Total Hip Arthroplasty In Young Patients Research Articles

Bearing-Related Complications of Total Hip Arthroplasty Using Fourth-Generation Ceramic-On-Ceramic Articulations: Does Articular Noise Increase Over Time?

BackgroundWe previously reported the mean 6-year outcomes of total hip arthroplasty (THA) using fourth-generation ceramic-on-ceramic (CoC) articulations. With extended observations, this study aimed to report the mean 12-year outcomes focusing on bearing-related complications of CoC THA. MethodsWe reviewed primary CoC THAs performed between May 2009 and April 2012 at a single institution. Of the 831 hips (739 patients), 716 hips (635 patients) that satisfied a minimum 10-year follow-up were included. The mean age at operation was 54 years (range, 16 to 83). The occurrence of bearing-specific complications, including ceramic fractures and noise generation, was evaluated. The mean follow-up duration was 12 years (range, 10 to 14). ResultsA total of 2 (0.3%) ceramic liner fractures occurred, as previously reported. No additional ceramic fractures were observed during the extended follow-up period. However, the cumulative incidence of audible noise increased from 6.4 (48 of 749) to 8.2% (59 of 716). Of the 59 hips with noise, 26 (44.1%) developed noise within 1 year, whereas 13 (22.0%) presented with noise more than 5 years after THA. The noise was described as clicking in 35 hips (4.9%) and as squeaking in 24 hips (3.4%). No revision surgeries were performed for noise, except in 2 cases of concomitant liner fractures. The implant survivorship free of any revision was 98.1% at 12 years. ConclusionsNo additional ceramic fractures were identified in this extension study at a minimum follow-up of 10 years. However, the prevalence of articular noise has increased from 6.4 to 8.2% since the previous report. Possible late-onset noise should be considered when performing CoC THA in younger patients.

Midterm Results of Contemporary Uncemented Total Hip Arthroplasty in Patients 45 Years or Younger.

Total hip arthroplasty (THA) in young patients has varying results, and some reports show inferior results when compared with those of older patients. This study evaluated the outcomes of contemporary uncemented THA in patients 45 years or younger. This was a retrospective review from 2003 to 2015 at an academic institution. Three hundred one uncemented THAs in 232 patients 45 years or younger were evaluated. All patients had a minimum follow-up of 5 years. Ninety-day complications, survivorship free of revision, and dislocations were evaluated. Mean age was 35.7 years, 43.1% of patients were women, and mean follow-up was 9.3 years. Ninety-day complications included 26 emergency department visits, 11 readmissions, 3 revisions, and 3 dislocations. The rate of 10-year survivorship free of revision was 85.5%, and the rate of 10-year survivorship free of aseptic revision was 87.7%. Excluding metal-on-metal (MOM) THAs, 10-year aseptic survivorship was 93.3%. The most common reasons for revision were adverse local tissue reaction after MOM THA (16 hips) and periprosthetic joint infection (6 hips). In a multivariable logistic regression model, sickle cell disease (SCD) and conversion THA were associated with 90-day readmissions. Both MOM THA and SCD were associated with revision (P<.05). Patients who are 45 years or younger undergoing THA (excluding MOM articulation) had a rate of 10-year survival free of aseptic revision of 93.3%. At 9.3 years' mean follow-up, THA in young patients was associated with low revision rates with acceptable risk of prosthetic joint infection and dislocation. Patients with SCD are at increased risk for early readmission and revision at latest follow-up. [Orthopedics. 2023;46(1):e45-e51.].

