Medium-term outcomes of uncemented total hip arthroplasty in patients younger than 25 years old: A retrospective research

Medium-term outcomes of uncemented total hip arthroplasty in patients younger than 25 years old: A retrospective research | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Medium-term outcomes of uncemented total hip arthroplasty in patients younger than 25 years old: A retrospective research Xin-Yuan Yu, Yong-Jie Qiao, Xu-Sheng Li, Zi-Yao Li, Li-Rui Zhan, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3562066/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To evaluate the medium-term outcomes of uncemented total hip arthroplasty in patients ≤ 25 years. Methods: A retrospective research was performed on patients ≤ 25 who received uncemented total hip arthroplasty at the Department of Orthopedics of the 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army from January 2009 to December 2018. The clinical evaluation was measured with modified Harris Hip Score, Western Ontario & McMaster Universities Osteoarthritis Index, and Short-Form 36. Postoperative complications (such as infection, revision, dislocation, and incisional healing issues) were recorded. Using pelvic anteroposterior, hip anteroposterior and lateral X-rays, the radiographic outcome was evaluated, including the position of the implants, loosening, bearing-surface wear, osteolysis, and heterotopic ossification. Loosening of the acetabular or femoral component or revision for any reason was defined as failure. Results: At a follow-up of 8.3±2.4 years (range, 3.8 to 12 years), the preoperative modified Harris hip score was 43.5±12.9 (range, 18 to 62) and increased to 88.3 ± 8.8 (range, 72 to 97), and the preoperative postoperative Western Ontario & McMaster Universities Osteoarthritis Index score improved from 43.6±8.4 (range, 33.1 to 62.3) to 11.5 ± 6.8 (range, 2.5 to 25.8). The Physical Component score-SF-36 improved from 48.5 ± 8.6 (range, 36.4 to 61.3) to 81.2 ± 10.3 (range, 60.3 to 97.5), while the Mental Component score-SF-36 increased from 56.6±12.5 (range, 39.4 to 78.6) to 82.6 ± 12.9 (range, 54.7 to 97). The latest X-ray revealed that the position of the implants did not change substantially since the postoperative image. The abduction angle of acetabular cup was 41.8° ± 6.7° (range, 31° to 57°),the anteversion angle of acetabular cup was 18.2° ± 3.6° (range, 9.5° to 25.7°), and the filling ratio was 90.1% ± 3% (range, 85.2%-95.3%). The preoperative leg length discrepancy was 1.8 cm ± 0.8 cm (range, 1 cm to 5 cm) and reduced to 1.4 cm ± 0.5 cm (range, 0.5 cm to 2.5 cm). No considerable loosening, bearing-surface wear, osteolysis, or heterotopic ossification was observed. At the latest follow-up, the overall survival rate of the 49 hips was 98%. Conclusion: For patients with end-stage hip disease under 25 years old, uncemented THA exhibit excellent outcomes, with a high survival rate and fewer complications at medium-term follow-up. Young Adults Femur Head Necroses Total Hip Arthroplasty Prostheses and Implants Survivorship Figures Figure 1 Figure 2 Introduction Total hip arthroplasty (THA) has been routinely utilized to treat advanced hip diseases in the elderly. It has been praised as “one of the most successful operations in the 20th century” because of its remarkable clinical performance[ 1 ]. Several diseases, such as avascular necrosis (AN), juvenile idiopathic arthritis (JIA), infection, and chronic dislocation, may cause disabling symptoms in young adults, but THA is rarely recommended to young patients due to multiple factors, including activity level, social attributes, the longevity of implants, subsequent revision, and surgery complications.[ 2 – 4 ]. However, THA can reduce patients' financial burden and achieve a more accurate outcome when compared to the potential additional expenses that may result from conservative treatment. Therefore, THA is an effective and cost-effective choice for the treatment of young patients with advanced hip disease. Currently, cemented and uncemented fixation are the two main methods of THA, and the efficacy of these two methods has been controversial [ 4 – 7 ]. This study seeks to determine and report the clinical and radiographic outcomes of the mid-term follow-up of uncemented THA in patients under the age of 25 in order to provide doctors with a reference for future surgical decision-making. Materials and Methods Inclusion Criteria (1) Patients who underwent THA due to end-stage hip disease at the Department of Orthopedics of the 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army. (2) Patients who were under 25 at the time of surgery. (3) patients who received uncemented THA. Exclusion Criteria (1) Patients undergoing tumor-type THA for hip cancer; (2) Patients undergoing THA due to hip infection;(3) The duration of follow-up was less than three years; (4) Patients who were lost to follow-up or had incomplete data. Operation Method The patient was positioned in a healthy lateral decubitus position following a satisfactory anesthetic. The epidermis, subcutaneous tissue, and fascia lata were sliced progressively using a 12-centimeter-long Kocher-Langebeck (K-L) approach. The gluteus maximus muscle was split and retracted anteriorly to reveal the gluteus medius muscle. The hip joint was exposed by severing the external rotation muscle group and joint capsule complex from the external posterior edge of the greater trochanter. The femoral head was removed 1 cm above the lesser trochanter after external rotation and oblique osteotomy. The labrum surrounding the acetabulum was excised, exposing the acetabulum in its entirety and cleaning the soft tissue of the acetabulum. In the hip joint, the proximal femur was exposed, followed by an open mouth opening with a medullary cavity number file and expanding pulp, a test after selecting an appropriate type side femoral prosthesis and neck long femoral head, and a hip reset immediately after the installation of the femoral prosthesis handle and femoral head prosthesis, all directions without dislocation of the hip and the impact of the event. Perioperative Management (1) Infection prevention: Use second-generation cephalosporin antibiotics for 48 hours after surgery, change dressing frequently to avoid exudation, and insert a drainage tube within 24h following the operation. (2) Thrombus prevention: Nadroparin Calcium Injection 3075 IU was injected subcutaneously once daily, and rivaroxaban tablet 10 mg was taken orally once a day after discharge until 5 weeks after surgery; Lower extremity pressure therapy instrument was used twice a day. Besides, patients were encouraged to perform lower limb ankle pump exercise. (3) Functional exercise: non-weight-bearing standing exercises were conducted the day after surgery, and partial weight-bearing exercises were performed two weeks later. Walking with crutches and carrying weight began six weeks following surgery. Walking without a cane three months following surgery. Clinical Evaluation The clinical outcome was assessed by modified Harris hip Score (mHHS) and Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC), while the Quality of life was evaluated by the Short-Form 36 (SF-36). Additionally, post-operative complications will be recorded (e.g., infection, revision, dislocation, wound healing problems, etc.). The goal of mHHS is to measure preoperative function impairment and postoperative improvement. The WOMAC index is used to evaluate changes in health following surgery, higher scores imply a poorer prognosis. The SF-36 is a generic questionnaire on quality of life which can be divided into a Physical Component Summary (PCS) and Mental Component summary (MCS), higher scores indicate a better outcome. Radiographic Evaluation Radiographic follow-up was performed in the anteroposterior pelvis, anteroposterior and lateral hip joint X-ray. Included in the evaluation were implants position, loosening, bearing-surface wear, osteolysis, heterotopic ossification and filling ratio. The appearance of a complete radiolucent line on radiography, the femur sinking by 2mm or more, or the acetabular prosthesis shifting by more than 4 mm horizontally or vertically, or turning by more than 5 degrees, was characterized as loosening. In addition, if loosening was discovered, it was recorded by the Charnley’s three acetabular zones and the Gruen’s seven femoral zones [2; 8]. According to Tsukanaka's previous report, osteolysis was defined as a clear area ≥ 3 mm in diameter surrounding the prosthesis[8; 9]. On the anteroposterior and lateral X-rays, the filling ratio was assessed at three levels: the upper