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A Scoping Review of Total Hip Arthroplasty Survival and Reoperation Rates in Patients of 55 Years or Younger: Health Services Implications for Revision Surgeries

Open AccessPublished:July 18, 2022DOI:https://doi.org/10.1016/j.artd.2022.05.012

      Abstract

      Background

      Total hip arthroplasty (THA) in younger patients is projected to increase by a factor of 5 by 2030 and will have important implications for clinical practice, policymaking, and research. This scoping review aimed to synthesize and summarize THA implants' survival, reoperation, and wear rates and identify indications and risk factors for reoperation following THA in patients ≤55 years old.

      Material and methods

      Standardized scoping review methodology was applied. We searched 4 electronic databases (Medline, Embase, CINAHL, and Web of Science) from January 1990 to May 2019. Selection criteria were patients aged ≤55 years, THA survival, reoperation, and/or wear rate reported, a minimum of 20 reoperations included, and minimum level III based on the Oxford Level of Evidence. Two authors independently reviewed the citations, extracted data, and assessed quality.

      Results

      Of the 2255 citations screened, 35 retrospective cohort studies were included. Survival rates for THA at 5 and 20 years were 90%-100% and 60.4%-77.7%, respectively. Reoperation rates at ≤5-year post THA ranged from 1.6% to 5.4% and increased at 10-20 years post THA (8.2%-67%). Common causes for reoperation were aseptic loosening of hip implants, osteolysis, wear, and infection. Higher reoperation and lower survival rates were seen with hip dysplasia and avascular necrosis than with other primary diagnoses.

      Conclusions

      Over time, THA prosthetic survival rates decreased, and reoperation increased in patients ≤55 years. Aseptic loosening of hip implants, osteolysis, wear, and infection were the most frequent reasons for the reoperation.

      Keywords

      Introduction

      Over the past 20 years, the number of patients undergoing total hip arthroplasty (THA) for end-stage osteoarthritis (OA) has dramatically increased [
      • Kurtz S.M.
      • Lau E.
      • Ong K.
      • Zhao K.
      • Kelly M.
      • Bozic K.J.
      Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030.
      ,
      • Maradit Kremers H.
      • Larson D.R.
      • Noureldin M.
      • Schleck C.D.
      • Jiranek W.A.
      • Berry D.J.
      Long-term mortality trends after total hip and knee arthroplasties: a population-based study.
      ,
      • Maradit Kremers H.
      • Larson D.R.
      • Crowson C.S.
      • Kremers W.K.
      • Washington R.E.
      • Steiner C.A.
      • et al.
      Prevalence of total hip and knee replacement in the United States.
      ]. By the year 2030, the demand for THA among young patients is projected to grow by a factor of 5 [
      • Kurtz S.M.
      • Lau E.
      • Ong K.
      • Zhao K.
      • Kelly M.
      • Bozic K.J.
      Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030.
      ,
      • Kurtz S.
      • Mowat F.
      • Ong K.
      • Chan N.
      • Lau E.
      • Halpern M.
      Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002.
      ]. THA provides substantial pain relief and resumption of many activities, including sporting activities such as hiking, skiing, swimming, and cycling in younger patients [
      • Vogel L.A.
      • Carotenuto G.
      • Basti J.J.
      • Levine W.N.
      Physical activity after total joint arthroplasty.
      ]. Previous reviews [
      • Evans J.T.
      • Evans J.P.
      • Walker R.W.
      • Blom A.W.
      • Whitehouse M.R.
      • Sayers A.
      How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.
      ,
      • Adelani M.A.
      • Keeney J.A.
      • Palisch A.
      • Fowler S.A.
      • Clohisy J.C.
      Has total hip arthroplasty in patients 30 years or younger improved? A systematic review.
      ], including a recent systematic review, reported a 15-year survival rate of 87.9% (95% confidence interval [CI]: 87.2 to 88.5) for patients aged between 58 and 74 years [
      • Evans J.T.
      • Evans J.P.
      • Walker R.W.
      • Blom A.W.
      • Whitehouse M.R.
      • Sayers A.
      How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.
      ]. The 15- to 20-year survival rate for THA, however, poses a challenge for young patients who likely will need multiple reoperations in their lifetime [
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish arthroplasty register.
      ,
      • Röder C.
      • Parvizi J.
      • Eggli S.
      • Berry D.J.
      • Müller M.E.
      • Busato A.
      Demographic factors affecting long-term outcome of total hip arthroplasty.
      ,
      • Matharu G.S.
      • McBryde C.W.
      • Pynsent W.B.
      • Pynsent P.B.
      • Treacy R.B.
      The outcome of the Birmingham Hip Resurfacing in patients aged < 50 years up to 14 years post-operatively.
      ,
      • McAuley J.P.
      • Szuszczewicz E.S.
      • Young A.
      • Engh C.A.
      Total hip arthroplasty in patients 50 years and younger.
      ]. Besides the longer duration that young patients will have with their THA, they tend to adopt an active lifestyle when pain and stiffness are relieved after THA.
      Unlike older patients who often require THA for OA, indications in patients younger than 55 years include pathologies such as rheumatoid arthritis, avascular necrosis (AVN) of the hip, and developmental dysplasia of the hip (DDH) [
      • Martin C.T.
      • Callaghan J.J.
      • Gao Y.
      • Pugely A.J.
      • Liu S.S.
      • Warth L.C.
      • et al.
      What can we learn from 20-year followup studies of hip replacement?.
      ,
      • Studers P.
      • Belajevs D.
      • Jurkevics V.
      • Likums P.
      Ten to fifteen-year clinical and radiographic follow-up with a third-generation cementless stem in a young patient population.
      ]. Thus, a greater proportion of younger patients undergo complex primary THA, which can be more technically demanding due to anatomic abnormalities and bone loss [
      • Petis S.
      • Howard J.L.
      • Lanting B.L.
      • Vasarhelyi E.M.
      Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes.
      ]. With different THA indications and procedures in the younger patient population, survivorship and reoperation rates may differ from older patients with THA [
      • Evans J.T.
      • Evans J.P.
      • Walker R.W.
      • Blom A.W.
      • Whitehouse M.R.
      • Sayers A.
      How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.
      ,
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish arthroplasty register.
      ,
      • Bolland B.J.
      • Whitehouse S.L.
      • Timperley A.J.
      Indications for early hip revision surgery in the UK--a re-analysis of NJR data.
      ,
      • Eskelinen A.
      • Paavolainen P.
      • Helenius I.
      • Pulkkinen P.
      • Remes V.
      Total hip arthroplasty for rheumatoid arthritis in younger patients: 2,557 replacements in the Finnish Arthroplasty Register followed for 0-24 years.
      ,
      • Munn Z.
      • Peters M.D.J.
      • Stern C.
      • Tufanaru C.
      • McArthur A.
      • Aromataris E.
      Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach.
      ]. It is also uncertain if younger patients with more active lifestyle accelerate polyethylene wear rates (annual erosion of polyethylene of THA implant based on radiographic view), leading to increased reoperation rate [
      • Bayliss L.E.
      • Culliford D.
      • Monk A.P.
      • Glyn-Jones S.
      • Prieto-Alhambra D.
      • Judge A.
      • et al.
      The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.
      ].
      Although systematic reviews have determined survivorship and reoperation rates in the general THA population, examining a younger subset with unique characteristics is needed to develop appropriate surgical indications, inform care planning, and develop monitoring strategies. The financial and economic impact of revision THA is substantially greater than that of primary THA [
      • Ackerman I.N.
      • Bohensky M.A.
      • Zomer E.
      • Tacey M.
      • Gorelik A.
      • Brand C.A.
      • et al.
      The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030.
      ], due to longer times of surgery, more expensive prostheses, longer length of stay, and higher rates of complications and burden on the healthcare system [
      • Kurtz S.M.
      • Lau E.
      • Ong K.
      • Zhao K.
      • Kelly M.
      • Bozic K.J.
      Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030.
      ,
      • Kurtz S.M.
      • Lau E.
      • Schmier J.
      • Ong K.L.
      • Zhao K.
      • Parvizi J.
      Infection burden for hip and knee arthroplasty in the United States.
      ,
      • Kurtz S.M.
      • Lau E.
      • Watson H.
      • Schmier J.K.
      • Parvizi J.
      Economic burden of periprosthetic joint infection in the United States.
      ]. Studies examining survival rates of THA in younger adults are needed to provide an outlook on the future burden of revision THA. Based on the rising number of primary THA, it is hypothesized that the volume of revision procedures will rapidly increase in the future, which will place an immense burden on future healthcare systems and also raises the question if current clinical standards and treatment strategies have to be reconsidered.
      The overall aim of this scoping review is to synthesize evidence regarding THA in younger patients and identify any existing gaps in knowledge. Specifically, the objectives are to 1) summarize the survival, reoperation, and wear rates of THA and 2) identify indications for reoperation following THA, including factors associated with reoperation in individuals who are 55 years of age or younger.

      Material and methods

      As our overall aim was to provide a detailed overview of studies that examined the survival, reoperation, and wear rates in THA in younger patients, the scoping review methodology best fit our objectives [
      • Eingartner C.
      Current trends in total hip arthroplasty.
      ]. The framework proposed by Arksey and O'Malley [
      • Eingartner C.
      Current trends in total hip arthroplasty.
      ] and Levac [
      • Jonas K.
      • Nils W.
      • Alexander D.
      • Stefan B.
      • Henning W.
      • Thilo F.
      The etiology of revision total hip arthroplasty: current trends in a retrospective survey of 3450 cases.
      ] was used to guide the scoping review methodology. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines were followed to ensure a high and consistent quality of research reporting [
      • Dixon T.
      • Shaw M.
      • Ebrahim S.
      • Dieppe P.
      Trends in hip and knee joint replacement: socioeconomic inequalities and projections of need.
      ]. This review's protocol was registered a priori on the Open Science Framework (OSF) (Protocol ID#:osf.io/u4gpn).

      Development of research questions

      The main concept of interest is THA survival, reoperation, and wear rates, regardless of the implant used or surgical approach in adults aged 55 years or younger who underwent THA. The outcomes of interest were 1) survival, reoperation, and wear rate of THA and 2) reasons for THA reoperation and factors associated with reoperation.
      Survivorship of THA is defined by the cumulative incidence of any surgical procedure that involves removal or exchange of an implant (the cup and/or stem or the liner) [
      • Arksey H.
      • O'Malley L.
      Scoping studies: towards a methodological framework.
      ], while reoperation rates are defined as surgical procedures after the primary THA for any reason but do not necessarily involve implant removal. Reoperation reasons can be patient-related, implant-related, and failures related to surgical technique [
      • Levac D.
      • Colquhoun H.
      • O'Brien K.K.
      Scoping studies: advancing the methodology.
      ,
      • Tricco A.C.
      • Lillie E.
      • Zarin W.
      • O'Brien K.K.
      • Colquhoun H.
      • Levac D.
      • et al.
      PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation.
      ,
      • Mäkelä K.T.
      • Eskelinen A.
      • Pulkkinen P.
      • Paavolainen P.
      • Remes V.
      Results of 3,668 primary total hip replacements for primary osteoarthritis in patients under the age of 55 years.
      ,
      • Espehaug B.
      • Havelin L.I.
      • Engesaeter L.B.
      • Langeland N.
      • Vollset S.E.
      Patient-related risk factors for early revision of total hip replacements. A population register-based case-control study of 674 revised hips.
      ,
      • Kuijpers M.F.L.
      • Hannink G.
      • van Steenbergen L.N.
      • Schreurs B.W.
      Total hip arthroplasty in young patients in The Netherlands: trend analysis of >19,000 primary hip replacements in the Dutch arthroplasty register.
      ].

