Abstract
Introduction
Numerous musculoskeletal and systemic conditions may affect the hips of paediatric patients. While the large majority of patients go on to achieve positive outcomes, a small number will progress to end stage arthropathy with significant functional impairment. Management options have been significantly limited for this population. An adolescent hip arthroplasty program was developed with the aim to improve symptoms and quality of life for patients with pain and disability refractory to joint preserving management strategies.
Methods
All patients were assessed jointly by a paediatric hip surgeon and an adult hip arthroplasty surgeon pre-operatively, with all procedures conducted at a dedicated tertiary care paediatric centre under general anesthesia. All procedures were completed through a direct lateral (trans-gluteal) approach, using uncemented components (Zimmer Biomet®, Warsaw, IN) and a ceramic on highly cross-linked polyethylene bearing. Data was collected prospectively after approval from the Institutional Review Board. All patients completed clinical examination and functional scores pre-operatively and at six months post-operatively.
Results
Twenty-eight patients (29 hips) have undergone adolescent THA through this program. The most common diagnoses were avascular necrosis (n=18), idiopathic chondrolysis (n=2), chondrolysis secondary to slipped capital femoral epiphysis (n=2), and juvenile idiopathic arthritis (n=2). Numerous additional diagnoses accounted for 1 case each. Mean age at surgery was 16.0 years (11.8–18.7; SD=2.1). OHS improved from 24.8 (7–43; 10.9) pre-op to 39.3 (15–46; 7.6) at six months (p = p<0.00001). WOMAC improved from 49.4 (4–88; 23.1) to 10.4 (1–53; 12.1) (p<0.00001), while ASKp improved from 77.6 (32.7–99.2; 20.0) to 90.6 (48.3–100; 12.0) (p=0.009). There were 2 early complications: 1 intra-operative acetabular fracture (managed with primary components) and 1 post-operative pulmonary embolus (medical management).
Conclusion
Adolescent patients with end-stage hip arthropathy who underwent THA demonstrated significant early improvements in symptoms and function. THA may be a viable management option in severely impaired adolescent patients with end stage hip arthropathy, in whom no joint preserving options remain. Longer term follow up is required to assess the longevity of THA in this population.
- Abbreviations:
- THA -
-
Total hip arthroplasty
- OHS -
-
Oxford Hip Score
- WOMAC -
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Western Ontario and McMaster Universities Osteoarthritis Index
- ASKp -
-
Activity Scale for Kids - performance version
