Total hip replacement due to osteoarthritis secondary to dysplasia
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Jul 28, 2017
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Abstract
Introduction
We present the results of a group of patients treated with total hip replacement due to osteoarthritis secondary to dysplasia, and describe the technical problems associated with the procedure in this group.
Materials and methods
Retrospective evaluation of 81 cases, with a minimum follow-up of 2-year. One case excluded for insufficient follow up. There were sixty-four women (80%) and 16 men. Age at time of surgery was less than 60 years in 67.5% of the group. According to Crowe, there were 24 cases of type 1 (30%), 36 type 2 (45%), 14 type 3 (17.5%) of type 4 and 6 (7.5%). In all patients underwent radiographic measurement in millimeters from the center of rotation of the hip and length discrepancy (Pre-and postoperative), in order to determine the modification by the procedure.
Results
There were 10 complications related to the procedure. One case presented a deep infection, 6 patients required prosthetic revision for mechanical loosening. A case of femoral nerve injury, and 2 cases of early prosthetic dislocation. The implant survival rate was 91.25% at 10 years of average follow up.
Acetabular center of rotation was restored to an anatomic position in 67 cases (up to1 cm), at a position well tolerated in 12 patients (1 to1.5 cm), and only in one case the center of rotation of the hip exceed1.5 cm. The members length discrepancy was22.8 mmaverage preoperative (range 0-90 mm), and the final discrepancy averaged5.6 mm(range 0-25 mm).
Conclusion
Total hip replacement in hip dysplasia remains a challenge for the specialist. We report a high rate of failure using cemented acetabular components after 10 years, which increases due to bone defect and cuase the patient is younger. Initial results with uncemented acetabular components seem promising, but we need more studies that demonstrate a good performance, with a greater number of cases. We continue to consider appropriate the use of structural bone graft to uncontained defects and milled bone to the protrusion, cemented acetabular components is usefull when en uncemented option is not available.
We present the results of a group of patients treated with total hip replacement due to osteoarthritis secondary to dysplasia, and describe the technical problems associated with the procedure in this group.
Materials and methods
Retrospective evaluation of 81 cases, with a minimum follow-up of 2-year. One case excluded for insufficient follow up. There were sixty-four women (80%) and 16 men. Age at time of surgery was less than 60 years in 67.5% of the group. According to Crowe, there were 24 cases of type 1 (30%), 36 type 2 (45%), 14 type 3 (17.5%) of type 4 and 6 (7.5%). In all patients underwent radiographic measurement in millimeters from the center of rotation of the hip and length discrepancy (Pre-and postoperative), in order to determine the modification by the procedure.
Results
There were 10 complications related to the procedure. One case presented a deep infection, 6 patients required prosthetic revision for mechanical loosening. A case of femoral nerve injury, and 2 cases of early prosthetic dislocation. The implant survival rate was 91.25% at 10 years of average follow up.
Acetabular center of rotation was restored to an anatomic position in 67 cases (up to1 cm), at a position well tolerated in 12 patients (1 to1.5 cm), and only in one case the center of rotation of the hip exceed1.5 cm. The members length discrepancy was22.8 mmaverage preoperative (range 0-90 mm), and the final discrepancy averaged5.6 mm(range 0-25 mm).
Conclusion
Total hip replacement in hip dysplasia remains a challenge for the specialist. We report a high rate of failure using cemented acetabular components after 10 years, which increases due to bone defect and cuase the patient is younger. Initial results with uncemented acetabular components seem promising, but we need more studies that demonstrate a good performance, with a greater number of cases. We continue to consider appropriate the use of structural bone graft to uncontained defects and milled bone to the protrusion, cemented acetabular components is usefull when en uncemented option is not available.
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How to Cite
Mana Pastrián, D., Garabano, G., & del Sel, H. (2017). Total hip replacement due to osteoarthritis secondary to dysplasia. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 82(3), 231-241. https://doi.org/10.15417/641
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Clinical Research
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References
1. Malchau H, Herberts P, Ahnfelt L. Prognosis of total hip replacement in Sweden: follow-up of 92,675 operations performed 1978-1990. Acta Orthop Scand 1993;64: 497-506.
