JOA - 2026-09-21 - Journal Article
Revision Indication Is Associated with Early Mortality After Revision Total Hip Arthroplasty: A Population-Based Study.
Restrepo DJ, Gonzalez-Bravo AE, Guarin Perez SF, Perry KI, Taunton MJ, Abdel MP, Hannon CP, Trousdale RT, Bedard NA, Sierra RJ
Topics
Key Takeaway
Revision THA for periprosthetic fracture and PJI carries 3–4× higher 90-day mortality versus aseptic loosening (HR 3.96 and 2.95, respectively), with 30-day SMRs of 3.67 and 3.18 compared to the general population.
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Summary
This single-institution retrospective cohort evaluated 30- and 90-day mortality across revision indications in 8,667 R-THAs using Kaplan-Meier and adjusted Cox regression with SMR comparison to US population norms. Overall 30- and 90-day mortality were 0.5% and 0.9%, but unadjusted 90-day mortality was 2.6% for periprosthetic fracture and 1.4% for PJI versus 0.4% for aseptic loosening. Extent of revision (single vs. both vs. modular component) was not independently associated with mortality, while revision indication was the dominant risk driver.
Key Limitation
Single-institution retrospective design precludes adjustment for unmeasured comorbidity burden and acuity differences inherent to each revision indication, which likely confound the indication-mortality association.
Original Abstract
BACKGROUND
Revision total hip arthroplasty (R-THA) is associated with increased complexity and potential for early postoperative complications, including mortality. This study evaluated 30- and 90-day mortality after R-THA.
METHODS
We identified 6,946 patients undergoing 8,667 R-THA at a single institution between 1997 and 2023. Their mean age was 66 years and had a mean body mass index (BMI) of 30, and 53% were women. Indications for R-THA included aseptic loosening (37%), periprosthetic joint infection (PJI) (15%), dislocation (14%), and periprosthetic fracture (PPFX) (11%). Revisions included single-component (49%), both-component (30%), and modular-component exchanges (21%). Mortality at 30 and 90 days was assessed using Kaplan-Meier analysis. Adjusted Cox models identified risk factors. The observed number of deaths was compared with the expected number of deaths using standardized mortality ratios (SMR).
RESULTS
The 30- and 90-day mortalities were 0.5% (n = 38) and 0.9% (n = 75), respectively. Unadjusted mortality rates at 90 days were 2.6% for PPfx, 1.4% for PJI, 0.9% for dislocation, and 0.4% for aseptic loosening. Compared with aseptic loosening, revision for PPFx and PJI had increased adjusted 30-day mortality (hazard ratio (HR) = 5.37 and 3.16) and 90-day mortality (HR = 3.96 and 2.95; all P < 0.01). Extent of revision was not associated with mortality (P > 0.05). Overall, compared with individuals in the general population, 30-day mortality among patients undergoing R-THA was higher (SMR = 1.77; P = 0.002), and this is primarily driven by a higher 30- and 90-day mortality seen in those undergoing revision for PPFx (30-day SMR = 3.67; 90-day SMR = 2.61) or PJI (30-day SMR = 3.18; 90-day SMR = 2.0 (all P < 0.001)).
CONCLUSION
Revision THA carries a low 30- and 90-day mortality risk that is not associated with the extent of revision, but is strongly impacted by the indication for revision. Patients revised for PPfx and PJI face a 3- and 4-fold higher risk of mortality within 90 days compared to aseptic loosening and demonstrate increased early mortality when compared with age- and sex-matched United States population expectations.