title: Early failure in total hip arthroplasty.
abstract: Although some patients experience a success rate greater than 90% after total hip arthroplasty, others require revision surgery within 5 years after the index procedure. The purpose of our study was to analyze the failure mechanisms in patients who had revision surgery within 5 years after index total hip arthroplasty. We retrospectively reviewed 824 revision total hip arthroplasties performed in 692 patients from 1986-2001. Seven hundred forty-five patients had adequate data. Two hundred ninety-one (39%) patients had revisions within 5 years after index arthroplasty. Ninety-six (33%) patients had revision surgery for instability, 88 (30%) for aseptic loosening, 41 (14%) for infection, 14 (5%) for osteolysis, 44 (15%) for failed painful hemiarthroplasties, and eight (3%) for periprosthetic fractures. Early revisions for aseptic loosening decreased from 38% in the early period to 24% in the current period, whereas revisions for instability increased from 9% to 42%. We were alarmed that 39% of the revisions at our institution were performed during the first 5 years after index surgery. Although improved fixation methods decreased early revisions for loosening, early revisions for instability increased substantially during the same time. Steps to avoid short-term failure must be taken.
authors.affiliation: Tuckahoe Orthopaedic Associates, Ltd., Richmond, VA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Dobzyniak
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Fehring
authors.forename: Susan
authors.initials: S
authors.lastname: Odum
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D015994:Incidence; D007593:Joint Instability / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013997:Time Factors