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


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.


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.


  1. 1.
    Amstutz HC, Nasser S, More RC, Kabo JM (1989) The anthropometric total hip femoral prosthesis. Preliminary clinical and roentgenographic findings of exact-fit cementless application. Clin Orthop 242:104–119PubMedGoogle Scholar
  2. 2.
    Bellamy N, Campbell J, Stevens J, Pilch L, Stewart C, Mahmood Z (1997) Validation study of a computerized version of the Western Ontario and McMaster Universities VA3.0 Osteoarthritis index. J Rheumatol 24:2413–2415PubMedGoogle Scholar
  3. 3.
    Capello WN, D’Antonio JA, Feinberg JR, Manley MT (2003) Ten-year results with hydroxyapatite-coated total hip femoral components in patients less than fifty years old. A concise follow-up of a previous report. J Bone Joint Surg Am 85:885–889PubMedGoogle Scholar
  4. 4.
    D’Antonio JA, Capello WN, Manley MT, Feinberg J (1997) Hydroxyapatite coated implants: total hip arthroplasty in the young patient and patients with avascular necrosis. Clin Orthop 344:124–138PubMedGoogle Scholar
  5. 5.
    Dorr LD, Kane TJ 3rd, Conaty JP (1994) Long-term results of cemented total hip arthroplasty in patients 45 years old or younger. A 16-year follow-up study. J Arthroplasty 19:453–456CrossRefGoogle Scholar
  6. 6.
    Dudkiewicz I, Salai M, Ganel A, Blankstein A, Chechik A (2002) Total hip arthroplasty in patients younger than 30 years of age following developmental dysplasia of hip in infancy. Arch Orthop Trauma Surg 122:134–142CrossRefGoogle Scholar
  7. 7.
    Emery DF, Clarke HJ, Grover ML (1997) Stanmore total hip replacement in younger patients: review of a group of patients under 50 years of age at operation. J Bone Joint Surg [Br] 79:240–246Google Scholar
  8. 8.
    Engh CA, Bobyn JD, Glassman AH (1987) Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg [Br] 69:45–55Google Scholar
  9. 9.
    Giannikas KA, Din R, Sadiq S, Dunningham TH (2002) Medium-term results of the ABG total hip arthroplasty in young patients. J Arthroplasty 17:184–188PubMedCrossRefGoogle Scholar
  10. 10.
    Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop 141:17–27PubMedGoogle Scholar
  11. 11.
    Holm I, Nordsletten L, Steen H, Folleras G, Bjerkreim I (1994) Muscel function after mid-shaft femoral shortening. A prospective study with a two year follow-up. J Bone Joint Surg [Br] 76:143–146Google Scholar
  12. 12.
    Kawamura H, Dunbar MJ, Murray P, Bourne RB, Rorabeck CH (2001) The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg [Am] 83:1333–1338Google Scholar
  13. 13.
    Kilgus DJ, Shimaoka EE, Tipton JS, Eberle RW (1993) Dual-enrgy X-ray absorbtiometry measurement of bone mineral density around porous-coated cementless femoral implants. Methods and preliminary results. J Bone Joint Surg Br 75:279–287PubMedGoogle Scholar
  14. 14.
    Kind P, Dolan P, Gudex C, Williams A (1988) Variation in population health status: results from a United Kingdom national questionnaire survey. Br Med 316:734–741Google Scholar
  15. 15.
    Loupasis G, Hyde ID, Morris EW (1998) The furlong hydroxyapatite coated femoral prosthesis: a 4 to 7 year follow up study. Arch Orthop Traum Surg 117:132–135CrossRefGoogle Scholar
  16. 16.
    Malchau H, Karrholm J, Wang YX, Herberts P (1995) Accuracy of migration analysis in hip arthroplasty. Digitized and conventional radiography, compared to radiosterometry in 51 patients. Acta Orthop Scand 66:418–424PubMedCrossRefGoogle Scholar
  17. 17.
    Malchau P, Herberts P, Soderman P, Oden A (2000) Update and validation of results from the Swedish Hip Arthroplasty Registry 1979–1998. In: Proc 67th Annu Meet Am Acad Orthop Surg. Orlando, FloridaGoogle Scholar
  18. 18.
    Nilsdotter A-K, Peterson IF, Roos EM, Lohmander LS (2003) Predictors of patient relevant outcome after total hip replacement for osteoarthritis: a prospective study. Ann Rheum Dis 62:923–930PubMedCrossRefGoogle Scholar
  19. 19.
    Overgaard S, Soballe K, Lind M, Bunger C (1997) Resorption of hydroxyapatite and fluorapatite coatings in man. An experimental study in trabecular bone. J Bone Joint Surg [Br] 79:654–659CrossRefGoogle Scholar
  20. 20.
    Reikeras O, Gunderson RB (2002) Failure of HA coating on a gritblasted acetabular cup: 155 patients followed for 7–10 years. Acta Orthop Scand 73:104–108PubMedCrossRefGoogle Scholar
  21. 21.
    Reikeras O, Gunderson RB (2003) Excellent results of HA coating on a grit-blasted stem: 245 patients followed for 8–12 years. Acta Orthop Scand 74:140–145PubMedCrossRefGoogle Scholar
  22. 22.
    Wroblewski BM, Siney PD, Fleming PA (2002) Charnley low-frictional torque arthroplasty in patients under the age of 51 years. Follow-up to 33 years. J Bone Joint Surg [Br] 84:540–543CrossRefGoogle Scholar
  23. 23.
    Zicat B, Engh CA, Gokcen E (1995) Pattern of osteolysis around total hip components inserted with and without cement. J Bone Joint Surg [Am] 77:432–539Google Scholar

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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