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Do retained pediatric implants impact later total hip arthroplasty?
Jessica Woodcock1, A Noelle Larson, Tad M Mabry
1Mayo Clinic, Rochester, MN 55905, USA.
Insights
Pediatric implants left in the proximal femur increase surgical complexity and complications during total hip arthroplasty (THA). Routine removal of these implants in children is recommended to mitigate risks during future hip replacement surgeries.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Arthroplasty
Background:
- The necessity of removing pediatric proximal femur implants during childhood remains debated.
- Hardware removal entails additional surgery and potential postoperative fracture risks.
- The long-term effects of retained pediatric implants on subsequent total hip arthroplasty (THA) are not fully understood.
Purpose of the Study:
- To investigate the impact of retained pediatric implants on the complexity and complications of THA.
- To provide evidence-based insights regarding the management of pediatric proximal femoral implants.
Main Methods:
- A case-control study comparing 31 THAs with retained pediatric hardware to 31 matched controls.
- Data collected between 1990 and 2007 at a tertiary referral center.
- Mean follow-up of 7 years post-arthroplasty.
Main Results:
- Retained implant group experienced significantly longer operative times (230 vs. 159 min) and hospital stays (5.2 vs. 3.8 days).
- Increased need for strut allograft, revision femoral stems, and bone grafting in the retained implant cohort.
- Higher estimated blood loss (886 vs. 583 mL) and a greater incidence of major complications, including intraoperative fractures, in the retained implant group.
Conclusions:
- Retained pediatric proximal femoral implants are associated with increased operative time, hospital stay, and intraoperative fracture risk during THA.
- Routine removal of pediatric proximal femoral implants is supported for patients likely to undergo future THA.
Background:
It is debated whether all pediatric implants in the proximal femur should be removed in childhood. Hardware removal requires an additional surgical procedure and may put the child at risk for postoperative fracture. However, the impact of retained pediatric implants on future surgeries such as total hip arthroplasty (THA) is not well-understood. We undertook this case-control study to evaluate the effect of retained pediatric implants on surgical complexity and complications at the time of THA. This may offer insight as to whether pediatric proximal femoral implants should be removed in childhood.
Methods:
Case-control study. Between 1990 and 2007, 15,601 primary THAs were performed at a tertiary referral center. Of those, 31 hips had pediatric hardware that had been implanted at a mean of 31 years before the time of THA. Perioperative course and complications were compared with an age-matched, sex-matched, and BMI-matched cohort of 31 patients with no retained implants. Mean follow-up after arthroplasty was 7 years.
Results:
Operative time was significantly longer in the retained implant group compared with the control group (230 vs. 159 min; P<0.0001), as was the hospital stay (5.2 vs. 3.8 d; P=0.02). Four of the 14 patients with retained plates required a strut allograft at the time of primary THA. Revision femoral stems and bone grafting were more frequently required in the retained implant cohort. Estimated blood loss was also higher in the retained implant cohort (886 vs. 583 mL; P=0.031). Seven patients in the retained hardware group had a major complication, including intraoperative fracture (5), bleeding (1), and nerve injury (1), whereas no patients in the control group sustained major complications (P=0.017).
Conclusions:
Retained pediatric implants removed at the time of THA were associated with increased operative time, length of stay, and risk of intraoperative fracture. This data supports routine removal of proximal femoral implants in pediatric patients with a high likelihood of future THA.
Level Of Evidence:
III, case-control study.
