Factors Affecting Survival of Uncemented Total Hip Arthroplasty in Patients 50 Years or Younger

Abstract

Providing a long-lasting total hip arthroplasty for patients younger than 50 years remains one of the greatest challenges for modern arthroplasty surgery. We retrospectively reviewed 221 patients younger than 50 years who underwent 299 uncemented total hip arthroplasties from 1983 to 2000. We assessed 5- to 15-year survival with revision as the endpoint. Femoral stem survival was 99.3% (range, 98.4-100%), 98.9% (range, 97.7-100%), and 96.8% (92.5-100%) at 5, 10, and 15 years, respectively. Including all component designs acetabular survival was 98.7% (range, 97.4-100%), 84.6% (78.8-90.4%), and 52.5% (40.7-64.3%) at 5, 10, and 15 years, respectively. Overall survival was 46.8% (33.5-58.1%) at 15 years. Total hip arthroplasties performed for hip dysplasia had lower 10-year and 15-year survival. Zirconium-on-polyethylene articulations had lower acetabular revision rates compared with cobalt-chrome-on-polyethylene. Sixty-nine revisions were performed, most commonly for polyethylene wear. Uncemented femoral stems resulted in 90% survival at 15 years followup in patients younger than 50 years at index operation. Contemporary bearing surfaces in association with such stems may provide long-lasting total hip arthroplasties, even in young, active patients.

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

“…Wear is the most important factor limiting long-term results in THA [4,19,23,25,[32][33][34]. Alternative bearing surfaces, such as the new highly cross-linked polyethylene, metal-on-metal and ceramic-on-ceramic, are being specifically used for young patients [4,7,42,43].…”

“…Both patients with secondary arthritis and those who are active are at risk due to their substantially higher revision rates of more than 90% at 20 years of followup in patients older than 40 years of age, and less than 70% in younger patients [14-16, 24, 28, 32, 37, 50]. Although other options, such as osteotomy and hip resurfacing, have been considered, THA is still the most frequent indication for a great number of cases and surgeons [15,16,32,36,37,43]. However, poor long-term survival has been described with both cemented and uncemented cups in this population because of high wear in conventional polyethylene and loosening rates [25].…”

Mean 5-Year Clinical and Radiographic Outcomes of Cementless Total Hip Arthroplasty in Patients under the Age of 30

“…Moreover, of the available studies, many discuss the outcomes of THA in patients with inflammatory arthritis [1–3] leaving few studies describing the outcome of THA in noninflammatory hip degeneration [4–11]. From an implant standpoint, the primary concern is the increased risk of failure and high likelihood for revision surgery in the patient's lifetime, making the use of cementless implants appealing as the likelihood for aseptic loosening is decreased and stable long-term fixation is expected [10–12]. Additionally, if the implant becomes loose, the revision procedure is technically more facile as the surgeon does not need to remove cement.…”

Titanium and cobalt–chromium alloys for hips and knees

“…Additionally, the acetabular component survival is relatively poor (Capello et al, 2003;Kearns et al, 2006). This is mainly because cementless hip replacements still suffer from polyethylene wear debris and osteolysis.…”