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      Risk factors for revision of primary total hip arthroplasty: a systematic review

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          Abstract

          Background

          Numerous papers have been published examining risk factors for revision of primary total hip arthroplasty (THA), but there have been no comprehensive systematic literature reviews that summarize the most recent findings across a broad range of potential predictors.

          Methods

          We performed a PubMed search for papers published between January, 2000 and November, 2010 that provided data on risk factors for revision of primary THA. We collected data on revision for any reason, as well as on revision for aseptic loosening, infection, or dislocation. For each risk factor that was examined in at least three papers, we summarize the number and direction of statistically significant associations reported.

          Results

          Eighty-six papers were included in our review. Factors found to be associated with revision included younger age, greater comorbidity, a diagnosis of avascular necrosis (AVN) as compared to osteoarthritis (OA), low surgeon volume, and larger femoral head size. Male sex was associated with revision due to aseptic loosening and infection. Longer operating time was associated with revision due to infection. Smaller femoral head size was associated with revision due to dislocation.

          Conclusions

          This systematic review of literature published between 2000 and 2010 identified a range of demographic, clinical, surgical, implant, and provider variables associated with the risk of revision following primary THA. These findings can inform discussions between surgeons and patients relating to the risks and benefits of undergoing total hip arthroplasty.

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          Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review.

          H Kreder, Roni Wright, Richard Glazier … (2008)
          Total joint arthroplasty is a highly efficacious and cost-effective procedure for moderate to severe arthritis in the hip and knee. Although patient characteristics are considered to be important determinants of who receives total joint arthroplasty, no systematic review has addressed how they affect the outcomes of total joint arthroplasty. This study addresses how patient characteristics influence the outcomes of hip and knee arthroplasty in patients with osteoarthritis. We searched 4 bibliographic databases (MEDLINE 1980-2001, CINAHL 1982-2001, EMBASE 1980-2001, HealthStar 1998-1999) for studies involving more than 500 patients with osteoarthritis and 1 or more of the following outcomes after total joint arthroplasty: pain, physical function, postoperative complications (short-and long-term) and time to revision. Prognostic patient characteristics of interest included age, sex, race, body weight, socioeconomic status and work status. Sixty-four of 14,276 studies were eligible for inclusion and had extractable data. Younger age (variably defined) and male sex increased the risk of revision 3-fold to 5-fold for hip and knee arthroplasty. The influence of weight on the risk of revision was contradictory. Mortality was greatest in the oldest age group and among men. Function for older patients was worse after hip arthroplasty (particularly in women). Function after knee arthroplasty was worse for obese patients. Although further research is required, our findings suggest that, after total joint arthroplasty, younger age and male sex are associated with increased risk of revision, older age and male sex are associated with increased risk of mortality, older age is related to worse function (particularly among women), and age and sex do not influence the outcome of pain. Despite these findings, all subgroups derived benefit from total joint arthroplasty, suggesting that surgeons should not restrict access to these procedures based on patient characteristics. In addition, future research needs to provide standardized measures of outcomes.
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            Prosthetic joint infection risk after total hip arthroplasty in the Medicare population.

            Kevin Ong, Steven M. Kurtz, Edmund Lau … (2009)
            Periprosthetic joint infection is one of the most challenging complications of total joint arthroplasty. We evaluated the incidence of early-onset (less than 2 years) and late-onset (greater than 2 years) periprosthetic joint infection after primary total hip arthroplasty (THA). The Medicare 5% national sample data set (1997-2006) was used to longitudinally follow primary THA patients. Deep infections were identified with the International Classification of Diseases, Ninth Revision, Clinical Modification code 996.66. Kaplan-Meier survivorship curves were compiled with infection as the end point. Cox regression was used to evaluate patient and hospital characteristics. Eight hundred eighty-seven THA infections were identified from 39,929 THA patients. The incidence of infection was 1.63% within 2 years and 0.59% between 2 and 10 years. Comorbidities, sex, procedure duration, and socioeconomic status were found to be significant risk factors. This is the first study to establish the incidence and risk factors associated with early onset and delayed periprosthetic joint infection in the Medicare patient population.
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              Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register

