Primary total hip arthroplasty failure: aseptic loosening remains the most common cause of revision.

OBJECTIVE

Revision total hip arthroplasty (THA) imposes physical and financial burdens on patients and depletes limited medical resources. Causes for revision THAs can change as technology changes. Therefore, understanding contemporary causes is essential for clinical decision-making. We analyzed causes and trends associated with revision THA in the 2010s.

METHODS

We retrospectively identified 803 revision cases after primary THAs were performed at our center from January 2011 to December 2020. Causes for revision were reviewed and compared among patients who were grouped by the date of revision and interval between primary and revision THA.

RESULTS

The most common causes were aseptic loosening (66.6%), infection (11.0%), osteolysis (6.0%), periprosthetic fracture (5.5%), and instability (3.5%). The values for incidence of infection, fracture, and instability were higher in the early revision group than in the late revision group (threshold, 2 years after primary surgery, all P<0.05). The proportion of revision THAs increased by 25.6% from 2011-2015 to 2016-2020, and the time between primary and revision THAs increased from 8.8 ± 7.0 years to 10.2 ± 6.8 years (P=0.003). In the last 5 years of the study period, the incidence of aseptic loosening decreased and the rates of osteolysis, acetabular wear by hemiarthroplasty, and instability increased, compared to 2011-2015 (all P<0.05).

CONCLUSIONS

Aseptic loosening was the most common cause of revision THA. Revisions due to infection, fracture, and instability occurred more frequently during the early post-THA period after primary THA. Revisions due to osteolysis, instability, and acetabular wear have increased in recent years.