Revision Total Hip Arthroplasty: Epidemiology and Causes

Failed hip arthroplasty constitutes a high economic burden, with a higher mortality and complication rate than primary total hip arthroplasty (THA). The widespread use of hip replacements in ever-increasing age groups and greater life expectancies contributes to maintaining a revision burden despite improved prostheses and techniques. Registries provide valuable epidemiological data regarding the risks of revision related to patient or implant characteristics. Patient’s age at the time of the prosthetic implantation and diagnosis defines THA survivorship. Male patients with high activity levels are at risk of requiring revision surgery. Improved highly cross-linked polyethylene (HXLPE) implants have a lower wear rate. Hence, this has reduced osteolysis and wear-related revisions, especially in younger patients. Aseptic loosening has become less common than in previous historical series, and other causes have come to account for more than half of the revisions. Dislocation and infection are now the current unsolved issues in THA. Reduced wear has allowed an increase in head size diameter in order to prevent dislocation, but registry data do not support this strategy. The use of dual mobility constructs has become more widespread, yet we need longer follow-up of these designs to analyze survivorship results. Longer life expectancies and the increasing use of uncemented fixation have increased the incidence of periprosthetic fractures. According to registry data, stem revision provides superior results to open reduction and internal fixation (ORIF). Infection is the most devastating complication, and the current standard of care is two-stage revision, though one-stage revision in selected cases may provide better results. Revision THA presents a higher failure rate than primary arthroplasty. Fixation techniques have been improved and aseptic loosening is less frequent. However, dislocation, infection, and periprosthetic fractures continue to compromise long-term survivorship.