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Wang JC, Liu KC, Gettleman BS, Chen M, Piple AS, Yang J, Heckmann ND, Christ AB. Characteristics of Very Young Patients Undergoing Total Hip Arthroplasty: A Contemporary Assessment. Arthroplast Today 2024; 25:101268. [PMID: 38235399 PMCID: PMC10792167 DOI: 10.1016/j.artd.2023.101268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 01/19/2024] Open
Abstract
Background This study aims to compare indications, patient characteristics, hospital factors, and complication rates between total hip arthroplasty (THA) patients aged 30 years or younger and those older than 30 years using a large national database. Methods The Premier Healthcare Database was utilized to identify primary THA patients from 2015 to 2021 who were aged ≤30 or >30 years. Patient demographics, hospital factors, and primary indications were compared for each cohort. Rates of complications and readmissions were assessed for each cohort by primary indication. Differences were assessed through univariate analysis. Results Overall, 539,173 primary THA patients were identified (age ≤30: 1849; >30: 537,234). Compared to the >30 cohort, the ≤30 cohort was more likely to be male (56.5% vs 44.9%, P < .001) and non-White (34.0% vs 14.2%, P < .001). The most common indications for THA in the ≤30 cohort were osteonecrosis (49.3%), osteoarthritis (17.8%), and congenital hip deformities (16.0%), and in the >30 cohort, they were osteoarthritis (77.0%), other arthritis (11.3%), and osteonecrosis (5.4%). Patients aged ≤30 years had lower rates of respiratory failure (0.16% vs 0.57%, P < .001), acute renal failure (0.32% vs 1.72%, P < .001), and urinary tract infection (0.38% vs 1.11%, P = .003) than those aged >30 years, but higher rates of wound dehiscence (0.59% vs 0.29%, P = .015) and transfusion (3.68% vs 2.21%, P < .001). There were no differences in 90-day readmission rates (P = .811) or 90-day in-hospital death (P = .173) between cohorts. Conclusions Younger patients undergoing THA differed significantly in indication, patient characteristics, and hospital factors compared to the older population on univariate analysis. Despite differences in indications, the cohorts did not differ markedly with regard to complication rates in this study.
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Affiliation(s)
- Jennifer C. Wang
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Kevin C. Liu
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | | | - Matthew Chen
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Amit S. Piple
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Jaewon Yang
- University of Washington Medical Center, Seattle, WA, USA
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Cheng R, Krell EC, Chiu YF, Stimac JD, Heyse TJ, Abdel MP, Figgie MP, Blevins JL. Survivorship and Clinical Outcomes of Primary Total Knee Arthroplasty Performed in Patients 35 Years of Age and Younger. J Arthroplasty 2023; 38:2316-2323.e1. [PMID: 37286054 DOI: 10.1016/j.arth.2023.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Total knee arthroplasties (TKAs) for patients aged ≤35 years are rare but necessary for patients who have diseases such as juvenile idiopathic arthritis, osteonecrosis, osteoarthritis, and rheumatoid arthritis. Few studies have examined the 10-year and 20-year survivorship and clinical outcomes of TKAs for young patients. METHODS A retrospective registry review identified 185 TKAs in 119 patients aged ≤ 35 years performed between 1985 and 2010 at a single institution. The primary outcome was implant survivorship free of revision. Patient-reported outcomes were assessed at 2 time points: 2011 to 2012 and 2018 to 2019. The average age was 26 years (range, 12 to 35). Mean follow-up was 17 years (range, 8 to 33). RESULTS Survivorship decreased from 84% (95% confidence interval [CI]: 79 to 90) at 5 years to 70% (95% CI: 64 to 77) at 10 years and to 37% (95% CI: 29 to 45) at 20 years. The most common reasons for revision were aseptic loosening (6%) and infection (4%). Risk factors for revision included increasing age at time of surgery (Hazards Ratio [HR] 1.3, P = .01) and use of constrained (HR 1.7, P = .05) or hinged prostheses (HR 4.3, P = .02). There were 86% of patients reporting that their surgery resulted in "a great improvement" or better. CONCLUSION Survivorship of TKAs in young patients is less favorable than expected. However, for the patients who responded to our surveys, TKA demonstrated substantial pain relief and improvement in function at 17-year follow-up. Revision risk increased with older age and higher levels of constraint.