border of the lesser trochanter, the mid-stem, and 1 cm proximal to the prosthesis tip[ 10 ]. THA failure was defined as loosening of the acetabular or femoral prosthesis or revision for any reason. Statistical Method The measurement data in accordance with normal distribution were expressed as (Mean ± SD), paired sample t-tests were used for clinical scores and independent sample t-tests were used for comparison between different liners. P ＜0.05 was considered statistically significant. All the analysis were performed with SPSS software version 25.0 (SPSS, IBM, Armonk, NY, USA). After all participants were identified, we gathered their contact information and verbal consent for the study. This study was a retrospective study, and the Committee waived the requirement for written informed consent because the patient data remained anonymous and the study had no adverse effects on patient health. Results A total of 89 patients (112 hips) who underwent THA in our department from January 2009 to December 2018 were screened according to the inclusion criteria. Following exclusion criteria, 37 patients (49 hips) were enrolled in this study, including 26 males (33 hips) and 11 females (16 hips). The general data of the patients are shown in Table 1 . The mean age was (21.8 ± 2.6) years (19–25 years), with 29 left-sided hips (48.1%) and 20 right-sided hips (51.9%). 12 patients received bilateral THA and 25 patients underwent unilateral THA. The average body mass index (BMI) was (22.3 ± 3.2) kg/m 2 (16.8–29.1 kg/m 2 ). The mean duration of follow-up time was (8.3 ± 2.4) years (3.8–12 years). The average length of hospitalization was (13 ± 4.7) days (5–18 days). 4 hips received general anesthesia, while 45 hips received intrathecal anesthesia. The average operation time was (128.2 ± 40.8) minutes (60–240 minutes), and the average intraoperative blood loss was (360.6 ± 171.4) ml (150–800 ml). On the choice of bearing surfaces, 23 hips (46.9%) were lined with the ceramic-on-highly cross-linked polyethylene (CoP), and 26 hips (53.1%) were lined with the ceramic-on-ceramic (CoC). There was no significant difference between the two bearing surfaces at the latest follow-up, as shown in Table 2 . The causes of 49 hips included Avascular necrosis of the femoral head (AVN) (30 hips), Developmental Dysplasia of the Hip (DDH) (8 hips), Rheumatoid arthritis (RA) (5 hips), Ankylosing spondylitis (AS) (5 hips), and hip osteoarthritis (OA) (1 hip). In the patients with Avascular necrosis of femoral head, the causes were mainly trauma (11 hips), idiopathic (9 hips), hormone (8 hips), and alcohol (2 hips), as shown in Table 3 . The preoperative modified Harris hip score was 43.5 ± 12.9 (range, 18 to 62) and increased to 88.3 ± 8.8 (range, 72 to 97), and the preoperative postoperative Western Ontario & McMaster Universities Osteoarthritis Index score improved from 43.6 ± 8.4 (range, 33.1 to 62.3) to 11.5 ± 6.8 (range, 2.5 to 25.8). The Physical Component score-SF-36 improved from 48.5 ± 8.6 (range, 36.4 to 61.3) to 81.2 ± 10.3 (range, 60.3to 97.5), and the Mental Component score-SF-36 increased from 56.6 ± 12.5 (range, 39.4 to 78.6) to 82.6 ± 12.9 (range, 54.7 to 97). The comparison of clinical scores is shown in Table 4 . The latest X-ray revealed that the position of the implants did not change substantially since the postoperative image. The abduction angle of acetabular cup was 41.8° ± 6.7° (range, 31° to 57°), the anteversion angle of acetabular cup was 18.2° ± 3.6° (range, 9.5° to 25.7°), and the filling ratio was 90.1% ± 3% (range, 85.2–95.3%) (Fig. 1 and Fig. 2 ). The preoperative leg length discrepancy was 1.8 cm ± 0.8 cm (range, 1 cm to 5 cm) and reduced to 1.4 cm ± 0.5 cm (range, 0.5 cm to 2.5 cm). No obvious loosening, wear, osteolysis, or heterotopic ossification. All components were stable and integrated. There were no differences between CoC and CoP bearing surfaces( P ＞0.05). Table 1 General data of 37 patients (49 hips) No. of patients 37 No. of hips 49 Age at time of surgery(yr) 21.8 Mean body mass index(kg/m 2 ) 22.3 Follow-up time(yr) 8.3 Hospitalization time(d) 13 Mean operation time(min) 128.2 Mean blood loss(ml) 360.6 Gender Male Female 26 11 Laterality Left Right 29 20 Bearing surface CoP CoC 23 26 Anesthesia method General anesthesia intrathecal anesthesia 4 45 Table 2 Comparison of CoC and CoP modified Harris hip score WOMAC score The Physical Component score-SF-36 The Mental Component score-SF-36 CoC 87.2 ± 8.5 6.8 ± 4.9 79.9 ± 10.9 85.8 ± 12.6 CoP 88.9 ± 9.1 7.9 ± 4.2 81.9 ± 10.1 80.4 ± 12.9 t value -0.49 -0.66 0.49 1.08 P value ＞0.05 ＞0.05 ＞0.05 ＞0.05 Table 3 Causes of 49 hips diagnosis AVN DDH RA AS OA 30 8 5 5 1 the causes of AVN Trauma Idiopathic Hormone Alcohol 11 9 8 2 Table 4 Comparison of clinical scores modified Harris hip score WOMAC score The Physical Component score-SF-36 The Mental Component score-SF-36 Preoperative 43.5 ± 12.9 43.6 ± 8.4 48.5 ± 8.6 56.6 ± 12.5 Latest follow up 88.3 ± 8.8 11.5 ± 6.8 81.2 ± 10.3 82.6 ± 12.9 t value -25.3 19.6 -10.2 -7.3 P value ＜0.05 ＜0.05 ＜0.05 ＜0.05 Complications and preoperative interventions A patient suffered a sinus tract at the surgical site more than 4 months after right THA, and was readmitted for surgical treatment. During the surgery, it was discovered that the sinus tract connected to the deep gluteus maximus muscle and hip capsule. The granulation tissue was entirely removed, and the liner and femoral head was replaced. One patient with bilateral femoral head necrosis received bilateral core decompression(CD) nine months prior to THA, whereas the other patient with more severe right femoral head necrosis than left underwent left core decompression during right THA. Before THA, all patients with trauma-induced femoral head necrosis had had various hip procedures, including closed reduction and cannulated screw internal fixation and open reduction and internal fixation. At the latest follow-up, the overall survival rate of the 49 hips was 98%. Discussion Although THA has been widely utilized in elderly patients with advanced hip disease, its application in younger patients remains controversial. Torchia[ 11 ]discovered that the failure rates in young patients increased significantly over time, reaching as high as 45%. Halvorsen[ 12 ] reported 747 patients (881 hips) under the age of 21 who received THA and discovered an 86% 10-year survival rate. These high reported failure rates may be attributed to the design of early prosthesis and the cemented technique[ 13 ]. In light of these high failure rates, few young patients receive THA, and relevant data and study findings are still lacking. However, compared with the "hip preservation" treatment with uncertain efficacy and eventual surgery, THA can help young patients in regaining hip function, rebuilding normal social attributes, and reducing the impact of the disease on their studies, work and life. In this study, we focused on patients ≤ 25 years who received uncemented THA. During an average of 8.3 years follow-up, the mHHS and WOMAC index significantly improved at the last follow-up, indicating that the uncemented THA is suitable for young patients and can achieve optimal performance. The quality of life, both physical and mental components, as measured by the SF-36, showed significant improvement in 49 hips. Furthermore, the latest X-ray revealed that the position of the implants did not change substantially since the postoperative image, and that there was no obvious loosening, wear, osteolysis, or heterotopic ossification. All components were stable and integrated. The total survival rate was 98%, which was comparable to the survival rate recorded in literature[4; 9; 14–16]. Traditionally, the most common THA fixation methods are cemented and uncemented fixation. Cemented THA can achieve good initial stability, but the bone cement is particularly prone to fatigue fracture under long-term stress, and the bone cement particles generated can cause osteolysis around the prosthesis and lead to prosthesis loosening, which is more common in patients with high activity or young age; within contrast to cemented THA, the early stability of uncemented THA depends on the tight compression of bone tissue and prosthesis, while the later stability depends on the bone tissue growing into the prosthesis[17; 18]. It is generally accepted that uncemented THA has a better prognosis and is more conducive to at least one revision surgery in the future for patients with younger age, longer life expectancy, greater mobility, and good bone growth function[ 18 – 20 ]. Although modern cement technology has increased the efficacy of prosthesis fixation, the