, Volume 469, Issue 4, pp 1141-1147
Date: 18 Nov 2010

Risk Factors for Revision of Hip Arthroplasties in Patients Younger Than 30 Years

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Abstract

Background

Numerous reports of THAs in patients younger than 30 years indicate a high risk of revision. Although risk factors for revision have been reported for older patients, it is unclear whether these risk factors are the same as those for patients younger than 30 years.

Questions/purposes

We therefore (1) determined function and survivorship of revision THAs performed in patients younger than 30 years, and (2) assessed the risk factors for revision THAs in this younger population by comparison with a group of patients younger than 30 years who did not undergo revision.

Patients and Methods

We retrospectively reviewed the clinical records and radiographs of 55 patients younger than 30 years (average age at revision, 24.3 years; range, 14–30 years) who underwent 77 hip revisions. Revision was performed, on average, 4.6 years (range, 0.4–12 years) after the primary THA. The results for these 55 patients (77 revision THAs) were compared with results for a nonrevised group, including 819 THAs in patients younger than 30 years. Minimum followup of the revision group was 1 year (mean, 6.2 years; range, 1–15 years).

Results

At followup after the revision, the Merle d’Aubigné-Postel score improved from 12.2 to 14.6. The rates of dislocation, neurologic lesions, and fractures were 15%, 7.8%, and 14%, respectively. The 10-year survival rate was 36% (95% confidence interval [CI], 21%–51%). Compared with the nonrevised group, the independent revision risk factors were young age at primary THA (OR 1.14 [1.07–1.19]), high number of previous surgeries (OR 5.41 [2.67–10.98]), and occurrence of at least one dislocation (OR 3.98 [1.74–9.07]). Hard-on-soft bearings had a higher risk (OR 3.42 [1.91–6.1]) of revision compared with hard-on-hard bearings.

Conclusions

Revision THAs are likely in patients younger than 30 years, and the complication rate is high. The survivorship of hip revision in this population is low and alternative solutions should be advocated whenever possible.

Level of Evidence

Level III, therapeutic study, case control study. See the Guidelines for Authors for a complete description of levels of evidence.

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at Lille University Hospital.