What Are the Outcomes of Total Hip Arthroplasty in Patients Aged Under 30 Years? Results From the Aoanjrr

Background Young patients with end-stage hip pathology present challenging treatment decisions for orthopaedic surgeons. With advances in implant technology and design, total hip replacement (THR) now is a reasonable alternative to arthrodesis or joint salvage in younger patients with arthritis. This study investigated the cumulative percent revision (CPR) of THR performed in patients aged under 30 years in Australia. Methods Data for patients aged under 30 years, who underwent primary THR with modern bearing surfaces for all diagnoses, excluding tumour, from September 1999 to December 2022 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Primary diagnoses, implant survivorship, and reasons for revision were compared with patients aged 30–54 years who underwent THR. Results There were 2,278 procedures recorded for patients who underwent THR aged less than 30 years, compared to 64,237 procedures in patients aged 30–54 years. While osteoarthritis was the most common diagnosis in both cohorts, the primary diagnoses differed between groups, with osteonecrosis (25.5%), developmental dysplasia (17.7%), rheumatoid arthritis (7.8%), and Perthes’ disease (7.1%) being more common in the younger cohort. At 20 years follow-up, the all-cause CPR for patients aged under 30 years, adjusted for gender, was 9.7%, compared to 8.9% for those aged 30–54 years (HR 1.19; 95% CI 1.0, 1.43, p=0.055). There was no difference in CPR between the two groups comparing all cementless to hybrid fixation. When there were enough procedures there was no difference in the two cohorts for specific diagnoses. Revision diagnoses and types of revision procedures were similar between the two cohorts. Conclusion Long-term implant survivorship following THR in patients under 30 years is good, with comparable results to patients aged 30–54 years. Orthopaedic surgeons can confidently recommend THR to young patients with end-stage hip pathology where non-surgical treatment options have been exhausted