Aims. The aim of this study was to explore the relationship between reason for revision total hip arthroplasty (rTHA) and outcomes in terms of patient-reported outcome measures (PROMs). Methods. We reviewed a prospective cohort of 647 patients undergoing full or partial rTHA at a single high-volume centre with a minimum of two years’ follow-up. The reasons for revision were classified as: infection; aseptic loosening; dislocation; structural failure; and painful THA for other reasons. PROMs (modified Oxford Hip Score (mOHS), EuroQol five-dimension three-level health questionnaire (EQ-5D-3L) score, and visual analogue scales for pain during rest and activity), complication rates, and failure rates were compared among the groups. Results. The indication for revision influenced PROMs improvement over time. This finding mainly reflected preoperative differences between the groups, but diminished between the first and second postoperative years. Preoperatively, patients revised due to infection and aseptic loosening had a lower mOHS than patients with other indications for revision. Pain scores at baseline were highest in patients being revised for dislocation. Infection and aseptic loosening groups showed marked changes over time in both mOHS and EQ-5D-3L. Overall complications and re-revision rates were 35.4% and 9.7% respectively, with no differences between the groups (p = 0.351 and p = 0.470, respectively). Conclusion. Good outcomes were generally obtained regardless of the reason for revision, with patients having the poorest preoperative scores exhibiting the greatest improvement in PROMs. Furthermore, overall complication and reoperation rates were in line with previous reports and did not differ between different indications for rTHA. Cite this article: Bone Joint J 2022;104-B(7):859–866

We designed a study to evaluate whether (1) there were differences in PROMs between different reasons for revision THA at baseline, (2) there was a different interaction effect for revision THA for all PROMs, and (3) complication and re-revision rates differ between reason for revision THA. Prospective cohort of 647 patients undergoing rTHA, with a minimum of 2 years FU. The reason for revision were classified as infection, aseptic loosening, dislocation, structural failure and painful THA with uncommon causes. PROMs (EQ-5D score, Oxford hip score (OHS), VAS pain, complication and failure rates were compared between different groups. Patients with different reason for revision had improvement of PROMs’ over time. Preoperatively, patients revised due to infection and aseptic loosening had poorer OHS and EQ-5D than patients with other reason for revision. Pain scores at baseline were highest in patients revised due to dislocation. Infection and aseptic loosening groups also showed a significant interaction effect over time in both OHS and EQ-5D. No PROMs significant differences between groups were observed 2 years postoperatively. Overall complications, and re-revision rates were 35.4 and 9.7% respectively. The reason for revision THA did not associate with clinical outcomes. Good outcomes were reached regardless of the reason for revision, as patients with the poorest pre-operative scores had the best improvement in PROMs over time. Complication and re-operation rates were relatively high, in line with previous reports, but did not differ between different reasons for revision THA

Dislocation is still one of the more common reasons for revision of THR.Registry and large institutional data has demonstrated the effectiveness of Dual Mobility articulations in reducing revision for dislocation after THR. There is little data about whether the use of dual mobility is associated with a comprised clinical functional outcome. This study aimed to ascertain whether the use of Dual Mobility articulations (DM cups) comes within a compromise to the functional of the THR procedure as measured by the Hip disability and Osteoarthritis Outcome Score (HOOS). Utilising a retrospective design, patients were grouped into those with DM cups with 12 PROMs (Cohort 1) or a large data base of all THR procedures also with a complete set of 12 month PROMs (Cohort 2). The 2 groups were matched for age and gender through propensity score matching. The comparison focused on five domains of the HOOS: Pain, Symptoms, Activities of Daily Living (ADL), Sports and Recreation, and Quality of Life (QOL) at 6- and 12-months post-operation. 12 month PROM data suggested a convergence in scores for several domains, no uniform superiority of one articulation type over the other was found across all domains. These results suggest that both DM cup and standard articulations can effectively improve patient-reported outcomes in THR surgeries, but there are variations in recovery within each cohort that are potentially influenced by factors beyond the articulation type. This study contributes to the ongoing dialogue on optimising prosthetic selection to enhance recovery trajectories and quality of life for THR patients, emphasising the critical role of evidence-based decision-making in orthopaedic surgery