risk of failure remains higher than with uncemented fixation. Buddhdev[ 21 ] reported 51 patients accepting uncemented THA at the age of 16.7 years, with an average survival rate of 97% after 9.3 years of follow-up. Smith[ 22 ] conducted a long-term follow-up of 50 hips undergoing cemented THA and found the revision rate to be 38%. Boyle[ 23 ] observed that the revision rates of cemented THA was significantly higher than uncemented THA. In this study, all 49 hips were treated with uncemented THA, thereby avoiding complications such as osteolysis and prosthesis loosening caused by bone cement. Although uncemented prostheses reduce several issues associated with cemented prostheses, intraoperative and postoperative complications still exist. For instance, intraoperative cleavage fractures frequently occur in the proximal femur in order to ensure a close fit between implants and bone bed; in addition, a large amount of evidence proves that uncemented prostheses within two years of THA frequently exhibit varying degrees of micro thigh pain related to the distal femoral prosthesis [ 24 ]. In this study, no postoperative thigh pain was identified in 49 hips until the follow-up, which may be attributable to the close fit of the prosthesis to the bone bed during surgery and the patients' healthy bone mass. As uncemented implants have generally replaced the traditional cemented implants, the prosthesis bearing surfaces have undergone several iterations to reduce excessive wear and osteolysis[5; 25]. The CoP bearing has superior wetness, hardness and inertness, whereas the CoC bearing improves wear, wetness, biological inertia and osteolysis, and has become the most prevalent bearing surface in young patients over the past decade[21; 26–31]. In this study, 49 THA were treated with CoP (23 cases, 46.9%) and CoC bearings (26 cases, 53.1%) respectively. The survival rate and clinical results of these two bearings at the latest follow-up were similar to those of Pallante[ 26 ], who retrospectively analyzed the clinical outcomes of CoP, CoC and metal-on- highly cross-linked polyethylene (MoP), finding CoC and CoP with excellent outcomes. Kim[ 32 ] found that highly cross-linked polyethylene had superior wear resistance compared to traditional polyethylene, and that neither osteolysis nor aseptic loosening of the prosthesis occurred. Buddhdev[ 21 ] evaluated 51 patients (60 hips) receiving THA at a mean age of 16.7 years, 60 hips adopted CoC bearing, and the overall survival rate was 97% after an average follow-up of 9.3 years. Therefore, it is wise to utilize CoP and CoC as the bearing of choice for youth[26; 28]. In this study, AVN (30 hips) was the most common diagnosis among 49 hips, and the pathogenic factors were trauma (8 hips), idiopathic (9 hips), hormone (8 hips) and alcohol (2 hips). This is comparable to the findings of Konopitski[ 5 ], who revealed that THA indications had evolved over time. From 1971 to 1992, the most prevalent surgical indication was JIA, followed by DDH and post-traumatic arthritis. From 2000 to 2015, the most common indication for THA was AVN. This may be related to the early diagnosis and treatment of JIA and DDH, resulting in a lower frequency of late complications associated with these diseases[ 33 ]. In young patients, acetabular and femoral prosthesis loosening and polyethylene wear are the major causes of revision, with aseptic loosening accounting for up to 60% of THA failure[8; 34; 35]. The history of one or more previous procedures, hip trauma, disorders affecting lower limb function, and a high preoperative BMI will all raise the failure rate[ 4 ]. Besides, Ravi[ 36 ] believed that the risk of revision is also closely related to the annual operation volume of the surgeon. When the surgeon does fewer than 35 THA per year, the probability of early revision of THA increases. Therefore, competent surgeons and a thorough preoperative examination can effectively lower the chance of THA failure in young patients. In our study, all patients got a thorough preoperative evaluation, and the operations were performed by experienced chief physicians, resulting in good clinical and imaging outcomes. Conclusion We ascribe the majority of patients' improvement in this study to uncemented implants, the use of CoC and CoP bearings, enhanced surgical procedures, and higher bone quality in younger patients. Along with the continuous renewal of prostheses and the development of new technologies such as computer navigation, the number of young patients will increase, and they will be able to obtain a better surgical outcome. These data can help surgeons in decision-making and improve confidence in young patients. This research is a retrospective study of a small sample with selection bias, and the length of the follow-up period may impact the accuracy of the results. Future multicenter, large-sample, randomized, controlled trials are required to evaluate the efficacy of uncemented THA in young patients. Abbreviations THA: Total hip arthroplasty AN: avascular necrosis JIA: juvenile idiopathic arthritis K-L: Kocher-Langebeck approach mHHS: modified Harris hip Score WOMAC: Western Ontario & McMaster Universities Osteoarthritis Index SF-36: Short-Form 36 PCS: Physical Component Summary MCS: Mental Component summary CoP: ceramic-on-highly cross-linked polyethylene CoC: ceramic-on-ceramic MoP: metal-on- highly cross-linked polyethylene AVN: Avascular necrosis of the femoral head DDH: Developmental Dysplasia of the Hip RA: Rheumatoid arthritis AS: Ankylosing spondylitis OA: osteoarthritis Declarations Ethics approval and consent to participate The study was approved by Ethics Committee of The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army. This study was a retrospective study, the Committee waived the requirement for written informed consent because the patient data remained anonymous and the study had no adverse effects on patient health. All methods were carried out in accordance with relevant guidelines and regulations, and follows the ethical principles of the Declaration of Helsinki 1964. Consent for publication Verbal consent was obtained from all patients. Availability of data and materials All data generated or analyzed during this study are included in this published article. Competing interests The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article. Funding Science and technology project of Gansu Province (No.20JR5RA588); Military Logistics Research Project (No. CWH17J009); Lan Zhou Talent Innovation and Entrepreneurship Project (No.2019-RC-65); the Youth Science and Technology Foundation of Gansu Province (No.21JR7RA014); Gansu Provincial Key R&D Program (No.21YF5FA154) Authors' contributions Yu XY and Zhan LR contributed equally to this work and should be considered as equal first authors. Yu XY and Zhan LR wrote the manuscript and revised it. Qiao YJ, Li XS, Li ZY, Song XY, Zhang WH completed follow-up visits and collected data. Zhang HQ made the final review and revision of the manuscript. Acknowledgements All authors acknowledge the fund support and thank the 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army. References Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. 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Arch Orthop Trauma Surg, 142(9):2371–2380 Pierannunzii LM (2008) Thigh pain after total hip replacement: a pathophysiological review and a comprehensive classification. Orthopedics, 31(7):691–699; quiz 700 – 691 Morrey BF (2011) Cementless Femoral Fixation in Total Hip Arthroplasty. Yearbook of Orthopedics, 2011:148–149 Pallante GD, Statz JM, Milbrandt TA, Trousdale RT (2020) Primary Total Hip Arthroplasty in Patients 20 Years Old and Younger. J Bone Joint Surg Am, 102(6):519–525 Urban JA, Garvin KL, Boese CK, et al. (2001) Ceramic-on-polyethylene bearing surfaces in total hip arthroplasty. Seventeen to twenty-one-year results. J Bone Joint Surg Am, 83(11):1688–1694 Rajaee SS, Trofa D, Matzkin E, Smith E (2012) National trends in primary total hip arthroplasty in extremely young patients: a focus on bearing surface usage. 