2. Haddad FS, Masri BA, Garbuz DS, Duncan CP. Primary total replacement of the dysplastic hip. J Bone Joint Surg [Am] 1999;81-A:1462-82.
3. Sochart DH, Porter ML. The long term results of Charnley low friction arthroplasty in young patients who have congenital dislocation, degenerative arthrosis, or rheumatoid arthritis. J Bone Joint Surg [Am] 1997;79-A:1599-617.
4. Numair J, Joshi AB, Murphy JCM, Porter ML, Hardinge K. Total hip arthroplasty for congenital dysplasia or dislocation of the hip: survivorship analysis and long-term results. J Bone Joint Surg [Am] 1997;79-A:1352-60.
5. Chougle, M. V. Hemmady, J. P. Hodgkinson. Severity of hip dysplasia and loosening of the socket in cemented total hip replacement. J Bone Joint Surg [Br].2005;87-B:16-20.
6. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg [Am] 1979;61-A:15-23.
7. Francone V, García Tornadu E, Saffe MR, Locaso E. Luxación congénita inveterada de cadera. Tratamiento quirúrgico. Rev Asoc Arg Ortop Traumatol. 1993, Vol 58:359-365.
8. Merlo FJ. Rev Asoc Arg Ortp Traumatol. 1988, Vol 53(1):17-22.
9. Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg (Br).1982,64:17-25.
10. Hartofilakidis G, Stamos K, Ioannidis TT. Low friction arthroplasty for old
untreated congenital dislocation of the hip. J Bone Joint Surg [Br] 1988;70- B:182-6.
11. Harris WM. Total hip replacement for congenital dysplasia of the hip : Technique. In: The hip, proceedings of the second Open Scientific Meeting of the Hip Society. 1974,251-265.
12. Cabanela ME. Total hip Arthroplasty for developmental dysplasia of the hip. Orthopedics. 2001; 24,9:865-866.
13. Charnley J, Feagin JA. Low friction arthroplasty in congenital subluxation of the hip. Clin Orthop 1973;91:98-113.
14. Dunn HK, Hess WE. Total hip reconstruction in chronically dislocated hips. J Bone. Joint Surg [Am] 1976;58-A:838-45.
15. Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N. Congenital hip disease in adults: classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg [Am] 1996;78-A:683-92.
16. Dorr LD, Tawakkol S, Moorthy M, Long W, Wan Z. Medial protrusio technique for placement of a porous coated, hemispherical acetabular component without cement in a total hip arthroplasty in patients who have acetabular dysplasia. J Bone Joint Surg [Am] 1999;81-A:83-92.
17. Huo MH, Zurauskas A, Zatorska LE, Keggi KJ. Cementless total hip replacement in patients with developmental dysplasia of the hip. J South Orthop Assoc 1998;7:171-9.
18. Anderson MJ, Harris WH. Total hip arthroplasty with the insertion of the acetabular component without cement in hips with total congenital dislocation or marked congenital dysplasia. J Bone Joint Surg [Am] 1999;81-A:347-54.
19. Johnston RC, Brand RA, Crowninshield RD. Reconstruction of the hip. A mathematical approach to determine optimum geometric relationships. J Bone Joint Surg Am. 1979;61(5):639-52.
20. Schutzer SF, Harris WH. High placement of porous-coated acetabular components in complex total hip arthroplasty. J Arthroplasty. 1994;9:358-367.
21. Russotti GM, Harris WH. Proximal placement of the acetabular component in total hip arthroplasty. A long-term follow study. J Bone Joint Surg.1991;73A:587-592.
22. Yoder SA, Brand RA, Pedersen DR. Total hip acetabular component position affects component loosening rates. Clin Orthop. 1988; 228:79-87.