Total hip arthroplasty in ankylosing spondylitis in young patients: A prospective study

Background: Ankylosing spondylitis (AS) is a chronic seronegative inflammatory arthritis of unknown etiology characterized by inflammation of joints of the axial skeleton. It primarily affect the spine and pelvis but peripheral arthritis and enthesitis are common features. The mean age of onset of symptoms is between 15 to 25 years and it is more common in males. Severe disability and functional impairment can result rapidly due to a combination of axial spine and hip involvement. When painful degenerative changes occur, Total Hip Arthroplasty (THA) has been shown to alleviate pain and improve function. The aim of this study is to evaluate the clinical, radiological and functional outcome of uncemented THA in young patients of ankylosing spondylitis.Materials and Methods: This prospective study was carried out in 12 male patients of ankylosing spondylitis all aged above 25 years. Uncemented THA was done in all 12 cases of AS. The study was conducted for a period of 12 months and cases were followed up for a period of 6 months. Functional outcome of hip were evaluated using Harris Hip Score (HHS) at regular intervals.Results: 12 young male AS patients were selected for the study and average age of surgery is 36 years. The final functional outcome of hip on the basis of Harris Hip Score(HHS) were 8(67%) patients good result, 3(25%) patients excellent result and 1(8%) patient have shown fair result. Radiological outcome was passed on the basis of Anterior-posterior (AP) radiograph taken immediate postoperatively and then at 1,2,3,6 months. Radiological outcome was satisfactory except in 3 cases where heterotrophic ossification were noticed in AP radiograph later after 6 months of surgery.Conclusion: This study concludes that uncemented Total Hip Arthroplasty (THA) in young patients done for ankylosing spondylitis provide substantial clinical and functional outcome in patients function. The improvement of in functional outcome and quality of life and postoperative reduction of pain have justified the need of THA in these stiff hips in AS.

Patient-reported outcome of 95% of young patients improves after primary total hip arthroplasty: identification of 3 recovery trajectories in 3,207 patients younger than 55 years from the Dutch Arthroplasty Register.

Background and purposeLittle is known about the outcome after receiving total hip arthroplasty (THA), specifically in young patients. We identified different recovery trajectories in young patients using data from the Dutch Arthroplasty Register (LROI). We also explored whether risk factors commonly associated with functional outcome were associated with recovery trajectory.Patients and methodsWe used HOOS-PS score data up to 1 year postoperatively from the LROI from all patients younger than 55 years who received a primary THA between 2014 and 2019. To investigate whether different recovery trajectories could be distinguished, we performed latent class growth analysis (LCGA). Subsequently, we used multinomial logistic regression analyses to explore factors associated with class membership.Results3,207 patients were included. LCGA identified 3 groups of patients: optimal responders (75%), good responders (21%), and poor responders (4.7%). Female sex (RR 1.1; 95% CI 1.1–1.1), ASA II (RR 1.1; CI 1.0–1.1), ASA III–IV (RR 1.1; CI 1.0–1.2), smoking (RR 1.1; CI 1.0–1.1), cemented fixation (RR 1.2; CI 1.1–1.2), and a 22–28 mm head diameter (RR 1.1; CI 1.0–1.2) were associated with “good responder” class membership. ASA II (RR 1.1; 1.0–1.2), ASA III–IV (RR 1.2; 1.1–1.3), smoking (RR 1.2; CI 1.1–1.2), and hybrid fixation (RR 1.2; CI 1.0–1.2) were associated with “poor responder” class membership.Interpretation3 recovery trajectories could be identified. Female sex, higher ASA classifications, smoking, cemented or hybrid fixation, and small head diameter were associated with a suboptimal result after primary THA in young patients. These findings can aid in the process to determine which patients are at risk of a suboptimal outcome.

A Patient and Public Involvement Study to Explore the Need for Further Research into the Experience of Younger Patients Undergoing Total Hip Arthroplasty.

