Total hip arthroplasty in the young arthritic patient

Hip disease is a major cause of immobility and pain in children and young adults with inflammatory arthritides. Total hip arthroplasty (THA) has previously been avoided in young patients because of the concern about durability of the prosthesis and the need for multiple revisions. There are now, however, growing reports of the success of such procedures in improving mobility and relieving pain in the young patient with severe hip disease. In this study we aimed to determine the clinical and radiological results in patients with inflammatory arthritides who had undergone THA before the age of 35 years.

Twenty-one patients who had undergone a total of 38 hip arthroplasties were identified. Patients' hips were scored both pre-operatively and at follow-up using the scoring system of the Hospital for Special Surgery, which allots a score for pain, walking, motion and muscle power, and function. Complications were noted and follow-up X-rays were compared to postoperative films to assess radiological loosening.

The mean age at operation was 24 years, and the mean follow-up was 8.6 years. The results in terms of pain relief, mobility, movement and functional capacity were good. Revision was required in 13 hips (34%). This was mostly due to the failure of resurfacing prostheses. Radiological loosening was evident in a further six hips, five of which were asymptomatic.

THA can dramatically improve the quality of life of the young patient with arthritis. The main concern is the likely need for multiple revisions, with progressive loss of bone stock.