Thirty-five-Year Results After Charnley Total HipArthroplasty in Patients Less Than Fifty Years Old

We report the updated results for a previously described cohort of patients who were less than fifty years old at the time of the index Charnley total hip arthroplasty with cement. The original cohort consisted of ninety-three consecutive hips in sixty-nine patients. The patients were followed for a minimum of thirty-five years after surgery or until death. At the latest follow-up evaluation, there were forty-one total hip replacements (44%) in thirty-two living patients. Thirty-four (37%) of the ninety-three total hip replacements in the original cohort had been revised or removed. Twenty acetabular (22%) and seven femoral (8%) components had been revised for aseptic loosening. Since the twenty-five-year follow-up, the average six-minute-walk distance decreased from 395 m to 171 m, and this decrease correlated with increasing comorbidity. This study demonstrates the durability of cemented total hip replacements in a young patient population. Although 63% (fiftynine) of the ninety-three original hip replacements were functioning at the latest follow-up or at the time of death, a significant decrease in activity level was seen over time (p < 0.001). Of the forty-one original implants in the patients who were alive at the time of the thirty-five-year follow-up, only 46% (nineteen) were retained. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Background The purpose of the present study was to evaluate the results thirty-five years after Charnley total hip arthroplasty in a previously reported group of patients less than fifty years old at the time of index arthroplasty. We include data on patient function and radiographic follow-up. This series of patients represents a consecutive, nonselected cohort with all arthroplasties performed by a single surgeon (R.C.J.). In the original cohort, Charnley total hip arthroplasty was performed in ninety-three hips in sixty-nine patients. The *Original Publications Sullivan PM, MacKenzie JR, Callaghan JJ, Johnston RC. Total hip arthroplasty with cement in patients who are less than fifty years old. A sixteen to twentytwo-year follow-up study. J Bone Joint Surg Am. 1994 Jun;76(6):863-9. Callaghan JJ, Forest EE, Olejniczak JP, Goetz DD, Johnston RC. Charnley total hip arthroplasty in patients less than fifty years old. A twenty to twenty-fiveyear follow-up note. J Bone Joint Surg Am. 1998 May;80(5):704-14. Keener JD, Callaghan JJ, Goetz DD, Pederson DR, Sullivan PM, Johnston RC. Twenty-five-year results after Charnley total hip arthroplasty in patients less than fifty years old: a concise follow-up of a previous report. J Bone Joint Surg Am. 2003 Jun;85(6):1066-72. Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article. Peer Review: This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. It was also reviewed by an expert in methodology and statistics. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors. 1814 COPYRIGHT 2014 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED J Bone Joint Surg Am. 2014;96:1814-9 d http://dx.doi.org/10.2106/JBJS.M.01573 average age at the time of the index procedure was forty-two years (range, eighteen to forty-nine years). Thirty five patients were women, and thirty-four patients were men. A Charnley hip prosthesis (Thackray, Leeds, England, or Zimmer, Warsaw, Indiana) was used in all patients. A stainless-steel polished flatback or narrow femoral stem (modified to a thinner diameter in four hips) with a 22-mm-diameter head and an ultra-high molecular weight polyethylene acetabular component were inserted with cement. The cement was hand-packed, with surgery performed through the transtrochanteric approach. No antibiotics were used perioperatively (Fig. 1). Methods Radiographs were made at a minimum of thirty-five years (range, 35.1 to 40.8 years; average, 36.9 years) postoperatively for thirty-one of thirty-nine hips in living patients (excluding two previously explanted hips). Observations and serial measurements were based on anteroposterior pelvic radiographs made early in the postoperative period and usually at five-year intervals thereafter until the latest follow-up visit. Radiographic analysis of heterotopic ossification, femoral TABLE I Number of Revisions at Time of Final Follow-up Outcome All Hips* (N = 93) Hips of Patients Alive at ‡35 Years Following Index Surgery* (N = 41) Original prosthesis retained 59 (63%) 19 (46%)