ICJR Interviews: Implications of Data on Revision THA

    A number of interesting details have emerged from a review of records of 870 patients who underwent revision total hip arthroplasty (THA) betweem 2004 and 2014 at Washington University in St. Louis, Missouri:

    • 84% of patients were referrals from other institutions
    • 75% of patients were having their first revision; 25% were having their second revision
    • 20% of patients were less than 50 years old

    Aseptic loosening, osteolysis, and instability were the top 3 reasons for revision THA

    Adam Sassoon, MD, said these data could have far-reaching implications for the future of joint replacement.

    Take the data point on referrals, for example. Dr. Sassoon noted that if surgeons across the country are referring patients for revisions to their local tertiary care centers at the same rate, then tertiary care centers could soon be inundated with the most complex hip cases.

    How that plays out under bundle payment models remains to be seen, he said, but it could put serious pressure on the finances of tertiary care centers like Washington University. Could it even limit patient access to care?

    Dr. Sassoon also delved deeper into the data on the reasons for revision procedures. One of the goals of the study was to determine if the indications for revision surgery changed during the 10-year study period as the patient population and the implants used evolved.

    Dr. Sassoon and his colleagues found that the answer was yes: Although aseptic loosening was an issue throughout the study period, osteolysis and instability were not.

    Osteolysis emerged as an indication later – about 10 years after the index procedure – while instability were more likely to occur 2 to 5 years after the procedure.

    Infection was also more common within the first 2 years of the index procedure, Dr. Sassoon said, but not as common after 5 years.

    One revision indication that was small in this study – only 4% of revisions – but that could become a bigger issue in the future is metallosis. The reason: The 4% of revisions for metallosis represents a 400% increase in these revisions at Washington University compared with data prior to 2004. It seems the longer patients have metal-on-metal implants, the greater the risk for revisions, Dr. Sassoon said.

    Click on the image above to hear Dr. Sassoon share more insights on the findings of the study, “Current Indications for Revision Hip Arthroplasty: A Ten-Year Retrospective Review” (Paper 813), which was presented at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons in Orlando.

    Producer: Henrik B. Pedersen, MD; Director: Michael Bugera; Post Production: Charles J. Maynard