      Identifying relevant studies

      A health sciences librarian developed and implemented literature searches in Medline, Embase, CINAHL, and Web of Science from 1990 to May 31, 2019. The search dates were chosen to reflect more recent implants and surgical techniques. Our multidisciplinary study members helped conceptualize the search strategy, which was based on the concepts of joint replacement, reoperation, adults 55 years old or younger, with multiple text words and subject headings (eg, Medical Subject Headings) describing each concept. This search strategy was limited to English. The search strategies are detailed in Appendix A.

      Selection criteria

      Studies were included if 1) the patient group was ≤55 years of age or the cohort reported findings stratified by age groups with a group meeting the age requirement; 2) THA survival, reoperation, or wear rate for any reason was reported; 3) there was a minimum of 20 reoperations reported; and 4) the minimum level III evidence (based on the Oxford Level of Evidence) was attained. Studies of hemiarthroplasty surgical procedures were excluded.

      Screening and study selection

      Search results were uploaded to the Covidence platform [
      Covidence systematic review software, veritas health innovation, Melbourne, Australia.
      ]. After removing duplicates, 2 team members independently reviewed the titles and abstracts and applied the inclusion and exclusion criteria. If there were insufficient details to make an informed decision, the article was retrieved for review. To confirm eligibility, 2 team members independently assessed the full-text articles using the same inclusion and exclusion criteria. Any disagreement was resolved through consensus or third-party adjudication.

      Data extraction

      A standardized data abstraction form was created by the research team. Two team members then used the pretested data abstraction form to abstract data from included full-text articles.

      Quality assessment

      One reviewer evaluated the quality of selected full-text articles using the Oxford Level of Evidence [
      Group OLoEW
      “The Oxford 2011 levels of evidence”. Oxford centre for evidence-based medicine.
      ], which is recommended to determine a hierarchy of the best evidence [

      Howick J CI, Greenhalgh T, Heneghan C, Greenhalgh, T., Heneghan, C., Liberati A., et al. “The 2011 Oxford CEBM Evidence Levels of Evidence (Introductory Document)”. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653 [accessed 01.03.22].

      ]. The Scottish Intercollegiate Guidelines Network guidelines were used to assess study quality through the completion of their cohort checklist, including items such as subject selection, assessment, confounding, and statistical analysis [

      Scottish Intercollegiate Guidelines Network. SIGN Methodology Checklist 3: Cohort Studies. Checklists (sign.ac.uk). [accessed 03.01.22].

      ].

      Summarizing and reporting the findings

      Data were organized to report information regarding authors, study design, population characteristics, THA indication, THA surgical characteristics (implant and surgical approach), outcome measures, and tools used to measure the outcome of interest.

      Results

      Of the 4887 citations retrieved, 2255 were eligible for screening after deduplication, of which 2150 were excluded based on the title and the abstract. Of the 105 full-text articles assessed, 70 were excluded, leaving 35 studies included in the review [
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish arthroplasty register.
      ,
      • McAuley J.P.
      • Szuszczewicz E.S.
      • Young A.
      • Engh C.A.
      Total hip arthroplasty in patients 50 years and younger.
      ,
      • Martin C.T.
      • Callaghan J.J.
      • Gao Y.
      • Pugely A.J.
      • Liu S.S.
      • Warth L.C.
      • et al.
      What can we learn from 20-year followup studies of hip replacement?.
      ,
      • Studers P.
      • Belajevs D.
      • Jurkevics V.
      • Likums P.
      Ten to fifteen-year clinical and radiographic follow-up with a third-generation cementless stem in a young patient population.
      ,
      • Bolland B.J.
      • Whitehouse S.L.
      • Timperley A.J.
      Indications for early hip revision surgery in the UK--a re-analysis of NJR data.
      ,
      • Eskelinen A.
      • Paavolainen P.
      • Helenius I.
      • Pulkkinen P.
      • Remes V.
      Total hip arthroplasty for rheumatoid arthritis in younger patients: 2,557 replacements in the Finnish Arthroplasty Register followed for 0-24 years.
      ,
      • Arksey H.
      • O'Malley L.
      Scoping studies: towards a methodological framework.
      ,
      • Gallo J.
      • Langova K.
      • Havranek V.
      • Cechova I.
      Poor survival of ABG I hip prosthesis in younger patients.
      ,
      • Dorr L.D.
      • Kane T.J.
      • Conaty J.P.
      Long-term results of cemented total hip arthroplasty in patients 45 years old or younger. A 16-year follow-up study.
      ,
      • Emery D.F.
      • Clarke H.J.
      • Grover M.L.
      Stanmore total hip replacement in younger patients: review of a group of patients under 50 years of age at operation.
      ,
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4,661 primary replacements followed for 0-22 years.
      ,
      • Hooper G.J.
      • Rothwell A.G.
      • Stringer M.
      • Frampton C.
      Revision following cemented and uncemented primary total hip replacement: a seven-year analysis from the New Zealand Joint Registry.
      ,
      • McMinn D.J.
      • Snell K.I.
      • Daniel J.
      • Treacy R.B.
      • Pynsent P.B.
      • Riley R.D.
      Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study.
      ,
      • Sochart D.H.
      Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty.
      ,
      • Sochart D.H.
      • Porter M.L.
      The long-term results of Charnley low-friction arthroplasty in young patients who have congenital dislocation, degenerative osteoarthrosis, or rheumatoid arthritis.
      ,
      • Kim Y.H.
      • Park J.W.
      • Park J.S.
      The 27 to 29-year outcomes of the PCA total hip arthroplasty in patients younger than 50 years old.
      ,
      • Sedrakyan A.
      • Romero L.
      • Graves S.
      • Davidson D.
      • de Steiger R.
      • Lewis P.
      • et al.
      Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data.
      ,
      • Suh D.H.
      • Yun H.H.
      • Chun S.K.
      • Shon W.Y.
      Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty.
      ,
      • Strömberg C.N.
      • Herberts P.
      A multicenter 10-year study of cemented revision total hip arthroplasty in patients younger than 55 years old. A follow-up report.
      ,
      • Pedersen A.B.
      • Mehnert F.
      • Havelin L.I.
      • Furnes O.
      • Herberts P.
      • Kärrholm J.
      • et al.
      Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association.
      ,
      • Girard J.
      • Glorion C.
      • Bonnomet F.
      • Fron D.
      • Migaud H.
      Risk factors for revision of hip arthroplasties in patients younger than 30 years.
      ,
      • Tsukanaka M.
      • Halvorsen V.
      • Nordsletten L.
      • Ø EngesæTer I.
      • EngesæTer L.B.
      • Fenstad A.M.
      • et al.
      Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old.
      ,
      • Abdel M.P.
      • Roth P.V.
      • Harmsen W.S.
      • Berry D.J.
      What is the lifetime risk of revision for patients undergoing total hip arthroplasty? a 40-year observational study of patients treated with the Charnley cemented total hip arthroplasty.
      ,
      • Philippot R.
      • Neri T.
      • Boyer B.
      • Viard B.
      • Farizon F.
      Bousquet dual mobility socket for patient under fifty years old. More than twenty year follow-up of one hundred and thirty one hips.
      ,
      • Swarup I.
      • Shields M.
      • Mayer E.N.
      • Hendow C.J.
      • Burket J.C.
      • Figgie M.P.
      Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip.
      ,
      • Swarup I.
      • Lee Y.Y.
      • Chiu Y.F.
      • Sutherland R.
      • Shields M.
      • Figgie M.P.
      Implant survival and patient-reported outcomes after total hip arthroplasty in young patients.
      ,
      • Dessyn E.
      • Flecher X.
      • Parratte S.
      • Ollivier M.
      • Argenson J.N.
      A 20-year follow-up evaluation of total hip arthroplasty in patients younger than 50 using a custom cementless stem.
      ,
      • Halawi M.J.
      • Brigati D.
      • Messner W.
      • Brooks P.J.
      Total hip arthroplasty in patients 55 years or younger: risk factors for poor midterm outcomes.
      ,
      • Halvorsen V.
      • Fenstad A.M.
      • Engesæter L.B.
      • Nordsletten L.
      • Overgaard S.
      • Pedersen Alma B.
      • et al.
      Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016.
      ,
      • Duffy G.P.
      • Berry D.J.
      • Rowland C.
      • Cabanela M.E.
      Primary uncemented total hip arthroplasty in patients <40 years old: 10- to 14-year results using first-generation proximally porous-coated implants.
      ,
      • Kim Y.H.
      • Kim J.S.
      • Park J.W.
      • Joo J.H.
      Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years.
      ,
      • Kim Y.H.
      • Park J.W.
      • Kim J.S.
      • Kim I.W.
      Twenty-five- to twenty-seven-year results of a cemented vs a cementless stem in the same patients younger than 50 Years of age.
      ,
      • Chiu K.Y.
      • Ng T.P.
      • Tang W.M.
      • Poon K.C.
      • Ho W.Y.
      • Yip D.
      Charnley total hip arthroplasty in Chinese patients less than 40 years old.
      ,
      • Pakvis D.
      • Biemond L.
      • van Hellemondt G.
      • Spruit M.
      A cementless elastic monoblock socket in young patients: a ten to 18-year clinical and radiological follow-up.
      ] (Fig. 1).
      Figure thumbnail gr1
      Figure 1PRISMA flow diagram describing identification and selection of studies.

