High-volume hospitals do not perform better than low-volume hospitals in septic and aseptic revision total hip arthroplasty: an analysis of re-revision risk and mortality based on the Dutch Arthroplasty Register.

Background and purpose:  Revision total hip arthroplasty (rTHA) is a complex procedure that may benefit from centralization. We examined the association between annual hospital volume of rTHA and re-revision risk and mortality.

Methods:  We included all rTHAs between 2007 and 2022 in general hospitals, registered in the Dutch Arthroplasty Register (LROI; n = 12,515). Hospitals were categorized into low (< 25 rTHA/year) or high volume (≥ 25 rTHA/year). Competing-risk analyses and Cox proportional hazard regression analyses were performed to assess implant re-revision and Kaplan-Meier survival analysis for mortality. Results were stratified into septic (permanent Girdlestone, 1-stage, and 2-stage revisions) and aseptic first revisions.

Results:  1-stage septic revisions showed a higher risk of re-revision in high-volume hospitals (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.1-2.4). We found no difference in re-revision risk after DAIR (HR 1.1, CI 0.9-1.3). 2-stage septic revisions were more often performed in high-volume hospitals (5% vs 2%). There was no statistical difference in re-revision rates between hospitals after revision for aseptic loosening (HR 1.1, CI 0.9-1.4), dislocation (HR 1.1, CI 0.9-1.4), and periprosthetic fractures (HR 1.1, CI 0.8-1.5). Mortality showed no differences between groups, neither for septic nor aseptic revisions.

Conclusion:  There was no difference between high-volume hospitals and low-volume hospitals regarding risk for re-revision after aseptic loosening, dislocation and periprosthetic fracture, and septic DAIR and mortality. In high-volume hospitals, 1-stage septic revisions was associated with a significantly higher re-revision risk. 2-stage revisions are more frequent in high-volume hospitals, indicating more complex pathology.