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

Abstract

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.

Keywords

total hip arthroplasty / young patients / Middle Eastern

References

[1] Lau R.L., Gandhi R., Mahomed S., Mahomed N. Patient satisfaction after total knee and hip arthroplasty. Clin Geriatr Med. 2012;28(3):349-365. doi: 10.1016/j.cger.2012.05.001.

[2] Jones C.A., Pohar S. Health-related quality of life after total joint arthroplasty: a scoping review. Clin Geriatr Med. 2012;28(3):395-429. doi: 10.1016/j.cger.2012.06.001.

[3] Kurtz S., Ong K., Lau E., Mowat F., Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780-785. doi: 10.2106/JBJS.F.00222.

[4] Galloway R., Monnington K., Moss R., Donaldson J., Skinner J., McCulloch R. Satisfaction rates, function, and return to activity following young adult total hip arthroplasty. Bone Joint Open. 2024;5(4):304-311. doi: 10.1302/2633-1462.54.BJO-2024-0005.R1.

[5] Shon W.Y., Park B.Y., Rajsankar R.N., Park P.S., Im J.T., Yun H.H. Total Hip Arthroplasty: Past, Present, and Future. What Has Been Achieved? Hip Pelvis. 2019;31(4): 179-189. doi: 10.5371/hp.2019.31.4.179.

[6] Bessette B.J., Fassier F., Tanzer M., Brooks C.E. Total hip arthroplasty in patients younger than 21 years: a minimum, 10-year follow-up. Can J Surg. 2003;46(4):257-262.

[7] Achakri H., Ben-Shlomo Y., Blom A., Boulton C., Bridgens J., Brittain R. et al. The National Joint Registry 20th Annual Report 2023. London: National Joint Registry; 2022 Dec. Available from: https://www.ncbi.nlm.nih.gov/books/NBK601075/.

[8] Flatø B., Lien G., Smerdel A., Vinje O., Dale K., Johnston V. et al. Prognostic factors in juvenile rheumatoid arthritis: a case-control study revealing early predictors and outcome after 14.9 years. J Rheumatol. 2003;30(2):386-393.

[9] Huerfano E., Bautista M., Huerfano M., Nossa J.M. Total hip arthroplasty in adolescents: a systematic review and meta-analysis. Int Orthop. 2024;48(9): 2483-2492. doi: 10.1007/s00264-024-06175-8.

[10] Torchia M.E., Klassen R.A., Bianco A.J. Total hip arthroplasty with cement in patients less than twenty years old. Long-term results. J Bone Joint Surg Am. 1996;78(7):995-1003. doi: 10.2106/00004623-199607000-00003.

[11] Nizard R., Pourreyron D., Raould A., Hannouche D., Sedel L. Alumina-on-alumina hip arthroplasty in patients younger than 30 years old. Clin Orthop Relat Res. 2008;466(2):317-323. doi: 10.1007/s11999-007-0068-4.

[12] Rahm S., Hoch A., Tondelli T., Fuchs J., Zingg P.O. Revision rate of THA in patients younger than 40 years depends on primary diagnosis - a retrospective analysis with a minimum follow-up of 10 years. Eur J Orthop Surg Traumatol. 2021;31(7):1335-1344. doi: 10.1007/s00590-021-02881-w.

[13] Sedrakyan A., Romero L., Graves S., Davidson D., de Steiger R., Lewis P. et al. Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data. J Bone Joint Surg Am. 2014;96(Suppl 1):73-78. doi: 10.2106/JBJS.N.00541.

[14] Novais E.N. Treatment Options for End-Stage Hip Disease in Adolescents: To Replace, Fuse, or Reconstruct? J Pediatr Orthop. 2021;41(Suppl 1):47-52. doi: 10.1097/BPO.0000000000001780.

[15] Bayliss L.E., Culliford D., Monk A.P., Glyn-Jones S., Prieto-Alhambra D., Judge A. et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet. 2017;389(10077):1424-1430. doi: 10.1016/S0140-6736(17)30059-4.

[16] Shetty V., Shitole B., Shetty G., Thakur H., Bhandari M. Optimal bearing surfaces for total hip replacement in the young patient: a meta-analysis. Int Orthop. 2011;35(9):1281-1287. doi: 10.1007/s00264-010-1104-7.

[17] Wilson A.E., O’Malley M.J. Total Hip Arthroplasty in Adolescents and Young Adults. Operative Tech Orthop. 2020;30(1):100785. doi: 10.1016/j.oto.2020.100785.

[18] Adelani M.A., Keeney J.A., Palisch A., Fowler S.A., Clohisy J.C. Has total hip arthroplasty in patients 30 years or younger improved? A systematic review. Clin Orthop Relat Res. 2013;471(8):2595-2601. doi: 10.1007/s11999-013-2975-x.

[19] Khalifa A.A., Bakr H.M. Updates in biomaterials of bearing surfaces in total hip arthroplasty. Arthroplasty. 2021;3(1):32. doi: 10.1186/s42836-021-00092-6.

[20] Swarup I., Lee Y.Y., Chiu Y.F., Sutherland R., Shields M., Figgie M.P. Implant Survival and Patient-Reported Outcomes After Total Hip Arthroplasty in Young Patients. J Arthroplasty. 2018;33(9):2893-2898. doi: 10.1016/j.arth.2018.04.016.

[21] Chapot A., Zambelli P.Y., Merckaert S.R. Functional and Patient-related Outcomes of Total Hip Arthroplasty in Patients Younger Than 20 Years. Arthroplast Today. 2023;20:101100. doi: 10.1016/j.artd.2023.101100.

[22] Desai A.S., Dramis A., Board T.N. Leg length discrepancy after total hip arthroplasty: a review of literature. Curr Rev Musculoskelet Med. 2013;6(4):336-341. doi: 10.1007/s12178-013-9180-0.

[23] Faldini C. Leg length discrepancy after primary total hip replacement. Musculoskelet Surg. 2023;107(1):1-5. doi: 10.1007/s12306-023-00780-3.

RIGHTS & PERMISSIONS

Eco-Vector