Background: Total Hip Arthroplasty (THA) is one of the most commonly performed operations in orthopaedics. It is an operation usually performed in older patients, however the need for THA in younger patients is increasing. There is a lack of literature examining whether current recovery pathways address the specific needs of younger patients. Public and Patient Involvement (PPI) is a core aspect of good research practice and is recommended throughout the research process, including the formulation and refinement of pertinent research questions. Therefore, the explicit aim of this PPI study was to collect qualitative data from patients on the feasibility and requirement for further research into the experience of younger hip arthroplasty patients. Methods: Qualitative data was collected via an online questionnaire that was advertised on social media, requesting the input of anybody who had experienced a lower limb musculoskeletal injury or condition before the age of 50. The survey asked the respondents to describe their experiences and reflect on their priorities and goals throughout their recovery. Results: There were 71 respondents, of which 90% were female, with an average age of 43. Qualitative responses identified many concerns that were issues that could be translated across all patient ages. However, other priorities were raised that are not always recognised as important when measuring successful outcomes after a THA. Furthermore, many respondents described not feeling listened to by clinicians or treatment options not being sufficiently addressed and explored. Multiple respondents reported being told they were too young to have anything serious or that nothing could be done until they were older. Conclusions: The responses to the survey indicate that current care pathways are not fulfilling the needs and priorities in younger patients. Further research is required to explore these priorities and goals in more depth in order to understand how healthcare professionals can address them.

Average 22-Year Results of Total Hip Arthroplasty Using Harris-Galante Prosthesis in Patients under 50 Years.

BackgroundThe Harris-Galante (HG) prosthesis is a first-generation, cementless total hip arthroplasty (THA) prosthesis. Considering the recent increase in the demand for THA in young patients and their life expectancy, a study with a follow-up duration of longer than 20 years in a young population is needed. Therefore, we evaluated the long-term clinical and radiographic results after cementless THA using the HG prosthesis in patients younger than 50 years.MethodsA total of 61 THAs performed using the HG with a minimum follow-up of 10 years were included. There were 38 men and 11 women with an average age of 46 years and the mean follow-up duration was 22 years. Clinical evaluation included modified Harris Hip Score (HHS) and radiographic analysis consisted of cup inclination, anteversion angle, component stability, osteolysis, liner wear rate, wear-through, liner dissociation, and heterotopic ossification. Complications included recurrent dislocation, periprosthetic femoral fracture, and periprosthetic joint infection. Survivorship analysis included cup and stem revision for aseptic loosening, as well as any revision.ResultsThe HHS improved from 46.5 preoperatively to 81.8 postoperatively (p < 0.001). The average linear wear rate was 0.36 mm/yr. A total of 34 hips (56%) were revised: stem revision in 10 (16.4%), cup revision in 9 (14.8%), exchange limited to bearing surface in 8 (13.1%), and revision of all components in 7 (11.5%). Estimated survivorship at 34 years postoperatively was 90.9% for cup revision for aseptic loosening, 80.5% for stem revision for aseptic loosening, and 22.1% for any revision.ConclusionsTHA using the HG prosthesis showed satisfactory estimated survivorship of the acetabular and femoral components at 34 years postoperatively with good clinical outcomes. Bearing-related problems, such as osteolysis and liner dissociation, accounted for 56% of revision operations and were concerns in patients younger than 50 years.

Stem cell therapy for osteonecrosis of femoral head: Opportunities and challenges.

Osteonecrosis of the femoral head (ONFH) is a progressive disease with a complex etiology and unclear pathogenesis, resulting in severe hip pain and dysfunction mainly observed in young patients. Although total hip arthroplasty (THA) is the most effective treatment for patients with ONFH in the terminal stage, the results of THA in young patients or active populations are often not favorable, with some complications related to the prosthesis. With the development of biotechnology, an increasing number of studies pay attention to use of stem cells for the treatment of ONFH. Stem cells are characterized by the ability to self-renew and differentiate into multiple cell types, including differentiation into osteoblasts and endothelial cells to mediate bone repair and angiogenesis. Furthermore, stem cells can offer growth factors to promote blood supply in the necrotic regions by paracrine effects. Therefore, stem cell therapy has become one of the hip-preserving alternatives for ONFH. This review summarized the current trends in stem cell therapy for ONFH, from clinical applications to related basic research, and showed that an increasing number of studies have confirmed the effectiveness of stem cell therapy in ONFH. However, many unsolved problems and challenges in practical applications of stem cell therapy still exist, such as patient selection, standardized procedures, safety assessment, and the fate of transplanted cells in the body. Additional studies are required to find ideal cell sources, appropriate transplantation methods, and the optimal number of cells for transplantation.

