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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.

Journal of Pediatric Orthopedics
|March 14, 2013
PubMed
Summary

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.

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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.