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Affiliation(s)
- Ryan Cheng
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Ethan C Krell
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jeffrey D Stimac
- Department of Orthopedic Surgery, Norton Healthcare, Louisville, Kentucky
| | - Thomas J Heyse
- Medical Faculty, Philipps-University of Marburg, Marburg, Germany; Red Cross Hospital, Frankfurt, Germany
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mark P Figgie
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jason L Blevins
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Peagler CL, Dobek AJ, Tabaie S. Trends in the Use of Total Hip Arthroplasty in the Pediatric Population: A Review of the Literature. Cureus 2023; 15:e43978. [PMID: 37622056 PMCID: PMC10445662 DOI: 10.7759/cureus.43978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 08/26/2023] Open
Abstract
Current literature shows that the utilization of total hip arthroplasty (THA) to address pediatric hip pathology has seen a significant rise worldwide in recent decades. However, performing THA in pediatric patients presents unique challenges due to their increased activity levels, varying skeletal maturity, and diverse medical conditions. These challenges have relegated THA to a secondary option for young patients. Nonetheless, despite these difficulties, recent studies have demonstrated a growing prevalence of THA in pediatrics. Consequently, there is an urgent need for a comprehensive review of the existing literature on this topic. In this study, we examined large database and single-institution studies involving pediatric patients aged 21 years and under who underwent THA. The primary indications for THA in this population were osteoarthritis, osteonecrosis, and inflammatory arthritis. To ensure informed decision-making for pediatric patients, it is crucial to gather consolidated information on trends and outcomes related to THA indications. This review aims to provide insights into these trends and facilitate better decision-making for the treatment of pediatric patients.
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Affiliation(s)
- Correggio L Peagler
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Alexander J Dobek
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Sean Tabaie
- Orthopaedic Surgery, Children's National Hospital, Washington DC, USA
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Robin JX, Huebschmann N, Villa JC, Schwarzkopf R. Staged Bilateral Total Hip Arthroplasty in a Patient With Larsen Syndrome. Arthroplast Today 2023; 21:101147. [PMID: 37274834 PMCID: PMC10238462 DOI: 10.1016/j.artd.2023.101147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 06/07/2023] Open
Abstract
Larsen syndrome is a rare genetic disorder characterized by weak connective tissues and various musculoskeletal abnormalities. This is a case report of a 39-year-old patient with Larsen syndrome who presented with over a decade of bilateral hip pain and difficulty ambulating. This patient has a prior history of bilateral congenital hip dislocations that were treated with open reduction and spica casting as a child with good result. Years later, she went on to develop bilateral hip osteoarthritis with significant remodeling of the proximal femur. The goal of this case presentation is to demonstrate the utility of total hip arthroplasty for this patient and discuss surgical challenges and considerations.
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Affiliation(s)
- Joseph X. Robin
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, 10003, USA
| | - Nathan Huebschmann
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, 10003, USA
| | - Jordan C. Villa
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, 10003, USA
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Klein C, Barbier V, Glorion C, Gouron R. Surgical Treatment of Juvenile Idiopathic Arthritis in the Era of Novel Drug Therapies. J Clin Med 2023; 12:jcm12103402. [PMID: 37240508 DOI: 10.3390/jcm12103402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/11/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Juvenile idiopathic arthritis is the most common chronic rheumatic disease encountered in children under the age of sixteen and causes significant impairments in daily life. Over the last two decades, the introduction of new drug treatments (including disease-modifying antirheumatic drugs and biologics) has changed the course of this disease, thus reducing the indication for surgery. However, some patients fail to respond to drug therapy and thus require personalized surgical management, e.g., the local reduction of joint effusion or a synovial pannus (via intra-articular corticosteroid injections, synovectomy, or soft tissue release), and management of the sequelae of arthritis (such as growth disorders and joint degeneration). Here, we provide an overview of the surgical indications and outcomes of the following interventions: intra-articular corticosteroid injections, synovectomy, soft tissue release, surgery for growth disorders, and arthroplasty.
