Hip arthroplasty up to the age of 30 and considerations in relation to subsequent revision

We reviewed a series of 17 hip arthroplasties in 16 patients performed when the patients were 30 years old or younger who presented to us for consideration of revision. The mean age was 23.1 years (14 to 30) at the initial arthroplasty. At the time of the original procedure there were 4 sequelae of septic arthritis, 7 old traumatic hip injures, 3 cases of developmental dysplasia (DDH), 1 case of rheumatoid arthritis (RA), 1 steroid-induced avascular necrosis, and 1 old slipped upper femoral epiphysis (SUFE) The implants inculded 11 total hip arthroplasties (THA), 3 double cup arthroplasties,1 bipolar arthroplasty,1 monopolar arthroplasty and 1 cup arthroplasty. The cause for revision lay on the acetabular side in 16 cases and on the femoral side in 6 cases (some had failure on both sides of the joint). There was one revision for recurrent dislocation. The patients had undergone a mean of 1.1 procedures (range 0-3) before the primary arthroplasty. There was a mean interval of 10.6 years (2-33)between the arthroplasty and the revision and the patients had a mean of 1.9 further revision procedures(0 to 4). Complications of revision surgery inculded 1 case of sepsis, 2 recurrent dislocations and 8 re-revisions. Postel and Merle d'Aubigne (PMA) score increased from 10.1 to 14.6 at an mean follow-up of 5.4 years (1 to 20). The typical patient was male (11/17) having had the first arthroplasty at age 23 for trauma sequelae (7/17), a revision at 34 (acetabular failure (16/17). At age 46.4, and after 1.9 secondary procedures hip scores were not exceptional. Such generally disappointing results arose from errors in implant selection or technical mistakes. Careful surgery is critical, and the way of life of the patient may need to be modified.