Total Kalça Artroplastisi Revizyonu: Son Yirmi Yılda Nedenler ve Değişimler?

Year 2025, Volume: 6 Issue: 3, 288 - 294, 28.09.2025

Evrim Duman , Mehmet Çıtak , Osman Yağız Atlı , Burhan Kurtuluş

https://doi.org/10.47482/acmr.1675820

Abstract

Giriş: Total kalça artroplastisi revizyonu, primer total kalça artroplastisine göre daha zor ve daha az başarılı bir girişimdir. Revizyon cerrahisi daha fazla cerrahi süre, daha fazla kan kaybı ve primer cerrahiye kıyasla daha yüksek komplikasyon demektir. Revizyon nedenleri arasında komponentlerin ağrılı gevşemesi, implant yetmezliği, çıkıklar, enfeksiyonlar ve periprotesik kırıklar yer alır. Cerrahi teknik, implant tasarımı ve kemik kaybı yönetimindeki ilerlemeler, cerrahların total kalça artroplastisi revizyonunun zorluklarının üstesinden gelmelerine ve revizyon cerrahisi geçiren hastalar için sonuçları iyileştirmelerine yardımcı olmuştur.
Yöntem: Bu retrospektif çalışma, yirmi yıl arayla total kalça artroplastisi revizyonu yapılan iki grup hastayı incelemiştir. Hastaların yaş, cinsiyet, primer ve revizyon total kalça artroplastisi geçirdikleri tarih, revizyon nedenleri ve ayrıntılı ameliyat bulguları olmak üzere verileri kaydedildi.
Bulgular: Her iki grupta da demografik özellikler benzerdi, ancak ortalama yaş farklıydı - ilk grupta ortalama yaş 55,4 yıl iken, ikinci grupta 63,5 yıldı. Her iki grupta da revizyonun en yaygın nedeni aseptik gevşeme iken çıkıklar, enfeksiyon ve periprotesik kırıklar diğer nedenler arsındaydı.
Sonuç: Veriler, çıkıkların zaman içinde azalan bir oranda görüldüğünü destekliyor. Bu azalma muhtemelen cerrahi tekniğin geliştirilmesine, implant tasarımındaki yeniliklere ve “constraint liner” kullanımına bağlanabilir. Bununla birlikte, enfeksiyon hala önemli bir komplikasyon olarak önemini korumaktadır.

Keywords

Revizyon Cerrahisi , Total Kalça Artroplastisi , Protez Gevşemesi

Total Hip Arthroplasty Revision: Causes and Changes Over the Past Two Decades?

Abstract

Background: The revision of total hip arthroplasty (THA) is more challenging and has less successful outcomes than primary THA. Revision surgery takes more time, results in more blood loss, and has higher complication risks compared to primary surgery. Common reasons for revision include painful component loosening, implant failure, dislocations, infections, and periprosthetic fractures. Advances in surgical methods, implant designs, and bone loss management have assisted surgeons in addressing the challenges of revision THA and improving outcomes for patients undergoing this complex procedure.
Methods: In this retrospective cohort study, the THA revision surgeries of two groups conducted two decades apart were evaluated. All patient data, including age, gender, date of primary THA, date of revision surgery, reason for revision, and detailed intraoperative findings were recorded.
Results: The demographics were similar in both groups, but the average age was statistically significantly different (p<0.001). In the first group, it was 55.4 years, while in the second group, it was 63.5 years. The most common reason for revision in both groups was aseptic loosening. Infection, dislocation, and periprosthetic fractures were other reasons for revision.
Conclusion: The data indicate that dislocations have constituted a decreasing proportion of revision causes over time, likely attributable to improvements in surgical techniques, advancements in implant design, and the utilization of constrained liners. Nonetheless, infection persists as a significant challenge.

Keywords

Revision Surgery , Total Hip Arthroplasty , Prosthesis Loosening.

Ethical Statement

Our study was approved by the Ethics Committee of Ankara Etlik City Hospital (Date: 12.03.2025, No: AEŞH-BADEK-2025-243).

