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Revision & Reoperation

Revision total hip arthroplasty (rTHA) for aseptic loosening, PJI, instability, or fracture, including risk stratification and management of high-mortality cohorts.

Overview

Revision arthroplasty carries distinct risks that vary by joint and etiology. In males, revision surgery increases the risk of repeat revision [1]. Following revision reverse total shoulder arthroplasty, the re-revision rate is 13% in the first two years, rising to 35% at five years [2]. For infection-related revision total hip arthroplasty, both the highest re-revision and mortality rates occur within the first six months postoperatively [5]. Similarly, roughly half of all revision surgeries for conversion or revision total hip arthroplasty following acetabular fractures in the elderly occur within the first year [6].

Outcomes are often predictable based on the specific indication for the procedure [48]. In patients younger than 65 years, complication, reoperation, and revision rates following primary reverse total shoulder arthroplasty are similar to older cohorts, with no increase in revisions owing to aseptic loosening [10]. For loose glenoid components after anatomic total shoulder arthroplasty, all four types of revision arthroplasty share a similar 20% reoperation rate at latest follow-up, though conversion to reverse total shoulder arthroplasty yields a higher proportion of satisfied patients [11]. In lumbar spine surgery, the same-level recurrence rate following single-level microdiscectomy is 22.8%, with a revision surgery rate of 11.7% [7].

Surgical strategy and patient selection significantly influence reoperation needs. Factors predictive of re-revision following metal-on-metal hip arthroplasty revision for adverse reactions to metal debris include those modifiable by the surgeon [4]. The best opportunity for optimal outcomes in repeat revision hip arthroscopy is a well-executed primary surgery to avoid the need for repeat revision [21]. Regarding knee revisions, unicompartmental knee arthroplasty revision more frequently requires components with increased operation duration compared with high tibial osteotomy revision, yet results in fewer complications requiring re-operation [44]. Finally, the need for readmission and reoperation is similar across surgical approaches for various revision total hip arthroplasty procedures [53].

Anatomy & Pathophysiology

Kinematics and Dynamic Stability

Instability following hip arthroplasty is a common, devastating complication with multifactorial causes [59]. Dynamic pelvic behavior may contribute to anterior instability patterns in patients with dislocation after total hip arthroplasty [35]. Hip microinstability is characterized by abnormal femoral head micromotion within the acetabulum [41], which leads to cartilage damage and osteoarthritis [41]. This microinstability is often associated with acetabular dysplasia or femoroacetabular impingement syndrome [41]. Continuous dynamic stability of the hip may contribute to a slight increase in the cumulative risk of dislocation after 1 month following direct anterior total hip arthroplasty [54]. Spinopelvic stiffness is associated with increased age and increased femoral motion [86], and increased femoral motion may lead to impingement and dislocation in the context of spinopelvic stiffness [86].

Osseous and Component Factors

Impaction deformation with consequent friction, wear, and micromotion likely contributed to the early failure of the Durom acetabular component [57]. High placement of an acetabular component inserted without cement in revision total hip arthroplasty did not adversely affect function of the abductor muscles [58], though the mean limb-length discrepancy was reduced by femoral reconstruction in these cases [58]. Current classification of borderline hip dysplasia based solely on lateral center edge angle is insufficient [74]; the focus for borderline hip dysplasia must shift to assessing hip instability to better predict treatment outcomes and the need for bony realignment [74]. Increasing symptoms and decreased function related to degenerative hip disease may occur fifteen to twenty years after Colonna arthroplasty with concomitant femoral shortening and rotational osteotomy [56].

Soft Tissue and Functional Outcomes

Complications of polyethylene liner and femoral head exchange in total hip arthroplasty are not uncommon [52]. Abductor tears may be repaired at the time of hip arthroplasty without forgoing desirable functional outcomes [65], and clinical outcomes did not differ significantly between cases with gluteal repair and those without tears in degenerative gluteal tears associated with hip arthroplasty [65]. There is no significant benefit for gait kinematics in the early postoperative period (three months) for patients undergoing total hip arthroplasty through a minimally invasive Watson-Jones approach compared with a standard transgluteal approach [78]. One year after second-stage knee revision surgery, kinematic and kinetic values remain lower than those observed in a normal reference population [64].

Implant Selection and Salvage Strategies

Dual-mobility components may be protective against dislocation compared with smaller-diameter femoral head sizes following total hip arthroplasty for hip fracture [61]. The constrained acetabular component provides durable protection against additional dislocations in salvage of a recurrently dislocating total hip prosthesis [66] and does not have substantial deleterious effects on component fixation in this setting [66]. There seems to be no difference between bipolar hemiarthroplasty and unipolar hemiarthroplasty with regards to hip function at 2 years in patients aged 70 years or older with a femoral neck fracture [70]. For experienced hip surgeons, the learning curve for avoiding early complications in hip resurfacing is short (25 cases or less) [55], whereas the learning curve for achieving desired component positioning radiographically in hip resurfacing is much longer (75 to 100 cases or more) [55]. At a population level, the lifetime risk of revision hip replacement remains low at less than 1 in 50 people in 2017 [82].

Classification

Revision Risk Stratification: Revision surgery in males increases the risk of repeat revision surgery [1]. The rate of re-revision after revision reverse total shoulder arthroplasty is 13% in the first 2 years postoperatively, increasing to 35% at 5 years [2]. Re-revision beyond 5 years following revision knee arthroplasty in the elderly is uncommon [3]. The highest re-revision rates following revision total hip arthroplasty for infection occur in the first six months postoperatively [5]. Roughly half of all revision surgeries for conversion or revision total hip arthroplasty following acetabular fractures in the elderly occur within the first year postoperatively [6]. Re-revision rates for revised unicompartmental knee replacements are similar to those for total knee replacements but considerably higher than for primary total knee replacements [42].

Infection and Aseptic Failure: The lowest risk of failure following revision knee arthroplasty due to periprosthetic joint infection was observed after one-stage revision [17]. In a cohort of revision hip arthroplasty for aseptic loosening, the presence of low-grade infection did not increase the risk of re-revision [50]. The majority of revision shoulder arthroplasties are performed for patients unlikely to have a periprosthetic joint infection, with less than 10% meeting ICM criteria for definite PJI [47]. Factors predictive of re-revision following metal-on-metal hip arthroplasty revision for adverse reactions to metal debris include those modifiable by the surgeon [4].

Glenoid Component Revision: All four types of revision arthroplasty for a loose glenoid component after anatomic total shoulder arthroplasty had a similar reoperation rate of 20% at the latest follow-up [11]. Conversion to reverse shoulder arthroplasty provided a higher proportion of patients satisfied with the procedure compared to other revision types for loose glenoid components [11].

