Cementless Total Hip Arthroplasty in Patients Fifty Years of Age or Younger: A Minimum Ten-Year Follow-up

Background: The durability of total hip arthroplasty in younger patients has been reported to be less than that in older patients. The purpose of this study was to evaluate the results of cementless total hip arthroplasty performed in a consecutive series of patients fifty years of age or younger who were followed for a minimum of ten years. Methods: We prospectively followed 100 consecutive patients (115 hips) who were fifty years of age or younger when they were treated with primary cementless total hip arthroplasty with use of a second-generation, extensively porous-coated femoral stem and a cementless acetabular component. The patients were followed for a minimum of ten years, and the results were compared with our patients in the same age group who had total hip arthroplasty with cement. Evaluation included the need for revision, activity questionnaires, six-minute walks, activity level monitoring with an accelerometer, and radiographic evaluation for evidence of loosening, wear, and osteolysis. Results: Seventy-three patients (eighty-two hips) were available for follow-up at ten years (mean, twelve years). Seventeen patients (twenty-three hips) had died, and ten patients (ten hips) were lost to follow-up. The average age at the time of surgery was 40.1 years. Three femoral stems were revised for periprosthetic fracture. No acetabular shell or femoral stem was revised for loosening, and none were loose on radiographs made at the time of a minimum ten-year follow-up. This compares favorably with the cemented cohort, which had poorer survivorship of the implant with regard to revision for aseptic loosening and radiographic loosening. Reoperation for any reason was similar between the two cohorts at ten years, primarily because of the relatively large numbers of revisions for polyethylene wear in the cementless group. Conclusions: Cement less total hip arthroplasty with use of a second-generation, extensively porous-coated stem demonstrated durable fixation in an active, younger population at a minimum follow-up of ten years and had better survivorship with respect to fixation compared with our previously reported cemented cohort.