Top

Clinical Orthopaedics and Related Research®

Published in:

01-04-2011 | Clinical Research

Risk Factors for Revision of Hip Arthroplasties in Patients Younger Than 30 Years

Authors: Julien Girard, MD, MSc, Christophe Glorion, MD, François Bonnomet, MD, Damien Fron, MD, Henri Migaud, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 4/2011

Abstract

Background

Numerous reports of THAs in patients younger than 30 years indicate a high risk of revision. Although risk factors for revision have been reported for older patients, it is unclear whether these risk factors are the same as those for patients younger than 30 years.

Questions/purposes

We therefore (1) determined function and survivorship of revision THAs performed in patients younger than 30 years, and (2) assessed the risk factors for revision THAs in this younger population by comparison with a group of patients younger than 30 years who did not undergo revision.

Patients and Methods

We retrospectively reviewed the clinical records and radiographs of 55 patients younger than 30 years (average age at revision, 24.3 years; range, 14–30 years) who underwent 77 hip revisions. Revision was performed, on average, 4.6 years (range, 0.4–12 years) after the primary THA. The results for these 55 patients (77 revision THAs) were compared with results for a nonrevised group, including 819 THAs in patients younger than 30 years. Minimum followup of the revision group was 1 year (mean, 6.2 years; range, 1–15 years).

Results

At followup after the revision, the Merle d’Aubigné-Postel score improved from 12.2 to 14.6. The rates of dislocation, neurologic lesions, and fractures were 15%, 7.8%, and 14%, respectively. The 10-year survival rate was 36% (95% confidence interval [CI], 21%–51%). Compared with the nonrevised group, the independent revision risk factors were young age at primary THA (OR 1.14 [1.07–1.19]), high number of previous surgeries (OR 5.41 [2.67–10.98]), and occurrence of at least one dislocation (OR 3.98 [1.74–9.07]). Hard-on-soft bearings had a higher risk (OR 3.42 [1.91–6.1]) of revision compared with hard-on-hard bearings.

Conclusions

Revision THAs are likely in patients younger than 30 years, and the complication rate is high. The survivorship of hip revision in this population is low and alternative solutions should be advocated whenever possible.

Level of Evidence

Level III, therapeutic study, case control study. See the Guidelines for Authors for a complete description of levels of evidence.

Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip and knee. J Rheumatol. 1988;15:1833–1840.PubMed

Bonnomet F, Clavert P, Laffargue P, Duhamel A. Global results and complications. Rev Chir Orthop Reparatrice Appar Mot. 2000;86(suppl 1):48–50.PubMed

Callaghan JJ, Templeton JE, Liu SS, Pedersen DR, Goetz DD, Sullivan PM, Johnston RC. Results of Charnley total hip arthroplasty at a minimum of thirty years. J Bone Joint Surg Am. 2004;86:690–695.PubMed

Chandler HP, Reineck FT, Wixson RL, McCarthy JC. Total hip replacement in patients younger than thirty years old: a five-year follow-up study. J Bone Joint Surg Am. 1981;63:1426–1434.PubMed

Charnley J. Low Friction Arthroplasty of the Hip: Theory and Practice. New York, NY: Springer; 1979:60.

Chmell MJ, Scott RD, Thomas WH, Sledge CB. Total hip arthroplasty with cement for juvenile rheumatoid arthritis: results at a minimum of ten years in patients less than thirty years old. J Bone Joint Surg Am. 1997;79:44–52.PubMed

DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.PubMed

de Thomasson E, Guingand O, Terracher R, Mazel C. [Perioperative complications after total hip revision surgery and their predictive factors: a series of 181 consecutive procedures] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2001;87:477–488.PubMed

Devane PA, Horne JG, Martin K, Coldham G, Krause B. Three-dimensional polyethylene wear of a press-fit titanium prosthesis: factors influencing generation of polyethylene debris. J Arthroplasty. 1997;12:256–266.PubMedCrossRef

10.

