Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip.
BACKGROUND
Osteonecrosis of the hip is a clinical, radiographic, and pathologic entity that commonly affects young patients. This study evaluates long-term implant survival and patient-reported outcomes after primary total hip arthroplasty (THA) in patients with osteonecrosis aged 35 or younger.


METHODS
A retrospective study with prospective follow-up was conducted at a major academic medical center. Chart review was performed to identify young THA patients with osteonecrosis, and follow-up surveys were conducted to determine implant survival and patient-reported outcomes. Kaplan-Meier survival analysis was performed to evaluate implant survival, and the hip disability and osteoarthritis outcome score (HOOS) was used to describe patient-reported outcomes.


RESULTS
The study included 135 patients (204 THAs) with a mean time to follow-up of 14 years. In this group, 10-year implant survival was 86% and 20-year implant survival was 66%. Implant survival was longer in male patients (p = 0.02) and patients that were over the age of 25 at the time of surgery (p = 0.03). The mean HOOS scores at follow-up were 87 for pain, symptoms, and ADLs, and 77 for sports. All HOOS measures were lower in patients that underwent a revision THA, and HOOS-Pain and HOOS-Sport scores were lower in patients that were over the age of 25 at the time of surgery (p<0.05).


CONCLUSIONS
Young patients with osteonecrosis have good implant survival and long-term outcomes after THA. Patient factors and implant characteristics should be considered when predicting implant survival and outcomes after THA in young patients with osteonecrosis.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York - USA.
Ishaan
I
Swarup
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York - USA.
Marisa
M
Shields
David Geffen School of Medicine at UCLA, Los Angeles - USA.
Erik N
EN
Mayer
New York Medical College, Valhalla - USA.
Chelsea J
CJ
Hendow
Healthcare Research Institute, Hospital for Special Surgery, New York - USA.
Jayme C
JC
Burket
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York - USA.
Mark P
MP
Figgie
D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006085:Graft Survival; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D010020:Osteonecrosis / Q000175:diagnosis / Q000601:surgery*; D000071066:Patient Reported Outcome Measures; D011184:Postoperative Period; D011446:Prospective Studies; D011475:Prosthesis Failure; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome