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Alumina-alumina hip replacement in patients younger than 50 years old
L Sedel1, R S Nizard, L Kerboull
1Department of Orthopaedic Surgery, Hôpital Saint Louis, Paris, France.
Insights
Total hip arthroplasty in patients under 50 shows excellent long-term survival. Alumina-alumina bearings may contribute to low wear, suggesting suitability for active young individuals.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
Background:
- Total hip arthroplasty (THA) in young, active patients presents unique challenges due to higher functional demands.
- Long-term outcomes of THA with specific bearing surfaces in this demographic are crucial for surgical decision-making.
Purpose of the Study:
- To evaluate the survivorship and failure modes of total hip arthroplasties in patients younger than 50 years.
- To investigate the performance of alumina-alumina bearings in a young, active patient cohort.
Main Methods:
- Retrospective analysis of 131 THAs performed between 1977 and 1990 on 113 patients under 50 years old.
- Survivorship analysis using revision arthroplasty as the endpoint, with a mean follow-up of five years (up to 11 years).
- Analysis of femoral component (cemented titanium alloy stem) and acetabular component (cemented or press-fit alumina socket) performance.
Main Results:
- 97.5% survival at five years, 89.4% at ten years, and 86.2% at 11 years.
- Six of nine revisions were due to acetabular cup loosening, exclusively in cemented sockets.
- No femoral stem revisions were required before ten years; only one revision occurred in patients aged 40 or younger.
Conclusions:
- Total hip arthroplasty using cemented alumina sockets demonstrates favorable long-term survivorship in patients under 50.
- Acetabular component fixation is a critical factor for success in this young demographic.
- The low wear debris associated with alumina-alumina articulation warrants further investigation for its potential benefits in young, active patients.
Abstract:
From April 1977 to December 1990, 131 total hip arthroplasties were performed on 113 patients younger than 50 years of age (median, 41 years); 64 were men and 49 women. The majority were active people. Sixty-six hips had no previous operations, and 33 had at least one previous arthroplasty. The femoral component was a cemented collared titanium alloy stem, and alumina socket was cemented for 99 hips and press-fit for 32. The mean follow-up period was five years, with 32 hips followed for more than ten years. Revision arthroplasty was considered as a failure. Survivorship analysis depicted a 97.5% rate of survival at five years, an 89.4% rate at ten years, and an 86.2% at 11 years. Nine revisions were performed: one experienced a femoral head rupture after three years, one had bipolar loosening, one experienced femoral cystic formation, and six were revised for acetabular cup loosening, all from the cemented group. Two revisions occurred on the same patient. No stem revision was necessary before ten years. Only one of these revisions was required in patients aged 40 or younger (64 patients). Alumina-alumina friction is an extremely interesting phenomenon in young patients, and could be related to the low wear debris production.