Femoral Reconstruction: A classification system and algorithmic approach exist to guide femoral reconstruction in revision total hip arthroplasty based on the type of femoral deficiency [34].

Other Considerations: Two-stage revision procedures for septic hip and knee arthroplasty are substantially more complex than primary procedures [30]. Detailed analysis of intraoperative and postoperative complications and shoulder function at the time of revision offers new information for revision shoulder arthroplasty [40]. The risk of revision after total hip arthroplasty in patients younger than 55 years depends on surgical approach, femoral head size, and bearing type [49].

Clinical Presentation

Revision surgery carries distinct prognostic implications based on patient demographics and index procedure. Male sex increases the risk of repeat revision surgery [1], while patients with a history of previous revisions face a higher risk of re-revision [15]. In the context of reverse total shoulder arthroplasty (rTSA), the re-revision rate is 13% in the first 2 years postoperatively, increasing to 35% at 5 years [2]. Complication, reoperation, and revision rates following primary rTSA in patients younger than 65 years are similar to those seen in older cohorts, with no increase in revisions owing to aseptic loosening [10]. Conversely, re-revision beyond 5 years following revision knee arthroplasty in the elderly is uncommon [3]. Patients who undergo revision surgery generally demonstrate a poorer prognosis during subsequent follow-up [9].

Temporal patterns of failure vary by joint and etiology. The highest re-revision rates and mortality following revision total hip arthroplasty (THA) for infection occur in the first six months postoperatively [5]. Roughly half of all revision surgeries for conversion or revision THA following acetabular fractures in the elderly occur within the first year postoperatively [6]. For isolated tibial insert exchange in revision total knee arthroplasty, the best results are observed for polyethylene wear [8]; for diagnoses other than polyethylene wear, the re-revision rate is higher and the failure mode is most commonly recurrence of the original indication [8]. The cause of failure leading to early revision varies between late and early revision cases following shoulder arthroplasty [14].

Specific clinical presentations and risk factors guide the assessment of instability, infection, and bearing surface issues. Patients revised to metal-on-metal bearings had higher rates of re-revision following revision of metal-on-metal hip replacements for adverse reaction to metal debris [16], whereas patients not requiring re-revision had good functional results [16]. Modifiable factors predictive of re-revision following metal-on-metal hip arthroplasty revision for adverse reactions to metal debris include those modifiable by the surgeon [4]. Patients undergoing revision due to dislocation face a higher risk of postoperative dislocation [15]. In the spine, the same-level recurrence rate after single-level lumbar microdiscectomy is 22.8%, with a revision surgery rate of 11.7% [7]. Both primary and revision posterior cruciate ligament reconstruction resulted in significant clinical improvements [13].

Infection and surgical strategy present specific diagnostic and prognostic markers. The presence of a sinus tract, positive cultures during the first stage revision, and elevated CRP levels prior to the second stage revision are all associated with increased reinfection risk after two-stage revision surgery for prosthetic hip joint infection [24]. The lowest risk of failure following revision knee arthroplasty due to periprosthetic joint infection was observed after one-stage revision [17], though one-stage revision for periprosthetic joint infection may not be suitable for all patients [17]. Revisions for humeral loosening in reverse shoulder arthroplasty yield modest clinical improvements but are more likely to experience complications resulting in re-revision [28]. Complications are common following revision of failed hemiarthroplasty and anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty and can compromise results [26].

Diagnostic clarity significantly influences outcomes in complex revisions. Revision of unicompartmental knee replacement to total knee replacement for unexplained pain generally results in a less favourable outcome than revision for a known cause of pain [25]. General revision surgery for the entire complaint is not the aim of treatment for multiply reoperated knee instabilities; the specific problem should be extracted and solved with the most limited procedure possible [29].

Investigations

Plain radiography: Revision surgery in males increases the risk of repeat revision surgery [1]. Re-revision beyond 5 years following revision knee arthroplasty in the elderly is uncommon [3]. Roughly half of all revisions for conversion or revision THA after acetabular fractures in the elderly occur within the first year postoperatively [6]. Revision with use of a cemented femoral component remains an option for selected patients, with an acceptable ten-year survival rate and fair radiographic evidence of fixation [23]. Hybrid fixation (cementless acetabular and cemented femoral components) resulted in lower rates of repeat revision and radiographic loosening for the acetabular component compared to fully cemented revisions [71]. Revision total hip arthroplasty with the BIAS femoral component provided similar clinical results but inferior radiographic fixation compared with modern cementing techniques [84]. There was no significant increased revision rate for all-cause revision or aseptic loosening, or periimplant radiolucencies with a modern total knee arthroplasty design regarding early tibial component loosening [77].

MRI: Gadolinium intra-articular contrast magnetic resonance imaging is not required for every patient undergoing hip arthroscopy [63]. Patients requiring revision surgery after primary hip arthroscopy for femoroacetabular impingement syndrome presented with smaller postoperative labral size (less than 1 mm difference) compared with those patients that did not require later revision surgery [73]. Patients requiring revision surgery after primary hip arthroscopy for femoroacetabular impingement syndrome presented with greater reduction of labral size (at or less than 1mm difference) on MRI 12 months after primary surgery compared with those patients that did not require later revision surgery [73]. Greater chondral pathologic abnormalities at revision anterior cruciate ligament reconstruction surgery were associated with reduced function at follow-up [76].

CT: Contrast magnetic resonance imaging plus computed tomography with 3-dimensional reconstruction are essential for patients requiring revision hip arthroscopy [63].

Other Considerations: The best results for isolated tibial insert exchange in revision total knee arthroplasty are for polyethylene wear [8]. For diagnoses other than polyethylene wear in isolated tibial insert exchange, the re-revision rate is higher and the failure mode is most commonly recurrence of the original indication [8]. Both primary and revision posterior cruciate ligament reconstruction resulted in significant clinical improvements [13]. The cause of failure leading to early revision varies between late and early revision cases after shoulder arthroplasty [14]. Patients revised to metal-on-metal bearings had higher rates of re-revision compared to other bearing types [16]. Patients not requiring re-revision after revision of metal-on-metal hip replacements for adverse reaction to metal debris had good functional results [16]. The overall midterm risk of revision after reverse shoulder arthroplasty for cuff tear arthropathy is low (5%) [60]. Anterior lumbar interbody fusion has proven effective for revision lumbar fusion surgery, yielding positive clinical and radiographic results [62]. Thirteen revised hips treated with bone grafting and the third generation cement technique were performing well with no re-revisions within ten years after surgery [68]. Revision of previously cemented hip arthroplasties with uncemented modular femoral components yielded good mid-term clinical and radiological results [69]. Revision reverse total shoulder arthroplasty with glenoid bone grafting resulted in good clinical and radiographic outcomes at short-term follow-up [79]. Late revision surgeries for nonunion were more than twice as common as those for adjacent segment disease after anterior cervical discectomy and fusion [85]. Late revision surgeries for nonunion occurred earlier and more commonly when a greater number of levels were used in anterior cervical discectomy and fusion [85].

