Abstract
BackgroundThe 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.MethodsThe 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.ResultsKaplan-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.ConclusionsHip resurfacing exceeds the stricter 2014 NICE survivorship criteria independently in men and women even when performed on patients under 50 years old.
Highlights
The Nordic registry reports patients under 50 years old with total hip replacements realize only 83% 10-year implant survivorship
Survival rates varied by sex (Fig. 4), with males displaying significantly greater implant survivorship at 12 years than females in both group 1 (98 vs. 93%, respectively, log-rank and Wilcoxon p < 0.0001) and group 2 (99 vs. 95%, respectively, log-rank and Wilcoxon p < 0.0001)
The only statistically significant difference in occurrence of any failure mode was that of recurrent instability, with which was greater in group 1 (0.2% in group 1 and 0.0% in group 2, p = 0.03)
Summary
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. Sir John Charnley warned against performing THA in younger patients, citing that the procedure was not robust enough [7]; as an increasing number of younger patients demanded better, longer-lasting solutions [8], hip resurfacing arthroplasty (HRA) emerged as an alternative, bone-preserving option It is well known THA implants display markedly lower survivorship in patients younger than 50 years old [2,3,4]. In a literature review by De Kam on THA in patients under 50 [9], only 15 of 37 papers met the outdated NICE
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