Revision Indication Is Associated with Early Mortality After Revision Total Hip Arthroplasty: A Population-Based Study.

BACKGROUND: Revision total hip arthroplasty (R-THA) is associated with increased complexity and potential for early postoperative complications, including mortality. This study evaluated 30- and 90-day mortality after R-THA.

METHODS: We identified 6,946 patients undergoing 8,667 R-THA at a single institution between 1997 and 2023. Their mean age was 66 years and had a mean body mass index (BMI) of 30, and 53% were women. Indications for R-THA included aseptic loosening (37%), periprosthetic joint infection (PJI) (15%), dislocation (14%), and periprosthetic fracture (PPFX) (11%). Revisions included single-component (49%), both-component (30%), and modular-component exchanges (21%). Mortality at 30 and 90 days was assessed using Kaplan-Meier analysis. Adjusted Cox models identified risk factors. The observed number of deaths was compared with the expected number of deaths using standardized mortality ratios (SMR).

RESULTS: The 30- and 90-day mortalities were 0.5% (n = 38) and 0.9% (n = 75), respectively. Unadjusted mortality rates at 90 days were 2.6% for PPfx, 1.4% for PJI, 0.9% for dislocation, and 0.4% for aseptic loosening. Compared with aseptic loosening, revision for PPFx and PJI had increased adjusted 30-day mortality (hazard ratio (HR) = 5.37 and 3.16) and 90-day mortality (HR = 3.96 and 2.95; all P < 0.01). Extent of revision was not associated with mortality (P > 0.05). Overall, compared with individuals in the general population, 30-day mortality among patients undergoing R-THA was higher (SMR = 1.77; P = 0.002), and this is primarily driven by a higher 30- and 90-day mortality seen in those undergoing revision for PPFx (30-day SMR = 3.67; 90-day SMR = 2.61) or PJI (30-day SMR = 3.18; 90-day SMR = 2.0 (all P < 0.001)).

CONCLUSION: Revision THA carries a low 30- and 90-day mortality risk that is not associated with the extent of revision, but is strongly impacted by the indication for revision. Patients revised for PPfx and PJI face a 3- and 4-fold higher risk of mortality within 90 days compared to aseptic loosening and demonstrate increased early mortality when compared with age- and sex-matched United States population expectations.