Functional and Radiological evaluation of Primary Total Hip Arthroplasty in less than 50 years old- A Retrospective Evaluation

Volume 12 | Issue 4 | Oct-Dec 2017 | Page 4-9 | Milind G Kulkarni, Supreet Bajwa, Shrey Singh, Shekhar P Malve, Nitish Arora, Deepak Garg

Authers: Milind G Kulkarni [1], Supreet Bajwa [1], Shrey Singh [1], Shekhar P Malve [1], Nitish Arora [1], Deepak Garg [1].

[1]Department of Orthopaedics, Post Graduate Institute of Swasthiyog Pratishthan, Station Road, Extension Area, Miraj, Maharashtra – 416410.

Address of Correspondence
Dr. Supreet Bajwa
Department of Orthopaedics, Post Graduate Institute of Swasthiyog Pratishthan,
Station Road, Extension Area, Miraj, Maharashtra – 416410.
Email ID:


Background: Performing primary Total Hip Arthroplasty in young is challenging. The increased physical demands predisposes them to early wear, osteolysis and subsequent loss of fixation. The main purpose of this study is to evaluate the radiological and functional outcome of uncemented and hybrid Total hip arthroplasty with different bearings, in patient less than 50 years of age.
Methods: We retrospectively reviewed all primary Total Hip Arthroplasty (65 uncemented and 19 hybrid) done in our institute from 1997 to 2010. There were 74 patients with 84 Hip joint operated with a mean age 38.37 years at the time of initial THA (range21-49years). Clinical evaluation was done with the help of Harris Hip Score. Radiological evaluation was done using an anteroposterior and lateral xray to look for the radiological loosening, osteolysis, polyethylenewear (eccentric positioning of femoral head), heterotrophic ossification, position of stem and acetabulum cup.
Results: The mean follow up time was 7.62 years with a mean Harris hip score of 87.8 ± 9.02. Mean Harris hip score increases as the age group increases and the results are marginally significant (P-0.09).The overall implant survival rate was 94% with results slightly better in Hybrid group. Ceramic on Ceramic bearing proved significantly (P-0.002) better than ceramic on polyethylene and Metal on polyethylene in 5- 10 year follow up. In 10-20 year follow up ceramic on polyethylene (P-0.009) proved better than metal on polyethylene. We do not have cases of ceramic on ceramic in 10-20 year follow up. Complications included superficial infection, deep infection, Acetabular migration, femoral stem loosening, polyethylene wear, post traumatic dislocation and fracture. All were dealt appropriately.
Conclusion: The present study shows excellent outcome of Total hip arthroplasty in patients younger than 50 years, clinically better as the age advances but that might be because of the confounding effects produced by the systemic conditions in young patients. Ceramic on ceramic bearing proved better in a short term follow up 5-10 years clinically, Ceramic on polyethylene bearing proved better than Metal on polyethylene clinically in a long term follow up. The debate of hybrid versus uncemented needs further studies with large sample size.
KeyWords: Total Hip arthroplasty, Young patients, Hybrid Total Hip Arthroplasty, Uncemented Total Hip Arthroplasty, primary total hip arthroplasty


