Why Do Primary Total Hip Arthroplasties Fail in Patients Under 65 Years of Age? A Systematic Review and Meta-Analysis

Primary total hip arthroplasties (THAs) are increasing among patients younger than 65 years of age. Hence, there is a need to elucidate implant survivorship and etiologies of revision THA. The purpose of this systematic review was to identify: (1) implant survivorship; and (2) the most common etiologies for failure of primary THA in patients younger than 65 years of age.

A comprehensive search of four major databases was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in selecting studies, data extraction, and analysis. There were 11 studies selected from a total of 574 studies from searches.

There was a revision rate of 4.5% (n = 2,811 revisions) with substantial publication bias (P = 0.03) and heterogeneity among studies (I² = 88%; P = 0.0001). The implant survivorships at 5, 10, and 15 years were 96% (n = 59,440), 92% (n = 1,338), and 84% (n = 788 hips), respectively. The most common etiology for revision was infection with no publication bias (P = 0.6) and substantial heterogeneity (I² = 99%; P = 0.0001).

This review showed high implant survivorships up to 15 years in patients younger than 65 years of age. There are multiple confounders that were not controlled for in this study, and future studies should focus on evaluating patient- and surgery-specific factors that could influence implant survivorship.