Indications and Early Outcome of Total HIP Arthroplasty in Young Adults at Muhimbili Orthopedic Institute from 2015 – 2019

Abstract

Total hip arthroplasty is an effective surgical procedure in patients with end stage hip diseases, example osteoarthritis (OA) and other degenerative hip diseases(1). In the recent years there is an increase in indication for total hip arthroplasty among young adults(2). The success of total hip arthroplasty with its improvement in techniques and biomaterial has increased demand for the procedure in young adults. The indications for primary and reoperation THA, early outcome and its associated risk factors for total hip arthroplasty in young adults are not well known at Muhimbili orthopedic institute. Objectives: To determine the indications, early outcome and associated risk factors for total hip arthroplasty among young adults operated at Muhimbili orthopedic institute from 2015 to 2019. Patients and methods: The study design was a hospital based descriptive retrospective cross-sectional study, involving 341 patients who underwent total hip arthroplasty at Muhimbili orthopedic institute (MOI) between 2015 to 2019. The study was set up in accordance with the Muhimbili University of Health and allied sciences standards using a valid structured questionnaire. Data were retrieved from MOI total joint registry, verified from patient’s files and hospital management information system (HMIS). Data were analyzed using statistical package for social sciences (SPSS version 20). The approval for the study was granted by Muhimbili University of health and allied Sciences ethical committee. Permission to conduct the study was granted by the executive director of Muhimbili orthopedic institute. Results A total of 341 patients were enrolled in the study, with mean age 40± SD 12 years and male predominance of 54.4% and female 46.6%. The leading indication for primary THA was osteoarthritis 48.2%, followed by avascular necrosis (AVN) 27.2%, femoral neck fracture 14.4%, neglected dislocation 4.9%, acetabular fracture 3.3% and DDH 1%. In majority of patients the implant of choice was the uncemented THA 85.6%, Hybrid THA 9.2% and the vi cemented THA 4.3%. Among 341 patients 36 (10.6%) showed early complications. Hip dislocation was the leading early complication 5.3% followed by aseptic loosening 2.1%, periprosthetic fracture 1.2%, implant mal position 1.2% and surgical site infection 0.9%. The complications showed male predominance 52.8% and female 47.2% and increased with advancing age, more at age group 46 to 55 years. The reoperation rate for THA within one year was 6.2%. Conclusion Total hip arthroplasty is common among young adults with mean age at the fourth decade of life. Osteoarthritis (OA) is the leading indication for primary THA followed by avascular necrosis of femoral head, femoral neck fractures, neglected hip dislocations, acetabular fracture, sequelae of hip infection and sequelae of childhood developmental hip dysplasia (DDH). The predominant implant of choice was the uncemented THA. The early complications after primary THA within one year requiring reoperations were due to hip dislocations followed by aseptic loosening, periprosthetic fractures, implant malposition and surgical site infection. The risk factors for reoperations within one year were associated with advancing age of patients and male gender