Total hip arthroplasty results in the osteoarthritis secondary to developmental dysplasia

Year 2012, , 33 - 37, 17.04.2012

Bülent Köksal N. Turgut Karaismailoğlu Ali Terkuran E.eren Desteli B.özgür Yazıcı Hicabi Sezgin , Fatih Yanık

https://doi.org/10.5835/jecm.omu.29.01.009

Abstract

Together with standard total hip arthroplasty (THA), total hip arthroplasty in hip dysplasia and hip dislocation cases has also increased in our country. In this study short and long term evaluation of total hip arthroplasty cases secondary to osteoarthritis following Crowe type III and IV developmental dysplasia of the hip (DDH) has been evaluated. In Ondokuz Mayis University Medical Faculty Department of Orthopaedics and Traumatology we have retrospectively evaluated 78 THA patients presenting with high dislocation between May 2000 and May 2008. Out of 65 patients seventy-eight hips were assessed in the study. One of the patients was male and remaining 64 patients were females. Thirty-four (43.6%) patients were operated from their right hips, while 44 (56.4%) patients were operated from their left hips. Mean follow up time was 49.5 months (10–105 months). Seventy-eight hips were operated using posterolateral approach. Patients were postop¬eratively evaluated in 1st, 5th, 3rd, 5th, 6th and 12th months and once for the subsequent year. Clinical Harris scale and radiological Callaghan and Engh criteria were used to evaluate the results. Results were evaluated both clinically and radiologically. Twenty-two (28.2%) of the 78 hips were determined to be Crowe type III and 56 (71.8%) of them were type IV. Mean value of limb length deficiency before operation was 3.29 cm (distribution 0–7.5 cm, ± 2.06), in the final control it was determined to be 0.84 cm (distribution 0–2 cm, ±0.89). Trochanteric osteotomy was performed for 41 (52.5%) hips and sub trochanteric osteotomy was performed for 21 (%26.9) hips. In these osteotomized hips acetabulum was moved to its plausible location. Shortening was not performed in 16 (20.5%) patients. Mean value for distance of greater trochanter–minor trochanter was 49.20 mm. (31–65mm, ± 6.5). In 21 (26.9%) of the patients autograft taken from femoral head was put on to superolateral of acetabulum. Acetabular covering was 20-35%, and the median value was 30 (20-35) %. In 10 (12.8%) of the 62 osteotomized hips non-union was detected. In 7 patients (8.9%) there was late dislocation (except one). Preoperative mean Harris score was 41.9 (± 8.9) while postoperative mean Harris score was 88.9 (± 9.5). According to these results, 69 (69.7%) of the cases were excellent, 22 (22.2%) were very good, 6 (6.1%) were good and 2 (2%) were average. Results of total hip arthroplasties following developmental dysplasia or dislocation of hip are quite good. When examining the complaints leading to losses in PO Harris score, it has been found out that holding the handrails while climbing up the stairs as well as wearing shoes and socks have been detected to be the factors resulting in most decreases in the score. On the other hand, it has apparently been showed that in all the criteria including pain, walking, activity, deformity and latitude of motion which are the general basis of Harris evaluation schedule, point increase that is recovery has been determined in PO period. 

Keywords

Developmental hip dysplasia, Arthroplasty, Osteoarthritis, Femoral shortening osteotomy, Trochanteric osteotomy

