Top

Clinical Orthopaedics and Related Research®

Published in:

01-05-2011 | Clinical Research

Custom Cementless THA in Patients with Skeletal Dysplasia Results in Lower Apparent Revision Rates than Other Types of Femoral Fixation

Authors: Mathew D. Sewell, BSc (Hons), MRCS (Eng), Sammy A. Hanna, MRCS (Eng), Sarah K. Muirhead-Allwood, BSc, FRCS, Stephen R. Cannon, MA, MCh (Orth), FRCS, Timothy W. R. Briggs, MD (Res), MCh (Orth), FRCS

Published in: Clinical Orthopaedics and Related Research® | Issue 5/2011

Abstract

Background

Patients with skeletal dysplasia are prone to degenerative hip disease thus requiring THA at a younger age than the general population. This is a technically demanding procedure with high complication and revision rates. Achieving good femoral fixation can be challenging because of the abnormal features of the hip.

Questions/purposes

We therefore determined: (1) survivorship, (2) function, (3) radiographic findings, and (4) complications associated with a cementless custom-made femoral component used in THAs for patients with skeletal dysplasia and compared these parameters with those from other types of femoral fixation.

Patients and Methods

Between 1992 and 2005, 40 THAs were performed in 25 patients with skeletal dysplasia using custom-made cementless femoral components. There were 15 men and 10 women with a mean age of 37.5 years (range, 18–61 years) and a mean height of 145 cm (range, 120–173 cm). Patients were followed clinically and radiographically for a minimum of 4.3 years (mean, 10.1 years; range, 4.3–18.2 years).

Results

The survivorship rates for the femoral and acetabular components were 92% and 70%, respectively, at 220 months. Revision arthroplasty was performed in four of 40 hips (10%). In two, the acetabular component was revised for aseptic loosening, one had both components revised for aseptic loosening, and one had an isolated femoral component revision for deep infection. The mean Harris hip score improved from 41 (range, 27–57) preoperatively to 80 (range, 51–94) at final followup. There were two intraoperative proximal femoral fractures and one dislocation.

Conclusions

When compared with studies with equal followup, custom-made cementless components in THAs for patients with skeletal dysplasia apparently had lower revision and complication rates with comparable function and higher midterm survival.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Ain MC, Andres BM, Somel DS, Fiskin Z, Frassica FJ. Total hip arthroplasty in skeletal dysplasias: patient selection, pre-operative planning and operative techniques. J Arthroplasty. 2004;19:1–7.PubMedCrossRef

Bargar WL. Shape the implant to the patient: a rationale for the use of custom-fit cementless total hip implants. Clin Orthop Relat Res. 1989;249:73–78.PubMed

Bobyn JD, Tanzer M, Krygier JJ, Dujovne AR, Brooks CE. Concerns with modularity in total hip arthroplasty. Clin Orthop Relat Res. 1994;298:27–36.PubMed

Brand RA, Yoder SA, Pedersen DR. Interobserver variability in interpreting radiographic lucencies about total hip reconstructions. Clin Orthop Relat Res. 1985;192:237–239.PubMed

Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–1632.PubMed

Brown RR, Monsell F. Understanding the skeletal dysplasias. Curr Orthop. 2003;17:44–55.CrossRef

Charnley J, Feagin JA. Low-friction arthroplasty in congenital subluxation of the hip. Clin Orthop Relat Res. 1973;91:98–113.PubMedCrossRef

Chiavetta JB, Parvizi J, Shaughnessy WJ, Cabanela ME. Total hip arthroplasty in patients with dwarfism. J Bone Joint Surg Am. 2004;86:298–304.PubMed

Chmell MJ, Rispler D, Poss R. The impact of modularity in total hip arthroplasty. Clin Orthop Relat Res. 1995;319:77–84.PubMed

10.

Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1979; 61:15–23.PubMed

11.

DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.PubMed

12.

De Man FH, Haverkamp D, Van der Vis HM, Besselaar PP, Marti RK. Small stem total hip arthroplasty in hypoplasia of the femur. Clin Orthop Relat Res. 2008;466:1429–1437.PubMedCrossRef

13.

DiFazio F, Shon WY, Salvati EA, Wilson PD Jr. Long-term results of total hip arthroplasty with a cemented custom-designed swan-neck femoral component for congenital dislocation or severe dysplasia: a follow-up note. J Bone Joint Surg Am. 2002;84:204–207.PubMed

14.

Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement: the factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987;69:45–55.PubMed

15.

Erdemli B, Yilmaz C, Atalar H, Guzel B, Cetin I. Total hip arthroplasty in developmental high dislocation of the hip. J Arthroplasty. 2005;20:1021–1028.PubMedCrossRef

16.