Advances in total hip and knee replacement technologies have heretofore been largely driven by corporate marketing hype with each seeming advancement accompanied by a cost increase often out in front of peer-reviewed reports documenting their efficacy or not. As example, consider the growing use of ceramic femoral heads in primary total hip arthroplasty (THA). The question to consider is “Can an upcharge of $350 for a ceramic femoral head in primary THA be justified?” The answer to this question lies in an appreciation of whether the technology modifies the potential for costly revision arthroplasty procedures. Peer-Reviewed Laboratory & Clinical Review - According to the 2022 Australian National Joint Replacement Registry, the four leading causes of primary THA failure requiring revision are: 1.) infection, 2.) dislocation/instability, 3.) periprosthetic fracture and 4.) loosening, which constitute 87.5% of the reported reasons for revision. Focusing on these failure modes, hip simulator findings report that ceramic femoral heads dramatically reduce wear debris generation, decreasing the potential for osteolytic response leading to loosening. Further, ceramic materials enable the utilization of larger head sizes, avoiding the potential for dislocation. The overall mid- to long-term survival rate reported in the peer-reviewed, clinical literature for these bearings has exceeded 95% with virtually no osteolysis. Also, could bearing surface choice influence periprosthetic joint infection (PJI)? A study on a total of more than 10,500 primary THA procedures reported a confirmed PJI incidence of 2.4% for cobalt-chrome and 1.6% for ceramic femoral heads, suggesting that the employ of a ceramic bearing surface may also play a role in decreasing the potential for infection. Review of the clinical data available for ceramic bearings justifies that it is better to “pay me now than to pay orders of magnitude later”, if in fact a revision THA can be avoided, significantly reducing the overall financial burden to the healthcare system

Pelvic discontinuity (PD) is a detrimental complication following total hip arthroplasty (THA). The aim of this study was to assess the clinical and radiological results of patients with PD who were revised using a custom-made triflange acetabular component (CTAC). This is a single centre prospective study of patients with PD following THA who were treated with a CTAC. The Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Oxford Hip Score (mOHS), EurQol five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at one- and two-year follow-up. Clinical and radiological complications, including reasons for revisions were registered. Trends over time are described and tested for significance and clinical relevance. 18 females with 22 CTACs were included with a mean age of 73.5 years (SD 7.7). There were significant improvements between baseline and final follow-up in HOOS (p<0.01), mOHS (p<0.01), EQ-5D-3L utility (p<0.01), EQ-5D-3L NRS (p<0.01), VAS pain rest (p<0.01), and VAS pain activity (p<0.01). A minimal clinically important improvement in mOHS and the HOOS was observed in 16 patients (73%) and 14 patients (64%), respectively. Definite healing of the PD was observed in 19 hips (86%). Complications included six cases with broken screws (27%), four cases (18%) with bony fractures, and one case (4.5%) with sciatic nerve paresthesia. One patient with concurrent bilateral PD had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage. This is the first prospective assessment in clinical outcome of patients with PD who were treated with a CTAC. We have demonstrated that CTAC in patients with THA acetabular loosening and PD can result in stable constructs with no mechanical failures. Moreover, clinically relevant improvements in health-related quality of life at two years’ follow-up was observed

