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Cementless Ceramic-on-Ceramic Total Hip Replacement in Children and Adolescents

Background: total hip replacement (THR) is a rare surgical option in children and adolescents with disabling hip diseases. The aim of this study is to report results from a retrospective cohort of patients aged 18 years or less who underwent cementless Ceramic-on-Ceramic (CoC) THR at a single instit...

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Autores principales: Trisolino, Giovanni, Stallone, Stefano, Castagnini, Francesco, Bordini, Barbara, Cosentino, Monica, Lucchini, Stefano, Zarantonello, Paola, Ferrari, Daniele, Dallari, Dante, Traina, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534320/
https://www.ncbi.nlm.nih.gov/pubmed/34682123
http://dx.doi.org/10.3390/children8100858
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author Trisolino, Giovanni
Stallone, Stefano
Castagnini, Francesco
Bordini, Barbara
Cosentino, Monica
Lucchini, Stefano
Zarantonello, Paola
Ferrari, Daniele
Dallari, Dante
Traina, Francesco
author_facet Trisolino, Giovanni
Stallone, Stefano
Castagnini, Francesco
Bordini, Barbara
Cosentino, Monica
Lucchini, Stefano
Zarantonello, Paola
Ferrari, Daniele
Dallari, Dante
Traina, Francesco
author_sort Trisolino, Giovanni
collection PubMed
description Background: total hip replacement (THR) is a rare surgical option in children and adolescents with disabling hip diseases. The aim of this study is to report results from a retrospective cohort of patients aged 18 years or less who underwent cementless Ceramic-on-Ceramic (CoC) THR at a single institution, investigating clinical and radiographic outcomes, survival rates, and reasons for revision of the implants. Materials and methods: we queried the Registry of Prosthetic Orthopedic Implants (RIPO) to identify all children and adolescents undergoing THR between 2000 and 2019 at a single Institution. Inclusion criteria were patients undergoing cementless CoC THR, aged less than 18 years at surgery, followed for at least 2 years. Sixty-eight patients (74 hips) matched all the inclusion criteria and were enrolled in the study. We assessed the clinical and radiographic outcomes, the rate of complications, the survival rate, and reasons for revision of the implants. Results: The mean follow-up was 6.6 ± 4.4 years (range 2–20). The most frequent reason for THR was post-traumatic or chemotherapy-induced avascular necrosis (38%). The overall survival rate of the cohort was 97.6% (95% CI: 84.9–99.7%) at 5 years of follow-up, 94.4% (95% CI: 79.8–98.6%) at 10 years and 15 years of follow-up. Two THR in two patients (2.7%) required revision. With the numbers available, Cox regression analysis could not detect any significant interaction between preoperative or intraoperative variables and implant survivorship (p-value 0.242 to 0.989).” The average HOOS was 85 ± 14.3 (range 30.6–100). Overall, 23 patients (48%) reported excellent HOOS scores (>90 points), 21 patients (44%) reported acceptable HOOS scores (60–90 points) while 4 patients (8%) reported poor outcomes (<60 points). Twenty-one patients (43%) were regularly involved into moderate- to high-intensity sport activities (UCLA ≥ 6). Conclusions: Cementless CoC THR is a successful procedure in children and teenagers, having demonstrated high implant survivorship and low rates of complications and failure. A meticulous preoperative planning and implant selection is mandatory, to avoid implant malposition, which is the main reason of failure and revision in these cases. Further studies are needed to assess the impact of the THR on the psychosocial wellbeing of teenagers, as well as risks and benefits and cost-effectiveness in comparison to the hip preserving surgical procedures.
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spelling pubmed-85343202021-10-23 Cementless Ceramic-on-Ceramic Total Hip Replacement in Children and Adolescents Trisolino, Giovanni Stallone, Stefano Castagnini, Francesco Bordini, Barbara Cosentino, Monica Lucchini, Stefano Zarantonello, Paola Ferrari, Daniele Dallari, Dante Traina, Francesco Children (Basel) Article Background: total hip replacement (THR) is a rare surgical option in children and adolescents with disabling hip diseases. The aim of this study is to report results from a retrospective cohort of patients aged 18 years or less who underwent cementless Ceramic-on-Ceramic (CoC) THR at a single institution, investigating clinical and radiographic outcomes, survival rates, and reasons for revision of the implants. Materials and methods: we queried the Registry of Prosthetic Orthopedic Implants (RIPO) to identify all children and adolescents undergoing THR between 2000 and 2019 at a single Institution. Inclusion criteria were patients undergoing cementless CoC THR, aged less than 18 years at surgery, followed for at least 2 years. Sixty-eight patients (74 hips) matched all the inclusion criteria and were enrolled in the study. We assessed the clinical and radiographic outcomes, the rate of complications, the survival rate, and reasons for revision of the implants. Results: The mean follow-up was 6.6 ± 4.4 years (range 2–20). The most frequent reason for THR was post-traumatic or chemotherapy-induced avascular necrosis (38%). The overall survival rate of the cohort was 97.6% (95% CI: 84.9–99.7%) at 5 years of follow-up, 94.4% (95% CI: 79.8–98.6%) at 10 years and 15 years of follow-up. Two THR in two patients (2.7%) required revision. With the numbers available, Cox regression analysis could not detect any significant interaction between preoperative or intraoperative variables and implant survivorship (p-value 0.242 to 0.989).” The average HOOS was 85 ± 14.3 (range 30.6–100). Overall, 23 patients (48%) reported excellent HOOS scores (>90 points), 21 patients (44%) reported acceptable HOOS scores (60–90 points) while 4 patients (8%) reported poor outcomes (<60 points). Twenty-one patients (43%) were regularly involved into moderate- to high-intensity sport activities (UCLA ≥ 6). Conclusions: Cementless CoC THR is a successful procedure in children and teenagers, having demonstrated high implant survivorship and low rates of complications and failure. A meticulous preoperative planning and implant selection is mandatory, to avoid implant malposition, which is the main reason of failure and revision in these cases. Further studies are needed to assess the impact of the THR on the psychosocial wellbeing of teenagers, as well as risks and benefits and cost-effectiveness in comparison to the hip preserving surgical procedures. MDPI 2021-09-27 /pmc/articles/PMC8534320/ /pubmed/34682123 http://dx.doi.org/10.3390/children8100858 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Trisolino, Giovanni
Stallone, Stefano
Castagnini, Francesco
Bordini, Barbara
Cosentino, Monica
Lucchini, Stefano
Zarantonello, Paola
Ferrari, Daniele
Dallari, Dante
Traina, Francesco
Cementless Ceramic-on-Ceramic Total Hip Replacement in Children and Adolescents
title Cementless Ceramic-on-Ceramic Total Hip Replacement in Children and Adolescents
title_full Cementless Ceramic-on-Ceramic Total Hip Replacement in Children and Adolescents
title_fullStr Cementless Ceramic-on-Ceramic Total Hip Replacement in Children and Adolescents
title_full_unstemmed Cementless Ceramic-on-Ceramic Total Hip Replacement in Children and Adolescents
title_short Cementless Ceramic-on-Ceramic Total Hip Replacement in Children and Adolescents
title_sort cementless ceramic-on-ceramic total hip replacement in children and adolescents
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534320/
https://www.ncbi.nlm.nih.gov/pubmed/34682123
http://dx.doi.org/10.3390/children8100858
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