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. 2019 Aug;90(4):331-337.
doi: 10.1080/17453674.2019.1615263. Epub 2019 May 15.

Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016

Vera Halvorsen  1 , Anne Marie Fenstad  2 , Lars B Engesæter  2   3 , Lars Nordsletten  1   4 , Søren Overgaard  5   6 , Alma B Pedersen  6   7 , Johan Kärrholm  8   9 , Maziar Mohaddes  8   9 , Antti Eskelinen  10   11 , Keijo T Mäkelä  11   12 , Stephan M Röhrl  1
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Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016

Vera Halvorsen et al. Acta Orthop. 2019 Aug.

Abstract

Background and purpose - The literature is scarce on the outcome of the youngest patients with total hip arthroplasties (THAs). We analyzed register data, revision risk, and related factors in patients 21 years or younger with THAs in the Nordic Arthroplasty Register Association (NARA). Patients and methods - We included all THA patients 21 years or younger reported during 1995 through 2016 to the Danish, Finnish, Norwegian, and Swedish hip arthroplasty registers and merged these into the NARA dataset. Primary outcome was any implant revision. Results - We identified 881 THAs in 747 patients. Mean age at primary surgery was 18 years (9-21). The indications for THA were pediatric hip diseases (33%), systemic inflammatory disease (23%), osteoarthritis (4%), avascular necrosis (12%), hip fracture sequelae (7%), and other diagnoses (21%). Unadjusted 10-year survival for all THAs was 86%. Comparison between indications showed no differences in survival. Uncemented implants were used most frequently. Survival for uncemented and cemented implants was the same adjusted for sex, indication, head size, and time period for primary surgery. Aseptic loosening was the main cause of revision. Interpretation - Both cemented and uncemented fixations seem to be a viable option in this age group, but with a lower implant survival than in older patient groups.

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Figures

Figure 1.
Figure 1.
Indications for THAs in patients 21 years or younger in NARA countries 1995–2016. Other: tumors, sequelae after infection, pharmaceutically induced femoral necrosis. Pediatric: developmental dysplasia of the hip (DDH), Perthes, slipped capital femoral epiphysis (SCFE). SIDs: systemic inflammatory diseases including rheumatoid arthritis, ankylosing spondylitis, and other inflammatory diseases. AVN: avascular necrosis. OA: osteoarthritis.
Figure 2.
Figure 2.
Kaplan–Meier revisionfree survival curve. Confidence intervals are shaded. The 10-year survival was 86%.
Figure 3.
Figure 3.
Kaplan–Meier survival curves for cups (red) and stems (blue). Confidence interval are shaded. Data from Finland are not included because surgical procedure at revision is not registered.
Figure 4.
Figure 4.
Kaplan–Meier unadjusted survival curves with confidence intervals (shaded areas) for different fixation methods with uncemented fixation as reference. (a) Uncemented versus cemented; (b) uncemented versus hybrid; (c) uncemented versus reverse hybrid. For adjusted survival see Table 4. 31 resurfacing arthroplasties were not included.
Figure 4.
Figure 4.
Kaplan–Meier unadjusted survival curves with confidence intervals (shaded areas) for different fixation methods with uncemented fixation as reference. (a) Uncemented versus cemented; (b) uncemented versus hybrid; (c) uncemented versus reverse hybrid. For adjusted survival see Table 4. 31 resurfacing arthroplasties were not included.
Figure 4.
Figure 4.
Kaplan–Meier unadjusted survival curves with confidence intervals (shaded areas) for different fixation methods with uncemented fixation as reference. (a) Uncemented versus cemented; (b) uncemented versus hybrid; (c) uncemented versus reverse hybrid. For adjusted survival see Table 4. 31 resurfacing arthroplasties were not included.
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