HIP REPLACEMENT IN YOUNG OSTEOARTHRITIC PATIENTS – CURRENT PRACTICE IN THE UK

Abstract

Approximately 10% of primary hip replacements performed each year for osteoarthritis are in patients aged 55 or less. These patients have a longer life expectancy and a higher activity level than an elder cohort, which may translate to higher revision rates.

We utilized a regional hip register (Trent and Welsh Arthroplasty Audit Group (TWAAG)) to review current surgical practice in this age group. The TWAAG group comprises 118 surgeons working in 31 different hospitals covering a population of 8 million (14.2% of the population).

1 January 2000 to 31 December 2002, we were notified of 7,678 primary THRs for osteoarthritis. 911 (11.7%) were performed on patients aged 55 or less. Age, gender, grade of lead operating surgeon, type of femoral and acetabular prosthesis implanted, fixation method, femoral head size and bearing surfaces were recorded. There were 434 males, 477 females, with an age range of 16–55. Thirty-five femoral and thirty-three acetabular components were identified. 61.7% of femoral prostheses were cemented. 67.4 % of acetabular prostheses were uncemented. 30% of THRs implanted in the group over the study period were hybrid. 50% of implants had a metal/UHMWPE bearing. Other bearing surfaces comprised ceramic/UHMWPE 28.7%, metal/ metal resurfacing 13.8% and ceramic/ceramic 7.5%. Consultants performed 84.5% of procedures.

Femoral prostheses with little or no published data are used and, unless closely monitored, such practices will not be compliant with NICE recommendations. 40% of THRs performed had components implanted that were produced by different manufacturers. At the present time there does not appear to be a clear picture as to what is the ‘gold’ standard for young patients. Continued monitoring of these implants is essential to provide feedback and drive choice.