Early, Mid-Term, and Late-Term Aseptic Femoral Revisions After THA: Comparing Causes, Complications, and Resource Utilization.
BACKGROUND
Registry data suggest increasing rates of early revisions after total hip arthroplasty (THA). We sought to analyze modes of failure over time after index THA to identify risk factors for early revision.


METHODS
We identified 208 aseptic femoral revision THAs performed between February 2011 and July 2019 using an institutional database. We compared demographics, diagnoses, complications, and resource utilization between aseptic femoral revision THA occurring within 90 days (early), 91 days to 2 years (mid), and greater than 2 years (late) after index arthroplasty.


RESULTS
Early revisions were 33% of revisions at our institution in the time period analyzed. Periprosthetic fractures were 81% of early, 27% of mid, and 21% of late femoral revisions (P < .01). Women were more likely to have early revisions than men (75% vs 53% of mid and 48% of late revisions; P < .01). Patients who had early revisions were older (67.97 ± 10.06) at the time of primary surgery than those who had mid and late revisions (64.41 ± 12.10 and 57.63 ± 12.52, respectively, P < .01). Index implants were uncemented in 99% of early, 96% of mid, and 64% of late revisions (P < .01). Early revisions had longer postoperative length of stay (4.4 ± 3.3) than mid and late revisions (3.0 ± 2.2 and 3.7 ± 2.1, respectively, P = .02). In addition, 58% of early revisions were discharged to an inpatient facility compared with 36% of mid and 41% of late revisions (P = .03).


CONCLUSION
Early aseptic femoral revisions largely occur in older women with uncemented primary implants and primarily due to periprosthetic fractures. Reducing the incidence of periprosthetic fractures is critical to decreasing the large health care utilization of early revisions.
['Schwarz|Julia S|JS|', 'Lygrisse|Katherine A|KA|', 'Roof|Mackenzie A|MA|', 'Long|William J|WJ|', 'Schwarzkopf|Ran M|RM|', 'Hepinstall|Matthew S|MS|']
D000368:Aged D019644:Arthroplasty, Replacement, Hip D005260:Female D005269:Femur D006622:Hip Prosthesis D006801:Humans D008297:Male D011474:Prosthesis Design D011475:Prosthesis Failure D012086:Reoperation D012189:Retrospective Studies D012307:Risk Factors
revision total hip arthroplasty periprosthetic fracture length of stay health care utilization