Abstract
Introduction
Historically, US arthroplasty revision rates are based on CMS data that cannot verify initial surgery date in patients under 65 years or laterality of revision. We calculated US one-year revision rates for primary total hip replacement (THR) using a representative cohort. Reasons for revision were documented.
Methods
A multi-center cohort from US surgeons in 28 states collected sociodemographic data; medical, emotional, musculoskeletal comorbidities; BMI; and patient-reported pain and function (SF36, HOOS) for elective THR patients. Cases in 2011–2013 were matched with CMS data to ascertain 1 year revision through 2014. Predictors of revision were identified. Chart reviews to verify reasons for revision were performed.
Results
Overall, 1.6% of 2926 primary THR surgeries were revised within 12 months. Mean age was 72 years, 59% female. No significant difference in pre-operative age, sex, BMI, pain, function, or emotional health was detected between revision and non-revision patients. Severe low back pain was twice as prevalent among revisions (23% vs. 11%; p<0.04) as was prior stroke (8.5% vs. 3%). Primary reasons for revision were infection (30%), mechanical failure including dislocation (26%), fracture (19%), metal ions (15%) and other (10%). In patients under 65 years of age, the distribution of reasons for revision are identical.
Conclusion
The incidence of revision THR in the US within 12 months of the index procedure is 1.6%. Infection and mechanical failure, including dislocation, are the most common causes of early revision, followed by peri-prosthetic fracture. Patients with severe pre-op lumbar spine pain are at higher risk for early revision after THR.
Abbreviations: total hip replacement (THR)
