Mid-Term Survival of Total Hip Arthroplasty in Patients Younger Than 55-year-old

J Arthroplasty. 2022 Jul;37(7S):S517-S523. doi: 10.1016/j.arth.2022.02.092. Epub 2022 Feb 28.


Background: Survivorship of total hip arthroplasty (THA) in younger patients is concerning given the inverse relationship between age and lifetime risk for revision. The purpose of this study is to determine if risk of revision has improved for patients aged 55 years or younger who undergo primary THA using modern polyethylene liners.

Methods: A retrospective review identified 2,461 consented patients (2,814 hips) with minimum 2-year follow-up who underwent primary THA at our institution between September 2007 and August 2014 using components from a single manufacturer (Zimmer Biomet), all with vitamin E-infused highly crosslinked polyethylene acetabular inserts. There were 561 patients (643 THA; 23%) aged 55 or younger and 1,900 (2,171 THA; 77%) older than 55.

Results: Mean follow-up was 5.0 years for both groups. There were more male patients in the younger (55%) than older (41%) group. Body mass index (BMI) was higher in younger patients independent of gender. Improvement in Harris hip score (HHS) was similar between groups. Kaplan-Meier survival to endpoint of all cause revision was similar between groups at 12 years (P = .8808) with 97.5% (95% CI: ±0.7%) for younger versus 97.1% (95% CI: ±0.6%) for older patients. Most frequent reason for revision overall was periprosthetic femoral fracture (21; 0.75%); univariate analysis revealed risk factors were female gender (P = .28) and age ≥65 years (P = .012).

Conclusion: Use of modern polyethylene, such as vitamin E-stabilized highly cross-linked, liners during THA may improve survivorship in younger patients undergoing THA. Younger patients undergoing primary THA with highly cross-linked polyethylene liners had no increased rate of revision at mid-term follow-up.

Keywords: highly crosslinked polyethylene; primary cementless total hip arthroplasty; revision risk; survival; vitamin E infused polyethylene; young patients.

MeSH terms

  • Arthroplasty, Replacement, Hip* / adverse effects
  • Female
  • Follow-Up Studies
  • Hip Prosthesis* / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Periprosthetic Fractures* / etiology
  • Polyethylene
  • Prosthesis Design
  • Prosthesis Failure
  • Reoperation
  • Retrospective Studies
  • Treatment Outcome
  • Vitamin E


  • Vitamin E
  • Polyethylene