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Orthopade, 50(9):742–749 Mulcahy H, Chew FS (2012) Current concepts of hip arthroplasty for radiologists: part 1, features and radiographic assessment. AJR Am J Roentgenol, 199(3):559–569 Kahlenberg CA, Swarup I, Krell EC, Heinz N, Figgie MP (2019) Causes of Revision in Young Patients Undergoing Total Hip Arthroplasty. J Arthroplasty, 34(7):1435–1440 Ravi B, Jenkinson R, Austin PC, et al. (2014) Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study. BMJ (Clinical research ed.), 348:g3284 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3562066","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":249240131,"identity":"26962fc1-3bae-44e2-93d0-415d49e1f652","order_by":0,"name":"Xin-Yuan Yu","email":"","orcid":"","institution":"The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xin-Yuan","middleName":"","lastName":"Yu","suffix":""},{"id":249240132,"identity":"3f183dcb-7dfb-4d4c-a49f-62ae2ce10c34","order_by":1,"name":"Yong-Jie Qiao","email":"","orcid":"","institution":"The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yong-Jie","middleName":"","lastName":"Qiao","suffix":""},{"id":249240133,"identity":"d9372715-d775-4880-9031-5e5fd20f1a56","order_by":2,"name":"Xu-Sheng Li","email":"","orcid":"","institution":"The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xu-Sheng","middleName":"","lastName":"Li","suffix":""},{"id":249240134,"identity":"c90d7b46-4ca3-4b7e-8052-8f15b49d5f8f","order_by":3,"name":"Zi-Yao Li","email":"","orcid":"","institution":"The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zi-Yao","middleName":"","lastName":"Li","suffix":""},{"id":249240135,"identity":"0255caac-23c2-4fd2-b50f-10419afb814d","order_by":4,"name":"Li-Rui Zhan","email":"","orcid":"","institution":"Western Theater General Hospital, Department of Orthopedics","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Li-Rui","middleName":"","lastName":"Zhan","suffix":""},{"id":249240138,"identity":"c2b70cb4-d3c0-432c-bb78-78a8672a9b99","order_by":5,"name":"Xiao-Yang Song","email":"","orcid":"","institution":"The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiao-Yang","middleName":"","lastName":"Song","suffix":""},{"id":249240141,"identity":"85649bff-9704-4a9b-962d-f42868ad78f4","order_by":6,"name":"Wen-Hua Zhang","email":"","orcid":"","institution":"The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wen-Hua","middleName":"","lastName":"Zhang","suffix":""},{"id":249240145,"identity":"d7e30816-b5ef-4863-a9e5-ec0a9dedafc9","order_by":7,"name":"Hao-Qiang Zhang","email":"data:image/png;base64,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","orcid":"","institution":"The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Hao-Qiang","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2023-11-05 11:14:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3562066/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3562066/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":46572343,"identity":"f4ee873f-bc33-4ed4-bff2-b640ad3ac2e9","added_by":"auto","created_at":"2023-11-16 16:03:35","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":559604,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA 24-year-old male patient who undergone the left THA.\u003c/strong\u003e A. Preoperative anteroposterior pelvic X-ray showed left femoral head necrosis. B. Anteroposterior pelvic X-ray immediately after surgery; C. Lateral hip joint X-ray immediately after surgery; D. Anteroposterior hip joint X-ray 3 years after surgery; E. Lateral hip joint X-ray 3 years after surgery. F. Anteroposterior pelvic X-ray at the latest follow-up.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3562066/v1/9940a188b43eeeb5f870a02f.jpeg"},{"id":46572344,"identity":"adf21ced-5f32-4509-b7b2-7d8b01a3f6b2","added_by":"auto","created_at":"2023-11-16 16:03:35","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":439761,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA 22-years-old female patient who undergone the left THA.\u003c/strong\u003e A. Preoperative anteroposterior pelvic X-ray showed left DDH; B. Anteroposterior pelvic X-ray immediately after surgery; C. Lateral hip joint X-ray immediately after surgery; D. Anteroposterior pelvic X-ray at the latest follow-up.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3562066/v1/dc7eabcc1cdf6cb98c0049a0.jpeg"},{"id":48315995,"identity":"de107626-0fa6-4785-9153-b7ae5b444900","added_by":"auto","created_at":"2023-12-16 09:37:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":537866,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3562066/v1/551001ef-f382-4a67-a789-b4c39a335954.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Medium-term outcomes of uncemented total hip arthroplasty in patients younger than 25 years old: A retrospective research","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTotal hip arthroplasty (THA) has been routinely utilized to treat advanced hip diseases in the elderly. It has been praised as \u0026ldquo;one of the most successful operations in the 20th century\u0026rdquo; because of its remarkable clinical performance[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Several diseases, such as avascular necrosis (AN), juvenile idiopathic arthritis (JIA), infection, and chronic dislocation, may cause disabling symptoms in young adults, but THA is rarely recommended to young patients due to multiple factors, including activity level, social attributes, the longevity of implants, subsequent revision, and surgery complications.[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, THA can reduce patients' financial burden and achieve a more accurate outcome when compared to the potential additional expenses that may result from conservative treatment. Therefore, THA is an effective and cost-effective choice for the treatment of young patients with advanced hip disease.\u003c/p\u003e \u003cp\u003eCurrently, cemented and uncemented fixation are the two main methods of THA, and the efficacy of these two methods has been controversial [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This study seeks to determine and report the clinical and radiographic outcomes of the mid-term follow-up of uncemented THA in patients under the age of 25 in order to provide doctors with a reference for future surgical decision-making.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion Criteria\u003c/h2\u003e \u003cp\u003e(1) Patients who underwent THA due to end-stage hip disease at the Department of Orthopedics of the 940th Hospital of Joint Logistic Support Force of Chinese People\u0026rsquo;s Liberation Army. (2) Patients who were under 25 at the time of surgery. (3) patients who received uncemented THA.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eExclusion Criteria\u003c/h2\u003e \u003cp\u003e(1) Patients undergoing tumor-type THA for hip cancer; (2) Patients undergoing THA due to hip infection;(3) The duration of follow-up was less than three years; (4) Patients who were lost to follow-up or had incomplete data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eOperation Method\u003c/h2\u003e \u003cp\u003eThe patient was positioned in a healthy lateral decubitus position following a satisfactory anesthetic. The epidermis, subcutaneous tissue, and fascia lata were sliced progressively using a 12-centimeter-long Kocher-Langebeck (K-L) approach. The gluteus maximus muscle was split and retracted anteriorly to reveal the gluteus medius muscle. The hip joint was exposed by severing the external rotation muscle group and joint capsule complex from the external posterior edge of the greater trochanter. The femoral head was removed 1 cm above the lesser trochanter after external rotation and oblique osteotomy. The labrum surrounding the acetabulum was excised, exposing the acetabulum in its entirety and cleaning the soft tissue of the acetabulum. In the hip joint, the proximal femur was exposed, followed by an open mouth opening with a medullary cavity number file and expanding pulp, a test after selecting an appropriate type side femoral prosthesis and neck long femoral head, and a hip reset immediately after the installation of the femoral prosthesis handle and femoral head prosthesis, all directions without dislocation of the hip and the impact of the event.