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Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old

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ABSTRACT

Background and purpose: Total hip replacement (THR) is not recommended for children and very young teenagers because early and repetitive revisions are likely. We investigated the clinical and radiographic outcomes of THR performed in children and teenage patients.

Patients and methods: We included 111 patients (132 hips) who underwent THR before 20 years of age. They were identified in the Norwegian Arthroplasty Register, together with information on the primary diagnosis, types of implants, and any revisions that required implant change. Radiographs and Harris hip score (HHS) were also evaluated.

Results: The mean age at primary THR was 17 (11–19) years and the mean follow-up time was 14 (3–26) years. The 10-year survival rate after primary THR (with the endpoint being any revision) was 70%. 39 patients had at least 1 revision and 16 patients had 2 or more revisions. In the latest radiographs, osteolysis and atrophy were observed in 19% and 27% of the acetabulae and 21% and 62% of the femurs, respectively. The mean HHS at the final follow-up was 83 (15–100).

Interpretation: The clinical score after THR in these young patients was acceptable, but many revisions had been performed. However, young patients with developmental dysplasia of the hip had lower implant survival. Moreover, the bone stock in these patients was poor, which could complicate future revisions.

No MeSH data available.


Survival curves.a. Primary THR with revision as endpoint.b. Primary THR operated during the periods 1987–1998 and 1999–2010.c. Primary THR with cup change as endpoint.d. Primary THR with stem change as endpoint.e. First revision with second revision as endpoint.
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Figure 0003: Survival curves.a. Primary THR with revision as endpoint.b. Primary THR operated during the periods 1987–1998 and 1999–2010.c. Primary THR with cup change as endpoint.d. Primary THR with stem change as endpoint.e. First revision with second revision as endpoint.

Mentions: 39 hips (30%) had undergone at least 1 revision. 32 acetabular components and 23 stems had been revised. The 10-year survival of the primary implant with the endpoint being any revision was 70%. It was 78% with the endpoint being a change of acetabular component and it was 90% with the endpoint being a change of stem. According to underlying disease, the 10-year survival with the endpoint being any revision was 77% for 45 hips with SID, 52% for 25 hips with developmental dysplasia of the hip (DDH), and 73% for 31 hips diagnosed as SCFE, Perthes’ disease, or trauma. The 5-year survival of the THRs carried out in 1987–1998 was 84%, as compared to 97% in 1999–2010 (Figure 3).


Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old
Survival curves.a. Primary THR with revision as endpoint.b. Primary THR operated during the periods 1987–1998 and 1999–2010.c. Primary THR with cup change as endpoint.d. Primary THR with stem change as endpoint.e. First revision with second revision as endpoint.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016906&req=5

Figure 0003: Survival curves.a. Primary THR with revision as endpoint.b. Primary THR operated during the periods 1987–1998 and 1999–2010.c. Primary THR with cup change as endpoint.d. Primary THR with stem change as endpoint.e. First revision with second revision as endpoint.
Mentions: 39 hips (30%) had undergone at least 1 revision. 32 acetabular components and 23 stems had been revised. The 10-year survival of the primary implant with the endpoint being any revision was 70%. It was 78% with the endpoint being a change of acetabular component and it was 90% with the endpoint being a change of stem. According to underlying disease, the 10-year survival with the endpoint being any revision was 77% for 45 hips with SID, 52% for 25 hips with developmental dysplasia of the hip (DDH), and 73% for 31 hips diagnosed as SCFE, Perthes’ disease, or trauma. The 5-year survival of the THRs carried out in 1987–1998 was 84%, as compared to 97% in 1999–2010 (Figure 3).

View Article: PubMed Central - PubMed

ABSTRACT

Background and purpose: Total hip replacement (THR) is not recommended for children and very young teenagers because early and repetitive revisions are likely. We investigated the clinical and radiographic outcomes of THR performed in children and teenage patients.

Patients and methods: We included 111 patients (132 hips) who underwent THR before 20 years of age. They were identified in the Norwegian Arthroplasty Register, together with information on the primary diagnosis, types of implants, and any revisions that required implant change. Radiographs and Harris hip score (HHS) were also evaluated.

Results: The mean age at primary THR was 17 (11–19) years and the mean follow-up time was 14 (3–26) years. The 10-year survival rate after primary THR (with the endpoint being any revision) was 70%. 39 patients had at least 1 revision and 16 patients had 2 or more revisions. In the latest radiographs, osteolysis and atrophy were observed in 19% and 27% of the acetabulae and 21% and 62% of the femurs, respectively. The mean HHS at the final follow-up was 83 (15–100).

Interpretation: The clinical score after THR in these young patients was acceptable, but many revisions had been performed. However, young patients with developmental dysplasia of the hip had lower implant survival. Moreover, the bone stock in these patients was poor, which could complicate future revisions.

No MeSH data available.