Background: To clarify contemporary indications for first-time revision surgery after primary cementless total hip arthroplasty (THA) for addressing potential issues with cementless THA. Methods: Data for 101 consecutive hips in 94 patients who underwent primary cementless THA at our institution and subsequently underwent first-time revision surgery were retrospectively reviewed. Baseline characteristics, indications for first-time revision surgery, and time from the primary THA to first-time revision surgery were evaluated. Results: The overall mean time to first-time revision surgery was 10.3 years (range, 0–33 years). The indications for first-time revision surgery were polyethylene wear and osteolysis in 33 hips, aseptic loosening in 25 hips, infection in 17 hips, periprosthetic fracture in 13 hips, instability in 8 hips, and component failure (liner dissociation or stem fracture) in 5 hips. Thirty-seven hips (37%) had undergone first-time revision surgery within 5 years of primary THA, of which the most common indications were infection and periprosthetic fracture. Conclusion: The current results suggested that reducing the number of early failures seems to be essential form improving THA outcomes.
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