{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T23:11:03Z","timestamp":1783725063086,"version":"3.55.0"},"update-to":[{"DOI":"10.1371\/journal.pmed.1004538","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000}}],"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","award":["NIHR203331"],"award-info":[{"award-number":["NIHR203331"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Implant revision is an operation with exchange of implants, and is used as a standard outcome after total hip replacement (THR), but may not fully represent the patient experience after a THR. Major reoperation (hereafter referred to as \u2018reoperation\u2019) without revision of implants can also lead to increased patient morbidity and mortality, and most commonly occurs when the femur fractures around an implant (postoperative periprosthetic femoral fractures; POPFF) and is treated with fixation and the implant is left in place. Reliance on revision metrics that do not capture these reoperations has led to large-scale underreporting of reoperations in THR, and is likely to have affected implant performance estimates, which have guided national policy and implant selection. It is important to include these additional reoperations when estimating treatment success to guide innovation and clinical practice. We aimed to estimate the incidence of reoperation following primary THR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>We performed a large national cohort study on a mandatory, prospective database, the National Joint Registry, linked to Hospital Episode Statistics. All linkable primary THRs using recently available implants, with highest safety ratings between 01\/01\/2010 and 31\/12\/2020, were included. Major reoperation was defined as the first revision for any cause or fixation of POPFF and was identified using a combination of procedural and diagnosis codes. We identified 372,967 THRs representing 2,127,464 prostheses years at risk with a median follow-up time of 5.39 years (range 0 to 12.1 years). A total of 8,043 reoperations were identified that had been surgically treated by revision for any cause or fixation of POPFF. The incidence of reoperation was 3.78% (95% confidence interval [CI 3.70%, 3.86%]) per 1,000 prostheses years in comparison to 3.00% (95% CI [2.93%, 3.07%]) per 1,000 prostheses years when using conventional revision only outcomes. Cumulative incidence of major reoperation at 10 years was 3.1% (95% CI [3.0%, 3.1%]). Cumulative reoperation estimates were stratified by age and sex. In men aged 68 years and older, collared cementless stems performed better than cemented stems and in women aged 75 years and older, the relationship was reversed. Residual differences in patient characteristics may affect the accuracy of the estimates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Treatment failure after THR has been underrepresented by revision-only estimates. Major reoperation rates in older men were lowest with cementless collared stems, and in older women, reoperation rates were lowest with cemented polished taper stems made of stainless steel. These results prompt a review of the current implant guidance for hip replacements in older patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>III (Retrospective cohort study).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004538","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T18:41:38Z","timestamp":1764182498000},"page":"e1004538","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["The association between implant design, age, sex and the rate of major reoperation in patients undergoing primary total hip replacement: A retrospective study of UK National Joint Registry and Hospital Episodes Statistics data"],"prefix":"10.1371","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0166-9406","authenticated-orcid":true,"given":"Josh N.","family":"Lamb","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7452-5043","authenticated-orcid":true,"given":"Adrian","family":"Sayers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5577-3674","authenticated-orcid":true,"given":"Jeremy Mark","family":"Wilkinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemant","family":"Pandit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Whitehouse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"issue":"10172","key":"pmed.1004538.ref001","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/S0140-6736(18)31665-9","article-title":"How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up","volume":"393","author":"JT Evans","year":"2019","journal-title":"Lancet"},{"issue":"10158","key":"pmed.1004538.ref002","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/S0140-6736(18)31777-X","article-title":"Hip replacement","volume":"392","author":"RJ Ferguson","year":"2018","journal-title":"Lancet"},{"issue":"5","key":"pmed.1004538.ref003","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1302\/0301-620X.94B5.27073","article-title":"A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff","volume":"94","author":"IS Vanhegan","year":"2012","journal-title":"J Bone Joint Surg Br"},{"issue":"10","key":"pmed.1004538.ref004","article-title":"The incidence of postoperative periprosthetic femoral fracture following total hip replacement: an analysis of UK National Joint Registry and Hospital Episodes statistics data","volume":"21","author":"JN Lamb","year":"2024","journal-title":"PLoS Med"},{"issue":"3","key":"pmed.1004538.ref005","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1177\/1120700018779558","article-title":"Incidence and demographics of 1751 surgically treated periprosthetic femoral fractures around a primary hip prosthesis","volume":"29","author":"G Chatziagorou","year":"2019","journal-title":"Hip Int"},{"issue":"2","key":"pmed.1004538.ref006","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1302\/0301-620X.103B2.BJJ-2020-0695.R1","article-title":"Vancouver B periprosthetic fractures involving the Exeter cemented stem","author":"MFR Powell-Bowns","year":"2021","journal-title":"Bone Joint J"},{"issue":"3","key":"pmed.1004538.ref007","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1302\/0301-620X.102B3.BJJ-2019-0935.R1","article-title":"Treatment and outcomes of Vancouver type B periprosthetic femoral fractures","author":"H Zheng","year":"2020","journal-title":"Bone Joint J"},{"key":"pmed.1004538.ref008","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.f7592","article-title":"Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations","volume":"348","author":"KT M\u00e4kel\u00e4","year":"2014","journal-title":"BMJ"},{"key":"pmed.1004538.ref009","unstructured":"Briggs T. 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