Cemented Hip Designs are a Reasonable Option in Young Patients

BACKGROUND: Young patients with degenerative cartilage disease of the hip remain a challenge for the orthopaedic surgeon. Different treatment options are available of which uncemented hips are the most popular owing to long-term concerns about cemented implants. As an alternative, we have used a cemented hip design in combination with bone impaction grafting in patients with acetabular defects. QUESTIONS/PURPOSES: We therefore determined the survival rates and radiological failures of cemented THA in patients younger than 30 years and reported clinical scores, complications and current state of the revised THAs. METHODS: We retrospectively reviewed all 48 patients (69 hips) younger than 30 years at the time of surgery who had a primary cemented THA performed between 1988 and 2004. Acetabular defects were reconstructed using bone impaction grafting in 29 hips. Mean age at surgery was 24.6 years (range, 16–29 years). Revisions were documented, radiographs were analyzed, and the Kaplan-Meier method was used to determine survival for different end points. No patient was lost to followup, three patients (four hips) had died. Minimum followup was 2 years (mean, 8.4 years; range, 2–18 years). RESULTS: Eight hips were revised (three for infection and five for aseptic loosening) and one hip dislocated for which open reduction was necessary. One additional cup was considered a radiographic failure. The 10-year survival was 83% (95% confidence interval, 69%–92%) with revision for any reason as the end point and 90% (95% confidence interval, 77%–96%) with revision for aseptic loosening. CONCLUSIONS: We found a high survival rate of these cemented THA in young patients. In young patients with acetabular bone defects we recommend reconstruction using cemented implants with bone impaction grafting. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.