Abstract Introduction: The standard treatment for patients who require total hip replacement is the implantation of an intramedullary diaphyseal anchored hip prosthesis. A bone-sparing thrust plate hip prosthesis (TPP) can be used as an alternative device for young patients. The TPP relies on proximal femoral metaphyseal fixation. The the- oretical advantage of leaving diaphyseal bone intact is easier conversion to a stemmed prosthesis. This retrospec- tive study evaluated the medium- and short-term results after total joint replacement using the third generation TPP. Materials and methods: Between 1997 and 2001, 58 TPPs were used for 52 patients. Clinical and demographic data were obtained from the patients’ charts and our elec- tronic database. Their average age at time of surgery was 40.9±11.4 years. At follow-up, the Harris hip score, resid- ual pain, required pain medication, and the ability to lie on the operated side were documented. Radiographic evalua- tion included standardized radiographs of the hip joint and the pelvis. Results: Four patients required revision surgery (6.9%). For 51 of the remaining 54 TPPs, a postoperative functional and radiological status was obtained. The aver- age follow-up was 26±11.0 months. 88% of the patients experienced some or complete relief of pain. The median Harris hip score at follow-up was 73±20.5 points. A post- operative hip dislocation occurred in 5 patients (8.6%). Conclusion: Since many patients experienced some or complete relief of pain, the TPP can be recommended as a feasible implant for the treatment of hip disorders requir- ing total hip arthroplasty in young patients. Revision sur- geries are facilitated by the good bone stock remaining in the proximal femur. Keywords Osteoarthritis of the hip · Thrust plate prosthesis · Harris hip score · Total hip arthroplasty Introduction The treatment of young patients with hip disorders requir- ing total hip arthroplasty is challenging. Since the average survival rate of total hip arthroplasties is roughly 10–15 years, most young patients can require multiple revision sur- geries. Therefore, an implant that minimizes bone stock loss at the index procedure would present a theoretical advan- tage. A hip prosthesis that relies on metaphyseal fixation without affecting diaphyseal bone has been developed by Huggler and Jacob [13]. This thrust plate hip prosthesis (TPP; -SulzerMedica) is shown in Fig. 1. The first im- plantation of a TPP was performed in 1978 [14, 15]. The force transfer with this prosthesis is biomechanically sim- ilar to the normal physiologic state [16, 17], minimizing the postoperative bone remodeling in the proximal femur [13, 16, 17]. Although the TPP has been used since 1978, there are few clinical outcome reports [7, 8, 14]. The aim of this study was to evaluate the medium- and short-term results after TPP implantation and to assess clinical and radio- graphic variables that are predictive of the outcome. Patients and methods Between 1997 and 2001, 58 prostheses (29 right/29 left) were im- planted into 52 patients (33 male/19 female). Their average age at the time of surgery was 40.9±11.4 years. Indications for implanta- tion are shown in Fig. 2. Thirty-one patients had undergone previ- ous surgery prior to TPP implantation (Table 1). For the 25 pa- tients with posttraumatic osteoarthritis, the time between injury and TPP implantation was 5.6±7.2 years. Seventeen patients had sustained an acetabular fracture; five patients had sustained a femoral head or neck fracture; and three patients had a fracture of both components. For patients with femoral head avascular necro- Boris A. Zelle · Torsten G. Gerich · Leonard Bastian · Franklin D. Shuler · Hans-Christoph Pape · Christian Krettek Total hip arthroplasty in young patients using the thrust plate prosthesis: clinical and radiological results Arch Orthop Trauma Surg (2004) 124 : 310–316 DOI 10.1007/s00402-004-0652-y Received: 4 March 2003 / Published online: 14 April 2004 ORIGINAL ARTICLE B. A. Zelle · T. G. Gerich · L. Bastian · H.-C. Pape · C. Krettek Department of Trauma Surgery, Hannover Medical School, Hannover, Germany B. A. Zelle · F. D. Shuler Department of Orthopaedics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA B. A. Zelle (✉) 327 McKee Place, Pittsburgh, PA 15213, USA Tel.: 412-628-8014, Fax: 412-687-3724, e-mail: zelleba@msx.upmc.edu © Springer-Verlag 2004