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Article Abstract
Background And Purpose: Revision total hip arthroplasty (rTHA) is a complex procedure that may benefit from centralization. We examined the association between annual hospital volume of rTHA and re-revision risk and mortality.
Methods: We included all rTHAs between 2007 and 2022 in general hospitals, registered in the Dutch Arthroplasty Register (LROI; n = 12,515). Hospitals were categorized into low (< 25 rTHA/year) or high volume (≥ 25 rTHA/year). Competing-risk analyses and Cox proportional hazard regression analyses were performed to assess implant re-revision and Kaplan-Meier survival analysis for mortality. Results were stratified into septic (permanent Girdlestone, 1-stage, and 2-stage revisions) and aseptic first revisions.
Results: 1-stage septic revisions showed a higher risk of re-revision in high-volume hospitals (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.1-2.4). We found no difference in re-revision risk after DAIR (HR 1.1, CI 0.9-1.3). 2-stage septic revisions were more often performed in high-volume hospitals (5% vs 2%). There was no statistical difference in re-revision rates between hospitals after revision for aseptic loosening (HR 1.1, CI 0.9-1.4), dislocation (HR 1.1, CI 0.9-1.4), and periprosthetic fractures (HR 1.1, CI 0.8-1.5). Mortality showed no differences between groups, neither for septic nor aseptic revisions.
Conclusion: There was no difference between high-volume hospitals and low-volume hospitals regarding risk for re-revision after aseptic loosening, dislocation and periprosthetic fracture, and septic DAIR and mortality. In high-volume hospitals, 1-stage septic revisions was associated with a significantly higher re-revision risk. 2-stage revisions are more frequent in high-volume hospitals, indicating more complex pathology.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357176 | PMC |
| http://dx.doi.org/10.2340/17453674.2025.44331 | DOI Listing |
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