Large Diameter Metal-On-Metal Total Hip Arthroplasty for Crowe IV Developmental Dysplasia of the Hip

Abstract

The short-term results of middle-aged patients with severe developmental dysplasia of the hip treated with subtrochanteric femoral shortening and cementless large diameter metal-on-metal total hip arthroplasty were retrospectively evaluated. Clinical and radiological results of 15 hips of 13 patients with Crowe IV developmental dysplasia of the hip were enrolled in this study. The average follow-up period was 49 months (36-62 months). The average age of patients at the time of surgery was 45.5 years (range, 36-65 years). Radiographs were evaluated for component position, subsidence, loosening, and osteolysis. Intraoperatively, two patients had a small proximal femoral shaft split that was held with a cable wire. The average preoperative Harris hip score was 58; at 3 years, 82. Trendelenburg sign was negative in 11 hips at the last assessment. Loosening, subsidence, infection, dislocation, hypersensitivity and neurovascular complications were not observed. One hip had to be revised 1 year after surgery because of nonunion at the osteotomy site. Our study shows that large diameter metal-on-metal total hip arthroplasty, incorporating subtrochanteric femoral shortening, decreases dislocation rate and provides excellent results for the completely dislocated hip.

Two-Stage Progressive Femoral Lowering Followed by Cementless Total Hip Arthroplasty for Treating Crowe IV–Hartofilakidis Type 3 Developmental Dysplasia of the Hip

“…Nevertheless, the following procedure-related complications have been documented: nerve palsy [3,[21][22][23][24][25], non-union, delayed union, or cement interposition at the osteotomy site [4,5,21,23,24,27], intraoperative femoral fracture [3,4,27,28], and dislocation [3,4,[23][24][25]28]. The major limit of the technique remains, however, the residual postoperative leg length discrepancy [23,25,28].…”

“…Specifically, patients with 28 or 36 mm metal-on-metal articulation did not experience symptoms that could be considered associated with adverse wear related failures (AWRF) or metal hypersensitivity (ALVAL). Among the reviewed literature, Parmaksizoglu et al [27] were the only authors who documented the use of large diameter metal-on-metal articulation (38 or 40 mm) in combination with cups with external diameter of 44 or 46 mm. The authors reported a mean Harris hip score of 82 points (range, 62-100 points), no dislocation, and no metal hypersensitivity at a mean follow-up of 49 months.…”

“…Subtrochanteric femoral shortening osteotomy is considered the "gold-standard" technique and has had quite satisfactory results [3][4][5][6][21][22][23][24][25][26][27][28]. Nevertheless, the following procedure-related complications have been documented: nerve palsy [3,[21][22][23][24][25], non-union, delayed union, or cement interposition at the osteotomy site [4,5,21,23,24,27], intraoperative femoral fracture [3,4,27,28], and dislocation [3,4,[23][24][25]28].…”

Total Hip Replacement in Developmental Dysplasia of the Hip Using Wagner Cone Prosthesis with Small Diameter Metal-On-Metal Articulation

“…Parmaksizoglu et al [11] have shown good functional and radiographic results with large diameter metal on metal total hip arthroplasty, incorporating subtrochenteric femoral shortening in fifteen hips with Crowe IV dysplasia; however Cobb et al [12] have recently published their concern regarding the unexplained post operative pain with these implants, which may be related with the iliopsoas impingement independent of the acetabular component. National Joint Registry for England and Wales 8th Annual report [13] has shown lower revision rate with small diameter (<36 mm) metal on metal prosthesis following primary total hip replacement as compared to large head (> 36 mm) with resurfacing cup after 6 years .In our study, all hips were implanted with 28 mm prosthetic metal head with a mean cup inclination angle of 42 (range, 32-60).…”

Hip International in 2010 and Beyond

“…Metal on metal resurfacing (12,13,14,15,16,17,18) remains topical, and the associated issues relating to biomechanics (19,20) and blood supply (21). Advances in the early and late management of developmental dysplasia have been addressed (22,23,24,25,26), and new methods of imaging for this condition and femoro-acetabular impingement have been evaluated (27,28). In addition, numerous and diverse clinical series and case reports have been published during the last 12 months.…”