23. PagnanoMW, Hanssen A, Lewallen D, Shaughnessy W. The effect of superior placement of the acetabular component on the rate of loosenig after total hip arthroplasty. Long term results in patients who have Crowe type II Congenital Dysplasia of the hip. J Bone Joint Surg Am. 1996; 78(7):1004-14.
24. Harris WH, Crothers O, Oh I. Total hip replacement and femoral head born grafting for severe acetabular deficiency in adults. J Bone Joint Surg [Am] 1977;59-A:752-9.
25. Gerber SD, Harris WH. Femoral head autografting to augment
acetabular deficiency In patients requiring total hip replacement: a minimum five-year and an average seven-year follow-up study. J Bone Joint Surg [Am] 1986;68-A:1241-8.
26. Shinar AA, Harris WH. Bulk structural autogenous grafts and allografts for reconstruction of the acetabulum in total hip arthroplasty: sixteen year average follow-up. J Bone Joint Surg [Am] 1997;79-A:159-68.
27. Inao S, Matsuno T. Cemented total hip arthroplasty with autogenous bone graftingfor hips with developmental dysplasia in adults: the results at a minimum of ten years. J Bone Joint Surg [Br] 2000;82-B:375-7.
28. Bobak P, Wroblewski BM, Siney PD, Fleming PD, Hall R. Charnley low friction arthroplasty with an autograft of the femoral head for developmental dysplasia of the hip: the 10- to 15-year results. J Bone Joint Surg [Br] 2000;82-B:508-11.
29. Cameron HU, Eren OT, Solomon M. Nerve injury in the prosthetic management of the displastic hip. Orthopedics. 1998;21: 980-981.
30. Lewallwen DG. Neurovascular injury associated with hip arthropasty. J Bone Joint Surg. 1997;79-A: 1870-80.
31. Eggli S, Hankemayer S, Müller ME. Nerve palsy after leg lenghtening in total replacement arthroplasty for developmental dysplasia of the hip. J Bone Joint Surg (Br). 1999;81-B: 843-5.
32. Takao M, Ohzono K, Nishii T, Sugano N. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg. 2011;93-A:548-555.
2. Haddad FS, Masri BA, Garbuz DS, Duncan CP. Primary total replacement of the dysplastic hip. J Bone Joint Surg [Am] 1999;81-A:1462-82.
3. Sochart DH, Porter ML. The long term results of Charnley low friction arthroplasty in young patients who have congenital dislocation, degenerative arthrosis, or rheumatoid arthritis. J Bone Joint Surg [Am] 1997;79-A:1599-617.
4. Numair J, Joshi AB, Murphy JCM, Porter ML, Hardinge K. Total hip arthroplasty for congenital dysplasia or dislocation of the hip: survivorship analysis and long-term results. J Bone Joint Surg [Am] 1997;79-A:1352-60.
5. Chougle, M. V. Hemmady, J. P. Hodgkinson. Severity of hip dysplasia and loosening of the socket in cemented total hip replacement. J Bone Joint Surg [Br].2005;87-B:16-20.
6. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg [Am] 1979;61-A:15-23.
7. Francone V, García Tornadu E, Saffe MR, Locaso E. Luxación congénita inveterada de cadera. Tratamiento quirúrgico. Rev Asoc Arg Ortop Traumatol. 1993, Vol 58:359-365.
8. Merlo FJ. Rev Asoc Arg Ortp Traumatol. 1988, Vol 53(1):17-22.
9. Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg (Br).1982,64:17-25.
10. Hartofilakidis G, Stamos K, Ioannidis TT. Low friction arthroplasty for old
untreated congenital dislocation of the hip. J Bone Joint Surg [Br] 1988;70- B:182-6.
11. Harris WM. Total hip replacement for congenital dysplasia of the hip : Technique. In: The hip, proceedings of the second Open Scientific Meeting of the Hip Society. 1974,251-265.