For over a decade, modular titanium fluted tapered (TFT) stems have demonstrated excellent clinical success for femoral revision total hip arthroplasty (THA) surgery. The aim of this study was to report the short-term outcomes of a novel modern monoblock TFT stem used for revision and complex primary THA with a minimum of 2 years follow-up. We identified 126 patients who received a single monoblock TFT stem - 26 patients for complex THA (failed fracture fixation) and 100 patients for revision THA. The reasons for revision THA included 40 for previous prosthetic joint infection (PJI), 42 for aseptic loosening, 9 for trunnionosis, 9 for periprosthetic fractures. The Paprosky grading for femoral bone loss at the time of surgery and the measured subsidence of femoral stems at 3 months follow-up were determined. We evaluated the number and indications for re-operations. The mean time from surgery was 3.9 years (range 2.0 to 6.9 years). A paired t-test analysis showed significant improvement from pre-operative versus post-operative clinical outcome scores (p<0.001) for HHS (38.76 +/- 15.24vs. 83.42 +/- 15.38), WOMAC (45.6 ± 19.0 vs. 69.9 ± 21.3) and SF-12 Physical component (31.7 ± 8.1 vs. 37.8 ± 11.3) and SF-12 Mental component (48.2 ± 12.2 vs. 51.6 ± 12.5). The Paprosky grading for femoral bone loss was Grade 1 (3.9%), Grade 2 (35.7%), Grade 3A (47.6%), Grade 3B (11.1%) and Grade 4 (1.6%) cases. There were 18 re-operations (14.7%) with 13 for PJI (7 treated with implant retention, 6 treated with a two-staged revision), 4 for instability and one for acetabular aseptic loosening. There were no aseptic failures of the stem. This novel modern monoblock TFT stem provided reliable femoral fixation and has increasingly supplanted the use of modular TFT stems for complex primary and revision surgery in our institution

The incidence of hip fractures in the elderly is increasing. Minimally displaced and un-displaced hip fractures can be treated with either internal fixation or hemiarthroplasty. The aim was identifying the revision rate of internal fixation and hemiarthroplasty in patients 60 years or older with Garden I or II hip fractures and to identify risk factors associated with each method. A retrospective analysis was conducted from 2 Major Trauma Centres and 9 Trauma Units between 01/01/2015 and 31/12/2020. Patients managed conservatively, treated with a total hip replacement and missing data were excluded from the study. 1273 patients were included of which 26.2% (n=334) had cannulated hip fixation (CHF), 19.4% (n=247) had a dynamic hip screw (DHS) and 54.7% (n=692) had a hemiarthroplasty. 66 patients in total (5.2%) required revision surgery. The revision rates for CHF, DHS and hemiarthroplasty were 14.4%, 4%, 1.2% (p<0.001) respectively. Failed fixation was the most common reason for revision with the incidence increasing by 7-fold in the CHF group [45.8% (n=23) vs. 33.3% (n=3) in DHS; p<0.01]. The risk factors identified for CHF revision were age >80 (p<0.05), female gender (p<0.05) and smoking (p<0.05). The average length of hospital stay was decreased when using CHF compared to DHS and hemiarthroplasty (12.6 days vs 14.9 days vs 18.1 days respectively, p<0.001) and the 1 year mortality rate for CHF, DHS and hemiarthroplasty was 2.5%, 2% and 9% respectively. Fixation methods for Garden I and II hip fractures in elderly patients are associated with a higher revision rate than hemiarthroplasty. CHF has the highest revision rate at 14.4% followed by DHS and hemiarthroplasty. Female patients, patients over the age of 80 and patients with poor bone quality are considered high risk for fixation failure with CHF. When considering a fixation method in such patients, DHS is more robust than a screw construct, followed by hemiarthroplasty

