Total hip arthroplasty in patients 16 years of age or younger

Abstract

Purpose: Total hip arthroplasty (THA) is rarely recommended in skeletally immature patients. The goal of the present study was to report our short- to mid-term results of THA in a series of children aged 16 years or younger, including clinical outcomes and post-operative complications, signs of radiographic loosening of the prostheses, and revision rate.

Methods: The 18 children (two male and 16 female patients, 24 hips) underwent cementless THA at a mean age of 14.6 years (11 to 16). Five patients had a bilateral, one-stage surgical procedure. Clinical assessment of these hips used the Merle d'Aubigné et Postel scale modified by Charnley to facilitate assessment of the function of walking. Clinical and radiographic follow-up was conducted at six weeks, six months and then yearly for the first three years. All post-operative complications were recorded.

Results: No intra-operative or early post-operative complications occurred. At a mean follow-up of 3.8 years (1 to 8), all patients had greatly improved pain and function scores. All children in the present study improved from severely impaired gait, including four children who were wheelchair-bound, to completely unrestricted gait. All hips demonstrated good alignment with no evidence of wear or radiographic lucencies. No revision of components has been required. One patient had persistent adductor contracture which was addressed with adductor tendon release.

Conclusions: THA is a successful procedure for unsalvageable hip arthritis in children at a mean follow-up of 3.8 years. Long-term follow-up will be needed to determine implant longevity of the components in these children.

Keywords: Total hip arthroplasty (THA); arthritis; children; complications; indication; outcomes.

Fig. 1. A series of pelvic radiographs of the same patient, illustrating the progression of hip pathology despite surgical attempts at preserving the hip: (a) bilateral hip dysplasia with subluxation was noted on the radiographs during the assessment of constipation in a six-year-old patient with Kabuki syndrome. Despite bilateral varus osteotomies of the femur (b), bilateral pelvic osteotomies and medial hemi-epiphysiodeses (c), gross degenerative changes developed in the left hip (d) with near ankylosis - resulting significant pain and the patient being wheelchair-bound; (e) post-operative radiographs after left total hip arthroplasty at 12 years, with the patient pain free and walking independently.