Ambulatory status after revision total hip arthroplasty in elective versus fracture indications

To improve revision total hip arthroplasty (rTHA) prognosis and postoperative management, a better understanding of how non-elective and elective indications influence clinical outcomes is needed. We sought to compare ambulatory status, complication rates, and implant survival rates in patients who underwent aseptic rTHA for periprosthetic fracture or elective indications.

This retrospective study examined all aseptic rTHA patients with a minimum follow-up of two years at a single tertiary referral center. Patients were divided into two groups: fracture rTHA (F-rTHA) if the patient had a periprosthetic femoral or acetabular fracture, and elective rTHA (E-rTHA) if the patient underwent rTHA for other aseptic indications. Multivariate regression was performed for clinical outcomes to adjust for baseline characteristics, and Kaplan-Meier analysis was performed to assess implant survival.

A total of 324 patients (F-rTHA: 67, E-rTHA: 257) were included. In the F-rTHA cohort, 57 (85.0%) and 10 (15.0%) had femoral and acetabular periprosthetic fractures, respectively. F-rTHA patients were more likely to be discharged to skilled nursing (40.3% vs. 22.2%, p = 0.049) and acute rehabilitation facilities (19.4% vs. 7.8%, p = 0.004). F-rTHA patients had higher 90-day readmission rates (26.9% vs. 16.0%, p = 0.033). Ambulatory status at three months postoperatively significantly differed (p = 0.004); F-rTHA patients were more likely to use a walker (44.6% vs. 18.8%) and less likely to ambulate independently (19.6% vs. 28.6%) or with a cane (28.6% vs. 41.1%). These differences did not persist at one and two years postoperatively. Freedom from all-cause re-revision (77.6% vs. 74.7%, p = 0.912) and re-revision due to PJI (88.1% vs. 91.9%, p = 0.206) were similar at five-year follow-up.

Compared to rTHA performed for elective aseptic indications, fracture rTHA patients had poorer early functional outcomes, with greater need for ambulatory aids and non-home discharge. However, these differences did not persist long term and did not portend increased infection or re-revision rates.