Hip Replacement In Young Patients Research Articles

The effect of previous surgical treatment on the outcome of total hip replacement in young patients with dysplastic coxarthrosis

Introduction Hip dysplasia of various genesis is recognized as a common cause of coxarthrosis. Total hip replacement (THR) is the operation of choice for the patients with the final stage of the pathological process. There are different opinions on the impact of previous surgical treatment of hip dysplasia on THR.The aim of the study was to explore the effects of previous surgical treatment on the outcomes of THR in young patients with dysplastic and secondary coxarthrosis.Material and methods Surgical outcomes of 78 patients (58 females and 20 males; 91 joints) with dysplastic and secondary coxarthrosis (age 14-30 years, average age 24.3 ± 4.3 years) treated witrh THR were retrospectively reviewed. Patients we assigned to two groups. Group I (control) included 27 patients (33 joints) with dysplastic coxarthrosis primarily treated with THR. Group II (treatment group) included 51 patients (58 joints) who had previously undergone THR.Results Patients of group II demonstrated longer duration of surgery by 47.89 %, greater blood loss by 16.92 % and the higher complication rate by 42.1 %.Discussion The treatment group showed a significantly increased frequency of late complications in the form of implant instability. Patients of group II dermonstrated better functional results estimated with HHS as compared to the outcomes of patients of group I.Conclusion Hip reconstructions performed earlier were associated with technical difficulties, aggressive THR procedure, a greater risk of late complications, but showed no significant effect on the outcomes.

Minimum 20-year follow-up of a press-fit acetabular cup in cementless total hip replacement in young patients.

We aimed to determine the minimum 20-year survival rates of a cementless press-fit cup in young patients. This is a retrospective, single-center, multi-surgeon cohort study investigating the minimum 20-year clinical and radiological outcome of the first 121 consecutive total hip replacements (THRs) using a cementless, press-fit cup (Allofit, Zimmer, Warsaw, IN, USA) performed between 1999 and 2001. 28-mm metal-on-metal (MoM) and ceramic-on-conventionally not highly crosslinked polyethylene (CoP) bearings were used in 71% and 28%, respectively. Median patient age at surgery was 52 (range 21-60) years. Kaplan-Meier survival analysis was conducted for different endpoints. The 22-year survival rate for the endpoint aseptic cup or inlay revision was 94% (95% confidence interval [CI] 87-96) and 99% (CI 94-100) for aseptic cup loosening. 20 patients (21 THRs; 17%) had died and 5 (5 THRs; 4%) were lost to follow-up. No THR showed evidence of radiographic cup loosening. Osteolysis was observed in 40% of THRs with MoM and 77% with CoP bearings. 88% of THRs with CoP bearings showed significant polyethylene wear. The investigated cementless press-fit cup, which is still in clinical use today, showed excellent long-term survival rates in patients under the age of 60 years at surgery. However, osteolysis due to polyethylene and metal wear was frequently observed and is a matter of concern in the third decade after surgery.

Midterm results of the Birmingham hip resurfacing: a single-surgeon series.

Birmingham hip resurfacing (BHR) is readily used as alternative to total hip replacement in younger patients. The current study aims to compare outcomes in terms of adverse local tissue reactions (ALTR), elevated metal ion levels and survival rates between low-risk (femoral component size ≥ 48mm) and high-risk (femoral component size < 48mm) BHR patients at a minimum 5-year follow-up (FU). We report the minimum 5-year, single surgeon outcome results of 183 BHRs, performed between 2007 and 2012. 154 patients, 18 women (20 hips) and 136 men (163 hips) were included in the study. Patients were grouped in 149 low-risk cases (femoral component size ≥ 48mm) and in 34 high-risk cases (18 female/12 male) patients with a femoral head size < 48mm). At a minimum of 5-years FU time, 91% of the patients were available for FU. The overall survival rate was 91.8%. There were five revisions (survival rate 96.6%) in the low-risk group and ten revisions (survival rate 70.6%) in the high-risk group. In the low-risk group, six patients (6.5%) showed elevated metal ion levels (> 7μg/l), compared to five patients (20.8%) in the high risk-group (p = 0.03). Including the surgeon's initial learning curve, the BHR shows very good mid-term survival rates in the low-risk group but should, as previously demonstrated, not be considered for patients with less than 48mm femoral head size. Level III: retrospective cohort study.

