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Mid-to long-term results of revision total hip replacement in patients aged 50 years or younger
P T H Lee1, D L Lakstein2, B Lozano3
1Royal London Hospital, Barts Health NHS Trust. Whitechapel Rd, London, E1 1BB, UK.
Insights
Revision total hip replacement (THR) in patients under 50 presents challenges. This study shows moderate long-term component survival and functional improvement, informing young patient expectations for revision hip surgery.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
Background:
- Revision total hip replacement (THR) in younger patients (<50 years) is technically complex and may require further revisions.
- Assessing long-term outcomes is crucial for managing expectations in this demographic.
Purpose of the Study:
- To evaluate the survivorship, functional outcomes, and complication rates of revision THR in patients under 50 years old.
- To provide data for counseling young patients considering revision hip surgery.
Main Methods:
- A longitudinal series of 132 consecutive revision THR procedures (181 hips) in patients aged 22-50 years.
- Mean follow-up of 11 years, with assessment of component survival, complications, and functional scores (modified Harris Hip Score).
- Bone stock restoration with allograft was performed when indicated.
Main Results:
- Acetabular component survival was 71% at 10 years and 54% at 20 years; femoral component survival was 80% at 10 years and 62% at 20 years.
- Complications included dislocations (6.1%), periprosthetic fractures (5.5%), deep infections (1.1%), and nerve palsies (2.2%).
- Mean modified Harris Hip Score improved from 41 pre-operatively to 77 post-operatively and at latest review.
Conclusions:
- Revision THR in young patients yields moderate mid- to long-term component survival.
- Functional outcomes improve significantly, but complication rates necessitate careful patient counseling.
- This data is valuable for advising younger patients on the prospects of revision hip surgery.
Abstract:
Revision total hip replacement (THR) for young patients is challenging because of technical complexity and the potential need for subsequent further revisions. We have assessed the survivorship, functional outcome and complications of this procedure in patients aged < 50 years through a large longitudinal series with consistent treatment algorithms. Of 132 consecutive patients (181 hips) who underwent revision THR, 102 patients (151 hips) with a mean age of 43 years (22 to 50) were reviewed at a mean follow-up of 11 years (2 to 26) post-operatively. We attempted to restore bone stock with allograft where indicated. Using further revision for any reason as an end point, the survival of the acetabular component was 71% (sd 4) and 54% (sd 7) at ten- and 20 years. The survival of the femoral component was 80% (sd 4) and 62% (sd 6) at ten- and 20 years. Complications included 11 dislocations (6.1%), ten periprosthetic fractures (5.5%), two deep infections (1.1%), four sciatic nerve palsies (2.2%; three resolved without intervention, one improved after exploration and freeing from adhesions) and one vascular injury (0.6%). The mean modified Harris Hip Score was 41 (10 to 82) pre-operatively, 77 (39 to 93) one year post-operatively and 77 (38 to 93) at the latest review. This overall perspective on the mid- to long-term results is valuable when advising young patients on the prospects of revision surgery at the time of primary replacement.
