Primary Total Hip Arthroplasty in Patients 20 Years Old and Younger

Abstract

Background: Historically, total hip arthroplasty (THA) performed in patients ≤20 years old has been associated with poor survivorship because of bearing-surface wear with conventional polyethylene, acetabular loosening with cemented sockets, and liner fracture in ceramic-on-ceramic (CoC) THA. For this population, there is a paucity of data regarding outcomes of THAs performed with use of modern implants and bearing surfaces. The purpose of the present study was to examine the mid- to long-term outcomes of modern THA in patients ≤20 years old. Methods: Utilizing a single-institution, prospectively collected total joint registry, we retrospectively identified 91 primary THAs performed in 78 patients ≤20 years old from 1998 to 2016. The average patient age was 17 years (range, 11 to 20 years), and the average body mass index was 26 kg/m2 (range, 16 to 49 kg/m2). Forty-eight THAs (53%) were performed in male patients, and 47 (52%) were performed on the right hip. Bearing surfaces included CoC (53 THAs, 58%), metal-on-highly cross-linked polyethylene (MoP; 28 THAs, 31%), and ceramic-on-highly cross-linked polyethylene (CoP; 10 THAs, 11%). Outcome measures included reoperations, revisions, complications, clinical outcome scores, and bearing-surface wear. Results: At an average follow-up of 8 years (range, 2 to 18 years), the average modified Harris hip score was 92 (range, 54 to 100), and 95% of patients reported feeling “much better” following the surgical procedure. Survivorship at 2, 5, and 10 years postoperatively was 96.7%, 96.7%, and 95.0% for reoperation; 98.9%, 98.9%, and 97.2% for revision; and 91.2%, 91.2%, and 89.5% for complications, respectively. The most common complications were instability (3 THAs, 3%), aseptic acetabular loosening (2 THAs, 2%), and postoperative foot drop (2 THAs, 2%). Linear articular wear averaged 0.019 mm/yr. There were no correlations between age, sex, body mass index, bearing surface, femoral head size, use of cement, or operative time and survivorship from complications, reoperations, or revisions. There were no differences in linear wear among CoC, CoP, and MoP bearing surfaces. Conclusions: In patients ≤20 years old, THAs performed with use of modern implants exhibit excellent clinical outcome scores and survivorship at mid- to long-term follow-up. CoC, CoP, and MoP bearing surfaces have similar survivorship, clinical outcomes, and bearing-surface wear in this population. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Medium-term outcomes of total hip arthroplasty in juvenile patients

“…In any case, THA clearly improves the HHS also in these young patients, and our results are in line with the most recent literature [42]. Nevertheless, the correct timing of this surgery remains unknown.…”

Do Not Postpone Revision of Worn Conventional Liners in Ceramic-on-Polyethylene Total Hip Arthroplasty: A New Dramatic Failure

“…Different cup sizes were reported, but it is worth mentioning that a specific cup (OptiFix; Smith & Nephew Co., Memphis, TN) from one manufacturer was used in 5 cases. While the average time from primary implantation to failure was 11.6 years (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], the time from manifestation to failure was about only 7 months (range, 1-24) according to available data [1][2][3][4][5][6][7][8][9][10][11].…”

“…Polyethylene manufacturing seems to have a more critical role than the head material because thin and conventional liners were common findings among the cases regardless of the articulating head, and they might have mainly contributed to such catastrophic failures [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. Recent literature has demonstrated favorable long-term THA results using highly cross-linked polyethylene liners with different ceramic and metal heads in general populations, as well as in young patients showing low wear rates [ [15] , [16] , [17] , [18] , [19] , [20] ].…”

“…Despite continuous evolution in the manufacturing of arthroplasty materials, this mode of failure has not yet been eliminated, as all bearing surfaces will wear [ 14 ]. There was no superiority between different bearing surfaces in young and active patients until long-term follow-up [ 15 , 16 ]. However, focusing on ceramic-on-polyethylene bearing THA, ceramic heads were associated with reduced wear of conventional polyethylene liners among young and active patients compared with metal heads on long-term follow-up [ 17 ].…”

Does Activity Level After Primary Total Hip Arthroplasty Affect Aseptic Survival?

“…In an even younger cohort of patients aged <20 years at the time of index THA, Pallante et al. reported a 97.2% survivorship at 10 years [ 29 ]. The 2 aforementioned studies are on very young patients for arthroplasty.…”