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First Revision Total Hip Arthroplasty for Instability: 10-Year Outcomes and Risk Factors Associated With Rerevision
Liam Z Yapp1, Lisa C Howard2, Nelson V Greidanus2
1Division of Adult Reconstruction & Oncology, Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
First revision total hip arthroplasty for instability has a 10-year survival rate of 82.2%. Dual mobility components and large femoral heads show good survivorship, while factors like younger age and BMI increase revision risk.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Recurrent instability is a primary cause of failure in revision total hip arthroplasty (rTHA).
- Assessing the long-term success of the initial rTHA for instability is crucial for patient management.
- Identifying predictive factors for failure can guide surgical decision-making.
Purpose of the Study:
- To evaluate the 10-year survivorship of the first rTHA performed for hip instability.
- To identify patient-specific and implant-related factors associated with re-revision due to instability or other causes.
Main Methods:
- Retrospective analysis of 284 first rTHA cases for instability (2000-2022).
- Exclusion of re-revisions and oncology cases.
- Kaplan-Meier survival analysis and multivariable Cox regression for identifying risk factors.
Main Results:
- 10-year instability-free survival was 82.2%; all-cause re-revision survival was 73.6%.
- Dual mobility (DM) components demonstrated superior instability-free survival compared to standard bearings and constrained liners.
- Younger age, higher BMI, abductor deficiency, and constrained liners were linked to increased all-cause re-revision risk.
Conclusions:
- Nearly 20% of patients experience recurrent instability after first rTHA for instability, with 30% undergoing further revision within 10 years.
- DM components and large femoral heads (≥36mm) offer favorable 10-year survivorship.
- Patient demographics and specific implant choices significantly influence the risk of re-revision.