title: Contemporary Surgical Indications and Referral Trends in Revision Total Hip Arthroplasty: A 10-Year Review.
abstract: BACKGROUND
  Revision total hip arthroplasty (THA) represents nearly 15% of all hip arthroplasty procedures in the United States and is projected to increase. The purpose of our study was to summarize the contemporary indications for revision THA surgery at a tertiary referral medical center. We also sought to identify the indications for early and late revision surgery and define the prevalence of outside institution referral for revision THA.
  
  
  METHODS
  Using our institution's arthroplasty registry, we identified a retrospective cohort of 870 consecutive patients who underwent revision THA at our hospital from 2004 to 2014. Records were reviewed to collect data on patient's primary and revision THA procedures, and the interval between primary THA and revision surgery was determined.
  
  
  RESULTS
  Aseptic loosening (31.3%), osteolysis (21.8%), and instability (21.4%) were the overall most common indications for revision THA and the most common indications for revision surgery within 5 years of primary THA. Aseptic loosening and osteolysis were the most common indications for revision greater than 5 years from primary THA. Only 16.4% of revised hips had their index arthroplasty performed at our hospital, whereas 83.6% were referred to our institution.
  
  
  CONCLUSIONS
  Aseptic loosening, osteolysis, and instability remain the most common contemporary indications for revision THA in an era of alternative bearings and modular components. Most of our revisions were referred from outside institutions, which highlights the transfer of a large portion of the revision THA burden to tertiary referral centers, a pattern that could be exacerbated under future bundled payment models.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Haynes
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Stambough
authors.affiliation: Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington.
authors.forename: Adam A
authors.initials: AA
authors.lastname: Sassoon
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Staci R
authors.initials: SR
authors.lastname: Johnson
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: John C
authors.initials: JC
authors.lastname: Clohisy
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Nunley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000601:surgery*; D015995:Prevalence; D011475:Prosthesis Failure; D012017:Referral and Consultation / Q000639:trends*; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D055815:Young Adult
keywords: aseptic loosening; metallosis; osteolysis; revision hip arthroplasty; revision indications