Total hip arthroplasty

Primary total hip arthroplasty has become one of the most successful surgical procedures over the past 50 years and is currently performed worldwide with similar techniques and excellent results. Despite variations in technique and implant selection, medium and long term outcome studies have demonstrated over 90% implant survival at 15 to 25 years. Previous problems with implant fixation have now been reduced, and the focus has shifted to the selection of improved bearing surfaces to limit wear, hip replacement options for younger patients, and improved surgical and anesthetic techniques. Current surgical approaches to the hip rely most often on direct lateral or posterolateral exposure. The most commonly utilized bearing surface for both hip replacement and hip resurfacing in Canada is a metal (cobalt-chrome) femoral head combined with a second-generation cross-linked polyethylene, combined with cementless implant fixation. Alternative bearings such as ceramic-on-ceramic and metal-on-metal may be considered for hip replacement in younger patients. Although it has not been determined which surface will prove best for younger patients in the long term, there is no question about the benefits of total hip arthroplasty. With current techniques, the results are favorable, and patient satisfaction, pain relief, and long-term implant survival are excellent.

Evaluation of clinical outcome of cementless ceramic on ceramic primary total hip replacement in young patients of avascular necrosis of femoral head

ObjectiveTo evaluate clinical outcome of cementless ceramic on ceramic primary total hip arthroplasty in young patients of Avascular necrosis of Femoral head. MethodsA total of 30 hips undergoing cementless ceramic on ceramic primary total hip arthroplasty using S-ROM femoral stem were prospectively and retrospectively evaluated. ResultsPre-operatively the mean HHS was 32.73 which increased to a mean of 87.8 post-operatively. The difference was statistically significant (p value < 0.0005) with relatively minor complaints. ConclusionBased on our study, we recommend ceramic on ceramic THR for younger patients in the age group of less than 50 years of age.

Total hip replacement in femoral head osteonecrosis

The experience of hip replacement in young patients with osteonecrosis of the femoral head was analyzed in the article. The results of operations in the osteonecrosis group and osteoarthritis group in 3 years and 7 months after operations were compared. In 97.5 % of cases, cementless fixation implants with a ceramic on ceramic friction pair (45 %) and ceramic on polyethylene friction pair (45 %) were used. Surgical approaches by Moore, Hardinge and AMIS technique were applied. The clinical results of operations in the studied groups were similar, but the survival rate of endoprostheses in the osteonecrosis group was 91.5 %, and in the osteoarthritis group 97.2 %. In the osteonecrosis group an increased frequency of complications (dislocation of the endoprosthesis head, periprosthetic fracture, periprosthetic infection) and revision operations were observed. Our results show the influence of risk factors, concomitant diseases, the level of activity of young patients on the long-term total hip arthroplasty result.

New Advances in Stem Cell Therapy for Osteonecrosis of the Femoral Head.

Osteonecrosis of the femoral head (ONFH) is a common refractory orthopedic disease with multiple etiologies that more frequently occurs in middle-aged and young people. ONFH is the main cause of hip replacement in young patients. Since Professor Hernigou first reported the use of stem cells in the treatment of early stage ONFH, a large number of studies have demonstrated the potential of stem cells in the treatment of adult patients with ONFH. With the rise of interdisciplinary stem cell therapy combined with platelet-rich plasma therapy, gene therapy or other methods have gradually attracted the attention of researchers. This article summarizes the current advances in stem cell therapy for ONFH, as well as the problems and challenges, which may provide reference for further research.

A new classification for proximal femur bone defects in conservative hip arthroplasty revisions

In last three decades, total hip replacement in young patients became an habitual procedure. Principles of bone preservation are pushing many surgeons to implant conservative femoral components in patient younger than 65years. Despite an overall good survivorship and clinical outcomes of conservative implants, failed cases are reported and the need to revise a conservative femoral component became an occasional procedure (with high prevalence of failed resurfacing implants). During conservative femoral component revisions, we analyzed proximal bone stock preservation, considering the type of original component removed, aetiology of failure, timing of revision, and femoral explantation technique. We identified four patterns of proximal femoral changes (types I-IV). We suggest, for each of them, a revision strategy directed toward a "conservative revision procedure" using conservative or primary component. Out of our 21 cases, none underwent further revision due to mechanical failure (follow-up ranging from 6 to 152months, mean 54months). We had two cases of re-operation: one for early septic loosening and one for prosthetic modular neck fracture. If literature offers well-established guidelines to femoral revision of conventional stems, there is, on the other hand, a lack of data about revision strategies in presence of failed conservative implants. Although the mean follow-up of our procedures is still too short (4.5years) to give final conclusions, we would leave a message: a conservative hip arthroplasty is not a "one time" opportunity for young and active people. A "conservative revision" is a valid option for at least a part of them, when an early failure of primary procedure occurred.

