Hip Replacements on the Rise Among the Very Young

November 10, 2021
Robert Preidt

It may look like bad news, but a new study says it's not: The number of people younger than 21 who had total hip replacement surgery in the United States jumped from 347 in 2000 to 551 in 2016.

The increase wasn't due to a rise in the number of children with inflammatory arthritis, which often prompts a hip replacement in the very young. That suggests that non-surgical treatments to control that painful condition are effective, said senior study author Dr. Bella Mehta, a rheumatologist at the Hospital for Special Surgery in New York City.

For the study, the researchers analyzed data on total hip replacement in U.S. patients younger than 21 from about 4,200 hospitals in 46 states. The mean age of patients was 17.

Osteonecrosis (the death of bone cells due to lack of blood supply), osteoarthritis and juvenile idiopathic arthritis (JIA)/inflammatory arthritis were the most common reasons for total hip replacement.

Over the study period, total hip replacement for osteonecrosis rose from 24% to 38% of patients, but it fell from 27% to 4% for arthritis, likely due to recent improvements in drug treatments for arthritis, according to the study.

The findings were scheduled for presentation Tuesday at the American College of Rheumatology annual meeting and recently published in The Journal of Arthroplasty.

"Our study shows that although THA [total hip arthroplasty] procedures are increasingly being performed in young people, we aren't seeing more of these patients seeking surgery for inflammatory arthritis," Mehta said in a hospital news release.

"We're doing a better job at treating these individuals so they don't develop end-stage joint damage," Mehta added. "Twenty years ago, we didn't have access to effective pharmacologic treatments for these conditions, and now we're using them well and helping these patients live a better life."

Improvements in implant technology and materials have also made them far more durable than they were 20 years ago, so surgeons now feel more comfortable offering hip replacement surgery to young patients because their implants are likely to hold up under the wear and tear of decades of activity, noted study co-author Dr. Mark Figgie, chief emeritus of the surgical arthritis service at the hospital.

Mehta said the findings could be of value both to clinicians and young patients.

"I would use these results to say to a young person: 'There are a lot of people who get these procedures; you're not alone,'" Mehta said. "I find that, especially for young patients, knowing they're not the only ones to experience something really helps. And it's a life-changing procedure for them."

More information

The U.S. National Institutes of Health has more on childhood arthritis.

SOURCE: Hospital for Special Surgery, news release, Nov. 9, 2021

Adolescents / Teens Arthritis: Osteo Artificial Hips Bone / Joint / Tendon Problems Surgery: Misc.