International Orthopaedics

, Volume 32, Issue 2, pp 203–208 | Cite as

Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with a HA-coated stem

  • H. Wangen
  • P. Lereim
  • I. Holm
  • R. Gunderson
  • O. Reikerås
Original Paper

Abstract

It is well accepted that youth and high activity levels are among the factors that increase the risk of mechanical failure of total hip prostheses. However, there are few reports of long-term results in very young patients. In this study, we evaluated the results of total 49 hip replacements (THRs) using an uncemented total hip prosthesis in 44 patients (28 females) who were 30 years or younger (range: 15–30 years). The diagnosis was ostearthritis due to congenital dislocations in 28 patients, with the remaining patients having diagnoses of sequelae of fracture, infection, Calve-Legg-Perthes disease, avascular necrosis, chondrodystrophia and epiphyseal dysplasia. In all cases we used an uncemented straight stem fully coated with hydroxyapatite (HA). In 36 cases we used a hemispherical cup inserted with press fit, and in seven cases we used a hemispherical screw cup. The patients were evaluated ten to 16 years (mean: 13 years) after the operation by radiographic and clinical examinations, including the Harris Hip, WOMAC and EuroQol-5D scores. In a sub-group of nine patients with a unilateral prosthesis, the muscle strength of the quadriceps and hamstrings was tested using a Cybex 6000. None of the stems were revised at the follow-up examination, and all were classified as well integrated, with no signs of radiological loosening. Twenty-four hips had revision of the acetabular component due to mechanical failure. The Harris Hip score was, on average, 88 (range: 62–100), the WOMAC score 80 (range: 37–100) and the EuroQol score 0.68 (range: −0.14–1). Isokinetic muscle strength testing showed that seven of the nine tested patients were weaker on the operated side. In conclusion, we found mechanical failures at the acetabular side, but excellent results with a fully HA-coated femoral stem, with no revisions after ten to 16 years.

Résumé

Il est habituel de penser que le jeune âge des sujets et leur haut niveau d’activité sont parmi les facteurs les plus importants d’échecs des prothèses totales de hanche. Peu d’études font part des résultats à très long terme chez les patients jeunes. Nous avons réalisé une étude des résultats chez des patients âgés de moins de 30 ans et traités par une prothèse sans ciment. Cette étude a porté chez 44 patients dont 28 femmes porteurs de 49 prothèses totales de hanche. L’âge des patients s’est étalé de 15 à 30 ans. Le diagnostic le plus fréquent a été la coxarthrose secondaire liée à une luxation congénitale chez 28 patients les autres étiologies étant surtout secondaires à des séquelles de fractures, d’infection, de maladies de Legg Perther Calvé, de nécroses avasculaires, de chondrodystrophies ou de dysplasies épiphysaires. Dans tous les cas nous avons utilisé une prothèse non cimentée avec une pièce fémorale droite recouverte totalement d’hydroxyapatite. Nous avons également utilisé dans 36 cas une cupule hémisphérique implantée en press fit, dans 7 cas une cupule hémisphérique vissée. Les patients ont été suivis 13 ans en moyenne (de 10 à 16 ans), la surveillance a été radiographique et clinique avec évaluation du score de Harris, de Womac et de l’Euroquol-5D. Dans un petit sous groupe de 9 patients nous avons testé la force du quadriceps et des ischio jambiers en utilisant un appareil de type Cybex 6000. Sur un long suivi, aucune pièce fémorale n’a été révisée, toutes ont été parfaitement intégrées sans aucun signe de descellement. 24 hanches ont subi une révision du composant acétabulaire pour des problèmes mécaniques. Le score de Harris a été en moyenne de 88 (de 62 à 100), le score de Womac de 80 (de 37 à 100) et l’Euroquol de 0,68 (0,14 à 1). Pour sept patients, la force musculaire est moins importante du côté opéré. En conclusion, cette série de patients a montré une faillite mécanique de l’implant acétabulaire mais une excellent résultat au niveau de la pièce fémorale recouverte d’hydroxapatite, sans aucune révision entre 10 et 16 ans.

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • H. Wangen
    • 1
  • P. Lereim
    • 1
  • I. Holm
    • 2
  • R. Gunderson
    • 3
  • O. Reikerås
    • 1
  1. 1.Department of OrthopaedicsRikshospitalet-Radiumhospitalet Medical CentreOsloNorway
  2. 2.Department of PhysiotherapyRikshospitalet-Radiumhospitalet Medical CentreOsloNorway
  3. 3.Department of RadiologyRikshospitalet-Radiumhospitalet Medical CentreOsloNorway

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