Functional and Patient-related Outcomes of Total Hip Arthroplasty in Patients Younger Than 20 Years

Protocol for a systematic review of the outcomes, including return to play (RTP), for tennis players undergoing total hip arthroplasty (THA)

Background

With a surge in younger, more active individuals undergoing hip surgery, both recreational players and elite athletes seek to break free from post-surgery limitations. Despite advancements, the safety of returning to tennis following Total Hip Arthroplasty (THA) remains underexplored. This systematic review aims to explore the insights which may guide informed decision-making concerning return to the sport.

Methods

This systematic review aims to assess the clinical and functional outcomes of THA in tennis players. A protocol has been registered with PROSPERO, adhering to PRISMA-P guidelines. A comprehensive literature search will be carried out and this will include PubMed, MEDLINE, Embase, Google Scholar, Cochrane Reviews and SPORTDiscus databases for the last 20 years. The search terms focus on tennis and hip replacement, without language or study design restrictions. Studies featuring recreational or professional tennis players post-THA will be considered for inclusion. A team of independent reviewers will screen extracted studies for inclusion based on pre-defined criteria.

Discussion

The review aims to consolidate evidence on post-THA outcomes in tennis players, identifying variables such as implant types, pre and post-surgery play levels, and return-to-play timeframes. Divergent opinions among Orthopaedic surgeons about post-THA tennis participation warrants a comprehensive analysis. Moreover, the differentiation between singles and doubles tennis in post-THA recommendations is a critical but underexplored area. The systematic review seeks to bridge these gaps and establish a foundation for consensus-based guidelines, aiding patient counselling and decision-making regarding surgical treatment and post-surgery recommendations, specifically concerning returning to tennis.

Systematic review registration

This systematic review protocol is registered with the National Institute of Health Research (NIHR) Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42024495730.

Early results of primary total hip arthroplasty performed in young adults at a regional Saudi-Arabian orthopedics center: a prospective observational study

Background. Younger patients undergoing primary total hip arthroplasty (THA) have different indications and outcomes than elderly patients. Furthermore, studies reporting the results of THA in young patients are scarce in our area. The aim of the study is to report the early experience and clinical results after total hip arthroplasty in patients ≤40 years old from a regional Saudi-Arabian hospital as a representative of the Arab (Middle Eastern) population. Methods. We conducted a prospective observational study over one year by following all patients (≤40 years) who underwent primary THA at a regional Saudi-Arabin orthopedics center. Twenty-five patients (a mean age of 31.60±6.07 years, and 14 (56%) were males) were eligible for final inclusion. The functional assessment was performed according to the Harris Hip Score (HHS), leg length discrepancy (LLD) was evaluated, and complications at any point were reported. Results. The commonest indication was advanced avascular necrosis (28%) followed by post-traumatic osteoarthritis (24%) and rheumatoid arthritis (24%). Cementless fixation was utilized in 20 (80%) THAs, and the bearing surface was either metal- or ceramic-on-polyethylene in 92% of THAs. After a mean follow up of 20.0±4.5 months, HHS improved from a pre-operative mean of 29.20±5.29 to 85.48±7.18 (p = 0.0001). Excellent and good results were reported in 84%. All working patients (52%) returned to their jobs after THAs. The leg length discrepancy improved significantly from a pre-operative mean of 2.12±1.01 cm to the last follow up mean of 0.72±0.4 cm, p = 0.0001. Two (8%) patients had superficial wound infections at the time of suture removal, which were treated successfully by daily dressing and antibiotics. None required revision. Conclusions. Primary total hip arthroplasty is the option for managing end-stage hip disease, even in younger patients when hip preservation surgeries are invalid. Our results showed improved functional outcomes and a return to pre-disease daily activities in most patients, with considerably lower complication incidence.

Total hip arthroplasty in adolescents: a systematic review and meta-analysis

PURPOSE

Total hip arthroplasty (THA) has demonstrated excellent results in elderly patients, however, the indications, outcomes, and long-term results in adolescent patients are less understood. This study aims to assess the outcomes of THA in patients under 21, providing insights for clinical decision-making in this exceptional population.

METHODS

A systematic review in PubMed, Ovid MEDLINE, and Embase database was performed. We included studies reporting clinical, radiological, and functional outcomes of THA in patients younger than 21 years, for any cause, with a with a minimum follow-up of one year. The ten year survivorship estimate was pooled using a meta-analysis methodology and each study was weighted according to its standard error, calculated from published confidence intervals.

