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Total hip arthroplasty in adolescents: a systematic review and meta-analysis

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Abstract

Purpose

Total hip arthroplasty (THA) has demonstrated excellent results in elderly patients, however, the indications, outcomes, and long-term results in adolescent patients are less understood. This study aims to assess the outcomes of THA in patients under 21, providing insights for clinical decision-making in this exceptional population.

Methods

A systematic review in PubMed, Ovid MEDLINE, and Embase database was performed. We included studies reporting clinical, radiological, and functional outcomes of THA in patients younger than 21 years, for any cause, with a with a minimum follow-up of one year. The ten year survivorship estimate was pooled using a meta-analysis methodology and each study was weighted according to its standard error, calculated from published confidence intervals.

Results

We included 25 studies involving 1166 hips. Median age was 17 years old, 60% were females, and the average follow-up was 8.1 years. Juvenile inflammatory arthritis was the main indication for total hip arthroplasty (THA). The all-cause revision rate was 14.4% and aseptic loosening was the most common cause. Only eight studies reported ten year survival rates and form the pooled analysis an 84.91% survival rate (95% CI 70.56 – 99.27) was obtained. An average score of 88.08 in the Harris Hip Score (HHS) was observed. We found a 3.43% complication rate.

Conclusions

Hip arthroplasty is an acceptable option for adolescents with end-stage arthritis. However, the altered hip anatomy, the elevated revision rate, and the long-term implant survival must be considered before performing a THA in adolescent patients.

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Data availability

All data supporting the findings of this study are available within the article and its supplementary materials. Additional data related to this paper may be requested from the authors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Instituto Roosevelt and Medsport, Carrera 4 Este # 17 – 50, Bogotá, Colombia

    Elina Huerfano & Juan M. Nossa

  2. Department of Orthopedic Surgery, Hospital Universitario Fundación Valle del Lili, Cali, Colombia

    Maria Bautista

  3. Department of Nephrology, Hospital Universitario Mayor Méderi, Bogotá, Colombia

    Manuel Huerfano

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Elina Huerfano, Maria Bautista and Manuel Huerfano. The first draft of the manuscript was written by Elina Huerfano and Maria Bautista and Juan M. Nossa all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Elina Huerfano.

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This study is a meta-analysis that integrates data from previously published research, without direct involvement or interaction with human or animal subjects. In accordance with the guidelines and standards for meta-analyses, this type of study does not require ethical approval.

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Huerfano, E., Bautista, M., Huerfano, M. et al. Total hip arthroplasty in adolescents: a systematic review and meta-analysis. International Orthopaedics (SICOT) (2024). https://doi.org/10.1007/s00264-024-06175-8

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