Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.
Clin Orthop Relat Res. 2010 Aug;468(8):2046-51. doi: 10.1007/s11999-010-1251-6.
Revision total hip arthroplasty (THA), although relieving pain and restoring function, fails in some patients. In contrast to failures in primary THA, the frequency of the causes of failure in revision THA has been less well established.
QUESTIONS/PURPOSES: We therefore determined the rate of each failure mode and the survivorship of revision THAs.
We retrospectively reviewed the charts of 1366 revision THAs performed between 2000 and 2007. There were 609 (44.5%) men and 757 (55.5%) women with a mean age of 66 years. The indications for the revision surgery were mainly aseptic loosening (51%), instability (15%), wear (14%), and infection (8%). The minimum followup was 1 day (mean, 5.5 years; range, 1 day to 9 years).
Two hundred fifty-six of the revisions (18.7%) failed with an average time to failure of 16.6 months (range, 1 day to 7.5 years). Among 256 failed hips, infection was the most common cause of failure (30.2%) followed by instability (25.1%) and aseptic loosening (19.4%). At 5 years, the survivorships of septic and aseptic groups were 67% and 84.8%, respectively. Revision for infection or instability appears to have a considerably lower survivorship when compared to revision for aseptic causes.
The lower survivorship of revision for infection or instability highlights the importance of implementing better preventative methods that can minimize the impact of these two major causes of failure.
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
翻修全髋关节置换术（THA）虽然可以缓解疼痛和恢复功能，但在某些患者中会失败。与初次 THA 失败不同，翻修 THA 失败的原因频率尚未得到很好的确定。
问题/目的：因此，我们确定了每种失败模式的发生率和翻修 THA 的生存率。
我们回顾性地审查了 2000 年至 2007 年间进行的 1366 例翻修 THA 患者的病历。其中 609 例（44.5%）为男性，757 例（55.5%）为女性，平均年龄为 66 岁。翻修手术的指征主要为无菌性松动（51%）、不稳定（15%）、磨损（14%）和感染（8%）。最短随访时间为 1 天（平均 5.5 年；范围为 1 天至 9 年）。
256 例翻修术（18.7%）失败，平均失败时间为 16.6 个月（范围为 1 天至 7.5 年）。在 256 例失败的髋关节中，感染是最常见的失败原因（30.2%），其次是不稳定（25.1%）和无菌性松动（19.4%）。在 5 年时，感染组和无菌性组的生存率分别为 67%和 84.8%。与无菌性原因相比，感染或不稳定的翻修生存率明显较低。
感染或不稳定的翻修生存率较低，突出了实施更好的预防方法的重要性，这些方法可以最大限度地减少这两个主要失败原因的影响。
III 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
