The results of uncemented total hip replacement in children with juvenile idiopathic arthritis at ten years

Abstract

The inherent challenges of total hip replacement (THR) in children include the choice of implant for the often atypical anatomical morphology, its fixation to an immature growing skeleton and the bearing surface employed to achieve a successful long-term result. We report the medium-term results of 52 consecutive uncemented THRs undertaken in 35 paediatric patients with juvenile idiopathic arthritis. The mean age at the time of surgery was 14.4 years (10 to 16). The median follow-up was 10.5 years (6 to 15). During the study period 13 THRs underwent revision surgery. With revision as an endpoint, subgroup analysis revealed 100% survival of the 23 ceramic-on-ceramic THRs and 55% (16 of 29) of the metal- or ceramic-on-polyethylene. This resulted in 94% (95% CI 77.8 to 98.4) survivorship of the femoral component and 62% (95% CI 41.0 to 78.0) of the acetabular component. Revision of the acetabular component for wear and osteolysis were the most common reasons for failure accounting for 11 of the 13 revisions. The success seen in patients with a ceramic-on-ceramic articulation seems to indicate that this implant strategy has the potential to make a major difference to the long-term outcome in this difficult group of patients.

How Have Alternative Bearings and Modularity Affected Revision Rates in Total Hip Arthroplasty?

“…According to all registry reports, THA modular necks had lower survivorship as did the clinical series that we reviewed for this aspect of modularity [1,4,6,8,12,17,19,20,24,35,40,44,48,68,71,73,75,[78][79][80][81]. Similar survivorships and revision rates were found for modular stem/body and body/neck femoral components, whereas registry data revealed similar results except when these types of stems were paired with a MoM articulating bearing, which was reported to increase revision rates even further [1].…”

“…In the MoM group, there were only two reports with Level I to II evidence [86,87] and one report with Level III evidence [18]. In the ceramic-on-ceramic group, there were two reports with Level I evidence [16,53], one report with Level II evidence [50], and two reports with Level III evidence [19,69] (Tables 1 and 2). …”

“…No study involving retrieval analysis or metal ion levels was included. Twenty reports on dual modular femoral components in the literature met inclusion criteria [4,6,8,12,17,19,20,24,35,40,44,48,68,71,73,75,[78][79][80][81]. The levels of evidence for these articles that met inclusion criteria were: Level I (zero), Level II (four), Level III (four), and Level IV (twelve).…”

“…This increased frequency of revision with exchangeable neck prostheses occurred with all bearing surfaces in the Australian Registry (Table 3). Twelve studies reported on various types of modular femoral neck and stem components with a range of survivorship from 91% to 100% with a range of followup of 8.6 and 5 years, respectively [4,8,17,19,20,35,44,68,73,[79][80][81]. Eight reports dealing specifically with the S-ROM modular stem/body (DePuy Orthopaedics Inc, Warsaw, IN, USA) reported a range of survivorships for aseptic loosening of 93.3% to 100% with a range of followup of 19 years and 10 years, respectively [6,12,24,40,48,71,75,78].…”

Total Hip Arthroplasty for the Sequelae of Femoral Neck Fractures in the Pediatric Patient

“…Total hip arthroplasty (THA) is a procedure rarely performed in pediatric patients, which has resulted in a paucity of published literature on the topic [10,11]. Relative to adults, THA in the pediatric population is performed for a wider array of indications, including pediatric hip diseases, neoplastic conditions, systemic inflammatory disease, osteoarthritis, ON, postinfectious joint degeneration, and hip fracture sequelae [10][11][12]. Although there are conflicting reports in the literature regarding outcomes of THA in pediatric patients, most studies report favorable medium-to longterm survivorship and significant improvements in patient function after surgery [10][11][12][13][14].…”