Long-term results of total hip arthroplasty in young patients

: Recent literature shows patient activity level to be the major factor in the success of long-term implant survival, irrespective of patient age. Young rheumatoid patients therefore do universally well with cemented low-friction arthroplasties as the standard. With osteoarthritis and avascular necrosis, results are less satisfactory in young patients. Cemented Charnley-type stems have good track records, whereas cemented acetabular components appear to have higher failure rates. Porous coated devices generally do not meet minimum success criteria for long-term follow-up, although individual series can yield good results based on excellent surgical technique. Hydroxyapatite coatings are promising with excellent midterm survival rates; however, long-term data are not yet available. The importance of surgical technique is generally underestimated. Ultimate survival of implants will be influenced by the reaction of the implant fixation system to wear debris particles. There is a great need for better friction materials. (C) Lippincott-Raven Publishers.