title: Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data.
abstract: BACKGROUND
  One of the least researched areas in orthopaedic pediatrics is the safety and effectiveness of joint replacement, in part because it is uncommon and is undertaken for a wide range of conditions not common for adult joint replacement. This study used data from the AOANJRR (Australian Orthopaedic Association National Joint Replacement Registry) to analyze the use of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in the pediatric population and to provide preliminary data on the outcome of these procedures.
  
  
  METHODS
  The AOANJRR, which is part of the ICOR (International Consortium of Orthopaedic Registries), provided information on pediatric procedures reported to the registry by hospitals undertaking arthroplasty procedures in Australia. All THA and TKA procedures reported to the registry from 1999 to 2012 were included. The cumulative percent revision and the hazard ratio from Cox proportional-hazards models were used for analysis. All tests were two-tailed, with a 5% level of significance. Additionally, an overview of the literature is presented to provide a point of reference.
  
  
  RESULTS
  Primary conventional THA was performed in 297 patients twenty years of age or younger; the cumulative percent revision at five years was 4.5%. Primary conventional THA was performed in 975 young adults twenty-one to thirty years of age; the cumulative percent revision at five years was 5.4%. Primary THA was performed in 105 patients twenty years of age or younger; the cumulative percent revision at five years was 4.6%. Primary TKA was performed in 159 young adults twenty-one to thirty years of age; the cumulative percent revision at five years was 10.3%.
  
  
  CONCLUSIONS
  Compared with older adults, pediatric patients and young adults undergoing THA and TKA have very different diagnoses, including a high prevalence of tumor. Although the reported rate of revision surgery is currently similar to that for older patients, the number of reported procedures and the follow-up period remain limited. It is important for registries to continue to collect and analyze data relevant to this cohort and to coordinate these activities in order to better understand the safety and effectiveness of joint arthroplasty in the pediatric population.
authors.affiliation: Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
authors.affiliation: Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065.
authors.forename: Lucas
authors.initials: L
authors.lastname: Romero
authors.affiliation: Australian Orthopaedic Association National Joint Replacement Registry (S.G., D.D., P.L., and R.V.) and Data Management & Analysis Centre (M.L.), Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Graves
authors.affiliation: Australian Orthopaedic Association National Joint Replacement Registry (S.G., D.D., P.L., and R.V.) and Data Management & Analysis Centre (M.L.), Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Davidson
authors.affiliation: The University of Melbourne, 185-187 Hoddle Street, Richmond, VIC 3121, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: de Steiger
authors.affiliation: Australian Orthopaedic Association National Joint Replacement Registry (S.G., D.D., P.L., and R.V.) and Data Management & Analysis Centre (M.L.), Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Lewis
authors.affiliation: PO Box 579, Rose Bay, NSW 2029, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Solomon
authors.affiliation: Australian Orthopaedic Association National Joint Replacement Registry (S.G., D.D., P.L., and R.V.) and Data Management & Analysis Centre (M.L.), Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Vial
authors.affiliation: Australian Orthopaedic Association National Joint Replacement Registry (S.G., D.D., P.L., and R.V.) and Data Management & Analysis Centre (M.L.), Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lorimer
mesh_terms: D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult