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Open Access Highly Accessed Research article

Risk factors for revision of primary total hip arthroplasty: a systematic review

Julian JZ Prokopetz1, Elena Losina123, Robin L Bliss4, John Wright12, John A Baron5 and Jeffrey N Katz1267*

Author affiliations

1 Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

2 Harvard Medical School, Boston, MA, USA

3 Boston University School of Public Health, Boston, MA, USA

4 Veristat, Inc., Holliston, MA, USA

5 University of North Carolina, Chapel Hill, NC, USA

6 Harvard School of Public Health, Boston, MA, USA

7 Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, 75 Francis St. OBC-4, Boston, MA, 02115, USA

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Citation and License

BMC Musculoskeletal Disorders 2012, 13:251  doi:10.1186/1471-2474-13-251

Published: 15 December 2012

Abstract

Background

Numerous papers have been published examining risk factors for revision of primary total hip arthroplasty (THA), but there have been no comprehensive systematic literature reviews that summarize the most recent findings across a broad range of potential predictors.

Methods

We performed a PubMed search for papers published between January, 2000 and November, 2010 that provided data on risk factors for revision of primary THA. We collected data on revision for any reason, as well as on revision for aseptic loosening, infection, or dislocation. For each risk factor that was examined in at least three papers, we summarize the number and direction of statistically significant associations reported.

Results

Eighty-six papers were included in our review. Factors found to be associated with revision included younger age, greater comorbidity, a diagnosis of avascular necrosis (AVN) as compared to osteoarthritis (OA), low surgeon volume, and larger femoral head size. Male sex was associated with revision due to aseptic loosening and infection. Longer operating time was associated with revision due to infection. Smaller femoral head size was associated with revision due to dislocation.

Conclusions

This systematic review of literature published between 2000 and 2010 identified a range of demographic, clinical, surgical, implant, and provider variables associated with the risk of revision following primary THA. These findings can inform discussions between surgeons and patients relating to the risks and benefits of undergoing total hip arthroplasty.

Keywords:
Total hip arthroplasty; Revision; Failure; Risk factor; Aseptic loosening; Infection; Dislocation; Systematic review