Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
Bone Joint J. 2018 Jul;100-B(7):867-874. doi: 10.1302/0301-620X.100B7.BJJ-2017-1603.R1.
For this retrospective cohort study, patients aged ≤ 30 years (very young) who underwent total hip arthroplasty (THA) were compared with patients aged ≥ 60 years (elderly) to evaluate the rate of revision arthroplasty, implant survival, the indications for revision, the complications, and the patient-reported outcomes.
We retrospectively reviewed all patients who underwent primary THA between January 2000 and May 2015 from our institutional database. A total of 145 very young and 1359 elderly patients were reviewed. The mean follow-up was 5.3 years (1 to 18). Logistic generalized estimating equations were used to compare characteristics and the revision rate. Survival was evaluated using Kaplan-Meier curves and hazard rates were created using Cox regression.
The overall revision rate was 11% (16/145) in the very young and 3.83% (52/1359) in the elderly groups (odds ratio (OR) 2.58, 95% confidence interval (CI) 1.43 to 4.63). After adjusting for the American Society of Anesthesiologists (ASA) score, gender, and a history of previous surgery in a time-to-event model, the risk of revision remained greater in the very young (adjusted hazard ratio (HR) 2.48, 95% CI 1.34 to 4.58). Survival at ten years was 82% (95% CI, 71 to 89) in the very young and 96% (95% CI, 94 to 97) in the elderly group (p < 0.001). The very young had a higher rate of revision for complications related to metal-on-metal (MoM) bearing surfaces (p < 0.001). At last follow-up, the very young group had higher levels of physical function (p = 0.002), lower levels of mental health (p = 0.001), and similar levels of pain (p = 0.670) compared with their elderly counterparts.
The overall revision rate was greater in very young THA patients. This was largely explained by the use of MoM bearings. Young patients with non-MoM bearings had high survivorship with similar complication profiles to patients aged ≥ 60 years. Cite this article: Bone Joint J 2018;100-B:867-74.
本回顾性队列研究比较了≤30 岁（非常年轻）和≥60 岁（老年）接受全髋关节置换术（THA）的患者，以评估翻修率、假体生存率、翻修指征、并发症和患者报告的结果。
我们回顾性分析了 2000 年 1 月至 2015 年 5 月期间我院数据库中所有接受初次 THA 的患者。共回顾了 145 例非常年轻的患者和 1359 例老年患者。平均随访时间为 5.3 年（1 至 18 年）。采用逻辑广义估计方程比较特征和翻修率。采用 Kaplan-Meier 曲线评估生存率，并采用 Cox 回归创建危险率。
非常年轻组的总体翻修率为 11%（16/145），老年组为 3.83%（52/1359）（比值比（OR）2.58，95%置信区间（CI）1.43 至 4.63）。在时间事件模型中，调整美国麻醉医师协会（ASA）评分、性别和既往手术史后，非常年轻组的翻修风险仍然更高（校正后的危险比（HR）2.48，95%CI 1.34 至 4.58）。非常年轻组的 10 年生存率为 82%（95%CI，71 至 89），老年组为 96%（95%CI，94 至 97）（p<0.001）。非常年轻组因金属对金属（MoM）轴承表面相关并发症而导致翻修的比例更高（p<0.001）。末次随访时，非常年轻组的身体功能评分更高（p=0.002），心理健康评分更低（p=0.001），疼痛评分相似（p=0.670）。
非常年轻的 THA 患者总体翻修率更高。这在很大程度上归因于 MoM 轴承的使用。非 MoM 轴承的年轻患者具有较高的生存率，并发症谱与≥60 岁患者相似。
Bone Joint J 2018;100-B:867-74.
