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Huerfano E, Bautista M, Huerfano M, Nossa JM. Total hip arthroplasty in adolescents: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2024; 48:2483-2492. [PMID: 38619564 DOI: 10.1007/s00264-024-06175-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE Total hip arthroplasty (THA) has demonstrated excellent results in elderly patients, however, the indications, outcomes, and long-term results in adolescent patients are less understood. This study aims to assess the outcomes of THA in patients under 21, providing insights for clinical decision-making in this exceptional population. METHODS A systematic review in PubMed, Ovid MEDLINE, and Embase database was performed. We included studies reporting clinical, radiological, and functional outcomes of THA in patients younger than 21 years, for any cause, with a with a minimum follow-up of one year. The ten year survivorship estimate was pooled using a meta-analysis methodology and each study was weighted according to its standard error, calculated from published confidence intervals. RESULTS We included 25 studies involving 1166 hips. Median age was 17 years old, 60% were females, and the average follow-up was 8.1 years. Juvenile inflammatory arthritis was the main indication for total hip arthroplasty (THA). The all-cause revision rate was 14.4% and aseptic loosening was the most common cause. Only eight studies reported ten year survival rates and form the pooled analysis an 84.91% survival rate (95% CI 70.56 - 99.27) was obtained. An average score of 88.08 in the Harris Hip Score (HHS) was observed. We found a 3.43% complication rate. CONCLUSIONS Hip arthroplasty is an acceptable option for adolescents with end-stage arthritis. However, the altered hip anatomy, the elevated revision rate, and the long-term implant survival must be considered before performing a THA in adolescent patients.
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Affiliation(s)
- Elina Huerfano
- Department of Orthopaedic Surgery, Instituto Roosevelt and Medsport, Carrera 4 Este # 17 - 50, Bogotá, Colombia.
| | - Maria Bautista
- Department of Orthopedic Surgery, Hospital Universitario Fundación Valle del Lili, Cali, Colombia
| | - Manuel Huerfano
- Department of Nephrology, Hospital Universitario Mayor Méderi, Bogotá, Colombia
| | - Juan M Nossa
- Department of Orthopaedic Surgery, Instituto Roosevelt and Medsport, Carrera 4 Este # 17 - 50, Bogotá, Colombia
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Kang SY, Ko YS, Kim HS, Yoo JJ. Outcome and complication rate of total hip arthroplasty in patients younger than twenty years: which bearing surface should be used? INTERNATIONAL ORTHOPAEDICS 2024; 48:1381-1390. [PMID: 38217722 PMCID: PMC11076316 DOI: 10.1007/s00264-023-06086-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE Total hip arthroplasty (THA) in younger patients remains controversial due to concerns regarding long-term implant survival and potential complications. This study aimed to evaluate long-term clinical outcomes, complications, differences in complication and revision rates by bearing surfaces, and Kaplan-Meier survival curves for THA in patients under 20 years old. METHODS A retrospective review was conducted for 65 patients (78 hips) who underwent THA between 1991 and 2018. Their mean age was 18.9 years. Their clinical outcomes were assessed using the Harris Hip Score (HHS). Radiological outcomes were evaluated based on the presence of loosening, osteolysis, and heterotopic ossification. Complications such as dislocation, periprosthetic fractures, and infections were assessed. The mean follow-up period was 13.2 years (range, 5.0-31.2 years). RESULTS The mean HHS improved from 44.6 to 90.1. There were two cases of dislocation. However, no periprosthetic fracture, deep infection, or ceramic component fracture was noted. There were 19 revisions of implants. Eighteen of 19 hips were operated with hard-on-soft bearings in the index surgery (p < 0.01). The 23-year survivorship was 97.8% for THA using ceramic-on-ceramic bearings, while the 31-year survivorship was 36.7% using hard-on-soft bearings. CONCLUSION THA in patients under 20 years old yielded promising clinical and radiological outcomes, although polyethylene-bearing-related concerns persisted. Previously operated patients with hard-on-soft bearing should be meticulously examined during the follow-up. As ceramic-on-ceramic bearing showed excellent survivorship in this particular cohort, we recommend the use of this articulation as the bearing of choice.
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Affiliation(s)
- Sang Yoon Kang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Young-Seung Ko
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hong Seok Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Perez Alamino L, Garabano G, Rodriguez J, Lopreite F, Pesciallo C. Total hip arthroplasty in patients under 50 years old: Does cementless fixation have better results? Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00079-1. [PMID: 38643855 DOI: 10.1016/j.recot.2024.04.005] [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: 10/17/2023] [Revised: 03/20/2024] [Accepted: 04/14/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Cementless fixation for hip arthroplasties has increased in the last decades, particularly in younger patients. The purpose of this study was to compare the long-term results three different types of fixations in patients under 50years old. METHODS Cemented, hybrid and cementless fixations were assessed in patients under 50years old with a minimum follow-up of 8years. Loosening, demarcation, complications, and prosthesis survival were assessed. Functional analysis was performed with the modified Harris Hip Score and Visual analogue scale was collected. RESULTS Final series consisted in 222 patients. Significant improvement was observed regarding mHHS and VAS score in each group. We observed statistically significant difference regarding demarcation between the groups (P<.001). The higher rate of acetabular and femoral stem loosening was observed in the cemented (20.0%) and hybrid (18.9%) group. The lowest prosthesis survival rate after 16 years was observed in hybrid group (P<.001). CONCLUSION Total hip replacement has good long-term clinical and functional outcomes. The lowest rate of prosthesis survival was observed in hybrid group with 84.2% after 16years.
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Affiliation(s)
- L Perez Alamino
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
| | - G Garabano
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - J Rodriguez
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - F Lopreite
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - C Pesciallo
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
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Clark SC, Pan X, Grigoriou E, Krych AJ, Hevesi M, Sierra RJ. Osteochondral Allograft Transplantation for the Treatment of an Acetabular Defect: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00043. [PMID: 38820204 DOI: 10.2106/jbjs.cc.24.00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
CASE A 20-year-old woman presented with a unipolar, 1.8 × 1.8-cm osteochondral defect of the left acetabulum. Osteochondral allograft transplantation was performed using a medial tibial plateau allograft resulting in excellent clinical outcomes across 4 different outcome scores and maintenance of the joint space at 4.3 years postoperatively. CONCLUSION Although previous literature has demonstrated long-term clinical success of osteochondral allograft transplantation in knee, excellent clinical outcomes can also be obtained in the hip. Thus, osteochondral allograft transplantation may be a viable treatment option for adolescents and young adults with concomitant cartilage and subchondral bone hip defects.
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Affiliation(s)
- Sean C Clark
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Mazur M, Steelman K, Sayeed Z, Chen C, Darwiche H, Little B. Total Hip Arthroplasty in the Ultrayoung. Arthroplast Today 2023; 23:101181. [PMID: 37731593 PMCID: PMC10507074 DOI: 10.1016/j.artd.2023.101181] [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: 02/04/2023] [Revised: 06/21/2023] [Accepted: 07/01/2023] [Indexed: 09/22/2023] Open
Abstract
Background Total hip arthroplasty (THA) procedures provide a surgical option for "ultrayoung" patients ≤30 years old with end-stage hip arthropathy. This has historically been coupled with concerns over early component failure and challenging surgical technique leading to increased risk of overall morbidity. The purpose of this study is to better elucidate the poorly defined indications and outcomes for THA in ultrayoung patients with end-stage hip disease. Methods A total of 40 THAs in 35 patients ≤30 years old performed at our institution from 2009 to 2016 were retrospectively followed for an average of 2 years (median 11 months, interquartile range 1-31.25). Primary outcome measure was THA revision. Patient demographics were compared against outcomes. The effects on revision rate of hip joint pathology and type of bearing surface were investigated. T-test, chi-square test, and bivariate correlation were performed to determine statistical significance (P < .05). Machine learning was used to determine the normalized important factor leading to THA revision. Results Fifteen male and 25 female patients were included. Median patient age was 23 (interquartile range 19-27) years, with an average body mass index of 27.0 ± 7.9. A majority of THAs were indicated for osteonecrosis (32) and bearing surface type was predominantly metal-on-highly cross-linked polyethylene (36). The overall revision rate was 7.5%, without a correlation between revision and demographic characteristics. Revision surgery was significantly correlated with bearing surface type (P = .028). Important factors for revision were age (100%), bearing surface type (84.7%), and body mass index (52.1%). Conclusions In patients ≤30 years old, THAs performed with the use of modern implants and surgical methods show satisfactory survivorship and functional outcomes with short-term follow-up.
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Affiliation(s)
- Matthew Mazur
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Kevin Steelman
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Zain Sayeed
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Chaoyang Chen
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Hussein Darwiche
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Bryan Little
- Department of Orthopedic Surgery, Detroit Medical Center, Wayne State University, Detroit, MI, USA
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Cieremans D, Shah A, Slover J, Schwarzkopf R, Meftah M. Trends in Complications and Outcomes in Patients Aged 65 Years and Younger Undergoing Total Hip Arthroplasty: Data From the American Joint Replacement Registry. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202303000-00009. [PMID: 36930818 PMCID: PMC10027031 DOI: 10.5435/jaaosglobal-d-22-00256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/27/2023] [Indexed: 03/19/2023]
Abstract
This study sought to determine common complications and the rates of readmission and revision in total hip arthroplasty patients younger than 65 years. Using the American Joint Replacement Registry, we conducted a retrospective review of all THAs in patients aged 18 to 65 years from 2012 to 2020. We excluded patients aged older than 65 years, revisions, oncologic etiology, conversion from prior surgery, and nonelective cases. Primary outcomes included cumulative revision rate, 90-day readmission rate, and reason for revision. The Kaplan-Meier method and univariate analysis were used. Five thousand one hundred fifty-three patients were included. The average age was 56.7 years (SD 7.8 years), 51% were female, 85% were White, and 89% had a Charlson Comorbidity Index of 0 (1 = 7%, >2 = 4%). The mean follow-up was 39.57 months. Fifty-three patients (1.0%) underwent revision. Seventy-four patients (1.4%) were readmitted within 90 days. Revision was more common in Black patients (P = 0.023). Survivorship was 99% (95% confidence interval, 98.7 to 99.3) and 99% (95% confidence interval, 98.5 to 99.3) at 5 and 8 years, respectively. Infection (21%), instability (15%), periprosthetic fracture (15%), and aseptic loosening (9%) were the most common indications for revision. Total hip arthroplasty performed in young and presumed active patients had a 99% survivorship at 8 years. A long-term follow-up is needed to evaluate survival trends in this growing population.