Dorr LD, Luckett M, Conaty JP. Total hip arthroplasties in patients younger than 45 years: a nine- to ten-year follow-up study. Clin Orthop Relat Res. 1990;260:215–219.PubMed

11.

Dorr LD, Wan Z, Longjohn DB, Dubois B, Murken R. Total hip arthroplasty with use of the Metasul metal-on-metal articulation: four to seven-year results. J Bone Joint Surg Am. 2000;82:789–798.PubMed

12.

Dudkiewicz I, Salai M, Israeli A, Amit Y, Chechick A. Total hip arthroplasty in patients younger than 30 years of age. Isr Med Assoc J. 2003;5:709–712.PubMed

13.

Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990; 257:107–128.PubMed

14.

Farfalli GL, Buttaro MA, Piccaluga F. Femoral fractures in revision hip surgeries with impacted bone allograft. Clin Orthop Relat Res. 2007;462:130–136.PubMedCrossRef

15.

Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.PubMed

16.

Harris WH, McCarthy JC Jr, O’Neill DA. Femoral component loosening using contemporary techniques of femoral cement fixation. J Bone Joint Surg Am. 1982;64:1063–1067.PubMed

17.

Jialiang T, Zhongyou M, Fuxing P, Zongke Z, Bin S, Jing Y. Primary total hip arthroplasty with Duraloc cup in patients younger than 50 years: a 5- to 7-year follow-up study. J Arthroplasty. 2009;24:1184–1187.PubMedCrossRef

18.

Keener JD, Callaghan JJ, Goetz DD, Pederson DR, Sullivan PM, Johnston RC. Twenty-five-year results after Charnley total hip arthroplasty in patients less than fifty years old: a concise follow-up of a previous report. J Bone Joint Surg Am. 2003;85:1066–1072.PubMed

19.

Kerboull L, Hamadouche M, Courpied JP, Kerboull M. Long-term results of Charnley-Kerboull hip arthroplasty in patients younger than 50 years. Clin Orthop Relat Res. 2004;418:112–118.PubMedCrossRef

20.

Kinkel S, Kaefer W, Reissig W, Puhl W, Kessler S. Revision total hip arthroplasty: the influence of gender and age on the perioperative complication rate. Acta Chir Orthop Traumatol Cech. 2003;70:269–273.PubMed

21.

Lewthwaite SC, Squires B, Gie GA, Timperley AJ, Ling RS. The Exeter Universal hip in patients 50 years or younger at 10-17 years’ followup. Clin Orthop Relat Res. 2008;466:324–331.PubMedCrossRef

22.

Meek RM, Garbuz DS, Masri BA, Greidanus NV, Duncan CP. Intraoperative fracture of the femur in revision total hip arthroplasty with a diaphyseal fitting stem. J Bone Joint Surg Am. 2004;86:480–485.PubMed

23.

Merle D’Aubigne R. [Numerical evaluation of hip function] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1970;56:481–486.

24.

Migaud H, Jobin A, Chantelot C, Giraud F, Laffargue P, Duquennoy A. Cementless metal-on-metal hip arthroplasty in patients less than 50 years of age: comparison with a matched control group using ceramic-on-polyethylene after a minimum 5-year follow-up. J Arthroplasty. 2004;19(8 suppl 3):23–28.PubMed

25.

Odent T, Journeau P, Prieur AM, Touzet P, Pouliquen JC, Glorion C. Cementless hip arthroplasty in juvenile idiopathic arthritis. J Pediatr Orthop. 2005;25:465–470.PubMedCrossRef

26.

Ornstein E, Atroshi I, Franzen H, Johnsson R, Sandquist P, Sundberg M. Early complications after one hundred and forty-four consecutive hip revisions with impacted morselized allograft bone and cement. J Bone Joint Surg Am. 2002;84:1323–1328.PubMed

27.

Park YS, Moon YW, Lim SJ. Revision total hip arthroplasty using a fluted and tapered modular distal fixation stem with and without extended trochanteric osteotomy. J Arthroplasty. 2007;22:993–999.PubMedCrossRef

28.

