Epidemiology of revision of total hip arthroplasty in France: a multicentre case series of 963 patients

Background: The incidence of total hip arthroplasty (THA) is increasing due to an aging population and expanded indications. Projections indicate a substantial rise in primary and revision procedures in France by 2050. Revision surgery presents significant clinical challenges, including higher complication rates and increased costs compared to primary arthroplasty.

Objective: This multicenter study aimed to analyze the epidemiology of THA revision in France and identify specific risk factors associated with revision failure, defined as subsequent re-operation or re-revision.

Key Points: A retrospective cohort of 963 patients was evaluated between 2015 and 2021. The overall failure rate was 14%, with infection accounting for 53% of these cases. Primary indications for revision included aseptic loosening (35.6%), periprosthetic fracture (32%), and prosthetic joint infection (15.2%). Statistical analysis identified younger age, revision iteration beyond the first (R>1), and initial etiologies of infection or dislocation as significant risk factors for failure. The use of constrained liners and acetabular reinforcement devices was also associated with higher failure rates. Conversely, dual mobility components demonstrated a protective effect against failure, particularly in revisions performed for periprosthetic fractures. In revisions for dislocation, the failure rate reached 29%, primarily due to recurrent instability.

Conclusion: Infection remains the predominant cause of failure following THA revision. To optimize clinical outcomes and reduce the risk of instability, the routine use of dual mobility constructs is recommended in revision settings, including those involving periprosthetic fractures.