Journal of clinical orthopaedics and trauma · 2026
Fifteen-year trends in revision total hip arthroplasty: Evolving aetiology, surgical complexity and the 'Double-Hit' effect of comorbidities.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Mukartihal Ravikumar, Anoop J, Udhayaprakash Saminathan, Vishnu R, Annapareddy Adarsh, Reddy Gurava, Patil Sharan S, Wilson Soujanya K
Аннотация
BACKGROUND: Revision total hip arthroplasty (rTHA) is increasing globally, driven by rising primary THA volumes and improved implant longevity. This study evaluates long-term trends in rTHA, focusing on shifts in etiology, surgical complexity, and the independent and combined impact of patient comorbidities on infection risk.
METHODS: We retrospectively analysed 252 rTHA cases performed across two tertiary centres between 2011 and 2025. We collected demographic details, revision indications, Paprosky bone defect classifications, and markers of surgical complexity. To identify evolving trends, we compared outcomes between two distinct periods: 2011-2017 and 2018-2025.
RESULTS: The most frequent indications for revision were aseptic loosening (31.0%), infection (20.6%), and instability (16.3%). Over the 15-year study period, cases of aseptic loosening declined significantly, while revisions for infection, instability, and periprosthetic fractures steadily increased. Consequently, the reliance on complex reconstructive techniques-such as extended trochanteric osteotomies, acetabular augments, and cup-cage constructs-rose significantly. Severe bone loss was most prevalent in patients undergoing revision for infection or staged reimplantation. Notably, patients with a "double-hit" comorbidity profile-diabetes mellitus combined with at least one other major comorbidity had a significantly higher risk of 38.7% (OR 3.9, 95% CI 2.1-7.4, p < 0.001).
CONCLUSIONS: The clinical landscape of rTHA is shifting away from aseptic loosening and toward early complications like infection and instability, a trend that is driving greater procedural complexity. Patients burdened with a combination of diabetes and systemic comorbidities face a compounded risk of infection. Preoperative optimisation and targeted resource allocation for these high-risk subgroups are essential to improving long-term outcomes.
LEVEL OF EVIDENCE: Retrospective cohort study of 252 cases; Level III evidence.
METHODS: We retrospectively analysed 252 rTHA cases performed across two tertiary centres between 2011 and 2025. We collected demographic details, revision indications, Paprosky bone defect classifications, and markers of surgical complexity. To identify evolving trends, we compared outcomes between two distinct periods: 2011-2017 and 2018-2025.
RESULTS: The most frequent indications for revision were aseptic loosening (31.0%), infection (20.6%), and instability (16.3%). Over the 15-year study period, cases of aseptic loosening declined significantly, while revisions for infection, instability, and periprosthetic fractures steadily increased. Consequently, the reliance on complex reconstructive techniques-such as extended trochanteric osteotomies, acetabular augments, and cup-cage constructs-rose significantly. Severe bone loss was most prevalent in patients undergoing revision for infection or staged reimplantation. Notably, patients with a "double-hit" comorbidity profile-diabetes mellitus combined with at least one other major comorbidity had a significantly higher risk of 38.7% (OR 3.9, 95% CI 2.1-7.4, p < 0.001).
CONCLUSIONS: The clinical landscape of rTHA is shifting away from aseptic loosening and toward early complications like infection and instability, a trend that is driving greater procedural complexity. Patients burdened with a combination of diabetes and systemic comorbidities face a compounded risk of infection. Preoperative optimisation and targeted resource allocation for these high-risk subgroups are essential to improving long-term outcomes.
LEVEL OF EVIDENCE: Retrospective cohort study of 252 cases; Level III evidence.