Factors Leading to Re-revision Surgery Following the Index Total Hip Arthroplasty Revision: Mid-Term Results

Abstract

Objective: The aim of this study was to evaluate the factors that led to re-revision surgeries in patients who underwent revision total hip arthroplasties (THA). Methods: A total of 352 revision THAs in 274 hips of 252 patients (January 2001-December 2012) were retrospectively analyzed. Patients with a history of a major component revision surgery, replacement of the modular components, debridement and irrigation with liner exchange in the presence of infection and a two-stage revision surgery were included in the study. The mean follow-up period after the revision surgery was 7.5 (range: 2 to 15) years. Results: A re-revision surgery was required in 17.6\% of the index THA revision patients (62 THA re-revisions/352 THA revisions). The mean time between the index revision and re-revision surgeries was 60.4 (range: 0.5 to 348) months. The most common reason for the second revision surgery was aseptic loosening (38 THA revisions61.2\%), followed by instability (8 THA revisions12.9\%) and infection (6 THA revisions9.1\%). When the re-revision surgery was taken as end point for assessing the survival rate after the index revision surgery, the cumulative survival rate 10 years after the first revision surgery was found 70.8\%. No significant relationship was established between age, gender and the type of fixation and the rate of repeat revisions. However, re-revision rates were significantly higher in acetabular-only component revision cases in comparison to other or both component revisions. Conclusion: In our revision series, the major factor that necessitated a re-revision following index revision surgery was aseptic loosening, followed by instability.