Effect of hydroxyapatite coating on risk of revision after primary total hip arthroplasty in younger patients: findings from the Danish Hip Arthroplasty Registry

Background The effect of hydroxyapatite (HA) on implant survival in the medium and long term is uncertain. We studied the effect of HA coating of uncemented implants on the risk of cup and stem revision in primary total hip arthroplasty (THA).

Patients and methods Using the Danish Hip Arthroplasty Registry (DHR), we identified patients less than 70 years old who had undergone uncemented primary THA during 1997-2005. 4,125 HA-coated and 7,737 non-HA-coated cups and 3,158 HA-coated and 4,749 non-HA-coated stems were available for analysis. The mean follow-up time was 3.4 years for cups and 3.2 years for stems. We estimated the relative risk (RR) of revision due to aseptic loosening or any cause, and adjusted for possible confounders (age, sex, fixation of opposite implant part, and diagnosis for primary THA) using multivariate Cox regression analysis.

Results The adjusted RRs for revision of HA-coated cups and stems due to aseptic loosening were 0.89 (95%CI: 0.37-2.2) and 0.71 (95%CI: 0.27-1.9) with up to 9 years of follow-up, compared to non-HA-coated implants. When taking all causes of revision into consideration, the risk estimates were 0.85 (95%CI: 0.68-1.1) and 0.81 (95%CI: 0.61-1.1) for HA-coated cups and stems, respectively.

Interpretation In this medium-term follow-up study, the use of HA-coated implants was not associated with any clearly reduced overall risk of revision compared to non-HA-coated implants.     

Increasing risk of revision due to deep infection after hip arthroplasty: A study on 97,344 primary total hip replacements in the Norwegian Arthroplasty Register from 1987 to 2007

Background and purpose Over the decades, improvements in surgery and perioperative routines have reduced the incidence of deep infections after total hip arthroplasty (THA). There is, however, some evidence to suggest that the incidence of infection is increasing again. We assessed the risk of revision due to deep infection for primary THAs reported to the Norwegian Arthroplasty Register (NAR) over the period 1987–2007.Method We included all primary cemented and uncemented THAs reported to the NAR from September 15, 1987 to January 1, 2008 and performed adjusted Cox regression analyses with the first revision due to deep infection as endpoint. Changes in revision rate as a function of the year of operation were investigated.Results Of the 97,344 primary THAs that met the inclusion criteria, 614 THAs had been revised due to deep infection (5-year survival 99.46%). Risk of revision due to deep infection increased throughout the period studied. Compared to the THAs implanted in 1987–1992, the risk of revision due to infection was 1.3 times higher (95%CI: 1.0–1.7) for those implanted in 1993–1997, 1.5 times (95% CI: 1.2–2.0) for those implanted in 1998–2002, and 3.0 times (95% CI: 2.2–4.0) for those implanted in 2003–2007. The most pronounced increase in risk of being revised due to deep infection was for the subgroup of uncemented THAs from 2003–2007, which had an increase of 5 times (95% CI: 2.6–11) compared to uncemented THAs from 1987–1992.Interpretation The incidence of deep infection after THA increased during the period 1987–2007. Concomitant changes in confounding factors, however, complicate the interpretation of the results.     

Risk factors for revision for early dislocation in total hip arthroplasty

Risk factors were investigated for revision for dislocation in primary total hip arthroplasties (THAs) between September 1, 1999, and December 31, 2004, as reported by the Australian Orthopaedic Association National Joint Replacement Registry. For 65 992 primary THAs, the only initial diagnoses with significantly increased relative risk (RR) of revision for dislocation compared to osteoarthritis were fractured neck of femur (RR, 2.03; P < .001), rheumatoid arthritis (RR, 2.01; P < .01), and avascular necrosis (RR, 1.57; P < .05). A total of 58 109 primary THAs for osteoarthritis were investigated for effect of age group, sex, and fixation method. There were 428 (0.7%) revisions for dislocation, 369 (0.8%) with a cementless acetabulum, and 59 (0.6%) with cemented acetabulum (RR, 1.59; P < .01). There is a significantly increasing risk of revision for dislocation as head size decreases (P < .001). Cementless acetabula, particularly with smaller heads, have a higher rate of revision for dislocation.     