      Study characteristics

      In 33 of the 35 included studies, 69,219 THAs were performed. Two studies did not report the number of THAs in patients 55 years old or younger. The authors of these studies were contacted by email to request the number of patients of this subgroup, but they did not respond. All included studies were published between 1994 and 2019, with 18 (51.4%) conducted in Europe [
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish arthroplasty register.
      ,
      • Studers P.
      • Belajevs D.
      • Jurkevics V.
      • Likums P.
      Ten to fifteen-year clinical and radiographic follow-up with a third-generation cementless stem in a young patient population.
      ,
      • Bolland B.J.
      • Whitehouse S.L.
      • Timperley A.J.
      Indications for early hip revision surgery in the UK--a re-analysis of NJR data.
      ,
      • Eskelinen A.
      • Paavolainen P.
      • Helenius I.
      • Pulkkinen P.
      • Remes V.
      Total hip arthroplasty for rheumatoid arthritis in younger patients: 2,557 replacements in the Finnish Arthroplasty Register followed for 0-24 years.
      ,
      • Arksey H.
      • O'Malley L.
      Scoping studies: towards a methodological framework.
      ,
      • Gallo J.
      • Langova K.
      • Havranek V.
      • Cechova I.
      Poor survival of ABG I hip prosthesis in younger patients.
      ,
      • Emery D.F.
      • Clarke H.J.
      • Grover M.L.
      Stanmore total hip replacement in younger patients: review of a group of patients under 50 years of age at operation.
      ,
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4,661 primary replacements followed for 0-22 years.
      ,
      • McMinn D.J.
      • Snell K.I.
      • Daniel J.
      • Treacy R.B.
      • Pynsent P.B.
      • Riley R.D.
      Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study.
      ,
      • Sochart D.H.
      Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty.
      ,
      • Sochart D.H.
      • Porter M.L.
      The long-term results of Charnley low-friction arthroplasty in young patients who have congenital dislocation, degenerative osteoarthrosis, or rheumatoid arthritis.
      ,
      • Strömberg C.N.
      • Herberts P.
      A multicenter 10-year study of cemented revision total hip arthroplasty in patients younger than 55 years old. A follow-up report.
      ,
      • Pedersen A.B.
      • Mehnert F.
      • Havelin L.I.
      • Furnes O.
      • Herberts P.
      • Kärrholm J.
      • et al.
      Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association.
      ,
      • Girard J.
      • Glorion C.
      • Bonnomet F.
      • Fron D.
      • Migaud H.
      Risk factors for revision of hip arthroplasties in patients younger than 30 years.
      ,
      • Tsukanaka M.
      • Halvorsen V.
      • Nordsletten L.
      • Ø EngesæTer I.
      • EngesæTer L.B.
      • Fenstad A.M.
      • et al.
      Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old.
      ,
      • Abdel M.P.
      • Roth P.V.
      • Harmsen W.S.
      • Berry D.J.
      What is the lifetime risk of revision for patients undergoing total hip arthroplasty? a 40-year observational study of patients treated with the Charnley cemented total hip arthroplasty.
      ,
      • Philippot R.
      • Neri T.
      • Boyer B.
      • Viard B.
      • Farizon F.
      Bousquet dual mobility socket for patient under fifty years old. More than twenty year follow-up of one hundred and thirty one hips.
      ,
      • Dessyn E.
      • Flecher X.
      • Parratte S.
      • Ollivier M.
      • Argenson J.N.
      A 20-year follow-up evaluation of total hip arthroplasty in patients younger than 50 using a custom cementless stem.
      ,
      • Halvorsen V.
      • Fenstad A.M.
      • Engesæter L.B.
      • Nordsletten L.
      • Overgaard S.
      • Pedersen Alma B.
      • et al.
      Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016.
      ,
      • Pakvis D.
      • Biemond L.
      • van Hellemondt G.
      • Spruit M.
      A cementless elastic monoblock socket in young patients: a ten to 18-year clinical and radiological follow-up.
      ,
      • Wangen H.
      • Lereim P.
      • Holm I.
      • Gunderson R.
      • Reikerås O.
      Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with a HA-coated stem.
      ], 8 (22.9%) conducted in the USA [
      • McAuley J.P.
      • Szuszczewicz E.S.
      • Young A.
      • Engh C.A.
      Total hip arthroplasty in patients 50 years and younger.
      ,
      • Martin C.T.
      • Callaghan J.J.
      • Gao Y.
      • Pugely A.J.
      • Liu S.S.
      • Warth L.C.
      • et al.
      What can we learn from 20-year followup studies of hip replacement?.
      ,
      • Dorr L.D.
      • Kane T.J.
      • Conaty J.P.
      Long-term results of cemented total hip arthroplasty in patients 45 years old or younger. A 16-year follow-up study.
      ,
      • Swarup I.
      • Shields M.
      • Mayer E.N.
      • Hendow C.J.
      • Burket J.C.
      • Figgie M.P.
      Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip.
      ,
      • Swarup I.
      • Lee Y.Y.
      • Chiu Y.F.
      • Sutherland R.
      • Shields M.
      • Figgie M.P.
      Implant survival and patient-reported outcomes after total hip arthroplasty in young patients.
      ,
      • Halawi M.J.
      • Brigati D.
      • Messner W.
      • Brooks P.J.
      Total hip arthroplasty in patients 55 years or younger: risk factors for poor midterm outcomes.
      ], 4 (11.4%) in Korea [
      • Kim Y.H.
      • Park J.W.
      • Park J.S.
      The 27 to 29-year outcomes of the PCA total hip arthroplasty in patients younger than 50 years old.
      ,
      • Suh D.H.
      • Yun H.H.
      • Chun S.K.
      • Shon W.Y.
      Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty.
      ,
      • Kim Y.H.
      • Kim J.S.
      • Park J.W.
      • Joo J.H.
      Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years.
      ,
      • Kim Y.H.
      • Park J.W.
      • Kim J.S.
      • Kim I.W.
      Twenty-five- to twenty-seven-year results of a cemented vs a cementless stem in the same patients younger than 50 Years of age.
      ], and single studies conducted in Australia [
      • Sedrakyan A.
      • Romero L.
      • Graves S.
      • Davidson D.
      • de Steiger R.
      • Lewis P.
      • et al.
      Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data.
      ] and New Zealand [
      • Hooper G.J.
      • Rothwell A.G.
      • Stringer M.
      • Frampton C.
      Revision following cemented and uncemented primary total hip replacement: a seven-year analysis from the New Zealand Joint Registry.
      ]. All articles were prognostic retrospective articles with level III quality, of which 11 studies used national or international data registries. Four studies used the Finnish Arthroplasty Register, 2 used the nationwide hip arthroplasty registries in Sweden, Norway, Denmark, and Finland; and another 2 studies used the National Joint Registry of England and Wales. The New Zealand Joint Registry, Australian Orthopaedic Association National Joint Replacement Registry, and the Norwegian Arthroplasty Register were used in 1 study.
      After assessing the quality of the included studies using the Scottish Intercollegiate Guidelines Network guidelines, 16 (45.7%) articles were classified as good quality [
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish arthroplasty register.
      ,
      • McAuley J.P.
      • Szuszczewicz E.S.
      • Young A.
      • Engh C.A.
      Total hip arthroplasty in patients 50 years and younger.
      ,
      • Martin C.T.
      • Callaghan J.J.
      • Gao Y.
      • Pugely A.J.
      • Liu S.S.
      • Warth L.C.
      • et al.
      What can we learn from 20-year followup studies of hip replacement?.
      ,
      • Bolland B.J.
      • Whitehouse S.L.
      • Timperley A.J.
      Indications for early hip revision surgery in the UK--a re-analysis of NJR data.
      ,
      • Eskelinen A.
      • Paavolainen P.
      • Helenius I.
      • Pulkkinen P.
      • Remes V.
      Total hip arthroplasty for rheumatoid arthritis in younger patients: 2,557 replacements in the Finnish Arthroplasty Register followed for 0-24 years.
      ,
      • Arksey H.
      • O'Malley L.
      Scoping studies: towards a methodological framework.
      ,
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4,661 primary replacements followed for 0-22 years.
      ,
      • Hooper G.J.
      • Rothwell A.G.
      • Stringer M.
      • Frampton C.
      Revision following cemented and uncemented primary total hip replacement: a seven-year analysis from the New Zealand Joint Registry.
      ,
      • McMinn D.J.
      • Snell K.I.
      • Daniel J.
      • Treacy R.B.
      • Pynsent P.B.
      • Riley R.D.
      Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study.
      ,
      • Sochart D.H.
      Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty.
      ,
      • Sochart D.H.
      • Porter M.L.
      The long-term results of Charnley low-friction arthroplasty in young patients who have congenital dislocation, degenerative osteoarthrosis, or rheumatoid arthritis.
      ,
      • Kim Y.H.
      • Park J.W.
      • Park J.S.
      The 27 to 29-year outcomes of the PCA total hip arthroplasty in patients younger than 50 years old.
      ,
      • Sedrakyan A.
      • Romero L.
      • Graves S.
      • Davidson D.
      • de Steiger R.
      • Lewis P.
      • et al.
      Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data.
      ,
      • Strömberg C.N.
      • Herberts P.
      A multicenter 10-year study of cemented revision total hip arthroplasty in patients younger than 55 years old. A follow-up report.
      ,
      • Halvorsen V.
      • Fenstad A.M.
      • Engesæter L.B.
      • Nordsletten L.
      • Overgaard S.
      • Pedersen Alma B.
      • et al.
      Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016.
      ], 16 (45.7%) articles were regarded as fair quality [
      • Gallo J.
      • Langova K.
      • Havranek V.
      • Cechova I.
      Poor survival of ABG I hip prosthesis in younger patients.
      ,
      • Emery D.F.
      • Clarke H.J.
      • Grover M.L.
      Stanmore total hip replacement in younger patients: review of a group of patients under 50 years of age at operation.
      ,
      • Suh D.H.
      • Yun H.H.
      • Chun S.K.
      • Shon W.Y.
      Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty.
      ,
      • Girard J.
      • Glorion C.
      • Bonnomet F.
      • Fron D.
      • Migaud H.
      Risk factors for revision of hip arthroplasties in patients younger than 30 years.
      ,
      • Tsukanaka M.
      • Halvorsen V.
      • Nordsletten L.
      • Ø EngesæTer I.
      • EngesæTer L.B.
      • Fenstad A.M.
      • et al.
      Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old.
      ,
      • Abdel M.P.
      • Roth P.V.
      • Harmsen W.S.
      • Berry D.J.
      What is the lifetime risk of revision for patients undergoing total hip arthroplasty? a 40-year observational study of patients treated with the Charnley cemented total hip arthroplasty.
      ,
      • Swarup I.
      • Shields M.
      • Mayer E.N.
      • Hendow C.J.
      • Burket J.C.
      • Figgie M.P.
      Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip.
      ,
      • Swarup I.
      • Lee Y.Y.
      • Chiu Y.F.
      • Sutherland R.
      • Shields M.
      • Figgie M.P.
      Implant survival and patient-reported outcomes after total hip arthroplasty in young patients.
      ,
      • Dessyn E.
      • Flecher X.
      • Parratte S.
      • Ollivier M.
      • Argenson J.N.
      A 20-year follow-up evaluation of total hip arthroplasty in patients younger than 50 using a custom cementless stem.
      ,
      • Halawi M.J.
      • Brigati D.
      • Messner W.
      • Brooks P.J.
      Total hip arthroplasty in patients 55 years or younger: risk factors for poor midterm outcomes.
      ,
      • Duffy G.P.
      • Berry D.J.
      • Rowland C.
      • Cabanela M.E.
      Primary uncemented total hip arthroplasty in patients <40 years old: 10- to 14-year results using first-generation proximally porous-coated implants.
      ,
      • Kim Y.H.
      • Kim J.S.
      • Park J.W.
      • Joo J.H.
      Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years.
      ,
      • Kim Y.H.
      • Park J.W.
      • Kim J.S.
      • Kim I.W.
      Twenty-five- to twenty-seven-year results of a cemented vs a cementless stem in the same patients younger than 50 Years of age.
      ,
      • Chiu K.Y.
      • Ng T.P.
      • Tang W.M.
      • Poon K.C.
      • Ho W.Y.
      • Yip D.
      Charnley total hip arthroplasty in Chinese patients less than 40 years old.
      ,
      • Pakvis D.
      • Biemond L.
      • van Hellemondt G.
      • Spruit M.
      A cementless elastic monoblock socket in young patients: a ten to 18-year clinical and radiological follow-up.
      ,
      • Wangen H.
      • Lereim P.
      • Holm I.
      • Gunderson R.
      • Reikerås O.
      Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with a HA-coated stem.
      ], and 4 (11.4%) articles were deemed poor quality [
      • Studers P.
      • Belajevs D.
      • Jurkevics V.
      • Likums P.
      Ten to fifteen-year clinical and radiographic follow-up with a third-generation cementless stem in a young patient population.
      ,
      • Dorr L.D.
      • Kane T.J.
      • Conaty J.P.
      Long-term results of cemented total hip arthroplasty in patients 45 years old or younger. A 16-year follow-up study.
      ,
      • Pedersen A.B.
      • Mehnert F.
      • Havelin L.I.
      • Furnes O.
      • Herberts P.
      • Kärrholm J.
      • et al.
      Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association.
      ,
      • Philippot R.
      • Neri T.
      • Boyer B.
      • Viard B.
      • Farizon F.
      Bousquet dual mobility socket for patient under fifty years old. More than twenty year follow-up of one hundred and thirty one hips.
      ] often due to incomplete reporting or not conducting multivariate analyses (Appendix B, Table B.1).

