An algorithmic approach to total hip arthroplasty in patient with post-polio paralysis and fixed pelvic obliquity

Abstract

Aims Total hip arthroplasty (THA) in patients with post-polio residual paralysis (PPRP) is challenging. Despite relief in pain after THA, pre-existing muscle imbalance and altered gait may cause persistence of difficulty in walking. The associated soft tissue contractures not only imbalances the pelvis, but also poses the risk of dislocation, accelerated polyethylene liner wear, and early loosening. Methods In all, ten hips in ten patients with PPRP with fixed pelvic obliquity who underwent THA as per an algorithmic approach in two centres from January 2014 to March 2018 were followed-up for a minimum of two years (2 to 6). All patients required one or more additional soft tissue procedures in a pre-determined sequence to correct the pelvic obliquity. All were invited for the latest clinical and radiological assessment. Results The mean Harris Hip Score at the latest follow-up was 79.2 (68 to 90). There was significant improvement in the coronal pelvic obliquity from 16.6o (SD 7.9o) to 1.8o (SD 2.4o; p < 0.001). Radiographs of all ten hips showed stable prostheses with no signs of loosening or migration, regardless of whether paralytic or non-paralytic hip was replaced. No complications, including dislocation or infection related to the surgery, were observed in any patient. The subtrochanteric shortening osteotomy done in two patients had united by nine months. Conclusion Simultaneous correction of soft tissue contractures is necessary for obtaining a stable hip with balanced pelvis while treating hip arthritis by THA in patients with PPRP and fixed pelvic obliquity. Cite this article: Bone Jt Open 2021;2(9):696–704.

Primary total knee arthroplasty in patients with post-polio syndrome

“…We believe these differences are possibly attributable to the limited postoperative ROM in affected limbs and caused by post-polio syndrome’s flaccid paralysis, muscle atrophy, and quadriceps weakness. 4,6,19…”

“…We believe these differences are possibly attributable to the limited postoperative ROM in affected limbs and caused by post-polio syndrome's flaccid paralysis, muscle atrophy, and quadriceps weakness. 4,6,19 Ps designs (72%; n = 83) were the most common designs overall. In the affected limbs, RH and VVC TKAs were used in almost 40% (n = 25) of cases versus only 8% (n = 4) of unaffected limbs.…”

Should more attention be paid to polio sequela cases in China?

“…Good results have been achieved in treating these complications through rehabilitation intervention and orthopedic surgery (12). Even though most people with disability still have difficulty in adapting to the environment and realizing "normalization, " the rapid development of new medical technology [exoskeleton, artificial intelligence, and advanced limb reconstruction technology (13)] can greatly improve previously untreatable physical disabilities. However, polio survivors, especially those in rural and remote areas, have a limited awareness of polio itself and PPS due to the relatively low level of medical services and their different culture.…”