OUTCOME OF UNCEMENTED TOTAL HIP ARTHROPLASTY IN PATIENTS AGED 50 YEARS OR YOUNGER.

Abstract

Purpose: The young patient with hip arthritis remains one of the biggest challenges to arthroplasty surgeons. The difficulty of providing a long-lasting total hip arthroplasty (THA) has been clearly documented in the literature. The aim of this study was to assess the outcomes of uncemented THA’s performed in our unit in patients aged under 50.

Methods: In our unit information on all patients is recorded prospectively on an arthroplasty database. From this database we identified 273 uncemented THAs in 237 patients under the age of 50 performed in our unit between 1985 and 2000 with a minimum of 5 year follow up. Outcomes were assessed in terms of 10 and 15-year survival with revision for any reason as the endpoint. Hip scores at routine and most recent follow-up were also reviewed. All surviving implants were radiographically assessed for acetabular wear, component loosening and for the presence of osteolysis.

Results: The mean age of patients at the time of surgery was 41.1 years. 36 patients had bilateral THA. The overall 10 and 15 year survival was 88.7 ± 2.4% and 65.6 ± 4.8 % respectively. Femoral stem survival was significantly higher at 100 % and 98.4 ± 1.6% at 10 and 15 years. Acetabular component survival was 88.6 ± 2.5 % at 10 years and 65.9 ± 4.8 % at 15 years. In unrevised THA’s 56.9% had asymmetric polyethylene wear > 2mm. 2% had definite evidence of acetabular loosening. 25.5% had radiographic evidence of femoral cortical hypertrophy or spot-welds. The mean HHS pre–operatively, at 5 and 10-year follow-up was 46.4 ± 13, 90.7 ± 12.2 and 87.9 ± 14.7 respectively.

Conclusions: Uncemented THA is effective even in young active patients. The main challenges remain ace-tabular polyethylene wear and loosening. Femoral uncemented stems provide long-term functional fixation. Contemporary bearing surfaces in association with such stems may provide long lasting THA’s even in young active patients.