Abstract
Introduction
Complications can be defined as preventable, potentially preventable, or non-preventable. While often discussed, there are virtually no data whether or not the most common causes of revision total hip arthroplasty (THA) are preventable or not. The goal of this study was to identify and report preventable causes of revision THA within 5 years of the index THA.
Methods
We conducted a retrospective review of 128 consecutive revision THAs between August 2015 and August 2017, with 62% being referred from another institution. Mean time to revision THA from the index arthroplasty was 10 months. Mean age at revision THA was 61 years, with 67% being female. Three fellowship-trained adult reconstruction surgeons reviewed the radiographs and operative notes and classified the revision THAs into two categories: preventable vs. non-preventable. Reviewers were instructed to be extremely lenient with the benefit of the doubt given to the operative surgeon. Inter-observer reliability was assessed by Cohen's kappa analysis.
Results
A large proportion of revision THAs were considered preventable (60 cases; 47%). Of the 60 revision THAs considered preventable, the following were identified as the reasons: recurrent instability from component malpositioning (48%), intraoperative fracture (from inadequate exposure, incorrect stem choice, or a fracture missed on an intraoperative x-ray; 33%), early (<2 weeks) aseptic loosening of acetabular components placed without screws (7%), symptomatic leg length discrepancy of >1cm (7%), and femoral component subsidence due to stem under-sizing (5%). Inter-observer reliability was perfect among the three reviewers with a kappa of 1.00.
Conclusion: An alarmingly large proportion (47%) of revision THAs are preventable. Furthermore, surgeons are responsible for carefully evaluating causes for revision THAs in their practice and identifying new methods to address these issues. Emphasis should be placed on careful preoperative templating and accurate intraoperative execution.
Summary
An alarmingly large proportion (47%) of revision THA is potentially preventable. Surgeons are responsible for carefully evaluating causes for revision THA in their own practice.