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Affiliation(s)
- David Cieremans
- From New York University Langone Orthopedic Hospital, New York, NY
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Özdemir E, Kuijpers MFL, Schreurs BW, Rijnen WHC. Long-term follow-up of 96 patients younger than age 25 with 119 primary cemented total hip arthroplasties. Acta Orthop 2023; 94:102-106. [PMID: 36856613 PMCID: PMC9976709 DOI: 10.2340/17453674.2023.9410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Long-term follow-up of young patients following cemented primary THA is scarce. Therefore, we analyzed the survival of all consecutive primary THAs in patients under 25 years performed at our institute. PATIENTS AND METHODS All primary THAs performed in patients younger than 25 years in our tertiary care institute between 1988 and 2015 were included (n = 119). Cemented fixation was used in all patients. In the case of acetabular bone deficiencies, reconstruction was performed using impaction bone grafting (IBG). We used Kaplan-Meier analysis to determine the survival of the primary THA with endpoints revision for any reason and aseptic loosening. RESULTS The mean age at the primary THA was 20 years. The most prevalent diagnosis was avascular necrosis (31%). The mean follow-up of the primary THA was 11 years (range 0-32). 2 patients (2 hips) were lost to follow-up. 16 revisions were registered. The survival of any component for endpoint revision for any reason was estimated at 92% (95% confidence interval [CI] 84-96) and 81% (CI 67-90) at 10- and 15-year follow-up, respectively. The survival of any component for endpoint revision for aseptic loosening was 99% (CI 93-100) and 88% (CI 71-95) at 10 and 15 years, respectively. 3 hips were revised due to infection. CONCLUSION Favorable long-term outcomes of primary THA in very young patients can be obtained using cemented fixation and IBG.
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Affiliation(s)
- Erim Özdemir
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Orthopedics, Nijmegen, The Netherlands
| | - Martijn F L Kuijpers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Orthopedics, Nijmegen, The Netherlands
| | - B Willem Schreurs
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Orthopedics, Nijmegen, The Netherlands
| | - Wim H C Rijnen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Orthopedics, Nijmegen, The Netherlands.
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8
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Fernandez-Fernandez R, Moraleda-Novo L, De Armas JN, Cruz-Pardos A. Outcome measures and survivorship following total hip arthroplasty in adolescent population. INTERNATIONAL ORTHOPAEDICS 2022; 46:2785-2791. [PMID: 35945465 DOI: 10.1007/s00264-022-05536-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/28/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The most frequent indication for total hip arthroplasty (THA) in adolescent patients has been juvenile idiopathic arthritis (JIA). However, in recent years, other causes have become more prevalent. QUESTIONS/PURPOSES (1) What is the survivorship following THA across the diagnostic spectrum in adolescent population? (2) How are quality of life results affected by systemic medical conditions? METHODS We retrospectively reviewed all consecutive THA in patients under 21 years of age, performed at our Institution between 1993 and 2018. There were 34 prostheses implanted in 26 patients with a mean age of 18.4 years (range 11 to 21). The most frequent diagnosis was JIA (14 hips), followed by avascular necrosis (10 hips). Patient reported outcomes were assessed using Harris and Oxford Hip Scores (HHS and OHS), Visual Analogue Scale (VAS) and EuroQol-5D. Survivorship for revision and aseptic loosening was determined with Kaplan Meier analysis. RESULTS At final follow-up, the overall survival rate was of 89.3% at 12-year follow-up. Three acetabular components underwent revision surgery for aseptic loosening. Clinical HHS significantly improved from 37.5 to 90.6 points (p < 0.001). Mean OHH was 37.4 points, with a final VAS of 1.64 points. Mean 5Q-5D was 0.704 with an interquartile range of 0.4 to 1.0. JIA patients displayed worse pre-operative HHS scores, and at final follow-up had worse HHS, OHS, VAS and EQ-5D scores compared to the rest of the patients. Complications included three intra-operative femoral fractures, one sciatic nerve palsy and one adductor contracture. CONCLUSION THA in adolescent patients provides improved functional outcomes with acceptable revision rates at mid-term follow-up.
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Affiliation(s)
| | | | | | - Ana Cruz-Pardos
- La Paz University Hospital, Pso. Castellana 261, 28046, Madrid, Spain
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9
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Banskota B, Yadav P, Rajbhandari A, Aryal R, Banskota AK. Hip arthrodesis in children : a review of 26 cases with a mean of 20 years' follow-up. Bone Joint J 2022; 104-B:1089-1094. [PMID: 36047017 DOI: 10.1302/0301-620x.104b9.bjj-2022-0123.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To examine the long-term outcome of arthrodesis of the hip undertaken in a paediatric population in treating painful arthritis of the hip. In our patient population, most of whom live rurally in hilly terrain and have limited healthcare access and resources, hip arthrodesis has been an important surgical option for the monoarticular painful hip in a child. METHODS A follow-up investigation was undertaken on a cohort of 28 children previously reported at a mean of 4.8 years. The present study looked at 26 patients who had an arthrodesis of the hip as a child at a mean follow-up of 20 years (15 to 29). RESULTS The mean Harris Hip Score (HHS) increased from 39.60 (SD 11.06) preoperatively to 81.02 (SD 8.86; p = 0.041) at final review. At latest follow-up, the HHS was found to be excellent in four patients (15%), good in 11 (42%), and fair in 11 (42%). A total of 16 patients (62%) reported mild low back pain, five (19%) had moderate pain, and five (19%) patients had no back pain. Mild ipsilateral knee pain was reported by 19 (73%), moderate pain by one (4%), and no pain by six (23%) patients. Mild contralateral hip pain was reported by ten patients (38%), and no pain by 16 (62%). The 36-Item Short Form Health Survey scores were very good in four patients (15%), good in 18 (70%), and poor in four (15%), with a mean score of 70.92 (SD 12.65). Of 13 female patients who had given birth, 12 did so with uncomplicated vaginal delivery. All patients had to modify their posture for toileting, putting on lower body clothes, foot care, and putting on shoes. CONCLUSION Our results show that with hip arthrodesis, most patients have relatively good function at long-term follow-up, although some pain is experienced in adjacent joints, and modification in some activities of daily living is common.Cite this article: Bone Joint J 2022;104-B(9):1089-1094.
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Affiliation(s)
- Bibek Banskota
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
| | - Prakash Yadav
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
| | - Ansul Rajbhandari
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
| | - Rajendra Aryal
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
| | - Ashok K Banskota
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
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Rainer W, Shirley MB, Trousdale RT, Shaughnessy WJ. The Open Triradiate Cartilage: How Young Is Too Young for Total Hip Arthroplasty? J Pediatr Orthop 2021; 41:e793-e799. [PMID: 34411043 DOI: 10.1097/bpo.0000000000001940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is, to our knowledge, no published literature regarding primary total hip arthroplasty (THA) in pediatric patients with an open triradiate cartilage. The purpose of this study was to report the outcomes following primary THA in pediatric patients with open triradiate cartilage at a single intuition. METHODS Using a single institution's Total Joint Registry, 12 patients (13 hips) were identified as having undergone primary THA with open triradiate cartilage between the years of 2000 and 2019. The mean age and body mass index of this group were 13.1 years and 25.5 kg/m2, respectively. The cohort was composed of 10 males, and the mean follow up was 5.5 years. Indications for surgery, functional outcomes, and radiographic signs of stable fixation were analyzed. RESULTS The most common indication for surgery was avascular necrosis secondary to corticosteroid use (31%), followed by avascular necrosis after operative management of slipped capital femoral epiphysis (23%). The proportion of patients able to achieve independent, gait-aid free, ambulation improved from 23% to 100%. Mean postoperative Harris Hip Score was 92.3. All constructs were cementless, and bearing surfaces included ceramic-on-ceramic in 62% and ceramic on highly crosslinked polyethylene bearings in the remainder. Radiographic review at final follow up demonstrated osseointegration in 12 of 13 (92%) acetabular components. Although 1 patient experienced both acetabular component loosening and instability, on separate occasions, there were no incidences of infection, wound dehiscence, thromboembolic events, or failure secondary to wear. CONCLUSIONS In this study, THA in patients with an open triradiate cartilage yielded significant clinical improvement, low complication rates and good initial implant survivorship at early follow up. Awaiting closure of the triradiate cartilage for concerns of decreased fixation and implant survivorship may be unnecessary. LEVEL OF EVIDENCE Level IV-case series.
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Affiliation(s)
- William Rainer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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11
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Trisolino G, Stallone S, Castagnini F, Bordini B, Cosentino M, Lucchini S, Zarantonello P, Ferrari D, Dallari D, Traina F. Cementless Ceramic-on-Ceramic Total Hip Replacement in Children and Adolescents. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8100858. [PMID: 34682123 PMCID: PMC8534320 DOI: 10.3390/children8100858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 02/07/2023]
Abstract
Background: total hip replacement (THR) is a rare surgical option in children and adolescents with disabling hip diseases. The aim of this study is to report results from a retrospective cohort of patients aged 18 years or less who underwent cementless Ceramic-on-Ceramic (CoC) THR at a single institution, investigating clinical and radiographic outcomes, survival rates, and reasons for revision of the implants. Materials and methods: we queried the Registry of Prosthetic Orthopedic Implants (RIPO) to identify all children and adolescents undergoing THR between 2000 and 2019 at a single Institution. Inclusion criteria were patients undergoing cementless CoC THR, aged less than 18 years at surgery, followed for at least 2 years. Sixty-eight patients (74 hips) matched all the inclusion criteria and were enrolled in the study. We assessed the clinical and radiographic outcomes, the rate of complications, the survival rate, and reasons for revision of the implants. Results: The mean follow-up was 6.6 ± 4.4 years (range 2-20). The most frequent reason for THR was post-traumatic or chemotherapy-induced avascular necrosis (38%). The overall survival rate of the cohort was 97.6% (95% CI: 84.9-99.7%) at 5 years of follow-up, 94.4% (95% CI: 79.8-98.6%) at 10 years and 15 years of follow-up. Two THR in two patients (2.7%) required revision. With the numbers available, Cox regression analysis could not detect any significant interaction between preoperative or intraoperative variables and implant survivorship (p-value 0.242 to 0.989)." The average HOOS was 85 ± 14.3 (range 30.6-100). Overall, 23 patients (48%) reported excellent HOOS scores (>90 points), 21 patients (44%) reported acceptable HOOS scores (60-90 points) while 4 patients (8%) reported poor outcomes (<60 points). Twenty-one patients (43%) were regularly involved into moderate- to high-intensity sport activities (UCLA ≥ 6). Conclusions: Cementless CoC THR is a successful procedure in children and teenagers, having demonstrated high implant survivorship and low rates of complications and failure. A meticulous preoperative planning and implant selection is mandatory, to avoid implant malposition, which is the main reason of failure and revision in these cases. Further studies are needed to assess the impact of the THR on the psychosocial wellbeing of teenagers, as well as risks and benefits and cost-effectiveness in comparison to the hip preserving surgical procedures.
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Affiliation(s)
- Giovanni Trisolino
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.Z.); (D.F.)
- Correspondence: (G.T.); (S.S.)
| | - Stefano Stallone
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.Z.); (D.F.)
- Correspondence: (G.T.); (S.S.)
| | - Francesco Castagnini
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.C.); (S.L.); (F.T.)
