Search

Hip dislocation secondary to developmental dysplasia of the hip is a debilitating condition. Total hip arthroplasty has proven successful in improving pain, restoring joint function, and correcting leg length discrepancies in this select population. Various techniques have been developed to address the increased complexity inherent to the reconstruction of the severely dysplastic hip. Despite this, femoral and/or sciatic nerve palsy remains a potential catastrophic complication after surgery, with reported rates up to five times that in the general population. We present three cases using a previously unreported technique for performing primary total hip arthroplasty via an anterior approach for Crowe IV hip dysplasia. The goal of this technique is to minimize the risk of postoperative nerve palsy following reconstruction of the severely dysplastic hip. A brief discussion of our technique and the topic of nerve dysfunction after total hip arthroplasty for developmental dysplasia of the hip follows., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The clinical success of primary total hip arthroplasty in elderly patients is well established. Because of the rapid growth rate of the population aged 85 years and older and the increasing life expectancy of this group of patients, the number of patients in their 8th, 9th, and even 10th decades of life requiring revision total hip arthroplasty will increase. We present the only documented case of revision total hip arthroplasty in a centenarian and a review of the relevant literature.

Total hip arthroplasty imparts significant physical forces on the patient at the time of surgery. We report a case of an injury to the superior mesenteric vein that is thought to have occurred at the time of impaction of the acetabular component of a total hip arthroplasty. This complication has been reported previously only from high-energy nonpenetrating trauma, such as motor vehicle accidents.

Twenty-one patients (21 hips) underwent cementless total hip replacement surgeries for previous acetabular fractures. The mean age at the time of hip replacement was 52 years (range, 23-78 years). The mean follow-up was 65 months (range, 48-104 months). One hip required revision of the stem secondary to a periprosthetic femur fracture from a fall at 3 months after surgery. Good to excellent clinical rating was achieved and maintained in 19 hips. Radiographic evaluation demonstrated stable cup and stem fixation in 17 and 15 hips. Only 1 patient with radiographic loosening of the components was sufficiently symptomatic. The results in this series appeared slightly better than those reported previously in hip replacements done with cement at comparable medium-term follow-up. The mechanical failure rates remained high in this patient population: 19% for the cups and 29% for the stems.

Seventy-two cementless total hip arthroplasties were performed by a single surgeon in 58 patients with the diagnosis of femoral head osteonecrosis. All patients were less than 50 years old (mean, 37 years). The mean follow-up was 84 months with a minimum of 48 months. Good-to-excellent results were maintained at final follow-up in 94% of the hips. Revision rate was 1.5% each for the cups and the stems. Mechanical failure rate was 7.6% for the cups, and 6% for the stems. If the results were analyzed excluding the data from the group of patients who received the Mittelmeier prostheses, the mechanical failure rates for the cups was 0% and for the stems was 4.2%. The probability of survival for the entire series using revision as the endpoint was 96.9% at 11 years. Survival probability decreased to 88.5% if radiographic failures were included. Excluding the Mittelmeier prostheses, survival probability was estimated to be 100% for the cups using both revision and radiographic failures as endpoints; for the stems, the survival probability was 98.0% using revision as the endpoint and 95.8% including radiographic failures. Femoral osteolysis was observed in 1.5% of the hips. No hip had acetabular osteolysis. No measurements of polyethylene wear were attempted in this study. These results appeared superior to total hip arthroplasties done with early cementing techniques in this population of young patients with femoral head osteonecrosis.

Eighty primary total hip arthroplasties were performed using a first-generation modular femoral stem inserted without cement. Modular distal sleeves made of methacrylate were used in 33% of the hips. Dorr type B or C femoral geometry was present in 80% of the cases. The mean follow-up period was 81 months with a minimum of 48 months. Satisfactory clinical results were observed in 74% of the hips at the final follow-up visit. Revision of the stem had been performed in 14% of the hips, all for aseptic loosening. The overall mechanical failure rate was 48%. Canal fill by the stem was not any better with the sleeves than without. The incidence of failure, however, was less in those hips in which sleeves were used. Femoral osteolysis was present in 19% of the hips. The experience with this particular stem design has been disappointing.

Cementless total hip arthroplasties were performed in 25 consecutive young patients (27 hips), with a mean age of 36.5 years, using prostheses that offered ceramic-on-ceramic articulation. The median follow-up period was 75 months, with all hips being followed a minimum of 5 years. Revision surgery was necessary in one hip at 60 months for fracture of the cup. Ninety-six percent of the remaining hips were rated good or excellent clinically using the Harris hip scale. Radiographic loosening of one or both components was evident in 3 hips. There was no incidence of femoral or acetabular osteolysis observed at follow-up periods of 5 to 8 years.

A prospective study was undertaken over a 2-year period to evaluate the clinical efficacy of using the Zweymuller femoral component (Allopro, Berne, Switzerland) in cementless total hip arthroplasty. Forty consecutive patients (46 hips) were included for final evaluation. Ninety-four percent of the femurs were classified as Dorr class B or C before surgery. The mean follow-up period was 50 months (median, 48 months). Ninety-eight percent of the hips were rated good or excellent clinically. No stem was classified as definitely loose. No hip has required any reoperation. There was no incidence of femoral or acetabular osteolysis up to 6 years.

Success of total hip arthroplasty using cementless implants is dependent on intimate contact of the prostheses with viable host-bone and achievement of optimal fit and rigid implant fixation. A technique of oblique femoral osteotomy has been used to correct proximal femoral deformity and to facilitate difficult revision surgery in selected cases. This prospective study included 26 osteotomies performed in 25 consecutive patients with a minimum follow-up period of 3 years. The median follow-up period was 50 months. Eighty-four percent of the reconstructions remained in situ at the final follow-up examination, with 81% of them rated clinically excellent or good. Three stems were revised for aseptic loosening at a mean interval of 46 months. One additional femoral revision was necessary for nonunion of the osteotomy. Two of the remaining stems were classified as radiographically loose. Although oblique femoral osteotomy serves as a useful adjunct surgical technique in difficult femoral reconstructions, nearly 25% of the hips in this study either failed or were loose at the medium-term follow-up examination. Long-term success of this technique with cementless prostheses remains to be defined.