WHAT ARE WE DOING WRONG? REASONS FOR REVISION IN A CONSECUTIVE SINGLE SURGEON SERIES OF 176 CASES

Introduction: Revision hip arthroplasty places a significant burden on hospital resources. Huge pressure is being placed on the orthopaedic community to alter practices with respect to implant selection and bearing surfaces in order to try to reduce the likelihood of revision due to aseptic socket loosening. To date there is little clinical evidence to support these changes. Aim: To review the case mix requiring revision surgery at a specialist arthroplasty unit in order to identify the common reasons for failure of primary arthroplasties. Methods: A retrospective single surgeon review was performed to identify patients who had undergone revision hip surgery over the study period. The reasons for revision were identified for all cases. Particular attention was paid to the cases with aseptic socket loosening to determine the time to revision for these cases. Results: 176 revision procedures were performed between October 2001 and May 2005. In 74 (42%) cases aseptic socket loosening was identified (average socket survival 15.4 years). In 16 cases this was the sole cause for revision. In 58 cases the femoral component was also loose. 102 (58%) cases were performed for other reasons. Dislocation was the cause in 14%, femoral component loosening in 20%, infection in 18% and fracture in 6%. Aseptic loosening of cemented sockets less than 10 years old was only seen in 7 (4%) cases. Conclusions: Aseptic loosening of cemented sockets less than 10 years old was the least common cause of revision in this series. Cemented polyethylene acetabular components continue to provide a satisfactory bearing surface on the acetabular side of total hip arthroplasties. We recommend caution when interpreting the information provided with new products with respect to the benefits of different fixation and bearing surfaces for the majority of patients.