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (B.B.); (M.C.)
| | - Monica Cosentino
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (B.B.); (M.C.)
| | - Stefano Lucchini
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.C.); (S.L.); (F.T.)
| | - Paola Zarantonello
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.Z.); (D.F.)
| | - Daniele Ferrari
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.Z.); (D.F.)
| | - Dante Dallari
- Conservative Orthopedic Surgery and Innovative Techniques, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Francesco Traina
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.C.); (S.L.); (F.T.)
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12
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Agrawal Y, Kerry RM, Stockley I, Hamer AJ. Review of total hip arthroplasty in patients younger than 30 years: mid- to long-term results. Hip Int 2021; 31:533-541. [PMID: 31971014 DOI: 10.1177/1120700020901685] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Data on the outcome of THA in patients under the age of 30 years is sparse. There is a perceived reluctance to offer surgery to young patients on the basis of potential early failure of the implant. The aim of this study was to review clinical and radiological outcomes of THA in patients under the age of 30 years in a high-volume specialist arthroplasty unit. METHODS A retrospective review of patients between 1989 and 2009 was undertaken. 95 patients (118 THAs) were identified but 17 patients were excluded for lack of clinical records or for follow-up under 5 years. Clinical records were reviewed for demographics, underlying pathology, details of operation and failures. Radiographs were reviewed for evidence of loosening and wear of the components. Functional assessment was carried out using the modified Hip disability and Osteoarthritis Outcome Score, Oxford Hip Score and EQ-5D-5L. RESULTS Mean age was 25 (16-30) years and 65% patients were females. The most common underlying pathologies were development dysplasia of the hip (29%) and juvenile rheumatoid arthritis (25%). Mean follow-up was 12.6 (5-24) years, during which 19 patients (25%) were revised. The majority of the revisions were for aseptic loosening of the acetabular component. CONCLUSIONS Surgeons are cautious when considering THA in very young patients despite the significant documented improvement in function and quality of life after THA. This study reports on the mid- to long-term results of THA which will be valuable when advising young patients on the prospects of revision surgery at the time of primary THA.
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Affiliation(s)
- Yuvraj Agrawal
- Lower Limb Arthroplasty Unit, Northern General Hospital, Sheffield, England, UK
| | - Robert M Kerry
- Lower Limb Arthroplasty Unit, Northern General Hospital, Sheffield, England, UK
| | - Ian Stockley
- Lower Limb Arthroplasty Unit, Northern General Hospital, Sheffield, England, UK
| | - Andrew J Hamer
- Lower Limb Arthroplasty Unit, Northern General Hospital, Sheffield, England, UK
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Abstract
INTRODUCTION This paper aims to review the indications criteria for the surgical treatment of adolescents with hip osteoarthritis and summarize the contemporary techniques that orthopaedic surgeons can apply for hip reconstruction. DISCUSSION Hip osteoarthritis remains a concerning burden to North American society. While the rate of total hip replacement (THR) in younger patients has increased in the last decades, younger patients may have a higher risk of revision hip replacement because of their increased level of activity and expected patient longevity compared with the elderly. Increased demand for multiple revision surgeries is a concern for the adolescent patient. Although in general THR has been increasingly recommended for the treatment of end-stage osteoarthritis secondary to pediatric hip disorders, hip arthrodesis remains a beneficial alternative for the treatment of severe hip disease secondary to infection and for patients who desire to engage in a very active lifestyle. Hip preservation procedures are ideally performed in the prearthritic stage or in hips with minimal degeneration to preserve the joint and achieve the most optimal outcomes. However, adolescents and young adults with moderate and rarely advanced arthritis may benefit from surgical treatment using hip preservation techniques. CONCLUSIONS Treatment of adolescents with pain and dysfunction because of end-stage hip disease is challenging and controversial. THR and arthrodesis are the 2 principal alternatives. However, in particular circumstances, hip reconstruction may be recommended.
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Total Hip Arthroplasty in Adolescents and Young Adults for Management of Advanced Corticosteroid-Induced Osteonecrosis Secondary to Treatment for Hematologic Malignancies. J Arthroplasty 2021; 36:1352-1360. [PMID: 33281023 DOI: 10.1016/j.arth.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a potentially severe toxicity associated with glucocorticoid treatment for pediatric hematologic malignancy. We examined clinical outcomes of THA in adolescents and young adults treated for hematologic malignancies who developed advanced ONFH. METHODS In a single-institution cohort, we retrospectively reviewed medical records and imaging for perioperative complications, reoperations, functional assessment at last follow-up, and radiological outcomes. Twenty-seven patients (41 hips) underwent THA (bilateral in 14 patients). There were 11 males. Median (interquartile range [IQR]) age at primary diagnosis was 14.9 years [1.8-18.9]. The median (IQR) age at THA was 19.8 years [14.6-30.3]. Mean (range) post-THA follow-up was 111.5 months (65.4-165.8). RESULTS Perioperative complications included one intraoperative calcar fracture that was secured with a cerclage wire and one posterior hip dislocation that occurred 6 days postoperatively, requiring closed reduction. One hip required a revision 21.1 months post-THA due to a fractured ceramic liner. The radiographic review was available for 38 of 41 hips and demonstrated none with loosening, subsidence, or osteolysis; nine developed periacetabular stress shielding. Incidence of stress shielding was associated with increased postoperative pain (P = .0130). There was a significant functional improvement in range of motion (ROM), pain, use of supports, participation in school, work, and sports, and use of pain medication from preoperative to postoperative clinical visits (P < .001). DISCUSSION Total hip arthroplasty in adolescents and young adults offers symptomatic and functional improvement in patients with ONFH. We found it to be safe with low perioperative complication rates even in patients undergoing active treatment for malignancy. LEVEL OF EVIDENCE Level IV, case series study. See Instructions for authors for a complete description of levels of evidence.
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15
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Rahm S, Hoch A, Tondelli T, Fuchs J, Zingg PO. Revision rate of THA in patients younger than 40 years depends on primary diagnosis - a retrospective analysis with a minimum follow-up of 10 years. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1335-1344. [PMID: 33495905 PMCID: PMC8448705 DOI: 10.1007/s00590-021-02881-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/15/2021] [Indexed: 01/12/2023]
Abstract
Background Treating osteoarthritis in elderly patients with THA is very successful. However, surgeons hesitate to recommend THA in younger patients. The spectrum of etiologies for end stage hip disease in the younger population is diverse and therefore different courses may be assumed. Our objective was to evaluate THA revision rate within a minimum follow-up period of 10 years in young patients and to analyze the difference between different primary diagnoses. Methods We included 144 consecutive hips in 127 patients younger than 40 years, who received a primary THA from 01/1996 to 12/2007. Operative reports, clinical and radiographic documentation were reviewed to determine primary diagnosis, prior hip surgery, component specifications and revision surgery. 111 hips in 97 patients were available for outcome analysis with a minimum follow-up of 10 years. Results The mean age was 33 years (range 15–40 years) at the time of the index THA, 68 patients were female and 59 were male. Ten years revision rate on the prosthetic components was 13%. The most common primary diagnosis was DDH. DDH was associated with a risk of 17% for requiring a reoperation on the prosthetic components because of mechanical fatigue and therefore, significantly higher than for any other primary diagnosis (p = 0.005). Conclusion THA in young patients is associated with a high revision rate of 13% in 10 years. 17% of patients with DDH required revision surgery for mechanical fatigue within 10 years, which was significantly higher than for any other primary diagnosis (1.2%, OR 16.8).
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Affiliation(s)
- Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Timo Tondelli
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Johannes Fuchs
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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16
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Kenanidis E, Kakoulidis P, Panagiotidou S, Leonidou A, Lepetsos P, Topalis C, Anagnostis P, Potoupnis M, Tsiridis E. Total hip arthroplasty in patients with slipped capital femoral epiphysis: a systematic analysis of 915 cases. Orthop Rev (Pavia) 2020; 12:8549. [PMID: 33585021 PMCID: PMC7874953 DOI: 10.4081/or.2020.8549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/13/2020] [Indexed: 11/23/2022] Open
Abstract
There is limited evidence on the outcomes of Total Hip Arthroplasty (THA) in Slipped Capital Femoral Epiphysis (SCFE) patients. This systematic review aims to evaluate the current literature in terms of survival rate, functional outcomes, complications and types of implants of THA in SCFE patients. Following the established methodology of PRISMA guidelines, PubMed, Cochrane library, ScienceDirect and Ovid MEDLINE were systematically searched from inception to September 2018. The search criteria used were: (“total hip arthroplasty’’ OR ‘’total hip replacement’’ OR “hip arthroplasty’’ OR ‘’hip replacement’’) AND (‘’slipped capital femoral epiphysis’’ OR ‘’slipped upper femoral epiphysis’’ OR ‘’femoral epiphysis’’). Ten studies were finally included in the analysis and were qualitatively appraised using the Newcastle-Ottawa tool. Variables were reported differently between studies. The sample size varied from 12 to 374 THAs. A total of 877 patients undergone 915 THAs. The mean reported follow-up ranged from 4.4 to 15.2 years and the mean patients’ age at the time of THA from 26 to 50 years. Four studies specified the type of implants used, with 62% being uncemented, 24% hybrid (uncemented cup/cemented stem) and 14% cemented. All but three studies reported the mean survival of implants that ranged from 64.9% to 94.8%. A limited number of complications were mentioned. There was a tendency for more favorable functional outcomes in modern studies. Modern THA-studies in SCFE patients showed improvement of survivorship, clinical outcomes and patient satisfaction. Future higher-quality studies are necessary to estimate long-term postoperative outcomes better.
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Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
| | - Panagiotis Kakoulidis
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
| | - Sousana Panagiotidou
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
| | | | | | - Christos Topalis
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
| | - Panagiotis Anagnostis
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
| | - Michael Potoupnis
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
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17
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Buddhdev PK, Vanhegan IS, Khan T, Hashemi-Nejad A. Early to medium-term outcomes of uncemented ceramic-bearing total hip arthroplasty in teenagers for paediatric hip conditions. Bone Joint J 2020; 102-B:1491-1496. [PMID: 33135445 DOI: 10.1302/0301-620x.102b11.bjj-2020-0668.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Despite advances in the treatment of paediatric hip disease, adolescent and young adult patients can develop early onset end-stage osteoarthritis. The aims of this study were to address the indications and medium-term outcomes for total hip arthroplasty (THA) with ceramic bearings for teenage patients. METHODS Surgery was performed by a single surgeon working in the paediatric orthopaedic unit of a tertiary referral hospital. Databases were interrogated from 2003 to 2017 for all teenage patients undergoing THA with a minimum 2.3 year follow-up. Data capture included patient demographics, the underlying hip pathology, number of previous surgeries, and THA prostheses used. Institutional ethical approval was granted to contact patients for prospective clinical outcomes and obtain up-to-date radiographs. In total, 60 primary hips were implanted in 51 patients (35 female, 16 male) with nine bilateral cases. The mean age was 16.7 years (12 to 19) and mean follow-up was 9.3 years (2.3 to 16.8). RESULTS The most common indication for teenage hip arthroplasty was avascular necrosis secondary to slipped upper femoral epiphysis (31%; n = 16). Overall, 64% of patients (n = 33) had undergone multiple previous operations. The survival at follow-up was 97%; two patients required revision for aseptic loosening (one femoral stem, one acetabular component). Both patients had fused hips noted at the time of arthroplasty. A further two patients had radiolucent lines but were asymptomatic. At latest follow-up the mean Oxford Hip Score was 44 (31 to 48) and a Visual Analogue Scale measurement of 1.5, indicating satisfactory function. CONCLUSION Operating on this cohort can be complicated by multiple previous surgeries and distorted anatomy, which in some cases require custom-made prostheses. We have demonstrated a good outcome with low revision rate in this complex group of patients. Cite this article: Bone Joint J 2020;102-B(11):1491-1496.