12. Cabanela ME. Total hip Arthroplasty for developmental dysplasia of the hip. Orthopedics. 2001; 24,9:865-866.
13. Charnley J, Feagin JA. Low friction arthroplasty in congenital subluxation of the hip. Clin Orthop 1973;91:98-113.
14. Dunn HK, Hess WE. Total hip reconstruction in chronically dislocated hips. J Bone. Joint Surg [Am] 1976;58-A:838-45.
15. Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N. Congenital hip disease in adults: classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg [Am] 1996;78-A:683-92.
16. Dorr LD, Tawakkol S, Moorthy M, Long W, Wan Z. Medial protrusio technique for placement of a porous coated, hemispherical acetabular component without cement in a total hip arthroplasty in patients who have acetabular dysplasia. J Bone Joint Surg [Am] 1999;81-A:83-92.
17. Huo MH, Zurauskas A, Zatorska LE, Keggi KJ. Cementless total hip replacement in patients with developmental dysplasia of the hip. J South Orthop Assoc 1998;7:171-9.
18. Anderson MJ, Harris WH. Total hip arthroplasty with the insertion of the acetabular component without cement in hips with total congenital dislocation or marked congenital dysplasia. J Bone Joint Surg [Am] 1999;81-A:347-54.
19. Johnston RC, Brand RA, Crowninshield RD. Reconstruction of the hip. A mathematical approach to determine optimum geometric relationships. J Bone Joint Surg Am. 1979;61(5):639-52.
20. Schutzer SF, Harris WH. High placement of porous-coated acetabular components in complex total hip arthroplasty. J Arthroplasty. 1994;9:358-367.
21. Russotti GM, Harris WH. Proximal placement of the acetabular component in total hip arthroplasty. A long-term follow study. J Bone Joint Surg.1991;73A:587-592.
22. Yoder SA, Brand RA, Pedersen DR. Total hip acetabular component position affects component loosening rates. Clin Orthop. 1988; 228:79-87.
23. PagnanoMW, Hanssen A, Lewallen D, Shaughnessy W. The effect of superior placement of the acetabular component on the rate of loosenig after total hip arthroplasty. Long term results in patients who have Crowe type II Congenital Dysplasia of the hip. J Bone Joint Surg Am. 1996; 78(7):1004-14.
24. Harris WH, Crothers O, Oh I. Total hip replacement and femoral head born grafting for severe acetabular deficiency in adults. J Bone Joint Surg [Am] 1977;59-A:752-9.
25. Gerber SD, Harris WH. Femoral head autografting to augment
acetabular deficiency In patients requiring total hip replacement: a minimum five-year and an average seven-year follow-up study. J Bone Joint Surg [Am] 1986;68-A:1241-8.
26. Shinar AA, Harris WH. Bulk structural autogenous grafts and allografts for reconstruction of the acetabulum in total hip arthroplasty: sixteen year average follow-up. J Bone Joint Surg [Am] 1997;79-A:159-68.
27. Inao S, Matsuno T. Cemented total hip arthroplasty with autogenous bone graftingfor hips with developmental dysplasia in adults: the results at a minimum of ten years. J Bone Joint Surg [Br] 2000;82-B:375-7.
28. Bobak P, Wroblewski BM, Siney PD, Fleming PD, Hall R. Charnley low friction arthroplasty with an autograft of the femoral head for developmental dysplasia of the hip: the 10- to 15-year results. J Bone Joint Surg [Br] 2000;82-B:508-11.
29. Cameron HU, Eren OT, Solomon M. Nerve injury in the prosthetic management of the displastic hip. Orthopedics. 1998;21: 980-981.
30. Lewallwen DG. Neurovascular injury associated with hip arthropasty. J Bone Joint Surg. 1997;79-A: 1870-80.
31. Eggli S, Hankemayer S, Müller ME. Nerve palsy after leg lenghtening in total replacement arthroplasty for developmental dysplasia of the hip. J Bone Joint Surg (Br). 1999;81-B: 843-5.
32. Takao M, Ohzono K, Nishii T, Sugano N. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg. 2011;93-A:548-555.