Treatment

Non-Operative

Non-surgical management of an unstable patella after total knee arthroplasty is generally unsuccessful [88]. Operative intervention for recurrent dislocation after total hip arthroplasty results in a significantly better functional outcome than non-operative management [83]. A revision operation for shoulder instability should be considered only if extensive non-operative treatment has failed in a motivated patient [87]. Non-surgical treatment of a concomitant medial collateral ligament injury in the setting of an anterior cruciate ligament reconstruction may increase the risk of anterior cruciate ligament revision [89].

Operative

Indications: Periprosthetic joint infection (PJI) is the most common indication for secondary total knee arthroplasty revision within one year after primary total knee arthroplasty [51]. The commonest indications for revision surgery of unicompartmental knee arthroplasty are aseptic loosening and progression of arthritis [37]. Revision of a stable component in total hip arthroplasty is not justifiable on the basis of its long duration in use [80], non-ideal position [80], or possible loosening on radiographs [80].

Surgical Approach / Technique: Isolated tibial insert exchange in revision total knee arthroplasty yields the best results for polyethylene wear [8]. For diagnoses other than polyethylene wear, isolated tibial insert exchange in revision total knee arthroplasty has a higher re-revision rate [8], with the failure mode most commonly being recurrence of the original indication [8]. Reported success rates for selective component retainment in the treatment of chronic periprosthetic infection after total hip arthroplasty are high and comparable with complete revision arthroplasty, though the quality of studies on this approach is poor [31]. Major malposition of components causing an unstable patella after total knee arthroplasty is best managed by implant revision [88].

Implant Selection: Revision with use of a cemented femoral component in revision total hip arthroplasty remains an option for selected patients [23], demonstrating an acceptable ten-year survival rate [23] and fair radiographic evidence of fixation [23]. Conversion to reverse shoulder arthroplasty (RSA) for a loose glenoid component after anatomic total shoulder arthroplasty provided a higher proportion of patients satisfied with the procedure compared to other revision types [11]. All 4 types of revision arthroplasty for a loose glenoid component after anatomic total shoulder arthroplasty had a similar reoperation rate of 20% at the latest follow-up [11].

Alignment / Balancing Strategy: Factors predictive of re-revision following metal-on-metal hip arthroplasty revision for adverse reactions to metal debris include those modifiable by the surgeon [4]. Future studies on the etiology of failure in revision total knee arthroplasty should focus on patient- and surgery-specific factors that could maximize safety and efficacy [45].

Adjuncts: Post-revision antibiotic therapy was associated with an infection-free survival rate of 91% at a mean of >4 years of follow-up after single-stage revision shoulder arthroplasty [22].

Revision: Revision surgery in males increases the risk of repeat revision surgery [1]. The rate of re-revision after revision reverse total shoulder arthroplasty is 13% in the first 2 years postoperatively [2] and increases to 35% at 5 years [2]. Revision reverse shoulder arthroplasty demonstrates an implant survival rate of 85% at ten years [19]. Re-revision beyond 5 years following revision knee arthroplasty in the elderly is uncommon [3]. The same-level recurrence rate after single-level lumbar microdiscectomy is 22.8% [7], while the revision surgery rate after single-level lumbar microdiscectomy is 11.7% [7]. The short-term risk of revision after reverse shoulder arthroplasty for acute proximal humeral fractures is low [12]. The best opportunity for optimal outcomes in repeat revision hip arthroscopy is a well-executed primary surgery to avoid the need for repeat revision [21]. A high proportion of patients undergoing revision surgery for unicompartmental knee arthroplasty will require additional surgical measures to compensate for loss of bone stock [37]. The real success rate of two-stage revision for chronic hip and knee periprosthetic joint infection may be overestimated by 9% due to the exclusion of patients who do not undergo reimplantation [39]. Repeat two-stage revision for recurrent knee periprosthetic joint infection yields low infection control rates [43] and is associated with major morbidity, including a 23% amputation rate [43]. Both second revision anterior cruciate ligament reconstruction and nonsurgical management of failed first revision anterior cruciate ligament reconstruction were associated with high rates of return to sport [67]. Success of revision operation for shoulder instability is most probable if a correctable anatomical lesion ignored at the first procedure is identified [87].

Complications

Infection (PJI): The highest rates of re-revision and mortality following revision total hip arthroplasty for infection occur within the first six months postoperatively [5].

Instability: Patients undergoing revision total hip arthroplasty due to dislocation face a higher risk of postoperative dislocation, and those with a history of previous revisions tend to have a higher risk of re-revision [15].

Aseptic loosening: There is no increase in revisions owing to aseptic loosening following primary reverse total shoulder arthroplasty in patients younger than 65 years [10]. Contemporary long cemented revision stems are associated with a low risk for femoral re-revision at 10 years in revision total hip arthroplasty, a risk not influenced by demographics, cause for revision, or surgical factors [32].

Polyethylene wear: Factors predictive of re-revision following metal-on-metal hip arthroplasty revision for adverse reactions to metal debris include those modifiable by the surgeon [4].

Other Considerations: Revision surgery in males increases the risk of repeat revision surgery [1]. The rate of re-revision after revision reverse total shoulder arthroplasty is 13% in the first 2 years postoperatively, increasing to 35% at 5 years [2]. Over 80% of revision shoulder replacements last 5 years, and over 70% last 10 years [20]. Re-revision beyond 5 years following revision knee arthroplasty in the elderly is uncommon [3]. Roughly half of all revision surgeries for conversion or revision total hip arthroplasty following acetabular fractures in the elderly occur within the first year postoperatively [6]. The short-term risk of revision following reverse shoulder arthroplasty for acute proximal humeral fractures is low [12]. Complication, reoperation, and revision rates following primary reverse total shoulder arthroplasty in patients younger than 65 years are similar to those seen in older patient cohorts [10]. Failure rates and complications following aseptic revision total knee arthroplasty remain high compared to primary procedures, with an increased risk for overall re-reoperation and early readmission at 30 days [33]. Patients undergoing revision surgery demonstrate a poorer prognosis during subsequent follow-up compared to those who did not [9]. The same-level recurrence rate following single-level lumbar microdiscectomy is 22.8%, with a revision surgery rate of 11.7% [7]. Up to 5 years of follow-up, there are no differences in revision rates between cervical laminoplasty and posterior laminectomy and fusion, though cervical laminoplasty is associated with fewer postoperative complications [18].

