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Background: In 2020, more than 14,000 aseptic revision procedures for total hip arthroplasty (THA) were registered in Germany. Patient expectations of revision hip arthroplasty are not substantially different from expectations of primary hip replacement., Outcome: However, revision surgery is associated with increased complication rates and a higher proportion of dissatisfied patients. In particular, poorer postoperative function and mobility as well as increased pain levels following revision THA have been described compared to the outcome after primary THA. Quality of life and return-to-work can also be impaired., Survival Rate: Implant survival is influenced by age, BMI, and comorbidities of the patients, but also by the size and complexity of bone defects, the extent of periprosthetic soft tissue compromise and the choice of revision implant(s). In addition, the number of previous revision surgeries inversely correlates with the survival rates. Previous revisions have been shown to be associated with increased risks of aseptic loosening, instability and periprosthetic infection., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

In recent years, increasing concern has been raised regarding potential systemic toxicity of metals released from arthroplasty implants. A lack of valid metal thresholds for human (organ) toxicity and the prospect of multi-decade survival of modern hip and knee replacements pose special challenges. Indeed, evidence of systemic effects of metals released from such implants is largely missing. Systemic cobalt exposure has repeatedly been associated with cardiotoxic and neurotoxic effects, and also with thyroid dysfunction. The toxic potential of chromium is considered less pronounced. Yet, in arthroplasty there is usually a co-exposure to chromium and cobalt which complicates evaluation of element-specific effects. Toxicity of titanium dioxide nanoparticles has been subject to debate among international regulatory authorities. Their wide use in a variety of products in everyday life, such as toothpaste, cosmetics and food colorants, hampers the assessment of an arthroplasty-induced systemic titanium exposure. To date there is no clear evidence for systemic complications due to titanium dioxide released from arthroplasty implants. Release of further metals such as tantalum, niobium, nickel, vanadium and zirconium from hip and knee replacement implants has been described occasionally, but systemic effects of respective long-term exposure scenarios are unknown. Generally, the characterization of all released metals regarding their chemical and physical specifications is critical for the evaluation of potential systemic risks. Systematic studies investigating the accumulation of metals relevant in arthroplasty in different organs/organ systems and the biological consequences of such accumulations are urgently needed., Competing Interests: The authors gratefully acknowledge financial support of research projects by the ENDO-Verein e. V. (Hamburg, Germany), the Deutsche Arthrose-Hilfe e. V. (P327-A844-AE-EP1), the Einstein Foundation Berlin through the Einstein Center for Regenerative Therapies (EZ-2016-289), the Berlin-Brandenburg Center for Regenerative Therapies and the Berlin-Brandenburg School for Regenerative Therapies (GSC 203). The authors further acknowledge support from the German Research Foundation (DFG) and the Open Access Publication Fund of Charité – Universitätsmedizin Berlin. The authors received the AE basic science research award 2017 by the Deutsche Gesellschaft fuer Endoprothetik e. V. (AE) and the Stiftung Endoprothetik e. V. In 2017, Anastasia Rakow received a “quality and safety in arthroplasty” scholarship of the Deutsche Gesellschaft fuer Orthopaedie und Unfallchirurgie (DGOU). The above funders had no role in design, data collection and analysis, decision to publish, or preparation of this manuscript./Die Autoren erklären, dass sie innerhalb der vergangenen 3 Jahre Forschungsunterstützung von dem ENDO-Verein e. V. (Hamburg, Deutschland), der Deutschen Arthrose-Hilfe e. V (P327-A844-AE-EP1), der Einstein Stiftung Berlin bzw. dem Einstein Center for Regenerative Therapies (EZ-2016-289) und dem Berlin-Brandenburger Centrum für Regenerative Therapien und der Berlin-Brandenburger Schule für Regenerative Therapien (GSC 203) erhalten haben. Sie erklären ferner, dass sie finanzielle Unterstützung für Open Access Publikationen von der Deutschen Forschungsgemeinschaft DFG und dem Open Access Publication Fund der Charité – Universitätsmedizin Berlin erhalten haben. Die Autoren erhielten den AE-Preis 2017 auf dem Gebiet der Grundlagenforschung von der Deutschen Gesellschaft für Endoprothetik e. V. (AE) und der Stiftung Endoprothetik e. V.; Anastasia Rakow erhielt 2017 ein Stipendium („Qualität und Sicherheit in der Endoprothetik“) der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU). Konzeption, Inhalt und Veröffentlichung der vorliegenden Arbeit sowie Akquise und Analysen hier erwähnter Daten blieben von genannten Institutionen/Organisationen/Stiftungen/Vereinen/Fachgesellschaften unbeeinflusst., (Thieme. All rights reserved.)