References

• Chougle, A., Hemmady, M.V., Hodgkinson, J.P., 2006. Long-term survival of the acetabular component after total hip arthroplasty with cement in patients with developmental dysplasia of the hip. J. Bone Joint Surg. 88, 71-79.
• Crowe, J.F., Mani, J., Ranawat, C., 1979. Total hip replacement in congenital dislocation and dysplasia of the hip. J. Bone Joint Surg. 61, 15-23.
• Dunn, H.K., Hess, W.E., 1976.Total hip reconstruction in chronically dislocated hips. J. Bone Joint Surg. 58, 838-845.
• Eskelinen, A., Helenius, I., Remes, V., Ylinen, P., Tallroth, K., Paavilainen, T., 2005.Cementless total hip arthroplasty in patients with high congenital hip dislocation. J. Bone Joint Surg. 88, 80-91.
• Flecher, X., Parratte, S., Brassart, N., Aubaniac, J.M., Argenson, J.N., 2008.Evaluation of the hip center in total hip arthroplasty for old developmental dysplasia. J. Arthroplasty. 8, 1189-1196.
• Gorski, J.M., 1988. Modular no cemented total hip arthroplasty for congenital dislocation of the hip. A case report and design rationale. Clin. Orthop. 228, 110-116.
• Haddad, F.S., Masri, B.A., Garbuz, D.S., Duncan, C.P., 1999. Primary total replacement of the dysplastic hip. AAOS Instruct Course LECT. J. Bone Joint Surg. 81, 1462-1482.
• Hampton, B.J., Harris, W.H., 2006. Primary cement less acetabular components in hip with severe developmental dysplasia or total dislocation. A concise follow-up, at an average of sixteen years, of a previous report. J. Bone Joint Surg. 88, 1549-1552.
• Harris, W.H., 1988. Total hip arthroplasty in the management of the congenital hip dislocation. In Callaghan, J.J., Rosenberg, A.G., Rubash, H.E., (eds): The adult hip. Lippincott-Rawen, Philadelphia.1651-1682
• Hartofilakidis, G., Karachalios, T., 2004. Total hip arthroplasty for congenital hip disease. J. Bone Joint Surg. 86, 242-250.
• Hartofilakidis, G., Stamos, K., Karachalios, T., 1998. Treatment of high dislocation of the hip in adults with total hip arthroplasty. J. Bone Joint Surg. 80, 510-517.
• Hasegawa, Y., Iwata, H., Iwase, T., Kawamoto, K., Iwasada, S., 1996. Cement less total hip arthroplasty with autologous bone grafting for hip dysplasia. Clin. Orthop. 324, 179-186.
• Holtgrewe, J.L., Hungerford, D.S., 1989. Primary and revision total hip replacement without cement and with associated femoral osteotomy. J. Bone Joint Surg. 71, 1487-1495.
• Iida, H., Matsusue, Y., Kawanabe, K., Okumura H, Yamamuro T, Nakamura T., 2000. Cemented hip arthroplasty with acetabular bone graft for developmental dysplasia. J. Bone Joint Surg. 82, 176-184.
• Ito H, Matsuno T, Minami A, Aoki Y; 2003 Intermediate-term results after hybrid total hip arthroplasty for the treatment of dysplastic hips. J Bone Joint Surg.85-A: 1725-1732.
• Johnston, R.C., Brand, R.A., Crowninshield, R.D., 1979. Recostruction of the hip. A mathematical approach to determine optimum geometric relationships. J. Bone Joint Surg. 61, 639-652.
• Klapach, A.S., Callaghan, J.J., Miller, K.A., Goetz, D.D., Sullivan, P.M., Pedersen, D.R., Johnston, R.C., 2005. Total hip arthroplasty with cement and without acetabular bone graft for severe hip dysplasia. A concise follow-up, at a minimum of twenty years, of a previous report. J. Bone Joint Surg. 87, 280-285.
• Mattingly DA; 2006 The modular stem in developmental dysplasia of the hip. In Barrack RL, Rosenberg AG (eds): Master techniques in orthopaedic surgery. The Hip. Lippincott Williams, Philadelphia. 249-260.
• Mendes, D.G., 1981. Total hip arthroplasty in congenital dislocated hips. Clin. Orthop. 161, 163-179.
• Mulroy, R.D., Jr Harris, W.H., 1990. Failure of acetabuler autografts in total hip arthroplasty. Increasing incidence: A follow-up note. J. Bone Joint Surg.72, 1536-1540.
• Paavialinen, T., 1997. Total hip replacement for developmental dysplasia of the hip. Acta. Orthop. Scand. 68, 77-84.
• Paavilainen, T., Hoikka, V., Paavolainen, P., 1993. Cement less total hip arthroplasty for congenitally dislocated or dysplastic hips. Clin. Orthop. 297, 71-81.
• Paavilainen, T., Hoikka, V., Solonen, K.A., 1990. Cement less total replacement for severely dysplastic or dislocated hips. J. Bone Joint Surg. 72, 205-211.
• Sugano, N., Noble, P.C., Kamaric, E., Salama, J.K., Ochi, T., Tullos, H.S., 1998. The morphology of the femur in developmental dysplasia of the hip. J. Bone Joint Surg. 81, 711-719.
• Symeonides, P.P., Pournaras, J.J., Petsatodes, G., Christoforides, J., Hatzokos, I., Pantazis, E., 1997. Total hip arthroplasty in neglected congenital dislocation of the hip. Clin. Orthop. 341, 51-55.
• Yasgur, D.J., Stuchin, S.A., Adler, E.M., DiCesare, P.E., 1997. Subtrochanterik femoral shortening osteotomy in total hip arthroplasty for hiriding developmental dislocation of the hip. J. Arthroplasty. 12, 880-888.