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Younger total hip arthroplasty (THA) patients have historically experienced poor long-term outcomes associated with implant failure.

That appears to be changing: A study utilizing data from the American Joint Replacement Registry (AJRR) found that only 1% of sampled patients under age 65 needed revision surgery for THA within an 8-year period.

The study, presented at the 2023 annual meeting of the American Academy of Orthopaedic Surgeons, also highlighted higher THA revision rates among Black patients when compared with white patients.

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“The demand for total hip replacements is expected to increase 174% from 2005 to 2030, said lead author David Cieremans, MS, a medical student at Philadelphia College of Osteopathic Medicine. “And 28% of the 572,000 THA procedures performed annually are in patients under the age of 55.

“When a young and active patient is exploring THA, it’s important for their surgeon to understand the expected life span of the implant to help make informed decisions. The AJRR provided an incredible resource for our team to obtain robust data on hip replacements, along with a standardized metric to analyze surgical trends and patient outcomes from around the country.”

Primary Outcomes

In younger, more-active THA patients, implant failure has most commonly been associated with component loosening, polyethylene wear, instability and infection. Surgical techniques and implant designs have improved over the past 15 years, however, and the researchers sought to determine if there have been corresponding improvements in outcomes and implant longevity in younger patients.

For the study, “Trends in Complications and Outcomes in Patients Aged 65 and Younger Undergoing Total Hip Arthroplasty: Data from the American Joint Replacement Registry,” the researchers identified all THAs in the AJJR that were performed between 2012 and 2020 in patients age 18 to 65. Revision and oncologic THA cases, conversions from prior surgery, and non-elective cases were excluded.

The primary outcomes of interest included:

• Cumulative revision rate
• 90-day readmission rate
• Reason for revision

In total, 5153 patients were included in the analysis (51% female and 49% male), with an average age of 56.7 years ± 7.8 years. Mean follow up was 39.57 months.

Study Findings

The study authors reported the following:

• Fifty-three patients (1%) underwent revision during the study period, and 74 patients (1.4%) were readmitted within 90 days.
• The most common causes for revision were infection (20.8%), instability (15.1%), periprosthetic fracture (13.2%), and aseptic loosening (9.4%).
• The most common reasons for 90-day readmission without revision were infection (22.9%), pain (9.5%), and periprosthetic fracture (5.4%).

The study also found racial disparities in revision rates, as readmission within 90 days requiring revision were 2.76 times more common in Black patients compared with white patients.

“This is an important finding, and more long-term outcome studies are needed to understand why Black patients are being disproportionately affected,” said senior author Ran Schwarzkopf, MD, MSc, professor of orthopaedics at NYU Langone Orthopedic Hospital.

“Other research has concluded that Black patients are 30% less likely to undergo an elective total hip replacement than white patients, and patients from lower socioeconomic backgrounds experience higher baseline scores for pain and function.

“Given the advances in THA and favorable outcomes for patients under the age of 65, the orthopaedic community needs to work to improve patient outcomes for all patients.”

Although the results of this study represent trends in data and cannot yet be used to make definitive conclusions on outcomes due to inherent limitations of the database, Mr. Cieremans noted that the team looks forward to continuing to follow the patient cohort over a longer period of time.

“This study is extremely promising, and it demonstrates the power and the capabilities of the Registry,” he said. “As we conduct further research on these patients over the next few years, we’ll be able to continue to inform treatment decisions and outcomes, including the average lifespan of the implants beyond 8 years.”