In 1997 the Birmingham Hip Resurfacing was introduced to address the needs of young active patients. Alternative designs were introduced to try and improve wear performance. The aim of this study was a comparative cohort study of two types of metal-on-metal bearing to determine the mechanism of failure at 15 years. The study reviewed 91 Brimingham Hip Resurfacings (BHR) (Smith and Nephew) and 715 DUROM hip resurfacing (Zimmer) procedures in prior to 2009. Failure was defined as revision of either component for any reason. Kaplan-Meyer survivorship analysis performed. Routine follow-up with serum metal ion levels and radiographs. Mean follow-up was 17.9 years (range 15.2 – 25.1). The mean age at operation was 51.6 years (SD 8.6, range 20.7 to 70.2), including 299 women (37.1%). The Birmingham resurfacing demonstrated 92.3% survivorship at 15 years (SE 2.8, 95% CI 3.9 – 7.8) and 90.0% at latest follow-up (SE 3.5, 95% CI 4.9 to 9.4). By comparison, the DUROM survivorship at 15 years was 89.1% at 15 years (SE 1.2, 95% CI 2.0 to 2.5) and 87.4% (SE 1.3, 95% CI 2.5 to 2.3) at latest follow-up. There was no statistically significant difference in survivorship between groups (p= 0.32). Survival in male patients was 92.7% compared to 80.0% in females. The reported failures occurred from Adverse Reaction to Metal Debris (32 patients), periprosthetic femoral neck fracture (6) and aseptic loosening (41), PJI (12) and undiagnosed pain (6). The mean cobalt and chromium levels at last follow-up were 33.4 nmol/L and 36.5 nmol/L respectively. This study demonstrates two differently designed metal-on-metal hip resurfacing provided a durable alternative to total hip replacement, particularly in younger male patients with osteoarthritis. Differences in design did determine the reason for revision with acetabular fixation being one of the principal failure mechanisms for the DUROM compared to elevated ion levels

Introduction. The rise of the anterior approach (AA) in primary surgery has led to enthusiasm for using this approach in revision surgery, especially because head and liner exchanges have been accompanied by a high dislocation rate when the posterior approach (PA) is used. The aim of this study was to compare the institutional dislocation rate comparing the PA and AA in isolated head and liner exchange. Methods. A retrospective institutional database query was done to identify all aseptic head and liner exchanges between the years 2010- June, 2020. 186 hips were identified with an average age of 64.8+/−10.8 yrs (27.9–87.6) and average BMI of 28.7+/−6.3 kg/m2 (16.2–52). The reason for revision was polyethylene wear and osteolysis in 105 hips (56.5%), adverse tissue reaction to metal on metal (MOM) in 43 hips (23.1%), and recurrent instability in 38 hips (20.4%). The approach used for the revision surgery was PA in 128 hips (68.8%) and AA in 58 hips (31.2%). The mean follow-up for this cohort is 1.9±2 yrs (0.0–8.6). Results. The overall dislocation rate for the entire cohort was 28/186 (15%). There was no difference in the dislocation rate whether the revision surgery was performed by the PA 19/128 (15%) or the AA 9/58 (16%) (p=0.9). With the numbers available, there was no difference in dislocation rates when comparing reason for revision: poly wear/osteolysis 12/105 (11%), MOM 8/43 (19%) or recurrent instability 8/38 (21%) (p=0.28). The head size used in the exchange did not influence the dislocation rate; 28 mm-2/11 (18%), 32 mm-6/56 (11%), 36 mm-16/91 (18%), 40 mm-4/26 (15%) (p=0.89). Conclusion. The use of either the PA or AA did not alter the dislocation rate in our cohort. While there was a trend towards a higher dislocation rate when liner exchange was performed for MOM or recurrent instability, no statistical difference was shown with the numbers available. The head size used in the revision did not influence the rate of dislocation

Aims. Periprosthetic femoral fractures (PPF) are a serious complication of total hip arthroplasty (THA) and are becoming an increasingly common indication for revision arthroplasty with the ageing population. This study aimed to identify potential risk factors for PPF based on an analysis of registry data. Methods. Cases recorded with PPF as the primary indication for revision arthroplasty in the German Arthroplasty Registry (Endoprothesenregister Deutschland (EPRD)), as well as those classified as having a PPF according to the International Classification of Diseases (ICD) codes in patients’ insurance records were identified from the complete datasets of 249,639 registered primary hip arthroplasties in the EPRD and included in the analysis. Results. The incidence of PPFs was higher (24.6%; 1,483) than reported in EPRD annual reports listing PPF as the main reason for revision (10.9%; 654). The majority of fractures occurred intraoperatively and were directly related to the implantation process. Patients who were elderly, female, or had comorbidities were at higher risk of PPFs (p < 0.001). German hospitals with a surgical volume of < 300 primary procedures per year had a higher rate of PPFs (p < 0.001). The use of cemented and collared prostheses had a lower fracture risk PPF compared to uncemented and collarless components, respectively (both p < 0.001). Collared prostheses reduced the risk of PPF irrespective of the fixation method and hospital’s surgical volume. Conclusion. The high proportion of intraoperative fractures emphasises the need to improve surgeon training and surgical technique. Registry data should be interpreted with caution because of potential differences in coding standards between institutions. Cite this article: Bone Joint J 2021;103-B(4):650–658

