BACKGROUND: Revision total hip arthroplasty (rTHA) volume is projected to increase substantially over the coming decades. However, the referral pathways through which rTHA patients arrive at tertiary care centers and their corresponding outcomes have been incompletely characterized. This study aimed to describe the patient demographics and referral patterns of rTHA patients at a tertiary care center and compare clinical outcomes across referral groups.
METHODS: We retrospectively reviewed 242 consecutive rTHAs by a single surgeon (2012 to 2019), categorizing patients by referral status: internal to the surgeon's practice (IS), internal to the hospital (IH), or external (E). Between these cohorts, we compared demographics, revision history, indications, hip disability and Osteoarthritis Outcome Scores (HOOS), and re-revision rates at 90 days, one year, two years, and final follow-up. Multivariate logistic regressions were performed to examine the effects of referral status and prior revision history on outcomes.
RESULTS: Compared to IS patients, E patients had higher prior revision rates (41.8 versus 4.2%, P < 0.001). Final follow-up HOOS scores did not differ significantly between E and IS patients. On multivariate analyses, prior revision history independently predicted re-revision at final follow-up (odds ratio (OR) = 2.50, P = 0.023), while external referral status did not.
CONCLUSION: At this tertiary referral center, externally referred patients had a greater prior revision rate than internally referred patients, yet reached similar postoperative HOOS scores. Baseline scores were unavailable, so these data reflect postoperative function rather than the magnitude of improvement. These findings identify prior revision history as the strongest patient-level predictor of subsequent failure in our cohort, a relationship that warrants validation in multi-center registry data.
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