Long-term results of cemented total hip arthroplasty in patients younger than 30 years and the outcome of subsequent revisions

BMC Musculoskeletal Disorders

B Willem Schreurs²  René PH Veth²  Jan CM Hendriks¹  Jean WM Gardeniers²  Vincent JJF Busch²  Marloes WJL Schmitz² 

[1] Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, P.O. Box 9101, Nijmegen, HB 6500, The Netherlands;Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Internal Post 357, PO Box 9101, Nijmegen, HB 6500, The Netherlands

关键词: Hip;    Bone;    Cement;    Revision THA;    Young;    Impaction bone grafting;    Total hip arthroplasty;   

Others  :  1134102
DOI  :  10.1186/1471-2474-14-37

 received in 2012-08-20, accepted in 2013-01-15,  发布年份 2013

【 摘 要 】

Background

The number of total hip arthroplasties in patients under 30 years is increasing over the years. Almost all of them will face at least one or more future revisions in their life. Therefore, the implant used should have a high survival rate, and needs to be easily revisable resulting in a low re-revision rate. Several studies have evaluated the outcome of total hip arthroplasties in patients under 30 years. However, only a few reported on the follow-up outcome of 10 years or more. In addition, none of these reports published data of the subsequent revisions of these implants within their original report.

Methods

We studied historically prospective collected data of 48 consecutive patients (69 hips) younger than 30 years, treated with a cemented primary total hip prosthesis between 1988 and 2004. Since the last evaluation of this cohort, two patients were lost to follow-up. For all hip revisions in this cohort, again cemented implants were used, mostly in combination with bone impaction grafting. Kaplan-Meier survival curves at 10- and 15 years for the primary total hip arthroplasties and revisions were determined.

Results

The mean age at time of primary surgery was 25 years (range, 16 to 29 years). Mean follow-up of the primary hips was 11.5 years (range, 7 to 23 years). During follow-up 13 revisions were performed; in 3 cases a two-stage total revision was performed for septic loosening and 9 cups were revised for aseptic loosening. There were no aseptic stem revisions. The 10 and 15-year survival rates with endpoint revision for aseptic loosening of the primary total hip were 90% (95% CI: 79 to 96) and 82% (95% CI: 65 to 92) respectively. None of our 13 subsequent revisions needed a re-revision within 10 years after re-implantation.

Conclusions

Cemented total hip implants in patients under 30 years have an encouraging outcome at 10 and 15 years after surgery in these young patients. The 13 revised hips, treated with bone grafting and the third generation cement technique, were performing well with no re-revisions within ten years after surgery.

