Current Trends in Revision Hip Arthroplasty: Indications and Types of Components Revised

Zoe W Hinton; Christine J Wu; Sean P Ryan; Daniel J Cunningham; Cynthia L Green; Paul F Lachiewicz

doi:10.1016/j.arth.2022.03.008

Current Trends in Revision Hip Arthroplasty: Indications and Types of Components Revised

J Arthroplasty. 2022 Jul;37(7S):S611-S615.e7. doi: 10.1016/j.arth.2022.03.008. Epub 2022 Mar 10.

Authors

Zoe W Hinton¹, Christine J Wu¹, Sean P Ryan¹, Daniel J Cunningham¹, Cynthia L Green², Paul F Lachiewicz³

Affiliations

¹ Department of Orthopaedic Surgery, Duke University, Durham, North Carolina.
² Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
³ Department of Orthopaedic Surgery, Duke University, Durham, North Carolina; Durham Veterans Administration Medical Center, Durham, North Carolina.

PMID: 35276275
DOI: 10.1016/j.arth.2022.03.008

Abstract

Background: The materials and techniques for both primary and revision total hip arthroplasty (THA) have changed over time. This study evaluated if the indications for revision THA, rates of components utilized (femoral or acetabulum, both, or head/liner exchange), length of stay (LOS), and payments to surgeons and facilities have also changed.

Methods: A retrospective study, utilizing the PearlDiver database, of 38,377 revision THA patients from January 2010 through December 2018 was performed. Data included the indication for revision, components revised (femoral or acetabulum, both, or head/liner exchange), LOS, and payments. Indications and components were analyzed by logistic regression (Dunnett's post hoc test). Revision totals were analyzed with a linear regression model. Analysis of variance assessed changes in LOS and payments.

Results: Patients' median age was 67 years (Q1-Q3: 59-74), and 58.7% were female. Revisions for dislocation decreased between 2010 and 2018 (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.68-0.98). Revisions for component loosening increased (OR 1.54, 95% CI 1.25-1.91). Dislocation remained the most common indication (19.3%), followed by PJI (17.3%) and loosening (17.1%). Both-component (OR:1.45; 95% CI:1.25-1.67) and femoral component only revisions increased; acetabular component only and head/liner exchanges decreased. Acetabular (OR 0.57, 95% CI 0.47-0.70) and head/liner exchange (OR 0.29, 95% CI 0.20-0.43) revisions decreased, while both component exchange (OR 1.45, 95% CI 1.25-1.67) and femoral revisions (OR 1.17, 95% CI 0.99-1.37) increased. Average LOS (-0.68 days; P < .001) and surgeon payments decreased (-$261.8; P < .001) while facility payments increased ($4,211; P < .001).

Conclusion: Indications for revision THA in this database study changed over time, with revision for dislocation decreasing and revision for loosening increasing over time. Both component and femoral revisions increased, and acetabular component and head/liner exchanges decreased. It is possible that these associations could be attributed to a number of details, the method of femoral fixation, surgical approach, and cementing, all of which require additional study.

Keywords: adult reconstruction; arthroplasty; components; indications; revision total hip arthroplasty.

MeSH terms

Acetabulum / surgery
Aged
Arthroplasty, Replacement, Hip* / methods
Female
Hip Prosthesis*
Humans
Male
Prosthesis Design
Prosthesis Failure
Reoperation / methods
Retrospective Studies