LONG-TERM OUTCOMES OF TOTAL HIP REPLACEMENT IN PATIENTS UNDER 50

Abstract

Background: Total hip replacement (THR) is an established and effective treatment for degenerative hip disease, traditionally performed in older adults. However, the increasing number of younger patients requiring THR presents unique challenges due to their higher activity levels and longer life expectancy. Evaluating long-term outcomes in this population is essential to determine the durability, functionality, and safety of modern implants and surgical techniques.

Methods: A retrospective cohort study was conducted on 120 patients who underwent primary THR under the age of 50 between 2005 and 2015, with a minimum follow-up of 10 years. Data were collected on demographic characteristics, etiological factors, implant type, fixation method, functional outcomes, and complications. Functional improvement was assessed using the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Statistical analysis was performed using SPSS version 25, with a significance level of p < 0.05.

Results: The study included 68 males (56.7%) and 52 females (43.3%), with a mean age of 43.2 ± 4.7 years and an average follow-up of 11.6 ± 1.3 years. Avascular necrosis was the most common indication (42.5%), and cementless fixation was used in 75% of cases. The mean HHS improved significantly from 45.6 ± 8.3 preoperatively to 91.4 ± 6.7 postoperatively (p < 0.001), while WOMAC scores decreased from 68.2 ± 9.4 to 18.7 ± 7.2 (p < 0.001). The overall complication rate was 20%, with heterotopic ossification (6.7%) and aseptic loosening (5.0%) being the most frequent. The 10-year implant survival rate was 90%, with a 10% revision rate, primarily due to aseptic loosening.

Conclusion: Total hip replacement in patients under 50 years of age provides excellent long-term functional outcomes and implant survival with low complication and revision rates. Cementless fixation and advanced bearing surfaces, particularly ceramic-on-ceramic combinations, contribute to durable performance in younger, active individuals. These results support the continued use of modern THR as a reliable and effective intervention for younger patients requiring hip joint reconstruction.