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Revision rates for THA in young patients are unacceptably high, study says

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Orthopaedic investigators evaluated prostheses survival rates in 14,160 primary total hip arthroplasties in patients younger than 50 years and reported better outcomes in cemented, cementless and reverse hybrid total hip arthroplasties compared with traditional hybrids, but in some cases, the revision rate could be as high as 20% at 10 years.

“The main, take-home message is that there was no difference in implant survival between cementless and cemented [prostheses] and that hybrid total hip replacements had a 24% increased risk for revision,” Soren Overgaard, MD, DmSc, told Orthopaedics Today Europe in an interview conducted prior to the presentation of the study at the 2010 EFORT Congress.

NARA database

Overgaard and colleagues obtained the data for their study from the Nordic Arthroplasty Register Association (NARA) database. They included 14,160 total hip arthroplasties (THAs) performed in Denmark, Sweden and Norway between 1995 and 2007.

“In Sweden and Norway the tradition during the years has been cemented prosthetic components, which has changed a little during the last few years. In Denmark the tradition has mainly been use of cementless components in patients younger than 50 years,” Overgaard said.

Diagnoses

According to the study abstract, 49.4% of the THAs included in the study were performed in men. Cementless prostheses were used in 49%, cemented in 27%, hybrid in 14% and inverse hybrid in 8%. Indications for THA were :idiopathic osteoarthrosis (OA) in 46%; childhood disease in 26%; inflammatory arthritis (IA) in 12%; nontraumatic osteonecrosis in 9%; and fracture in 6%.

Risk for revision

The investigators calculated prosthesis survival with any revision as an endpoint using Cox’s multiple regression model, which they adjusted for diagnosis, age, gender, calendar year and surgical approach.

The following results were reported in their abstract:

• an 83% overall 10-year survival;
• no difference between genders;
• a 37% reduced risk of revision in patients with IA vs. those with OA;
• no difference between childhood disease and primary OA;
• lower revision rate for inverse THA vs. cemented THA in men; and
• the lowest aseptic loosening rates were seen in cementless THA.

Proceed with caution

The investigators wrote in their abstract that revision rates following THA in younger patients are unacceptably high and could be up to 20% at 10 years.

“The results should remind every surgeon that at the moment there doesn’t seem to be difference between the cementless and cemented implants, and that new implants have to be introduced with caution and only following proper validation,” Overgaard said.

• Reference:

Overgaard S, Pedersen A, Havelin LI, et al. The prognosis of total hip arthroplasty (THA) in patients younger than 50 years of age. Paper #3497. To be presented at the 2010 EFORT Congress. June 2-5. Madrid.