Flecher X, Parratte S, Aubaniac JM, Argenson JN. Three-dimensional custom-designed cementless femoral stem for osteoarthritis secondary to congenital dislocation of the hip. J Bone Joint Surg Br. 2007;89:1586–1591.PubMed

17.

Gruen TA, McNeice GM, Amstutz HG. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.PubMed

18.

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mould arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMed

19.

Helenius I, Remes V, Tallroth K, Peltonen J, Poussa M, Paavilainen T. Total hip arthroplasty in diastrophic dysplasia. J Bone Joint Surg Am. 2003;85:441–447.PubMed

20.

Hoppenfeld S, de Boer P, Buckley R. Approaches to the hip. Surgical Exposures in Orthopaedics: The Anatomic Approach. Ed 3. Philadelphia, PA: Lippincott Williams & Wilkins; 2003:365–453.

21.

Hua J, Walker PS. Closeness of fit of uncemented stems improves the strain distribution in the femur. J Orthop Res. 1995;13:339–346.PubMedCrossRef

22.

Hua J, Walker PS, Muirhead-Alwood W, Bentley G, McCullough CJ. The rationale for CAD-CAM uncemented custom-hips: an interim assessment. Hip Int. 1995;5:52–62.

23.

Huo MH, Salvati EA, Lieberman JR, Burstein AH, Wilson PD Jr. Custom-designed femoral prostheses in total hip arthroplasty done with cement for severe dysplasia of the hip. J Bone Joint Surg Am. 1993;75:1497–1504.PubMed

24.

Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.CrossRef

25.

Lim SJ, Park YS, Moon YW, Jung SM, Ha HC, Seo JG. Modular cementless total hip arthroplasty for multiple epiphyseal dysplasia. J Arthroplasty. 2009;24:77–82.PubMedCrossRef

26.

Manaster BJ. From the RSNA refresher courses. Total hip arthroplasty: radiographic evaluation. Radiographics. 1996;16:645–660.PubMed

27.

Mulroy WF, Estok DM, Harris WH. Total hip arthroplasty with use of so-called second-generation cementing techniques: a fifteen-year average follow-up study. J Bone Joint Surg Am. 1995;77:1845–1852.PubMed

28.

Onodera S, Majima T, Ito H, Matsuno T, Kishimoto T, Minami A. Cementless total hip arthroplasty using the modular S-ROM prosthesis combined with corrective proximal femoral osteotomy. J Arthroplasty. 2006;21:664–669.PubMedCrossRef

29.

Peltonen JI, Hoikka V, Poussa M, Paavilainen T, Kaitila I. Cementless hip arthroplasty in diastrophic dysplasia. J Arthroplasty. 1992;7(suppl):369–376.PubMedCrossRef

30.

Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg Am. 1980;62:1059–1065.PubMed

31.

Sekundiak TD. Total hip arthroplasty in patients with dwarfism. Orthopedics. 2005;28(9 suppl):s1075–1078.PubMed

32.

Sheridan BD, Gargan MF, Monsell FP (2009) The hip in osteochondrodysplasias: general rules for diagnosis and treatment. Hip Int 19(suppl 6):S26–34.PubMed

33.

Umarji SI, Lee MB, Gargan MF, Portinaro NM, Learmonth ID. Total hip arthroplasty in skeletal dysplasia. Hip Int. 2003;13:177–183.

34.

Wirtz DC, Birnbaum K, Siebert CH, Heller KD. Bilateral total hip replacement in pseudoachondroplasia. Acta Orthop Belg. 2000;66:405–408.PubMed

Title: Custom Cementless THA in Patients with Skeletal Dysplasia Results in Lower Apparent Revision Rates than Other Types of Femoral Fixation
Authors: Mathew D. Sewell, BSc (Hons), MRCS (Eng)
Sammy A. Hanna, MRCS (Eng)
Sarah K. Muirhead-Allwood, BSc, FRCS
Stephen R. Cannon, MA, MCh (Orth), FRCS
Timothy W. R. Briggs, MD (Res), MCh (Orth), FRCS
Publication date: 01-05-2011
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 5/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-010-1656-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Custom Cementless THA in Patients with Skeletal Dysplasia Results in Lower Apparent Revision Rates than Other Types of Femoral Fixation

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 5/2011

Adult Consequences of Spina Bifida: A Cohort Study

The Classic: Studies on Spina Bifida

Editorial: Emerging Research Ideas in Orthopaedics and Musculoskeletal Medicine

Can VEPTR® Control Progression of Early-onset Kyphoscoliosis?: A Cohort Study of VEPTR® Patients With Severe Kyphoscoliosis

Surgical Technique: Modern Luqué Trolley, a Self-growing Rod Technique

A Periacetabular Osteotomy for the Treatment of Severe Dysplastic Hips