              Nils Hailer, Göran Garellick, Johan Kärrholm (2010)
              Background and purpose Since the introduction of total hip arthroplasty (THA) in Sweden, both components have most commonly been cemented. A decade ago the frequency of uncemented fixation started to increase, and this change in practice has continued. We therefore analyzed implant survival of cemented and uncemented THA, and whether the modes of failure differ between the two methods of fixation. Patients and methods All patients registered in the Swedish Hip Arthroplasty Register between 1992 and 2007 who received either totally cemented or totally uncemented THA were identified (n = 170,413). Kaplan-Meier survival analysis with revision of any component, and for any reason, as the endpoints was performed. Cox regression models were used to calculate risk ratios (RRs) for revision for various reasons, adjusted for sex, age, and primary diagnosis. Results Revision-free 10-year survival of uncemented THA was lower than that of cemented THA (85% vs. 94%, p < 0.001). No age or diagnosis groups benefited from the use of uncemented fixation. Cox regression analysis confirmed that uncemented THA had a higher risk of revision for any reason (RR = 1.5, 95% CI: 1.4–1.6) and for aseptic loosening (RR = 1.5, CI: 1.3–1.6). Uncemented cup components had a higher risk of cup revision due to aseptic loosening (RR = 1.8, CI: 1.6–2.0), whereas uncemented stem components had a lower risk of stem revision due to aseptic loosening (RR = 0.4, CI: 0.3–0.5) when compared to cemented components. Uncemented stems were more frequently revised due to periprosthetic fracture during the first 2 postoperative years than cemented stems (RR = 8, CI: 5–14). The 5 most common uncemented cups had no increased risk of revision for any reason when compared with the 5 most commonly used cemented cups (RR = 0.9, CI: 0.6–1.1). There was no significant difference in the risk of revision due to infection between cemented and uncemented THA. Interpretation Survival of uncemented THA is inferior to that of cemented THA, and this appears to be mainly related to poorer performance of uncemented cups. Uncemented stems perform better than cemented stems; however, unrecognized intraoperative femoral fractures may be an important reason for early failure of uncemented stems. The risk of revision of the most common uncemented cup designs is similar to that of cemented cups, indicating that some of the problems with uncemented cup fixation may have been solved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMC Musculoskelet Disord
                Journal ID (iso-abbrev): BMC Musculoskelet Disord
                Title: BMC Musculoskeletal Disorders
                Publisher: BioMed Central
                ISSN (Electronic): 1471-2474
                Publication date Collection: 2012
                Publication date (Electronic): 15 December 2012
                Volume: 13
                Page: 251
                Affiliations
                [1 ]Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
                [2 ]Harvard Medical School, Boston, MA, USA
                [3 ]Boston University School of Public Health, Boston, MA, USA
                [4 ]Veristat, Inc., Holliston, MA, USA
                [5 ]University of North Carolina, Chapel Hill, NC, USA
                [6 ]Harvard School of Public Health, Boston, MA, USA
                [7 ]Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, 75 Francis St. OBC-4, Boston, MA, 02115, USA
                Article
                Publisher ID: 1471-2474-13-251
                DOI: 10.1186/1471-2474-13-251
                PMC ID: 3541060
                PubMed ID: 23241396
                SO-VID: 153dce15-619d-4ae6-b7cc-32f602dfb88e
                Copyright © Copyright ©2012 Prokopetz et al.; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 26 April 2012
                Date accepted : 5 December 2012
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Orthopedics
                Keywords: total hip arthroplasty,revision,failure,risk factor,aseptic loosening,infection,dislocation,systematic review
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: total hip arthroplasty, revision, failure, risk factor, aseptic loosening, infection, dislocation, systematic review

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