Aims. Large-diameter metal-on-metal (MoM) total hip arthroplasty (THA) has demonstrated unexpected high failure rates and pseudotumour formation. The purpose of this prospective cohort study is to report ten-year results in order to establish revision rate, prevalence of pseudotumour formation, and relation with whole blood cobalt levels. Methods. All patients were recalled according to the guidelines of the Dutch Orthopaedic Association. They underwent clinical and radiographical assessments (radiograph and CT scan) of the hip prosthesis and whole blood cobalt ion measurements. Overall, 94 patients (95 hips) fulfilled our requirements for a minimum ten-year follow-up. Results. Mean follow-up was 10.9 years (10 to 12), with a cumulative survival rate of 82.4%. Reason for revision was predominantly pseudotumour formation (68%), apart from loosening, pain, infection, and osteolysis. The prevalence of pseudotumour formation around the prostheses was 41%, while our previous report of this cohort (with a mean follow-up of 3.6 years) revealed a 39% prevalence. The ten-year revision-free survival with pseudotumour was 66.7% and without pseudotumour 92.4% (p < 0.05). There was poor discriminatory ability for cobalt for pseudotumour formation. Conclusion. This prospective study reports a minimum ten-year follow-up of large-head MoM THA. Revision rates are high, with the main reason being the sequelae of pseudotumour formation, which were rarely observed after five years of implantation. Blood ion measurements show limited discriminatory capacity in diagnosing pseudotumour formation. Our results evidence that an early comprehensive follow-up strategy is essential for MoM THA to promptly identify and manage early complications and revise on time. After ten years follow-up, we do not recommend continuing routine CT scanning or whole cobalt blood measurements, but instead enrolling these patients in routine follow-up protocols for THA. Cite this article: Bone Jt Open 2022;3(1):61–67

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)

The increasing number of total hip arthroplasty (THA) used in young patients will inevitably lead to more revision procedures at younger ages, especially since the outcome of primary THA in young patients is already inferior compared to older patients. However, these data are lacking in literature. The aim of this study was to determine the survival of both acetabular and femoral components placed during primary and revision hip arthroplasty in patients under 55 years using Dutch Arthroplasty Register (LROI) data. All primary THA registered in the LROI between 2007–2018 in patients under 55 years were selected (n=25,682). Subsequent cup- and stem revision procedures were included. Kaplan-Meier survival analyses were used to estimate the survival probability of primary and revised cup- and stem components. Mean follow-up of primary cups and stems was 5.8 years (SD 3.2) and 5.9 years (SD 3.2), respectively. In total, 659 cup revision procedures and 532 stem revision procedures were registered. Most common reason for cup revision was acetabular loosening (n=163), most common reason for stem revision was femoral loosening (n=202). Primary cup survival for any reason at 10 years follow-up was 96.1% (95%CI: 95.7–96.4). For primary stems, 10 year survival for any reason was 97.1% (95%CI: 96.7–97.3). Mean follow-up of all revision procedures was 4.1 years (SD 2.9). Out of 659 cup revisions, 113 cup re-revisions were registered. Survival of revised cups, with end-point cup re-revision for any reason was 82.2% (95%CI: 78.8–85.1) at 5 years follow-up. Out of 532 stem revisions, 89 stem re-revisions were registered. For revised stems, survival at 5 year follow-up, with endpoint stem re-revision for any reason was 82.0% (95%CI: 78.2–85.2). The outcome of revised acetabular and femoral components is worrisome, with a survival of 82% at 5 years follow-up. This information is valuable to provide realistic expectations for these young patients at time of primary THA

