Congenital hip dysplasia treated by total hip arthroplasty using cementless tapered stem in patients younger than 50 years old: results after 12-years follow-up

Abstract

BackgroundCongenital hip dysplasia may lead to severe acetabular and femoral abnormalities that can make total hip arthroplasty a challenging procedure. We assessed a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using cementless tapered stem and here we report the outcomes at long-term follow-up.Materials and methodsTwenty-eight patients (24 women and 4 men) aged between 44 and 50 years (mean 47 years) were observed. Clinical evaluation was rated with the Harris Hip Score. Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe’s classification, 16 hips presented dysplasia grade 1, 14 grade 2, and 4 grade 3. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis). Six patients were operated bilaterally, with a totally of 34 hips operated. After surgery, the patients were clinically and radiographically checked at 3, 6, and 12 months and yearly thereafter until an average follow-up of 12 years (range 10–14 years).ResultsAverage Harris Hip Score was 56 ± 9 (range 45–69) preoperatively, 90 ± 9 (range 81–100) 12 months after surgery, and 91 ± 8 (range 83–100) at last follow-up. Radiographic evaluation demonstrated excellent osteointegration of the implants. Signs of bone resorption were present in 6 hips, nevertheless no evidence of loosening was observed and none of the implants has been revised.Conclusions Even in dysplasic femur, the tapered stem allowed adequate stability and orientation of the implant. We consider tapered stem a suitable option for total hip arthroplasty in developmental hip dysplasia, also in case of young patients, thanks to the favourable long-term results.

Can a Conical Implant Successfully Address Complex Anatomy in Primary THA? Radiographs and Hip Scores at Early Followup

“…The patients in this study should comparable improvement in their hip scores compared to previous reports of patients who underwent complex, primary, cementless, total hip arthroplasty with conical prostheses as well as modular prostheses [1,2,6,8,11,15,19,27,28,30,31]. Despite predictable success with similar stems, it remains critically important to systematically report clinical and radiographic results whenever new technology is introduced.…”

“…Like the former two types of stems, these taper stems can also achieve satisfactory long-term results with an incidence of thigh pain as low as 2% to 4% [4,12]. The taper cone prosthesis has a narrow round proximal cross-section that facilitates adjustment of the anteversion angle; this implant design is ideal for the femur with proximal femoral deformity such as developmental dysplasia of the hip (DDH) [1,8,15,27,28,31].…”

Can Radiographs Predict the Use of Modular Stems in Developmental Dysplasia of the Hip?

“…Thus, these results might not be applicable to all practices. For example, Faldini et al [4] reported on a series of 46 patients who underwent primary THA secondary to DDH using a Wagner uncemented stem aimed at achieving 10°to 20°of anteversion. However, they did not report on how many patients achieved that alignment.…”

“…The medullary canal can be small and abnormally shaped with a smaller mediolateral diameter than AP diameter [8,12]. Because of these associated anatomic variants, some authors recommend the use of modular or specially designed components to accommodate the shape of the dysplastic femur, whereas other authors have published good long-term results with cementless tapered stems [4,8].…”

Metal-on-metal dysplasia cup total hip arthroplasty for hip osteoarthritis secondary to developmental dysplasia of the hip

“…These abnormalities include both femur and acetabulum, which increase the complication rates and reduce long-term survival of the prosthesis. [10,11] Placing the acetabular component at a normal anatomical level has several advantages in terms of stability and biomechanics. True acetabulum has adequate bone stock at anterior and posterior columns.…”