Re-revision and mortality rate following revision total hip arthroplasty for infection.

Aims: This study compares the re-revision rate and mortality following septic and aseptic revision hip arthroplasty (rTHA) in registry data, and compares the outcomes to previously reported data.
Methods: This is an observational cohort study using data from the German Arthroplasty Registry (EPRD). A total of 17,842 rTHAs were included, and the rates and cumulative incidence of hip re-revision and mortality following septic and aseptic rTHA were analyzed with seven-year follow-up. The Kaplan-Meier estimates were used to determine the re-revision rate and cumulative probability of mortality following rTHA.
Results: The re-revision rate within one year after septic rTHA was 30%, and after seven years was 34%. The cumulative mortality within the first year after septic rTHA was 14%, and within seven years was 40%. After multiple previous hip revisions, the re-revision rate rose to over 40% in septic rTHA. The first six months were identified as the most critical period for the re-revision for septic rTHA.
Conclusion: The risk re-revision and reinfection after septic rTHA was almost four times higher, as recorded in the ERPD, when compared to previous meta-analysis. We conclude that it is currently not possible to assume the data from single studies and meta-analysis reflects the outcomes in the 'real world'. Data presented in meta-analyses and from specialist single-centre studies do not reflect the generality of outcomes as recorded in the ERPD. The highest re-revision rates and mortality are seen in the first six months postoperatively. The optimization of perioperative care through the development of a network of high-volume specialist hospitals is likely to lead to improved outcomes for patients undergoing rTHA, especially if associated with infection.
Competing Interests: A. Steinbrück reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Johnson & Johnson and ImplantCast, unrelated to this study. C. Perka reports royalties or licenses from Zimmer, Smith & Nephew, and DePuy Synthes, and consulting fees and support for attending meetings and/or travel from Smith & Nephew, Zimmer, Link, and DePuy Synthes, all of which are unrelated to this study. C. Perka also holds leadership or fiduciary roles in DGOOC, International Hip Society, and Arbeitsgemeinschaft Endoprothetik.
(© 2024 The British Editorial Society of Bone & Joint Surgery.)