The Journal of Hip Surgery 2018; 02(03): 117-125
DOI: 10.1055/s-0038-1672127
Special Section Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment of Early-Onset Hip Osteoarthritis in Young Patients

Molly A. Day
1   Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Timothy S. Brown
1   Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Anthony Miniaci
2   Department of Orthopedic Surgery, Cleveland Clinic, Garfield Heights, Ohio
,
Robert W. Westermann
1   Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
› Author Affiliations
Further Information

Publication History

14 March 2018

24 July 2018

Publication Date:
05 October 2018 (online)

Abstract

Pain and debilitating symptoms due to hip osteoarthritis (OA) can significantly compromise quality of life in young, active patients. The management of the young adult with hip OA presents a unique set of challenges, with symptoms that originate from a variety of underlying hip pathologies, and patient age spanning from youth through middle age. Early options for hip OA include nonoperative treatment with anti-inflammatory medications, physical therapy, and injections. For patients with structural hip abnormalities (femoroacetabular impingement or dysplasia), arthroscopy or reconstructive osteotomy are acceptable treatment options. In advanced disease, joint-preserving techniques are often ineffective, and patients may require joint resurfacing or replacement. The treatment strategies for early hip OA continues to evolve with the development of new and refined surgical techniques, especially in the setting of underlying hip pathology, and a growing popularity of utilizing biologic agents. The purpose of this manuscript is to review current conservative and surgical management and to describe an algorithm for treatment of early-onset hip OA.

 
  • References

  • 1 Lawrence RC, Helmick CG, Arnett FC. , et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998; 41 (05) 778-799
  • 2 Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003; (417) 112-120
  • 3 Nicholls AS, Kiran A, Pollard TCB. , et al. The association between hip morphology parameters and nineteen-year risk of end-stage osteoarthritis of the hip: a nested case-control study. Arthritis Rheum 2011; 63 (11) 3392-3400
  • 4 Wells J, Schoenecker P, Duncan S, Goss CW, Thomason K, Clohisy JC. Intermediate-term hip survivorship and patient-reported outcomes of periacetabular osteotomy: the Washington University experience. J Bone Joint Surg Am 2018; 100 (03) 218-225
  • 5 Zhang W, Moskowitz RW, Nuki G. , et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008; 16 (02) 137-162
  • 6 Hernández-Molina G, Reichenbach S, Zhang B, Lavalley M, Felson DT. Effect of therapeutic exercise for hip osteoarthritis pain: results of a meta-analysis. Arthritis Rheum 2008; 59 (09) 1221-1228
  • 7 French HP, Cusack T, Brennan A. , et al. Exercise and manual physiotherapy arthritis research trial (EMPART): a multicentre randomised controlled trial. BMC Musculoskelet Disord 2009; 10: 9
  • 8 Hinman RS, Heywood SE, Day AR. Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blind randomized controlled trial. Phys Ther 2007; 87 (01) 32-43
  • 9 AAOS. Management of osteoarthritis of the hip: Evidence-based clinical practice guideline. Adopted by the American Academy of Orthopaedic Surgeons Board of Directors. 2017
  • 10 Baerwald C, Verdecchia P, Duquesroix B, Frayssinet H, Ferreira T. Efficacy, safety, and effects on blood pressure of naproxcinod 750 mg twice daily compared with placebo and naproxen 500 mg twice daily in patients with osteoarthritis of the hip: a randomized, double-blind, parallel-group, multicenter study. Arthritis Rheum 2010; 62 (12) 3635-3644
