Time to Revision of Primary THA Is Shorter for Specialists Than Nonspecialists

We asked if there was a shorter time to revision, and different indications for revision, for primary total hip arthroplasties performed in the community by general orthopaedic surgeons (nonspecialists) as compared with primary total hip arthroplasties performed by specialists. We retrospectively reviewed 560 revision total hip arthroplasties performed in 486 patients from 1998 to 2006 at our tertiary referral center. One hundred ninety revisions from the community (nonspecialists cohort) and 109 revisions for which the primary arthroplasty was performed by the specialists (specialist cohort) at our center met the criteria for inclusion. These cohorts were analyzed by the time to revision and the indications for revision. Our findings were that the specialists had a shorter mean time to revision (8.3 years versus 10.1 years). This result may reflect a greater concern by specialists over the potential complications of osteolysis as reflected by the finding that the indication for surgery was more often aseptic loosening for the nonspecialists (57.9% versus 12.8%) and osteolysis for the specialists (61.5% versus 15.8%). As a result of possible selection bias in cases referred by the non-specialists, the indications for revision may not represent the modes of failure for arthroplasties performed by nonspecialists.

Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.