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Prior reports have noted an increased risk of early revision among younger patients undergoing total hip arthroplasty (THA) but have been confounded by the inclusion of various diagnoses. The purpose of this study was to assess the revision rate and the time to revision for patients undergoing THA for osteoarthritis based on age. Patients with a diagnosis of osteoarthritis who underwent both primary and revision THA at the same institution were identified. The time between primary and revision surgery and the indication for revision were collected. Patients were stratified into 2 groups based on age at the time of primary THA: 64 years or younger (group 1) or 65 years or older (group 2). Between 1996 and 2016, a total of 4662 patients (5543 hips) underwent primary THA for a diagnosis of osteoarthritis. Of these, 100 patients (104 hips) received a revision THA (62 in group 1 and 42 in group 2). Mean age was 52.7±8.4 years in group 1 vs 73.4±6.3 years in group 2 (P<.001). There was no significant difference in mean body mass index (29.7±7.3 kg/m 2 vs 28.4±4.6 kg/m 2 , P=.30). Rate of revision was not significantly different between the groups (1.8% vs 2.0%, P=.7). Average time from primary to revision surgery was 3.0±3.2 years for group 1 and 1.1±2.1 years for group 2 (P=.001). Among patients undergoing primary THA for a diagnosis of osteoarthritis, younger age is not associated with an increased rate of early failure or revision. [Orthopedics. 2017; 40(6):e1069-e1073.]., (Copyright 2017, SLACK Incorporated.)

This new information has recently been incorporated into a series of algorithms for evaluating painful cemented and cementless total hip replacements. As the interpretation of many tests varies significantly between cemented and cementless components, the approach to these two situations differs accordingly. Careful review of sequential plain radiographs remains a mainstay of initial evaluation. The sedimentation rate is also a cost effective method of adding useful information. Based on this assessment, cemented and cementless components can be classified as loose, well fixed, or having lysis without being loose. Subsequent evaluation should incorporate new information regarding the effectiveness, limitations, and cost of various diagnostic tests available for the evaluation of the painful total hip replacement.