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Charnley total hip arthroplasty in Chinese patients less than 40 years old
1Division of Joint Replacement Surgery, Department of Orthopaedic Surgery, The University of Hong Kong, Room 516, Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong.
Insights
This study on young Chinese patients undergoing total hip arthroplasty found high revision rates, especially for avascular necrosis. Early cementing techniques showed poor long-term survival for acetabular components.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
Background:
- Total hip arthroplasty (THA) in young patients (<40 years) presents unique challenges.
- Avascular necrosis is a common indication for THA in this demographic.
- Early cementing techniques for THA require long-term evaluation.
Purpose of the Study:
- To evaluate the long-term outcomes of Charnley total hip arthroplasty in Chinese patients under 40.
- To identify failure modes and survival rates of acetabular and femoral components.
- To assess the impact of diagnosis and cement mantle thickness on THA survival.
Main Methods:
- Retrospective review of 47 THAs in 33 Chinese patients (<40 years at operation).
- Charnley prosthesis with early cementing techniques used in all cases.
- Follow-up averaged 14.9 years, assessing Harris hip scores, revision rates, and component survival.
Main Results:
- High revision rate (63%) primarily due to aseptic loosening of the acetabular component.
- Acetabular component survival: 86.3% at 10 years, 27.0% at 15 years.
- Femoral component survival: 81.3% at 15 years. Avascular necrosis and thin cement (<2mm) correlated with higher failure rates.
Conclusions:
- Early cementing techniques for Charnley THA demonstrate suboptimal long-term acetabular component survival in young patients.
- Avascular necrosis is a significant risk factor for THA failure in this population.
- Acetabular component fixation and cement mantle integrity are critical for long-term success.
Abstract:
Forty-seven total hip arthroplasties were reviewed in 33 Chinese patients who were <40 years old at the time of operation. The preoperative diagnosis was avascular necrosis in 40% of the hips. A Charnley prosthesis was inserted using early cementing techniques in every hip. The average follow-up was 14.9 years (range, 6.9-21.1 years). The mean preoperative Harris hip score was 43.8 (range, 26-74), and the mean score at latest follow-up was 87.7 (range, 74-99) for the surviving hips. Thirty hips (63%) were revised, and 1 hip was removed because of late deep infection. The main cause of failure was aseptic loosening of the acetabular component. Using revision and radiologic loosening as endpoints, the cumulative survival rate for the acetabular component was 86.3% at 10 years and 27.0% at 15 years. The survival of the femoral components was 81.3% at 15 years. Patients with avascular necrosis had a higher failure rate than patients with other diagnoses (P =.001). An area of cement mantle that was <2 mm thick affected adversely the survival rate of the acetabular components (P =.04).