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Metal-on-metal hip resurfacing in patients younger than 50 years

Total hip arthroplasty (THA) durability does not meet the requirements for young patients compared to the younger population.

 SEE ALSO:  3D Templating for Total Hip Arthroplasty

Back in 2014, the UK’s National Institute for Health and Care Excellence (NICE) presented a benchmark criterion for hip implants from 90 to 95% 10-year survivorship. The Orthopaedic Data Evaluation Panel listed only 32 THA femoral stems which have found themselves on this new stricter benchmark, with potentially far fewer meeting NICE criteria in younger patients.

John Charnley warned against performing THA in younger patients, citing that the procedure was not perfect and since there was an increasing number of younger patients demanding a better, longer-lasting solutions, hip resurfacing arthroplasty (HRA) emerged as an alternative, bone-preserving option. It is well known THA implants display markedly lower survivorship in patients younger than 50 years old. If we consider the underestimation of failure in the registry, 10-year survivorship could be lower. Using literature review by De Kam on THA in patients under 50, only 15 to 37 papers met the outdated NICE criteria and only two studies met the new standard.

Experts attribute reduced implant survivorship in younger patients to more complex procedures and naturally higher activity levels. The most common diseases of the younger hip include:

  • Osteonecrosis;
  • Dysplasia;
  • Legg-Perthes disease;
  • Post-traumatic arthritis.

In an analysis of over 109 studies on patients under 50, only 37 had a mean survivorship gather than 10 years. Combined risks make the THA challenging in patients under 50.

Despite many HRA studies with excellent outcomes, registry results have been mixed. In the Australian registry, it was confirmed that 10-year HRA implant survivorship surpasses the THA in men under 60, the reverse is true for women and older men. In the UK’s National Joint Registry, the study registered inexperienced surgeons performing an average of only 2.6 HRA cases a year.

Highly rates from poorly designed implants and excessive publicity on adverse wear-related failures (AWRF) from a small number of outlier centers have called into question the value of HRA. Experienced surgeons, including the present senior author (TPG), have routinely surpassed HRA and THA outcomes in arthroplasty registers.

The mixed available results, the scarcity of published outcomes on younger patients, and the poor viability of THA in younger patients, hopefully, will establish a successful example for HRA implant survivorship in patients under 50 years old.

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