Total hip arthroplasty in patients 55 years or younger: Risk factors for poor midterm outcomes

Abstract

Background: Total hip arthroplasty (THA) is increasingly performed in younger patients. The purpose of this study is to report on the midterm outcomes of primary cementless THA in patients 55 years and younger; and specifically to examine the risk factors for aseptic failure, all-cause revision, and mortality in this patient population.

Methods: Four hundred and twenty-six consecutive patients with minimum 5-year follow-up were retrospectively reviewed. Multivariate analyses were conducted to control for potential confounding factors identified by univariate analyses.

Results: Mean follow-up was 92.12 ± 30.9 months. The overall 5-year implant survival rate was 90.8% and the aseptic survival rate was 92.6%. Among the potential risk factors, only bearing surface had a significant relationship with aseptic revision (P = 0.041). Aseptic revisions occurred more frequently with metal-on-polyethylene articulation (P = 0.012). Higher Charlson comorbidity index (CCI) was a significant risk factor for all-cause complications (P = 0.04) while higher CCI and lower body mass index were significant risk factors for mortality (P = 0.001 and 0.006 respectively).

Conclusion: Bearing type was the only risk factor for revision surgery, particularly metal-on-polyethylene bearing. Patients with higher comorbidities were at increased risk for postoperative complications and mortality, while higher body weight appeared to have a protective effect against mortality. These findings should be considered before surgery for risk modification and management of patient expectations. While it appears that bearing couples other than metal-on-polyethylene are especially suitable for young patients, more studies are needed to determine the best bearing couple and to reduce the rates of postoperative complications in this patient population.

Keywords: Midterm outcomes; Mortality; Revision surgery; Total hip arthroplasty; Young patients.