RESULTS

We included 25 studies involving 1166 hips. Median age was 17 years old, 60% were females, and the average follow-up was 8.1 years. Juvenile inflammatory arthritis was the main indication for total hip arthroplasty (THA). The all-cause revision rate was 14.4% and aseptic loosening was the most common cause. Only eight studies reported ten year survival rates and form the pooled analysis an 84.91% survival rate (95% CI 70.56 - 99.27) was obtained. An average score of 88.08 in the Harris Hip Score (HHS) was observed. We found a 3.43% complication rate.

CONCLUSIONS

Hip arthroplasty is an acceptable option for adolescents with end-stage arthritis. However, the altered hip anatomy, the elevated revision rate, and the long-term implant survival must be considered before performing a THA in adolescent patients.

Mid-term outcomes of total hip arthroplasty in patients younger than 30 years

INTRODUCTION

Total hip arthroplasty (THA) has predominantly been utilized to treat older patients with primary osteoarthritis. However, recent improvements in surgical technique and implant materials have increased implant longevity, making THA a viable option for younger patients (< 30 years old). While trend analyses indicate an expanding utilization of THA in younger patients with non-OA diagnoses, current data on mid- and long-term THA outcomes in this population are limited. This study aims to describe the demographics, perioperative data, and implant survivorship of patients younger than 30 years undergoing THA.

METHODS

A retrospective study across two large urban academic medical institutions identified 135 patients aged < 30 years who underwent 155 primary THAs between 2012 and 2017, with up to 10-year clinical follow-up. Baseline demographics, surgical indications, intraoperative details, and postoperative outcomes were analyzed.

RESULTS

The mean age at surgery was 24.9 years (range 18-29). Osteonecrosis of the femoral head (55.5%), developmental hip dysplasia (28.3%), and arthritis (15.5%) were the primary indications. Most surgeries utilized the posterior approach (64.5%), manual technique (65.8%), and Ceramic-on-Polyethylene articulation (71.6%). Seven patients (4.5%) were readmitted within 90-days of surgery, including three non-orthopedic-related readmissions (1.9%) and four orthopedic-related readmissions (2.6%). Dislocations were reported in two patients (1.3%). There were six all-cause revisions (3.9%), four aseptic (2.6%) and two septic (1.3%). Kaplan-Meier analysis showed 10-year survival from implant retaining reoperation was 98.7%, 10-year survival from all-cause revision was 96.1%, and 10-year survival from aseptic revision was 97.4%.

CONCLUSION

With a 10-year aseptic implant survivorship rate of 97.4%, THA is a reliable surgical intervention for patients younger than 30 years of age who have severe hip pathology. Further studies are warranted for a more comprehensive understanding of mid- and long-term survivorship risk factors in this demanding population, facilitating improved risk assessment and informed surgical decisions.

Outcome and complication rate of total hip arthroplasty in patients younger than twenty years: which bearing surface should be used?

PURPOSE

Total hip arthroplasty (THA) in younger patients remains controversial due to concerns regarding long-term implant survival and potential complications. This study aimed to evaluate long-term clinical outcomes, complications, differences in complication and revision rates by bearing surfaces, and Kaplan-Meier survival curves for THA in patients under 20 years old.

METHODS

A retrospective review was conducted for 65 patients (78 hips) who underwent THA between 1991 and 2018. Their mean age was 18.9 years. Their clinical outcomes were assessed using the Harris Hip Score (HHS). Radiological outcomes were evaluated based on the presence of loosening, osteolysis, and heterotopic ossification. Complications such as dislocation, periprosthetic fractures, and infections were assessed. The mean follow-up period was 13.2 years (range, 5.0-31.2 years).

RESULTS

The mean HHS improved from 44.6 to 90.1. There were two cases of dislocation. However, no periprosthetic fracture, deep infection, or ceramic component fracture was noted. There were 19 revisions of implants. Eighteen of 19 hips were operated with hard-on-soft bearings in the index surgery (p < 0.01). The 23-year survivorship was 97.8% for THA using ceramic-on-ceramic bearings, while the 31-year survivorship was 36.7% using hard-on-soft bearings.

CONCLUSION

THA in patients under 20 years old yielded promising clinical and radiological outcomes, although polyethylene-bearing-related concerns persisted. Previously operated patients with hard-on-soft bearing should be meticulously examined during the follow-up. As ceramic-on-ceramic bearing showed excellent survivorship in this particular cohort, we recommend the use of this articulation as the bearing of choice.

