Deere, Kevin, Whitehouse, Michael R., Kunutsor, Setor K., Sayers, Adrian, Mason, James and Blom, Ashely W. (2022) How long do revised and multiply revised hip replacements last? A retrospective observational study of the National Joint Registry. The Lancet Rheumatology, 4 (7). E468-E479. doi:10.1016/S2665-9913(22)00097-2 ISSN 2665-9913.

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Abstract

Background
Hip replacements are common and effective operations but patients that undergo this intervention are at risk of the replacements failing, requiring costly and often complex revision surgery with poorer outcomes than primary surgery. There is paucity of reliable data examining the treatment pathway for hip replacements over the life of the patient in terms of risk of revision and re-revisions. We aim to provide detailed information on the longevity of hip revision surgery.

Methods
We did a retrospective observational registry-based study of the National Joint Registry, using data on hip replacements from all participating hospitals in England and Wales, UK. We included data on all first revisions, with an identifiable primary procedure, with osteoarthritis as the sole indication for the original primary procedure. Kaplan-Meier estimates were used to determine the cumulative probability of revision and subsequent re-revision after primary hip replacement. Analyses were stratified by age and gender, and the influence of time from first to second revision on the risk of further revision was explored.

Findings
Between April 1, 2003, and Dec 31, 2019, there were 29 010 revision hip replacements with a linked primary episode. Revision rates of revision hip replacements were higher in patients younger than 55 years than in older age groups. After revision of primary total hip replacement, 21·3% (95% CI 18·6–24·4) of first revisions were revised again within 15 years, 22·3% (20·3–24·4) of second revisions were revised again within 7 years, and 22·3% (18·3–27·0) of third revisions were revised again within 3 years. After revision of hip resurfacing, 23·7% (95% CI 19·6–28·5) of these revisions were revised again within 15 years, 21·0% (17·0–25·8) of second revisions were revised again within 7 years, and 19·3% (11·9–30·4) of third revisions were revised again within 3 years. A shorter time between revision episodes was associated with earlier subsequent revision.

Interpretation
Younger patients are at an increased risk of multiple revisions. Patients who undergo a revision have a steadily increasing risk of further revision the more procedures they undergo, and each subsequent revision lasts for approximately half the time of the previous one. Although hip replacements are effective for improving pain and function and usually last a remarkably long time, if they are revised, successive revisions are progressively and markedly less successful.

Item Type:	Journal Article
Subjects:	R Medicine > RD Surgery
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Total hip replacement -- Reoperation, Total hip replacement -- Surgery -- Complications
Journal or Publication Title:	The Lancet Rheumatology
Publisher:	Elsevier
ISSN:	2665-9913
Official Date:	1 July 2022
Dates:	Date Event 1 July 2022 Published 23 June 2022 Available 21 March 2022 Accepted
Volume:	4
Number:	7
Page Range:	E468-E479
DOI:	10.1016/S2665-9913(22)00097-2
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	13 April 2022
Date of first compliant Open Access:	1 July 2022
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED University Hospitals Bristol and Weston NHS Foundation Trust https://www.uhbw.nhs.uk/ UNSPECIFIED Healthcare Quality Improvement Partnership https://www.hqip.org.uk/ UNSPECIFIED National Joint Registry https://www.njrcentre.org.uk/ MR/L01226X/1 [MRC] Medical Research Council http://dx.doi.org/10.13039/501100000265
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