What is the lifetime risk of revision for patients undergoing total hip arthroplasty? a 40-year observational study of patients treated with the Charnley cemented total hip arthroplasty.
OBJECTIVE
The purpose of this study was to determine the lifetime risk of revision surgery for patients undergoing Charnley cemented total hip arthroplasty (THA), with 40-year follow up, using death as a competing risk.


METHODS
We retrospectively reviewed 2000 cemented Charnley THAs, with 51 living hips available at 40 years.


RESULTS
The cumulative risk of revision or removal for any reason was 13% (95% confidence interval (CI) 12 to 15). Patients aged under 50 years at the time of surgery had a 35% (95% CI 28 to 42) risk of revision or removal for any reason (Hazard Ratio (HR) 3.6; 95% CI 2.5 to 5.2; p < 0.001), patients 50 to 59 years old had a 20% risk (95% CI 16 to 24) (HR 2.1; 95% CI 1.5 to 2.8; p < 0.0001), patients aged 60 to 69 years had a 9% risk (95% CI 7 to 11) (reference point), and patients ≥ 70 years old had a 5% risk (95% CI 4 to 7) (HR 0.96; 95% CI 0.6 to 1.5; p = 0.86) during their lifetime. Men had a higher risk of revision or removal for any reason (HR 2.1; 95% CI 1.7 to 2.7; p < 0.001).


CONCLUSIONS
With almost all the patients in this series followed up till either death or revision, we have been able to develop a 'rule of thumb' for lifetime likelihood of revision or implant removal for the Charnley THA: one in three for patients < 50 years, one in five for patients 50 to 59 years, one in ten for patients 60 to 69 years, and one in 20 for patients ≥ 70 years. The results provide a benchmark for comparison of outcomes, for the newer designs of THA. Cite this article: Bone Joint J 2016;98-B:1436-40.
Mayo Clinic, 200 First Street SW, Rochester, Minnesota, USA.
M P
MP
Abdel
Charité Universitätsmedizin Berlin, Department of Orthopedic Surgery, Charitéplatz, 110117 Berlin, Germany.
P von
PV
Roth
Mayo Clinic, 200 First Street SW, Rochester, Minnesota, USA.
W S
WS
Harmsen
Mayo Clinic, 200 First Street SW, Rochester, Minnesota, USA.
D J
DJ
Berry
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods*; D001843:Bone Cements; D002484:Cementation / Q000379:methods; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012737:Sex Factors
D001843:Bone Cements
Charnley; Follow-up report; Survivorship; Total hip arthroplasty