Recovery

Light activity (weeks): Evidence regarding specific week ranges for light activity such as desk work or driving is not provided in the current evidence base. While short-term clinical outcomes of revision rotator cuff repair are similar to primary repair [36], and patients undergoing revision after hip resurfacing can expect function similar to their primary surgery [38], no specific timeline for light activity is defined.

Full activity (months): No specific month ranges for full activity, manual work, or sport are defined in the provided evidence. However, revision rotator cuff reconstruction improves clinical outcomes and shoulder function at midterm follow-up [27], and over 80% of revision shoulder replacements last 5 years [20].

Complete recovery / outcome plateau (months): The evidence does not specify a month range for the stabilization of pain, strength, or final functional outcomes. Long-term follow-up indicates that hemiarthroplasty and total shoulder arthroplasty in patients younger than 50 years provide lasting pain relief and improved range of motion [46], with survivorship in excess of 75% at 20 years [46].

Rehabilitation protocol: No specific rehabilitation protocols, including PT phasing, immobilisation duration, or weight-bearing progression, are detailed in the provided evidence.

Functional milestones: No validated PROM trajectories or specific outcome-measure benchmarks (e.g., Constant, ASES, WOMAC) are reported in the evidence base.

Other Considerations: Recovery trajectories vary significantly by procedure and complication status. The rate of re-revision after revision reverse total shoulder arthroplasty is 13% in the first 2 years postoperatively [2] and increases to 35% at 5 years [2], while implant survival for revision reverse shoulder arthroplasty is 85% at ten years [19]. Over 70% of revision shoulder replacements last 10 years [20]. For infection, the highest re-revision and mortality rates following revision total hip arthroplasty occur in the first six months postoperatively [5]. Utilizing 1-stage revision over DAIR in early prosthetic joint infections might improve prognosis by decreasing the risk of reoperation without increasing mortality [81]. Post-revision antibiotic therapy is associated with an infection-free survival rate of 91% at a mean of >4 years of follow-up [22]. Patients undergoing revision surgery demonstrate a poorer prognosis during subsequent follow-up compared to those who did not [9]. Patients who had early revision surgeries for symptomatic failed arthroscopic rotator cuff repair had significantly worse clinical outcomes after primary surgery than patients who had late revision surgeries [75]. Early dislocation within 7 days of hip surgery carries an increased risk of a subsequent revision for instability compared to dislocation within 7 to 90 days, though both have similar all-cause revision-free survivorship [92]. The risk of re-revision after hip resurfacing arthroplasty is low [38]. The overall 15-year revision rate for anterior cruciate ligament reconstruction is estimated as 7.1% [90]. The same-level recurrence rate after single-level lumbar microdiscectomy is 22.8%, with a revision surgery rate of 11.7% [7]. The short-term risk of revision after reverse shoulder arthroplasty for acute proximal humeral fractures is low [12]. Cervical laminoplasty is associated with fewer postoperative complications than posterior laminectomy and fusion, with no differences in revision rates between the two up to 5 years of follow-up [18].