Increasing but levelling out risk of revision due to infection after total hip arthroplasty: a study on 108,854 primary THAs in the Norwegian Arthroplasty Register from 2005 to 2019

Background and purpose — Focus on prevention, surveillance, and treatment of infection after total hip arthroplasty (THA) in the last decade has resulted in new knowledge and guidelines. Previous publications have suggested an increased incidence of surgical revisions due to infection after THA. We assessed whether there have been changes in the risk of revision due to deep infection after primary THAs reported to the Norwegian Arthroplasty Register (NAR) over the period 2005–2019.Patients and methods — Primary THAs reported to the NAR from January 1, 2005 to December 31, 2019 were included. Adjusted Cox regression analyses with the first revision due to deep infection after primary THA were performed. We investigated changes in the risk of revision as a function of time of primary THA. Time was stratified into 5-year periods. We studied the whole population of THAs, and the subgroups: all-cemented, all-uncemented, reverse hybrid (cemented cup), and hybrid THAs (cemented stem). In addition, we investigated factors that were associated with the risk of revision, and changes in the time span from primary THA to revision.Results — Of the 108,854 primary THAs that met the inclusion criteria, 1,365 (1.3%) were revised due to deep infection. The risk of revision due to infection, at any time after primary surgery, increased through the period studied. Compared with THAs implanted in 2005–2009, the relative risk of revision due to infection was 1.4 (95% CI 1.2–1.7) for 2010–2014, and 1.6 (1.1–1.9) for 2015–2019. We found an increased risk for all types of implant fixation. Compared to 2005–2009, for all THAs, the risk of revision due to infection 0–30 days postoperatively was 2.2 (1.8–2.8) for 2010–2014 and 2.3 (1.8–2.9) for 2015–2019, 31–90 days postoperatively 1.0 (0.7–1.6) for 2010–2014 and 1.6 (1.0–2.5) for 2015–2019, and finally 91 days–1 year postoperatively 1.1 (0.7–1.8) for 2010–2014 and 1.6 (1.0–2.6) for 2015–2019. From 1 to 5 years postoperatively, the risk of revision due to infection was similar to 2005–2009 for both the subsequent time periodsInterpretation — The risk of revision due to deep infection after THA increased throughout the period 2005–2019, but appears to have levelled out after 2010. The increase was mainly due to an increased risk of early revisions, and may partly have been caused by a change of practice rather than a change in the incidence of infection.

“Postoperative infection is the saddest of all complications…” John Charnley postulated in 1982 (Waugh and Charnley 1990). Despite advances in knowledge and awareness of prophylactic perioperative routines, there are indications that the incidence of infections after total hip arthroplasty (THA) is still increasing (Dale et al. 2012, Parvizi et al. 2013, Lenguerrand et al. 2017, Parvizi et al. 2017, Brochin et al. 2018, Kurtz et al. 2018). To disclose changes in the risk of infection we need a large number of primary THAs, registered in a uniform manner. The Norwegian Arthroplasty Register (NAR) found an increasing risk of deep infection after primary THA during the years 1987–2007. Over 10 years ago, Kurtz et al. (2007) projected a substantial demand for revisions due to infection in the coming decades. We have now assessed changes in the risk of surgical revision due to deep infection for THAs reported to the NAR during the years 2005 to 2019, as a follow-up of our previous study (Dale et al. 2009). In addition, we investigated factors that could be associated with revision, and the time span between primary and revision surgery.     

