Total hip arthroplasty revision etiologies: a cross-sectional study in Isfahan, Iran

Mehdi Teimouri; Mehdi Motififard; Sahar Sadat Lalehzar; Saeed Hatami; Sina Raeisi

doi:10.4103/jrms.jrms_959_21

Total hip arthroplasty revision etiologies: a cross-sectional study in Isfahan, Iran

J Res Med Sci. 2022 Sep 27:27:70. doi: 10.4103/jrms.jrms_959_21. eCollection 2022.

Authors

Mehdi Teimouri¹, Mehdi Motififard¹, Sahar Sadat Lalehzar², Saeed Hatami², Sina Raeisi²

Affiliations

¹ Department of Orthopedic Surgery, School of Medicine, Isfahan, Iran.
² Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Background: Complications after primary total hip arthroplasty (THA) are the most common reason for revision. Due to the high prevalence of revision surgery, we investigated the frequency of postprimary THA complications and related risk factor revision surgery.

Materials and methods: This is a cohort study that was performed in 2011-2019 on all patients who underwent primary THA surgery re-admitted to the Kashani and Saadi Hospital affiliated to Isfahan University of Medical Science, Iran, due to some complications after THA. Demographic and basic data were collected from patient's medical documents. Harris hip score (HHS) was calculated for all patients 6 months after the last surgery. The obtained data were analyzed using SPSS software version 21. Appropriate statistical tests were conducted to compare the results between the study groups.

Results: Among 1260 patients who underwent primary THA, 1006 of them entered the study after applying the exclusion criteria. Thirty nine patients were under revision, 53.8% had prosthesis infection, 56.4% had instability, 6% had aseptic loosening, and 30.8% had periprosthetic fracture. Odds ratio for the above complications were 45.5, 45, 6.4, and 15.5, respectively. HHS postoperatively was also significantly (P < 0.001) higher in patients without revision. No correlation between gender or surgeon experience and revision was detected; however wound discharge (P < 0.001), body mass index (BMI) (P = 0.003), and Infection during hospitalization (P < 0.001) affect revision rate significantly. All four postsurgery complications, i.e., instability, postoperative prothesis infections, periprosthetic fractures, and aseptic loosening, significantly increased the risk of revision (P < 0.001, for all).

Conclusion: Instability, prosthetic infections, periprosthetic fractures, and aseptic loosening were the most common causes for increasing revision rates after THA, respectively. Higher BMI, persistent wound discharge, and nosocomial infections during the first hospitalization also increased the rate of revision after primary THA.

Keywords: Aseptic loosening; instability; periprosthetic fracture; revision; septic loosening; total hip arthroplasty.