Aims. The purpose of this study is to examine six types of bearing surfaces implanted at a single institution over three decades to determine whether the reasons for revision vary among the groups and how long it takes to identify differences in survival. Methods. We considered six cohorts that included a total of 1,707 primary hips done between 1982 and 2010. These included 223 conventional polyethylene sterilized with γ irradiation in air (CPE-GA), 114 conventional polyethylene sterilized with gas plasma (CPE-GP), 116 crosslinked polyethylene (XLPE), 1,083 metal-on-metal (MOM), 90 ceramic-on-ceramic (COC), and 81 surface arthroplasties (SAs). With the exception of the COC, all other groups used cobalt-chromium (CoCr) femoral heads. The mean follow-up was 10 (0.008 to 35) years. Descriptive statistics with revisions per 100 component years (re/100 yr) and survival analysis with revision for any reason as the endpoint were used to compare bearing surfaces. Results. XLPE liners demonstrated a lower cumulative incidence of revision at 15 years compared to the CPE-GA and CPE-GP groups owing to the absence of wear-related revisions (4% for XLPE vs 18%, p = 0.02, and 15%, p = 0.003, respectively). Revisions for adverse local tissue reactions occurred exclusively among the MOM (0.8 re/100 year) and SA groups (0.1 re/100 year). The revision rate for instability was lower among hips with 36 mm and larger head sizes compared to smaller head sizes (0.2% vs 2%, p < 0.001). Conclusion. The introduction of XLPE has eliminated wear-related revisions through 15-year follow-up compared to CPE-GP and CPE-GA. Dislocation incidence has been reduced with the introduction of larger diameter heads but remains a persistent concern. The potential for adverse local tissue reactions with MOM requires continued follow-up. Cite this article: Bone Joint J 2020;102-B(7 Supple B):105–111

Arthroplasty has consistently shown ‘beneficial and often dramatic improvements in quality of life'. In developed healthcare systems arthroplasty has evolved to minimised complications through evidence-based implant selection, rigorous infection control and high volume training. The Children's Surgical Centre has performed 256 THAs since 2007, We aim to assess the outcome of arthroplasty in a LMIC. Our primary outcome was all cause of re-operation and our secondary outcome was any complications not requiring return to theatre. A retrospective review of all consecutive THA since 2007 was conducted. Electronic and physical case notes were reviewed and basic demographics, indication for THA, risk factors for complications, implant combinations and complications were recorded. Statistical analysis was performed using MedCalc. A total of 256 THA were identified in 225 patients. The mean age was 43, with a M2:1F ratio. The most common pathologies were (1)AVN (44%), (2)OA (11%) and (3)DDH (11%). Revision rate was 13%. The mean time from implantation to revision was 2.8 years (0–9). The most common reasons for revision were (1)stem fracture (5.8%), (2)aseptic loosening (4.8%) and (3)infection (2.7%). Six different stems have been use over the time period. The best surviving were the Zimmer ML Taper and the UMA Muller stems. The UMA C-Stem was the worst performing which suffered 100% stem fracture. 109 complications were identified in 85 patients (33.2%). The three most common complications were (1)aseptic loosening (10.5%) (2)stem fracture (5.8%) and (3)dislocation (5.8%). Previous surgery (n=44) was found to be a significant risk for complications but not infection. OHS initially improved but began to decline after year 3. Patients present to CSC with neglected hip pathology, disability and significant pre-operative deformity. These patients benefit from THA and the initially high complication rates at CSC are declining suggesting the apex of the ‘learning curve' has passed. Cheap poorly manufactured implants continue to cause catastrophic failure

