Abstract
BackgroundTotal hip arthroplasty (THA) is used increasingly in younger patients. There is little knowledge about the effect of THA characteristics on risk of revision, especially in young patients. Therefore, we studied the influence of both patient-related and surgical factors on the risk of revision using data from the Dutch Arthroplasty Registry (LROI).MethodsAll patients younger than 55 years with a primary THA implanted in the Netherlands between 2007 and 2017 were selected (n = 19,682). The covariates age, sex, primary diagnosis, ASA-classification, surgical approach, fixation method, bearing type, head size and year of surgery were entered into Cox proportional hazards models to calculate hazard ratios for the risk of revision.ResultsThe overall 5-year survival of primary THA was 95.3% (95% CI, 94.9–95.6). Use of the anterior approach resulted in a lower risk of revision than the use of the posterolateral approach (HR: 0.66, 95% CI: 0.47–0.92). THAs with a head diameter ≥ 38 mm had a higher risk of revision (HR: 1.90, 95% CI: 1.33–2.72) than THAs with 32 mm heads. Use of MoM bearings resulted in an increased risk when compared to C-PE (HR: 1.76, 95% CI: 1.27–2.43).ConclusionThe risk of revision in patients younger than 55 years depends on surgical approach, head size and bearing type. The anterior approach resulted in a decreased risk of revision, whereas use of ≥38 mm heads and MoM bearings resulted in an increased risk of revision for any reason.
Highlights
Total hip arthroplasty (THA) is used increasingly in younger patients
Patient- and implant characteristics Between January 1st, 2007 and December 31st, 2016, a total number of 19,682 THAs were registered in patients under 55 years in the LROI
Multivariable risk of revision for any reason The use of the anterior approach resulted in a decreased risk for revision after THA when compared with the posterolateral approach (HR: 0.66, 95% CI: 0.47–0.92, p = 0.01)
Summary
Total hip arthroplasty (THA) is used increasingly in younger patients. There is little knowledge about the effect of THA characteristics on risk of revision, especially in young patients. Total hip arthroplasty (THA) has shown to be a cost-effective treatment for osteoarthritis of the hip, with reported increase in quality of life, regained physical ability and reduction of pain [1, 2]. THA is used increasingly in young patients, and this number will grow in the coming years. The outcome of THA in these young patients is inferior compared with older patients [4,5,6]. Young patients will outlive their prosthesis due to longer life expectancy, and survival at mid- and long-term is lower in patients younger than 55 years when compared with older patients [7]
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