Work

A decade of revisions: Can we reduce the re-revision rate?

Year: 2025

Type: article

Abstract: The global burden of revision and re-revision total hip arthroplasty (THA) is increasing. This study presents a detailed, single-centre analysis of revision and re-revision THA to identify specific risk factors for early failure and subsequent re-revision within our patient cohort. We analysed 427 revision THA procedures performed between 2010 and 2020 at a UK Major Trauma Centre. For prosthetic joint infection (PJI), a re-revision was included if it represented a distinct second revision, not merely the second stage of a two-stage revision. Postoperative imaging from the index revision in the re-revision group was assessed by a consensus of three independent reviewers for potentially correctible factors in surgical technique (PCFST) contributing to subsequent failure. Of 427 operations, 58 re-revision THAs were identified; 37 underwent re-revision less than two years from their index revision, a clinically significant timeframe. Common reasons for early re-revision were dislocation (19 patients), PJI (10 patients), aseptic loosening (6 patients), and periprosthetic fracture (2 patients). The median time from initial THA to index revision was 13.6 years for single revisions but only 7.4 years for re-revisions. Overall, 37 (8.6%) revisions required re-revision within 2 years. 10 (27%) PCFSTs were identified from index revision imaging in the early re-revision group. The mean time to re-revision in the PCFST group was 0.30 years, compared to 0.71 years for the rest of the early (<2 years) re-revision group (P = 0.074). Dislocation, PJI, and aseptic loosening remain significant challenges in revision THA. While aseptic loosening led to primary revision, dislocation was the main reason for re-revision, possibly due to extensile surgical approaches. Earlier failures were observed following revision arthroplasty when PCFSTs were identified on initial postoperative radiographs. Insights from this study suggest potential avenues for improvement, such as enhanced surgical precision through dual consultant operating or advanced navigation, and optimizing PJI management.

Source: Journal of Orthopaedic Reports

DOI: 10.1016/j.jorep.2025.100785

Authors: Tom Havenhand, Lauren Smith, Jennifer Barclay, George McLauchlan

Institution: Lancashire Teaching Hospitals NHS Foundation Trust

Language: English

Topic: Orthopaedic implants and arthroplasty

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $600