Pregnancy and childbirth can occur successfully in patients who have a total hip replacement, according to the results of a study presented today at the American Academy of Orthopaedic Surgeons’ (AAOS) Annual Meeting.
In the past, hip replacement also called total hip arthroplasty (THA) was an option primarily for people over 60 years of age. Typically, older people are less active and put less strain on the artificial hip than younger, more active people. However, with the advent of new prosthetic designs and advances in surgical techniques, total hip arthroplasty is now a viable treatment option for younger patients suffering from hip conditions such as hip dyplasia or dislocation, juvenile inflammatory arthritis and hip fractures or trauma –conditions that can affect females of childbearing age. According to the National Center for Health Statistics, National Hospital Discharge Survey, 2000, over 5,000 total hip arthroplasties were performed on women 45 and under.
“A concern for many women of childbearing age that have THA is that pregnancy and childbirth will dramatically increase their need for future revision,” said Rafael J. Sierra, MD, co-author of the study conducted at the Mayo Clinic in Rochester, Minn. “What we found in our research is that once patient age at the time of arthroplasty is factored in, association between pregnancy/childbirth and revision rates is not statistically significant.”
The study found that vaginal delivery is possible in the majority of patients with a total hip arthroplasty. A small number of women experience increased hip pain during pregnancy and an even smaller number of those women’s pain continues after delivery.
A retrospective review of the Mayo Clinic total joint registry was conducted to identify all female patients between the ages of 18 and 45 who had undergone a primary total hip arthroplasty between 1975 and 1995. The qualifying group was comprised of 343 females with the mean age of 35 years. Out of that group, 627 pregnancies occurred in 228 patients with 108 occurring in 57 patients (17%) after their total hip arthroplasty (range 1 to 9 pregnancies). The mean time from total hip arthroplasty to the first pregnancy resulting in live childbirth after was 3.8 years. The patient’s first baby after THA was delivered by C-section in 20 and vaginally in 31 (6 unknown). Of the 57 patients who became pregnant after THA, 8 (14%) patients noted an increase in hip pain during pregnancy and half of those 14 patients said pain persisted after pregnancy. In regards to revision rates, of the 57 patients who had a pregnancy after their primary total hip arthroplasty, 24 were revised. Out of the 286 women who did not have pregnancies after THA, 114 had revision surgery.