Total hip arthroplasty in patients younger than 21 years: a minimum 10-year follow-up

Introduction: To evaluate the function, radiographic results and implant survival in patients younger than 21 years at the time of operation and with at least a 10-year follow-up, we reviewed the course of young adults who underwent total hip arthroplasty at McGill University Health Centre. Patients and methods: Twelve patients (16 hips) met the criteria for inclusion in this study. They ranged in age from 10-20 years (median 16.5 yr). One patient (1 hip) died 5 years after the index surgery and was excluded from the study. Functional results were measured by the Harris hip score, and radiographs of surviving implants were assessed for radiolucencies, ostcolysis and eccentric polyethylene wear. Results: Eleven arthroplasties were cementless, 2 were hybrid and 2 were cemented. At follow-up ranging from 10 to 25 years (mean 13.6 yr), the Harris hip score ranged from 34.2-97.2 (mean 64.5). Four (26%) acetabular components were revised and (at the time of writing) 1 required revision. Only 1 (7%) femoral stem was revised. Radiographically, there was a high prevalence of eccentric polyethylene wear, but none of the surviving implants were found to be loose. Overall, 67% (10 of 15) of the total hip arthroplasties continued to function well at a mean of 13.6 years postoperatively. Conclusions: Total hip arthroplasty remains a reasonable option in adolescence and early adulthood in selected patients with severe debility from multiple joint disease. Polyethylene wear is a particularly significant problem in this group of active young people.