Incidence and Characteristics of Osteolysis in HXLPE THA at 16-Year Follow up in Patients 50 Years and Less

IntroductionYoung patients present a challenge for total hip arthroplasty (THA) survivorship. Highly cross-linked polyethylene (HXLPE) liners have decreased the prevalence of osteolysis; however, concerns exist regarding the biologic activity of wear particles. The purpose of this study was to determine the incidence and characteristics of osteolytic lesions in young HXLPE THA patients at an average 16-year follow up and determine the ability to detect osteolysis. MethodsWe performed a retrospective study involving 22 patients (26 THA) under age 50 at primary THA receiving HXLPE liners coupled with cobalt-chrome (CoCr) femoral heads. Computed tomography (CT) scans were reviewed for osteolysis. Chi-squared analysis was used for categorical variables and unpaired Kruskal-Wallis rank-sum test for continuous variables. Logistic regression was used to compare wear rates between those patients with and without osteolysis. ResultsThe mean age at surgery was 38.5 years. The mean time from surgery to CT scan was sixteen years (range 14.25–19.5 years). Nine of the 26 THA showed osteolysis. The mean volume of the lesions was 2.8 cm3. Linear (mean 0.008 mm/y) and volumetric (mean 4.5 mm3/year) wear rates were negligible. One-third of osteolytic lesions were visible on radiographs. Logistic regression failed to demonstrate a correlation between wear rates or UCLA activity score and osteolysis. ConclusionWe observed osteolysis in 35% of HXLPE THA in young patients at mean 16-year follow up despite zero revisions for wear-related problems and clinically insignificant wear rates. Level of EvidenceIV.

Implant Survival and Patient-Reported Outcomes After Total Hip Arthroplasty in Young Patients

BackgroundYounger patients are undergoing total hip arthroplasty (THA) for various conditions that affect the hip joint. This study evaluates the implant survival and long-term patient-reported outcomes of THA in patients aged 35 years or younger. MethodsData were collected through a retrospective chart review, and follow-up surveys were conducted to determine implant survival and patient-reported outcomes. Kaplan-Meier survival analysis was performed to evaluate implant survival, and the hip disability and osteoarthritis outcome score (HOOS) was used to describe patient-reported outcomes. Descriptive statistics were used to summarize baseline and follow-up data, and univariate and multivariate analyses were used to compare implant survival and patient-reported outcomes. ResultsThis study included 400 patients (548 THAs). The average age at the time of surgery was 27 (range: 8-35) years, and the mean time to follow-up was 14 (range: 2-29.7) years. The 10- and 20-year implant survival was 87% and 61%, respectively. Implant survival differed based on primary diagnosis (P = .05), and it was significantly better in patients aged 25 years or older at the time of surgery, male patients, and patients with ceramic-on-ceramic or ceramic-on-plastic implants (P < .05). Mean HOOS scores at follow-up were 86 for pain, 84 for symptoms, 86 for ADLs, and 77 for sports. All HOOS scores were significantly worse after revision THA (P < .01). ConclusionYoung patients have good implant survival and favorable long-term outcomes after THA. There are several predictors of implant survival and patient-reported outcomes after THA in young patients.

The Effect of Previous Hip Surgery on the Outcome of Hip Arthroplasty in Young Patients

BackgroundThe 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. MethodsData 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). ResultsThe 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). ConclusionsIt 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.

Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip.

