Systematic review: lack of evidence for the success of revision arthroplasty outcome in younger patients

Total hip arthroplasties (THAs) in younger patients are becoming increasingly popular. However, the outcome of subsequent revisions in younger patients is not well known and, therefore, their success (subsequent revision prosthesis survival) might be overestimated. We investigated available data on the outcome of primary- and subsequent revision THAs performed in the same cohort of patients who underwent primary THA under the age of 50.

Medline, Embase and the Cochrane Library (CENTRAL) were searched up until April 13, 2016 for studies that reported both the survival of primary and subsequent revisions THA of single cohorts of patients younger than 50. Eligible articles had to include Kaplan Meier analysis or competing risk analysis for survival of the primary THA at a mean follow-up of 10 years, as well as for the subsequent revision THA within the same cohort.

We found 4,799 unique records; 43 of which were potentially eligible. Only 1 paper met our inclusion criteria. It reported on the survival of 69 primary prostheses at a mean of more than 10 years follow-up and 13 subsequent revisions.

There is a clear lack of evidence about the outcomes of the revision arthroplasty in younger patients. Only 1 study reported the survival-rate of subsequent revision arthroplasty with the minimum 10-year survival rate of the original THA cohort. In the future, this serious lack of knowledge could result in a large number of patients with no further reconstructive options after failed THA, and a large medical burden for society.