      Cohort characteristics

      Different age groupings were used as inclusion criteria. While several studies evaluated patients who were 55 years old or younger (n = 10, 28.6%; 57,401 THAs) [
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish arthroplasty register.
      ,
      • Bolland B.J.
      • Whitehouse S.L.
      • Timperley A.J.
      Indications for early hip revision surgery in the UK--a re-analysis of NJR data.
      ,
      • Eskelinen A.
      • Paavolainen P.
      • Helenius I.
      • Pulkkinen P.
      • Remes V.
      Total hip arthroplasty for rheumatoid arthritis in younger patients: 2,557 replacements in the Finnish Arthroplasty Register followed for 0-24 years.
      ,
      • Arksey H.
      • O'Malley L.
      Scoping studies: towards a methodological framework.
      ,
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4,661 primary replacements followed for 0-22 years.
      ,
      • Hooper G.J.
      • Rothwell A.G.
      • Stringer M.
      • Frampton C.
      Revision following cemented and uncemented primary total hip replacement: a seven-year analysis from the New Zealand Joint Registry.
      ,
      • McMinn D.J.
      • Snell K.I.
      • Daniel J.
      • Treacy R.B.
      • Pynsent P.B.
      • Riley R.D.
      Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study.
      ,
      • Strömberg C.N.
      • Herberts P.
      A multicenter 10-year study of cemented revision total hip arthroplasty in patients younger than 55 years old. A follow-up report.
      ,
      • Pedersen A.B.
      • Mehnert F.
      • Havelin L.I.
      • Furnes O.
      • Herberts P.
      • Kärrholm J.
      • et al.
      Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association.
      ,
      • Halawi M.J.
      • Brigati D.
      • Messner W.
      • Brooks P.J.
      Total hip arthroplasty in patients 55 years or younger: risk factors for poor midterm outcomes.
      ], others reported findings on patients 50 years of age or younger (n = 10, 28.6%; 1893 THAs) [
      • McAuley J.P.
      • Szuszczewicz E.S.
      • Young A.
      • Engh C.A.
      Total hip arthroplasty in patients 50 years and younger.
      ,
      • Martin C.T.
      • Callaghan J.J.
      • Gao Y.
      • Pugely A.J.
      • Liu S.S.
      • Warth L.C.
      • et al.
      What can we learn from 20-year followup studies of hip replacement?.
      ,
      • Emery D.F.
      • Clarke H.J.
      • Grover M.L.
      Stanmore total hip replacement in younger patients: review of a group of patients under 50 years of age at operation.
      ,
      • Kim Y.H.
      • Park J.W.
      • Park J.S.
      The 27 to 29-year outcomes of the PCA total hip arthroplasty in patients younger than 50 years old.
      ,
      • Abdel M.P.
      • Roth P.V.
      • Harmsen W.S.
      • Berry D.J.
      What is the lifetime risk of revision for patients undergoing total hip arthroplasty? a 40-year observational study of patients treated with the Charnley cemented total hip arthroplasty.
      ,
      • Philippot R.
      • Neri T.
      • Boyer B.
      • Viard B.
      • Farizon F.
      Bousquet dual mobility socket for patient under fifty years old. More than twenty year follow-up of one hundred and thirty one hips.
      ,
      • Dessyn E.
      • Flecher X.
      • Parratte S.
      • Ollivier M.
      • Argenson J.N.
      A 20-year follow-up evaluation of total hip arthroplasty in patients younger than 50 using a custom cementless stem.
      ,
      • Kim Y.H.
      • Kim J.S.
      • Park J.W.
      • Joo J.H.
      Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years.
      ,
      • Kim Y.H.
      • Park J.W.
      • Kim J.S.
      • Kim I.W.
      Twenty-five- to twenty-seven-year results of a cemented vs a cementless stem in the same patients younger than 50 Years of age.
      ,
      • Pakvis D.
      • Biemond L.
      • van Hellemondt G.
      • Spruit M.
      A cementless elastic monoblock socket in young patients: a ten to 18-year clinical and radiological follow-up.
      ]. Ten studies (n = 10) did not report the mean or median age of the included participants; however, an age-related inclusion criterion of 55 years or younger was reported. Of those reporting age, the mean (standard deviation) age of participants was 36.76 (10.39) years. Males comprised 40.8%-100% [
      • Martin C.T.
      • Callaghan J.J.
      • Gao Y.
      • Pugely A.J.
      • Liu S.S.
      • Warth L.C.
      • et al.
      What can we learn from 20-year followup studies of hip replacement?.
      ,
      • Studers P.
      • Belajevs D.
      • Jurkevics V.
      • Likums P.
      Ten to fifteen-year clinical and radiographic follow-up with a third-generation cementless stem in a young patient population.
      ,
      • Arksey H.
      • O'Malley L.
      Scoping studies: towards a methodological framework.
      ,
      • McMinn D.J.
      • Snell K.I.
      • Daniel J.
      • Treacy R.B.
      • Pynsent P.B.
      • Riley R.D.
      Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study.
      ,
      • Sedrakyan A.
      • Romero L.
      • Graves S.
      • Davidson D.
      • de Steiger R.
      • Lewis P.
      • et al.
      Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data.
      ,
      • Suh D.H.
      • Yun H.H.
      • Chun S.K.
      • Shon W.Y.
      Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty.
      ,
      • Pedersen A.B.
      • Mehnert F.
      • Havelin L.I.
      • Furnes O.
      • Herberts P.
      • Kärrholm J.
      • et al.
      Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association.
      ,
      • Girard J.
      • Glorion C.
      • Bonnomet F.
      • Fron D.
      • Migaud H.
      Risk factors for revision of hip arthroplasties in patients younger than 30 years.
      ,
      • Tsukanaka M.
      • Halvorsen V.
      • Nordsletten L.
      • Ø EngesæTer I.
      • EngesæTer L.B.
      • Fenstad A.M.
      • et al.
      Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old.
      ,
      • Abdel M.P.
      • Roth P.V.
      • Harmsen W.S.
      • Berry D.J.
      What is the lifetime risk of revision for patients undergoing total hip arthroplasty? a 40-year observational study of patients treated with the Charnley cemented total hip arthroplasty.
      ,
      • Philippot R.
      • Neri T.
      • Boyer B.
      • Viard B.
      • Farizon F.
      Bousquet dual mobility socket for patient under fifty years old. More than twenty year follow-up of one hundred and thirty one hips.
      ,
      • Swarup I.
      • Shields M.
      • Mayer E.N.
      • Hendow C.J.
      • Burket J.C.
      • Figgie M.P.
      Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip.
      ,
      • Swarup I.
      • Lee Y.Y.
      • Chiu Y.F.
      • Sutherland R.
      • Shields M.
      • Figgie M.P.
      Implant survival and patient-reported outcomes after total hip arthroplasty in young patients.
      ,
      • Dessyn E.
      • Flecher X.
      • Parratte S.
      • Ollivier M.
      • Argenson J.N.
      A 20-year follow-up evaluation of total hip arthroplasty in patients younger than 50 using a custom cementless stem.
      ,
      • Halawi M.J.
      • Brigati D.
      • Messner W.
      • Brooks P.J.
      Total hip arthroplasty in patients 55 years or younger: risk factors for poor midterm outcomes.
      ,
      • Halvorsen V.
      • Fenstad A.M.
      • Engesæter L.B.
      • Nordsletten L.
      • Overgaard S.
      • Pedersen Alma B.
      • et al.
      Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016.
      ,
      • Duffy G.P.
      • Berry D.J.
      • Rowland C.
      • Cabanela M.E.
      Primary uncemented total hip arthroplasty in patients <40 years old: 10- to 14-year results using first-generation proximally porous-coated implants.
      ,
      • Kim Y.H.
      • Kim J.S.
      • Park J.W.
      • Joo J.H.
      Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years.
      ,
      • Kim Y.H.
      • Park J.W.
      • Kim J.S.
      • Kim I.W.
      Twenty-five- to twenty-seven-year results of a cemented vs a cementless stem in the same patients younger than 50 Years of age.
      ,
      • Chiu K.Y.
      • Ng T.P.
      • Tang W.M.
      • Poon K.C.
      • Ho W.Y.
      • Yip D.
      Charnley total hip arthroplasty in Chinese patients less than 40 years old.
      ,
      • Pakvis D.
      • Biemond L.
      • van Hellemondt G.
      • Spruit M.
      A cementless elastic monoblock socket in young patients: a ten to 18-year clinical and radiological follow-up.
      ,
      • Wangen H.
      • Lereim P.
      • Holm I.
      • Gunderson R.
      • Reikerås O.
      Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with a HA-coated stem.
      ] of the 22 (62.9%) studies that reported sex distribution (Table 1). Thirty-four (97.1%) studies reported reoperation and/or survival rate [
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish arthroplasty register.
      ,
      • McAuley J.P.
      • Szuszczewicz E.S.
      • Young A.
      • Engh C.A.
      Total hip arthroplasty in patients 50 years and younger.
      ,
      • Martin C.T.
      • Callaghan J.J.
      • Gao Y.
      • Pugely A.J.
      • Liu S.S.
      • Warth L.C.
      • et al.
      What can we learn from 20-year followup studies of hip replacement?.
      ,
      • Studers P.
      • Belajevs D.
      • Jurkevics V.
      • Likums P.
      Ten to fifteen-year clinical and radiographic follow-up with a third-generation cementless stem in a young patient population.
      ,
      • Bolland B.J.
      • Whitehouse S.L.
      • Timperley A.J.
      Indications for early hip revision surgery in the UK--a re-analysis of NJR data.
      ,
      • Eskelinen A.
      • Paavolainen P.
      • Helenius I.
      • Pulkkinen P.
      • Remes V.
      Total hip arthroplasty for rheumatoid arthritis in younger patients: 2,557 replacements in the Finnish Arthroplasty Register followed for 0-24 years.
      ,
      • Arksey H.
      • O'Malley L.
      Scoping studies: towards a methodological framework.
      ,
      • Gallo J.
      • Langova K.
      • Havranek V.
      • Cechova I.
      Poor survival of ABG I hip prosthesis in younger patients.
      ,
      • Dorr L.D.
      • Kane T.J.
      • Conaty J.P.
      Long-term results of cemented total hip arthroplasty in patients 45 years old or younger. A 16-year follow-up study.
      ,
      • Emery D.F.
      • Clarke H.J.
      • Grover M.L.
      Stanmore total hip replacement in younger patients: review of a group of patients under 50 years of age at operation.
      ,
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4,661 primary replacements followed for 0-22 years.
      ,
      • Hooper G.J.
      • Rothwell A.G.
      • Stringer M.
      • Frampton C.
      Revision following cemented and uncemented primary total hip replacement: a seven-year analysis from the New Zealand Joint Registry.
      ,
      • McMinn D.J.
      • Snell K.I.
      • Daniel J.
      • Treacy R.B.
      • Pynsent P.B.
      • Riley R.D.
      Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study.
      ,
      • Sochart D.H.
      Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty.
      ,
      • Sochart D.H.
      • Porter M.L.
      The long-term results of Charnley low-friction arthroplasty in young patients who have congenital dislocation, degenerative osteoarthrosis, or rheumatoid arthritis.
      ,
      • Kim Y.H.
      • Park J.W.
      • Park J.S.
      The 27 to 29-year outcomes of the PCA total hip arthroplasty in patients younger than 50 years old.
      ,
      • Sedrakyan A.
      • Romero L.
      • Graves S.
      • Davidson D.
      • de Steiger R.
      • Lewis P.
      • et al.
      Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data.
      ,
      • Suh D.H.
      • Yun H.H.
      • Chun S.K.
