Abstract
Introduction
The epidemiology of re-revision total hip arthroplasty (THA) is not well understood. The purpose of this study is to investigate the epidemiology of re-revision THA, and identify risk factors that are associated with failure of re-revision THA.
Methods
A retrospective analysis was performed on 288 patients who underwent revision THA at a single institution between 1/2012 and 12/2013. Patients who underwent revision hip arthroplasty two or more times were included. Patients were excluded if their indication for their first revision was due to periprosthetic joint infection (PJI). Patient demographics, surgical indications, revision details, and available follow-up information were collected through the electronic medical record. Re-revision failure was defined as the need for any additional return to the operating room, regardless of indication. A logistic regression analysis was performed to assess for significant predictors of re-revision failure.
Results
A total of 51 re-revision patients were included in this study. Mean age at re-revision was 59.6 (±14.2 years). There were 32 (67%) females. Mean BMI was 28.8 (±5.4). Median ASA level was 2 (23; 55%). The median number of revisions was 3 (range 2–11). The most common indication for re-revision was acetabular component loosening (15; 29%), followed by PJI (13; 25%) and instability (9; 18%). Among re-revision patients, the most common indication of the first revision was acetabular component loosening (11; 27%), followed by polyethylene wear (8; 19%) and instability (8; 19%) (Figure 1). There was a significantly increased risk of re-revision failure if the re-revision procedure involved exchanging only the head and polyethylene liner (RR=1.792; p=0.017), if instability was the indication for the first revision (RR=3.000; p<0.001), as well as if instability was the indication for the re-revision (RR=1.867; p=0.038). If only the femoral component was exchanged during the re-revision, there was a decreased risk of failure (RR=0.268, p=0.046). 1-year re-revision survival was 54% (23/43).
Discussion
Acetabular component loosening and PJI were the most common indications for re-revision. There was an increased risk of re-revision failure if instability was a cause for reoperation at any point during the revision history, or if only an isolated head and polyethylene liner exchange was indicated during the re-revision procedure. There was a decreased risk of re-revision failure if only an isolated femoral stem revision was performed. A better understanding of the indications and patient factors that are associated with re-revision failures can help align surgeon and patient expectations in this challenging population.
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