Although some patients experience a success rate greater than 90% after total hip arthroplasty, others require revision surgery within 5 years after the index procedure. The purpose of our study was to analyze the failure mechanisms in patients who had revision surgery within 5 years after index total hip arthroplasty. We retrospectively reviewed 824 revision total hip arthroplasties performed in 692 patients from 1986-2001. Seven hundred forty-five patients had adequate data. Two hundred ninety-one (39%) patients had revisions within 5 years after index arthroplasty. Ninety-six (33%) patients had revision surgery for instability, 88 (30%) for aseptic loosening, 41 (14%) for infection, 14 (5%) for osteolysis, 44 (15%) for failed painful hemiarthroplasties, and eight (3%) for periprosthetic fractures. Early revisions for aseptic loosening decreased from 38% in the early period to 24% in the current period, whereas revisions for instability increased from 9% to 42%. We were alarmed that 39% of the revisions at our institution were performed during the first 5 years after index surgery. Although improved fixation methods decreased early revisions for loosening, early revisions for instability increased substantially during the same time. Steps to avoid short-term failure must be taken.
Level of Evidence: Therapeutic Study, Level III (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.
From *Tuckahoe Orthopaedic Associates, Ltd., Richmond, VA; and †Ortho-Carolina, Charlotte, NC.
Received: April 11, 2005 Revised: October 31, 2005 Accepted: December 16, 2005
The institution of one or more of the authors (TKF, SO) has received research funding from DePuy, J & J.
Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
Correspondence to: Thomas K. Fehring, MD, 1915 Randolph Road, Charlotte, NC 28207. Phone: 704-339-1391; Fax: 704-339-1444; E-mail: Thomas.Fehring@orthocarolina.com.