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Affiliation(s)
- Céline Klein
- Department of Paediatric Orthopaedics, Amiens Picardie University Hospital, University of Picardie Jules Verne, 80054 Amiens, France
- MP3CV-EA7517, CURS-Amiens University Hospital, Jules Verne University of Picardie, 80000 Amiens, France
| | - Vincent Barbier
- Department of Paediatric Orthopaedics, Amiens Picardie University Hospital, University of Picardie Jules Verne, 80054 Amiens, France
- MP3CV-EA7517, CURS-Amiens University Hospital, Jules Verne University of Picardie, 80000 Amiens, France
| | - Christophe Glorion
- Paediatric Orthopaedic Surgery Department, Necker University Hospital, Sorbonne Paris Cité, 75015 Paris, France
| | - Richard Gouron
- Department of Paediatric Orthopaedics, Amiens Picardie University Hospital, University of Picardie Jules Verne, 80054 Amiens, France
- MP3CV-EA7517, CURS-Amiens University Hospital, Jules Verne University of Picardie, 80000 Amiens, France
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Chapot A, Zambelli PY, Merckaert SR. Functional and Patient-related Outcomes of Total Hip Arthroplasty in Patients Younger Than 20 Years. Arthroplast Today 2023; 20:101100. [PMID: 36923059 PMCID: PMC10009676 DOI: 10.1016/j.artd.2023.101100] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 03/18/2023] Open
Abstract
Background Total hip arthroplasty (THA) in adolescent and young adults represent only about 10% of all THAs. Despite the advances in hip conservation surgery, there are still adolescents and young adults who progress to severe joint degeneration. THA seems to be the last solution in these cases. We aimed to assess the clinical and patient-related outcomes at short-term to midterm follow-up for THAs performed before the age of 20 years. Material and methods We performed a retrospective monocentric study including all patients that underwent a THA before the age of 20 years between January 2008 and December 2018 at our tertiary orthopaedic center with a minimum follow-up of 2 years. Demographic data were recorded. The Harris and Oxford hip scores were used to assess clinical and patient-related outcomes. Results A total of 11 patients (12 THAs) were included. Juvenile inflammatory arthritis and avascular necrosis due to slipped capital femoral epiphysis were the most commonly encountered etiologies. The mean age at surgery was 16 years (minimum 13, maximum 19 years). The mean follow-up duration was 6 years (minimum 2, maximum 9 years) without any revision. Regarding the Harris and Oxford hip scores, the mean score were 81 and 39.5 for clinical and patient-related outcomes respectively. The Spearman correlation test revealed a statistically significant positive correlation between the 2 scores of ρ = 0.811 with a P value < .001. Conclusions THA in adolescents and young adults suffering from end-stage osteoarthritis due to pediatric hip disorders provides improved hip function and notable pain relief at short-term to midterm follow-up.
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Affiliation(s)
- Antoine Chapot
- Centre Hospitalier Universitaire Vaudois, Service de chirurgie orthopédique pédiatrique, Lausanne, Switzerland
| | - Pierre-Yves Zambelli
- Centre Hospitalier Universitaire Vaudois, Service de chirurgie orthopédique pédiatrique, Lausanne, Switzerland.,Centre Hospitalier Universitaire Vaudois, Service d'Orthopédie adulte, Lausanne, Switzerland
| | - Sophie Rosa Merckaert
- Centre Hospitalier Universitaire Vaudois, Service de chirurgie orthopédique pédiatrique, Lausanne, Switzerland
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