Key Evidence

  • [L4] The rate of re-revision after revision RTSA is low in the first 2 years postoperatively (13%) but increases to 35% at 5 years. (10.1016/j.jse.2022.11.024)
  • [L4] Re‐revision beyond 5 years is uncommon. (10.1002/ksa.70190)
  • [L3] However, the factors predictive of re-revision included those which could be modified by the surgeon, suggesting that rates of failure following ARMD revision may be reduced further. (10.1302/0301-620x.99b8.bjj-2016-0889.r1)
  • [L3] The highest re-revision rates and mortality are seen in the first six months postoperatively. (10.1302/0301-620x.106b6.bjj-2023-1181.r1)
  • [L3] Revision surgeries for either conversion or revision THA were relatively common in both groups, with roughly half of all revisions occurring within the first year postoperatively. (10.5435/jaaos-d-23-00771)
  • [L3] This retrospective study demonstrates a same-level recurrence rate of 22.8% with an 11.7% revision surgery rate. (10.5435/jaaos-d-24-00879)
  • [L3] The best results were for polyethylene wear, while for other diagnoses, the re-revision rate was higher and the failure mode was most commonly recurrence of the original indication. (10.1302/0301-620x.103b6.bjj-2020-1954.r2)
  • [L3] Patients that underwent revision surgery also demonstrated poorer prognosis during subsequent follow-up. (10.1016/j.arth.2008.11.096)
  • [L4] Complication, reoperation, and revision rates were similar to those seen in older patient cohorts, without an increase in revisions owing to aseptic loosening. (10.1016/j.jse.2020.02.004)
  • [L1] All 4 types of revision arthroplasty had a similar reoperation rate (20%) at the latest follow-up, but conversion to RSA provided a higher proportion of patients satisfied with the procedure. (10.1016/j.jse.2022.10.006)
  • [L3] The short-term risk of revision is low. (10.1016/j.jses.2019.10.114)
  • [L2] Both primary and revision PCLR resulted in significant clinical improvements. (10.1002/ksa.70323)
  • [L3] The cause of failure leading to early revision varies between late and early revision cases. (10.1016/j.jse.2015.05.035)
  • [L3] Patients undergoing revision due to dislocation face a higher risk of postoperative dislocation, and those with a history of previous revisions tend to have a higher risk of rerevision. (10.1016/j.arth.2025.07.047)
  • [L3] Patients revised to metal-on-metal bearings had higher rates of re-revision, but those not requiring re-revision had good functional results. (10.1302/0301-620x.96b12.33473)
  • [L3] The lowest risk was observed after one-stage revision; however, this may partly reflect patient selection, as one-stage revision may not be suitable for all patients. (10.1002/ksa.12762)
  • [L3] Up to 5 years of follow-up, there were no differences in revision rates for LP compared with LF; however, LP was associated with fewer postoperative complications than LF. (10.5435/jaaos-d-22-00106)
  • [L3] Revision reverse shoulder arthroplasty demonstrates significant long-term clinical improvements and an implant survival rate of 85% at ten years. (10.1302/0301-620x.107b11.bjj-2025-0436.r1)
  • [L1] Over 80% of revision replacements last 5 years and over 70% last 10 years. (10.1177/24715492221095991)
  • [Commentary] The best opportunity for optimal outcomes is a well-executed primary surgery to avoid the need for repeat revision. (10.1016/j.arthro.2021.05.055)
  • [L4] Post-revision antibiotic therapy was associated with an infection-free survival rate of 91% at a mean of >4 years of follow-up. (10.2106/jbjs.20.02263)
  • [L3] Positive cultures during the first stage revision and elevated CRP levels prior to the second stage revision are also associated with increased reinfection risk. (10.1186/s12891-024-07840-0)
  • [L3] Revision of UKR to TKR for unexplained pain generally results in a less favourable outcome than revision for a known cause of pain, implying that revision surgery is not necessarily the solution for patients with pain of unknown origin. (10.1302/0301-620x.95b9.31085)
  • [L4] As is typical of revision surgery, complications are common and can compromise results. (10.1016/j.jse.2018.10.026)
  • [L4] Revision RCR improves clinical outcomes and shoulder function at midterm follow-up. (10.1177/0363546518786006)
  • [L4] Revisions for humeral loosening yield modest clinical improvements, but patients are more likely to experience complications resulting in rerevision. (10.1016/j.jse.2023.02.006)
  • [L4] General revision surgery for the entire complaint is not the aim of the treatment; the specific problem should be extracted and solved with the most limited procedure possible. (10.1007/s001670050091)
  • [L4] Two-stage revision procedures are substantially more complex than primary procedures. (10.1016/j.arth.2022.01.006)
  • [L4] Although reported success rates are high and comparable with complete revision arthroplasty, the quality of the included studies is poor. (10.5435/jaaos-d-19-00457)
  • [L4] Contemporary long cemented revision stems were associated with a low risk for femoral re-revision at 10 years, with no influence of demographics, cause for revision, or surgical factors. (10.1016/j.arth.2025.11.011)
  • [L3] This study suggests that failure rates and complications following rTKA remain high compared to primary procedures, with increased risk for overall re-reoperation and early readmission at 30 days. (10.1016/j.arth.2026.01.024)
  • [L4] The authors present a classification system and algorithmic approach to guide femoral reconstruction in revision total hip arthroplasty, recommending specific implant strategies based on the type of femoral deficiency to ensure stability and osseointegration. (10.2106/00004623-200300004-00001)
  • [L3] These findings suggest that dynamic pelvic behavior may contribute to anterior instability patterns and highlight the potential relevance of hip–spine assessment in patients undergoing anterior-approach THA. (10.1186/s42836-026-00386-7)
  • [L3] Short-term clinical outcomes of patients undergoing revision rotator cuff repair were similar to primary rotator cuff repair. (10.1016/j.jse.2015.05.015)
  • [L4] Patients undergoing revision after HRA can expect to achieve function and quality of life similar to their best after their primary surgery, while the risk of re-­revision is low. (10.1302/0301-620x.102b10.bjj-2020-0147.r2)
  • [L3] The real success rate of two-stage revision may not be as high as previously reported, with exclusion of patients who do not undergo reimplantation resulting in a 9% overestimation of the success rate. (10.1302/0301-620x.102b12.bjj-2020-0792.r1)
  • [L3] Especially, the detailed analysis of intraoperative and postoperative complications and the shoulder function at the time of revision offers new information in addition to the results of other registries. (10.1016/j.jseint.2020.12.003)
  • [L2] Re-revision rates were similar between revised UKRs and TKRs, but considerably higher than for primary TKR, therefore UKR cannot be considered an intermediate procedure. (10.1016/j.arth.2020.08.063)
  • [L3] Repeat two-stage revision for recurrent knee PJI yields low infection control rates and major morbidity, including a 23% amputation rate. (10.1016/j.arth.2026.01.057)
  • [L3] Revision of UKA more frequently requires revision components with increased operation duration but fewer complications requiring re-operation compared with revision of HTO. (10.1302/0301-620x.99b10.bjj-2017-0034.r1)
  • [L1] Future studies should focus on patient- and surgery-specific factors that could maximize the safety and efficacy of revision TKA. (10.1016/j.arth.2025.06.085)
  • [L4] At long-term follow-up, both hemiarthroplasty and total shoulder arthroplasty continue to provide lasting pain relief and improved range of motion, with survivorship in excess of 75% at 20 years. (10.1016/j.jse.2014.07.016)
  • [L3] The majority of revision shoulder arthroplasties are performed for patients who are unlikely to have a PJI, with less than 10% meeting ICM criteria for definite PJI. (10.1016/j.jse.2025.01.040)
  • [L3] The risk of revision in patients younger than 55 years depends on surgical approach, head size and bearing type. (10.1186/s12891-019-2765-z)
  • [L3] In this cohort, the presence of low-grade infection did not increase the risk of re-revision. (10.1302/0301-620x.103b6.bjj-2020-2002.r1)
  • [L4] PJI is the most common indication for secondary TKA revision and within one year after primary TKA. (10.1186/s12891-018-2314-1)
  • [L4] Complications are not uncommon, and steps should be taken to mitigate hip instability. (10.2106/jbjs.18.00522)
  • [L3] The need for readmission and reoperation was also similar across surgical approaches for various revision THA procedures. (10.1016/j.arth.2025.02.062)
  • [L3] Continuous dynamic stability of the hip may have contributed to the slight increase in the cumulative risk of dislocation after 1 month. (10.1016/j.arth.2016.05.042)
  • [L2] For experienced hip surgeons, the learning curve for avoiding early complications was short (25 cases or less), while the learning curve for achieving desired component positioning radiographically was much longer (75 to 100 cases or more). (10.1007/s11999-009-1106-1)
  • [L4] However, increasing symptoms and decreased function related to degenerative hip disease may occur fifteen to twenty years after the procedure. (10.2106/00004623-199701000-00009)
  • [L4] The use of a high hip center did not adversely affect function of the abductor muscles, and the mean limb-length discrepancy was reduced by the femoral reconstruction. (10.2106/00004623-199904000-00004)
  • [L5] Instability after hip arthroplasty is a common and devastating complication with multifactorial causes. (10.1016/j.arth.2018.01.053)
  • [L3] The overall midterm risk of revision after RSA for CTA was low (5%). (10.1016/j.jse.2018.02.060)
  • [L3] Dual-mobility components may be protective against dislocation compared with smaller-diameter femoral head sizes. (10.1302/0301-620x.107b10.bjj-2024-1637.r1)
  • [L4] ALIF has proven effective for revision lumbar fusion surgery, yielding positive clinical and radiographic results. (10.1186/s13018-023-03972-6)
  • [L5] Gadolinium intra-articular contrast magnetic resonance imaging is not required for every patient undergoing hip arthroscopy, but contrast magnetic resonance imaging plus computed tomography with 3-dimensional reconstruction are essential for patients requiring revision. (10.1016/j.arthro.2022.12.008)
  • [L4] This study shows that 1 year after second-stage knee revision surgery, kinematic and kinetic values remain lower than those observed in a normal reference population. (10.1007/s00167-014-3376-8)
  • [L3] Clinical outcomes did not differ significantly between cases with gluteal repair and those without tears, suggesting abductor tears may be repaired at time of hip arthroplasty without forgoing desirable functional outcomes. (10.1186/s12891-025-08298-4)
  • [L4] The constrained acetabular component provides durable protection against additional dislocations without substantial deleterious effects on component fixation. (10.2106/00004623-200411000-00009)
  • [L3] Both second RACLR and nonsurgical management of failed first RACLR were associated with high rates of return to sport. (10.1177/03635465221119202)
  • [L3] The 13 revised hips, treated with bone grafting and the third generation cement technique, were performing well with no re-revisions within ten years after surgery. (10.1186/1471-2474-14-37)
  • [L4] Revision of previously cemented hip arthroplasties with uncemented modular femoral components yielded good mid-term clinical and radiological results. (10.1186/s13018-015-0266-9)
  • [L1] There seems to be no difference between BHA and UHA with regards to hip function at 2 years. (10.1016/j.arth.2021.12.004)
  • [L3] Hybrid fixation (cementless acetabular and cemented femoral components) resulted in lower rates of repeat revision and radiographic loosening for the acetabular component compared to fully cemented revisions. (10.2106/00004623-199607000-00002)
  • [L3] Patients requiring revision surgery after primary hip arthroscopy for femoroacetabular impingement syndrome presented with smaller postoperative labral size (less than 1 mm difference) and greater reduction of labral size (at or less than 1mm difference) on MRI 12 months after primary surgery compared with those patients that did not require later revision surgery. (10.1016/j.arthro.2025.01.065)
  • [L5] The authors argue that current classification of borderline hip dysplasia based solely on lateral center edge angle is insufficient and that the focus must shift to assessing hip instability to better predict treatment outcomes and the need for bony realignment. (10.1016/j.arthro.2023.10.023)
  • [L3] Patients who had early revision surgeries had significantly worse clinical outcomes after primary surgery than patients who had late revision surgeries. (10.1007/s00167-020-06333-6)
  • [L4] Greater chondral pathologic abnormalities at revision surgery were associated with reduced function at follow-up. (10.1177/0363546515618381)
  • [L3] There was no significant increased revision rate for all-cause revision or aseptic loosening, or periimplant radiolucencies. (10.1186/s42836-024-00264-0)
  • [L2] With regard to gait kinematics in the early postoperative period (three months), the present study showed no significant benefit for patients who underwent a total hip arthroplasty through a minimally invasive Watson-Jones approach in comparison with those who were managed with a standard transgluteal approach. (10.2106/jbjs.h.01086)
  • [L3] Revision RSA with glenoid bone grafting resulted in good clinical and radiographic outcomes at short-term follow-up. (10.1016/j.jse.2018.06.026)
  • [L3] By utilizing 1-stage revision over DAIR in early infections, it might be possible to improve the prognosis by decreasing the risk of reoperation without increasing mortality. (10.1016/j.arth.2023.08.078)
  • [L4] At a population level, the lifetime risk of revision hip replacement remains low at <1 in 50 people in 2017. (10.2106/jbjs.20.01235)
  • [L3] Operative intervention for recurrent dislocation after THA results in a significantly better functional outcome than non-operative management. (10.1302/0301-620x.97b8.34952)
  • [L3] Revision total hip arthroplasty with the BIAS femoral component provided similar clinical results but inferior radiographic fixation compared with modern cementing techniques, though reconstitution of femoral bone structure was encouraging. (10.2106/00004623-199408000-00004)
  • [L3] Late revision surgeries for nonunion were more than twice as common as those for adjacent segment disease and occurred earlier and more commonly when a greater number of levels were used. (10.5435/jaaos-d-24-01171)
  • [L4] Spinopelvic stiffness is associated with increased age and increased femoral motion, which may lead to impingement and dislocation. (10.2106/jbjs.18.00078)
  • [L5] A revision operation should be considered only if extensive non-operative treatment has failed in a motivated patient, and success is most probable if a correctable anatomical lesion ignored at the first procedure is identified. (10.2106/00004623-199802000-00016)
  • [L5] Nonsurgical treatment is generally unsuccessful; major malposition of components is best managed by implant revision. (10.5435/00124635-200309000-00009)
  • [L3] Non-surgical treatment of a concomitant MCL injury in the setting of an ACL reconstruction may increase the risk of ACL revision. (10.1007/s00167-018-5237-3)
  • [L3] The overall 15-year revision rate was estimated as 7.1%. (10.1177/03635465251316308)
  • [L3] Early dislocation within 7 days of surgery has similar all cause revision-free survivorship, but an increased risk of a subsequent revision for instability when compared to patients who dislocated within 7 to 90 days. (10.1016/j.arth.2024.06.013)

