Sports Activity and Patient-Related Outcomes after Cementless Total Hip Arthroplasty in Patients Younger than 40 Years

Abstract

Background: The management of degenerative hip diseases in young patients remains a challenge. Despite the improvement of hip-preserving procedures, total hip arthroplasty (THA) may be required in some instances. In addition, young patients undergoing THA have high expectations concerning their postoperative level of activity. Purpose: (1) to define the sports activity level and the return to sports after THA, (2) to describe the modification or initiation of new sports disciplines, and (3) to report the clinically meaningful outcomes after THA in patients younger than 40 years. Methods: A total of 36 patients (40 hips) were prospectively analyzed at a midterm follow-up of 3.9 years. The modified Harris Hip Score (mHHS); the Visual Analog Scale (VAS) for pain; the University of California, Los Angeles (UCLA) activity scale; and sports and recreational activity levels were assessed via questionnaire. The minimal clinically important difference (MCID) was determined by calculating half of the standard deviation, and the substantial clinical benefit (SCB) as well as patient acceptable symptomatic state (PASS), were calculated by the anchor method for the mHHS. Results: At the final follow-up, there was a significant improvement in mHHS (34.1 to 92.6; p < 0.0001), UCLA (3.2 to 7.6; p < 0.0001), and VAS for pain (8 to 1; p < 0.0001). More patients were active in sports at follow-up than before surgery (44% to 92%, p < 0.0001). In addition, the duration and frequency of sports activities showed a significant increase (p < 0.0001). The MCID, SCB and PASS for mHHS were 89% and 58%, respectively. No revision surgery had to be performed. Conclusion: This study showed that a large proportion of patients under 40 years of age who underwent THA increased their physical activity. Eighty-six percent of the patients were highly active, with a UCLA score ≥ 7. Furthermore, the reported MCID, SCB, and PASS for mHHS were achieved by more than 80% of patients.

Length doesn’t play a role – Sexual activity in men after short stem Total hip Arthroplasty

“…Concerning PROMs, the mean postoperative mHHS after one year in the general population was 88.6 (preoperative 50.8) points [16]. Patients who underwent THA under 40 years of age after 4 years follow-up showed a significant improvement of the mHHS from 34.1 preoperative to 92.6 after THA [17]. Patients with a mean age of 31 years of age showed a mean postoperative Harris Hip Score (HHS) of 84.6 points at 7 year follow-up [18].…”

Length doesn´t play a role – Sexual Activity in Men After Short Stem Total Hip Arthroplasty

“…Concerning PROMs, the mean postoperative mHHS after one year in the general population was 88.6 (preoperative 50.8) points(16). Patients who underwent THA under 40 years of age after 4 years follow-up showed a signi cant improvement of the mHHS from 34.1 preoperative to 92.6 after THA (17). Patients with a mean age of 31 years of age showed a mean postoperative Harris Hip Score (HHS) of 84.6 points at 7 year follow-up(18).…”

Outcome scores after hip surgery in young adults: an editorial approach

“…Over the past several years, total hip arthroplasty has been used more and more in young patients; projections show that by the year 2030, more than half of all primary total hip arthroplasties will be placed in patients younger than 65 years of age, with the higher increase in patients between 45 and 54 years of age [1]. Current conditions, such as the femoroacetabular impingement, developmental dysplasia of the hip, and trauma are common sources of pain and functional limitations in active individuals that eventually develop hip osteoarthritis [2,3]. In this age group, hip arthrodesis and resection arthroplasty were considered alternative salvage procedures in the past; currently, hip preservation surgical techniques such as hip arthroscopy and resurfacing have developed with the appreciation that most hip problems in young adults are associated with altered hip morphology [2,4].…”

“…Young patients undergoing total hip arthroplasty have high expectations concerning their post-operative level of activity [3,[5][6][7]. However, data on the outcome of primary and revision hip arthroplasty in young patients are limited [8].…”

“…Additionally, some scores show floor and ceiling effects (where >15% of participants scored the worst and best scores, respectively). The implication is that patients may report high scores and still suffer functional deficits [3,5,11,12]. Therefore, is there any chance that we are using incorrect outcome scores after hip surgery in young adults?…”