Failure mode of total hip replacement: a 21-year retrospective study of over 300 revision total hip replacements

Abstract

Introduction: In 1999, our department published data regarding the cause, complication, and survival of revision total hip replacement (THR). Since then, highly cross-linked polyethylene has been introduced, potentially changing the survival of THR. Therefore, we aimed to review our latest data in order to determine any change in the mode of failure of THR and survival after revision THR and to compare the latest results with our previous study. Methods: All revision THR surgeries at a tertiary teaching hospital from 1998 to 2018 were reviewed. Kaplan-Meier survival analysis was performed to predict the cumulative rate of success for revision THR. The results were compared to our previously published data collected from 1984 to 1997. Results: A total of 331 revision THR surgeries were performed on 277 patients. The average time interval between primary and revision was 13.2 years and the average follow-up after revision was 8.7 years. The commonest reason was mechanical loosening (41.7%) followed by articular bearing surface wear (39.0%), infection (10.0%), and periprosthetic fracture (3.9%). There were 92 (27%) cases of complication including dislocation (9.4%), infection (5.1%), and periprosthetic fractures (3.6%). There were 39 (11.8%) hips that underwent re-revision. The Kaplan-Meier survival analysis predicted cumulative survival of 95.2% at 5 years and 88.9% at 10 years. Conclusion: We demonstrated a significant increase in revision for polyethylene wear as mode of failure in late revisions, despite the introduction of highly cross-linked polyethylene which eliminates the issue of polyethylene wear.