JOA - 2026-04-16 - Journal Article
Epidemiology and Outcomes of Total Hip Arthroplasty in Patients Aged ≤ 30 Years: A Nationwide Population-Based Study in France From 2011 to 2022.
Barbier S, Leboucher C, Flecher X, Pauly V, François C, Boyer L
Topics
Key Takeaway
THA in patients ≤30 years (n=4,416; 0.4% of 1,017,320 primary THAs) carries a reintervention rate of 8.4% versus 6.3% in the general THA population over a mean 5.8-year follow-up, with aseptic loosening accounting for 4.9% of reinterventions.
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Summary
This nationwide French database study (PMSI, 2010–2023) compared primary THA outcomes in patients ≤30 years against the general THA population to quantify reintervention burden and procedural complexity in this subgroup. Patients ≤30 years more frequently required THA after femoral head reduction procedures (7.5% vs. 0.8%) and following prior fracture fixation or cervico-cephalic prosthesis (5.3% vs. 1.3%). Reintervention rates were higher (8.4% vs. 6.3%) and occurred faster, driven primarily by aseptic loosening (4.9% vs. 3.5%) and dislocation (2.7% vs. 2.0%).
Key Limitation
Absence of implant-level data (bearing surface, fixation mode, cup position) prevents determination of which surgical variables drive the excess reintervention rate, limiting actionable guidance for implant selection in this cohort.
Original Abstract
BACKGROUND
Total hip arthroplasty (THA) is an effective procedure, commonly performed following osteoarthritis in those over 70 years of age. In younger patients who have a longer life expectancy and higher functional demands, often with heterogeneous and complex hip disorders, it raises concerns about durability, complications, and follow-up care. Yet population-level data on this subgroup remains limited.
METHODS
We conducted a nationwide cohort study using the French national hospital database (PMSI) from 2010 to 2023. All patients undergoing primary THA were included and compared to the subgroup aged ≤ 30 years, evaluating surgical procedure types and reinterventions after the first THA. Among 1,017,320 patients who underwent primary THA, 4,416 (0.4%) were aged ≤ 30 years and were followed up on average for 5.8 years (range, 0 to 13,8). Their mean age was 24 years (range, 5 to 109) and 57% were men.
RESULTS
Compared to the overall THA population, they more frequently underwent THA after procedures involving femoral head lowering into the acetabulum (7.5 versus 0.8%) and following fracture fixation or cervico-cephalic prosthesis (5.3 versus 1.3%). Over the follow-up period, reintervention rates were higher in this group than for the general population (8.4 versus 6.3%), with 2.7% (n = 118) for non-surgical dislocation (versus 2.0%), 4.9% (n = 216) for aseptic loosening (versus 3.5%), 2.4% (n = 106) for periprosthetic fracture (versus 2.2%), and 0.5% (n = 24) for implant removal (versus 0.3%), and those events occurred faster.
CONCLUSION
A THA is rarely performed in patients aged ≤ 30 years but seems to be associated with more complex procedures and higher complication rates than in the older general population. Given their elevated lifetime risk of reintervention, tailored surgical strategies and long-term care planning are essential to improve outcomes in this high-risk group.