      • Shon W.Y.
      Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty.
      ,
      • Strömberg C.N.
      • Herberts P.
      A multicenter 10-year study of cemented revision total hip arthroplasty in patients younger than 55 years old. A follow-up report.
      ,
      • Pedersen A.B.
      • Mehnert F.
      • Havelin L.I.
      • Furnes O.
      • Herberts P.
      • Kärrholm J.
      • et al.
      Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association.
      ,
      • Girard J.
      • Glorion C.
      • Bonnomet F.
      • Fron D.
      • Migaud H.
      Risk factors for revision of hip arthroplasties in patients younger than 30 years.
      ,
      • Tsukanaka M.
      • Halvorsen V.
      • Nordsletten L.
      • Ø EngesæTer I.
      • EngesæTer L.B.
      • Fenstad A.M.
      • et al.
      Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old.
      ,
      • Abdel M.P.
      • Roth P.V.
      • Harmsen W.S.
      • Berry D.J.
      What is the lifetime risk of revision for patients undergoing total hip arthroplasty? a 40-year observational study of patients treated with the Charnley cemented total hip arthroplasty.
      ,
      • Philippot R.
      • Neri T.
      • Boyer B.
      • Viard B.
      • Farizon F.
      Bousquet dual mobility socket for patient under fifty years old. More than twenty year follow-up of one hundred and thirty one hips.
      ,
      • Swarup I.
      • Shields M.
      • Mayer E.N.
      • Hendow C.J.
      • Burket J.C.
      • Figgie M.P.
      Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip.
      ,
      • Swarup I.
      • Lee Y.Y.
      • Chiu Y.F.
      • Sutherland R.
      • Shields M.
      • Figgie M.P.
      Implant survival and patient-reported outcomes after total hip arthroplasty in young patients.
      ,
      • Dessyn E.
      • Flecher X.
      • Parratte S.
      • Ollivier M.
      • Argenson J.N.
      A 20-year follow-up evaluation of total hip arthroplasty in patients younger than 50 using a custom cementless stem.
      ,
      • Halawi M.J.
      • Brigati D.
      • Messner W.
      • Brooks P.J.
      Total hip arthroplasty in patients 55 years or younger: risk factors for poor midterm outcomes.
      ,
      • Halvorsen V.
      • Fenstad A.M.
      • Engesæter L.B.
      • Nordsletten L.
      • Overgaard S.
      • Pedersen Alma B.
      • et al.
      Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016.
      ,
      • Duffy G.P.
      • Berry D.J.
      • Rowland C.
      • Cabanela M.E.
      Primary uncemented total hip arthroplasty in patients <40 years old: 10- to 14-year results using first-generation proximally porous-coated implants.
      ,
      • Kim Y.H.
      • Kim J.S.
      • Park J.W.
      • Joo J.H.
      Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years.
      ,
      • Kim Y.H.
      • Park J.W.
      • Kim J.S.
      • Kim I.W.
      Twenty-five- to twenty-seven-year results of a cemented vs a cementless stem in the same patients younger than 50 Years of age.
      ,
      • Chiu K.Y.
      • Ng T.P.
      • Tang W.M.
      • Poon K.C.
      • Ho W.Y.
      • Yip D.
      Charnley total hip arthroplasty in Chinese patients less than 40 years old.
      ,
      • Pakvis D.
      • Biemond L.
      • van Hellemondt G.
      • Spruit M.
      A cementless elastic monoblock socket in young patients: a ten to 18-year clinical and radiological follow-up.
      ,
      • Wangen H.
      • Lereim P.
      • Holm I.
      • Gunderson R.
      • Reikerås O.
      Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with a HA-coated stem.
      ], while 5 (14.3%) studies reported an annual wear rate of the revised hip arthroplasty components [
      • McAuley J.P.
      • Szuszczewicz E.S.
      • Young A.
      • Engh C.A.
      Total hip arthroplasty in patients 50 years and younger.
      ,
      • Sochart D.H.
      Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty.
      ,
      • Kim Y.H.
      • Park J.W.
      • Park J.S.
      The 27 to 29-year outcomes of the PCA total hip arthroplasty in patients younger than 50 years old.
      ,
      • Kim Y.H.
      • Kim J.S.
      • Park J.W.
      • Joo J.H.
      Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years.
      ,
      • Kim Y.H.
      • Park J.W.
      • Kim J.S.
      • Kim I.W.
      Twenty-five- to twenty-seven-year results of a cemented vs a cementless stem in the same patients younger than 50 Years of age.
      ].
      Table 1Included study characteristics.
      AuthorYearCountryData sourceAge groups (y)Sex (% male)
      Registry data
      Eskelinen et al. [
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4,661 primary replacements followed for 0-22 years.
      ]
      2005FinlandThe Finnish Arthroplasty Register<55NR
      Eskelinen et al. [
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish arthroplasty register.
      ]
      2006FinlandThe Finnish Arthroplasty Register<55NR
      Eskilenen et al. [
      • Eskelinen A.
      • Paavolainen P.
      • Helenius I.
      • Pulkkinen P.
      • Remes V.
      Total hip arthroplasty for rheumatoid arthritis in younger patients: 2,557 replacements in the Finnish Arthroplasty Register followed for 0-24 years.
      ]
      2006FinlandThe Finnish Arthroplasty Register<55NR
      Hooper et al. [
      • Hooper G.J.
      • Rothwell A.G.
      • Stringer M.
      • Frampton C.
      Revision following cemented and uncemented primary total hip replacement: a seven-year analysis from the New Zealand Joint Registry.
      ]
      2009New ZealandThe New Zealand Joint Registry<55
      a study included participants older than 55 y, but only the subgroup aged 55 y or younger was included in the review.
      NR
      Makela et al. [
      • Arksey H.
      • O'Malley L.
      Scoping studies: towards a methodological framework.
      ]
      2011FinlandThe Finnish Arthroplasty Register49.7 (16-54)
      mean and range.
      50.5
      Bolland et al. [
      • Bolland B.J.
      • Whitehouse S.L.
      • Timperley A.J.
      Indications for early hip revision surgery in the UK--a re-analysis of NJR data.
      ]
      2012EnglandThe National Joint Registry of England and Wales<55 (55.1-72.7)
      range.
      NR
      McMinn et al. [
      • McMinn D.J.
      • Snell K.I.
      • Daniel J.
      • Treacy R.B.
      • Pynsent P.B.
      • Riley R.D.
      Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study.
      ]
      2012EnglandThe National Joint Registry of England and Wales<55
      a study included participants older than 55 y, but only the subgroup aged 55 y or younger was included in the review.
      100
      Sedrayken et al. [
      • Sedrakyan A.
      • Romero L.
      • Graves S.
      • Davidson D.
      • de Steiger R.
      • Lewis P.
      • et al.
      Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data.
      ]
      2014AustraliaAustralian Orthopaedic Association National Joint Replacement Registry<2045
      Pedersen et al. [
      • Pedersen A.B.
      • Mehnert F.
      • Havelin L.I.
      • Furnes O.
      • Herberts P.
      • Kärrholm J.
      • et al.
      Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association.
      ]
      2014ScandinaviaThe nationwide hip arthroplasty registries in Sweden, Norway, Denmark, and Finland.35-55
      range.
      52.1
      Tsukanaka et al. [
      • Tsukanaka M.
      • Halvorsen V.
      • Nordsletten L.
      • Ø EngesæTer I.
      • EngesæTer L.B.
      • Fenstad A.M.
      • et al.
      Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old.
      ]
      2016NorwayThe Norwegian Arthroplasty Register17 (11-19)
      mean and range.
      44.1
      Halvorsen et al. [
      • Halvorsen V.
      • Fenstad A.M.
      • Engesæter L.B.
      • Nordsletten L.
      • Overgaard S.
      • Pedersen Alma B.
      • et al.
      Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016.
      ]
      2019Denmark, Finland, Norway, SwedenThe Nordic Arthroplasty Register Association (a collaboration between the national joint replacement registers in Denmark, Finland, Norway, and Sweden)18 (2.4)
      mean with or without slandered deviation.
      47
      Hospital/Institutional Data
      Sochart et al. [
      • Sochart D.H.
      Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty.
      ]
      1999United KingdomInstitutional data, Centre for Hip Surgery, Wrightington Hospital, UK31.7
      mean with or without slandered deviation.
      NR
      Duffy et al. [
      • Duffy G.P.
      • Berry D.J.
      • Rowland C.
      • Cabanela M.E.
      Primary uncemented total hip arthroplasty in patients <40 years old: 10- to 14-year results using first-generation proximally porous-coated implants.
      ]
      2001USAInstitutional data, Department of Orthopedics, Mayo Clinic32 (17-39)
      mean and range.
      54.2
      McAuley et al. [
      • McAuley J.P.
      • Szuszczewicz E.S.
      • Young A.
      • Engh C.A.
      Total hip arthroplasty in patients 50 years and younger.
      ]
      2004USAInstitutional data, Anderson Orthopaedic Research Institute40 (16-50)
      mean and range.
      NR
      Gallo et al. [
      • Gallo J.
      • Langova K.
      • Havranek V.
      • Cechova I.
      Poor survival of ABG I hip prosthesis in younger patients.
      ]
      2008Czech RepublicInstitutional data, Olomouc, Czech Republic46.5 (6.7)
      mean with or without slandered deviation.
      NR
      Struders et al. [
      • Studers P.
      • Belajevs D.
      • Jurkevics V.
      • Likums P.
      Ten to fifteen-year clinical and radiographic follow-up with a third-generation cementless stem in a young patient population.
      ]
      2016LatviaInstitutional data, Department of Orthopaedic Surgery, Riga Stradins University,47.4 (18-77)
      mean and range.
      40.8
      Abdel et al. [
      • Abdel M.P.
      • Roth P.V.
      • Harmsen W.S.
      • Berry D.J.
      What is the lifetime risk of revision for patients undergoing total hip arthroplasty? a 40-year observational study of patients treated with the Charnley cemented total hip arthroplasty.
      ]
      2016USAInstitutional data, Department of Orthopedics, Mayo Clinic<50
      a study included participants older than 55 y, but only the subgroup aged 55 y or younger was included in the review.
      50
      Philippot et al. [
      • Philippot R.
      • Neri T.
      • Boyer B.
      • Viard B.
      • Farizon F.
      Bousquet dual mobility socket for patient under fifty years old. More than twenty year follow-up of one hundred and thirty one hips.
      ]
      2017FranceInstitutional data, Orthopaedic Surgery Unit of the Saint Etienne, University Hospital, France41 (18-50)
      mean and range.
      57.9
      Swarup et al. [
      • Swarup I.
      • Shields M.
      • Mayer E.N.
      • Hendow C.J.
      • Burket J.C.
      • Figgie M.P.
      Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip.
      ]
      2017USAA hospital-based registry, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA27.3 (13-35)
      mean and range.
      52.5
      Halawi et al. [
      • Halawi M.J.
      • Brigati D.
      • Messner W.
      • Brooks P.J.
      Total hip arthroplasty in patients 55 years or younger: risk factors for poor midterm outcomes.
      ]
      2018USAInstitutional data, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, USA.46.9 (7.1)
      mean with or without slandered deviation.
      53.7
      Swarup et al. [
      • Swarup I.
      • Lee Y.Y.
      • Chiu Y.F.
      • Sutherland R.
      • Shields M.
      • Figgie M.P.
      Implant survival and patient-reported outcomes after total hip arthroplasty in young patients.
      ]
      2018USAInstitutional data, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA27 (8-35)
      mean and range.
      41.4
      Dessyn et al. [