  • 11 Kivitz AJ, Moskowitz RW, Woods E. , et al. Comparative efficacy and safety of celecoxib and naproxen in the treatment of osteoarthritis of the hip. J Int Med Res 2001; 29 (06) 467-479
  • 12 Makarowski W, Zhao WW, Bevirt T, Recker DP. Efficacy and safety of the COX-2 specific inhibitor valdecoxib in the management of osteoarthritis of the hip: a randomized, double-blind, placebo-controlled comparison with naproxen. Osteoarthritis Cartilage 2002; 10 (04) 290-296
  • 13 Schnitzer TJ, Dattani ID, Seriolo B. , et al. A 13-week, multicenter, randomized, double-blind study of lumiracoxib in hip osteoarthritis. Clin Rheumatol 2011; 30 (11) 1433-1446
  • 14 Svensson O, Malmenäs M, Fajutrao L, Roos EM, Lohmander LS. Greater reduction of knee than hip pain in osteoarthritis treated with naproxen, as evaluated by WOMAC and SF-36. Ann Rheum Dis 2006; 65 (06) 781-784
  • 15 Kullenberg B, Runesson R, Tuvhag R, Olsson C, Resch S. Intraarticular corticosteroid injection: pain relief in osteoarthritis of the hip?. J Rheumatol 2004; 31 (11) 2265-2268
  • 16 Robinson P, Keenan AM, Conaghan PG. Clinical effectiveness and dose response of image-guided intra-articular corticosteroid injection for hip osteoarthritis. Rheumatology (Oxford) 2007; 46 (02) 285-291
  • 17 Hirsch G, Kitas G, Klocke R. Intra-articular corticosteroid injection in osteoarthritis of the knee and hip: factors predicting pain relief--a systematic review. Semin Arthritis Rheum 2013; 42 (05) 451-473
  • 18 Lambert RG, Hutchings EJ, Grace MG, Jhangri GS, Conner-Spady B, Maksymowych WP. Steroid injection for osteoarthritis of the hip: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2007; 56 (07) 2278-2287
  • 19 Atchia I, Kane D, Reed MR, Isaacs JD, Birrell F. Efficacy of a single ultrasound-guided injection for the treatment of hip osteoarthritis. Ann Rheum Dis 2011; 70 (01) 110-116
  • 20 Qvistgaard E, Christensen R, Torp-Pedersen S, Bliddal H. Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, corticosteroid, and isotonic saline. Osteoarthritis Cartilage 2006; 14 (02) 163-170
  • 21 Krych AJ, Griffith TB, Hudgens JL, Kuzma SA, Sierra RJ, Levy BA. Limited therapeutic benefits of intra-articular cortisone injection for patients with femoro-acetabular impingement and labral tear. Knee Surg Sports Traumatol Arthrosc 2014; 22 (04) 750-755
  • 22 Wernecke C, Braun HJ, Dragoo JL. The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Orthop J Sports Med 2015; 3 (05) 2325967115581163
  • 23 Meermans G, Corten K, Simon J. Is the infection rate in primary THA increased after steroid injection?. Clin Orthop Relat Res 2012; 470: 3213-3219
  • 24 McMahon SE, Lovell ME. Total hip arthroplasty after ipsilateral intra-articular steroid injection: 8 years follow up. Acta Orthop Belg 2012; 78 (03) 333-336
  • 25 Wang Q, Jiang X, Tian W. Does previous intra-articular steroid injection increase the risk of joint infection following total hip arthroplasty or total knee arthroplasty? A meta-analysis. Med Sci Monit 2014; 20: 1878-1883
  • 26 Werner BC, Cancienne JM, Browne JA. The timing of total hip arthroplasty after intraarticular hip injection affects postoperative infection risk. J Arthroplasty 2016; 31 (04) 820-823
  • 27 Schairer WW, Nwachukwu BU, Mayman DJ, Lyman S, Jerabek SA. Preoperative hip injections increase the rate of periprosthetic infection after total hip arthroplasty. J Arthroplasty 2016; 31 (9, Suppl): 166-169.e1
