Total Hip Arthroplasty in Patients Under 30 Years Who Have Osteonecrosis of the Femoral Head: Mean Follow-Up of More than 120 Months.

Abstract

Osteonecrosis of the femoral head (ONFH) primarily affects young adults, leading to femoral head collapse and secondary osteoarthritis. Treatments include joint-preserving surgery, which has been performed preferentially, especially for young adults, and joint arthroplasty, i.e., total hip arthroplasty (THA). Although advancements in implant materials have markedly improved performance, there are few data regarding implant survival and clinical outcomes in younger patients. This study aimed to assess long-term implant survival of more than 120 months and clinical outcomes in young ONFH patients undergoing primary THA. This retrospective single-center study assessed 99 joints in 66 ONFH patients who underwent primary THA between 1997 and 2019. Patients were categorized according to age at the time of THA: group A, aged less than 30 years (20 joints) and group B, aged 30 years or more (79 joints). The mean age was 43 years, and 36 patients were men. The mean follow-up duration was 128.1 months. Clinical and radiographic characteristics were compared. The median Japanese Orthopaedic Association score at the final follow-up was 100 in both groups (P = 0.41). Major complications occurred in 13 joints: one in group A and 12 in group B (P = 0.46). Overall implant survival rate was 100% at 60 months, 98% at 120 months, and 94% at 180 months. When considering aseptic loosening as the endpoint, the 180-month survival rate was 100%. No significant differences in survival rate were found between the groups with either endpoint (P = 1.00, P = 0.67). Our results showed THA was a safe, effective treatment for young ONFH patients, with demonstrated efficacy over 120 months. Advances in implants and revision techniques support THA as a viable treatment, even as an initial treatment for young ONFH patients. Future research should assess longer follow-up with larger cohorts and standardized surgical methods.