Osteonecrosis of the hip is a clinical, radiographic, and pathologic entity that commonly affects young patients. This study evaluates long-term implant survival and patient-reported outcomes after primary total hip arthroplasty (THA) in patients with osteonecrosis aged 35 or younger. A retrospective study with prospective follow-up was conducted at a major academic medical center. Chart review was performed to identify young THA patients with osteonecrosis, and follow-up surveys were conducted to determine implant survival and patient-reported outcomes. Kaplan-Meier survival analysis was performed to evaluate implant survival, and the hip disability and osteoarthritis outcome score (HOOS) was used to describe patient-reported outcomes. The study included 135 patients (204 THAs) with a mean time to follow-up of 14 years. In this group, 10-year implant survival was 86% and 20-year implant survival was 66%. Implant survival was longer in male patients (p = 0.02) and patients that were over the age of 25 at the time of surgery (p = 0.03). The mean HOOS scores at follow-up were 87 for pain, symptoms, and ADLs, and 77 for sports. All HOOS measures were lower in patients that underwent a revision THA, and HOOS-Pain and HOOS-Sport scores were lower in patients that were over the age of 25 at the time of surgery (p<0.05). Young patients with osteonecrosis have good implant survival and long-term outcomes after THA. Patient factors and implant characteristics should be considered when predicting implant survival and outcomes after THA in young patients with osteonecrosis.

Ceramic-on-ceramic bearings total hip arthroplasty in young patients.

BackgroundThe 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.MethodsA 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.ResultsThe 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.ConclusionsThis study with the use of CoC bearings THAs in younger patients have shown promising results and higher rate of survivorship without evidence of osteolysis.

Implant survival and patient-reported outcomes after total hip arthroplasty in young patients with developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) is a common cause of hip pain in young patients, and may require treatment with total hip arthroplasty (THA). This study evaluates implant survival and describes patient-reported outcomes after primary THA in DDH patients aged 35 or younger. A retrospective study with prospective follow-up was conducted at a major academic medical centre. Patient charts were reviewed to identify young THA patients with DDH, and follow-up surveys were conducted to determine implant survival and patient-reported outcomes. Kaplan-Meier survival analysis was performed to evaluate implant survival, and the hip disability and osteoarthritis outcome score (HOOS) was used to describe patient-reported outcomes. This study included 61 patients (75 THAs, 75% follow-up), and the mean time to follow-up was 13 years (range 3-25 years). The 10-year and 20-year implant survival was 87% (95% CI, 78%-94%) and 55% (95% CI, 37%-72%), respectively, and implant survival was significantly better in patients over the age of 25 at the time of surgery (p value &lt;0.01). The mean HOOS patient scores were 83 for pain (SD 20.29), 78 for symptoms (SD 19.72), 83 for ADLs (SD 20.89), and 74 for sports (SD 25.92). Patients that were younger at the time of surgery or required custom implants reported worse HOOS-Symptom scores at follow-up (p value = 0.02). Young patients with DDH have good outcomes after surgery. Patient factors and implant characteristics should be considered when predicting implant survival and outcomes after THA in young patients with DDH.

Preoperative Joint Space Width Predicts Patient-Reported Outcomes After Total Hip Arthroplasty in Young Patients

BackgroundIn a new health care economy, there is an emerging need to understand and quantify predictors of total hip arthroplasty (THA) outcomes. We investigated the association between preoperative radiographic disease (as measured quantitatively by joint space width [JSW]) and patient-reported function, activity, pain, and quality of life after THA. MethodsWe retrospectively analyzed 146 patients (146 hips) 55 years or younger with a diagnosis of osteoarthritis who underwent cementless THA between January 2009 and December 2010. Preoperative pelvic radiographs were measured by 1 author blinded to clinical outcomes to establish JSW, defined as the shortest distance between the femoral head margin and the superolateral weight-bearing portion of the acetabulum. The JSW value was treated as a continuous variable when applied to statistical modeling. The relationship between the JSW and the improvement of clinical outcome was examined via a general linear modeling approach with adjustments for patients' age, body mass index, and sex. ResultsWe identified an inverse relationship between preoperative JSW and improvements in functional, activity, pain, and quality of life. We found that, as JSW decreased by 1 mm, the outcome measure improvements were modified Harris Hip Score of 6.3 (p<0.001); SF-12 physical: 2.1 (p=0.027); WOMAC-pain: 4.8 (p=0.01); and UCLA Activity: 0.44 (p=0.02). ConclusionsOur results demonstrate that patients with greater preoperative joint space have less predictable improvement in terms of function, pain relief, and activity. These findings suggest that THA in young patients with a JSW less than 1.5 to 2 mm provides more predictable improvements in pain and functional outcomes.