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Affiliation(s)
- Pranai K Buddhdev
- Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Ivor S Vanhegan
- Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Tahir Khan
- Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Aresh Hashemi-Nejad
- Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
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18
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Jones LC, Kaste SC, Karol SE, DeFeo B, Kim HKW, Neel MD, Levin AS. Team approach: Management of osteonecrosis in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2020; 67:e28509. [PMID: 32860663 DOI: 10.1002/pbc.28509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022]
Abstract
With current treatments for acute lymphoblastic leukemia (ALL), the overall prognosis for survival is favorable. Increasing emphasis is placed on recognizing and managing the long-term consequences of ALL and its treatment, particularly involving osteonecrosis. Early osteonecrosis diagnosis and management may improve outcomes and is best accomplished through coordinated teams that may include hematologic oncologists, radiologists, orthopedic surgeons, physical therapists, and the patient and their family. Magnetic resonance imaging is the "gold standard" for diagnosis of early-stage and/or multifocal osteonecrosis. Treatments for osteonecrosis in ALL patients are risk stratified and may include observation, corticosteroid or chemotherapy adjustment, and pharmaceutical or surgical approaches.
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Affiliation(s)
- Lynne C Jones
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sue C Kaste
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.,Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Seth E Karol
- Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brian DeFeo
- Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Harry K W Kim
- Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, UT Southwestern Medical Center, Dallas, Texas
| | - Michael D Neel
- Division of Orthopaedics, St. Jude Children's Research Hospital, Memphis, TN
| | - Adam S Levin
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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19
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Luceri F, Morelli I, Sinicato CM, Della Grazia A, Verdoni F, Maffulli N, Peretti GM, Curci D. Medium-term outcomes of total hip arthroplasty in juvenile patients. J Orthop Surg Res 2020; 15:476. [PMID: 33066797 PMCID: PMC7566112 DOI: 10.1186/s13018-020-01990-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Juvenile hip osteoarthritis is often the end result of congenital conditions or acquired hip ailments occurred during the paediatric age. This study evaluated the middle term results of total hip arthroplasty for end-stage juvenile hip osteoarthritis. MATERIALS AND METHODS This is a retrospective analysis of prospectively collected data on a cohort of 10 consecutive patients (12 hips), aged between 14 and 20 at operation, who underwent cementless total hip arthroplasty for end-stage juvenile secondary hip osteoarthritis in two orthopaedic tertiary referral centres between 2009 and 2018. RESULTS Juvenile hip osteoarthritis occurred as a consequence of developmental dysplasia of the hip, Legg-Calvé-Perthes disease, femoral head necrosis or slipped capital femoral epiphysis. All patients showed a significant improvement in Harris Hip Score (p < 0.01) at 3.3 years average follow-up (range 0.7-10.1 years). CONCLUSION The management of juvenile hip osteoarthritis following developmental dysplasia of the hip, Legg-Calvé-Perthes disease, femoral head necrosis or slipped capital femoral epiphysis is still challenging. Careful preoperative planning is essential to achieve good outcomes and improve the Harris Hip Score in these young patients. Total hip arthroplasty is a suitable option for end-stage secondary juvenile hip osteoarthritis, when proximal femoral osteotomies and conservative treatments fail to improve patients' symptoms and quality of life. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Ilaria Morelli
- Residency Program in Orthopedics and Traumatology, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
| | - Carlo Maria Sinicato
- Casa di Cura I Cedri, HABILITA SPA, Via Bologna, 1, Zingonia di Ciserano, Bergamo, Italy
| | - Alberto Della Grazia
- U.O. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Fabio Verdoni
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Nicola Maffulli
- San Giovanni di Dio e Ruggi D’Aragona Hospital “Clinica Ortopedica” Department, University of Salerno, Salerno, Italy
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, E1 4DG England
| | - Giuseppe M. Peretti
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
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20
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Kong X, Chai W, Yang M, Ong A, Chen J, Wang Y, Zhou Y. Modular stem in total hip arthroplasty for patients with trochanter valgus deformity: surgical technique and case series. BMC Musculoskelet Disord 2020; 21:124. [PMID: 32093714 PMCID: PMC7041298 DOI: 10.1186/s12891-020-3145-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/17/2020] [Indexed: 01/22/2023] Open
Abstract
Background Trochanter valgus deformity (TVD) is a rare condition of total hip arthroplasty (THA). Femoral osteotomy could be required in correcting the deformity to implant femoral stem in severe TVD. In this study, we described one unpublished technique of reverse sleeve of S-ROM to get through the complex situation. This study aimed to summarize and evaluate its technical challenges, safety and effectiveness. Methods From January 2006 to December 2014, we enrolled patients whose sleeves were implanted towards the great trochanter in THA with TVD. Their demographics, perioperative and postoperative information were recorded. To explore its indication, we measured and analyzed the ratio of greater trochanter/lesser trochanter (G/L ratio) and trochanter valgus angle (TVA). Results Twelve patients (1 male and 11 female, average age 42.30 ± 10.23) had mean follow-up of 6 years. Among them, only two patients had intraoperative femoral fracture. The survivorship of femoral prosthesis was 100%. The Harris hip score (HHS) increased from preoperative 34.31 ± 14.43 to postoperative 84.12 ± 11.33. All patients’ G/L ratio were larger than 1.50. Conclusions The reverse sleeve of S-ROM was a reliable method for the patients with severe TVD, which brought satisfying clinical outcomes in mid-term follow-up.
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Affiliation(s)
- Xiangpeng Kong
- Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, China
| | - Wei Chai
- Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, China
| | - Minzhi Yang
- Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, China.,Nankai university, Tianjin, China
| | - Alvin Ong
- The Rothman Institute, Thomas Jefferson University, 500 English Creek Avenue, Building 1300, Egg Harbor Township, Philadelphia, USA
| | - Jiying Chen
- Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, China
| | - Yan Wang
- Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, China.
| | - Yonggang Zhou
- Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, China.
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21
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Intramedullary Nailing of a Periprosthetic Intertrochanteric Fracture in the Setting of Prior Hip Resurfacing: A New Technique for Fracture Fixation. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Mahiques-Segura G, Lizaur-Utrilla A, Vizcaya-Moreno MF, Miralles-Muñoz FA, Lopez-Prats FA. A Comparison Study of the Outcomes of Ceramic-on-Ceramic Total Hip Arthroplasty in Young vs Older Patients: A Minimum 10-Year Follow-Up Prospective Matched Study. J Arthroplasty 2019; 34:1731-1735. [PMID: 31003784 DOI: 10.1016/j.arth.2019.03.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to analyze the outcome and prosthesis survival in patients aged between 20 and 40 years who received a cementless total hip arthroplasty (THA) with a minimum follow-up of 10 years compared to older patients. METHODS Prospective matched comparative study was conducted between 94 young patients with mean age of 37.2 (range 22-40) years and 90 older patients with mean age of 64.7 (range 60-70) years treated with ceramic-on-ceramic THA. Clinical outcomes were assessed by the Harris Hip Score, reduced Western Ontario and MacMaster University (WOMAC), and Short-Form-12 (SF12) questionnaires. Radiological evaluation was also performed. The primary outcome was the THA survival rate. RESULTS Mean follow-up of 13.6 (range, 10-15) years. At the final follow-up, there was no significant difference between groups in Harris Hip Score (P = .356), WOMAC-pain (P = .461), SF12-physical (P = .305), or SF12-mental (P = .511), but younger group had significantly higher WOMAC-function score (P = .013). There were 7 revisions in the younger group and 4 in the older group (P = .197). The 14-year prosthesis survival for any reason was 93.2% (95% confidence interval [CI] 86.7-99.7) in the younger group and 98.3% (95% CI 95.1-100) in the older group (P = .189). For aseptic reason, the 14-year survival was 94.7% (95% CI 88.9-100) in the younger group and 98.3% (95% CI 95.1-100) in the older group (P = .332). CONCLUSION At minimum follow-up of 10 years, THA with cementless stem and ceramic-on-ceramic bearing provides successful survival and functional outcomes in young patients between 20 and 40 years old.
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Affiliation(s)
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain; Department of Traumatology and Orthopaedics, Miguel Hernandez University, San Juan de Alicante, Alicante, Spain
| | - Maria F Vizcaya-Moreno
- Department of Nursing, Clinical Research Group, Faculty of Health Sciences, University of Alicante, San Vicente del Raspeig, Alicante, Spain
| | | | - Fernando A Lopez-Prats
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, San Juan de Alicante, Alicante, Spain
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23
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Halvorsen V, Fenstad AM, Engesæter LB, Nordsletten L, Overgaard S, Pedersen AB, Kärrholm J, Mohaddes M, Eskelinen A, Mäkelä KT, Röhrl SM. Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016. Acta Orthop 2019; 90:331-337. [PMID: 31088343 PMCID: PMC6718182 DOI: 10.1080/17453674.2019.1615263] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The literature is scarce on the outcome of the youngest patients with total hip arthroplasties (THAs). We analyzed register data, revision risk, and related factors in patients 21 years or younger with THAs in the Nordic Arthroplasty Register Association (NARA). Patients and methods - We included all THA patients 21 years or younger reported during 1995 through 2016 to the Danish, Finnish, Norwegian, and Swedish hip arthroplasty registers and merged these into the NARA dataset. Primary outcome was any implant revision. Results - We identified 881 THAs in 747 patients. Mean age at primary surgery was 18 years (9-21). The indications for THA were pediatric hip diseases (33%), systemic inflammatory disease (23%), osteoarthritis (4%), avascular necrosis (12%), hip fracture sequelae (7%), and other diagnoses (21%). Unadjusted 10-year survival for all THAs was 86%. Comparison between indications showed no differences in survival. Uncemented implants were used most frequently. Survival for uncemented and cemented implants was the same adjusted for sex, indication, head size, and time period for primary surgery. Aseptic loosening was the main cause of revision. Interpretation - Both cemented and uncemented fixations seem to be a viable option in this age group, but with a lower implant survival than in older patient groups.