References

• Ferguson RJ, Palmer AJ, Taylor A, Porter ML, Malchau H, Glyn-Jones S. Hip replacement. Lancet. 2018;392(10158):1662-71.
• Singh JA, Yu S, Chen L, Cleveland JD. Rates of Total Joint Replacement in the United States: Future Projections to 2020-2040 Using the National Inpatient Sample. J Rheumatol. 2019;46(9):1134-40.
• Knight SR, Aujla R, Biswas SP. Total Hip Arthroplasty - over 100 years of operative history. Orthop Rev (Pavia). 2011;3(2):e16.
• Eynon-Lewis NJ, Ferry D, Pearse MF. Themistocles Gluck: an unrecognised genius. BMJ. 1992;305(6868):1534-6. Charnley J. Long-term results of low-friction arthroplasty. Hip. 1982:42-9.
• Bota NC, Nistor DV, Caterev S, Todor A. Historical overview of hip arthroplasty: From humble beginnings to a high-tech future. Orthop Rev (Pavia). 2021;13(1):8773.
• Yanmiş I, Tunay S, Yildiz C, Solakoğlu C, Gür E. [Our clinical experience with non-cemented total hip revision arthroplasty]. Acta Orthop Traumatol Turc. 2003;37(1):1-8.
• Rowan FE, Benjamin B, Pietrak JR, Haddad FS. Prevention of Dislocation After Total Hip Arthroplasty. J Arthroplasty. 2018;33(5):1316-24.
• Altıntaş F, Uç, Özler T. Total kalça artroplastisinde mekanik art sorunlar. TOTBİD Dergisi. 2013:254-67.
• Azboy İ, Yalvaç ES, Azboy N, Şahin İ, Zehir S. [Preferences of surgeons in total knee and hip arthroplasty, and operating room facilities in Turkey: a survey]. Eklem Hastalik Cerrahisi. 2016;27(1):34-40.
• Girdlestone GR. The role of fusion operations as applied to the hip-joint. Br Med J. 1933;2(3799):777-88.
• Patel I, Nham F, Zalikha AK, El-Othmani MM. Epidemiology of total hip arthroplasty: demographics, comorbidities and outcomes. Arthroplasty. 2023;5(1):2.
• Jones CM, Acuña AJ, Jan K, Forlenza EM, Della Valle CJ. Trends and Epidemiology in Revision Total Hip Arthroplasty: A Large Database Study. J Arthroplasty. 2025.
• Schwartz AM, Farley KX, Guild GN, Bradbury TL Jr. Projections and Epidemiology of Revision Hip and Knee Arthroplasty in the United States to 2030. J Arthroplasty. 2020;35(6s):S79-S85.
• Lakshmanan P, Ahmed SM, Hansford RG, Woodnutt DJ. Achieving the required medial offset and limb length in total hip arthroplasty. Acta Orthop Belg. 2008;74(1):49-53.
• Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res. 2002;(405):46-53.
• Moretti VM, Post ZD. Surgical Approaches for Total Hip Arthroplasty. Indian J Orthop. 2017;51(4):368-76.
• Atrey A, Ward SE, Khoshbin A, Hussain N, Bogoch E, Schemitsch EH, et al. Ten-year follow-up study of three alternative bearing surfaces used in total hip arthroplasty in young patients: a prospective randomised controlled trial. Bone Joint J. 2017;99-B(12):1590-5.
• Williams JT Jr, Ragland PS, Clarke S. Constrained components for the unstable hip following total hip arthroplasty: a literature review. Int Orthop. 2007;31(3):273-7.
• Slullitel PA, Oñativia JI, Buttaro MA, Sánchez ML, Comba F, Zanotti G, et al. State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty. EFORT Open Rev. 2018;3(7):434-41.
• Badarudeen S, Shu AC, Ong KL, Baykal D, Lau E, Malkani AL. Complications After Revision Total Hip Arthroplasty in the Medicare Population. J Arthroplasty. 2017;32(6):1954-8.
• Evans JT, Blom AW, Timperley AJ, Dieppe P, Wilson MJ, Sayers A, et al. Factors associated with implant survival following total hip replacement surgery: A registry study of data from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man. PLoS Med. 2020;17(8):e1003291.
• Cheng T, Feng JG, Liu T, Zhang XL. Minimally invasive total hip arthroplasty: a systematic review. Int Orthop. 2009;33(6):1473-81.
• Moralidou M, Di Laura A, Henckel J, Hothi H, Hart AJ. Three-dimensional pre-operative planning of primary hip arthroplasty: a systematic literature review. EFORT Open Rev. 2020;5(12):845-55.
• Noman AA, Shaari MS, Mehboob H, Azman AH. Recent advancements in additively manufactured hip implant design using topology optimization technique. Results Eng. 2025;25:103932.
• Hinton ZW, Wu CJ, Ryan SP, Cunningham DJ, Green CL, Lachiewicz PF. Current Trends in Revision Hip Arthroplasty: Indications and Types of Components Revised. J Arthroplasty. 2022;37(7s):S611-S5.e7.