  • 28 Wang D, Camp CL, Ranawat AS, Coleman SH, Kelly BT, Werner BC. The timing of hip arthroscopy after intra-articular hip injection affects postoperative infection risk. Arthroscopy 2017; 33 (11) 1988-1994.e1
  • 29 Cancienne JM, Gwathmey FW, Werner BC. Intraoperative corticosteroid injection at the time of knee arthroscopy is associated with increased postoperative infection rates in a large Medicare population. Arthroscopy 2016; 32 (01) 90-95
  • 30 Werner BC, Cancienne JM, Burrus MT, Park JS, Perumal V, Cooper MT. Risk of infection after intra-articular steroid injection at the time of ankle arthroscopy in a Medicare population. Arthroscopy 2016; 32 (02) 350-354
  • 31 Paoloni M, Di Sante L, Dimaggio M. , et al. Kinematic and kinetic modifications in walking pattern of hip osteoarthritis patients induced by intra-articular injections of hyaluronic acid. Clin Biomech (Bristol, Avon) 2012; 27 (07) 661-665
  • 32 Migliore A, Tormenta S, Massafra U. , et al. Intra-articular administration of hylan G-F 20 in patients with symptomatic hip osteoarthritis: tolerability and effectiveness in a large cohort study in clinical practice. Curr Med Res Opin 2008; 24 (05) 1309-1316
  • 33 Richette P, Ravaud P, Conrozier T. , et al. Effect of hyaluronic acid in symptomatic hip osteoarthritis: a multicenter, randomized, placebo-controlled trial. Arthritis Rheum 2009; 60 (03) 824-830
  • 34 Sánchez M, Guadilla J, Fiz N, Andia I. Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip. Rheumatology (Oxford) 2012; 51 (01) 144-150
  • 35 Doria C, Mosele GR, Caggiari G, Puddu L, Ciurlia E. Treatment of early hip osteoarthritis: ultrasound-guided platelet rich plasma versus hyaluronic acid injections in a randomized clinical trial. Joints 2017; 5 (03) 152-155
  • 36 Battaglia M, Guaraldi F, Vannini F. , et al. Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis. Orthopedics 2013; 36 (12) e1501-e1508
  • 37 Dallari D, Stagni C, Rani N. , et al. Ultrasound-guided injection of platelet-rich plasma and hyaluronic acid, separately and in combination, for hip osteoarthritis: a Randomized Controlled Study. Am J Sports Med 2016; 44 (03) 664-671
  • 38 Emadedin M, Ghorbani Liastani M, Fazeli R. , et al. Long-term follow-up of intra-articular injection of autologous mesenchymal stem cells in patients with knee, ankle or hip osteoarthritis. Arch Iran Med 2015; 18 (06) 336-344
  • 39 Mardones R, Jofré CM, Tobar L, Minguell JJ. Mesenchymal stem cell therapy in the treatment of hip osteoarthritis. J Hip Preserv Surg 2017; 4 (02) 159-163
  • 40 Bozic KJ, Chan V, Valone III FH, Feeley BT, Vail TP. Trends in hip arthroscopy utilization in the United States. J Arthroplasty 2013; 28 (8, Suppl) 140-143
  • 41 Colvin AC, Harrast J, Harner C. Trends in hip arthroscopy. J Bone Joint Surg Am 2012; 94 (04) e23
  • 42 Montgomery SR, Ngo SS, Hobson T. , et al. Trends and demographics in hip arthroscopy in the United States. Arthroscopy 2013; 29 (04) 661-665
  • 43 Stevens MS, Legay DA, Glazebrook MA, Amirault D. The evidence for hip arthroscopy: grading the current indications. Arthroscopy 2010; 26 (10) 1370-1383
  • 44 Kemp JL, MacDonald D, Collins NJ, Hatton AL, Crossley KM. Hip arthroscopy in the setting of hip osteoarthritis: systematic review of outcomes and progression to hip arthroplasty. Clin Orthop Relat Res 2015; 473 (03) 1055-1073
  • 45 Egerton T, Hinman RS, Takla A, Bennell KL, O'Donnell J. Intraoperative cartilage degeneration predicts outcome 12 months after hip arthroscopy. Clin Orthop Relat Res 2013; 471 (02) 593-599