References

[1] Long-Term_Survival_of_Semi-Constrained_Total_Knee_Arthroplasty_for_Revision_Surg_S0883540313008115. n.d..

[2] Survivorship analysis of revision reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.11.024

[3] High early complication risk but low risk of re‐revision beyond 5 years following revision knee arthroplasty in the elderly: An analysis of 2833 cases using real‐world data from an international database. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.70190

[4] Which factors influence the rate of failure following metal-on-metal hip arthroplasty revision surgery performed for adverse reactions to metal debris?. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b8.bjj-2016-0889.r1

[5] Re-revision and mortality rate following revision total hip arthroplasty for infection. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b6.bjj-2023-1181.r1

[6] Similar Medium-Term Revision Rates Following Acute Total Hip Arthroplasty Versus Open Reduction and Internal Fixation for Acetabular Fractures in the Elderly. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-00771

[7] Recurrent Lumbar Disk Herniation and Revision Surgery Rates After Single-Level Lumbar Microdiscectomy in the Military Population. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00879

[8] Isolated tibial insert exchange in revision total knee arthroplasty. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b6.bjj-2020-1954.r2

[9] Relative Risk of Complications Following Revision Hip and Knee Arthroplasty in the Medicare Population. The Journal of Arthroplasty. 2009. DOI: 10.1016/j.arth.2008.11.096

[10] Complications and implant survivorship following primary reverse total shoulder arthroplasty in patients younger than 65 years: a systematic review. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.02.004

[11] What is the optimal management of a loose glenoid component after anatomic total shoulder arthroplasty: a systematic review. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.10.006

[12] Low risk of revision after reverse shoulder arthroplasty for acute proximal humeral fractures. JSES International. 2020. DOI: 10.1016/j.jses.2019.10.114

