Alumina-on-alumina Total Hip Arthroplasty in Young Patients: Diagnosis is More Important than Age

Abstract

Total hip arthroplasty (THA) in young patients has a high loosening rate, due in part to acetabular deformities that may compromise bone fixation and polyethylene wear. We therefore asked whether wear or osteolysis and loosening differ in patients under 40 years of age with alumina-on-alumina THA compared to those who are older. We prospectively followed 56 patients (63 hips) younger than 40 years (Group 1) and 247 patients (274 hips) older than 40 (Group 2) who had an alumina-on-alumina THA. The minimum followup was 4 years (mean, 5.6 years; range, 4-9 years). The two groups differed in various features: there were no patients with primary osteoarthritis in Group 1 and they had worse preoperative function and range of mobility, while weight, activity level, and implant size were greater in Group 2. The survival rate for cup loosening at 80 months postsurgery was 90.8% (95% confidence interval, 82.9-98.6%) for Group 1 and 96.5% (95% confidence interval, 94.2-98.7%) for Group 2. Cup loosening was less frequent with primary osteoarthritis than with severe developmental dysplasia of the hip. Although an alumina-on-alumina THA provided similar midterm survival and radiographic loosening in both age groups, the preoperative diagnosis seems more important than age for outcome. Continued followup will be required to determine if the alumina-on-alumina bearings in young patients result less risk of osteolysis and loosening.

Ceramic-on-ceramic THA Implants in Patients Younger Than 20 Years

“…Some authors have suggested that higher rates of failures in the patients younger than 20 years were more likely attributable to the underlying cause of hip dysfunction rather than young age, especially in the case of developmental dysplasia and inflammatory arthritis [17]. In our study, the underlying diagnosis was mainly chemotherapy or steroid-induced osteonecrosis in 56% of the hips.…”

What Host Factors Affect Aseptic Loosening After THA and TKA?

“…Among modifiable risk factors, multiple factors such as high activity level [3,14,17,30,43,44,48], obesity [2,9,10,34,37,38,43,46,48,51,52], and smoking [10,12,16,17,19,32,35,41] may be associated with an increase in the risk of aseptic loosening after THA.…”

Alumina-on-alumina THA Performed in Patients Younger Than 30 Years: A 10-year Minimum Followup Study

“…Alumina-on-alumina bearings, which exhibit little wear, were introduced as an option for young patients [11,30]. These bearings are characterized by low surface roughness, high hardness for major scratch resistance, and high wettability [16].…”

“…Several reports describe alumina-on-alumina bearings used in THAs in young patients [1,3,19,30], and report survivorship ranging from 91% to 99% at 7 to 11 years [10,11,21,24]. We previously reported 5-year followup results of patients younger than 40 years [38], and 10-year followup results in a series of 100 patients [24].…”

“…Patients younger than 30 years expect to be in the workforce and lead normal active lives after THA, and female patients expect successful pregnancies and deliveries. In this regard, alumina-on-alumina ceramic bearings seem a reasonable option for young, active patients [11,30]. Further, they are free of concerns regarding metal ions, which could cross the placental barrier [4,41].…”