Dislocation is a Leading Cause of Decreased Survival Rate in Primary Total Hip Arthroplasty Performed by Low-Volume Surgeons: Long-Term Retrospective Cohort Study.

Abstract Background This study aimed to evaluate the complications and long-term survival of primary total hip arthroplasty (THA) performed by low-volume surgeons at a low-volume hospital. We also determined the relationship between complications and revisions. Methods This retrospective cohort study included 220 THAs in 194 patients treated at our institution between 1998 and 2008, who received a minimum of a 10-year follow-up. The median annual THA volume at this hospital was 23 procedures (range, 11–32), and the annual volume per surgeon ranged from 1 to 19. We investigated the 90-day mortality and rates of periprosthetic joint infections, dislocations, and periprosthetic fractures up to the last visit (median follow-up, 11.8 years). Kaplan–Meier survival was calculated with revision as the end point. Results Postoperative infections, dislocations, and fractures at any time during the follow-up period were reported for one hip (0.5%), 23 hips (9.8%), and four hips (1.8%), respectively. One death occurred within the first 90 days postoperatively. Fifteen hips required revision surgery, and the survival rate was 95.5% at 5 years and 94.1% at 10 years. Of 10 hips that required early revision surgery within 5 years after the index surgery, nine were revisions to address recurrent dislocation. Conclusion The risk of dislocation was high. A high number of patients who underwent THA by low-volume surgeons required early revision due to dislocation. To achieve optimal long-term survivorship, low-volume surgeons should consider measures to reduce the risk of dislocation.