What Is the #1 Cause For Revision THA?

Need current information on revision total hip arthroplasty (THA) that includes the period when conventional polyethylene and large head metal-on-metal (MoM) were all the rage? Look no further than a new study from Anne Arundel Medical Center/Luminus Health in Annapolis, Maryland.

Researchers, led by Justin Turcotte, Ph.D., M.B.A., conducted a retrospective chart review on 535 revisions performed on 444 THAs from January 2010 to May 2019 at Anne Arundel. Their study, “Reasons for Revision: Primary Total Hip Arthroplasty Mechanisms of Failure,” appears in the January 15, 2021 edition of the Journal of the American Academy of Orthopaedic Surgeons.

Dr. Turcotte, Director, Orthopedic and Surgery Research at Anne Arundel Medical Center/Luminis Health, told OTW, “We were noticing that our indications for late revisions appeared to be evolving over time compared to previously published reports following the large number of metal-on-metal hip replacements done in the 2000s.”

The researchers found that the average time to revision THA was 8.51 ± 8.38 years (30.9% of cases occurred within two years after the primary THA). As for the failure mechanisms leading to revision, 36.5% experienced mechanical failure, 21.4% experienced metallosis, 14.6% had dislocation or instability, 10.4% had a periprosthetic fracture, 9.9% had an infection, 3.4% had a hematoma or poor wound healing, and3.8% had pain or “other.”

Showing MoM the Door

“We found that over the past decade at our institution, late revisions were most commonly performed for mechanical failure, with many of these being related to failed metal-on-metal articulations. Early revisions performed less than two years after the index surgery were more likely to be related to infection or periprosthetic fracture.”

“The indications for hip revisions are likely to evolve over time and need to be re-evaluated every few years. As metal-on-metal articulations become much less commonly used, the burden of revision surgery for this indication will decline. With improvements in polyethylene, revisions related to polyethylene wear and related osteolysis may become less common. The emerging understanding of adverse reactions to metal debris that may be generated from the trunnion in metal on polyethylene hip replacements may become more of a significant factor in indications for late revisions moving forward.”