Van Rens Fonds grant for department of Orthopedics

Schreurs , Wim

Wim Schreurs (project leader), Gerjon Hannink (co-project leader), Marloes Schmitz and Ena Colo received a grant of  €240,000 for research on the outcome of total hip arthroplasty in patients under 50 years old. Data from the Dutch Arthroplasty Register (LROI) will be combined with Radboudumc data, containing more than 800 patients who underwent total hip arthroplasty under the age of 50.

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Total hip arthroplasty (THA) is regarded as one of the most successful surgical treatments of the past century. Due to this success and higher demands of society, THAs are nowadays used more often in young patients under the age of 50 as well and the number will continue to increase. Unfortunately, the outcomes of THA in these young patients are still inferior compared to older patients. One possible explanation is that the osteoarthritis in these young patients often has an underlying cause with serious hip deformations, such as childhood hip diseases, arthritis or trauma. These bone stock defects hamper the implantation of a THA. In addition, these patients are more active than the older patients and it is known that higher activity levels are related to more loading cycles and this will often lead to more wear of the prosthesis compared to older patients. For many implants, increased wear is related to a higher chance of failure of the hip implant. Due to all the above mentioned reasons, it is of great importance to realize that young patients that require THA are a very demanding, more difficult and challenging group of patients. The care given to these patients should be optimized, not only intraoperatively, but pre- and postoperatively as well.

This project aims to analyze the trends of the used types of THA in young patients in the Netherlands, study the midterm survival of THA and to analyze which procedures are most successful and to identify the ones that have a higher risk for early revisions. By using the patient reported outcome measurements (PROMs), available in the LROI data set up to one year postoperatively, we aim to investigate which implant or technique will produce the highest patient satisfaction and functionality one year after THA.

In addition, we will study the short-term outcomes of revisions. In young patients, by the current state of the art, revisions are almost inevitable, as they will outlive their implant. Unfortunately, it is unlikely that in the short-term an implant will be developed that will have a lifelong survival in the young patients. Therefore, information about the possibility to revise an implant after a failed THA is important. It may be that revisions of some failed implants may be more demanding than others. The ability to revise an implant is an increasingly important aspect for young patients in the decision-making of a THA.

Furthermore, we will increase the accuracy of the implemented data in the LROI registry by trying to add a new item to the LROI registry: the pre-operative planning radiograph. This facilitates us to perform at random validation checks of variables collected by the LROI on young THA patients. Furthermore, it enables us to subgroup patients with developmental dysplasia of the hip (DDH) which is the largest group of young patients registered by the LROI. By doing this we can act more patient-specific and increase the quality of the registered LROI data at the same time. 

All data obtained by the proposed questions will be used to inform young patients requiring THA in a better and more patient-specific way, especially regarding their expectations. This information can guide patients to decide whether they want a THA or not (yet). Additionally, orthopaedic surgeons can be educated about specific techniques or implant that create a higher risk of early revision in specific patient groups.

From an economical point of view, this project will select those procedures that are successful and can bring back the young patients into society, reducing the costs for these patients in the Netherlands. The project will also identify specific combinations of implants, surgical techniques and indications that lead to early revisions or lower PROMs. Then, these procedures can be prevented and can save money for society.  This information will be important for insurance companies, the Dutch society and the government as an effective use of the restrained budget for health economics plays an important role in these days.

 


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