Acetabular Subchondral Bone Decortication and Its Role in the Outcome of Cemented Total Hip Replacement in Young Patients.

PurposeLong-term fixation of cemented acetabular components can be problematic in younger active patients. Our technique is put forward to improve outcomes and maximize implant survivorship in this particular patient population.Materials and MethodsWe report on a cohort of young adult patients (less than 55 years old) with cemented total hip replacement (THR) using a novel technique in preparing and cementing the acetabulum with a minimum follow-up of 10 years (mean follow-up, 14 years). Retrospectively collected data on clinical and radiological outcomes were reviewed.ResultsSixty-five THRs were performed with the minimum study follow-up period. Average age for patients was 44 years old (range, 19–55 years). The mean Hip Disability and Osteoarthritis Outcome Score for patients at final appointment was 92.7. Radiographs taken at an average of 14 years after operation showed 63 of 65 hips showed no evidence of any radiological loosening. Cup survivorship was 100% at the end of the study period.ConclusionOur technique of preparing the acetabulum in combination with cement fixation is reproducible with excellent results in a cohort of patients prone to early aseptic loosening of the acetabular component.

Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications.

For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoral head and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage (generally over age 10), including adolescents and young adults (generally up to around age 40), the Bernese periacetabular osteotomy (PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation.

The effects of cobalt–chromium–molybdenum wear debris in vitro on serum cytokine profiles and T cell repertoire

Cobalt–chromium–molybdenum (CoCrMo) alloy-based metal-on-metal prostheses have been the implant of choice for total hip replacement in younger patients. However 6.2% of patients require revision of their CoCrMo total hip replacement (THR) implant within five years of surgery and their use was restricted in 2013. We aimed to determine if there were individual differences in the immune response to wear debris that might indicate a poor outcome with a CoCrMo prosthesis.Blood from 22 donors was incubated with CoCrMo particles (>99.9% less than 10 μm diameter) generated by a wear simulator for 24 h. T cell phenotype was assessed by immunostaining and secretion of 8 different pro- and anti-inflammatory cytokines was measured using multiplex technology. Clear differences were seen between individuals in the induction of Th17 and Th1 responses, with some donors showing pro-inflammatory responses (increased IL17 or IFNγ) and others showing anti-inflammatory responses (decreased IL17 or IFNγ). The only differences seen for gender and age related to increased IL-10 expression from T cells in females (p = 0.008) and a trend towards decreased IL-6 expression systemically for older donors (p = 0.058).We conclude that individuals show differential responses to CoCrMo wear debris and that these responses could give early indications of the suitability of the patient for a metal-on-metal prosthesis.

AB1197 Total hip replacement in young patients with juvenile idiopathic arthritis

BackgroundJuvenile idiopathic arthritis (JIA) is one of the most serious chronic diseases in children. The osteoarthritis degenerative destructive changes occur in all components of the hip. Basic of pathogenetic approach...

Optimal bearing surfaces for total hip replacement in the young patient: a meta-analysis

Although there is general consensus about the efficacy of total hip replacement (THR) in young patients, the most appropriate bearings in young patients remain highly debated. The three most popular bearings in use include metal-on-polyethylene (MOP), metal-on-metal (MOM) and ceramic-on-ceramic (COC). We conducted a systematic review and meta-analysis of literature to summarise the best available evidence on relative success of the three most popular bearings used in THR in young active patients. Our findings support the use of MOM bearings in the management of the young arthritic hip. These findings, largely based upon observational studies, should be taken in the context of the limitations of such non-randomised study designs.