Satisfying outcomes scores and survivorship achieved with impaction grafting for revision THA in young patients.

BackgroundThe increasing number of total hip arthroplasties (THAs) performed in younger patients will inevitably generate larger numbers of revision procedures for this specific group of patients. Unfortunately, no satisfying revision method with acceptable survivorship 10 years after revision has been described for these patients so far.Questions/purposesThe purposes of this study were to (1) analyze the clinical outcome; (2) complication rate; (3) survivorship; and (4) radiographic outcome of cemented revision THA performed with impaction bone grafting (IBG) on both the acetabular and femoral sides in one surgery in patients younger than 55 years old.MethodsDuring the period 1991 to 2007, 86 complete THA revisions were performed at our institution in patients younger than 55 years. In 34 of these 86 revisions (40%), IBG was used on both the acetabular and femoral sides in 33 patients. Mean patient age at revision surgery was 46.4 years (SD 7.6). No patient was lost to followup, but three patients died during followup. None of the deaths were related to the revision surgery. The mean followup for the surviving hips was 11.7 years (SD 4.6). We also analyzed complication rate.ResultsThe mean Harris hip score improved from 55 (SD 18) preoperatively to 80 points (SD 16) at latest followup (p = 0.009). Six hips underwent a rerevision (18%): in four patients, both components were rerevised; and in two hips, only the cup was revised. Patient 10-year survival rate with the endpoint of rerevision for any component for any reason was 87% (95% confidence interval [CI], 67%–95%) and with the endpoint of rerevision for aseptic loosening, the survival rate was 97% (95% CI, 80%–100%). In total six cups were considered radiographically loose, of which four were rerevised. Three stems were radiographically loose, of which none was rerevised.ConclusionsIBG is a valuable biological revision technique that may restore bone stock in younger patients. Bone stock reconstruction is important, because these patients likely will outlive their revision implants. Bone reconstruction with impaction grafting may facilitate future revisions.Level of EvidenceLevel IV, therapeutic study.

Long term outcomes of Charnley THA in patients under the age of 50: an editorial comment on recently published article by Warth et al.

Fifty three years have passed from 1962 when Sir John Charnley developed the procedure of total hip arthroplasty (THA) in UK (1). Since then the principles of total joint replacement remain very similar to those advocated by Charnley. Moreover, the Charnley low friction arthroplasty represents the most classical cemented arthroplasty that has been used and currently used in several orthopaedic centers with minor changes regarding the initial procedure and implant design and the only implant where long term outcomes exceeding 30 years have been reported. The published literature is dominated by a large amount of studies reporting on outcomes of Charnley THA (2-5). The vast majority of these studies report on outcomes not exceeding follow-up periods longer than 30 years and usually involve a wide range of ages among the included patients. Although THA was initially developed to treat end-stage arthritic conditions in older patients, the need for the procedure in younger, more active patients is increasing. However, despite the improvements in the design of the implants and the surgical techniques THA in younger patients has not showed comparable outcomes to those performed in older patients, rising from the increased biomechanical demand of patients under 50 due to the higher activity levels (2,6).

Implant Survival and Patient-Reported Outcomes After Total Hip Arthroplasty in Young Patients With Juvenile Idiopathic Arthritis

Juvenile Idiopathic Arthritis (JIA) is a common rheumatologic disease that frequently involves the hip joint and requires treatment with total hip arthroplasty (THA). A retrospective study with prospective follow-up was conducted to determine implant survival and patient-reported outcomes in JIA patients aged 35 or younger treated with THA. This study included 56 patients, and the mean time to follow-up was 12years. The 10-year implant survival was 85%, and implant survival was significantly longer in older patients (P value=0.04). Hip disability and osteoarthritis outcome (HOOS) scores were favorable at follow-up, but significantly worse in women and patients with custom implants or history of revision THA. Overall, patient factors and implant characteristics predict implant survival and outcomes after THA in young patients with JIA.

