Total joint arthroplasty in younger patients: heading for trouble?
Schreurs, B Willem; Hannink, GerjonHip Knee
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Traditionally, the success of total hip and knee arthroplasty has been determined by the measurement of survival. In the Lancet, Lee Bayliss and colleagues
now introduce the use of lifetime risk as a novel approach to illustrate the risk of revision surgery following joint replacement. Lifetime risk data, which describe the probability of an event occurring over the course of a lifetime, is useful to patients, clinicians, and other health-care professionals because it is easier to convey and understand than the commonly used survival rates.
report an LTRR around 5% for both THA and TKA patients at age 70 years, and LTRR of reduced further above this age. However, a potential threat for less successful long-term outcome in patients over 70 years of age is the worldwide trend of increased use of cementless implants instead of cemented ones, which is paradoxical, as more and more reports show that in older patients this leads to higher revision rates and re-operation rates than with cemented hips.
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Explanations for this trend are the intensive marketing of the more expensive cementless implants by the orthopaedics industry, and the willingness of orthopaedic surgeons to adopt to the less time-consuming cementless surgical technique.
The introduction of larger heads, in an attempt to overcome dislocations, might also generate higher revision rates.
As a consequence, the number of revisions is expected to increase dramatically.
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and orthopaedic surgeons have very little data on the outcome of revision THA and TKA in young patients. To our knowledge, there are only two papers on the long-term outcome of revision THA in patients who were younger than 55 years at the time of their revision.
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One study reported an alarming survival rate of 63% at 10 years,
and the other, using a biological reconstruction technique with impaction bone grafting, showed more promising results with a 10 year survival of 87%.
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