There is a paucity of mid-term data on modular dual-mobility (MDM) constructs versus large (≥40 mm) femoral heads (LFH) in revision total hip arthroplasties (THAs). The purpose of this study was to update our prior series at 10 years, with specific emphasis on survivorships free of re-revision for dislocation, any re-revision, and dislocation. We identified 300 revision THAs performed at a single tertiary care academic institution from 2011 to 2014. Aseptic loosening of the acetabular component (n=65), dislocation (n=59), and reimplantation as part of a two-stage exchange protocol (n=57) were the most common reasons for index revision. Dual-mobility constructs were used in 124 cases, and LFH were used in 176 cases. Mean age was 66 years, mean BMI was 31 kg/m. 2. , and 45% were female. Mean follow-up was 7 years. The 10-year survivorship free of re-revision for dislocation was 97% in the MDM cohort and 91% in the LFH cohort with a significantly increased risk of re-revision for dislocation in the LFH cohort (HR 5.2; p=0.03). The 10-year survivorship free of any re-revision was 90% in the MDM cohort and 84% in the LFH cohort with a significantly increased risk of any re-revision in the LFH cohort (HR 2.5; p=0.04). The 10-year survivorship free of any dislocation was 92% in the MDM cohort and 87% in the LFH cohort. There was a trend towards an increased risk of any dislocation in the LFH cohort (HR 2.3; p=0.06). In this head-to-head comparison, revision THAs using MDM constructs had a significantly lower risk of re-revision for dislocation compared to LFH at 10 years. In addition, there was a trend towards lower risk of any dislocation. Level of Evidence: IV

Aims. The aim of this study was to determine the outcome of all primary total hip arthroplasties (THAs) and their subsequent revision procedures in patients aged under 50 years performed at our institution. Methods. All 1,049 primary THAs which were undertaken in 860 patients aged under 50 years between 1988 and 2018 in our tertiary care institution were included. We used cemented implants in both primary and revision surgery. Impaction bone grafting was used in patients with acetabular or femoral bone defects. Kaplan-Meier analyses were used to determine the survival of primary and revision THA with the endpoint of revision for any reason, and of revision for aseptic loosening. Results. The mean age of the patients at the time of the initial THA was 38.6 years (SD 9.3). The mean follow-up of the THA was 8.7 years (2.0 to 31.5). The rate of survival for all primary THAs, acetabular components only, and femoral components only at 20 years’ follow-up with the endpoint of revision for any reason, was 66.7% (95% confidence interval (CI) 60.5 to 72.2), 69.1% (95% CI 63.0 to 74.4), and 83.2% (95% CI 78.1 to 87.3), respectively. A total of 138 revisions were performed. The mean age at the time of revision was 48.2 years (23 to 72). Survival of all subsequent revision procedures, revised acetabular, and revised femoral components at 15 years’ follow-up with the endpoint of revision for any reason was 70.3% (95% CI 56.1 to 80.7), 69.7% (95% CI 54.3 to 80.7), and 76.2% (95% CI 57.8 to 87.4), respectively. A Girdlestone excision arthroplasty was required in six of 860 patients (0.7%). Conclusion. The long-term outcome of cemented primary and subsequent revision THA is promising in these young patients. We showed that our philosophy of using impaction bone grafting in patients with acetabular and femoral defects is a very suitable option when treating young patients. Surgeons should realize that knowledge of the outcome of subsequent revision surgery, which is inevitable in young patients, must be communicated to this group of patients prior to their initial THA. Cite this article: Bone Joint J 2022;104-B(3):368–375

Aim. To assess the effect of different polyethylene modifications on Total Hip Replacement survival. Methods. We combined the NJR dataset with polyethylene manufacturing properties as supplied by the manufacturers. Cause specific and overall reasons for revisions were analysed using Kaplan-Meier and multi-variate Cox proportional hazard regression survival analyses. Revision for aseptic loosening was the primary endpoint. Modification variables included resin type, radiation source, multiple cross-linking treatments, cross-linking dose, terminal sterilisation method, terminal sterilisation radiation dose, stabilisation treatment, total radiation dose, and packaging. Results. A total of 292,920 primary THR cases were included with an associated 5,329 revisions. The variables found to significantly affect implant survival were the total radiation dose, liner face asymmetry, and stabilisation treatment. Total radiation dose was divided into four groups: G1 (no radiation); G2 (>0 Mrad and <5 Mrad); G3 (>5 Mrad and <10 Mrad), and G4 (>10 Mrad). The adjusted Cox Regression model with revision for aseptic loosening as the endpoint (G1 as reference) revealed a HR of 0.74 (0.64, 0.86) for G2, HR 0.36 (0.30, 0.43) for G3 and HR 0.38 (0.31, 0.47) for G4. In groups 3 and 4, stabilisation with vitamin E and heating above melting point performed best. Conclusion. Irradiation of polyethylene with 5MRad or more was associated with a marked reduction in the risk of revision for aseptic loosening. Irradiation with higher doses was not associated with a further reduction at 12 years of follow up