人工全髋关节置换术后早期手术部位感染的危险因素分析

目的探讨人工全髋关节置换术（THA）后早期手术部位感染的危险因素。方法回顾分析2000年1月至2010年10月本组所行153例单侧THA的患者,其中男46例,女107例,年龄29～79岁,平均（61．0±8．9）岁。回顾性分析多项临床因素与手术部位感染的相关性。连续变量包括：年龄、手术时间、手术出血量、术前白蛋白血清浓度、伤口引流管停留时间;分类变量包括：性别、有无长期使用激素病史、是否合并糖尿病、有无前次手术史、是否使用骨水泥、预防性抗生素使用方案。153例患者按照是否发生手术部位感染分成两组,对连续变量采用f检验、分类变量采用√检验进行比较。结果153例患者中8例出现手术部位感染,发生率为5．23％。单因素分析发现术前白蛋白血清浓度因素差异有统计学意义（t=2．752,P〈0．05）;白蛋白〈35g／L与白蛋白〉35g／L比较差异有统计学意义（岔=7．23,P〈0．05）。有无长期口服激素、有无前次手术比较差异有统计学意义（其Х^2值分别为3．93与12．38,P〈0．05）。年龄、性别、手术时间、术中出血量、抗生素使用时间、引流管停留时间、是否合并糖尿病、是否使用骨水泥等因素对手术部位感染发生无影响,均无统计学差异。结论THA术前低蛋白血症、前次手术史、长期口服激素史是手术部位感染的高危因素。     

Risk factors for pulmonary embolism after hip and knee arthroplasty: a population-based study

Pulmonary embolism (PE) is a cause of death after total hip and knee arthroplasty (THA, TKA). We characterised the patient population suffering from in-hospital PE and identified perioperative risk factors associated with PE using nationally representative data. Data from the National Hospital Discharge Survey between 1990 and 2004 on patients who underwent primary or revision THA/TKA in the United States were analysed. Multivariate regression analysis was performed to determine if perioperative factors were associated with increased risk of in-hospital PE. An estimated 6,901,324 procedures were identified. The incidence of in-hospital PE was 0.36%. Factors associated with an increased risk for the diagnosis of PE included: revision THA, female gender, dementia, obesity, renal and cerebrovascular disease. An increased association with PE was found among patients with diagnosis of Adult Respiratory Distress Syndrome (ARDS), psychosis (confusion), and peripheral thrombotic events. Our findings may be useful in stratifying the individual patient’s risk of PE after surgery.     

Trochanteric osteotomy in primary and revision total hip arthroplasty: risk factors for non-union

Background  

Trochanteric osteotomies (TO) facilitate exposure and “true hip reconstruction” in complex primary and revision total hip arthroplasty (THA). However, non-union represents a clinically relevant complication. The purpose of the present study was to identify risk factors for trochanteric non-union.     

全髋关节置换术后感染的诊断和二期翻修

全髋关节置换术(THA)后感染一旦发生,通常意味着手术失败,处理相当棘手。明确THA后感染的诊断,寻求有效的治疗方法尤为重要。至今尚未建立THA后感染的统一诊断标准,目前的诊断需结合临床表现、血清学检查、影像学资料、术中所见、组织学和细菌学检查结果并作综合分析。THA后感染治疗方法包括单独应用抗生素、关节清理、一期翻修、二期翻修、关节切除成形、关节融合,甚至截肢,但以二期翻修较为常用且有效。该文就THA后感染的诊断、二期翻修治疗效果作一综述。     

Risk factors for total ankle arthroplasty failure: A Dutch Arthroplasty Register study

