The burden of Revision Hip Arthroplasty is constantly rising due to an ever-increasing number of total hip arthroplasty (THA) procedures performed annually. The estimated increase in the number of THA is projected to be 71% by the year 20301 and the anticipated deluge of revision surgery for both, time related and unrelated, failures must prompt us to prepare for the challenge it will pose. The “Operation of the Century” can spell misery for the patient and healthcare providers when gone awry. Failures are inevitable in spite of remarkable improvements in the implant materials and designs as well as surgical techniques. Revision arthroplasty comes with inferior outcomes and a greater financial burden. The charges in revision arthroplasty have been reported to be 76.0% higher when compared with primary joint replacements.2 Higher implant costs, length of hospital stay and complication rates, as well as readmission to the hospital following revision surgery, are noted to contribute to the financial burden. However, in spite of higher infection rates and poorer outcomes, revision arthroplasty remains a safe procedure with acceptable complication rates though there is scope to reduce adverse outcomes and improve patient satisfaction.
This special issue was conceived with the several purposes viz. a) understanding the causes of revision THA better, in order to reduce the incidence of failure of total hip replacements as well as revision hip replacements, b) to perform better revision surgeries by addressing various challenges, reduce complications, and c) to improve the outcomes and patient satisfaction. This issue addresses the diagnosis of a failed THA,3 which allows a timely intervention depending on the cause. The most common causes of revision and re revision remain acetabular component loosening,4 instability, and Periprosthetic Joint Infection (PJI). Revision due to instability is a recurrent problem that leads to re-revision failure and no special issue on revision THA would be complete without addressing instability. Periprosthetic fractures result in significant morbidity and revisions for periprosthetic fracture have been shown to have worse outcomes and higher mortality than elective revision arthroplasty. Verma et al.5 provide tips for revising Vancouver B2 and B3 periprosthetic fractures around THA which are associated with the loose primary femoral prosthesis. Tandon et al.6 suggest that distal femoral arthroplasty may be a suitable alternative to osteosynthesis for periprosthetic fractures around Total Knee Arthroplasty among patients in the eighth decade of life.
The impact of systemic diseases such as Diabetes and Chronic kidney disease and outcomes in patients with solid organ transplant is important to realize in view of a burgeoning population of these subgroups of patients.7 Metal on Metal (MoM) articulations spelt doom for the patients and a large number out of over a million articulations implanted worldwide are still in situ. Chang and Haddad8 outline, in their work, the understanding of the aetiology, presentation and management strategies for these patients with an aim to optimize their clinical outcomes. Goderecci et al.9 have presented a reliable ultrasound-based diagnostic algorithm to detect clinically significant peri-prosthetic joint effusions and MoM THA failures.
We are optimistic that a better understanding of the indications and patient factors contributing to poor outcomes, evidence-based interventions to minimize the risk of failure of the primary and revision arthroplasty, early diagnosis, and improved surgical techniques will remain the key determinants to curb the tide.
References
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