Primary Total Hip Arthroplasty in Patients Less Than 30 Years of Age: Durable, but Not Free of Complications.

Abstract

Primary total hip arthroplasty (THA) in young patients presents surgical challenges due to preoperative conditions and the likelihood of an active postoperative lifestyle. This study assessed mid-term (mean 7.5 years) survivorship and risk factors for revisions and reoperations in patients aged ≤30 undergoing primary THA. We reviewed 353 patients (428 hips) aged ≤30 years who underwent primary THA between 2000 and 2020. The average follow-up was 7.5 years (range, 2 to 22), and the mean age at surgery was 23 years, with 51% being women. The mean BMI was 27 (range, 15 to 51). Common diagnoses included osteonecrosis (30%), hip dysplasia (25%), and osteoarthritis (14%). Bearing surfaces included ceramic-on-highly-cross-linked polyethylene (C-XP) in 192 hips (45%), ceramic-on-ceramic (CoC) in 156 hips (37%), and metal-on-highly-cross-linked polyethylene (M-XP) in 78 hips (18%). Revisions, reoperations, and the latest follow-up were end points in survivorship analyses. Cox regression model identified predictive variables. Survivorship-free revision was 97, 94, and 88% at 5, 10, and 15 years, respectively, while survivorship-free reoperation was 96, 93, and 87% at the same time intervals. Complications occurred in 67 cases, with the most common being instability (28%), intraoperative fractures (18%), and periprosthetic joint infection (15%). Index THA secondary to infection increased the risk of reoperation (hazard ratio [HR] = 11.48, P = 0.0081). The 28-mm femoral head sizes and M-XP bearings increased the risk of complications (HR = 1.88, P < 0.043 and HR = 1.89, P < 0.031). Cemented stems were associated with complications (HR = 2.53, P < 0.0036), revision (HR = 7.79, P < 0.0001), and reoperations (HR = 8.02, P < 0.0001). Extended femoral osteotomy and lateral approaches were associated with higher complication rates (HR = 7.49, P < 0.0008 and HR = 9.70, P < 0.0001, respectively). At 15 years, patients ≤30 years undergoing modern THA showed high survivorship. Factors associated with increased complexity, such as the use of cemented stems, preoperative infection, and extended approaches, were associated with higher failure rates.