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePerioperative Management\u003c/h2\u003e \u003cp\u003e(1) Infection prevention: Use second-generation cephalosporin antibiotics for 48 hours after surgery, change dressing frequently to avoid exudation, and insert a drainage tube within 24h following the operation. (2) Thrombus prevention: Nadroparin Calcium Injection 3075 IU was injected subcutaneously once daily, and rivaroxaban tablet 10 mg was taken orally once a day after discharge until 5 weeks after surgery; Lower extremity pressure therapy instrument was used twice a day. Besides, patients were encouraged to perform lower limb ankle pump exercise. (3) Functional exercise: non-weight-bearing standing exercises were conducted the day after surgery, and partial weight-bearing exercises were performed two weeks later. Walking with crutches and carrying weight began six weeks following surgery. Walking without a cane three months following surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eClinical Evaluation\u003c/h2\u003e \u003cp\u003eThe clinical outcome was assessed by modified Harris hip Score (mHHS) and Western Ontario \u0026amp; McMaster Universities Osteoarthritis Index (WOMAC), while the Quality of life was evaluated by the Short-Form 36 (SF-36). Additionally, post-operative complications will be recorded (e.g., infection, revision, dislocation, wound healing problems, etc.). The goal of mHHS is to measure preoperative function impairment and postoperative improvement. The WOMAC index is used to evaluate changes in health following surgery, higher scores imply a poorer prognosis. The SF-36 is a generic questionnaire on quality of life which can be divided into a Physical Component Summary (PCS) and Mental Component summary (MCS), higher scores indicate a better outcome.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRadiographic Evaluation\u003c/h2\u003e \u003cp\u003eRadiographic follow-up was performed in the anteroposterior pelvis, anteroposterior and lateral hip joint X-ray. Included in the evaluation were implants position, loosening, bearing-surface wear, osteolysis, heterotopic ossification and filling ratio. The appearance of a complete radiolucent line on radiography, the femur sinking by 2mm or more, or the acetabular prosthesis shifting by more than 4 mm horizontally or vertically, or turning by more than 5 degrees, was characterized as loosening. In addition, if loosening was discovered, it was recorded by the Charnley\u0026rsquo;s three acetabular zones and the Gruen\u0026rsquo;s seven femoral zones [2; 8]. According to Tsukanaka's previous report, osteolysis was defined as a clear area\u0026thinsp;\u0026ge;\u0026thinsp;3 mm in diameter surrounding the prosthesis[8; 9]. On the anteroposterior and lateral X-rays, the filling ratio was assessed at three levels: the upper border of the lesser trochanter, the mid-stem, and 1 cm proximal to the prosthesis tip[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTHA failure was defined as loosening of the acetabular or femoral prosthesis or revision for any reason.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Method\u003c/h2\u003e \u003cp\u003e The measurement data in accordance with normal distribution were expressed as (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD), paired sample t-tests were used for clinical scores and independent sample t-tests were used for comparison between different liners. \u003cem\u003eP\u003c/em\u003e＜0.05 was considered statistically significant. All the analysis were performed with SPSS software version 25.0 (SPSS, IBM, Armonk, NY, USA).\u003c/p\u003e \u003cp\u003e After all participants were identified, we gathered their contact information and verbal consent for the study. This study was a retrospective study, and the Committee waived the requirement for written informed consent because the patient data remained anonymous and the study had no adverse effects on patient health.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 89 patients (112 hips) who underwent THA in our department from January 2009 to December 2018 were screened according to the inclusion criteria. Following exclusion criteria, 37 patients (49 hips) were enrolled in this study, including 26 males (33 hips) and 11 females (16 hips). The general data of the patients are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age was (21.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6) years (19\u0026ndash;25 years), with 29 left-sided hips (48.1%) and 20 right-sided hips (51.9%). 12 patients received bilateral THA and 25 patients underwent unilateral THA. The average body mass index (BMI) was (22.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2) kg/m\u003csup\u003e2\u003c/sup\u003e (16.8\u0026ndash;29.1 kg/m\u003csup\u003e2\u003c/sup\u003e). The mean duration of follow-up time was (8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4) years (3.8\u0026ndash;12 years).\u003c/p\u003e \u003cp\u003eThe average length of hospitalization was (13\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7) days (5\u0026ndash;18 days). 4 hips received general anesthesia, while 45 hips received intrathecal anesthesia. The average operation time was (128.2\u0026thinsp;\u0026plusmn;\u0026thinsp;40.8) minutes (60\u0026ndash;240 minutes), and the average intraoperative blood loss was (360.6\u0026thinsp;\u0026plusmn;\u0026thinsp;171.4) ml (150\u0026ndash;800 ml). On the choice of bearing surfaces, 23 hips (46.9%) were lined with the ceramic-on-highly cross-linked polyethylene (CoP), and 26 hips (53.1%) were lined with the ceramic-on-ceramic (CoC). There was no significant difference between the two bearing surfaces at the latest follow-up, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The causes of 49 hips included Avascular necrosis of the femoral head (AVN) (30 hips), Developmental Dysplasia of the Hip (DDH) (8 hips), Rheumatoid arthritis (RA) (5 hips), Ankylosing spondylitis (AS) (5 hips), and hip osteoarthritis (OA) (1 hip). In the patients with Avascular necrosis of femoral head, the causes were mainly trauma (11 hips), idiopathic (9 hips), hormone (8 hips), and alcohol (2 hips), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The preoperative modified Harris hip score was 43.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9 (range, 18 to 62) and increased to 88.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8 (range, 72 to 97), and the preoperative postoperative Western Ontario \u0026amp; McMaster Universities Osteoarthritis Index score improved from 43.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4 (range, 33.1 to 62.3) to 11.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8 (range, 2.5 to 25.8). The Physical Component score-SF-36 improved from 48.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6 (range, 36.4 to 61.3) to 81.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3 (range, 60.3to 97.5), and the Mental Component score-SF-36 increased from 56.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5 (range, 39.4 to 78.6) to 82.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9 (range, 54.7 to 97). The comparison of clinical scores is shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The latest X-ray revealed that the position of the implants did not change substantially since the postoperative image. The abduction angle of acetabular cup was 41.8\u0026deg; \u0026plusmn; 6.7\u0026deg; (range, 31\u0026deg; to 57\u0026deg;), the anteversion angle of acetabular cup was 18.2\u0026deg; \u0026plusmn; 3.6\u0026deg; (range, 9.5\u0026deg; to 25.7\u0026deg;), and the filling ratio was 90.1% \u0026plusmn; 3% (range, 85.2\u0026ndash;95.3%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The preoperative leg length discrepancy was 1.8 cm\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 cm (range, 1 cm to 5 cm) and reduced to 1.4 cm\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5 cm (range, 0.5 cm to 2.5 cm). No obvious loosening, wear, osteolysis, or heterotopic ossification. All components were stable and integrated. There were no differences between CoC and CoP bearing surfaces(\u003cem\u003eP\u003c/em\u003e＞0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral data of 37 patients (49 hips)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eNo. of patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eNo. of hips\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eAge at time of surgery(yr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e21.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMean body mass index(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e22.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eFollow-up time(yr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eHospitalization time(d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMean operation time(min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e128.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMean blood loss(ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e360.