Predictors of mid-late term revision of total hip replacement: A nation-wide retrospective cohort study (UK SAFE) 

Judge, Andrew; Garriga-Fuentes, Cesar; Kingsbury, Sarah; Smith, Lindsay; Porter, Martin; Pinedo-Villanueva, Rafael; Arden, Nigel; Conaghan, Philip

Abstract

Objective: Identify which patients are most likely to require mid-late revision surgery to inform targeted follow-up.

Methods: Setting: Primary care using Clinical Practice Research Datalink (CPRD) data and secondary care using National Joint Registry data linked to English Hospital Episode Statistics (HES) and Patient Reported Outcome Measures (PROMs). Patients: Primary elective total hip replacements (THR) aged ≥18. Event of interest: Revision surgery ≥5 years after primary THR. Statistical methods: Cox regression modelling to ascertain influential factors of mid-late term revision. Hazard ratios (HR) and 95% confidence intervals (CI) assessed the association of sociodemographic factors, comorbidities, medication, surgical variables and PROMs with mid-late term revision.

Results: NJR-HES-PROMs data was available from 2008-2011 on 142,275 THR. The CPRD-HES data covered a longer period from 1995-2011 on 22,312 THR. Patients had a minimum 5-years post primary surgery to end 2016. Age and gender distribution were similar across both datasets; mean age 70 years, 62% female. In the NJR there were 3,582 (2.5%) revision procedures over a median time-to-revision 1.9 years (range 0.01-8.7 years), of which 598 (0.4%) were mid-late term revisions. In CPRD 982 (5.8%) revisions over median time-to-revision 5.3 years (range 0 -20 years), with 520 (3.1%) mid-late term revisions. Older age was related to significantly lower revision after 5 years (HR: 0.97; 95% CI: 0.96-0.98). Ceramic-on-ceramic bearings (0.70; 0.54-0.91) and ceramic-on-polyethene (0.75; 0.57-0.98) were protective for mid-late revision compared to metal-on-polyethylene bearings. Femoral head size >28mm diameter had higher mid-late term revision risk (≥44 mm: 2.74, 1.17-6.40). Pre-operative hypertension (0.77; 0.61-0.96) conferred a lower risk, whilst hyperlipidaemia (1.46; 1.09-1.95), antidepressant medication (1.38; 1.14-1.67) and steroid injections (1.32; 1.05-1.66) increased mid-late revision risk.

Conclusion: Younger age, metal-on-polyethylene bearings and larger femoral head sizes may be relevant factors in deciding which patients require extended follow-up based on their mid-late term revision risk.

• Presentation Conference Type: Conference Paper (published)
• Start Date: Sep 14, 2020
• End Date: Sep 25, 2020
• Acceptance Date: Aug 24, 2020
• Online Publication Date: Sep 25, 2020
• Publication Date: Sep 25, 2020
• Deposit Date: Jun 21, 2021
• Book Title: BOA Annual Congress 2020
• Public URL: https://uwe-repository.worktribe.com/output/6814427
• Publisher URL: https://www.boa.ac.uk/abstracts2020.html
• Additional Information: BOA Virtual Congress 2020/Abstracts/Hip/Accepted abstracts Part I:690