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Study: Revision THA within 5 years often due to dislocation, mechanical failure
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Nearly 2.7% of total hip arthroplasties were revised, many for dislocation and mechanical failure, among 20,374 total hip arthroplasty procedures performed May 2007 to December 2012 in one of the top studies scheduled to be presented at the upcoming EFORT Congress in Prague.
Lazaros Poultsides, MD, and colleagues evaluated overall survival and failure rates, trends of early failure and predictors of total hip arthroplasty (THA) revision through 5 years of follow-up utilizing a prospective THA database. They found dislocation was the leading cause of revision within 2 years following index surgery. Within the 2-year to 5-year follow-up, mechanical failure was the leading reason for THA revision.
“We found when post-traumatic arthritis develops or when total hip replacement is performed because of a fracture, this patient is more likely to fail within 5 years. In addition, anemic patients and patients with depression and other neurological disorders were more likely to be revised early. Patients who experienced syncope and collapse during hospitalization after index surgery or had a longer length of stay for any reason were associated with increased odds for early revision. One interesting point: patients who had same-day bilateral hip replacement were less likely to fail early than those who underwent unilateral or two separate unilateral hip replacements,” Poultsides told Orthopaedics Today Europe.
The leading causes of failure and time to revision for the first group were dislocation (47.6%, 6.2 months), periprosthetic fracture (15.2%, 3.4 months) and mechanical failure (13.9%, 14.6 months).
In the second group, the main causes of failure and time to revision were mechanical failure (64.7%, 38.4 months), dislocation (17.9%, 38.1 months) and mechanical loosening (9.8%, 40.0 months).
A Kaplan-Meier survival analysis showed 97% 5-year survival.
Clinical characteristics of patients who underwent revision within 2 years of the primary surgery (372 hips; 1.8%) were compared with those who were revised during the 2-year to 5-year follow-up period (177 hips; 0.9%). Patients who were older, with a primary diagnosis of fracture, post-traumatic arthritis or congenital disorder were more likely to undergo revision within 2 years compared to the 2-year to 5-year period, as well as patients who were depressed, obese or received blood transfusions during primary THA.
Based on that information, the investigators concluded preoperative patient factors, such as anemia, depression and other neurological disorders can increase the early risk of THA revision and surgeons should address these issues with patients prior to THA to reduce risk of revision.
“The revision risk is much higher the first 2 years. In addition, we found some implant designs were less likely to survive and probably some of these new advancements in THA do not all work well, so maybe we have to earlier evaluate them and justify the risk of their use,” Poultsides said. – by Robert Linnehan
- Reference:
- Poultsides L, et al. Paper #3895. Scheduled to be presented 27 May at: EFORT Congress; May 27-29, 2015; Prague.
- For more information:
- Lazaros Poultsides, MD, can be reached at Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA; email: poultsidesl@hss.edu.
Disclosure: Poultsides reports no relevant financial disclosures.