMI decreased the expected death by 6.7%, ASA-3 or ASA-4 patients had a 3.1 -fold increased expected death compared to ASA-1 or ASA-2 patients.

The number of revisions a patient underwent did not significantly impact mortality. Increased age and ASA were positively associated with mortality but higher BMI was negatively associated. If health status is appropriate, patients can undergo multiple revisions without risk of decreased survival.