Contemporary THA yielded improved clinical results for patients aged 30 years and younger
Key takeaways:
- Patients aged 30 years and younger who underwent THA had improved clinical outcomes at 10 years.
- THA may be a solution for this population when joint preservation is not feasible.
Results published in the Journal of Arthroplasty showed patients aged 30 years and younger who underwent contemporary total hip arthroplasty had improved clinical outcomes at 10 years with encouraging survivorship rates.
Researchers performed a retrospective analysis of 144 contemporary primary THAs with a highly crosslinked polyethylene acetabular bearing surface in 121 patients aged 30 years and younger (mean age of 23 years). They analyzed clinical outcomes, such as modified Harris Hip scores (mHHS), University of California Los Angeles (UCLA) activity scores, complications, polyethylene wear and implant survivorship.
With an average follow-up of 10.7 years, researchers found mHHS improved from 47 to 81 and UCLA scores improved from 4 to 6. The overall complication rate was 5.6%. Six hips (4.2%) required revision surgery for instability (n = 3) late infection (n = 1), liner dissociation (n = 1) and acetabular loosening (n = 1). However, researchers noted no revisions occurred after the first 6 years.
Researchers also found low mean linear (0.0438 mm/year) and volumetric (29.07 mm3/year) wear rates. They noted survivorship free from revision was 97.2 at 5 years, 95.8 at 10 years and 95.8 at 15 years, according to the study.
“THA in the very young can be challenging due to previous corrective surgeries, which may result in abnormalities of acetabular version, proximal femoral morphology, femoral alignment, and femoral version,” the researchers wrote in the study. “Based on the above outcomes and wear data, we remain optimistic that THA is a reasonable solution for this unique patient population when joint preservation procedures are not feasible or predictable,” they concluded.
Perspective
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Surgeons have often been reluctant to perform total hip replacements on younger individuals, even when they desperately need it due to debilitating arthritis or congenital conditions. As younger patients face unique challenges in decision-making for arthroplasty and historically have had higher failure rates, we applaud the authors for courageously publishing on THR in this group.
While excellent outcomes have been shown in this and other studies on young patients, the results also highlight that THR in the young population is not free of risk. The fact that a small subset of patients may require a revision at this young age, whether for dislocation, liner failure, infection or loosening, shines light on the opportunity to continue to improve technology and technique in hip arthroplasty.
Recent technological advancements in arthroplasty have indeed revolutionized the field. Utilization of robotics and other advanced technologies has substantially improved precision and accuracy, diminishing the risk for instability, leg length discrepancies and other issues that may necessitate early revision. Advances in implant materials have enhanced osteointegration rates, decreased osteolysis and prolonged implant survivorship. The advent of outpatient arthroplasty in subspecialized centers has mitigated the risk of hospital-borne infections. Together, these advances have changed the game, making THR a more viable proposition in young, high-demand patients.
Furthermore, the rise in hip arthroscopy and preservation surgery means that it is becoming more common that young patients in need of arthroplasty have had previous surgery. In these patients, THR may be complicated by scar tissue or residual effects on the surrounding nerves and muscles, and specific surgical considerations may be required to obtain excellent results.
In conclusion, technological and technique advances have made THR a valid option to help many young patients in need. We see opportunities to continue to improve their outcomes through use of robotics and other advanced technologies, subspecialized ambulatory surgery facilities and improved understanding of surgical considerations for the subset of patients who has had previous hip preservation surgery.
References:
Domb BG, et al. J Am Acad Orthop Surg. 2020;doi:10.5435/JAAOS-D-19-00328.
Redmond JM, et al. Orthopedics. 2016;doi:10.3928/01477447-20160404-06.
Rosinsky PJ, et al. J Am Acad Orthop Surg. 2020;doi:10.5435/JAAOS-D-19-00459.
Shapira J, et al. Hip Int. 2021;doi:10.1177/1120700020911639.
Stake CE, et al. J Arthroplasty. 2015;doi:10.1016/j.arth.2015.01.032.
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