NEW YORK (MedscapeWire) Feb 19 — Orthopaedic surgeons are rethinking traditional wisdom about who is and who isn't a good candidate for total hip replacement surgery (THR).
Once reserved primarily for patients older than 60 years, the surgery offers a more desirable option for younger patients with disabling arthritis than previously believed, John J. Callaghan, MD, reported at the 69th Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Only 5% to 10% of the 150,000 to 200,000 total hip replacements performed each year are in patients younger than 50 years.

"That could change," said Dr. Callaghan, professor and Lawrence and Marilyn Door Chair of the Department of Orthopaedics at the University of Iowa. "Anyone under 60 with severe arthritis can be a candidate for THR if he or she is willing to take care of the hip."

That means making lifestyle changes, including a shift to more moderate activity — hiking, biking, and doubles tennis rather than jogging and high impact aerobics.

According to the results of a University of Iowa study of 70 patients presented by Dr. Callaghan at the AAOS meeting, the prostheses of 65% of patients who underwent THR before the age of 50 remained intact 25 years later.

"The finding means good news for younger patients, particularly because recent improvements in surgical materials are extending the life span of prostheses," explained Dr. Callaghan. "Younger patients could keep the same hip for 20 years or more.

"Standard surgical treatment for patients under the age of 50 with disabling arthritis has focused on the surgical fusion of the two bones of the hip," said Dr. Callaghan, who moderated a symposium at the meeting entitled "Total Hip Replacement in the Young Patient — So Many Options: What's Best for My Patients?"

Fusion eliminates pain but also renders the joint virtually immobile and often leads to back pain as the patient compensates for the restricted range of motion. Orthopaedic surgeons have traditionally steered clear of THR for younger patients, however, fearing complications, including deterioration or loosening of the prosthesis and an increased risk of repeat surgeries.

Strides in the development of surgical materials will make THR an even more viable option for younger patients. The recent fabrication of metal, plastic and ceramic prostheses with superior strength and durability will increase their longevity and reduce the need for additional procedures.

Hip prostheses consist of 2 components, a ball and a socket, that mimic the function of the natural hip. Until recently, most prostheses have been made of a metal ball and a socket lined with plastic. New prostheses pair metal with metal or ceramic with ceramic, and metal on more durable plastics, with the potential of reducing wear and tear on the prosthesis and producing joints with the potential for less wear problems.

"Prostheses introduced within the last year are allowing surgeons to replace a worn liner on the socket component of the prosthesis rather than the entire prosthesis," said Dr. Callaghan. He likened the process to changing tires on a car rather than buying a new car. The new socket liners work compatibly with metal, ceramic or plastic ball components.

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