Risk Factors for Early Revision After Total Hip Arthroplasty

Authors

  • Christopher J. Dy,

    1. Hospital for Special Surgery, New York, New York
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  • Kevin J. Bozic,

    1. Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
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    • Dr. Bozic has received consultant fees, speaking fees, and/or honoraria (more than $10,000 each) from Integrated Healthcare Association, Pacific Business Group on Health, and Harvard Business School (visiting scholar), and holds board memberships with AAOS (Council on Research and Quality), AAHKS (Health Policy, EBPC), American Joint Replacement Registry (Board of Directors), COA (President), OREF (Board of Trustees), and UCSF Medical Center (HTAP).

  • Ting Jung Pan,

    1. Hospital for Special Surgery, New York, New York
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  • Timothy M. Wright,

    1. Hospital for Special Surgery, New York, New York
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  • Douglas E. Padgett,

    1. Hospital for Special Surgery, New York, New York
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    • Dr. Padgett has received consultant fees, speaking fees, and/or honoraria (more than $10,000 each) from Mako and Stryker, owns stock and/or holds stock options in Mako, receives royalties from the Mako Surgical Robotic Program, and conducted a paid consultation with investment analysts (Wells Fargo).

  • Stephen Lyman

    Corresponding author
    1. Hospital for Special Surgery, New York, New York
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Abstract

Objective

Revision total hip arthroplasty (THA) is associated with increased cost, morbidity, and technical challenge compared to primary THA. A better understanding of the risk factors for early revision is needed to inform strategies to optimize patient outcomes.

Methods

A total of 207,256 patients who underwent primary THA between 1997–2005 in California and New York were identified from statewide databases. Unique patient identifiers were used to identify early revision THA (<10 years from index procedure). Patient characteristics (demographics, comorbidities, insurance type, and preoperative diagnosis), community characteristics (education level, poverty, and population density), and hospital characteristics (annual THA volume, bed size, and teaching status) were evaluated using multivariable regression to determine risk factors for early revision.

Results

The probabilities of undergoing early aseptic revision and early septic revision were 4% and <1% at 5 years, respectively. Women were 29% less likely than men to undergo early septic revision (P < 0.001). Patients with Medicaid and Medicare were 91% and 24%, respectively, more likely to undergo early septic revision than privately insured patients (P = 0.01 and P < 0.001, respectively). Hospitals performing <200 THAs annually had a 34% increased risk of early aseptic revision compared to hospitals performing >400 THAs annually (P < 0.001).

Conclusion

A number of identifiable factors, including younger age, Medicaid, and low hospital volume, increase the risk of undergoing early revision THA. Patient-level characteristics distinctly affect the risk of revision within 10 years, particularly if due to infection. Our findings reinforce the need for continued investigation of the predictors of early failure following THA.

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