Complications after total hip arthroplasty requiring early revision surgery
Authors:
P. Musil 1,2; V. Džupa 3
Authors‘ workplace:
Penta Hospitals, Mladá Boleslav, Ortopedie Kliniky dr. Pírka
1; Univerzita Karlova, Lékařská fakulta v Plzni
2; 3. lékařská fakulta Univerzity Karlovy a FNKV, Praha, Ortopedicko-traumatologická klinika
3
Published in:
Prakt. Lék. 2026; 106(4): 154-157
Category:
Of different specialties
Overview
Total hip arthroplasty (THA) is a highly successful and frequent procedure. With the increasing number of operated patients, the absolute number of complications requiring early revision surgery within one year of primary implantation is rising. The dominant causes of early revision include postoperative hematoma, wound healing disturbances, periprosthetic joint infection, periprosthetic fractures, and early joint dislocation due to instability. Aseptic loosening of components is less common during the first postoperative year and is mainly caused by primary mechanical failure or implant malposition. Timely detection, risk stratification and close cooperation between primary care physicians and orthopaedic surgeons are essential for successful management of these complications.
Keywords:
Total hip arthroplasty – periprosthetic fracture – revision surgery – periprosthetic joint infection – dislocation
Sources
1. Abu-Amer Y, Darwech I, Clohisy JC. Aseptic loosening of total joint replacements: mechanisms underlying osteolysis and potential therapies. Arthritis Res Ther. 2007; 9(Suppl 1): S6.
2. Berry DJ. Epidemiology: hip and knee. Orthop Clin North Am. 1999; 30(2): 183–190.
3. Boddice T, Thomas M, Harding G, Foguet P. Periprosthetic fractures around total hip replacement – is there a rush to fix? J Clin Med. 2023; 12(10): 3512.
4. Charles L, Martinot P, Dartus J, et al. Should microbiological samples be taken routinely when performing revision surgery for post-surgical hematoma after hip or knee replacement? Retrospective study of 78 cases of surgically drained hematoma with a minimum follow-up of 2 years. Orthop Traumatol Surg Res. 2023; 109(4): 103585.
5. Feng X, Gu J, Zhou Y. Primary total hip arthroplasty failure: aseptic loosening remains the most common cause of revision. Am J Transl Res. 2022; 14(10): 7080–7089.
6. Gallo J, Havranek V, Zapletalova J. Risk factors for accelerated polyethylene wear and osteolysis in ABG I total hip arthroplasty. Int Orthop. 2010; 34(1): 19–26.
7. Healy WL, Bedair H, Clarke IC, et al. Complications of total hip arthroplasty: standardized list, definitions, and stratification developed by the Hip Society. Clin Orthop Relat Res. 2016; 474(2): 357–364.
8. Jahng KH, Bas MA, Rodriguez JA, Cooper HJ. Risk factors for wound complications after direct anterior approach hip arthroplasty. J Arthroplasty 2016; 31(11): 2583–2587.
9. Kim SJ, Cho YJ. Current guideline for diagnosis of periprosthetic joint infection: a review article. Hip Pelvis. 2021; 33(1): 11–17.
10. Kunutsor SK, Gillott E, Lodge C, et al. Risk factors for dislocation after primary total hip replacement: a systematic review and meta-analysis of 125 studies involving approximately five million hip replacements. Lancet Rheumatol. 2019; 1(2): e111–e121.
11. Kurtz SM, Ong KL, Lau E, Bozic KJ. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012; 27(8 Suppl.): 61–65.e1.
12. Landor I, Vavřík P, Gallo J, Sosna A, a kol. Revizní operace totálních náhrad kyčelního kloubu. Praha: Maxdorf 2012.
13. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet 2007; 370(9597): 1508–1519.
14. Manning L, Metcalf S, Clark B, et al. Clinical characteristics, etiology, and initial management strategy of newly diagnosed periprosthetic joint infection: a multicenter, prospective observational cohort study of 783 patients. Open Forum Infect Dis. 2020; 7(5): ofaa068.
15. McMaster Arthroplasty Collaborative. Risk factors for periprosthetic joint infection following primary total hip arthroplasty: a 15-year, population-based cohort study. J Bone Joint Surg Am. 2020; 102(6): 503–509.
16. Musil D, Gallo J, Chrdle A. Infekce v ortopedii. Praha: Maxdorf 2022.
17. Parvizi J, Tan TL, Goswami K, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 2018; 33(5): 1309–1314.e2.
18. Pathak N, Bovonratwet P, Purtill JJ, et al. Incidence, risk factors, and subsequent complications of postoperative hematomas requiring reoperation after primary total hip arthroplasty. Arthroplast Today 2022; 19 : 101015.
19. Pokorný D, Šlouf M, Veselý F, a kol. Distribuce otěrových částic UHMWPE v periprotetických tkáních u TEP kyčelního kloubu. Acta Chir Orthop Traumatol Cech. 2010; 77(2): 87–92.
20. Prock-Gibbs H, Pumilia CA, Meckmongkol T, et al. Incidence of osteolysis and aseptic loosening following metal-on-highly cross-linked polyethylene hip arthroplasty: a systematic review of studies with up to 15-year follow-up. J Bone Joint Surg Am. 2021; 103(8): 728–740.
21. Sirignano MN, Lange JK, Carender CN, et al. Incidence of instability following primary total hip arthroplasty continues to decline in the Medicare population. J Arthroplasty 2023; 38(7 Suppl): S89–S94.e1.
22. Slavković N, Jovanović A, Živanović D, et al. Total hip arthroplasty. Srp Arh Celok Lek. 2012; 140(5–6): 379–384.
23. Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the US, 2014 to 2030. J Bone Joint Surg Am. 2018; 100(17): 1455–1460.
24. Steckelberg JM, Osmon DR. Prosthetic joint infection. In: Waldvogel FA, Bisno AL. (Eds.) Infections associated with indwelling medical devices. Washington: ASM Press 2000; 173–209.
25. Thien TM, Chatziagorou G, Garellick G, et al. Periprosthetic femoral fracture within two years after total hip replacement: analysis of 437,629 operations in the Nordic Arthroplasty Register Association database. J Bone Joint Surg Am. 2014; 96(19): e167.
26. Yang B, Lei Y, Zeng Y, et al. Risk factors for infection in patients undergoing hip replacement: a systematic review and meta - -analysis. J Hosp Infect. 2025; 160 : 60–73.
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General Practitioner
2026 Issue 4
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