Causes and Risk Factors in Primary Total Hip Replacement Leading to Revision Surgery

Background:Total hip replacement (THR) is a widely performed and highly successful orthopedic procedure. However, the increasing frequency of primary THR has led to a corresponding rise in revision surgeries. Revision total hip replacement (RTHR) is associated with increased surgical complexity, morbidity, healthcare costs, and poorer outcomes compared to primary THR. Identifying the causes and risk factors leading to revision is essential for improving long-term implant survival and optimizing patient care. Objectives: This study aims to analyze the common causes of failure following primary THR and to evaluate the demographic, clinical, and surgical risk factors associated with an increased likelihood of revision. Materials And Methods: This retrospective, observational, case-control study was conducted in the Department of Orthopaedics at Jagannath Gupta Institute of Medical Sciences And Hospital, Budge Budge, Kolkata, West Bengal 700137 over a period of Nov 2022 to Oct 2024. A total of 240 patients who had previously undergone primary total hip replacement (THR) were included. These patients were categorized into two groups: the Revision Group (n = 120), comprising individuals who required revision surgery after primary THR, and the Control Group (n = 120), consisting of patients who had an uncomplicated course following primary THR without the need for revision during the follow-up period. Results: The comparison between revision and control groups (each with 120 patients) showed no significant differences in gender, laterality, BMI, or Charlson Comorbidity Index. However, significant differences were noted in the type of THR fixation (p 5 years), while infections (15%) and instability (10%) were more common in early failures (<5 years). Cox regression analysis revealed younger age (<45 years) and hybrid fixation significantly increased revision risk, while gender, BMI, primary diagnosis, comorbidities, and other fixation types were not significant predictors. Conclusion: The comparison between the revision and control groups showed no notable differences in gender, side of surgery, body mass index, or comorbidity burden. However, significant variations were observed in the type of hip replacement fixation and the underlying diagnosis, with more cemented and hybrid fixations seen in the revision group and avascular necrosis being more frequent in the control group. Aseptic loosening emerged as the most common reason for revision, especially in cases failing after several years, whereas infections and instability were more often linked to early failures. Further analysis indicated that younger age and hybrid fixation were associated with a higher risk of revision, while other factors showed no significant influence.