Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Surgery

Supervisor

Lanting, Brent

2nd Supervisor

Degen, Ryan

Joint Supervisor

Abstract

Total hip arthroplasty (THA) is the gold standard in treatment of hip arthritis yet is often avoided in young patients due to concerns of inferior survivorship. We aim to explore the role of THA in young patients and assess whether these historical concerns are valid in contemporary THA by presenting the results of: (1) a systematic review and meta-analysis of the current literature, (2) a retrospective database review, and (3) a retrospective population-based study. We found excellent long-term survivorship with modern THA in young patients, demonstrating greater than 90% revision-free survival up to 15 years. Factors that may increase risk of revision include metal-on-metal bearing surfaces, younger age, female sex, non-osteoarthritis diagnosis, early surgical complications, and low surgeon volumes. Young patients appear to benefit greatly from THA with respect to their patient-reported outcome measures. In conclusion, THA in young patients is a successful operation and should not be avoided.

Summary for Lay Audience

Total hip arthroplasty (THA), or total hip replacement, is the treatment of choice in end-stage hip disease. It is an operation that provides excellent pain relief, restoration of function, and improved quality of life. Despite this, THA is often avoided in young patients due to concerns of implant wear and complications requiring additional surgery. We aim to explore the role of THA in young patients and assess whether these historical concerns are valid in contemporary THA by presenting the results of: (1) a systematic review and meta-analysis of the current literature, (2) a retrospective database review, and (3) a retrospective population-based study. We found that modern THA was a durable operation in young patients with greater than 90% of THA expected to last longer than 15 years. We also identified many factors that may contribute to early failure of THA including metal-on-metal bearing surfaces, younger age, female sex, non-osteoarthritis diagnosis, early surgical complications, and low surgeon volumes. More research is needed to make definitive conclusions on these risk factors. In general, young patients appear to benefit greatly from THA with respect to their patient-reported outcome measures. In conclusion, THA in young patients is a successful operation and should not be avoided in patients with end-stage disease of the hip.

Available for download on Monday, April 01, 2024

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