Mid-to long-term results of revision total hip replacement in patients aged 50 years or younger

Abstract

Revision total hip replacement (THR) for young patients is challenging because of technical complexity and the potential need for subsequent further revisions. We have assessed the survivorship, functional outcome and complications of this procedure in patients aged < 50 years through a large longitudinal series with consistent treatment algorithms. Of 132 consecutive patients (181 hips) who underwent revision THR, 102 patients (151 hips) with a mean age of 43 years (22 to 50) were reviewed at a mean follow-up of 11 years (2 to 26) post-operatively. We attempted to restore bone stock with allograft where indicated. Using further revision for any reason as an end point, the survival of the acetabular component was 71% (sd 4) and 54% (sd 7) at ten- and 20 years. The survival of the femoral component was 80% (sd 4) and 62% (sd 6) at ten- and 20 years. Complications included 11 dislocations (6.1%), ten periprosthetic fractures (5.5%), two deep infections (1.1%), four sciatic nerve palsies (2.2%; three resolved without intervention, one improved after exploration and freeing from adhesions) and one vascular injury (0.6%). The mean modified Harris Hip Score was 41 (10 to 82) pre-operatively, 77 (39 to 93) one year post-operatively and 77 (38 to 93) at the latest review. This overall perspective on the mid- to long-term results is valuable when advising young patients on the prospects of revision surgery at the time of primary replacement.

Outcome of revision hip arthroplasty in patients younger than 55 years: an analysis of 1,037 revisions in the Dutch Arthroplasty Register

“…Survival at 5-year follow-up was lower when compared with the available literature on young patients (Lee et al 2014, Gromov et al 2015, Te Stroet et al 2015. Few papers ana- Table 3.…”

“…Te Stroet et al (2015) reported a survival rate of 87% after follow-up of 10 years in a single-center study with only 34 revision procedures. Lee et al (2014) reported a survival rate of 63% at 10-year follow-up, whereas survival at 5 years was approximately 88%. Several studies assessed the survival of revision hip arthroplasty in older patients, where reported survival varied between 81% and 83% at 5 years (Jafari et al 2010, Ong et al 2010 and 72% at 10 years (Lie et al 2004).…”

“…There are a few studies available that assessed the survival of revision procedures. The outcome of these studies was disappointing, with reported survival rates between 36% and 87% at 10-year follow-up (Girard et al 2011, Adelani et al 2014, Lee et al 2014, Te Stroet et al 2015, Beckmann et al 2018. Besides this inferior outcome, most of these studies were single-center studies and had small sample sizes.…”

Satisfying Outcomes Scores and Survivorship Achieved With Impaction Grafting for Revision THA in Young Patients

“…The increasing number of THAs performed in patients younger than 55 years will inevitably generate a larger number of revision procedures for this specific group of patients. Unfortunately, data on the recent results of revision THA in younger patients are limited, and survivorship data from studies of younger patients are not encouraging [ 1 , 16 , 22 ]. The single long-term survival study reports a disappointing outcome of 63% at 10 years for patients when the endpoint was rerevision for any reason [ 22 ].…”

Pelvic X-ray examinations in follow-up of hip arthroplasty or femoral osteosynthesis – Dose reduction and quality criteria

“…On the other hand, with longer survivorship of artificial hips, young patients become more and more candidates for THA, as other surgical options are limited [4]. For this reason, radiation exposure is increasingly becoming a focus.…”