An Encouraging Report on Outcomes of THA in Patients Under Age 30
Primary total hip arthroplasty (THA) is very rare in patients younger than age 30 – the median age for elective primary THA in the American Joint Replacement Registry’s 2020 annual report is 66  – but it is increasingly being offered as a viable treatment option to restore function and relieve pain in young patients with end-stage degenerative conditions of the hip, such as osteonecrosis, post-traumatic arthritis, and dysplasia.
However, because THA is so rarely performed in this patient population, little is known about mid- and long-term outcomes – data that surgeons and patients need to make informed decisions about proceeding with surgery.
At the recent annual meeting of the American Association of Hip & Knee Surgeons, a team from Washington University School of Medicine in St. Louis, led by John C. Clohisy, MD, provided some of this much-needed data with a retrospective review of 140 patients under age 30 who underwent primary THA with a highly cross-linked polyethylene (HXLPE) liner. Patient age ranged from 11 to 30 years, with an average age of 22 years at the time of surgery.
Dr. Clohisy and colleagues investigated implant survivorship, patient-reported outcomes (PROs), and polyethylene wear rates. At a mean of 10.6 years follow-up, they found:
- 95.8% survivorship of the THAs, with a 4.2% revision rate (causes: instability, infection, aseptic loosening, and liner disassociation)
- Significant increase in the modified Harris Hip score: 47 to 85 (P<0.001)
- Clinically important improvements in WOMAC pain, stiffness, and physical function scores: 45 to 79, 42 to 70, and 47 to 78, respectively
- Increase in the UCLA score: 3.8 to 5.9 (P<0.01)
- Improvement in the SF-12 physical score (31 to 41; P<0.01), but no change in the SF-12 mental score (49 to 44; P=0.25)
- Mean linear wear rate of 0.03 mm/year (SD 0.129) and mean volumetric wear rate of 29.00 mm3/year (SD 42.58), as measured by the Martell Hip Analysis Suite
These results are good news for surgeons and their young patients who might benefit from THA, with the research team concluding that, “[m]arked improvements in pain, function, and activity, combined with low failure and polyethylene wear rates, strongly support THA in very young patients with disabling hip disease.”
Anthony CA, Abu-Amer W, Freiman S, Pashos G, Clohisy JC. Contemporary Total Hip Arthroplasty in Patients less than 30 Years: 10 Year Outcomes Are Encouraging. Abstract 35. Presented at the annual meeting of the American Association of Hip & Knee Surgeons, November 5-8, Dallas, Texas.
- American Joint Replacement Registry (AJRR): 2020 Annual Report. Rosemont, Illinois: American Academy of Orthopaedic Surgeons (AAOS), 2020.