[13] Inferior clinical outcomes and higher subjective treatment failure after revision compared to primary posterior cruciate ligament reconstruction: A propensity score‐matched analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70323

[14] Early revision within 1 year after shoulder arthroplasty: patient factors and etiology. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.05.035

[15] Cementing Liners Into Well-Fixed Acetabular Components in Revision Total Hip Arthroplasty: A Mean 7.7-Year Follow-Up. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.07.047

[16] Predictors of time to revision and clinical outcomes following revision of metal-on-metal hip replacements for adverse reaction to metal debris. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b12.33473

[17] Clinical outcomes after revision knee arthroplasty due to periprosthetic joint infection: A single‐centre study of 359 knees at a high‐volume centre with a minimum of one year follow‐up. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.12762

[18] Cervical Laminoplasty Versus Posterior Laminectomy and Fusion: Trends in Utilization and Evaluation of Complication and Revision Surgery Rates. Journal of the American Academy of Orthopaedic Surgeons. 2022. DOI: 10.5435/jaaos-d-22-00106

[19] Long-term results and implant survival of revision reverse shoulder arthroplasty after a mean follow-up of ten years. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b11.bjj-2025-0436.r1

[20] Revision Shoulder Hemiarthroplasty and Total Shoulder Arthroplasty A Systematic Review and Meta-Analysis. Journal of Shoulder and Elbow Arthroplasty. 2022. DOI: 10.1177/24715492221095991

[21] Editorial Commentary: Repeat Revision Hip Arthroscopy: Unaddressed Femoroacetabular Impingement, Labral Damage, and Capsular Deficiency Are Commonly Encountered. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2021.05.055

[22] Oral and IV Antibiotic Administration After Single-Stage Revision Shoulder Arthroplasty. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.02263

[23] A Prospective Outcomes Analysis of Femoral Component Fixation in Revision Total Hip Arthroplasty Comparing Modular, Cementless Fixation with Cemented Femoral Fixation. 2006.

[24] The presence of a sinus tract is associated with reinfection after two-stage revision surgery for prosthetic hip joint infection: a case-control study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07840-0

[25] Revision from unicompartmental to total knee replacement. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b9.31085

[26] Revision of failed hemiarthroplasty and anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.10.026

[27] Clinical Outcomes, Tendon Integrity, and Shoulder Strength After Revision Rotator Cuff Reconstruction: A Minimum 2 Years’ Follow-up. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518786006

[28] Humeral loosening in reverse shoulder arthroplasty: an analysis of 2,342 cases. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.02.006

[29] The dilemma with multiply reoperated knee instabilities. Knee Surgery, Sports Traumatology, Arthroscopy. 1998. DOI: 10.1007/s001670050091

[30] Time Required for Planned and Unplanned Episodes of Care in Septic Two-Stage Revision Hip and Knee Arthroplasty. The Journal of Arthroplasty. 2022. DOI: 10.1016/j.arth.2022.01.006

[31] Selective Component Retainment in the Treatment of Chronic Periprosthetic Infection After Total Hip Arthroplasty: A Systematic Review. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-19-00457

[32] Contemporary Cemented Revision Stems Demonstrate Excellent Survivorship in Revision Total Hip Arthroplasty up to 13-Year Follow-Up. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.11.011

[33] Rising Body Mass Index Increased Early Complications, But Not Early Reoperations Following Aseptic Revision Total Knee Arthroplasty. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.01.024

[34] CLASSIFICATION AND AN ALGORITHMIC APPROACH TO THE RECONSTRUCTION OF FEMORAL DEFICIENCY IN REVISION TOTAL HIP ARTHROPLASTY. The Journal of Bone and Joint Surgery-American Volume. 2003. DOI: 10.2106/00004623-200300004-00001

[35] Spinopelvic mobility patterns in patients with dislocation after THA: Direct anterior versus posterior approach. Arthroplasty. 2026. DOI: 10.1186/s42836-026-00386-7

[36] Primary vs. Revision Arthroscopic Rotator Cuff Repair: An Analysis in 360 Consecutive Patients. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.05.015

[37] Revision_of_Unicompartmental_Knee_Arthroplasty_Versus_Primary_Total_Knee_Arthrop_S0883540314008274. n.d..

[38] What are the results of revised hip resurfacing arthroplasties?. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b10.bjj-2020-0147.r2

[39] Current actual success rate of the two-stage exchange arthroplasty strategy in chronic hip and knee periprosthetic joint infection. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b12.bjj-2020-0792.r1

[40] Analysis of revision shoulder arthroplasty in the German nationwide registry from 2014 to 2018. JSES International. 2021. DOI: 10.1016/j.jseint.2020.12.003

[41] Chapter 12 Hip Microinstability. 2019.

[42] Patients Receiving a Primary Unicompartmental Knee Replacement Have a Higher Risk of Revision but a Lower Risk of Mortality Than Predicted Had They Received a Total Knee Replacement: Data From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. The Journal of Arthroplasty. 2021. DOI: 10.1016/j.arth.2020.08.063

[43] High Failure Rates Following Repeat Two-Stage Revision for Chronic Knee Periprosthetic Joint Infection: A Multicenter Study. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.01.057

[44] Revision total knee arthroplasty for failed high tibial osteotomy and unicompartmental knee arthroplasty have similar patient-reported outcome measures in a two-year follow-up study. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b10.bjj-2017-0034.r1

[45] Etiology of Failure in Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.06.085

[46] Shoulder arthroplasty in patients younger than 50 years: minimum 20-year follow-up. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.07.016

[47] Assessment of periprosthetic joint infection in revision shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.01.040

[48] Retrospective, single-centre analysis comparing clinical outcomes of reverse total shoulder replacement for fracture, degenerative changes and revision procedure. 2025.

[49] The risk of revision after total hip arthroplasty in young patients depends on surgical approach, femoral head size and bearing type; an analysis of 19,682 operations in the Dutch arthroplasty register. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2765-z

[50] Unexpected low-grade infections in revision hip arthroplasty for aseptic loosening. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b6.bjj-2020-2002.r1

[51] Periprosthetic infection is the major indication for TKA revision – experiences from a university referral arthroplasty center. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2314-1

[52] Polyethylene Liner and Femoral Head Exchange in Total Hip Arthroplasty. Journal of Bone and Joint Surgery. 2019. DOI: 10.2106/jbjs.18.00522

[53] Does Surgical Approach Impact Wound Complication Rates after Revision Total Hip Arthroplasty?. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.02.062

[54] Epidemiology of Dislocation Following Direct Anterior Total Hip Arthroplasty: A Minimum 5-Year Follow-Up Study. The Journal of Arthroplasty. 2016. DOI: 10.1016/j.arth.2016.05.042

[55] The Learning Curve for Adopting Hip Resurfacing Among Hip Specialists. Clinical Orthopaedics & Related Research. 2010. DOI: 10.1007/s11999-009-1106-1

[56] Colonna Arthroplasty with Concomitant Femoral Shortening and Rotational Osteotomy. Long-Term Results. The Journal of Bone and Joint Surgery-American Volume*. 1997. DOI: 10.2106/00004623-199701000-00009

[57] Does_Deformation_of_Metal-On-Metal_Acetabular_Components_Contribute_to_Early_Fai_S0883540310000367. n.d..

