Hevesi, Mario

Abstract Introduction The utilization of total hip arthroplasty (THA) in skeletally immature patients remains controversial, with an open triradiate cartilage traditionally perceived as a relative contraindication due to concerns of acetabular fixation and component loosening. Early evidence suggests that THA may be a feasible option in this patient population yielding favorable short-term outcomes, however larger series and mid-term data are lacking. This study presents the largest series of THA in patients with open triradiate cartilage to date with mid-term clinical, radiographic, and patient-reported outcomes. Methods A retrospective review of our institutional Total Joint Registry identified 19 patients (22 hips) who underwent THA while having an open triradiate cartilage growth plate between the year 2000 and 2024. Skeletal maturity was assessed utilizing the modified Oxford bone age and all patients had a score of “1” or “2” on the triradiate cartilage stage of maturation. Demographics, surgical characteristics, implant data, radiographic parameters, and clinical outcomes were collected. Functional hip scores were assessed via the Harris Hip Score (HHS). Kaplan-Meier analysis was performed to analyze reoperation rates. Results The average age at surgery was 14 years (SD=1.68), the average BMI was 24 (SD=7.1) and 64% were male. Mean follow-up was 6.05 years (range 1-15). The mean modified Oxford bone age for this cohort was 23 (SD=1.4). The most common indications for THA were avascular necrosis (64%), degenerative joint disease (27%), and neoplasia (9%). Preoperatively, 54.5% of patients utilized gait aids. Postoperatively, all patients reported independent ambulation without assistive devices with an average HHS of 91.65 (SD=11.42). Ninety-six percent of implants were stable at final radiographic follow up. Both reported complications involved acetabular cup loosening, requiring revision of the acetabular component. Conclusion This study presents the largest cohort in the literature of patients who underwent THA with open triradiate cartilage. Our results highlight high patient reported outcomes and low revision rates at mid-term follow up. All patients had excellent implant fixation without radiographic signs of loosening at final radiographic follow up. These results support the use of THA in skeletally immature patients without the need to delay THA for closure of the triradiate cartilage.

Abstract Introduction Understanding factors that impact outcomes of total hip arthroplasty (THA) can aid clinical decision-making and patient counselling. The purpose of this study was to investigate functional outcomes, complications, and reoperation rates among patients undergoing primary THA after hip arthroscopy (HA-THA) compared to a matched cohort of primary THA patients without prior arthroscopy (THA-only). Methods A retrospective review was performed to identify all patients who underwent primary THA after prior hip arthroscopy from 2009-2022 at a single institution. Patients with a history of revision arthroscopy were excluded. Cases were propensity-matched with primary THA controls in a 1:4 ratio by age at time of THA, sex, body mass index, surgical approach, and year of surgery. At minimum 2-year follow-up, patient-reported outcomes (PROs) including Forgotten Joint Score (FJS), Modified Harris Hip Score (mHHS), Hip Disability and Osteoarthritis Outcome Score Pain (HOOS pain), and Visual Analog Pain Scale (VAS) were analyzed. Results Sixty-three hips in 60 patients (age: 47.3±9.4 years, BMI: 29.8±6.2 kg/m2) were matched to 252 THA-only hips, with patients converting to THA at a mean 3.1 years (range 0.3-10.3) following hip arthroscopy. While both HA-THA and THA patients demonstrated significant (p<0.001) postoperative improvements in PROs, HA-THA patients reported significantly lower postoperative FJS, mHHS, HOOS pain, and VAS pain scores (p<0.001) as compared to THA-only controls. At mean 6.6±3.2 years follow-up, HA-THA patients with preoperative Tönnis grades 2-3 reported significantly increased FJS, mHHS, and HOOS pain compared to those with preoperative Tönnis grades of 0-1 (p≤0.03). Additionally, HA-THA patients with preoperative Tönnis grades 0-1 exhibited worse PROs (p<0.001) as compared to THA-only controls. While there were no differences in complication rates between HA-THA patients and THA-only controls (8% vs. 5%, p=0.49), all-cause reoperation was greater amongst HA-THA patients compared to THA-only (10% vs. 2%, p=0.01). Conclusion While improved compared to preoperatively, patients undergoing THA after prior hip arthroscopy demonstrated inferior outcomes at mid-term follow up as compared to a demographically age-matched cohort without prior arthroscopy. When considering conversion to THA following arthroscopy, clinicians should consider counseling patients regarding improved outcomes in the setting of advanced radiographic osteoarthritis, and potentially increased all-cause reoperation.