Aim. To assess the effect of the bearing surface and head size on the survival of total hip replacements with modern bearing surface combinations. Methods. We combined the NJR dataset with polyethylene manufacturing properties as supplied by the manufacturers to sub-divide polyethylene into conventional (PE) and highly crosslinked (XLPE). Cause specific and overall reasons for revisions were analysed using Kaplan-Meier and multi-variate Cox proportional hazard regression survival analyses. The bearing surface analysis was repeated in patients undergoing THR under the age of 55. Results. A total of 337,786 primary THR cases were included with an associated 5,618 revisions. Head size was grouped in <= 28mm (group A), 32mm (group B) and >=36mm (group C). A Cox regression model adjusted for age, gender, bearing combination and stem fixation was used to provide Hazard Ratios (HR). With Group C as reference, revision for all causes in Group A had a HR 1.07 (95%CI 0.99, 1.15) and in Group B HR 0.92 (0.86, 0.98). In patients <55y of age, with MoP as reference, Hazard Ratio for MoXLPE was 0.77 (0.59, 1.01), CoC 0.64 (0.52, 0.78), CoXLPE 0.61 (0.47, 0.78), CoP 0.50 (0.36, 0.70) and CMoXLPE 0.47 (0.30, 0.76). Conclusion. When combined with modern bearing combinations, the use of femoral heads of 36mm or larger was associated with a decreased cumulative incidence of revision for dislocation and an increased incidence of revision for aseptic loosening. In patients under the age of 55, CMoXLPE performed best at maximum follow up of 11 years

Introduction. Previous reports have investigated the correlation between time to revision hip arthroplasty (rTHA) and reason for revision, but little is known regarding the impact of timing on outcomes following rTHA. The purpose of this study is to evaluate the effect of time to rTHA on both indication and outcomes of rTHA. Methods. This retrospective observational study reviewed patients who underwent unilateral, aseptic rTHA at an academic orthopedic specialty hospital between January 2016 and April 2019 with at least 1-year of follow-up. Patients were early revisions if they were revised within 2 years of primary THA (pTHA) or late revisions if revised after greater than 2 years. Patient demographics, surgical factors, and post-operative outcomes were compared between the groups. Post-hoc power analysis was performed (1-β=0.991). Results. 188 cases were identified, with 61 hips undergoing early revision and 127 undergoing late revision. There were no differences in demographics and comorbidities between the groups. Type of revision differed between the groups, with early revisions having a greater proportion of femoral revisions (54.1% vs.20.5%) and late revisions having a greater proportion of both component (10.2% vs.6.6%), acetabular (30.7% vs.26.2%), or head/liner (38.6% vs. 13.1%;p< 0.001) revisions. Indication for index revision differed between the groups, with early revisions having a greater proportion for dislocation/instability (21.3% vs. 10.2%) and peri-prosthetic fracture (42.6% vs.9.4%), and late revisions having a greater proportion for loosening/osteolysis (40.9% vs.24.6%), metal-on-metal complications (11.0% vs.0.0%), and liner wear (18.9% vs.0.0%;p< 0.001). Early revisions experienced longer length of stay (LOS; 5.18±4.43 vs.3.43±2.76 days;p=0.005) and more often underwent reoperation (8.2% vs 1.6%;p=0.037). Conclusions. Early aseptic revisions had worse outcomes with longer LOS and higher rates of reoperation. These differences may be attributable to the type and indication for revision. Arthroplasty surgeons should be aware of these differences when counseling patients after THA