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Affiliation(s)
- Vera Halvorsen
- Division of Orthopedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway; ,Correspondence:
| | - Anne Marie Fenstad
- Norwegian Arthroplasty Registry, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Lars B Engesæter
- Norwegian Arthroplasty Registry, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, University of Bergen, Bergen, Norway;
| | - Lars Nordsletten
- Division of Orthopedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway; ,University of Oslo, Oslo, Norway;
| | - Søren Overgaard
- Department of Orthopaedic Surgery, Traumatology and Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Odense, Denmark; ,Danish Hip Arthroplasty Register, Denmark;
| | - Alma B Pedersen
- Danish Hip Arthroplasty Register, Denmark; ,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark;
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register, Sweden; ,Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, University of Gothenburg, Sweden;
| | - Maziar Mohaddes
- The Swedish Hip Arthroplasty Register, Sweden; ,Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, University of Gothenburg, Sweden;
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; ,The Finnish Arthroplasty Register, Finland;
| | - Keijo T Mäkelä
- The Finnish Arthroplasty Register, Finland; ,Department of Orthopaedics and Traumatology, Turku University Hospital, Turku
| | - Stephan M Röhrl
- Division of Orthopedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway;
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Kargin D, İncesoy MA, Onaç O, Albayrak A, Kaygusuz MA, Bayhan IA. The Effect of Previous Hip Surgery on the Outcome of Hip Arthroplasty in Young Patients. J Arthroplasty 2018; 33:2890-2892. [PMID: 29731266 DOI: 10.1016/j.arth.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The incidence of total hip arthroplasty (THA) is increasing in all age groups, especially in young patients. The outcome of THA is believed to be affected by morphological deformities created by previous pelvic or femoral procedures performed in childhood. The aim of the present study was to assess whether previous hip surgery impaired the functional outcome in young patients who underwent THA. METHODS Data were collected from the records of patients aged less than 30 years who had undergone THA between 2002 and 2011. Thirty-five patients (44 hips) were included. The Western Ontario and McMaster Universities Osteoarthritis Index and Harris Hip Scores were collected as primary functional outcome measures. The secondary outcome measures were the major and minor complications. Patients were divided into 2 groups: those who had not undergone hip surgery before THA (group I, 17 patients, 24 hips) and those with a history of prior hip surgery (group II, 18 patients, 20 hips). RESULTS The mean age at the time of surgery was 25 ± 4 years in group I and 23 ± 4 years in group II. The mean Harris Hip Score was slightly higher in group I (90 ± 7) than in group II (87 ± 7) (P = .2). The mean Western Ontario and McMaster Universities Osteoarthritis Index scores were similar in both groups (in group I 14 ± 7 and in group II 14 ± 6, P = .9). Complication rates were also similar in both groups (P = .7). CONCLUSIONS It is often difficult to decide whether to perform THA in young patients. One potential risk factor for complications is hip surgery before THA. Our study revealed that young patients with or without a history of previous hip surgery achieved satisfactory functional outcomes with similar complication rates after THA.
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Affiliation(s)
- Deniz Kargin
- Health Science University Baltimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Alper İncesoy
- Health Science University Baltimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Osman Onaç
- Health Science University Baltimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Akif Albayrak
- Health Science University Baltimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Akif Kaygusuz
- Health Science University Baltimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Ilhan A Bayhan
- Health Science University Baltimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
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Abstract
INTRODUCTION Articular cartilage lesions of the hip are difficult to effectively treat. Osteochondral allograft (OCA) transplantation in the knee has been associated with long-term success, but OCA for the hip has not been extensively studied. Here, we present the clinical and radiological outcomes from a cohort of 10 patients treated with fresh OCA transplants for large osteochondral defects of the femoral head and/or acetabulum. METHODS 10 patients who had undergone osteochondral allograft transplantation of the femoral head and/or acetabulum at our institution between 2013 and 2016 were identified from our Institutional Review Board-approved registry. Hip disability and Osteoarthritis Outcome Score (HOOS) was used to track patient progress. RESULTS 10 patients with an average clinical follow-up of 1.4 years were included in this study. 4 patients were treated solely with OCA plugs for femoral head defects, while the remaining 6 received femoral OCA plugs and at least 1 concomitant procedure for additional intraarticular pathology. 7 patients (70%) had successful functional outcomes, while 3 (30%) had unsuccessful outcomes and were subsequently converted to total hip arthroplasty (THA) 5 to 29 months after OCA. CONCLUSIONS OCA transplantation can be an effective treatment strategy for young, healthy individuals with articular cartilage lesions of the hip. Smoking, avascular necrosis aetiology, acetabular involvement and concomitant procedures may be risk factors for unsuccessful outcomes necessitating salvage with THA. Long-term clinical studies to refine indications and determine functional outcomes and survival rates are warranted.
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Abstract
PURPOSE Total hip arthroplasty (THA) is rarely recommended in skeletally immature patients. The goal of the present study was to report our short- to mid-term results of THA in a series of children aged 16 years or younger, including clinical outcomes and post-operative complications, signs of radiographic loosening of the prostheses, and revision rate. METHODS The 18 children (two male and 16 female patients, 24 hips) underwent cementless THA at a mean age of 14.6 years (11 to 16). Five patients had a bilateral, one-stage surgical procedure. Clinical assessment of these hips used the Merle d'Aubigné et Postel scale modified by Charnley to facilitate assessment of the function of walking. Clinical and radiographic follow-up was conducted at six weeks, six months and then yearly for the first three years. All post-operative complications were recorded. RESULTS No intra-operative or early post-operative complications occurred. At a mean follow-up of 3.8 years (1 to 8), all patients had greatly improved pain and function scores. All children in the present study improved from severely impaired gait, including four children who were wheelchair-bound, to completely unrestricted gait. All hips demonstrated good alignment with no evidence of wear or radiographic lucencies. No revision of components has been required. One patient had persistent adductor contracture which was addressed with adductor tendon release. CONCLUSIONS THA is a successful procedure for unsalvageable hip arthritis in children at a mean follow-up of 3.8 years. Long-term follow-up will be needed to determine implant longevity of the components in these children.
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Affiliation(s)
- S. K. Van de Velde
- Orthopaedic Surgery, The Royal Children’s Hospital Melbourne, Melbourne, VIC, Australia,Correspondence should be sent to: S. K. Van de Velde, The Royal Children’s Hospital Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia. E-mail:
| | - B. Loh
- Orthopaedic Surgery, The Royal Children’s Hospital Melbourne, Melbourne, VIC, Australia
| | - L. Donnan
- Orthopaedic Surgery, The Royal Children’s Hospital Melbourne, Melbourne, VIC, Australia
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Abstract
Total hip arthroplasty (THA) is a very successful and effective orthopedic operation with very good immediate as well as long-term results to alleviate pain and improve health-related quality of life. A THA is indicated in end-stage hip osteoarthritis with a high degree of persistent suffering when conservative treatment has failed and in patients who wish a THA. This statement is generally valid for patients where the medical history, clinical examination and radiographic findings are conclusive, the pressure of suffering and the expectations are realistic. The timing of THA is based on the patient's discomfort. The treatment of these patients should include an interdisciplinary approach and the main goal is to improve the quality of life. Patients will learn to have reasonable expectations and should be well informed about the risks and benefits of THA. Realistic patient expectations seem to be a predictive factor for a good subjective outcome after THA.
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Affiliation(s)
- S Rahm
- Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz.
| | - P O Zingg
- Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz
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Wear of XLPE liner against zirconium heads in cementless total hip arthroplasty for patients under 40 years of age. Hip Int 2017; 27:532-536. [PMID: 28574118 DOI: 10.5301/hipint.5000513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) in the young is challenging. The purpose of this study was to retrospectively determine the clinical, radiographic, and polyethylene wear rate of relatively young patients. METHODS We evaluated the outcome of consecutive patients receiving primary THA who were under 40 years of age with a minimum 10-year follow-up. Indications for THA in these patients were osteoarthritis due to developmental dysplasia of the hip joint (9 hips), osteonecrosis of the femoral head (7 hips), juvenile idiopathic arthritis (2 hips), and osteoarthritis due to Perthes disease (1 hip). All THA were performed with a cross-linked ultra-high-molecular-weight polyethylene (XLPE) liner against zirconium heads with cementless implants. RESULTS The average Japanese Orthopaedic Association hip score significantly improved from 42 to 93 points at the latest follow-up. The mean steady wear was 0.015 mm/year (maximum 0.033 mm/year), and the mean creep wear was 0.111 mm (maximum 0.4 mm). Osteolysis was observed around 1 acetabular component and 2 stems. 1 femoral component had subsidence over 5 mm. All of the femoral components achieved fixation with an optimal interface with spot welds at the latest follow-up. Stress shielding was observed in all hips. CONCLUSIONS THA using an XLPE liner against zirconium heads appeared to have improved THA longevity. However, the imaging findings in some cases were suggestive of wear debris. A rigorous continual follow-up is required for relatively young patients undergoing THA.
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Gaillard MD, Gross TP. Metal-on-metal hip resurfacing in patients younger than 50 years: a retrospective analysis : 1285 cases, 12-year survivorship. J Orthop Surg Res 2017; 12:79. [PMID: 28578684 PMCID: PMC5455178 DOI: 10.1186/s13018-017-0579-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 05/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Nordic registry reports patients under 50 years old with total hip replacements realize only 83% 10-year implant survivorship. These results do not meet the 95% 10-year survivorship guideline posed by the UK's National Institute for Health and Care Excellence (NICE) in 2014. METHODS The purpose of this study is threefold: First, we evaluate if metal-on-metal hip resurfacing arthroplasty meets these high standards in younger patients. Next, we compare outcomes between age groups to determine if younger patients are at higher risk for revision or complication. Lastly, we assess how outcomes between sexes changed over time. From January 2001 to August 2013, a single surgeon performed 1285 metal-on-metal hip resurfacings in patients younger than 50 years old. We compared these to an older cohort matched by sex and BMI. RESULTS Kaplan-Meier implant survivorship was 96.5% at 10 years and 96.3% at 12 years; this did not differ from implant survivorship for older patients. Implant survivorship at 12 years was 98 and 93% for younger men and women, respectively; survivorship for women improved from 93 to 97% by using exclusively Biomet implants. There were four (0.3%) adverse wear-related failures, with no instances of wear or problematic ion levels since 2009. Activity scores improved from 5.4 ± 2.3 preoperatively to 7.6 ± 1.9 postoperatively (p < 0.0001), with 43% of patients reporting a UCLA activity score of 9 or 10. CONCLUSIONS Hip resurfacing exceeds the stricter 2014 NICE survivorship criteria independently in men and women even when performed on patients under 50 years old.
