JOA - 2026-06-10 - Journal Article
First Revision Total Hip Arthroplasty for Instability: 10-Year Outcomes and Risk Factors Associated with Re-Revision.
Yapp LZ, Howard LC, Greidanus NV, Garbuz DS, Masri BA, Neufeld ME
Topics
Key Takeaway
First-time revision THA for instability yields 73.6% all-cause re-revision-free survival at 10 years, with constrained liners carrying a 2.7x higher hazard of instability-related re-revision compared to dual-mobility constructs.
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Summary
This study evaluated 10-year survivorship and failure risk factors in 284 consecutive first-time revision THAs performed for instability between 2000 and 2022. Kaplan-Meier analysis demonstrated 82.2% instability-free and 73.6% all-cause re-revision-free survival at 10 years. Constrained liners carried HR 2.7 for instability re-revision; younger age, elevated BMI, abductor deficiency, and constrained liner use predicted all-cause re-revision, while dual-mobility and large femoral heads (≥36 mm) showed equivalent instability-free survival (P=0.59).
Key Limitation
Surgeon-directed implant selection without randomization means constrained liners were likely implanted in the most biomechanically compromised hips, making the HR 2.7 for re-revision an association rather than a causal effect of the implant itself.
Original Abstract
BACKGROUND
Recurrent instability remains a leading cause of failure after revision total hip arthroplasty (rTHA). This study assessed the 10-year survivorship of the first rTHA when undertaken for instability and identified factors associated with failure.
METHODS
We retrospectively identified all consecutive rTHA performed for instability at our institution between 2000 and 2022. Of the 678 rTHA identified, 284 (41.9%) were the first rTHA and included in the study. Re-revisions and oncology cases were excluded. The mean age at revision was 65 years, and 63.2% were women. The mean follow-up was 11.4 years (range, two to 22). A total of 84 (29.6%) hips underwent at least one re-revision. Survival free from instability-related and all-cause re-revision at 10 years was calculated using Kaplan-Meier analysis. Multivariable Cox proportional hazard regression modeling was used to assess factors associated with 10-year survival.
RESULTS
The 10-year survivorship was 82.2% for instability and 73.6% for all-cause re-revision. Dual mobility (DM) components had higher 10-year instability-free survival than both standard bearings and constrained liners (P = 0.04). However, when considering 'large' (≥ 36 mm) femoral heads, there was no difference in the revision rate when compared to DM components (P = 0.59). Constrained liners were associated with a higher risk of revision for instability (HR [hazard ratio] 2.7, 95% CI [confidence interval] 1.05 to 6.8, P = 0.01). Younger age at surgery (P = 0.002), elevated body mass index (BMI) (P = 0.01), abductor deficiency (P = 0.03), and using a constrained liner (P = 0.04) were significantly associated with all-cause re-revision.
CONCLUSIONS
In patients undergoing first-time rTHA for instability, nearly 20% will have recurrent instability, and 30% will undergo further revision within 10 years. The DM and large femoral heads demonstrate 10-year survivorship. Several patient and implant-related factors are associated with instability-specific and all-cause re-revision.