Peters CL, McPherson E, Jackson JD, Erickson JA. Reduction in early dislocation rate with large-diameter femoral heads in primary total hip arthroplasty. J Arthroplasty. 2007;22(6 suppl 2):140–144.PubMedCrossRef

29.

Restrepo C, Lettich T, Roberts N, Parvizi J, Hozack WJ. Uncemented total hip arthroplasty in patients less than twenty-years. Acta Orthop Belg. 2008;74:615–622.PubMed

30.

Ruddlesdin C, Ansell BM, Arden GP, Swann M. Total hip replacement in children with juvenile chronic arthritis. J Bone Joint Surg Br. 1986;68:218–222.PubMed

31.

Schmalzried TP, Shepherd EF, Dorey FJ, Jackson WO, dela Rosa M, Fa’vae F, McKellop HA, McClung CD, Martell J, Moreland JR, Anstutz HC. The John Charnley Award. Wear is function of use, not time. Clin Orthop Relat Res. 2000;381:36–46.PubMedCrossRef

32.

Sochart DH, Porter ML. Long-term results of cemented Charnley low-friction arthroplasty in patients aged less than 30 years. J Arthroplasty. 1998;13:123–131.PubMedCrossRef

33.

Stover MD, Beaule PE, Matta JM, Mast JW. Hip arthrodesis: a procedure for the new millennium? Clin Orthop Relat Res. 2004;418:126–133.PubMedCrossRef

34.

Stromberg CN, Herberts P, Ahnfelt L. Revision total hip arthroplasty in patients younger than 55 years old: clinical and radiologic results after 4 years. J Arthroplasty. 1988;3:47–59.PubMedCrossRef

35.

Torchia ME, Klassen RA, Bianco AJ. Total hip arthroplasty with cement in patients less than twenty years old: long-term results. J Bone J Surg Am. 1996;78:995–1003.CrossRef

36.

Turgeon TR, Phillips W, Kantor SR, Santore RF. The role of acetabular and femoral osteotomies in reconstructive surgery of the hip: 2005 and beyond. Clin Orthop Relat Res. 2005; 441:188–199.PubMedCrossRef

37.

Vendittoli PA, Lavigne M, Girard J, Roy AG. A randomised study comparing resection of acetabular bone at resurfacing and total hip replacement. J Bone Joint Surg Br. 2006;88:997–1002.PubMedCrossRef

38.

Witt JD, Swann M, Ansell BM. Total hip replacement for juvenile chronic arthritis. J Bone J Surg Br. 1991;73:770–773.

39.

Young L, Duckett S, Dunn A. The use of the cemented Exeter Universal femoral stem in a District General Hospital: a minimum ten-year follow-up. J Bone Joint Surg Br. 2009;91:170–175.PubMedCrossRef

Title: Risk Factors for Revision of Hip Arthroplasties in Patients Younger Than 30 Years
Authors: Julien Girard, MD, MSc
Christophe Glorion, MD
François Bonnomet, MD
Damien Fron, MD
Henri Migaud, MD
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 4/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-010-1669-x

At a glance: The STEP trials

Springer Medicine

Risk Factors for Revision of Hip Arthroplasties in Patients Younger Than 30 Years

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 4/2011

Acetabular Anteversion with CT in Supine, Simulated Standing, and Sitting Positions in a THA Patient Population

Perivascular and Diffuse Lymphocytic Inflammation are not Specific for Failed Metal-on-metal Hip Implants

Skeletal Muscle Abnormalities and Genetic Factors Related to Vertical Talus

Greater Strength Increase with Cyst Decompression and SLAP Repair than SLAP Repair Alone

What Is the Best Femoral Fixation of Hamstring Autografts in Anterior Cruciate Ligament Reconstruction?: A Meta-analysis

Can This Prosthesis Be Saved?: Implant Salvage Attempts in Infected Primary TKA