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLaterality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBearing surface\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eCoP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCoC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesia method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eGeneral anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eintrathecal anesthesia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of CoC and CoP\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003emodified Harris hip\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWOMAC\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe Physical Component score-SF-36\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe Mental Component score-SF-36\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80.4\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e＞0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e＞0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e＞0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e＞0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCauses of 49 hips\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAVN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eDDH\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eRA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eAS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eOA\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ethe causes of AVN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eIdiopathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eHormone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eAlcohol\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinical scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003emodified Harris hip score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWOMAC score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe Physical Component score-SF-36\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe Mental Component score-SF-36\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLatest follow up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-25.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-7.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e＜0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e＜0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e＜0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e＜0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eComplications and preoperative interventions\u003c/h2\u003e \u003cp\u003eA patient suffered a sinus tract at the surgical site more than 4 months after right THA, and was readmitted for surgical treatment. During the surgery, it was discovered that the sinus tract connected to the deep gluteus maximus muscle and hip capsule. The granulation tissue was entirely removed, and the liner and femoral head was replaced. One patient with bilateral femoral head necrosis received bilateral core decompression(CD) nine months prior to THA, whereas the other patient with more severe right femoral head necrosis than left underwent left core decompression during right THA. Before THA, all patients with trauma-induced femoral head necrosis had had various hip procedures, including closed reduction and cannulated screw internal fixation and open reduction and internal fixation.\u003c/p\u003e \u003cp\u003eAt the latest follow-up, the overall survival rate of the 49 hips was 98%.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAlthough THA has been widely utilized in elderly patients with advanced hip disease, its application in younger patients remains controversial. Torchia[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]discovered that the failure rates in young patients increased significantly over time, reaching as high as 45%. Halvorsen[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] reported 747 patients (881 hips) under the age of 21 who received THA and discovered an 86% 10-year survival rate. These high reported failure rates may be attributed to the design of early prosthesis and the cemented technique[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In light of these high failure rates, few young patients receive THA, and relevant data and study findings are still lacking. However, compared with the \"hip preservation\" treatment with uncertain efficacy and eventual surgery, THA can help young patients in regaining hip function, rebuilding normal social attributes, and reducing the impact of the disease on their studies, work and life. In this study, we focused on patients\u0026thinsp;\u0026le;\u0026thinsp;25 years who received uncemented THA. During an average of 8.3 years follow-up, the mHHS and WOMAC index significantly improved at the last follow-up, indicating that the uncemented THA is suitable for young patients and can achieve optimal performance. The quality of life, both physical and mental components, as measured by the SF-36, showed significant improvement in 49 hips. Furthermore, the latest X-ray revealed that the position of the implants did not change substantially since the postoperative image, and that there was no obvious loosening, wear, osteolysis, or heterotopic ossification. All components were stable and integrated. The total survival rate was 98%, which was comparable to the survival rate recorded in literature[4; 9; 14\u0026ndash;16].\u003c/p\u003e \u003cp\u003eTraditionally, the most common THA fixation methods are cemented and uncemented fixation. Cemented THA can achieve good initial stability, but the bone cement is particularly prone to fatigue fracture under long-term stress, and the bone cement particles generated can cause osteolysis around the prosthesis and lead to prosthesis loosening, which is more common in patients with high activity or young age; within contrast to cemented THA, the early stability of uncemented THA depends on the tight compression of bone tissue and prosthesis, while the later stability depends on the bone tissue growing into the prosthesis[17; 18]. It is generally accepted that uncemented THA has a better prognosis and is more conducive to at least one revision surgery in the future for patients with younger age, longer life expectancy, greater mobility, and good bone growth function[\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Although modern cement technology has increased the efficacy of prosthesis fixation, the risk of failure remains higher than with uncemented fixation. Buddhdev[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] reported 51 patients accepting uncemented THA at the age of 16.7 years, with an average survival rate of 97% after 9.3 years of follow-up. Smith[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] conducted a long-term follow-up of 50 hips undergoing cemented THA and found the revision rate to be 38%. Boyle[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] observed that the revision rates of cemented THA was significantly higher than uncemented THA. In this study, all 49 hips were treated with uncemented THA, thereby avoiding complications such as osteolysis and prosthesis loosening caused by bone cement.\u003c/p\u003e \u003cp\u003eAlthough uncemented prostheses reduce several issues associated with cemented prostheses, intraoperative and postoperative complications still exist. For instance, intraoperative cleavage fractures frequently occur in the proximal femur in order to ensure a close fit between implants and bone bed; in addition, a large amount of evidence proves that uncemented prostheses within two years of THA frequently exhibit varying degrees of micro thigh pain related to the distal femoral prosthesis [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In this study, no postoperative thigh pain was identified in 49 hips until the follow-up, which may be attributable to the close fit of the prosthesis to the bone bed during surgery and the patients' healthy bone mass.\u003c/p\u003e \u003cp\u003eAs uncemented implants have generally replaced the traditional cemented implants, the prosthesis bearing surfaces have undergone several iterations to reduce excessive wear and osteolysis[5; 25]. The CoP bearing has superior wetness, hardness and inertness, whereas the CoC bearing improves wear, wetness, biological inertia and osteolysis, and has become the most prevalent bearing surface in young patients over the past decade[21; 26\u0026ndash;31]. In this study, 49 THA were treated with CoP (23 cases, 46.9%) and CoC bearings (26 cases, 53.1%) respectively. The survival rate and clinical results of these two bearings at the latest follow-up were similar to those of Pallante[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], who retrospectively analyzed the clinical outcomes of CoP, CoC and metal-on- highly cross-linked polyethylene (MoP), finding CoC and CoP with excellent outcomes. Kim[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] found that highly cross-linked polyethylene had superior wear resistance compared to traditional polyethylene, and that neither osteolysis nor aseptic loosening of the prosthesis occurred. Buddhdev[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] evaluated 51 patients (60 hips) receiving THA at a mean age of 16.7 years, 60 hips adopted CoC bearing, and the overall survival rate was 97% after an average follow-up of 9.3 years. Therefore, it is wise to utilize CoP and CoC as the bearing of choice for youth[26; 28].