Long-term results of intertrochanteric varus osteotomy for dysplastic osteoarthritis of the hip

The beneficial role of intertrochanteric varus or valgus osteotomy in the treatment of hip osteoarthrosis has been recognised since the 1920s. Even today, it has an important role to delay the need for hip replacement in younger patients. The purpose of this study was to evaluate the long-term results of intertrochanteric varus osteotomy for dysplastic osteoarthritis of the hip. Between 1980 and 1995, 52 hips with dysplastic osteoarthritis underwent an intertrochanteric varus osteotomy. All patients could be followed up after 17.8years. Radiographic assessment included centre-edge (CE) angle of Wiberg and collodiaphyseal (CCD) angle. Dysplastic hip dislocation was classified according to Crowe. Osteoarthritis was graded according to Tönnis. Preoperative osteoarthritis was Tonnis grade 1 in 19 hips, grade 2 in 28 and grade 3 in five. Complications were also documented. Clinical evaluation included score according to Merle d'Aubigné, Harris Hip Score and range of motion. Six of 52 patients underwent total hip replacement (THR) within fiveyears after intertrochanteric osteotomy. In these cases, preoperative osteoarthritis was grade 3 in four cases and grade 2 in one case according to Tönnis. Twenty-five of 52 patients underwent THR after an interval of five to ten years after intertrochanteric osteotomy. In these cases, preoperative osteoarthritis was grade 3 in one case and grade 2 in 24 cases according to Tönnis. Sixteen of 52 patients underwent THR after an interval of ten to 15years after intertrochanteric osteotomy. In these cases, preoperative osteoarthritis was grade 2 in four cases and grade 1 in 12 cases according to Tönnis. In five patients the hip was functioning well after a period longer than 15years. In all these cases osteoarthritis was grade 1 according to Tönnis. In 40.4% of patients, THR was delayed longer than tenyears. The osteotomy performed well at a mean time of 9.7years after the procedure (range 3-21). Intertrochanteric varus osteotomy for dysplastic osteoarthritis of the hip should be considered in early or mild osteoarthritic changes of the hip. Good prognosis with delay of THR of more than tenyears can be expected to exceed 40%, even when indications are less than optimum.

Treatment of nontraumatic osteonecrosis of the femoral head using bone impaction grafting through a femoral neck window

Nontraumatic osteonecrosis of the femoral head (non-ONFH) is a disorder that can lead to femoral head collapse and the need for total hip replacement. Various head-preserving procedures have been used for this disease to avert the need for total hip replacement. These include various vascularised and nonvascularised bone grafting procedures. We examined the effect of bone-grafting through a window at the femoral head-neck junction known as the "light bulb" approach for the treatment of osteonecrosis of the femoral head with a combination of demineralised bone matrix (DBM) and auto-iliac bone. The study included 110 patients (138 hips; 41 females, 69 males; mean age 32.36 years, range 17-54 years) with stage IIA-IIIA nontraumatic avascular necrosis of the femoral head according to the system of the ARCO (Association Research Circulation Osseous). The bone grafting procedure is called "light bulb" procedure in which the diseased bone was replaced by a bone graft substitute (combination of DBM and auto-iliac bone).The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The mean follow-up was 25.37 months (range 7-42 months). All data were processed by a statistics analysis including Cox risk model analysis and Kaplan-Meier survival analysis. Pre- and postoperative evaluations showed that the mean Harris hip score increased from 62 to 79. Clinically, 94 of 138 hips (68%) were successful at the latest follow-up, and radiological improvement was noted in 100% of patients in stage IIA, 76.67% of patients in stage IIB and 50.96% of patients in stage IIC and IIIA cases. Excellent and good results according to the Harris score were obtained in 100% of cases in stage IIA, 93.33% in stage IIB and 59.62% in stages IIIA and IIC stage, with a survivorship of 85% in stages IIA and IIB and 60% in stage IIIA and IIC cases. Cox risk model analysis showed that the clinical success rate correlated with both pre-operation stage and the necrotic area of the femoral head. The complications included ectopic ossification, lateral femoral cutaneous nerve lesion and joint infection. This procedure may be effective at avoiding or forestalling the need for total hip replacement in young patients with early to intermediate stages of osteonecrosis of the femoral head. Therefore, it may be the treatment of choice particularly in nontraumatic osteonecrosis of the femoral head of pre-collapse stage with small and middle area (<30%, or the depth of collapse <2 mm).