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Affiliation(s)
- Melissa D Gaillard
- Midlands Orthopaedics & Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA.
| | - Thomas P Gross
- Midlands Orthopaedics & Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA
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Orthopedics. Biomaterials 2017. [DOI: 10.1016/b978-0-12-809478-5.00011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ranawat CS, Ranawat AS, Ramteke AA, Nawabi D, Meftah M. Long-term Results of a First-Generation Annealed Highly Cross-Linked Polyethylene in Young, Active Patients. Orthopedics 2016; 39:e225-9. [PMID: 26811959 DOI: 10.3928/01477447-20160119-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/13/2015] [Indexed: 02/03/2023]
Abstract
The survivorship of total hip arthroplasty in younger patients is dependent on the wear characteristics of the bearing surfaces. Long-term results with conventional polyethylene in young patients show a high failure rate. This study assessed the long-term results of a first-generation annealed highly cross-linked polyethylene (HCLPE) in uncemented total hip arthroplasty in young, active patients. Between 1999 and 2003, 112 total hip arthroplasty procedures performed in 91 patients with an average University of California Los Angeles activity score of 8 and mean age of 53 years (range, 24-65 years) were included from a prospective database. In all patients, a 28-mm metal femoral head on annealed HCLPE (Crossfire; Stryker, Mahwah, New Jersey) was used. At minimum 10-year follow-up (11.5±0.94 years), Kaplan-Meier survivorship was 97% for all failures (1 periprosthetic infection and 1 late dislocation) and 100% for mechanical failure (no revisions for osteolysis or loosening). This study showed low revision rates for wear-related failure and superior survivorship in young, active patients. Oxidation causing failure of the locking mechanism has not been a problem with Crossfire for up to 10 years.
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Moon KH, Shin EH, Kang JS. Bilateral Idiopathic Chondrolysis of the Hip in an Adult: A Case Report and Review of the Literature. Hip Pelvis 2016; 28:243-248. [PMID: 28097114 PMCID: PMC5240312 DOI: 10.5371/hp.2016.28.4.243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022] Open
Abstract
Idiopathic chondrolysis of the hip usually develops in adolescents and is a disease characterized by gradual degenerative changes of the hyaline cartilage surrounding the head of the femur. It eventually decreases the hip joint space and causes limitations in the hip joint range of motion due to pain. The authors had experienced an unusual case of bilateral idiopathic chondrolysis of the hip in an 54 year-old male; thus, we report the treatment results and literature reviews in this case report.
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Affiliation(s)
- Kyoung-Ho Moon
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Korea
| | - Eun-Ho Shin
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Korea
| | - Joon-Soon Kang
- Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Korea
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Nakashima Y, Yamamoto T, Fukushi JI, Motomura G, Hamai S, Kohno Y, Iwamoto Y. Transtrochanteric rotational osteotomy for avascular necrosis of the femoral head after unstable slipped capital femoral epiphysis: 10-year clinical results. J Orthop Sci 2016; 21:831-835. [PMID: 27461924 DOI: 10.1016/j.jos.2016.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/21/2016] [Accepted: 07/02/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric rotational osteotomy of the femoral head (TRO) for AVN. METHODS This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads. The direction of rotation was anterior in 3 hips and posterior in 4. The Merle d'Aubigné-Postel score (MDPS) was used for clinical assessment, and joint degeneration was assessed with the Kellgren and Lawrence classification (KL-grade). RESULTS The spherical intact area of the femoral head was moved to the weight-bearing portion, and subluxation was corrected via rotation combined with intentional varus positioning. The mean MDPS improved from 10.3 points to 15.6 points at 5 years, and it was maintained at 15.0 points by 10 years; 3 hips were excellent, 1 was good, 2 were fair, and 1 showed poor outcomes. No patient experienced re-collapse after TRO or required conversion to hip replacement or arthrodesis. After 10 years, degenerative changes became evident over time, and 2 hips progressed to KL-4 with a decreased MDPS. CONCLUSIONS Although some joint degeneration is inevitable in the long-term, TRO is an effective salvage procedure for treating AVN after unstable SCFE.
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Affiliation(s)
- Yasuharu Nakashima
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Jun-Ichi Fukushi
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yusuke Kohno
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Tsukanaka M, Halvorsen V, Nordsletten L, EngesæTer IØ, EngesæTer LB, Marie Fenstad A, Röhrl SM. Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old. Acta Orthop 2016; 87:479-84. [PMID: 27435903 PMCID: PMC5016906 DOI: 10.1080/17453674.2016.1212180] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Total hip replacement (THR) is not recommended for children and very young teenagers because early and repetitive revisions are likely. We investigated the clinical and radiographic outcomes of THR performed in children and teenage patients. Patients and methods - We included 111 patients (132 hips) who underwent THR before 20 years of age. They were identified in the Norwegian Arthroplasty Register, together with information on the primary diagnosis, types of implants, and any revisions that required implant change. Radiographs and Harris hip score (HHS) were also evaluated. Results - The mean age at primary THR was 17 (11-19) years and the mean follow-up time was 14 (3-26) years. The 10-year survival rate after primary THR (with the endpoint being any revision) was 70%. 39 patients had at least 1 revision and 16 patients had 2 or more revisions. In the latest radiographs, osteolysis and atrophy were observed in 19% and 27% of the acetabulae and 21% and 62% of the femurs, respectively. The mean HHS at the final follow-up was 83 (15-100). Interpretation - The clinical score after THR in these young patients was acceptable, but many revisions had been performed. However, young patients with developmental dysplasia of the hip had lower implant survival. Moreover, the bone stock in these patients was poor, which could complicate future revisions.
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Affiliation(s)
- Masako Tsukanaka
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo;,Correspondence:
| | - Vera Halvorsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo
| | - Lars Nordsletten
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo
| | - Ingvild Ø EngesæTer
- The Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway
| | - Lars B EngesæTer
- The Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway
| | - Stephan M Röhrl
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo
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Wang T, Sun JY, Zhao XJ, Liu Y, Yin HB. Ceramic-on-ceramic bearings total hip arthroplasty in young patients. Arthroplast Today 2016; 2:205-209. [PMID: 28326429 PMCID: PMC5247519 DOI: 10.1016/j.artd.2016.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 12/12/2022] Open
Abstract
Background The results of ceramic-on-ceramic (CoC) total hip arthroplasty (THA) in younger patients were not univocal. This study aims to evaluate the results of CoC bearing THA in patients younger than 50 years. Methods A total of 90 younger patients performed CoC THAs during March 2003 and May 2008 were included in this study. Hip function and activity were evaluated with Harris hip score and University of California Los Angeles activity score. We had discussed survival rates, radiological findings of component loosening or osteolysis, and ceramic-related complications in these patients. Results The mean Harris hip score increased from 46.3 ± 12.0 points (range, 28-70 points) before surgery to 92.5 ± 5.6 points (range, 78-100 points) at the final follow-up. The mean preoperative University of California Los Angeles activity score was 4.2 ± 1.1 points (range, 2-6 points), which improved to a mean of 7.2 ± 1.3 points (range, 4-10 points). At the time of the last follow-up, there was found to be 1 occurrence of hip dislocation, 1 squeaking, and 2 “sandwich” ceramic liners fractured during normal activity of daily living. No hips showed osteolysis or required revision for aseptic loosening. Kaplan-Meier survivorship with revision due to loosening or osteolysis was 100% and with revision due to ceramic fracture was 97.3% (95% confidence interval, 93.7%-100%) at a mean of 9.4 years. Conclusions This study with the use of CoC bearings THAs in younger patients have shown promising results and higher rate of survivorship without evidence of osteolysis.
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Affiliation(s)
- Tao Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun-Ying Sun
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xi-Jiang Zhao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China; Department of Orthopedic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Yong Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hai-Bo Yin
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Hannouche D, Devriese F, Delambre J, Zadegan F, Tourabaly I, Sedel L, Chevret S, Nizard R. Ceramic-on-ceramic THA Implants in Patients Younger Than 20 Years. Clin Orthop Relat Res 2016; 474:520-7. [PMID: 26341897 PMCID: PMC4709277 DOI: 10.1007/s11999-015-4546-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 08/26/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Poor survival of THA implants in very young patients has been attributed to use of cemented implants, wear of conventional polyethylene, and the presence of morphologic deformities in the proximal femur or in the acetabulum. Few studies have reported the long-term results of ceramic-on-ceramic implants in THAs in patients younger than 20 years. QUESTION/PURPOSES We determined: (1) the proportion of patients who experienced complications related to the ceramic bearing (squeaking, fracture); (2) the survivorship free from loosening and free from revision for any reason; (3) whether patients with osteonecrosis had inferior survivorship compared with patients whose surgical indication was all other diagnoses including sequelae of pediatric hip disorders (developmental dysplasia of the hip, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis); and (4) clinical function. METHODS Between 1979 and 2013, we performed 113 primary THAs in 91 patients younger than 20 years at the time of surgery. Of those, 105 THAs (83 patients) were done with ceramic-on-ceramic bearings (91% of the 91 patients); during that period, a ceramic-on-ceramic bearing couple was indicated in all patients younger than 20 years. In eight patients (eight hips), a cemented polyethylene cup was implanted because the diameter of the acetabulum was smaller than the smallest available ceramic cup (46 mm), or because adequate fixation of a ceramic press-fit cup could not be achieved despite careful reaming of the acetabulum. The most common diagnosis indicating THA was avascular necrosis of the femoral head (56.2%; 59 hips). Thirty-five patients (40 hips) had undergone previous operations before the replacement. Three patients (4%; four hips) died from unrelated causes, nine patients (11%; 13 hips) were lost to followup, and four patients (five hips) had a followup greater than 8.5 years but have not been seen in the last 5 years. Patients were assessed clinically (using the Merle d'Aubigne-Postel score, Hip disability and Osteoarthritis Outcome score (HOOS), and the SF-12(®) Health Survey, and radiographically for signs of radiolucencies, subsidence, or osteolysis on plain films. The mean followup was 8.8 ± 6.1 years (range, 2-34.4 years). RESULTS Five patients experienced transient noise generation, defined as a snap in four patients and squeaking in one. Seventeen hips underwent revision surgery-16 for aseptic loosening and one for septic loosening. The implant survival rate at 10 years with aseptic loosening as the endpoint was 90.3% (95% CI, 82.4%-98.9%). No hip had acetabular or femoral osteolysis. Survivorship in patients with osteonecrosis did not differ from survivorship in patients with other diagnoses. The Merle d'Aubigne-Postel score increased from 10.1 ± 4.0 to 17.6 ± 1.1 (p < 0.01); the mean HOOS score was 79.3 ± 13.8 (range, 50.6-100); the mean SF-12(®) physical and mental component scores were 48.1 ± 7.9 (range, 21.4-57.6), and 47.4 ± 12.2 (range, 24.5-99.4), respectively. CONCLUSIONS We found that patient-reported outcomes scores improved in most patients undergoing THA in this very young study group. Underlying diagnosis did not affect long-term survivorship. However, the revision-free survival rate at 10 years is lower than published estimates in older patients, and with 11% of patients lost to followup, our estimates may represent a best-case scenario. Therefore, we believe THA should be performed as a last resort in this population. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Didier Hannouche
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France.
