What factors influence the return to physical and sporting activity following hip arthroplasty in the young patient? Results of the symposium

Total hip replacement (THR) is increasingly performed in younger, more active patients who have high functional demand and sporting ambitions. Published evidence remains sparse, and numerous questions regarding implant choice, rehabilitation, return to sport, and long-term outcomes leave considerable room for individual practice variation. Following two earlier SOFCOT symposia (1997 and 2004), the present symposium, conducted under the auspices of the SFHG, sought to analyse current practice and outcomes of hip arthroplasty in the young patient.

Methods: A non-inferiority, non-randomised, observational, multicentre study was conducted combining three data sources: a questionnaire distributed to SOFCOT/SFHG members (231 respondents); a prospective cohort of 513 patients across 12 centres (mean age 42 years); and a retrospective cohort of 475 patients across 10 centres (mean age 42 years; mean follow-up 11 years). Four bearing couples were compared: hip resurfacing arthroplasty (HRA), ceramic-on-ceramic hard-on-hard fixed-bearing (HHFB), hard-on-soft fixed-bearing (HSFB), and dual-mobility (DM) implants. Clinical outcomes included the UCLA activity score, FJS, and SHV scores; the minimum clinically important difference (MCID) for UCLA was set at 2 points.

Results: Primary osteoarthritis (36%), avascular necrosis (13%), developmental dysplasia (12%), and femoroacetabular impingement (10%) were the leading aetiologies. The posterior approach predominated (74% prospectively). Day-case management reached 14%, exceeding the national average. Return to sport was effective at six months, with a mean UCLA gain of +2.3 points irrespective of prosthesis type (p = 0.209), reaching the MCID. Between three and six months, 76% of patients returned to the same occupation. The reoperation rate was 1.75% prospectively; 11-year survivorship was 93.7%, with no significant difference between bearing couples (HHFB 96.3%, HSFB 94.6%, DM 92.3%, HRA 92.2%).

Conclusion: Hip arthroplasty in the young patient allows reliable return to sporting and professional activity by six months, with satisfactory mid-term survivorship and no demonstrable superiority of any bearing couple. Patient counselling should nonetheless acknowledge a non-negligible complication rate.