Abstract
Background
These days, total hip arthroplasties (THA) are more implanted in young patients. Due to the expected lifespan of a THA and the life expectancy of young patients, a future revision is inevitable. Indirectly increasing the number of revisions in these patients. Therefore we evaluated the results of revision THA in patients under the age of 60 years. However, we used a unique protocol in which we used in all cases of acetabular and/or femoral bone deficiencies reconstruction with bone impaction grafting.
Methods
To determine the mid- to longterm results of cemented revision total hip arthroplasties in patients under the age of 60, all clinical data and radiographs were analyzed of patients operated between 1992 and 2005. Patients with multiple previous revisions were also included. Only cemented components were used. During this period 146 consecutive revision total hip arthroplasties were implanted in 129 patients. This included 124 cup and 106 stem revisions. The average age at index surgery was 47 years. No case was lost. Mean follow-up was 7.6 (range, 2.0–16.7) years.
Results
Outcome of clinical questionnaires improved significantly after revision THA. During follow-up 19% (28 hips) needed a repeat revision (aseptic loosening 13, septic loosening 10, recurrent dislocations 2, traumatic loosening 2, and abductor contracture 1). Seven of 146 cases (4.8%) ended finally in a permanent Girdlestone. Seventeen (14%) of the 124 cups were radiographically loose, 11 were revised. Four (4%) of the 106 stems were radiographically loose, 2 were revised.
The 10-years survival was 78% with endpoint revision for any reason and 87% with endpoint revision for aseptic loosening. 28 hips needed repeat revision after the index revision. No significant differences in survival were found looking at the different indications for revision
Conclusions
The survival of cemented revision THA in patients under the age of 60 is satisfying. Reconstruction of acetabular and femoral bone deficiencies with bone impaction grafting is a promising and biological attractive technique in this young and high demanding population and enhances the revisability of a THA.
