Teenage Total Hip Arthroplasty Yields High Satisfaction and Excellent Survival up to 20-Year Follow-Up.

Abstract

Total hip arthroplasty (THA) is increasingly performed in patients younger than 20 years who have destructive hip pathology. The unique anatomical and developmental characteristics of this population, along with the high likelihood of future revision surgery, have led to cautious clinical decision-making. Data on safety, effectiveness, and long-term (20-year) outcomes in teenagers remain limited. This study aimed to evaluate implant survival, patient satisfaction, functional outcomes, and complications following THA in teenagers. This retrospective cohort study with cross-sectional evaluation was conducted at a tertiary academic center. All patients aged 10 to 19 at the time of surgery with ≥ one year follow-up were included. The study population comprised 68 teenagers (75 THAs), who had a median age at surgery of 16 years (range, 11 to 19). The median follow-up was 5.4 years (range, 1.0 to 20.4). The most common indications were developmental dysplasia of the hip (28%), slipped capital femoral epiphysis (20%), and osteonecrosis (17.3%). Of the 75 hips, 37 (49%) had undergone prior hip-preserving procedures. Implant survival was assessed using Kaplan-Meier analysis, with revision as the primary endpoint. Additionally, Hip disability and Osteoarthritis Outcome Score for Physical Function (HOOS-PS; 0 to 100) and patient satisfaction (Likert scale; 1 to 10) were assessed. Pre- and postoperative pain and mobility were extracted from patient records. There were five reoperations (6.7%), of which four revisions were treated, corresponding to a 5-year survival of 94.2% (95% confidence interval (CI): 82.7 to 98.2). With a 10- and 15-year survival of 90.1% (95% CI: 73.9 to 96.5). At follow-up, 96% of respondents rated their hip prosthesis as satisfactory (Likert scale ≥ 6 out of 10). There was one postoperative wound infection successfully treated with irrigation and antibiotics. The HOOS-PS score was 15.1 (range, 0 to 50.8). Postoperative pain and mobility demonstrated statistically significant improvement (P < 0.001). This study demonstrates good implant survival at follow-up and high satisfaction rates in teenagers following THA, representing, to our knowledge, the first standardized cross-sectional evaluation of satisfaction in this population.