Revision Joint Surgery in Orthopaedic Trauma Theatres: An Increasingly Complex Problem?

Abstract

Introduction As rates of primary hip and knee arthroplasty rise alongside an aging population, a corresponding increase in revision joint surgery is inevitable. Indications include prosthetic joint infection, periprosthetic fracture/dislocation and mechanical failure of implant components. These procedures are technically complex with a risk of perioperative complications such as major blood loss. This study aimed to evaluate annual theatre resource utilisation for revision surgery at a major trauma centre and its evolution over time, and to characterise the complexity of this patient population. Methods A retrospective service evaluation was conducted of revision arthroplasty and periprosthetic fracture procedures performed in two orthopaedic trauma theatres 2019-2025. Data were extracted from electronic patient records and theatre management system. Results A total of 584 procedures were included. The annual number increased 227% from 52 in 2019 to 127 in 2025. Median anaesthetic time was 90 minutes (IQR 55-210) and surgical time 125 minutes (IQR 90-165). Patients had a median age of 75 (IQR 67-83) with 52% male. Median length of stay was 17 days (IQR 10-39). In-hospital mortality was 3.2% and 45% were discharged to a nursing home or other hospital. Discharge documentation was incomplete in 114 cases; of the remaining 470 patients, 87% had at least one documented co-morbidity, including cardiac (22.7%), respiratory (10.2%), renal disease (3%), and dementia/stroke (6.6%). Conclusions Revision joint surgery and associated perioperative care represents an increasing and resource-intensive proportion of the emergency orthopaedic workload. Patients are older, increasingly frail and with significant co-morbidities. The associated perioperative morbidity is reflected by prolonged hospital stay, discharge to nursing home and other care facilities and in-hospital mortality.