【 授权许可】

   
2013 Schmitz et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 4.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Halley DK, Charnley J: Results of low friction arthroplasty in patients thirty years of age or younger. Clin Orthop Relat Res 1975, 112:180-91.
• [2]Chandler HP, Reineck FT, Wixson RL, McCarthy JC: Total hip replacement in patients younger than thirty years old. A five-year follow-up study. J Bone Joint Surg Am 1981, 63(9):1426-34.
• [3]Witt JD, Swann M, Ansell BM: Total hip replacement for juvenile chronic arthritis. J Bone Joint Surg Br 1991, 73(5):770-3.
• [4]Cage DJ, Granberry WM, Tullos HS: Long-term results of total arthroplasty in adolescents with debilitating polyarthropathy. Clin Orthop Relat Res 1992, 283:156-62.
• [5]Maric Z, Haynes RJ: Total hip arthroplasty in juvenile rheumatoid arthritis. Clin Orthop Relat Res 1993, 290:197-9.
• [6]Torchia ME, Klassen RA, Bianco AJ: Total hip arthroplasty with cement in patients less than twenty years old. Long-term results. J Bone Joint Surg Am 1996, 78(7):995-1003.
• [7]Chmell MJ, Scott RD, Thomas WH, Sledge CB: Total hip arthroplasty with cement for juvenile rheumatoid arthritis. Results at a minimum of ten years in patients less than thirty years old. J Bone Joint Surg Am 1997, 79(1):44-52.
• [8]Sochart DH, Porter ML: Long-term results of cemented charnley low-friction arthroplasty in patients aged less than 30 years. J Arthroplasty 1998, 13(2):123-31.
• [9]Kumar MN, Swann M: Uncemented total hip arthroplasty in young patients with juvenile chronic arthritis. Ann R Coll Surg Engl 1998, 80(3):203-9.
• [10]Haber D, Goodman SB: Total hip arthroplasty in juvenile chronic arthritis: a consecutive series. J Arthroplasty 1998, 13(3):259-65.
• [11]Lebel E, Itzchaki M, Hadas-Halpern I, Zimran A, Elstein D: Outcome of total hip arthroplasty in patients with gaucher disease. J Arthroplasty 2001, 16(1):7-12.
• [12]Odent T, Journeau P, Prieur AM, Touzet P, Pouliquen JC, Glorion C: Cementless hip arthroplasty in juvenile idiopathic arthritis. J Pediatr Orthop 2005, 25(4):465-70.
• [13]McCullough CJ, Remedios D, Tytherleigh-Strong G, Hua J, Walker PS: The use of hydroxyapatite-coated CAD-CAM femoral components in adolescents and young adults with inflammatory polyarthropathy: ten-year results. J Bone Joint Surg Br 2006, 88(7):860-4.
• [14]Kitsoulis PB, Stafilas KS, Siamopoulou A, Soucacos PN, Xenakis TA: Total hip arthroplasty in children with juvenile chronic arthritis: long-term results. J Pediatr Orthop 2006, 26(1):8-12.
• [15]Nizard R, Pourreyron D, Raould A, Hannouche D, Sedel L: Alumina-on-alumina hip arthroplasty in patients younger than 30 years old. Clin Orthop Relat Res 2008, 466(2):317-23.
• [16]Wangen H, Lereim P, Holm I, Gunderson R, Reikeras O: Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with a HA-coated stem. Int Orthop 2008, 32(2):203-8.
• [17]Busch V, Klarenbeek R, Slooff T, Schreurs BW, Gardeniers J: Cemented hip designs are a reasonable option in young patients. Clin Orthop Relat Res 2010, 468(12):3214-20.
• [18]Wroblewski BM, Purbach B, Siney PD, Fleming PA: Charnley low-friction arthroplasty in teenage patients: the ultimate challenge. J Bone Joint Surg Br 2010, 92(4):486-8.
• [19]Clohisy JC, Oryhon JM, Seyler TM, Wells CW, Liu SS, Callaghan JJ: Function and fixation of total hip arthroplasty in patients 25 years of age or younger. Clin Orthop Relat Res 2010, 468(12):3207-13.
• [20]Raphael BS, Dines JS, Akerman M, Root L: Long-term followup of total hip arthroplasty in patients with cerebral palsy. Clin Orthop Relat Res 2010, 468(7):1845-54.
• [21]Simon JP, Maes M, Robbens E, Bellemans J: Total hip arthroplasty in inflammatory arthritis in patients under 35 years. A 7 to 19 year follow-up. Hip Int 2010, 20(2):163-70.
• [22]Girard J, Bocquet D, Autissier G, Fouilleron N, Fron D, Migaud H: Metal-on-metal hip arthroplasty in patients thirty years of age or younger. J Bone Joint Surg Am 2010, 92(14):2419-26.
• [23]McAuley JP, Szuszczewicz ES, Young A, Engh CA Sr: Total hip arthroplasty in patients 50 years and younger. Clin Orthop Relat Res 2004, 418:119-25.
• [24]Gie GA, Linder L, Ling RSM, Slooff TJJH, Timperley AJ: Impacted cancellous allografts and cement for revision total hip arthroplasty. J Bone soint Surg 1993, 75-B:14-21.
• [25]Schreurs BW, Slooff TJ, Gardeniers JW, Buma P: Acetabular reconstruction with bone impaction grafting and a cemented cup: 20 years’ experience. Clin Orthop Relat Res 2001, 393:202-15.
• [26]D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG: Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res 1989, 243:126-37.
• [27]Conn RA Peterson LFA, Stuaffer RN, Ilstrup D: Management of acetabular deficiency: long-term results of bone grafting the acetabulum in total hip arthroplasty. Orthop Trans 1985, 9:451-452.
• [28]DeLee JG, Charnley J: Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 1976, 121:20-32.
• [29]Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr: Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 1973, 55(8):1629-32.
• [30]Dorr LD, Wan Z: Comparative results of a distal modular sleeve, circumferential coating, and stiffness relief using the anatomic porous replacement II. J Arthroplasty 1996, 11(4):419-28.
• [31]Gruen TA, McNeice GM, Amstutz HC: “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 1979, 141:17-27.
• [32]Loudon JR, Older MW: Subsidence of the femoral component related to long-term outcome of hip replacement. J Bone Joint Surg Br 1989, 71(4):624-8.
• [33]Harris WH, McCarthy JC Jr, O’Neill DA: Femoral component loosening using contemporary techniques of femoral cement fixation. J Bone Joint Surg Am 1982, 64(7):1063-7.
• [34]Schreurs BW, Arts JJ, Verdonschot N, Buma P, Slooff TJ, Gardeniers JW: Femoral component revision with use of impaction bone-grafting and a cemented polished stem. Surgical technique. J Bone Joint Surg Am 2006, 88(Suppl 1 Pt 2):259-74.
• [35]Busch VJ, Gardeniers JW, Verdonschot N, Slooff TJ, Schreurs BW: Acetabular reconstruction with impaction bone-grafting and a cemented cup in patients younger than fifty years old: a concise follow-up, at twenty to twenty-eight years, of a previous report. J Bone Joint Surg Br 2011, 6;93(4):367-71. [Research Support, Non-U.S. Gov’t]
• [36]de Kam DC, Gardeniers JW, Hendriks JC, Veth RP, Schreurs BW: Cemented polyethylene cups in patients younger than 40 years. Clin Orthop Relat Res 2009, 467(7):1753-64.
• [37]National Institute for Clinical Excellence (NICE): Guidance on the selection of prostheses for primary total hip replacement. Londen: NICE; 2003.
• [38]Macpherson GJ, Breusch SJ: Metal-on-metal hip resurfacing: a critical review. Arch Orthop Trauma Surg 2011, 131(1):101-10.
• [39]Australian Orthopaedic Association, National Joint Replacement Registry, Annual Report 2011. available at http://aoanjrr.dmac.adelaide.edu.au/ webcite (accessed December 2012)
• [40]Smith AJ, Dieppe P, Howard PW, Blom AW, National Joint Registry for England and Wales: Failure rates of metal-on-metal hip resurfacings: analysis of data from the national joint registry for england and wales. Lancet 2012, 17;380(9855):1759-66.
• [41]Murray DW, Britton AR, Bulstrode CJ: Loss to follow-up matters. J Bone Joint Surg Br 1997, 79(2):254-7.
• [42]Swedish Hip Arthroplasty Register, Annual Report 2009. Available at http://www.shpr.se/Libraries/Documents/AnnualReport-2009-EN.sflb.ashx webcite, Accessed February 1, 2012