BackgroundStudies concerning total ankle arthroplasty could be influenced by several forms of bias. Independent national arthroplasty registries represent objective data on survival and patient reported outcomes. The aim of this study was to determine survival and identify risk factors for early failure in a nationwide series of total ankle arthroplasties from the Dutch Arthroplasty Register (LROI).Patients and methodsData of 810 patients, who received 836 total ankle arthroplasties between 2014 and 2020 were obtained from the Dutch Arthroplasty Register (LROI) with a median follow-up of 38 months (range 1–84 months). Survival was expressed in Kaplan-Meier analysis and associated hazard ratios for implant failure were determined. Implant failure was defined as the need for revision surgery for any reason or (pan)arthrodesis.ResultsDuring follow-up, we recorded 39 failures (4.7%) resulting in a implant survival of 95.3% with a median follow-up of 38 months (range 1–84 months). Medial malleolus osteotomy (HR = 2.27), previous surgery (HR = 1.83), previous osteotomy (HR = 2.82) and previous ligament reconstruction (HR = 2.83) all showed potentially clinically meaningful associations with a higher incidence of implant failure, yet only previous OCD treatment (HR = 6.21), BMI (HR = 1.09) and age (HR = 0.71) were statistically significant.InterpretationExcellent short-term survival (95.3%) with a median follow-up of 38 months was reported for TAA patients from the Dutch Arthroplasty Register. Patients with a lower age, a higher BMI or who had a prior surgical OCD treatment before TAA surgery appear to have a higher risk for revision after short-term clinical follow-up. Thorough patient selection with emphasis on risk factors associated with early implant failure might be essential to improve TAA survivorship.     

Dislocation and infection after revision total hip arthroplasty: comparison between the first and multiply revised total hip arthroplasty

Dislocation and infection are common complications of total hip arthroplasty (THA). This study evaluated the correlation between the number of revision THAs and the incidence of these complications. Data were obtained from 749 revision THAs. Average follow-up was 13.2 ± 5.9 years. Patients were grouped as first, second, third, and fourth or greater revision THA. Dislocation rates (5.68%, 7.69%, 8.33%, and 27.45%) and infection rates (1.35%, 1.92%, 2.5%, and 7.84%) in the first, second, third, and fourth or greater groups, respectively, correlated directly with the revision number and were highest (P < .001) in the fourth or greater group. Dislocation and infection are exponentially correlated with the number of revision THA. From the fourth revision onward, those risks are multiplied.     

Risk factors for readmission within thirty days following revision total hip arthroplasty

BackgroundThe number of total hip arthroplasties (THA) being performed has been steadily increasing for decades. With increased primary THA surgical volume, revision THA numbers are also increasing at a steady pace. With the aging, increasingly comorbid patient populations and newly imposed financial penalties for hospitals with high readmission rates, refining understanding of factors influencing readmission following THA is a research priority. We hypothesize that numerous preoperative medical comorbidities and postoperative medical complications will emerge as significant positive risk factors for 30-day readmission.MethodsACS-NSQIP database identified patients who underwent revision THA from 2005 to 2015. The primary outcome assessed was hospital readmission within 30 days. Patient demographics, preoperative comorbidities, laboratory studies, operative characteristics, and postsurgical complications were compared between readmitted and non-readmitted patients. Logistic regression identified significant independent risk factors for 30-day readmission among these variables.Results10,032 patients underwent revision THA in the ACS-NSQIP from 2005 to 2015; 855 (8.5%) were readmitted within 30-days. Increasing age, the presence of preoperative comorbidities, high ASA class, and increased operative time were significant positively associated independent risk factors for 30-day readmission. Several postoperative medical and surgical complications such as myocardial infarction, stroke, pneumonia, and sepsis demonstrated significant positive associations with readmission.ConclusionIdentifying and understanding risk factors associated with readmission allows for the implementation of evidence-based interventions aimed at minimizing risk and reducing 30-day readmission rates following revision THA.     

Risk factors for revision total hip arthroplasty: emphasis on the characteristics of Japanese lifestyle

Introduction  

Total hip arthroplasty (THA) is a common technique for increasing quality of life (QOL) in patients with degenerative or traumatic hip arthropathy. However, there is always a risk of THA requiring revision. The present study aimed to develop guidelines for QOL assessment and patient education by analyzing the risk factors for revision THA.     