1. Kamath AF, Prieto H, Lewallen DG. Alternative bearings in total hip arthroplasty in the young patient. Orthop Clin North Am. 2013;44(4):451-62.
2. H. Wangen PL, 1 I. Holm,2 R. Gunderson,3 and O. Reikerås. H. Wangen,1 P. Lereim,1 I. Holm,2 R. Gunderson,3 and O. Reikerås. Int Orthop. 2008;32.
3. Vincent Busch M, Rik Klarenbeek, MD, Tom Slooff, MD, PhD, B. Willem Schreurs, MD, PhD, and Jean Gardeniers, MD, PhDcorresponding author. Cemented Hip Designs are a Reasonable Option in Young Patients. Clin Orthop Relat Res. 2010;468(12).
4. Lars B Engesæter, 2 Ingvild Ø Engesæter, 1 , 2 Anne Marie Fenstad, 1 Leif I Havelin, 1 , 2 Johan Kärrholm, 3 Göran Garellick, 3 Alma B Pedersen, 4 , 5 and Søren Overgaard 4 , 6. Low revision rate after total hip arthroplasty in patients with pediatric hip diseases. Acta Orthop. 2012;83(5).
5. Rajaee SS, Theriault RV, Pevear ME, Smith EL. National Trends in Primary Total Hip Arthroplasty in Extremely Young Patients: A Focus on Bearing Surface Usage From 2009 to 2012. J Arthroplasty. 2016.
6. Scholl L, Longaray J, Raja L, Lee R, Faizan A, Herrera L, et al. Friction in modern total hip arthroplasty bearings: Effect of material, design, and test methodology. Proc Inst Mech Eng H. 2016;230(1):50-7.
7. Sharp DJ, Porter KM. The Charnley total hip arthroplasty in patients under age 40. Clin Orthop Relat Res. 1985(201):51-6.
8. Eftekhar NS, Nercessian O. Incidence and mechanism of failure of cemented acetabular component in total hip arthroplasty. Orthop Clin North Am. 1988;19(3):557-66.
9. Daras M, Macaulay W. Total hip arthroplasty in young patients with osteoarthritis. Am J Orthop (Belle Mead NJ). 2009;38(3):125-9.
10. Huo MH, Salvati EA, Buly RL. Wear debris in cemented total hip arthroplasty. Orthopedics. 1991;14(3):335-40.
11. Lakstein D, Bachar I, Debi R, Lubovsky O, Cohen O, Tan Z, et al. Radiographic templating of total hip arthroplasty for femoral neck fractures. Int Orthop. 2016.
12. Inaba Y, Kobayashi N, Suzuki H, Ike H, Kubota S, Saito T. Preoperative planning for implant placement with consideration of pelvic tilt in total hip arthroplasty: postoperative efficacy evaluation. BMC Musculoskelet Disord. 2016;17:280.
13. Schmalzried TP. Preoperative templating and biomechanics in total hip arthroplasty. Orthopedics. 2005;28(8 Suppl):s849-51.
14. Liang TJ, You MZ, Xing PF, Bin S, Ke ZZ, Jing Y. Uncemented total hip arthroplasty in patients younger than 50 years: a 6- to 10-year follow-up study. Orthopedics. 2010;33(4).
15. Christensen CP, Jacobs CA. Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study. J Arthroplasty. 2015;30(9 Suppl):94-7.
16. Singh JA, Schleck C, Harmsen S, Lewallen D. Clinically important improvement thresholds for Harris Hip Score and its ability to predict revision risk after primary total hip arthroplasty. BMC Musculoskelet Disord. 2016;17:256.
17. Mont MA, Seyler TM, Plate JF, Delanois RE, Parvizi J. Uncemented total hip arthroplasty in young adults with osteonecrosis of the femoral head: a comparative study. J Bone Joint Surg Am. 2006;88 Suppl 3:104-9.
18. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979(141):17-27.
19. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976(121):20-32.
20. Restrepo C, Lettich T, Roberts N, Parvizi J, Hozack WJ. Uncemented total hip arthroplasty in patients less than twenty-years. Acta Orthop Belg. 2008;74(5):615-22.
21. Hug KT, Alton TB, Gee AO. Classifications in brief: Brooker classification of heterotopic ossification after total hip arthroplasty. Clin Orthop Relat Res. 2015;473(6):2154-7.
22. Brooker AF, Bowerman JW, Robinson RA, Riley LH, Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55(8):1629-32.
23. H. Wangen PL, 1 I. Holm,2 R. Gunderson,3 and O. Reikerås. Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with a HA-coated stem. Int Orthop 32.
24. Adelani MA, Keeney JA, Palisch A, Fowler SA, Clohisy JC. Has total hip arthroplasty in patients 30 years or younger improved? A systematic review. Clin Orthop Relat Res. 2013;471(8):2595-601.
25. Saglam Y, Ozturk I, Cakmak MF, Ozdemir M, Yazicioglu O. Total hip arthroplasty in patients with ankylosing spondylitis: Midterm radiologic and functional results. Acta Orthop Traumatol Turc. 2016.
26. Yuasa T, Maezawa K, Nozawa M, Kaneko K. Cementless total hip arthroplasty for patients with rheumatoid arthritis: a more than 10-year follow-up. Eur J Orthop Surg Traumatol. 2016;26(6):599-603.
27. Bierbaum BE, Nairus J, Kuesis D, Morrison JC, Ward D. Ceramic-on-ceramic bearings in total hip arthroplasty. Clin Orthop Relat Res. 2002(405):158-63.
28. Kim YH, Park JW, Kim JS. Long-Term Results of Third-Generation Ceramic-on-Ceramic Bearing Cementless Total Hip Arthroplasty in Young Patients. J Arthroplasty. 2016.
29. Lim SJ, Kim SM, Kim DW, Moon YW, Park YS. Cementless total hip arthroplasty using Biolox(R)delta ceramic-on-ceramic bearing in patients with osteonecrosis of the femoral head. Hip Int. 2016;26(2):144-8.
30. Lee YK, Yoon BH, Choi YS, Jo WL, Ha YC, Koo KH. Metal on Metal or Ceramic on Ceramic for Cementless Total Hip Arthroplasty: A Meta-Analysis. J Arthroplasty. 2016.
31. Rajaee SS, Trofa D, Matzkin E, Smith E. National trends in primary total hip arthroplasty in extremely young patients: a focus on bearing surface usage. J Arthroplasty. 2012;27(10):1870-8.
32. Pakos EE, Paschos NK, Xenakis TA. Long Term Outcomes of Total Hip Arthroplasty in Young Patients under 30. Arch Bone Jt Surg. 2014;2(3):157-62.
33. Girard J, Glorion C, Bonnomet F, Fron D, Migaud H. Risk factors for revision of hip arthroplasties in patients younger than 30 years. Clin Orthop Relat Res. 2011;469(4):1141-7.
34. Soderman P, Malchau H, Herberts P, Zugner R, Regner H, Garellick G. Outcome after total hip arthroplasty: Part II. Disease-specific follow-up and the Swedish National Total Hip Arthroplasty Register. Acta Orthop Scand. 2001;72(2):113-9.
35. Bizot P, Hannouche D, Nizard R, Witvoet J, Sedel L. Hybrid alumina total hip arthroplasty using a press-fit metal-backed socket in patients younger than 55 years. A six- to 11-year evaluation. J Bone Joint Surg Br. 2004;86(2):190-4.

How to Cite this article:  Kulkarni M. G, Bajwa S, Singh S, Malve S. P, Arora1 N, Garg D. Functional and radiological evaluation of primary total hip arthroplasty in less than 50 years old- A retrospective evaluation . Journal of Trauma and Orthopaedic Surgery Oct-Dec 2017;12(4):4-9..

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