      • Dessyn E.
      • Flecher X.
      • Parratte S.
      • Ollivier M.
      • Argenson J.N.
      A 20-year follow-up evaluation of total hip arthroplasty in patients younger than 50 using a custom cementless stem.
      ]
      2019FranceInstitutional data, Department of Orthopaedics and Traumatology, St. Marguerite Hospital, France42.6 (4)
      mean with or without slandered deviation.
      50
      Single Surgeon Data
      Kim et al. [
      • Kim Y.H.
      • Kim J.S.
      • Park J.W.
      • Joo J.H.
      Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years.
      ]
      2011KoreaSingle-surgeon clinic45.1 (21-50)
      mean and range.
      76.4
      Suh et al. [
      • Suh D.H.
      • Yun H.H.
      • Chun S.K.
      • Shon W.Y.
      Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty.
      ]
      2013KoreaSingle-surgeon clinic46.8 (22-77)
      mean and range.
      ,
      a study included participants older than 55 y, but only the subgroup aged 55 y or younger was included in the review.
      69.8
      Kim et al. [
      • Kim Y.H.
      • Park J.W.
      • Park J.S.
      The 27 to 29-year outcomes of the PCA total hip arthroplasty in patients younger than 50 years old.
      ]
      2014KoreaSingle-surgeon clinic45.6 (11.1)
      mean with or without slandered deviation.
      NR
      Kim et al. [
      • Kim Y.H.
      • Park J.W.
      • Kim J.S.
      • Kim I.W.
      Twenty-five- to twenty-seven-year results of a cemented vs a cementless stem in the same patients younger than 50 Years of age.
      ]
      2016KoreaSingle-surgeon clinic47.7 (10.7)
      mean with or without slandered deviation.
      73.1
      Martin et al. [
      • Martin C.T.
      • Callaghan J.J.
      • Gao Y.
      • Pugely A.J.
      • Liu S.S.
      • Warth L.C.
      • et al.
      What can we learn from 20-year followup studies of hip replacement?.
      ]
      2016USASingle-surgeon clinic<5045
      Other Data Sources
      Stromberg et al. [
      • Strömberg C.N.
      • Herberts P.
      A multicenter 10-year study of cemented revision total hip arthroplasty in patients younger than 55 years old. A follow-up report.
      ]
      1994SwedenNational prospective multicenter study data47 (31-55)
      mean and range.
      NR
      Dorr et al. [
      • Dorr L.D.
      • Kane T.J.
      • Conaty J.P.
      Long-term results of cemented total hip arthroplasty in patients 45 years old or younger. A 16-year follow-up study.
      ]
      1994USANR31.1 (16-45)
      mean and range.
      NR
      Emery et al. [
      • Emery D.F.
      • Clarke H.J.
      • Grover M.L.
      Stanmore total hip replacement in younger patients: review of a group of patients under 50 years of age at operation.
      ]
      1997EnglandNR41 (17-49)
      mean and range.
      NR
      Sochart et al. [
      • Sochart D.H.
      • Porter M.L.
      The long-term results of Charnley low-friction arthroplasty in young patients who have congenital dislocation, degenerative osteoarthrosis, or rheumatoid arthritis.
      ]
      1997United KingdomNR31.7
      mean with or without slandered deviation.
      NR
      Chiu et al. [
      • Chiu K.Y.
      • Ng T.P.
      • Tang W.M.
      • Poon K.C.
      • Ho W.Y.
      • Yip D.
      Charnley total hip arthroplasty in Chinese patients less than 40 years old.
      ]
      2001Hong KongNR28.8 (6.2)
      mean with or without slandered deviation.
      60.6
      Wangen et al. [
      • Wangen H.
      • Lereim P.
      • Holm I.
      • Gunderson R.
      • Reikerås O.
      Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with a HA-coated stem.
      ]
      2008NorwayNR25 (15-30)
      mean and range.
      42.9
      Girard et al. [
      • Girard J.
      • Glorion C.
      • Bonnomet F.
      • Fron D.
      • Migaud H.
      Risk factors for revision of hip arthroplasties in patients younger than 30 years.
      ]
      2011FranceMulticenter trial conducted in 23 French centers specializing in THA for young patients19.7 (12-29)
      mean and range.
      52.6
      Pakvis et al. [
      • Pakvis D.
      • Biemond L.
      • van Hellemondt G.
      • Spruit M.
      A cementless elastic monoblock socket in young patients: a ten to 18-year clinical and radiological follow-up.
      ]
      2011The NetherlandsNR42.4 (16-50)
      mean and range.
      48.9
      NR, not reported.
      a mean with or without slandered deviation.
      b mean and range.
      c a study included participants older than 55 y, but only the subgroup aged 55 y or younger was included in the review.
      d range.
      Nearly all studies (n = 33, 94.3%) reported the primary reason for THA. Only 5 (14.3%) studies included participants with a primary diagnosis of OA [
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish arthroplasty register.
      ,
      • Arksey H.
      • O'Malley L.
      Scoping studies: towards a methodological framework.
      ,
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4,661 primary replacements followed for 0-22 years.
      ,
      • McMinn D.J.
      • Snell K.I.
      • Daniel J.
      • Treacy R.B.
      • Pynsent P.B.
      • Riley R.D.
      Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study.
      ,
      • Pedersen A.B.
      • Mehnert F.
      • Havelin L.I.
      • Furnes O.
      • Herberts P.
      • Kärrholm J.
      • et al.
      Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association.
      ], 1 (2.9%) included AVN [
      • Swarup I.
      • Shields M.
      • Mayer E.N.
      • Hendow C.J.
      • Burket J.C.
      • Figgie M.P.
      Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip.
      ], and another (2.9%) included rheumatoid arthritis [
      • Eskelinen A.
      • Paavolainen P.
      • Helenius I.
      • Pulkkinen P.
      • Remes V.
      Total hip arthroplasty for rheumatoid arthritis in younger patients: 2,557 replacements in the Finnish Arthroplasty Register followed for 0-24 years.
      ]. The remaining studies (n = 28, 80%) included cohorts with multiple indications for THA such as degenerative (OA, AVN), inflammatory (inflammatory arthritis, rheumatoid arthritis, ankylosing spondylitis, septic arthritis, autoimmune arthritis, juvenile inflammatory arthritis), developmental (dysplastic hip, slipped capital femoral epiphysis, Legg-Calve-Perthes disease), post-traumatic, oncologic, and neurologic diseases [
      • McAuley J.P.
      • Szuszczewicz E.S.
      • Young A.
      • Engh C.A.
      Total hip arthroplasty in patients 50 years and younger.
      ,
      • Martin C.T.
      • Callaghan J.J.
      • Gao Y.
      • Pugely A.J.
      • Liu S.S.
      • Warth L.C.
      • et al.
      What can we learn from 20-year followup studies of hip replacement?.
      ,
      • Studers P.
      • Belajevs D.
      • Jurkevics V.
      • Likums P.
      Ten to fifteen-year clinical and radiographic follow-up with a third-generation cementless stem in a young patient population.
      ,
      • Gallo J.
      • Langova K.
      • Havranek V.
      • Cechova I.
      Poor survival of ABG I hip prosthesis in younger patients.
      ,
      • Dorr L.D.
      • Kane T.J.
      • Conaty J.P.
      Long-term results of cemented total hip arthroplasty in patients 45 years old or younger. A 16-year follow-up study.
      ,
      • Emery D.F.
      • Clarke H.J.
      • Grover M.L.
      Stanmore total hip replacement in younger patients: review of a group of patients under 50 years of age at operation.
      ,
      • Sochart D.H.
      Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty.
      ,
      • Sochart D.H.
      • Porter M.L.
      The long-term results of Charnley low-friction arthroplasty in young patients who have congenital dislocation, degenerative osteoarthrosis, or rheumatoid arthritis.
      ,
      • Kim Y.H.
      • Park J.W.
      • Park J.S.
      The 27 to 29-year outcomes of the PCA total hip arthroplasty in patients younger than 50 years old.
      ,
      • Sedrakyan A.
      • Romero L.
      • Graves S.
      • Davidson D.
      • de Steiger R.
      • Lewis P.
      • et al.
      Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data.
      ,
      • Suh D.H.
      • Yun H.H.
      • Chun S.K.
      • Shon W.Y.
      Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty.
      ,
      • Strömberg C.N.
      • Herberts P.
      A multicenter 10-year study of cemented revision total hip arthroplasty in patients younger than 55 years old. A follow-up report.
      ,
      • Girard J.
      • Glorion C.
      • Bonnomet F.
      • Fron D.
      • Migaud H.
      Risk factors for revision of hip arthroplasties in patients younger than 30 years.
      ,
      • Tsukanaka M.
      • Halvorsen V.
      • Nordsletten L.
      • Ø EngesæTer I.
      • EngesæTer L.B.
      • Fenstad A.M.
      • et al.
      Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old.
      ,
      • Abdel M.P.
      • Roth P.V.
      • Harmsen W.S.
      • Berry D.J.
      What is the lifetime risk of revision for patients undergoing total hip arthroplasty? a 40-year observational study of patients treated with the Charnley cemented total hip arthroplasty.
      ,
      • Philippot R.
      • Neri T.
      • Boyer B.
      • Viard B.
      • Farizon F.
      Bousquet dual mobility socket for patient under fifty years old. More than twenty year follow-up of one hundred and thirty one hips.
      ,
      • Swarup I.
      • Lee Y.Y.
      • Chiu Y.F.
      • Sutherland R.
      • Shields M.
      • Figgie M.P.
      Implant survival and patient-reported outcomes after total hip arthroplasty in young patients.
      ,
      • Dessyn E.
      • Flecher X.
      • Parratte S.
      • Ollivier M.
      • Argenson J.N.
      A 20-year follow-up evaluation of total hip arthroplasty in patients younger than 50 using a custom cementless stem.
      ,
      • Halawi M.J.
      • Brigati D.
      • Messner W.
      • Brooks P.J.
      Total hip arthroplasty in patients 55 years or younger: risk factors for poor midterm outcomes.
      ,
      • Halvorsen V.
      • Fenstad A.M.
      • Engesæter L.B.
      • Nordsletten L.
      • Overgaard S.
      • Pedersen Alma B.
      • et al.
      Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016.
      ,
      • Duffy G.P.
      • Berry D.J.
      • Rowland C.
      • Cabanela M.E.
      Primary uncemented total hip arthroplasty in patients <40 years old: 10- to 14-year results using first-generation proximally porous-coated implants.
      ,
      • Kim Y.H.
      • Kim J.S.
      • Park J.W.
      • Joo J.H.
      Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years.
      ,
      • Kim Y.H.
      • Park J.W.
      • Kim J.S.
      • Kim I.W.
      Twenty-five- to twenty-seven-year results of a cemented vs a cementless stem in the same patients younger than 50 Years of age.
      ,
      • Chiu K.Y.
      • Ng T.P.
      • Tang W.M.
      • Poon K.C.
      • Ho W.Y.
      • Yip D.
      Charnley total hip arthroplasty in Chinese patients less than 40 years old.
      ,
      • Pakvis D.
      • Biemond L.
      • van Hellemondt G.
      • Spruit M.
      A cementless elastic monoblock socket in young patients: a ten to 18-year clinical and radiological follow-up.
      ,
      • Wangen H.
      • Lereim P.
      • Holm I.
      • Gunderson R.
      • Reikerås O.
      Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with a HA-coated stem.
      ] (Table 2).
      Table 2Total hip arthroplasty primary diagnosis and reasons for reoperation.
      AuthorYearDiagnosis and percentage of each diagnosisReason for revisions
      Dorr et al. [
      • Dorr L.D.
      • Kane T.J.
      • Conaty J.P.
      Long-term results of cemented total hip arthroplasty in patients 45 years old or younger. A 16-year follow-up study.
      ]
      1994Osteonecrosis

