Long Time Outcome Of Total Hip Replacement In Teenage Patients With Systemic Inflammatory Diseases

Background Total hip replacement (THR) is the most effective treatment for the progressed hip arthrosis. However, indication of THR for teenage patients is controversial because they might need several revisions in their lives, and the complication rate in revision surgery is high in systemic inflammatory patients (SID) [1]. However, alleviation of hip pain and improvement of function through THR might have substantial benefits on the physical, psychological and social development of these teenage patients. When considering THR for teenage patients with SID, it is highly important to discuss the potential risks and benefits. However, there are currently only a few reports on THR for this group of patients [2,3]. Objectives The aim of this study was to report the outcome of THR in teenage patients with systemic inflammatory diseases in order to provide objective data for decision-making. Methods We included patients with SID under 20 years of age who underwent THR in Norway during the period 1987 – 2010. Information about primary THR and implant revision was obtained from the Norwegian Arthroplasty Registrer. Radiographs, medical records, and recent Harris Hip Score (HHS) were obtained from local hospitals. Results Informed consent was available for 25 patients (37 hips) with SID. The diagnosis was juvenile idiopathic arthritis in 26 hips, ankylosing spondylitis in 6 hips, psoriatic arthritis in 1 hip and systemic lupus erythematosus with avascular necrosis of femoral head in 4 hips. Mean age of the primary surgery was 17.1 years (SD: 2.2, range: 11.1–19.9), and mean follow-up period was 15.0 years (SD: 7.2, range: 3.1–26.0). Five primary cups and 3 primary stems were revised. Implant survival rate was 88.1% at 10 years for cups and 91.4% at 10 years for stems. Steroid usage at the primary surgery had no effect on implant survival. Biologics had been used before the operation in 9 patients and started after the operation in additional 9 patients. No revision surgery had been reported from these patients. In the final radiographs, 17% of the acetabuli and 80% of the femura were Paprosky classification 2 or above. Recent HHS was documented for 27 hips. Mean HHS pain score was 41 (SD: 9.3) and mean HHS total score was 84 (SD: 16). Information about social status was available for 21 patients. Out of 21 patients, 14 had jobs, 4 were students, 1 used two crutches, 2 used wheelchair, 12 received higher education. Conclusions The function and survival were acceptable. However, loss of bone stock was observed in about 20% of patients. Negative effect of steroids and biologics were not observed. References Goodman SB, Hwang K, Imrie S. High complication rate in revision total hip arthroplasty in juvenile idiopathic arthritis. Clin Orthop Relat Res. 2014 Feb;472(2):637-44. Wroblewski BM, Purbach B, Siney PD, Fleming PA. Charnley low-friction arthroplasty in teenage patients: the ultimate challenge. J Bone Joint Surg Br. 2010 Apr;92(4):486-8. Bessette BJ, Fassier F, Tanzer M, Brooks CE. Total hip arthroplasty in patients younger than 21 years: a minimum, 10-year follow-up. Can J Surg. 2003 Aug;46(4):257-62. Disclosure of Interest None declared