Abstract
Introduction
Especially in young patients, total hip implants with proven long-term follow-up data should be used. Despite this, almost all patients under 30 years old will face a revision of their hip prosthesis during their life time because of their life expectancy. Therefore, all the used implants should be revisable with reliable outcome. Although, several studies have evaluated the outcome of different THA implants in patients under 30, only few report the long term follow-up of 10 years or more. None of them present the outcome of the revised total hips.
Methods
We retrospectively reviewed prospectively collected data of 48 consecutive patients (69 hips), all received a cemented implant and in case of acetabular bone stock deficiency (29 hips), a reconstruction with bone impaction grafting (BIG) was performed. Mean age at surgery was 24.6 years (range, 16.0–29.0 years). Two patients were lost to follow-up. As far as we know, no revisions are performed in these two patients and their data are included in the study up to their last radiographic control. All failed hips were revised with again cemented implants and, if needed, bone impaction grafting. For the primary THA Kaplan-Meier survival curves at 10- and 15-year endpoint revision for any reason and revision for aseptic loosening were calculated. Separate survival rates at 10- and 15- year were calculated for the BIG group versus the non-BIG group. The outcome of the revised hips was studied and reported with re-revision as the endpoint.
Results
Mean follow-up of all 69 hips was 11.5 years (range 2–23.4 years). During follow-up 13 revisions were performed. No stem revisions occurred, except in 3 septic failures. The 10- and 15-year survival rates with endpoint revision for any reason were 86% (95%-CI: 74–92%) and 75% (95%-CI:59-86%), the same endpoints revision for aseptic loosening were 90% (95%-CI: 79–96%) and 82% (95%-CI: 65–92%), respectively. The 10- and 15-year survival rates with endpoint revision for any reason in the BIG group were 93% (95%-CI: 74–98%) and 83% (95%-CI:49-95%), whereas for the non-BIG group the rates were 81% (95%-CI: 69–91%) and 71% (95%-CI:50-84%). None of the 13 revisions needed a re-revision within 10 years after re-implantation, although one cup failed after 13 years.
Conclusion
This study shows that cemented primary total hip implants in patients under 30 years have acceptable outcomes at 10 and 15 years after surgery. Remarkably, the outcomes of the bone impaction grafting technique are superior to non BIG hips, the BIG-group shows a higher survival percentage as the non-BIG group. However, the most interesting part of the study is that the revised hips, all again re-cemented and, if needed, reconstructed with bone impaction grafting were performing well with no re-revisions within 10 years after surgery.