      Osteoarthritis

      Inflammatory collagen disease
      Aseptic loosening (100%, n = 33)
      Stromberg et al. [
      • Strömberg C.N.
      • Herberts P.
      A multicenter 10-year study of cemented revision total hip arthroplasty in patients younger than 55 years old. A follow-up report.
      ]
      1994Not rheumatoidAseptic loosening
      Emery et al. [
      • Emery D.F.
      • Clarke H.J.
      • Grover M.L.
      Stanmore total hip replacement in younger patients: review of a group of patients under 50 years of age at operation.
      ]
      1997Osteoarthritis

      Rheumatoid arthritis

      Dysplastic hip

      Osteoarthritis

      Hip disease in childhood
      Mainly for aseptic loosening
      Sochart et al. [
      • Sochart D.H.
      • Porter M.L.
      The long-term results of Charnley low-friction arthroplasty in young patients who have congenital dislocation, degenerative osteoarthrosis, or rheumatoid arthritis.
      ]
      1997Rheumatoid arthritis (44.2%, n = 100)

      Degenerative osteoarthrosis (29.2%, n = 66)

      Congenital hip dislocation (26.5%, n = 60)
      Aseptic loosening

      Excessive wear

      Broken femoral component
      Sochart et al. [
      • Sochart D.H.
      Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty.
      ]
      1999Rheumatoid arthritis (37%, n = 87)

      Degenerative arthrosis (25.1%, n = 59)

      Congenital dislocation the hip (24.3%, n = 57)

      Ankylosing spondylitis (13.6%, n = 32)
      Implant fracture (3%, n = 8)

      Dislocation with marked acetabular wear (1.3%, n = 3)
      Chiu et al. [
      • Chiu K.Y.
      • Ng T.P.
      • Tang W.M.
      • Poon K.C.
      • Ho W.Y.
      • Yip D.
      Charnley total hip arthroplasty in Chinese patients less than 40 years old.
      ]
      2001Ankylosing spondylitis (44.7%)

      AVN (40.4%)

      Rheumatoid arthritis (16.4%)

      Juvenile chronic arthritis (4.3%)

      Post-traumatic osteoarthritis (2.2%)

      Hemophilia (2.2%)
      Infection

      Migration of acetabular component

      Instability

      Femoral component loosening
      Duffy et al. [
      • Duffy G.P.
      • Berry D.J.
      • Rowland C.
      • Cabanela M.E.
      Primary uncemented total hip arthroplasty in patients <40 years old: 10- to 14-year results using first-generation proximally porous-coated implants.
      ]
      2001Developmental dysplasia (36.1%)

      Osteonecrosis of femoral head (19.5%)

      Post-traumatic osteoarthritis (18.1%)

      Rheumatoid arthritis (8.3%)

      Ankylosing spondylitis (8.3%)

      Degenerative joint disease (2.7%)

      Psoriatic arthritis (2.7%)

      Reiter's syndrome (1.4%)
      Aseptic failure (91.7%)

      Infection (8.3%)
      McAuley et al. [
      • McAuley J.P.
      • Szuszczewicz E.S.
      • Young A.
      • Engh C.A.
      Total hip arthroplasty in patients 50 years and younger.
      ]
      2004Osteoarthritis (44%, n = 249)

      Developmental dysplasia (20%, n = 109)

      Osteonecrosis (20%, n = 111)

      Rheumatoid arthritis (9%, n = 53)

      Fracture (7%, n = 39)
      Any reason
      Eskelinen et al. [
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4,661 primary replacements followed for 0-22 years.
      ]
      2005Primary osteoarthritisAseptic loosening (82%, n = 581) Fracture of the implant (3%, n = 21)

      Infection (2.7%, n = 19)

      Prosthesis dislocation (2.7%, n = 19)

      Malposition of the prosthesis (2.3%, n = 16)

      Periprosthetic fracture (1.1%, n = 8)

      Other miscellaneous reasons (6.3%, n = 45)
      Eskelinen et al. [
      • Eskelinen A.
      • Remes V.
      • Helenius I.
      • Pulkkinen P.
      • Nevalainen J.
      • Paavolainen P.
      Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish arthroplasty register.
      ]
      2006Primary osteoarthritisAseptic loosening (range from 0.2%-23%)

      Infection (range from 0.2%-2.4%)

      Dislocation (range from 0.7%-12%)

      Malposition (range from 0.3%-1.6%)

      Fracture of stem (range from 0.6%-3%)

      Fracture of bone (range from 0.1%-0.9%)

      Other reasons for cup reoperation including exchange of liner (range from 0.6%-15%)
      Eskilenen et al. [
      • Eskelinen A.
      • Paavolainen P.
      • Helenius I.
      • Pulkkinen P.
      • Remes V.
      Total hip arthroplasty for rheumatoid arthritis in younger patients: 2,557 replacements in the Finnish Arthroplasty Register followed for 0-24 years.
      ]
      2006Rheumatoid arthritisAseptic loosening (82%)

      Prosthesis dislocation (3.3%)

      Infection (2.8%)

      Periprosthetic fracture (1.8%) Fracture of the stem (1.2%)

      Malposition of the prosthesis (1.0%)

      Other, miscellaneous reasons (including exchange of liner) (8.3%)
      Wangen et al. [
      • Wangen H.
      • Lereim P.
      • Holm I.
      • Gunderson R.
      • Reikerås O.
      Hip arthroplasty in patients younger than 30 years: excellent ten to 16-year follow-up results with a HA-coated stem.
      ]
      2008Secondary osteoarthrosis due to congenital dislocation (54.6%)

      AVN (13.6%)

      Coxitis (9.1%)

      Acetabular fractures (9.1%)

      Calve-Legg-Perthes disease (6.8%)

      Epiphyseal dysplasia (4.6%)

      Chondrodystrophia (2.3%)
      Loosening (58.3%)

      Polyethylene wear (29.2%)

      Repeated dislocations (12.5%)
      Gallo et al. [
      • Gallo J.
      • Langova K.
      • Havranek V.
      • Cechova I.
      Poor survival of ABG I hip prosthesis in younger patients.
      ]
      2008Osteoarthritis (44%),

      Dysplastic hip (40%)

      Traumatic hip (7%)

      AVN

      Inflammatory arthritis

      Slipped capital femoral epiphysis
      Osteolysis (57%)

      Cup loosening (25.5%)

      Periprosthetic fracture (7.8%)

      Instability (5.9%)

      Stem loosening (2%)

      Deep sepsis (2%)
      Hooper et al. [
      • Hooper G.J.
      • Rothwell A.G.
      • Stringer M.
      • Frampton C.
      Revision following cemented and uncemented primary total hip replacement: a seven-year analysis from the New Zealand Joint Registry.
      ]
      2009NRLoosening acetabular component

      Loosening femoral

      Component

      Dislocation

      Deep infection
      Makela et al. [
      • Arksey H.
      • O'Malley L.
      Scoping studies: towards a methodological framework.
      ]
      2011Primary osteoarthritisAseptic loosening (46.2%, n = 232)

      Dislocation (5.1%, n = 46)

      Malposition (4.8%, n = 24)

      Fracture of the prosthesis (4.4%, n = 22)

      Infection (3.8%, n = 19)

      Periprosthetic fracture (3%, n = 15)

      Other reasons (including, liner revisions due to excessive wear) (30.7%, n = 154)
      Girard et al. [
      • Girard J.
      • Glorion C.
      • Bonnomet F.
      • Fron D.
      • Migaud H.
      Risk factors for revision of hip arthroplasties in patients younger than 30 years.
      ]
      2011AVN (25.4%, n = 228)

      Inflammatory disease (20.3%, n = 182)

      Pediatric disease (18.5%, n = 166)

      Septic sequelae (8.6%, n = 77)

      Neurologic disease (6.6%, n = 59)

      Primary osteoarthritis (6.1%, n = 55)
      Aseptic loosening (51%, n = 40) Wear (24%, n = 19)

      Infection (8%, n = 6)

      Osteolysis (7%, n = 5)

      Recurrent dislocation (6%, n = 4) Implant breakage (4%, n = 3)
      Pakvis et al. [
      • Pakvis D.
      • Biemond L.
      • van Hellemondt G.
      • Spruit M.
      A cementless elastic monoblock socket in young patients: a ten to 18-year clinical and radiological follow-up.
      ]
      2011Primary osteoarthritis (30.4%)

      Hip dysplasia (24.1%)

      Rheumatoid disease (18.4%)

      Trauma (10.1%)

      Other causes (10.1%)

      Osteonecrosis (8.2%)
      Wear and osteolysis (63.6%)

      Trauma (18.2%)

      Aseptic loosening (9.1%)

      Malposition cup (9.1%)
      Kim et al. [
      • Kim Y.H.
      • Kim J.S.
      • Park J.W.
      • Joo J.H.
      Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years.
      ]
      2011Osteonecrosis (66.2%)

      Osteoarthritis (14.0%)

      Childhood pyogenic arthritis (11.5%)

      Ankylosing spondylitis (3.2%)

      Multiple epiphyseal dysplasia (2.5%)

      Developmental dysplasia (1.9%)

      Rheumatoid arthritis (0.6%)
      Polyethylene wear and osteolysis

      Recurrent dislocation

      Aseptic loosening

      Infection
      Bolland et al. [
      • Bolland B.J.
      • Whitehouse S.L.
      • Timperley A.J.
      Indications for early hip revision surgery in the UK--a re-analysis of NJR data.
      ]
      2012NRAseptic loosening