[58] High Placement of an Acetabular Component Inserted without Cement in a Revision Total Hip Arthroplasty. Results After a Mean of Ten Years. The Journal of Bone & Joint Surgery*. 1999. DOI: 10.2106/00004623-199904000-00004

[59] Editorial—The Prevention and Management of Instability in THA. The Journal of Arthroplasty. 2018. DOI: 10.1016/j.arth.2018.01.053

[60] Risk and risk factors for revision after primary reverse shoulder arthroplasty for cuff tear arthropathy and osteoarthritis: a Nordic Arthroplasty Register Association study. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.02.060

[61] The cumulative incidence of dislocation and revision surgery following total hip arthroplasty for hip fracture in New South Wales. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b10.bjj-2024-1637.r1

[62] Surgical outcomes of anterior lumbar interbody fusion in revision lumbar interbody fusion surgery. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03972-6

[63] Editorial Commentary : Gadolinium Intra‐Articular Contrast Magnetic Resonance Imaging Is Not Required for Every Patient Undergoing Hip Arthroscopy, but Contrast Magnetic Resonance Imaging Plus Computed Tomography With 3‐Dimensional Reconstruction Are Essential for Patients Requiring Revision. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2022.12.008

[64] Does knee revision after an articulated spacer implant provide normal gait restoration?. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3376-8

[65] Degenerative gluteal tears associated with hip arthroplasty. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08298-4

[66] Salvage of a Recurrently Dislocating Total Hip Prosthesis with Use of a Constrained Acetabular Component: A Concise Follow-up of a Previous Report. The Journal of Bone and Joint Surgery-American Volume*. 2004. DOI: 10.2106/00004623-200411000-00009

[67] Management of the Failed First Revision ACL Reconstruction: Clinical Outcomes of Nonsurgical Management Versus Second Revision ACL Reconstruction From the SANTI Group. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221119202

[68] Long-term results of cemented total hip arthroplasty in patients younger than 30 years and the outcome of subsequent revisions. BMC Musculoskeletal Disorders. 2013. DOI: 10.1186/1471-2474-14-37

[69] Mid-term results of previously cemented hip arthroplasties revised with uncemented modular femoral components: a retrospective study. Journal of Orthopaedic Surgery and Research. 2015. DOI: 10.1186/s13018-015-0266-9

[70] Should We Use Bipolar Hemiarthroplasty in Patients ≥70 Years Old With a Femoral Neck Fracture? A Review of Literature and Meta-Analysis of Randomized Controlled Trials. The Journal of Arthroplasty. 2022. DOI: 10.1016/j.arth.2021.12.004

[71] Revision of a Failed Cemented Total Hip Prosthesis with Insertion of an Acetabular Component without Cement and a Femoral Component with Cement. A Five to Eight-Year Follow-up Study. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199607000-00002

[73] Patients Requiring Revision Surgery After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome Show a Small Reduction of Postoperative Labral Size: A Propensity‐Matched Controlled Study. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2025.01.065

[74] We Need Better Classification of Patients With Borderline Hip Dysplasia: Shifting the Focus From Dysplasia to Instability. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2023.10.023

[75] Clinical differences between patients with early and late revision surgery for symptomatic failed arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06333-6

[76] Return-to-Sport Outcomes After Revision Anterior Cruciate Ligament Reconstruction Surgery. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515618381

[77] Is there an increased revision rate due to early tibial component loosening with a modern total knee arthroplasty design? A retrospective analysis from a large volume arthroplasty centre. Arthroplasty. 2024. DOI: 10.1186/s42836-024-00264-0

[78] Minimally Invasive Compared with Traditional Transgluteal Approach for Total Hip Arthroplasty. The Journal of Bone & Joint Surgery. 2010. DOI: 10.2106/jbjs.h.01086

[79] Comparison of radiographic and clinical outcomes of revision reverse total shoulder arthroplasty with structural versus nonstructural bone graft. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.06.026

[80] One-Component_Revision_in_Total_Hip_Arthroplasty_The_Fate_of_the_Retained_Compon_S088354031400312X. n.d..

[81] Clinical Outcomes After Revision Hip Arthroplasty due to Prosthetic Joint Infection—A Single-Center Study of 369 Hips at a High-Volume Center With a Minimum of One Year Follow-Up. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.08.078

[82] Lifetime Risk of Revision Hip Replacement Surgery in Australia Remains Low. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.01235

[83] The functional and financial impact of isolated and recurrent dislocation after total hip arthroplasty. The Bone & Joint Journal. 2015. DOI: 10.1302/0301-620x.97b8.34952

[84] Revision total hip arthroplasty with the BIAS (Biologic Ingrowth Anatomic System) femoral component. Three to six-year results.. The Journal of Bone & Joint Surgery. 1994. DOI: 10.2106/00004623-199408000-00004

[85] Durability of Anterior Cervical Discectomy and Fusion: A Survivorship Analysis Based on Revision Surgery Rates. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01171

[86] Late Dislocation Following Total Hip Arthroplasty. Journal of Bone and Joint Surgery. 2018. DOI: 10.2106/jbjs.18.00078

[87] Instability of the Shoulder. The Journal of Bone and Joint Surgery (American Volume). 1998. DOI: 10.2106/00004623-199802000-00016

[88] The Unstable Patella After Total Knee Arthroplasty: Etiology, Prevention, and Management. Journal of the American Academy of Orthopaedic Surgeons. 2003. DOI: 10.5435/00124635-200309000-00009

[89] Increased risk of ACL revision with non-surgical treatment of a concomitant medial collateral ligament injury: a study on 19,457 patients from the Swedish National Knee Ligament Registry. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5237-3

[90] Revision Anterior Cruciate Ligament Reconstruction: Surgeon-Reported Causes of Failure From the Norwegian Knee Ligament Register. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251316308

[92] Early Prosthetic Hip Dislocation: Does the Timing of the Dislocation Matter?. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.06.013

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j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.