Hip replacement in the young

Patients under 50–55 years of age are considered young to be having total hip replacements.
These patients nearly always have an identifiable cause for their premature arthritis making them different from normal 'wear and tear' arthritis of older age. These causes can often be identified if assessed by a surgeon experienced in these cases.

The commonest causes are:

  1. Dysplasia of the hip (DDH), where the cup of the hip and or the ball of the hip fail to form in the correct shape in early life. (Fig 1)

  2. Other childhood deformity such as Perthes disease and slipped hips.

  3. Femoro-acetabular impingement (FAI), when there is abnormal contact between the femur and the cup leading to damage to the joint.

  4. Injury to the joint (fractures and dislocations) (Fig 2).

  5. Avascular necrosis, where the ball of the hip collapses due to weakening of the bone.

  6. Infection.

  7. Inflammatory arthritis such as rheumatoid.
Stacks Image 1874
Fig 1: Dysplasia of the hip.
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Stacks Image 3622
Fig 2. Joint fractures and dislocations – fractured acetabulum.
 
Hip replacements in young patients have traditionally performed poorly because the patients put very high demands on their implants, and because they will be using their implants for decades longer than the older hip replacement patient. Also these patients frequently have deformity and previous surgery carried out on their hips, which can make the hip replacement surgery much more complicated.

Younger patients need careful evaluation, which may require special imaging such as CT scans. Deformity needs to be corrected as much as possible, and this may require special breaks in the bone, and frequently the use of specialist implants.

The weakest part of a conventional hip replacement is the bearing, which is where the movement occurs. Traditional bearings are made of high density plastic (UHMWP) and a metal head. Because these materials fail quickly in the young, special bearings are often chosen. Orthopaedics WA will select these depending on the individual needs of the patient, but will include ceramic materials, metal bearings, and especially hardwearing plastics. All of these materials have significant advantages but also potential risks associated with them, and need to be tailored to individual needs and circumstances.

Hip resurfacing

Hip resurfacing is a specialised kind of hip replacement suited to high activity, young, male patients without significant deformity. Advantages of this implant are preservation of bone and anatomy, hard-wearing bearings, stability, and very high levels of activity.

Even with he best implants, young patients must expect revision (redo) of their hip replacements, as they will inevitably wear out. Revision surgery is particularly complex and needs to be approached carefully by an experienced revision hip surgeon.

Orthopaedics WA offer the full range of options for treatment of the adult hip including resurfacing, ceramic bearings joint preserving procedures and revision.
See the frequently asked questions about hips. Also see the Related links on this page.
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