\u003c/p\u003e \u003cp\u003eIn this study, AVN (30 hips) was the most common diagnosis among 49 hips, and the pathogenic factors were trauma (8 hips), idiopathic (9 hips), hormone (8 hips) and alcohol (2 hips). This is comparable to the findings of Konopitski[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], who revealed that THA indications had evolved over time. From 1971 to 1992, the most prevalent surgical indication was JIA, followed by DDH and post-traumatic arthritis. From 2000 to 2015, the most common indication for THA was AVN. This may be related to the early diagnosis and treatment of JIA and DDH, resulting in a lower frequency of late complications associated with these diseases[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn young patients, acetabular and femoral prosthesis loosening and polyethylene wear are the major causes of revision, with aseptic loosening accounting for up to 60% of THA failure[8; 34; 35]. The history of one or more previous procedures, hip trauma, disorders affecting lower limb function, and a high preoperative BMI will all raise the failure rate[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Besides, Ravi[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] believed that the risk of revision is also closely related to the annual operation volume of the surgeon. When the surgeon does fewer than 35 THA per year, the probability of early revision of THA increases. Therefore, competent surgeons and a thorough preoperative examination can effectively lower the chance of THA failure in young patients. In our study, all patients got a thorough preoperative evaluation, and the operations were performed by experienced chief physicians, resulting in good clinical and imaging outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe ascribe the majority of patients' improvement in this study to uncemented implants, the use of CoC and CoP bearings, enhanced surgical procedures, and higher bone quality in younger patients. Along with the continuous renewal of prostheses and the development of new technologies such as computer navigation, the number of young patients will increase, and they will be able to obtain a better surgical outcome. These data can help surgeons in decision-making and improve confidence in young patients. This research is a retrospective study of a small sample with selection bias, and the length of the follow-up period may impact the accuracy of the results. Future multicenter, large-sample, randomized, controlled trials are required to evaluate the efficacy of uncemented THA in young patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTHA: Total hip arthroplasty\u003c/p\u003e\n\u003cp\u003eAN: avascular necrosis\u003c/p\u003e\n\u003cp\u003eJIA: juvenile idiopathic arthritis\u003c/p\u003e\n\u003cp\u003eK-L: Kocher-Langebeck approach\u003c/p\u003e\n\u003cp\u003emHHS: modified Harris hip Score\u003c/p\u003e\n\u003cp\u003eWOMAC: Western Ontario \u0026amp; McMaster Universities Osteoarthritis Index\u003c/p\u003e\n\u003cp\u003eSF-36: Short-Form 36\u003c/p\u003e\n\u003cp\u003ePCS: Physical Component Summary\u003c/p\u003e\n\u003cp\u003eMCS: Mental Component summary\u003c/p\u003e\n\u003cp\u003eCoP: ceramic-on-highly cross-linked polyethylene\u003c/p\u003e\n\u003cp\u003eCoC: ceramic-on-ceramic\u003c/p\u003e\n\u003cp\u003eMoP: metal-on- highly cross-linked polyethylene\u003c/p\u003e\n\u003cp\u003eAVN: Avascular necrosis of the femoral head\u003c/p\u003e\n\u003cp\u003eDDH: Developmental Dysplasia of the Hip\u003c/p\u003e\n\u003cp\u003eRA: Rheumatoid arthritis\u003c/p\u003e\n\u003cp\u003eAS: Ankylosing spondylitis\u003c/p\u003e\n\u003cp\u003eOA: osteoarthritis\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by Ethics Committee of The 940th Hospital of Joint Logistic Support Force of Chinese People\u0026rsquo;s Liberation Army. This study was a retrospective study, the Committee waived the requirement for written informed consent because the patient data remained anonymous and the study had no adverse effects on patient health. All methods were carried out in accordance with relevant guidelines and regulations, and follows the ethical principles of the Declaration of Helsinki 1964.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVerbal consent was obtained from all patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eScience and technology project of Gansu Province (No.20JR5RA588); Military Logistics Research Project (No. CWH17J009); Lan Zhou Talent Innovation and Entrepreneurship Project (No.2019-RC-65); the Youth Science and Technology Foundation of Gansu Province (No.21JR7RA014); Gansu Provincial Key R\u0026amp;D Program (No.21YF5FA154)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYu XY and Zhan LR contributed equally to this work and should be considered as equal first authors. Yu XY and Zhan LR wrote the manuscript and revised it. \u0026nbsp;Qiao YJ, Li XS, Li ZY, Song XY, Zhang WH completed follow-up visits and collected data. Zhang HQ made the final review and revision of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors acknowledge\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ethe fund support and thank the 940th Hospital of Joint Logistic Support Force of Chinese People\u0026rsquo;s Liberation Army.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLearmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet (London, England), 370(9597):1508\u0026ndash;1519\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeitlinger L, Gemayel A, Whitlock P, Sorger J (2021) Implant Survival and Clinical Outcomes of Total Hip Arthroplasty in Adolescent and Young Adult Patients. The Journal of Hip Surgery, 05(02):062\u0026ndash;069\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerguson RJ, Palmer AJR, Taylor A, Porter ML, Malchau H, Glyn-Jones S (2018) Hip replacement. The Lancet, 392(10158):1662\u0026ndash;1671\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRestrepo C, Lettich T, Roberts N, Parvizi J, Hozack WJ (2008) Uncemented total hip arthroplasty in patients less than twenty-years. Acta orthopaedica Belgica, 74(5):615\u0026ndash;622\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKonopitski A, Okafor C, Smith B, Baldwin K, Sheth NP (2022) Evolution of total hip arthroplasty in patients younger than 30 years of age: A systematic review and meta-analysis. Arch Orthop Trauma Surg\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkytta ET, Jarkko L, Antti E, Huhtala H, Ville R (2011) Increasing incidence of hip arthroplasty for primary osteoarthritis in 30- to 59-year-old patients. Acta Orthop, 82(1):1\u0026ndash;5\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorten K, Bourne RB, Charron KD, Au K, Rorabeck CH (2011) What works best, a cemented or cementless primary total hip arthroplasty?: minimum 17-year followup of a randomized controlled trial. Clin Orthop Relat Res, 469(1):209\u0026ndash;217\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang CY, Huang AJ, Palmer WE (2015) Radiographic evaluation of hip implants. Semin Musculoskelet Radiol, 19(1):12\u0026ndash;20\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsukanaka M, Halvorsen V, Nordsletten L, et al. (2016) Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old. Acta Orthop, 87(5):479\u0026ndash;484\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim YH, Kim VE (1993) Uncemented porous-coated anatomic total hip replacement. Results at six years in a consecutive series. J Bone Joint Surg Br, 75(1):6\u0026ndash;13\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTorchia ME, Klassen RA, Bianco AJ (1996) Total hip arthroplasty with cement in patients less than twenty years old. Long-term results. J Bone Joint Surg Am, 78(7):995\u0026ndash;1003\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHalvorsen V, Fenstad AM, Engesaeter LB, et al. (2019) Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995\u0026ndash;2016. Acta Orthop, 90(4):331\u0026ndash;337\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeller V, Lhotellier L, Marmor S, et al. (2014) One-stage exchange arthroplasty for chronic periprosthetic hip infection: results of a large prospective cohort study. J Bone Joint Surg Am, 96(1):e1\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePakos EE, Paschos