Ten-year survivorship of primary total hip arthroplasty in patients 30 years of age or younger

Bone Joint J. 2018 Jul;100-B(7):867-874. doi: 10.1302/0301-620X.100B7.BJJ-2017-1603.R1.


Aims: For this retrospective cohort study, patients aged ≤ 30 years (very young) who underwent total hip arthroplasty (THA) were compared with patients aged ≥ 60 years (elderly) to evaluate the rate of revision arthroplasty, implant survival, the indications for revision, the complications, and the patient-reported outcomes.

Patients and methods: We retrospectively reviewed all patients who underwent primary THA between January 2000 and May 2015 from our institutional database. A total of 145 very young and 1359 elderly patients were reviewed. The mean follow-up was 5.3 years (1 to 18). Logistic generalized estimating equations were used to compare characteristics and the revision rate. Survival was evaluated using Kaplan-Meier curves and hazard rates were created using Cox regression.

Results: The overall revision rate was 11% (16/145) in the very young and 3.83% (52/1359) in the elderly groups (odds ratio (OR) 2.58, 95% confidence interval (CI) 1.43 to 4.63). After adjusting for the American Society of Anesthesiologists (ASA) score, gender, and a history of previous surgery in a time-to-event model, the risk of revision remained greater in the very young (adjusted hazard ratio (HR) 2.48, 95% CI 1.34 to 4.58). Survival at ten years was 82% (95% CI, 71 to 89) in the very young and 96% (95% CI, 94 to 97) in the elderly group (p < 0.001). The very young had a higher rate of revision for complications related to metal-on-metal (MoM) bearing surfaces (p < 0.001). At last follow-up, the very young group had higher levels of physical function (p = 0.002), lower levels of mental health (p = 0.001), and similar levels of pain (p = 0.670) compared with their elderly counterparts.

Conclusion: The overall revision rate was greater in very young THA patients. This was largely explained by the use of MoM bearings. Young patients with non-MoM bearings had high survivorship with similar complication profiles to patients aged ≥ 60 years. Cite this article: Bone Joint J 2018;100-B:867-74.

Keywords: Outcomes; Survival; Total hip arthroplasty; Young.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip / adverse effects
  • Arthroplasty, Replacement, Hip / methods*
  • Child
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Hip Joint / surgery*
  • Hip Prosthesis / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures
  • Postoperative Complications / epidemiology
  • Proportional Hazards Models
  • Prosthesis Failure
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Survival Rate
  • Survivorship
  • Treatment Outcome
  • Young Adult