Bilateral Acrylic Hip Mold Arthroplasty in a Child With a Revision 60 years After Implantation: Clinical Case and Chemical Analysis of Endoprosthetic Material

A 68-year-old man was referred due to bilateral hip pain and gradual deterioration of walking. He had mold arthroplasties on both hips at the age of 7 years and has been functioning well for more than 5 decades. However, the original data on operative report and the prostheses were missing. The radiological examination revealed bilateral broken prosthetic material. Thus, stage bilateral revision total hip arthroplasty was performed. A detailed chemical analysis of retrieved mold arthroplasty implants proved that the acrylic material was noted to be the same composition with the difference in appearance likely being related to different thermal treatments originally applied to the implants. As presented in our clinical case, even obsolete implants may have good survivorship. According to the case presented, total hip arthroplasty could be considered an effective option with the desired functional outcome when conservative and joint-preserving measures are exhausted.

Total hip arthroplasty in patients with common pediatric hip orthopedic pathology

Purpose

Literature regarding total hip arthroplasty for pediatric hip diseases is scarce. This review aims to portray the various orthopedic conditions of childhood that can lead to significant impairment of the hip joint and, ultimately, to total hip arthroplasty in adolescence and adulthood.

Methods

In total, 61 out of 3666 articles were selected according to (1) the diagnosis of one of the 12 pediatric hip pathologies (Legg-Perthes-Calvé disease, developmental dysplasia of the hip, slipped capital femoral epiphysis, neuromuscular hip dysplasia, post-traumatic avascular necrosis of the proximal femur, juvenile rheumatoid arthritis, achondroplasia, spondyloepiphyseal dysplasia, mucopolysaccharidosis, mucolipidosis, hip infections, and tumors) that required total hip arthroplasty; (2) minimum follow-up of 16 months; (3) assessed outcome with a clinical or radiologic score; (4) Methodological Items for Non-Randomized Studies quality score of 9 or higher. The following information for each pathology was retrieved: mean age at total hip arthroplasty, reason for total hip arthroplasty, type of total hip arthroplasty, surgical technique, mean follow-up, and outcomes.

Results

Overall, the mean age at total hip arthroplasty for pediatric hip disease is in the sixth and seventh decade, except for tumors and skeletal dysplasias. The reason for performing total hip arthroplasty is often osteoarthrosis and abnormal anatomy. Prosthesis types change based on patient's conditions and technological advances; custom-made implants are used for tumors, juvenile rheumatoid arthritis, and skeletal dysplasias; for other diseases, the most frequent are modular cementless implants. Outcomes are generally good, and all studies portray functional and pain improvements.

Conclusion

Total hip arthroplasty is performed more frequently than in the past in patients with pediatric hip pathologies; it enhances patients' quality of life by reducing pain and improving function. However, revision rate in these patients is not negligible.

Case Report: Hip arthroplasty after fracture-related joint infection caused by extensively drug-resistant Klebsiella pneumoniae

This case-report focuses on a 23-year-old soldier suffering from a fracture-related hip joint infection (FRI) due to extensively drug-resistant Klebsiella pneumoniae and S. epidermidis. The patient underwent multiple septic revision surgeries including the removal of remaining shrapnel accompanied by last-resort antimicrobial therapy with cefiderocol and colistin. Additionally, the surgeries included repeated tissue sampling for microbiological and histopathological analysis. An antibiotic-loaded cemented filler containing cefiderocol was used to improve local antimicrobial therapy. The biopsies prior to and during hip replacement surgery confirmed successful microbe eradication. Hip arthroplasty restored hip joint function and significantly improved patient's quality of life. The utilization of a trabecular metal shell and a meta-diaphyseally anchored cementless hip stem ensured secure implant fixation and early patient mobilisation. An adjusted biofilm active oral antimicrobial therapy after arthroplasty intervention was continued to prevent early periprosthetic joint infection. This case emphasizes the difficulties of managing FRI and multidrug-resistant pathogens. It contributes valuable insight into navigating complex orthopedic cases while ensuring successful hip arthroplasty outcomes. In conclusion, early interdisciplinary collaboration, appropriate antimicrobial therapy along with tailored surgical interventions are crucial for managing such complex cases successfully.

Surgical Treatment of Juvenile Idiopathic Arthritis in the Era of Novel Drug Therapies

Juvenile idiopathic arthritis is the most common chronic rheumatic disease encountered in children under the age of sixteen and causes significant impairments in daily life. Over the last two decades, the introduction of new drug treatments (including disease-modifying antirheumatic drugs and biologics) has changed the course of this disease, thus reducing the indication for surgery. However, some patients fail to respond to drug therapy and thus require personalized surgical management, e.g., the local reduction of joint effusion or a synovial pannus (via intra-articular corticosteroid injections, synovectomy, or soft tissue release), and management of the sequelae of arthritis (such as growth disorders and joint degeneration). Here, we provide an overview of the surgical indications and outcomes of the following interventions: intra-articular corticosteroid injections, synovectomy, soft tissue release, surgery for growth disorders, and arthroplasty.