Body mass index is associated with risk of reoperation and revision after primary total hip arthroplasty: a study of the Swedish Hip Arthroplasty Register including 83,146 patients

Background and purpose — The prevalence of obesity is on the rise, becoming a worldwide epidemic. The main purpose of this register-based observational study was to investigate whether different BMI classes are associated with increased risk of reoperation within 2 years, risk of revision within 5 years, and the risk of dying within 90 days after primary total hip arthroplasty (THA). We hypothesized that increasing BMI would increase these risks.

Patients and methods — We analyzed a cohort of 83,146 patients who had undergone an elective THA for primary osteoarthritis between 2008 and 2015 from the Swedish Hip Arthroplasty Register (SHAR). BMI was classified according to the World Health Organization (WHO) into 6 classes: < 18.5 as underweight, 18.5–24.9 as normal weight, 25–29.9 as overweight, 30–34.9 as class I obesity, 35–39.9 as class II obesity, and ≥ 40 as class III obesity.

Results — Both unadjusted and adjusted parameter estimates showed increasing risk of reoperation at 2 years and revision at 5 years with each overweight and obesity class, mainly due to increased risk of infection. Uncemented and reversed hybrid fixations and surgical approaches other than the posterior were all associated with increased risk. Obesity class III (≥ 40), male sex, and increasing ASA class were associated with increased 90-day mortality.

Interpretation — Increasing BMI was associated with 2-year reoperation and 5-year revision risks after primary THA where obese patients have a higher risk than overweight or normal weight patients. As infection seems to be the main cause, customizing preoperative optimization and prophylactic measures for obese patients may help reduce risk.     

初次全髋关节置换术后髋关节疼痛发生影响因素分析

目的探讨初次人工全髋关节置换术后中重度髋关节疼痛发生影响因素分析。 方法选择2015年1月至2017年9月在四川省巴中骨科医院初次接受全髋关节置换术的完整成年患者的病历资料进行回顾性分析。翻修手术、长期慢性疼痛、合并恶性肿瘤、精神疾病等情况的病例排除在外。记录患者的性别、年龄、身体质量指数、合并症、置换类型、术前评估、术中指标和术后并发症发生情况等资料。采用单因素和多因素Logistic分析观察患者术后中重髋关节疼痛的发生率及上述资料与髋关节中重度疼痛发生的相关性。 结果共有476例(476例髋)患者纳入研究,中重度疼痛发生率为9.66%。单因素分析显示,置换部位、疾病类型、高血压、吸烟、饮酒不是影响初次髋关节置换术后中重度疼痛发生的危险因素(P>0.05);性别(χ²＝6.145)、年龄(χ²＝7.847)、身体质量指数(χ²＝14.704)、髋关节活动时间(χ²＝8.043)、糖尿病(χ²＝10.356)、美国麻醉师协会(ASA)分级(χ²＝10.654)、入路方式(χ²＝6.746)、假体类型(χ²＝5.917)、手术时间(χ²＝5.024)、下肢深静脉血栓(χ²＝11.145)、术后C反应蛋白(CRP)值(χ²＝7.494)是影响初次髋关节置换术后中重度疼痛的危险因素(P<0.05)。多因素Logistic分析结果显示,身体质量指数≥28 kg/m²[OR＝3.224,95%CI (2.059,8.159)]、下肢深静脉血栓[OR ＝6.902,95%CI (4.574,13.589)]是影响全髋关节置换术后中重度疼痛的独立危险因素(P<0.05),年龄≥60岁[OR ＝0.718,95%CI (0.611,0.829)]、关节活动时间>2 d [OR ＝0.624,95%CI(0.417,0.852)]是全髋关节置换术后中重度疼痛的保护性因素(P<0.05)。 结论初次人工全髋关节置换术后中重度髋关节发生是多因素综合作用的结果,临床应综合考虑这些因素,以降低全髋关节置换术后中重度疼痛的发生。     

