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Heterogeneity in Complication Risks and Temporal Trends Across Aseptic Indications for Revision Total Hip
Shaylan R Bera1, Tyler T Brady1, Andrew Adamczyk2
1Department of Orthopaedic Surgery, The University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.
The Journal of Arthroplasty
|July 14, 2026
Summary
Revision total hip arthroplasty for dislocation has the highest risk of re-revision and reoperation. While periprosthetic fractures are infection-prone, instability remains a challenging indication requiring specific risk assessment.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Research
- Biostatistics
Background:
- Increasing burden of revision total hip arthroplasty (rTHA).
- Incomplete understanding of comparative postoperative risk profiles among aseptic rTHA indications.
- Need to evaluate risks for periprosthetic fracture (PPFx), dislocation, and mechanical failure.
Purpose of the Study:
- Compare postoperative periprosthetic joint infection (PJI), reoperation, and re-revision rates for aseptic rTHA indications.
- Assess medical complications and temporal trends in rTHA.
- Stratify risks based on specific indications for revision surgery.
Main Methods:
- Utilized an insurance claims database for first-time rTHA patients.
- Stratified patients by aseptic indication: PPFx, dislocation, mechanical failure.
- Employed propensity-matching, Chi-square tests, Kaplan-Meier, Cox regressions, and ANOVAs for analysis up to five years.
- Evaluated annual temporal trends from 2016 to 2022.
Main Results:
- Dislocation showed the highest five-year re-revision (13%) and reoperation (15%) rates.
- Increased PJI risk identified for PPFx (HR: 1.43) and dislocation (HR: 1.35).
- rTHA for PPFx increased by 282% from 2016-2022; dislocation increased by 8.7%.
- PJI-free survival showed no improvement across indications.
Conclusions:
- Revision for dislocation carries the highest risk of re-revision and reoperation.
- rTHA for PPFx is infection-prone and resource-intensive.
- Instability is a challenging revision indication, necessitating indication-specific risk stratification.
