Community Surgeons Effectively Manage Revision of Unstable Hip Replacement

While data from high-volume surgeons show the number of patients undergoing unstable total hip arthroplasty (THA) who return to stability after hip revision surgery has been inconsistent and unpredictable, the outcomes achieved by community-based surgeons remain unclear.

To measure those outcomes, a group of researchers from the Minneapolis-St Paul region used a community joint registry to determine the frequency of repeat revision after surgery to treat unstable THA. They also categorized the surgical approaches frequently used in the community and looked for differences in repeat revision frequency associated with each approach. Finally, they looked for patterns as surgical technique and implant options evolved over time.

For their study, the authors reviewed 6,801 primary THAs over a period of 20 years. According to the researchers, the 118 patients who required revision surgery for instability or dislocation had a mean age of 67 years. Minimum follow-up was 2 years and 6 patients had incomplete follow-up.

The initial re-revision procedure was successful in 108 patients (92%). Ten patients required an additional surgery when they experienced recurrent dislocation. Surgeons most often used revision of the head and liner only (30%), followed by constrained devices in 19% of procedures.

Cumulative re-revision rates for instability or dislocation were similar regardless of the revision procedure used, the authors found. Over the study period, the incidence of dislocation requiring surgical intervention significantly decreased after 2003. However, patients who underwent hip revisions before 2003 were no more likely to require a repeat revision than those who underwent surgery recently.

The researchers concluded that community-based surgeons successfully manage revision surgery for unstable THA by using a variety of surgical interventions. Nevertheless, they stressed the need to identify the reason for dislocation and address the source.