Cementless total hip replacement without femoral osteotomy in patients with severe developmental dysplasia of the hip

Abstract

We describe the clinical and radiological results of cementless primary total hip replacement (THR) in 25 patients (18 women and seven men; 30 THRs) with severe developmental dysplasia of the hip (DDH). Their mean age at surgery was 47 years (23 to 89). In all, 21 hips had Crowe type III dysplasia and nine had Crowe type IV. Cementless acetabular components with standard polyethylene liners were introduced as close to the level of the true acetabulum as possible. The modular cementless S-ROM femoral component was used with a low resection of the femoral neck. A total of 21 patients (25 THRs) were available for review at a mean follow-up of 18.7 years (15.8 to 21.8). The mean modified Harris hip score improved from 46 points pre-operatively to 90 at final follow up (p < 0.001). A total of 15 patients (17 THRs; 57%) underwent revision of the acetabular component at a mean of 14.6 years (7 to 20.8), all for osteolysis. Two patients (two THRs) had symptomatic loosening. No patient underwent femoral revision. Survival with revision of either component for any indication was 81% at 15 years (95% CI 60.1 to 92.3), with 21 patients at risk. This technique may reduce the need for femoral osteotomy in severe DDH, while providing a good long-term functional result.

Treatment of Arthritis Associated With Legg–Calve–Perthes Disease With Modular Total Hip Arthroplasty

“…LCP femoral and acetabular deformities are similar to those associated with DDH, a diagnosis previously demonstrated to benefit from modular stem usage 33 . In 71% of our patient's hips, the stem anterversion was different than the metaphyseal anterversion, and this feature was employed for a more anatomic hip reconstruction, therefore potentially decreasing both impingement and instability.…”

Prediction of Polyethylene Wear Rates from Gait Biomechanics and Implant Positioning in Total Hip Replacement

“…The contralateral hip center was identified computationally using the Hip Analysis Suite by a three-point click on the native femoral head. The horizontal offset (H-SET) was defined as the mediolateral distance between the center of the head and the anatomic axis of the femur [25] (Fig. 1A).…”

“…This classification criterion was obtained from a study in which noncrosslinked UHMWPE wear less than 0.1 mm per year was considered ''low'' and a wear rate greater than 0.2 mm per year was associated with osteolysis and subsequent component loosening [41]. Using these criteria, our 73 patients with THRs were divided in three groups: 25 Table 3).…”

Total Hip Replacement in Developmental Dysplasia of the Hip: Pitfalls and Challenges

“…The 20-year survivorship free from acetabular revision was 66% for noncemented acetabular components with femoral head as autograft [45]. In another study, 57% of the acetabular components underwent revision at a mean of 14.6 years because of osteolysis [46]. Twenty percent of the superolateral aspect of the acetabular cup could be left uncovered to prevent the failure risk [47] but there is no exact data about the amount of adequate acetabular cup coverage.…”

“…In a study of 15 patients with 17 hips, 57% underwent revision of the acetabular component at a mean of 14.6 years because of osteolysis. But no patient underwent revision because of femoral component loosening [46].…”