Revision Total Hip Arthroplasty: Complications and Results

  • Eduardo García-Rey
  • Ana Cruz-Pardos
  • Ricardo Fernández-Fernández


Revision total hip arthroplasty (THA) is challenging. The clinical importance of this procedure has been increasing worldwide over the last years. Complex techniques are usually needed during surgery and require the best knowledge and skills in order to improve the clinical outcomes with the minimal rate of complications. The patients’ increasing age, associated medical comorbidities, and orthopedic problems, such as bone defect and fibrous tissue due to previous surgeries, add more difficulties to management. Despite the encouraging better understanding of this pathology, the overall result is often worse than in primary THA. Indications for revision THA are still changing, and some complications such as dislocation, periprosthetic fracture, or infection continue to be a great problem. This chapter tries to summarize most of the important issues related to the more frequent complications and their results in revision THA. In order to prevent these difficulties, the appropriate clinical evaluation of a painful THA is mandatory before undertaking the procedure: the possibility of infection, soft tissue status, as well as any bone defect in the acetabulum or femur must be considered, not only before surgery but also their situation after removing any previous implants.


Revision total hip arthroplasty Complications Dislocation Periprosthetic fracture Infection 


  1. 1.
    Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg. 2007;89:780.PubMedGoogle Scholar
  2. 2.
    Patel A, Pavlou G, Mújica-Mota RE, Toms AD. The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset. Bone Joint J. 2015;97-B:1076–81.CrossRefGoogle Scholar
  3. 3.
    Lavernia CJ, Drakeford MK, Tsao AK, Gittelsohn A, Krackow KA, Hungerford DS. Revision and primary hip and knee arthroplasty. A cost analysis. Clin Orthop Relat Res. 1995;311:136–41.Google Scholar
  4. 4.
    Crowe JF, Sculco TP, Kahn B. Revision total hip arthroplasty: hospital cost and reimbursement analysis. Clin Orthop Relat Res. 2003;413:175–82.CrossRefGoogle Scholar
  5. 5.
    Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg. 2009;91:128.CrossRefGoogle Scholar
  6. 6.
    Jafari SM, Coyle C, Mortazavi SM, Sharkey PF, Parvizi J. Revision hip arthroplasty: infection is the most common cause of failure. Clin Orthop Relat Res. 2010;468:2046–51.CrossRefGoogle Scholar
  7. 7.
    Wetters NG, Murray TG, Moric M, Sporer SM, Paprosky WG, Della Valle CJ. Risk factors for dislocation after revision total hip arthroplasty. Clin Orthop Relat Res. 2013;471:410–6.CrossRefGoogle Scholar
  8. 8.
    Swedish Hip Arthroplasty Register. Annual report. Gothenburg: Svenska Höftprotesregistret; 2014. Scholar
  9. 9.
    NJR. 15th Annual report. Hemel Hempstead: NJR; 2018. Scholar
  10. 10.
    Australian Orthopaedic Association National Joint Replacement Registry. Annual reports. Adelaide, SA: AOANJRR; 2016. Scholar
  11. 11.
    Padilla-Eguiluz NG, García-Rey E, Cordero-Ampuero J, Gómez-Barrena E. Regional variability in the rates of total hip replacement in Spain. Hip Int. 2014;24:81–90.CrossRefGoogle Scholar
  12. 12.
    Badarudeen S, Shu AC, Ong KL, Baykal D, Lau E, Malkani AL. Complications after revision total hip arthroplasty in the Medicare population. J Arthroplasty. 2017;32:1954–8.CrossRefGoogle Scholar
  13. 13.
    García-Rey E, García-Cimbrelo E. Abductor biomechanics clinically impact the total hip arthroplasty dislocation rate: a prospective long-term study. J Arthroplasty. 2016;31:484–90.CrossRefGoogle Scholar
  14. 14.