      Lysis

      Infection

      Periprosthetic fracture

      Pain

      Malalignment

      Dislocation

      Poly wear

      Dissociation liner

      Implant fracture

      Mismatch
      McMinn et al. [
      • McMinn D.J.
      • Snell K.I.
      • Daniel J.
      • Treacy R.B.
      • Pynsent P.B.
      • Riley R.D.
      Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study.
      ]
      2012OsteoarthritisAny reason
      Suh et al. [
      • Suh D.H.
      • Yun H.H.
      • Chun S.K.
      • Shon W.Y.
      Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty.
      ]
      2013AVN

      Osteoarthritis

      Dysplastic hip

      Trauma

      Post-septic hip
      Aseptic loosening of the femoral stem
      Kim et al. [
      • Kim Y.H.
      • Park J.W.
      • Park J.S.
      The 27 to 29-year outcomes of the PCA total hip arthroplasty in patients younger than 50 years old.
      ]
      2014Osteonecrosis

      Dysplastic hip

      Osteoarthritis

      Septic arthritis

      Post-traumatic arthritis
      Aseptic loosening
      Sedrayken et al. [
      • Sedrakyan A.
      • Romero L.
      • Graves S.
      • Davidson D.
      • de Steiger R.
      • Lewis P.
      • et al.
      Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data.
      ]
      2014Osteonecrosis (29%)

      Osteoarthritis (28%)

      Autoimmune arthritis (15%)

      Various types of dysplasia (12%)

      Bone tumor (9%)
      First reoperation for any reason:

      Loosening and/or osteolysis

      Prosthesis dislocation

      Infection
      Pedersen et al. [
      • Pedersen A.B.
      • Mehnert F.
      • Havelin L.I.
      • Furnes O.
      • Herberts P.
      • Kärrholm J.
      • et al.
      Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association.
      ]
      2014Primary osteoarthritisAseptic loosening (53.4%, n = 1290)

      Unspecified (17.2%, n = 415)

      Dislocation (11.9%, n = 288)

      Deep infection (9.1%, n = 219)

      Periprosthetic fracture (3.8%, n = 91)

      Pain only (3.2%, n = 78)
      Kim et al. [
      • Kim Y.H.
      • Park J.W.
      • Kim J.S.
      • Kim I.W.
      Twenty-five- to twenty-seven-year results of a cemented vs a cementless stem in the same patients younger than 50 Years of age.
      ]
      2016Osteonecrosis (57%)

      Developmental dysplastic hip (20%)

      Osteoarthritis (13%)

      Osteoarthritis secondary to childhood sepsis (7%)

      Multiple epiphyseal dysplasia (3%)
      Polyethylene wear and osteolysis

      Recurrent dislocation

      Aseptic loosening

      Infection
      Martin et al. [
      • Martin C.T.
      • Callaghan J.J.
      • Gao Y.
      • Pugely A.J.
      • Liu S.S.
      • Warth L.C.
      • et al.
      What can we learn from 20-year followup studies of hip replacement?.
      ]
      2016Degenerative arthrosis

      Post-traumatic arthritis

      Rheumatoid arthritis

      Dysplastic hip
      Aseptic loosening
      Struders et al. [
      • Studers P.
      • Belajevs D.
      • Jurkevics V.
      • Likums P.
      Ten to fifteen-year clinical and radiographic follow-up with a third-generation cementless stem in a young patient population.
      ]
      2016Osteoarthritis

      Dysplastic hip

      AVN

      Fracture

      Rheumatoid arthritis
      Any reason

      Wear/aseptic loosening (54.2%, n = 13)

      Wear (12.5%, n = 3)

      Infection (4.2%, n = 1)

      Malpositioning cup (4.2%, n = 1)

      Femoral head fracture (4.2%, n = 1)
      Tsukanaka et al. [
      • Tsukanaka M.
      • Halvorsen V.
      • Nordsletten L.
      • Ø EngesæTer I.
      • EngesæTer L.B.
      • Fenstad A.M.
      • et al.
      Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old.
      ]
      2016Pediatric disease (40.9%, n = 54)

      Systemic inflammatory disease (34.1%, n = 45) sequelae of trauma (8.3%, n = 11)

      sequelae of infection (5.3%, n = 7)
      Aseptic loosening (44.9%, n = 31)

      Wear (20.3%, n = 14)

      Infection (11.6%, n = 8)

      Osteolysis (8.7%, n = 6)

      Dislocation (5.8%, n = 4)

      Pain only (1.5%, n = 1)

      2-stage reoperation (1.5%, n = 1)

      Fracture (1.4%, n = 1)

      Other (4.3%, n = 3)
      Abdel et al. [
      • Abdel M.P.
      • Roth P.V.
      • Harmsen W.S.
      • Berry D.J.
      What is the lifetime risk of revision for patients undergoing total hip arthroplasty? a 40-year observational study of patients treated with the Charnley cemented total hip arthroplasty.
      ]
      2016Osteoarthritis (72.1%, n = 1441)

      Rheumatoid arthritis (9.9%, n = 198)

      Developmental dysplasia (8.3%, n = 165) post-traumatic (7.3%, n = 145)

      Others (2.6%, n = 51)
      Any reason including: aseptic loosening

      instability

      infection
      Philippot et al. [
      • Philippot R.
      • Neri T.
      • Boyer B.
      • Viard B.
      • Farizon F.
      Bousquet dual mobility socket for patient under fifty years old. More than twenty year follow-up of one hundred and thirty one hips.
      ]
      2017Dysplastic hip (27%)

      Post-traumatic hip OA (23%)

      AVN (23%) slipped capital femoral epiphysis (12%)

      Osteoarthritis (4%)

      Neurogenic osteoma (1%)
      Aseptic loosening (13.9%, n = 19)

      Intraprostatic dislocation (10.9%, n = 15)

      Femoral loosening (1.46%, n = 2)

      Acetabular loosening (0.79%, n = 1)

      Femoral stem fracture (0.79%, n = 1)

      Infection (0.79%, n = 1)
      Swarup et al. [
      • Swarup I.
      • Shields M.
      • Mayer E.N.
      • Hendow C.J.
      • Burket J.C.
      • Figgie M.P.
      Outcomes after total hip arthroplasty in young patients with osteonecrosis of the hip.
      ]
      2017AVNAny reasons

      Aseptic loosening (58%, n = 22) other reasons included:

      polyethylene wear

      periprosthetic

      fracture

      instability

      pain

      infection
      Halawi et al. [
      • Halawi M.J.
      • Brigati D.
      • Messner W.
      • Brooks P.J.
      Total hip arthroplasty in patients 55 years or younger: risk factors for poor midterm outcomes.
      ]
      2018Primary osteoarthritis (49.7%)

      AVN (23.7%)

      Dysplastic hip (14.3%)

      Slipped capital femoral epiphysis (5.5%)

      Posttraumatic arthritis (3.7%)

      Inflammatory arthritis (3.1%)
      Periprosthetic infection (4.9%)

      Aseptic loosening of the acetabular component (4.6%)

      Periprosthetic fractures (1.5%) Aseptic loosening of the femoral component (0.9%)
      Swarup et al. [
      • Swarup I.
      • Lee Y.Y.
      • Chiu Y.F.
      • Sutherland R.
      • Shields M.
      • Figgie M.P.
      Implant survival and patient-reported outcomes after total hip arthroplasty in young patients.
      ]
      2018AVN of the hip (34%)

      Dysplastic hip (15%)

      Juvenile inflammatory arthritis (14%)

      Post-traumatic arthritis (11%).
      Any reason
      Dessyn et al. [
      • Dessyn E.
      • Flecher X.
      • Parratte S.
      • Ollivier M.
      • Argenson J.N.
      A 20-year follow-up evaluation of total hip arthroplasty in patients younger than 50 using a custom cementless stem.
      ]
      2019Secondary osteoarthritis (49.4%, n = 115)

      Developmental dysplasia of the hip (37.8%, n = 88)

      AVN (33%, n = 77)

      Primary osteoarthritis (11.6%, n = 41)

      Post-traumatic (11.6%, n = 27)
      13 were isolated cup revisions:

      Loosening (3%, n = 7)

      Isolated polyethylene wear (2.6%, n = 6)

      Deep infection (2.6%, n = 6)

      Aseptic loosening of both components (1.3, n = 3)

      Chronic instability (0.4%, n = 1)
      Halvorsen et al. [
      • Halvorsen V.
      • Fenstad A.M.
      • Engesæter L.B.
      • Nordsletten L.
      • Overgaard S.
      • Pedersen Alma B.
      • et al.
      Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016.
      ]
      2019Pediatric (33%)

      Systemic inflammatory disease (23%)

      AVN (12%)

      Hip fracture (6.5%)

      Osteoarthritis (4.1%)

      Other (22%)
      Aseptic loosening (52%, n = 61)

      Dislocation (9.3%, n = 11)

      Deep infection (5.1%, n = 6)

      Periprosthetic fracture (2.5%, n = 3)

      Pain only (0.8%, n = 1)

      Other (31%, n = 36)
      NR, not reported; AVN, avascular necrosis.

      Surgical characteristics

      Of those few studies (n = 7, 20%) that reported surgeon characteristics [
      • Martin C.T.
      • Callaghan J.J.
      • Gao Y.
      • Pugely A.J.
      • Liu S.S.
      • Warth L.C.
      • et al.
      What can we learn from 20-year followup studies of hip replacement?.
      ,
      • Gallo J.
      • Langova K.
      • Havranek V.
      • Cechova I.
      Poor survival of ABG I hip prosthesis in younger patients.
      ,
      • Kim Y.H.
      • Park J.W.
      • Park J.S.
      The 27 to 29-year outcomes of the PCA total hip arthroplasty in patients younger than 50 years old.
      ,
      • Suh D.H.
      • Yun H.H.
      • Chun S.K.
      • Shon W.Y.
      Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty.
      ,
      • Halawi M.J.
      • Brigati D.
      • Messner W.
      • Brooks P.J.
      Total hip arthroplasty in patients 55 years or younger: risk factors for poor midterm outcomes.
      ,
      • Kim Y.H.
      • Kim J.S.
      • Park J.W.
      • Joo J.H.
      Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years.
      ,
      • Kim Y.H.
      • Park J.W.
      • Kim J.S.
      • Kim I.W.
      Twenty-five- to twenty-seven-year results of a cemented vs a cementless stem in the same patients younger than 50 Years of age.
      ], most were performed by a single orthopaedic surgeon (n = 5, 14.3%) [
      • Martin C.T.
      • Callaghan J.J.
      • Gao Y.
      • Pugely A.J.
      • Liu S.S.
      • Warth L.C.
      • et al.
      What can we learn from 20-year followup studies of hip replacement?.
      ,
      • Kim Y.H.
      • Park J.W.
      • Park J.S.
      The 27 to 29-year outcomes of the PCA total hip arthroplasty in patients younger than 50 years old.
      ,
      • Suh D.H.
      • Yun H.H.
      • Chun S.K.
      • Shon W.Y.
      Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty.
      ,
      • Kim Y.H.
      • Kim J.S.
      • Park J.W.
      • Joo J.H.
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