Value of MDT approach to complex hip arthroplasty

A Assaf, SH Chen, G Stranks, T Evans, J Griffiths

Hampshire Hospitals Foundation Trust

As patient longevity increases, so does the incidence of revision total hip arthroplasty (rTHA). National and international data shows a 9-13% re-revision rate in rTHA, most occuring in the first year. Guidelines have been issued to standardise the approach to rTHA, mainly high volume surgeon through MDT pathways. We analysed the clinical outcomes of rTHA after establishing a hip MDT pathway.

In this single-centre retrospective cohort study, all rTHA cases from September 2016 to March 2023 were included. The MDT was established and chaired by the senior author. All cases were discussed in the presence of radiology, microbiology and orthopaedic consultants. Case complexity was determined by the Revision Hip Complexity Classification (RHCC). Primary and secondary outcomes were re-revision rate and infection clearance rate, respectively.

271 rTHAs were included in this study, the majority of which were RHCC 2 (153/271) and just under 10% were RHCC 3s. Indications for rTHA included, but not limited to, aseptic loosening (majority), instability, periprosthetic fractures and infections. The re-revision rate was 4% (10/271): 4 due to periprosthetic fractures within 3 months of rTHA, 4 due to recurrent instability, 1 infected rTHA and 1 aseptic loosening. Overall infection clearance was 93% (29/31). 16 cases performed for pelvic discontinuity: 7 treated with custom implants, and 9 with distractions, with 100% survivorship out to 7 years.

This study shows improved outcomes compared to national and international data, thus demonstrating that the implementation of a complex hip MDT pathway yields excellent results in rTHA surgery.