Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old

Abstract

Background and purposeTotal hip replacement (THR) is not recommended for children and very young teenagers because early and repetitive revisions are likely. We investigated the clinical and radiographic outcomes of THR performed in children and teenage patients.Patients and methodsWe included 111 patients (132 hips) who underwent THR before 20 years of age. They were identified in the Norwegian Arthroplasty Register, together with information on the primary diagnosis, types of implants, and any revisions that required implant change. Radiographs and Harris hip score (HHS) were also evaluated.ResultsThe mean age at primary THR was 17 (11–19) years and the mean follow-up time was 14 (3–26) years. The 10-year survival rate after primary THR (with the endpoint being any revision) was 70%. 39 patients had at least 1 revision and 16 patients had 2 or more revisions. In the latest radiographs, osteolysis and atrophy were observed in 19% and 27% of the acetabulae and 21% and 62% of the femurs, respectively. The mean HHS at the final follow-up was 83 (15–100).InterpretationThe clinical score after THR in these young patients was acceptable, but many revisions had been performed. However, young patients with developmental dysplasia of the hip had lower implant survival. Moreover, the bone stock in these patients was poor, which could complicate future revisions.

Outcomes after Total Hip Arthroplasty Using a Cementless S‐ROM Modular Stem for Patients with High Hip Dislocation Secondary to Hip Pyogenic Arthritis

“…Femoral reduction may be difficult and is associated with a high risk of neurologic injury because of the high dislocation and soft tissue contracture. Furthermore, higher complication rates were reported for THA for high hip dislocation; these complications included intraoperative fractures, recurrent infection, dislocation, osteolysis, mechanical loosening, and revisions.…”

Total hip arthroplasty in patients 16 years of age or younger

“… 1 In addition, surgeons are wary of the need to revise the prostheses as most paediatric patients will likely outlive their implants. 2 , 3 Therefore, young patients with hip disease will often undergo various other surgical procedures which attempt to extend the survivorship of the paediatric hip and thus postpone THA. 4 Despite the advances in hip conserving techniques, there are still children in whom the hip disease progresses to disabling joint degeneration; and when all conservative measures have been exhausted THA becomes the only viable option allowing painless movement of the hip joint.…”

CORR Insights®: Satisfying Results of Primary Hip Arthroplasty in Patients with Hip Dysplasia at a Mean Followup of 20 Years

“…A unifying definition and classification of DDH is mandatory in order to improve the relevance of the reported results for larger populations. Registries could be a solution, but they have not focused their efforts on this specific topic except for the Norwegian [14] and the Danish registries [12]. Working on larger populations in a controlled environment may improve external validity because most of the reports on this topic are done by specialized units or surgeons.…”