FP12.6 Metal-on-Metal Hip Resurfacing in Patients 35 Years and Younger: 18-Year Survivorship and Outcomes From 184 Cases

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ID: 331278
2026
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Abstract
Abstract ICLA12 - The Chondral Masterclass: Advanced Scaffolds, Orthobiologic Realities, and Young THA, Auditorium B (BMCC Level 1), October 9, 2026, 10:30 - 12:30 Introduction Patients requiring hip arthroplasty before age 35 represent one of the most challenging populations in reconstructive surgery due to high activity demands, complex underlying diagnoses, and a lifetime revision risk. Registry data for this age group are lacking. Hip resurfacing arthroplasty (HRA) offers proximal femoral bone preservation, near-normal biomechanics, and improved revision access compared with stemmed total hip arthroplasty (THA). When preservation is no longer an option, this study provides 18-year survivorship data to guide arthroplasty conversion in the very young patient. Methods A prospectively maintained database of over 7000 consecutive HRAs was retrospectively reviewed. One hundred eighty-four cases in patients ≤35 years (mean age 28.9 years) performed between 2004 and 2022 were identified, with a control cohort of 6523 HRAs in patients older than 35 years. Kaplan-Meier (KM) survivorship was generated for all-cause revision. Failures, reoperations, Harris Hip Scores (HHS), University of California Los Angeles (UCLA) activity scores, and metal ion levels were compared between groups. Results KM implant survivorship in patients ≤35 years was 96.5% at 10 years and 95.2% at 18 years, representing no significant difference from the older cohort (log-rank p=0.077; Wilcoxon p=0.281). No adverse wear-related failures occurred in the under-35 group. Overall revision rates did not significantly differ between age groups (2.9% vs. 1.6%, p=0.23). Late femoral loosening was more frequent in younger patients with cemented fixation (1.1% vs. 0.1%, p=0.002). HHS and UCLA activity scores were excellent and equivalent between groups. Metal ion levels were low and consistent with well-functioning bearings. Conclusion Metal-on-metal HRA demonstrates durable 18-year implant survivorship of 95.2% in patients ≤35 years. This survivorship equivalent to older patients and exceeding THA benchmarks in this demanding group. The absence of adverse wear-related failure and excellent functional outcomes support HRA as the preferred arthroplasty option when preservation is no longer viable. Higher cemented femoral loosening in younger patients reinforces uncemented fixation as the preferred technique. These results from one of the only series of its size in patients under 35 years provide evidence to guide treatment in this demanding population.
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Authors Dani Gaillard-campbell, Thomas Gross
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.094
URL
https://doi.org/10.1093/jhps/hnag043.094
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