INDICATIONS FOR REVISION THR IN NORTHERN IRELAND

Abstract

Introduction: Revision Hip Surgery presents an increasing Orthopaedic Burden. Indications for revision include recurrent hip dislocation, infection, peri-prosthetic fracture, failure of implants, including aseptic loosening, osteolysis, wear or mechanical failure of components.

Within the region of Northern Ireland, we have investigated the indications for revision hip procedures, carried out from April 2006 to March 2007. We wanted to establish if the indications of revision surgery are comparable to other national registers.

Methods: An audit of all hospitals, which carry out hip revision surgery, was carried out, to identify patients who have undergone revision total hip surgery. The indications for revision procedures were identified, from hospital databases, patient records and examination of pre-operative X-rays. Revision procedures included replacement of one or both components, application of Posterior Lip Augmentation Devices and cable plating or component revision for peri-prosthetic fractures.

Results: 180 patients, who had undergone revision, were identified in six hospitals. 56 were female and 124 were male. Revisions were performed for a peri-prosthetic fracture in 38 (21%), infection in 12 (7%), recurrent dislocation in 23(13%) and failure of implants in 105 (58%). In 2 patients (1%) revision was performed after the development of avascular necrosis following resurfacing hip replacement.

Discussion: The largest body of information on revision hip surgery is the Swedish registry. Their incidence for revision hip surgery is 7%. Their indications were: aseptic loosening 71%, Infection 7.5%, Fracture as 5.6% and dislocation as 4.8%. Our data indicate a greater prevalence of revision for recurrent dislocation and peri-prosthetic fractures than the Swedish data. Further work should aim to identify any remediable surgical factors which account for these differences.