  • 46 Philippon MJ, Briggs KK, Yen Y-M, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br 2009; 91 (01) 16-23
  • 47 Larson CM, Giveans MR, Taylor M. Does arthroscopic FAI correction improve function with radiographic arthritis?. Clin Orthop Relat Res 2011; 469 (06) 1667-1676
  • 48 Helenius I, Tanskanen P, Haapala J. , et al. Hip arthroscopy in osteoarthritis. A review of 68 patients. Ann Chir Gynaecol 2001; 90 (01) 28-31
  • 49 Chegini S, Beck M, Ferguson SJ. The effects of impingement and dysplasia on stress distributions in the hip joint during sitting and walking: a finite element analysis. J Orthop Res 2009; 27 (02) 195-201
  • 50 Bogunovic L, Gottlieb M, Pashos G, Baca G, Clohisy JC. Why do hip arthroscopy procedures fail?. Clin Orthop Relat Res 2013; 471 (08) 2523-2529
  • 51 Clohisy JC, Nepple JJ, Larson CM, Zaltz I, Millis M. ; Academic Network of Conservation Hip Outcome Research (ANCHOR) Members. Persistent structural disease is the most common cause of repeat hip preservation surgery. Clin Orthop Relat Res 2013; 471 (12) 3788-3794
  • 52 Dwyer MK, Lee JA, McCarthy JC. Cartilage status at time of arthroscopy predicts failure in patients with hip dysplasia. J Arthroplasty 2015; 30 (9, Suppl): 121-124
  • 53 Larson CM, Ross JR, Stone RM. , et al. Arthroscopic management of dysplastic hip deformities: predictors of success and failures with comparison to an arthroscopic FAI cohort. Am J Sports Med 2016; 44 (02) 447-453
  • 54 Clohisy JC, Wright RW. Hip arthroscopy in the treatment of osteoarthritis. Oper Tech Sports Med 2002; 10: 219-223
  • 55 Domb BG, Chaharbakhshi EO, Perets I, Yuen LC, Walsh JP, Ashberg L. Hip arthroscopic surgery with labral preservation and capsular plication in patients with borderline hip dysplasia: minimum 5-year patient-reported outcomes. Am J Sports Med 2018; 46 (02) 305-313
  • 56 Minkara AA, Westermann RW, Rosneck J, Lynch TS. Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement. Am J Sports Med 2018. DOI: 10.1177/0363546517749475 [Epub ahead of print]
  • 57 Cvetanovich GL, Weber AE, Kuhns BD. , et al. Hip arthroscopic surgery for femoroacetabular impingement with capsular management: factors associated with achieving clinically significant outcomes. Am J Sports Med 2018; 46 (02) 288-296
  • 58 Philippon MJ, Briggs KK, Carlisle JC, Patterson DC. Joint space predicts THA after hip arthroscopy in patients 50 years and older. Clin Orthop Relat Res 2013; 471 (08) 2492-2496
  • 59 Haviv B, O'Donnell J. The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients. Sports Med Arthrosc Rehabil Ther Technol 2010; 2: 18
  • 60 Kim KC, Hwang DS, Lee CH, Kwon ST. Influence of femoroacetabular impingement on results of hip arthroscopy in patients with early osteoarthritis. Clin Orthop Relat Res 2007; 456 (456) 128-132
  • 61 Daivajna S, Bajwa A, Villar R. Outcome of arthroscopy in patients with advanced osteoarthritis of the hip. PLoS One 2015; 10 (01) e0113970
  • 62 Schairer WW, Nwachukwu BU, McCormick F, Lyman S, Mayman D. Use of hip arthroscopy and risk of conversion to total hip arthroplasty: a population-based analysis. Arthroscopy 2016; 32 (04) 587-593
  • 63 Domb BG, Gui C, Lodhia P. How much arthritis is too much for hip arthroscopy: a systematic review. Arthroscopy 2015; 31 (03) 520-529
  • 64 Chandrasekaran S, Darwish N, Gui C, Lodhia P, Suarez-Ahedo C, Domb BG. Outcomes of hip arthroscopy in patients with Tönnis grade 2 osteoarthritis at a mean 2-year follow-up: evaluation using a matched-pair analysis with Tönnis grade-0 and grade-1 cohorts. J Bone Joint Surg Am 2016; 98 (12) 973-982
