Abstract
Background
Because of the long life expectancy of young total hip arthroplasty (THA) patients and the limited durability of prosthetic implants in young patients, surgeon's always must take into account that the primary THA will be revised in the future. Therefore, not only the survival of the primary total hip in young patients is important, but we would also like to accentuate the revisability of a primary THA in this specific and high demanding patient population.
Methods
Based on our philosophy, we always use cemented hip in young patients, if needed with acetabular bone impaction grafting. 343 consecutive cemented THA in 270 patients under the age of 50 years were evaluated, all implanted between 1988 and 2006. We also assessed the results of the revised THA (n=53) within the same population. Clinical, radiographical and survival of primary and revision THA were evaluated.
Outcome
Survival analysis of all 343 hips with endpoint revision for any reason of either component showed a survival of 86% after 10 years. Survival of the stem and cup with endpoint aseptic loosening 93% after 10 years. Remarkably, the THA in which the cemented cup was combined with acetabular bone impaction grafting had a survival of 90% (SE 2.8) in contrast to a survival of 82% (SE 3.4) of the cups without an acetabular revision with endpoint revision for any reason of the whole prostheses(log-rank test, p=0.156) at 10 years. With no patient lost during follow-up, 53 primary hips were revised after a mean follow-up of 8.9 (range 2.0–19.3) years. The average follow-up of the revision THA was 4.2 (range 0.1–14.8) years. Three hips of this revision cohort needed a repeat revision, two had a reinfection after a septic revision and one revised cup failed 12 years after revision. The survival of the revised cohort with endpoint revision for any reason was 91% after 5 years, with endpoint aseptic loosening the survival at 5 years was 100 %. As well after primary as revision THA good clinical outcome scores were measured.
Interpretation
Cemented implants in young patients showed satisfying results in primary as well as after revision THA with very acceptable survival and clinical outcomes. Keeping in mind that the young patient will outlive their primary THA, the primary hip has to be revisable and the results of the revision THA must be as good as the primary THA. Bone defects both in primary and revision THA can be successful managed with impacted bone grafts, without the need for augments, cages or larger implants.
