[Perioperative complications after total hip revision surgery and their predictive factors. A series of 181 consecutive procedures].

PURPOSE OF THE STUDY

We conducted a retrospective study to assess morbidity and mortality in patients undergoing revision total hip arthroplasty (THA) procedures.

MATERIAL AND METHODS

Perioperative complications were recorded in 181 revision procedures (162 patients) performed between January 1995 and March 1999 (117 bipolar revisions and 64 acetabular isolated revisions).

RESULTS

There were 86 complications (68 patients) leading to 21 new revisions. About half (50/86) were related to the surgical procedure (dislocation, femoral fracture, infection.). Life-threatening complications (3.6%) ended in patient death in 1.6% of the cases. Complications were more frequent in patients with an ASA score=3 (p<0.01) or aged over 75 years (p<0.05). Age was also predictive of femoral misalignment and fracture (p<0.05). Dislocations (8.8%) were observed more frequently in patients who had undergone more than 2 procedures prior to the revision (p<0.05) (4.8% of the dislocations in patients undergoing a first revision procedure and 14.3% in the others). In addition, peroperative blood loss and duration of the procedure were significantly greater in case of bipolar replacement than for isolated acetabular replacement (sigma > 1.96).

DISCUSSION

Our experience and data in the literature point to the important age factor in the development of complications. Preservation of a well-fixed femoral component does not appear to worsen prognosis and leads to fewer complications than bipolar changes.

CONCLUSION

The decision to revise a THA must take into consideration the functional impairment but also the risks inherent in revision procedures, particularly in old patients who have undergone several procedures. Revising the acetabular component alone can be an interesting option if the femoral component remains well-fixed although our follow-up is insufficient to determine whether this attitude provides better long-term outcome than complete biopolar revision. Better patient selection and improved operative technique, in particular in femur preparation, should help reduce morbidity and mortality in this type of procedure.