Retrospective single-institution review of 535 revision surgeries on 444 primary THAs performed from 2010 to 2019. The study examines which failure mechanisms drove revision and when each failure type typically occurred relative to the index procedure. It captures a critical era when both conventional polyethylene and metal-on-metal implants were in widespread use.
The failure mechanism driving a THA revision is not random — it is strongly predicted by how much time has elapsed since the index surgery.
When a patient presents within 2 years of their primary THA, infection and periprosthetic fracture must lead your differential. Both are statistically concentrated in this early window and implicate surgical factors. Technique, positioning, sterility, antibiotic prophylaxis. Rather than implant wear.
When a patient with a known metal-on-metal implant presents with hip pain years post-op, do not anchor on aseptic loosening. Order serum cobalt and chromium levels and a metal artifact reduction sequence MRI to evaluate for metallosis before attributing symptoms to mechanical failure. Nearly 97% of metallosis-driven revisions occur after the 2-year mark, and MoM implants fail at roughly twice the rate of other articulations by 7 years.
The bearing surface chosen at the index operation determines the failure clock: hard-on-hard constructs reach late revision in half the time of hard-on-soft, and most hard-on-hard failures have already occurred by 10 years.
Retrospective single-institution review of 535 revision surgeries on 444 primary THAs performed from 2010 to 2019. The study examines which failure mechanisms drove revision and when each failure type typically occurred relative to the index procedure. It captures a critical era when both conventional polyethylene and metal-on-metal implants were in widespread use.
The failure mechanism driving a THA revision is not random — it is strongly predicted by how much time has elapsed since the index surgery.
When a patient presents within 2 years of their primary THA, infection and periprosthetic fracture must lead your differential. Both are statistically concentrated in this early window and implicate surgical factors. Technique, positioning, sterility, antibiotic prophylaxis. Rather than implant wear.
When a patient with a known metal-on-metal implant presents with hip pain years post-op, do not anchor on aseptic loosening. Order serum cobalt and chromium levels and a metal artifact reduction sequence MRI to evaluate for metallosis before attributing symptoms to mechanical failure. Nearly 97% of metallosis-driven revisions occur after the 2-year mark, and MoM implants fail at roughly twice the rate of other articulations by 7 years.
The bearing surface chosen at the index operation determines the failure clock: hard-on-hard constructs reach late revision in half the time of hard-on-soft, and most hard-on-hard failures have already occurred by 10 years.