Hip Resurfacing Does Not Improve Proprioception Compared With THA

Proposed benefits of total hip resurfacing arthroplasty over total hip arthroplasty (THA) include better proprioception, but this has not been rigorously tested or validated. Our purpose was to apply an advanced testing device that objectively quantifies dynamic postural stability to determine if total hip resurfacing is associated with improved proprioception compared with standard or large-head THA. Three groups of 25 patients (total hip resurfacing, THA femoral head > 32 mm, THA femoral head ≤ 32 mm) and a matched control group were recruited. All participants had UCLA scores ≥ 5 and Harris hip scores ≥ 90 at the time of testing. Testing was conducted using a commercially available device that uses a multidirectional, powered platform to measure deviations of the center of mass and consisted of trials with both double- and single-limb support. Double-limb testing showed no differences between groups. In single-limb testing, the operative side performed better in patients who had undergone total hip resurfacing versus THA, but this difference disappeared when the operative side was normalized to the nonoperative side. When compared with control subjects who had not had arthroplasty, both operative and nonoperative sides showed significantly worse proprioception for all arthroplasty cohorts, suggesting that decreased proprioception is associated with arthritis of the hip in young adults. Total hip resurfacing arthroplasty did not result in improved proprioception compared with THA. These results tend to refute the concept that improved proprioception is a rationale for selecting total hip resurfacing over THA in young patients.

Long-Term Results of Intertrochanteric Varus Osteotomy for the Dysplastic Hip

Total hip arthroplasty (THA) is a well established treatment for arthrosis of the hip, however many problems remain which have not yet been resolved, including component loosening and infection. Therefore, surgeons hesitate to perform THA in younger patients showing early signs of the disease. Intertrochanteric varus osteotomy was developed for osteoarthrosis with coxa valga. This procedure has been commonly used in patients with dysplastic hips. However, femoral head coverage is not sufficiently improved by this procedure. In order to overcome the disadvantages of this procedure, since 1972 we performed intertrochanteric varus osteotomy simultaneously combined with acetabuloplasty for the treatment of osteoarthrosis secondary to dysplasia. Between 1969 and 1994, we performed 104 intertrochanteric varus osteotomies for prearthrosis and early stage arthrosis of the hip due to acetabular dysplasia in 84 patients. In this study, we reviewed these patients clinically and radiographically, over 15 years. The intertrochanteric varus osteotomy alone was employed in 38 hips (varus group). Combined intertrochanteric varus osteotomy and acetabuloplasty was employed in 63 hips (combined group). The average Harris hip score at the latest follow-up in the combined group significantly higher than that in the 'varus' group. Postoperative centre-edge angle and age at operation were correlated with the Harris hip score at the most recent follow-up. The results of the present study indicate that this combined intertrochanteric varus osteotomy and acetabuloplasty for dysplastic hip should be considered in young patients when the disease is at an early stage.

Micro-imagerie confocale in-vivo des lésions précancéreuses de la sphère respiratoire. Application au modèle de cancérisation de la poche jugale du Hamster. Validation du chlorure de méthylthioninium comme fluorophore exogène pour le diagnostic et comme agent photodynamique in vivo

We retrospectively reviewed 474 patients (492 hips) with a contemporary cemented total hip arthroplasty (THA) (mean age, 38.9 years) and 504 patients (532 hips) with a cementless THA (mean age, 39.3 years). Patients were evaluated clinically and radiographically. The mean follow-up was similar (14.5 vs 14.8 years) in both groups. The mean postoperative Harris hip scores (93.6 vs 94.7 points), the mean Western Ontario and McMaster Universities Osteoarthritis Index scores (12 vs 13 points), and the mean University of California, Los Angeles activity scores (6.9 vs 7.1 points) were similar between the 2 groups. Incidence of acetabular osteolysis (16% vs 20%) and femoral osteolysis (8% vs 9%) was similar between the 2 groups. Survivorship of cup (86% vs 82%) and stem (98% vs 98.5%) was similar between the 2 groups. Periacetabular osteolysis constitutes the major challenge in modern THAs in young patients.