Clinical and radiological mid-term results of the thrust plate prosthesis

The purpose of this study was to perform an objective clinical and radiological assessment of the thrust plate prosthesis (TPP). Fifty-three prostheses were evaluated clinically using the Harris hip score (HHS), visual analog scale (VAS), and radiographically before surgery, at the time of discharge, and postoperatively after on average of 8.09 (range 4.61-9.93) years. The average HHS significantly (p < or = 0.05) improved from 48 (range 18-77) points to 95 (range 46-100) points. The VAS revealed significant (p < or = 0.05) reduction of pain at rest and under load. Radiographic analysis showed a considerable potential for osteolysis under the thrust plate. Sixteen prostheses revealed signs of radiolucent zones. In general, there was a good clinical outcome with no major limitations in function. Radiographic changes under the thrust plate indicate an adaptation processes resulting from changed biomechanics. This study suggests that the TPP could be a good alternative in total hip replacement in younger patients.

Primary total hip replacement in childhood, adolescence and young patients: Quality and outcome of clinical studies

The present meta-analysis illustrates relevant information about hip replacement in young patients that has been published during the past 3 decades. Based on a MedLine literature review a total of 95 studies were evaluated. Parameters for evaluation of study quality and outcome were implant survival rates (ISR),number of patients, indications, follow-up, surgical approaches and number of surgeons. Most studies consider patient numbers <50. In 33 studies one implant system was applied compared to 65 studies in which more than one system was used. Most studies include different surgical approaches. 20% of all studies contained neither the number of surgeons,nor the type of surgical approach. The overall ISR could be evaluated in 67 studies. Sufficient data about the ISR of stem and/or sockets were available in 50 papers. Most published studies analyzed inhomogeneous study populations; study variables vary as do the implants used for treatment.

Medium-term results using the cement-free link endoprosthesis. Ribbed shaft V socket

Since 3/84 340 primary implantations with the uncemented "Link" hip system (Rib-Type V socket) were done. The results with an average follow up of 3.2 years are published. Only 2.17% revision had to be suffered in the rib stem, while 0.77% socket revision had to be done. According to the score of Merle d'Aubigné the values of pain increased from 2.87% to 5.38%, walking ability from 3.68% to 5.27% and the range of motion from 133 degrees to 199 degrees. A high rate of good and satisfying results proved this anatomical implant system to be a good alternative in total hip replacement in younger patients.

Artificial hip replacement in young patients with hip dysplasia--long-term outcome after 10 years

The experience gained in three decades of hip arthroplasty includes observations on patients with congenital dysplasia of the hip (CDH) under 20 years of age. A study dealing with hip arthroplasty in patients with osteoarthritis following CDH in such young age is not known in the literature. In the present study we report about a long-term follow-up of 41 total hip arthroplasties which were performed using bone-cement in 29 patients from 1966 to 1995. The evaluation of this retrospective study was performed with an questionnaire and a clinical and radiological investigation (Harris hip score, Sutherland activity score). 18 patients with 27 THR (62%) were evaluated clinically and radiologically after a mean duration of follow-up of 10 years and 8 months. Seven additional THR had been revised in the meantime. Kaplan-Meier survival analysis showed a survival rate after 10 years of 64%. Acetabular loosening occurred three times as often as femoral loosening (overall revision rate 41.2%). The overall loosening rate of total hip replacement of young patients is significantly elevated. These findings suggest that total hip replacement in young patients with dysplastic hips should be considered most carefully. Implantation of a hip prosthesis is only justified in special cases where alternative procedures are contra-indicated or unacceptable.

Proximal load transfer with a stemless uncemented femoral implant

Bone stock preservation is crucial when performing total hip replacement in young patients. The aim is to save good bone stock for a possible revision procedure. Furthermore, there is an increasing demand from young and active patients to receive a new joint which allows a normal or nearly normal life style. With this in mind, we began, in 1993, to develop a new femoral implant. The purpose of this ultra-short stem was a physiologic strain distribution on the proximal femur with a proximal load transfer from the implant to the femoral bone. Main features were an almost complete absence of the diaphyseal portion of the stem, a well defined lateral flare with load transfer on the lateral column of the femur, and a very high femoral neck cut. These innovations resulted in a conservative implant on both the bone stock and the soft tissues. This implant, in the first years, was recommended only for young and active patients. Over the last thirteen years, this project has undergone several modifications but the basic principles of the implant have remained the same. In the present review, we present the rationale, the surgical technique and the clinical and experimental results so far obtained with this implant.