A 20-year follow-up evaluation of total hip arthroplasty in patients younger than 50 using a custom cementless stem

Abstract

Aim: The purpose of this study is to report the 20-year follow-up of a continuous series of 232 total hip arthroplasties (THAs) performed in patients aged less than 50 at the index surgery. Patients and methods: This is a retrospective monocentric study which reports the clinical, radiographical and survival results of 232 THAs performed with a custom cementless femoral stem in 212 patients evaluated at follow-up ranging from 14 to 27 years. Results: At the time of follow-up, the mean Harris Hip Score was 94.1 (range 48–100). The Hip disability and Osteoarthritis Outcome Score was >80 points in all 5 categories for 146 patients (68.9%). 18 hips (8.5%) showed radiographical femoral abnormalities. 23 hips (10.8%) underwent revision of the implants. 13 were isolated cup revisions. 3 more hips had bipolar revisions for aseptic loosening at 15, 20 and 21 years. Taking stem revision for aseptic loosening as an endpoint, survivorship was 96.8% at 20 years (95% confidence interval, 95.1–98.5; patients at risk 76) and 94.5% at 25 years (91.7–97.3; patients at risk 12). Conclusions: The results of this study confirm that THA using this custom-designed stem can provide excellent clinical and radiographical outcomes at a mean follow-up of 20 years in patients younger than 50. The individual 3D femoral stem and prosthetic neck has been able to restore extra- and intramedullary functional anatomy in this young and active cohort of patients.

A Scoping Review of Total Hip Arthroplasty Survival and Reoperation Rates in Patients of 55 Years or Younger: Health Services Implications for Revision Surgeries

“…Different age groupings were used as inclusion criteria. While several studies evaluated patients who were 55 years old or younger (n ¼ 10, 28.6%; 57,401 THAs) [8,15,16,22,38e40,46,47,55], others reported findings on patients 50 years of age or younger (n ¼ 10, 28.6%; 1893 THAs) [11,12,37,43,50,51,54,58,59,61]. Ten studies (n ¼ 10) did not report the mean or median age of the included participants; however, an age-related inclusion criterion of 55 years or younger was reported.…”

Trends and developments in hip and knee arthroplasty technology

“…46 Dessyn et al demonstrated similarly good follow-up at 20 years from their series of 232 hip replacements with 96.6% survivorship in a younger cohort of patients published more recently. 47 Newer additive manufacturing techniques have made it simpler to produce complex customised implants including porous structures with variable density and stiffness to minimise bone loss and remodelling due to stress shielding. 48,49 The majority of experience of custom additive manufactured implants comes from acetabular revision surgery.…”

“…demonstrated similarly good follow-up at 20 years from their series of 232 hip replacements with 96.6% survivorship in a younger cohort of patients published more recently. 47…”

Outcomes of primary total hip arthroplasty using 3D image-based custom stems in unselected patients: a systematic review

“… 6 , 9 , 15 , 43 , 44 Thus,a total of 17 articles were eligible for data extraction, 4 – 6 , 9 , 13 , 15 – 17 , 43 – 51 all of which reported on clinical or radiographic outcomes of primary THA using custom stems designed from 3D imaging. Finally, the outcomes of three articles were disregarded 16 , 17 , 45 because their patient populations were presented in other articles at longer follow-up and/or with more complete data, leaving 14 studies with unique patient populations. 4 , 6 , 9 , 13 , 15 , 17 , 43 , 44 , 46 – 51…”

“…Post-operative HHSs were reported in 13 of the 14 studies, with scores ranging from 95 to 96 in the short-term (≤ 2 years), 47 , 50 80 to 99 in the mid-term (> 2 to 10 years) 6 , 9 , 15 – 17 , 43 , 46 , 48 , 49 , 51 and 87 to 94 in the long-term (≥ 10 years) 4 , 5 , 44 , 45 ( Table 5 , Fig. 4 ).…”