Factors analysis on revision surgery after total hip replacement in young patients

doi:10.3877/cma.j.issn.1674-134X.2023.03.020

Abstract

Abstract:

Objective

To analyze the main causess for hip revision in patients who have primary total hip replacement(THA) under 40 years old, and to compare with the elderly (age≥60 years).

Methods

A retrospective analysis was conducted on 156 patients (76 in the young group and 80 in the elderly group) who underwent revision hip arthroplasty at Nanchang Hongdu Hospital of Traditional Chinese Medicine from January 2005 to October 2020. Clinical data of 188 hip joints (102 hips in the young group and 86 hips in the elderly group) were collected to clarify the reasons for hip revision, the time between two operations, and the difference in the revision part. Chi-square test was applied to analyze the relationship between revision parts and the fixation methods of primary THA (bone cement or cementless prostheses).

Results

The average interval between primary THA and revision surgery in the young group was(11±5)years. The most common causes of primary THA were: avascular necrosis of the femoral head, developmental dysplasia of the hip, traumatic arthritis and juvenile idiopathic arthritis. The causes for hip revision in the young group were: acetabular prosthesis loosening(29.4%), polyethylene liner wear(20.6%)and femoral prosthesis loosening(18.6%). The most common reasons for revision in the elderly group were: postoperative dislocation(26.7%), infection(20.9%), and loosening of the acetabular prosthesis(16.3%). In the young group, the revision part of prosthesis was not related to the fixation method in primary THA (χ²=0.146, P>0.05).

Conclusions

After primary THA, acetabular prosthesis loosening, polyethylene wear and femoral prosthesis loosening are the common causes of revision in young patients; while the incidences of postoperative dislocation and infection are lower in the youth than that in the elderly.

Key words: Arthroplasty, replacement, hip, Reoperation, Prosthesis failure, Joint, instability

Ying Pi, Gao Wang, Qiang Zhang, Zhirong Huang. Factors analysis on revision surgery after total hip replacement in young patients[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(03): 430-434.

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Figures/Tables 6

References 15

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组别Groups	例数Number of cases	初次THA至翻修手术时间[年，(±s)]Interval between primary THA and revision surgery	女性Female	使用糖皮质激素或生物制剂Glucorticoids or biologics
组别Groups	例数Number of cases		女性Female	是Yes	否None	未记录No record
青年组Young group	76	11±5	46	28	40	8
老年组Elderly group	80	7±6	38	17	50	13
统计值		t＝2.017	χ²＝2.661	χ²＝4.891
P值		<0.05	>0.05	>0.05

组别Groups	例数Number of cases	初次THA至翻修手术时间[年，(±s)]Interval between primary THA and revision surgery	女性Female	使用糖皮质激素或生物制剂Glucorticoids or biologics
组别Groups	例数Number of cases		女性Female	是Yes	否None	未记录No record
青年组Young group	76	11±5	46	28	40	8
老年组Elderly group	80	7±6	38	17	50	13
统计值		t＝2.017	χ²＝2.661	χ²＝4.891
P值		<0.05	>0.05	>0.05

组别Groups	例数Number of cases	翻修原因
组别Groups	例数Number of cases	髋臼假体松动Loosening of acetabular prosthesis	股骨假体松动Loosening of femoral prosthesis	感染Infection	脱位Dislocation	聚乙烯磨损Wearing of polyethylene	假体周围骨折Periprosthetic fractures	全髋假体松动Loosening of total prostheses
青年组Young group	76	30(29.4)	19(18.6)	8(7.8)	13(12.7)	21(20.6)	5(4.9)	6(5.9)
老年组Elderly group	80	14(16.3)	7(8.1)	18(20.9)	23(26.7)	8(9.3)	11(12.8)	5(4.8)
χ²值				24.968
P值				<0.001

组别Groups	例数Number of cases	翻修原因
组别Groups	例数Number of cases	髋臼假体松动Loosening of acetabular prosthesis	股骨假体松动Loosening of femoral prosthesis	感染Infection	脱位Dislocation	聚乙烯磨损Wearing of polyethylene	假体周围骨折Periprosthetic fractures	全髋假体松动Loosening of total prostheses
青年组Young group	76	30(29.4)	19(18.6)	8(7.8)	13(12.7)	21(20.6)	5(4.9)	6(5.9)
老年组Elderly group	80	14(16.3)	7(8.1)	18(20.9)	23(26.7)	8(9.3)	11(12.8)	5(4.8)
χ²值				24.968
P值				<0.001

固定方式Fixation methods	例数Number of cases	翻修的部位Revision parts
固定方式Fixation methods	例数Number of cases	髋臼侧Acetabular side	股骨侧Femoral side	全髋Total hip prostheses
股骨和髋臼侧均生物型Cementless components on both sides	31	19	10	2
髋臼侧生物型+股骨侧水泥型Cementless acetabular component + cemented femoral component	20	8	9	3
髋臼和股骨侧均水泥型Cemented components on both sides	4	3	0	1
χ²值		0.146
P值		>0.05

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