[Total hip arthroplasty in patients under 40 years of age and, if indicated, reconstruction of acetabular defects with bone impaction grafting]

Daniël C J de Kam, Jean W M Gardeniers, René P H Veth, B Willem Schreurs
Nederlands Tijdschrift Voor Geneeskunde 2010, 154: A811

OBJECTIVE: To determine the long-term results of primary cemented total hip arthroplasty in patients under the age of 40. In cases of acetabular defects, initial reconstruction with bone impaction grafting was performed.

DESIGN: Cohort analysis.

METHODS: Details of patients under the age of 40 who underwent primary cemented total hip arthroplasty between 1 January 1988 and 30 June 2004 were analysed. The primary goal of this study was to determine the time until revision surgery. Kaplan Meier analysis was used to calculate prosthesis survival.

RESULTS: A total of 175 total hip arthroplasties in 130 patients were included in the study. Acetabular reconstruction using bone impaction grafting was performed on 84 hips (48%). The average age at surgery was 31 years. Six patients (8 hips) died during follow-up; none of these had undergone revision surgery. Average follow-up was 8.1 years (range: 2.0-18.5). In total, 24 hips (14%) were revised. Reasons for revision were: septic loosening (n = 8), recurrent dislocations (n = 4), traumatic loosening (n = 1) and aseptic loosening (n = 11). The 10-year prosthesis survival was 83% (95% CI: 76-90) with the endpoint 'revision for any reason' and 92% (95% CI: 86-98) with the endpoint 'revision for aseptic loosening'. Aseptic survival of the cups with and without bone impaction grafting was 95% (95% CI: 89-100) and 90% (95% CI: 81-99) (p = 0.73), respectively.

CONCLUSION: Hip replacement with cemented total hip arthroplasty in patients under the age of 40 produced good long-term results. Acetabular deficiencies reconstructed with bone impaction grafting also produced good results in this group of patients.

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