Patient- Surgery-and Implant-Related Predictors of Complications, Reoperation and Implant Survivorship Following Revision Total Hip Arthroplasty: A Longitudinal Cohort Study

Background: Revision total hip arthroplasty is technically demanding and is associated with higher risks of complications, reoperation and implant failure than primary arthroplasty. Outcomes may be influenced by patient characteristics, surgical complexity and implant-related factors. Identification of these predictors may support risk stratification, perioperative optimization and improved surgical planning. Aim: To evaluate patient-, surgery- and implant-related predictors of complications, reoperation and implant survivorship following revision total hip arthroplasty. Materials and Methods: This longitudinal cohort study included 140 adult patients who underwent revision total hip arthroplasty at a tertiary care hospital. Patient-related variables, indication for revision, operative characteristics, bone loss, fixation method, bearing surface and implant-related factors were recorded. Patients were followed for postoperative complications, reoperations and implant failure. Predictors of complications and reoperation were evaluated using multivariable logistic regression. Implant survivorship was estimated using KaplanMeier analysis, and independent predictors of failure were determined using Cox proportional-hazards regression. A p value <0.05 was considered statistically significant. Results: The mean age was 66.8±10.9 years, and 59.3% of patients were male. Aseptic loosening was the most frequent indication for revision (33.6%), followed by periprosthetic joint infection (22.1%). Postoperative complications occurred in 43 (30.7%; 95% CI: 23.7-38.8) patients, while 24 (17.1%; 95% CI: 11.8-24.2) underwent reoperation. Dislocation was the most common complication (9.3%). Implant failure requiring repeat revision or component removal occurred in 17 (12.1%) patients. Advanced age, obesity, ASA class III-IV, infection-related revision, severe bone loss, operative duration >180 minutes, blood loss >1000 mL and component malposition independently predicted complications. Significant predictors of reoperation included age ≥70 years, two or more previous revisions, revision for infection and component malposition. Implant survivorship was 97.1% at six months, 94.2% at one year, 90.2% at two years and 85.9% at three years. Revision for periprosthetic joint infection (aHR=3.12; 95% CI: 1.18-8.26; p=0.022), Paprosky type III-IV bone loss (aHR=2.73; 95% CI: 1.04-7.17; p=0.042) and postoperative component malposition (aHR=2.86; 95% CI: 1.05-7.79; p=0.039) independently predicted implant failure. Conclusion: Complications and reoperations were relatively common following revision total hip arthroplasty, and implant survivorship declined progressively during follow-up. Infection-related revision, severe bone loss and component malposition were the principal independent predictors of implant failure. Improved infection control, reconstruction of bone defects and accurate component positioning may improve outcomes and implant longevity.