NK, Xenakis TA (2014) Long Term Outcomes of Total Hip Arthroplasty in Young Patients under 30. Arch Bone Jt Surg, 2(3):157\u0026ndash;162\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahiques-Segura G, Lizaur-Utrilla A, Vizcaya-Moreno MF, Miralles-Munoz FA, Lopez-Prats FA (2019) A Comparison Study of the Outcomes of Ceramic-on-Ceramic Total Hip Arthroplasty in Young vs Older Patients: A Minimum 10-Year Follow-Up Prospective Matched Study. J Arthroplasty, 34(8):1731\u0026ndash;1735\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmitz MW, Busch VJ, Gardeniers JW, Hendriks JC, Veth RP, Schreurs BW (2013) Long-term results of cemented total hip arthroplasty in patients younger than 30 years and the outcome of subsequent revisions. BMC Musculoskelet Disord, 14:37\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoyle AB, Zhu M, Frampton C, Vane A, Poutawera V (2021) Comparing uncemented, hybrid and cemented primary total hip arthroplasty in young patients, a New Zealand Joint Registry study. Arch Orthop Trauma Surg\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarimani B, Alraiyes T, Epure LM, et al. (2022) Long-Term Survivorship of Cemented and Uncemented Polyethylene Liner Exchange. J Arthroplasty, 37(11):2247\u0026ndash;2250\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eToci GR, Magnuson JA, DeSimone CA, Stambough JB, Star AM, Saxena A (2022) A Systematic Review and Meta-Analysis of Non-database Comparative Studies on Cemented Versus Uncemented Femoral Stems in Primary Elective Total Hip Arthroplasty. J Arthroplasty, 37(9):1888\u0026ndash;1894\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoyle AB, Zhu M, Frampton C, Poutawera V, Vane A (2022) Comparing modern uncemented, hybrid and cemented implant combinations in older patients undergoing primary total hip arthroplasty, a New Zealand Joint Registry study. Arch Orthop Trauma Surg\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuddhdev PK, Vanhegan IS, Khan T, Hashemi-Nejad A (2020) Early to medium-term outcomes of uncemented ceramic-bearing total hip arthroplasty in teenagers for paediatric hip conditions. Bone Joint J, 102-b(11):1491\u0026ndash;1496\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith SE, Estok DM, 2nd, Harris WH (2000) 20-year experience with cemented primary and conversion total hip arthroplasty using so-called second-generation cementing techniques in patients aged 50 years or younger. J Arthroplasty, 15(3):263\u0026ndash;273\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoyle AB, Zhu M, Frampton C, Vane A, Poutawera V (2022) Comparing uncemented, hybrid and cemented primary total hip arthroplasty in young patients, a New Zealand Joint Registry study. Arch Orthop Trauma Surg, 142(9):2371\u0026ndash;2380\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePierannunzii LM (2008) Thigh pain after total hip replacement: a pathophysiological review and a comprehensive classification. Orthopedics, 31(7):691\u0026ndash;699; quiz 700 \u0026ndash; 691\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorrey BF (2011) Cementless Femoral Fixation in Total Hip Arthroplasty. Yearbook of Orthopedics, 2011:148\u0026ndash;149\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePallante GD, Statz JM, Milbrandt TA, Trousdale RT (2020) Primary Total Hip Arthroplasty in Patients 20 Years Old and Younger. J Bone Joint Surg Am, 102(6):519\u0026ndash;525\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUrban JA, Garvin KL, Boese CK, et al. (2001) Ceramic-on-polyethylene bearing surfaces in total hip arthroplasty. Seventeen to twenty-one-year results. J Bone Joint Surg Am, 83(11):1688\u0026ndash;1694\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRajaee SS, Trofa D, Matzkin E, Smith E (2012) National trends in primary total hip arthroplasty in extremely young patients: a focus on bearing surface usage. J Arthroplasty, 27(10):1870\u0026ndash;1878\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeaule PE, Campbell P, Mirra J, Hooper JC, Schmalzried TP (2001) Osteolysis in a cementless, second generation metal-on-metal hip replacement. 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J Bone Joint Surg Am, 95(12):1088\u0026ndash;1093\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShakya H, Zhou K, Yao SY, Dahal S, Zhou ZK (2021) Short to mid-term outcome of total hip arthroplasty with cementless implants in patients younger than 25 years old. Orthopade, 50(9):742\u0026ndash;749\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMulcahy H, Chew FS (2012) Current concepts of hip arthroplasty for radiologists: part 1, features and radiographic assessment. AJR Am J Roentgenol, 199(3):559\u0026ndash;569\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKahlenberg CA, Swarup I, Krell EC, Heinz N, Figgie MP (2019) Causes of Revision in Young Patients Undergoing Total Hip Arthroplasty. J Arthroplasty, 34(7):1435\u0026ndash;1440\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRavi B, Jenkinson R, Austin PC, et al. (2014) Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study. BMJ (Clinical research ed.), 348:g3284\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Young Adults, Femur Head Necroses, Total Hip Arthroplasty, Prostheses and Implants, Survivorship","lastPublishedDoi":"10.21203/rs.3.rs-3562066/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3562066/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To evaluate the medium-term outcomes of uncemented total hip arthroplasty in patients ≤ 25 years.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective research was performed on patients ≤ 25 who received uncemented total hip arthroplasty at the Department of Orthopedics of the 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army from January 2009 to December 2018. The clinical evaluation was measured with modified Harris Hip Score, Western Ontario \u0026amp; McMaster Universities Osteoarthritis Index, and Short-Form 36. Postoperative complications (such as infection, revision, dislocation, and incisional healing issues) were recorded. Using pelvic anteroposterior, hip anteroposterior and lateral X-rays, the radiographic outcome was evaluated, including the position of the implants, loosening, bearing-surface wear, osteolysis, and heterotopic ossification. Loosening of the acetabular or femoral component or revision for any reason was defined as failure.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAt a follow-up of 8.3±2.4 years (range, 3.8 to 12 years), the preoperative modified Harris hip score was 43.5±12.9 (range, 18 to 62) and increased to 88.3 ± 8.8 (range, 72 to 97), and the preoperative postoperative Western Ontario \u0026amp; McMaster Universities Osteoarthritis Index score improved from 43.6±8.4 (range, 33.1 to 62.3) to 11.5 ± 6.8 (range, 2.5 to 25.8). The Physical Component score-SF-36 improved from 48.5 ± 8.6 (range, 36.4 to 61.3) to 81.2 ± 10.3 (range, 60.3 to 97.5), while the Mental Component score-SF-36 increased from 56.6±12.5 (range, 39.4 to 78.6) to 82.6 ± 12.9 (range, 54.7 to 97). The latest X-ray revealed that the position of the implants did not change substantially since the postoperative image. The abduction angle of acetabular cup was 41.8° ± 6.7° (range, 31° to 57°),the anteversion angle of acetabular cup was 18.2° ± 3.6° (range, 9.5° to 25.7°), and the filling ratio was 90.1% ± 3% (range, 85.2%-95.3%). The preoperative leg length discrepancy was 1.8 cm ± 0.8 cm (range, 1 cm to 5 cm) and reduced to 1.4 cm ± 0.5 cm (range, 0.5 cm to 2.5 cm). No considerable loosening, bearing-surface wear, osteolysis, or heterotopic ossification was observed. At the latest follow-up, the overall survival rate of the 49 hips was 98%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e For patients with end-stage hip disease under 25 years old, uncemented THA exhibit excellent outcomes, with a high survival rate and fewer complications at medium-term follow-up.\u003c/p\u003e","manuscriptTitle":"Medium-term outcomes of uncemented total hip arthroplasty in patients younger than 25 years old: A retrospective research","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-11-16 16:03:30","doi":"10.21203/rs.3.rs-3562066/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8bb45075-e711-4fba-b6cd-5d6fc3d8c101","owner":[],"postedDate":"November 16th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-12-16T09:29:20+00:00","versionOfRecord":[],"versionCreatedAt":"2023-11-16 16:03:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3562066","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3562066","identity":"rs-3562066","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}