  • 65 Chandrasekaran S, Gui C, Darwish N, Lodhia P, Suarez-Ahedo C, Domb BG. Outcomes of hip arthroscopic surgery in patients with Tönnis grade 1 osteoarthritis with a minimum 2-year follow-up: Evaluation using a matched-pair analysis with a control group with Tönnis grade 0. Am J Sports Med 2016; 44 (07) 1781-1788
  • 66 Clohisy JC, Beaulé PE, O'Malley A, Safran MR, Schoenecker P. AOA symposium. Hip disease in the young adult: current concepts of etiology and surgical treatment. J Bone Joint Surg Am 2008; 90 (10) 2267-2281
  • 67 Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 2008; 466 (02) 264-272
  • 68 Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 1988; (232) 26-36
  • 69 Clohisy JC, Schutz AL, St John L, Schoenecker PL, Wright RW. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res 2009; 467 (08) 2041-2052
  • 70 Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res 2008; 466 (07) 1633-1644
  • 71 Matheney T, Zaltz I, Kim YJ. , et al; ANCHOR Study Group. Activity level and severity of dysplasia predict age at Bernese periacetabular osteotomy for symptomatic hip dysplasia. J Bone Joint Surg Am 2016; 98 (08) 665-671
  • 72 Trousdale RT, Ekkernkamp A, Ganz R, Wallrichs SL. Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips. J Bone Joint Surg Am 1995; 77 (01) 73-85
  • 73 Matta JM, Stover MD, Siebenrock K. Periacetabular osteotomy through the Smith-Petersen approach. Clin Orthop Relat Res 1999; (363) 21-32
  • 74 Millis MB, Kain M, Sierra R. , et al. Periacetabular osteotomy for acetabular dysplasia in patients older than 40 years: a preliminary study. Clin Orthop Relat Res 2009; 467 (09) 2228-2234
  • 75 Fujii M, Nakashima Y, Jingushi S. , et al. Intraarticular findings in symptomatic developmental dysplasia of the hip. J Pediatr Orthop 2009; 29 (01) 9-13
  • 76 Domb BG, LaReau JM, Hammarstedt JE, Gupta A, Stake CE, Redmond JM. Concomitant hip arthroscopy and periacetabular osteotomy. Arthroscopy 2015; 31 (11) 2199-2206
  • 77 Maradit Kremers H, Larson DR, Crowson CS. , et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 2015; 97 (17) 1386-1397
  • 78 Bessette BJ, Fassier F, Tanzer M, Brooks CE. Total hip arthroplasty in patients younger than 21 years: a minimum, 10-year follow-up. Can J Surg 2003; 46 (04) 257-262
  • 79 Schmalzried TP, Shepherd EF, Dorey FJ. , et al. The John Charnley Award. Wear is a function of use, not time. Clin Orthop Relat Res 2000; 381 (381) 36-46
  • 80 Kinkel S, Kaefer W, Reissig W, Puhl W, Kessler S. Revision total hip arthroplasty: the influence of gender and age on the perioperative complication rate. Acta Chir Orthop Traumatol Cech 2003; 70 (05) 269-273
  • 81 Atrey A, Ward SE, Khoshbin A. , et al. Ten-year follow-up study of three alternative bearing surfaces used in total hip arthroplasty in young patients: a prospective randomised controlled trial. Bone Joint J 2017; 99-B (12) 1590-1595
  • 82 Kim YH, Park JW, Kim JS. Long-term results of third-generation ceramic-on-ceramic bearing cementless total hip arthroplasty in young patients. J Arthroplasty 2016; 31 (11) 2520-2524
  • 83 Rajaee SS, Theriault RV, Pevear ME, Smith EL. National trends in primary total hip arthroplasty in extremely young patients: a focus on bearing surface usage from 2009 to 2012. J Arthroplasty 2016; 31 (9, Suppl): 63-68
  • 84 Mall NA, Nunley RM, Zhu JJ, Maloney WJ, Barrack RL, Clohisy JC. The incidence of acetabular osteolysis in young patients with conventional versus highly crosslinked polyethylene. Clin Orthop Relat Res 2011; 469 (02) 372-381
