Total Hip Arthroplasty in Patients Aged 40 to 60 Years Old: A Population-Based Study
Aaron G Chen1, Olawale A Sogbein1, J Andrew McClure2
1Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada.
Insights
Total hip arthroplasty (THA) rates are rising in patients aged 40-60. Revision risk is low but associated with younger age, female sex, and other factors, informing future THA patient selection.
Area of Science:
- Orthopedic Surgery
- Biostatistics
- Epidemiology
Background:
- Contemporary total hip arthroplasty (THA) addresses implant longevity concerns in younger patients.
- The 40-60 year old demographic is the fastest-growing segment for THA.
- Understanding THA trends and revision risks in this cohort is crucial.
Purpose of the Study:
- Evaluate the rate of THA in patients aged 40-60 over time.
- Assess the cumulative incidence of revision surgery in this demographic.
- Identify risk factors associated with THA revision.
Main Methods:
- Retrospective population-based study using administrative data.
- Included 28,414 patients aged 40-60 undergoing primary THA.
- Utilized linear regression, Kaplan-Meier analysis, and Cox proportional hazards models.
Main Results:
- THA rates increased by 60.7% in the study period.
- Cumulative revision incidence was 2.9% at 5 years and 4.8% at 10 years.
- Risk factors for revision included younger age, female sex, non-osteoarthritis diagnosis, medical complications, and low surgeon volume.
Conclusions:
- THA demand is increasing significantly in the 40-60 age group.
- Revision risk is low, but specific patient and procedural factors increase this risk.
- Further research is needed to understand long-term implant survivorship and refine risk assessment.
Background:
Contemporary total hip arthroplasty (THA) has resolved many implant longevity concerns in younger patients. Patients in their fourth and fifth decades of life are projected to be the fastest-growing demographic of THA patients. We aimed to assess this demographic to: 1) evaluate the rate of THA over time; 2) evaluate the cumulative incidence of revision; and 3) identify risk factors for revision.
Methods:
A retrospective population-based study of patients between 40 and 60 years old undergoing primary THA was conducted using administrative data from a large clinical data repository. A total of 28,414 patients were included for analysis with a mean age of 53 years (range, 40-60 years) and median follow-up of 9 years (range, 0-17 years). Linear regressions were used to assess annual rates of THA in this cohort over time. Kaplan-Meier analysis was used to determine cumulative incidence of revision. Multivariate Cox proportional hazards models were used to determine association of variables with revision risk.
Results:
The annual rate of THA in our population increased by 60.7% over the study period (P < .0001). Cumulative incidence of revision was 2.9% at 5 years and 4.8% at 10 years. Younger age, women, non-osteoarthritis diagnosis, medical complications, and annual surgeon volume ≤ 60 THA were associated with increased revision risk.
Conclusion:
Demand for THA continues to dramatically increase in this cohort. Risk of revision was low but multiple risk factors were identified. Future studies will help delineate the effect of these variables on revision risk and assess implant survivorship beyond 10 years.
