Early revision in total joint arthroplasty surgery - a narrative review

Revision surgery is widely recognized as the main performance index for Total Joint Arthroplasty (TJA). Whereas long-term revision rate is used for measuring implant durability, "early revision" is still not clearly defined, with timeframes ranging from 3 to 6 months until 2 or even 3 years used in the literature. Aim of this work is to review the current literature specifically related to "early" revisions, in order to provide an overview over reasons for early revision surgery.

Because of lack of definitions, a narrative review approach was chosen. Literature review of articles published within the last 10 years retrieved 254 articles. After applying exclusion and inclusion criteria, 55 publications were analysed. An accepted standard for narrative review was used.

The analysed articles showed a marked heterogeneity in reported timeframes for early revision, but we found values labelled as "early" between 1 month and 5 years. 3-months revision rates ranged between 0.5% - 1.5% for total hip arthroplasty (THA), and were approximately 0.5% for total knee arthroplasty (TKA) for all causes. 5-year revision rates were between 2% - 4% for THA and between 3% - 5% for TKA for all causes. Furthermore, we found that the heterogeneity for the applied time definitions in early revisions do not allow a direct comparison for all-cause revision procedures.

Similarly to long term revision results, there is heterogeneity in short term revision results. It can be useful to take into account homogenous groups when comparing early revision outcomes, for example among same reason for revision. Moreover, several paper contributions suggested a significant dependence on modifiable patient characteristics at primary procedure.