Ultrasound for diagnosis of infection in revision total hip arthroplasty

Eighty consecutive patients (85 hips; 43 women; median age, 74 years [range, 33-90 years]) underwent a revision total hip arthroplasty. Preoperatively and guided by ultrasound, biopsy specimens of the joint pseudocapsule were taken, and joint fluid was aspirated for culture. Capsule morphology was investigated with light microscopy. When septic loosening was defined as 2 intraoperative cultures yielding the same microorganism, the prevalence was 12%. Sensitivity of the capsule biopsy cultures was 67%; specificity, 68%; positive predictive value, 22%; and negative predictive value, 94%. Joint fluid was often sparse and always falsely sterile. One specimen from a hip with septic loosening showed histologic changes (> or =3 foci, each with > or =3 plasma cells/high-power field) consistent with chronic infection. The remaining 8 septic loosenings eluded histologic detection, yielding 11% sensitivity. All aseptic loosenings were classified correctly (specificity 100%). Positive and negative predictive values were 100% and 89%. Ultrasound-guided aspiration and capsule biopsy with cultures and histology does not seem to be sufficiently accurate in the preoperative diagnosis of infected total hip arthroplasty.     

非骨水泥假体用于髋关节置换后感染翻修7例3．6年随访报告

[目的]探讨用非骨水泥假体对髋关节置换术后感染进行翻修术的效果.[方法]1997年11月～2006年12月,收治7例髋关节置换术后感染患者.以非骨水泥假体对其中4例行全髋关节翻修,2例仅翻修髋臼假体,1例仅更换股骨柄.一期翻修4例,二期翻修3例.随访时应用X线及Harris评分进行评价,并检测患者血沉和C反应蛋白浓度.[结果]7例患者平均随访3.6年(1.5～10.6年),Harris评分由术前的35分(18～63分)提高到末次随访时的89分(60～99分).无1例术后感染复发;1例股骨假体远端穿出股骨皮质而需翻修;末次随访时5例疼痛消失,2例活动时偶有隐痛;2例无跛行,5例轻度跛行;1髋发生Brooker 2级异位骨化;聚乙烯内衬磨损率为0.08 mm/年.无1例出现症状性深静脉血栓或神经损伤.[结论]以非骨水泥假体翻修髋关节置换术后感染,根据个体感染情况选择一期或二期翻修可取得较满意的临床疗效.对固定稳定、与周围骨质间无感染征象的的假体选择不翻修是否可行,有待更多病例的总结.     

Increasing risk of prosthetic joint infection after total hip arthroplasty: 2,778 revisions due to infection after 432,168 primary THAs in the Nordic Arthroplasty Register Association (NARA)

Background and purpose

The risk of revision due to infection after primary total hip arthroplasty (THA) has been reported to be increasing in Norway. We investigated whether this increase is a common feature in the Nordic countries (Denmark, Finland, Norway, and Sweden).

Materials and methods

The study was based on the Nordic Arthroplasty Register Association (NARA) dataset. 432,168 primary THAs from 1995 to 2009 were included (Denmark: 83,853, Finland 78,106, Norway 88,455, and Sweden 181,754). Adjusted survival analyses were performed using Cox regression models with revision due to infection as the endpoint. The effect of risk factors such as the year of surgery, age, sex, diagnosis, type of prosthesis, and fixation were assessed.

Results

2,778 (0.6%) of the primary THAs were revised due to infection. Compared to the period 1995–1999, the relative risk (with 95% CI) of revision due to infection was 1.1 (1.0–1.2) in 2000–2004 and 1.6 (1.4–1.7) in 2005–2009. Adjusted cumulative 5–year revision rates due to infection were 0.46% (0.42–0.50) in 1995–1999, 0.54% (0.50–0.58) in 2000–2004, and 0.71% (0.66–0.76) in 2005–2009. The entire increase in risk of revision due to infection was within 1 year of primary surgery, and most notably in the first 3 months. The risk of revision due to infection increased in all 4 countries. Risk factors for revision due to infection were male sex, hybrid fixation, cement without antibiotics, and THA performed due to inflammatory disease, hip fracture, or femoral head necrosis. None of these risk factors increased in incidence during the study period.

