The Journal of Bone and Joint Surgery 78:995-1003 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.
Total Hip Arthroplasty with Cement in Patients Less Than Twenty Years Old. Long-Term Results*
M. E. TORCHIA, M.D. ,
R. A. KLASSEN, M.D. and
A. J. BIANCO, M.D., ROCHESTER, MINNESOTA
Investigation performed at the Mayo Clinic and Mayo Foundation, Rochester
Sixty-three consecutive total hip arthroplasties were performed with cement in fifty adolescent patients from 1972 through 1980, and the results were determined after a minimum of ten years. A polyethylene cup without a metal backing and a non-modular femoral component with a collar and a fixed neck length were inserted, with use of so-called first-generation cementing techniques, in each hip. Kaplan-Meier survival analysis of all sixty-three hips demonstrated that the probability of failure (defined as revision or symptomatic loosening) increased steadily over time and reached 45 per cent after fifteen years. A number of specific variables were associated with a significantly higher probability of failure: a history of more than one previous procedure involving the hip (p = 0.0002), unilateral arthroplasty (p = 0.006), previous trauma involving the hip (p = 0.01), the absence of other disease that limited function of the ipsilateral lower extremity (p = 0.03), a high postoperative level of activity (involving moderate or strenuous manual labor) (p = 0.03), and a preoperative weight of more than sixty kilograms (p = 0.03). The probability of failure in the patients who had inflammatory arthritis (11 per cent) was significantly lower than that in those who had previous trauma involving the hip (47 per cent) (p = 0.0006).
Fifty-two hips (forty patients) were followed for a minimum of ten years or until revision. The mean duration of follow-up for these fifty-two hips was 12.6 years (range, 1.6 to 18.6 years). The result was evaluated clinically and radiographically with use of the Mayo hip-scoring system and was graded as excellent in ten hips (19 per cent), good in sixteen (31 per cent), fair in one (2 per cent), and poor in twenty-five (48 per cent). Most of the poor results were due to symptomatic loosening of the acetabular component.
The probability of radiographic loosening after fifteen years was 60 per cent for the acetabular component and 20 per cent for the femoral component. Radiographic evidence of polyethylene wear was associated with probable loosening of the acetabular component (p = 0.03).
The findings of the present study suggest that total hip arthroplasty in adolescents should be reserved for carefully selected patients for whom alternative procedures are contraindicated or unacceptable. Fixation of the acetabular component with cement is not recommended in this setting.
 CiteULike  Connotea  Del.icio.us  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
A. Chougle, M.V. Hemmady, and J.P. Hodgkinson
Long-Term Survival of the Acetabular Component After Total Hip Arthroplasty with Cement in Patients with Developmental Dysplasia of the Hip
J. Bone Joint Surg. Am.,
January 1, 2006;
88(1):
71 - 79.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Graham, M. Ries, and L. Pruitt
Effect of Bone Porosity on the Mechanical Integrity of the Bone-Cement Interface
J. Bone Joint Surg. Am.,
October 1, 2003;
85(10):
1901 - 1908.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
J. Parvizi, C. M. Lajam, R. T. Trousdale, W. J. Shaughnessy, and M. E. Cabanela
Total Knee Arthroplasty in Young Patients with Juvenile Rheumatoid Arthritis
J. Bone Joint Surg. Am.,
May 28, 2003;
85(6):
1090 - 1094.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. D. Komistek, D. A. Dennis, J. A. Ochoa, B. D. Haas, and C. Hammill
In Vivo Comparison of Hip Separation After Metal-on-Metal or Metal-on-Polyethylene Total Hip Arthroplasty
J. Bone Joint Surg. Am.,
October 10, 2002;
84(10):
1836 - 1841.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. E. Beaule, J. M. Matta, and J. W. Mast
Hip Arthrodesis: Current Indications and Techniques
J. Am. Acad. Ortho. Surg.,
July 1, 2002;
10(4):
249 - 258.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Crowther and P. F. Lachiewicz
Survival and Polyethylene Wear of Porous-Coated Acetabular Components in Patients Less than Fifty Years Old : Results at Nine to Fourteen Years
J. Bone Joint Surg. Am.,
May 1, 2002;
84(5):
729 - 735.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. CALLAGHAN, E. E. FOREST, J. P. OLEJNICZAK, D. D. GOETZ, and R. C. JOHNSTON
Charnley Total Hip Arthroplasty in Patients Less Than Fifty Years Old. A Twenty to Twenty-five-Year Follow-up Note
J. Bone Joint Surg. Am.,
May 1, 1998;
80(5):
704 - 14.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
E. M. KEATING
Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Current Options and Approaches for Blood Management in Orthopaedic Surgery*{{dagger}}
J. Bone Joint Surg. Am.,
May 1, 1998;
80(5):
750 - 62.
[Full Text]
|
|
|
|
|
|
|
D. H. SOCHART and M. L. PORTER
The Long-Term Results of Charnley Low-Friction Arthroplasty in Young Patients Who Have Congenital Dislocation, Degenerative Osteoarthrosis, or Rheumatoid Arthritis
J. Bone Joint Surg. Am.,
November 1, 1997;
79(11):
1599 - 1617.
[Abstract]
[Full Text]
|
|
|
|
