Authors: Didier Hannouche Flore Devriese Jérôme Delambre Frédéric Zadegan Idriss Tourabaly Laurent Sedel Sylvie Chevret Rémy Nizard
Publish Date: 2015/09/04
Volume: 474, Issue: 2, Pages: 520-527
Abstract
Poor survival of THA implants in very young patients has been attributed to use of cemented implants wear of conventional polyethylene and the presence of morphologic deformities in the proximal femur or in the acetabulum Few studies have reported the longterm results of ceramiconceramic implants in THAs in patients younger than 20 yearsWe determined 1 the proportion of patients who experienced complications related to the ceramic bearing squeaking fracture 2 the survivorship free from loosening and free from revision for any reason 3 whether patients with osteonecrosis had inferior survivorship compared with patients whose surgical indication was all other diagnoses including sequelae of pediatric hip disorders developmental dysplasia of the hip LeggCalvéPerthes disease slipped capital femoral epiphysis and 4 clinical functionBetween 1979 and 2013 we performed 113 primary THAs in 91 patients younger than 20 years at the time of surgery Of those 105 THAs 83 patients were done with ceramiconceramic bearings 91 of the 91 patients during that period a ceramiconceramic bearing couple was indicated in all patients younger than 20 years In eight patients eight hips a cemented polyethylene cup was implanted because the diameter of the acetabulum was smaller than the smallest available ceramic cup 46 mm or because adequate fixation of a ceramic pressfit cup could not be achieved despite careful reaming of the acetabulum The most common diagnosis indicating THA was avascular necrosis of the femoral head 562 59 hips Thirtyfive patients 40 hips had undergone previous operations before the replacement Three patients 4 four hips died from unrelated causes nine patients 11 13 hips were lost to followup and four patients five hips had a followup greater than 85 years but have not been seen in the last 5 years Patients were assessed clinically using the Merle d’AubignePostel score Hip disability and Osteoarthritis Outcome score HOOS and the SF12® Health Survey and radiographically for signs of radiolucencies subsidence or osteolysis on plain films The mean followup was 88 ± 61 years range 2–344 yearsFive patients experienced transient noise generation defined as a snap in four patients and squeaking in one Seventeen hips underwent revision surgery—16 for aseptic loosening and one for septic loosening The implant survival rate at 10 years with aseptic loosening as the endpoint was 903 95 CI 824–989 No hip had acetabular or femoral osteolysis Survivorship in patients with osteonecrosis did not differ from survivorship in patients with other diagnoses The Merle d’AubignePostel score increased from 101 ± 40 to 176 ± 11 p 001 the mean HOOS score was 793 ± 138 range 506–100 the mean SF12® physical and mental component scores were 481 ± 79 range 214–576 and 474 ± 122 range 245–994 respectivelyWe found that patientreported outcomes scores improved in most patients undergoing THA in this very young study group Underlying diagnosis did not affect longterm survivorship However the revisionfree survival rate at 10 years is lower than published estimates in older patients and with 11 of patients lost to followup our estimates may represent a bestcase scenario Therefore we believe THA should be performed as a last resort in this population
Keywords: