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Re-revision surgery in revision total hip arthroplasty: the impact of timing on outcomes
Juan Ameztoy1, Ana Cruz Pardos2, Ricardo Fernandez Fernandez2
1Hospital Universitario La Paz, Madrid, Spain. juanameztoygallego@gmail.com.
Background:
Epidemiology, risk factors and outcomes of re-revision total hip arthroplasty remain poorly defined. This study aimed to evaluate implant survivorship, timing of failure, and factors associated with subsequent re-revision surgery following index revision THA using time-to-event analyses.
Methods:
290 revision total hip arthroplasties were analyzed between 2017 and 2022 at a single academic institution. Re-revision surgery was defined as any further revision procedure following the index revision total hip arthroplasties. The primary endpoint was the first re-revision procedure after index revision total hip arthroplasty. Patients were stratified according to re-revision timing during available follow-up as early re-revision (< 1 year), late re-revision (> 1 year), or no re-revision during available follow-up. Kaplan-Meier survivorship analyses and Cox proportional hazards models were used to evaluate implant survival and independent risk factors for subsequent re-revision surgery.
Results:
Among 290 revision total hip arthroplasty, 72 (24.8%) re-revisions were identified, including 41 (14.1%) early and 31 (10.7%) late re-revisions. Early failures were proportionally more associated with instability and periprosthetic joint infection, whereas aseptic loosening and polyethylene wear were proportionally more frequent among later failures. In multivariable Cox proportional hazards analyses, revision total hip arthroplasty performed for periprosthetic joint infection remained independently associated with increased risk of subsequent re-revision surgery (HR 3.178, 95% CI 1.595-6.335; p < 0.001), whereas revision total hip arthroplasty performed for polyethylene wear demonstrated independently improved implant survivorship (HR 0.099, 95% CI 0.013-0.723; p = 0.023). Five-year survivorship free from re-revision surgery was 61.3% (95% CI 49.3%-73.3%) for periprosthetic joint infection revisions compared with 95.6% (95% CI 85.6%-98.9%) for polyethylene wear revisions. Significant postoperative functional improvement was observed in all groups (p < 0.001).
Conclusion:
Revision total hip arthroplasty performed for periprosthetic joint infection was independently associated with inferior implant survivorship and increased risk of subsequent re-revision surgery, whereas revision total hip arthroplasty performed for polyethylene wear demonstrated improved survivorship.