Interpretation

We found increased relative risk of revision and increased cumulative 5–year revision rates due to infection after primary THA during the period 1995–2009. No change in risk factors in the NARA dataset could explain this increase. We believe that there has been an actual increase in the incidence of prosthetic joint infections after THA.The outcome of hip replacement surgery and the survival of implants have improved during the last decades (Herberts and Malchau 2000, Liu et al. 2009, Fevang et al. 2010). However, an increase in the risk of revision due to infection after THA has also been reported in recent years (Kurtz et al. 2008, Dale et al. 2009, Pedersen et al. 2010b). We wanted to assess whether the increase in risk of revision due to infection is a common feature in the Nordic countries, and we therefore assessed time trends and risk factors for revision due to infection after primary total hip arthroplasty (THA) in the Nordic countries (Denmark, Finland, Norway, and Sweden). The aim was to compare revision rates due to infection in different time periods and different patient and implant groups, and to investigate factors that influence the risk of revision due to infection.     

Risk factors and reasons for revision after reverse total shoulder arthroplasty

BackgroundAs the indications for reverse shoulder arthroplasty (RSA) continue to expand, the need for revision surgery after RSA will become more frequent. The objective of this study was to characterize patient-related risk factors for revision RSA and to compare reasons for early vs. late revision after RSA.MethodsPatients who underwent primary and revision RSA from 2015 to 2019 were identified in a national insurance database. Subgroups of early revision (defined as revision within 1 year postoperatively) and late revision (more than 1 year postoperatively) were also identified. The primary outcome of interest was patient-related risk factors for revision RSA. Secondary outcomes of interest were patient-related risk factors for early vs. late revision RSA and to compare surgical diagnoses for early vs. late revision RSA. Univariate analysis using chi-square tests was performed to analyze any differences in reasons for revision. Multivariate regression was subsequently utilized to control for any confounding variables when identifying risk factors for revision.ResultsA total of 28,880 patients were identified who underwent RSA, with 553 (1.9%) patients undergoing revision RSA. Three hundred eighty-five patients (69.6%) were classified as early revision (within one year), while 141 (30.4%) underwent late revision more than a year postoperatively. Risk factors for overall revisions included age <65 years (odds ratio [OR] = 1.23, P = .032), male sex (OR = 2.21, P < .001), type I diabetes mellitus (OR = 1.44, P = .039), congestive heart failure (CHF) (OR = 1.79, P < .001), and depression (OR = 1.33, P = .002) in addition to RSAs performed for fracture (OR = 1.63, P < .001) and glenohumeral instability (OR = 2.25, P < .001) compared to RSA performed for arthritis. Risk factors for early revision RSA included male sex (OR = 2.54, P < .001) and CHF (OR = 1.81, P < .001) in addition to RSAs performed for fracture (OR = 1.84, P < .001) and glenohumeral instability (OR = 2.44, P < .001). Risk factors for late revision RSA included male sex (OR = 1.62, P = .004), CHF (OR = 1.83, P = .005), steroid use (OR = 1.79, P = .036), human immunodeficiency virus (OR = 3.50, P = .038), and RSA performed for glenohumeral instability (OR = 1.92, P = .004). Early revision RSA was more commonly performed for instability (63.1% vs. 25.0%, P < .001) and stiffness (5.5% vs. 1.2%, P = .021) than late revisions.ConclusionRevision RSA is uncommon at early follow-up. Overall patient-related risk factors for revision include male sex, age <65 years, type I diabetes mellitus, CHF, and depression in addition to RSAs performed for fracture and glenohumeral instability. Instability and stiffness were more common indications for early compared to late revision. Instability remained the most common reason for overall revision followed by periprosthetic infection.