    Jo S, Jimenez Almonte JH, Sierra RJ. The Cumulative risk of re-dislocation after revision THA performed for instability increases close to 35% at 15 years. J Arthroplasty. 2015;30:1177–82.CrossRefGoogle Scholar
  15. 15.
    Hamadouche M, Biau DJ, Huten D, Musset T, Gaucher F. The use of a cemented dual mobility socket to treat recurrent dislocation. Clin Orthop Relat Res. 2010;468:3248–54.CrossRefGoogle Scholar
  16. 16.
    Garcia-Cimbrelo E, Garcia-Rey E, Cruz-Pardos A. The extent of the bone defect affects the outcome of femoral reconstruction in revision surgery with impacted bone grafting: a five- to 17-year follow-up study. J Bone Joint Surg Br. 2011;93:1457–6.CrossRefGoogle Scholar
  17. 17.
    Abdel MP, Houdek MT, Watts CD, Lewallen DG, Berry DJ. Epidemiology of periprosthetic femoral fractures in 5417 revision total hip arthroplasties: a 40-year experience. Bone Joint J. 2016;98-B:468–74.CrossRefGoogle Scholar
  18. 18.
    Paprosky WG, Sporer SM. Controlled femoral fracture: easy in. J Arthroplasty. 2003;18(3 Suppl 1):91–3.CrossRefGoogle Scholar
  19. 19.
    García-Rey E, Cruz-Pardos A, Madero R. The evolution of the technique of impaction bone grafting in femoral revision surgery has improved clinical outcome. A prospective mid-term study. J Arthroplasty. 2015;30:95–100.CrossRefGoogle Scholar
  20. 20.
    Tsiridis E, Krikler S, Giannoudis PV. Periprosthetic femoral fractures: current aspects of management. Injury. 2007;38:649–50.CrossRefGoogle Scholar
  21. 21.
    Lindahl H, Malchau H, Odén A, Garellick G. Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg Br. 2006;88:26–30.CrossRefGoogle Scholar
  22. 22.
    Randelli F, Pace F, Priano D, Giai Via A, Randelli P. Re-fractures after periprosthetic femoral fracture: a difficult to treat growing evidence. Injury. 2018;49(Suppl 3):S43–7.CrossRefGoogle Scholar
  23. 23.
    Natsuhara KM, Shelton TJ, Meehan JP, Lum ZC. Mortality during total hip periprosthetic joint infection. J Arthroplasty. 2019;34:S337. pii: S0883-5403(18)31225-7.CrossRefGoogle Scholar
  24. 24.
    Lenguerrand E, Whitehouse MR, Beswick AD, Jones SA, Porter ML, Blom AW. Revision for prosthetic joint infection following hip arthroplasty: evidence from the National Joint Registry. Bone Joint Res. 2017;6:391–8.CrossRefGoogle Scholar
  25. 25.
    Boddapati V, Fu MC, Tetreault MW, Blevins JL, Richardson SS, Su EP. Short-term complications after revision hip arthroplasty for prosthetic joint infection are increased relative to noninfectious revisions. J Arthroplasty. 2018;33:2997–3002.CrossRefGoogle Scholar
  26. 26.
    Cordero-Ampuero J. Girdlestone procedure: when and why. Hip Int. 2012;22(Suppl 8):S36–9.CrossRefGoogle Scholar
  27. 27.
    El-Husseiny M, Haddad FS. The role of highly selective implant retention in the infected hip arthroplasty. Clin Orthop Relat Res. 2016;474:2157–63.CrossRefGoogle Scholar
  28. 28.
    Garcia-Rey E, Cruz-Pardos A, Madero R. Clinical outcome following conversion of Girdlestone's resection arthroplasty to total hip replacement: a retrospective matched case-control study. Bone Joint J. 2014;96-B:1478–84.CrossRefGoogle Scholar
  29. 29.
    Garcia-Cimbrelo E, Tapia M, Martin-Hervas C. Multislice computed tomography for evaluating acetabular defects in revision THA. Clin Orthop Relat Res. 2007;463:138–43.PubMedGoogle Scholar
  30. 30.
    Wasielewski RC, Cooperstein LA, Kruger MP, Rubash HE. Acetabular anatomy and the transacetabular fixation of screws in total hip arthroplasty. J Bone Joint Surg Am. 1990;72:501–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Eduardo García-Rey
    • 1
  • Ana Cruz-Pardos
    • 1
  • Ricardo Fernández-Fernández
    • 1
  1. 1.Department of Orthopedic Surgery“La Paz” University HospitalMadridSpain

Personalised recommendations