Cemented hip designs are a reasonable option in young patients

Vincent Busch, Rik Klarenbeek, Tom Slooff, B Willem Schreurs, Jean Gardeniers
Clinical Orthopaedics and related Research 2010, 468 (12): 3214-20

BACKGROUND: Young patients with degenerative cartilage disease of the hip remain a challenge for the orthopaedic surgeon. Different treatment options are available of which uncemented hips are the most popular owing to long-term concerns about cemented implants. As an alternative, we have used a cemented hip design in combination with bone impaction grafting in patients with acetabular defects.

QUESTIONS/PURPOSES: We therefore determined the survival rates and radiological failures of cemented THA in patients younger than 30 years and reported clinical scores, complications and current state of the revised THAs.

METHODS: We retrospectively reviewed all 48 patients (69 hips) younger than 30 years at the time of surgery who had a primary cemented THA performed between 1988 and 2004. Acetabular defects were reconstructed using bone impaction grafting in 29 hips. Mean age at surgery was 24.6 years (range, 16-29 years). Revisions were documented, radiographs were analyzed, and the Kaplan-Meier method was used to determine survival for different end points. No patient was lost to followup, three patients (four hips) had died. Minimum followup was 2 years (mean, 8.4 years; range, 2-18 years).

RESULTS: Eight hips were revised (three for infection and five for aseptic loosening) and one hip dislocated for which open reduction was necessary. One additional cup was considered a radiographic failure. The 10-year survival was 83% (95% confidence interval, 69%-92%) with revision for any reason as the end point and 90% (95% confidence interval, 77%-96%) with revision for aseptic loosening.

CONCLUSIONS: We found a high survival rate of these cemented THA in young patients. In young patients with acetabular bone defects we recommend reconstruction using cemented implants with bone impaction grafting.

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