Peer-reviewed article
Total Hip and Knee Arthroplasty in the Pediatric and Adolescent Population: A Systematic Review and Meta-Analysis.
Amir Human Hoveidaei, Mohammad Reza Ramezanpour, Mahyaar Omouri-Kharashtomi, Raha Shahrokhi, María Belén López Villagra et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a systematic review and meta-analysis of total hip and knee replacement surgery in patients under 25 years old. It examines surgical complications, functional outcomes, quality of life, and revision rates across 44 studies involving over 3,000 patients. The review finds that while these surgeries improve function and quality of life, revision and infection rates remain higher than in older adults, though outcomes have improved in recent years.
Key points
- Pooled periprosthetic joint infection rate after hip replacement was 1.6%, aseptic loosening 5.4%, and all-cause revision rate 8.7%
- Pooled periprosthetic joint infection rate after knee replacement was 2.9%, aseptic loosening 9.9%, and all-cause revision rate 12.4%
- Functional scores and quality-of-life measures improved substantially after hip replacement (standardized mean differences of 4.9 and 1.8 respectively)
- More recent patient cohorts showed lower revision and infection rates, suggesting improvements from advances in implant design and surgical technique
- The review included 44 studies reporting outcomes in patients younger than 25 years
Limitations
This document is a medical review of surgical procedures and does not address children's well-being in terms of survival, development, protection, or participation as understood in child welfare contexts. It focuses on orthopedic surgical outcomes rather than child health, education, safety, or rights.
Abstract
BACKGROUND: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are rarely performed in children and adolescents but may be required for end-stage joint disease. Evidence regarding safety, survivorship, and patient-reported outcomes in patients younger than 25 years remains limited. The aim of this study was to systematically evaluate postoperative complications, functional outcomes, quality of life, and revision rates following THA and TKA in this age group. METHODS: A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. MEDLINE, Embase, Scopus, and Web of Science were searched through October 2025 for studies reporting outcomes of THA or TKA in patients aged younger than 25 years. Random-effects models were used to pool complication rates, functional outcomes, quality of life, and all-cause revision separately for THA and TKA. Meta-regression explored the influence of age, sex, year of patient inclusion, arthroplasty indications, and bearing surface types. RESULTS: A total of 44 studies involving 3,317 patients and 5,632 joints were included. Following THA, pooled rates of periprosthetic joint infection (PJI), aseptic loosening, and periprosthetic fracture were 1.6%, 5.4%, and 1.4%, respectively, and all-cause revision rate was 8.7%. Functional scores (standardized mean difference [SMD] = 4.9) and quality-of-life measures (SMD = 1.8) improved substantially after THA. For TKA, pooled PJI and aseptic loosening rates were 2.9% and 9.9%, with an all-cause revision rate of 12.4%. Subgroup analyses demonstrated that more recent years of patient inclusion were associated with lower revision and infection rates following THA. CONCLUSION: THA and TKA in patients younger than 25 years can improve function and quality of life, although the risks of revision and infection remain higher than those in older adults. Outcomes have improved in more recent cohorts with advances in implant design and surgical technique. Further prospective studies with standardized reporting are needed to define optimal implant selection and long-term outcomes in this population. PROSPERO REGISTRATION CODE: CRD420261303010. LEVEL OF EVIDENCE: Therapeutic Level III (systematic review of retrospective cohort studies). See Instructions for Authors for a complete description of levels of evidence.