| | - Flore Devriese
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Jérôme Delambre
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Frédéric Zadegan
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Idriss Tourabaly
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Laurent Sedel
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Sylvie Chevret
- Department of Biostatistics and Medical Informatics, AP-HP, Hôpital Saint Louis, Université Paris 7 Denis Diderot, Paris, France
| | - Rémy Nizard
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France
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Sedrakyan A, Romero L, Graves S, Davidson D, de Steiger R, Lewis P, Solomon M, Vial R, Lorimer M. Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data. J Bone Joint Surg Am 2014; 96 Suppl 1:73-8. [PMID: 25520422 PMCID: PMC4271428 DOI: 10.2106/jbjs.n.00541] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND One of the least researched areas in orthopaedic pediatrics is the safety and effectiveness of joint replacement, in part because it is uncommon and is undertaken for a wide range of conditions not common for adult joint replacement. This study used data from the AOANJRR (Australian Orthopaedic Association National Joint Replacement Registry) to analyze the use of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in the pediatric population and to provide preliminary data on the outcome of these procedures. METHODS The AOANJRR, which is part of the ICOR (International Consortium of Orthopaedic Registries), provided information on pediatric procedures reported to the registry by hospitals undertaking arthroplasty procedures in Australia. All THA and TKA procedures reported to the registry from 1999 to 2012 were included. The cumulative percent revision and the hazard ratio from Cox proportional-hazards models were used for analysis. All tests were two-tailed, with a 5% level of significance. Additionally, an overview of the literature is presented to provide a point of reference. RESULTS Primary conventional THA was performed in 297 patients twenty years of age or younger; the cumulative percent revision at five years was 4.5%. Primary conventional THA was performed in 975 young adults twenty-one to thirty years of age; the cumulative percent revision at five years was 5.4%. Primary THA was performed in 105 patients twenty years of age or younger; the cumulative percent revision at five years was 4.6%. Primary TKA was performed in 159 young adults twenty-one to thirty years of age; the cumulative percent revision at five years was 10.3%. CONCLUSIONS Compared with older adults, pediatric patients and young adults undergoing THA and TKA have very different diagnoses, including a high prevalence of tumor. Although the reported rate of revision surgery is currently similar to that for older patients, the number of reported procedures and the follow-up period remain limited. It is important for registries to continue to collect and analyze data relevant to this cohort and to coordinate these activities in order to better understand the safety and effectiveness of joint arthroplasty in the pediatric population.
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Affiliation(s)
- Art Sedrakyan
- Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065
| | - Lucas Romero
- Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065
| | - Stephen Graves
- Australian Orthopaedic Association National Joint Replacement Registry (S.G., D.D., P.L., and R.V.) and Data Management & Analysis Centre (M.L.), Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia
| | - David Davidson
- Australian Orthopaedic Association National Joint Replacement Registry (S.G., D.D., P.L., and R.V.) and Data Management & Analysis Centre (M.L.), Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia
| | - Richard de Steiger
- The University of Melbourne, 185-187 Hoddle Street, Richmond, VIC 3121, Australia
| | - Peter Lewis
- Australian Orthopaedic Association National Joint Replacement Registry (S.G., D.D., P.L., and R.V.) and Data Management & Analysis Centre (M.L.), Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia
| | | | - Robyn Vial
- Australian Orthopaedic Association National Joint Replacement Registry (S.G., D.D., P.L., and R.V.) and Data Management & Analysis Centre (M.L.), Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia
| | - Michelle Lorimer
- Australian Orthopaedic Association National Joint Replacement Registry (S.G., D.D., P.L., and R.V.) and Data Management & Analysis Centre (M.L.), Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia
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Malcolm TL, Szubski CR, Nowacki AS, Klika AK, Iannotti JP, Barsoum WK. Activity levels and functional outcomes of young patients undergoing total hip arthroplasty. Orthopedics 2014; 37:e983-92. [PMID: 25361375 DOI: 10.3928/01477447-20141023-55] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/04/2014] [Indexed: 02/03/2023]
Abstract
The activity demands of young patients undergoing total hip arthroplasty (THA) have not been clearly defined. University of California Los Angeles (UCLA) activity score, Hip disability and Osteoarthritis Outcome Score (HOOS), Short Form-12 version 2 (SF-12v2), and Functional Comorbidity Index (FCI) questionnaires were administered to 70 young patients who had undergone THA (young THA group; ie, ≤30 years old), 158 general patients who had undergone THA (general THA group; ie, ≥31 years old), and 106 young, comorbidity-matched patients who had not undergone arthroplasty and had no significant hip disease (nonarthroplasty group). Mean postoperative UCLA activity scores were similar among groups (young THA group, 6.5; general THA group, 6.4; nonarthroplasty group, 6.6) before and after adjustment for comorbidity, sex, and race (P=.62 and P=.47, respectively). Adjusted analyses also found a negative association between postoperative activity and increases in comorbidity and female sex (P<.001). Patients in the young THA group reported higher expectations of postoperative activity (7.7) than those in the general THA group (7.1; P=.02). Postoperative HOOS results showed greater hip symptoms (P=.003) and poorer hip-related quality of life (P<.001) in the young THA group. Patient groups had similar postoperative SF-12v2 physical health scores (P=.31), although mental health scores were significantly higher in the general THA group (P<.001). The interesting finding of lower postoperative expectations, greater hip-related quality of life, and better mental health scores in the general THA group may indicate a need for better management of expectations in young patients undergoing THA, including a discussion of realistic gains in activity and potential comorbidity-related restrictions.
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Abdel MP, Figgie MP. Surgical management of the juvenile idiopathic arthritis patient with multiple joint involvement. Orthop Clin North Am 2014; 45:435-42. [PMID: 25199416 DOI: 10.1016/j.ocl.2014.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is recognized as a heterogenous group of disorders in which the common factor is persistent arthritis in at least 1 joint occurring before the age of 16 years. Although conservative management with nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs can be effective, approximately 10% of JIA patients have end-stage degenerative changes requiring total hip arthroplasties (THAs) and total knee arthroplasties (TKAs). This article discusses the overall epidemiology, coordination of care, and medical and surgical management of JIA patients undergoing THA and TKA.
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Affiliation(s)
- Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Mark P Figgie
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Fitzpatrick N, Law AY, Bielecki M, Girling S. Cementless Total Hip Replacement in 20 Juveniles Using BFX™ Arthroplasty. Vet Surg 2014; 43:715-25. [DOI: 10.1111/j.1532-950x.2014.12214.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 12/01/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | - Andy Y. Law
- Fitzpatrick Referrals; Eashing; Surrey United Kingdom
| | | | - Sarah Girling
- Fitzpatrick Referrals; Eashing; Surrey United Kingdom
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Abstract
Slipped capital femoral epiphysis (SCFE) is a hip disorder of adolescence, which has the potential for profound implications into adulthood. SCFE patients are at risk of early joint degeneration and subsequent need for arthroplasty. The rate at which arthroplasty is required is not precisely known, but is estimated to be approximately 45% by 50 years after a slip. The femoral neck and shaft displace anteriorly and rotate externally relative to the femoral epiphysis, which remains fixed in the acetabulum. Stabilization of the physis is the goal of acute management. Despite such efforts, accelerated joint degeneration may occur over time. This progression is due to avascular necrosis, chondrolysis, or following years of femoroacetabular impingement. Total hip arthroplasty (THA) and total hip resurfacing (THR) are options for end-stage hip arthritis due to SCFE. THR is technically more challenging, with very limited ability to address deformity-related issues of impingement, decreased hip offset, and trochanteric malposition. THR, as in any metal on metal arthroplasty, may be associated with local metal sensitivity or systemic metal toxicity. Given the limited utility and potential risks, THR is currently not recommended in the majority of cases. THA, although historically demonstrating poor long-term implant performance in the young patient, has become a more reliable option recently. The potential benefits of THA are considerable, even for the young patient with end-stage hip degeneration. Certain cemented and many cementless stem designs show good long-term survival, as do current cementless cups. Advances in bearing surfaces promise to minimize wear and extend implant longevity. Ceramic on ceramic, metal on highly cross-linked polyethylene, and ceramic on highly cross-linked polyethylene bearing couples offer promise.
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Goodman SB, Hwang K, Imrie S. High complication rate in revision total hip arthroplasty in juvenile idiopathic arthritis. Clin Orthop Relat Res 2014; 472:637-44. [PMID: 24136805 PMCID: PMC3890201 DOI: 10.1007/s11999-013-3326-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Revision total hip arthroplasty (THA) in patients with juvenile idiopathic arthritis (JIA) is challenging as a result of the patient's young age, systemic disease, multiple affected joints, small proportions, and bone loss. The intermediate- to long-term results of these surgeries remain unknown. QUESTIONS/PURPOSES The purpose of this study is to determine the (1) functional outcomes; (2) surgical complications; and (3) frequency of reoperation or revision after revision THA for JIA. METHODS We reviewed the records of all patients from one center who underwent revision THA for JIA who had a minimum of 5 years of followup (mean, 9 years; range, 5-19 years). This resulted in a series of 24 revision THAs in 15 patients. All patients were Charnley Class C. Age at revision averaged 35 years (range, 21-53 years). The 20 acetabular and 12 femoral revision components included 15 cementless cups, five reconstruction/roof rings with a cemented cup, and four cemented and eight cementless femoral stems. RESULTS The Harris hip scores improved from 54 (range, 34-85) to 77 (range, 37-100) (p < 0.001). Complications included two proximal femoral fractures associated with severe osteolysis and one sciatic nerve palsy in a patient with severe acetabular deficiency. A total of seven hips (29%) required reoperation or revision surgery, including three for infection (one early and two late) and four for mechanical loosening. CONCLUSIONS Revision THA in JIA is very challenging owing to patients' small proportions and compromised bone stock. The intraoperative and early complication rates are relatively high. Prognosis for long-term survivorship is guarded; limiting factors include periprosthetic osteolysis associated with older implants that used conventional polyethylene and cemented stems.
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Affiliation(s)
- Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, 450 Broadway Street, M/C 6342, Redwood City, CA 94063 USA
| | - Katherine Hwang
- Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, 450 Broadway Street, M/C 6342, Redwood City, CA 94063 USA
| | - Susanna Imrie
- Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, 450 Broadway Street, M/C 6342, Redwood City, CA 94063 USA
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Jain S, Giannoudis PV. Arthrodesis of the hip and conversion to total hip arthroplasty: a systematic review. J Arthroplasty 2013; 28:1596-602. [PMID: 23523503 DOI: 10.1016/j.arth.2013.01.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 01/18/2013] [Accepted: 01/25/2013] [Indexed: 02/01/2023] Open
Abstract
A systematic review of the literature was performed in order to evaluate the outcomes following arthrodesis of the hip and subsequent conversion to total hip arthroplasty. Eight studies regarding primary hip arthrodesis evaluating 249 hips revealed variable union rates (37.5%-100%) and patient satisfaction rates (69%-100%). Adjacent joint pain was commonly seen in the lower back (up to 75%) and ipsilateral knee (up to 57%) and complications were reported in 8.4%. Eleven studies regarding conversion arthroplasty evaluating 579 patients revealed inconsistent results regarding relief of pain. Complications were seen in up to 54%, most commonly due to mechanical failure, deep infection and nerve palsy. Whilst hip arthrodesis can provide pain relief and patient satisfaction, conversion arthroplasty is associated with an unacceptably high complication rate.
