THA viable for patients younger than 25 years of age - Academy News at the 2007 AAOS Annual Meeting

THA viable for patients younger than 25 years of age

By Carolyn Rogers

THA outcomes in these young subpopulations have been associated with high complication rates and questionable implant survival

Although any prosthetic replacement procedure in patients age 25 years or younger is likely to be revised at least once during the patient’s lifetime, total hip arthroplasty (THA) is a viable option for treating endstage hip disease in these individuals, according to poster exhibit P108.

In a difficult-to-treat population of young patients with a variety of conditions, these researchers found excellent-to-good outcomes in most patients, and a 94 percent implant survival rate at a mean follow-up of 72 months. Mean Harris Hip scores doubled, and only four of 58 patients required revision surgery.

THA in young patients

THA has been a successful treatment modality for elderly patients since the 1960s. In young patients, however, the procedure is generally avoided, especially when alternative treatment methods are available.

In addition, only a few reports have focused on the results of THA in this age group. Of these, many focus specifically on outcomes within certain subpopulations, such as patients with sickle cell disease, systemic lupus erythematosus and juvenile rheumatoid arthritis.

THA outcomes in these young subpopulations have been associated with high complication rates and questionable implant survival. Recently, advances in prosthetic designs and improved surgical techniques have shown improved results in these difficult-to-treat patients.

Data and results

To assess the clinical and radiographic outcome of THA in this population, the researchers conducted a multicenter study that included 58 patients (70 hips) under 25 years of age. Of these, 37 patients were female and 33 were male.

The mean age at the time of arthroplasty was 19.6 years (range: 12 to 25 years), with a mean BMI of 26.8 (range: 16.7 to 47.4). The most common reasons for the THA included avascular necrosis of the hip (26), osteoarthritis (19), sickle cell disease (11), inflammatory arthritis (9), congenital dysplasia of the hip (6), Legg-Calve-Perthes disease (6), posttraumatic arthritis (4), slipped capital femoral epiphysis (1) and Morquito syndrome (1).

The researchers attempted to correlate the clinical failures with underlying pathologies that have been implicated in negatively influencing the implant survival rate. Patients were evaluated using the Harris Hip rating system and radiographic analysis.

At a mean follow-up of 72 months (range: 24 to 204 months) implant survival was 94 percent, with one death not related to surgery. The Harris Hip scores increased from a mean of 41 points (range: 5 to 85 points) to a mean of 83 points (range: 39 to 100 points) at final follow-up.

Outcomes were excellent-to-good in 65 percent (44 hips) of the cases, fair for 19 percent (13 hips), and poor for 16 percent (11 hips). Four patients required revision surgery—two for deep joint infection, one for recurrent dislocations and one for aseptic loosening. In the two infection cases, sickle cell disease and calcar fracture were the associated pathologies. Other common complications included dislocations and wound healing problems.

The lead researcher for poster exhibit P108 is John C. Clohisy, MD, of Saint Louis. Coinvestigators include Thorsten M. Seyler, MD, of Baltimore; Frank R. Kolisek, MD, of Indianapolis; Ronald Emilio Delanois, MD, of Lutherville, Md.; Johannes F. Plate, BS, of Heidelberg, Germany; and Michael A. Mont, MD, of Baltimore. Dr. Clohisy receives research support from and serves as a consultant to Zimmer; Drs. Kolisek and Mont serve as consultants for Stryker.

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