  • 85 Kishida Y, Sugano N, Nishii T, Miki H, Yamaguchi K, Yoshikawa H. Preservation of the bone mineral density of the femur after surface replacement of the hip. J Bone Joint Surg Br 2004; 86 (02) 185-189
  • 86 Lavigne M, Vendittoli P, Roy A. , et al. A randomized study comparing surface replacement arthroplasty to total hip arthroplasty. Proceedings of the 75th Annual American Academy of Orthopaedic Surgeons Meeting, San Francisco, CA; 2008
  • 87 Vendittoli PA, Lavigne M, Roy AG, Lusignan D. A prospective randomized clinical trial comparing metal-on-metal total hip arthroplasty and metal-on-metal total hip resurfacing in patients less than 65 years old. Hip Int 2006; 16 (Suppl. 04) 73-81
  • 88 Barrack RL, Ruh EL, Berend ME. , et al. Do young, active patients perceive advantages after surface replacement compared to cementless total hip arthroplasty?. Clin Orthop Relat Res 2013; 471 (12) 3803-3813
  • 89 Girard J, Lons A, Ramdane N, Putman S. Hip resurfacing before 50 years of age: a prospective study of 979 hips with a mean follow-up of 5.1 years. Orthop Traumatol Surg Res 2018; 104 (03) 295-299
  • 90 Ziaee H, Daniel J, Datta AK, Blunt S, McMinn DJ. Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty: a controlled study. J Bone Joint Surg Br 2007; 89 (03) 301-305
  • 91 MacLean S, Evans S, Pynsent P, O'hara J. Mid-term results for hip resurfacing in patients under 30 years old with childhood hip disorders. Acta Orthop Belg 2015; 81 (02) 264-273
  • 92 Krantz N, Miletic B, Migaud H, Girard J. Hip resurfacing in patients under thirty years old: an attractive option for young and active patients. Int Orthop 2012; 36 (09) 1789-1794
  • 93 Malhotra R, Kannan A, Kumar V, Nagaraj C, Marimuthu K, Khatri D. Hip resurfacing arthroplasty in inflammatory arthritis a 3- to 5-year follow-up study. J Arthroplasty 2012; 27 (01) 15-20
  • 94 Amstutz HC, Beaulé PE, Dorey FJ, Le Duff MJ, Campbell PA, Gruen TA. Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg Am 2004; 86-A (01) 28-39
  • 95 Jiang Y, Zhang K, Die J, Shi Z, Zhao H, Wang K. A systematic review of modern metal-on-metal total hip resurfacing vs standard total hip arthroplasty in active young patients. J Arthroplasty 2011; 26 (03) 419-426
  • 96 Kumar A, Bloch BV, Esler C. Trends in total hip arthroplasty in young patients - results from a regional register. Hip Int 2017; 27 (05) 443-448
  • 97 Keeney JA, Martell JM, Pashos G, Nelson CJ, Maloney WJ, Clohisy JC. Highly cross-linked polyethylene improves wear and mid-term failure rates for young total hip arthroplasty patients. Hip Int 2015; 25 (05) 435-441
  • 98 Clohisy JC, Oryhon JM, Seyler TM. , et al. Function and fixation of total hip arthroplasty in patients 25 years of age or younger. Clin Orthop Relat Res 2010; 468 (12) 3207-3213
  • 99 Restrepo C, Lettich T, Roberts N, Parvizi J, Hozack WJ. Uncemented total hip arthroplasty in patients less than twenty-years. Acta Orthop Belg 2008; 74 (05) 615-622
  • 100 Finkbone PR, Severson EP, Cabanela ME, Trousdale RT. Ceramic-on-ceramic total hip arthroplasty in patients younger than 20 years. J Arthroplasty 2012; 27 (02) 213-219
  • 101 Hannouche D, Devriese F, Delambre J. , et al. Ceramic-on-ceramic THA implants in patients younger than 20 years. Clin Orthop Relat Res 2016; 474 (02) 520-527
  • 102 Polkowski GG, Callaghan JJ, Mont MA, Clohisy JC. Total hip arthroplasty in the very young patient. J Am Acad Orthop Surg 2012; 20 (08) 487-497