The Lawrence D. Dorr Surgical Techniques & Technologies Award: Why Are Contemporary Revision Total Hip Arthroplasties Failing? An Analysis of 2500 Cases

Background: As revision implants and techniques have evolved and improved, understanding why contemporary revision total hip arthroplasties (THAs) fail is important to direct further improvement and innovation. As such, the goals of this study are to determine the implant survivorship of contemporary revision THAs, as well as the most common indications for re-revision. Methods: We retrospectively reviewed 2589 aseptic revision THAs completed at our academic institution between 2005 and 2015 through our total joint registry. Thirty-nine percent were isolated acetabular revisions, 22% isolated femoral revisions, 18% both component revisions, and 21% head/liner component exchanges. Themean age at index revision THAwas 66 years, and 46% were male. The indications for the index revision THAwere aseptic loosening (21% acetabular, 15% femoral, 5% both components), polyethylene wear and osteolysis (18%), instability (13%), fracture (11%), and other (17%). Mean follow-up was 6 years. Results: There were 211 re-revision THAs during the study period. The overall survivorship free of any rerevision at 2, 5, and 10 years was 94%, 92%, and 88%, respectively. The most common reasons for rerevision were hip instability (52%), peri-prosthetic fracture (11%), femoral aseptic loosening (11%), acetabular aseptic loosening (9%), infection (6%), polyethylene wear (3%), and other (8%). Conclusion: Compared to historical series, the 88% survivorship free of any re-revision at 10 years in a revision cohort at a referral center is notably improved. As implant fixation has improved, aseptic loosening has become much less common after revision THA, and instability has come to account for more than half of re-revisions. (C) 2019 Elsevier Inc. All rights reserved.