The CCJR® Charles A. Engh, Sr, MD. Excellence in Hip Research Award: The Evolution of Revision Hip Arthroplasty and Impact on the Trainee's Experience

Stefano R Muscatelli; Alexander V Strait; Henry Ho; John R Dunn; Robert H Hopper Jr; Kevin B Fricka; William G Hamilton

doi:10.1016/j.arth.2024.03.003

The CCJR® Charles A. Engh, Sr, MD. Excellence in Hip Research Award: The Evolution of Revision Hip Arthroplasty and Impact on the Trainee's Experience

J Arthroplasty. 2024 Mar 10:S0883-5403(24)00206-7. doi: 10.1016/j.arth.2024.03.003. Online ahead of print.

Authors

Stefano R Muscatelli¹, Alexander V Strait², Henry Ho², John R Dunn², Robert H Hopper Jr², Kevin B Fricka¹, William G Hamilton¹

Affiliations

¹ Anderson Orthopaedic Research Institute, Alexandria, Virginia; Inova Mount Vernon Joint Replacement Center, Alexandria, Virginia.
² Anderson Orthopaedic Research Institute, Alexandria, Virginia.

PMID: 38467203
DOI: 10.1016/j.arth.2024.03.003

Abstract

Background: Advances in total hip arthroplasty (THA) have resulted in evolving revision indications and intraoperative techniques, which can influence the exposure of trainees to complex cases. We report 3 decades of revision experience from a tertiary referral center that trains fellows, comparing the reasons for revision and the complexity of revisions over time.

Methods: We retrospectively reviewed all revision THAs performed at our institution from 1990 to 2022. Revision diagnoses, components revised, types of revision implants used, and exposure techniques were collected. A "complex" revision was defined as a case that involved an extended trochanteric osteotomy, triflange and cup-cage construct, or acetabular augment.

Results: A total of 3,556 THA revisions were identified (108 revisions/year). Aseptic loosening was the most common indication in 1990 to 1999 (45 per year), but decreased to 28.3/year in 2010 to 2019. From 1990 to 1999 and 2010 to 2019, fracture increased from 3.1 to 7.3 per year, infection from 2.9/year to 16.9/year, and metallosis from 0.1 to 13.2 per year. Both component revision were common from 1990 to 1994 (42.6 per year), while polyethylene exchange was most common in 2010 to 2019 (43.3 per year). A decrease was observed in "complex" cases over time: 14.8 extended trochanteric osteotomies/year in 2000 to 2004 compared to 5.4 per year in 2018 to 2022, 4.5 triflange and cup-cage constructs/year in 2004 to 2007 compared to 0.8 per year in 2018 to 2022, and 4 acetabular augments per year in 2009 to 2012 compared to 1 per year in 2018 to 2022.

Conclusions: Indications for revision have changed over the decades, while the number of "complex" revisions has gradually decreased, presumably due to advances in implants and materials. If this trend extends to other training institutions, the next generation of arthroplasty surgeons will have less exposure to complex revisions during their training.

Keywords: complex; education; hip; revision; trainee.