Risk Factors for Early Revision after Total Hip Arthroplasty
Christopher J. Dy, MD MPH,1,2 Kevin J. Bozic, MD MBA,3 Ting Jung Pan, MPH,2 Timothy M. Wright, PhD,1 Douglas E. Padgett, MD,1 and Stephen Lyman, PhD2Hip
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
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, preoperative diagnosis), community characteristics (education level, poverty, population density), and hospital characteristics (annual THA volume, bed size, 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 less than 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; p<0.001). Hospitals performing <200 THA annually had a 34% increased risk of early aseptic revision compared to hospitals performing >400 THA 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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