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Affiliation(s)
- Sameer Jain
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, UK
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Abstract
Total hip arthroplasty is an effective treatment option for advanced hip arthritis in elderly patients. Studies in young patients have traditionally shown less durable results. With current implants, surgical technique, and cementless fixation methods, the durability of total hip arthroplasty may now be related to the wear performance of the bearing surfaces. To improve implant longevity, there are several bearing surface choices currently available for this demanding group of patients. Alternatives must be evaluated in terms of the risks and benefits associated with each articulation, and all new technologies must be carefully monitored over the long term.
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Woon RP, Johnson AJ, Amstutz HC. The results of metal-on-metal hip resurfacing in patients under 30 years of age. J Arthroplasty 2013; 28:1010-4. [PMID: 23433997 DOI: 10.1016/j.arth.2012.07.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 05/22/2012] [Accepted: 07/26/2012] [Indexed: 02/01/2023] Open
Abstract
Degenerative hip conditions most commonly affect older patients. However, many cases occur in younger patients. Total hip arthroplasty is the conventional approach; however, hip resurfacing is a viable option. Fifty-three metal-on-metal resurfacings in 46 patients under age 30 were performed. Patients had a variety of etiologies, and were followed clinically and radiographically with mean follow-up of 98.2 months. Clinical scores and x-rays were compared pre-operatively and post-operatively. The last follow-up SF-12 and UCLA scores significantly improved post-operatively (P<0.0001). Range of motion scores also improved (P<0.001), and the mean Harris Hip Score was 88. There were 6 revisions. The Kaplan-Meier survivorship estimate at 8 years was 95%. Metal-on-metal hip resurfacing appears to be an effective procedure for younger patients. Longer-term data are needed for confirmation.
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Affiliation(s)
- Regina P Woon
- Children's Hospital Los Angeles, Los Angeles, California, USA
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46
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Abstract
Debilitating arthritis in teenage patients is a complex problem with limited surgical options. Hip arthrodesis is unpopular amongst patients, and contemporary total hip arthroplasty (THA) may be a promising alternative. We report on the outcomes of THA in patients less than 20 years of age. All consecutive teenage patients undergoing THA at a tertiary referral centre were reviewed. Mean follow-up was 3.4 years (range 0.6-6.8) and 9 patients had at least 5 years follow-up. There were 51 THAs in 43 patients with a mean age of 17 years (range 12-19). The commonest indication was osteonecrosis (35 cases), mostly secondary to slipped upper femoral epiphysis (15 cases). Forty-six were uncemented and 5 were reverse hybrid THAs of which 7 were computer assisted design/manufacture (CADCAM) components. The commonest bearing surface used was ceramic on ceramic (40 cases). The survival rate was 96% and there were 2 complications. At latest follow-up, the mean Harris hip score was 90 (range 68-99) and UCLA activity score was 6 (range 4-9). Radiological analysis showed 2 patients with lucent lines around the acetabular component, but no signs of osteolysis or wear. We report good short to intermediate term survivorship and outcomes, and feel THA represents a valid alternative option to hip arthrodesis.
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Leclercq S, Lavigne M, Girard J, Chiron P, Vendittoli PA. Durom hip resurfacing system: retrospective study of 644 cases with an average follow-up of 34 months. Orthop Traumatol Surg Res 2013; 99:273-9. [PMID: 23562709 DOI: 10.1016/j.otsr.2012.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/25/2012] [Accepted: 10/15/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The performance of second-generation metal-on-metal bearings has led to the reintroduction of hip resurfacing. The goal of this multicentre study was to evaluate the short-term radiological and clinical outcomes with the Durom hip resurfacing system. HYPOTHESIS The Durom hip-resurfacing system will have similar results to other hip resurfacing systems and traditional hip arthroplasty implants. MATERIALS AND METHODS In the four participating centers, 580 patients (406 men, 174 women) and 644 hips were included. The average patient age was 48 years (range 16-77). A posterolateral surgical approach was used in 357 cases; a Hardinge-type approach was used in 182 cases and a Rottinger-type approach in 105. RESULTS After an average follow-up of 34 months, 31 hips (4.8%) had been revised. The reasons for revision were the following: 10 (1.6%) neck fracture (seven with Rottinger operative approach, one with Hardinge approach and one with posterolateral approach); 12 (1.9%) femoral loosening (four with lateral approach and eight with posterolateral approach); four (0.6%) acetabular cup migration; three (0.5%) unexplained pain; one (0.2%) adverse reaction to metal debris; one (0.2%) infection. Four hips (0.6%) dislocated but without recurrence - all were operated using the Hardinge approach. The 613 hips that were not operated on again had satisfactory clinical results; the Merle d'Aubigné score was 17.2 (range 12-18) and the WOMAC score was 91 (range 20-100). The five-year survival rate was 91% (95% CI: 87-94%). Based on radiographs, the average cup inclination was 44.4° (range 30 to 70°). The femoral offset was reduced by an average of 2.4mm (-31 to 23 mm) and the leg length had increased by an average of 0.8mm (-15 to 19 mm) relative to the other side, which was prosthesis-free. None of the non-revised implants showed any signs of loosening. DISCUSSION This multicentre evaluation revealed that the Durom revision rate was slightly higher than the rate with other hip resurfacing systems and traditional total hip arthroplasty. Although the Durom system displayed excellent tribological performance, the differences relative to other implants may be attributed to the challenges associated with impaction, related to the geometry and design of the cup, and to precarious primary fixation. The choice of surgical exposure and implantation technique was an important factor in the survival of the implant. LEVEL OF PROOF Level IV - Retrospective study.
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Affiliation(s)
- S Leclercq
- St Martin Hospital Center, 18, rue Rocquemonts, 14000 Caen, France
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Schmitz MWJL, Busch VJJF, Gardeniers JWM, Hendriks JCM, Veth RPH, Schreurs BW. Long-term results of cemented total hip arthroplasty in patients younger than 30 years and the outcome of subsequent revisions. BMC Musculoskelet Disord 2013; 14:37. [PMID: 23339294 PMCID: PMC3599466 DOI: 10.1186/1471-2474-14-37] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 01/15/2013] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Marloes WJL Schmitz
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Internal Post 357, PO Box 9101, Nijmegen, HB 6500, The Netherlands
| | - Vincent JJF Busch
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Internal Post 357, PO Box 9101, Nijmegen, HB 6500, The Netherlands
| | - Jean WM Gardeniers
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Internal Post 357, PO Box 9101, Nijmegen, HB 6500, The Netherlands
| | - Jan CM Hendriks
- Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, P.O. Box 9101, Nijmegen, HB 6500, The Netherlands
| | - René PH Veth
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Internal Post 357, PO Box 9101, Nijmegen, HB 6500, The Netherlands
| | - B Willem Schreurs
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Internal Post 357, PO Box 9101, Nijmegen, HB 6500, The Netherlands
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Daurka JS, Malik AK, Robin DA, Witt JD. The results of uncemented total hip replacement in children with juvenile idiopathic arthritis at ten years. ACTA ACUST UNITED AC 2012. [DOI: 10.1302/0301-620x.94b12.29124] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The inherent challenges of total hip replacement (THR) in children include the choice of implant for the often atypical anatomical morphology, its fixation to an immature growing skeleton and the bearing surface employed to achieve a successful long-term result. We report the medium-term results of 52 consecutive uncemented THRs undertaken in 35 paediatric patients with juvenile idiopathic arthritis. The mean age at the time of surgery was 14.4 years (10 to 16). The median follow-up was 10.5 years (6 to 15). During the study period 13 THRs underwent revision surgery. With revision as an endpoint, subgroup analysis revealed 100% survival of the 23 ceramic-on-ceramic THRs and 55% (16 of 29) of the metal- or ceramic-on-polyethylene. This resulted in 94% (95% CI 77.8 to 98.4) survivorship of the femoral component and 62% (95% CI 41.0 to 78.0) of the acetabular component. Revision of the acetabular component for wear and osteolysis were the most common reasons for failure accounting for 11 of the 13 revisions. The success seen in patients with a ceramic-on-ceramic articulation seems to indicate that this implant strategy has the potential to make a major difference to the long-term outcome in this difficult group of patients.
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Affiliation(s)
- J. S. Daurka
- St George’s Healthcare NHS Trust, Blackshaw
Road, Tooting, London
SW17 0QT, UK
| | - A. K. Malik
- Buckinghamshire Healthcare NHS Trust, Queen
Alexandra Road, High Wycombe, Buckinghamshire
HP11 2TT, UK
| | - D. A. Robin
- Masada Medical Centre, 36
Balaclava Road, East St Kilda, Victoria, Australia
| | - J. D. Witt
- University College London Hospitals NHS
Foundation Trust, Euston Road, London NW1
2PG, UK
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50
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Yoon HJ, Yoo JJ, Yoon KS, Koo KH, Kim HJ. Alumina-on-alumina THA performed in patients younger than 30 years: a 10-year minimum followup study. Clin Orthop Relat Res 2012; 470:3530-6. [PMID: 22826015 PMCID: PMC3492601 DOI: 10.1007/s11999-012-2493-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 07/06/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND THA in patients younger than 30 years presents challenges because of uncertainties regarding the long-term survivorship of prostheses. Alumina-on-alumina bearings, which exhibit little long-term wear, may be a reasonable option but the long-term survivorship is unknown. QUESTIONS/PURPOSES We determined (1) the survival rate of alumina-on-alumina bearings in patients younger than 30 years after a 10-year followup, (2) the incidence of audible hip clicking and squeaking, (3) radiographic evidence of osteolysis, and (4) the effects on pregnancy, childbirth, and career choice. METHODS We retrospectively reviewed 62 patients who had 75 THAs with alumina-on-alumina bearings followed more than 10 years (average, 11.5; range, 10-13.5 years). Mean patient age at the time of surgery was 24 years (range, 18-30 years). All operations were performed using the same cementless implant at a single center. We determined survival, presence of osteolysis, and function (Harris hip score, WOMAC). RESULTS The 10-year survival rate of alumina-on-alumina bearings in THAs, with revision for any reason as the end point, was 98.9%. Audible hip clicking and squeaking were identified in 10 hips and two hips, respectively. No osteolysis was detected. None of the 11 patients who became pregnant had been affected by their THA during pregnancy or childbirth. Seven of the 14 patients who were unemployed at the time of index surgery stated that their THA affected their job choice. CONCLUSIONS We found a high 10-year survival of cementless alumina-on-alumina bearings in THAs in patients younger than 30 years. Lifetime events such as job choice, pregnancy, and childbirth should be considered when choosing THA for patients younger than 30 years. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hyeong Jo Yoon
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 110-744 Seoul, South Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 110-744 Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 110-744 Seoul, South Korea
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 110-744 Seoul, South Korea ,Medical Research Center, Seoul National University, Seoul, South Korea
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